Radiation dose and prognosis of ultra-low-dose stress-first myocardial perfusion SPECT in patients with chest pain using a high-efficiency camera.
Although SPECT myocardial perfusion imaging (MPI) provides valuable information about patients with chest pain, there is growing concern regarding its radiation burden and lengthy duration. New high-efficiency (HE) cameras and stress-first protocols both offer the potential to markedly reduce radiation. No previous study has assessed outcomes and radiation doses of patients undergoing MPI on an HE-SPECT camera using an ultra-low-dose stress-first protocol.


METHODS
One hundred patients presenting to the emergency department with chest pain who were candidates for stress-first MPI underwent injection of approximately 185 MBq (5 mCi) of (99m)Tc-tetrofosmin at peak stress, followed by supine and prone imaging on an HE-SPECT camera. Same-day rest imaging was performed on patients with any abnormality on imaging after stress. Radiation effective dose was calculated from administered and residual activities. Patients were contacted 3 mo after discharge, and electronic records were accessed to evaluate the need for reevaluation for chest pain, additional imaging, or cardiac events.


RESULTS
Stress-only imaging was performed in 69 patients, for whom radiation effective dose averaged 0.99 mSv and study duration, 117 min. Radiation dose averaged 2.22 mSv over all patients. At 3 mo, 96 patients were free of major adverse cardiac events, repeat hospital chest pain evaluation, and repeat imaging or stress testing. One year after MPI and hospital discharge, all patients were living and without acute coronary syndrome.


CONCLUSIONS
HE-SPECT stress-only imaging can be performed in more than two thirds of chest pain patients without a high pretest probability of a stress perfusion defect, with excellent prognosis, a radiation dose averaging 1 mSv, and a test duration of less than 2 h.
Cardiology Division, Department of Medicine, Columbia University Medical Center and New York-Presbyterian Hospital, New York, New York Department of Radiology, Columbia University Medical Center and New York-Presbyterian Hospital, New York, New York; and andrew.einstein@columbia.edu.
Andrew J
AJ
Einstein
Cardiology Division, Department of Medicine, Columbia University Medical Center and New York-Presbyterian Hospital, New York, New York.
Lynne L
LL
Johnson
Cardiology Division, Department of Medicine, Columbia University Medical Center and New York-Presbyterian Hospital, New York, New York.
Albert J
AJ
DeLuca
Cardiology Division, Department of Medicine, Columbia University Medical Center and New York-Presbyterian Hospital, New York, New York.
Andrew C
AC
Kontak
Cardiology Division, Department of Medicine, Columbia University Medical Center and New York-Presbyterian Hospital, New York, New York.
Daniel W
DW
Groves
Cardiology Division, Department of Medicine, Columbia University Medical Center and New York-Presbyterian Hospital, New York, New York.
Jennifer
J
Stant
Cardiology Division, Department of Medicine, Columbia University Medical Center and New York-Presbyterian Hospital, New York, New York.
Ted
T
Pozniakoff
Department of Biostatistics, Columbia University, New York, New York.
Bin
B
Cheng
Cardiology Division, Department of Medicine, Columbia University Medical Center and New York-Presbyterian Hospital, New York, New York.
LeRoy E
LE
Rabbani
Cardiology Division, Department of Medicine, Columbia University Medical Center and New York-Presbyterian Hospital, New York, New York.
Sabahat
S
Bokhari
D000328:Adult; D000368:Aged; D002637:Chest Pain; D005080:Exercise Test; D005260:Female; D006321:Heart / Q000000981:diagnostic imaging*; D006801:Humans; D008297:Male; D008875:Middle Aged; D055414:Myocardial Perfusion Imaging / Q000379:methods*; D009206:Myocardium / Q000473:pathology*; D009943:Organophosphorus Compounds; D015609:Organotechnetium Compounds; D010477:Perfusion; D011379:Prognosis; D011446:Prospective Studies; D011829:Radiation Dosage; D019275:Radiopharmaceuticals; D015899:Tomography, Emission-Computed, Single-Photon / Q000379:methods*; D016896:Treatment Outcome
D009943:Organophosphorus Compounds; D015609:Organotechnetium Compounds; D019275:Radiopharmaceuticals; C078700:technetium tc-99m tetrofosmin
SPECT; high-efficiency camera; myocardial perfusion imaging; radiation dose reduction; stress-first; stress-only