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PURPOSE OF REVIEW: Radiation safety has been at the center of interest of both researchers and healthcare institutions. This review will summarize and shed light on the various techniques adapted to reduce staff exposure to ionizing radiation (IR) in the field of cardiac imaging. RECENT FINDINGS: In the last years, with the advance of awareness and the development of new technologies, there have been several tools and techniques adapted. The breakthrough of several technologies to lower radiation dose and shorten the duration of diagnostic tests associated with IR, the use of protection devices by staff members, and mostly the awareness of exposure to IR are the hallmark of these advances. Using all these measures has led to a significant decrease in staff exposure to IR. Reducing staff exposure to meet the "As Low As Reasonably Achievable" principle is feasible. This review introduces the most important strategies applied in cardiac imaging.
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Técnicas de Imagem Cardíaca/efeitos adversos , Exposição Ocupacional/prevenção & controle , Exposição à Radiação/prevenção & controle , Lesões por Radiação/prevenção & controle , Humanos , Doses de Radiação , Proteção Radiológica/métodos , Fatores de Risco , SegurançaRESUMO
AIMS: Cardiovascular magnetic resonance (CMR) imaging has long been a contraindication for patients with a cardiac implantable electronic device (CIED). Recent studies support the feasibility and safety for non-thoracic magnetic resonance imaging, but data for CMR are sparse. The aim of the current study was to determine the safety in patients with magnetic resonance (MR)-conditional or non-MR-conditional CIED and to develop a best practice approach. METHODS AND RESULTS: All patients with a CIED undergoing CMR imaging (1.5 T) between April 2014 and April 2017 were included in the study. Devices were programmed according to the standardized protocol directly before and after the CMR examination. Follow-up interrogation was performed 6 months after CMR examination. Results were compared with a large, reference cohort of CIED patients not undergoing any MR examination. A total of 200 consecutive patients with a CIED (non-MR-conditional, n = 103) were included in the study. Directly after CMR imaging, one device failure (0.5%, battery status = end of service) was noted necessitating premature generator replacement. In three patients (2%) of pacemaker/implantable cardioverter-defibrillator (ICD) carriers a sustained ventricular tachycardia (VT) occurred during CMR imaging. Ten ICD showed a decrease in battery capacity immediately after CMR. Overall, the reference cohort showed comparable changes of CIED function during follow-up. CONCLUSION: With adherence to a standardized protocol and established exclusion criteria CMR imaging could safely be performed in patients with a CIED. The potential risks of device malfunction necessitate the presence of a device trained individual during the entire CMR examination. If there is a history of VT storm the attendance of an experienced cardiologist, should be mandatory.
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Arritmias Cardíacas , Desfibriladores Implantáveis/efeitos adversos , Falha de Equipamento/estatística & dados numéricos , Marca-Passo Artificial/efeitos adversos , Arritmias Cardíacas/prevenção & controle , Arritmias Cardíacas/terapia , Técnicas de Imagem Cardíaca/efeitos adversos , Técnicas de Imagem Cardíaca/métodos , Estudos de Coortes , Segurança de Equipamentos/métodos , Feminino , Alemanha , Humanos , Imagem Cinética por Ressonância Magnética/métodos , Imagem Cinética por Ressonância Magnética/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Medição de RiscoAssuntos
Técnicas de Imagem Cardíaca , Cardiopatias/diagnóstico por imagem , Exposição Ocupacional/prevenção & controle , Doses de Radiação , Exposição à Radiação/prevenção & controle , Lesões por Radiação/prevenção & controle , Proteção Radiológica , Técnicas de Imagem Cardíaca/efeitos adversos , Angiografia por Tomografia Computadorizada , Angiografia Coronária , Humanos , Exposição Ocupacional/efeitos adversos , Segurança do Paciente , Tomografia por Emissão de Pósitrons , Valor Preditivo dos Testes , Exposição à Radiação/efeitos adversos , Lesões por Radiação/etiologia , Medição de Risco , Fatores de Risco , Tomografia Computadorizada de Emissão de Fóton ÚnicoRESUMO
