Current worldwide nuclear cardiology practices and radiation exposure: results from the 65 country IAEA Nuclear Cardiology Protocols Cross-Sectional Study (INCAPS).
Journal Article (Journal Article;Multicenter Study)
AIMS: To 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 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 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. 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.
Full Text
Duke Authors
Cited Authors
- Einstein, AJ; Pascual, TNB; Mercuri, M; Karthikeyan, G; Vitola, JV; Mahmarian, JJ; Better, N; Bouyoucef, SE; Hee-Seung Bom, H; Lele, V; Magboo, VPC; Alexánderson, E; Allam, AH; Al-Mallah, MH; Flotats, A; Jerome, S; Kaufmann, PA; Luxenburg, O; Shaw, LJ; Underwood, SR; Rehani, MM; Kashyap, R; Paez, D; Dondi, M; INCAPS Investigators Group,
Published Date
- July 7, 2015
Published In
Volume / Issue
- 36 / 26
Start / End Page
- 1689 - 1696
PubMed ID
- 25898845
Pubmed Central ID
- 25898845
Electronic International Standard Serial Number (EISSN)
- 1522-9645
Digital Object Identifier (DOI)
- 10.1093/eurheartj/ehv117
Language
- eng
Conference Location
- England