Abstract
The "radiation issue" is the need to consider possible deterministic effects (e.g., skin injuries) and long-term cancer risks due to ionizing radiation in the risk-benefit assessment of diagnostic or therapeutic testing. Although there are currently no data showing that high-dose medical studies have actually increased the incidence of cancer, the "linear-no threshold" model in radioprotection assumes that no safe dose exists; all doses add up in determining cancer risks; and the risk increases linearly with increasing radiation dose. The possibility of deterministic effects should also be considered when skin or lens doses may be over the threshold. Cardiologists have a special mission to avoid unjustified or non-optimized use of radiation, since they are responsible for 45% of the entire cumulative effective dose of 3.0 mSv (similar to the radiological risk of 150 chest x-rays) per head per year to the US population from all medical sources except radiotherapy. In addition, interventional cardiologists have an exposure per head per year two to three times higher than that of radiologists. The most active and experienced interventional cardiologists in high volume cath labs have an annual exposure equivalent to around 5 mSv per head and a professional lifetime attributable to excess cancer risk on the order of magnitude of 1 in 100. Cardiologists are the contemporary radiologists but sometimes imperfectly aware of the radiological dose of the examination they prescribe or practice, which can range from the equivalent of 1-60 mSv around a reference dose average of 10-15 mSv for a percutaneous coronary intervention, a cardiac radiofrequency ablation, a multi-detector coronary angiography, or a myocardial perfusion imaging scintigraphy. A good cardiologist cannot be afraid of life-saving radiation, but must be afraid of radiation unawareness and negligence.
Highlights
The “radiation issue” is the need to consider possible deterministic effects and long-term cancer risks due to ionizing radiation in the risk-benefit assessment of diagnostic or therapeutic testing
Radiation in cardiology: regulatory framework and missing evidences Almost 10 years ago, the “radiation issue” was raised, which refers to the need to include long-term cancer risks due to ionizing radiation in the risk-benefit assessment of diagnostic or therapeutic testing
An acute diagnostic or therapeutic x-ray exposure in the 10- to 50 mSv range - well below the threshold of epidemiological evidence linking radiation to cancer - is associated with a 15% increase in micronuclei in adults after invasive cardiovascular interventions [54], a 100% long-term increase in children treated for congenital heart disease 15 to 20 years after the exposure [55] and a 50% increase in interventional cardiologists after 10 to 20 years of catheterization laboratory exposure with cumulative professional dose in the 30 to 100 mSv range [56]
Summary
Sometimes cardiologists have been unaware of the radiological dose of the examination they prescribe or practice, but they should make every effort to reduce unnecessary radiation exposure from medical imaging This is best obtained through a systematic implementation of the 3A’s strategy proposed by the International Atomic Energy Agency in 2011: Audit (of true delivered dose); Appropriateness (since at least one-third of examinations are inappropriate); Awareness (since the knowledge of doses and risks is still largely suboptimal in doctors and patients) [75]. It can be repeated for imaging and invasive cardiologists what has been recently written of radiologists: “they must walk a digital tightrope strung between too much and too little radiation. A good cardiologist and even more so, a good imaging or interventional cardiologist - cannot be afraid of radiation, but must be very afraid of radiation unawareness
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