@article{608d129571e042a8bccab347d65b41c3,
title = "Nuclear cardiology practices and radiation exposure in Africa: Results from the IAEA Nuclear Cardiology Protocols Study (INCAPS)",
abstract = "Objective: While nuclear myocardial perfusion imaging (MPI) offers many benefits to patients with known or suspected cardiovascular disease, concerns exist regarding radiationassociated health effects. Little is known regarding MPI practice in Africa. We sought to characterise radiation doses and the use of MPI best practices that could minimise radiation in African nuclear cardiology laboratories, and compare these to practice worldwide. Methods: Demographics and clinical characteristics were collected for a consecutive sample of 348 patients from 12 laboratories in six African countries over a one-week period from March to April 2013. Radiation effective dose (ED) was estimated for each patient. A quality index (QI) enumerating adherence to eight best practices, identified a priori by an IAEA expert panel, was calculated for each laboratory. We compared these metrics with those from 7 563 patients from 296 laboratories outside Africa. Results: Median (interquartile range) patient ED in Africa was similar to that of the rest of the world [9.1 (5.1-15.6) vs 10.3 mSv (6.8-12.6), p = 0.14], although a larger proportion of African patients received a low ED, ≤ 9 mSv targeted in societal recommendations (49.7 vs 38.2%, p < 0.001). Bestpractice adherence was higher among African laboratories (QI score: 6.3 ± 1.2 vs 5.4 ± 1.3, p = 0.013). However, median ED varied significantly among African laboratories (range: 2.0-16.3 mSv; p < 0.0001) and QI range was 4-8. Conclusion: Patient radiation dose from MPI in Africa was similar to that in the rest of the world, and adherence to best practices was relatively high in African laboratories. Nevertheless there remain opportunities to further reduce radiation exposure to African patients from MPI.",
keywords = "Africa, Best practices, Effective dose, Myocardial perfusion imaging, Radiation",
author = "Bouyoucef, {Salah E.} and Mathew Mercuri and Pascual, {T. N.B.} and Allam, {Adel H.} and Mboyo Vangu and Vitola, {Jo{\~a}o V.} and Nathan Better and Ganesan Karthikeyan and J. Mahmarian and Rehani, {Madan M.} and Ravi Kashyap and M. Dondi and D. Paez and Einstein, {A. J.} and Einstein, {A. J.} and Pascual, {T. N.B.} and D. Paez and M. Dondi and N. Better and Bouyoucef, {S. E.} and G. Karthikeyan and R. Kashyap and V. Lele and Magboo, {V. P.C.} and M. Mercuri and F. Mut and Rehani, {M. M.} and Vitola, {J. V.} and E. Alex{\'a}nderson and A. Allam and Al-Mallah, {M. H.} and N. Better and Bouyoucef, {S. E.} and H. Bom and A. Flotats and S. Jerome and Kaufmann, {P. A.} and V. Lele and O. Luxenburg and Shaw, {L. J.} and Underwood, {S. R.} and J. Vitola and W. Amouri and H. Essabbah and Gassama, {S. S.} and Makhdomi, {K. B.} and {El Mustapha}, {G. I.E.} and {El Ouchdi}, N. and N. Qa{\"i}s and N. Soni and {INCAPS Investigators Group}",
note = "Funding Information: The authors gratefully acknowledge funding from the International Atomic Energy Agency, the Margaret Q Landenberger Research Foundation (in memory of Prof A Donny Strosberg) and the Irving Scholars Program. We affirm not having entered into an agreement with the funders that may have limited our ability to complete the research as planned, and indicate that we have had full control of all primary data. We are grateful to the INCAPS Investigators Group members* and their institutions for efforts in collecting the data, and to the cooperating professional societies, including the American Society of Nuclear Cardiology, the Asian Regional Cooperative Council for Nuclear Medicine, Australian and New Zealand Society of Nuclear Medicine, British Nuclear Medicine Society/British Nuclear Cardiology Society, Comiss{\~a}o Nacional de Energia Nuclear, European Association of Nuclear Medicine, European Council of Nuclear Cardiology, IAEA and the Intersocietal Accreditation Commission. Dr Einstein has received research grants for other investigator-initiated studies from GE Healthcare, Philips Healthcare, Spectrum Dynamics and Toshiba America Medical Systems. The other co-authors have no disclosures. Funding Information: The authors gratefully acknowledge funding from the International Atomic Energy Agency, the Margaret Q Landenberger Research Foundation (in memory of Prof A Donny Strosberg) and the Irving Scholars Program. We affirm not having entered into an agreement with the funders that may have limited our ability to complete the research as planned, and indicate that we have had full control of all primary data. We are grateful to the INCAPS Investigators Group members and their institutions for efforts in collecting the data, and to the cooperating professional societies, including the American Society of Nuclear Cardiology, the Asian Regional Cooperative Council for Nuclear Medicine, Australian and New Zealand Society of Nuclear Medicine, British Nuclear Medicine Society/British Nuclear Cardiology Society, Comiss{\~a}o Nacional de Energia Nuclear, European Association of Nuclear Medicine, European Council of Nuclear Cardiology, IAEA and the Intersocietal Accreditation Commission. Dr Einstein has received research grants for other investigator-initiated studies from GE Healthcare, Philips Healthcare, Spectrum Dynamics and Toshiba America Medical Systems. The other co-authors have no disclosures.",
year = "2017",
month = jul,
day = "1",
doi = "10.5830/CVJA-2016-091",
language = "English (US)",
volume = "28",
pages = "229--234",
journal = "Cardiovascular Journal of Africa",
issn = "1995-1892",
publisher = "Clinics Cardive Publishing (PTY)Ltd",
number = "4",
}