In children with congenital and acquired heart disease, cardiac imaging using ionizing radiation is essential for accurate diagnosis and safe intervention, but exposure can lead to potential radiation-related risks such as cancer. Recommendations to encourage informed imaging to achieve appropriate study quality at the lowest achievable radiation dose were published May 7 in JACC: Cardiovascular Imaging. The position statement, created by the Image Gently Alliance, was endorsed by the ACC.

The recommendations from Kevin D. Hill, MD, MS, et al., focus on optimization approaches that, when properly implemented, aim to improve the radiation safety profile for children with heart disease, without compromising the diagnostic information provided by these studies or other aspects of procedural safety.

The authors explain that justification and optimization are the underlying principles of medical imaging dose management recommendations. They note that a procedure should be appropriately indicated, benefits should outweigh any risks, radiation dose should be suitable for the intended medical purpose and unnecessary or unproductive radiation should be avoided.

The authors provide optimization strategies for cardiac computed tomography, nuclear cardiac imaging and fluoroscopically guided procedures. They also encourage involving patients and families in the decision-making process by communicating possible risks and benefits associated with radiation exposure. They add that dose monitoring programs should be implemented by imaging teams.

Looking forward, Hill and colleagues note that there is a need for standardization of dose metrics across imaging modalities, which will encourage comparative effectiveness studies across the spectrum of medical imaging in children with congenital and acquired heart disease. There is also a need to evaluate the relative merits of cumulative dose monitoring in children.

"The development of current cardiac imaging technologies has revolutionized the practice of cardiovascular medicine in children with congenital and acquired heart disease by facilitating improved diagnosis and less invasive intervention," the authors write. "It is now incumbent on the imaging community to ensure that these procedures are optimized to ensure image quality appropriate to the medical needs of the patient but at the lowest achievable dose."

Keywords: Cardiac Imaging Techniques, Child, Fluoroscopy, Heart Diseases, Neoplasms, Radiation, Ionizing, Risk Assessment, Tomography

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