Journal of Nuclear Cardiology

, Volume 18, Issue 3, pp 385–392 | Cite as

Strategies for defining an optimal risk-benefit ratio for stress myocardial perfusion SPECT

  • Reza Fazel
  • Vasken Dilsizian
  • Andrew J. Einstein
  • Edward P. Ficaro
  • Milena Henzlova
  • Leslee J. Shaw
ASNC Information Statement


  1. 1.
    Shaw LJ, Marwick TH, Zoghbi WA, et al. Why all the focus on cardiac imaging? JACC Cardiovasc Imaging 2010;3:789-94.PubMedCrossRefGoogle Scholar
  2. 2.
    Shaw LJ, Achenbach S, Chandrashekhar Y, et al. Imaging modalities and radiation: Benefit has its risks. JACC Cardiovasc Imaging 2010;3:550-2.PubMedCrossRefGoogle Scholar
  3. 3.
    Gerber TC, Gibbons RJ. Weighing the risks and benefits of cardiac imaging with ionizing radiation. JACC Cardiovasc Imaging 2010;3:528-35.PubMedCrossRefGoogle Scholar
  4. 4.
    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.PubMedCrossRefGoogle Scholar
  5. 5.
    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.CrossRefGoogle Scholar
  6. 6.
    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.PubMedCrossRefGoogle Scholar
  7. 7.
    Einstein AJ. Radiation risk from coronary artery disease imaging: How do different diagnostic tests compare? Heart 2008;94:1519-21.PubMedCrossRefGoogle Scholar
  8. 8.
    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.CrossRefGoogle Scholar
  9. 9.
    Einstein AJ, Moser KW, Thompson RC, Cerqueira MD, Henzlova MJ. Radiation dose to patients from cardiac diagnostic imaging. Circulation 2007;116:1290-305.PubMedCrossRefGoogle Scholar
  10. 10.
    Cerqueira MD, Allman KC, Ficaro EP, et al. Recommendations for reducing radiation exposure in myocardial perfusion imaging. J Nucl Cardiol 2010;17:709-18.PubMedCrossRefGoogle Scholar
  11. 11.
    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.PubMedCrossRefGoogle Scholar
  12. 12.
    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.CrossRefGoogle Scholar
  13. 13.
    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.PubMedCrossRefGoogle Scholar
  14. 14.
    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.CrossRefGoogle Scholar
  15. 15.
    Shaw LJ, Taylor A, Raggi P, Berman DS. Role of noninvasive imaging in asymptomatic high-risk patients. J Nucl Cardiol 2006;13:156-62.PubMedGoogle Scholar
  16. 16.
    National Research Council. Health risks from exposure to low levels of ionizing radiation: BEIR VII—Phase 2. Washington, DC: The National Academies Press; 2006.Google Scholar
  17. 17.
    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.PubMedCrossRefGoogle Scholar
  18. 18.
    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.PubMedCrossRefGoogle Scholar
  19. 19.
    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.PubMedCrossRefGoogle Scholar
  20. 20.
    Valentin J. Low-dose extrapolation of radiation-related cancer risk. Ann ICRP 2005;35:1-140.Google Scholar
  21. 21.
    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.PubMedCrossRefGoogle Scholar
  22. 22.
  23. 23.
    Senthamizhchelvan S, Bravo PE, Esaias C, et al. Human biodistribution and radiation dosimetry of 82Rb. J Nucl Med 2010;51:1592-9.PubMedCrossRefGoogle Scholar
  24. 24.
    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.PubMedCrossRefGoogle Scholar
  25. 25.
    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.PubMedCrossRefGoogle Scholar
  26. 26.
    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.PubMedCrossRefGoogle Scholar
  27. 27.
    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.PubMedCrossRefGoogle Scholar
  28. 28.
    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.PubMedCrossRefGoogle Scholar
  29. 29.
    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.PubMedCrossRefGoogle Scholar
  30. 30.
    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.PubMedCrossRefGoogle Scholar
  31. 31.
    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.PubMedCrossRefGoogle Scholar
  32. 32.
    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.PubMedCrossRefGoogle Scholar
  33. 33.
    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.PubMedCrossRefGoogle Scholar
  34. 34.
    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.PubMedCrossRefGoogle Scholar
  35. 35.
    Sandman PM. Explaining risk to non-experts: A communications challenge. Emerg Prep Dig 1987;14:25-92.Google Scholar
  36. 36.
    Higson D. Beir VII-2. J Radiol Prot 2005;25:324-5.PubMedGoogle Scholar
  37. 37.
    American College of Radiology, Radiological Society of North America. Radiation Exposure in X-ray and CT Examinations. Updated November 15, 2010. Accessed November 17, 2010.
  38. 38.
    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.PubMedCrossRefGoogle Scholar
  39. 39.
    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.PubMedCrossRefGoogle Scholar
  40. 40.
    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.PubMedGoogle Scholar
  41. 41.
    National Network of Libraries of Medicine. Health Literacy. Updated September 14, 2010. Accessed November 15, 2010.
  42. 42.
    Roter DL, Hall JA, Aoki Y. Physician gender effects in medical communication: A meta-analytic review. J Am Med Assoc 2002;288:756-64.CrossRefGoogle Scholar
  43. 43.
    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.PubMedCrossRefGoogle Scholar
  44. 44.
    Roter DL, Hall JA. Communication and adherence: Moving from prediction to understanding. Med Care 2009;47:823-5.PubMedCrossRefGoogle Scholar
  45. 45.
    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.PubMedCrossRefGoogle Scholar
  46. 46.
    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.CrossRefGoogle Scholar
  47. 47.
    Jacob K, Vivian G, Steel JR. X-ray dose training: Are we exposed to enough? Clin Radiol 2004;59:928-34. discussion 6-7.PubMedCrossRefGoogle Scholar
  48. 48.
    Quinn AD, Taylor CG, Sabharwal T, Sikdar T. Radiation protection awareness in non-radiologists. Br J Radiol 1997;70:102-6.PubMedGoogle Scholar
  49. 49.
    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.PubMedCrossRefGoogle Scholar

Copyright information

© American Society of Nuclear Cardiology 2011

Authors and Affiliations

  • Reza Fazel
    • 1
  • Vasken Dilsizian
    • 2
  • Andrew J. Einstein
    • 3
  • Edward P. Ficaro
    • 4
  • Milena Henzlova
    • 5
  • Leslee J. Shaw
    • 1
  1. 1.Emory University School of MedicineAtlantaUSA
  2. 2.University of Maryland Medical CenterBaltimoreUSA
  3. 3.Columbia University Medical CenterNew YorkUSA
  4. 4.University of MichiganAnn ArborUSA
  5. 5.Mount Sinai Medical CenterNew YorkUSA

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