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1. Abstracts of original contributions ASNC 2004 9th annual scientific session September 3-–October 3, 2004 New York, New York

Author: Abidov, A, Hachamovitch, R, Friedman, JD, Hayes, SW, Kang, X, Cohen, I, Germano, G, Berman, DS, Kjaer, A, Cortsen, A, Federspiel, M, Hesse, B, Holm, S, O’Connor, M, Dhalla, AK, Wong, M-Y, Wang, W-Q, Belardinelli, L, Therapeutics, CV, Epps, A, Dave, S, Brewer, K, Chiaramida, S, Gordon, L, Hendrix, GH, Feng, B, Pretorius, PH, Bruyant, PP, Boening, G, Beach, RD, Gifford, HC, King, MA, Fessler, JA, Hsu, B-L, Case, JA, Gegen, LL, Hertenstein, GK, Cullom, SJ, Bateman, TM, Akincioglu, C, Abidov, A, Nishina, H, Kavanagh, P, Kang, X, Aboul-Enein, F, Yang, L, Hayes, S, Friedman, J, Berman, D, Germano, G, Santana, CA, Rivero, A, Folks, RD, Grossman, GB, Cooke, CD, Hunsche, A, Faber, TL, Halkar, R, Garcia, EV, Hansen, CL, Silver, S, Kaplan, A, Rasalingam, R, Awar, M, Shirato, S, Reist, K, Htay, T, Mehta, D, Cho, J-H, Heo, J, Dubovsky, E, Calnon, DA, Grewal, KS, George, PB, Richards, DR, Hsi, DH, Singh, N, Meszaros, Z, Thomas, JL, Reyes, E, Loong, CY, Latus, K, Anagnostopoulos, C, Underwood, SR, Kostacos, EJ, Araujo, LI, Kostacos, EJ, Araujo, LI, Lewin, HC, Hyun, MC, DePuey, EG, Tanaka, H, Chikamori, T, Igarashi, Y, Harafuji, K, Usui, Y, Yanagisawa, H, Hida, S, Yamashina, A, Nasr, HA, Mahmoud, SA, Dalipaj, MM, Golanowski, LN, Kemp, RA de, Chow, BJ, Beanlands, RS, Ruddy, TD, Michelena, HI, Mikolich, BM, McNelis, P, Decker, WA Van, Stathopoulos, I, Duncan, S- A, Isasi, C, Travin, MI, Kritzman, JN, Ficaro, EP, Corbett, JR, Allison, JS, Weinsaft, JW, Wong, FJ, Szulc, M, Okin, PM, Kligfield, P, Harafuji, K, Chikamori, T, Igarashi, Y, Tanaka, H, Usui, Y, Yanagisawa, H, Hida, S, Ishimaru, S, Yamashima, A, Giedd, KN, Bergmann, SR, Shah, S, Emmett, L, Allman, KC, Magee, M, Van Gaal, W, Kritharides, L, Freedman, B, Abidov, A, Gerlach, J, Akincioglu, C, Friedman, J, Kavanagh, P, Miranda, R, Germano, G, Berman, DS, Hayes, SW, Damera, N, Lone, B, Singh, R, Shah, A, Yeturi, S, Prasad, Y, Blum, S, Heller, EN, Bhalodkar, NC, Koutelou, M, Kollaros, N, Theodorakos, A, Manginas, A, Leontiadis, E, Kouzoumi, A, Cokkinos, D, Mazzanti, M, Marini, M, Cianci, G, Perna, GP, Pai, M, Greenberg, MD, Liu, F, Frankenberger, O, Kokkinos, P, Hanumara, D, Goheen, E, Wu, C, Panagiotakos, D, Fletcher, R, Greenberg, MD, Liu, F, Frankenberger, O, Kokkinos, P, Hanumara, D, Goheen, E, Rodriguez, OJ, Iyer, VN, Lue, M, Hickey, KT, Blood, DK, Bergmann, SR, Bokhari, S, Chareonthaitawee, P, Christensen, SD, Allen, JL, Kemp, BJ, Hodge, DO, Ritman, EL, Gibbons, RJ, Smanio, P, Riva, G, Rodriquez, F, Tricoti, A, Nakhlawi, A, Thom, A, Pretorius, PH, King, MA, Dahlberg, S, Leppo, J, Slomka, PJ, Nishina, H, Berman, DS, Akincioglu, C, Abidov, A, Friedman, JD, Hayes, SW, Germano, G, Petrovici, R, Husain, M, Lee, DS, Nanthakumar, K, Iwanochko, RM, Brunken, RC, DiFilippo, F, Neumann, DR, Bybel, B, Herrington, B, Bruckbauer, T, Howe, C, Lohmann, K, Hayden, C, Chatterjee, C, Lathrop, B, Brunken, RC, Chen, MS, Lohmann, KA, Howe, WC, Bruckbauer, T, Kaczur, T, Bybel, B, DiFilippo, FP, Druz, RS, Akinboboye, OA, Grimson, R, Nichols, KJ, Reichek, N, Ngai, K, Dim, R, Ho, K- T, Pary, S, Ahmed, SU, Ahlberg, A, Cyr, G, Vitols, PJ, Mann, A, Alexander, L, Rosenblatt, J, Mieres, J, Heller, GV, Ahmed, SU, Ahlberg, AW, Cyr, G, Navare, S, O’Sullivan, D, Heller, GV, Chiadika, S, Lue, M, Blood, DK, Bergmann, SR, Bokhari, S, Heston, TF, Heller, GV, Cerqueira, MD, Jones, PG, Bryngelson, JR, Moutray, KL, Gegen, LL, Hertenstein, GK, Moser, K, Case, JA, Zellweger, MJ, Burger, PC, Pfisterer, ME, Mueller-Brand, J, Kang, WJ, Lee, BI, Lee, DS, Paeng, JC, Lee, JS, Chung, J-K, Lee, MC, To, BN, O’Connell, WJ, Botvinick, EH, Duvall, WL, Croft, LB, Einstein, AJ, Fisher, JE, Haynes, PS, Rose, RK, Henzlova, MJ, Prasad, Y, Vashist, A, Blum, S, Sagar, P, Heller, EN, Kuwabara, Y, Nakayama, K, Tsuru, Y, Nakaya, J, Shindo, S, Hasegawa, M, Komuro, I, Liu, Y-H, Wackers, F, Natale, D, DePuey, G, Taillefer, R, Araujo, L, Kostacos, E, Allen, S, Delbeke, D, Anstett, F, Kansal, P, Calvin, JE, Hendel, RC, Gulati, M, Pratap, P, Takalkar, A, Kostacos, E, Alavi, A, Araujo, L, Melduni, RM, Duncan, S-A, Travin, MI, Isasi