Forum for Science, Industry and Business

Sponsored by:     3M 
Search our Site:

 

ESC supports 'appropriate' use of nuclear imaging technology

24.03.2010
Cardiac nuclear imaging and computed tomography angiography (CCTA) still have an important role to play in cardiac disease diagnosis, say experts from the European Society of Cardiology (ESC).

Following the recent publications (1,2,3) highlighting potential dangers of ionising radiation resulting from imaging testing, the ESC experts feel that it is important to voice support of the technology.

“We want to reassure the public that for individual patients the benefits of receiving an accurate diagnosis are likely to far outweigh the small potential risks involved in having a scan,” said Professor Juhani Knuuti, of the ESC Working Group on Nuclear Cardiology and Cardiac CT, from Turku University Hospital (Turku, Finland). “The most fundamental question that clinicians need to ask themselves is whether a test is appropriate for the individual patient, and whether that patient will derive benefit from it.”

It needs to be remembered, he added, that tests like CCTA are used to select patients for invasive procedures that themselves carry risks. “Any procedure is a balance of risks and benefits. What has been overlooked in recent publications is the risk of cardiovascular disease going untreated, which can even result in immediate sudden death. The potential risks of imaging tests are small relative to the diagnostic information obtained,” said Knuuti.

“We have real concerns that following the publicity around the papers, the public may avoid these tests out of fear and that authorities might create unjustified recommendations for imaging use. They need to appreciate that radiation is a single aspect of the risks involved, and that these are really useful tests for cardiologists. Everything needs to be considered in the wider context,” said Knuuti

Papers highlighting the risks

Last year the problems of radiation exposure in patients undergoing medical imaging procedures were raised in three papers in major journals.

A Science Advisory statement from the American Heart Association Committee on Cardiac Imaging wrote that between 1980 and 2006 the collective dose from medical uses of radiation received by the US population increased by more than 700%. The paper, published in Circulation, added that in 2006 CTTA accounted for around 50 % of the collective dose(1).

A NEJM paper, by Reza Fazel and colleagues, from Emory University School of Medicine (Atlanta, Georgia), reviewed the radiation exposure of nearly one million US adults, aged 18 to 64(2). The investigators found that 69 % of participants had undergone at least one imaging procedure associated with radiation, and that the mean cumulative dose was 2.4 mSv per subject per year. “Our finding, that in some patients worrisome radiation doses from imaging procedures can accumulate over time, underscores the need to improve their use,” wrote the authors, adding that strategies for optimizing and ensuring appropriate use of the procedures in general should be introduced.

A paper in JAMA by Jorg Hausleiter and colleagues, from Klinik an der Technischen Universitat, (Munich, Germany) reviewed the radiation dose of CCTA from 50 study centres(3).Results revealed an estimated median radiation dose corresponding to 12mSv, and furthermore found a six fold difference in the dose delivered between the highest and lowest centres. “Improved education of physicians and technicians performing CCTA on these dose-saving strategies might be considered to keep the radiation dose 'as low as reasonably achievable' in every patient undergoing CCTA,” concluded the authors.

Radiation exposure risks put in context

It is important”, said Knuuti, for the public to try to achieve an understanding of exactly what the potential increased cancer risk might involve. “The difficulty involved here is that the risks are so small that you'd never be able to detect them in clinical trials unless you recruited millions of subjects and followed them for the rest of their lifetimes,” said Knuuti, adding that the current risk estimates have been derived from studies of atomic bomb survivors.

One study that helps put the risk of imaging into perspective suggests that living with a smoker (i.e. being a passive smoker) causes a 20 times higher risk of fatal cancer(4) than undergoing one CCTA scan (10 mSv). Another study suggests that the risk of having a fatal pedestrian traffic accident is three times higher than the risk of developing fatal cancer after one CCTA scan(5).

Cancer risks also need be considered in relation to the patient’s age at the time of undergoing the investigation. “For patients with chest pain over the age of 60 years the radiation risks involved are unlikely to have consequences since it takes anyway decades to develop potential adverse events,” said Knuuti, adding that the estimated risks would be greater for younger patients.

The way forward, said Knuuti, is to introduce strategies that reduce the radiation dose received by patients undergoing investigations. The PROTECTION 1 study, for example, showed that reducing the tube voltage from 120 kV to 100 kV resulted in a 53 % reduction in the median radiation dose for CCTA(6) “In the last five years the radiation dose from CCTA has been reduced from 20 to 30 mSv to 1-5 mSv. So the current dose is much lower than these papers are leading us to believe,” he added.

Furthermore, additional efforts need to be undertaken to ensure appropriate use of imaging tests in different patient populations. “Studies undertaken in the US have suggested that one third of tests are being undertaken in patients where there is not a good indication,” said Knuuti.

Authors:
ESC Media & Communications
Tel: +33 (0)4 92 94 86 27
press@escardio.org

ESC Press Office | EurekAlert!
Further information:
http://www.escardio.org

More articles from Medical Engineering:

nachricht PET identifies which prostate cancer patients can benefit from salvage radiation treatment
05.12.2017 | Society of Nuclear Medicine and Molecular Imaging

nachricht Designing a golden nanopill
01.12.2017 | University of Texas at Austin, Texas Advanced Computing Center

All articles from Medical Engineering >>>

The most recent press releases about innovation >>>

Die letzten 5 Focus-News des innovations-reports im Überblick:

Im Focus: First-of-its-kind chemical oscillator offers new level of molecular control

DNA molecules that follow specific instructions could offer more precise molecular control of synthetic chemical systems, a discovery that opens the door for engineers to create molecular machines with new and complex behaviors.

Researchers have created chemical amplifiers and a chemical oscillator using a systematic method that has the potential to embed sophisticated circuit...

Im Focus: Long-lived storage of a photonic qubit for worldwide teleportation

MPQ scientists achieve long storage times for photonic quantum bits which break the lower bound for direct teleportation in a global quantum network.

Concerning the development of quantum memories for the realization of global quantum networks, scientists of the Quantum Dynamics Division led by Professor...

Im Focus: Electromagnetic water cloak eliminates drag and wake

Detailed calculations show water cloaks are feasible with today's technology

Researchers have developed a water cloaking concept based on electromagnetic forces that could eliminate an object's wake, greatly reducing its drag while...

Im Focus: Scientists channel graphene to understand filtration and ion transport into cells

Tiny pores at a cell's entryway act as miniature bouncers, letting in some electrically charged atoms--ions--but blocking others. Operating as exquisitely sensitive filters, these "ion channels" play a critical role in biological functions such as muscle contraction and the firing of brain cells.

To rapidly transport the right ions through the cell membrane, the tiny channels rely on a complex interplay between the ions and surrounding molecules,...

Im Focus: Towards data storage at the single molecule level

The miniaturization of the current technology of storage media is hindered by fundamental limits of quantum mechanics. A new approach consists in using so-called spin-crossover molecules as the smallest possible storage unit. Similar to normal hard drives, these special molecules can save information via their magnetic state. A research team from Kiel University has now managed to successfully place a new class of spin-crossover molecules onto a surface and to improve the molecule’s storage capacity. The storage density of conventional hard drives could therefore theoretically be increased by more than one hundred fold. The study has been published in the scientific journal Nano Letters.

Over the past few years, the building blocks of storage media have gotten ever smaller. But further miniaturization of the current technology is hindered by...

All Focus news of the innovation-report >>>

Anzeige

Anzeige

Event News

See, understand and experience the work of the future

11.12.2017 | Event News

Innovative strategies to tackle parasitic worms

08.12.2017 | Event News

AKL’18: The opportunities and challenges of digitalization in the laser industry

07.12.2017 | Event News

 
Latest News

Engineers program tiny robots to move, think like insects

15.12.2017 | Power and Electrical Engineering

One in 5 materials chemistry papers may be wrong, study suggests

15.12.2017 | Materials Sciences

New antbird species discovered in Peru by LSU ornithologists

15.12.2017 | Life Sciences

VideoLinks
B2B-VideoLinks
More VideoLinks >>>