Strategies for defining an optimal risk-benefit ratio for stress myocardial perfusion SPECT
Rent the article at a discountRent now
* Final gross prices may vary according to local VAT.Get Access
Tremendous growth in medical imaging has prompted a re-focusing on the appropriateness of testing and the rationale for exposure to ionizing radiation for large segments of the adult population at intermediate to high likelihood for coronary artery disease (CAD).1-9 Part I of this series addressed the technical or methodological approaches to measuring radiation exposure and laboratory approaches to reducing exposure including the clinical utility of stress only imaging.10 In the current statement, we present a clinical approach for defining the risk:benefit ratio of myocardial perfusion imaging (MPI) focusing on the appropriate use of single photon-emission computed tomography (SPECT) or positron emission tomography (PET) MPI. We also review the concept of “patient-centered imaging” and discuss methods for effectively addressing patient concerns regarding procedural risk.
The Public’s and Payer’s Safety Concerns
Several recent high profile reports have highlighted the expans ...
- Shaw LJ, Marwick TH, Zoghbi WA, et al. Why all the focus on cardiac imaging? JACC Cardiovasc Imaging 2010;3:789-94. CrossRef
- Shaw LJ, Achenbach S, Chandrashekhar Y, et al. Imaging modalities and radiation: Benefit has its risks. JACC Cardiovasc Imaging 2010;3:550-2. CrossRef
- Gerber TC, Gibbons RJ. Weighing the risks and benefits of cardiac imaging with ionizing radiation. JACC Cardiovasc Imaging 2010;3:528-35. CrossRef
- Laskey WK, Feinendegen LE, Neumann RD, Dilsizian V. Low-level ionizing radiation from noninvasive cardiac imaging: Can we extrapolate estimated risks from epidemiologic data to the clinical setting? JACC Cardiovasc Imaging 2010;3:517-24. CrossRef
- Chen J, Einstein AJ, Fazel R, et al. Cumulative exposure to ionizing radiation from diagnostic and therapeutic cardiac imaging procedures: A population-based analysis. J Am Coll Cardiol 2010;56:712-4. CrossRef
- Fazel R, Krumholz HM, Wang Y, et al. Exposure to low-dose ionizing radiation from medical imaging procedures. N Engl J Med 2009;361:849-57. CrossRef
- Einstein AJ. Radiation risk from coronary artery disease imaging: How do different diagnostic tests compare? Heart 2008;94:1519-21. CrossRef
- Einstein AJ, Henzlova MJ, Rajagopalan S. Estimating risk of cancer associated with radiation exposure from 64-slice computed tomography coronary angiography. J Am Med Assoc 2007;298:317-23. CrossRef
- Einstein AJ, Moser KW, Thompson RC, Cerqueira MD, Henzlova MJ. Radiation dose to patients from cardiac diagnostic imaging. Circulation 2007;116:1290-305. CrossRef
- Cerqueira MD, Allman KC, Ficaro EP, et al. Recommendations for reducing radiation exposure in myocardial perfusion imaging. J Nucl Cardiol 2010;17:709-18. CrossRef
- Kim KP, Einstein AJ, Berrington de Gonzalez A. Coronary artery calcification screening: Estimated radiation dose and cancer risk. Arch Intern Med 2009;169:1188-94. CrossRef
- Olson MB, Shaw LJ, Kaizar EE, et al. Obesity distribution and reproductive hormone levels in women: A report from the NHLBI-sponsored WISE study. J Womens Health (Larchmt) 2006;15:836-42. CrossRef
- Berrington de Gonzalez A, Mahesh M, Kim KP, et al. Projected cancer risks from computed tomographic scans performed in the United States in 2007. Arch Intern Med 2009;169:2071-7. CrossRef
- Einstein AJ, Weiner SD, Bernheim A, et al. Multiple testing, cumulative radiation dose, and clinical indications in patients undergoing myocardial perfusion imaging. J Am Med Assoc 2010;304:2137-44. CrossRef
- Shaw LJ, Taylor A, Raggi P, Berman DS. Role of noninvasive imaging in asymptomatic high-risk patients. J Nucl Cardiol 2006;13:156-62.
