Nuclear cardiology practices and radiation exposure in Africa: Results from the IAEA Nuclear Cardiology Protocols Study (INCAPS)

Bouyoucef, Salah E.; Mercuri, Mathew; Pascual, Thomas N. B.; Allam, Adel H.; Vangu, Mboyo; Vitola, João V.; Better, Nathan; Karthikeyan, Ganesan; Mahmarian, John J.; Rehani, Madan M.; Kashyap, Ravi; Dondi, Maurizio; Paez, Diana; Einstein, Andrew J.; Einstein, A. J.; Pascual, T. N. B.; Paez, D.; Dondi, M.; Better, N.; Bouyoucef, S. E.; Karthikeyan, G.; Kashyap, R.; Lele, V.; Magboo, V. P. C.; Mahmarian, J. J.; Mercuri, M.; Mut, F.; Rehani, M. M.; Vitola, J. V.; Alexánderson, E.; Allam, A.; Al-Mallah, M. H.; Better, N.; Bouyoucef, S. E.; Bom, H.; Flotats, A.; Jerome, S.; Kaufmann, P. A.; Lele, V.; Luxenburg, O.; Mahmarian, J.; Shaw, L. J.; Underwood, S. R.; Vitola, J.; Amouri, W.; Essabbah, H.; Gassama, S. S.; Makhdomi, K. B.; El Mustapha, G. I. E.; El Ouchdi, N.; Qaïs, N.; Soni, N.; Vangu, W.; Abazid, R. M.; Adams, B.; Agarwal, V.; Alfeeli, M. A.; Alnafisi, N.; Bernabe, L.; Bural, G. G.; Chaiwatanarat, T.; Chandraguptha, J. M.; Cheon, G. J.; Cho, I.; Dogan, A. S.; Eftekhari, M.; Frenkel, A.; Garty, I.; George, S.; Geramifar, P.; Golan, H.; Habib, S.; Hussain, R.; Im, H.; Jeon, H. -J.; Kalawat, T.; Kang, W. J.; Keng, F.; Klaipetch, A.; Kumar, P. G.; Lee, J.; Lee, W. W.; Lim, I.; Macaisa, C. M. M.; Malhotra, G.; Mittal, B. R.; Mohammad, M. H.; Mohan, P.; Mulyanto, I. D.; Nariman, D.; Nayak, U. N.; Niaz, K.; Nikolov, G.; Obaldo, J. M.; Ozturk, E.; Park, J. M.; Park, S.; Patel, C. D.; Phuong, H. K.; Quinon, A. P.; Rajini, T. R.; Saengsuda, Y.; Santiago, J.; Sayman, H. B.; Shinto, A. S.; Sivasubramaniyan, V.; Son, M. H.; Sudhakar, P.; Syed, G. M. S.; Tamaki, N.; Thamnirat, K.; Thientunyakit, T.; Thongmak, S.; Velasco, D. N.; Verma, A.; Vutrapongwatana, U.; Wang, Y.; Won, K. S.; Yao, Z.; Yingsa-Nga, T.; Yudistiro, R.; Yue, K. T.; Zafrir, N.; Adrian, S. C.; Agostini, D.; Aguadé, S.; Armitage, G.; Backlund, M.; Backman, M.; Baker, M.; Balducci, M. T.; Bavelaar, C.; Berovic, M.; Bertagna, F.; Beuchel, R.; Biggi, A.; Bisi, G.; Bonini, R.; Bradley, A.; Brudin, L.; Bruno, I.; Busnardo, E.; Casoni, R.; Choudhri, A.; Cittanti, C.; Clauss, R.; Costa, D. C.; Costa, M.; Dixon, K.; Dziuk, M.; Egelic, N.; Eriksson, I.; Fagioli, G.; De Faria, D. B.; Florimonte, L.; Francini, A.; French, M.; Gallagher, E.; Garai, I.; Geatti, O.; Genovesi, D.; Gianolli, L.; Gimelli, A.; Del Giudice, E.; Halliwell, S.; Hansson, M. J.; Harrison, C.; Homans, F.; Horton, F.; Jȩdrzejuk, D.; Jogi, J.; Johansen, A.; Johansson, H.; Kalnina, M.; Kaminek, M.; Kiss, A.; Kobylecka, M.; Kostkiewicz, M.; Kropp, J.; Kullenberg, R.; Lahoutte, T.; Lang, O.; Larsson, Y. H.; Lázár, M.; Leccisotti, L.; Leners, N.; Lindner, O.; Lipp, R. W.; Maenhout, A.; Maffioli, L.; Marcassa, C.; Martins, B.; Marzullo, P.; Medolago, G.; Mendiguchía, C. G.; Mirzaei, S.; Mori, M.; Nardi, B.; Nazarenko, S.; Nikoletic, K.; Oleksa, R.; Parviainen, T.; Patrina, J.; Peace, R.; Pirich, C.; Piwowarska-Bilska, H.; Popa, S.; Prakash, V.; Pubul, V.; Puklavec, L.; Rac, S.; Ratniece, M.; Rogan, S. A.; Romeo, A.; Rossi, M.; Ruiz, D.; Sabharwal, N.; Salobir, B. G.; Santos, A. I.; Saranovic, S.; Sarkozi, A.; Schneider, R. P.; Sciagra, R.; Scotti, S.; Servini, Z.; Setti, L. R.; Starck, S-Ã….; Vajauskas, D.; Veselý, J.; Vieni, A.; Vignati, A.; Vito, I. M.; Weiss, K.; Wild, D.; Zdraveska-Kochovska, M.; Agüro, R. N.; Alvarado, N.; Barral, C. M.; Beretta, M.; Berrocal, I.; Batista Cuellar, J. F.; Cabral Chang, T. -M.; Cabrera Rodríguez, L. O.; Canessa, J.; Castro Mora, G.; Claudia, A. C.; Clavelo, G. F.; Cruz, A. F.; Faccio, F. F.; Fernández, K. M.; Gomez Garibo, J. R.; Gonzalez, U.; González, P. E.; Guzzo, M. A.; Jofre, J.; Kapitán, M.; Kempfer, G.; Lopez, J. L.; Massardo, T. V.; Medeiros Colaco, I.; Mesquita, C. T.; Montecinos, M.; Neubauer, S.; Pabon, L. M.; Puente, A.; Rochela Vazquez, L. M.; Serna Macias, J. A.; Silva Pino, A. G.; Tártari Huber, F. Z.; Tovar, A. P.; Vargas, L.; Wiefels, C.; Aljizeeri, A.; Alvarez, R. J.; Barger, D.; Beardwood, W.; Behrens, J.; Brann, L.; Brown, D.; Carr, H.; Churchwell, K.; Comingore, G. A.; Corbett, J.; Costello, M.; Cruz, F.; Depinet, T.; Dorbala, S.; Earles, M.; Esteves, F. P.; Etherton, E.; Fanning, R. J.; Fornace, J.; Franks, L.; Gewirtz, H.; Gulanchyn, K.; Hannah, C. -L.; Hays, J.; Hendrickson, J.; Hester, J.; Holmes, K.; Jerome, S.; Johnson, A.; Jopek, C.; Lewin, H.; Lyons, J.; Manley, C.; Meden, J.; Moore, S.; Moore, W. H.; Murthy, V.; Nace, R.; Neely, D.; Nelson, L.; Niedermaier, O.; Rice, D.; Rigs, R.; Schiffer, K.; Schockling, E.; Schultz, T.; Schumacker, T.; Sheesley, B.; Sheikh, A.; Siegel, B.; Slim, A. M.; Smith, J.; Szulc, M. C.; Tanskersley, N.; Tilkemeier, P.; Valdez, G. D.; Vrooman, R.; Wawrowicz, D.; Winchester, D. E.; Alcheikh, A.; Allen, B.; Atkins, E.; Bevan, J.; Bonomini, C.; Christiansen, J.; Clack, L.; Craig, E.; Dixson, H.; Duncan, I.; Fredericks, S.; Gales, S.; Hampson, R.; Hanley, T.; Hartcher, K.; Hassall, J.; Kelley, B.; Kelly, S.; Kidd, T.; De Kort, T.; Larcos, G.; Macdonald, W.; Mcgrath, C.; Murdoch, E.; O'Malley, S.; O'Rourke, M.; Pack, M.; Pearce, R.; Praehofer, R.; Ramsay, S.; Scarlett, L.; Smidt, K.; Souvannavong, F.; Taubman, K.; Taylor, G.; Tse, K.; Unger, S.; Weale, J.

