Radiation Exposure in Patients With Myocardial Infarction Another False Alarm

The ever-increasing global concerns for environmental threats, among which is public radiation exposure, are quite appropriate. Medical applications of radiation appear to contribute significantly to the overall radiation-related hazard. Kaul et al1 remind us that the collective radiation dose from medical imaging has increased by a factor 7 over the last 2 decades. Skeptics have observed that this evolution in practice is not matched by a proportionate improvement in outcomes. Each time another critical study on radiation-induced projected risk of cancer appears in the scientific literature, this publication triggers commentaries, position statements, and reports of all kinds, including in the lay press, eventually fueling the growing concerns in the community. The understandable emotional nature of the issue may amplify the perceived risk and cause irrational behaviors. Patients may refuse to undergo radiation-based diagnostic or therapeutic procedures out of fear, underestimating the risk they are presently exposed to and failing to fully appreciate the consequences of not being diagnosed or treated properly right now. Article see p 2160 The present analysis of radiation exposure to patients treated for acute myocardial infarction1 by the Duke Clinical Research Institute and the University Health System Consortium provides useful insights and illustrates a novel way forward in addressing this essential issue. The authors have identified >275 000 radiation-based procedures performed in nearly 65 000 patients with acute myocardial infarction treated in 49 academic hospitals over a 3-year period. The average in-hospital stay was 6 days, and the cumulative radiation dose was ≈15 mSv, which is 5 times the annual background level and a third of the annual limit for radiation workers. Few patients (2% of all cases) received a 50-mSv dose, which is the tolerated yearly maximum for radiation workers. In addition to modest local and regional variations, the main independent predictors of …