BACKGROUND: Atrial fibrillation (AF) is a growing financial burden on the healthcare system. Cardiac computed tomographic angiography (CCTA) is needed for pulmonary vein mapping before AF ablation (AFA). CCTA has shown to be an alternative to transesophageal echocardiogram (TEE) to rule out left atrial appendage thrombus (LAAT) pre-AFA. We aim to examine the safety, cost-effectiveness, and time-efficiency of utilizing CCTA alone to rule out LAAT before AFA. METHODS: We prospectively screened patients with paroxysmal AF undergoing cryoablation. CCTA with delayed enhancement was performed within 72 hours of AFA. Once LAAT was ruled out, patients were enrolled and planned TEE was cancelled. A retrospective control cohort that had both CCTA and TEE prior to AFA was identified. Direct cost data, electrophysiology laboratory utilization time, and 30-day stroke outcomes were collected from the EMR, follow-up phone calls, or clinic visits, and comparative analyses were performed. RESULTS: Seventy patients met the inclusion criteria in the prospective CCTA-only cohort, and 71 for the retrospective CCTA+TEE cohort. Baseline characteristics were similar between the two groups. There was a nonsignificant reduction in overall cost ($15,870 ± 1,710 vs $16,557 ± 2,508, P = 0.06) in CCTA-only cohort, whereas the electrophysiology laboratory utilization time was significantly reduced (241.6 ± 41.7 vs 181.3 ±36.4 minutes, P < 0.001). There were no strokes reported on 30-day follow-up in the CCTA-only group. CONCLUSIONS: In low-to-intermediate stroke risk patients with paroxysmal AF undergoing cryoablation, eliminating TEE and employing CCTA-only strategy to rule-out LAAT improves electrophysiology laboratory efficiency without influencing periprocedural cost or increasing postprocedural stroke risk.
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Fibrilação Atrial/cirurgia , Técnicas de Imagem Cardíaca/economia , Técnicas de Imagem Cardíaca/métodos , Ablação por Cateter , Custos e Análise de Custo , Cardiopatias/diagnóstico por imagem , Cuidados Pré-Operatórios/métodos , Trombose/diagnóstico por imagem , Tomografia Computadorizada por Raios X/economia , Fibrilação Atrial/complicações , Técnicas de Imagem Cardíaca/efeitos adversos , Feminino , Átrios do Coração/diagnóstico por imagem , Cardiopatias/complicações , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Trombose/complicações , Tomografia Computadorizada por Raios X/efeitos adversosRESUMO
Aims: Investigators have proposed that cardiovascular magnetic resonance (CMR) should have restrictions similar to those of ionizing imaging techniques. We aimed to investigate the acute effect of 1.5 T CMR on leucocyte DNA integrity, cell counts, and function in vitro, and in a large cohort of patients in vivo. Methods and results: In vitro study: peripheral blood mononuclear cells (PBMCs) were isolated from healthy volunteers, and histone H2AX phosphorylation (γ-H2AX) expression, leucocyte counts, and functional parameters were quantified using flow cytometry under the following conditions: (i) immediately following PBMC isolation, (ii) after standing on the benchside as a temperature and time control, (iii) after a standard CMR scan. In vivo study: blood samples were taken from 64 consecutive consenting patients immediately before and after a standard clinical scan. Samples were analysed for γ-H2AX expression and leucocyte counts. CMR was not associated with a significant change in γ-H2AX expression in vitro or in vivo, although there were significant inter-patient variations. In vitro cell integrity and function did not change with CMR. There was a significant reduction in circulating T cells in vivo following CMR. Conclusion: 1.5 T CMR was not associated with DNA damage in vitro or in vivo. Histone H2AX phosphorylation expression varied markedly between individuals; therefore, small studies using γ-H2AX as a marker of DNA damage should be interpreted with caution. Cardiovascular magnetic resonance was not associated with loss of leucocyte viability or function in vitro. Cardiovascular magnetic resonance was associated with a statistically significant reduction in viable leucocytes in vivo.
