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1. Sustained oxygenation improvement after first prone positioning is associated with liberation from mechanical ventilation and mortality in critically ill COVID-19 patients: a cohort study

Author

Scaramuzzo G., Gamberini L., Tonetti T., Zani G., Ottaviani I., Mazzoli C. A., Capozzi C., Giampalma E., Bacchi Reggiani M. L., Bertellini E., Castelli A., Cavalli I., Colombo D., Crimaldi F., Damiani F., Fusari M., Gamberini E., Gordini G., Laici C., Lanza M. C., Leo M., Marudi A., Nardi G., Papa R., Potalivo A., Russo E., Taddei S., Consales G., Cappellini I., Ranieri V. M., Volta C. A., Guerin C., Spadaro S., Tartaglione M., Chiarini V., Buldini V., Coniglio C., Moro F., Barbalace C., Citino M., Cilloni N., Giuntoli L., Bellocchio A., Matteo E., Pizzilli G., Siniscalchi A., Tartivita C., Matteo F., Marchio A., Bacchilega I., Bernabe L., Guarino S., Mosconi E., Bissoni L., Viola L., Meconi T., Pavoni V., Pagni A., Pompa Cleta P., Cavagnino M., Malfatto A., Adduci A., Pareschi S., Melegari G., Maccieri J., Marinangeli E., Racca F., Verri M., Falo G., Marangoni E., Boni F., Felloni G., Baccarini F. D., Terzitta M., Maitan S., Becherucci F., Parise M., Masoni F., Imbriani M., Orlandi P., Monetti F., Dalpiaz G., Golfieri R., Ciccarese F., Poerio A., Muratore F., Ferrari F., Mughetti M., Franchini L., Neziri E., Miceli M., Minguzzi M. T., Mellini L., Piciucchi S., Bartolucci M., Scaramuzzo G., Gamberini L., Tonetti T., Zani G., Ottaviani I., Mazzoli C.A., Capozzi C., Giampalma E., Bacchi Reggiani M.L., Bertellini E., Castelli A., Cavalli I., Colombo D., Crimaldi F., Damiani F., Fusari M., Gamberini E., Gordini G., Laici C., Lanza M.C., Leo M., Marudi A., Nardi G., Papa R., Potalivo A., Russo E., Taddei S., Consales G., Cappellini I., Ranieri V.M., Volta C.A., Guerin C., Spadaro S., Tartaglione M., Chiarini V., Buldini V., Coniglio C., Moro F., Barbalace C., Citino M., Cilloni N., Giuntoli L., Bellocchio A., Matteo E., Pizzilli G., Siniscalchi A., Tartivita C., Matteo F., Marchio A., Bacchilega I., Bernabe L., Guarino S., Mosconi E., Bissoni L., Viola L., Meconi T., Pavoni V., Pagni A., Pompa Cleta P., Cavagnino M., Malfatto A., Adduci A., Pareschi S., Melegari G., Maccieri J., Marinangeli E., Racca F., Verri M., Falo G., Marangoni E., Boni F., Felloni G., Baccarini F.D., Terzitta M., Maitan S., Becherucci F., Parise M., Masoni F., Imbriani M., Orlandi P., Monetti F., Dalpiaz G., Golfieri R., Ciccarese F., Poerio A., Muratore F., Ferrari F., Mughetti M., Franchini L., Neziri E., Miceli M., Minguzzi M.T., Mellini L., Piciucchi S., and Bartolucci M.

Subjects
medicine.medical_specialty, Supine position, COVID19, medicine.medical_treatment, Respiratory physiology, Prone positioning, ventilatory free days, Critical Care and Intensive Care Medicine, ICU, COVID19, Prone positioning, ventilatory free days, NO, 03 medical and health sciences, 0302 clinical medicine, Anesthesiology, medicine, 030212 general & internal medicine, Mechanical ventilation, business.industry, RC86-88.9, Research, Medical emergencies. Critical care. Intensive care. First aid, Oxygenation, respiratory system, respiratory tract diseases, Prone position, 030228 respiratory system, Anesthesia, ICU, Complication, business, Cohort study
Abstract

Background Prone positioning (PP) has been used to improve oxygenation in patients affected by the SARS-CoV-2 disease (COVID-19). Several mechanisms, including lung recruitment and better lung ventilation/perfusion matching, make a relevant rational for using PP. However, not all patients maintain the oxygenation improvement after returning to supine position. Nevertheless, no evidence exists that a sustained oxygenation response after PP is associated to outcome in mechanically ventilated COVID-19 patients. We analyzed data from 191 patients affected by COVID-19-related acute respiratory distress syndrome undergoing PP for clinical reasons. Clinical history, severity scores and respiratory mechanics were analyzed. Patients were classified as responders (≥ median PaO2/FiO2 variation) or non-responders (2/FiO2 variation) based on the PaO2/FiO2 percentage change between pre-proning and 1 to 3 h after re-supination in the first prone positioning session. Differences among the groups in physiological variables, complication rates and outcome were evaluated. A competing risk regression analysis was conducted to evaluate if PaO2/FiO2 response after the first pronation cycle was associated to liberation from mechanical ventilation. Results The median PaO2/FiO2 variation after the first PP cycle was 49 [19–100%] and no differences were found in demographics, comorbidities, ventilatory treatment and PaO2/FiO2 before PP between responders (96/191) and non-responders (95/191). Despite no differences in ICU length of stay, non-responders had a higher rate of tracheostomy (70.5% vs 47.9, P = 0.008) and mortality (53.7% vs 33.3%, P = 0.006), as compared to responders. Moreover, oxygenation response after the first PP was independently associated to liberation from mechanical ventilation at 28 days and was increasingly higher being higher the oxygenation response to PP. Conclusions Sustained oxygenation improvement after first PP session is independently associated to improved survival and reduced duration of mechanical ventilation in critically ill COVID-19 patients.

Published
2021

2. Factors influencing liberation from mechanical ventilation in coronavirus disease 2019: multicenter observational study in fifteen Italian ICUs

Author

Gamberini, L., Tonetti, T., Spadaro, S., Zani, G., Mazzoli, C. A., Capozzi, C., Giampalma, E., Bacchi Reggiani, M. L., Bertellini, E., Castelli, A., Cavalli, I., Colombo, D., Crimaldi, F., Damiani, F., Fogagnolo, A., Fusari, M., Gamberini, E., Gordini, G., Laici, C., Lanza, M. C., Leo, M., Marudi, A., Nardi, G., Ottaviani, I., Papa, R., Potalivo, A., Russo, E., Taddei, S., Volta, C. A., Ranieri, V. M., Tartaglione, M., Chiarini, V., Buldini, V., Coniglio, C., Moro, F., Cilloni, N., Giuntoli, L., Bellocchio, A., Matteo, E., Pizzilli, G., Siniscalchi, A., Tartivita, C., Matteo, F., Marchio, A., Bacchilega, I., Bernabe, L., Guarino, S., Mosconi, G., Bissoni, L., Viola, L., Meconi, T., Pavoni, V., Pagni, A., Pompacleta, P., Cavagnino, M., Malfatto, A., Adduci, A., Pareschi, S., Melegari, G., Maccieri, J., Marinangeli, E., Racca, F., Verri, M., Falo, G., Marangoni, E., Boni, F., Felloni, G., Baccarini, F. D., Terzitta, M., Maitan, S., Imbriani, M., Orlandi, P., Dalpiaz, G., Golfieri, R., Ciccarese, F., Poerio, A., Muratore, F., Ferrari, F., Mughetti, M., Franchini, L., Neziri, E., Miceli, M., Minguzzi, M. T., Mellini, L., Piciucchi, S., Gamberini, Lorenzo, Tonetti, Tommaso, Spadaro, Savino, Zani, Gianluca, Mazzoli, Carlo Alberto, Capozzi, Chiara, Giampalma, Emanuela, Bacchi Reggiani, Maria Letizia, Bertellini, Elisabetta, Castelli, Andrea, Cavalli, Irene, Colombo, Davide, Crimaldi, Federico, Damiani, Federica, Fogagnolo, Alberto, Fusari, Maurizio, Gamberini, Emiliano, Gordini, Giovanni, Laici, Cristiana, Lanza, Maria Concetta, Leo, Mirco, Marudi, Andrea, Nardi, Giuseppe, Ottaviani, Irene, Papa, Raffaella, Potalivo, Antonella, Russo, Emanuele, Taddei, Stefania, Volta, Carlo Alberto, and Ranieri, V Marco

Subjects
medicine.medical_specialty, ARDS, medicine.medical_treatment, artificial, Outcomes, Critical Care and Intensive Care Medicine, law.invention, NO, 03 medical and health sciences, 0302 clinical medicine, Mechanical ventilation, law, Coronavirus disease 2019, Intensive care, Outcomes, mortality, Respiration, artificial, medicine, 030212 general & internal medicine, Renal replacement therapy, business.industry, Research, Respiration, Organ dysfunction, lcsh:Medical emergencies. Critical care. Intensive care. First aid, 030208 emergency & critical care medicine, lcsh:RC86-88.9, medicine.disease, Intensive care unit, mortality, Respiratory failure, Emergency medicine, SOFA score, medicine.symptom, business
Abstract

Background A large proportion of patients with coronavirus disease 2019 (COVID-19) develop severe respiratory failure requiring admission to the intensive care unit (ICU) and about 80% of them need mechanical ventilation (MV). These patients show great complexity due to multiple organ involvement and a dynamic evolution over time; moreover, few information is available about the risk factors that may contribute to increase the time course of mechanical ventilation. The primary objective of this study is to investigate the risk factors associated with the inability to liberate COVID-19 patients from mechanical ventilation. Due to the complex evolution of the disease, we analyzed both pulmonary variables and occurrence of non-pulmonary complications during mechanical ventilation. The secondary objective of this study was the evaluation of risk factors for ICU mortality. Methods This multicenter prospective observational study enrolled 391 patients from fifteen COVID-19 dedicated Italian ICUs which underwent invasive mechanical ventilation for COVID-19 pneumonia. Clinical and laboratory data, ventilator parameters, occurrence of organ dysfunction, and outcome were recorded. The primary outcome measure was 28 days ventilator-free days and the liberation from MV at 28 days was studied by performing a competing risks regression model on data, according to the method of Fine and Gray; the event death was considered as a competing risk. Results Liberation from mechanical ventilation was achieved in 53.2% of the patients (208/391). Competing risks analysis, considering death as a competing event, demonstrated a decreased sub-hazard ratio for liberation from mechanical ventilation (MV) with increasing age and SOFA score at ICU admission, low values of PaO2/FiO2 ratio during the first 5 days of MV, respiratory system compliance (CRS) lower than 40 mL/cmH2O during the first 5 days of MV, need for renal replacement therapy (RRT), late-onset ventilator-associated pneumonia (VAP), and cardiovascular complications. ICU mortality during the observation period was 36.1% (141/391). Similar results were obtained by the multivariate logistic regression analysis using mortality as a dependent variable. Conclusions Age, SOFA score at ICU admission, CRS, PaO2/FiO2, renal and cardiovascular complications, and late-onset VAP were all independent risk factors for prolonged mechanical ventilation in patients with COVID-19. Trial registration NCT04411459

Published
2020

3. Impact of age on the selection of nuclear cardiology stress protocols: The INCAPS (IAEA nuclear cardiology protocols) study

