Nuclear cardiology practices and radiation exposure in Africa

Results from the IAEA Nuclear Cardiology Protocols Study (INCAPS)

INCAPS Investigators Group

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

Objective: While nuclear myocardial perfusion imaging (MPI) offers many benefits to patients with known or suspected cardiovascular disease, concerns exist regarding radiationassociated health effects. Little is known regarding MPI practice in Africa. We sought to characterise radiation doses and the use of MPI best practices that could minimise radiation in African nuclear cardiology laboratories, and compare these to practice worldwide. Methods: Demographics and clinical characteristics were collected for a consecutive sample of 348 patients from 12 laboratories in six African countries over a one-week period from March to April 2013. Radiation effective dose (ED) was estimated for each patient. A quality index (QI) enumerating adherence to eight best practices, identified a priori by an IAEA expert panel, was calculated for each laboratory. We compared these metrics with those from 7 563 patients from 296 laboratories outside Africa. Results: Median (interquartile range) patient ED in Africa was similar to that of the rest of the world [9.1 (5.1-15.6) vs 10.3 mSv (6.8-12.6), p = 0.14], although a larger proportion of African patients received a low ED, ≤ 9 mSv targeted in societal recommendations (49.7 vs 38.2%, p < 0.001). Bestpractice adherence was higher among African laboratories (QI score: 6.3 ± 1.2 vs 5.4 ± 1.3, p = 0.013). However, median ED varied significantly among African laboratories (range: 2.0-16.3 mSv; p < 0.0001) and QI range was 4-8. Conclusion: Patient radiation dose from MPI in Africa was similar to that in the rest of the world, and adherence to best practices was relatively high in African laboratories. Nevertheless there remain opportunities to further reduce radiation exposure to African patients from MPI.

Original languageEnglish (US)
Pages (from-to)229-234
Number of pages6
JournalCardiovascular Journal of Africa
Volume28
Issue number4
DOIs
StatePublished - Jul 1 2017

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Cardiology
Myocardial Perfusion Imaging
Practice Guidelines
Radiation
Radiation Exposure
Cardiovascular Diseases
Demography
Health

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine

Cite this

Nuclear cardiology practices and radiation exposure in Africa : Results from the IAEA Nuclear Cardiology Protocols Study (INCAPS). / INCAPS Investigators Group.

In: Cardiovascular Journal of Africa, Vol. 28, No. 4, 01.07.2017, p. 229-234.

Research output: Contribution to journalArticle

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abstract = "Objective: While nuclear myocardial perfusion imaging (MPI) offers many benefits to patients with known or suspected cardiovascular disease, concerns exist regarding radiationassociated health effects. Little is known regarding MPI practice in Africa. We sought to characterise radiation doses and the use of MPI best practices that could minimise radiation in African nuclear cardiology laboratories, and compare these to practice worldwide. Methods: Demographics and clinical characteristics were collected for a consecutive sample of 348 patients from 12 laboratories in six African countries over a one-week period from March to April 2013. Radiation effective dose (ED) was estimated for each patient. A quality index (QI) enumerating adherence to eight best practices, identified a priori by an IAEA expert panel, was calculated for each laboratory. We compared these metrics with those from 7 563 patients from 296 laboratories outside Africa. Results: Median (interquartile range) patient ED in Africa was similar to that of the rest of the world [9.1 (5.1-15.6) vs 10.3 mSv (6.8-12.6), p = 0.14], although a larger proportion of African patients received a low ED, ≤ 9 mSv targeted in societal recommendations (49.7 vs 38.2{\%}, p < 0.001). Bestpractice adherence was higher among African laboratories (QI score: 6.3 ± 1.2 vs 5.4 ± 1.3, p = 0.013). However, median ED varied significantly among African laboratories (range: 2.0-16.3 mSv; p < 0.0001) and QI range was 4-8. Conclusion: Patient radiation dose from MPI in Africa was similar to that in the rest of the world, and adherence to best practices was relatively high in African laboratories. Nevertheless there remain opportunities to further reduce radiation exposure to African patients from MPI.",
author = "{INCAPS Investigators Group} and Bouyoucef, {Salah E.} and Mathew Mercuri and Pascual, {Thomas N.B.} and Allam, {Adel H.} and Mboyo Vangu and Vitola, {Jo{\~a}o V.} and Nathan Better and Ganesan Karthikeyan and Mahmarian, {John J.} and Rehani, {Madan M.} and Ravi Kashyap and Maurizio Dondi and Diana Paez and Einstein, {Andrew J.} and Einstein, {A. J.} and Pascual, {T. N.B.} and D. Paez and M. Dondi and N. Better and Bouyoucef, {S. E.} and G. Karthikeyan and R. Kashyap and V. Lele and Magboo, {V. P.C.} and Mahmarian, {J. J.} and M. Mercuri and F. Mut and Rehani, {M. M.} and Vitola, {J. V.} and E. Alex{\'a}nderson and A. Allam and Al-Mallah, {M. H.} and N. Better and Bouyoucef, {S. E.} and H. Bom and A. Flotats and S. Jerome and Kaufmann, {P. A.} and V. Lele and O. Luxenburg and J. Mahmarian and Shaw, {L. J.} and Underwood, {S. R.} and J. Vitola and W. Amouri and H. Essabbah and Gassama, {S. S.} and Makhdomi, {K. B.} and {El Mustapha}, {G. I.E.} and Asim Choudhri",
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T1 - Nuclear cardiology practices and radiation exposure in Africa

T2 - Results from the IAEA Nuclear Cardiology Protocols Study (INCAPS)

AU - INCAPS Investigators Group

AU - Bouyoucef, Salah E.

