Patient-Centered Imaging: Shared Decision Making for Cardiac Imaging Procedures with Exposure to Ionizing Radiation

OBJECTIVES: An NIH-NHLBI/NCI-sponsored symposium was held in November 2012 to address these issues. To identify key components of a radiation accountability framework fostering patient-centered imaging and shared decision-making in cardiac imaging.

METHODS: Symposium participants, working in three 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.

RESULTS: 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 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.

CONCLUSIONS: 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. 

PMID: 24530677

Posted in Computed Tomography, Echo, Invasive Imaging, Magnetic Resonance Imaging, Nuclear Imaging, Radiography and tagged , , .

One Comment

  1. Must-read material!

    The authors present a really cool list to provide guidance for communicating risks and benefits following radiation exposure from cardiovascular imaging:
    1. There is low “numeracy” literacy among the US population that impairs understanding of health risks; thus avoid statistical terms and constructs.
    2. Use analogies for the projected risk of radiation exposure, using simple comparisons.
    3. Keep denominators and time frames constant for comparisons.
    4. Make clear the difference between the baseline risk of cancer and the projected risk of
    5. cancer following radiation exposure.
    6. Provide patient decision aids to enhance comprehension including the use of pictographs
    7. and visual aids comparing incremental risk and benefits.

    Gaining Perspective on the Risks of Ionizing Radiation for Cardiac Imaging.
    Lewis Wexler.
    J Am Coll Cardiol. 2014 Jan 31. pii: S0735-1097(14)00390-8.
    PMID: 24530679.

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