DNA damage-associated biomarkers in studying individual sensitivity to low-dose radiation from cardiovascular imaging

The use of diagnostic imaging and image-guided interventions using low-dose ionizing radiation has increased dramatically in recent years. This is explained by dramatic advances in imaging technology which provide invaluable diagnostic information for clinical decision-making.1 Although the benefits of appropriate use of advanced imaging technology outweigh the risks, the medical use of X-ray-based imaging techniques has become a leading source of man-made radiation exposure to the general population. According to a recent report by the National Council on Radiation Protection and Measurements, the total radiation exposure from medical imaging has increased six-fold from the early 1980s to the present, and currently almost 40% of medical radiation exposure (excluding radiotherapy) comes from cardiovascular imaging and image-guided interventions.2,3 This has prompted renewed interest in the potential long-term risks of low-dose radiation exposure for patients, physicians, and technical staff members.4,5 Clinical decision-making inherently requires balancing the potential benefits of e.g. a cardiac-imaging procedure and intervention with the projected risks, including those from radiation exposure. Although risk estimates for low-dose radiation exposures and international guidelines exist,6,7 these have been developed predominantly for the purpose of radiation protection and the development of occupational dose limits for radiation exposed workers (such as some physicians). Risk estimates for medical low-dose radiation exposure are associated with substantial uncertainties—to some extent this is due to the fact that our understanding of the biological effects of low-dose radiation exposure in humans is incomplete.6,8 Radiation dose from medical imaging, commonly referred to as effective dose, is expressed in units of millisieverts, which is the weighted average of the absorbed dose in mGy multiplied …