Author

Al-Mallah, Mh, Pascual, Tnb, Mercuri, M, Vitola, Jv, Karthikeyan, G, Better, N, Dondi, M, Paez, D, Eistein, Aj, Bouyoucef, Se, Allam, Ah, Vangu, M, Rehani, Mm, Kashyap, R, Lele, V, Magboo, Vpc, Mahmarian, Jj, Mut, F, Alexánderson, E, Allam, A, Bom, H, Flotats, A, Jerome, S, Kaufmann, Pa, Luxenburg, O, Mahmarian, J, Shaw, Lj, Underwood, Sr, Amouri, W, Essabbah, H, Gassama, Ss, Makhdomi, Kb, El Mustapha, Gie, El Ouchdi, N, Qaïs, N, Soni, N, Vangu, W, Abazid, Rm, Adams, B, Agarwal, V, Alfeeli, Ma, Alnafisi, N, Bernabe, L, Bural, Gg, Chaiwatanarat, T, Chandraguptha, Jm, Cheon, Gj, Cho, I, Dogan, As, Eftekhari, M, Frenkel, A, Garty, I, George, S, Geramifar, P, Golan, H, Habib, S, Hussain, R, Im, H, Jeon, H-J, Kalawat, T, Kang, Wj, Keng, F, Klaipetch, A, Kumar, Pg, Lee, J, Lee, Ww, Lim, I, Macaisa, Cmm, Malhotra, G, Mittal, Br, Mohammad, Mh, Mohan, P, Mulyanto, Id, Nariman, D, Nayak, Un, Niaz, K, Nikolov, G, Obaldo, Jm, Ozturk, E, Park, Jm, Park, S, Patel, Cd, Phuong, Hk, Quinon, Ap, Rajini, Tr, Saengsuda, Y, Santiago, J, Sayman, Hb, Shinto, As, Sivasubramaniyan, V, Son, Mh, Sudhakar, P, Syed, Gms, Tamaki, N, Thamnirat, K, Thientunyakit, T, Thongmak, S, Velasco, Dn, Verma, A, Vutrapongwatana, U, Wang, Y, Won, Ks, Yao, Z, Yingsa-Nga, T, Yudistiro, R, Yue, Kt, Zafrir, N, Adrian, Sc, Agostini, D, Aguadé, S, Armitage, G, Backlund, M, Backman, M, Baker, M, Balducci, Mt, Bavelaar, C, Berovic, M, Bertagna, F, Beuchel, R, Biggi, A, Bisi, G, Bonini, R, Bradley, A, Brudin, L, Bruno, I, Busnardo, E, Casoni, R, Choudhri, A, Cittanti, C, Clauss, R, Costa, Dc, Costa, M, Dixon, K, Dziuk, M, Egelic, N, Eriksson, I, Fagioli, G, De Faria, Db, Florimonte, L, Francini, Alberto, French, M, Gallagher, E, Garai, I, Geatti, O, Genovesi, D, Gianolli, L, Gimelli, A, Del Giudice, E, Halliwell, S, Hansson, Mj, Harrison, C, Homans, F, Horton, F, Jȩdrzejuk, D, Jogi, J, Johansen, A, Johansson, H, Kalnina, M, Kaminek, M, Kiss, A, Kobylecka, M, Kostkiewicz, M, Kropp, J, Kullenberg, R, Lahoutte, T, Lang, O, Larsson, Yh, Lázár, M, Leccisotti, L, Leners, N, Lindner, O, Lipp, Rw, Maenhout, A, Maffioli, L, Marcassa, C, Martins, B, Marzullo, P, Medolago, G, Mendiguchía, Cg, Mirzaei, S, Mori, M, Nardi, B, Nazarenko, S, Nikoletic, K, Oleksa, R, Parviainen, T, Patrina, J, Peace, R, Pirich, C, Piwowarska-Bilska, H, Popa, S, Prakash, V, Pubul, V, Puklavec, L, Rac, S, Ratniece, M, Rogan, Sa, Romeo, Annunziata, Rossi, M, Ruiz, D, Sabharwal, N, Salobir, Bg, Santos, Ai, Saranovic, S, Sarkozi, A, Schneider, Rp, Sciagra, R, Scotti, S, Servini, Z, Setti, Lr, Starck, S-A., Vajauskas, D, Veselý, J, Vieni, A, Vignati, A, Vito, I. M., Weiss, K, Wild, D, Zdraveska-Kochovska, M, Agüro, Rn, Alvarado, N, Barral, Cm, Beretta, M, Berrocal, I, Batista Cuellar, Jf, Cabral Chang, T-M, Cabrera Rodríguez, Lo, Canessa, J, Castro Mora, G, Claudia, Ac, Clavelo, Gf, Cruz, Af, Faccio, Ff, Fernández, Km, Gomez Garibo, Jr, Gonzalez, U, González, Pe, Guzzo, Ma, Jofre, J, Kapitán, M, Kempfer, G, Lopez, Jl, Massardo, Tv, Medeiros Colaco, I, Mesquita, Ct, Montecinos, M, Neubauer, S, Pabon, Lm, Puente, A, Rochela Vazquez, Lm, Serna Macias, Ja, Silva Pino, Ag, Tártari Huber, Fz, Tovar, Ap, Vargas, L, Wiefels, C, Aljizeeri, A, Alvarez, Rj, Barger, D, Beardwood, W, Behrens, J, Brann, L, Brown, D, Carr, H, Churchwell, K, Comingore, Ga, Corbett, J, Costello, M, Cruz, F, Depinet, T, Dorbala, S, Earles, M, Esteves, Fp, Etherton, E, Fanning, Rj, Fornace, J, Franks, L, Gewirtz, H, Gulanchyn, K, Hannah, C-L, Hays, J, Hendrickson, J, Hester, J, Holmes, K, Johnson, A, Jopek, C, Lewin, H, Lyons, J, Manley, C, Meden, J, Moore, S, Moore, Wh, Murthy, V, Nace, R, Neely, D, Nelson, L, Niedermaier, O, Rice, D, Rigs, R, Schiffer, K, Schockling, E, Schultz, T, Schumacker, T, Sheesley, B, Sheikh, A, Siegel, B, Slim, Am, Smith, J, Szulc, Mc, Tanskersley, N, Tilkemeier, P, Valdez, Gd, Vrooman, R, Wawrowicz, D, Winchester, De, Alcheikh, A, Allen, B, Atkins, E, Bevan, J, Bonomini, C, Christiansen, J, Clack, L, Craig, E, Dixson, H, Duncan, I, Fredericks, S, Gales, S, Hampson, R, Hanley, T, Hartcher, K, Hassall, J, Kelley, B, Kelly, S, Kidd, T, De Kort, T, Larcos, G, Macdonald, W, Mcgrath, C, Murdoch, E, O'Malley, S, O'Rourke, M, Pack, M, Pearce, R, Praehofer, R, Ramsay, S, Scarlett, L, Smidt, K, Souvannavong, F, Taubman, K, Taylor, G, Tse, K, Unger, S, and Weale, J

Subjects
Ionizing radiation, Male, medicine.medical_specialty, Cross-sectional study, Cardiology, Guidelines, 030204 cardiovascular system & hematology, Radiation Dosage, Effective dose (radiation), NO, Cohort Studies, 03 medical and health sciences, Myocardial perfusion imaging, Age, 0302 clinical medicine, Internal medicine, Humans, Medicine, 030212 general & internal medicine, Tomography, Age Factors, Aged, Cross-Sectional Studies, Female, Middle Aged, Myocardial Perfusion Imaging, Positron-Emission Tomography, Practice Guidelines as Topic, Radiation Exposure, Retrospective Studies, Tomography, Emission-Computed, Single-Photon, Nuclear Energy, medicine.diagnostic_test, business.industry, Retrospective cohort study, Radiation exposure, Cohort, Emission-Computed, Cardiology and Cardiovascular Medicine, business, Single-Photon, Cohort study
Abstract

There is growing concern about radiation exposure from nuclear myocardial perfusion imaging (MPI), particularly among younger patients who are more prone to develop untoward effects of ionizing radiation, and hence US and European professional society guidelines recommend age as a consideration in weighing radiation risk from MPI. We aimed to determine how patient radiation doses from MPI vary across age groups in a large contemporary international cohort.Data were collected as part of a global cross-sectional study of centers performing MPI coordinated by the International Atomic Energy Agency (IAEA). Sites provided information on each MPI study completed during a single week in March-April 2013. We compared across age groups laboratory adherence to pre-specified radiation-related best practices, radiation effective dose (ED; a whole-body measure reflecting the amount of radiation to each organ and its relative sensitivity to radiation's deleterious effects), and the proportion of patients with ED ≤ 9 mSv, a target level specified in guidelines.Among 7911 patients undergoing MPI in 308 laboratories in 65 countries, mean ED was 10.0 ± 4.5 mSv with slightly higher exposure among younger age groups (trend p value 0.001). There was no difference in the proportion of patients with ED ≤ 9 mSv across age groups, or in adherence to best practices based on the median age of patients in a laboratory.In contemporary nuclear cardiology practice, the age of the patient appears not to impact protocol selection and radiation dose, contrary to professional society guidelines.

Published
2018

4. Nuclear cardiology practices and radiation exposure in Africa: results from the IAEA Nuclear Cardiology Protocols Study (INCAPS)

Author

Bouyoucef, Salah E., Mercuri, Mathew, Pascual, Thomas N. B., Allam, Adel H., Vangu, Mboyo, Vitola, João V., Better, Nathan, Karthikeyan, Ganesan, Mahmarian, John J., Rehani, Madan M., Kashyap, Ravi, Dondi, Maurizio, Paez, Diana, Einstein, Andrew J., Einstein, A. J., Pascual, T. N. B., Paez, D., Dondi, M., Better, N., Bouyoucef, S. E., Karthikeyan, G., Kashyap, R., Lele, V., Magboo, V. P. C., Mahmarian, J. J., Mercuri, M., Mut, F., Rehani, M. M., Vitola, J. V., Alexánderson, E., Allam, A., Al-Mallah, M. H., Bom, H., Flotats, A., Jerome, S., Kaufmann, P. A., Luxenburg, O., Mahmarian, J., Shaw, L. J., Underwood, S. R., Vitola, J., Amouri, W., Essabbah, H., Gassama, S. S., Makhdomi, K. B., El Mustapha, G. I. E., El Ouchdi, N., Qaïs, N., Soni, N., Vangu, W., Abazid, R. M., Adams, B., Agarwal, V., Alfeeli, M. A., Alnafisi, N., Bernabe, L., Bural, G. G., Chaiwatanarat, T., Chandraguptha, J. M., Cheon, G. J., Cho, I., Dogan, A. S., Eftekhari, M., Frenkel, A., Garty, I., George, S., Geramifar, P., Golan, H., Habib, S., Hussain, R., Im, H., Jeon, H. -J., Kalawat, T., Kang, W. J., Keng, F., Klaipetch, A., Kumar, P. G., Lee, J., Lee, W. W., Lim, I., Macaisa, C. M. M., Malhotra, G., Mittal, B. R., Mohammad, M. H., Mohan, P., Mulyanto, I. D., Nariman, D., Nayak, U. N., Niaz, K., Nikolov, G., Obaldo, J. M., Ozturk, E., Park, J. M., Park, S., Patel, C. D., Phuong, H. K., Quinon, A. P., Rajini, T. R., Saengsuda, Y., Santiago, J., Sayman, H. B., Shinto, A. S., Sivasubramaniyan, V., Son, M. H., Sudhakar, P., Syed, G. M. S., Tamaki, N., Thamnirat, K., Thientunyakit, T., Thongmak, S., Velasco, D. N., Verma, A., Vutrapongwatana, U., Wang, Y., Won, K. S., Yao, Z., Yingsa-Nga, T., Yudistiro, R., Yue, K. T., Zafrir, N., Adrian, S. C., Agostini, D., Aguadé, S., Armitage, G., Backlund, M., Backman, M., Baker, M., Balducci, M. T., Bavelaar, C., Berovic, M., Bertagna, F., Beuchel, R., Biggi, A., Bisi, G., Bonini, R., Bradley, A., Brudin, L., Bruno, I., Busnardo, E., Casoni, R., Choudhri, A., Cittanti, C., Clauss, R., Costa, D. C., Costa, M., Dixon, K., Dziuk, M., Egelic, N., Eriksson, I., Fagioli, G., De Faria, D. B., Florimonte, L., Francini, A., French, M., Gallagher, E., Garai, I., Geatti, O., Genovesi, D., Gianolli, L., Gimelli, A., Del Giudice, E., Halliwell, S., Hansson, M. J., Harrison, C., Homans, F., Horton, F., Jȩdrzejuk, D., Jogi, J., Johansen, A., Johansson, H., Kalnina, M., Kaminek, M., Kiss, A., Kobylecka, M., Kostkiewicz, M., Kropp, J., Kullenberg, R., Lahoutte, T., Lang, O., Larsson, Y. H., Lázár, M., Leccisotti, L., Leners, N., Lindner, O., Lipp, R. W., Maenhout, A., Maffioli, L., Marcassa, C., Martins, B., Marzullo, P., Medolago, G., Mendiguchía, C. G., Mirzaei, S., Mori, M., Nardi, B., Nazarenko, S., Nikoletic, K., Oleksa, R., Parviainen, T., Patrina, J., Peace, R., Pirich, C., Piwowarska-Bilska, H., Popa, S., Prakash, V., Pubul, V., Puklavec, L., Rac, S., Ratniece, M., Rogan, S. A., Romeo, A., Rossi, M., Ruiz, D., Sabharwal, N., Salobir, B. G., Santos, A. I., Saranovic, S., Sarkozi, A., Schneider, R. P., Sciagra, R., Scotti, S., Servini, Z., Setti, L. R., Starck, S-Ã…., Vajauskas, D., Veselý, J., Vieni, A., Vignati, A., Vito, I. M., Weiss, K., Wild, D., Zdraveska-Kochovska, M., Agüro, R. N., Alvarado, N., Barral, C. M., Beretta, M., Berrocal, I., Batista Cuellar, J. F., Cabral Chang, T. -M., Cabrera Rodríguez, L. O., Canessa, J., Castro Mora, G., Claudia, A. C., Clavelo, G. F., Cruz, A. F., Faccio, F. F., Fernández, K. M., Gomez Garibo, J. R., Gonzalez, U., González, P. E., Guzzo, M. A., Jofre, J., Kapitán, M., Kempfer, G., Lopez, J. L., Massardo, T. V., Medeiros Colaco, I., Mesquita, C. T., Montecinos, M., Neubauer, S., Pabon, L. M., Puente, A., Rochela Vazquez, L. M., Serna Macias, J. A., Silva Pino, A. G., Tártari Huber, F. Z., Tovar, A. P., Vargas, L., Wiefels, C., Aljizeeri, A., Alvarez, R. J., Barger, D., Beardwood, W., Behrens, J., Brann, L., Brown, D., Carr, H., Churchwell, K., Comingore, G. A., Corbett, J., Costello, M., Cruz, F., Depinet, T., Dorbala, S., Earles, M., Esteves, F. P., Etherton, E., Fanning, R. J., Fornace, J., Franks, L., Gewirtz, H., Gulanchyn, K., Hannah, C. -L., Hays, J., Hendrickson, J., Hester, J., Holmes, K., Johnson, A., Jopek, C., Lewin, H., Lyons, J., Manley, C., Meden, J., Moore, S., Moore, W. H., Murthy, V., Nace, R., Neely, D., Nelson, L., Niedermaier, O., Rice, D., Rigs, R., Schiffer, K., Schockling, E., Schultz, T., Schumacker, T., Sheesley, B., Sheikh, A., Siegel, B., Slim, A. M., Smith, J., Szulc, M. C., Tanskersley, N., Tilkemeier, P., Valdez, G. D., Vrooman, R., Wawrowicz, D., Winchester, D. E., Alcheikh, A., Allen, B., Atkins, E., Bevan, J., Bonomini, C., Christiansen, J., Clack, L., Craig, E., Dixson, H., Duncan, I., Fredericks, S., Gales, S., Hampson, R., Hanley, T., Hartcher, K., Hassall, J., Kelley, B., Kelly, S., Kidd, T., De Kort, T., Larcos, G., Macdonald, W., Mcgrath, C., Murdoch, E., O'Malley, S., O'Rourke, M., Pack, M., Pearce, R., Praehofer, R., Ramsay, S., Scarlett, L., Smidt, K., Souvannavong, F., Taubman, K., Taylor, G., Tse, K., Unger, S., and Weale, J.

