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Editor's Note
June 10, 2013

Radiation Minimization Strategies for Medical Imaging : Comment on “Radiation Safety in Nuclear Cardiology—Current Knowledge and Practice”

JAMA Intern Med. 2013;173(11):1021-1037. doi:10.1001/jamainternmed.2013.6621

On a population basis, radiation exposure from medical imaging substantially increases cancer risk. Nearly 40% of the medical radiation exposure to the US population (excluding therapeutic radiotherapy) is related to cardiovascular imaging and intervention.

Einstein and colleagues are to be applauded for bravely tackling this difficult problem from within the nuclear cardiology profession. With the support of the leadership of the American Society of Nuclear Cardiology (ASNC), they surveyed a sample of ASNC members on their use and knowledge of nuclear stress testing and find room for improvement. For example, only 7% of all studies use low-dose stress-first imaging instead or rest and stress, although stress-first imaging has the potential to decrease radiation exposure by 75%. Other radiation minimization strategies that also appear underused are the use of newer camera systems and decreasing the dose of radiopharmaceuticals, with maintenance of image quality by increasing imaging time. Because there are more than 10 million nuclear stress tests performed annually, a profession-led campaign to decrease radiation exposure would maintain the benefits of testing but lower the rate of cancers due to these procedures in the next decades significantly. Documenting the current practice is the first and an important step in the move to reduce radiation exposure for our patients.