Exposure to Low-Dose Ionizing Radiation From Cardiac Procedures in Patients With Congenital Heart Disease: 15-Year Data From a Population-Based Longitudinal Cohort.

Circulation. 2016 Jan 5;133(1):12-20. doi: 10.1161/CIRCULATIONAHA.115.019137. Epub 2015 Nov 4.

Exposure to Low-Dose Ionizing Radiation From Cardiac Procedures in Patients With Congenital Heart Disease: 15-Year Data From a Population-Based Longitudinal Cohort.

Beauséjour Ladouceur V1Lawler PR1Gurvitz M1Pilote L1Eisenberg MJ1Ionescu-Ittu R1Guo L1Marelli AJ2.

Comment by Michiel Winter

Abstract

This article by Beauséjour Ladouceur et al. describes the important issue of increasing exposure to low-dose ionizing radiation (LDIR) in the congenital heart disease (HCD) population. Survival of CHD patients has steadily increased over the last decades. This fact, combined with the increasing use of LDIR-emitting medical technologies, make the CHD population at increased risk to be exposed to ionizing radiation. With recent studies linking LDIR to a greater incidence in malignancies, it seemed important to evaluate LDIR exposure in the CHD population. Indeed, the authors found that in the Quebec CHD database 16.253 patients were exposed to LDIR, within 317.988 available follow-up years. During follow-up (1990-2005) the number of yearly LDIR exposures was found to increase dramatically, from 18,5 to 51,9 per 1000 patients per year. Moreover, the authors found a progressively younger age at first LDIR exposure (from 5,0 years, to 9,6 months). This increased exposure was due to an increase in both diagnostic (most importantly cardiac CT and nuclear medicine studies) and therapeutic (most importantly catheter based interventions) use of LDIR, and was most significant in patients with severe CHD. This knowledge warrants studies, which clarify the clinical impact of increased LDIR exposure in CHD patients. For now, the authors underline the “as low as reasonable achievable (ALARA)” principle, but advise physicians not to refrain from necessary LDIR emitting procedures out of fear of increased exposure.