News | Radiation Dose Management | May 12, 2017

Study Reveals Low Adoption of IAEA Recommendations for Reduced Nuclear Cardiology Radiation Exposure

Majority of sites worldwide found to be using less than half of the suggested quality metrics to achieve dose of 9 mSv or less

Study Reveals Low Adoption of IAEA Recommendations for Reduced Nuclear Cardiology Radiation Exposure

May 12, 2017 — A study in 65 countries has revealed low adoption of International Atomic Energy Agency (IAEA) recommendations to reduce nuclear cardiology radiation exposure. The research was presented at ICNC 2017, May 7-9 in Vienna Austria, by Edward Hulten, M.D., a cardiologist at the Walter Reed National Military Medical Center, Bethesda, Md.

Nuclear cardiology uses small amounts of radioactive tracers that are injected into the veins and taken up by the heart. A gamma camera images the radiation from the tracer. The cardiac images are used to measure the heart size and function, identify coronary heart disease and predict the risk of a heart attack.

Hulten said, “Nuclear cardiology is a key part of contemporary cardiology management and around 15 to 20 million procedures are performed annually. It gives information regarding diagnosis, prognosis, and the effects of therapeutic interventions.”

“Concerns have been raised about tests, including nuclear cardiology, that expose patients to ionizing medical radiation,” he continued. “Medical radiation potentially raises the lifetime risk of cancer which is important for all patients, especially younger patients or when considering additional radiation over time from further medical studies.”

A goal of 9 mSv or less radiation exposure per scan was recommended by the American Society of Nuclear Cardiology (ASNC) in 2010. It was noted in a 2016 International Atomic Energy Agency (IAEA) nuclear cardiology guideline but not formally endorsed as a recommendation.

The IAEA developed eight quality metrics for responsible radiation use in nuclear cardiology:

  • Avoiding thallium 201 stress testing;
  • Avoiding dual isotope testing;
  • Avoiding too much technetium-99m and thallium 201;
  • Using stress-only imaging;
  • Use of camera technologies to reduce dose;
  • Use of weight-based dosing strategies for technetium-99m; and
  • Avoiding inappropriate dosing that can lead to “shine-through” artifacts.

The IAEA Nuclear Cardiology Protocols Study (INCAPS) assessed adherence to the eight quality metrics. The present analysis investigated which metrics were most helpful in meeting the ASNC’s 9 mSv target. During one week in 2013, 308 nuclear cardiology laboratories were studied in 65 countries in Africa, Asia, Europe, Latin America, North America and Oceania.

The survey included 7,911 nuclear cardiology scans. There was significant variability in adherence to the quality metrics across laboratories and regions. There was low adherence overall, with the majority of sites implementing less than half of the quality metrics.

When the researchers performed multivariable logistic regression analysis, they found that the practices most strongly associated with achieving a 9 mSv or less scan were the use of stress or rest only imaging, avoiding thallium, and use of camera technologies to reduce radiation dose.

Hulten said, “When the 9 mSv recommendation was made in 2010 it was suggested that it should be achieved in 50 percent of scans by 2014. The INCAPS survey shows that there is still work to do. It is possible to reduce radiation exposure with existing techniques. Cadmium zinc telluride (CZT) cameras are more sensitive and allow for reduced dose scanning. With certain tracers you can achieve 1 mSv or less. But some scans use more than 30 mSv, so there is huge variability.”

Not every site has all of the hardware and technology, said Hulten, so the first step is to look at what is possible within each lab. He said, “There are improvements every lab can make regardless of money – for example multiple position imaging, weight-based dosing and stress-only techniques. They do require adapting existing workflows which takes leadership but they should be feasible in most labs.”

He added, “Eventually cameras wear out and perhaps the decision on a replacement could factor in a reduced radiation dose which also lowers false positive tests and has the potential to reduce lab costs.”

Hulten concluded, “The INCAPS survey is a crucial step towards improving patient care in the field of nuclear cardiology by quantifying worldwide adherence to best practices. Any test involving ionising radiation will increase cancers within a population but the risk must be weighed against the benefit of gaining information about heart disease. The 9 mSv goal is achievable, and the lower the better.”

For more information: www.escardio.org

 

Read the article "Recent Advances in Cardiac Nuclear Imaging Technology." 

Watch the VIDEO "PET vs. SPECT in Nuclear Cardiology and Recent Advances in Technology." An interview with Prem Soman, M.D., director of nuclear cardiology at the Heart and Vascular Institute, University of Pittsburgh, and president-elect of the American Society of Nuclear Cardiology (ASNC), explained advances in PET and SPECT imaging. 

Watch the VIDEO "Trends in Nuclear Cardiology Imaging." A discussion with David Wolinsky, M.D., director of nuclear cardiology at Cleveland Clinic Florida and past-president of the American Society of Nuclear Cardiology (ASNC), discusses advancements in nuclear imaging and some of the issues facing the subspecialty. 

Related Content

New Policy Decisions Give Millions Access to HeartFlow FFRct Analysis
News | Cardiac Imaging | February 01, 2018
February 1, 2018 – HeartFlow announced that seven new commercial payers issued positive medical policies covering the
Clear detail of the in-stent restenosis can be seen in this image from the new high-resolution Canon Precision CT system. RSNA 2017, #RSNA2017, #RSNA17

Clear detail of the in-stent restenosis can be seen in this image from the new high-resolution Canon Aquilion Precision CT system.

Feature | Cardiac Imaging | January 23, 2018 | Dave Fornell
Medical imaging plays a key role in cardiology, and most of the newest radiology technology advances are first unveil
Philips Introduces Technology Maximizer Program for Imaging Equipment Upgrades
Technology | Cardiac Imaging | January 17, 2018
Philips recently announced the launch of Technology Maximizer, a cross-modality program designed to boost the clinical...
Videos | Cardiac Imaging | December 29, 2017
ITN and DAIC Editor Dave Fornell takes a tour of some of the most interesting new medical imaging technologies on the
Siemens Healthineers Introduces Share360 Tailored Service Portfolio
News | Cardiac Imaging | November 10, 2017
To address the specific needs of medical imaging clinical engineering departments nationwide, Siemens Healthineers has...
HeartFlow's FFR-CT (FFRct) analysis software can create a virtual FFR to assess coronary artery disease.

HeartFlow's FFR-CT analysis software uses a computed tomography scan and supercomputing fluid dynamics software to create a noninvasive, virtual FFR map of the entire coronary artery tree to determine the flow-limiting severity of ant lesions. 

News | Cardiac Imaging | November 06, 2017
November 6, 2017 – The Centers for Medicare & Medicaid Services (CMS) has finalized a New Technology Ambulatory P
Philips Announces Findings of Patient Experience in Imaging Research
News | Cardiac Imaging | October 24, 2017
Philips recently announced the key findings of its research focused on the patient experience in diagnostic imaging...
ASNC and SNMMI Release Joint Document on Diagnosis, Treatment of Cardiac Sarcoidosis
News | Cardiac Imaging | August 18, 2017
August 18, 2017 — The American Society of...
Houston Methodist Hospital Enters Multi-Year Technology and Research Agreement With Siemens Healthineers
News | Cardiac Imaging | August 17, 2017
Houston Methodist Hospital and Siemens Healthineers have entered into a multi-year agreement to bring cutting-edge...
Videos | Cardiac Imaging | July 18, 2017
Leslee Shaw, Ph.D., director of clinical research and professor of medicine at Emory University, Atlanta, and past-pr
Overlay Init