NEW YORK (Reuters Health) - Cardiologists should discuss with patients the risks and benefits of chest imaging using ionizing radiation before the procedure, according to a new statement endorsed by several medical organizations.
Ionizing radiation, which can come from cardiac stress tests, CT scans and certain heart procedures, is tied to increased cancer risk.
“There is continuing concern on the part of patients in the area of ionizing radiation,” said Dr. Andrew J. Einstein, an associate professor of medicine in radiology at Columbia University in New York.
In general, the risks of the radiation are small and the benefits of clinically appropriate imaging outweigh the risks, but many patients still have unanswered questions, said Einstein, a member of the writing committee for the new statement.
The statement, published in the journal Circulation, is endorsed by the American Heart Association, the American College of Cardiology and several other medical organizations.
“The purpose of this document is to address physicians in particular and provide recommendations in terms of methods that can enhance safety and methods that can enhance patient understanding,” he told Reuters Health by phone.
He and his coauthors recommend that providers explain to patients why radiation imaging is being used, the risks it involves and the benefits it offers.
The decision to go ahead with ionizing radiation imaging should be shared between the doctor and the patient, they write.
“Patient centered imaging is really tailored to the needs of the patient and their preferences,” Einstein said. “The education responsibility falls squarely on the doctors.”
“As doctors, it is our obligation to make sure that we, our colleagues and our patients understand the potential benefits of a medical imaging study as well as potential risks,” he said. “Patients shouldn’t be scared off by a one in X chance of developing cancer, they should be reassured by the benefits of the imaging.”
For example, concerned patients should be reassured during certain heart procedures that the benefits are greater than the small risk posed by the radiation, Einstein said.
Radiation imaging helps obtain useful, in many cases crucial information for decisions regarding the treatment, which often is life-saving, said Yehoshua Socol, a physicist and executive analyst at Falcon Analytics in Karnei Shomron, Israel.
Socol was not involved in writing the new statement.
Cancer risk only elevates slightly after multiple exposures to the radiation, he told Reuters Health by email.
Past studies have found, however, that the small amount of radiation absorbed through medical tests may increase the risk of cancer over a lifetime (see Reuters Health stories of June 6, 2012 here: reut.rs/Ms8cWl and of July 13, 2009 here: reut.rs/1yylxne).
For heart patients, there is no federal regulation of radiation dose for medical tests, leaving the appropriate use in the hands of doctors.
“When it comes to ionizing radiation doses there is tremendous variability between facilities for the same tests,” Einstein said.
Some of that is because doses are tailored to the individual patient, but some is unnecessary, he said.
The statement includes recommendations for making sure the right test is being done at the right time and that the lowest possible dose of radiation is used.
“You should use enough radiation to answer the question but not more so than you need,” he said.
Doctors ordering imaging tests should understand when each type of test is appropriate, the typical average radiation dose, diagnostic accuracy, potential risks, availability, cost, and convenience, according to the statement.
SOURCE: bit.ly/1orlP5v Circulation, online September 29, 2014