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Safety of cardiac imaging: danger zone?

Cardiac imaging is booming, as it is essential for diagnosis, prognosis, guidance and follow-up of therapy. With the increasing use of ionizing and non-ionizing imaging techniques, awareness of the potential health hazards of each technique is growing.

Medical imaging low-dose radiation exposure (effective dose expressed as milliSieverts (mSv)) carries a known but hard-to-estimate genotoxic risk (including individual variable sensitivity) for the development of cancer (especially leukemia).One hundred mSv is the lowest (cumulative) dose known to cause cancer. Moreover, this oncological risk depends on the patient’s age at radiation exposure (the younger the patient, the higher the risk).

Currently, ultrasound and more recently, magnetic resonance imaging (MRI) are considered a safe alternative in many clinical situations. The known potential hazards of MRI are static magnetic field (attraction of ferromagnetic materials), radiofrequency pulses (heating) and gradient magnetic field (nerve stimulation). However, recently, preliminary data have been published showing potential (transient?) short-term damage to DNA. Whether these genotoxic effects will result in a clinically relevant oncological risk is not known. Today, it is generally believed that if regulations and MRI machine settings are respected, these potential genotoxic effects are clinically negligible. MRI is an extremely safe imaging technique.

When prescribing medical imaging in the individual patient, it therefore remains crucial to keep in mind the importance of the ALARA-principle (As Low As Reasonably Achievable),especially when considering repeated radiation exposure.

These largely unknown or ill-defined health risks should be taken into account and balanced against the expected benefit of each imaging technique. Meanwhile, further improvements in radiation decreasing techniques are warranted.

The content of this article reflects the personal opinion of the author/s and is not necessarily the official position of the European Society of Cardiology.