Picano Eugenio
Institute of Clinical Physiology, Consiglio Nazionale delle Ricerche, Pisa, Italy.
Am J Med. 2003 Feb 1;114(2):126-30. doi: 10.1016/s0002-9343(02)01427-4.
Stress echocardiography is a popular cardiac imaging technique that provides similar diagnostic and prognostic accuracy as radionuclide stress perfusion imaging. Similar accuracy, however, should not be synonymous with being "clinically interchangeable." Because of economic cost, environmental impact, and individual biohazard exposure, a nuclear examination should be performed only when it cannot be replaced by other techniques that do not employ ionizing radiation. Nuclear medical imaging procedures, of which cardiological procedures are an important part, account for 4% of the annual effective radiation dose received by the average person in the United States. At the individual level, the radiological exposure of a single nuclear cardiology procedure conveys a low, but measurable, risk of fatal cancer, which varies from 1 in 1000 to 1 in 10,000, depending on the type of examination (higher for thallium scans; lower for technetium 99m methoxyisobutylisonitrile scans). Because the information provided by stress echocardiography and stress radionuclide perfusion imaging are similar, the choice of test should be made in the context of the environmental, biological, and economic effects of that choice.
负荷超声心动图是一种常用的心脏成像技术，其诊断和预后准确性与放射性核素负荷灌注成像相似。然而，相似的准确性并不等同于“临床可互换”。由于经济成本、环境影响和个体生物危害暴露等因素，只有在无法被不使用电离辐射的其他技术替代时，才应进行核检查。核医学成像程序（其中心脏程序是重要组成部分）占美国普通人群每年接受的有效辐射剂量的4%。在个体层面，单次核心脏病学检查的辐射暴露会带来低但可测量的致命癌症风险，根据检查类型的不同，风险从千分之一到万分之一不等（铊扫描风险较高；锝99m甲氧基异丁基异腈扫描风险较低）。由于负荷超声心动图和负荷放射性核素灌注成像提供的信息相似，检查方法的选择应考虑该选择对环境、生物和经济的影响。
