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References
Picano E. Sustainability of medical imaging.BMJ. 2004;328:578–80. [DOI] [PubMed] [PMC]
Mahesh M, Ansari AJ, Mettler FA Jr. Patient Exposure from Radiologic and Nuclear Medicine Procedures in the United States and Worldwide: 2009–2018.Radiology. 2023;307:e221263. [DOI] [PubMed] [PMC]
Andreassi MG, Piccaluga E, Guagliumi G, Del Greco M, Gaita F, Picano E. Occupational Health Risks in Cardiac Catheterization Laboratory Workers.Circ Cardiovasc Interv. 2016;9:e003273. [DOI] [PubMed]
Picano E, Vañó E, Rehani MM, Cuocolo A, Mont L, Bodi V, et al. The appropriate and justified use of medical radiation in cardiovascular imaging: a position document of the ESC Associations of Cardiovascular Imaging, Percutaneous Cardiovascular Interventions and Electrophysiology.Eur Heart J. 2014;35:665–72. [DOI] [PubMed]
Hirshfeld JW Jr, Ferrari VA, Bengel FM, Bergersen L, Chambers CE, Einstein AJ, et al. 2018 ACC/HRS/NASCI/SCAI/SCCT Expert Consensus Document on Optimal Use of Ionizing Radiation in Cardiovascular Imaging-Best Practices for Safety and Effectiveness, Part 2: Radiological Equipment Operation, Dose-Sparing Methodologies, Patient and Medical Personnel Protection: A Report of the American College of Cardiology Task Force on Expert Consensus Decision Pathways.J Am Coll Cardiol. 2018;71:2829–55. [DOI] [PubMed]
Gräfe F, Teske F, Riede FT, Dähnert I, Rosolowski M, Gräfe D. Decreasing radiation exposure in interventional pediatric cardiology: a 10-year European single-center analysis of 3683 procedures. Clin Res Cardiol. 2026. [DOI] [PubMed]
Sachdeva R, Valente AM, Armstrong AK, Cook SC, Han BK, Lopez L, et al. ACC/AHA/ASE/HRS/ISACHD/SCAI/SCCT/SCMR/SOPE 2020 Appropriate Use Criteria for Multimodality Imaging During the Follow-Up Care of Patients With Congenital Heart Disease.J Am Soc Echocardiogr. 2020;33:e1–48. [DOI] [PubMed]
Einstein AJ, Williams MC, Weir-McCall JR, Shaw LJ, Karthikeyan G, Better N, et al. Worldwide Radiation Dose in Coronary Artery Disease Diagnostic Imaging.JAMA. 2026;335:1148–58. [DOI] [PubMed] [PMC]
Bedetti G, Botto N, Andreassi MG, Traino C, Vano E, Picano E. Cumulative patient effective dose in cardiology.Br J Radiol. 2008;81:699–705. [DOI] [PubMed]
Fazel R, Krumholz HM, Wang Y, Ross JS, Chen J, Ting HH, et al. Exposure to Low-Dose Ionizing Radiation from Medical Imaging Procedures.N Engl J Med. 2009;361:849–57. [DOI] [PubMed] [PMC]
Ait-Ali L, Andreassi MG, Foffa I, Spadoni I, Vano E, Picano E. Cumulative patient effective dose and acute radiation-induced chromosomal DNA damage in children with congenital heart disease.Heart. 2009;96:269–74. [DOI] [PubMed]
National Academy of Sciences. Health Risks from Exposure to Low Levels of Ionizing Radiation (BEIR VII Phase 2). Washington, DC: National Academy Press; 2006.