CR, Rivero, A, Santana, C, Esiashvili, S, Grossman, G, Halkar, R, Folks, RD, Garcia, EV, Su, H, Dobrucki, LW, Chow, C, Hu, X, Bourke, BN, Cavaliere, P, Hua, J, Sinusas, AJ, Spinale, FG, Sweterlitsch, S, Azure, M, Edwards, DS, Sudhakar, S, Chyun, DA, Young, LH, Inzucchi, SE, Davey, JA, Wackers, FJ, Noble, GL, Navare, SM, Calvert, J, Hussain, SA, Ahlberg, AM, Katten, DM, Boden, WE, Heller, GV, Shaw, LJ, Yang, Y, Antunes, A, Botelho, MF, Gomes, C, de Lima, JJP, Silva, ML, Moreira, JN, Simões, S, GonÇalves, L, Providência, LA, Elhendy, A, Bax, JJ, Schinkel, AF, Valkema, R, van Domburg, RT, Poldermans, D, Arrighi, J, Lampert, R, Burg, M, Soufer, R, Veress, AI, Weiss, JA, Huesman, RH, Gullberg, GT, Moser, K, Case, JA, Loong, CY, Prvulovich, EM, Reyes, E, Aswegen, A van, Anagnostopoulos, C, Underwood, SR, Htay, T, Mehta, D, Sun, L, Lacy, J, Heo, J, Brunken, RC, Kaczur, T, Jaber, W, Ramakrishna, G, Miller, TD, O’connor, MK, Gibbons, RJ, Bural, GG, Mavi, A, Kumar, R, El-Haddad, G, Srinivas, SM, A Alavi, El-Haddad, G, Alavi, A, Araujo, L, Thomas, GS, Johnson, CM, Miyamoto, MI, Thomas, JJ, Majmundar, H, Ryals, LA, Ip, ZTK, Shaw, LJ, Bishop, HA, Carmody, JP, Greathouse, WG, Yanagisawa, H, Chikamori, T, Tanaka, H, Usui, Y, Igarashi, U, Hida, S, Morishima, T, Tanaka, N, Takazawa, K, Yamashina, A, Diedrichs, H, Weber, M, Koulousakis, A, Voth, E, Schwinger, RHG, Mohan, HK, Livieratos, L, Gallagher, S, Bailey, DL, Chambers, J, Fogelman, I, Sobol, I, Barst, RJ, Nichols, K, Widlitz, A, Horn, E, Bergmann, SR, Chen, J, Galt, JR, Durbin, MK, Ye, J, Shao, L, Garcia, EV, Mahenthiran, J, Elliott, JC, Jacob, S, Stricker, S, Kalaria, VG, Sawada, S, Scott, JA, Aziz, K, Yasuda, T, Gewirtz, H, Hsu, BL, Moutray, K, Udelson, JE, Barrett, RJ, Johnson, JR, Menenghetti, C., Taillefer, R, Ruddy, T, Hachamovitch, R, Jenkins, SA, Massaro, J, Haught, H, Lim, CS, Underwood, R, Rosman, J, Hanon, S, Shapiro, M, Schweitzer, P, VanTosh, A, Jones, S, Harafuji, K, Giedd, K N, Johnson, N P, Berliner, J I, Sciacca, R R, Chou, R L, Hickey, K T, Bokhari, S S, Rodriguez, O, Bokhari, S, Moser, KW, Moutray, KL, Koutelou, M, Theodorakos, A, Kollaros, N, Manginas, A, Leontiadis, E, Cokkinos, D, Mazzanti, M, Marini, M, Cianci, G, Perna, GP, Nanasato, M, Fujita, H, Toba, M, Nishimura, T, Nikpour, M, Urowitz, M, Gladman, D, Ibanez, D, Harvey, P, Floras, J, Rouleau, J, Iwanochko, R, Pai, M, Guglin, ME, Ginsberg, FL, Reinig, M, Parrillo, JE, Cha, R, Merhige, ME, Watson, GM, Oliverio, JG, Shelton, V, Frank, SN, Perna, AF, Ferreira, MJ, Ferrer-Antunes, AI, Rodrigues, V, Santos, F, Lima, J, Cerqueira, MD, Magram, MY, Lodge, MA, Babich, JW, Dilsizian, V, Line, BR, Bhalodkar, NC, Lone, B, Singh, R, Prasad, Y, Yeturi, S, Blum, S, Heller, EN, Rodriguez, OJ, Skerrett, D, Charles, C, Shuster, MD, Itescu, S, Wang, TS, Bruyant, PP, Pretorius, PH, Dahlberg, S, King, MA, Petrovici, R, Iwanochko, RM, Lee, DS, Emmett, L, Husain, M, Hosokawa, R, Ohba, M, Kambara, N, Tadamura, E, Kubo, S, Nohara, R, Kita, T, Thompson, RC, McGhie, AI, O’Keefe, JH, Christenson, SD, Chareonthaitawee, P, Kemp, BJ, Jerome, S, Russell, TJ, Lowry, DR, Coombs, VJ, Moses, A, Gottlieb, SO, Heiba, SI, Yee, G, Coppola, J, Elmquist, T, Braff, R, Youssef, I, Ambrose, JA, Abdel-Dayem, HM, Canto, J, Dubovsky, E, Scott, J, Terndrup, TE, Faber, TL, Folks, RD, Dim, UR, Mclaughlin, J, Pollepalle, D, Schapiro, W, Wang, Y, Akinboboye, O, Ngai, K, Druz, RS, Polepalle, D, Phippen-Nater, B, Leonardis, J, and Druz, R
Published: 2004
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2. 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, Bom, HHS, Lele, V, Magboo, VPC, Alexanderson, 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: SPECT, camera technology, &nbsp, myocardial perfusion scintigraphy, radiation dose reduction, nuclear cardiology protocols
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
Published: 2021

