Gender Differences in Radiation Dose From Nuclear Cardiology Studies Across the World Findings From the INCAPS Registry

• Type of Material: Article
• Authors: Lynn Shi, Columbia University; Sharmila Dorbala, Harvard University; Diana Paez, International Atomic Energy Agency, Austria; Leslee Shaw, Emory University; Katherine A. Zukotynski, McMaster University; Thomas N. B. Pascual, International Atomic Energy Agency; Ganesan Karthikeyan, All India Institute of Medical Sciences; Joao V. Vitola, Quanta Diagnost & Terapia; Nathan Better, Royal Melbourne Hospital; Nadia Bokhari, Columbia University; Madan M. Rehani, International Atomic Energy Agency; Ravi Kashyap, International Atomic Energy Agency; Maurizio Dondi, International Atomic Energy Agency; Mathew Mercuri, Columbia University; Andrew J. Einstein, Columbia University
• Language: English
• Date: 2016-04-04
• Publisher: Elsevier
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2016 American College of Cardiology Foundation.
• Final Published Version (URL): http://dx.doi.org/10.1016/j.jcmg.2016.01.001
• Title of Journal or Parent Work: JACC: Cardiovascular Imaging
• ISSN: 1936-878X
• Volume: 9
• Issue: 4
• Start Page: 376
• End Page: 384
• Grant/Funding Information: Dr. Dorbala has received an institutional research grant from Astellas, and owns stock in GE.; Funding was provided by NIH-NHLBI Summer Research Program at Columbia University (5T35HL007616-34), the International Atomic Energy Agency (Vienna, Austria), and the Margaret Q. Landenberger Research Foundation (Wilmington, DE) in memory of Professor A. Donny Strosberg, and the Irving Scholars Program.; Dr. Einstein has received institutional research grants for other research from GE Healthcare, Philips Healthcare, Spectrum Dynamics, and Toshiba America Medical Systems.
• Keywords: Science & Technology; TOMOGRAPHY; Life Sciences & Biomedicine; nuclear cardiology; gender; WOMEN; radiation exposure; DISEASE; PROGNOSTIC VALUE; Radiology, Nuclear Medicine & Medical Imaging; EXPOSURE; MEDICINE; Cardiac & Cardiovascular Systems; MYOCARDIAL-PERFUSION SPECT; Cardiovascular System & Cardiology; RISK STRATIFICATION; MANAGEMENT; SEX
• Research Categories: Health Sciences, Radiology; Health Sciences, Medicine and Surgery

Abstract

Objectives: The aim of this study was to investigate gender-based differences in nuclear cardiology practice globally, with a particular focus on laboratory volume, radiation dose, protocols, and best practices. Background: It is unclear whether gender-based differences exist in radiation exposure for nuclear cardiology procedures. Methods: In a large, multicenter, observational, cross-sectional study encompassing 7,911 patients in 65 countries, radiation effective dose was estimated for each examination. Patient-level best practices relating to radiation exposure were compared between genders. Analysis of covariance was used to determine any difference in radiation exposure according to gender, region, and the interaction between gender and region. Linear, logistic, and hierarchical regression models were developed to evaluate gender-based differences in radiation exposure and laboratory adherence to best practices. The study also included the United Nations Gender Inequality Index and Human Development Index as covariates in multivariable models. Results: The proportion of myocardial perfusion imaging studies performed in women varied among countries; however, there was no significant correlation with the Gender Inequality Index. Globally, mean effective dose for nuclear cardiology procedures was only slightly lower in women (9.6 ± 4.5 mSv) than in men (10.3 ± 4.5 mSv; p < 0.001), with a difference of only 0.3 mSv in a multivariable model adjusting for patients' age and weight. Stress-only imaging was performed more frequently in women (12.5% vs. 8.4%; p < 0.001); however, camera-based dose reduction strategies were used less frequently in women (58.6% vs. 65.5%; p < 0.001). Conclusions: Despite significant worldwide variation in best practice use and radiation doses from nuclear cardiology procedures, only small differences were observed between genders worldwide. Regional variations noted in myocardial perfusion imaging use and radiation dose offer potential opportunities to address gender-related differences in delivery of nuclear cardiology care.