title: Gender Differences in Radiation Dose From Nuclear Cardiology Studies Across the World: Findings From the INCAPS Registry.
abstract: OBJECTIVE
  The aim of this study was to investigate gender-based differences in nuclear cardiology practice globally, with a particular focus on laboratory volume, radiation dose, protocols, and best practices.
  
  
  BACKGROUND
  It is unclear whether gender-based differences exist in radiation exposure for nuclear cardiology procedures.
  
  
  METHODS
  In a large, multicenter, observational, cross-sectional study encompassing 7,911 patients in 65 countries, radiation effective dose was estimated for each examination. Patient-level best practices relating to radiation exposure were compared between genders. Analysis of covariance was used to determine any difference in radiation exposure according to gender, region, and the interaction between gender and region. Linear, logistic, and hierarchical regression models were developed to evaluate gender-based differences in radiation exposure and laboratory adherence to best practices. The study also included the United Nations Gender Inequality Index and Human Development Index as covariates in multivariable models.
  
  
  RESULTS
  The proportion of myocardial perfusion imaging studies performed in women varied among countries; however, there was no significant correlation with the Gender Inequality Index. Globally, mean effective dose for nuclear cardiology procedures was only slightly lower in women (9.6 ± 4.5 mSv) than in men (10.3 ± 4.5 mSv; p < 0.001), with a difference of only 0.3 mSv in a multivariable model adjusting for patients' age and weight. Stress-only imaging was performed more frequently in women (12.5% vs. 8.4%; p < 0.001); however, camera-based dose reduction strategies were used less frequently in women (58.6% vs. 65.5%; p < 0.001).
  
  
  CONCLUSIONS
  Despite significant worldwide variation in best practice use and radiation doses from nuclear cardiology procedures, only small differences were observed between genders worldwide. Regional variations noted in myocardial perfusion imaging use and radiation dose offer potential opportunities to address gender-related differences in delivery of nuclear cardiology care.
authors.affiliation: College of Physicians and Surgeons, Columbia University, New York, New York.
authors.forename: Lynn
authors.initials: L
authors.lastname: Shi
authors.affiliation: Division of Cardiology, Department of Medicine, Brigham and Women's Hospital, Harvard University, Boston, Massachusetts.
authors.forename: Sharmila
authors.initials: S
authors.lastname: Dorbala
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, and Emory Clinical Cardiovascular Research Institute, Emory University School of Medicine, Atlanta, Georgia.
authors.forename: Leslee J
authors.initials: LJ
authors.lastname: Shaw
authors.affiliation: Departments of Medicine and Radiology, McMaster University, Hamilton, Ontario, Canada.
authors.forename: Katherine A
authors.initials: KA
authors.lastname: Zukotynski
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: TN
authors.lastname: Pascual
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: Quanta Diagnóstico & Terapia, Curitiba, Brazil.
authors.forename: João V
authors.initials: JV
authors.lastname: Vitola
authors.affiliation: Departments of Cardiology and Nuclear Medicine, Royal Melbourne Hospital, Melbourne, Australia.
authors.forename: Nathan
authors.initials: N
authors.lastname: Better
authors.affiliation: Department of Medicine, Cardiology Division, Columbia University Medical Center, New York, New York.
authors.forename: Nadia
authors.initials: N
authors.lastname: Bokhari
authors.affiliation: Radiation Protection of Patients Unit, International Atomic Energy Agency, Vienna, Austria; Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts.
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: Department of Medicine, Cardiology Division, Columbia University Medical Center, New York, New York.
authors.forename: Mathew
authors.initials: M
authors.lastname: Mercuri
authors.affiliation: Department of Medicine, Cardiology Division, 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. Electronic address: andrew.einstein@columbia.edu.
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Einstein
mesh_terms: D000349:Africa; D000368:Aged; D001208:Asia; D016009:Chi-Square Distribution; D003326:Coronary Circulation; D003430:Cross-Sectional Studies; D005060:Europe; D005260:Female; D054625:Healthcare Disparities; D006331:Heart Diseases / Q000000981:diagnostic imaging* / Q000503:physiopathology; D006801:Humans; D007843:Latin America; D016014:Linear Models; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D055414:Myocardial Perfusion Imaging / Q000009:adverse effects / Q000379:methods*; D009656:North America; D044349:Oceania; D016017:Odds Ratio; D049268:Positron-Emission Tomography / Q000009:adverse effects; D011829:Radiation Dosage; D000069079:Radiation Exposure; D019275:Radiopharmaceuticals / Q000008:administration & dosage* / Q000009:adverse effects; D012042:Registries; D018570:Risk Assessment; D012307:Risk Factors; D012737:Sex Factors; D015899:Tomography, Emission-Computed, Single-Photon / Q000009:adverse effects
chemical_list: D019275:Radiopharmaceuticals
keywords: gender; nuclear cardiology; radiation exposure