Cumulative exposure to ionizing radiation from diagnostic and therapeutic cardiac imaging procedures: A population-based analysis

Jersey Chen, Andrew J. Einstein, Reza Fazel, Harlan M. Krumholz, Yongfei Wang, Joseph S. Ross, Henry H. Ting, Nilay D Shah, Khurram Nasir, Brahmajee K. Nallamothu

Research output: Contribution to journalArticle

123 Citations (Scopus)

Abstract

Objectives: 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 ≤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 <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.

Original languageEnglish (US)
Pages (from-to)702-711
Number of pages10
JournalJournal of the American College of Cardiology
Volume56
Issue number9
DOIs
StatePublished - Aug 24 2010

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Ionizing Radiation
Population
Radiation
Therapeutics
Background Radiation
Health Care Sector
Occupational Exposure
Radiation Exposure

Keywords

  • computed tomography
  • CT
  • MPI
  • myocardial perfusion imaging
  • PCI
  • percutaneous coronary intervention
  • UHC
  • United Healthcare

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Medicine(all)

Cite this

Cumulative exposure to ionizing radiation from diagnostic and therapeutic cardiac imaging procedures : A population-based analysis. / Chen, Jersey; Einstein, Andrew J.; Fazel, Reza; Krumholz, Harlan M.; Wang, Yongfei; Ross, Joseph S.; Ting, Henry H.; Shah, Nilay D; Nasir, Khurram; Nallamothu, Brahmajee K.

In: Journal of the American College of Cardiology, Vol. 56, No. 9, 24.08.2010, p. 702-711.

Research output: Contribution to journalArticle

Chen, Jersey ; Einstein, Andrew J. ; Fazel, Reza ; Krumholz, Harlan M. ; Wang, Yongfei ; Ross, Joseph S. ; Ting, Henry H. ; Shah, Nilay D ; Nasir, Khurram ; Nallamothu, Brahmajee K. / Cumulative exposure to ionizing radiation from diagnostic and therapeutic cardiac imaging procedures : A population-based analysis. In: Journal of the American College of Cardiology. 2010 ; Vol. 56, No. 9. pp. 702-711.
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abstract = "Objectives: 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 ≤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 <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.",
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T1 - Cumulative exposure to ionizing radiation from diagnostic and therapeutic cardiac imaging procedures

T2 - A population-based analysis

AU - Chen, Jersey

AU - Einstein, Andrew J.

AU - Fazel, Reza

AU - Krumholz, Harlan M.

AU - Wang, Yongfei

AU - Ross, Joseph S.

AU - Ting, Henry H.

AU - Shah, Nilay D

AU - Nasir, Khurram

AU - Nallamothu, Brahmajee K.

PY - 2010/8/24

Y1 - 2010/8/24

N2 - Objectives: 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 ≤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 <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.

AB - Objectives: 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 ≤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 <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.

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KW - CT

KW - MPI

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KW - PCI

KW - percutaneous coronary intervention

KW - UHC

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