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1. 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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2. 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

3. 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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4. 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

5. 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

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, TNB, 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, Bouyoucef, SE, Lele, V, Magboo, VPC, Mut, F, Meeks, JB, Alexanderson, 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, 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, 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, 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, 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, S-A, 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, Junior, AFC, Faccio, FF, Fernandez, KM, Garibo, JRG, Gonzalez, U, Gonzalez, PE, 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, 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, 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, O, Pascual, TNB, 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, Bouyoucef, SE, Lele, V, Magboo, VPC, Mut, F, Meeks, JB, Alexanderson, 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, 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, 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, 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, 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, S-A, 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, Junior, AFC, Faccio, FF, Fernandez, KM, Garibo, JRG, Gonzalez, U, Gonzalez, PE, 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, 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, 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

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

Published
2016

7. Validation of Blood-Pool SPECT Heart Atria Measurements

Author

Žigman M, Punda M, Planinc D, Rogan SA, Kusić Z and N, N

Subjects
SPECT, heart atria measurements, cardiovascular system, musculoskeletal system
Abstract

Validation of Blood-Pool SPECT Heart Atria Measurements.

Published
2009

11. Current status of iodine intake in Croatia--the results of 2009 survey.

Author

Kusić Z, Jukić T, Rogan SA, Juresa V, Dabelić N, Stanicić J, Borić M, Lukinac L, Mihaljević I, Punda A, Smokvina A, Topalović Z, and Katalenić M

Subjects
Adult, Child, Croatia epidemiology, Female, Goiter, Endemic drug therapy, Goiter, Endemic metabolism, Humans, Iodine administration & dosage, Iodine urine, Male, Pregnancy, Pregnancy Complications drug therapy, Pregnancy Complications metabolism, Thyroid Gland pathology, Goiter, Endemic epidemiology, Health Surveys statistics & numerical data, Iodine deficiency, Pregnancy Complications epidemiology, Sodium Chloride, Dietary administration & dosage, Thyroid Gland metabolism
Abstract

In 1996, due to persistence of mild to moderate iodine deficiency, new law on obligatory salt iodination with 25 mg of potassium iodide (KI) per kg of salt was implemented in Croatia. Along with a new law, a new program for monitoring of iodine prophylaxis was implemented. Investigations of goiter and iodine intake performed in 2002, demonstrated sufficient iodine intake in Croatia with overall median of urinary iodine concentration (UIC) for schoolchildren in Croatia of 140 microg/L. In 2002, thyroid volumes (TV) measured by ultrasound in schoolchildren from all four geographic regions of Croatia were for the first time within the normal range according to ICCIDD reference values. Nowadays, Croatia is internationally recognized as iodine sufficient country. The aim of the present study was to assess current status of iodine intake in Croatia. The investigation was carried out in 2009. A total of 386 schoolchildren aged 7-10 years from all four major geographic regions of Croatia, 103 euthyroid pregnant women and 36 women of child-bearing age from Zagreb, the capital, were included in the survey. Urinary iodine concentration (UIC) was measured in all participants. Thyroid volumes were measured by ultrasound in schoolchildren from the capital of Zagreb (N = 101) and the village of Rude (N = 56). In the time period 2002-2009, the content of KI was analyzed in 384 salt samples from Croatian salt plants and samples of imported salt. An overall median UIC for schoolchildren in Croatia was 248 microg/L. Median UIC in pregnant women was 159 microg/L, with 50% of samples below and under 150 microg/L. Median UIC in women of child-bearing age was 136 microg/L. Thyroid volumes in schoolchildren were within the normal range according to the new reference values. Mean value of KI/kg of salt in samples from Croatian salt plants was 25.5 mg/kg and 24.9 mg/kg in samples of imported salt. A total of 72/384 (18.8%) of salt samples didn't corresponded to the Croatian law on obligatory salt iodination. Presented data indicate sufficient iodine intake of the Croatian population. Current medians of UIC in schoolchildren in Croatia are significantly higher than medians measured in 2002. This indicates that other potential sources of iodine are present in Croatian diet that may contribute to overall iodine intake. Due to rising medians of UIC in schoolchildren in Croatia, it is important to conduct nutrition studies to identify potential sources of "silent prophylaxis" in order to avoid iodine excess.

Published
2012

12. The vascular hybrid room--operating room of the future.

Author

Hudorović N, Rogan SA, Lovricević I, Zovak M, and Schmidt S

Subjects
Humans, Radiography, Interventional, Surgical Equipment, Vascular Diseases diagnostic imaging, Endovascular Procedures instrumentation, Operating Rooms, Vascular Diseases surgery, Vascular Surgical Procedures instrumentation
Abstract

The last two decades have seen a paradigm shift in the treatment of vascular related diseases from once traditional open surgical repairs to the entire vascular tree being amenable to percutaneous interventions. Neither the classic operating room nor the conventional angiography suite is optimal for both open surgery and endovascular procedures. Important issues for the vascular hybrid operating room include quality of the imaging equipment, radiation burden, ease of use of the equipment, need for specially trained personnel, ergonomics, ability to perform both open and percutaneous procedures, sterile environments, as well as quality and efficiency of patient care. The most important feature of working in a dedicated hybrid vascular suite should be the ability to attain best treatment of vascular patients. Whether the interventional radiologist or the vascular surgeon uses the facilities is of less importance. Establishment of an endovascular operating room suite has the benefit of a sterile environment, and the possibility of performing hybrid procedures and conversions when necessary. Moreover, angiography immediately before treatment gives contemporary anatomical information, and after treatment provides quality control. Consequently, better quality and service can be provided to the individual patient. These changes in the treatment of vascular disease require that a new type of vascular specialist, named 'vascular hybrid surgeon', trained to perform both endovascular and open surgical procedures in this highly complex patient group.

