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Economic, ethical, and environmental sustainability of cardiac imaging
1Research Director, Institute of Clinical Physiology of the National Research Council, CNR Research Campus, Via Moruzzi, 1, Building C- First floor- Room 130, 56124 Pisa, Italy.
Insights
Cardiology guidelines recommend five chest pain imaging tests, but they vary significantly in cost, patient risk, and environmental impact. Adopting sustainable, affordable, and radiation-optimized practices benefits everyone involved.
Area of Science:
- Cardiology
- Medical Imaging
- Healthcare Sustainability
Background:
- Current cardiology guidelines recommend five class 1 imaging techniques for chest pain diagnosis.
- These techniques include coronary computed tomography angiography (CCTA), stress single-photon emission tomography (SPECT), stress positron emission tomography (PET), stress cardiovascular magnetic resonance (CMR), and stress echocardiography.
- Physician choice is based on local availability and expertise, overlooking significant differences in cost, applicability, risk, and environmental impact.
Purpose of the Study:
- To analyze the cost, patient risk, and environmental impact of the five recommended chest pain imaging techniques.
- To highlight the discrepancies between current practices and ethical/legal recommendations for responsible healthcare resource utilization.
- To advocate for the adoption of more sustainable, affordable, and radiation-optimized practices in cardiology.
Main Methods:
- Comparative analysis of cost, radiation exposure, and carbon footprint for five major cardiac imaging modalities.
- Review of ethical guidelines (World Medical Association 2021) and legal regulations (Euratom law 2013/directive 59) regarding healthcare resource use and radiation safety.
- Extrapolation of the cumulative impact of billions of annual tests on healthcare economics, public health, and climate change.
Main Results:
- The five recommended imaging techniques exhibit wide variations in immediate costs (50–1000 euros), radiation exposure (0–500 chest x-rays), and environmental footprint (3–300 kg CO2 equivalent).
- The cumulative effect of widespread use presents an unaffordable economic burden, significant long-term public health damage, and considerable climate change impacts.
- Current practices may not align with principles of responsible healthcare spending, patient harm minimization, and environmental protection.
Conclusions:
- A significant disparity exists between the recommended cardiac imaging techniques regarding their economic, health, and environmental consequences.
- There is a compelling need for the cardiology community to transition towards sustainable practices that are affordable, radiation-optimized, and environmentally conscious.
- Adopting sustainable imaging strategies will yield substantial benefits for patients, physicians, healthcare payers, and the planet.
Abstract:
Current cardiology guidelines assign a class of recommendation 1 for the diagnosis of chest pain to five imaging techniques based on either anatomic (coronary computed tomography angiography) or functional approaches, such as stress single-photon emission tomography, stress positron emission tomography, stress cardiovascular magnetic resonance, and stress echocardiography. The choice is left to the prescribing physician, based on local availability and expertise. However, the five techniques differ substantially in their cost, applicability based on patient characteristics, long-term risk, and environmental impact. The average European immediate cost ranges from 50 to 1000 euros. The radiation exposure ranges from 0 to 500 chest x-rays. The environmental footprint ranges from 3 to 300 kg of carbon dioxide emissions equivalent. The ethical code of the World Medical Association 2021 recommends the responsible use of healthcare money by doctors, with the minimization of potential damage to patients and the environment. The Euratom law 2013/directive 59 reinforces the justification principle and the optimization principle for medical radiation exposures, with the legal responsibility of both the referrer and the practitioner. A small cost, a minimal long-term risk, and a modest carbon emission per examination multiplied by billions of tests per year become an unaffordable economic burden in the short-term, significant population damage to public health over the years, and impacts on climate change in decades. The cardiology community may wish to adopt a more sustainable practice with affordable, radiation-optimized, and carbon-neutral practices for the benefit of patients, physicians, payers, and the planet.
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