New recommendations concerning radiation exposure from cardiac imaging procedures call for shared decision-making between providers and patients involving disclosure of the use of ionizing radiation as well as measures to ensure the safety and effectiveness of the procedure. The recommendations were published Feb. 12 in the Journal of the American College of Cardiology , and were based on a symposium sponsored by the National Heart, Lung, and Blood Institute last November.

According to the recommendations, a cardiac imaging procedure with an effective radiation dose of ≤3 mSv is associated with a very low risk of adverse events from radiation exposure. This does not require a detailed discussion from the ordering physician or written consent from the patient.

However, if the effective radiation dose exceeds 20 mSv, the ordering physician should have either a detailed discussion with the patient of specific radiation exposure risks and any projected cancer risks, or written informed consent from the patient. The physician should use simple and clear language to communicate potential radiation risks.

In the diagnostic imaging laboratory, the imaging team should avoid administering tests that involve radiation exposure to patients with inappropriate indications, adhere to quality standards, maintain a database of radiation dosimetric safety metrics for all patients undergoing imaging procedures involving exposure to radiation and follow clinical practice guidelines in performing the tests.

"The development of current cardiac imaging technologies revolutionized the practice of cardiovascular medicine by allowing for 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," the study's authors concluded.

An accompanying editorial by Lewis Wexler, MD, FACC, Department of Radiology, Stanford University School of Medicine, notes that the authors also recommend that insurance carriers become involved "so that diagnostic testing using radiation is performed optimally when indicated." He also noted a recommendation urging education in medical school curricula about the benefits and risks of radiation exposure.

He concludes that "patients deserve a conversation that honors their concerns and presents them with evidence in a manner that is understandable to help them share in the decision to undergo a cardiac imaging test that is best suited to elucidate the nature of their problem and that puts their concerns in perspective."

Keywords: Radiology, National Heart, Lung, and Blood Institute (U.S.), Insurance Carriers, Radiation, Ionizing, Social Responsibility, Disclosure, Schools, Medical, Diagnostic Imaging, Risk Assessment, Informed Consent