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Técnicas de Imagem Cardíaca/efeitos adversos , Leucócitos Mononucleares/efeitos da radiação , Imagem Cinética por Ressonância Magnética/efeitos adversos , Adulto , Dano ao DNA/efeitos da radiação , Feminino , Humanos , Leucócitos Mononucleares/química , Leucócitos Mononucleares/citologia , Masculino , Pessoa de Meia-Idade , Estudos ProspectivosRESUMO
BACKGROUND: Utilization of cardiac magnetic resonance imaging (cMRI) as an imaging modality in clinical practice is rapidly increasing. More evidence from randomized studies establishing clinical safety and performance of pacing systems in patients undergoing a cMRI scan is needed. OBJECTIVES: The purpose of this prospective, multicenter, randomized study was to demonstrate safety and efficacy of the Accent MRI™ conditional pacing systems (St. Jude Medical, St. Paul, MN, USA) in patients undergoing cMRI scan. METHODS: Patients (n = 283) indicated for dual-chamber pacemaker implant were randomized to either the MRI Group (MG) (n = 140) or the Control Group (CG) (n = 143) after successful device implantation of the Accent MRI™ system. Clinical evaluation and device interrogation were performed at pre- and post-MRI scan, and 1 month post-MRI for all patients. At 9-12 weeks postimplant, patients in MG underwent a nondiagnostic cMRI scan at 1.5 Tesla (T), while patients in CG underwent device interrogation and clinical evaluation twice with a 45-minute waiting period in between. The safety endpoint was freedom from MRI scan-related complications and that for efficacy was significant changes in right atrial/ventricular capture threshold and sensing amplitude between right before MRI, immediately after MRI, and 1 month post-MRI. RESULTS: Results showed 100% freedom from MRI scan-related complications. There were no significant changes in device performance between pre-MRI scan and 1 month post-MRI scan time points in both study groups. CONCLUSIONS: cMRI scanning with 1.5 T scanners is safe in patients implanted with the Accent MRI™ conditional pacing system and has no significant effect on the electrical parameters of the device and leads.
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Técnicas de Imagem Cardíaca , Desfibriladores Implantáveis , Imageamento por Ressonância Magnética , Marca-Passo Artificial , Adulto , Idoso , Idoso de 80 Anos ou mais , Técnicas de Imagem Cardíaca/efeitos adversos , Feminino , Humanos , Imageamento por Ressonância Magnética/efeitos adversos , Masculino , Pessoa de Meia-Idade , Estudos ProspectivosRESUMO
Our use of modern cardiovascular imaging tools has not kept pace with their technological development. Diagnostic errors are common but seldom investigated systematically. Rather than more impressive pictures, our main goal should be more precise tests of function which we select because their appropriate use has therapeutic implications which in turn have a beneficial impact on morbidity or mortality. We should practise analytical thinking, use checklists to avoid diagnostic pitfalls, and apply strategies that will reduce biases and avoid overdiagnosis. We should develop normative databases, so that we can apply diagnostic algorithms that take account of variations with age and risk factors and that allow us to calculate pre-test probability and report the post-test probability of disease. We should report the imprecision of a test, or its confidence limits, so that reference change values can be considered in daily clinical practice. We should develop decision support tools to improve the quality and interpretation of diagnostic imaging, so that we choose the single best test irrespective of modality. New imaging tools should be evaluated rigorously, so that their diagnostic performance is established before they are widely disseminated; this should be a shared responsibility of manufacturers with clinicians, leading to cost-effective implementation. Trials should evaluate diagnostic strategies against independent reference criteria. We should exploit advances in machine learning to analyse digital data sets and identify those features that best predict prognosis or responses to treatment. Addressing these human factors will reap benefit for patients, while technological advances continue unpredictably.