Subjects
Male, medicine.medical_specialty, Heart Diseases, Cross-sectional study, MEDLINE, effective dose, Cardiology, 030204 cardiovascular system & hematology, Effective dose (radiation), NO, 030218 nuclear medicine & medical imaging, CONSECUTIVE SAMPLE, 03 medical and health sciences, Myocardial perfusion imaging, 0302 clinical medicine, Interquartile range, Internal medicine, medicine, best practices, Humans, Registries, Africa, Best practices, Effective dose, Radiation, Aged, Cross-Sectional Studies, Female, Incidence, Middle Aged, Myocardial Perfusion Imaging, Radiation Exposure, Radiation Injuries, Tomography, Emission-Computed, Single-Photon, Cardiology and Cardiovascular Medicine, Tomography, medicine.diagnostic_test, business.industry, Cardiovascular Topics, Radiation dose, General Medicine, Radiation exposure, radiation, Emission-Computed, business, Single-Photon
Abstract

OBJECTIVE While nuclear myocardial perfusion imaging (MPI) offers many benefits to patients with known or suspected cardiovascular disease, concerns exist regarding radiation-associated health effects. Little is known regarding MPI practice in Africa. We sought to characterise radiation doses and the use of MPI best practices that could minimise radiation in African nuclear cardiology laboratories, and compare these to practice worldwide. METHODS Demographics and clinical characteristics were collected for a consecutive sample of 348 patients from 12 laboratories in six African countries over a one-week period from March to April 2013. Radiation effective dose (ED) was estimated for each patient. A quality index (QI) enumerating adherence to eight best practices, identified a priori by an IAEA expert panel, was calculated for each laboratory. We compared these metrics with those from 7 563 patients from 296 laboratories outside Africa. RESULTS Median (interquartile range) patient ED in Africa was similar to that of the rest of the world [9.1 (5.1-15.6) vs 10.3 mSv (6.8-12.6), p = 0.14], although a larger proportion of African patients received a low ED, ≤ 9 mSv targeted in societal recommendations (49.7 vs 38.2%, p < 0.001). Bestpractice adherence was higher among African laboratories (QI score: 6.3 ± 1.2 vs 5.4 ± 1.3, p = 0.013). However, median ED varied significantly among African laboratories (range: 2.0-16.3 mSv; p < 0.0001) and QI range was 4-8. CONCLUSION Patient radiation dose from MPI in Africa was similar to that in the rest of the world, and adherence to best practices was relatively high in African laboratories. Nevertheless there remain opportunities to further reduce radiation exposure to African patients from MPI.

Published
2017

5. Nuclear cardiology practice in Asia: Analysis of radiation exposure and best practice for myocardial perfusion imaging ― results from the IAEA nuclear cardiology protocols cross-sectional study (INCAPS)

Author

Pascual, Tnb, Mercuri, M, El-Haj, N, Hee-Sung Bom, H, Lele, V, Al-Mallah, Mh, Luxenburg, O, Karthikeyan, G, Vitola, Jv, Mahmarian, Jj, Better, N, Shaw, Lj, Rehani, Mm, Kashyap, R, Paez, D, Dondi, M, Eistein, Aj, Bouyoucef, Salah E., Allam, Adel H., Vangu, Mboyo, Magboo, V. P. C., Mut, F., Alexánderson, E., Allam, A., Bom, H., Flotats, A., Jerome, S., Kaufmann, P. A., Underwood, S. R., Vitola, J., Amouri, W., Essabbah, H., Gassama, S. S., Makhdomi, K. B., El Mustapha, G. I. E., El Ouchdi, N., Qaïs, N., Soni, N., Vangu, W., Abazid, R. M., Adams, B., Agarwal, V., Alfeeli, M. A., Alnafisi, N., Bernabe, L., Bural, G. G., Chaiwatanarat, T., Chandraguptha, J. M., Cheon, G. J., Cho, I., Dogan, A. S., Eftekhari, M., Frenkel, A., Garty, I., George, S., Geramifar, P., Golan, H., Habib, S., Hussain, R., Im, H., Jeon, H. -J., Kalawat, T., Kang, W. J., Keng, F., Klaipetch, A., Kumar, P. G., Lee, J., Lee, W. W., Lim, I., Macaisa, C. M. M., Malhotra, G., Mittal, B. R., Mohammad, M. H., Mohan, P., Mulyanto, I. D., Nariman, D., Nayak, U. N., Niaz, K., Nikolov, G., Obaldo, J. M., Ozturk, E., Park, J. M., Park, S., Patel, C. D., Phuong, H. K., Quinon, A. P., Rajini, T. R., Saengsuda, Y., Santiago, J., Sayman, H. B., Shinto, A. S., Sivasubramaniyan, V., Son, M. H., Sudhakar, P., Syed, G. M. S., Tamaki, N., Thamnirat, K., Thientunyakit, T., Thongmak, S., Velasco, D. N., Verma, A., Vutrapongwatana, U., Wang, Y., Won, K. S., Yao, Z., Yingsa-Nga, T., Yudistiro, R., Yue, K. T., Zafrir, N., Adrian, S. C., Agostini, D., Aguadé, S., Armitage, G., Backlund, M., Backman, M., Baker, M., Balducci, M. T., Bavelaar, C., Berovic, M., Bertagna, F., Beuchel, R., Biggi, A., Bisi, G., Bonini, R., Bradley, A., Brudin, L., Bruno, I., Busnardo, E., Casoni, R., Choudhri, A., Cittanti, C., Clauss, R., Costa, D. C., Costa, M., Dixon, K., Dziuk, M., Egelic, N., Eriksson, I., Fagioli, G., De Faria, D. B., Florimonte, L., Francini, A., French, M., Gallagher, E., Garai, I., Geatti, O., Genovesi, D., Gianolli, L., Gimelli, A., Del Giudice, E., Halliwell, S., Hansson, M. J., Harrison, C., Homans, F., Horton, F., Jȩdrzejuk, D., Jogi, J., Johansen, A., Johansson, H., Kalnina, M., Kaminek, M., Kiss, A., Kobylecka, M., Kostkiewicz, M., Kropp, J., Kullenberg, R., Lahoutte, T., Lang, O., Larsson, Y. H., Lázár, M., Leccisotti, L., Leners, N., Lindner, O., Lipp, R. W., Maenhout, A., Maffioli, L., Marcassa, C., Martins, B., Marzullo, P., Medolago, G., Mendiguchía, C. G., Mirzaei, S., Mori, M., Nardi, B., Nazarenko, S., Nikoletic, K., Oleksa, R., Parviainen, T., Patrina, J., Peace, R., Pirich, C., Piwowarska-Bilska, H., Popa, S., Prakash, V., Pubul, V., Puklavec, L., Rac, S., Ratniece, M., Rogan, S. A., Romeo, A., Rossi, M., Ruiz, D., Sabharwal, N., Salobir, B. G., Santos, A. I., Saranovic, S., Sarkozi, A., Schneider, R. P., Sciagra, R., Scotti, S., Servini, Z., Setti, L. R., Starck, S-Ã…., Vajauskas, D., Veselý, J., Vieni, A., Vignati, A., Vito, I. M., Weiss, K., Wild, D., Zdraveska-Kochovska, M., Agüro, R. N., Alvarado, N., Barral, C. M., Beretta, M., Berrocal, I., Batista Cuellar, J. F., Cabral Chang, T. -M., Cabrera Rodríguez, L. O., Canessa, J., Castro Mora, G., Claudia, A. C., Clavelo, G. F., Cruz, A. F., Faccio, F. F., Fernández, K. M., Gomez Garibo, J. R., Gonzalez, U., González, P. E., Guzzo, M. A., Jofre, J., Kapitán, M., Kempfer, G., Lopez, J. L., Massardo, T. V., Medeiros Colaco, I., Mesquita, C. T., Montecinos, M., Neubauer, S., Pabon, L. M., Puente, A., Rochela Vazquez, L. M., Serna Macias, J. A., Silva Pino, A. G., Tártari Huber, F. Z., Tovar, A. P., Vargas, L., Wiefels, C., Aljizeeri, A., Alvarez, R. J., Barger, D., Beardwood, W., Behrens, J., Brann, L., Brown, D., Carr, H., Churchwell, K., Comingore, G. A., Corbett, J., Costello, M., Cruz, F., Depinet, T., Dorbala, S., Earles, M., Esteves, F. P., Etherton, E., Fanning, R. J., Fornace, J., Franks, L., Gewirtz, H., Gulanchyn, K., Hannah, C. -L., Hays, J., Hendrickson, J., Hester, J., Holmes, K., Johnson, A., Jopek, C., Lewin, H., Lyons, J., Manley, C., Meden, J., Moore, S., Moore, W. H., Murthy, V., Nace, R., Neely, D., Nelson, L., Niedermaier, O., Rice, D., Rigs, R., Schiffer, K., Schockling, E., Schultz, T., Schumacker, T., Sheesley, B., Sheikh, A., Siegel, B., Slim, A. M., Smith, J., Szulc, M. C., Tanskersley, N., Tilkemeier, P., Valdez, G. D., Vrooman, R., Wawrowicz, D., Winchester, D. E., Alcheikh, A., Allen, B., Atkins, E., Bevan, J., Bonomini, C., Christiansen, J., Clack, L., Craig, E., Dixson, H., Duncan, I., Fredericks, S., Gales, S., Hampson, R., Hanley, T., Hartcher, K., Hassall, J., Kelley, B., Kelly, S., Kidd, T., De Kort, T., Larcos, G., Macdonald, W., Mcgrath, C., Murdoch, E., O'Malley, S., O'Rourke, M., Pack, M., Pearce, R., Praehofer, R., Ramsay, S., Scarlett, L., Smidt, K., Souvannavong, F., Taubman, K., Taylor, G., Tse, K., Unger, S., and Weale, J.

Subjects
Male, medicine.medical_specialty, Asia, Cross-sectional study, Best practice, Cardiology, Practice Patterns, 030204 cardiovascular system & hematology, Radiation Dosage, Effective dose (radiation), 030218 nuclear medicine & medical imaging, NO, 03 medical and health sciences, Myocardial perfusion imaging, 0302 clinical medicine, medicine, Humans, Medical physics, Dosing, Practice Patterns, Physicians', Quality of care, Thallium, Aged, Quality of Health Care, Radiation, Physicians', medicine.diagnostic_test, business.industry, Radiation dose, Technetium, Nuclear cardiology, General Medicine, Middle Aged, Radiation Exposure, Radiation exposure, Cross-Sectional Studies, Female, Nuclear Medicine, Cardiology and Cardiovascular Medicine, business, Myocardial Perfusion Imaging
Abstract

BACKGROUND This paper examines the current status of radiation exposure to patients in myocardial perfusion imaging (MPI) in Asia.Methods and Results:Laboratories voluntarily provided information on MPI performed over a 1-week period. Eight best practice criteria regarding MPI were predefined by an expert panel. Implementation of ≥6 best practices (quality index [QI] ≥6) was pre-specified as a desirable goal for keeping radiation exposure at a low level. Radiation effective dose (ED) in 1,469 patients and QI of 69 laboratories in Asia were compared against data from 239 laboratories in the rest of the world (RoW). Mean ED was significantly higher in Asia (11.4 vs. 9.6 mSv; P

Published
2017

6. Nuclear Cardiology Practices and Radiation Exposure in the Oceania Region: results From the IAEA Nuclear Cardiology Protocols Study (INCAPS)

