Recommendations for reducing radiation exposure in myocardial perfusion imaging

Radionuclide myocardial perfusion imaging (MPI) using single photon emission computed tomography (SPECT) or positron emission tomography (PET) for the detection of ischemia in patients with known or suspected coronary artery disease (CAD) has widespread clinical utilization and has been shown to have high accuracy and incremental prognostic value. Amidst the recent publicity regarding the increasing use of all types of ionizing radiation in the United States, patients and medical professionals are scrutinizing the need for diagnostic testing and how radiation exposure can be reduced. There are three critical questions that physicians must consider and answer with regard to radiation exposure and performing MPI in a particular patient:

[1]  M. Cerqueira,et al.  Asnc Imaging Guidelines for Nuclear Cardiology Procedures Stress Protocols and Tracers , 2022 .

[2]  American Society of Nuclear Cardiology review of the ACCF/ASNC appropriateness criteria for single-photon emission computed tomography myocardial perfusion imaging (SPECT MPI) , 2007, Journal of nuclear cardiology : official publication of the American Society of Nuclear Cardiology.

[3]  D. Berman,et al.  High-speed myocardial perfusion imaging initial clinical comparison with conventional dual detector anger camera imaging. , 2008, JACC. Cardiovascular imaging.

[4]  G Bibbo,et al.  Physics in Nuclear Medicine, 3rd edition , 2005 .

[5]  S. Cherry,et al.  Physics in Nuclear Medicine , 2004 .

[6]  G Germano,et al.  Incremental value of prognostic testing in patients with known or suspected ischemic heart disease: a basis for optimal utilization of exercise technetium-99m sestamibi myocardial perfusion single-photon emission computed tomography. , 1995, Journal of the American College of Cardiology.

[7]  Freek J. Beekman,et al.  Evaluation of 3D Monte Carlo-based scatter correction for 99mTc cardiac perfusion SPECT. , 2006, Journal of nuclear medicine : official publication, Society of Nuclear Medicine.

[8]  Ernest V. Garcia,et al.  2.05: A new solid state, ultra fast cardiac multi-detector SPECT system , 2008 .

[9]  Eric C. Frey,et al.  Comparison of 180° and 360° acquisition for myocardial perfusion SPECT with compensation for attenuation, detector response, and scatter: Monte Carlo and mathematical observer results , 2006 .

[10]  E. Depuey,et al.  Wide beam reconstruction “quarter-time” gated myocardial perfusion SPECT functional imaging: a comparison to “full-time” ordered subset expectation maximum , 2009, Journal of nuclear cardiology : official publication of the American Society of Nuclear Cardiology.

[11]  D. Berman,et al.  Multicenter trial of high-speed versus conventional single-photon emission computed tomography imaging: quantitative results of myocardial perfusion and left ventricular function. , 2010, Journal of the American College of Cardiology.

[12]  J. Case,et al.  Clinical value of attenuation correction in stress-only Tc-99m sestamibi SPECT imaging , 2004, Journal of nuclear cardiology : official publication of the American Society of Nuclear Cardiology.

[13]  John D Friedman,et al.  Diagnostic accuracy of rest/stress ECG-gated Rb-82 myocardial perfusion PET: Comparison with ECG-gated Tc-99m sestamibi SPECT , 2006, Journal of nuclear cardiology : official publication of the American Society of Nuclear Cardiology.

[14]  James A. Case,et al.  Overestimation of LVEF by gated MIBI myocardial perfusion SPECT in patients with small hearts , 1998 .

[15]  Daniel S. Berman,et al.  Myocardial perfusion and function: Single photon emission computed tomography , 2006, Journal of nuclear cardiology : official publication of the American Society of Nuclear Cardiology.

[16]  L. Johnson,et al.  Low event rate for stress-only perfusion imaging in patients evaluated for chest pain. , 2002, Journal of the American College of Cardiology.

[17]  C. Bai,et al.  Prospective multicenter evaluation of rapid, gated SPECT myocardial perfusion upright imaging , 2008, Journal of nuclear cardiology : official publication of the American Society of Nuclear Cardiology.

[18]  O. Israel,et al.  Directions and Magnitudes of Misregistration of CT Attenuation-Corrected Myocardial Perfusion Studies: Incidence, Impact on Image Quality, and Guidance for Reregistration , 2009, Journal of Nuclear Medicine.

[19]  Division on Earth.  Health Risks from Exposure to Low Levels of Ionizing Radiation: BEIR VII Phase 2 , 2006 .

[20]  Christian Vanhove,et al.  OSEM reconstruction, associated with temporal fourier and depth-dependant resolution recovery filtering, enhances results from sestamibi and 201Tl 16-interval gated SPECT. , 2005, Journal of nuclear medicine : official publication, Society of Nuclear Medicine.

[21]  E. Ficaro.  Imaging Guidelines for Nuclear Cardiology Procedures , 2006 .

