Table 2.

Imaging Screening Guidelines and Consensus Recommendations by Major Societies Following Chest Radiation Therapy

Organization(s) (Ref. #)	Year	Significant Risk Factors	Cardiac Structure and Function Screening	Coronary Ischemia Screening
European Association of Cardiovascular Imaging and American Society of Echocardiography (81)	2013	Anterior or left chest RT with ≥1 risk factor: •High cumulative dose (>30 Gy) •Younger patients (<50 y) •Higher doses of radiation fractions (>2 Gy/d) •Presence and extent of tumor in or next to the heart •Lack of shielding •Concomitant chemotherapy (eg, anthracyclines) •Cardiovascular risk factors •Pre-existing cardiovascular disease	TTE 5 y after RT in patients at high risk, TTE 10 y after RT in patients not at high risk, TTE every 5 y thereafter	Stress testing 5 y after RT in patients at high risk, and every 5 y thereafter in patients without previous inducible ischemia
International Late Effects of Childhood Cancer Guideline Harmonization Group (56)	2015	Surveillance recommended in those with: •Chest radiation dose ≥35 Gy •Moderate to high doses of anthracyclines (≥100 mg/m2) combined with moderate- to high-dose chest radiation (≥15 Gy) •May be reasonable in those with moderate doses of radiation (≥15 to <35 Gy)	TTE no later than 2 y after completion of therapy in high-risk survivors, again at 5 y, and every 5 y thereafter	N/A
American Society of Clinical Oncology (82)	2017	High-dose RT (>30 Gy) where the heart is in the treatment field Lower-dose anthracycline (eg, 250 mg/m2 doxorubicin or 600 mg/m2 epirubicin) in combination with lower-dose RT (<30 Gy) where the heart is in the treatment field	TTE 6-12 months after completion of therapy in patients at increased risk, no specific screening interval recommended thereafter	N/A
Children’s Oncology Group (85)	2018	Increased risk: •Any anthracycline exposure or •≥15 Gy radiation Highest risk: •≥35 Gy or •≥15 Gy in combination with <250 mg/m2 doxorubicin (or equivalent) or •Any radiation in combination with ≥ 250 mg/m2 doxorubicin (or equivalent) Additional risk factors to consider: <5 y old at treatment, anteriorly weighted radiation field, lack of subcarinal shielding, longer time since treatment	Annual physical and electrocardiography in patients with ≥15 Gy Echocardiography every 5 y: •15-35 Gy or •<250 mg/m2 doxorubicin and 0-15 Gy. Echocardiography every 2 y: •≥35 Gy or •≥15 Gy and any anthracyclines or •≥250 mg/m2 doxorubicin	Cardiology consultation 5-10 y after radiation in patients at highest risk
European Society of Medical Oncology (83)	2020	Mediastinal RT ± cardiotoxic chemotherapy, not further specified	Cardiac biomarkers and potentially cardiac imaging 6-12 months after therapy, 2 y after treatment, and possibly periodically thereafter	Evaluation for CAD and ischemia starting at 5 y after RT and every 3-5 y thereafter
International Cardio-Oncology Society (84)	2021	Reasserted previously defined high-risk groups: •Mediastinal RT ≥30 Gy with the heart in the treatment field •Lower dose RT (<30 Gy) with anthracycline exposure •Patients aged <50 years and longer time since RT •Higher doses of RT fractions (>2 Gy/d) •Presence and extent of tumor in or next to the heart •Presence of cardiovascular risk factors. •Pre-existing cardiovascular disease.	Guided by individual patient risk: TTE as early as 6-12 months after RT in patients at high risk, and all patients should have TTE by 5 y after RT. Additional TTE and/or NT-proBNP every 5 y can be useful	Focus on diagnosing early CAD rather than ischemia for initiation of preventive therapy Review available CT scans for coronary calcifications In patients without known CAD, screening with stress testing, CAC, or CT angiography every 5 y

CAC = coronary artery calcium; CAD = coronary artery disease; CT = computed tomography; NT-proBNP = N-terminal pro–B-type natriuretic peptide; RT = radiation therapy; TTE = transthoracic echocardiography.