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EXPEDITED PUBLICATION

Cumulative Exposure to Ionizing Radiation from Diagnostic and Therapeutic Cardiac Imaging Procedures

A Population-Based Analysis

Jersey Chen, MD, MPH^_*,,_*, Andrew J. Einstein, MD, PhD^||, Reza Fazel, MD, MSc^¶, Harlan M. Krumholz, MD, SM^_*,,,, Yongfei Wang, MS, Joseph S. Ross, MD, MHS^#, Henry H. Ting, MD, MBA^_**, Nilay D. Shah, PhD, Khurram Nasir, MD, MPH and Brahmajee K. Nallamothu, MD, MPH

^_* Section of Cardiovascular Medicine, Department of Medicine, Yale University School of Medicine, New Haven, Connecticut
Robert Wood Johnson Clinical Scholars Program, Department of Medicine, Yale University School of Medicine, New Haven, Connecticut
Section of Health Policy and Administration, Yale School of Epidemiology and Public Health, New Haven, Connecticut
Center for Outcomes Research and Evaluation, Yale–New Haven Hospital, New Haven, Connecticut
^|| Department of Medicine, Cardiology Division, and Department of Radiology, Columbia University College of Physicians and Surgeons, New York, New York
^¶ Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
^# Mount Sinai School of Medicine and James J. Peters Veterans Affairs Medical Center, New York, New York
^_** Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota
Division of Health Care Policy and Research, Mayo Clinic, Rochester, Minnesota
Johns Hopkins Ciccarone Preventive Cardiology Center, Baltimore, Maryland; Department of Internal Medicine, Boston Medical Center, Boston, Massachusetts
Veterans Affairs Ann Arbor Health Services Research and Development Center of Excellence and Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, Michigan

Manuscript received December 4, 2009; revised manuscript received April 23, 2010, accepted May 27, 2010.

^_* Reprint requests and correspondence: Dr. Jersey Chen, Yale University School of Medicine, 333 Cedar Street, New Haven, Connecticut 06520 (Email: jersey.chen{at}yale.edu).

Objectives: The purpose of this study was to describe radiation exposure from cardiac imaging procedures over time in a general population.

Background: Cardiac imaging procedures frequently expose patients to ionizing radiation, but their contribution to effective doses of radiation in the general population is unknown.

Methods: We used administrative claims to identify cardiac imaging procedures performed from 2005 to 2007 in 952,420 nonelderly insured adults in 5 U.S. health care markets. We estimated 3-year cumulative effective doses of radiation in millisieverts from these procedures We then calculated population-based annual rates of radiation exposure to effective doses 3 mSv/year (background level of radiation from natural sources), >3 to 20 mSv/year, or >20 mSv/year (upper annual limit for occupational exposure averaged over 5 years).

Results: A total of 90,121 (9.5%) individuals underwent at least 1 cardiac imaging procedure using radiation. Among patients who underwent 1 cardiac imaging procedures, the mean cumulative effective dose over 3 years was 16.4 mSv (range 1.5 to 189.5 mSv). Myocardial perfusion imaging accounted for 74% of the cumulative effective dose. Overall, 47.8% of cardiac imaging procedures were performed in physician offices; this proportion was higher for myocardial perfusion imaging (74.8%) and cardiac computed tomography studies (76.5%). The annual population-based rate of receiving an effective dose of >3 to 20 mSv/year was 89.0 per 1,000; and 3.3 per 1,000 for cumulative doses >20 mSv/year. Annual effective doses increased with age and were generally higher among men.

Conclusions: Cardiac imaging procedures lead to substantial radiation exposure and effective doses for many patients in the U.S.

Key Words: epidemiology • imaging • radiation

Abbreviations and Acronyms   CT = computed tomography   MPI = myocardial perfusion imaging   PCI = percutaneous coronary intervention   UHC = United Healthcare

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