TY - JOUR
T1 - Worldwide Diagnostic Reference Levels for Single-Photon Emission Computed Tomography Myocardial Perfusion Imaging
T2 - Findings From INCAPS
AU - INCAPS Investigators Group
AU - Hirschfeld, Cole B.
AU - Dondi, Maurizio
AU - Pascual, Thomas N.B.
AU - Mercuri, Mathew
AU - Vitola, Joao
AU - Karthikeyan, Ganesan
AU - Better, Nathan
AU - Mahmarian, John J.
AU - Bouyoucef, Salah E.
AU - Hee-Seung Bom, Henry
AU - Lele, Vikram
AU - Magboo, Vincent Peter C.
AU - Alexánderson, Erick
AU - Allam, Adel H.
AU - Al-Mallah, Mouaz H.
AU - Flotats, Albert
AU - Jerome, Scott
AU - Kaufmann, Philipp A.
AU - Luxenburg, Osnat
AU - Underwood, S. Richard
AU - Rehani, Madan M.
AU - Vassileva, Jenia
AU - Paez, Diana
AU - Einstein, Andrew J.
AU - Einstein, A. J.
AU - Paez, D.
AU - Dondi, M.
AU - Better, N.
AU - Bouyoucef, S. E.
AU - Karthikeyan, G.
AU - Kashyap, R.
AU - Lele, V.
AU - Magboo, V. P.C.
AU - Mahmarian, J. J.
AU - Meeks, J. B.
AU - Mercuri, M.
AU - Mut, F.
AU - Rehani, M. M.
AU - Vitola, J. V.
AU - Alexanderson, E.
AU - Allam, A.
AU - Bom, H.
AU - Flotats, A.
AU - Jerome, S.
AU - Luxenburg, O.
AU - Mahmarian, J.
AU - Shaw, L. J.
AU - Underwood, S. R.
AU - Vitola, J.
AU - Zafrir, N.
N1 - Publisher Copyright:
© 2021 American College of Cardiology Foundation
PY - 2021/3/1
Y1 - 2021/3/1
N2 - Objectives: This study sought to establish worldwide and regional diagnostic reference levels (DRLs) and achievable administered activities (AAAs) for single-photon emission computed tomography (SPECT) myocardial perfusion imaging (MPI). Background: Reference levels serve as radiation dose benchmarks to compare individual laboratories against aggregated data, helping to identify sites in greatest need of dose reduction interventions. DRLs for SPECT MPI have previously been derived from national or regional registries. To date there have been no multiregional reports of DRLs for SPECT MPI from a single standardized dataset. Methods: Data were submitted voluntarily to the INCAPS (International Atomic Energy Agency Nuclear Cardiology Protocols Study), a cross-sectional, multinational registry of MPI protocols. A total of 7,103 studies were included. DRLs and AAAs were calculated by protocol for each world region and for aggregated worldwide data. Results: The aggregated worldwide DRLs for rest-stress or stress-rest studies employing technetium Tc 99m–labeled radiopharmaceuticals were 11.2 mCi (first dose) and 32.0 mCi (second dose) for 1-day protocols, and 23.0 mCi (first dose) and 24.0 mCi (second dose) for multiday protocols. Corresponding AAAs were 10.1 mCi (first dose) and 28.0 mCi (second dose) for 1-day protocols, and 17.8 mCi (first dose) and 18.7 mCi (second dose) for multiday protocols. For stress-only technetium Tc 99m studies, the worldwide DRL and AAA were 18.0 mCi and 12.5 mCi, respectively. Stress-first imaging was used in 26% to 92% of regional studies except in North America where it was used in just 7% of cases. Significant differences in DRLs and AAAs were observed between regions. Conclusions: This study reports reference levels for SPECT MPI for each major world region from one of the largest international registries of clinical MPI studies. Regional DRLs may be useful in establishing or revising guidelines or simply comparing individual laboratory protocols to regional trends. Organizations should continue to focus on establishing standardized reporting methods to improve the validity and comparability of regional DRLs.
AB - Objectives: This study sought to establish worldwide and regional diagnostic reference levels (DRLs) and achievable administered activities (AAAs) for single-photon emission computed tomography (SPECT) myocardial perfusion imaging (MPI). Background: Reference levels serve as radiation dose benchmarks to compare individual laboratories against aggregated data, helping to identify sites in greatest need of dose reduction interventions. DRLs for SPECT MPI have previously been derived from national or regional registries. To date there have been no multiregional reports of DRLs for SPECT MPI from a single standardized dataset. Methods: Data were submitted voluntarily to the INCAPS (International Atomic Energy Agency Nuclear Cardiology Protocols Study), a cross-sectional, multinational registry of MPI protocols. A total of 7,103 studies were included. DRLs and AAAs were calculated by protocol for each world region and for aggregated worldwide data. Results: The aggregated worldwide DRLs for rest-stress or stress-rest studies employing technetium Tc 99m–labeled radiopharmaceuticals were 11.2 mCi (first dose) and 32.0 mCi (second dose) for 1-day protocols, and 23.0 mCi (first dose) and 24.0 mCi (second dose) for multiday protocols. Corresponding AAAs were 10.1 mCi (first dose) and 28.0 mCi (second dose) for 1-day protocols, and 17.8 mCi (first dose) and 18.7 mCi (second dose) for multiday protocols. For stress-only technetium Tc 99m studies, the worldwide DRL and AAA were 18.0 mCi and 12.5 mCi, respectively. Stress-first imaging was used in 26% to 92% of regional studies except in North America where it was used in just 7% of cases. Significant differences in DRLs and AAAs were observed between regions. Conclusions: This study reports reference levels for SPECT MPI for each major world region from one of the largest international registries of clinical MPI studies. Regional DRLs may be useful in establishing or revising guidelines or simply comparing individual laboratory protocols to regional trends. Organizations should continue to focus on establishing standardized reporting methods to improve the validity and comparability of regional DRLs.
KW - SPECT myocardial perfusion imaging
KW - administered activity
KW - diagnostic reference level
KW - radiation dose reduction
UR - http://www.scopus.com/inward/record.url?scp=85090201881&partnerID=8YFLogxK
U2 - 10.1016/j.jcmg.2020.06.029
DO - 10.1016/j.jcmg.2020.06.029
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C2 - 32828783
AN - SCOPUS:85090201881
SN - 1936-878X
VL - 14
SP - 657
EP - 665
JO - JACC: Cardiovascular Imaging
JF - JACC: Cardiovascular Imaging
IS - 3
ER -