drivers of radiation dose reduction with myocardial perfusion imaging: a large health system experience

Despite increasing emphasis on reducing radiation exposure from myocardial perfusion imaging (mpi), the use of radiation-sparing practices (rsp) at nuclear laboratories remains limited. defining real-world impact of rsps on effective radiation dose (e) can potentially further motivate their adoption. mpi studies performed between 1/2010 and 12/2016 within a single health system were included. mean e was compared between sites with ‘basic’ rsp (defined as elimination of thallium-based protocols and use of stress-only (so) imaging on conventional single photonemission computed tomography (spect) cameras) and those with ‘advanced’ capabilities (sites that additionally used solid-state detector (ssd) spect cameras, advanced post-processing software (apps) or positron emission tomography (pet) imaging), after matching patients by age, gender, and weight. contributions of individual rsp to e reduction were determined using multiple linear regression after adjusting for factors affecting tracer dose. among 55,930 mpi studies performed, the use of advanced rsp was associated with significantly lower mean e compared to basic rsp (7 ± 5.6 msv and 16 ± 5.4 msv, respectively; p < 0.001), with a greater likelihood of achieving e < 9 msv (65.7% vs. 10.8%, respectively; or 15.8 [95% ci 14 to 17.8]; p < 0.0001). main driver of e reduction was so-ssd spect (mean reduction = 11.5 msv), followed by use of so-spect + apps (mean reduction = 10.1 msv), ;et (mean reduction = 9.7 msv); and elimination of thallium protocols (mean reduction = 9.1 msv); p < 0.0001 for all comparisons. in a natural experiment with implementation of radiation-saving practices at a large health system, stress-only protocols used in conjunction with modern spect technologies, the use of pet and elimination of thallium-based protocols were associated with greatest reductions in radiation dose. availability of several approaches to dose reduction within a health system can facilitate achievement of targeted radiation benchmarks in a greater number of performed studies.