Drivers of radiation dose reduction with myocardial perfusion imaging: A large health system experience.
Autor: Al Badarin, Firas J.; Spertus, John A.; Bateman, Timothy M.; Patel, Krishna K.; Burgett, Eric V.; Kennedy, Kevin F.; Thompson, Randall C.
Publication year: 2020
Journal of nuclear cardiology : official publication of the American Society of Nuclear Cardiology
issn:1532-6551 1071-3581
doi: 10.1007/s12350-018-01576-w
Abstract:
BACKGROUND: Despite increasing emphasis on reducing radiation exposure from myocardial perfusion imaging (MPI), the use of radiation-sparing practices (RSP) at nuclear laboratories remains limited. Defining real-world impact of RSPs on effective radiation dose (E) can potentially further motivate their adoption. METHODS: MPI studies performed between 1/2010 and 12/2016 within a single health system were included. Mean E was compared between sites with ‘basic’ RSP (defined as elimination of thallium-based protocols and use of stress-only (SO) imaging on conventional single photon emission computed tomography (SPECT) cameras) and those with ‘advanced’ capabilities (sites that additionally used solid-state detector (SSD) SPECT cameras, advanced post-processing software (APPS) or positron emission tomography (PET) imaging), after matching patients by age, gender, and weight. Contributions of individual RSP to E reduction were determined using multiple linear regression after adjusting for factors affecting tracer dose. RESULTS: Among 55,930 MPI studies performed, the use of advanced RSP was associated with significantly lower mean E compared to basic RSP (7 ± 5.6 mSv and 16 ± 5.4 mSv, respectively; P < 0.001), with a greater likelihood of achieving E < 9 mSv (65.7% vs. 10.8%, respectively; OR 15.8 [95% CI 14 to 17.8]; P < 0.0001). Main driver of E reduction was SO-SSD SPECT (mean reduction = 11.5 mSv), followed by use of SO-SPECT + APPS (mean reduction = 10.1 mSv), ;ET (mean reduction = 9.7 mSv); and elimination of thallium protocols (mean reduction = 9.1 mSv); P < 0.0001 for all comparisons. CONCLUSION: In a natural experiment with implementation of radiation-saving practices at a large health system, stress-only protocols used in conjunction with modern SPECT technologies, the use of PET and elimination of thallium-based protocols were associated with greatest reductions in radiation dose. Availability of several approaches to dose reduction within a health system can facilitate achievement of targeted radiation benchmarks in a greater number of performed studies. Language: eng Rights: Pmid: 30706351 Tags: Humans; Reproducibility of Results; Aged; Female; Male; Middle Aged; Retrospective Studies; Software; Positron-Emission Tomography/*methods; Radiopharmaceuticals; Myocardial perfusion imaging; Myocardial Perfusion Imaging/*methods; Tomography, Emission-Computed, Single-Photon/*methods; Cadmium; Image Processing, Computer-Assisted/methods; Radiation Dosage; Radiation Exposure; Perfusion; Tellurium; Zinc; effective dose; radiation exposure Link: https://pubmed.ncbi.nlm.nih.gov/30706351/
