Radiation-associated circulatory disease mortality in a pooled analysis of 77,275 patients from the Massachusetts and Canadian tuberculosis fluoroscopy cohorts.

When these variables are included in the model they have (as a group) highly significant independent effect, apart from radiation exposure, on all circulatory disease, IHD and heart disease apart from IHD and hypertensive disease ( p < 0.01, results not shown); the adjusted trends with dose are very similar to those of the main analysis ( Table 3 , Supplementary Table S4 ).

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S2 demonstrate that there is a decreasing trend in mortality risk with dose for all circulatory disease ( p = 0.014) and IHD ( p = 0.003).

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It may be significant that the type of radiation used in this study, moderate energy X-rays, is quite similar to the type of low energy, and largely unfiltered, fluoroscopy X-rays used here 20 , albeit for therapeutic rather than diagnostic purposes, and contrasts with the rather higher energy radiation to which nuclear

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The Canadian study also reported an increasing trend for IHD mortality with dose in the entire dose range with an inverse risk modification by dose fractionation using 10-year lag, the evidence for which became much weaker when dose was restricted to less than 0.5 Gy, or when 5-year lag was used 18 .

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This contrasts with analysis over the full dose range, when a negative trend in excess mortality risk with dose was observed for all circulatory disease, IHD, all deaths, and all deaths excluding circulatory disease.

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