Despite increasing awareness of patient radiation exposure as a result of the use of diagnostic imaging, to date there has been no publication of the radiation dose received by patients with end stage heart failure (ESHF) as a result of their pre and post transplant imaging studies.Retrospective analysis of patients undergoing cardiac transplant workup at The Prince Charles Hospital (TPCH) from January 2009 - December 2010 was performed. Radiation doses from medical imaging were calculated using dose parameters recorded routinely by radiographic staff. Imaging studies included were those performed from the commencement of transplant workup at TPCH until 1 year after heart transplantation or after transplant workup commenced for those not transplanted.43 patients were included in the analysis, mean age 45 years, 18 female. Each patient underwent a mean of 30.5 radiological imaging studies. 16 transplanted patients underwent mean 54.1 studies vs. 17.8 studies for those not transplanted. 66% of all studies were chest x-rays, 11% fluoroscopy, 9% CT. Median effective dose was 33mSv (range 4 – 87mSv) for the whole cohort, 28.6mSv for those not transplanted 36.5mSv for those transplanted and 38.9mSv for those requiring mechanical cardiac support. For transplanted patients this represents a radiation dose 80% higher than the Australian recommended averaged annual occupational radiation dose.Patients undergoing cardiac transplant receive high doses of radiation both in the process of assessment and post transplantation. This is greater for those with MCS. Transplant recipients are at an increased risk of cancer and radiation from medical imaging may contribute to that.