Nuclear cardiology practice and associated radiation doses in Europe: results of the IAEA Nuclear Cardiology Protocols Study (INCAPS) for the 27 European countries

Purpose

Nuclear cardiology is widely used to diagnose coronary artery disease and to guide patient management, but data on current practices, radiation dose-related best practices, and radiation doses are scarce. To address these issues, the IAEA conducted a worldwide study of nuclear cardiology practice. We present the European subanalysis.

Methods

In March 2013, the IAEA invited laboratories across the world to document all SPECT and PET studies performed in one week. The data included age, gender, weight, radiopharmaceuticals, injected activities, camera type, positioning, hardware and software. Radiation effective dose was calculated for each patient. A quality score was defined for each laboratory as the number followed of eight predefined best practices with a bearing on radiation exposure (range of quality score 0 – 8). The participating European countries were assigned to regions (North, East, South, and West). Comparisons were performed between the four European regions and between Europe and the rest-of-the-world (RoW).

Results

Data on 2,381 European patients undergoing nuclear cardiology procedures in 102 laboratories in 27 countries were collected. A cardiac SPECT study was performed in 97.9 % of the patients, and a PET study in 2.1 %. The average effective dose of SPECT was 8.0?±?3.4 mSv (RoW 11.4?±?4.3 mSv; P?<?0.001) and of PET was 2.6?±?1.5 mSv (RoW 3.8?±?2.5 mSv; P?<?0.001). The mean effective doses of SPECT and PET differed between European regions (P?<?0.001 and P?=?0.002, respectively). The mean quality score was 6.2?±?1.2, which was higher than the RoW score (5.0?±?1.1; P?<?0.001). Adherence to best practices did not differ significantly among the European regions (range 6 to 6.4; P?=?0.73). Of the best practices, stress-only imaging and weight-adjusted dosing were the least commonly used.

Conclusion

In Europe, the mean effective dose from nuclear cardiology is lower and the average quality score is higher than in the RoW. There is regional variation in effective dose in relation to the best practice quality score. A possible reason for the differences between Europe and the RoW could be the safety culture fostered by actions under the Euratom directives and the implementation of diagnostic reference levels. Stress-only imaging and weight-adjusted activity might be targets for optimization of European nuclear cardiology practice.

     

Dipyridamole thallium imaging may not be a reliable screening test for coronary artery disease in patients undergoing vascular surgery

Dipyridamole thallium imaging has been proposed for cardiac risk stratification in patients undergoing peripheral vascular surgery. The purpose of this study was to define the benefit of this investigation in routine preoperative evaluation of these patients. The outcome of 86 patients undergoing vascular surgery procedures was examined in light of preoperative clinical assessment and dipyridamole SPECT thallium imaging (DST). Fifty-one patients (59%) were considered at high risk on clinical grounds, and 22 patients (26%) had perfusion defects. Ten patients suffered a perioperative coronary event, including unstable angina, myocardial infarction, or cardiac death. Seven of the patients with such events were among the 51 clinically high-risk subjects (14%). Three perioperative events occurred in the group of 19 patients with positive DST images who underwent surgery (16%), but the DST test failed to identify 7 patients who suffered coronary events. The frequency of abnormal thallium imaging was similar to the prevalence of angiographically significant coronary disease reported previously at this center, but considerably less than the rate of abnormal thallium imaging in past studies of vascular surgery patients. The application of the test to a low to moderate risk population is probably responsible for its lower predictive accuracy for coronary events. DST is not an ideal routine noninvasive technique for risk stratification in patients undergoing vascular surgery.     

Assessment of coronary artery stenosis by magnetic resonance imaging.