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Técnicas de Imagem Cardíaca/métodos , Técnicas de Imagem Cardíaca/normas , Erros de Diagnóstico/prevenção & controle , Guias de Prática Clínica como Assunto , Controle de Qualidade , Técnicas de Imagem Cardíaca/efeitos adversos , Erros de Diagnóstico/estatística & dados numéricos , Ecocardiografia/efeitos adversos , Ecocardiografia/normas , Ergonomia , Europa (Continente) , Medicina Baseada em Evidências , Feminino , Humanos , Masculino , Medição de Risco , Sensibilidade e EspecificidadeRESUMO
PURPOSE OF REVIEW: Cardiotoxicity is an important complication of cancer therapy. With a significant improvement in the overall survival and prognosis of patients undergoing cancer therapy, cardiovascular toxicity of cancer therapy has become an important public health issue. Several well-established as well as newer anticancer therapies such as anthracyclines, trastuzumab, and other HER2 receptor blockers, antimetabolites, alkylating agents, tyrosine kinase inhibitors, angiogenesis inhibitors, checkpoint inhibitors, and thoracic irradiation are associated with significant cardiotoxicity. RECENT FINDINGS: Cardiovascular imaging employing radionuclide imaging, echocardiography, and magnetic resonance imaging is helpful in early detection of the cardiotoxicity and prevention of overt heart failure. These techniques also provide important tools for understanding the mechanism of cardiotoxicity of these modalities, which would help develop strategies for the prevention of cardiac morbidity and mortality related to the use of these agents. An understanding of the mechanism of the cardiotoxicity of cancer therapies can help prevent and treat their adverse cardiovascular consequences. Clinical implementation of algorithms based upon cardiac imaging and several non-imaging biomarkers can prevent cardiac morbidity and mortality associated with the use of cardiotoxic cancer therapies.
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Antraciclinas/efeitos adversos , Antineoplásicos/efeitos adversos , Técnicas de Imagem Cardíaca/efeitos adversos , Cardiotoxicidade/prevenção & controle , Insuficiência Cardíaca/prevenção & controle , Neoplasias/tratamento farmacológico , Função Ventricular Esquerda/efeitos dos fármacos , Técnicas de Imagem Cardíaca/tendências , Guias como Assunto , Insuficiência Cardíaca/induzido quimicamente , Humanos , PrognósticoRESUMO
Cardiovascular imaging plays a central role in the diagnosis and treatment of cardiovascular disease. Recently, increased emphasis has been placed on quality in cardiovascular imaging, and it is becoming a central priority for various stakeholders, including patients, physicians, and payers. The changing health care landscape and associated challenges imposed on cardiac imagers, including reductions in reimbursement and growing need for pre-authorization, have also helped bring quality metrics to the forefront. Continuous quality improvement initiatives provide the framework for the team of physicians, technical staff members, administrators, and other health care professionals to deliver high-quality care. Efforts to improve quality in cardiac imaging have started to form the foundation for numerous research studies in this arena, and although few in number, randomized control trials have begun to emerge. This review highlights quality improvement studies focusing on appropriate use education, reporting, and radiation dose reduction in cardiovascular imaging.
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Técnicas de Imagem Cardíaca/normas , Doenças Cardiovasculares/diagnóstico por imagem , Ensaios Clínicos como Assunto/normas , Melhoria de Qualidade/normas , Indicadores de Qualidade em Assistência à Saúde/normas , Projetos de Pesquisa/normas , Técnicas de Imagem Cardíaca/efeitos adversos , Doenças Cardiovasculares/terapia , Medicina Baseada em Evidências/normas , Humanos , Segurança do Paciente , Valor Preditivo dos Testes , Prognóstico , Doses de Radiação , Exposição à Radiação/efeitos adversos , Exposição à Radiação/prevenção & controle , Fatores de Risco , Procedimentos Desnecessários/normasRESUMO
Multimodality cardiovascular imaging plays a central role in caring for patients with congenital heart disease (CHD). CHD clinicians and scientists are interested not only in cardiac morphology but also in the maladaptive ventricular responses and extracellular changes predisposing to adverse outcomes in this population. Expertise in the applications, strengths, and pitfalls of these cardiovascular imaging techniques as they relate to CHD is essential. The purpose of this article is to provide an overview of cardiovascular imaging in CHD. We focus on the role of 3 widely used noninvasive imaging techniques in CHD-echocardiography, cardiac magnetic resonance imaging, and cardiac computed tomography. Consideration is given to the common goals of cardiac imaging in CHD, including assessment of structural and residual heart disease before and after surgery, quantification of ventricular volume and function, stress imaging, shunt quantification, and tissue characterization. Extracardiac imaging is highlighted as an increasingly important aspect of CHD care.
