Radiologic sustainability in cardiology: risks, awareness, and clinical implications

Medical radiation exposure in cardiology represents a significant and often underappreciated component of patient risk, with profound implications for individual and population health. Ionizing radiation is a proven carcinogen even at low doses, yet awareness among prescribers and practitioners remains suboptimal. Cardiologists are responsible for approximately half of all medical radiation exposure, with cumulative doses exceeding 100 mSv in one out of five adult cardiology patients and children with congenital heart disease—equivalent to 5,000 chest X-rays and corresponding to one excess cancer per 100 exposed individuals. Radiation exposure also contributes to non-cancer risks, including accelerated atherosclerosis, through mechanisms involving DNA instability and chronic inflammation. Professional exposure among interventional cardiologists is 4–5 times higher than that of diagnostic radiologists, with documented increases in chromosomal aberrations and vascular disease. Current guidelines emphasize justification, optimization, and education as cornerstones of radiation safety. Technological advances have enabled substantial dose reductions across all imaging modalities, and non-ionizing alternatives such as echocardiography and cardiac magnetic resonance offer effective diagnostic options without carcinogenic risk. This review examines the scope of radiation exposure in cardiology, associated cancer and non-cancer risks, current guideline recommendations, and strategies for achieving radiologic sustainability through responsible imaging practices.