@article{3e8e944a241649ec8b2c1400f6a673a2,
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 ≤3mSv is considered very low risk, not warranting extensive discussion or written informed consent. However, a protocol effective dose >20mSv 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.",
keywords = "appropriate use, image quality, imaging, radiation safety",
author = "Einstein, {Andrew J.} and Berman, {Daniel S.} and Min, {James K.} and Hendel, {Robert C.} and Gerber, {Thomas C.} and Carr, {J. Jeffrey} and Cerqueira, {Manuel D.} and Cullom, {S. James} and Robert Dekemp and Dickert, {Neal W.} and Sharmila Dorbala and Reza Fazel and Garcia, {Ernest V.} and Gibbons, {Raymond J.} and Halliburton, {Sandra S.} and J{\"o}rg Hausleiter and Heller, {Gary V.} and Scott Jerome and Lesser, {John R.} and Raff, {Gilbert L.} and Peter Tilkemeier and Williams, {Kim A.} and Shaw, {Leslee J.}",
note = "Funding Information: The Advanced Cardiovascular Imaging Consortium is an ongoing quality improvement program incorporating 40 imaging centers in the state of Michigan that provide coronary CT angiographic services (2–4,59) . The program is funded by BlueCross BlueShield of Michigan, and participation is required for reimbursement. Data collected include demographics, procedural indications, technical details including radiation doses, and clinical outcomes through 90 days of follow-up. An essential part of the continuous quality initiative process is a quarterly report for participating sites that enables cross-center comparisons on an array of quality metrics. A dose reduction “best practice” algorithm was established early as part of a consortium-wide intervention, and this algorithm is regularly revised to incorporate improving technology. Sites are required to present their quality improvement methods annually, resulting in steady declines in median radiation dose (2) . Funding Information: Funding for this symposium was provided by the National Heart, Lung, and Blood Institute (NHLBI) and the National Cancer Institute (grant 1R13 HL112549-01 ), Astellas Healthcare , Bracco Diagnostics , Lantheus Medical Imaging , and MedSolutions . Dr. Einstein was supported in part by grant R01 HL109711 from the NHLBI and by Victoria and Esther Aboodi and Herbert Irving Assistant Professorships. Dr. Dorbala was supported in part by grant K23 HL092299. Dr. Shaw was supported in part by grant U01 HL105561. Dr. Einstein has received research grants from GE Healthcare, Philips Healthcare, and Spectrum Dynamics . Dr. DeKemp is a consultant for Jubilant DraxImage and receives royalties for rubidium positron emission tomographic technology. Dr. Dorbala has received a research grant from Astellas Healthcare ; and holds stock in GE. Dr. Garcia has received research grants from GE Healthcare . Dr. Gibbons has served as a consultant to Lantheus; and has received honoraria from AstraZeneca. Dr. Halliburton is a speaker for Philips Medical Systems. Dr. Hausleiter has received a research grant from Siemens Medical Solutions ; and speaker's honoraria from Abbott Vascular. Dr. Heller is a consultant for GE Healthcare; and is a member of the science advisory board for Lantheus Medical Imaging. Dr. Jerome has received a research grant from the Intersocietal Accreditation Commission . Dr. Raff has received a research grant from Siemens . Dr. Williams served on a research advisory board that was funded by Astellas . Dr. Williams is currently affiliated with the Rush University School of Medicine, Chicago, Illinois. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose. ",
year = "2014",
month = apr,
day = "22",
doi = "10.1016/j.jacc.2013.10.092",
language = "English (US)",
volume = "63",
pages = "1480--1489",
journal = "Journal of the American College of Cardiology",
issn = "0735-1097",
publisher = "Elsevier USA",
number = "15",
}