Published
2010

13. The story of the Croatian village of Rude after fifty years of compulsory salt iodination in Croatia.

Author

Jukić T, Dabelić N, Rogan SA, Nõthig-Hus D, Lukinac L, Ljubicić M, and Kusić Z

Subjects
Croatia epidemiology, Goiter, Endemic diet therapy, Goiter, Endemic epidemiology, History, 20th Century, History, 21st Century, Humans, Iodine deficiency, Iodine therapeutic use, Prevalence, Sodium Chloride, Dietary therapeutic use, Goiter, Endemic history, Iodine history, Public Health history, Sodium Chloride, Dietary history
Abstract

The village of Rude is situated near Zagreb, the capital of Croatia in the last Alpine valley on Balkan. In the past, the village was well-known area of severe iodine deficiency disorders (IDD). In 1952', distinguished Croatian endocrinologist Professor Josip Matovinović carried out detailed village survey. Goiter prevalence in school-age children was 85.0% (with 2.3% of cretins in the village). In 1953, the first regulation on compulsory salt iodination with 10 mg of KI/kg of salt was established in former Yugoslavia. Ten years later a dramatic decrease in goiter prevalence was recorded in all endangered areas of the country and no new cretins appeared. However, at the beginning of 1990' mild to moderate iodine deficiency still persisted in Croatia. In 1991, the village of Rude survey demonstrated goiter prevalence in school-age children of 35.0% and median of urinary iodine excretion (UIE) of 7.4 microg/dL. In 1996, the new obligatory regulation with 25 mg of KI/kg of salt was established in Croatia. The study aim was to monitor IDD status in the village after the new law on compulsory salt iodination. Measurements of UIE and thyroid volumes (Tvol) by ultrasound were performed in 7-11-y-old schoolchildren living in the village of Rude. Medians of UIE and body surface area (BSA)-adjusted Tvol in boys and girls were calculated. The study included 84 children in 1997, 132 in 2000, 72 in 2002, 85 in 2003 and 46 in 2004 for UIE measurement. Thyroid volumes were measured in 1999 (43 boys and 26 girls) and in 2005 (22 boys and 26 girls). Data were compared with the new WHO/ICCIDD reference values. Medians of UIE in schoolchildren from the village of Rude demonstrated rising values in microg/dL: 11.4 in 1997, 14.3 in 2000, 17.3 in 2002, 15.4 in 2003 and 19.0 in 2004. Significant decrease in BSA-adjusted Tvol was recorded from 1999-2005 in boys and girls from the village of Rude and in 2005 Tvol were within the normal range according to the new international reference values for Tvol in iodine-sufficient schoolchildren. As a result of increased iodine prophylaxis, IDD no longer exist in Croatia. Monitoring of IDD status in the village of Rude after new law on compulsory salt iodination in Croatia demonstrated rising medians of UIE together with significant reduction of Tvol. In 2005, Tvol in schoolchildren from the village of Rude were within the normal range according to the new international reference values for Tvol in iodine-sufficient schoolchildren.

Published
2008

14. Biological value of melanoma inhibitory activity serum concentration in patients with primary skin melanoma.

Author

Vucetić B, Rogan SA, Hrabac P, Hudorović N, Cupić H, Lukinac L, Ledinsky M, Matejcić A, Lovricević I, and Zekan M

Subjects
Adult, Aged, Biomarkers, Tumor analysis, Biomarkers, Tumor blood, Carcinoma, Basal Cell blood, Carcinoma, Basal Cell pathology, Dysplastic Nevus Syndrome blood, Female, Humans, Lymphatic Metastasis, Male, Melanoma pathology, Middle Aged, Predictive Value of Tests, Prognosis, Reference Values, Sensitivity and Specificity, Sentinel Lymph Node Biopsy, Skin Neoplasms pathology, Extracellular Matrix Proteins blood, Melanoma blood, Melanoma diagnosis, Neoplasm Proteins blood, Skin Neoplasms blood, Skin Neoplasms diagnosis
Abstract

Melanoma inhibitory activity (MIA) protein was identified in significant quantities in primary and metastatic malignant melanomas, where it has an important role in promoting tumor development and progression. Our hypothesis was that MIA serum level will be elevated in patients with metastases or local spreading of the disease before any symptom of such progression is clinically apparent. We compared MIA serum levels in two groups of patients with primary melanoma; those with positive as opposed to those with negative sentinel lymph nodes. In addition, MIA serum levels were studied in two control groups; patients with dysplastic nevi and patients with basal cell carcinoma. A blood sample was obtained from each patient included in the study and MIA levels were assessed using standard enzyme-linked immunosorbent assay method. Patients with histologically positive sentinel lymph nodes, meaning that tumor cells were found in the lymph nodes, had much higher mean MIA values than any other patient group considered in this study. With mean value of 14.53 ng/ml, it was almost twice as high as mean MIA value in patients with histologically negative sentinel lymph nodes (7.32 ng/ml) and more than twice as high than any of the two control groups (P<0.001). However, neither the classification by Clarke nor the classification by Breslow could be used to distinguish patients with positive sentinel lymph nodes from those with negative sentinel lymph nodes. In our opinion, MIA serum level is the ideal test for screening the tumor spread to sentinel lymph nodes.

Published
2008
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