Patient-Centered Imaging Shared Decision Making for Cardiac Imaging Procedures With Exposure to Ionizing Radiation

• Type of Material: Article
• Authors: Andrew J. Einstein, Columbia University; Daniel S. Berman, Cedars-Sinai Medical Center; James K. Min, Weill Cornell Medical College; Robert C. Hendel, University of Miami; Thomas C. Gerber, Mayo Clinic; J. Jeffrey Carr, Vanderbilt University; Manuel D. Cerqueira, Cleveland Clinic Foundation; S. James Cullom, Mid-America Heart Institute; Robert DeKemp, Ottawa Heart Insitute; Neal Dickert, Emory University; Sharmila Dorbala, Brigham & Women's Hospital; Ernest V Garcia, Emory University; Raymond J. Gibbons, Mayo Clinic; Sandra S. Halliburton, Cleveland Clinic Foundation; Jorg Hausleiter, Technische Universität München; Gavy V. Heller, Morristown Medical Center; Scott Jerome, University of Maryland; John R. Lesser, Minneapolis Heart Institute; Reza Fazel, Emory University; Gilbert L. Raff, William Beaumont Hospital; Peter Tilkemeier, Brown University; Kim A. Williams, Wayne State University; Leslee Shaw, Emory University
• Language: English
• Date: 2014-04-22
• Publisher: Elsevier: 12 months
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2014 by the American College of Cardiology Foundation.
• License: Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1016/j.jacc.2013.10.092
• Title of Journal or Parent Work: Journal of the American College of Cardiology
• ISSN: 0735-1097
• Volume: 63
• Issue: 15
• Start Page: 1480
• End Page: 1489
• Grant/Funding Information: Dr. Einstein was supported in part by NIH-NHLBI R01 HL109711 and by Victoria and Esther Aboodi and Herbert Irving Assistant Professorships; Dr. Dorbala was supported in part by K23 HL092299; Dr. Shaw was supported in part by U01 HL105561.; Funding for this symposium was provided by the NIH-NHLBI/NCI (1R13 HL112549-01); Astellas Healthcare; Bracco Diagnostics;Lantheus Medical Imaging; and MedSolutions.
• Keywords: Science & Technology; OF-CARDIOLOGY FOUNDATION; Cardiovascular System & Cardiology; COLLEGE; Cardiac & Cardiovascular Systems; NUCLEAR CARDIOLOGY; APPROPRIATE USE CRITERIA; TASK-FORCE; STATEWIDE REGISTRY; imaging; CARDIOVASCULAR COMPUTED-TOMOGRAPHY; appropriate use; image quality; radiation safety; INFORMED-CONSENT; AMERICAN-HEART-ASSOCIATION; Life Sciences & Biomedicine; CT SCANS
• Research Categories: Physics, Radiation; Health Sciences, Medicine and Surgery; Health Sciences, Radiology

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.