Cardiology Roundup: New Research on Radiation Exposure

2017-06-22
 

Cardiology imaging clinicianAs health systems make the transition to value-based care, it’s becoming more important than ever to treat the whole patient, not just the current problem. Part of this holistic approach is monitoring a patient’s cumulative radiation exposure. That means eliminating unnecessary scans (which also helps boost efficiency on the care provider’s side), but also reducing radiation exposure when possible.

There’s also a growing consensus that the concern shouldn’t be limited to patients, but should extend to the clinicians who perform the scans. Fortunately, new research shows it is possible to reduce exposure on both sides of the provider-patient relationship. Read on for the latest research in radiation reduction and avoidance, and to see where opportunities for further reduction remain.

1. Cardiologists Advocate for Atrial Fibrillation Procedure that Limits Radiation Exposure

Fluoroscopy is the imaging technique commonly used to guide atrial fibrillation (AF) ablation procedures. While fluoroscopy is capable of generating high-quality images, it also exposes both patients and caregivers to high doses of radiation, equivalent to over 800 individual X-rays.

Cardiologists at the New York-Presbyterian/Weill Cornell Medical Center are seeking to popularize an alternative known as intracardiac echocardiography (ICE), which uses high-frequency sound waves rather than X-rays. The imaging technique is augmented by computerized 3-D mapping technology. Though ICE has been available to cardiologists for several years, adoption rates are low, possibly because it takes training and practice to use the technology effectively.

By publishing their successful experiences with ICE, the team hopes to inspire other cardiologists to use it as a replacement for traditional fluoroscopy, reducing radiation exposure for patients and physicians.

2. Large Nuclear Cardiology Laboratory Slashes Radiation Dose by 60% in Eight Years

A team of imaging clinicians at the Mid America Heart Institute in Kansas City just published the results of a nearly decade-long initiative to reduce radiation dosage in their facility. Through modifying protocols and upgrading equipment, the team was able to more than halve the average radiation dose.

Key to the initiative’s success was the introduction of small field-of-view cameras with advanced post-processing, which require less radiation or shorter acquisition times to acquire an image. Protocol changes included using technetium tracers instead of thallium, for 1/3rd the radiation dose, and performing stress-only tests instead of stress and rest scans whenever possible. The research shows that it is possible to lower radiation doses in real-world, practical applications.

3. Study Reveals Low Adoption of Advice to Reduce Nuclear Cardiology Radiation Exposure

The International Atomic Energy Agency (IAEA) has developed eight quality metrics to use as guidelines for reducing radiation dosage in nuclear cardiology. Unfortunately, according to a 65-country study, these recommendations are not translating into change in the real world.

The recommendations include some of the steps the Mid America Heart Institute used to reduce their average dosage, such as avoiding thallium, using stress-only imaging, and upgrading camera technologies.

While some of the lack of adoption comes down to lack of resources to upgrade equipment, the IAEA stresses that there are steps every lab can take, including using weight-based dosing and stress-only techniques.

4. Transradial Catheterizations Boost Operators’ Radiation Exposure

Radiation dosage is a concern for clinicians as well as patients. A recent analysis of 650 coronary catheterization procedures, done by transradial access, show that operators receive nearly twice the radiation dose of transfemoral procedures. While transradial access produces significantly better outcomes for patients, the procedure does appear to pose greater risks for operators.

Further research is necessary, however, as the analysis showed a variability in exposure level among the operators who participated in the study. This variance may indicate that some operators were not using all of the exposure protection available to them.

5. Studies Defy Taboo of MR Imaging of Abandoned Cardiac Leads

In brighter news, new research shows that MRI for patients with cardiac implantable electronic devices appears to be safe, even with abandoned leads. Usually abandoned leads are considered a firm contraindication for MRI, and the few clinicians that would attempt it didn’t discuss the procedure with the medical community at large.

MRI is frequently the optimal imaging technique for cardiac patients, but those with abandoned leads are generally encouraged to have a CT scan instead. A study from the Mayo Clinic in Rochester, Minnesota found no clinical or electrical evidence of device dysfunction, and no arrhythmia or pain, in 56 patients with abandoned leads.

Scans that use radiation are vital for keeping patient’s healthy. However, reducing the number of scans, and the dose in each scan, is also vital for patient wellbeing. These articles indicate that cardiologists have options available to reduce radiation. Now it’s up to the industry as a whole to embrace these new technologies and best practices and move forward.

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