Myocardial perfusion scintigraphy in Europe 2005

Abstract

Purpose

We have conducted a survey of myocardial perfusion scintigraphy (MPS) in 2005 in Europe with the intention of initiating a regular series of surveys to track usage of the technique.

Methods

Information was obtained from 234 centres in 18 counties. The returning centres served 27% of the population of their countries, and estimates of the numbers of MPS per million of population (pmp) were made assuming that the population not reported either performed no studies (lower estimate) or the same number pmp as the reporting centres (upper estimate).

Results

Estimates of MPS for the countries surveyed ranged from a lower limit of 373 pmp to an upper limit of 1,388 pmp. There were marked variations between countries with higher numbers (lower limit of estimate above the mid range of all countries combined) in Austria, Greece, Hungary, the Netherlands, Sweden and Slovenia, and lower numbers (upper limit of estimate below the mid range of all countries) in Finland, Germany and Poland. The ratio of MPS to coronary angiography to revascularisation procedures was 0.6 to 1.5 to 1. The median number of studies per centre was 496, with 32% of centres performing fewer than 250 studies in the year. The median waiting time for routine studies was 21 days and for urgent studies 3.4 days. Fifty-three percent of studies used pharmacological stress, with roughly equal numbers of adenosine and dipyridamole. Eighty-two percent of studies used ^99mTc-based tracers. Tomographic acquisition was almost universal with 65% of studies being ECG-gated and 20% attenuation-corrected. Eighteen percent of studies were reported from hard copy alone, and 60% of studies were reported without viewing the rotating planar data.

Conclusion

We conclude that relatively low numbers of MPS studies are being performed in the surveyed centres, particularly when compared with coronary angiography and revascularisation. The use of ^99mTc-based tracers is high, but ECG-gated studies are less common. Some reporting practices are not ideal. These data will serve as a valuable baseline for future surveys, which are likely to be more complete.

Appendix

European Council of Nuclear Cardiology

Myocardial Perfusion Scintigraphy Survey 2005

This is the first of a regular series of surveys performed by the European Council on Nuclear Cardiology (ECNC). It concerns activity in myocardial perfusion scintigraphy throughout Europe. Previous national surveys have had important roles in service planning and in lobbying for resources, and so, your assistance in this effort may well have indirect benefit for your own practice. The results will be published and will be available to all participants.

Where several options are presented, you may need to select more than one. Where a number is requested, please give an estimate if the exact figure is not available. Please provide data in terms of the number of patients studied rather than the number of image acquisitions. For example, a stress + rest perfusion study = 1 patient.

Please provide your contact details in case we need to clarify matters:

• 1. Contact name:

• 2. E-mail address:

• 3. Telephone number:

• 4. Institution address:

Essential Questions

If you do nothing else, please answer these questions to the best of your ability

• 5. What size of population does your department serve for nuclear cardiology studies? See question 8 for hints in how to estimate this.

• 6. How many myocardial perfusion studies did your department perform in 2005?

Desirable Questions

Some of these questions are more detailed or complex. The more that you can answer or estimate, the more valuable all of our efforts will be. If you have no estimation of 2005, you can use data from 2004.

About your institution

• 7. Type of institution:

• □ Undergraduate or postgraduate teaching hospital

• □ Mainly non-teaching hospital (may be allied to a teaching hospital)

• □ Mainly privately funded hospital or clinic

• □ Other (please specify)

  • 8. What size of population do you serve for general cardiology?

This number is difficult to know but important. Please estimate as best you can. If you are an “average” site, one way of doing this may be from your national coronary angiography or revascularisation rate and the number of angiograms or revascularisations performed at your institution. For instance, if your national rate of revascularisation (CABG + PCI) is 2,500 per million population per year and you perform 750 revascularisations per year, then the population that you serve is likely to be 300,000.

If you cannot answer this, then suitable answers in the next question may allow us to do it for you.

• 9. Number (in year 2005) of:

• Stress ECGs

• Stress echocardiograms

• Cardiac magnetic resonance scans

• Coronary angiograms

• Percutaneous coronary interventions

• Coronary bypass graft operations

About your department

• 10. Type of department:

• □ Cardiology

• □ Nuclear Medicine

• □ Radiology

• □ Other (please specify)

  • 11. Total number of general nuclear medicine studies in year 2005:

About your equipment

• 12. How many gamma cameras are there in your department?