- National Research Council. Health risks from exposure to low levels of ionizing radiation: BEIR VII—Phase 2. Washington, DC: The National Academies Press; 2006.
- Brenner DJ, Doll R, Goodhead DT, et al. Cancer risks attributable to low doses of ionizing radiation: Assessing what we really know. Proc Natl Acad Sci USA 2003;100:13761-6. CrossRef
- Little MP, Wakeford R, Tawn EJ, Bouffler SD, Berrington de Gonzalez A. Risks associated with low doses and low dose rates of ionizing radiation: Why linearity may be (almost) the best we can do. Radiology 2009;251:6-12. CrossRef
- Shaw LJ, Heller GV, Casperson P, et al. Gated myocardial perfusion single photon emission computed tomography in the clinical outcomes utilizing revascularization and aggressive drug evaluation (COURAGE) trial, Veterans Administration cstudy no. 424. J Nucl Cardiol 2006;13:685-98. CrossRef
- Valentin J. Low-dose extrapolation of radiation-related cancer risk. Ann ICRP 2005;35:1-140.
- Berrington de Gonzalez A, Kim K-P, Smith-Bindman R, McAreavey D. Myocardial perfusion scans: Projected population cancer risks from current levels of use in the United States. Circulation 2010;122:2403-10. CrossRef
- http://www.cancer.org/Research/CancerFactsFigures/CancerFactsFigures/cancer-facts-and-figures-2010. Accessed January 11, 2011.
- Senthamizhchelvan S, Bravo PE, Esaias C, et al. Human biodistribution and radiation dosimetry of 82Rb. J Nucl Med 2010;51:1592-9. CrossRef
- Einstein AJ, Elliston CD, Arai AE, et al. Radiation dose from single-heartbeat coronary CT angiography performed with a 320-detector row volume scanner. Radiology 2010;254:698-706. CrossRef
- Einstein AJ, Wolff SD, Manheimer ED, et al. Comparison of image quality and radiation dose of coronary computed tomographic angiography between conventional helical scanning and a strategy incorporating sequential scanning. Am J Cardiol 2009;104:1343-50. CrossRef
- Berman DS, Kang X, Tamarappoo B, et al. Stress thallium-201/rest technetium-99m sequential dual isotope high-speed myocardial perfusion imaging. JACC Cardiovasc Imaging 2009;2:273-82. CrossRef
- Einstein AJ, Sanz J, Dellegrottaglie S, et al. Radiation dose and cancer risk estimates in 16-slice computed tomography coronary angiography. J Nucl Cardiol 2008;15:232-40. CrossRef
- Duvall WL, Croft LB, Godiwala T, Ginsberg E, George T, Henzlova MJ. Reduced isotope dose with rapid SPECT MPI imaging: Initial experience with a CZT SPECT camera. J Nucl Cardiol 2010;17:1009-14. CrossRef
- Hendel RC, Berman DS, Di Carli MF, et al. ACCF/ASNC/ACR/AHA/ASE/SCCT/SCMR/SNM 2009 appropriate use criteria for cardiac radionuclide imaging. Circulation 2009;119:e561-87. CrossRef
- Berman DS, Hachamovitch R, Kiat H, et al. Incremental value of prognostic testing in patients with known or suspected ischemic heart disease: A basis for optimal utilization of exercise technetium-99m sestamibi myocardial perfusion single-photon emission computed tomography. J Am Coll Cardiol 1995;26:639-47. CrossRef
- Ward RP, Al-Mallah MH, Grossman GB, et al. American Society of Nuclear Cardiology review of the ACCF/ASNC appropriateness criteria for single-photon emission computed tomography myocardial perfusion imaging (SPECT MPI). J Nucl Cardiol 2007;14:e26-38. CrossRef
- Iskandrian AS, Chae SC, Heo J, Stanberry CD, Wasserleben V, Cave V. Independent and incremental prognostic value of exercise single-photon emission computed tomographic (SPECT) thallium imaging in coronary artery disease. J Am Coll Cardiol 1993;22:665-70. CrossRef
- Shaw LJ, Berman DS, Blumenthal RS, et al. Clinical imaging for prevention: Directed strategies for improved detection of presymptomatic patients with undetected atherosclerosis—Part I: Clinical imaging for prevention. J Nucl Cardiol 2008;15:e6-19. CrossRef
- Beach MC, Roter DL, Wang NY, Duggan PS, Cooper LA. Are physicians’ attitudes of respect accurately perceived by patients and associated with more positive communication behaviors? Patient Educ Couns 2006;62:347-54. CrossRef
- Sandman PM. Explaining risk to non-experts: A communications challenge. Emerg Prep Dig 1987;14:25-92.
