Worldwide Diagnostic Reference Levels for Single-Photon Emission Computed Tomography Myocardial Perfusion Imaging

Abstract

Objectives: To establish worldwide and regional diagnostic reference levels (DRLs) and achievable administered activities (AAAs) for SPECT MPI.Background: Reference levels serve as radiation dose benchmarks to compare individual laboratories against aggregated data, helping to identify sites in greatest need of dose reduction interventions. DRLs for SPECT myocardial perfusion imaging (MPI) have previously been derived from national or regional registries. To date there have been no multi-regional reports of DRLs for SPECT MPI from a single standardized dataset.Methods: Data were submitted voluntarily to the International Atomic Energy Agency Nuclear Cardiology Protocols Study (INCAPS), a cross-sectional, multinational registry of MPI protocols. 7,103 studies were included. DRLs and AAAs were calculated by protocol for each world region and for aggregated worldwide data. Results:The aggregated worldwide DRLs for rest/stress or stress/rest studies employing Tc-99m labelled radiopharmaceuticals were 11.2 mCi (1 st dose) and 32.0 mCi (2 nd dose) for 1-day protocols, and 23.0 mCi (1 st dose) and 24.0 mCi (2 nd dose) for multi-day protocols.Corresponding AAAs were 10.1 mCi (1 st dose) and 28.0 mCi (2 nd dose) for 1-day protocols, and 17.8 mCi (1 st dose) and 18.7 mCi (2 nd dose) for multi-day protocols. For stress-only Tc-99m studies, the worldwide DRL and AAA were 18.0 mCi and 12.5 mCi, respectively. Stress-first imaging was used in 26-92% of regional studies except in North America where it was used in just 7% of cases. Significant differences in DRLs and AAAs were observed between regions. Conclusions:This study reports reference levels for SPECT MPI for each major world region from one of the largest international registries of clinical MPI studies. Regional DRLs may be useful in establishing or revising guidelines or simply comparing individual laboratory protocols

Predictive value of incidental right ventricular abnormalities identified on SPECT for mortality and pulmonary hypertension

“…7,13,[24][25][26] Given the frequent and widespread use of SPECT imaging to risk-stratify patients for coronary artery disease, the use of SPECT imaging findings in this fashion could potentially result in earlier diagnosis of pulmonary vascular disease and improved clinical outcomes in a significant number of patients. 27,28 In our study we also observed a significant association with Black race and risk of echocardiographic PH among patients with low-risk SPECT studies. However, after evaluating our model for the interaction between race and incidental RV abnormalities on SPECT imaging, no significant relationship was observed (Table 1).…”

Worldwide Variation in the Use of Nuclear Cardiology Camera Technology, Reconstruction Software, and Imaging Protocols

“…analyzed variations in regional doses, diagnostic reference levels, and adherence to best practices (17,(19)(20)(21)(22)(23)(24)(25), but have not evaluated specific technologies. In this study, we compare regional utilization of camera technologies, advanced post-processing software, and imaging protocols and their impact on patient radiation dose.…”

Radiation Dose Assessment for Myocardial Perfusion Imaging: A Single Institution Survey

“…Indeed, the primary challenge for MPI procedures is designing an MPI protocol that delivers the lowest radiation burden necessary to acquire adequate diagnostic image quality via NM administered activity during SPECT or PET and the CT component of SPECT/CT and PET/CT scans [ 7 , 8 ]. To facilitate the dose reduction process, the concept of diagnostic reference levels (DRLs) has emerged as a gauge for monitoring the radiation doses of diagnostic medical imaging modalities.…”

“…This is because the majority of NDRL reports focus on reporting administered activity from only MPI SPECT or MPI PET scans, with only a few identified studies reporting NDRLs for the CT component of these examinations [ 9 ]. Furthermore, the literature review highlighted that variation in NDRL value for the administered activities related to the stress and rest one-day protocol range from 407 MBq and 740 MBq to 555 MBq and 1184 MBq for 99m Tc-Tetrofosmin /Sestamibi, respectively [ 8 , 11 , 12 ]. Regarding CT components, a few articles reflect the change of variation in NDRL related to the CT dose, for instance, the CTDI vol value ranges from 2.2 mGy to 36 mGy and the DLP value ranges from 36 mGy.cm to 380 mGy.cm [ 13 , 14 , 15 , 16 , 17 ].…”