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

Author: Al-Mallah, Mh, Pascual, Tnb, Mercuri, M, Vitola, Jv, Karthikeyan, G, Better, N, Dondi, M, Paez, D, Eistein, Aj, Bouyoucef, Se, Allam, Ah, Vangu, M, Rehani, Mm, Kashyap, R, Lele, V, Magboo, Vpc, Mahmarian, Jj, Mut, F, Alexánderson, E, Allam, A, Bom, H, Flotats, A, Jerome, S, Kaufmann, Pa, Luxenburg, O, Mahmarian, J, Shaw, Lj, Underwood, Sr, Amouri, W, Essabbah, H, Gassama, Ss, Makhdomi, Kb, El Mustapha, Gie, El Ouchdi, N, Qaïs, N, Soni, N, Vangu, W, Abazid, Rm, Adams, B, Agarwal, V, Alfeeli, Ma, Alnafisi, N, Bernabe, L, Bural, Gg, Chaiwatanarat, T, Chandraguptha, Jm, Cheon, Gj, Cho, I, Dogan, As, Eftekhari, M, Frenkel, A, Garty, I, George, S, Geramifar, P, Golan, H, Habib, S, Hussain, R, Im, H, Jeon, H-J, Kalawat, T, Kang, Wj, Keng, F, Klaipetch, A, Kumar, Pg, Lee, J, Lee, Ww, Lim, I, Macaisa, Cmm, Malhotra, G, Mittal, Br, Mohammad, Mh, Mohan, P, Mulyanto, Id, Nariman, D, Nayak, Un, Niaz, K, Nikolov, G, Obaldo, Jm, Ozturk, E, Park, Jm, Park, S, Patel, Cd, Phuong, Hk, Quinon, Ap, Rajini, Tr, Saengsuda, Y, Santiago, J, Sayman, Hb, Shinto, As, Sivasubramaniyan, V, Son, Mh, Sudhakar, P, Syed, Gms, Tamaki, N, Thamnirat, K, Thientunyakit, T, Thongmak, S, Velasco, Dn, Verma, A, Vutrapongwatana, U, Wang, Y, Won, Ks, Yao, Z, Yingsa-Nga, T, Yudistiro, R, Yue, Kt, Zafrir, N, Adrian, Sc, Agostini, D, Aguadé, S, Armitage, G, Backlund, M, Backman, M, Baker, M, Balducci, Mt, Bavelaar, C, Berovic, M, Bertagna, F, Beuchel, R, Biggi, A, Bisi, G, Bonini, R, Bradley, A, Brudin, L, Bruno, I, Busnardo, E, Casoni, R, Choudhri, A, Cittanti, C, Clauss, R, Costa, Dc, Costa, M, Dixon, K, Dziuk, M, Egelic, N, Eriksson, I, Fagioli, G, De Faria, Db, Florimonte, L, Francini, Alberto, French, M, Gallagher, E, Garai, I, Geatti, O, Genovesi, D, Gianolli, L, Gimelli, A, Del Giudice, E, Halliwell, S, Hansson, Mj, Harrison, C, Homans, F, Horton, F, Jȩdrzejuk, D, Jogi, J, Johansen, A, Johansson, H, Kalnina, M, Kaminek, M, Kiss, A, Kobylecka, M, Kostkiewicz, M, Kropp, J, Kullenberg, R, Lahoutte, T, Lang, O, Larsson, Yh, Lázár, M, Leccisotti, L, Leners, N, Lindner, O, Lipp, Rw, Maenhout, A, Maffioli, L, Marcassa, C, Martins, B, Marzullo, P, Medolago, G, Mendiguchía, Cg, Mirzaei, S, Mori, M, Nardi, B, Nazarenko, S, Nikoletic, K, Oleksa, R, Parviainen, T, Patrina, J, Peace, R, Pirich, C, Piwowarska-Bilska, H, Popa, S, Prakash, V, Pubul, V, Puklavec, L, Rac, S, Ratniece, M, Rogan, Sa, Romeo, Annunziata, Rossi, M, Ruiz, D, Sabharwal, N, Salobir, Bg, Santos, Ai, Saranovic, S, Sarkozi, A, Schneider, Rp, Sciagra, R, Scotti, S, Servini, Z, Setti, Lr, Starck, S-A., Vajauskas, D, Veselý, J, Vieni, A, Vignati, A, Vito, I. M., Weiss, K, Wild, D, Zdraveska-Kochovska, M, Agüro, Rn, Alvarado, N, Barral, Cm, Beretta, M, Berrocal, I, Batista Cuellar, Jf, Cabral Chang, T-M, Cabrera Rodríguez, Lo, Canessa, J, Castro Mora, G, Claudia, Ac, Clavelo, Gf, Cruz, Af, Faccio, Ff, Fernández, Km, Gomez Garibo, Jr, Gonzalez, U, González, Pe, Guzzo, Ma, Jofre, J, Kapitán, M, Kempfer, G, Lopez, Jl, Massardo, Tv, Medeiros Colaco, I, Mesquita, Ct, Montecinos, M, Neubauer, S, Pabon, Lm, Puente, A, Rochela Vazquez, Lm, Serna Macias, Ja, Silva Pino, Ag, Tártari Huber, Fz, Tovar, Ap, Vargas, L, Wiefels, C, Aljizeeri, A, Alvarez, Rj, Barger, D, Beardwood, W, Behrens, J, Brann, L, Brown, D, Carr, H, Churchwell, K, Comingore, Ga, Corbett, J, Costello, M, Cruz, F, Depinet, T, Dorbala, S, Earles, M, Esteves, Fp, Etherton, E, Fanning, Rj, Fornace, J, Franks, L, Gewirtz, H, Gulanchyn, K, Hannah, C-L, Hays, J, Hendrickson, J, Hester, J, Holmes, K, Johnson, A, Jopek, C, Lewin, H, Lyons, J, Manley, C, Meden, J, Moore, S, Moore, Wh, Murthy, V, Nace, R, Neely, D, Nelson, L, Niedermaier, O, Rice, D, Rigs, R, Schiffer, K, Schockling, E, Schultz, T, Schumacker, T, Sheesley, B, Sheikh, A, Siegel, B, Slim, Am, Smith, J, Szulc, Mc, Tanskersley, N, Tilkemeier, P, Valdez, Gd, Vrooman, R, Wawrowicz, D, Winchester, De, Alcheikh, A, Allen, B, Atkins, E, Bevan, J, Bonomini, C, Christiansen, J, Clack, L, Craig, E, Dixson, H, Duncan, I, Fredericks, S, Gales, S, Hampson, R, Hanley, T, Hartcher, K, Hassall, J, Kelley, B, Kelly, S, Kidd, T, De Kort, T, Larcos, G, Macdonald, W, Mcgrath, C, Murdoch, E, O'Malley, S, O'Rourke, M, Pack, M, Pearce, R, Praehofer, R, Ramsay, S, Scarlett, L, Smidt, K, Souvannavong, F, Taubman, K, Taylor, G, Tse, K, Unger, S, and Weale, J
Subjects: Ionizing radiation, Male, medicine.medical_specialty, Cross-sectional study, Cardiology, Guidelines, 030204 cardiovascular system & hematology, Radiation Dosage, Effective dose (radiation), NO, Cohort Studies, 03 medical and health sciences, Myocardial perfusion imaging, Age, 0302 clinical medicine, Internal medicine, Humans, Medicine, 030212 general & internal medicine, Tomography, Age Factors, Aged, Cross-Sectional Studies, Female, Middle Aged, Myocardial Perfusion Imaging, Positron-Emission Tomography, Practice Guidelines as Topic, Radiation Exposure, Retrospective Studies, Tomography, Emission-Computed, Single-Photon, Nuclear Energy, medicine.diagnostic_test, business.industry, Retrospective cohort study, Radiation exposure, Cohort, Emission-Computed, Cardiology and Cardiovascular Medicine, business, Single-Photon, Cohort study
Abstract: There is growing concern about radiation exposure from nuclear myocardial perfusion imaging (MPI), particularly among younger patients who are more prone to develop untoward effects of ionizing radiation, and hence US and European professional society guidelines recommend age as a consideration in weighing radiation risk from MPI. We aimed to determine how patient radiation doses from MPI vary across age groups in a large contemporary international cohort.Data were collected as part of a global cross-sectional study of centers performing MPI coordinated by the International Atomic Energy Agency (IAEA). Sites provided information on each MPI study completed during a single week in March-April 2013. We compared across age groups laboratory adherence to pre-specified radiation-related best practices, radiation effective dose (ED; a whole-body measure reflecting the amount of radiation to each organ and its relative sensitivity to radiation's deleterious effects), and the proportion of patients with ED ≤ 9 mSv, a target level specified in guidelines.Among 7911 patients undergoing MPI in 308 laboratories in 65 countries, mean ED was 10.0 ± 4.5 mSv with slightly higher exposure among younger age groups (trend p value 0.001). There was no difference in the proportion of patients with ED ≤ 9 mSv across age groups, or in adherence to best practices based on the median age of patients in a laboratory.In contemporary nuclear cardiology practice, the age of the patient appears not to impact protocol selection and radiation dose, contrary to professional society guidelines.
Published: 2018
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4. HISTOLOGY OF HIBERNATING MYOCARDIUM CHARACTERISED BY T1-201 IMAGING AND DOBUTAMINE CINE MRI

Author: Gunning, MG, Kaprielian, RR, Pepper, J, Pennell, DJ, Fox, K, Sheppard, Severs, NJ, and Underwood, SR
Published: 1998

5. DO AORTIC COMPLIANCE AND CORONARY CALCIFICATION PREDICT THE PRESENCE OF CORONARY ARTERY DISEASE?

Author: Mohiaddin, RH, Roberts, RH, Gatehouse, PG, Stock, K, Yang, GZ, Rubens, M, Sutton, G, Wood, D, and Underwood, SR
Published: 1997

6. ADENOSINE MYOCARDIAL PERFUSION SCINTIGRAPHY: CAN CLINICAL OBSERVATIONS PREDICT ISCHAEMIA?

Author: Serup-Hansen, K and Underwood, SR
Published: 1997

7. IDENTIFICATION OF HIBERNATING MYOCARDIUM: A COMPARISON OF TI-201, Tc-99m TETROFOSMIN, AND DOBUTAMINE CINE MAGNETIC RESONANCE IMAGING

Author: Gunning, MG, Knight, CJ, Anagnostopoulos, C, Chua, TP, Burman, E, Pennell, DJ, Pepper, J, Ell, PJ, Fox, K, and Underwood, SR
Published: 1996

8. MYOCARDIAL PERFUSION IMAGING PERFORMED USING ECHO-PLANAR SINGLE SHOT MAGNETIC RESONANCE IMAGING WITH A MOBILE 0.5 TESLA SCANNER

Author: Pennell, DJ, Gatehouse, PD, Burman, Underwood, SR, and Firmin
Published: 1996

