title: Cumulative exposure to ionizing radiation from diagnostic and therapeutic cardiac imaging procedures: a population-based analysis.
abstract: OBJECTIVE
  The purpose of this study was to describe radiation exposure from cardiac imaging procedures over time in a general population.
  
  
  BACKGROUND
  Cardiac imaging procedures frequently expose patients to ionizing radiation, but their contribution to effective doses of radiation in the general population is unknown.
  
  
  METHODS
  We used administrative claims to identify cardiac imaging procedures performed from 2005 to 2007 in 952,420 nonelderly insured adults in 5 U.S. health care markets. We estimated 3-year cumulative effective doses of radiation in millisieverts from these procedures We then calculated population-based annual rates of radiation exposure to effective doses < or =3 mSv/year (background level of radiation from natural sources), >3 to 20 mSv/year, or >20 mSv/year (upper annual limit for occupational exposure averaged over 5 years).
  
  
  RESULTS
  A total of 90,121 (9.5%) individuals underwent at least 1 cardiac imaging procedure using radiation. Among patients who underwent > or =1 cardiac imaging procedures, the mean cumulative effective dose over 3 years was 23.1 mSv (range 1.5 to 543.7 mSv). Myocardial perfusion imaging accounted for 74% of the cumulative effective dose. Overall, 47.8% of cardiac imaging procedures were performed in physician offices; this proportion was higher for myocardial perfusion imaging (74.8%) and cardiac computed tomography studies (76.5%). The annual population-based rate of receiving an effective dose of >3 to 20 mSv/year was 89.0 per 1,000; and 3.3 per 1,000 for cumulative doses >20 mSv/year. Annual effective doses increased with age and were generally higher among men.
  
  
  CONCLUSIONS
  Cardiac imaging procedures lead to substantial radiation exposure and effective doses for many patients in the U.S.
authors.affiliation: Section of Cardiovascular Medicine, Department of Medicine, Yale School of Epidemiology and Public Health, New Haven, Connecticut 06520, USA. jersey.chen@yale.edu
authors.forename: Jersey
authors.initials: J
authors.lastname: Chen
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Einstein
authors.forename: Reza
authors.initials: R
authors.lastname: Fazel
authors.forename: Harlan M
authors.initials: HM
authors.lastname: Krumholz
authors.forename: Yongfei
authors.initials: Y
authors.lastname: Wang
authors.forename: Joseph S
authors.initials: JS
authors.lastname: Ross
authors.forename: Henry H
authors.initials: HH
authors.lastname: Ting
authors.forename: Nilay D
authors.initials: ND
authors.lastname: Shah
authors.forename: Khurram
authors.initials: K
authors.lastname: Nasir
authors.forename: Brahmajee K
authors.initials: BK
authors.lastname: Nallamothu
mesh_terms: D000293:Adolescent; D000328:Adult; D015906:Angioplasty, Balloon, Coronary / Q000706:statistics & numerical data; D006328:Cardiac Catheterization / Q000706:statistics & numerical data; D003952:Diagnostic Imaging / Q000009:adverse effects / Q000706:statistics & numerical data*; D005260:Female; D006321:Heart / Q000000981:diagnostic imaging; D006331:Heart Diseases / Q000175:diagnosis*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011839:Radiation, Ionizing; D011859:Radiography / Q000706:statistics & numerical data*; D011875:Radionuclide Angiography / Q000706:statistics & numerical data; D011877:Radionuclide Imaging / Q000706:statistics & numerical data*; D014481:United States