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01-08-2017 | Information Statement

Status of cardiovascular PET radiation exposure and strategies for reduction: An Information Statement from the Cardiovascular PET Task Force

Authors: James A. Case, PhD, Robert A. deKemp, PhD, Piotr J. Slomka, PhD, Mark F. Smith, PhD, Gary V. Heller, MD, PhD, Manuel D. Cerqueira, MD

Published in: Journal of Nuclear Cardiology | Issue 4/2017

Abstract

Cardiovascular positron emission tomography (PET) imaging provides high-quality visual and quantitative myocardial perfusion and function images. In addition, cardiovascular PET can assess myocardial viability, myocardial inflammatory disorders such as cardiac sarcoid, and infections of implanted devices including pacemakers, ventricular assist devices, and prosthetic heart valves. As with all nuclear cardiology procedures, the benefits need to be considered in relation to the risks of exposure to radiation. When performed properly, these assessments can be obtained while simultaneously minimizing radiation exposure. The purpose of this information statement is to present current concepts to minimize patient and staff radiation exposure while ensuring high image quality.

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International Atomic Energy Agency. Radiological protection for medical exposition to ionizing radiation. IAEA Safety Standard, 2002:RS-G-15.

US Food and Drug Administration. Initiative to reduce unnecessary radiation exposure from medical imaging, , February 2010, http://www.fda.gov/downloads/Radiation-EmittingProducts/RadiationSafety/RadiationDoseReduction/UCM200087.pdf

Cerqueira MD, Allman KC, Ficaro EP, Hansen CL, Nichols KJ, Thompson RC, et al. American Society for Nuclear Cardiology Information Statement: Recommendations for reducing radiation exposure in myocardial perfusion imaging. J Nucl Cardiol. 2010;17:709–18.CrossRef

Piccinelli M, Garcia EV. Advances in software for faster procedure and lower radiotracer dose myocardial perfusion imaging. Prog Cardiovasc Dis. 2015;57:579–87.CrossRef

Hill KD, Einstein AJ. New approaches to radiation exposure. Trends Cardiovasc Med. 2016;26:55–65.CrossRef

Einstein AJ, Blankstein R, Andrews H, Fish M, Padgett R, Hayes SW, et al. Comparison of image quality, myocardial perfusion, and left ventricular function between standard imaging and single-injection ultra-low-dose imaging using a high-efficiency SPECT camera: the MILLISIEVERT study. J Nucl Med. 2014;55:1430–7.CrossRef

Bracco Diagnostics. [Prescribing Information] CardioGen-82^® (Rubidium Rb 82 Generator), Bracco Diagnostics (NJ, USA) revised April 2013. Available at: http://imaging.bracco.com/sites/braccoimaging.com/files/technica_sheet_pdf/Cardiogen%20Full%20Prescribing%20Information.pdf. Accessed June 30, 2016.

Jubilant DRAXIMAGE. [Prescribing Information] Ruby-Fill^® (rubidium Rb 82 generator), Jubilant DRAXIMAGE (Kirkland Quebec). Available at: http://www.draximage.com/DATA/TEXTEDOC/Approval-202153-Ruby-Fill-Labeling-30Sept-2016.pdf. Accessed October 1, 2016.

Senthamizhchelvan S, Bravo PE, Esaias C, Lodge MA, Merrill J, Hobbs RF, et al. Human biodistribution and radiation dosimetry of 82Rb. J Nucl Med. 2010;51:1592–9.CrossRef

10.

International Commission on Radiological Protection, 2015. Radiation dose to patients from radiopharmaceuticals: A compendium of current information related to frequently used substances. ICRP Publication 128. Ann. ICRP 44(2S).

11.

Hunter CR, Hill J, Ziadi MC, Beanlands RS, deKemp RA. Biodistribution and radiation dosimetry of (82)Rb at rest and during peak pharmacological stress in patients referred for myocardial perfusion imaging. Eur J Nucl Med Mol Imaging. 2015;42:1032–42.CrossRef

12.

Saha GB. Fundamentals of nuclear pharmacy. 5th ed. New York: Springer; 2004.

13.

Schindler TH, Schelbert HR. Quantitation of myocardial perfusion: absolute blood flow versus relative uptake. In: Dilsizian V, Narula J, editors. Atlas of nuclear cardiology. 4th ed. New York: Springer; 2013.

14.

