Author + information
- Received September 25, 2013
- Revision received October 28, 2013
- Accepted October 28, 2013
- Published online April 22, 2014.
- Andrew J. Einstein, MD, PhD∗∗ (, )
- Daniel S. Berman, MD†,
- James K. Min, MD‡,
- Robert C. Hendel, MD§,
- Thomas C. Gerber, MD, PhD‖,
- J. Jeffrey Carr, MD¶,
- Manuel D. Cerqueira, MD#,
- S. James Cullom, PhD∗∗,
- Robert DeKemp, PhD††,
- Neal W. Dickert, PhD, MD‡‡,
- Sharmila Dorbala, MD§§,
- Reza Fazel, MD‡‡,
- Ernest V. Garcia, PhD‡‡,
- Raymond J. Gibbons, MD‖,
- Sandra S. Halliburton, PhD#,
- Jörg Hausleiter, MD‖‖,
- Gary V. Heller, MD, PhD¶¶,
- Scott Jerome, DO##,
- John R. Lesser, MD∗∗∗,
- Gilbert L. Raff, MD†††,
- Peter Tilkemeier, MD‡‡‡,
- Kim A. Williams, MD§§§ and
- Leslee J. Shaw, PhD‡‡
- ∗Columbia University Medical Center and New York-Presbyterian Hospital, New York, New York
- †Cedars-Sinai Medical Center, Los Angeles, California
- ‡Weill Cornell Medical College, New York, New York
- §University of Miami Miller School of Medicine, Miami, Florida
- ‖Mayo Clinic, Rochester, Minnesota
- ¶Vanderbilt University, Nashville, Tennessee
- #Cleveland Clinic Foundation, Cleveland, Ohio
- ∗∗Mid-America Heart Institute, Kansas City, Missouri
- ††Ottawa Heart Institute, Ottawa, Ontario, Canada
- ‡‡Emory University School of Medicine, Atlanta, Georgia
- §§Brigham and Women's Hospital, Boston, Massachusetts
- ‖‖Technische Universität München, Munich, Germany
- ¶¶Morristown Medical Center, Morristown, New Jersey
- ##University of Maryland, Baltimore, Maryland
- ∗∗∗Minneapolis Heart Institute, Minneapolis, Minnesota
- †††William Beaumont Hospital; Royal Oak, Michigan
- ‡‡‡Brown University, Providence, Rhode Island
- §§§Wayne State University, Detroit, Michigan
- ↵∗Reprint requests and correspondence:
Dr. Andrew J. Einstein, Columbia University Medical Center, Cardiology Division, 622 West 168th Street, PH 10-203A, New York, New York 10032.
The current paper details the recommendations arising from an NIH-NHLBI/NCI-sponsored symposium held in November 2012, aiming to identify key components of a radiation accountability framework fostering patient-centered imaging and shared decision-making in cardiac imaging. Symposium participants, working in 3 tracks, identified key components of a framework to target critical radiation safety issues for the patient, the laboratory, and the larger population of patients with known or suspected cardiovascular disease. The use of ionizing radiation during an imaging procedure should be disclosed to all patients by the ordering provider at the time of ordering, and reinforced by the performing provider team. An imaging protocol with effective dose ≤3mSv is considered very low risk, not warranting extensive discussion or written informed consent. However, a protocol effective dose >20mSv was proposed as a level requiring particular attention in terms of shared decision-making and either formal discussion or written informed consent. Laboratory reporting of radiation dosimetry is a critical component of creating a quality laboratory fostering a patient-centered environment with transparent procedural methodology. Efforts should be directed to avoiding testing involving radiation, in patients with inappropriate indications. Standardized reporting and diagnostic reference levels for computed tomography and nuclear cardiology are important for the goal of public reporting of laboratory radiation dose levels in conjunction with diagnostic performance. The development of cardiac imaging technologies revolutionized cardiology practice by allowing routine, noninvasive assessment of myocardial perfusion and anatomy. It is now incumbent upon the imaging community to create an accountability framework to safely drive appropriate imaging utilization.
Funding for this symposium was provided by the National Heart, Lung, and Blood Institute (NHLBI) and the National Cancer Institute (grant 1R13 HL112549-01), Astellas Healthcare, Bracco Diagnostics, Lantheus Medical Imaging, and MedSolutions. Dr. Einstein was supported in part by grant R01 HL109711 from the NHLBI and by Victoria and Esther Aboodi and Herbert Irving Assistant Professorships. Dr. Dorbala was supported in part by grant K23 HL092299. Dr. Shaw was supported in part by grant U01 HL105561. Dr. Einstein has received research grants from GE Healthcare, Philips Healthcare, and Spectrum Dynamics. Dr. DeKemp is a consultant for Jubilant DraxImage and receives royalties for rubidium positron emission tomographic technology. Dr. Dorbala has received a research grant from Astellas Healthcare; and holds stock in GE. Dr. Garcia has received research grants from GE Healthcare. Dr. Gibbons has served as a consultant to Lantheus; and has received honoraria from AstraZeneca. Dr. Halliburton is a speaker for Philips Medical Systems. Dr. Hausleiter has received a research grant from Siemens Medical Solutions; and speaker's honoraria from Abbott Vascular. Dr. Heller is a consultant for GE Healthcare; and is a member of the science advisory board for Lantheus Medical Imaging. Dr. Jerome has received a research grant from the Intersocietal Accreditation Commission. Dr. Raff has received a research grant from Siemens. Dr. Williams served on a research advisory board that was funded by Astellas. Dr. Williams is currently affiliated with the Rush University School of Medicine, Chicago, Illinois. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received September 25, 2013.
- Revision received October 28, 2013.
- Accepted October 28, 2013.
- American College of Cardiology Foundation