OBJECTIVE: The findings of magnetic resonance and x-ray angiography were compared for assessment of coronary artery stenosis in this validation study. BACKGROUND: Magnetic resonance angiography of the coronary arteries has recently been described, but there has been no comparison with x-ray angiography of localisation or assessment of important characteristics of coronary stenosis. METHODS: A breath hold, segmented k-space, 2D gradient echo imaging technique incorporating fat suppression was used in 39 patients (55 coronary stenoses) with known coronary artery disease. RESULTS: Overall, 47 stenoses (85%) were assessed by magnetic resonance (29 of 33 stenoses in the left anterior descending artery, one of one in the left main stem, 14 of 17 in the right coronary artery, and three of four in the left circumflex artery were detected). There was close agreement between magnetic resonance and x-ray angiography for the distance of the stenosis from the arterial origin (magnetic resonance mean (SD) 27 (16) mm versus x-ray angiography 27 (16) mm, P = NS, mean difference -0.2 mm). The distance to 39 stenoses (83%) agreed to within 5 mm, with increased scatter for more distal stenoses. The severity of magnetic resonance signal loss, assessed visually at the site of stenosis, varied significantly according to the percentage diameter stenosis (F = 30, P < 0.0001); stenosis severity with severe signal loss was 89 (7)%, with partial signal was 70 (16)%, and with irregular wall only 37 (11)%, with significant differences among the three groups (P < 0.001). A significant correlation was found between the proportional magnetic resonance signal loss at the stenosis and the percentage diameter stenosis severity (r = -0.67, P < 0.0001). The length of stenosis measured by magnetic resonance (6 (3) mm) was greater than by x-ray angiography (5 (2) mm, P < 0.006, mean difference +1.1 mm). Spearman's rank test showed that there was significant overestimation of stenosis length by magnetic resonance as stenosis severity increased (rs = 0.34, P < 0.02). CONCLUSIONS: Accurate localisation of coronary stenosis and a qualitative assessment of stenosis severity are possible by magnetic resonance, but stenosis length is overestimated as severity increases, probably because of disturbed patterns of flow with turbulence distal to severe stenoses. Reasonable results for the detection of coronary artery stenosis by magnetic resonance were achieved in this highly selected population, but further progress in imaging techniques is necessary before moving towards appreciable clinical application.     

Personality styles,manifest needs,and the perception of time in college women

Reports the continued development of a multivariate theory of personality styles and a scale, the Multivariate Personality Inventory, designed to measure these styles in both pathological and normal populations. In a sample of college women, theory-generated predictions of the manifest needs of each personality style were examined with the Edwards Personal Preference Schedule. Results supported the validity of the Multivariate Personality Inventory in regard to the need profile of each personality style group. To examine the relationship between the personality styles and behavior, a series of time estimation measures also were employed.     

Changes in functional connectivity in people with HIV switching antiretroviral therapy

Journal of NeuroVirology - We assessed changes in functional connectivity by fMRI (functional magnetic resonance imaging) and cognitive measures in otherwise neurologically asymptomatic people with...     

Investigation of Damage to Multilayer Optics in X-Ray Laser Cavities: W/C, WRe/C, WC/C, Stainless-Steel/C, and Cr3C2/C Mirrors

In many applications, multilayer mirrors are exposed to damaging fluences of x rays. In x-ray laser cavities intense optical and broad-band x radiation, from the x-ray laser plasma amplifier, can damage multilayer mirrors on time scales of hundreds of picoseconds. We describe experiments using short duration (500 ps) bursts of soft x rays from a laser produced gold plasma to damage multilayer mirrors designed to reflect wavelengths close to 45 ? at normal incidence. The effect of the damaging x-ray flux on normal incidence reflectivity was time resolved for W/C, WRe/C, WC/C, 303-stainless-steel/C, and Cr3C2/C multilayers. The damage thresholds of the different mirrors were compared, and the Cr3C2/C mirrors were found to be the most resilient. The outer layers of the multilayers were observed to expand slowly as x rays were absorbed, and a more rapid expansion then preceded the total loss of reflectivity, at temperatures well below the melting temperature of the mirror components. It is believed that the dominant expansion mechanism is a change in the amorphous carbon layers to a more graphitic structure. The data are fit quite well by a model that assumes expansion of up to 25% in the thickness of the outermost carbon layers, followed by intermixing of the hotter layers. The rapid expansion has been observed to occur in times from 40 to 150 ps and may be the fastest resolution to date of the phenomenon of graphitization. The integrated reflectivity of the mirrors was observed to increase by up to a factor of 2.5 as they damaged; this reflectivity increase may be consistent with a reduction in the layer roughness.