Approaches to Reducing Radiation Dose from Radionuclide Myocardial Perfusion Imaging

Abstract

Learning Objectives: On successful completion of this activity, participants should be able to (1) describe the application of appropriate use criteria for SPECT and PET myocardial perfusion imaging, (2) apply stress-only/stress-first myocardial perfusion imaging in clinical practice, and (3) list methods to perform lowradiation-dose myocardial perfusion imaging using traditional and novel technology.Financial Disclosure: Dr. Dorbala was supported by NIH-NHLBI K23HL092299, has received a research grant from Astellas Pharma (unrelated to this work), and has investment interest with General Electric. The authors of this article have indicated no other relevant relationships that could be perceived as a real or apparent conflict of interest. CME Credit: SNMMI is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to sponsor continuing education for physicians. SNMMI designates each JNM continuing education article for a maximum of 2.0 AMA PRA Category 1 Credits. Physicians should claim only credit commensurate with the extent of their participation in the activity. For CE credit, SAM, and other credit types, participants can access this activity through the SNMMI website (http://www.snmmilearningcenter.org) through April 2018.Radionuclide myocardial perfusion imaging (MPI) plays a vital role in the evaluation and management of patients with coronary artery disease. However, because of a steep growth in MPI in the mid 2000s, concerns about inappropriate use of MPI and imaging-related radiation exposure increased. In response, the professional societies developed appropriate-use criteria for MPI. Simultaneously, novel technology, image-reconstruction software for traditional scanners, and dedicated cardiac scanners emerged and facilitated the performance of MPI with low-dose and ultra-low-dose radiotracers. This paper provides a practical approach to performing low-radiationdose MPI using traditional and novel technologies.

The impact of IUGR on pancreatic islet development and β-cell function

“…Fluorescence imaging combined with several microscopy techniques have been successfully utilized to verify responsiveness to glucose and vascular networking in islet transplants or excised pancreases (Nyman, et al 2008; Speier, et al 2008). Adaptations of clinical imaging techniques including MRI, PET, and SPECT have been used to distinguish the exocrine and endocrine pancreas and increased resolution of these techniques may be enhanced by the continued evaluation of β-cell specific contrast agents and radio-ligands (Antkowiak, et al 2009; Moore 2009; Steyn, et al 2015; Willekens, et al 2015). Further development of in vivo imaging techniques will allow for detailed investigation of complex cellular processes regulating β-cell proliferation, vascularization, and insulin secretion in pathophysiological conditions.…”

It’s about time we think about lowering radiation dose in obese patients too

“…[5][6][7] Suggested approaches include utilization of appropriate use criteria, stress-only imaging, limited use of a dual isotope protocol, and PET imaging, where appropriate. Other approaches rely on recent improvements in camera hardware and software such as highsensitivity cadmium zinc telluride (CZT) solid-state detectors and iterative reconstruction resolution recovery algorithms, which can allow injection of less radiotracer and/or decrease image acquisition time.…”

The tools are ready, are we?

“…One option is the measurement of stress MBF with low-dose CT coronary angiography and calcium scoring, which can identify significant coronary artery disease that may warrant aggressive medical therapy. 24 Low-dose CT coronary angiographies can now be achieved with a radiation dose below 1 mSv by use of automated exposure control, electrocardiographically controlled tube modulation, and reduced tube voltage. 25 …”