Worldwide variability in best practice use and radiation exposure from cardiac imaging: findings of the United Nations International Atomic Energy Agency Noninvasive Cardiology Protocols Study Group

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Abstract Background Use of cardiac imaging has evolved considerably, but worldwide best practice use and radiation doses from nuclear cardiology (NC) and cardiac computed tomography (CT) have not been systematically studied. Methods We conducted a worldwide cross-sectional study of NC and CT used for coronary artery disease imaging. Sites performing NC or CT reported patient characteristics, acquisition protocols and radiation-related parameters for each procedure performed during a single week in October-December 2023. For each laboratory and test, a quality index (QI) reflecting number of best practices used was determined. For each patient, radiation effective dose (ED) was determined. Lab target levels were prespecified as median ED ≤9 mSv, per guidelines, and QI with at least 70% of best practices used. Hierarchical regression evaluated impact of lab best practice use on patient radiation dose. Results 747 centers in 101 countries reported data on 19,448 patients. Median [interquartile range] patient EDs were 1.2 [0.7-2.2] mSv for coronary calcium scoring, 2.0 [1.6-2.4] mSv positron emission tomography, 6.5 [3.9-8.6] mSv single photon emission CT, and 7.4 [3.5-15.5] mSv coronary CT angiography (CCTA). Significantly more NC than CCTA labs achieved target ED (80% vs. 46%) and target QI (76% vs. 24%). While worldwide, ED was lower for single photon NC than CCTA, in labs achieving target QI it was lower for CCTA (3.4 vs. 6.4 mSv). QIs were greater and EDs lower in higher income countries. Lowest median EDs, in Western Europe, coincided with high best practice adherence. The highest EDs, in Latin America for NC (7.8 [5.4-9.7] mSv) and Africa (25.2 [14.7-35.3] mSv) for CCTA, were associated with low QIs. Nevertheless, lab best practice use was independently associated with lower EDs, across regions and income levels. Conclusion Best practice use and radiation doses from imaging vary widely, with much higher doses noted in labs underutilizing best practices, across world regions and income levels. The variability in use of these best practices, especially for CCTA, offers numerous opportunities to improve the quality and safety of cardiac imaging worldwide.Worldwide Variability in Radiation Doses Doses and Best Practice Use

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