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)

• Published in: Journal of nuclear cardiology Vol. 24; no. 3; pp. 851 - 859
• Main Authors: Vitola, João V., Mut, Fernando, Alexánderson, Erick, Pascual, Thomas N.B., Mercuri, Mathew, Karthikeyan, Ganesan, Better, Nathan, Rehani, Madan M., Kashyap, Ravi, Dondi, Maurizio, Paez, Diana, Einstein, Andrew J.
• Format: Journal Article
• Language: English
• Published: New York Elsevier Inc 01-06-2017; Springer US; Springer Nature B.V
• Subjects: best practices; Cardiology; Cardiology - standards; Cardiology - statistics & numerical data; Cross-sectional studies; Guideline Adherence - standards; Guideline Adherence - statistics & numerical data; Health Care Surveys; Humans; Imaging; Internationality; Laboratories; Latin America; Latin America - epidemiology; Medicine; Medicine & Public Health; Middle Aged; Myocardial Perfusion Imaging - standards; Myocardial Perfusion Imaging - statistics & numerical data; Nuclear cardiology; Nuclear Medicine; Original Article; PET; Practice Patterns, Physicians' - standards; Practice Patterns, Physicians' - statistics & numerical data; Quality Assurance, Health Care - statistics & numerical data; Quality Improvement; radiation dose; Radiation Exposure - prevention & control; Radiation Protection - standards; Radiation Protection - statistics & numerical data; Radiology; SPECT; Tomography, Emission-Computed - standards; Tomography, Emission-Computed - statistics & numerical data; Utilization Review; IHD; MPI; Nuclear cardiology; IQR; SPECT; Latin America; ALARA; LA; NC; IAEA; best practices; QI; INCAPS; radiation dose; RoW; PET; ED
• ISSN: 1071-3581; 1532-6551
• DOI: 10.1007/s12350-016-0433-3

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 of 99mTc 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.