The Challenge of Radiation

Medical radiation from x-rays and nuclear medicine is the largest man-made source of radiation exposure in Western countries and accounts for a mean effective dose (ED) of 3.0 mSv/y per person, equivalent to a radiation dose of 150 chest x-rays. In the United States, cardiologists are responsible for 40 % of the entire cumulative ED to the popu-lation from all sources, excluding radiotherapy.1 In pediatric patients with congenital heart disease (CHD), the annual ED is relatively low (<3 mSv/y), but this extra yearly exposure accrues over the lifetime and can reach high values (>100 mSv) in selected cohorts of pediatric chronic patients,2 espe-cially those undergoing interventional fluoroscopy proce-dures and serial computerized tomography (CT) evaluations.3 The benefits of ionizing imaging in children, especially in those with CHD, are immense and often life-saving, even more so with the advent of invasive fluoroscopy and CT, yet the use of radiation in children raises special concerns and offers a unique challenge for the current generation of pedi-atric cardiologists. Article see p 16