title: Opportunities for improvement on current nuclear cardiology practices and radiation exposure in Latin America: Findings from the 65-country IAEA Nuclear Cardiology Protocols cross-sectional Study (INCAPS).
abstract: Comparison of Latin American (LA) nuclear cardiology (NC) practice with that in the rest of the world (RoW) will identify areas for improvement and lead to educational activities to reduce radiation exposure from NC.
  
  
  
  INCAPS collected data on all SPECT and PET procedures performed during a single week in March-April 2013 in 36 laboratories in 10 LA countries (n = 1139), and 272 laboratories in 55 countries in RoW (n = 6772). Eight "best practices" were identified a priori and a radiation-related Quality Index (QI) was devised indicating the number used. Mean radiation effective dose (ED) in LA was higher than in RoW (11.8 vs 9.1 mSv, p < 0.001). Within a populous country like Brazil, a wide variation in laboratory mean ED was found, ranging from 8.4 to 17.8 mSv. Only 11% of LA laboratories achieved median ED <9 mSv, compared to 32% in RoW (p < 0.001). QIs ranged from 2 in a laboratory in Mexico to 7 in a laboratory in Cuba. Three major opportunities to reduce ED for LA patients were identified: (1) more laboratories could implement stress-only imaging, (2) camera-based methods of ED reduction, including prone imaging, could be more frequently used, and (3) injected activity of99mTc could be adjusted reflecting patient weight/habitus.
  
  
  
  On average, radiation dose from NC is higher in LA compared to RoW, with median laboratory ED <9 mSv achieved only one third as frequently as in RoW. Opportunities to reduce radiation exposure in LA have been identified and guideline-based recommendations made to optimize protocols and adhere to the "as low as reasonably achievable" (ALARA) principle.
authors.affiliation: Quanta Diagnóstico & Terapia, Curitiba, Brazil.
authors.forename: João V
authors.initials: JV
authors.lastname: Vitola
authors.affiliation: Departamento de Medicina Nuclear, Asociación Española, Montevideo, Uruguay.
authors.forename: Fernando
authors.initials: F
authors.lastname: Mut
authors.affiliation: Departamento de Cardiología Nuclear, Instituto Nacional de Cardiología "Ignacio Chávez", Mexico, Mexico.
authors.forename: Erick
authors.initials: E
authors.lastname: Alexánderson
authors.affiliation: Section of Nuclear Medicine and Diagnostic Imaging, Division of Human Health, International Atomic Energy Agency, Vienna, Austria.
authors.forename: Thomas N B
authors.initials: TNB
authors.lastname: Pascual
authors.affiliation: Division of Cardiology, Department of Medicine, Columbia University Medical Center and New York-Presbyterian Hospital, 622 West 168th Street PH 10-203, New York, NY, 10032, USA.
authors.forename: Mathew
authors.initials: M
authors.lastname: Mercuri
authors.affiliation: Department of Cardiology, All India Institute of Medical Sciences, New Delhi, India.
authors.forename: Ganesan
authors.initials: G
authors.lastname: Karthikeyan
authors.affiliation: Department of Nuclear Medicine, Royal Melbourne Hospital and University of Melbourne, Parkville, Australia.
authors.forename: Nathan
authors.initials: N
authors.lastname: Better
authors.affiliation: Radiation Protection of Patients Unit, International Atomic Energy Agency, Vienna, Austria.|Harvard Medical School, Massachusetts General Hospital, Boston, MA, USA.
authors.forename: Madan M
authors.initials: MM
authors.lastname: Rehani
authors.affiliation: Section of Nuclear Medicine and Diagnostic Imaging, Division of Human Health, International Atomic Energy Agency, Vienna, Austria.
authors.forename: Ravi
authors.initials: R
authors.lastname: Kashyap
authors.affiliation: Section of Nuclear Medicine and Diagnostic Imaging, Division of Human Health, International Atomic Energy Agency, Vienna, Austria.
authors.forename: Maurizio
authors.initials: M
authors.lastname: Dondi
authors.affiliation: Section of Nuclear Medicine and Diagnostic Imaging, Division of Human Health, International Atomic Energy Agency, Vienna, Austria.
authors.forename: Diana
authors.initials: D
authors.lastname: Paez
authors.affiliation: Division of Cardiology, Department of Medicine, Columbia University Medical Center and New York-Presbyterian Hospital, 622 West 168th Street PH 10-203, New York, NY, 10032, USA. ae2214@cumc.columbia.edu.|Department of Radiology, Columbia University Medical Center and New York-Presbyterian Hospital, New York, NY, USA. ae2214@cumc.columbia.edu.
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Einstein
mesh_terms: D002309:Cardiology / Q000592:standards* / Q000706:statistics & numerical data; D019983:Guideline Adherence / Q000592:standards / Q000706:statistics & numerical data; D019538:Health Care Surveys; D006801:Humans; D038622:Internationality; D007843:Latin America / Q000453:epidemiology; D008875:Middle Aged; D055414:Myocardial Perfusion Imaging / Q000592:standards / Q000706:statistics & numerical data*; D010818:Practice Patterns, Physicians' / Q000592:standards / Q000706:statistics & numerical data*; D011785:Quality Assurance, Health Care / Q000706:statistics & numerical data*; D058996:Quality Improvement; D000069079:Radiation Exposure / Q000517:prevention & control*; D011835:Radiation Protection / Q000592:standards / Q000706:statistics & numerical data*; D014055:Tomography, Emission-Computed / Q000592:standards / Q000706:statistics & numerical data*; D014600:Utilization Review
keywords: Latin America; Nuclear cardiology; PET; SPECT; best practices; radiation dose