AimsTo 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 resultsWe 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.ConclusionMarked 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.

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Background: Radiation exposure during nuclear cardiology procedures has received much attention and has prompted citations for radiation reduction. In 2010, the American Society of Nuclear Cardiology recommended reducing the average patient study radiation exposure to <9 mSv in 50% of studies by 2014. Cardiac positron emission tomography (PET) for myocardial perfusion imaging (MPI) has emerged within recent years, but current radiation exposure in cardiac nuclear PET laboratories is unknown. This study evaluated current reported patient radiation exposure from nuclear laboratories in the United States applying for Intersocietal Accreditation Commission accreditation for MPI using single photon emission computed tomography (SPECT) or PET. Methods and Results: This was an analysis of nuclear cardiology studies submitted to the Intersocietal Accreditation Commission for either or both cardiac PET and SPECT accreditation. Cardiac SPECT data represented year 2015 while PET data combined years 2013 to 2015. Data was analyzed with χ 2 and Mann-Whitney U tests (reported as median, 25th percentile, and 75th percentile). Reported PET MPI radiation exposure for 111 laboratories (532 patient cases) was 3.7 (3.2–4.1) mSv per study with no geographic variation. Reported SPECT MPI radiation exposure for 665 laboratories (3067 patient studies) was 12.8 (12.2–14.3) mSv. Highest radiation exposure was found in the South region. Technetium-only studies resulted in a median of 12.2 mSv per study. Conclusions: Radiation exposure from cardiac PET MPI in US laboratories applying for Intersocietal Accreditation Commission accreditation is low (111 laboratories, 3.7 mSv) and substantially lower than cardiac SPECT (665 laboratories, 12.8 mSv).

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The Intersocietal Accreditation Commission (IAC) began accrediting echocardiography laboratories in 1996 to improve quality in diagnostic imaging facilities. With no existing data linking accreditation to improved outcomes, the aim of this study was to examine the perceived value of accreditation among individuals who have successfully achieved IAC echocardiography accreditation. An electronic survey was sent to accredited facilities soliciting demographic data along with questions regarding the perceived value of accreditation related to 15 quality indicators; 10 455 emails were sent with 999 responses (9.6%), and 63% of respondents reported improvement in results due to accreditation. Of the 15 quality indicators, the process was perceived as leading to improvement by a majority for 10 of the quality indicators. Nonphysicians tended to report more improvement compared with physicians (64% vs. 54%, P = .056). The perceptions from hospital-based respondents were more favorable than nonhospital-based respondents (67% vs. 59%, P < .001). More than 90% of respondents reported that maintaining accreditation was important for improved quality and better reimbursement. The study showed that IAC echocardiography facility accreditation is perceived by most facilities to improve operations for most quality indicators, particularly regarding study quality and reporting.