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Variation in Revascularization Practice and Outcomes in Asymptomatic Stable Ischemic Heart Disease Considerations for Single-Measurement Risk-Stratification Strategies for Myocardial Infarction Using Cardiac Troponin Assays Society of cardiac angiography and interventions: suggested management of the no-reflow phenomenon in the cardiac catheterization laboratory ACC/AATS/AHA/ASE/ASNC/HRS/SCAI/SCCT/SCMR/STS 2019 Appropriate Use Criteria for Multimodality Imaging in the Assessment of Cardiac Structure and Function in Nonvalvular Heart Disease: A Report of the American College of Cardiology Appropriate Use Criteria Task Force, American Association for Thoracic Surgery, American Heart Association, American Society of Echocardiography, American Society of Nuclear Cardiology, Heart Rhythm Society, Society for Cardiovascular Angiography and Interventions, Society of Cardiovascular Computed Tomography, Society for Cardiovascular Magnetic Resonance, and the Society of Thoracic Surgeons A Novel Familial Cardiac Arrhythmia Syndrome with Widespread ST-Segment Depression Screening for Cardiovascular Disease Risk With Electrocardiography: US Preventive Services Task Force Recommendation Statement Percutaneous coronary intervention using a combination of robotics and telecommunications by an operator in a separate physical location from the patient: an early exploration into the feasibility of telestenting (the REMOTE-PCI study) Sudden Cardiac Arrest Survivorship: A Scientific Statement From the American Heart Association
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JOURNAL：American College of Cardiology Article Link

心脏成像电离辐射专家共识

Troy M LaBounty, M.D., FACC

  1. 1.    Typical effective radiation doses are provided for coronary computed tomography angiography, calcium score, single-photon emission computed tomography (SPECT), PET, diagnostic fluoroscopy, and interventional fluoroscopy studies. Many of these have wide ranges of typical effective doses (e.g., SPECT can range from 2.3 to 23 mSv).
  2. 2.    Population exposure to medical radiation has grown rapidly and was reported as 3.2 mSv/year when last estimated in 2006. This exceeds the natural background radiation that averages 3.0 mSv/year in the United States.
  3. 3.   Physicians performing interventional cardiovascular procedures can be exposed to significant radiation, which can exceed 100 uSv for a single procedure. An active interventional cardiologist can be expected to receive as much as 10 mSv/year of radiation in addition to background radiation.
  4. 4.    Doses over 100 mSv are associated with increased cancer risk in adults, with smaller doses associated with risk in children. Some patients and some physicians may be exposed to lifetime exposures that exceed this threshold.
  5. 5.    Effective radiation dose is estimated by measuring the radiation dose to specific tissues and organs, and adjusting this using a weighting factor that incorporates the sensitivity of each tissue and organ to cancer risk.
  6. 6.    Radiation risks can include tissue reactions due to cell injury (e.g., skin injuries), cancer, and mutations to germ cells that may be transmitted to offspring.
  7. 7.    The most accepted model of cancer risk suggests a linear relationship between dose and cancer risk, with no dose threshold under which there is no risk.
  8. 8.   Increased cancer risk is associated with higher doses, exposure of radiation-sensitive organs, female gender, and younger age. The predicted lifetime risk of cancer from exposure to 100 mSv of radiation is estimated at 2% for males and 4% for females under 15 years of age, and this risk decreases with greater age.
  9. 9.    Recommended radiation limits for workers exposed to occupational radiation are 20 mSv/year averaged over 5 years.
  10. 10.    The ALARA concept is that radiation dose should always be “as low as reasonably achievable.
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