CORRESPONDENCE: LETTER TO THE EDITOR
Reply
H. William Strauss, MD*
* Nuclear Medicine, Training Program Director, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, Room S212, New York, New York 10021 (Email: straussh{at}mskcc.org).
We appreciate and agree with Prof. Conti’s insightful commentary and the perspective he provides. We do not advocate either multislice computed tomography (MSCT) or conventional coronary angiography as the superior diagnostic modality (1). Rather, we have attempted to place their respective radiation risks in the context of total procedure risk. Although there is a greater procedure risk associated with selective coronary arteriography than with MSCT, this is only one component of the total decision-making process. Catheterization, with intent to treat, provides a range of options that can be readily exercised during the procedure. Depending on the clinical circumstances, selecting catheterization with the potential to perform a percutaneous intervention, rather than MSCT, might be entirely appropriate. However, in the patient where there is uncertainty about the diagnosis or where a "road map" may expedite the interventional procedure, MSCT may be a valuable first step in the process.
Patients will, of course, ultimately benefit by receiving the appropriate diagnostic and therapeutic procedures. Prof. Conti has identified circumstances where conventional coronary angiography is the "gold standard," and clinical considerations would, justifiably, lead the physician to choose conventional over MSCT coronary angiography. Our contention remains that this choice should, however, not be based on dosimetric considerations.
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References
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1. Zanzonico P, Rothenberg LN, Strauss HW. Radiation exposure of computed tomography and direct intracoronary angiography: risk has its reward J Am Coll Cardiol 2006;47:1846-1849.[Abstract/Free Full Text]
Related Article
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Comparing Radiation Doses From 2 Diagnostic Tests
- C. Richard Conti
J. Am. Coll. Cardiol. 2007 49: 828.
[Full Text]
[PDF]
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