Author

Biswas, S, Better, N, Pascual, TNB, Mercuri, M, Vitola, JV, Karthikeyan, G, Westcott, J, Alexanderson, E, Allam, AH, Al-Mallah, MH, Bom, HHS, Bouyoucef, SE, Flotats, A, Jerome, S, Kaufman, PA, Lele, V, Luxenburg, O, Mahmarian, JJ, Shaw, LJ, Underwood, SR, Rehani, M, Kashyap, R, Dondi, M, Paez, D, Einstein, AJ, Alcheikh, A, Allen, B, Kelley, B, Bonomini, C, McGrath, C, Atkins, E, Craig, E, Murdoch, E, Souvannavong, F, Larcos, G, Taylor, G, Dixson, H, Duncan, I, Bevan, J, Christiansen, J, Hassall, J, Weale, J, Hartcher, K, Smidt, K, Taubman, K, Tse, K, Clark, L, Scarlett, L, O'Rourke, M, Pack, M, Hampson, R, Pearce, R, Praehofer, R, Fredericks, S, Gales, S, Kelly, S, O'Malley, S, Ramsay, S, Unger, S, de Kort, T, Hanley, T, Kidd, T, Macdonald, W, Magboo, VPC, Mut, F, Meeks, JB, Rehani, MM, Allam, A, Bom, H, Kaufmann, PA, Mahmarian, J, Vitola, J, Amouri, W, Essabbah, H, Gassama, SS, Makhdomi, KB, El Mustapha, GIE, El Ouchdi, N, Qais, N, Soni, N, Vangu, W, Abazid, RM, Adams, B, Agarwal, V, Alfeeli, MA, Alnafisi, N, Bernabe, L, Bural, GG, Chaiwatanarat, T, Chandraguptha, JM, Cheon, GJ, Cho, I, Dogan, AS, Eftekhari, M, Frenkel, A, Garty, I, George, S, Geramifar, P, Golan, H, Habib, S, Hussain, R, Im, H, Jeon, HJ, Kalawat, T, Kang, WJ, Keng, F, Klaipetch, A, Kumar, PG, Lee, J, Lee, WW, Lim, I, Macaisa, CMM, Malhotra, G, Mittal, BR, Mohammad, MH, Mohan, P, Mulyanto, ID, Nariman, D, Nayak, UN, Niaz, K, Nikolov, G, Obaldo, JM, Ozturk, E, Park, JM, Park, S, Patel, CD, Phuong, HK, Quinon, AP, Rajini, TR, Saengsuda, Y, Santiago, J, Sayman, HB, Shinto, AS, Sivasubramaniyan, V, Son, MH, Sudhakar, P, Syed, GMS, Tamaki, N, Thamnirat, K, Thientunyakit, T, Thongmak, S, Velasco, DN, Verma, A, Vutrapongwatana, U, Wang, Y, Won, KS, Yao, Z, Yingsa-Nga, T, Yudistiro, R, Yue, KT, Zafrir, N, Adrian, SC, Agostini, D, Aguade, S, Armitage, G, Backlund, M, Backman, M, Baker, M, Balducci, MT, Bavelaar, C, Berovic, M, Bertagna, F, Beuchel, R, Biggi, A, Bisi, G, Bonini, R, Bradley, A, Brudin, L, Bruno, I, Busnardo, E, Casoni, R, Choudhri, A, Cittanti, C, Clauss, R, Costa, DC, Costa, M, Dixon, K, Dziuk, M, Egelic, N, Eriksson, I, Fagioli, G, de Faria, DB, Florimonte, L, Francini, A, French, M, Gallagher, E, Garai, I, Geatti, O, Genovesi, D, Gianolli, L, Gimelli, A, del Giudice, E, Halliwell, S, Hansson, MJ, Harrison, C, Homans, F, Horton, F, Jedrzejuk, D, Jogi, J, Johansen, A, Johansson, H, Kalnina, M, Kaminek, M, Kiss, A, Kobylecka, M, Kostkiewicz, M, Kropp, J, Kullenberg, R, Lahoutte, T, Lang, O, Larsson, YH, Lazar, M, Leccisotti, L, Leners, N, Lindner, O, Lipp, RW, Maenhout, A, Maffioli, L, Marcassa, C, Martins, B, Marzullo, P, Medolago, G, Mendiguchia, CG, Mirzaei, S, Mori, M, Nardi, B, Nazarenko, S, Nikoletic, K, Oleksa, R, Parviainen, T, Patrina, J, Peace, R, Pirich, C, Piwowarska-Bilska, H, Popa, S, Prakash, V, Pubul, V, Puklavec, L, Rac, S, Ratniece, M, Rogan, SA, Romeo, A, Rossi, M, Ruiz, D, Sabharwal, N, Salobir, BG, Santos, AI, Saranovic, S, Sarkozi, A, Schneider, RP, Sciagra, R, Scotti, S, Servini, Z, Setti, LR, Starck, SA, Vajauskas, D, Vesely, J, Vieni, A, Vignati, A, Vito, IM, Weiss, K, Wild, D, Zdraveska-Kochovska, M, Aguro, RN, Alvarado, N, Barral, CM, Beretta, M, Berrocal, I, Cuellar, JFB, Chang, TMC, Rodriguez, LOC, Canessa, J, Mora, GC, Claudia, AC, Clavelo, GF, Cruz, AF, Faccio, FF, Fernandez, KM, Garibo, JRG, Gonzalez, U, Gonzalez, P, Guzzo, MA, Jofre, J, Kapitan, M, Kempfer, G, Lopez, JL, Massardo, TV, Colaco, IM, Mesquita, CT, Montecinos, M, Neubauer, S, Pabon, LM, Puente, A, Vazquez, LMR, Macias, JAS, Pino, AGS, Huber, FZT, Tovar, AP, Vargas, L, Wiefels, C, Aljizeeri, A, Alvarez, RJ, Barger, D, Beardwood, W, Behrens, J, Brann, L, Brown, D, Carr, H, Churchwell, K, Comingore, GA, Corbett, J, Costello, M, Cruz, F, Depinet, T, Dorbala, S, Earles, M, Esteves, FP, Etherton, E, Fanning, RJ, Fornace, J, Franks, L, Gewirtz, H, Gulanchyn, K, Hannah, CL, Hays, J, Hendrickson, J, Hester, J, Holmes, K, Johnson, A, Jopek, C, Lewin, H, Lyons, J, Manley, C, Meden, J, Moore, S, Moore, WH, Murthy, V, Nace, R, Neely, D, Nelson, L, Niedermaier, O, Rice, D, Rigs, R, Schiffer, K, Schockling, E, Schultz, T, Schumacker, T, Sheesley, B, Sheikh, A, Siegel, B, Slim, AM, Smith, J, Szulc, M, Tanskersley, N, Tilkemeier, P, Valdez, GD, Vrooman, R, Wawrowicz, D, Winchester, DE, Dixon, H, and INCAPS Investigators Grp

Subjects
Pulmonary and Respiratory Medicine, Male, medicine.medical_specialty, Oceania, 030204 cardiovascular system & hematology, Radiation Dosage, Effective dose (radiation), Sievert, 030218 nuclear medicine & medical imaging, NO, 03 medical and health sciences, Myocardial perfusion imaging, Radiation exposure, Aged, Female, Humans, Middle Aged, Myocardial Perfusion Imaging, Radiation Exposure, 0302 clinical medicine, Internal medicine, medicine, medicine.diagnostic_test, business.industry, Radiation dose, Cardiology, Cardiology and Cardiovascular Medicine, business
Abstract

Background There is concern about radiation exposure with radionuclide myocardial perfusion imaging (MPI). This sub-study of the International Atomic Energy Agency (IAEA) Nuclear Cardiology Protocols Study reports radiation doses from MPI, and use of dose-optimisation protocols in Australia and New Zealand (ANZ), and compares them with data from the rest of the world. Methods Data were collected from 7911 MPI studies performed in 308 laboratories worldwide in one week in 2013, including 439 MPI studies from 34 ANZ laboratories. For each laboratory, effective radiation dose (ED) and a quality index (QI) score (out of 8) based on pre-specified "best practices'' was determined. Results In ANZ patients, ED ranged from 0.9-17.9 milliSievert (mSv). Median ED was similar in ANZ compared with the rest of the world (10.0 (IQR: 6.5-11.7) vs. 10.0 (IQR 6.4-12.6, P=0.15), as were mean QI scores (5.5 +/- 0.7 vs. 5.4 +/- 1.3, P= 0.84). Use of stress-only imaging (17.6% vs. 31.8% of labs, P= 0.09) and weight-based dosing of technetium-99m (14.7% vs. 30.3%, P= 0.07) was lower in ANZ compared with the rest of the world but this difference was not statistically significant. Median ED was significantly lower in metropolitan versus nonmetropolitan laboratories (10.1 mSv vs. 11.6 mSv, P < 0.01), although mean QI scores were similar (5.4 +/- 0.8 vs. 5.5 +/- 0.7, P= 0.75). Conclusion Across ANZ, there is variability in ED from MPI, and use of radiation safety practices, particularly between metropolitan and non-metropolitan laboratories. Overall, ANZ laboratories have a similar median ED to laboratories in the rest of the world.

Published
2017

7. Estimating the Reduction in the Radiation Burden From Nuclear Cardiology Through Use of Stress-Only Imaging in the United States and Worldwide

Author

Mathew, Mercuri, Pascual, Thomas N. B., Mahmarian, John J., Shaw, Leslee J., Maurizio, Dondi, Diana, Paez, Einstein, A. J., Pascual, T. N. B., Paez, D., Dondi, M., Better, N., Bouyoucef, S. E., Karthikeyan, G., Kashyap, R., Lele, V., Mut, F., Magboo, V. P. C., Mahmarian, J. J., Mercuri, M., Rehani, M. M., Vitola, J. V., Alexanderson, E., Allam, A., Al-Mallah, M. H., Bom, H., Flotats, A., Jerome, S., Kaufmann, P. A., Luxenburg, O., Mahmarian, J., Shaw, L. J., Underwood, S. R., Vitola, J., Amouri, W., Essabbah, H., Gassama, S. S., Makhdomi, K. B., El Mustapha, G. I. E., El Ouchdi, N., Qaïs, N., Soni, N., Vangu, W., Abazid, R. M., Adams, B., Agarwal, V., Alfeeli, M. A., Alnafisi, N., Bernabe, L., Bural, G. G., Chaiwatanarat, T., Chandraguptha, J. M., Cheon, G. J., Cho, I., Dogan, A. S., Eftekhari, M., Frenkel, A., Garty, I., George, S., Geramifar, P., Golan, H., Habib, S., Hussain, R., Im, H., Jeon, H-J., Kalawat, T., Kang, W. J., Keng, F., Klaipetch, A., Kumar, P. G., Lee, J., Lee, W. W., Lim, I., Macaisa, C. M. M., Malhotra, G., Mittal, B. R., Mohammad, M. H., Mohan, P., Mulyanto, I. D., Nariman, D., Nayak, U. N., Niaz, K., Nikolov, G., Obaldo, J. M., Ozturk, E., Park, J. M., Park, S., Patel, C. D., Phuong, H. K., Quinon, A. P., Rajini, T. R., Saengsuda, Y., Santiago, J., Sayman, H. B., Shinto, A. S., Sivasubramaniyan, V., Son, M. H., Sudhakar, P., Syed, G. M. S., Tamaki, N., Thamnirat, K., Thientunyakit, T., Thongmak, S., Velasco, D. N., Verma, A., Vutrapongwatana, U., Wang, Y., Won, K. S., Yao, Z., Yingsa-nga, T., Yudistiro, R., Yue, K. T., Zafrir, N., Adrian, S. C., Agostini, D., Aguadé, S., Armitage, G., Backlund, M., Backman, M., Baker, M., Balducci, M. T., Bavelaar, C., Berovic, M., Bertagna, F., Beuchel, R., Biggi, A., Bisi, G., Bonini, R., Bradley, A., Brudin, L., Bruno, Iliane Chiara, Busnardo, E., Casoni, R., Choudhri, A., Cittanti, C., Clauss, R., Costa, D. C., Costa, M., Dixon, K., Dziuk, M., Egelic, N., Eriksson, I., Fagioli, G., de Faria, D. B., Florimonte, L., Francini, A., French, M., Gallagher, E., Garai, I., Geatti, O., Genovesi, D., Gianolli, L., Gimelli, A., del Giudice, E., Halliwell, S., Hansson, M. J., Harrison, C., Homans, F., Horton, F., Jędrzejuk, D., Jogi, J., Johansen, A., Johansson, H., Kalnina, M., Kaminek, M., Kiss, A., Kobylecka, M., Kostkiewicz, M., Kropp, J., Kullenberg, R., Lahoutte, T., Lang, O., Larsson, Y. H., Lázár, M., Leccisotti, L., Leners, N., Lindner, O., Lipp, R. W., Maenhout, A., Maffioli, L., Marcassa, C., Martins, B., Marzullo, P., Medolago, G., Meeks, J. B., Mendiguchía, C. G., Mirzaei, S., Mori, M., Nardi, B., Nazarenko, S., Nikoletic, K., Oleksa, R., Parviainen, T., Patrina, J., Peace, R., Pirich, C., Piwowarska-Bilska, H., Popa, S., Prakash, V., Pubul, V., Puklavec, L., Rac, S., Ratniece, M., Rogan, S. A., Romeo, A., Rossi, M., Ruiz, D., Sabharwal, N., Salobir, B. G., Santos, A. I., Saranovic, S., Sarkozi, A., Schneider, R. P., Sciagra, R., Scotti, S., Servini, Z., Setti, L. R., Starck, S. -Å., Vajauskas, D., Veselý, J., Vieni, A., Vignati, A., Vito, I. M., Weiss, K., Wild, D., Zdraveska-Kochovska, M., Agüro, R. N., Alvarado, N., Barral, C. M., Beretta, M., Berrocal, I., Batista Cuellar, J. F., Cabral Chang, T. -M., Cabrera Rodríguez, L. O., Canessa, J., Castro Mora, G., Claudia, A. C., Clavelo, G. F., Cruz Jr, A. F., Faccio, F. F., Fernández, K. M., Gomez Garibo, J. R., Gonzalez, U., González, P., Guzzo, M. A., Jofre, J., Kapitán, M., Kempfer, G., Lopez, J. L., Massardo, T., Medeiros Colaco, I., Mesquita, C. T., Montecinos, M., Neubauer, S., Pabon, L. M., Puente, A., Rochela Vazquez, L. M., Serna Macias, J. A., Silva Pino, A. G., Tártari Huber, F. Z., Tovar, A. P., Vargas, L., Wiefels, C., Aljizeeri, A., Alvarez, R. J., Barger, D., Beardwood, W., Behrens, J., Brann, L., Brown, D., Carr, H., Churchwell, K., Comingore, G. A., Corbett, J., Costello, M., Cruz, F., Depinet, T., Dorbala, S., Earles, M., Esteves, F. P., Etherton, E., Fanning Jr, R. J., Fornace, J., Franks, L., Gewirtz, H., Gulanchyn, K., Hannah, C. -L., Hays, J., Hendrickson, J., Hester, J., Holmes, K., Johnson, A., Jopek, C., Lewin, H., Lyons, J., Manley, C., Meden, J., Moore, S., Moore, W. H., Murthy, V., Nace, R., Neely, D., Nelson, L., Niedermaier, O., Rice, D., Rigs, R., Schiffer, K., Schockling, E., Schultz, T., Schumacker, T., Sheesley, B., Sheikh, A., Siegel, B., Slim, A. M., Smith, J., Szulc, M., Tanskersley, N., Tilkemeier, P., Valdez, G. D., Vrooman, R., Wawrowicz, D., Winchester, D. E., Alcheikh, A., Allen, B., Atkins, E., Bevan, J., Bonomini, C., Christiansen, J., Clack, L., Craig, E., Dixson, H., Duncan, I., Fredericks, S., Gales, S., Hampson, R., Hanley, T., Hartcher, K., Hassall, J., Kelley, B., Kelly, S., Kidd, T., de Kort, T., Larcos, G., Macdonald, W., Mcgrath, C., Murdoch, E., O’Malley, S., O’Rourke, M., Pack, M., Pearce, R., Praehofer, R., Ramsay, S., Scarlett, L., Smidt, K., Souvannavong, F., Taubman, K., Taylor, G., Tse, K., Unger, S., and Weale, J.

