RADIATION therapy is a powerful tool for improving the survival rate of those diagnosed with certain forms of cancer. But the dozens of doses of high-energy radiation involved carry a risk, as healthy cells are zapped along with cancerous ones. Many short-term and long-term consequences are well known, including an increased risk of developing new cancers decades after successful treatment. But improvements in early diagnoses, chemotherapy and surgery (as well as, lately, immunology) have combined with radiation to produce larger numbers of cancer survivors living beyond the ten-year mark from the end of treatment. This has brought a previously suspected link into sharper focus: radiation-induced heart disease (RIHD). On July 16th a study called for higher level of cardiovascular screening in cancer survivors. But how can radiation therapy cause heart disease?

a position document of the ESC Associations of Cardiovascular Imaging, Percutaneous Cardiovascular Interventions and Electrophysiology

The benefits of cardiac imaging are immense, and modern medicine requires the extensive and versatile use of a variety of cardiac imaging techniques. Cardiologists are responsible for a large part of the radiation exposures every person gets per year from all medical sources. Therefore, they have a particular responsibility to avoid unjustified and non-optimized use of radiation, but sometimes are imperfectly aware of the radiological dose of the examination they prescribe or practice. This position paper aims to summarize the current knowledge on radiation effective doses (and risks) related to cardiac imaging procedures. We have reviewed the literature on radiation doses, which can range from the equivalent of 1–60 milliSievert (mSv) around a reference dose average of 15 mSv (corresponding to 750 chest X-rays) for a percutaneous coronary intervention, a cardiac radiofrequency ablation, a multidetector coronary angiography, or a myocardial perfusion imaging scintigraphy. We provide a European perspective on the best way to play an active role in implementing into clinical practice the key principle of radiation protection that: ‘each patient should get the right imaging exam, at the right time, with the right radiation dose’.