9. Limitations of Chest Pain Categorization Models to Predict Coronary Artery Disease

Author: Rovai, D, Neglia, D, Lorenzoni, V, Caselli, C, Knuuti, J, Underwood, SR, and EVINCI Study Investigators
Subjects: Adult, Male, medicine.medical_specialty, Atypical Angina, Population, Fractional flow reserve, Coronary Artery Disease, Chest pain, Angina Pectoris, Angina, Coronary artery disease, Cohort Studies, Sex Factors, Predictive Value of Tests, Risk Factors, Internal medicine, medicine, Humans, Age Factors, Aged, Europe, Female, Middle Aged, Symptom Assessment, Cardiology and Cardiovascular Medicine, Medicine (all), cardiovascular diseases, education, education.field_of_study, business.industry, ta3121, medicine.disease, Stenosis, Coronary vessel, Cardiology, medicine.symptom, business
Abstract: We aimed to evaluate how chest pain categorization, currently used to assess the pretest probability of coronary artery disease (CAD), predicts the actual presence of CAD in a population of patients with stable symptoms. We studied 475 consecutive patients enrolled in the Evaluation of Integrated Cardiac Imaging for the Detection and Characterization of Ischemic Heart Disease study based on possible symptoms of CAD. Chest pain or discomfort was categorized as typical angina, atypical angina, or as nonanginal according to the guidelines. Exertional dyspnea and fatigue suspected to be angina equivalents were classified as atypical angina. Patients with a probability of CAD 90% based on age, gender, and symptoms were excluded. The end points of this substudy were significant CAD (defined by invasive coronary angiography as >50% reduction in lumen diameter in the left main stem or >70% stenosis in a major coronary vessel or 30% to 70% stenosis with fractional flow reserve ≤0.8), inducible myocardial ischemia at noninvasive stress imaging, and their association. Patients' symptoms had limited ability to predict the presence of significant CAD, global chi-square being 5.0. The inclusion of age increased global chi-square to 18.7 and gender increased it further to 51.1. Using inducible myocardial ischemia or the association of CAD with inducible ischemia as end points, the ability to predict these end points was again better for patient demographics than for patient symptoms. Thus, the ability of current models based on symptoms, age, and gender to predict the presence of CAD is mainly based on patient demographics as opposed to symptoms.
Published: 2015
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10. 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

11. 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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12. 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

13. 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

14. E-learning in cardiovascular imaging: another step towards a structured educational approach

Author: Cosyns, B, De Diego, JJ, Stefanidis, A, Galderisi, M, Ernande, L, Underwood, SR, Bucciarelli-Ducci, C, Lancellotti, P, Habib, G, EACVI education, web-communication and certification committees, Document reviewers: Thor Edvardsen and Julien Magne, Cosyns, Bernard, De Diego, Jose Juan Gomez, Stefanidis, Alexandro, Galderisi, Maurizio, Ernande, Laura, Underwood, S. Richard, Bucciarelli Ducci, Chiara, Lancellotti, Patrizio, Habib, Gilbert, Clinical sciences, and Cardio-vascular diseases
Subjects: Internet, Intranet, Knowledge management, business.industry, Online learning, Cardiology, General Medicine, Knowledge acquisition, Educational approach, Multimedia, Educational resources, Imaging technology, Humans, Medicine, Radiology, Nuclear Medicine and imaging, The Internet, Educational Measurement, Radiology, Cardiology and Cardiovascular Medicine, business, TUTOR, computer, Computer-Assisted Instruction, computer.programming_language
Abstract: The availability of educational resources in cardiovascular imaging varies between European countries, and access to imaging technology also differs. A survey of European cardiovascular imaging by the European Association of Cardiovascular Imaging (EACVI) provides a snapshot of imaging practice in 40 countries of the European Society of Cardiology (http://www.escardio.org/communities/EACVI/imaging-organisations/Documents/eacvi-highlight-book-v5.pdf). Consistency of education is important, but it must also take account of personal and national requirements. The European Commission definition of e-learning is ‘the use of new multimedia technologies and of the Internet to improve the quality of learning by facilitating access to resources and services, as well as remote exchanges and collaboration’. However, the relationship between e-learning and the quality of education is unproved, and an alternative definition is that of LabSET, ‘online learning focuses on the development of skills by the learner and structured by interactions with the tutor and peers’. The term ‘online’ refers to a computer attached to some form of network, either local (intranet) …
Published: 2015

15. 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

16. Type 1 Diabetes Abolishes the Sex Difference in Coronary Artery Calcification

Author: COLHOUN, HELEN M, RUBENS, MICHAEL R, CHATURVEDI, NISH, UNDERWOOD, SR, and FULLER, JOHN H
Subjects: Diabetes -- Research, Health
Abstract: Type 1 diabetes (DM) abolishes the sex difference in coronary heart disease (CHD) mortality. Whether this is due to increased atheroma is not clear. Coronary artery calcification (CAC) is a [...]
Published: 1999

17. Myocardial perfusion scintigraphy: the evidence - A consensus conference organised by the British Cardiac Society, the British Nuclear Cardiology Society and the British Nuclear Medicine Society, endorsed by the Royal College of Physicians of London and the Royal College of Radiologists

Author: Underwood, SR, Anagnostopoulos, C, Cerqueira, M, Ell, PJ, Flint, EJ, Harbinson, M, Kelion, AD, Al-Mohammad, A, Prvulovich, EM, Shaw, LJ, and Tweddel, AC
Subjects: INCREMENTAL PROGNOSTIC VALUE, Science & Technology, PERIPHERAL VASCULAR-SURGERY, Radiology, Nuclear Medicine & Medical Imaging, CORONARY-ARTERY-DISEASE, EMISSION COMPUTED-TOMOGRAPHY, TC-99M SESTAMIBI TOMOGRAPHY, Life Sciences & Biomedicine, DOBUTAMINE STRESS ECHOCARDIOGRAPHY, MEDICALLY TREATED PATIENTS, DIPYRIDAMOLE TL-201 SCINTIGRAPHY, ABDOMINAL AORTIC-SURGERY, VENTRICULAR EJECTION FRACTION
Published: 2004

18. Regional myocardial motion and thickening assessed at rest by ECG-gated Tc-99m-MIBI emission tomography and by magnetic resonance imaging

Author: Anagnostopoulos, C Gunning, MG Pennell, DJ Laney, R and Proukakis, H Underwood, SR
Abstract: We have validated EGG-gated emission tomography using technetium-99m methoxyisobutylisonitrile for the assessment of regional ventricular function by comparing it with cine magnetic resonance imaging (MRI), Gated tomography was performed at rest in 24 patients referred for myocardial perfusion imaging [17 males and seven females with a mean age of 58 years, nine of whom had had a previous myocardial infarction (MI)]. Scores were assigned to each of nine myocardial segments for wall motion and for thickening. Cine MRI was analysed in an identical fashion. Four out of 216 (2%) segments were uninterpretable by gated tomography because of inadequate tracer uptake. In eight patients without coronary artery disease (CAD), wall motion and thickening were normal by both methods. Gated tomography showed abnormal wall motion or thickening in all patients with previous MI and in five of seven patients with CAD but no prior MI. Association between wall motion and thickening was good (r(s)=0.86). Overall, there was good agreement between gated tomography and MRI for both wall motion (178/212 kappa=0.66) and wall thickening (184/212 kappa=0.69). In segments with severely reduced perfusion, however, there was poorer agreement (kappa=0.31). Interobserver and intraobserver agreement was high (kappa from 0.61 to 0.78), Thus, in patients investigated for CAD, there is good overall agreement between gated tomography and MRI but the agreement is lower in segments with severe perfusion defects.
Published: 1996

19. Journeys to Other Worlds: Maiden of Deception Pass: A Traditional Samish Story.

Author: Underwood Sr., Victor
Subjects: DAUGHTERS
Published: 2008

20. Echocardiography Over-Estimates Left Ventricular Mass: Results of a Comparison with Magnetic Resonance Imaging

Author: Missouris, CG, primary, Forbat, S, primary, Underwood, SR, primary, Singer, Drj, primary, and Macgregor, GA, primary
Published: 1994
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21. Significant inducible perfusion abnormality in an asymptomatic patient with hypertrophic cardiomyopathy demonstrated by radionuclide myocardial perfusion imaging

Author: Loong, CY, Reyes, E, and Underwood, SR
Subjects: Perfusion (Physiology) -- Analysis -- Case studies, Cardiomyopathy, Hypertrophic -- Risk factors -- Case studies -- Analysis, Diagnostic imaging -- Case studies -- Analysis, Health, Analysis, Case studies, Risk factors
Abstract: An asymptomatic 21 year old man with non-obstructive hypertrophic cardiomyopathy (HCM) was referred for radionuclide myocardial perfusion imaging for risk assessment. Adenosine was infused at 140 µg/kg/min over six minutes [...]
Published: 2003

22. Effects of Age, Gender, Obesity, and Diabetes on the Efficacy and Safety of the Selective A2A Agonist Regadenoson Versus Adenosine in Myocardial Perfusion Imaging Integrated ADVANCE-MPI Trial Results

