Gender Differences in Radiation Dose from Nuclear Cardiology Studies Across the World Findings from the INCAPS Registry

Shi, Lynn; Dorbala, Sharmila; Paez, Diana; Shaw, Leslee J.; Zukotynski, Katherine A.; Pascual, Thomas N. B.; Karthikeyan, Ganesan; Vitola, João V.; Better, Nathan; Bokhari, Nadia; Rehani, Madan M.; Kashyap, Ravi; Dondi, Maurizio; Mercuri, Mathew; 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.; Meeks, J. B.; Mut, F.; Rehani, M. M.; Vitola, J. V.; Alexanderson, 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. -A.; 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 Júnior, A. F.; Faccio, F. F.; Fernández, K. M.; Gomez Garibo, J. R.; Gonzalez, U.; González, E. P.; Guzzo, M. A.; Jofre, J.; Kapitán, M.; Kempfer, G.; Lopez, J. L.; Massardo, V. T.; 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.; 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:10.1016/j.jcmg.2016.01.001

Objectives The aim of this study was to investigate gender-based differences in nuclear cardiology practice globally, with a particular focus on laboratory volume, radiation dose, protocols, and best practices. Background It is unclear whether gender-based differences exist in radiation exposure for nuclear cardiology procedures. Methods In a large, multicenter, observational, cross-sectional study encompassing 7,911 patients in 65 countries, radiation effective dose was estimated for each examination. Patient-level best practices relating to radiation exposure were compared between genders. Analysis of covariance was used to determine any difference in radiation exposure according to gender, region, and the interaction between gender and region. Linear, logistic, and hierarchical regression models were developed to evaluate gender-based differences in radiation exposure and laboratory adherence to best practices. The study also included the United Nations Gender Inequality Index and Human Development Index as covariates in multivariable models. Results The proportion of myocardial perfusion imaging studies performed in women varied among countries; however, there was no significant correlation with the Gender Inequality Index. Globally, mean effective dose for nuclear cardiology procedures was only slightly lower in women (9.6 ± 4.5 mSv) than in men (10.3 ± 4.5 mSv; p < 0.001), with a difference of only 0.3 mSv in a multivariable model adjusting for patients' age and weight. Stress-only imaging was performed more frequently in women (12.5% vs. 8.4%; p < 0.001); however, camera-based dose reduction strategies were used less frequently in women (58.6% vs. 65.5%; p < 0.001). Conclusions Despite significant worldwide variation in best practice use and radiation doses from nuclear cardiology procedures, only small differences were observed between genders worldwide. Regional variations noted in myocardial perfusion imaging use and radiation dose offer potential opportunities to address gender-related differences in delivery of nuclear cardiology care.