Author + information
- Received December 30, 2015
- Revision received January 6, 2016
- Accepted January 7, 2016
- Published online April 1, 2016.
- Lynn Shi, ABa,
- Sharmila Dorbala, MBBSb,
- Diana Paez, MDc,
- Leslee J. Shaw, PhDd,
- Katherine A. Zukotynski, MDe,
- Thomas N.B. Pascual, MDc,
- Ganesan Karthikeyan, MBBS, MD, DMf,
- João V. Vitola, MD, PhDg,
- Nathan Better, MBBSh,
- Nadia Bokharii,
- Madan M. Rehani, PhDj,k,
- Ravi Kashyap, MDc,
- Maurizio Dondi, MDc,
- Mathew Mercuri, PhDi,
- Andrew J. Einstein, MD, PhDl,m,∗ (, )
- INCAPS Investigators Group
- aCollege of Physicians and Surgeons, Columbia University, New York, New York
- bDivision of Cardiology, Department of Medicine, Brigham and Women’s Hospital, Harvard University, Boston, Massachusetts
- cSection of Nuclear Medicine and Diagnostic Imaging, Division of Human Health, International Atomic Energy Agency, Vienna, Austria
- dDivision of Cardiology, Department of Medicine, and Emory Clinical Cardiovascular Research Institute, Emory University School of Medicine, Atlanta, Georgia
- eDepartments of Medicine and Radiology, McMaster University, Hamilton, Ontario, Canada
- fDepartment of Cardiology, All India Institute of Medical Sciences, New Delhi, India
- gQuanta Diagnóstico & Terapia, Curitiba, Brazil
- hDepartments of Cardiology and Nuclear Medicine, Royal Melbourne Hospital, Melbourne, Australia
- iDepartment of Medicine, Cardiology Division, Columbia University Medical Center, New York, New York
- jRadiation Protection of Patients Unit, International Atomic Energy Agency, Vienna, Austria
- kDepartment of Radiology, Massachusetts General Hospital, Boston, Massachusetts
- lDepartment of Medicine, Cardiology Division, Columbia University Medical Center and New York-Presbyterian Hospital, New York, New York
- mDepartment of Radiology, Columbia University Medical Center and New York-Presbyterian Hospital, New York, New York
- ↵∗Reprint requests and correspondence:
Dr. Andrew J. Einstein, Division of Cardiology, Columbia University Medical Center, 622 West 168th Street PH 10-203, New York, New York 10032.
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.
Funding was provided by the National Institutes of Health–National Heart, Lung, and Blood Institute Summer Research Program at Columbia University (5T35HL007616-34); the International Atomic Energy Agency; and the Margaret Q. Landenberger Research Foundation in memory of Professor A. Donny Strosberg; and the Irving Scholars Program. Dr. Dorbala has received an institutional research grant from Astellas; and owns stock in GE. Dr. Einstein has received institutional research grants for other research from GE Healthcare, Philips Healthcare, Spectrum Dynamics, and Toshiba America Medical Systems. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
Heinrich Schelbert, MD, served as the Guest Editor for this article.
- Received December 30, 2015.
- Revision received January 6, 2016.
- Accepted January 7, 2016.
- American College of Cardiology Foundation