Exploration of Cardiology

Experimental model	Effect
Cell types (lymphocytes)	DNA damage increased from 30% to 200%
ICM without X-rays	No effect
ICM added after X-rays	No effect
ICM pre-irradiated before mixing with blood	No effect
ICM irradiated with gamma rays	No effect
Increasing concentrations of iodine	Linear dose-dependent effect
Different ICM brands or manufacturers	No difference (only iodine concentration counts)

Declarations

Author contributions

CI: Conceptualization, Writing—original draft. MX, VP, and EC: Writing—review & editing.

Conflicts of interest

The authors declare that there are no conflicts of interest.

Ethical approval

Not applicable.

Consent to participate

Not applicable.

Consent to publication

Not applicable.

Availability of data and materials

Not applicable.

Funding

Not applicable.

Copyright

References

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. Erratum in: Radiology. 2023;307:e239006. Erratum in: Radiology. 2023;307:e239013. [DOI] [PubMed] [PMC]

Sodagari F, Mozaffary A, Wood CG 3rd, Schmitz B, Miller FH, Yaghmai V. Reactions to both nonionic iodinated and gadolinium-based contrast media: incidence and clinical characteristics. AJR Am J Roentgenol. 2018;210:715–9. [DOI] [PubMed]

Berrington de Gonzalez A, Kleinerman RA. CT scanning: is the contrast material enhancing the radiation dose and cancer risk as well as the image? Radiology. 2015;275:627–9. [DOI] [PubMed] [PMC]

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]

Harbron R, Ainsbury EA, Bouffler SD, Tanner RJ, Eakins JS, Pearce MS. Enhanced radiation dose and DNA damage associated with iodinated contrast media in diagnostic X-ray imaging. Br J Radiol. 2017;90:20170028. [DOI] [PubMed] [PMC]

Perisinakis K, Tzedakis A, Spanakis K, Papadakis AE, Hatzidakis A, Damilakis J. The effect of iodine uptake on radiation dose absorbed by patient tissues in contrast enhanced CT imaging: implications for CT dosimetry. Eur Radiol. 2018;28:151–8. [DOI] [PubMed]

Mazloumi M, Van Gompel G, Kersemans V, de Mey J, Buls N. The presence of contrast agent increases organ radiation dose in contrast-enhanced CT. Eur Radiol. 2021;31:7540–9. [DOI] [PubMed] [PMC]

Ferlazzo ML, Devic C, Granzotto A, Charvet AM, Pilleul F, Colin C, et al. DNA breaks induced by iodine-containing contrast medium in radiodiagnostics: a problem of tungsten? Eur Radiol Exp. 2018;2:21. [DOI] [PubMed] [PMC]

Schmid E, Bauchinger M. The cytogenetic effect of an X-ray contrast medium in Chinese hamster cell cultures. Mutat Res. 1976;34:291–7. [DOI] [PubMed]

10.

Norman A, Adams FH, Riley RF. Cytogenetic effects of contrast media and triiodobenzoic acid derivatives in human lymphocytes. Radiology. 1978;129:199–203. [DOI] [PubMed]

11.

Callisen HH, Norman A, Adams FH. Absorbed dose in the presence of contrast agents during pediatric cardiac catheterization. Med Phys. 1979;6:504–9. [DOI] [PubMed]

12.

Hadnagy W, Stephan G, Kossel F. Enhanced yield of chromosomal aberrations in human peripheral lymphocytes in vitro using contrast media in X-irradiation. Mutat Res. 1982;104:249–54. [DOI] [PubMed]

13.

Matsubara S, Kong ZS, Omura M, Kurihara H, Torigoe S, Iwasawa T, et al. The effect of iodine-based contrast agents on the levels of radiation-induced chromosomal aberrations. Radiat Res. 1997;147:263–8. [PubMed]

14.

Joubert A, Biston MC, Boudou C, Ravanat JL, Brochard T, Charvet AM, et al. Irradiation in presence of iodinated contrast agent results in radiosensitization of endothelial cells: consequences for computed tomography therapy. Int J Radiat Oncol Biol Phys. 2005;62:1486–96. [DOI] [PubMed]

15.

Jost G, Golfier S, Pietsch H, Lengsfeld P, Voth M, Schmid TE, et al. The influence of x-ray contrast agents in computed tomography on the induction of dicentrics and γ-H2AX foci in lymphocytes of human blood samples. Phys Med Biol. 2009;54:6029–39. [DOI] [PubMed]

16.

Grudzenski S, Kuefner MA, Heckmann MB, Uder M, Löbrich M. Contrast medium–enhanced radiation damage caused by CT examinations. Radiology. 2009;253:706–14. [DOI] [PubMed]

17.

Pathe C, Eble K, Schmitz-Beuting D, Keil B, Kaestner B, Voelker M, et al. The presence of iodinated contrast agents amplifies DNA radiation damage in computed tomography. Contrast Media Mol Imaging. 2011;6:507–13. [DOI] [PubMed]

18.

