Radiation and Chest CT Scan Examinations: What Do We Know?

In the past 3 decades, the total number of CT scans performed has grown exponentially. In 2007, > 70 million CT scans were performed in the United States. CT scan studies of the chest comprise a large portion of the CT scans performed today because the technology has transformed the management of common chest diseases, including pulmonary embolism and coronary artery disease. As the number of studies performed yearly increases, a growing fraction of the population is exposed to low-dose ionizing radiation from CT scan. Data extrapolated from atomic bomb survivors and other populations exposed to low-dose ionizing radiation suggest that CT scan-associated radiation may increase an individual's lifetime risk of developing cancer. This finding, however, is not incontrovertible. Because this topic has recently attracted the attention of both the scientific community and the general public, it has become increasingly important for physicians to understand the cancer risk associated with CT scan and be capable of engaging in productive dialogue with patients. This article reviews the current literature on the public health debate surrounding CT scan and cancer risk, quantifies radiation doses associated with specific studies, and describes efforts to reduce population-wide CT scan-associated radiation exposure. CT scan examinations of the chest, including CT scan pulmonary and coronary angiography, high-resolution CT scan, low-dose lung cancer screening, and triple rule-out CT scan, are specifically considered.From the Department of Medicine (Dr Sarma); Department of Radiology (Dr Conner); and Division of Pulmonary and Critical Care Medicine (Dr Elliott) and Division of General Internal Medicine (Drs Stevens and Woller), Department of Medicine, Intermountain Medical Center, Murray, UT; and Department of Radiology (Dr Heilbrun) and Department of Internal Medicine (Drs Stevens, Woller, and Elliott), University of Utah School of Medicine, Salt Lake City, UT.Correspondence to: Asha Sarma, MD, c/o Cami Bills, Transitional Year Residency Program, 5121 S Cottonwood St, Ste 303, Murray, UT 84107; e-mail: asha.sarma@imail.orgFinancial/nonfinancial disclosures: The authors have reported to CHEST that no potential conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.Other contributions: Jana Johnson provided additional editorial and formatting assistance. We thank Julie Felice, CPM, and Ulrich Rassner, MD, for their advice on the topic of medical physics.Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.For editorial comment see page 549.     

Chest Pain and Mental Stress–Induced Myocardial Ischemia: Sex Differences

Background

Mental stress–induced myocardial ischemia is a frequent phenomenon in patients with coronary artery disease. Women with coronary artery disease tend to have more mental stress–induced myocardial ischemia and more chest pain/anginal symptoms than men, but whether the association between mental stress–induced myocardial ischemia and angina burden differs in women and men is unknown.

Chest pain in adult congenital heart disease: where does it come from?

Chest pain is common in adolescents and in young adults and usually not associated with a severe underlying cardiovascular disorder. However, in adults with congenital heart disease, residua or sequellae of previous interventions may provoke potential complications. Moreover, chest pain may be the first sign of a life-threatening condition. Basic knowledge is mandatory and will lead to the correct diagnosis and treatment. Data in literature, which focus on this issue, are scarce and motivated to summarize the experience of daily practice from the eye point of the clinician.