Current worldwide nuclear cardiology practices and radiation exposure: results from the 65 country IAEA Nuclear Cardiology Protocols Cross-Sectional Study (INCAPS)

Abstract

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.

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

“…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.…”

Automatic evaluation of myocardial perfusion on SPECT: Need for “Normality”

“…8,9 Nevertheless, even with the evident advantages of nuclear cardiac imaging, SPECT MPI is also characterized by some relevant drawbacks that should be always taken into account, particularly if traditional Anger cameras are employed. Above all, the relatively high radiation burden of a stress/rest imaging protocol performed with a classical SPECT camera equipped with Na/I scintillating crystals-especially if 201 Tl was used as radiotracer instead of the more favorable 99m Tcbased compounds-has always represented a theoretical limitation of this imaging modality, 10 making the clinician often favor other non-ionizing non-invasive myocardial imaging techniques. Secondly, the relatively lengthy acquisition protocol of traditional myocardial SPECT imaging, still not too infrequently performed on a two-day basis, has made the other non-invasive imaging techniques look more appealing.…”

“…Secondly, the relatively lengthy acquisition protocol of traditional myocardial SPECT imaging, still not too infrequently performed on a two-day basis, has made the other non-invasive imaging techniques look more appealing. 1,10 In the last decade, both those limitations have been practically solved by several improvements consistently both the architecture and software settings of traditional Anger cameras.…”

Reply to responsible growth of nuclear cardiology in Spain

“…The use of appropriate use criteria (AUC) is commonplace in Spain where the NC Working Group of SEMNIM has advocated AUC for many years and recently launched a multicentric national trial assessing its use. In the INCAPS study 3 …”