Nuclear Cardiology Practices and Radiation Exposure in the Oceania Region: Results From the IAEA Nuclear Cardiology Protocols Study (INCAPS) - 18/04/17

Doi : 10.1016/j.hlc.2016.05.112

Sinjini Biswas, MBBS, BMedSc ^a,^⁎ , Nathan Better, MBBS, FRACP ^a, Thomas N.B. Pascual, MD ^b, Mathew Mercuri, PhD ^c, João V. Vitola, MD, PhD ^d, Ganesan Karthikeyan, MBBS, MD, DM, MSc ^e, James Westcott, BAppSc(MedRad) ^a, Erick Alexánderson, MD ^f, Adel H. Allam, MD ^g, Mouaz H. Al-Mallah, MD, MS ^h, Henry Hee-Seung Bom, MD, PhD ⁱ, Salah E. Bouyoucef, MD ^j, Albert Flotats, MD ^k, Scott Jerome, DO ^l,^m, Philip A. Kaufman, MD ⁿ, Vikram Lele, MD ^o, Osnat Luxenburg, MD, MPH, MBA ^p,^q, John J. Mahmarian, MD ^r, Leslee J. Shaw, PhD ^s, S. Richard Underwood, DM, FRCP ^t,^u, Madan Rehani, PhD ^v,^w, Ravi Kashyap, MD ^b, Maurizio Dondi, MD ^b, Diana Paez, MD ^b, Andrew J. Einstein, MD, PhD ^c,^x
for the INCAPS Investigators Group
^a Department of Cardiology and Department of Nuclear Medicine, Royal Melbourne Hospital, Melbourne, Vic., Australia
^b Section of Nuclear Medicine and Diagnostic Imaging, Division of Human Health International Atomic Energy Agency, Vienna, Austria
^c Division of Cardiology, Department of Medicine, Columbia University Medical Center and New York-Presbyterian Hospital, New York, NY, USA
^d Quanta Diagnostico & Terapia, Curitiba, Brazil
^e Department of Cardiology, All India Institute of Medical Sciences, New Delhi, India
^f Departamento de Cardiología Nuclear, Instituto Nacional de Cardiología “Ignacio Chávez”, Mexico, Mexico
^g Cardiology Department, Al Azhar University, Cairo, Egypt
^h Division of Advanced Cardiac Imaging, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
ⁱ Department of Nuclear Medicine, Chonnam National University Medical School, Gwangju, Korea
^j Centre Hospitalo-Universitaire de Bab El Ouéd, Alger, Algeria
^k Nuclear Medicine Department, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
^l Intersocietal Accreditation Commission, Ellicott City, Maryland, USA
^m Division of Cardiovascular Medicine, University of Maryland, Baltimore, USA
ⁿ Department of Nuclear Medicine and Cardiac Imaging, University Hospital Zurich, Zurich, Switzerland
^o Department of Nuclear Medicine and PET-CT, Jaslok Hospital and Research Centre, Mumbai, India
^p Medical Technology and Infrastructure Administration, Ministry of Health, Jerusalem, Israel
^q Israeli Center for Technology Assessment in Health Care, Gertner Institute for Epidemiology and Health Policy Research, Tel Hashomer, Israel
^r Department of Cardiology, Houston Methodist DeBakey Heart and Vascular Center, Houston, Texas, USA
^s Division of Cardiology, Department of Medicine, and Emory Clinical Cardiovascular Research Institute, Emory University School of Medicine, Atlanta, Georgia, USA
^t National Heart and Lung Institute, Imperial College London, London, England
^u Department of Nuclear Medicine, Royal Brompton and Harefield Hospitals, London, England
^v Radiation Protection of Patients Unit, International Atomic Energy Agency, Vienna, Austria
^w Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
^x Department of Radiology, Columbia University Medical Center and New York-Presbyterian Hospital, New York, NY, USA

^⁎Corresponding author at: Department of Cardiology & Nuclear Medicine, Royal Melbourne Hospital, Parkville, Victoria 3052, Tel.: +61 401 067 058

Résumé

Background

There is concern about radiation exposure with radionuclide myocardial perfusion imaging (MPI). This sub-study of the International Atomic Energy Agency (IAEA) Nuclear Cardiology Protocols Study reports radiation doses from MPI, and use of dose-optimisation protocols in Australia and New Zealand (ANZ), and compares them with data from the rest of the world.

Methods

Data were collected from 7911 MPI studies performed in 308 laboratories worldwide in one week in 2013, including 439 MPI studies from 34 ANZ laboratories. For each laboratory, effective radiation dose (ED) and a quality index (QI) score (out of 8) based on pre-specified “best practices” was determined.

Results

In ANZ patients, ED ranged from 0.9-17.9 milliSievert (mSv). Median ED was similar in ANZ compared with the rest of the world (10.0 (IQR: 6.5-11.7) vs. 10.0 (IQR 6.4-12.6, P=0.15), as were mean QI scores (5.5±0.7 vs. 5.4±1.3, P=0.84). Use of stress-only imaging (17.6% vs. 31.8% of labs, P=0.09) and weight-based dosing of technetium-99m (14.7% vs. 30.3%, P=0.07) was lower in ANZ compared with the rest of the world but this difference was not statistically significant. Median ED was significantly lower in metropolitan versus non-metropolitan laboratories (10.1 mSv vs. 11.6 mSv, P<0.01), although mean QI scores were similar (5.4±0.8 vs. 5.5±0.7, P=0.75).

Conclusion

Across ANZ, there is variability in ED from MPI, and use of radiation safety practices, particularly between metropolitan and non-metropolitan laboratories. Overall, ANZ laboratories have a similar median ED to laboratories in the rest of the world.

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Keywords : Myocardial perfusion imaging, Radiation exposure

Abbreviations : MPI, IAEA, INCAPS, ANZ, ED, QI, CAD, mSv

Plan

Introduction

Methods

Study Design and Data Collection Instrument

Best Practices and Quality Index

Study Approval

Statistical Methodology

Results

Comparison with the Rest of the World

Comparison within ANZ

Discussion

Stress-Only Imaging

Weight-Based Dosing

Camera-Based Strategies to Reduce Radiation Exposure

Comparison of Metropolitan vs. Non-Metropolitan Laboratories

Limitations

New Knowledge Gained

Sources of Funding

Conflict of Interest Disclosure Statement

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Nuclear Cardiology Practices and Radiation Exposure in the Oceania Region: Results From the IAEA Nuclear Cardiology Protocols Study (INCAPS) - 18/04/17

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Background

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Results

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