Low-level ionizing radiation from noninvasive cardiac imaging: can we extrapolate estimated risks from epidemiologic data to the clinical setting?
Clinical decision-making regarding the use of low-level ionizing radiation for diagnostic and/or therapeutic purposes in patients with cardiovascular disease must, as in all other clinical scenarios, encompass the broad range of the risk-benefit ratio. Concerns regarding the late carcinogenic effects of exposure to low levels, i.e., <100 mSv, of ionizing radiation stem from extrapolation of exposure-outcome data in survivors of World War II atomic bomb explosions. However, ongoing debate regarding the true incremental risk to subjects exposed to doses currently administered in cardiovascular procedures fails to take into account the uncertainty of the dose-response relationship in this lower range, as well as tissue-specific reparative responses, also manifest at lower levels of exposure. The present discussion draws attention to both of these aspects as they relate to clinical decision-making.
Laskey
Warren K
WK
Department of Medicine, University of New Mexico School of Medicine, Albuquerque, New Mexico 87131, USA. wlaskey@salud.unm.edu
Feinendegen
Ludwig E
LE
Neumann
Ronald D
RD
Dilsizian
Vasken
V
D004249:DNA Damage; D004260:DNA Repair / Q000528:radiation effects; D003952:Diagnostic Imaging / Q000009:adverse effects*; D004307:Dose-Response Relationship, Radiation; D006334:Heart Function Tests / Q000009:adverse effects*; D006801:Humans; D009381:Neoplasms, Radiation-Induced / Q000453:epidemiology / Q000209:etiology* / Q000235:genetics; D018579:Patient Selection; D011829:Radiation Dosage; D018570:Risk Assessment; D012307:Risk Factors; D035501:Uncertainty