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Técnicas de Imagem Cardíaca/métodos , Cardiopatias Congênitas/diagnóstico por imagem , Técnicas de Imagem Cardíaca/efeitos adversos , HumanosRESUMO
BACKGROUND: Patients with coronary artery disease can accumulate significant radiation dose through repeated exposures to coronary computed tomographic angiography, myocardial perfusion imaging with single photon emission computed tomography or positron emission tomography, and to invasive coronary angiography. Aim of the study was to audit radiation doses of coronary computed tomographic angiography, single photon emission computed tomography, positron emission tomography and invasive coronary angiography in patients enrolled in the prospective, randomized, multi-centre European study-EVINCI (Evaluation of Integrated Cardiac Imaging for the Detection and Characterization of Ischemic Heart Disease). METHODS: We reviewed 1070 tests (476 coronary computed tomographic angiographies, 85 positron emission tomographies, 310 single photon emission computed tomographies, 199 invasive coronary angiographies) performed in 476 patients (mean age 60 ± 9 years, 60% males) enrolled in 12 centers of the EVINCI. The effective doses were calculated in milli-Sievert (mSv) as median, interquartile range (IQR) and coefficient of variation of the mean. RESULTS: Coronary computed tomographic angiography (476 exams in 12 centers) median effective dose was 9.6 mSv (IQR = 13.2 mSv); single photon emission computed tomography (310 exams in 9 centers) effective dose was 9.3 (IQR = 2.8); positron emission tomography (85 in 3 centers) effective dose 1.8 (IQR = 1.6) and invasive coronary angiography (199 in 9 centers) effective dose 7.4 (IQR = 7.3). Inter-institutional variability was highest for invasive coronary angiography (100%) and coronary computed tomographic angiography (54%) and lowest for single photon emission computed tomography (20%). Intra-institutional variability was highest for invasive coronary angiography (121%) and coronary computed tomographic angiography (115%) and lowest for single photon emission computed tomography (14%). CONCLUSION: Coronary computed tomographic angiography and invasive coronary angiography doses vary substantially between and within centers. The variability in nuclear medicine procedures is substantially lower. The findings highlight the need to audit doses, to track cumulative exposures and to standardize doses for imaging techniques. TRIAL REGISTRATION: The study protocol is available at https://www.clinicaltrials.gov/ (ClinicalTrials.gov Identifier: NCT00979199 ). Information provided on September 16, 2009.
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Técnicas de Imagem Cardíaca , Doença da Artéria Coronariana/diagnóstico por imagem , Doses de Radiação , Exposição à Radiação , Idoso , Técnicas de Imagem Cardíaca/efeitos adversos , Angiografia por Tomografia Computadorizada , Angiografia Coronária , Europa (Continente) , Feminino , Disparidades em Assistência à Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Imagem de Perfusão do Miocárdio , Segurança do Paciente , Tomografia por Emissão de Pósitrons , Padrões de Prática Médica , Valor Preditivo dos Testes , Estudos Prospectivos , Exposição à Radiação/efeitos adversos , Exposição à Radiação/prevenção & controle , Lesões por Radiação/etiologia , Lesões por Radiação/prevenção & controle , Monitoramento de Radiação/métodos , Proteção Radiológica/métodos , Medição de Risco , Fatores de Risco , Tomografia Computadorizada de Emissão de Fóton ÚnicoRESUMO
Exposure to ionizing radiation is associated with a long-term risk of health effects, including cancer. Radiation exposure to the U.S. population from cardiac imaging has increased markedly over the past three decades. Initiatives to reduce radiation exposure have focused on the tenets of appropriate study "justification" and "optimization" of imaging protocols. This article reviews ways to optimally reduce radiation dose across the spectrum of cardiac imaging.
