Current Status of Patient Radiation Exposure of Cardiac Positron Emission Tomography and Single-Photon Emission Computed Tomographic Myocardial Perfusion Imaging

Abstract

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).

Good drivers: Achieving dose reduction across a health care system through implementation of multiple radiation-sparing practices

“…Data submitted to accreditation bodies around the same time as the cases observed by Al Baldarin and colleagues suggest a large majority of laboratories in the United States are exceeding the benchmark ED of B9 mSv for MPI cases. [6][7][8][9] Similar results were observed in the United States laboratories that participated in the INCAPS study. 5 The INCAPS study also showed that the majority of those participating laboratories had yet to implement many of the radiation dose optimization best practices identified by the IAEA.…”

The Newer, the Better; and May Be Not Good Enough?

“…Despite these well-established methods, most clinical laboratories in the United States are failing to reduce radiation exposure during SPECT and have not significantly changed their daily practice. 3 In 2010, the American Society of Nuclear Cardiology recommended reducing the average patient study radiation exposure to \ 9 mSv in 50% of SPECT studies by 2014. 4 A study based on data of the Intersocietal Accreditation Commission database of accredited laboratories has been published recently.…”

“…4 A study based on data of the Intersocietal Accreditation Commission database of accredited laboratories has been published recently. 3 The goal of this study was to evaluate if this target was reached. The results document that radiation exposure of cardiac PET studies was & 3.6 mSv per study, whereas the average SPECT exposure was & 14.6 mSv.…”

“…In contrast, only 2.6% of SPECT laboratories reached this goal. 3 Besides the slightly higher diagnostic accuracy and radiation dose reduction other important practical points of CZT-SPECT have to be taken into account, which may play an important role why CZT-SPECT technology is not in broader use yet: there are higher purchase costs than with C-SPECT, and technically, a smaller field of view, resulting in the fact that CZT-SPECT is a specific ''cardiac camera'' and can't be used as an allround SPECT camera.…”

A Novel Dual Fluorochrome Near-Infrared Imaging Probe for Potential Alzheimer’s Enzyme Biomarkers-BACE1 and Cathepsin D

“…Current biomarkers are either invasive or expensive: cerebrospinal fluid (CSF) sampling requires a lumbar puncture [4], which many people find objectionable. MRI and PET scans are expensive, the latter involve potentially hazardous radiation exposure [5], and they are better suited to research at academic centers but not appropriate for massive use in primary care settings and real-life communities. Hence, there is an urgent and unmet medical need for imaging probes of biomarkers that can reliably distinguish normal from abnormal brain function or cognition and robustly predict or correlate with its clinical decline.…”