Journal
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY
Volume 63, Issue 15, Pages 1480-1489Publisher
ELSEVIER SCIENCE INC
DOI: 10.1016/j.jacc.2013.10.092
Keywords
appropriate use; image quality; imaging; radiation safety
Categories
Funding
- National Heart, Lung, and Blood Institute (NHLBI)
- National Cancer Institute [1R13 HL112549-01]
- Astellas Healthcare
- Bracco Diagnostics
- Lantheus Medical Imaging
- MedSolutions
- NHLBI [R01 HL109711]
- Victoria and Esther Aboodi
- Herbert Irving Assistant Professorships
- GE Healthcare
- Philips Healthcare
- Spectrum Dynamics
- Siemens Medical Solutions
- Intersocietal Accreditation Commission
- Siemens
- Astellas
- [K23 HL092299]
- [U01 HL105561]
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The current paper details the recommendations arising from an NIH-NHLBI/NCI-sponsored symposium held in November 2012, aiming to identify key components of a radiation accountability framework fostering patient-centered imaging and shared decision-making in cardiac imaging. Symposium participants, working in 3 tracks, identified key components of a framework to target critical radiation safety issues for the patient, the laboratory, and the larger population of patients with known or suspected cardiovascular disease. The use of ionizing radiation during an imaging procedure should be disclosed to all patients by the ordering provider at the time of ordering, and reinforced by the performing provider team. An imaging protocol with effective dose <= 3mSv is considered very low risk, not warranting extensive discussion or written informed consent. However, a protocol effective dose >20mSv was proposed as a level requiring particular attention in terms of shared decision-making and either formal discussion or written informed consent. Laboratory reporting of radiation dosimetry is a critical component of creating a quality laboratory fostering a patient-centered environment with transparent procedural methodology. Efforts should be directed to avoiding testing involving radiation, in patients with inappropriate indications. Standardized reporting and diagnostic reference levels for computed tomography and nuclear cardiology are important for the goal of public reporting of laboratory radiation dose levels in conjunction with diagnostic performance. The development of cardiac imaging technologies revolutionized cardiology practice by allowing routine, noninvasive assessment of myocardial perfusion and anatomy. It is now incumbent upon the imaging community to create an accountability framework to safely drive appropriate imaging utilization. (C) 2014 by the American College of Cardiology Foundation
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