Assuntos
Técnicas de Imagem Cardíaca , Doenças Cardiovasculares/diagnóstico , Exposição à Radiação , Lesões por Radiação , Saúde Radiológica/métodos , Técnicas de Imagem Cardíaca/efeitos adversos , Técnicas de Imagem Cardíaca/métodos , Humanos , Exposição à Radiação/efeitos adversos , Exposição à Radiação/prevenção & controle , Lesões por Radiação/etiologia , Lesões por Radiação/prevenção & controleRESUMO
BACKGROUND: The burden of low-dose ionizing radiation (LDIR) exposure from medical procedures among individuals with congenital heart disease (CHD) is unknown. In this longitudinal population-based study, we sought to determine exposure to LDIR-related cardiac imaging and therapeutic procedures in children and adults with CHD. METHODS AND RESULTS: In an analysis of the Quebec CHD database, exposure to the following LDIR-related cardiac procedures was recorded: catheter-based diagnostic procedures, structural heart interventions, coronary interventions, computed tomography scans of the chest, nuclear procedures, and pacemaker/implantable cardioverter-defibrillator insertion and repair. From 1990 to 2005, there were 16 253 LDIR-exposed patients with CHD with 317 988 patient-years of available follow-up. The total number of LDIR-related procedures increased from 18.5 to 51.9 per 1000 CHD patients per year (P<0.0001). This increase was attributable to increases in rates per 1000 CHD patients in diagnostic cardiac catheterizations (11.7 to 13.7 per 1000), structural heart interventions (1.0 to 5.2 per 1000), coronary interventions (1.0 to 2.4 per 1000), pacemaker/implantable cardioverter-defibrillator insertions (1.6 to 4.4 per 1000), nuclear procedures (4.2 to 13.8 per 1000), and computed tomography scans of the chest (2.5 to 12.3 per 1000). Over time, among children with CHD, the median age at first LDIR procedure decreased from 5.0 years to 9.6 months. Severity of CHD significantly predicted extent of exposure. CONCLUSIONS: From 1990 to 2005, patients with CHD were exposed to increasing numbers of LDIR-emitting cardiac procedures. This exposure occurred at progressively younger ages. These findings provide an important perspective on longitudinal LDIR exposure in this at-risk population.
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Técnicas de Imagem Cardíaca/tendências , Interpretação Estatística de Dados , Cardiopatias Congênitas/diagnóstico , Cardiopatias Congênitas/epidemiologia , Vigilância da População , Radiação Ionizante , Adulto , Idoso , Técnicas de Imagem Cardíaca/efeitos adversos , Estudos de Coortes , Feminino , Cardiopatias Congênitas/terapia , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Quebeque/epidemiologia , Estudos Retrospectivos , Fatores de Risco , Fatores de TempoRESUMO
PURPOSE: Nuclear cardiology is widely used to diagnose coronary artery disease and to guide patient management, but data on current practices, radiation dose-related best practices, and radiation doses are scarce. To address these issues, the IAEA conducted a worldwide study of nuclear cardiology practice. We present the European subanalysis. METHODS: In March 2013, the IAEA invited laboratories across the world to document all SPECT and PET studies performed in one week. The data included age, gender, weight, radiopharmaceuticals, injected activities, camera type, positioning, hardware and software. Radiation effective dose was calculated for each patient. A quality score was defined for each laboratory as the number followed of eight predefined best practices with a bearing on radiation exposure (range of quality score 0 - 8). The participating European countries were assigned to regions (North, East, South, and West). Comparisons were performed between the four European regions and between Europe and the rest-of-the-world (RoW). RESULTS: Data on 2,381 European patients undergoing nuclear cardiology procedures in 102 laboratories in 27 countries were collected. A cardiac SPECT study was performed in 97.9 % of the patients, and a PET study in 2.1 %. The average effective dose of SPECT was 8.0 ± 3.4 mSv (RoW 11.4 ± 4.3 mSv; P < 0.001) and of PET was 2.6 ± 1.5 mSv (RoW 3.8 ± 2.5 mSv; P < 0.001). The mean effective doses of SPECT and PET differed between European regions (P < 0.001 and P = 0.002, respectively). The mean quality score was 6.2 ± 1.2, which was higher than the RoW score (5.0 ± 1.1; P < 0.001). Adherence to best practices did not differ significantly among the European regions (range 6 to 6.4; P = 0.73). Of the best practices, stress-only imaging and weight-adjusted dosing were the least commonly used. CONCLUSION: In Europe, the mean effective dose from nuclear cardiology is lower and the average quality score is higher than in the RoW. There is regional variation in effective dose in relation to the best practice quality score. A possible reason for the differences between Europe and the RoW could be the safety culture fostered by actions under the Euratom directives and the implementation of diagnostic reference levels. Stress-only imaging and weight-adjusted activity might be targets for optimization of European nuclear cardiology practice.
