Review of radiation reduction strategies in clinical cardiovascular imaging.

The use of ionizing radiation for medical diagnostic tests and interventional procedures has grown substantially over the past 2 decades, and there is now considerable concern expressed in both the medical literature and the lay press of the harmful effects of radiation exposure. Although there is some controversy regarding whether this medical radiation is actually harmful, minimizing the dose to the patient is logical and a basic part of proper care. To do this, clinicians must have an understanding of the amount of radiation that is involved with each test. Physicians have a responsibility to keep the level of radiation exposure as low as reasonably achievable. A number of simple and common sense measures can help achieve this goal. Encouragingly, there are also numerous new technologies which can substantially lower radiation dose, especially in cardiovascular studies. This review will highlight various ways to reduce radiation in cardiovascular imaging.

Changes in myocardial ischemic burden following percutaneous coronary intervention of chronic total occlusions.

OBJECTIVES: We assessed the potential for percutaneous coronary intervention (PCI) of a chronic total occlusion (CTO) to decrease myocardial ischemia and established objective criteria to predict post-procedure improvement. BACKGROUND: Optimal treatment for CTO of coronary arteries is controversial, and selection criteria for PCI of CTO are subjective. METHODS: All patients undergoing CTO PCI at a single center between 2002 and 2007 were included if myocardial perfusion imaging (MPI) was performed within 12 ± 3 months before and a follow-up study within 12 ± 3 months after PCI. Average summed difference scores were calculated and converted to percent ischemic myocardium to classify patients as having normal/minimal, mild, moderate, or severe ischemia. A significant improvement in ischemia following PCI was classified as an absolute ≥5% decrease in ischemic myocardium. Receiver operating characteristic (ROC) curves were used to identify ischemic thresholds predictive of decreased and increased ischemic burden on follow-up MPI. RESULTS: In 301 patients, average baseline ischemic burden was 13.1% ± 11.9% and decreased to 6.9% ± 6.5% (P < 0.001) during follow-up. Overall, 53.5% of patients met criteria for improvement following PCI. These patients were more likely to be male, without diabetes, with CTO in the left anterior descending artery, and classified as having high ischemic burden at baseline. ROC analysis identified a baseline 12.5% ischemic burden as optimal in identifying those most likely to have a significantly decreased ischemic burden post-PCI. Those with a baseline ischemic burden less than 6.25% were more likely to have an increased ischemic burden post-PCI. CONCLUSIONS: Ischemic burden is reduced following CTO PCI, and the decrease is greater at high ischemic burden. A threshold of 12.5% ischemic burden is suggested as a criterion for performing PCI in the setting of CTO.