title: Nuclear Cardiology Practices and Radiation Exposure in the Oceania Region: Results From the IAEA Nuclear Cardiology Protocols Study (INCAPS).
abstract: BACKGROUND
  There is concern about radiation exposure with radionuclide myocardial perfusion imaging (MPI). This sub-study of the International Atomic Energy Agency (IAEA) Nuclear Cardiology Protocols Study reports radiation doses from MPI, and use of dose-optimisation protocols in Australia and New Zealand (ANZ), and compares them with data from the rest of the world.
  
  
  METHODS
  Data were collected from 7911 MPI studies performed in 308 laboratories worldwide in one week in 2013, including 439 MPI studies from 34 ANZ laboratories. For each laboratory, effective radiation dose (ED) and a quality index (QI) score (out of 8) based on pre-specified "best practices" was determined.
  
  
  RESULTS
  In ANZ patients, ED ranged from 0.9-17.9 milliSievert (mSv). Median ED was similar in ANZ compared with the rest of the world (10.0 (IQR: 6.5-11.7) vs. 10.0 (IQR 6.4-12.6, P=0.15), as were mean QI scores (5.5±0.7 vs. 5.4±1.3, P=0.84). Use of stress-only imaging (17.6% vs. 31.8% of labs, P=0.09) and weight-based dosing of technetium-99m (14.7% vs. 30.3%, P=0.07) was lower in ANZ compared with the rest of the world but this difference was not statistically significant. Median ED was significantly lower in metropolitan versus non-metropolitan laboratories (10.1 mSv vs. 11.6 mSv, P<0.01), although mean QI scores were similar (5.4±0.8 vs. 5.5±0.7, P=0.75).
  
  
  CONCLUSIONS
  Across ANZ, there is variability in ED from MPI, and use of radiation safety practices, particularly between metropolitan and non-metropolitan laboratories. Overall, ANZ laboratories have a similar median ED to laboratories in the rest of the world.
authors.affiliation: Department of Cardiology and Department of Nuclear Medicine, Royal Melbourne Hospital, Melbourne, Vic., Australia. Electronic address: sinjini@gmail.com.
authors.forename: Sinjini
authors.initials: S
authors.lastname: Biswas
authors.affiliation: Department of Cardiology and Department of Nuclear Medicine, Royal Melbourne Hospital, Melbourne, Vic., Australia.
authors.forename: Nathan
authors.initials: N
authors.lastname: Better
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: Division of Cardiology, Department of Medicine, Columbia University Medical Center and New York-Presbyterian Hospital, New York, NY, USA.
authors.forename: Mathew
authors.initials: M
authors.lastname: Mercuri
authors.affiliation: Quanta Diagnostico & Terapia, Curitiba, Brazil.
authors.forename: João V
authors.initials: JV
authors.lastname: Vitola
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 Cardiology and Department of Nuclear Medicine, Royal Melbourne Hospital, Melbourne, Vic., Australia.
authors.forename: James
authors.initials: J
authors.lastname: Westcott
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: Cardiology Department, Al Azhar University, Cairo, Egypt.
authors.forename: Adel H
authors.initials: AH
authors.lastname: Allam
authors.affiliation: Division of Advanced Cardiac Imaging, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.
authors.forename: Mouaz H
authors.initials: MH
authors.lastname: Al-Mallah
authors.affiliation: Department of Nuclear Medicine, Chonnam National University Medical School, Gwangju, Korea.
authors.forename: Henry Hee-Seung
authors.initials: HH
authors.lastname: Bom
authors.affiliation: Centre Hospitalo-Universitaire de Bab El Ouéd, Alger, Algeria.
authors.forename: Salah E
authors.initials: SE
authors.lastname: Bouyoucef
authors.affiliation: Nuclear Medicine Department, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain.
authors.forename: Albert
authors.initials: A
authors.lastname: Flotats
authors.affiliation: Intersocietal Accreditation Commission, Ellicott City, Maryland, USA; Division of Cardiovascular Medicine, University of Maryland, Baltimore, USA.
authors.forename: Scott
authors.initials: S
authors.lastname: Jerome
authors.affiliation: Department of Nuclear Medicine and Cardiac Imaging, University Hospital Zurich, Zurich, Switzerland.
authors.forename: Philip A
authors.initials: PA
authors.lastname: Kaufman
authors.affiliation: Department of Nuclear Medicine and PET-CT, Jaslok Hospital and Research Centre, Mumbai, India.
authors.forename: Vikram
authors.initials: V
authors.lastname: Lele
authors.affiliation: Medical Technology and Infrastructure Administration, Ministry of Health, Jerusalem, Israel; Israeli Center for Technology Assessment in Health Care, Gertner Institute for Epidemiology and Health Policy Research, Tel Hashomer, Israel.
authors.forename: Osnat
authors.initials: O
authors.lastname: Luxenburg
authors.affiliation: Department of Cardiology, Houston Methodist DeBakey Heart and Vascular Center, Houston, Texas, USA.
authors.forename: John J
authors.initials: JJ
authors.lastname: Mahmarian
authors.affiliation: Division of Cardiology, Department of Medicine, and Emory Clinical Cardiovascular Research Institute, Emory University School of Medicine, Atlanta, Georgia, USA.
authors.forename: Leslee J
authors.initials: LJ
authors.lastname: Shaw
authors.affiliation: National Heart and Lung Institute, Imperial College London, London, England; Department of Nuclear Medicine, Royal Brompton and Harefield Hospitals, London, England.
authors.forename: S Richard
authors.initials: SR
authors.lastname: Underwood
authors.affiliation: Radiation Protection of Patients Unit, International Atomic Energy Agency, Vienna, Austria; Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA.
authors.forename: Madan
authors.initials: M
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, New York, NY, USA; Department of Radiology, Columbia University Medical Center and New York-Presbyterian Hospital, New York, NY, USA.
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Einstein
mesh_terms: D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D055414:Myocardial Perfusion Imaging / Q000009:adverse effects*; D044349:Oceania; D011829:Radiation Dosage; D000069079:Radiation Exposure
keywords: Myocardial perfusion imaging; Radiation exposure