Nuclear Cardiology Practice in Asia: Analysis of Radiation Exposure and Best Practice for Myocardial Perfusion Imaging　- Results From the IAEA Nuclear Cardiology Protocols Cross-Sectional Study (INCAPS).
This paper examines the current status of radiation exposure to patients in myocardial perfusion imaging (MPI) in Asia.



Laboratories voluntarily provided information on MPI performed over a 1-week period. Eight best practice criteria regarding MPI were predefined by an expert panel. Implementation of ≥6 best practices (quality index [QI] ≥6) was pre-specified as a desirable goal for keeping radiation exposure at a low level. Radiation effective dose (ED) in 1,469 patients and QI of 69 laboratories in Asia were compared against data from 239 laboratories in the rest of the world (RoW). Mean ED was significantly higher in Asia (11.4 vs. 9.6 mSv; P<0.0001), with significantly lower doses in South-East vs. East Asia (9.7 vs. 12.7 mSv; P<0.0001). QI in Asia was lower than in RoW. In comparison with RoW, Asian laboratories used thallium more frequently, used weight-based technetium dosing less frequently, and trended towards a lower rate of stress-only imaging.



MPI radiation dose in Asia is higher than that in the RoW and linked to less consistent use of laboratory best practices such as avoidance of thallium, weight-based dosing, and use of stress-only imaging. Given that MPI is performed in Asia within a diverse array of medical contexts, laboratory-specific adoption of best practices offers numerous opportunities to improve quality of care.
Section of Nuclear Medicine and Diagnostic Imaging, Division of Human Health, International Atomic Energy Agency.
Thomas N B
TN
Pascual
Mathew
M
Mercuri
Noura
N
El-Haj
Henry Hee-Sung
HH
Bom
Vikram
V
Lele
Mouaz H
MH
Al-Mallah
Osnat
O
Luxenburg
Ganesan
G
Karthikeyan
Joao
J
Vitola
John J
JJ
Mahmarian
Nathan
N
Better
Leslee J
LJ
Shaw
Madan M
MM
Rehani
Ravi
R
Kashyap
Diana
D
Paez
Maurizio
M
Dondi
Andrew J
AJ
Einstein
D000368:Aged; D001208:Asia; D002309:Cardiology / Q000379:methods; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D055414:Myocardial Perfusion Imaging / Q000009:adverse effects*; D009683:Nuclear Medicine / Q000379:methods; D010818:Practice Patterns, Physicians' / Q000592:standards*; D011787:Quality of Health Care; D011829:Radiation Dosage; D000069079:Radiation Exposure / Q000706:statistics & numerical data*; D013667:Technetium / Q000008:administration & dosage; D013793:Thallium / Q000008:administration & dosage
D013667:Technetium; D013793:Thallium