The Radiation Issue in Cardiology: the time for action is now

The "radiation issue" is the need to consider possible deterministic effects (e.g., skin injuries) and long-term cancer risks due to ionizing radiation in the risk-benefit assessment of diagnostic or therapeutic testing. Although there are currently no data showing that high-dose medical studies have actually increased the incidence of cancer, the "linear-no threshold" model in radioprotection assumes that no safe dose exists; all doses add up in determining cancer risks; and the risk increases linearly with increasing radiation dose. The possibility of deterministic effects should also be considered when skin or lens doses may be over the threshold. Cardiologists have a special mission to avoid unjustified or non-optimized use of radiation, since they are responsible for 45% of the entire cumulative effective dose of 3.0 mSv (similar to the radiological risk of 150 chest x-rays) per head per year to the US population from all medical sources except radiotherapy. In addition, interventional cardiologists have an exposure per head per year two to three times higher than that of radiologists. The most active and experienced interventional cardiologists in high volume cath labs have an annual exposure equivalent to around 5 mSv per head and a professional lifetime attributable to excess cancer risk on the order of magnitude of 1 in 100. Cardiologists are the contemporary radiologists but sometimes imperfectly aware of the radiological dose of the examination they prescribe or practice, which can range from the equivalent of 1-60 mSv around a reference dose average of 10-15 mSv for a percutaneous coronary intervention, a cardiac radiofrequency ablation, a multi-detector coronary angiography, or a myocardial perfusion imaging scintigraphy. A good cardiologist cannot be afraid of life-saving radiation, but must be afraid of radiation unawareness and negligence

TOWARDS NATIONAL DIAGNOSTIC REFERENCE LEVELS FOR MAMMOGRAPHY IN SERBIA

Abstract The objective of this work is to investigate the possibility to set a national diagnostic reference levels (nDRLs) for diagnostic and screening mammography in Serbia based on local practice and available resources. This study included all types of mammography systems that are currently used in Serbia, namely screen-film mammography (SFM), computed radiography (CR) and full-field digital mammography (FFDM). The nDRLs are provided in terms of mean glandular dose (MGD) for different breast thicknesses simulated by polymethyl methacrylate (PMMA) phantom. For each breast thickness, MGD was calculated for the X-ray tube output, using clinically used exposure parameters. DRLs were chosen as the 75th percentile of MGD distribution for 20-, 40-, 45-, 60- and 70-mm phantom thicknesses. For SFM units proposed nDRL values are 0.7, 2.1, 2.7, 4.6 and 6.8 mGy; for CR units proposed nDRL values are 0.7, 1.8, 2.4, 4.5 and 5.6 mGy; and corresponding values for FFDM units are 0.8, 1.7, 2, 2. and 3.2 mGy for 20-, 40-, 45-, 60- and 70-mm PMMA thickness, respectively.</jats:p

SKIN DOSE MAPPING IN INTERVENTIONAL CARDIOLOGY: A PRACTICAL SOLUTION

Abstract Numerous cases of radiation-induced tissue reactions following interventional cardiology (IC) procedures have been reported, resulting in the need for an optimized and personalized dosimetry. At present, there are many fluoroscopy units without Digital Imaging and Communications in Medicine (DICOM) Radiation Dose Structured Report globally installed. Many of these have not been updated yet, and may never be, therefore, the main objectives of this paper are to develop an offline skin dose mapping application, which uses DICOM headers for the peak skin dose (PSD) assessment and to compare the PSD assessment results to XR-RV3 Gafchromic film for common IC procedures. The mean deviation between the measured and the calculated PSD was 8.7 ± 26.3%. Simulated skin dose map showed good matching with XR-RV3 Gafchromic film. The skin dose mapping application presented in this paper is an elegant solution and a suitable alternative to XR-RV3 Gafchromic film.</jats:p