27 / 88
CARDIOVASCULAR JOURNAL OF AFRICA • Volume 28, No 4, July/August 2017
AFRICA
229
Nuclear cardiology practices and radiation exposure
in Africa: results from the IAEA Nuclear Cardiology
Protocols Study (INCAPS)
Salah E Bouyoucef, Mathew Mercuri, Thomas NB Pascual, Adel H Allam, Mboyo Vangu, João V Vitola,
Nathan Better, Ganesan Karthikeyan, John J Mahmarian, Madan M Rehani, Ravi Kashyap, Maurizio
Dondi, Diana Paez, Andrew J Einstein, for the INCAPS investigators group
Abstract
Objective:
While nuclear myocardial perfusion imaging (MPI)
offers many benefits to patients with known or suspected
cardiovascular disease, concerns exist regarding radiation-
associated health effects. Little is known regarding MPI prac-
tice 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). Best-
practice 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.
Keywords:
myocardial perfusion imaging, radiation, effective
dose, best practices, Africa
Submitted 25/5/16, accepted 16/10/16
Cardiovasc J Afr
2017;
28
: 229–234
www.cvja.co.zaDOI: 10.5830/CVJA-2016-091
The increasing burden of cardiovascular disease, affecting
rates of morbidity and mortality, has brought with it a rise
in technological innovations for diagnosing and managing
disease. In recent decades, cardiovascular imaging modalities
that use ionising radiation have become essential to cardiology
practice. Myocardial perfusion imaging (MPI) is one such
technology. Through the use of an injected radiopharmaceutical
in conjunction with a single-photon emission computed
tomography (SPECT) or positron emission tomography (PET)
Centre Hospitalo-Universitaire de Bab El Ouéd, Alger, Algeria
Salah E Bouyoucef, MD
Division of Cardiology, Department of Medicine, Columbia
University Medical Center and NewYork-Presbyterian
Hospital, NewYork, USA
Mathew Mercuri, PhD
Andrew J Einstein, MD, PhD,
andrew.einstein@columbia.eduSection of Nuclear Medicine and Diagnostic Imaging,
Division of Human Health, International Atomic Energy
Agency, Vienna, Austria
Thomas NB Pascual, MD, MHPEd
Ravi Kashyap, MD
Maurizio Dondi, MD
Diana Paez, MD
Cardiology Department, Al Azhar University, Cairo, Egypt
Adel H Allam, MD
Department of Nuclear Medicine, Charlotte Maxeke
Johannesburg Academic Hospital, University of the
Witwatersrand, Johannesburg, South Africa
Mboyo Vangu, MD, MMed, MSc, PhD
Quanta Diagnóstico & Terapia, Curitiba, Brazil
João V Vitola, MD, PhD
Department of Nuclear Medicine, Royal Melbourne
Hospital and University of Melbourne, Melbourne, Australia
Nathan Better, MB BS
Department of Cardiology, All India Institute of Medical
Sciences, New Delhi, India
Ganesan Karthikeyan, MB BS, MD, DM, MSc
Department of Cardiology, Houston Methodist DeBakey
Heart and Vascular Center, Houston, Texas, USA
John J Mahmarian, MD
Radiation Protection of Patients Unit, International
Atomic Energy Agency, Vienna, Austria; and Department
of Radiology, Massachusetts General Hospital, Harvard
Medical School, Boston, Massachusetts, USA
Madan M Rehani, PhD
Department of Radiology, Columbia University Medical
Center and NewYork-Presbyterian Hospital, NewYork, USA
Andrew J Einstein, MD, PhD