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Int. J. Environ. Res. Public Health 2009, 6(5), 1649-1664; doi:10.3390/ijerph6051649

The Risks of Inappropriateness in Cardiac Imaging

Institute of Clinical Physiology, CNR, Pisa, Italy
Received: 20 April 2009 / Accepted: 12 May 2009 / Published: 14 May 2009
(This article belongs to the Special Issue Public Health: How Safe Is Cardiac Imaging?)
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The immense clinical and scientific benefits of cardiovascular imaging are well-established, but are also true that 30 to 50% of all examinations are partially or totally inappropriate. Marketing messages, high patient demand and defensive medicine, lead to the vicious circle of the so-called Ulysses syndrome. Mr. Ulysses, a typical middle-aged “worried-well” asymptomatic subject with an A-type coronary personality, a heavy (opium) smoker, leading a stressful life, would be advised to have a cardiological check-up after 10 years of war. After a long journey across imaging laboratories, he will have stress echo, myocardial perfusion scintigraphy, PET-CT, 64-slice CT, and adenosine-MRI performed, with a cumulative cost of >100 times a simple exercise-electrocardiography test and a cumulative radiation dose of >4,000 chest x-rays, with a cancer risk of 1 in 100. Ulysses is tired of useless examinations, exorbitant costs. unaffordable even by the richest society, and unacceptable risks.
Keywords: appropriateness; benefit; radiation; risk appropriateness; benefit; radiation; risk
This is an open access article distributed under the Creative Commons Attribution License (CC BY) which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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Picano, E. The Risks of Inappropriateness in Cardiac Imaging. Int. J. Environ. Res. Public Health 2009, 6, 1649-1664.

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