AU - Mercuri, Mathew

AU - Pascual, Thomas N.B.

AU - Allam, Adel H.

AU - Vangu, Mboyo

AU - Vitola, João V.

AU - Better, Nathan

AU - Karthikeyan, Ganesan

AU - Mahmarian, John J.

AU - Rehani, Madan M.

AU - Kashyap, Ravi

AU - Dondi, Maurizio

AU - Paez, Diana

AU - Einstein, Andrew J.

AU - Einstein, A. J.

AU - Pascual, T. N.B.

AU - Paez, D.

AU - Dondi, M.

AU - Better, N.

AU - Bouyoucef, S. E.

AU - Karthikeyan, G.

AU - Kashyap, R.

AU - Lele, V.

AU - Magboo, V. P.C.

AU - Mahmarian, J. J.

AU - Mercuri, M.

AU - Mut, F.

AU - Rehani, M. M.

AU - Vitola, J. V.

AU - Alexánderson, E.

AU - Allam, A.

AU - Al-Mallah, M. H.

AU - Better, N.

AU - Bouyoucef, S. E.

AU - Bom, H.

AU - Flotats, A.

AU - Jerome, S.

AU - Kaufmann, P. A.

AU - Lele, V.

AU - Luxenburg, O.

AU - Mahmarian, J.

AU - Shaw, L. J.

AU - Underwood, S. R.

AU - Vitola, J.

AU - Amouri, W.

AU - Essabbah, H.

AU - Gassama, S. S.

AU - Makhdomi, K. B.

AU - El Mustapha, G. I.E.

AU - Choudhri, Asim

PY - 2017/7/1

Y1 - 2017/7/1

N2 - Objective: While nuclear myocardial perfusion imaging (MPI) offers many benefits to patients with known or suspected cardiovascular disease, concerns exist regarding radiationassociated health effects. Little is known regarding MPI practice in Africa. We sought to characterise radiation doses and the use of MPI best practices that could minimise radiation in African nuclear cardiology laboratories, and compare these to practice worldwide. Methods: Demographics and clinical characteristics were collected for a consecutive sample of 348 patients from 12 laboratories in six African countries over a one-week period from March to April 2013. Radiation effective dose (ED) was estimated for each patient. A quality index (QI) enumerating adherence to eight best practices, identified a priori by an IAEA expert panel, was calculated for each laboratory. We compared these metrics with those from 7 563 patients from 296 laboratories outside Africa. Results: Median (interquartile range) patient ED in Africa was similar to that of the rest of the world [9.1 (5.1-15.6) vs 10.3 mSv (6.8-12.6), p = 0.14], although a larger proportion of African patients received a low ED, ≤ 9 mSv targeted in societal recommendations (49.7 vs 38.2%, p < 0.001). Bestpractice adherence was higher among African laboratories (QI score: 6.3 ± 1.2 vs 5.4 ± 1.3, p = 0.013). However, median ED varied significantly among African laboratories (range: 2.0-16.3 mSv; p < 0.0001) and QI range was 4-8. Conclusion: Patient radiation dose from MPI in Africa was similar to that in the rest of the world, and adherence to best practices was relatively high in African laboratories. Nevertheless there remain opportunities to further reduce radiation exposure to African patients from MPI.

AB - Objective: While nuclear myocardial perfusion imaging (MPI) offers many benefits to patients with known or suspected cardiovascular disease, concerns exist regarding radiationassociated health effects. Little is known regarding MPI practice in Africa. We sought to characterise radiation doses and the use of MPI best practices that could minimise radiation in African nuclear cardiology laboratories, and compare these to practice worldwide. Methods: Demographics and clinical characteristics were collected for a consecutive sample of 348 patients from 12 laboratories in six African countries over a one-week period from March to April 2013. Radiation effective dose (ED) was estimated for each patient. A quality index (QI) enumerating adherence to eight best practices, identified a priori by an IAEA expert panel, was calculated for each laboratory. We compared these metrics with those from 7 563 patients from 296 laboratories outside Africa. Results: Median (interquartile range) patient ED in Africa was similar to that of the rest of the world [9.1 (5.1-15.6) vs 10.3 mSv (6.8-12.6), p = 0.14], although a larger proportion of African patients received a low ED, ≤ 9 mSv targeted in societal recommendations (49.7 vs 38.2%, p < 0.001). Bestpractice adherence was higher among African laboratories (QI score: 6.3 ± 1.2 vs 5.4 ± 1.3, p = 0.013). However, median ED varied significantly among African laboratories (range: 2.0-16.3 mSv; p < 0.0001) and QI range was 4-8. Conclusion: Patient radiation dose from MPI in Africa was similar to that in the rest of the world, and adherence to best practices was relatively high in African laboratories. Nevertheless there remain opportunities to further reduce radiation exposure to African patients from MPI.

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U2 - 10.5830/CVJA-2016-091

DO - 10.5830/CVJA-2016-091

M3 - Article

VL - 28

SP - 229

EP - 234

JO - Cardiovascular Journal of Africa

JF - Cardiovascular Journal of Africa

SN - 1995-1892

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ER -