Author: Cerqueira, MD, Nguyen, P, Staehr, P, Underwood, SR, and Iskandrian, AE
Abstract: ObjectivesTo compare the effects of age, gender, body mass index, and diabetes on the safety and efficacy of regadenoson stress myocardial perfusion imaging, and to assess the noninferiority of regadenoson to adenosine for the detection of reversible myocardial perfusion defects.BackgroundPrevious reports have shown that a fixed unit bolus of regadenoson is safe and noninferior to adenosine for the detection of reversible perfusion defects by radionuclide imaging.MethodsUsing a database of 2,015 patients, we evaluated the effects of age, gender, body mass index, and diabetes on the safety and efficacy of regadenoson compared to adenosine.ResultsFor detection of ischemia relative to adenosine, noninferiority was demonstrated for all patients (agreement rate difference 0%, 95% CI −6.2% to +6.8%). The average agreement rate between adenosine-adenosine and adenosine-regadenoson were 0.62 ± 0.03 and 0.63 ± 0.02. Detection of ischemia was also comparable in specific subgroups. Agreement was less for both agents in women versus men with moderate and large areas of ischemia. Compared to adenosine, regadenoson had a lower combined symptom score and less chest pain, flushing, and throat, neck, or jaw pain, but more headache and gastrointestinal discomfort. This was true in nearly all subgroups. Regadenoson patients reported feeling more comfortable (1.7 ± .02 vs. 1.9 ± 0.03, p < 0.001). Based on the overall tolerability score, women felt less comfortable than men with both stress agents. Image quality was rated good or excellent in 92% for both agents.ConclusionsRegadenoson can be safely administered as a fixed unit bolus and is as efficacious as adenosine in detecting ischemia regardless of age, gender, body mass index, and diabetes. Regadenoson is better tolerated overall and across various subgroups.
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23. Cine magnetic resonance blood flow imaging in clinical use

Author: Longmore, DB, primary, Firmin, DN, additional, Naylor, GL, additional, Underwood, SR, additional, and Klipstein, RH, additional
Published: 1986
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24. Magnetic resonance assessment of regional left ventricular function

Author: Underwood, SR, primary, Rees, RSO, additional, Savage, PE, additional, Klipstein, RH, additional, Firmin, DN, additional, Fox, KM, additional, Poole-Wilson, PA, additional, and Longmore, DB, additional
Published: 1986
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25. Rapid measurement of left ventricular volume from single oblique magnetic resonance images

Author: Underwood, SR, primary, Firmin, DN, additional, Klipstein, RH, additional, Fox, KM, additional, Poole-Wilson, PA, additional, Rees, RSO, additional, and Longmore, DB, additional
Published: 1986
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26. Magnetic resonance quantification of atrial shunting and valvular regurgitation

Author: Underwood, SR, primary, Klipstein, RH, additional, Firmin, DN, additional, Fox, KM, additional, Poole-Wilson, PA, additional, Rees, RSO, additional, and Longmore, DB, additional
Published: 1986
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27. NICE and chest pain diagnosis. W(h)ither the exercise ECG?

Author: Underwood SR
Published: 2010
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28. Exercise ECGs in angina: cost effective investigation of suspected angina.

Author: Underwood SR
Published: 2009

29. Introduction. Myocardial perfusion scintigraphy in the UK: how much are we doing and how can we do more?

Author: Kelion AD and Underwood SR
Published: 2005

30. Procedure guidelines for radionuclide myocardial perfusion imaging.

Author: Anagnostopoulos C, Harbinson M, Kelion A, Kundley K, Loong CY, Notghi A, Reyes E, Tindale W, Underwood SR, Anagnostopoulos, C, Harbinson, M, Kelion, A, Kundley, K, Loong, C Y, Notghi, A, Reyes, E, Tindale, W, and Underwood, S R
Published: 2004
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31. Radioisotopes and airport security.

Author: Iqbal MB, Sharma R, Underwood SR, and Kaddoura S
Published: 2005
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32. Economics of myocardial perfusion imaging - empire study

Author: Underwood, SR, Godman, B, Salyani, S, Ogle, J, Sechtem, U, and Eli, PJ
Published: 1997
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33. Identification of myocardial hibernation: Comparison of Tl-201, Tc-99m tetrofosmin SPECT and cine magnetic resonance imaging

Author: Gunning, M, Anagnostopoulos, C, Knight, CJ, Pepper, J, Fox, K, Pennell, DJ, Ell, PJ, and Underwood, SR
Published: 1997
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34. Gated Tc-99m-tetrofosmin spect in the identification of myocardial hibernation: Comparison with T1-201 spect and cine MRI

Author: Gunning, M, Anagnostopoulos, C, Davies, G, Knight, CJ, Pennell, DJ, Fox, K, Pepper, J, and Underwood, SR
Published: 1997
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35. Adenosine and arbutamine compared during myocardial perfusion imaging

Author: Anagnostopoulos, C, Pennell, DJ, Francis, J, Serup-Hansen, K, Davies, G, and Underwood, SR
Published: 1997
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36. Current state of knowledge on Takotsubo syndrome: a Position Statement from the Taskforce on Takotsubo Syndrome of the Heart Failure Association of the European Society of Cardiology

Author: Ar, Lyon, Bossone E, Schneider B, Sechtem U, Citro R, Sr, Underwood, Mn, Sheppard, Ga, Figtree, Parodi G, Yoshihiro Akashi, Ruschitzka F, Filippatos G, Mebazaa A, Omerovic E, University of Zurich, Lyon, Alexander R, Lyon, Ar, Bossone, E, Schneider, B, Sechtem, U, Citro, R, Underwood, Sr, Sheppard, Mn, Figtree, Ga, Parodi, G, Akashi, Yj, Ruschitzka, F, Filippatos, G, Mebazaa, A, and Omerovic, E
Subjects: stress, Cardiovascular System & Hematology, 10209 Clinic for Cardiology, heart failure, 610 Medicine & health, risk stratification, Takotsubo syndrome, 1102 Cardiovascular Medicine And Haematology, 2705 Cardiology and Cardiovascular Medicine

37. Diagnostic Performance of Quantitative Perfusion Cardiac Magnetic Resonance Imaging in Patients with Prior Coronary Artery Disease.

Author: Hoek R, Borodzicz-Jazdzyk S, van Diemen PA, Somsen YBO, de Winter RW, Jukema RA, Twisk JWR, Raijmakers PG, Knuuti J, Maaniitty T, Underwood SR, Nagel E, Robbers LFHJ, Demirkiran A, von Bartheld MB, Driessen RS, Danad I, Götte MJW, and Knaapen P
Abstract: Aims: The diagnostic performance of quantitative perfusion cardiac magnetic resonance (QP-CMR) imaging has scarcely been evaluated in patients with a history of coronary artery disease (CAD) and new onset chest pain. The present study compared the diagnostic performance of automated QP-CMR for detection of fractional flow reserve (FFR) defined hemodynamically significant CAD with visual assessment of first-pass stress perfusion CMR (v-CMR) and quantitative [15O]H2O positron emission tomography (PET) imaging in a true head-to-head fashion in patients with prior CAD., Methods and Results: This PACIFIC-2 substudy included 145 symptomatic chronic coronary symptom patients with prior myocardial infarction (MI) and/or percutaneous coronary intervention (PCI). All patients underwent dual-sequence, single bolus perfusion CMR and [15O]H2O PET perfusion imaging followed by invasive coronary angiography with three-vessel FFR. Hemodynamically significant CAD was defined as an FFR ≤0.80. QP-CMR, v-CMR and PET exhibited a sensitivity of 66%, 67%, and 80%, respectively, whereas specificity was 60%, 62%, and 63%. Sensitivity of QP-CMR was lower than PET (P=0.015), whereas specificity of QP-CMR and PET was comparable. Diagnostic accuracy and area under the curve (AUC) of QP-CMR (64% and 0.66) was comparable to both v-CMR (66% [P=NS] and 0.67 (P=NS]) and PET (74% [P=NS] and 0.78 [P=NS])., Conclusions: In patients with prior MI and/or PCI, the diagnostic performance of QP-CMR was comparable to visual assessment of first-pass stress perfusion CMR and quantitative [15O]H2O PET for the detection of hemodynamically significant CAD as defined by FFR., (© The Author(s) 2024. Published by Oxford University Press on behalf of the European Society of Cardiology.)
Published: 2024
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38. Cardiac transplant rejection assessment with 18F-FDG PET-CT: initial single-centre experience for diagnosis and management.