Subjects
South asia, business.industry, Coronary arteriosclerosis, Myocardial Perfusion Imaging, 030204 cardiovascular system & hematology, Radiation Dosage, Thallium stress test, Clinical Protocols, Exercise Test, Humans, United States, Internal Medicine, Executive committee, 030218 nuclear medicine & medical imaging, NO, Radiation exposure, 03 medical and health sciences, Kingdom, 0302 clinical medicine, Radiology Specialty, Medicine, business, Humanities
Abstract

Group Information: The INCAPS Investigators Group includes executive committee members A. J. Einstein (chair), T. N. B. Pascual (IAEA project lead), D. Paez (IAEA section head), M. Dondi (IAEA section head); N. Better, S.E. Bouyoucef, G. Karthikeyan, R. Kashyap, V. Lele, F. Mut, V. P. C. Magboo, J. J. Mahmarian, M. Mercuri, M. M. Rehani, and J. V. Vitola, and regional coordinators E. Alexanderson (Latin America), A. Allam (Africa andMiddle East), M. H. Al-Mallah (Middle East), N. Better (Oceania), S. E. Bouyoucef (Africa), H. Bom (East Asia), A. Flotats (Europe), S. Jerome (United States), P. A. Kaufmann (Europe), V. Lele (South Asia), O. Luxenburg (Israel), J. Mahmarian (North America), L. J. Shaw (North America), S. R. Underwood (United Kingdom), and J. Vitola (Latin America). Members by region include W. Amouri, H. Essabbah, S. S. Gassama, K. B. Makhdomi, G. I. E. El Mustapha, N. El Ouchdi, N. Qais, N. Soni, andW. Vangu (Africa); R. M. Abazid, B. Adams, V. Agarwal, M. A. Alfeeli, N. Alnafisi, L. Bernabe, G. G. Bural, T. Chaiwatanarat, J. M. Chandraguptha, G. J. Cheon, I. Cho, A. S. Dogan, M. Eftekhari, A. Frenkel, I. Garty, S. George, P. Geramifar, H. Golan, S. Habib, R. Hussain, H. Im, H-J. Jeon, T. Kalawat, W. J. Kang, F. Keng, A. Klaipetch, P. G. Kumar, J. Lee, W.W. Lee, I. Lim, C. M. M. Macaisa, G. Malhotra, B. R. Mittal, M. H. Mohammad, P. Mohan, I. D. Mulyanto, D. Nariman, U. N. Nayak, K. Niaz, G. Nikolov, J. M. Obaldo, E. Ozturk, J. M. Park, S. Park, C. D. Patel, H. K. Phuong, A. P. Quinon, T. R. Rajini, Y. Saengsuda, J. Santiago, H. B. Sayman, A. S. Shinto, V. Sivasubramaniyan, M. H. Son, P. Sudhakar, G. M. S. Syed, N. Tamaki, K. Thamnirat, T. Thientunyakit, S. Thongmak, D. N. Velasco, A. Verma, U. Vutrapongwatana, Y. Wang, K. S. Won, Z. Yao, T. Yingsa-nga, R. Yudistiro, K. T. Yue, and N. Zafrir (Asia); S. C. Adrian, D. Agostini, S. Aguade, G. Armitage, M. Backlund, M. Backman, M. Baker, M. T. Balducci, C. Bavelaar, M. Berovic, F. Bertagna, R. Beuchel, A. Biggi, G. Bisi, R. Bonini, A. Bradley, L. Brudin, I. Bruno, E. Busnardo, R. Casoni, A. Choudhri, C. Cittanti, R. Clauss, D. C. Costa, M. Costa, K. Dixon, M. Dziuk, N. Egelic, I. Eriksson, G. Fagioli, D. B. de Faria, L. Florimonte, A. Francini, M. French, E. Gallagher, I. Garai, O. Geatti, D. Genovesi, L. Gianolli, A. Gimelli, E. del Giudice, S. Halliwell, M. J. Hansson, C. Harrison, F. Homans, F. Horton, D. Jedrzejuk, J. Jogi, A. Johansen, H. Johansson, M. Kalnina, M. Kaminek, A. Kiss, M. Kobylecka, M. Kostkiewicz, J. Kropp, R. Kullenberg, T. Lahoutte, O. Lang, Y. H. Larsson, M. Lazar, L. Leccisotti, N. Leners, O. Lindner, R. W. Lipp, A. Maenhout, L. Maffioli, C. Marcassa, B. Martins, P. Marzullo, G. Medolago, J. B. Meeks, C. G. Mendiguchia, S. Mirzaei, M. Mori, B. Nardi, S. Nazarenko, K. Nikoletic, R. Oleksa, T. Parviainen, J. Patrina, R. Peace, C. Pirich, H. Piwowarska-Bilska, S. Popa, V. Prakash, V. Pubul, L. Puklavec, S. Rac, M. Ratniece, S. A. Rogan, A. Romeo, M. Rossi, D. Ruiz, N. Sabharwal, B. G. Salobir, A. I. Santos, S. Saranovic, A. Sarkozi, R. P. Schneider, R. Sciagra, S. Scotti, Z. Servini, L. R. Setti, S.-A. Starck, D. Vajauskas, J. Veselý, A. Vieni, A. Vignati, I. M. Vito, K. Weiss, D. Wild, andM. Zdraveska-Kochovska (Europe); R. N. Aguro, N. Alvarado, C. M. Barral, M. Beretta, I. Berrocal, J. F. Batista Cuellar, T.-M. Cabral Chang, L. O. Cabrera Rodriguez, J. Canessa, G. Castro Mora, A. C. Claudia, G. F. Clavelo, A. F. Cruz Jr, F. F. Faccio, K. M. Fernandez, J. R. Gomez Garibo, U. Gonzalez, P. Gonzalez, M. A. Guzzo, J. Jofre, M. Kapitan, G. Kempfer, J. L. Lopez, T. Massardo, I. Medeiros Colaco, C. T. Mesquita, M. Montecinos, S. Neubauer, L. M. Pabon, A. Puente, L. M. Rochela Vazquez, J. A. Serna Macias, A. G. Silva Pino, F. Z. Tartari Huber, A. P. Tovar, L. Vargas, and C. Wiefels (Latin America); A. Aljizeeri, R. J. Alvarez, D. Barger, W. Beardwood, J. Behrens, L. Brann, D. Brown, H. Carr, K. Churchwell, G. A. Comingore, J. Corbett, M. Costello, F. Cruz, T. Depinet, S. Dorbala, M. Earles, F. P. Esteves, E. Etherton, R. J. Fanning Jr, J. Fornace, L. Franks, H. Gewirtz, K. Gulanchyn, C.-L. Hannah, J. Hays, J. Hendrickson, J. Hester, K. Holmes, S. Jerome, A. Johnson, C. Jopek, H. Lewin, J. Lyons, C. Manley, J. Meden, S. Moore, W. H. Moore, V. Murthy, R. Nace, D. Neely, L. Nelson, O. Niedermaier, D. Rice, R. Rigs, K. Schiffer, E. Schockling, T. Schultz, T. Schumacker, B. Sheesley, A. Sheikh, B. Siegel, A. M. Slim, J. Smith, M. Szulc, N. Tanskersley, P. Tilkemeier, G. D. Valdez, R. Vrooman, D. Wawrowicz, and D. E. Winchester (North America); and A. Alcheikh, B. Allen, E. Atkins, J. Bevan, C. Bonomini, J. Christiansen, L. Clack, E. Craig, H. Dixson, I. Duncan, S. Fredericks, S. Gales, R. Hampson, T. Hanley, K. Hartcher, J. Hassall, B. Kelley, S. Kelly, T. Kidd, T. de Kort, G. Larcos, W. Macdonald, C. McGrath, E. Murdoch, S. O’Malley, M. O’Rourke, M. Pack, R. Pearce, R. Praehofer, S. Ramsay, L. Scarlett, K. Smidt, F. Souvannavong, K. Taubman, G. Taylor, K. Tse, S. Unger, and J. Weale (Oceania).

Published
2016

8. Nuclear cardiology practice and associated radiation doses in Europe: results of the IAEA Nuclear Cardiology Protocols Study (INCAPS) for the 27 European countries

