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Environmental impact of cardiac imaging tests for the diagnosis of coronary artery disease
  1. Thomas H Marwick1,
  2. Jonathan Buonocore2
  1. 1Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
  2. 2Harvard School of Public Health, Boston, Massachusetts, USA
  1. Correspondence to Dr T H Marwick, Cardiovascular Imaging J1-5, Heart and Vascular Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA; marwict{at}


The use of cardiovascular imaging is growing inexorably and concerns have been expressed about its cost and radiation safety. In this study, the relative environmental impact of MRI, single photon emission tomography and cardiac ultrasound (echo) for the diagnosis of coronary artery disease were examined. The results emphasise that echo causes the least environmental impact at each stage of its life cycle. The effect of one echo on human health, ecosystem effects and resource use was of the order of 1–20% of those of the alternative methods. Although there are circumstances in which one imaging modality is preferred on clinical grounds, when everything else is equal, these results support the selection of echocardiography as the preferred test on environmental grounds.

  • Echocardiography-exercise
  • exercise testing
  • MRI
  • radionuclide imaging
  • coronary artery disease (CAD)

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  • Competing interests None.

  • Patient consent Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.