Trends of Increasing Medical Radiation Exposure in a Population Hospitalized for Cardiovascular Disease (1970–2009)

BACKGROUND: High radiation doses employed in cardiac imaging may increase cancer frequency in exposed patients after decades. The aim of this study was to evaluate the relative trends in medical radiation exposure in a population hospitalized for cardiovascular disease. METHODS AND RESULTS: An observational single-center study was conducted to examine 16,431 consecutive patients with heart disease admitted to the Italian National Research Council Institute of Clinical Physiology between January 1970 and December 2009. In all patients, the cumulative estimated effective dose was obtained from data mining of electronic records of hospital admissions, adopting the effective dose typical values of the American Heart Association 2009 statement and Mettler’s 2008 catalog of doses. Cumulative estimated effective dose per patient in the last 5 years was 22 (12–42) mSv (median, 25(th)–75(th) percentiles), with higher values in ischemic heart disease (IHD), 37 (20–59) vs non-IHD, 13 (8–22) mSv, p<0.001. Trends in radiation exposure showed a steady increase in IHD and a flat trend in non-IHD patients, with variation from 1970–74 to 2005–2009 of +155% for IHD (p<0.001) and −1% in non-IHD (NS). The relative contribution of different imaging techniques was remodeled over time, with nuclear cardiology dominating in 1970s (23% of individual exposure) and invasive fluoroscopy in the last decade (90% of individual exposure). CONCLUSION: A progressive increase in cumulative estimated effective dose is observed in hospitalized IHD patients. The growing medical radiation exposure may encourage a more careful justification policy regarding ionizing imaging in cardiology patients applying the two main principles of radiation protection: appropriate justification for ordering and performing each procedure, and careful optimization of the radiation dose used during each procedure.