title: Myocardial perfusion scintigraphy dosimetry: optimal use of SPECT and SPECT/CT technologies in stress-first imaging protocol.
abstract: OBJECTIVE
  Over the past decade, nuclear medicine experts have been seeking to minimize patient exposure to radiation in myocardial perfusion scintigraphy (MPS). This review describes the latest technological innovations in MPS, particularly with regard to dose reduction.
  
  
  METHODS
  We searched in PubMed for original clinical papers in English, published after 2008, using the following research criteria: (dose) and ((reduction) or (reducing)) and ((myocardial) or (cardiac) or (heart)) and ((nuclear medicine) or (nuclear imaging) or (radionuclide) or (scintigraphy) or (SPET) or (SPECT)). Thereafter, recent reviews on the topic were considered and other relevant clinical papers were added to the results.
  
  
  RESULTS
  Of 202 non-duplicate articles, 17 were included. To these, another eight papers cited in recent reviews were added. By optimizing the features of software, i.e., through algorithms for iterative reconstruction with resolution recovery (IRRs), and hardware, i.e., scanners and collimators, and by preferring, unless otherwise indicated, the use of stress-first imaging protocols, it has become possible to reduce the effective dose by at least 50% in stress/rest protocols, and by up to 89% in patients undergoing a diagnostic stress-only study with new technology. With today's SPECT/CT systems, the use of a stress-first protocol can conveniently be performed, resulting in an overall dose reduction of about 35% if two-thirds of stress-first examinations were considered definitively normal.
  
  
  CONCLUSIONS
  Using innovative gamma cameras, collimators and software, as well as, unless otherwise indicated, stress-first imaging protocols, it has become possible to reduce significantly the effective dose in a high percentage of patients, even when X-ray CT scanning is performed for attenuation correction.
authors.affiliation: Health Physics, San Paolo Hospital, Via Antonio di Rudini, 20142 Milan, Italy ; Department of Health Sciences, University of Milan, Milan, Italy.
authors.forename: M
authors.initials: M
authors.lastname: Lecchi
authors.affiliation: Nuclear Medicine Unit, Department of Diagnostic Services, ASST Santi Paolo e Carlo, Milan, Italy.
authors.forename: S
authors.initials: S
authors.lastname: Malaspina
authors.affiliation: Health Physics, San Paolo Hospital, Via Antonio di Rudini, 20142 Milan, Italy.
authors.forename: C
authors.initials: C
authors.lastname: Scabbio
authors.affiliation: Department of Advanced Biomedical Sciences, University Federico II, Naples, Italy.
authors.forename: V
authors.initials: V
authors.lastname: Gaudieri
authors.affiliation: Department of Health Sciences, University of Milan, Milan, Italy ; Nuclear Medicine Unit, Department of Diagnostic Services, ASST Santi Paolo e Carlo, Milan, Italy.
authors.forename: A
authors.identifier: 0000-0001-5364-9602
authors.initials: A
authors.lastname: Del Sole
keywords: CT; Dose reduction; Myocardial perfusion imaging; Patient dose; Radiation exposure; SPECT