TY - JOUR
T1 - Nuclear cardiology practice and associated radiation doses in Europe
T2 - results of the IAEA Nuclear Cardiology Protocols Study (INCAPS) for the 27 European countries
AU - for the INCAPS Investigators Group
AU - Lindner, Oliver
AU - Pascual, Thomas N.B.
AU - Mercuri, Mathew
AU - Acampa, Wanda
AU - Burchert, Wolfgang
AU - Flotats, Albert
AU - Kaufmann, Philipp A.
AU - Kitsiou, Anastasia
AU - Knuuti, Juhani
AU - Underwood, S. Richard
AU - Vitola, João V.
AU - Mahmarian, John J.
AU - Karthikeyan, Ganesan
AU - Better, Nathan
AU - Rehani, Madan M.
AU - Kashyap, Ravi
AU - Dondi, Maurizio
AU - Paez, Diana
AU - Einstein, Andrew J.
N1 - Funding Information:
The authors thank the members of the INCAPS Investigators Group, listed in the Appendix , and their institutions, for their effort in collecting data, and the cooperating professional societies, including the American Society of Nuclear Cardiology, Asian Regional Cooperative Council for Nuclear Medicine, Australian and New Zealand Society of Nuclear Medicine, British Nuclear Medicine Society/British Nuclear Cardiology Society, Comissao Nacional de Energia Nuclear, European Association of Nuclear Medicine, European Council of Nuclear Cardiology, IAEA, and Intersocietal Accreditation Commission. Funding was obtained from the IAEA, the Margaret Q. Landenberger Research Foundation, and the Irving Scholars Program. Dr. Lindner has received lecture honoraria from GE healthcare, MEDISO, and Carinopharm. Dr. Kaufmann regularly receives an institutional research contract from GE Healthcare. Dr. Einstein has received institutional research grants for other investigator-initiated studies from GE Healthcare, Philips Healthcare, Spectrum Dynamics, and Toshiba America Medical Systems.
Publisher Copyright:
© 2015, The Author(s).
PY - 2016/4/1
Y1 - 2016/4/1
N2 - Purpose: Nuclear cardiology is widely used to diagnose coronary artery disease and to guide patient management, but data on current practices, radiation dose-related best practices, and radiation doses are scarce. To address these issues, the IAEA conducted a worldwide study of nuclear cardiology practice. We present the European subanalysis. Methods: In March 2013, the IAEA invited laboratories across the world to document all SPECT and PET studies performed in one week. The data included age, gender, weight, radiopharmaceuticals, injected activities, camera type, positioning, hardware and software. Radiation effective dose was calculated for each patient. A quality score was defined for each laboratory as the number followed of eight predefined best practices with a bearing on radiation exposure (range of quality score 0 – 8). The participating European countries were assigned to regions (North, East, South, and West). Comparisons were performed between the four European regions and between Europe and the rest-of-the-world (RoW). Results: Data on 2,381 European patients undergoing nuclear cardiology procedures in 102 laboratories in 27 countries were collected. A cardiac SPECT study was performed in 97.9 % of the patients, and a PET study in 2.1 %. The average effective dose of SPECT was 8.0 ± 3.4 mSv (RoW 11.4 ± 4.3 mSv; P < 0.001) and of PET was 2.6 ± 1.5 mSv (RoW 3.8 ± 2.5 mSv; P < 0.001). The mean effective doses of SPECT and PET differed between European regions (P < 0.001 and P = 0.002, respectively). The mean quality score was 6.2 ± 1.2, which was higher than the RoW score (5.0 ± 1.1; P < 0.001). Adherence to best practices did not differ significantly among the European regions (range 6 to 6.4; P = 0.73). Of the best practices, stress-only imaging and weight-adjusted dosing were the least commonly used. Conclusion: In Europe, the mean effective dose from nuclear cardiology is lower and the average quality score is higher than in the RoW. There is regional variation in effective dose in relation to the best practice quality score. A possible reason for the differences between Europe and the RoW could be the safety culture fostered by actions under the Euratom directives and the implementation of diagnostic reference levels. Stress-only imaging and weight-adjusted activity might be targets for optimization of European nuclear cardiology practice.
AB - Purpose: Nuclear cardiology is widely used to diagnose coronary artery disease and to guide patient management, but data on current practices, radiation dose-related best practices, and radiation doses are scarce. To address these issues, the IAEA conducted a worldwide study of nuclear cardiology practice. We present the European subanalysis. Methods: In March 2013, the IAEA invited laboratories across the world to document all SPECT and PET studies performed in one week. The data included age, gender, weight, radiopharmaceuticals, injected activities, camera type, positioning, hardware and software. Radiation effective dose was calculated for each patient. A quality score was defined for each laboratory as the number followed of eight predefined best practices with a bearing on radiation exposure (range of quality score 0 – 8). The participating European countries were assigned to regions (North, East, South, and West). Comparisons were performed between the four European regions and between Europe and the rest-of-the-world (RoW). Results: Data on 2,381 European patients undergoing nuclear cardiology procedures in 102 laboratories in 27 countries were collected. A cardiac SPECT study was performed in 97.9 % of the patients, and a PET study in 2.1 %. The average effective dose of SPECT was 8.0 ± 3.4 mSv (RoW 11.4 ± 4.3 mSv; P < 0.001) and of PET was 2.6 ± 1.5 mSv (RoW 3.8 ± 2.5 mSv; P < 0.001). The mean effective doses of SPECT and PET differed between European regions (P < 0.001 and P = 0.002, respectively). The mean quality score was 6.2 ± 1.2, which was higher than the RoW score (5.0 ± 1.1; P < 0.001). Adherence to best practices did not differ significantly among the European regions (range 6 to 6.4; P = 0.73). Of the best practices, stress-only imaging and weight-adjusted dosing were the least commonly used. Conclusion: In Europe, the mean effective dose from nuclear cardiology is lower and the average quality score is higher than in the RoW. There is regional variation in effective dose in relation to the best practice quality score. A possible reason for the differences between Europe and the RoW could be the safety culture fostered by actions under the Euratom directives and the implementation of diagnostic reference levels. Stress-only imaging and weight-adjusted activity might be targets for optimization of European nuclear cardiology practice.
KW - Best practices
KW - Europe
KW - Myocardial perfusion scintigraphy
KW - Nuclear cardiology
KW - PET
KW - Quality of care
KW - Radiation dose
KW - SPECT
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U2 - 10.1007/s00259-015-3270-8
DO - 10.1007/s00259-015-3270-8
M3 - Article
C2 - 26686336
AN - SCOPUS:84959079601
VL - 43
SP - 718
EP - 728
JO - European Journal of Nuclear Medicine and Molecular Imaging
JF - European Journal of Nuclear Medicine and Molecular Imaging
SN - 1619-7070
IS - 4
ER -