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

Publication ,  Journal Article
Einstein, AJ; Pascual, TNB; Mercuri, M; Karthikeyan, G; Vitola, JV; Mahmarian, JJ; Better, N; Bouyoucef, SE; Hee-Seung Bom, H; Lele, V; Paez, D ...
Published in: Eur Heart J
July 7, 2015

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.

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Published In

Eur Heart J

DOI

EISSN

1522-9645

Publication Date

July 7, 2015

Volume

36

Issue

26

Start / End Page

1689 / 1696

Location

England

Related Subject Headings

  • Tomography, Emission-Computed, Single-Photon
  • Regression Analysis
  • Radiation Exposure
  • Radiation Dosage
  • Quality of Health Care
  • Professional Practice
  • Practice Guidelines as Topic
  • Positron-Emission Tomography
  • Myocardial Perfusion Imaging
  • Middle Aged
 

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Einstein, A. J., Pascual, T. N. B., Mercuri, M., Karthikeyan, G., Vitola, J. V., Mahmarian, J. J., … INCAPS Investigators Group, . (2015). Current worldwide nuclear cardiology practices and radiation exposure: results from the 65 country IAEA Nuclear Cardiology Protocols Cross-Sectional Study (INCAPS). Eur Heart J, 36(26), 1689–1696. https://doi.org/10.1093/eurheartj/ehv117
Einstein, Andrew J., Thomas N. B. Pascual, Mathew Mercuri, Ganesan Karthikeyan, João V. Vitola, John J. Mahmarian, Nathan Better, et al. “Current worldwide nuclear cardiology practices and radiation exposure: results from the 65 country IAEA Nuclear Cardiology Protocols Cross-Sectional Study (INCAPS).Eur Heart J 36, no. 26 (July 7, 2015): 1689–96. https://doi.org/10.1093/eurheartj/ehv117.
Einstein AJ, Pascual TNB, Mercuri M, Karthikeyan G, Vitola JV, Mahmarian JJ, et al. Current worldwide nuclear cardiology practices and radiation exposure: results from the 65 country IAEA Nuclear Cardiology Protocols Cross-Sectional Study (INCAPS). Eur Heart J. 2015 Jul 7;36(26):1689–96.
Einstein, Andrew J., et al. “Current worldwide nuclear cardiology practices and radiation exposure: results from the 65 country IAEA Nuclear Cardiology Protocols Cross-Sectional Study (INCAPS).Eur Heart J, vol. 36, no. 26, July 2015, pp. 1689–96. Pubmed, doi:10.1093/eurheartj/ehv117.
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. Current worldwide nuclear cardiology practices and radiation exposure: results from the 65 country IAEA Nuclear Cardiology Protocols Cross-Sectional Study (INCAPS). Eur Heart J. 2015 Jul 7;36(26):1689–1696.
Journal cover image

Published In

Eur Heart J

DOI

EISSN

1522-9645

Publication Date

July 7, 2015

Volume

36

Issue

26

Start / End Page

1689 / 1696

Location

England

Related Subject Headings

  • Tomography, Emission-Computed, Single-Photon
  • Regression Analysis
  • Radiation Exposure
  • Radiation Dosage
  • Quality of Health Care
  • Professional Practice
  • Practice Guidelines as Topic
  • Positron-Emission Tomography
  • Myocardial Perfusion Imaging
  • Middle Aged