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Técnicas de Imagem Cardíaca/métodos , Tomografia por Emissão de Pósitrons/métodos , Guias de Prática Clínica como Assunto , Doses de Radiação , Técnicas de Imagem Cardíaca/efeitos adversos , Técnicas de Imagem Cardíaca/instrumentação , Técnicas de Imagem Cardíaca/normas , Cardiologia/organização & administração , União Europeia , Medicina Nuclear/organização & administração , Tomografia por Emissão de Pósitrons/efeitos adversos , Tomografia por Emissão de Pósitrons/instrumentação , Tomografia por Emissão de Pósitrons/normas , Sociedades CientíficasAssuntos
Técnicas de Imagem Cardíaca/efeitos adversos , Angiografia Coronária/efeitos adversos , Ventrículos do Coração/diagnóstico por imagem , Dor no Peito , Ponte de Artéria Coronária , Doença da Artéria Coronariana/diagnóstico por imagem , Doença da Artéria Coronariana/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Miocárdio/químicaRESUMO
BACKGROUND: Low radiation doses from diagnostic and therapeutic procedures may increase cancer incidence after decades in cardiac patients. The aim of the study was to evaluate the long-term outcome and the prognostic effect of radiological exposure. METHODS: A retrospective cohort study examined 16,311 Italian cardiac patients without cancer consecutively hospitalized between 1970 and 2009 and followed-up for a median of 10 years. Cumulative estimated effective dose was calculated for the imaging procedures. Main causes of death and primary cancer onset were the end points and their relation with radiation exposure was analyzed by Cox model. RESULTS: Over the years, there was an increasing trend of cancer, a decreasing trend of cardiovascular, with stability of other-causes death. Cumulative estimated effective radiation dose was higher in patients who died for cancer (20 ± 19 mSv) compared to cardiovascular (17 ± 17, P < 0.001) and other-causes deaths (15 ± 17, p < 0.001). The cumulative estimated effective dose adjusted HR was 1.004 (95% CI 1.000-1.009, p = 0.045) for cancer death and 1.008 (95% CI 1.005-1.011, p < 0.001) for (fatal and non-fatal) cancer onset. Radiation effective dose was not predictive of cardiovascular mortality (HR = 0.991), nor it was of other types of deaths (HR = 0.995). Smoking was a predictor for cardiovascular mortality, but it was not of other types of deaths. CONCLUSIONS: Non-cardiovascular causes of death are responsible for almost half of later deaths in cardiac patients. The radiological exposure from medical imaging procedures is predictive of cancer risk and cancer death.