[22]  Rachida Lebtahi,et al.  Performance of OSEM and depth-dependent resolution recovery algorithms for the evaluation of global left ventricular function in 201Tl gated myocardial perfusion SPECT. , 2003, Journal of nuclear medicine : official publication, Society of Nuclear Medicine.

[23]  P. Raggi,et al.  Novel solid-state-detector dedicated cardiac camera for fast myocardial perfusion imaging: multicenter comparison with standard dual detector cameras , 2009, Journal of Nuclear Cardiology.

[24]  J. Case,et al.  Obtaining optimum and consistent SPEW myocardial counts using an anterior planar view to determine SPECT acquisition times , 1998 .

[25]  Wojciech Zbijewski,et al.  Evaluation of 3D Monte Carlo–Based Scatter Correction for 201Tl Cardiac Perfusion SPECT , 2007, Journal of Nuclear Medicine.

[26]  S. Blum,et al.  Normal stress-only versus standard stress/rest myocardial perfusion imaging: similar patient mortality with reduced radiation exposure. , 2010, Journal of the American College of Cardiology.

[27]  D. Berman,et al.  ACCF/ASNC/ACR/AHA/ASE/SCCT/SCMR/SNM 2009 Appropriate Use Criteria for Cardiac Radionuclide Imaging: A Report of the American College of Cardiology Foundation Appropriate Use Criteria Task Force, the American Society of Nuclear Cardiology, the American College of Radiology, the American Heart Associa , 2009, Journal of the American College of Cardiology.

[28]  S. Chae,et al.  Independent and incremental prognostic value of exercise single-photon emission computed tomographic (SPECT) thallium imaging in coronary artery disease. , 1993, Journal of the American College of Cardiology.

[29]  J. Case,et al.  Multicenter investigation comparing a highly efficient half-time stress-only attenuation correction approach against standard rest-stress Tc-99m SPECT imaging , 2008, Journal of nuclear cardiology : official publication of the American Society of Nuclear Cardiology.

[30]  Randall C. Thompson,et al.  Radiation Dose to Patients From Cardiac Diagnostic Imaging , 2007, Circulation.

[31]  Gated stress-only 99mTc myocardial perfusion SPECT imaging accurately assesses coronary artery disease , 2003, Nuclear medicine communications.

[32]  J E Bowsher,et al.  Treatment of Compton scattering in maximum-likelihood, expectation-maximization reconstructions of SPECT images. , 1991, Journal of nuclear medicine : official publication, Society of Nuclear Medicine.

[33]  J. Case,et al.  A multicenter evaluation of a new post-processing method with depth-dependent collimator resolution applied to full-time and half-time acquisitions without and with simultaneously acquired attenuation correction , 2009, Journal of nuclear cardiology : official publication of the American Society of Nuclear Cardiology.

[34]  D. Berman,et al.  Impact of Diabetes on the Risk Stratification Using Stress Single-Photon Emission Computed Tomography Myocardial Perfusion Imaging in Patients With Symptoms Suggestive of Coronary Artery Disease , 2002, Circulation.

[35]  Christopher L. Hansen,et al.  Digital image processing for clinicians, part III: Spect reconstruction , 2002, Journal of nuclear cardiology : official publication of the American Society of Nuclear Cardiology.

[36]  Guido Germano,et al.  Advances in technical aspects of myocardial perfusion SPECT imaging , 2009, Journal of Nuclear Cardiology.

[37]  J. Lima,et al.  Prospective electrocardiogram-gated delayed enhanced multidetector computed tomography accurately quantifies infarct size and reduces radiation exposure. , 2009, JACC. Cardiovascular imaging.

[38]  Avinash C. Kak,et al.  3. Algorithms for Reconstruction with Nondiffracting Sources , 2001 .

[39]  Jim Patton,et al.  A Novel High-Sensitivity Rapid-Acquisition Single-Photon Cardiac Imaging Camera , 2009, Journal of Nuclear Medicine.

[40]  E. G. Hawman,et al.  Evaluation of SPECT angular sampling effects: continuous versus step-and-shoot acquisition. , 1987, Journal of nuclear medicine : official publication, Society of Nuclear Medicine.

[41]  Faisal Nabi,et al.  Normal stress-only versus standard stress/rest myocardial perfusion imaging: similar patient mortality with reduced radiation exposure. , 2010, Journal of the American College of Cardiology.

[42]  V. Dilsizian,et al.  PET myocardial perfusion and metabolism clinical imaging , 2009 .

[43]  E. Gordon DePuey,et al.  Ordered subset expectation maximization and wide beam reconstruction “half-time” gated myocardial perfusion SPECT functional imaging: A comparison to “full-time” filtered backprojection , 2008, Journal of nuclear cardiology : official publication of the American Society of Nuclear Cardiology.

[44]  Importance of consideration of radiation doses from cardiac imaging procedures and risks of cancer , 2010, Journal of nuclear cardiology : official publication of the American Society of Nuclear Cardiology.

[45]  Arik Wolak,et al.  Stress thallium-201/rest technetium-99m sequential dual isotope high-speed myocardial perfusion imaging. , 2009, JACC. Cardiovascular imaging.