title: Nationwide Laboratory Adherence to Myocardial Perfusion Imaging Radiation Dose Reduction Practices: A Report From the Intersocietal Accreditation Commission Data Repository.
abstract: OBJECTIVE
  This study sought to examine current laboratory practices for radiation effective doses for myocardial perfusion imaging (MPI) and laboratory adherence to guideline-directed radiation reduction practices.
  
  
  BACKGROUND
  A recent focus on radiation dose reduction for cardiovascular imaging has led to several published guidelines and consensus statements detailing performance metrics for laboratory practices. We sought to examine laboratory adherence to optimized radiation dose protocol recommendations among 5,216 submitted cases from 1,074 MPI laboratories evaluated for Intersocietal Accreditation Commission accreditation.
  
  
  METHODS
  Eligible imaging centers included MPI laboratories enrolled in the Intersocietal Accreditation Commission data repository of accreditation applications from 2012 to 2013. Accreditation requires submission of 3 to 5 cases for evaluation of a range of representative cases. Based on standard dosimetry for rest and stress MPI, an effective dose (in millisieverts) was calculated. Model simulations were performed to estimate guideline-directed effective doses.
  
  
  RESULTS
  The average effective dose was 14.9 ± 5.8 mSv (range 1.4 to 42.4 mSv). A 1-day technetium Tc 99m protocol was used in 82.9% of cases, whereas a 2-day technetium Tc 99m and dual isotope protocol was used in 7.5% of submitted cases. Only 1.5% of participating imaging centers met current guidelines for an average laboratory radiation exposure ≤9 mSv, whereas 10.1% of patient effective doses were >20.0 mSv. A model simulation replacing the radiation exposure of dual isotope MPI with that of a 1-day technetium Tc 99m protocol reduced the proportion of patients receiving an effective dose >20 mSv to only 2.7% of cases (p < 0.0001).
  
  
  CONCLUSIONS
  Mandatory laboratory accreditation for MPI allows for examination of current radiation dosimetry practices. Current guidelines for reduced patient-specific radiation exposure are rarely implemented, with few laboratories meeting recommendations of ≤9 mSv for 50% of patients. Increased educational efforts and the development of performance measures for laboratory accreditation may be required to meet current radiation dose-reduction standards.
authors.affiliation: Division of Cardiovascular Medicine, University of Maryland School of Medicine, Baltimore, Maryland. Electronic address: sjerome@medicine.umaryland.edu.
authors.forename: Scott D
authors.initials: SD
authors.lastname: Jerome
authors.affiliation: Department of Medicine, Greenville Health System, Greenville, South Carolina.
authors.forename: Peter L
authors.initials: PL
authors.lastname: Tilkemeier
authors.affiliation: Intersocietal Accreditation Commission, Ellicott City, Maryland.
authors.forename: Mary B
authors.initials: MB
authors.lastname: Farrell
authors.affiliation: Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia.
authors.forename: Leslee J
authors.initials: LJ
authors.lastname: Shaw
mesh_terms: D000068:Accreditation / Q000592:standards*; D019411:Clinical Laboratory Techniques / Q000592:standards*; D003198:Computer Simulation; D003326:Coronary Circulation; D016208:Databases, Factual; D019983:Guideline Adherence / Q000592:standards*; D006331:Heart Diseases / Q000000981:diagnostic imaging* / Q000503:physiopathology; D006801:Humans; D059021:Laboratory Proficiency Testing / Q000592:standards*; D055414:Myocardial Perfusion Imaging / Q000379:methods / Q000592:standards*; D015588:Observer Variation; D009943:Organophosphorus Compounds / Q000592:standards; D015609:Organotechnetium Compounds / Q000592:standards; D017410:Practice Guidelines as Topic / Q000592:standards*; D011237:Predictive Value of Tests; D011829:Radiation Dosage; D000069079:Radiation Exposure / Q000517:prevention & control / Q000592:standards*; D019275:Radiopharmaceuticals / Q000008:administration & dosage / Q000592:standards*; D015203:Reproducibility of Results; D017256:Technetium Tc 99m Sestamibi / Q000592:standards; D014481:United States
chemical_list: D009943:Organophosphorus Compounds; D015609:Organotechnetium Compounds; D019275:Radiopharmaceuticals; C078700:technetium tc-99m tetrofosmin; D017256:Technetium Tc 99m Sestamibi
keywords: laboratory accreditation; myocardial perfusion imaging; performance measures; radiation exposure