• Single head general purpose SPECT:

• Multihead general purpose SPECT:

• Dedicated cardiac SPECT:

• Planar:

  • 13. What are the ages (in years) of each gamma camera?

• Single head general purpose SPECT:

• Multihead general purpose SPECT:

• Dedicated cardiac SPECT:

• Planar:

About routine myocardial perfusion imaging

Patients studied

• 14. Percentages of inpatients/outpatients studied (should add up to 100):

• Outpatients:

• Inpatients:

  • 15. Percentage referred from your own or from other hospitals (should add up to 100):

• Your hospital:

• Other hospitals:

  • 16. Percentage of referrals from (please estimate if necessary):

• Cardiologist:

• Cardiac surgeon:

• Noncardiac physician:

• Noncardiac surgeon:

• Primary care physician:

  • 17. Percentage indications for myocardial perfusion imaging:

• Diagnosis of coronary disease

• Assessment of known coronary disease (excluding hibernation):

• Assessment of hibernation or viability

  • 18. Average waiting time for routine myocardial perfusion imaging:

  • 19. Average waiting time for clinically urgent myocardial perfusion imaging

Stress

• 20. How many staff members supervise a typical stress test:

• 21. What is their background (give numbers of individuals at a typical stress test):

• Cardiologist:

• Nuclear physician:

• Radiologist:

• Other physician:

• Nurse:

• Radiographer or imaging technician:

• Physicist:

• Cardiac technician:

• Other (specify):

  • 22. What type of stress is used? (% of patients studied, should add up to 100%)

• Exercise (bicycle or treadmill):

• Adenosine:

• Dipyridamole:

• Dobutamine:

• Other:

  • 23. When you use vasodilator stress, is it routinely combined with exercise?

• □ Yes

• □ No

Radiopharmaceutical protocols

• 24. What radiopharmaceutical protocols are used?

• □ Thallium stress/redistribution

• □ Thallium stress/reinjection

• □ MIBI 1-day stress/rest

• □ MIBI 1-day rest/stress

• □ MIBI 2-day

• □ Tetrofosmin 1-day stress/rest

• □ Tetrofosmin 1-day rest/stress

• □ Tetrofosmin 2-day

• □ Dual isotope

• □ Other

Imaging protocols

• 25. Percentage of acquisition types (should add up to 100%):

• Ungated planar:

• ECG-gated planar:

• Ungated SPECT:

• ECG-gated SPECT:

  • 26. What percentage of SPECT studies is attenuation corrected?

  • 27. In what percentage of SPECT studies do you perform prone imaging, either as well as supine or instead of supine?

  • 28. In what percentage of SPECT studies do you perform motion correction?

Reporting

• 29. Who reports nuclear cardiology studies (% of patients studied, may add up to more than 100% if several people report together)?

• Cardiologist

• Nuclear physician

• Radiologist

• Other physician

• Nurse

• Radiographer

• Physicist

• Cardiac technician

• Other

  • 30. Do you report from hard copy or from computer screen?

• □ Hard copy

• □ Computer screen

  • 31. In what percentage of SPECT studies is planar projection data examined by the reporter?

  • 32. What percentage of ungated studies do you view for the assessment of perfusion using the following colour tables (may add up to more than 100% if you use a combination):

• Grey scale

• Monochrome colour scale (e.g. hot body)

• Continuous colour scale

  • e.g. “Cool” or “GE”

  • e.g. “Rainbow”

  • e.g. Other

• Discrete colour scale (i.e. with discontinuities or contours)

  • 33. What percentage of ECG-gated studies do you view for the assessment of LV function using the following colour tables (may add up to more than 100% if you use a combination):

• Grey scale

• Monochrome colour scale (e.g. hot body)

• Continuous colour scale

  • e.g. “Cool” or “GE”

  • e.g. “Rainbow”

  • e.g. Other

• Discrete colour scale (i.e. with discontinuities or contours)

About radionuclide ventriculography

• 34. How many radionuclide ventriculograms were performed in your institution in 2005?

• Equilibrium studies:

• First pass studies:

About other nuclear cardiology techniques

• 35. Number of patients studied in 2005 with:

• Cardiac (FDG ± perfusion) PET

  • – Dedicated PET

  • – Gamma camera PET

• FDG SPECT

• Fatty acid imaging (SPECT or PET)

• MIBG

• Other (please specify)

Other comments

• 36. Please use this space to make any other comments that you think we may find useful: