The risk of cumulative radiation exposure in chest imaging and the advantage of bedside ultrasound

Luna Gargani, Eugenio Picano, Luna Gargani, Eugenio Picano

Abstract

The increasing use and complexity of imaging techniques have not been matched by increasing awareness and knowledge by prescribers and practitioners. Imaging examinations that expose to ionizing radiation provide immense benefits when appropriate, yet they may result in an increased incidence of radiation-induced cancer in the long-term. The radiation issue is relevant not only for the individual patient but also for the community because small individual risks multiplied by millions of examinations become a significant population risk. As recently highlighted by recent European and American Guidelines, the long-term risk associated with radiation exposure should be considered in the risk-benefit assessment behind appropriate prescription of diagnostic testing.

Keywords: Chest imaging; Lung ultrasound; Point of care; Radiation exposure.

References

    1. Picano E (2004) Sustainability of medical imaging. BMJ 328:578–80, Education and Debate
    1. Picano E, Vañó E, Rehani MM, Cuocolo A, Mont L, Bodi V, Bar O, Maccia C, Pierard L, Sicari R, Plein S, Mahrholdt H, Lancellotti P, Knuuti J, Heidbuchel H, Di Mario C, Badano LP. The appropriate and justified use of medical radiation in cardiovascular imaging: a position document of the ESC Associations of Cardiovascular Imaging, Percutaneous Cardiovascular Interventions and Electrophysiology. Eur Heart J. 2014;35(10):665–72. doi: 10.1093/eurheartj/eht394.
    1. Fazel R, Gerber TC, Balter S, Brenner DJ, Carr JJ, Cerqueira MD, Chen J, Einstein AJ, Krumholz HM, Mahesh M, McCollough CH, Min JK, Morin RL, Nallamothu BK, Nasir K, Redberg RF, Shaw LJ. American Heart Association Council on Quality of Care and Outcomes Research, Council on Clinical Cardiology, and Council on Cardiovascular Radiology and Intervention. Approaches to enhancing radiation safety in cardiovascular imaging: a scientific statement from the American Heart Association. Circulation. 2014;130(19):173–48. doi: 10.1161/CIR.0000000000000048.
    1. Committee to Assess Health Risks from Exposure to Low Levels of Ionizing Radiation. Health risks from exposure to low levels of ionizing radiation: BEIR VII Phase 2. Washington, DC: The National Academies Press; 2006. [].
    1. World Health Organization, International Agency for Research on Cancer: Overall evaluations of carcinogenicity to humans, list of all agents evaluated to date. [].
    1. Commission E. Radiation protection 118: referral guidelines for imaging. Office for Official Publications of the European. Luxembourg: Communities; 2001.
    1. Dorfman AL, Fazel R, Einstein AJ, Applegate KE, Krumholz HM, Wang Y, Christodoulou E, Chen J, Sanchez R, Nallamothu BK. Use of medical imaging procedures with ionizing radiation in children: a population-based study. Arch Pediatr Adolesc Med. 2011;165:458–64. doi: 10.1001/archpediatrics.2010.270.
    1. Sidhu M, Coley BD, Goske MJ, Connolly B, Racadio J, Yoshizumi TT, Utley T, Strauss KJ. Image Gently Step Lightly: increasing radiation dose awareness in pediatric interventional radiology. Pediatr Radiol. 2011;39:1135–8. doi: 10.1007/s00247-009-1392-5.
    1. COUNCIL DIRECTIVE (2013) 2013/59/EURATOM of 5 December 2013 laying down basic safety standards for protection against the dangers arising from exposure to ionising radiation, and repealing Directives 89/618/Euratom, 90/641/Euratom, 96/29/Euratom, 97/43/Euratom and 2003/122/Euratom
    1. Lee CI, Haims AH, Monico EP, Brink JA, Forman HP. Diagnostic CT scans: assessment of patient, physician, and radiologist awareness of radiation dose and possible risks. Radiology. 2004;231(2):393–8. doi: 10.1148/radiol.2312030767.
    1. Einstein AJ, Tilkemeier P, Fazel R, Rakotoarivelo H, Shaw LJ, American Society of Nuclear Cardiology Radiation safety in nuclear cardiology-current knowledge and practice: results from the 2011 American Society of Nuclear Cardiology member survey. JAMA. Intern Med. 2013;173(11):1021–3. doi: 10.1001/jamainternmed.2013.483.
    1. Picano E. Informed consent and communication of risk from radiological and nuclear medicine examinations: how to escape from a communication inferno. BMJ. 2004;329(7470):849–51. doi: 10.1136/bmj.329.7470.849.
    1. Terranova G, Ferro M, Carpeggiani C, Recchia V, Braga L, Semelka RC, Picano E. Low quality and lack of clarity of current informed consent forms in cardiology: how to improve them. JACC Cardiovasc Imaging. 2012;5(6):649–55. doi: 10.1016/j.jcmg.2012.03.007.
    1. Amis ES, Jr, Butler PF, Applegate KE, Birnbaum SB, Brateman LF, Hevezi JM, Mettler FA, Morin RL, Pentecost MJ, Smith GG, Strauss KJ, Zeman RK. American College of Radiology white paper on radiation dose in medicine. J Am Coll Radiol. 2007;4:272–84. doi: 10.1016/j.jacr.2007.03.002.
    1. Frush DP. Radiation, thoracic imaging, and children: radiation safety. Radiol Clin North Am. 2011;49(5):1053–69. doi: 10.1016/j.rcl.2011.06.003.
    1. Gibbons RJ, Miller TD, Hodge D, Urban L, Araoz PA, Pellikka P, McCully RB. Application of appropriateness criteria to stress single-photon emission computed tomography sestamibi studies and stress echocardiograms in an academic medical center. J Am Coll Cardiol. 2008;51:1283–9. doi: 10.1016/j.jacc.2007.10.064.
    1. Carpeggiani C, Marraccini P, Morales MA, Prediletto R, Landi P, Picano E. Inappropriateness of cardiovascular radiological imaging testing; a tertiary care referral center study. PLoS One. 2013;8(11):e81161. doi: 10.1371/journal.pone.0081161.
    1. Via G, Storti E, Gulati G, Neri L, Mojoli F, Braschi A. Lung ultrasound in the ICU: from diagnostic instrument to respiratory monitoring tool. Minerva Anestesiol. 2012;78(11):1282–96.
    1. Volpicelli G, Elbarbary M, Blaivas M, Lichtenstein DA, Mathis G, Kirkpatrick AW, Melniker L, Gargani L, Noble VE, Via G, Dean A, Tsung JW, Soldati G, Copetti R, Bouhemad B, Reissig A, Agricola E, Rouby JJ, Arbelot C, Liteplo A, Sargsyan A, Silva F, Hoppmann R, Breitkreutz R, Seibel A, Neri L, Storti E, Petrovic T, International Liaison Committee on Lung Ultrasound (ILC-LUS) for International Consensus Conference on Lung Ultrasound (ICC-LUS) International evidence-based recommendations for point-of-care lung ultrasound. Intensive Care Med. 2012;38(4):577–91. doi: 10.1007/s00134-012-2513-4.
    1. Barskova T, Gargani L, Guiducci S, Randone SB, Bruni C, Carnesecchi G, Conforti ML, Porta F, Pignone A, Caramella D, Picano E, Cerinic MM. Lung ultrasound for the screening of interstitial lung disease in very early systemic sclerosis. Ann Rheum Dis. 2013;72(3):390–5. doi: 10.1136/annrheumdis-2011-201072.
    1. Picano E, Semelka R, Ravenel J, Matucci-Cerinic M. Rheumatological diseases and cancer: the hidden variable of radiation exposure. Ann Rheum Dis. 2014;73(12):2065–8. doi: 10.1136/annrheumdis-2014-206585.
    1. Einstein AJ, Knuuti J. Cardiac imaging: does radiation matter? Eur Heart J. 2012;33(5):573–8. doi: 10.1093/eurheartj/ehr281.
    1. Andreassi MG, Picano E. Reduction of radiation to children: our responsibility to change. Circulation. 2014;130(2):135–7. doi: 10.1161/CIRCULATIONAHA.114.010699.

Source: PubMed

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