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

• Type of Material: Article
• Authors: Andrew J. Einstein, Columbia University; Thomas N. B. Pascual, International Atomic Energy Agency; Mathew Mercuri, Columbia University; Ganesan Karthikeyan, All India Institute of Medical Sciences; Joao V. Vitola, Quanta Diagnostics and Therapy; John J. Mahmarian, Houston Methodist DeBakey Heart and Vascular Center; Nathan Better, Royal Melbourne Hospital; Salah E. Bouyoucef, Centre Hospitalo-Universitaire de Bab El Ouéd; Henry Hee-Seung Bom, Chonnam National University; Vikram Lele, Jaslok Hospital and Research Center; V. Peter C. Magboo, University of the Philippines; Erick Alexanderson, Instituto Nacional de Cardiología; Adel H. Allam, Al Azhar University; Mouaz H. Al-Mallah, King Saud bin Abdulaziz University; Albert Flotats, Universitat Autonoma de Barcelona; Scott Jerome, Intersocietal Accreditat Commiss; Philipp A. Kaufmann, University of Zurich; Osnat Luxenburg, Ministry of Health, Jerusalem; Leslee J Shaw, Emory University; S. Richard Underwood, University of London; Madan M. Rehani, International Atomic Energy Agency; Ravi Kashyap, International Atomic Energy Agency; Diana Paez, International Atomic Energy Agency; Maurizio Dondi, International Atomic Energy Agency; Fabio Esteves, Emory University
• Language: English
• Date: 2015-07-07
• Publisher: OXFORD UNIV PRESS
• Publication Version: Final Published Version
• Copyright Statement: © The Author 2015.
• License: Creative Commons Attribution-NonCommercial 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1093/eurheartj/ehv117
• Title of Journal or Parent Work: EHJ Cardiovascular Imaging / European Heart Journal - Cardiovascular Imaging
• Volume: 36
• Issue: 26
• Start Page: 1689
• End Page: 1696
• Grant/Funding Information: Funding to pay the Open Access publication charges for this article was provided by the International Atomic Energy Agency.; This work was supported by the International Atomic Energy Agency, the Margaret Q. Landenberger Research Foundation, and the Irving Scholars Program (A.J.E.).
• Keywords: Cardiac & Cardiovascular Systems; Quality of care; SPECT; Cardiovascular System & Cardiology; Science & Technology; CANCER-RISKS; MORTALITY; PET; Best practices; Radiation dose; CORONARY-ARTERY-DISEASE; Life Sciences & Biomedicine; Nuclear cardiology
• Research Categories: Health Sciences, Oncology; Biology, Radiation

Abstract

Aims To characterize patient radiation doses from nuclear myocardial perfusion imaging (MPI) and the use of radiationoptimizing 'best practices' worldwide, and to evaluate the relationship between laboratory use of best practices and patient radiation dose. Methods and results We 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 exposurewere 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 Conclusion Marked 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.