Nuclear cardiology practice in Asia: Analysis of radiation exposure and best practice for myocardial perfusion imaging ― results from the IAEA nuclear cardiology protocols cross-sectional study (INCAPS)

Pascual, Tnb; Mercuri, M; El-Haj, N; Hee-Sung Bom, H; Lele, V; Al-Mallah, Mh; Luxenburg, O; Karthikeyan, G; Vitola, Jv; Mahmarian, Jj; Better, N; Shaw, Lj; Rehani, Mm; Kashyap, R; Paez, D; Dondi, M; Eistein, Aj; Bouyoucef, Salah E.; Allam, Adel H.; Vangu, Mboyo; Magboo, V. P. C.; Mut, F.; Alexánderson, E.; Allam, A.; Bom, H.; Flotats, A.; Jerome, S.; Kaufmann, P. A.; 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:10.1253/circj.CJ-16-0677

Background: This paper examines the current status of radiation exposure to patients in myocardial perfusion imaging (MPI) in Asia. Methods and Results: Laboratories voluntarily provided information on MPI performed over a 1-week period. Eight best practice criteria regarding MPI were predefined by an expert panel. Implementation of ≥6 best practices (quality index [QI] ≥6) was pre-specified as a desirable goal for keeping radiation exposure at a low level. Radiation effective dose (ED) in 1,469 patients and QI of 69 laboratories in Asia were compared against data from 239 laboratories in the rest of the world (RoW). Mean ED was significantly higher in Asia (11.4 vs. 9.6 mSv; P<0.0001), with significantly lower doses in South-East vs. East Asia (9.7 vs. 12.7 mSv; P<0.0001). QI in Asia was lower than in RoW. In comparison with RoW, Asian laboratories used thallium more frequently, used weight-based technetium dosing less frequently, and trended towards a lower rate of stress-only imaging. Conclusions: MPI radiation dose in Asia is higher than that in the RoW and linked to less consistent use of laboratory best practices such as avoidance of thallium, weight-based dosing, and use of stress-only imaging. Given that MPI is performed in Asia within a diverse array of medical contexts, laboratory-specific adoption of best practices offers numerous opportunities to improve quality of care.