Taegtmeyer H, Dilsizian V. Imaging cardiac metabolism. In: Dilsizian V, Narula J, editors. Atlas of nuclear cardiology. 4th ed. New York: Springer; 2013.

15.

Dilsizian V, Bacharach SL, Beanlands SR, Bergmann SR, Delbeke D, Dorbala S, et al. ASNC imaging guidelines/SNMMI procedure standard for positron emission tomography (PET) nuclear cardiology procedures. J Nucl Cardiol. 2016;23:1187–226.CrossRef

16.

Dorbala S. Standard myocardial perfusion and cardiac FDG PET protocols and associated patient radiation doses. http://www.imagewisely.org/~/media/ImageWisely%20Files/NucMed/Standard%20Myocardial%20Perfusion.pdf. Accessed, May 10, 2016.

17.

Carroll LR, Kertz P, Orcut O. The orbiting rod source: improving performance in PET transmission correction scans. In: Esser PD. Emission computed tomography: Current trends. New York: The Society of Nuclear Medicine; 1983, p 235-247.

18.

Slomka PJ, Pan T, Germano G. Recent advances and future progress in PET instrumentation. Semin Nucl Med. 2016;46:5–19.CrossRef

19.

Hsu BL, Case JA, Moser KW, Bateman TM, Cullom SJ. Reconstruction of rapidly acquired germanium-68 transmission scans for cardiac PET attenuation correction. J Nucl Cardiol. 2007;14:706–14.CrossRef

20.

Kinahan PE, Townsend DW, Beyer T, Sashin D. Attenuation correction for a combined 3D PET/CT scanner. Med Phys. 1998;25:2046–53.CrossRef

21.

Dorbala S, Di Carli MF, Delbeke D, Abbara S, DePuey EG, Dilsizian V, et al. SNMMI/ASNC/SCCT guideline for cardiac SPECT/CT and PET/CT 1.0. J Nucl Med. 2013;54:1485–507.CrossRef

22.

Wu TH, Huang YH, Lee JJ, Wang SY, Wang SC, Su CT, et al. Radiation exposure during transmission measurements: Comparison between CT- and germanium-based techniques with a current PET scanner. Eur J Nucl Med Mol Imaging. 2004;31:38–43.CrossRef

23.

Gould L, Pan T-S, Laghin C, Johnson NP, Guha A, Sdringola S. Frequent diagnostic errors in cardiac PET/CT due to misregistration of CT attenuation and emission PET images: A definite analysis of causes, consequences and corrections. J Nucl Med. 2007;48:1112–21.CrossRef

24.

Chang S, Nabi F, Xu J, Peterson LE, Achari A, Pratt CM, et al. The coronary artery calcium score and stress myocardial perfusion imaging provide independent and complementary prediction of cardiac risk. J Am Coll Cardiol. 2009;54:1872–82.CrossRef

25.

Einstein AJ, Johnson LL, Bokhari S, Son J, Thompson RC, Bateman TM, et al. Agreement of visual estimation of coronary artery calcium from low-dose CT attenuation correction scans in hybrid PET/CT and SPECT/CT with standard Agatston Score. J Am Coll Cardiol. 2010;56:1914–21.CrossRef

26.

Cherry SR, Dahlborn M, Hoffman EJ. 3D PET using a conventional multislice tomography without septa. J Comput Assist Tomogr. 1991;15:655–68.CrossRef

27.

Knesaurek K, Machac J, Krynyckyi BR, Almeida OD. Comparison of 2-dimensional and 3-dimensional 82Rb myocardial perfusion PET imaging. J Nucl Med. 2003;4:1350–6.

28.

Lekx KS, deKemp RA, Beanlands RS, Wisenberg G, Wells G, Stodilka RZ, et al. 3D versus 2D dynamic ⁸²Rb myocardial blood flow imaging in a canine model of stunned and infarcted myocardium. Nucl Med Commun. 2010;31:75–81.CrossRef

29.

Padole A, Ali Khawaja RD, Kalra M, Singh S. CT radiation dose and iterative reconstruction techniques. AJR Am J Roentgenol. 2015;204:W384–92.CrossRef

30.

de Juan R, Seifert B, Berthold T, von Schulthess GK, Goerres GW. Clinical evaluation of a breathing protocol for PET/CT. Eur Radiol. 2004;14:1118–23.CrossRef

31.

Alessio AM, Kohlmyer S, Branch K, Chen G, Caldwell J, Kinahan P. Cine CT for attenuation correction in cardiac PET/CT. J Nucl Med. 2007;48:794–801.CrossRef

32.

