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1. Worldwide Variation in the Use of Nuclear Cardiology Camera Technology, Reconstruction Software, and Imaging Protocols.

Author

Hirschfeld CB, Mercuri M, Pascual TNB, Karthikeyan G, Vitola JV, Mahmarian JJ, Better N, Bouyoucef SE, Hee-Seung Bom H, Lele V, Magboo VPC, Alexánderson E, Allam AH, Al-Mallah MH, Dorbala S, Flotats A, Jerome S, Kaufmann PA, Luxenburg O, Shaw LJ, Underwood SR, Rehani MM, Paez D, Dondi M, and Einstein AJ

Subjects
Cross-Sectional Studies, Humans, Predictive Value of Tests, Radiation Dosage, Software, Technology, Tomography, Emission-Computed, Single-Photon, Tomography, X-Ray Computed, Cardiology, Myocardial Perfusion Imaging
Abstract

Objectives: This study sought to describe worldwide variations in the use of myocardial perfusion imaging hardware, software, and imaging protocols and their impact on radiation effective dose (ED)., Background: Concerns about long-term effects of ionizing radiation have prompted efforts to identify strategies for dose optimization in myocardial perfusion scintigraphy. Studies have increasingly shown opportunities for dose reduction using newer technologies and optimized protocols., Methods: Data were submitted voluntarily to the INCAPS (International Atomic Energy Agency Nuclear Cardiology Protocols Study) registry, a multinational, cross-sectional study comprising 7,911 imaging studies from 308 labs in 65 countries. The study compared regional use of camera technologies, advanced post-processing software, and protocol characteristics and analyzed the influence of each factor on ED., Results: Cadmium-zinc-telluride and positron emission tomography (PET) cameras were used in 10% (regional range 0% to 26%) and 6% (regional range 0% to 17%) of studies worldwide. Attenuation correction was used in 26% of cases (range 10% to 57%), and advanced post-processing software was used in 38% of cases (range 26% to 64%). Stress-first single-photon emission computed tomography (SPECT) imaging comprised nearly 20% of cases from all world regions, except North America, where it was used in just 7% of cases. Factors associated with lower ED and odds ratio for achieving radiation dose ≤9 mSv included use of cadmium-zinc-telluride, PET, advanced post-processing software, and stress- or rest-only imaging. Overall, 39% of all studies (97% PET and 35% SPECT) were ≤9 mSv, while just 6% of all studies (32% PET and 4% SPECT) achieved a dose ≤3 mSv., Conclusions: Newer-technology cameras, advanced software, and stress-only protocols were associated with reduced ED, but worldwide adoption of these practices was generally low and varied significantly between regions. The implementation of dose-optimizing technologies and protocols offers an opportunity to reduce patient radiation exposure across all world regions., Competing Interests: Funding Support and Author Disclosures This work was supported by the International Atomic Energy Agency, the Margaret Q. Landenberger Research Foundation (in memory of Prof. A. Donny Strosberg), and the Irving Scholars Program (to Dr. Einstein). Dr. Einstein has served as a consultant to W.L. Gore and Associates; has received an honorarium for lecturing from Ionetix; has received institutional research grants from the National Institutes of Health, International Atomic Energy Agency, Canon Medical Systems, GE Healthcare, Roche Medical Systems, and W.L. Gore and Associates; and has received travel expenses unrelated to activities listed from HeartFlow. Dr. Kaufmann has received institutional research grant support from GE Healthcare. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose., (Copyright © 2021 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.)

Published
2021
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2. Nuclear cardiology practices and radiation exposure in Africa: results from the IAEA Nuclear Cardiology Protocols Study (INCAPS).

Author

Bouyoucef SE, Mercuri M, Pascual TN, Allam AH, Vangu M, Vitola JV, Better N, Karthikeyan G, Mahmarian JJ, Rehani MM, Kashyap R, Dondi M, Paez D, and Einstein AJ

Subjects
Africa epidemiology, Aged, Cross-Sectional Studies, Female, Humans, Incidence, Male, Middle Aged, Cardiology statistics & numerical data, Heart Diseases diagnosis, Myocardial Perfusion Imaging adverse effects, Radiation Exposure adverse effects, Radiation Injuries epidemiology, Registries, Tomography, Emission-Computed, Single-Photon adverse effects
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
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3. Assessing the need for nuclear cardiology and other advanced cardiac imaging modalities in the developing world.

Author

Vitola JV, Shaw LJ, Allam AH, Orellana P, Peix A, Ellmann A, Allman KC, Lee BN, Siritara C, Keng FY, Sambuceti G, Kiess MC, Giubbini R, Bouyoucef SE, He ZX, Thomas GS, Mut F, and Dondi M

Subjects
Developed Countries, Cardiology statistics & numerical data, Diagnostic Imaging statistics & numerical data, Health Services Accessibility statistics & numerical data, Needs Assessment, Nuclear Medicine statistics & numerical data
Abstract

Background: In 2005, 80% of cardiovascular disease (CVD) deaths occurred in low- to middle-income countries (i.e., developing nations). Cardiovascular imaging, such as myocardial perfusion SPECT, is one method that may be applied to detect and foster improved detection of at-risk patients. This document will review the availability and utilization for nuclear cardiology procedures worldwide and propose strategies to devise regional centers of excellence to achieve quality imaging around the world., Methods: As a means to establish the current state of nuclear cardiology, International Atomic Energy Agency member and non-member states were queried as to annual utilization of nuclear cardiology procedures. Other sources for imaging statistics included data from medical societies (American Society of Nuclear Cardiology, European Society of Cardiology, and the European Association of Nuclear Medicine) and nuclear cardiology working groups within several nations. Utilization was calculated by dividing annual procedural volume by 2007 population statistics (/100,000) and categorized as high (>1,000/100,000), moderate-high (250-999/100,000), moderate (100-249/100,000), low-moderate (50-99/100,000) and low (<50/100,000)., Results: High nuclear cardiology utilization was reported in the United States, Canada, and Israel. Most Western European countries, Australia, and Japan reported moderate-high utilization. With the exception of Argentina, Brazil, Colombia and Uruguay, South America had low usage. This was also noted across Eastern Europe, Russia, and Asia. Utilization patterns generally mirrored each country's gross domestic product. However, nuclear cardiology utilization was higher for developing countries neighboring moderate-high "user" countries (e.g., Algeria and Egypt); perhaps the result of accessible high-quality training programs., Conclusions: Worldwide utilization patterns for nuclear cardiology vary substantially and may be influenced by physician access to training and education programs. Development of regional training centers of excellence can guide utilization of nuclear cardiology through the application of guideline- and appropriateness-driven testing, training, continuing education, and quality assurance programs aiding developing nations to confront the epidemics of CVD.

Published
2009
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4. 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
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5. 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

6. 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
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7. 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

8. 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

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