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VIEWPOINT

Radiation Exposure of Computed Tomography and Direct Intracoronary Angiography

Risk Has its Reward

Departments of Medical Physics and Radiology (Nuclear Medicine Section), Memorial Sloan Kettering Cancer Center, New York, New York.

Manuscript received September 12, 2005; revised manuscript received October 6, 2005, accepted October 25, 2005.

^_* Reprint requests and correspondence: Dr. H. William Strauss, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, New York 10021. (Email: straussh{at}mskcc.org).

A hallmark of noninvasive testing has been the identification of patients with coronary artery disease. Now, with multislice computed tomography (MSCT), information about coronary anatomy can be obtained without the need for catheterization. A major concern with the application of MSCT coronary angiography is the radiation exposure to the patient. Both MSCT and selective coronary angiography share the risks of procedure-related complications, such as allergic contrast reactions, and stochastic risks (i.e., cancer induction) of low-level radiation. There is a substantially higher radiation dose for MSCT angiography (effective dose [ED] 14 mSv) than for CCA (ED 6 mSv). These exposures yield lifetimes risks of 0.07% and 0.02%, respectively, of inducing a fatal cancer in the general (i.e., age- and gender-averaged) population. However, CCA poses additional serious risks associated with cardiac catheterization, yielding a non-radiogenic risk of mortality—excluding contrast reactions—of 0.11%. Combining the radiogenic and non-radiogenic risks (0.02% and 0.11%, respectively) yields a 0.13% overall risk of mortality from CCA—nearly two-fold higher than that for MSCT angiography (0.07%). If one were to use the lower, more age-appropriate risk factors for the older patient population in question, the radiogenic risks of both CCA and MSCT would be reduced by about one-half, further widening the overall safety ratio of MSCT relative to CCA. When weighing the relative risks of alternative medical procedures, therefore, it is imperative that one consider the overall risk of the respective procedures.

Abbreviations and Acronyms   CCA = conventional coronary angiography   CT = computed tomography   CTDI = computed tomography dose index   DAP = dose-area product   ED = effective dose   MSAD = multiple-scan average dose   MSCT = multislice computed tomography   TLD = thermo luminescent dosimeter

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