Author: Dar O, Dulay MS, Riesgo-Gil F, Morley-Smith A, Brookes P, Lyster H, Rice A, Underwood SR, Dunning J, and Wechalekar K
Abstract: Background: Rejection is a major cause of mortality and morbidity in heart transplant (HTx) recipients. Current methods for diagnosing rejection have limitations. Imaging methods to map the entire left ventricle and reliably identify potential sites of rejection is lacking. Animal studies suggest FDG PET-CT (FDG PET) could have potential application in human HTx recipients., Methods: Between December 2020 and February 2022, all HTx recipients at Harefield Hospital, London, with definite or suspected rejection underwent FDG PET in addition to routine work-up., Results: Thirty HTx recipients (12 with definite and 18 with suspected rejection) underwent FDG PET scans. Overall, 12 of the 30 patients had FDG PET with increased myocardial avidity, of whom 2 died (17%). Eighteen patients of the 30 patients had FDG PET with no myocardial avidity and all are alive (100%, p = 0.15). All patients with definite rejection, scanned within 2 weeks of starting anti-rejection treatment, showed increased myocardial avidity. In 5 cases, FDG PET showed myocardial avidity beyond 6 weeks despite pulsed steroid treatment, suggesting unresolved myocardial rejection., Conclusion: Preliminary findings suggest FDG PET may have a role in diagnosing cardiac transplant rejection. Future blinded studies are needed to help further validate this., (© 2024. Crown.)
Published: 2024
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39. The diagnostic performance of quantitative flow ratio and perfusion imaging in patients with prior coronary artery disease.

Author: van Diemen PA, de Winter RW, Schumacher SP, Everaars H, Bom MJ, Jukema RA, Somsen YB, Raijmakers PG, Kooistra RA, Timmer J, Maaniitty T, Robbers LF, von Bartheld MB, Demirkiran A, van Rossum AC, Reiber JH, Knuuti J, Underwood SR, Nagel E, Knaapen P, Driessen RS, and Danad I
Subjects: Humans, Coronary Angiography methods, Predictive Value of Tests, Coronary Artery Disease diagnostic imaging, Coronary Artery Disease therapy, Fractional Flow Reserve, Myocardial, Percutaneous Coronary Intervention, Myocardial Perfusion Imaging methods, Coronary Stenosis
Abstract: Aims: In chronic coronary syndrome (CCS) patients with documented coronary artery disease (CAD), ischaemia detection by myocardial perfusion imaging (MPI) and an invasive approach are viable diagnostic strategies. We compared the diagnostic performance of quantitative flow ratio (QFR) with single-photon emission computed tomography (SPECT), positron emission tomography (PET), and cardiac magnetic resonance imaging (CMR) in patients with prior CAD [previous percutaneous coronary intervention (PCI) and/or myocardial infarction (MI)]., Methods and Results: This PACIFIC-2 sub-study evaluated 189 CCS patients with prior CAD for inclusion. Patients underwent SPECT, PET, and CMR followed by invasive coronary angiography with fractional flow reserve (FFR) measurements of all major coronary arteries (N = 567), except for vessels with a sub-total or chronic total occlusion. Quantitative flow ratio computation was attempted in 488 (86%) vessels with measured FFR available (FFR ≤0.80 defined haemodynamically significant CAD). Quantitative flow ratio analysis was successful in 334 (68%) vessels among 166 patients and demonstrated a higher accuracy (84%) and sensitivity (72%) compared with SPECT (66%, P < 0.001 and 46%, P = 0.001), PET (65%, P < 0.001 and 58%, P = 0.032), and CMR (72%, P < 0.001 and 33%, P < 0.001). The specificity of QFR (87%) was similar to that of CMR (83%, P = 0.123) but higher than that of SPECT (71%, P < 0.001) and PET (67%, P < 0.001). Lastly, QFR exhibited a higher area under the receiver operating characteristic curve (0.89) than SPECT (0.57, P < 0.001), PET (0.66, P < 0.001), and CMR (0.60, P < 0.001)., Conclusion: QFR correlated better with FFR in patients with prior CAD than MPI, as reflected in the higher diagnostic performance measures for detecting FFR-defined, vessel-specific, significant CAD., Competing Interests: Conflict of interests: J.H.R., R.A.K., and J.T. are employees of Medis Medical Imaging. J.K. received consultancy fees from GE Healthcare and AstraZeneca and speaker fees from GE Healthcare, Bayer, Lundbeck, and Merck. P.K. received research grants from HeartFlow Inc. All others have no conflict of interests to disclose., (© The Author(s) 2023. Published by Oxford University Press on behalf of the European Society of Cardiology.)
Published: 2023
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40. Functional stress imaging to predict abnormal coronary fractional flow reserve: the PACIFIC 2 study.

Author: Driessen RS, van Diemen PA, Raijmakers PG, Knuuti J, Maaniitty T, Underwood SR, Nagel E, Robbers LFHJ, Demirkiran A, von Bartheld MB, van de Ven PM, Hofstra L, Somsen GA, Tulevski II, Boellaard R, van Rossum AC, Danad I, and Knaapen P
Subjects: Coronary Angiography methods, Humans, Predictive Value of Tests, Prospective Studies, Tomography, X-Ray Computed, Coronary Artery Disease diagnostic imaging, Fractional Flow Reserve, Myocardial, Myocardial Perfusion Imaging methods, Percutaneous Coronary Intervention
Abstract: Aims: The diagnostic performance of non-invasive imaging in patients with prior coronary artery disease (CAD) has not been tested in prospective head-to-head comparative studies. The aim of this study was to compare the diagnostic performance of qualitative single-photon emission computed tomography (SPECT), quantitative positron emission tomography (PET), and qualitative magnetic resonance imaging (MRI) in patients with a prior myocardial infarction (MI) or percutaneous coronary intervention (PCI)., Methods and Results: In this prospective clinical study, all patients with prior MI and/or PCI and new symptoms of ischaemic CAD underwent 99mTc-tetrofosmin SPECT, [15O]H2O PET, and MRI, followed by invasive coronary angiography with fractional flow reserve (FFR) in all coronary arteries. All modalities were interpreted by core laboratories. Haemodynamically significant CAD was defined by at least one coronary artery with an FFR ≤0.80. Among the 189 enrolled patients, 63% had significant CAD. Sensitivity was 67% (95% confidence interval 58-76%) for SPECT, 81% (72-87%) for PET, and 66% (56-75%) for MRI. Specificity was 61% (48-72%) for SPECT, 65% (53-76%) for PET, and 62% (49-74%) for MRI. Sensitivity of PET was higher than SPECT (P = 0.016) and MRI (P = 0.014), whereas specificity did not differ among the modalities. Diagnostic accuracy for PET (75%, 68-81%) did not statistically differ from SPECT (65%, 58-72%, P = 0.03) and MRI (64%, 57-72%, P = 0.052). Using FFR < 0.75 as a reference, accuracies increased to 69% (SPECT), 79% (PET), and 71% (MRI)., Conclusion: In this prospective head-to-head comparative study, SPECT, PET, and MRI did not show a significantly different accuracy for diagnosing FFR defined significant CAD in patients with prior PCI and/or MI. Overall diagnostic performances, however, were discouraging and the additive value of non-invasive imaging in this high-risk population is questionable., Competing Interests: Conflict of interest: J.K. received consultancy fees from GE Healthcare and AstraZeneca and speaker fees from GE Healthcare, Bayer, Lundbeck, and Merck. P.K. received research grants from HeartFlow Inc. All other others have no conflict of interests to disclose., (© The Author(s) 2022. Published by Oxford University Press on behalf of European Society of Cardiology.)
Published: 2022
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41. 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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42. Nuclear cardiology: state of the art.

