Why should doctors be aware of the harms of cardiac tomography?

Physicians are required to discuss with their patients the risks and benefits of imaging diagnostic methods that use X-ray radiation in the heart area before ordering such a test.

Such a scientific statement was recently made by experts from the American Heart Association and published in the journal Circulation.

According to Dr. Reza Fazel, a cardiologist at Beth Israel Deaconess Medical Center in Boston, USA, doctors are becoming increasingly dependent on medical imaging methods to diagnose and treat patients with heart disease, the leading cause of death in the US, and and in Bulgaria – according to NSI data in 2011, those who died from diseases of the circulatory system accounted for 67% of the total mortality in the country for the year, and compared to 2000, this ratio has slightly increased as then it was 66.3% of the total number of those who died.

Dr. Reza Fazel notes that with the expansion of the spectrum of indications in which these diagnostic methods are already applied, the radiation load of patients also increases.

Cardiac imaging procedures take up almost 40% of the total amount of medical radiation that is applied during diagnostic procedures,’ he added.

Among the most popular imaging methods of the heart are computed tomography (CT), radiography and isotope studies of the heart.

Exposure to a radiation source is capable of causing some adverse reactions such as vomiting, diarrhea, internal bleeding, damage to the central nervous system, cancer and even death.

The severity of these side effects depends on the dose of radiation to which a person is exposed, however, according to Dr. Fazel and his colleagues, to date, none of the X-ray methods of diagnosis, including mammography, there are no federal standards to regulate medical imaging.

In this regard, Bulgaria has issued an ordinance of the Ministry of Health which approves the “Imaging Diagnostics” standard.

But it only regulates the conditions in which to carry out these studies – that is, requirements for the premises where the equipment is placed and how to obtain a quality image and the observance of safety rules by the operating personnel with the relevant equipment.

Requirements for the specialists who appoint these imaging studies and for which diseases it is not desirable to appoint them, however, are not included in the regulation.

And this means that the choice of what dose of radiation the patient will be exposed to and how many times he will undergo imaging diagnostic procedures – is entirely left to the discretion of the doctor.

That is why, as early as 2009, the American Heart Association /AKA/ urged doctors to be careful when conducting cardiac imaging studies on patients and, if possible, to reduce and limit their exposure to radiation.< /p>

The recent AKA statement is much more detailed and provides physicians with specific and practical recommendations for the application of these diagnostic methods.

The authors of the application emphasize that the doctor who orders a tomography of the heart must make sure that the patient is aware of the risk he is exposed to when undergoing this examination and the separate risks of any diagnostic procedure.

In general, according to Dr. Fazel, the danger of any imaging test for the individual patient is extremely small, and if there are certain indications for him, then those /indications/ usually exceed any possible harm that the radiation could cause.