Columbia University Irving Medical Center (CUIMC), New York Presbyterian Hospital, International Atomic Energy Agency [Vienna] (IAEA), McMaster University [Hamilton, Ontario], University of Toronto, All India Institute of Medical Sciences [New Delhi], The Royal Melbourne Hospital, University of Melbourne, Methodist Debakey Heart and Vascular Center [Houston, TX, USA], Houston Methodist Hospital [Houston, TX, USA], Centre Hospitalier Universitaire de Bab-el-Oued, Alger, Algérie., Chonnam National University [Gwangju], Jaslok Hospital & Research Centre, University of the Philippines (UP System), University of Santo Tomas Hospital, Instituto Nacional de Cardiologia Ignacio Chavez, Universidad Nacional Autónoma de México (UNAM), Al-Azhar University [Cairo, Egypt], Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona (UAB), University of Maryland [Baltimore], University hospital of Zurich [Zurich], The Gertner Institute for Epidemiology and Health Policy Research, National Heart and Lung Institute [London] (NHLI), Imperial College London-Royal Brompton and Harefield NHS Foundation Trust, Massachusetts General Hospital [Boston], Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier)
المصدر:
JACC: Cardiovascular Imaging JACC: Cardiovascular Imaging, Elsevier/American College of Cardiology, 2021, 14 (3), pp.657-665. ⟨10.1016/j.jcmg.2020.06.029⟩
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.
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