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Submitted by William A. Van Decker , MD, USNRC Advisory Committee on the Medical Use of Isotopes
   Commenting as an individual
Document Patient and Staff Radiological Protection in Cardiology
1. Page 23, line 969 should be reworded. Physicians may wish to consider other alternate tests but this should be based on their independent clinical judgment  and the individual patient circumstances and the diagnostic needs. 

2. NCRP Report 160 NC population exposure is cited. It needs to be pointed out that the report assumed 33% thallium use in Myocardial Perfusion Imaging----------------- thallium use is now about 50 % less than it was at time of report from many sources ( based on the useful feedback from this report) and this motion in a positive direction should be acknowledged.

3. Table 7.2 ( page 84)  should list equivalent doses in mCi in parentheses.

4. Table 7.1 (page 83) has a column of "effective dose" which is not clear and not easily consistent with the better laid out graph on Figure 7.1 which is much clearer.

5. Again, on page 88, section 7.7.1 , the wording should be restructured to suggest testing modality selection is based on individual patients and individual physician judgement which also factors in the ALARA principle.

 Thank you for the opportunity to submit comments.............. overall , a balanced and well written manuscript citing many of the leading manuscripts from ACC/ASNC/SCCT/SCAI ............