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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?)


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 3.0).

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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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