- Higson D. Beir VII-2. J Radiol Prot 2005;25:324-5.
- American College of Radiology, Radiological Society of North America. Radiation Exposure in X-ray and CT Examinations. http://www.radiologyinfo.org/en/safety/index.cfm?pg=sfty_xray#part2. Updated November 15, 2010. Accessed November 17, 2010.
- Hendel RC, Cerqueira M, Douglas PS, et al. A multicenter assessment of the use of single-photon emission computed tomography myocardial perfusion imaging with appropriateness criteria. J Am Coll Cardiol 2010;55:156-62. CrossRef
- Brewer NT, Tzeng JP, Lillie SE, Edwards AS, Peppercorn JM, Rimer BK. Health literacy and cancer risk perception: Implications for genomic risk communication. Med Decis Making 2009;29:157-66. CrossRef
- Sharp LK, Zurawski JM, Roland PY, O’Toole C, Hines J. Health literacy, cervical cancer risk factors, and distress in low-income African-American women seeking colposcopy. Ethn Dis 2002;12:541-6.
- National Network of Libraries of Medicine. Health Literacy. http://nnlm.gov/outreach/consumer/hlthlit.html. Updated September 14, 2010. Accessed November 15, 2010.
- Roter DL, Hall JA, Aoki Y. Physician gender effects in medical communication: A meta-analytic review. J Am Med Assoc 2002;288:756-64. CrossRef
- Helitzer DL, Lanoue M, Wilson B, de Hernandez BU, Warner T, Roter D. A randomized controlled trial of communication training with primary care providers to improve patient-centeredness and health risk communication. Patient Educ Couns 2010;82:21-9. CrossRef
- Roter DL, Hall JA. Communication and adherence: Moving from prediction to understanding. Med Care 2009;47:823-5. CrossRef
- Ghods BK, Roter DL, Ford DE, Larson S, Arbelaez JJ, Cooper LA. Patient-physician communication in the primary care visits of African Americans and whites with depression. J Gen Intern Med 2008;23:600-6. CrossRef
- Young LH, Wackers FJ, Chyun DA, et al. Cardiac outcomes after screening for asymptomatic coronary artery disease in patients with type 2 diabetes: The DIAD study: A randomized controlled trial. J Am Med Assoc 2009;301:1547-55. CrossRef
- Jacob K, Vivian G, Steel JR. X-ray dose training: Are we exposed to enough? Clin Radiol 2004;59:928-34. discussion 6-7. CrossRef
- Quinn AD, Taylor CG, Sabharwal T, Sikdar T. Radiation protection awareness in non-radiologists. Br J Radiol 1997;70:102-6.
- Shiralkar S, Rennie A, Snow M, Galland RB, Lewis MH, Gower-Thomas K. Doctors’ knowledge of radiation exposure: Questionnaire study. BMJ 2003;327:371-2. CrossRef
- Strategies for defining an optimal risk-benefit ratio for stress myocardial perfusion SPECT
Journal of Nuclear Cardiology
Volume 18, Issue 3 , pp 385-392
- Cover Date
- Print ISSN
- Online ISSN
- Additional Links
- Industry Sectors
- Author Affiliations
- 1. Emory University School of Medicine, Atlanta, GA, USA
- 2. University of Maryland Medical Center, Baltimore, MD, USA
- 3. Columbia University Medical Center, New York, NY, USA
- 4. University of Michigan, Ann Arbor, MI, USA
- 5. Mount Sinai Medical Center, New York, NY, USA