Berrington de Gonzalez A, Sawyer I, Veiga LHS. Comparison of radiation-related cancer risks from the atomic bomb survivors with studies of pediatric medical radiation exposure.Carcinogenesis. 2025;46:bgaf058. [DOI] [PubMed] [PMC]
Andreassi MG, Cioppa A, Botto N, Joksic G, Manfredi S, Federici C, et al. Somatic DNA damage in interventional cardiologists: a case‐control study.FASEB J. 2005;19:998–9. [DOI] [PubMed]
Berrington de Gonzalez A, Kim KP, Smith-Bindman R, McAreavey D. Myocardial perfusion scans: projected population cancer risks from current levels of use in the United States.Circulation. 2010;122:2403–10. [DOI] [PubMed] [PMC]
Smith-Bindman R, Chu PW, Azman Firdaus H, Stewart C, Malekhedayat M, Alber S, et al. Projected Lifetime Cancer Risks From Current Computed Tomography Imaging.JAMA Intern Med. 2025;185:710–9. [DOI] [PubMed] [PMC]
Berrington de González A, Darby S. Risk of cancer from diagnostic X-rays: estimates for the UK and 14 other countries.Lancet. 2004;363:345–51. [DOI] [PubMed]
Picano E. Risk of cancer from diagnostic X-rays.Lancet. 2004;363:1909–10. [DOI] [PubMed]
Rühm W, Laurier D, Wakeford R. Cancer risk following low doses of ionising radiation – Current epidemiological evidence and implications for radiological protection.Mutat Res Genet Toxicol Environ Mutagen. 2022;873:503436. [DOI] [PubMed]
Sidhu MS, Alexander KP, Huang Z, O'Brien SM, Chaitman BR, Stone GW, et al. Causes of cardiovascular and noncardiovascular death in the ISCHEMIA trial.Am Heart J. 2022;248:72–83. [DOI] [PubMed] [PMC]
Cohen S, Liu A, Gurvitz M, Guo L, Therrien J, Laprise C, et al. Exposure to Low-Dose Ionizing Radiation From Cardiac Procedures and Malignancy Risk in Adults With Congenital Heart Disease.Circulation. 2018;137:1334–45. [DOI] [PubMed]
Authors on behalf of ICRP, Stewart FA, Akleyev AV, Hauer-Jensen M, Hendry JH, Kleiman NJ, et al. ICRP PUBLICATION 118: ICRP Statement on Tissue Reactions and Early and Late Effects of Radiation in Normal Tissues and Organs — Threshold Doses for Tissue Reactions in a Radiation Protection Context.Ann ICRP. 2012;41:1–322. [DOI] [PubMed]
Little MP, Azizova TV, Richardson DB, Tapio S, Bernier MO, Kreuzer M, et al. Ionising radiation and cardiovascular disease: systematic review and meta-analysis.BMJ. 2023;380:e072924. [DOI] [PubMed] [PMC]
Venneri L, Rossi F, Botto N, Andreassi MG, Salcone N, Emad A, et al. Cancer risk from professional exposure in staff working in cardiac catheterization laboratory: Insights from the National Research Council's Biological Effects of Ionizing Radiation VII Report.Am Heart J. 2009;157:118–24. [DOI] [PubMed]
Massalha S, Lugassi R, Raysberg E, Koskosi A, Lechtenberg G, Israel O, et al. Evaluation of Staff Radiation Exposure during Transthoracic Echocardiography Close to Myocardial Perfusion Imaging.J Am Soc Echocardiogr. 2018;31:763–70. [DOI] [PubMed]
Garcia-Sayan E, Jain R, Wessly P, Mackensen GB, Johnson B, Quader N. Radiation Exposure to the Interventional Echocardiographers and Sonographers: A Call to Action.J Am Soc Echocardiogr. 2024;37:698–705. [DOI] [PubMed]
Hirshfeld JW Jr, Balter S, Brinker JA, Kern MJ, Klein LW, Lindsay BD, et al. ACCF/AHA/HRS/SCAI Clinical Competence Statement on Physician Knowledge to Optimize Patient Safety and Image Quality in Fluoroscopically Guided Invasive Cardiovascular Procedures.Circulation. 2005;111:511–32. [DOI] [PubMed]
Gerber TC, Carr JJ, Arai AE, Dixon RL, Ferrari VA, Gomes AS, et al. Ionizing radiation in cardiac imaging: a science advisory from the American Heart Association.Circulation. 2009;119:1056–65. [DOI]
Fazel R, Gerber TC, Balter S, Brenner DJ, Carr JJ, Cerqueira MD, et al. Approaches to enhancing radiation safety in cardiovascular imaging: a scientific statement from the American Heart Association.Circulation. 2014;130:1730–48. [DOI]
Picano E. Informed consent and communication of risk from radiological and nuclear medicine examinations: how to escape from a communication inferno.BMJ. 2004;329:849–51. [DOI] [PubMed] [PMC]
