Scientific statement encourages discussion of radiation risks before CV imaging
A new scientific statement from the American Heart Association encourages doctors to discuss radiation risks with patients before CV imaging.
“Empowering patients with the knowledge of the benefits and risks of imaging will facilitate their meaningful participation in decisions related to their health care, which is necessary to achieve patient-centered care,” writing group chair Rena Fazel, MD, MSc, FAHA, and colleagues wrote. “Limiting the use of imaging to appropriate clinical indications can ensure that the benefits of imaging outweigh any potential risks.”
The panel recommended that cardiac imaging using CT, radiopharmaceuticals or fluoroscopy should be performed only after the patient is made aware of the clinical justification and expected benefit of the test; all potential risks of the test, including radiation-related risks; and risks and benefits of the alternatives, including no testing.
“The decision to proceed with imaging should be consistent with both current medical evidence and patient values and preferences,” Fazel, cardiologist at Beth Israel Deaconess Medical Center, and colleagues wrote.
The panel cited the following effective communication techniques as potentially helpful:
- Provide the patient with key facts on the procedure in simple language, highlighting the benefits of accurate diagnosis, early detection and early intervention.
- Affirm whether the imaging study is appropriate based on appropriate use criteria, highlighting that an appropriate indication means there is a favorable benefit-risk ratio.
- Create a dialogue, allowing the patient to ask questions.
- Directly address patient and family concerns on risks of the procedure, including those related to radiation, contrast media and anesthesia.
- Compare risk estimates from exposure to ionizing radiation to those of everyday procedures such as driving a car.
The panel also recommended that all clinicians requesting cardiac imaging procedures know which ones use ionizing radiation, know basic concepts related to radiation exposure and know typical dose estimates for the most commonly used cardiac imaging procedures. In addition, those performing cardiac imaging procedures should demonstrate adequate knowledge of dose-optimization techniques for patients and dose-minimization techniques for operators and staff.
“The continually expanding repertoire of techniques that allow high-quality imaging with lower radiation exposure should be used when available to achieve safer imaging,” Fazel and colleagues wrote.
The statement was endorsed by the American College of Cardiology, the American Society of Nuclear Cardiology, the North American Society for Cardiovascular Imaging, the Society of Cardiovascular Computed Tomography and the Society for Coronary Angiography and Intervention.
Disclosure: See the full statement for a list of the relevant financial disclosures of the members of the writing group and the reviewers.