Author

Lindner, O., Pascual, Tn, Mercuri, M, Acampa, W, Burchert, W, Flotats, A, Kaufmann, Pa, Kitsiou, A, Knuuti, J, Underwood, Sr, Vitola, Jv, Mahmarian JJ, Karthikeyan, G, Better, N, Rehani, Mm, Kashyap, R, Dondi, M, Paez, D, Einstein, Aj, INCAPS Investigators Group: Pascual TN, Bouyoucef, Se, Lele, V, Magboo, Vp, Mut, F, Mahmarian, Jj, Meeks, Jb, Alexánderson, E, Allam, A, Al-Mallah, Mh, Bom, H, Jerome, S, Luxenburg, O, Mahmarian, J, Shaw, Lj, Vitola, J, Amouri, W, Essabbah, H, Gassama, Ss, Makhdomi, Kb, El Mustapha GI, El Ouchdi, N, Qaïs, N, Soni, N, Vangu, W, Abazid, Rm, Adams, B, Agarwal, V, Alfeeli, Ma, Alnafisi, N, Bernabe, L, Bural, Gg, Chaiwatanarat, T, Chandraguptha, Jm, Cheon, Gj, Cho, I, Dogan, As, Eftekhari, M, Frenkel, A, Garty, I, George, S, Geramifar, P, Golan, H, Habib, S, Hussain, R, Im, H, Jeon, Hj, Kalawat, T, Kang, Wj, Keng, F, Klaipetch, A, Kumar, Pg, Lee, J, Lee, Ww, Lim, I, Macaisa, Cm, Malhotra, G, Mittal, Br, Mohammad, Mh, Mohan, P, Mulyanto, Id, Nariman, D, Nayak, Un, Niaz, K, Nikolov, G, Obaldo, Jm, Ozturk, E, Park, Jm, Park, S, Patel, Cd, Phuong, Hk, Quinon, Ap, Rajini, Tr, Saengsuda, Y, Santiago, J, Sayman, Hb, Shinto, As, Sivasubramaniyan, V, Son, Mh, Sudhakar, P, Syed, Gm, Tamaki, N, Thamnirat, K, Thientunyakit, T, Thongmak, S, Velasco, Dn, Verma, A, Vutrapongwatana, U, Wang, Y, Won, Ks, Yao, Z, Yingsa-nga, T, Yudistiro, R, Yue, Kt, Zafrir, N, Adrian, Sc, Agostini, D, Aguadé, S, Armitage, G, Backlund, M, Backman, M, Baker, M, Balducci, Mt, Bavelaar, C, Berovic, M, Bertagna, F, Beuchel, R, Biggi, A, Bisi, G, Bonini, R, Bradley, A, Brudin, L, Bruno, I, Busnardo, E, Casoni, R, Choudhri, A, Cittanti, C, Clauss, R, Costa, Dc, Costa, M, Dixon, K, Dziuk, M, Egelic, N, Eriksson, I, Fagioli, G, de Faria DB, Florimonte, L, Francini, A, French, M, Gallagher, E, Garai, I, Geatti, O, Genovesi, D, Gianolli, L, Gimelli, A, del Giudice, E, Halliwell, S, Hansson, Mj, Harrison, C, Homans, F, Horton, F, Jędrzejuk, D, Jogi, J, Johansen, A, Johansson, H, Kalnina, M, Kaminek, M, Kiss, A, Kobylecka, M, Kostkiewicz, M, Kropp, J, Kullenberg, R, Lahoutte, T, Lang, O, Larsson, Yh, Lázár, M, Leccisotti, L, Leners, N, Lindner, O, Lipp, Rw, Maenhout, A, Maffioli, L, Marcassa, C, Martins, B, Marzullo, P, Medolago, G, Mendiguchía, Cg, Mirzaei, S, Mori, M, Nardi, B, Nazarenko, S, Nikoletic, K, Oleksa, R, Parviainen, T, Patrina, J, Peace, R, Pirich, C, Piwowarska-Bilska, H, Popa, S, Prakash, V, Pubul, V, Puklavec, L, Rac, S, Ratniece, M, Rogan, Sa, Romeo, A, Rossi, M, Ruiz, D, Sabharwal, N, Salobir, Bg, Santos, Ai, Saranovic, S, Sarkozi, A, Schneider, Rp, Sciagra, R, Scotti, S, Servini, Z, Setti, Lr, Starck, Så, Vajauskas, D, Veselý, J, Vieni, A, Vignati, A, Vito, Im, Weiss, K, Wild, D, Zdraveska-Kochovska, M, Agüro, Rn, Alvarado, N, Barral, Cm, Beretta, M, Berrocal, I, Batista Cuellar JF, Cabral Chang TM, Cabrera Rodríguez LO, Canessa, J, Castro Mora, G, Claudia, Ac, Clavelo, Gf, Cruz Júnior AF, Faccio, Ff, Fernández, Km, Gomez Garibo JR, Gonzalez, U, E P, González, Guzzo, Ma, Jofre, J, Kapitán, M, Kempfer, G, Lopez, Jl, V T, Massardo, Medeiros Colaco, I, Mesquita, Ct, Montecinos, M, Neubauer, S, Pabon, Lm, Puente, A, Rochela Vazquez LM, Serna Macias JA, Silva Pino AG, Tártari Huber FZ, Tovar, Ap, Vargas, L, Wiefels, C, Aljizeeri, A, Alvarez, Rj, Barger, D, Beardwood, W, Behrens, J, Brann, L, Brown, D, Carr, H, Churchwell, K, Comingore, Ga, Corbett, J, Costello, M, Cruz, F, Depinet, T, Dorbala, S, Earles, M, Esteves, Fp, Etherton, E, Fanning RJ Jr, Fornace, J, Franks, L, Gewirtz, H, Gulanchyn, K, Hannah, Cl, Hays, J, Hendrickson, J, Hester, J, Holmes, K, Johnson, A, Jopek, C, Lewin, H, Lyons, J, Manley, C, Meden, J, Moore, S, Moore, Wh, Murthy, V, Nace, R, Neely, D, Nelson, L, Niedermaier, O, Rice, D, Rigs, R, Schiffer, K, Schockling, E, Schultz, T, Schumacker, T, Sheesley, B, Sheikh, A, Siegel, B, Slim, Am, Smith, J, Szulc, M, Tanskersley, N, Tilkemeier, P, Valdez, Gd, Vrooman, R, Wawrowicz, D, Winchester, De, Alcheikh, A, Allen, B, Atkins, E, Bevan, J, Bonomini, C, Christiansen, J, Clack, L, Craig, E, Dixson, H, Duncan, I, Fredericks, S, Gales, S, Hampson, R, Hanley, T, Hartcher, K, Hassall, J, Kelley, B, Kelly, S, Kidd, T, de Kort, T, Larcos, G, Macdonald, W, Mcgrath, C, Murdoch, E, O'Malley, S, O'Rourke, M, Pack, M, Pearce, R, Praehofer, R, Ramsay, S, Scarlett, L, Smidt, K, Souvannavong, F, Taubman, K, Taylor, G, Tse, K, Unger, S, Weale, J., Lindner, Oliver, Pascual, Thomas N. B, Mercuri, Mathew, Acampa, Wanda, Burchert, Wolfgang, Flotats, Albert, Kaufmann, Philipp A, Kitsiou, Anastasia, Knuuti, Juhani, Underwood, S. Richard, Vitola, João V, Mahmarian, John J, Karthikeyan, Ganesan, Better, Nathan, Rehani, Madan M, Kashyap, Ravi, Dondi, Maurizio, Paez, Diana, Einstein, Andrew J., Columbia University Medical Center (CUMC), and Columbia University [New York]

Subjects
INCAPS Investigators Group, [SDV.IB.IMA]Life Sciences [q-bio]/Bioengineering/Imaging, Computed tomography, Best practice, 030204 cardiovascular system & hematology, Myocardial perfusion scintigraphy, 030218 nuclear medicine & medical imaging, 0302 clinical medicine, Nuclear Medicine and Imaging, Medicine, media_common, medicine.diagnostic_test, Radiation dose, Scientific, General Medicine, 3. Good health, Patient management, Europe, Nuclear Medicine & Medical Imaging, Radiology Nuclear Medicine and imaging, SPECT, Practice Guidelines as Topic, Cardiology, Original Article, Radiology, Societies, Scientific, medicine.medical_specialty, Best practices, 0299 Other Physical Sciences, [SDV.IB.MN]Life Sciences [q-bio]/Bioengineering/Nuclear medicine, Radiation Dosage, NO, 03 medical and health sciences, Internal medicine, media_common.cataloged_instance, Radiology, Nuclear Medicine and imaging, Medical physics, European Union, Quality of care, European union, Cardiac Imaging Technique, business.industry, Nuclear cardiology, PET, Cardiac Imaging Techniques, Nuclear Medicine, Positron-Emission Tomography, Radiology, Nuclear Medicine and Imaging, 1103 Clinical Sciences, business, Societies, Medical therapy, [SDV.MHEP]Life Sciences [q-bio]/Human health and pathology
Abstract

Purpose Nuclear cardiology is widely used to diagnose coronary artery disease and to guide patient management, but data on current practices, radiation dose-related best practices, and radiation doses are scarce. To address these issues, the IAEA conducted a worldwide study of nuclear cardiology practice. We present the European subanalysis. Methods In March 2013, the IAEA invited laboratories across the world to document all SPECT and PET studies performed in one week. The data included age, gender, weight, radiopharmaceuticals, injected activities, camera type, positioning, hardware and software. Radiation effective dose was calculated for each patient. A quality score was defined for each laboratory as the number followed of eight predefined best practices with a bearing on radiation exposure (range of quality score 0 - 8). The participating European countries were assigned to regions (North, East, South, and West). Comparisons were performed between the four European regions and between Europe and the rest-of-the-world (RoW). Results Data on 2,381 European patients undergoing nuclear cardiology procedures in 102 laboratories in 27 countries were collected. A cardiac SPECT study was performed in 97.9 % of the patients, and a PET study in 2.1 %. The average effective dose of SPECT was 8.0 +/- 3.4 mSv (RoW 11.4 +/- 4.3 mSv; P < 0.001) and of PET was 2.6 +/- 1.5 mSv (RoW 3.8 +/- 2.5 mSv; P < 0.001). The mean effective doses of SPECT and PET differed between European regions (P < 0.001 and P = 0.002, respectively). The mean quality score was 6.2 +/- 1.2, which was higher than the RoW score (5.0 +/- 1.1; P < 0.001). Adherence to best practices did not differ significantly among the European regions (range 6 to 6.4; P = 0.73). Of the best practices, stress-only imaging and weight-adjusted dosing were the least commonly used. Conclusion In Europe, the mean effective dose from nuclear cardiology is lower and the average quality score is higher than in the RoW. There is regional variation in effective dose in relation to the best practice quality score. A possible reason for the differences between Europe and the RoW could be the safety culture fostered by actions under the Euratom directives and the implementation of diagnostic reference levels. Stress-only imaging and weight-adjusted activity might be targets for optimization of European nuclear cardiology practice.

Published
2016

9. Comparison of Radiation Doses and Best-Practice Use for Myocardial Perfusion Imaging in US and Non-US Laboratories: Findings From the IAEA (International Atomic Energy Agency) Nuclear Cardiology Protocols Study

Author

Mercuri, Mathew, N B, Pascual Thomas, Mahmarian John, J, Shaw Leslee, J, Rehani Madan, M, Paez, Diana, Einstein, Andrew J, INCAPS Investigators Group: Pascual, T, Paez, D, Dondi, M, Better, N, Bouyoucef, Se, Karthikeyan, G, Kashyap, R, Lele, V, Mut, F, Magboo, V, Mahmarian, J, Mercuri, M, Rehani, M, Vitola, J, Alexanderson, E, Allam, A, Al-Mallah, M, Bouyoucef, S, Bom, H, Flotats, A, Jerome, S, Kaufmann, P, Luxenburg, O, Shaw, L, Underwood, S, Amouri, W, Essabbah, H, Gassama, S, Makhdomi, K, El Mustapha, G, El Ouchdi, N, Qaïs, N, Soni, N, Vangu, W, Abazid, R, Adams, B, Agarwal, V, Alfeeli, M, Alnafisi, N, Bernabe, L, Bural, G, Chaiwatanarat, T, Chandraguptha, J, Cheon, G, Cho, I, Dogan, A, Eftekhari, M, Frenkel, A, Garty, I, George, S, Geramifar, P, Golan, H, Habib, S, Hussain, R, Im, H, Jeon, Hj, Kalawat, T, Kang, W, Keng, F, Klaipetch, A, Kumar, P, Lee, J, Lee, W, Lim, I, Macaisa, C, Malhotra, G, Mittal, B, Mohammad, M, Mohan, P, Mulyanto, I, Nariman, D, Nayak, U, Niaz, K, Nikolov, G, Obaldo, J, Ozturk, E, Park, J, Park, S, Patel, C, Phuong, H, Quinon, A, Rajini, T, Saengsuda, Y, Santiago, J, Sayman, H, Shinto, A, Sivasubramaniyan, V, Son, M, Sudhakar, P, Syed, G, Tamaki, N, Thamnirat, K, Thientunyakit, T, Thongmak, S, Velasco, D, Verma, A, Vutrapongwatana, U, Wang, Y, Won, K, Yao, Z, Yingsa-nga, T, Yudistiro, R, Yue, K, Zafrir, N, Adrian, S, Agostini, D, Aguadé, S, Armitage, G, Backlund, M, Backman, M, Baker, M, Balducci, M, Bavelaar, C, Berovic, M, Bertagna, F, Beuchel, R, Biggi, A, Bisi, G, Bonini, R, Bradley, A, Brudin, L, Bruno, I, Busnardo, E, Casoni, R, Choudhri, A, Cittanti, C, Clauss, R, Costa, D, Costa, M, Dixon, K, Dziuk, M, Egelic, N, Eriksson, I, Fagioli, G, de Faria, D, Florimonte, L, Francini, A, French, M, Gallagher, E, Garai, I, Geatti, O, Genovesi, D, Gianolli, L, Gimelli, A, del Giudice, E, Halliwell, S, Hansson, M, Harrison, C, Homans, F, Horton, F, Jędrzejuk, D, Jogi, J, Johansen, A, Johansson, H, Kalnina, M, Kaminek, M, Kiss, A, Kobylecka, M, Kostkiewicz, M, Kropp, J, Kullenberg, R, Lahoutte, T, Lang, O, Larsson, Y, Lázár, M, Leccisotti, L, Leners, N, Lindner, O, Lipp, R, Maenhout, A, Maffioli, L, Marcassa, C, Martins, B, Marzullo, P, Medolago, G, Meeks, J, Mendiguchía, C, Mirzaei, S, Mori, M, Nardi, B, Nazarenko, S, Nikoletic, K, Oleksa, R, Parviainen, T, Patrina, J, Peace, R, Pirich, C, Piwowarska-Bilska, H, Popa, S, Prakash, V, Pubul, V, Puklavec, L, Rac, S, Ratniece, M, Rogan, S, Romeo, A, Rossi, M, Ruiz, D, Sabharwal, N, Salobir, B, Santos, A, Saranovic, S, Sarkozi, A, Schneider, R, Sciagra, R, Scotti, S, Servini, Z, Setti, L, Starck, Så, Vajauskas, D, Veselý, J, Vieni, A, Vignati, A, Vito, I, Weiss, K, Wild, D, Zdraveska-Kochovska, M, Agüro, R, Alvarado, N, Barral, C, Beretta, M, Berrocal, I, Batista Cuellar, J, Cabral Chang TM, Cabrera Rodríguez, L, Canessa, J, Castro Mora, G, Claudia, A, Clavelo, G, Cruz, A Jr, Faccio, F, Fernández, K, Gomez Garibo, J, Gonzalez, U, González, P, Guzzo, M, Jofre, J, Kapitán, M, Kempfer, G, Lopez, J, Massardo, T, Medeiros Colaco, I, Mesquita, C, Montecinos, M, Neubauer, S, Pabon, L, Puente, A, Rochela Vazquez, L, Serna Macias, J, Silva Pino, A, Tártari Huber, F, Tovar, A, Vargas, L, Wiefels, C, Aljizeeri, A, Alvarez, R, Barger, D, Beardwood, W, Behrens, J, Brann, L, Brown, D, Carr, H, Churchwell, K, Comingore, G, Corbett, J, Costello, M, Cruz, F, Depinet, T, Dorbala, S, Earles, M, Esteves, F, Etherton, E, Fanning, R Jr, Fornace, J, Franks, L, Gewirtz, H, Gulanchyn, K, Hannah, Cl, Hays, J, Hendrickson, J, Hester, J, Holmes, K, Johnson, A, Jopek, C, Lewin, H, Lyons, J, Manley, C, Meden, J, Moore, S, Moore, W, Murthy, V, Nace, R, Neely, D, Nelson, L, Niedermaier, O, Rice, D, Rigs, R, Schiffer, K, Schockling, E, Schultz, T, Schumacker, T, Sheesley, B, Sheikh, A, Siegel, B, Slim, A, Smith, J, Szulc, M, Tanskersley, N, Tilkemeier, P, Valdez, G, Vrooman, R, Wawrowicz, D, Winchester, D, Alcheikh, A, Allen, B, Atkins, E, Bevan, J, Bonomini, C, Christiansen, J, Clack, L, Craig, E, Dixson, H, Duncan, I, Fredericks, S, Gales, S, Hampson, R, Hanley, T, Hartcher, K, Hassall, J, Kelley, B, Kelly, S, Kidd, T, de Kort, T, Larcos, G, Macdonald, W, Mcgrath, C, Murdoch, E, O'Malley, S, O'Rourke, M, Pack, M, Pearce, R, Praehofer, R, Ramsay, S, Scarlett, L, Smidt, K, Souvannavong, F, Taubman, K, Taylor, G, Tse, K, Unger, S, and Weale, J.

