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- Lewis Wexler, MD∗ ()
- ↵∗Department of Radiology, Stanford University School of Medicine, 805 Tolman Drive, Stanford, California 94305-1025
The letter by Drs. Castellano and Nicol in response to my editorial introduces an additional complexity regarding radiation exposure from cardiovascular computed tomography (CT), namely the difficulty in measuring the actual dose that any given patient receives. Because of this difficulty and lack of agreement on what to measure and how to express the result, a measurement is not even attempted on a regular basis in clinical practice. Most imaging sites use a generic estimate of radiation exposure that is included in the report of findings.
In either case, that is, trying to obtain an accurate measurement in each patient with all the unknowns and difficulties mentioned by Castellano and Nicol or using a generic estimate of radiation exposure, the ordering physician and the imaging center need the guidelines provided in the report by Einstein et al. so that a meaningful discussion of the issues of radiation exposure can be initiated with the patient.
I agree with the conclusion of Drs. Castellano and Nicol that, until the scientific community can agree on how to obtain these measurements and how best to express them to patients, discussions with our patients will lack some degree of uniformity. It would be a stretch to say that these discussions are evidence based. For the vast majority of patients, this is irrelevant; however, the real issue is understanding the “risk,” not the details of actual exposure to radiation.
- American College of Cardiology Foundation