While cardiovascular diagnostic testing and procedures have led to significant improvements in the treatment of cardiovascular disease, many of these procedures also expose patients to ionizing radiation. As a result, the Food and Drug Administration (FDA), Congress, and others are increasingly looking at medical radiation exposure and considering policies and/or programs to ensure patient and clinician safety.

In an effort to assist with these efforts, representatives from cardiovascular imaging societies, private payers, government and nongovernmental agencies, industry, medical physicists, and patient representatives met in February 2011 for a day-long Think Tank to better define the issues and needs around patient radiation safety in cardiovascular imaging and to develop an action plan to guide future efforts.

 The outcomes generated from this meeting, which were incorporated into a special white paper and released on March 22, 2012, fell into four broad categories:

1. Quantifying the estimated stochastic risks of low-dose radiation associated with cardiovascular imaging and therapeutic procedures.
   
2. Measuring and reporting radiation dose in cardiovascular imaging and procedures.
   
3. Minimizing radiation dose for single episodes of care and across entire systems of care.
   
4. Educating and communicating with multiple groups to increase awareness and achieve goals in minimizing exposure.

Despite the limited time-frame for deliberations, Think Tank participants were able to come together around the need for clarification of the relationship between medical radiation and stochastic events, and development of infrastructure to support robust dose assessment and longitudinal tracking. The white paper highlights the need for basic and clinical research (and the funding to support it) to understand the risks of the low-dose, multiple exposures that are characteristic of most cardiovascular uses.

Participants also identified the need for continued close attention to patient selection by balancing the benefit of cardiovascular testing and procedures against carefully minimized radiation exposures.  In particular, avoidance of inappropriate testing and procedures through the use of tools like appropriate use criteria was included in the recommendations.

Education of ordering and providing physicians and the collation, dissemination and implementation of best practices were also identified as key components of a radiation safety action plan. Robust education was identified as a need not just for the health care community, but for patients, the public and media as well.

“One of the most important elements for continued progress on improving radiation safety is broad collaboration across a large number of diverse stakeholders,” said Pamela Douglas, MD, MACC, former ACC President and the Ursula Geller Professor for Research in Cardiovascular Diseases at the Duke University Clinical Research Institute (DCRI), which joined the ACC Foundation and the American Heart Association in convening the Think Tank. “The Think Tank and this report are the first important steps.”

She echoed the findings of the paper, which states: “For [radiation safety] efforts to be successful, they must be conducted by multidisciplinary teams of medical and nonmedical scientists, with support from professional societies representing the active commitment of the house of cardiology. Funding agencies, payers, and industry must recognize the importance of this work to public health and invest in radiation safety. Professional societies and regulators in particular need to ensure timely implementation of these recommendations, and monitoring must be implemented to guard against unintended consequences.”

Moving forward, Douglas said the ACC plans to build upon the roadmap defined by the Think Tank and work with Think Tank participants and other stakeholders to ensure patients are receiving the best and most appropriate care and are not exposed to excessive or unnecessary radiation. Read the full report here and the 10 points to remember here.

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