Current worldwide nuclear cardiology practices and radiation exposure: results from the 65 country IAEA Nuclear Cardiology Protocols Cross-Sectional Study (INCAPS)
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Open Access
- 21 April 2015
- journal article
- research article
- Published by Oxford University Press (OUP) in European Heart Journal
- Vol. 36 (26), 1689-1696
- https://doi.org/10.1093/eurheartj/ehv117
Abstract
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. 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. 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.This publication has 26 references indexed in Scilit:
- Temporal Trends in Ischemic Heart Disease Mortality in 21 World Regions, 1980 to 2010Circulation, 2014
- The appropriate and justified use of medical radiation in cardiovascular imaging: a position document of the ESC Associations of Cardiovascular Imaging, Percutaneous Cardiovascular Interventions and ElectrophysiologyEuropean Heart Journal, 2014
- Risks and benefits of cardiac imaging: an analysis of risks related to imaging for coronary artery diseaseEuropean Heart Journal, 2013
- Radiation Safety in Nuclear Cardiology—Current Knowledge and Practice: Results From the 2011 American Society of Nuclear Cardiology Member SurveyJAMA Internal Medicine, 2013
- Multiple opportunities to reduce radiation dose from myocardial perfusion imagingEuropean Journal of Nuclear Medicine and Molecular Imaging, 2013
- ICRP Publication 120: Radiological Protection in CardiologyAnnals of the ICRP, 2013
- The Prognostic Value of Normal Exercise Myocardial Perfusion Imaging and Exercise Echocardiography: A Meta-AnalysisJournal of the American College of Cardiology, 2007
- Stress protocols and tracersJournal of Nuclear Cardiology, 2006
- EANM/ESC procedural guidelines for myocardial perfusion imaging in nuclear cardiologyEuropean Journal of Nuclear Medicine and Molecular Imaging, 2005
- Comparison of the Short-Term Survival Benefit Associated With Revascularization Compared With Medical Therapy in Patients With No Prior Coronary Artery Disease Undergoing Stress Myocardial Perfusion Single Photon Emission Computed TomographyCirculation, 2003