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Coronary artery disease (CAD) is the leading cause of mortality in the U.S., and medical exposures impart the highest per-capita source of radiation despite epidemiological evidence of cancer risk. The immediate challenge is to safely and economically employ ionizing radiation to improve detection of disease and risk stratification.
A Pubmed search using keywords “radiation,” “cancer risk,” and “cost-effectiveness” for coronary computed tomography angiography (CCTA), nuclear medicine myocardial perfusion imaging (NM MPS) and diagnostic invasive coronary angiography (DCA) was manually screened. Seventeen sources were selected for review.
Cancer risk from low-dose radiologic imaging may be extrapolated from atomic bomb data by the “linear-no-threshold” theory. Absorbed radiation varies with imaging modality and tissue-type; it is greatest in females and the young. CCTA with electrocardiography-controlled tube current modulation (ECTM) confers the least radiation and cancer risk in men with superior accuracy to NM MPS (99% sensitivity, 91% specificity). For patients with 10-50% pre-test probability and 30-50% CAD prevalence, CCTA-based imaging offered greatest cost-effectiveness ($17,516/correct diagnosis). DCA is optimal for CAD prevalence ≥ 80%.
|Imaging||Effective Dose Range, (Mean), millisieverts||Anterior-posterior Chest RadiographEquivalent||Lifetime Attributable Risk of CancerMales (60-year-old)||Lifetime Attributable Risk of Cancer Females (60-year-old)|
|NM MPS||2.2 – 31.5 (9.4, 11.1)||512||1 in 1,000||1 in 1,000|
|CCTA||5 – 32 (12, 16)||250–1600||1 in 790||1 in 420|
|ECTCM||1.1 – 3.0||55–150||1 in 1911||1 in 715|
|DCA||2.3 – 22.7 (7.0)||100 – 1,100||1 in 1190||1 in 1470|
For intermediate-risk patients with no known CAD, initial CCTA-based imaging is the most accurate and cost-effective modality associated with an acceptably low theoretical risk of cancer.
Poster Sessions, Expo North
Saturday, March 09, 2013, 3:45 p.m.-4:30 p.m.
Session Title: Imaging: CT/Multimodality III
Abstract Category: 20. Imaging: CT/Multimodality
Presentation Number: 1181-341
- 2013 American College of Cardiology Foundation