Sustainability of Cardiac Imaging

Medical imaging is the largest controllable source of radiation exposure in the population of industrialised countries – totalling around 150 chest X-rays per head per year. Of these exposures, one half comes from cardiovascular testing (cardio-computed tomography [CT], nuclear cardiology and interventional cardiology). The high level of radiation exposure provides immense benefits when appropriate, but may result in an increased incidence of radiation-induced cancer in the not-too-distant future. Current estimates suggest that about five to 10 % of all cancers may be due to medical radiation exposure. Of every three examinations, one is inappropriately prescribed (lack of justification) and another is performed with inappropriately high radiation doses (lack of optimisation). Cardiologists are often unaware of the radiological dose of the examination they prescribe or practice, but they should make every effort so that “each patient should get the right imaging exam, at the right time, with the right radiation dose”, as suggested by US Food and Drug Administration (FDA) in the 2010 initiative to reduce unnecessary radiation exposure from medical imaging. This is best obtained through a systematic implementation of the ‘3A’s strategy’ proposed by the International Atomic Energy Agency in 2011: audit (of true delivered dose); appropriateness (since at least one-third of examinations are inappropriate); awareness (since the knowledge of doses and risks is largely suboptimal in doctors and patients). A good cardiologist cannot be scared of radiation, but must always remain aware of the risks.