The very hungry caterpillar and the ongoing effort to reduce radiation in myocardial perfusion scintigraphy: Have we become the beautiful butterfly?

Abstract

See related article, pp. 26-35 Single photon emission computed tomography (SPECT) myocardial perfusion imaging (MPI) is a noninvasive test to diagnose coronary artery disease, stratify risk, predict outcomes, guide patient management, and control costs. 1-5 Over the past 30 years, successive technical innovations including, but not limited to, SPECT acquisition and ECG gating have granted myocardial perfusion imaging the status of a reliable, widely applicable, and increasingly useful technique. 6,7 Reflecting these benefits, MPI is widely used and its volume has grown rapidly worldwide over the past 2 decades, to approximately 15 to 20 million procedures annually. 8 Although SPECT MPI is widely used, it is also associated with a relatively high radiation dose. While there is a considerable worldwide variation, SPECT MPI has the highest per capita radiation dose of all medical tests, 9-11 contributing to approximately 10% of the cumulative radiation dose of medical procedures in the United States. 12 The authors of the IAEA Nuclear Cardiology Protocols Cross-Sectional Study (INCAPS) rightfully concluded that the significant relationship between best-practice implementation and lower doses

Cardiac motion correction for improving perfusion defect detection in cardiac SPECT at standard and reduced doses of activity

“…Furthermore, in this study we also investigate the benefit and robustness of the proposed PMC approach for SPECT imaging with a simulated reduction in administered activity (reduced dose). Due to concerns over the radiation risk associated with clinical SPECT imaging, there has been great interest in reducing the imaging dose for cardiac SPECT in recent years (Liu et al 2015, van Dijk et al 2018, Verberne and Scholtens 2018. In the experiments, we therefore also evaluated the PMC approach when the imaging dose was lowered to 50% (one half), 25% (one quarter) and 12.5% (one eighth) of standard dose in conventional acquisitions.…”