Subjects
Male, medicine.medical_specialty, Best practice, 030204 cardiovascular system & hematology, Radiation Dosage, Thallium stress test, 030218 nuclear medicine & medical imaging, NO, 03 medical and health sciences, Myocardial perfusion imaging, 0302 clinical medicine, Clinical Protocols, Internal Medicine, Radiology Specialty, Medical imaging, medicine, Humans, Medical physics, Aged, Female, Middle Aged, Myocardial Perfusion Imaging, Practice Guidelines as Topic, United States, medicine.diagnostic_test, business.industry, Atomic energy, Coronary arteriosclerosis, Radiation exposure, business
Published
2016

10. Opportunities for improvement on current nuclear cardiology practices and radiation exposure in Latin America: Findings from the 65-country IAEA Nuclear Cardiology Protocols cross-sectional Study (INCAPS)

Author

Vitola, Jv, Mut, F, Alexanderson, E, Pascual, Tnb, Mercuri, M, Karthikeyan, G, Better, N, Rehani, Mm, Kashyap, R, Dondi, M, Paez, D, Einstein, Aj, Bouyoucef, Se, Allam, Ah, Vangu, M, Magboo, Vpc, Mahmarian, Jj, Allam, A, Bom, H, Flotats, A, Jerome, S, Kaufmann, Pa, Lele, V, Luxenburg, O, Mahmarian, J, Shaw, Lj, Underwood, Sr, Amouri, W, Essabbah, H, Gassama, Ss, Makhdomi, Kb, El Mustapha, Gie, El Ouchdi, N, Qaïs, N, Soni, N, Vangu, W, Abazid, Rm, Adams, B, Agarwal, V, Alfeeli, Ma, Alnafisi, N, Bernabe, L, Bural, Gg, Chaiwatanarat, T, Chandraguptha, Jm, Cheon, Gj, Cho, I, Dogan, As, Eftekhari, M, Frenkel, A, Garty, I, George, S, Geramifar, P, Golan, H, Habib, S, Hussain, R, Im, H, Jeon, H-J, Kalawat, T, Kang, Wj, Keng, F, Klaipetch, A, Kumar, Pg, Lee, J, Lee, Ww, Lim, I, Macaisa, Cmm, Malhotra, G, Mittal, Br, Mohammad, Mh, Mohan, P, Mulyanto, Id, Nariman, D, Nayak, Un, Niaz, K, Nikolov, G, Obaldo, Jm, Ozturk, E, Park, Jm, Park, S, Patel, Cd, Phuong, Hk, Quinon, Ap, Rajini, Tr, Saengsuda, Y, Santiago, J, Sayman, Hb, Shinto, As, Sivasubramaniyan, V, Son, Mh, Sudhakar, P, Syed, Gms, Tamaki, N, Thamnirat, K, Thientunyakit, T, Thongmak, S, Velasco, Dn, Verma, A, Vutrapongwatana, U, Wang, Y, Won, Ks, Yao, Z, Yingsa-Nga, T, Yudistiro, R, Yue, Kt, Zafrir, N, Adrian, Sc, Agostini, D, Aguadé, S, Armitage, G, Backlund, M, Backman, M, Baker, M, Balducci, Mt, Bavelaar, C, Berovic, M, Bertagna, F, Beuchel, R, Biggi, A, Bisi, G, Bonini, R, Bradley, A, Brudin, L, Bruno, I, Busnardo, E, Casoni, R, Choudhri, A, Cittanti, C, Clauss, R, Costa, Dc, Costa, M, Dixon, K, Dziuk, M, Egelic, N, Eriksson, I, Fagioli, G, De Faria, Db, Florimonte, L, Francini, A, French, M, Gallagher, E, Garai, I, Geatti, O, Genovesi, D, Gianolli, L, Gimelli, A, Del Giudice, E, Halliwell, S, Hansson, Mj, Harrison, C, Homans, F, Horton, F, Jȩdrzejuk, D, Jogi, J, Johansen, A, Johansson, H, Kalnina, M, Kaminek, M, Kiss, A, Kobylecka, M, Kostkiewicz, M, Kropp, J, Kullenberg, R, Lahoutte, T, Lang, O, Larsson, Yh, Lázár, M, Leccisotti, L, Leners, N, Lindner, O, Lipp, Rw, Maenhout, A, Maffioli, L, Marcassa, C, Martins, B, Marzullo, P, Medolago, G, Mendiguchía, Cg, Mirzaei, S, Mori, M, Nardi, B, Nazarenko, S, Nikoletic, K, Oleksa, R, Parviainen, T, Patrina, J, Peace, R, Pirich, C, Piwowarska-Bilska, H, Popa, S, Prakash, V, Pubul, V, Puklavec, L, Rac, S, Ratniece, M, Rogan, Sa, Romeo, A, Rossi, M, Ruiz, D, Sabharwal, N, Salobir, Bg, Santos, Ai, Saranovic, S, Sarkozi, A, Schneider, Rp, Sciagra, R, Scotti, S, Servini, Z, Setti, Lr, Starck, S-A, Vajauskas, D, Veselý, J, Vieni, A, Vignati, A, Vito, I. M., Weiss, K, Wild, D, Zdraveska-Kochovska, M, Agüro, Rn, Alvarado, N, Barral, Cm, Beretta, M, Berrocal, I, Batista Cuellar, Jf, Cabral Chang, T-M, Cabrera Rodríguez, Lo, Canessa, J, Castro Mora, G, Claudia, Ac, Clavelo, Gf, Cruz, Af, Faccio, Ff, Fernández, Km, Gomez Garibo, Jr, Gonzalez, U, González, Pe, Guzzo, Ma, Jofre, J, Kapitán, M, Kempfer, G, Lopez, Jl, Massardo, Tv, Medeiros Colaco, I, Mesquita, Ct, Montecinos, M, Neubauer, S, Pabon, Lm, Puente, A, Rochela Vazquez, Lm, Serna Macias, Ja, Silva Pino, Ag, Tártari Huber, Fz, Tovar, Ap, Vargas, L, Wiefels, C, Aljizeeri, A, Alvarez, Rj, Barger, D, Beardwood, W, Behrens, J, Brann, L, Brown, D, Carr, H, Churchwell, K, Comingore, Ga, Corbett, J, Costello, M, Cruz, F, Depinet, T, Dorbala, S, Earles, M, Esteves, Fp, Etherton, E, Fanning, Rj, Fornace, J, Franks, L, Gewirtz, H, Gulanchyn, K, Hannah, C-L, Hays, J, Hendrickson, J, Hester, J, Holmes, K, Johnson, A, Jopek, C, Lewin, H, Lyons, J, Manley, C, Meden, J, Moore, S, Moore, Wh, Murthy, V, Nace, R, Neely, D, Nelson, L, Niedermaier, O, Rice, D, Rigs, R, Schiffer, K, Schockling, E, Schultz, T, Schumacker, T, Sheesley, B, Sheikh, A, Siegel, B, Slim, Am, Smith, J, Szulc, Mc, Tanskersley, N, Tilkemeier, P, Valdez, Gd, Vrooman, R, Wawrowicz, D, Winchester, De, Alcheikh, A, Allen, B, Atkins, E, Bevan, J, Bonomini, C, Christiansen, J, Clack, L, Craig, E, Dixson, H, Duncan, I, Fredericks, S, Gales, S, Hampson, R, Hanley, T, Hartcher, K, Hassall, J, Kelley, B, Kelly, S, Kidd, T, De Kort, T, Larcos, G, Macdonald, W, Mcgrath, C, Murdoch, E, O'Malley, S, O'Rourke, M, Pack, M, Pearce, R, Praehofer, R, Ramsay, S, Scarlett, L, Smidt, K, Souvannavong, F, Taubman, K, Taylor, G, Tse, K, Unger, S, and Weale, J

Subjects
best practices, Latin America, Nuclear cardiology, PET, radiation dose, SPECT, Cardiology, Guideline Adherence, Health Care Surveys, Humans, Internationality, Middle Aged, Myocardial Perfusion Imaging, Practice Patterns, Physicians', Quality Assurance, Health Care, Quality Improvement, Radiation Exposure, Radiation Protection, Tomography, Emission-Computed, Utilization Review, medicine.medical_specialty, Latin Americans, Cross-sectional study, Practice Patterns, 030204 cardiovascular system & hematology, Effective dose (radiation), 030218 nuclear medicine & medical imaging, NO, 03 medical and health sciences, 0302 clinical medicine, Internal medicine, medicine, Radiology, Nuclear Medicine and imaging, Medical physics, Tomography, Physicians', Guideline adherence, business.industry, Radiation dose, Coronary heart disease, Radiation exposure, Health Care, Emission-Computed, Radiation protection, Cardiology and Cardiovascular Medicine, business, Quality Assurance
Abstract

Comparison of Latin American (LA) nuclear cardiology (NC) practice with that in the rest of the world (RoW) will identify areas for improvement and lead to educational activities to reduce radiation exposure from NC. INCAPS collected data on all SPECT and PET procedures performed during a single week in March-April 2013 in 36 laboratories in 10 LA countries (n = 1139), and 272 laboratories in 55 countries in RoW (n = 6772). Eight “best practices” were identified a priori and a radiation-related Quality Index (QI) was devised indicating the number used. Mean radiation effective dose (ED) in LA was higher than in RoW (11.8 vs 9.1 mSv, p

Published
2015

11. Current worldwide nuclear cardiology practices and radiation exposure: results from the 65 country IAEA Nuclear Cardiology Protocols Cross-Sectional Study (INCAPS)

