Patient-centered imaging: Shared decision making for cardiac imaging procedures with exposure to ionizing radiation

Andrew J. Einstein, Daniel S. Berman, James K. Min, Robert Hendel, Thomas C. Gerber, J. Jeffrey Carr, Manuel D. Cerqueira, S. James Cullom, Robert Dekemp, Neal W. Dickert, Sharmila Dorbala, Reza Fazel, Ernest V. Garcia, Raymond J. Gibbons, Sandra S. Halliburton, Jörg Hausleiter, Gary V. Heller, Scott Jerome, John R. Lesser, Gilbert L. RaffPeter Tilkemeier, Kim A. Williams, Leslee J. Shaw

Research output: Contribution to journalArticle

81 Citations (Scopus)

Abstract

The current paper details the recommendations arising from an NIH-NHLBI/NCI-sponsored symposium held in November 2012, aiming to identify key components of a radiation accountability framework fostering patient-centered imaging and shared decision-making in cardiac imaging. Symposium participants, working in 3 tracks, identified key components of a framework to target critical radiation safety issues for the patient, the laboratory, and the larger population of patients with known or suspected cardiovascular disease. The use of ionizing radiation during an imaging procedure should be disclosed to all patients by the ordering provider at the time of ordering, and reinforced by the performing provider team. An imaging protocol with effective dose ≤3mSv is considered very low risk, not warranting extensive discussion or written informed consent. However, a protocol effective dose >20mSv was proposed as a level requiring particular attention in terms of shared decision-making and either formal discussion or written informed consent. Laboratory reporting of radiation dosimetry is a critical component of creating a quality laboratory fostering a patient-centered environment with transparent procedural methodology. Efforts should be directed to avoiding testing involving radiation, in patients with inappropriate indications. Standardized reporting and diagnostic reference levels for computed tomography and nuclear cardiology are important for the goal of public reporting of laboratory radiation dose levels in conjunction with diagnostic performance. The development of cardiac imaging technologies revolutionized cardiology practice by allowing routine, noninvasive assessment of myocardial perfusion and anatomy. It is now incumbent upon the imaging community to create an accountability framework to safely drive appropriate imaging utilization.

Original languageEnglish
Pages (from-to)1480-1489
Number of pages10
JournalJournal of the American College of Cardiology
Volume63
Issue number15
DOIs
StatePublished - Apr 22 2014

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Ionizing Radiation
Decision Making
Radiation
Foster Home Care
Social Responsibility
Cardiology
Informed Consent
Radiometry
National Heart, Lung, and Blood Institute (U.S.)
Patient Safety
Anatomy
Cardiovascular Diseases
Perfusion
Tomography
Technology
Population

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Patient-centered imaging : Shared decision making for cardiac imaging procedures with exposure to ionizing radiation. / Einstein, Andrew J.; Berman, Daniel S.; Min, James K.; Hendel, Robert; Gerber, Thomas C.; Carr, J. Jeffrey; Cerqueira, Manuel D.; Cullom, S. James; Dekemp, Robert; Dickert, Neal W.; Dorbala, Sharmila; Fazel, Reza; Garcia, Ernest V.; Gibbons, Raymond J.; Halliburton, Sandra S.; Hausleiter, Jörg; Heller, Gary V.; Jerome, Scott; Lesser, John R.; Raff, Gilbert L.; Tilkemeier, Peter; Williams, Kim A.; Shaw, Leslee J.

In: Journal of the American College of Cardiology, Vol. 63, No. 15, 22.04.2014, p. 1480-1489.

Research output: Contribution to journalArticle

Einstein, AJ, Berman, DS, Min, JK, Hendel, R, Gerber, TC, Carr, JJ, Cerqueira, MD, Cullom, SJ, Dekemp, R, Dickert, NW, Dorbala, S, Fazel, R, Garcia, EV, Gibbons, RJ, Halliburton, SS, Hausleiter, J, Heller, GV, Jerome, S, Lesser, JR, Raff, GL, Tilkemeier, P, Williams, KA & Shaw, LJ 2014, 'Patient-centered imaging: Shared decision making for cardiac imaging procedures with exposure to ionizing radiation', Journal of the American College of Cardiology, vol. 63, no. 15, pp. 1480-1489. https://doi.org/10.1016/j.jacc.2013.10.092
Einstein, Andrew J. ; Berman, Daniel S. ; Min, James K. ; Hendel, Robert ; Gerber, Thomas C. ; Carr, J. Jeffrey ; Cerqueira, Manuel D. ; Cullom, S. James ; Dekemp, Robert ; Dickert, Neal W. ; Dorbala, Sharmila ; Fazel, Reza ; Garcia, Ernest V. ; Gibbons, Raymond J. ; Halliburton, Sandra S. ; Hausleiter, Jörg ; Heller, Gary V. ; Jerome, Scott ; Lesser, John R. ; Raff, Gilbert L. ; Tilkemeier, Peter ; Williams, Kim A. ; Shaw, Leslee J. / Patient-centered imaging : Shared decision making for cardiac imaging procedures with exposure to ionizing radiation. In: Journal of the American College of Cardiology. 2014 ; Vol. 63, No. 15. pp. 1480-1489.
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