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. 2010 Aug 24;56(9):702-11.
doi: 10.1016/j.jacc.2010.05.014. Epub 2010 Jul 9.

Cumulative exposure to ionizing radiation from diagnostic and therapeutic cardiac imaging procedures: a population-based analysis

Jersey Chen  1 , Andrew J Einstein, Reza Fazel, Harlan M Krumholz, Yongfei Wang, Joseph S Ross, Henry H Ting, Nilay D Shah, Khurram Nasir, Brahmajee K Nallamothu
Affiliations

Cumulative exposure to ionizing radiation from diagnostic and therapeutic cardiac imaging procedures: a population-based analysis

Jersey Chen et al. J Am Coll Cardiol. .

Abstract

Objectives: The purpose of this study was to describe radiation exposure from cardiac imaging procedures over time in a general population.

Background: Cardiac imaging procedures frequently expose patients to ionizing radiation, but their contribution to effective doses of radiation in the general population is unknown.

Methods: We used administrative claims to identify cardiac imaging procedures performed from 2005 to 2007 in 952,420 nonelderly insured adults in 5 U.S. health care markets. We estimated 3-year cumulative effective doses of radiation in millisieverts from these procedures We then calculated population-based annual rates of radiation exposure to effective doses < or =3 mSv/year (background level of radiation from natural sources), >3 to 20 mSv/year, or >20 mSv/year (upper annual limit for occupational exposure averaged over 5 years).

Results: A total of 90,121 (9.5%) individuals underwent at least 1 cardiac imaging procedure using radiation. Among patients who underwent > or =1 cardiac imaging procedures, the mean cumulative effective dose over 3 years was 23.1 mSv (range 1.5 to 543.7 mSv). Myocardial perfusion imaging accounted for 74% of the cumulative effective dose. Overall, 47.8% of cardiac imaging procedures were performed in physician offices; this proportion was higher for myocardial perfusion imaging (74.8%) and cardiac computed tomography studies (76.5%). The annual population-based rate of receiving an effective dose of >3 to 20 mSv/year was 89.0 per 1,000; and 3.3 per 1,000 for cumulative doses >20 mSv/year. Annual effective doses increased with age and were generally higher among men.

Conclusions: Cardiac imaging procedures lead to substantial radiation exposure and effective doses for many patients in the U.S.

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Conflict of interest statement

Disclosures

Dr. Krumholz reports consulting fees for serving on the United Healthcare Cardiac Scientific Advisory Board. He received no fees related to this project. Dr Einstein reports having received research support from Spectrum Dynamics. No other potential conflicts of interest relevant to this article were reported by any of the authors.

Figures

Figure
Figure. Contribution to cumulative effective radiation dose, by type of cardiac imaging procedure
Abbreviations: MPI, Myocardial perfusion imaging; CATH, cardiac catheterization; PCI, percutaneous coronary intervention; ERNA, equilibrium radionuclide angiogram; MUGA, multi-gated acquisition scan; EP, electrophysiologic procedures; CCT, cardiac computed tomography
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