title: Patient-centered imaging: shared decision making for cardiac imaging procedures with exposure to ionizing radiation.
abstract: The current paper details the recommendations arising from an NIH-NHLBI/NCI-sponsored symposium held in November 2012, aiming to identify key components of a radiation accountability framework fostering patient-centered imaging and shared decision-making in cardiac imaging. Symposium participants, working in 3 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. The 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 ≤3 mSv is considered very low risk, not warranting extensive discussion or written informed consent. However, a protocol effective dose >20 mSv 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. 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.
authors: Columbia University Medical Center and New York-Presbyterian Hospital, New York, New York. Electronic address: andrew.einstein@columbia.edu.
authors: Andrew J
authors: AJ
authors: Einstein
authors: Cedars-Sinai Medical Center, Los Angeles, California.
authors: Daniel S
authors: DS
authors: Berman
authors: Weill Cornell Medical College, New York, New York.
authors: James K
authors: JK
authors: Min
authors: University of Miami Miller School of Medicine, Miami, Florida.
authors: Robert C
authors: RC
authors: Hendel
authors: Mayo Clinic, Rochester, Minnesota.
authors: Thomas C
authors: TC
authors: Gerber
authors: Vanderbilt University, Nashville, Tennessee.
authors: J Jeffrey
authors: JJ
authors: Carr
authors: Cleveland Clinic Foundation, Cleveland, Ohio.
authors: Manuel D
authors: MD
authors: Cerqueira
authors: Mid-America Heart Institute, Kansas City, Missouri.
authors: S James
authors: SJ
authors: Cullom
authors: Ottawa Heart Institute, Ottawa, Ontario, Canada.
authors: Robert
authors: R
authors: DeKemp
authors: Emory University School of Medicine, Atlanta, Georgia.
authors: Neal W
authors: NW
authors: Dickert
authors: Brigham and Women's Hospital, Boston, Massachusetts.
authors: Sharmila
authors: S
authors: Dorbala
authors: Emory University School of Medicine, Atlanta, Georgia.
authors: Reza
authors: R
authors: Fazel
authors: Emory University School of Medicine, Atlanta, Georgia.
authors: Ernest V
authors: EV
authors: Garcia
authors: Mayo Clinic, Rochester, Minnesota.
authors: Raymond J
authors: RJ
authors: Gibbons
authors: Cleveland Clinic Foundation, Cleveland, Ohio.
authors: Sandra S
authors: SS
authors: Halliburton
authors: Technische Universität München, Munich, Germany.
authors: Jörg
authors: J
authors: Hausleiter
authors: Morristown Medical Center, Morristown, New Jersey.
authors: Gary V
authors: GV
authors: Heller
authors: University of Maryland, Baltimore, Maryland.
authors: Scott
authors: S
authors: Jerome
authors: Minneapolis Heart Institute, Minneapolis, Minnesota.
authors: John R
authors: JR
authors: Lesser
authors: William Beaumont Hospital; Royal Oak, Michigan.
authors: Gilbert L
authors: GL
authors: Raff
authors: Brown University, Providence, Rhode Island.
authors: Peter
authors: P
authors: Tilkemeier
authors: Wayne State University, Detroit, Michigan.
authors: Kim A
authors: KA
authors: Williams
authors: Emory University School of Medicine, Atlanta, Georgia.
authors: Leslee J
authors: LJ
authors: Shaw
mesh_terms: D002309:Cardiology / Q000379:methods*; D002318:Cardiovascular Diseases / Q000175:diagnosis*; D003657:Decision Making; D003952:Diagnostic Imaging / Q000379:methods*; D006801:Humans; D018802:Patient-Centered Care / Q000379:methods*; D011829:Radiation Dosage; D011832:Radiation Injuries / Q000517:prevention & control*; D011839:Radiation, Ionizing
keywords: appropriate use; image quality; imaging; radiation safety