A new expert consensus document aims to provide best practices for safety and effectiveness when employing ionizing radiation in cardiovascular diagnostic and therapeutic procedures. The document, developed by the ACC, Heart Rhythm Society, North American Society for Cardiovascular Imaging, Society for Cardiovascular Angiography and Interventions, Society for Cardiovascular Computed Tomography, in collaboration with Mended Hearts, was published May 2 in the Journal of the American College of Cardiology.

As ionizing radiation-based cardiovascular procedures are being performed with increasing frequency, the writing committee, led by John W. Hirshfeld Jr., MD, FACC, developed an educational resource that compiles and interprets the current radiation biology and safety knowledge base applicable to cardiovascular imaging.

Our aim is "to enable cardiovascular practitioners to select the optimal imaging technique for a given clinical circumstance while balancing a technique's risk and benefits, and to apply that technique optimally to generate high-quality diagnostic images that deliver the greatest clinical value with minimal radiation exposure," write Hirshfeld et al.

Specifically, the document details:

• How radiation can harm patients and occupationally-exposed medical personnel;
• The relationship between radiation dose, subject characteristics and the risk of harm from radiation;
• How x-ray fluoroscopy machines, x-ray CT machines and nuclear cardiology scanners work;
• Measures and determinants of radiation dose delivered to patients and medical personnel by medical radiation producing machines;
• How medical providers can minimize radiation exposure to patients and to themselves while obtaining optimal radiological images;
• Training requirements for the operation of radiation producing machines; and
• Standards for quality assurance for cardiovascular procedures that involve radiation.

The writing group concludes that "the health care professional is responsible to be aware of [the issue of increased medical radiation exposure] and to work to optimize the risk-benefit balance both for the individual and at the population level."

The document is meant to compliment clinical practice guidelines, and to provide "practical guidance for transforming guideline recommendations into clinically actionable information."

Keywords: Ablation Techniques, Cardiac Catheterization, Cardiac Imaging Techniques, Multidetector Computed Tomography, Catheter Ablation, Angiography, Vascular Calcification, Electrophysiologic Techniques, Cardiac, Fluoroscopy, Diagnostic Imaging, Myocardial Perfusion Imaging, Pacemaker, Artificial, Percutaneous Coronary Intervention, Pregnancy, Positron-Emission Tomography, Radiation, Radionuclide Imaging, Safety, Tomography, Emission-Computed, Single-Photon, Transcatheter Aortic Valve Replacement, Radiobiology, Consensus, X-Rays, Radiography, Tomography, X-Ray Computed, Angiography, Radiation Dosage

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