Health care providers and patients need to understand and discuss the risks and benefits of heart imaging involving radiation before ordering or undergoing such testing. This is according to a new scientific statement from the American Heart Association, recently published in the journal Circulation.
According to Dr. Reza Fazel, a cardiologist at Beth Israel Deaconess Medical Center in Boston, MA, and chair of the writing committee for the statement, the medical world has become increasingly reliant on the use of medical imaging to treat and diagnose patients with heart disease – the leading cause of death in the US.
But he notes that with increased use of such tests comes a rise in radiation exposure. “Heart imaging procedures account for almost 40% of the radiation exposure from medical imaging,” he says.
The most common heart imaging tests involving radiation include computed tomography (CT) scans, such as coronary artery calcium scores and CT angiograms of the heart, fluoroscopy, and nuclear medicine tests, such as the nuclear stress test.
The seriousness of side effects can be dependent on the doses of radiation an individual is exposed to, but Dr. Fazel and colleagues note that – apart from mammography used for breast cancer screening – there is no federal regulation on the doses of radiation that should be used in medical imaging.
This means that it is up to health care providers to judge what imaging tests and radiation doses are best for the patient.
As such, a 2009 statement from the American Heart Association (AHA) called for clinicians to be cautious when it comes to administering heart imaging tests in patients, and provided some general guidelines for the use of such tests.
In this latest statement on the issue, the AHA set out in more detail what health care providers should take into account when ordering heart imaging tests, and they provide practical guidelines on the use of these tests.
The statement authors say that clinicians who order heart imaging tests should ensure they understand when each test is appropriate for patients, the doses of radiation involved and the risks of each test.
Commenting on this recommendation, Dr. Fazel says:
“Radiation-related risk is one of the factors that should be considered in the decision to use cardiovascular imaging with ionizing radiation, particularly in younger patients in whom the potential risk of radiation exposure is thought to be higher.”
Furthermore, the authors state that clinicians should be aware of the diagnostic accuracy of each test, as well as the cost, availability and convenience.
They note that professionals who perform the imaging tests should also be aware of how to use low doses of radiation to produce high-quality images, so that they are reducing patients’ exposure to radiation.
The statement also stresses the importance of communication between health care providers and patients.
The authors say that prior to undergoing heart imaging procedures, clinicians should discuss the tests with patients to address any questions and/or concerns they may have.
They point out some issues that may be raised. For example, the patient may want to know whether the test will help to diagnose or treat their heart problem, whether there are alternative testing methods that do not use radiation, the amount of the radiation they will be exposed to, and the chances of developing cancer later in life.
“In general, the radiation-related risk of any imaging test to an individual patient is very small and, when the test is clinically appropriate, the benefits of the test typically far outweigh any potential risks,” Dr. Fazel notes.
Earlier this year, Medical News Today reported on a study published in The Lancet Oncology, in which researchers detail a new radiation-free whole-body imaging technique that they say could effectively diagnose cancer.