Author: Schofield R, Menezes L, and Underwood SR
Abstract: Radionuclide imaging remains an essential component of modern cardiology. There is overlap with the information from other imaging techniques, but no technique is static and new developments have expanded its role. This review focuses on ischaemic heart disease, heart failure, infection and inflammation. Radiopharmaceutical development includes the wider availability of positron emission tomography (PET) tracers such as rubidium-82, which allows myocardial perfusion to be quantified in absolute terms. Compared with alternative techniques, myocardial perfusion scintigraphy PET and single photon emission computed tomography (SPECT) have the advantages of being widely applicable using exercise or pharmacological stress, full coverage of the myocardium and a measure of ischaemic burden, which helps to triage patients between medical therapy and revascularisation. Disadvantages include the availability of expertise in some cardiac centres and the lack of simple SPECT quantification, meaning that global abnormalities can be underestimated. In patients with heart failure, despite the findings of the STICH (Surgical Treatment for Ischemic Heart Failure) trial, there are still data to support the assessment of myocardial hibernation in predicting when abolition of ischaemia might lead to improvement in ventricular function. Imaging of sympathetic innervation is well validated, but simpler markers of prognosis mean that it has not been widely adopted. There are insufficient data to support its use in predicting the need for implanted devices, but non-randomised studies are promising. Other areas where radionuclide imaging is uniquely valuable are detection and monitoring of endocarditis, device infection, myocardial inflammation in sarcoidosis, myocarditis and so on, and reliable detection of deposition in suspected transthyretin-related amyloidosis., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2021. No commercial re-use. See rights and permissions. Published by BMJ.)
Published: 2021
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43. Worldwide Diagnostic Reference Levels for Single-Photon Emission Computed Tomography Myocardial Perfusion Imaging: Findings From INCAPS.

Author: Hirschfeld CB, Dondi M, Pascual TNB, Mercuri M, Vitola J, Karthikeyan G, Better N, Mahmarian JJ, Bouyoucef SE, Hee-Seung Bom H, Lele V, Magboo VPC, Alexánderson E, Allam AH, Al-Mallah MH, Flotats A, Jerome S, Kaufmann PA, Luxenburg O, Underwood SR, Rehani MM, Vassileva J, Paez D, and Einstein AJ
Subjects: Cross-Sectional Studies, Humans, Perfusion, Predictive Value of Tests, Radiation Dosage, Diagnostic Reference Levels, Tomography, Emission-Computed, Single-Photon
Abstract: Objectives: This study sought to establish worldwide and regional diagnostic reference levels (DRLs) and achievable administered activities (AAAs) for single-photon emission computed tomography (SPECT) myocardial perfusion imaging (MPI)., Background: Reference levels serve as radiation dose benchmarks to compare individual laboratories against aggregated data, helping to identify sites in greatest need of dose reduction interventions. DRLs for SPECT MPI have previously been derived from national or regional registries. To date there have been no multiregional reports of DRLs for SPECT MPI from a single standardized dataset., Methods: Data were submitted voluntarily to the INCAPS (International Atomic Energy Agency Nuclear Cardiology Protocols Study), a cross-sectional, multinational registry of MPI protocols. A total of 7,103 studies were included. DRLs and AAAs were calculated by protocol for each world region and for aggregated worldwide data., Results: The aggregated worldwide DRLs for rest-stress or stress-rest studies employing technetium Tc 99m-labeled radiopharmaceuticals were 11.2 mCi (first dose) and 32.0 mCi (second dose) for 1-day protocols, and 23.0 mCi (first dose) and 24.0 mCi (second dose) for multiday protocols. Corresponding AAAs were 10.1 mCi (first dose) and 28.0 mCi (second dose) for 1-day protocols, and 17.8 mCi (first dose) and 18.7 mCi (second dose) for multiday protocols. For stress-only technetium Tc 99m studies, the worldwide DRL and AAA were 18.0 mCi and 12.5 mCi, respectively. Stress-first imaging was used in 26% to 92% of regional studies except in North America where it was used in just 7% of cases. Significant differences in DRLs and AAAs were observed between regions., Conclusions: This study reports reference levels for SPECT MPI for each major world region from one of the largest international registries of clinical MPI studies. Regional DRLs may be useful in establishing or revising guidelines or simply comparing individual laboratory protocols to regional trends. Organizations should continue to focus on establishing standardized reporting methods to improve the validity and comparability of regional DRLs., Competing Interests: Funding Support and Author Disclosures Dr. Einstein’s institution has received funding for other research from Canon Medical Systems USA, Roche Medical Systems, and W. L. Gore & Associates; and he has served as a consultant to W. L. Gore & Associates. 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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44. Hybrid solid-state SPECT/CT left atrial innervation imaging for identification of left atrial ganglionated plexi: Technique and validation in patients with atrial fibrillation.

Author: Stirrup J, Gregg S, Baavour R, Roth N, Breault C, Agostini D, Ernst S, and Underwood SR
Subjects: Aged, Female, Heart Conduction System physiopathology, Humans, Male, Middle Aged, Observer Variation, Predictive Value of Tests, Prospective Studies, Tomography, X-Ray Computed, Treatment Outcome, 3-Iodobenzylguanidine pharmacology, Atrial Fibrillation diagnostic imaging, Heart diagnostic imaging, Heart Atria diagnostic imaging, Pulmonary Veins diagnostic imaging, Single Photon Emission Computed Tomography Computed Tomography methods, Tomography, Emission-Computed, Single-Photon methods
Abstract: Background: Ablating left atrial (LA) ganglionated plexi (GP), identified invasively by high-frequency stimulation (HFS) during pulmonary vein isolation (PVI), may reduce atrial fibrillation (AF) recurrence. 123 I-metaiodobenzylguanidine ( 123 I-mIBG) solid-state SPECT LA innervation imaging (LAII) has the spatial resolution to detect LAGP non-invasively but this has never been demonstrated in clinical practice., Methods: 20 prospective patients with paroxysmal AF scheduled for PVI underwent 123 I-mIBG LAII. High-resolution tomograms, reconstructed where possible using cardiorespiratory gating, were co-registered with pre-PVI cardiac CT. Location and reader confidence (1 [low] to 3 [high]) in discrete 123 I-mIBG LA uptake areas (DUAs) were recorded and correlated with HFS., Results: A total of 73 DUAs were identified, of which 59 (81%) were HFS positive (HFS +). HFS + likelihood increased with reader confidence (92% [score 3]). 64% of HFS-negative DUAs occurred over the lateral and inferior LA. Cardiorespiratory gating reduced the number of DUAs per patient (4 vs 7, P = .001) but improved: HFS + predictive value (76% vs 49%); reader confidence (2 vs 1, P = .02); and inter-observer, intra-observer, and inter-study agreement (κ = 0.84 vs 0.68; 0.82 vs 0.74; 0.64 vs 0.53 respectively)., Conclusions: 123 I-mIBG SPECT/CT LAII accurately and reproducibly identifies GPs verified by HFS, particularly when reconstructed with cardiorespiratory gating.
Published: 2020
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45. Anatomical and functional coronary imaging to predict long-term outcome in patients with suspected coronary artery disease: the EVINCI-outcome study.

