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Best practices for using ionizing radiation in cardiovascular imaging and tips to minimize radiation exposure to both patients and clinical personnel were released by the American College of Cardiology in a new expert consensus document.

Besides using alternative non-radiation techniques when possible (such as ultrasound, MRI, and electromagnetic mapping) and using modern equipment calibrated for minimal radiation exposures, the document offered several other dose-minimizing strategies:

• For X-ray fluoroscopy: optimal system positioning, choosing the slowest frame rate and smallest dose per frame when possible, and use of personal protective equipment
• For X-ray CT: opting for the lowest-dose scan possible that produces sufficient image quality and confining scans to the smallest body area possible
• For nuclear cardiology: selecting a stress-rest protocol when appropriate, choosing small radiopharmaceutical doses, and avoiding Thallium-201 whenever possible

The document, written by a committee chaired by John Hirshfeld, Jr., MD, and Victor Ferrari, MD, both of Philadelphia's Penn Medicine, appeared online in the . Its recommendations were signed off on by the Heart Rhythm Society, North American Society for Cardiovascular Imaging, Society for Cardiovascular Angiography and Interventions, and Society of Cardiovascular Computed Tomography.

"The stimulus to create this document was the recognition that ionizing radiation-based cardiovascular procedures are being performed with increasing frequency," according to the authors.

The consensus document is a resource that pulls together the evidence, they wrote. "By applying this knowledge base, cardiovascular practitioners will be able to select and perform procedures optimally, and, accordingly, minimize radiation exposure to patients and to personnel."

Importantly, it's not just physicians who work in a radiation environment that have a responsibility to minimize patient exposure, Hirshfeld and Ferrari's group emphasized. This is a responsibility also shared by anyone who refers patients to radiation-based imaging or manages radiological facilities and equipment.

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