doi:10.5830/CVJA-2016-091

Objective: While nuclear myocardial perfusion imaging (MPI) offers many benefits to patients with known or suspected cardiovascular disease, concerns exist regarding radiationassociated health effects. Little is known regarding MPI practice in Africa. We sought to characterise radiation doses and the use of MPI best practices that could minimise radiation in African nuclear cardiology laboratories, and compare these to practice worldwide. Methods: Demographics and clinical characteristics were collected for a consecutive sample of 348 patients from 12 laboratories in six African countries over a one-week period from March to April 2013. Radiation effective dose (ED) was estimated for each patient. A quality index (QI) enumerating adherence to eight best practices, identified a priori by an IAEA expert panel, was calculated for each laboratory. We compared these metrics with those from 7 563 patients from 296 laboratories outside Africa. Results: Median (interquartile range) patient ED in Africa was similar to that of the rest of the world [9.1 (5.1-15.6) vs 10.3 mSv (6.8-12.6), p = 0.14], although a larger proportion of African patients received a low ED, ≤ 9 mSv targeted in societal recommendations (49.7 vs 38.2%, p < 0.001). Bestpractice adherence was higher among African laboratories (QI score: 6.3 ± 1.2 vs 5.4 ± 1.3, p = 0.013). However, median ED varied significantly among African laboratories (range: 2.0-16.3 mSv; p < 0.0001) and QI range was 4-8. Conclusion: Patient radiation dose from MPI in Africa was similar to that in the rest of the world, and adherence to best practices was relatively high in African laboratories. Nevertheless there remain opportunities to further reduce radiation exposure to African patients from MPI.