Goerres GW, Kamel E, Heidelberg TN, Schwitter MR, Burger C, von Schulthess GK. PET-CT image co-registration in the thorax: Influence of respiration. Eur J Nucl Med Mol Imaging. 2002;29:351–60.CrossRef

33.

Xia T, Alessio AM, De Man B, Manjeshwar R, Asma E, Kinahan PE. Ultra-low dose CT attenuation correction for PET/CT. Phys Med Biol. 2012;57:309–28.CrossRef

34.

Case JA, Bateman TM. Taking the perfect nuclear image: Quality control, acquisition, and processing techniques for cardiac SPECT, PET, and hybrid imaging. J Nucl Cardiol. 2013;20:891–907.CrossRef

35.

O’Daniel JC, Stevens DM, Cody DD. Reducing radiation exposure from survey CT scans. AJR Am J Roentgenol. 2005;185:509–15.CrossRef

36.

Akamatsu G, Ishikawa K, Mitsumoto K, Taniguchi T, Ohya N, Baba S, et al. Improvement in PET/CT image quality with a combination of point-spread function and time-of-flight in relation to reconstruction parameters. J Nucl Med. 2012;53:1716–22.CrossRef

37.

Teoh EJ, McGowan DR, Macpherson RE, Bradley KM, Gleeson FV. Phantom and clinical evaluation of the Bayesian penalized likelihood reconstruction algorithm Q. Clear on an LYSO PET/CT system. J Nucl Med. 2015;56:1447–52.CrossRef

38.

Kaster T, Mylonas I, Renaud JM, Wells GA, Beanlands RS, deKemp RA. Accuracy of low dose rubidium-82 myocardial perfusion imaging for detection of coronary artery disease using 3D PET and normal database interpretation. J Nucl Cardiol. 2012;19:1135–45.CrossRef

39.

Klein R, Adler A, Beanlands RS, de Kemp RA. Precision-controlled elution of a 82Sr/82Rb generator for cardiac perfusion imaging with positron emission tomography. Phys Med Biol. 2007;52:659–73.CrossRef

40.

Lindner O, Pascual TN, Mercuri M, Acampa W, Burchert W, Flotats A, et al. Nuclear cardiology practice and associated radiation doses in Europe: results of the IAEA Nuclear Cardiology Protocols Study (INCAPS) for the 27 European countries. Eur J Nucl Med Mol Imaging. 2016;43:718–28.CrossRef

41.

Skali H, Schulman AR, Dorbala S. 18F-FDG PET/CT for the assessment of myocardial sarcoidosis. Curr Cardiol Rep. 2013;15:352.CrossRef

42.

Bateman TM, Dilsizian V, Beanlands RS, DePuey EG, Heller GV, Wolinsky DA. American Society of Nuclear Cardiology and Society of Nuclear Medicine and Molecular Imaging Joint Position Statement on the Clinical Indications for Myocardial Perfusion PET. J Nucl Cardiol. 2016;23:1227–31.CrossRef

43.

Ronan G, Wolk MJ, Bailey SR, Doherty JU, Douglas PS, Hendel RC, et al. ACCF/AHA/ASE/ASNC/HFSA/HRS/SCAI/SCCT/SCMR/STS 2013 multimodality appropriate use criteria for the detection and risk assessment of stable ischemic heart disease: a report of the American College of Cardiology Foundation Appropriate Use Criteria Task Force, American Heart Association, American Society of Echocardiography, American Society of Nuclear Cardiology, Heart Failure Society of America, Heart Rhythm Society, Society for Cardiovascular Angiography and Interventions, Society of Cardiovascular Computed Tomography, Society for Cardiovascular Magnetic Resonance, and Society of Thoracic Surgeons. J Nucl Cardiol. 2014;21:192–220.CrossRef

Title: Status of cardiovascular PET radiation exposure and strategies for reduction: An Information Statement from the Cardiovascular PET Task Force
Authors: James A. Case, PhD
Robert A. deKemp, PhD
Piotr J. Slomka, PhD
Mark F. Smith, PhD
Gary V. Heller, MD, PhD
Manuel D. Cerqueira, MD
Publication date: 01-08-2017
Publisher: Springer International Publishing
Published in: Journal of Nuclear Cardiology / Issue 4/2017
Print ISSN: 1071-3581
Electronic ISSN: 1532-6551
DOI: https://doi.org/10.1007/s12350-017-0897-9

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