Author

Einstein, Aj, Pascual, Tn, Mercuri, M, Karthikeyan, G, Vitola, Jv, Mahmarian, Jj, Better, N, Bouyoucef, Se, Hee-Seung Bom, H, Lele, V, Magboo, Vp, Alexánderson, E, Allam, Ah, Al-Mallah, Mh, Flotats, A, Jerome, S, Kaufmann, Pa, Luxenburg, O, Shaw, Lj, Underwood, Sr, Rehani, Mm, Kashyap, R, Paez, D, Dondi, M, INCAPS Investigators Group: Einstein AJ, Alexanderson, E, Allam, A, Bom, H, Mahmarian, J, Vitola, J, Amouri, W, Essabbah, H, Gassama, Ss, Makhdomi, Kb, El Mustapha GI, El Ouchdi, N, Qaïs, N, Soni, N, Vangu, W, Abazid, Rm, Adams, B, Agarwal, V, Alfeeli, Ma, Alnafisi, N, Bernabe, L, Bural, Gg, Chaiwatanarat, T, Chandraguptha, Jm, Cheon, Gj, Cho, I, Dogan, As, Eftekhari, M, Frenkel, A, Garty, I, George, S, Geramifar, P, Golan, H, Habib, S, Hussain, R, Im, H, Jeon, Hj, Kalawat, T, Kang, Wj, Keng, F, Klaipetch, A, Kumar, Pg, Lee, J, Lee, Ww, Lim, I, Macaisa, Cm, Malhotra, G, Mittal, Br, Mohammad, Mh, Mohan, P, Mulyanto, Id, Nariman, D, Nayak, Un, Niaz, K, Nikolov, G, Obaldo, Jm, Ozturk, E, Park, Jm, Park, S, Patel, Cd, Phuong, Hk, Quinon, Ap, Rajini, Tr, Saengsuda, Y, Santiago, J, Sayman, Hb, Shinto, As, Sivasubramaniyan, V, Son, Mh, Sudhakar, P, Syed, Gm, Tamaki, N, Thamnirat, K, Thientunyakit, T, Thongmak, S, Velasco, Dn, Verma, A, Vutrapongwatana, U, Wang, Y, Won, Ks, Yao, Z, Yingsa-nga, T, Yudistiro, R, Yue, Kt, Zafrir, N, Adrian, Sc, Agostini, D, Aguadé, S, Armitage, G, Backlund, M, Backman, M, Baker, M, Balducci, Mt, Bavelaar, C, Berovic, M, Bertagna, F, Beuchel, R, Biggi, A, Bisi, G, Bonini, R, Bradley, A, Brudin, L, Bruno, I, Busnardo, E, Casoni, R, Choudhri, A, Cittanti, C, Clauss, R, Costa, Dc, Costa, M, Dixon, K, Dziuk, M, Egelic, N, Eriksson, I, Fagioli, G, de Faria DB, Florimonte, L, Francini, A, French, M, Gallagher, E, Garai, I, Geatti, O, Genovesi, D, Gianolli, L, Gimelli, A, del Giudice, E, Halliwell, S, Hansson, Mj, Harrison, C, Homans, F, Horton, F, Jędrzejuk, D, Jogi, J, Johansen, A, Johansson, H, Kalnina, M, Kaminek, M, Kiss, A, Kobylecka, M, Kostkiewicz, M, Kropp, J, Kullenberg, R, Lahoutte, T, Lang, O, Larsson, Yh, Lázár, M, Leccisotti, L, Leners, N, Lindner, O, Lipp, Rw, Maenhout, A, Maffioli, L, Marcassa, C, Martins, B, Marzullo, P, Medolago, G, Meeks, Jb, Mendiguchía, Cg, Mirzaei, S, Mori, M, Nardi, B, Nazarenko, S, Nikoletic, K, Oleksa, R, Parviainen, T, Patrina, J, Peace, R, Pirich, C, Piwowarska-Bilska, H, Popa, S, Prakash, V, Pubul, V, Puklavec, L, Rac, S, Ratniece, M, Rogan, Sa, Romeo, A, Rossi, M, Ruiz, D, Sabharwal, N, Salobir, Bg, Santos, Ai, Saranovic, S, Sarkozi, A, Schneider, Rp, Sciagra, R, Scotti, S, Servini, Z, Setti, Lr, Starck, Så, Vajauskas, D, Veselý, J, Vieni, A, Vignati, A, Vito, Im, Weiss, K, Wild, D, Zdraveska-Kochovska, M, Agüro, Rn, Alvarado, N, Barral, Cm, Beretta, M, Berrocal, I, Batista Cuellar JF, Cabral Chang TM, Cabrera Rodríguez LO, Canessa, J, Castro Mora, G, Claudia, Ac, Clavelo, Gf, Cruz Júnior AF, Faccio, Ff, Fernández, Km, Gomez Garibo JR, Gonzalez, U, E P, González, Guzzo, Ma, Jofre, J, Kapitán, M, Kempfer, G, Lopez, Jl, V T, Massardo, Medeiros Colaco, I, Mesquita, Ct, Montecinos, M, Neubauer, S, Pabon, Lm, Puente, A, Rochela Vazquez LM, Serna Macias JA, Silva Pino AG, Tártari Huber FZ, Tovar, Ap, Vargas, L, Wiefels, C, Aljizeeri, A, Alvarez, Rj, Barger, D, Beardwood, W, Behrens, J, Brann, L, Brown, D, Carr, H, Churchwell, K, Comingore, Ga, Corbett, J, Costello, M, Cruz, F, Depinet, T, Dorbala, S, Earles, M, Esteves, Fp, Etherton, E, Fanning RJ Jr, Fornace, J, Franks, L, Gewirtz, H, Gulanchyn, K, Hannah, Cl, Hays, J, Hendrickson, J, Hester, J, Holmes, K, Johnson, A, Jopek, C, Lewin, H, Lyons, J, Manley, C, Meden, J, Moore, S, Moore, Wh, Murthy, V, Nace, R, Neely, D, Nelson, L, Niedermaier, O, Rice, D, Rigs, R, Schiffer, K, Schockling, E, Schultz, T, Schumacker, T, Sheesley, B, Sheikh, A, Siegel, B, Slim, Am, Smith, J, Szulc, M, Tanskersley, N, Tilkemeier, P, Valdez, Gd, Vrooman, R, Wawrowicz, D, Winchester, De, Alcheikh, A, Allen, B, Atkins, E, Bevan, J, Bonomini, C, Christiansen, J, Clack, L, Craig, E, Dixson, H, Duncan, I, Fredericks, S, Gales, S, Hampson, R, Hanley, T, Hartcher, K, Hassall, J, Kelley, B, Kelly, S, Kidd, T, de Kort, T, Larcos, G, Macdonald, W, Mcgrath, C, Murdoch, E, O'Malley, S, O'Rourke, M, Pack, M, Pearce, R, Praehofer, R, Ramsay, S, Scarlett, L, Smidt, K, Souvannavong, F, Taubman, K, Taylor, G, Tse, K, Unger, S, and Weale, J.

Subjects
Male, medicine.medical_specialty, Best practices, Cross-sectional study, Cardiology, Global Health, Radiation Dosage, Effective dose (radiation), NO, Myocardial perfusion imaging, Clinical Protocols, Internal medicine, medicine, Humans, Tomography, Nuclear cardiology, PET, Quality of care, Radiation dose, SPECT, Aged, Cross-Sectional Studies, Female, Guideline Adherence, Middle Aged, Myocardial Perfusion Imaging, Positron-Emission Tomography, Practice Guidelines as Topic, Professional Practice, Quality of Health Care, Radiation Exposure, Regression Analysis, Tomography, Emission-Computed, Single-Photon, Cardiology and Cardiovascular Medicine, medicine.diagnostic_test, business.industry, Radiation exposure, Positron emission tomography, Mauriceau–Smellie–Veit maneuver, Observational study, Emission-Computed, business, Single-Photon
Abstract

Aims To characterize patient radiation doses from nuclear myocardial perfusion imaging (MPI) and the use of radiation-optimizing ‘best practices’ worldwide, and to evaluate the relationship between laboratory use of best practices and patient radiation dose. Methods and results We conducted an observational cross-sectional study of protocols used for all 7911 MPI studies performed in 308 nuclear cardiology laboratories in 65 countries for a single week in March–April 2013. Eight ‘best practices’ relating to radiation exposure were identified a priori by an expert committee, and a radiation-related quality index (QI) devised indicating the number of best practices used by a laboratory. Patient radiation effective dose (ED) ranged between 0.8 and 35.6 mSv (median 10.0 mSv). Average laboratory ED ranged from 2.2 to 24.4 mSv (median 10.4 mSv); only 91 (30%) laboratories achieved the median ED ≤ 9 mSv recommended by guidelines. Laboratory QIs ranged from 2 to 8 (median 5). Both ED and QI differed significantly between laboratories, countries, and world regions. The lowest median ED (8.0 mSv), in Europe, coincided with high best-practice adherence (mean laboratory QI 6.2). The highest doses (median 12.1 mSv) and low QI (4.9) occurred in Latin America. In hierarchical regression modelling, patients undergoing MPI at laboratories following more ‘best practices’ had lower EDs. Conclusion Marked worldwide variation exists in radiation safety practices pertaining to MPI, with targeted EDs currently achieved in a minority of laboratories. The significant relationship between best-practice implementation and lower doses indicates numerous opportunities to reduce radiation exposure from MPI globally.

Published
2015

12. Health-related quality of life profiles, trajectories, persistent symptoms and pulmonary function one year after ICU discharge in invasively ventilated COVID-19 patients, a prospective follow-up study

Author

Antonio Poerio, Andrea Castelli, Sara Piciucchi, Giulia Falò, Davide Allegri, Marco Verri, Andrea Marudi, Massimiliano Mazzolini, Michele Imbriani, Loredana Franchini, Carlo Coniglio, Mirco Leo, Antonella Potalivo, Luigi Lazzari Agli, Roberta Nicali, Marco Cavagnino, Guglielmo Consales, Marina Terzitta, Harri Sintonen, Raffaella Papa, Maria Teresa Minguzzi, Cristiana Laici, Paolo Orlandi, Federica Damiani, Carlo Alberto Mazzoli, Silvia Orlando, Vito Marco Ranieri, Iacopo Cappellini, Valentina Chiarini, Elisa Marinangeli, Stefano Oldani, Virginia Buldini, Marco Tartaglione, Gianluca Zani, Lorenzo Mellini, Carlo Alberto Volta, Irene Ottaviani, Silvia Candini, Filippo Becherucci, Emanuela Giampalma, Maria Concetta Lanza, Federica Ciccarese, Irene Cavalli, Annalisa Marchio, Bruno Balbi, Fabrizio Racca, Matteo Monari, Luca Morini, Anna Malfatto, Elisabetta Bertellini, Francesco Boni, Emanuele Russo, Lorenzo Viola, Michele Valli, Savino Spadaro, Martina Ferioli, Emanuele Matteo, Giovanni Gordini, Marco Contoli, Ilaria Valentini, Chiara Tartivita, Alessia Guzzo, Lorenzo Giuntoli, Gaetano Scaramuzzo, Davide Colombo, Jessica Maccieri, Luca Bissoni, Stefano Nava, Angela Bellocchio, Patrizio Goti, Laura Bernabé, Jonathan Montomoli, Stefano Maitan, Tommaso Meconi, Angelo Senzi, Lorenzo Gamberini, Silvia Pareschi, Stefania Taddei, Angelica Venni, Fabio Ferrari, Marco Miceli, Chiara Capozzi, Elisabetta Marangoni, Lorenzo Tutino, Giulia Felloni, Antonio Siniscalchi, Giacinto Pizzilli, Francesco Muratore, Giorgia Dalpiaz, Federico Moro, Daniele Fecarotti, Vanni Agnoletti, Gabriele Melegari, Rita Golfieri, Federico Domenico Baccarini, Francesca Facondini, Patrizia Pompa Cleta, Marianna Padovani, Eva Bernardi, Tommaso Tonetti, Angelina Adduci, Federico Daniele, Anna Filomena Ferravante, Maurizio Fusari, Igor Bacchilega, Claudia Ravaglia, Nicola Cilloni, Martina Mughetti, Vittorio Pavoni, Ersenad Neziri, Irene Prediletto, Aline Pagni, Gamberini L., Mazzoli C.A., Prediletto I., Sintonen H., Scaramuzzo G., Allegri D., Colombo D., Tonetti T., Zani G., Capozzi C., Dalpiaz G., Agnoletti V., Cappellini I., Melegari G., Damiani F., Fusari M., Gordini G., Laici C., Lanza M.C., Leo M., Marudi A., Papa R., Potalivo A., Montomoli J., Taddei S., Mazzolini M., Ferravante A.F., Nicali R., Ranieri V.M., Russo E., Volta C.A., Spadaro S., Tartaglione M., Chiarini V., Buldini V., Coniglio C., Moro F., Orlando S., Fecarotti D., Cilloni N., Giuntoli L., Bellocchio A., Matteo E., Pizzilli G., Siniscalchi A., Tartivita C., Cavalli I., Castelli A., Marchio A., Bacchilega I., Bernabe L., Facondini F., Morini L., Bissoni L., Viola L., Meconi T., Pavoni V., Venni A., Pagni A., Cleta P.P., Cavagnino M., Guzzo A., Malfatto A., Adduci A., Pareschi S., Bertellini E., Maccieri J., Marinangeli E., Racca F., Verri M., Falo G., Marangoni E., Ottaviani I., Boni F., Felloni G., Baccarini F.D., Terzitta M., Maitan S., Tutino L., Senzi A., Consales G., Becherucci F., Imbriani M., Orlandi P., Candini S., Golfieri R., Ciccarese F., Poerio A., Muratore F., Ferrari F., Mughetti M., Giampalma E., Franchini L., Neziri E., Miceli M., Minguzzi M.T., Mellini L., Piciucchi S., Monari M., Valli M., Daniele F., Ferioli M., Nava S., Lazzari Agli L.A., Valentini I., Bernardi E., Balbi B., Contoli M., Padovani M., Oldani S., Ravaglia C., and Goti P.

Subjects
Pulmonary and Respiratory Medicine, Male, medicine.medical_specialty, Coronavirus disease 2019 (COVID-19), medicine.medical_treatment, Health-related quality of life, Population, Article, NO, Pulmonary function testing, 03 medical and health sciences, 0302 clinical medicine, Quality of life, DLCO, Acute respiratory distress syndrome, COVID-19, Dyspnea, Respiratory function tests, Internal medicine, Medicine, Humans, 030212 general & internal medicine, Prospective Studies, Survivors, education, Aged, Mechanical ventilation, Health related quality of life, education.field_of_study, Respiratory Distress Syndrome, business.industry, Middle Aged, Respiration, Artificial, Patient Discharge, humanities, 3. Good health, Intensive Care Units, 030228 respiratory system, Italy, Quality of Life, Female, business, Icu discharge, Follow-Up Studies
Abstract

Background Health-related quality of life (HRQoL) impairment is often reported among COVID-19 ICU survivors, and little is known about their long-term outcomes. We evaluated the HRQoL trajectories between 3 months and 1 year after ICU discharge, the factors influencing these trajectories and the presence of clusters of HRQoL profiles in a population of COVID-19 patients who underwent invasive mechanical ventilation (IMV). Moreover, pathophysiological correlations of residual dyspnea were tested. Methods We followed up 178 survivors from 16 Italian ICUs up to one year after ICU discharge. HRQoL was investigated through the 15D instrument. Available pulmonary function tests (PFTs) and chest CT scans at 1 year were also collected. A linear mixed-effects model was adopted to identify factors associated with different HRQoL trajectories and a two-step cluster analysis was performed to identify HRQoL clusters. Results We found that HRQoL increased during the study period, especially for the significant increase of the physical dimensions, while the mental dimensions and dyspnea remained substantially unchanged. Four main 15D profiles were identified: full recovery (47.2%), bad recovery (5.1%) and two partial recovery clusters with mostly physical (9.6%) or mental (38.2%) dimensions affected. Gender, duration of IMV and number of comorbidities significantly influenced HRQoL trajectories. Persistent dyspnea was reported in 58.4% of patients, and weakly, but significantly, correlated with both DLCO and length of IMV. Conclusions HRQoL impairment is frequent 1 year after ICU discharge, and the lowest recovery is found in the mental dimensions. Persistent dyspnea is often reported and weakly correlated with PFTs alterations. Trial registration NCT04411459.

Published
2021

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