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The risks of inappropriateness in cardiac imaging.

Picano E - Int J Environ Res Public Health (2009)

Bottom Line: Marketing messages, high patient demand and defensive medicine, lead to the vicious circle of the so-called Ulysses syndrome.Mr. Ulysses, a typical middle-aged "worried-well" asymptomatic subject with an A-type coronary personality, a heavy (opium) smoker, leading a stressful life, would be advised to have a cardiological check-up after 10 years of war.Ulysses is tired of useless examinations, exorbitant costs. unaffordable even by the richest society, and unacceptable risks.

View Article: PubMed Central - PubMed

Affiliation: Institute of Clinical Physiology, CNR, Pisa, Italy. picano@ifc.cnr.it

ABSTRACT
The immense clinical and scientific benefits of cardiovascular imaging are well-established, but are also true that 30 to 50% of all examinations are partially or totally inappropriate. Marketing messages, high patient demand and defensive medicine, lead to the vicious circle of the so-called Ulysses syndrome. Mr. Ulysses, a typical middle-aged "worried-well" asymptomatic subject with an A-type coronary personality, a heavy (opium) smoker, leading a stressful life, would be advised to have a cardiological check-up after 10 years of war. After a long journey across imaging laboratories, he will have stress echo, myocardial perfusion scintigraphy, PET-CT, 64-slice CT, and adenosine-MRI performed, with a cumulative cost of >100 times a simple exercise-electrocardiography test and a cumulative radiation dose of >4,000 chest x-rays, with a cancer risk of 1 in 100. Ulysses is tired of useless examinations, exorbitant costs. unaffordable even by the richest society, and unacceptable risks.

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Related in: MedlinePlus

On the x axis, the doses of 4 common imaging examination are shown: coronary angiography (250 chest x-rays); myocardial perfusion scintigraphy (500 chest x-rays); 64-slice CT (750 chest x-rays); whole body CT- PET scan (1,250 chest x-rays). On y-axis risk for children (male and female), adults (men and women) and the elderly. Redrawn and modified from ref. [35].
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f3-ijerph-06-01649: On the x axis, the doses of 4 common imaging examination are shown: coronary angiography (250 chest x-rays); myocardial perfusion scintigraphy (500 chest x-rays); 64-slice CT (750 chest x-rays); whole body CT- PET scan (1,250 chest x-rays). On y-axis risk for children (male and female), adults (men and women) and the elderly. Redrawn and modified from ref. [35].

Mentions: Besides these clearly recognized acute and subacute risks, long-term risks linked to imaging radiation should also be considered [32]. Medical x-rays and γ-rays are a proven human carcinogen [14,15,33]. In radiology and nuclear medicine, higher acute doses correspond to higher long-term risks; there are no safe doses, and all doses add up in determining the cumulative risks over a lifetime [14,15,34]. Doses of common imaging are reported in yellow in Figure 2, and range from the equivalent of 300 chest x-rays of a coronary angiography to that of 1,250 chest x-rays of a thallium or PET-CT scan [35]. With imaging cumulative doses (radiation expenditure), the patient “buys” increasing risks of developing cancer during their lifetime. The estimated risk of developing cancer, based on the Seventh Report of the authorative Committee to Assess Health Risks from Exposure to Low Levels of Ionizing Radiation (BEIR VII report) linear nothreshold model [33], is presented in Figure 3.


The risks of inappropriateness in cardiac imaging.

Picano E - Int J Environ Res Public Health (2009)

On the x axis, the doses of 4 common imaging examination are shown: coronary angiography (250 chest x-rays); myocardial perfusion scintigraphy (500 chest x-rays); 64-slice CT (750 chest x-rays); whole body CT- PET scan (1,250 chest x-rays). On y-axis risk for children (male and female), adults (men and women) and the elderly. Redrawn and modified from ref. [35].
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC2697934&req=5

f3-ijerph-06-01649: On the x axis, the doses of 4 common imaging examination are shown: coronary angiography (250 chest x-rays); myocardial perfusion scintigraphy (500 chest x-rays); 64-slice CT (750 chest x-rays); whole body CT- PET scan (1,250 chest x-rays). On y-axis risk for children (male and female), adults (men and women) and the elderly. Redrawn and modified from ref. [35].
Mentions: Besides these clearly recognized acute and subacute risks, long-term risks linked to imaging radiation should also be considered [32]. Medical x-rays and γ-rays are a proven human carcinogen [14,15,33]. In radiology and nuclear medicine, higher acute doses correspond to higher long-term risks; there are no safe doses, and all doses add up in determining the cumulative risks over a lifetime [14,15,34]. Doses of common imaging are reported in yellow in Figure 2, and range from the equivalent of 300 chest x-rays of a coronary angiography to that of 1,250 chest x-rays of a thallium or PET-CT scan [35]. With imaging cumulative doses (radiation expenditure), the patient “buys” increasing risks of developing cancer during their lifetime. The estimated risk of developing cancer, based on the Seventh Report of the authorative Committee to Assess Health Risks from Exposure to Low Levels of Ionizing Radiation (BEIR VII report) linear nothreshold model [33], is presented in Figure 3.

Bottom Line: Marketing messages, high patient demand and defensive medicine, lead to the vicious circle of the so-called Ulysses syndrome.Mr. Ulysses, a typical middle-aged "worried-well" asymptomatic subject with an A-type coronary personality, a heavy (opium) smoker, leading a stressful life, would be advised to have a cardiological check-up after 10 years of war.Ulysses is tired of useless examinations, exorbitant costs. unaffordable even by the richest society, and unacceptable risks.

View Article: PubMed Central - PubMed

Affiliation: Institute of Clinical Physiology, CNR, Pisa, Italy. picano@ifc.cnr.it

ABSTRACT
The immense clinical and scientific benefits of cardiovascular imaging are well-established, but are also true that 30 to 50% of all examinations are partially or totally inappropriate. Marketing messages, high patient demand and defensive medicine, lead to the vicious circle of the so-called Ulysses syndrome. Mr. Ulysses, a typical middle-aged "worried-well" asymptomatic subject with an A-type coronary personality, a heavy (opium) smoker, leading a stressful life, would be advised to have a cardiological check-up after 10 years of war. After a long journey across imaging laboratories, he will have stress echo, myocardial perfusion scintigraphy, PET-CT, 64-slice CT, and adenosine-MRI performed, with a cumulative cost of >100 times a simple exercise-electrocardiography test and a cumulative radiation dose of >4,000 chest x-rays, with a cancer risk of 1 in 100. Ulysses is tired of useless examinations, exorbitant costs. unaffordable even by the richest society, and unacceptable risks.

Show MeSH
Related in: MedlinePlus