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Técnicas de Imagem Cardíaca/efeitos adversos , Doenças Cardiovasculares/diagnóstico por imagem , Neoplasias Induzidas por Radiação/mortalidade , Idoso , Idoso de 80 Anos ou mais , Doenças Cardiovasculares/mortalidade , Feminino , Hospitalização/estatística & dados numéricos , Humanos , Transtornos de Início Tardio/etiologia , Transtornos de Início Tardio/mortalidade , Masculino , Pessoa de Meia-Idade , Neoplasias Induzidas por Radiação/etiologia , Modelos de Riscos Proporcionais , Radiografia , Estudos Retrospectivos , Fatores de TempoAssuntos
Técnicas de Imagem Cardíaca/efeitos adversos , Cardiologia , Pessoal de Saúde , Exposição Ocupacional/efeitos adversos , Radiação Ionizante , Técnicas de Imagem Cardíaca/métodos , Medicina Baseada em Evidências , Raios gama/efeitos adversos , Humanos , Infarto do Miocárdio/prevenção & controle , Neoplasias Induzidas por Radiação/prevenção & controle , Doses de Radiação , Proteção Radiológica , Fatores de Risco , Acidente Vascular Cerebral/prevenção & controle , Fatores de Tempo , Raios X/efeitos adversosRESUMO
The benefits of cardiac imaging are immense, and modern medicine requires the extensive and versatile use of a variety of cardiac imaging techniques. Cardiologists are responsible for a large part of the radiation exposures every person gets per year from all medical sources. Therefore, they have a particular responsibility to avoid unjustified and non-optimized use of radiation, but sometimes are imperfectly aware of the radiological dose of the examination they prescribe or practice. This position paper aims to summarize the current knowledge on radiation effective doses (and risks) related to cardiac imaging procedures. We have reviewed the literature on radiation doses, which can range from the equivalent of 1-60 milliSievert (mSv) around a reference dose average of 15 mSv (corresponding to 750 chest X-rays) for a percutaneous coronary intervention, a cardiac radiofrequency ablation, a multidetector coronary angiography, or a myocardial perfusion imaging scintigraphy. We provide a European perspective on the best way to play an active role in implementing into clinical practice the key principle of radiation protection that: 'each patient should get the right imaging exam, at the right time, with the right radiation dose'.
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Técnicas de Imagem Cardíaca/efeitos adversos , Cardiopatias/diagnóstico por imagem , Doses de Radiação , Cardiologia , Criança , Feminino , Cardiopatias/terapia , Humanos , Consentimento Livre e Esclarecido , Exposição Ocupacional/efeitos adversos , Exposição Ocupacional/prevenção & controle , Gravidez , Complicações na Gravidez/etiologia , Diagnóstico Pré-Natal/efeitos adversos , Lesões por Radiação/etiologia , Proteção Radiológica/métodos , Proteção Radiológica/normas , Fatores de Risco , Tomografia Computadorizada por Raios X/efeitos adversos , Procedimentos DesnecessáriosAssuntos
Técnicas de Imagem Cardíaca/efeitos adversos , Doença da Artéria Coronariana/diagnóstico , Meios de Contraste/efeitos adversos , Combinação de Medicamentos , Teste de Esforço , Humanos , Angiografia por Ressonância Magnética/efeitos adversos , Doses de Radiação , Radiação Ionizante , Medição de Risco/métodos , Amido/efeitos adversos , Talco/efeitos adversos , Tartaratos/efeitos adversosRESUMO
AIMS: Radiological inappropriateness in medical imaging leads to loss of resources and accumulation of avoidable population cancer risk. Aim of the study was to audit the appropriateness rate of different cardiac radiological examinations. METHODS AND PRINCIPAL FINDINGS: With a retrospective, observational study we reviewed clinical records of 818 consecutive patients (67 ± 12 years, 75% males) admitted from January 1-May 31, 2010 to the National Research Council - Tuscany Region Gabriele Monasterio Foundation cardiology division. A total of 940 procedures were audited: 250 chest x-rays (CXR); 240 coronary computed tomographies (CCT); 250 coronary angiographies (CA); 200 percutaneous coronary interventions (PCI). For each test, indications were rated on the basis of guidelines class of recommendation and level of evidence: definitely appropriate (A, including class I, appropriate, and class IIa, probably appropriate), uncertain (U, class IIb, probably inappropriate), or inappropriate (I, class III, definitely inappropriate). Appropriateness was suboptimal for all tests: CXR (A = 48%, U = 10%, I = 42%); CCT (A = 58%, U = 24%, I = 18%); CA (A = 45%, U = 25%, I = 30%); PCI (A = 63%, U = 15%, I = 22%). Top reasons for inappropriateness were: routine on hospital admission (70% of inappropriate CXR); first line application in asymptomatic low-risk patients (42% of CCT) or in patients with unchanged clinical status post-revascularization (20% of CA); PCI in patients either asymptomatic or with miscellaneous symptoms and without inducible ischemia on non-invasive testing (36% of inappropriate PCI). CONCLUSION AND SIGNIFICANCE: Public healthcare system--with universal access paid for with public money--is haemorrhaging significant resources and accumulating avoidable long-term cancer risk with inappropriate cardiovascular imaging prevention.