Beels L, Bacher K, Smeets P, Verstraete K, Vral A, Thierens H. Dose-length product of scanners correlates with DNA damage in patients undergoing contrast CT. Eur J Radiol. 2012;81:1495–9. [DOI] [PubMed]

19.

Deinzer CK, Danova D, Kleb B, Klose KJ, Heverhagen JT. Influence of different iodinated contrast media on the induction of DNA double-strand breaks after in vitro X-ray irradiation. Contrast Media Mol Imaging. 2014;9:259–67. [DOI] [PubMed]

20.

Gould R, McFadden SL, Horn S, Prise KM, Doyle P, Hughes CM. Assessment of DNA double-strand breaks induced by intravascular iodinated contrast media following in vitro irradiation and in vivo, during paediatric cardiac catheterization. Contrast Media Mol Imaging. 2016;11:122–9. [DOI] [PubMed]

21.

Wang L, Li Q, Zhong W, Hu S, Hu CH. Research on the effect of iodinate contrast agent on the DNA radiation damage at CT. Zhonghua Yi Xue Za Zhi. 2017;97:1643–6. Chinese. [DOI] [PubMed]

22.

Van Cauteren T, Honoria Da Silva E, Van Gompel G, Kersemans V, Sermon K, de Mey J, et al. Iodine dose of administered contrast media affects the level of radiation-induced DNA damage during cardiac CT scans. AJR Am J Roentgenol. 2019;213:404–9. [DOI] [PubMed]

23.

Adams FH, Norman A, Mello RS, Bass D. Effect of radiation and contrast media on chromosomes. Preliminary report. Radiology. 1977;124:823–6. [DOI] [PubMed]

24.

Cochran ST, Khodadoust A, Norman A. Cytogenetic effects of contrast material in patients undergoing excretory urography. Radiology. 1980;136:43–6. [DOI] [PubMed]

25.

Parvez Z, Kormano M, Satokari K, Moncada R, Eklund R. Induction of mitotic micronuclei by X-ray contrast media in human peripheral lymphocytes. Mutat Res. 1987;188:233–9. [DOI] [PubMed]

26.

Sinúes B, Nuñez E, Bernal ML, Alcala A, Saenz MA, Conde B. Micronucleus assay in biomonitoring of patients undergoing excretory urography with diatrizoate and ioxaglate. Mutat Res. 1991;260:337–42. [DOI] [PubMed]

27.

Piechowiak EI, Peter JF, Kleb B, Klose KJ, Heverhagen JT. Intravenous iodinated contrast agents amplify DNA radiation damage at CT. Radiology. 2015;275:692–7. [DOI] [PubMed]

28.

Wang L, Li Q, Wang XM, Hao GY, Bao J, Hu S, et al. Enhanced radiation damage caused by iodinated contrast agents during CT examination. Eur J Radiol. 2017;92:72–7. [DOI] [PubMed]

29.

Van Cauteren T, Tanaka K, Belsack D, Van Gompel G, Kersemans V, Jochmans K, et al. Potential increase in radiation-induced DNA double-strand breaks with higher doses of iodine contrast during coronary CT angiography. Med Phys. 2021;48:7526–33. [DOI] [PubMed] [PMC]

30.

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: a report of the American College of Cardiology Task Force on expert consensus decision pathways. J Am Coll Cardiol. 2018;71:e283–351. [DOI] [PubMed]

31.

Bosch de Basea Gomez M, Thierry-Chef I, Harbron R, Hauptmann M, Byrnes G, Bernier MO, et al. Risk of hematological malignancies from CT radiation exposure in children, adolescents and young adults. Nat Med. 2023;29:3111–9. [DOI] [PubMed] [PMC]

32.

Broder JS, Hamedani AG, Liu SW, Emerman CL. Emergency department contrast practices for abdominal/pelvic computed tomography—a national survey and comparison with the American College of Radiology Appropriateness Criteria^®. J Emerg Med. 2013;44:423–33. [DOI] [PubMed]

33.

James MT, Har BJ, Tyrrell BD, Faris PD, Tan Z, Spertus JA, et al. Effect of clinical decision support with audit and feedback on prevention of acute kidney injury in patients undergoing coronary angiography: a randomized clinical trial. JAMA. 2022;328:839–49. Erratum in: JAMA. 2022;328:1981. [DOI] [PubMed] [PMC]

34.

Markar SR, Vidal-Diez A, Sounderajah V, Mackenzie H, Hanna GB, Thompson M, et al. A population-based cohort study examining the risk of abdominal cancer after endovascular abdominal aortic aneurysm repair. J Vasc Surg. 2019;69:1776–85.e2. [DOI] [PubMed]

35.

European Society of Radiology (ESR). The current status of uptake of European Basic Safety Standard (2013/59/Euratom) requirements: results of a follow-up survey in European radiology departments. Insights Imaging. 2021;12:139. [DOI] [PubMed] [PMC]

36.

Adams FH, Rigler LG. Reduction of radiation to children. Circulation. 1964;30:161–2. [DOI]