Worldwide Variation in the Use of Nuclear Cardiology Camera Technology, Reconstruction Software, and Imaging Protocols
Hirschfeld CB., Mercuri M., Pascual TNB., 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., Dorbala S., Flotats A., Jerome S., Kaufmann PA., Luxenburg O., Shaw LJ., Underwood SR., Rehani MM., Paez D., Dondi M., Einstein AJ., Einstein AJ., Pascual TNB., Paez D., Dondi M., Karthikeyan G., Kashyap R., Lele V., Magboo VPC., Mahmarian JJ., Meeks JB., Mercuri M., Mut F., Rehani MM., Vitola JV., Alexanderson E., Allam A., Al-Mallah MH., Bom H., Flotats A., Jerome S., Kaufmann PA., Mahmarian J., Shaw LJ., Underwood SR., Vitola J., Amouri W., Essabbah H., Gassama SS., Makhdomi KB., El Mustapha GIE., El Ouchdi N., Qaïs N., Soni N., Vangu W., Abazid RM., Adams B., Agarwal V., Alfeeli MA., Alnafisi N., Bernabe L., Bural GG., Chaiwatanarat T., Chandraguptha JM., Cheon GJ., Cho I., Dogan AS., Eftekhari M., Frenkel A., Garty I., George S., Geramifar P., Golan H., Habib S., Hussain R., Im H., Jeon HJ., Kalawat T., Kang WJ., Keng F., Klaipetch A., Kumar PG., Lee J., Lee WW., Lim I., Macaisa CMM., Malhotra G., Mittal BR., Mohammad MH., Mohan P., Mulyanto ID., Nariman D., Nayak UN.
© 2021 American College of Cardiology Foundation Objectives: This study sought to describe worldwide variations in the use of myocardial perfusion imaging hardware, software, and imaging protocols and their impact on radiation effective dose (ED). Background: Concerns about long-term effects of ionizing radiation have prompted efforts to identify strategies for dose optimization in myocardial perfusion scintigraphy. Studies have increasingly shown opportunities for dose reduction using newer technologies and optimized protocols. Methods: Data were submitted voluntarily to the INCAPS (International Atomic Energy Agency Nuclear Cardiology Protocols Study) registry, a multinational, cross-sectional study comprising 7,911 imaging studies from 308 labs in 65 countries. The study compared regional use of camera technologies, advanced post-processing software, and protocol characteristics and analyzed the influence of each factor on ED. Results: Cadmium-zinc-telluride and positron emission tomography (PET) cameras were used in 10% (regional range 0% to 26%) and 6% (regional range 0% to 17%) of studies worldwide. Attenuation correction was used in 26% of cases (range 10% to 57%), and advanced post-processing software was used in 38% of cases (range 26% to 64%). Stress-first single-photon emission computed tomography (SPECT) imaging comprised nearly 20% of cases from all world regions, except North America, where it was used in just 7% of cases. Factors associated with lower ED and odds ratio for achieving radiation dose ≤9 mSv included use of cadmium-zinc-telluride, PET, advanced post-processing software, and stress- or rest-only imaging. Overall, 39% of all studies (97% PET and 35% SPECT) were ≤9 mSv, while just 6% of all studies (32% PET and 4% SPECT) achieved a dose ≤3 mSv. Conclusions: Newer-technology cameras, advanced software, and stress-only protocols were associated with reduced ED, but worldwide adoption of these practices was generally low and varied significantly between regions. The implementation of dose-optimizing technologies and protocols offers an opportunity to reduce patient radiation exposure across all world regions.