Author: Neglia D, Liga R, Caselli C, Carpeggiani C, Lorenzoni V, Sicari R, Lombardi M, Gaemperli O, Kaufmann PA, Scholte AJHA, Underwood SR, and Knuuti J
Subjects: Computed Tomography Angiography, Coronary Angiography, Female, Humans, Male, Outcome Assessment, Health Care, Predictive Value of Tests, Prognosis, Coronary Artery Disease diagnostic imaging
Abstract: Aims: To investigate the prognostic relevance of coronary anatomy, coronary function, and early revascularization in patients with stable coronary artery disease (CAD)., Methods and Results: From March 2009 to June 2012, 430 patients with suspected CAD (61 ± 9 years, 62% men) underwent coronary anatomical imaging by computed tomography coronary angiography (CTCA) and coronary functional imaging followed by invasive coronary angiography (ICA) if at least one non-invasive test was abnormal. Obstructive CAD was documented by ICA in 119 patients and 90 were revascularized within 90 days of enrolment. Core laboratory analysis showed that 134 patients had obstructive CAD by CTCA (>50% stenosis in major coronary vessels) and 79 significant ischaemia by functional imaging [>10% left ventricular (LV) myocardium]. Over mean follow-up of 4.4 years, major adverse events (AEs) (all-cause death, non-fatal myocardial infarction, or hospital admission for unstable angina or heart failure) or AEs plus late revascularization (LR) occurred in 40 (9.3%) and 58 (13.5%) patients, respectively. Obstructive CAD at CTCA was the only independent imaging predictor of AEs [hazard ratio (HR) 3.2, 95% confidence interval (CI) 1.10-9.30; P = 0.033] and AEs plus LR (HR 4.3, 95% CI 1.56-11.81; P = 0.005). Patients with CAD in whom early revascularization was performed in the presence of ischaemia and deferred in its absence had fewer AEs, similar to patients without CAD (HR 2.0, 95% CI 0.71-5.51; P = 0.195)., Conclusion: Obstructive CAD imaged by CTCA is an independent predictor of clinical outcome. Early management of CAD targeted to the combined anatomical and functional disease phenotype improves clinical outcome., (Published on behalf of the European Society of Cardiology. All rights reserved. © The Author(s) 2019. For permissions, please email: journals.permissions@oup.com.)
Published: 2020
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46. No Evidence That Electric Charge Increases Inhaled Ultrafine Particle Deposition in Human Lungs.

Author: Usmani OS, Matthews JC, Wright MD, Meah S, Underwood SR, Barnes PJ, Shallcross DE, and Biddiscombe MF
Subjects: Adult, Female, Humans, Male, Middle Aged, Radionuclide Imaging, Sodium Pertechnetate Tc 99m, Young Adult, Electricity, Inhalation Exposure, Lung diagnostic imaging, Particulate Matter
Published: 2020
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47. Impact of scan quality on the diagnostic performance of CCTA, SPECT, and PET for diagnosing myocardial ischemia defined by fractional flow reserve.

Author: van Diemen PA, Driessen RS, Stuijfzand WJ, Raijmakers PG, Schumacher SP, Bom MJ, Everaars H, Min JK, Leipsic JA, Knuuti J, Underwood SR, van de Ven PM, van Rossum AC, Danad I, and Knaapen P
Subjects: Aged, Clinical Trials as Topic, Female, Humans, Male, Middle Aged, Myocardial Ischemia physiopathology, Predictive Value of Tests, Reproducibility of Results, Computed Tomography Angiography, Coronary Angiography, Fractional Flow Reserve, Myocardial, Multidetector Computed Tomography, Myocardial Ischemia diagnostic imaging, Myocardial Perfusion Imaging, Positron Emission Tomography Computed Tomography, Tomography, Emission-Computed, Single-Photon
Abstract: Background: Scan quality can have a significant effect on the diagnostic performance of non-invasive imaging techniques. However, the extent of its influence has scarcely been investigated in a head-to-head manner., Methods: Two-hundred and eight patients underwent CCTA, SPECT, and PET prior to invasive fractional flow reserve measurements. Scan quality was classified as either good, moderate, or poor., Results: Distribution of good, moderate, and poor quality scans was; CCTA; 66%, 22%, 13%; SPECT; 52%, 38%, 9%; PET; 86%, 13%, 1%. Good quality CCTA scans possessed a higher specificity (75% vs. 31%, p = 0.001), positive predictive value (PPV, 71% vs. 51%, p = 0.050), and accuracy (80% vs. 60%, p = 0.009) compared to moderate quality scans, while sensitivity (94%) and negative predictive value (NPV, 88%) were similar to moderate and poor quality scans. Sensitivity (76%), NPV (84%), and accuracy (85%) of good quality SPECT scans was superior to those of moderate (41% p = 0.001, 56% p = 0.010, 70% p = 0.010) and poor quality (30% p = 0.003, 65% p = 0.069, 63% p = 0.038). Specificity (92%) and PPV (87%) of good quality SPECT scans did not differ from scans of diminished quality. Good quality PET scans exhibited high sensitivity (84%), specificity (86%), NPV (88%), PPV (81%) and accuracy (85%), which was comparable to scans of lesser quality. Good quality CCTA, SPECT, and PET scans demonstrated a similar diagnostic accuracy (p = 0.247)., Conclusion: Diagnostic performance of CCTA, and SPECT is hampered by scan quality, while the diagnostic value of PET is not affected. Good quality CCTA, SPECT, and PET scans possess a high diagnostic accuracy., (Copyright © 2020 Society of Cardiovascular Computed Tomography. Published by Elsevier Inc. All rights reserved.)
Published: 2020
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48. Correction to: Cost‑effectiveness analysis of stand‑alone or combined non‑invasive imaging tests for the diagnosis of stable coronary artery disease: results from the EVINCI study.

Author: Lorenzoni V, Bellelli S, Caselli C, Knuuti J, Underwood SR, Neglia D, and Turchetti G
Abstract: In the Published article, the value in the abstract has been published incorrectly. The correct abstract section is as follows.
Published: 2019
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49. Cost-effectiveness analysis of stand-alone or combined non-invasive imaging tests for the diagnosis of stable coronary artery disease: results from the EVINCI study.

Author: Lorenzoni V, Bellelli S, Caselli C, Knuuti J, Underwood SR, Neglia D, and Turchetti G
Subjects: Aged, Animals, Cost-Benefit Analysis, Europe, Female, Humans, Male, Middle Aged, Coronary Angiography economics, Coronary Artery Disease diagnostic imaging, Tomography, X-Ray Computed economics
Abstract: Aim: This study aimed at evaluating the cost-effectiveness of different non-invasive imaging-guided strategies for the diagnosis of obstructive coronary artery disease (CAD) in a European population of patients from the Evaluation of Integrated Cardiac Imaging in Ischemic Heart Disease (EVINCI) study., Methods and Results: Cost-effectiveness analysis was performed in 350 patients (209 males, mean age 59 ± 9 years) with symptoms of suspected stable CAD undergoing computed tomography coronary angiography (CTCA) and at least one cardiac imaging stress-test prior to invasive coronary angiography (ICA) and in whom imaging exams were analysed at dedicated core laboratories. Stand-alone stress-tests or combined non-invasive strategies, when the first exam was uncertain, were compared. The diagnostic end-point was obstructive CAD defined as > 50% stenosis at quantitative ICA in the left main or at least one major coronary vessel. Effectiveness was defined as the percentage of correct diagnosis (cd) and costs were calculated using country-specific reimbursements. Incremental cost-effectiveness ratios (ICERs) were obtained using per-patient data and considering "no-imaging" as reference. The overall prevalence of obstructive CAD was 28%. Strategies combining CTCA followed by stress ECHO, SPECT, PET, or stress CMR followed by CTCA, were all cost-effective. ICERs values indicated cost saving from - 969€/cd for CMR-CTCA to - 1490€/cd for CTCA-PET, - 3092€/cd for CTCA-SPECT and - 3776€/cd for CTCA-ECHO. Similarly when considering early revascularization as effectiveness measure., Conclusion: In patients with suspected stable CAD and low prevalence of disease, combined non-invasive strategies with CTCA and stress-imaging are cost-effective as gatekeepers to ICA and to select candidates for early revascularization.
Published: 2019
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50. Data on the impact of scan quality on the diagnostic performance of CCTA, SPECT, and PET for diagnosing myocardial ischemia defined by fractional flow reserve on a per vessel level.

Author: van Diemen PA, Driessen RS, Stuijfzand WJ, Raijmakers PG, Schumacher SP, Bom MJ, Everaars H, Min JK, Leipsic JA, Knuuti J, Underwood SR, van de Ven PM, van Rossum AC, Danad I, and Knaapen P
Abstract: Scan quality directly impacts the diagnostic performance of non-invasive imaging modalities as reported in a substudy of the PACIFC-trial: "Impact of Scan Quality on the Diagnostic Performance of CCTA, SPECT, and PET for Diagnosing Myocardial Ischemia Defined by Fractional Flow Reserve" [1]. This Data-in-Brief paper supplements the hereinabove mentioned article by presenting the diagnostic performance of CCTA, SPECT, and PET on a per vessel level for the detection of hemodynamic significant coronary artery disease (CAD) when stratified according to scan quality and vascular territory., (© 2019 The Author(s).)
Published: 2019
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