Approaches to Enhancing Radiation Safety in Cardiovascular Imaging

Fazel, Reza; Gerber, Thomas C.; Balter, Stephen; Brenner, David J.; Carr, J. Jeffrey; Cerqueira, Manuel D.; Chen, Jersey; Krumholz, Harlan M.; Mahesh, Mahadevappa; McCollough, Cynthia H.; Min, James K.; Morin, Richard L.; Nallamothu, Brahmajee K.; Nasir, Khurram; Redberg, Rita F.; Shaw, Leslee J.

doi:10.1161/cir.0000000000000048

Cited by 105 publications

(47 citation statements)

References 106 publications

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“…9 Several techniques can be used to keep radiation ALARA. 68 Their under utilization in contemporary practice provides nuclear cardiology laboratories with multiple opportunities to improve patient care. 69,70 Where feasible, and particularly for procedures with higher radiation exposure, e.g., effective dose [20 mSv, shared decisionmaking principles should be employed, 71 including discussion of options with the patient.…”

Section: Radiotracers and Protocolsmentioning

confidence: 99%

ASNC imaging guidelines for SPECT nuclear cardiology procedures: Stress, protocols, and tracers

Henzlova

Duvall

Einstein

et al. 2016

Journal of Nuclear Cardiology

Self Cite

529

386

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Section: Radiotracers and Protocolsmentioning

confidence: 99%

ASNC imaging guidelines for SPECT nuclear cardiology procedures: Stress, protocols, and tracers

Henzlova

Duvall

Einstein

et al. 2016

Journal of Nuclear Cardiology

Self Cite

529

386

View full text Add to dashboard Cite

“…[5][6][7] Suggested approaches include utilization of appropriate use criteria, stress-only imaging, limited use of a dual isotope protocol, and PET imaging, where appropriate. Other approaches rely on recent improvements in camera hardware and software such as highsensitivity cadmium zinc telluride (CZT) solid-state detectors and iterative reconstruction resolution recovery algorithms, which can allow injection of less radiotracer and/or decrease image acquisition time.…”

mentioning

confidence: 99%

It’s about time we think about lowering radiation dose in obese patients too

Kim

Farrell²,

Jerome

2017

Journal of Nuclear Cardiology

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“…12 The authors of the current paper should be congratulated for their effort to explore and critically assess novel protocols. The proposed dual-isotope protocol perhaps could be recommended in carefully selected subsets of patients: Older patients (perhaps [70 years of age, in whom higher radiation dose carries minimal attributable lifetime cancer risk), 13 or patients with known CAD and/or with a need for detection of myocardial viability (in whom both stress and rest imaging is needed and a 24 hours delayed Tl-201 images may have clinical relevance).…”

Section: See Related Article Pp 513-522mentioning

confidence: 99%

Return of dual-isotope SPECT myocardial perfusion imaging? Not so fast…

Henzlova

Duvall

2015

Journal of Nuclear Cardiology

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Myocardial perfusion imaging remains the most frequently used non-invasive modality for the detection and risk stratification of patients with obstructive epicardial coronary artery disease (CAD). From its inception more than 40 years ago, the mode of stressing, choice of radioactive tracers, and detection technology, have evolved: From exercise stress alone to a choice of four pharmacological stressors, from thallium-201 (Tl-201) to technetium-99m (Tc-99m) tracers, from planar to SPECT imaging, from single head to dual-head cameras, from Na-I crystals to CZT solid state cameras. Despite the long track record of diagnostic accuracy, prognostic robustness and ubiquitous availability, continued success for the modality cannot be taken for granted. With competition from the emergence of other non-invasive modalities (stress echocardiography, cardiac CT angiography, cardiac MRI) and with documented changes in the clinical manifestations of CAD, 1,2 the demands on the safety, efficiency, and convenience of myocardial perfusion imaging continue to grow.In the long absence of new tracers (Tc-99m-based agents were introduced more than 25 years ago!), the recent advent of solid state high-efficiency SPECT cameras allows for a re-assessment of by now ancient imaging protocols. Obvious and justified criticism of the length of the traditional rest-stress sequence as well as growing awareness of radiation doses to the patients and to the medical personnel can now be addressed with imagination and inventiveness.One of the novel tested approaches is described in the current issue of the Journal by authors from Grenoble, France.3 The authors propose a fast test, which was utilized in 1,336 patients, but analyzed in only 214 patients. Using the GE Discovery NM 530 high-efficiency SPECT camera (GE Healthcare), a mean dose of 82 MBq (2.2 mCi) of Tl-201 was injected at peak stress, 5 minutes stress imaging followed and a mean dose of 314 MBq (8.5 mCi) of Tc-99m was injected after stress imaging and 5 minutes rest imaging followed 2 minutes later. Thus, the whole stress-rest sequence was completed in 22.4 ± 4 minutes. Correlation with coronary angiography in 104 patients with high CAD prevalence was good. Normalcy rate in 110 patients with low pretest probability was also high.A similar protocol and tracer dosage (2-2.5 mCi of Tl-201 and 8-10 mCi of Tc-99m) was reported in 2009 by Berman et al using a different high-efficiency CZT cardiac camera (D-SPECT, Spectrum Dynamics, Israel) in 374 patients. 4 Image quality, radiation dose, and study length were analyzed, but not correlation to angiography.There are pros and cons of both Tl-201 and Tc-99m as myocardial perfusion agents, even though Tc-99m agents are currently used in the vast majority of SPECT myocardial perfusion imaging studies. Tl-201 has a rapid blood clearance half-time (\30 seconds), a high first pass extraction ([88%) and better linearity between flow und uptake.5 Tc-99m sestamibi, on the other hand, has a longer blood clearance half-time ([1 minute), smaller first pas...

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Approaches to Enhancing Radiation Safety in Cardiovascular Imaging

Cited by 105 publications

References 106 publications

ASNC imaging guidelines for SPECT nuclear cardiology procedures: Stress, protocols, and tracers

ASNC imaging guidelines for SPECT nuclear cardiology procedures: Stress, protocols, and tracers

It’s about time we think about lowering radiation dose in obese patients too

Return of dual-isotope SPECT myocardial perfusion imaging? Not so fast…

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