Gender Differences in Radiation Dose From Nuclear Cardiology Studies Across the World: Findings From the INCAPS Registry

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• 作者：Lynn Shi ; AB^a ; Sharmila Dorbala ; MBBS^b ; Diana Paez ; MD^c ; Leslee J. Shaw ; PhD^d ; Katherine A. Zukotynski ; MD^e ; Thomas N.B. Pascual ; MD^c ; Ganesan Karthikeyan ; MBBS ; MD ; DM^f ; Joã ; o V. Vitola ; MD ; PhD^g ; Nathan Better ; MBBS^h ; Nadia Bokhariⁱ ; Madan M. Rehani ; PhD^j ; ^k ; Ravi Kashyap ; MD^c ; Maurizio Dondi ; MD^c ; Mathew Mercuri ; PhDⁱ ; Andrew J. Einstein ; MD ; PhD^l ; ^m ; ^{andrew.einstein@columbia.edu" class="auth_mail" title="E-mail the corresponding author} ; for the INCAPS Investigators GroupA.J. Einstein ; T.N.B. Pascual ; D. Paez ; M. Dondi ; N. Better ; S.E. Bouyoucef ; G. Karthikeyan ; R. Kashyap ; V. Lele ; V.P.C. Magboo ; J.J. Mahmarian ; J.B. Meeks ; M. Mercuri ; F. Mut ; M.M. Rehani ; J.V. Vitola ; E. Alexanderson ; A. Allam ; M.H. Al-Mallah ; N. Better ; S.E. Bouyoucef ; H. Bom ; A. Flotats ; S. Jerome ; P.A. Kaufmann ; V. Lele ; O. Luxenburg ; J. Mahmarian ; L.J. Shaw ; S.R. Underwood ; J. Vitola ; W. Amouri ; H. Essabbah ; S.S. Gassama ; K.B. Makhdomi ; G.I.E. El Mustapha ; N. El Ouchdi ; N. Qaï ; s ; N. Soni ; W. Vangu ; R.M. Abazid ; B. Adams ; V. Agarwal ; M.A. Alfeeli ; N. Alnafisi ; L. Bernabe ; G.G. Bural ; T. Chaiwatanarat ; J.M. Chandraguptha ; G.J. Cheon ; I. Cho ; A.S. Dogan ; M. Eftekhari ; A. Frenkel ; I. Garty ; S. George ; P. Geramifar ; H. Golan ; S. Habib ; R. Hussain ; H. Im ; H.-J. Jeon ; T. Kalawat ; W.J. Kang ; F. Keng ; A. Klaipetch ; P.G. Kumar ; J. Lee ; W.W. Lee ; I. Lim ; C.M.M. Macaisa ; G. Malhotra ; B.R. Mittal ; M.H. Mohammad ; P. Mohan ; I.D. Mulyanto ; D. Nariman ; U.N. Nayak ; K. Niaz ; G. Nikolov ; J.M. Obaldo ; E. Ozturk ; J.M. Park ; S. Park ; C.D. Patel ; H.K. Phuong ; A.P. Quinon ; T.R. Rajini ; Y. Saengsuda ; J. Santiago ; H.B. Sayman ; A.S. Shinto ; V. Sivasubramaniyan ; M.H. Son ; P. Sudhakar ; G.M.S. Syed ; N. Tamaki ; K. Thamnirat ; T. Thientunyakit ; S. Thongmak ; D.N. Velasco ; A. Verma ; U. Vutrapongwatana ; Y. Wang ; K.S. Won ; Z. Yao ; T. Yingsa-nga ; R. Yudistiro ; K.T. Yue ; N. Zafrir ; S.C. Adrian ; D. Agostini ; S. Aguadé ; G. Armitage ; M. Backlund ; M. Backman ; M. Baker ; M.T. Balducci ; C. Bavelaar ; M. Berovic ; F. Bertagna ; R. Beuchel ; A. Biggi ; G. Bisi ; R. Bonini ; A. Bradley ; L. Brudin ; I. Bruno ; E. Busnardo ; R. Casoni ; A. Choudhri ; C. Cittanti ; R. Clauss ; D.C. Costa ; M. Costa ; K. Dixon ; M. Dziuk ; N. Egelic ; I. Eriksson ; G. Fagioli ; D.B. de Faria ; L. Florimonte ; A. Francini ; M. French ; E. Gallagher ; I. Garai ; O. Geatti ; D. Genovesi ; L. Gianolli ; A. Gimelli ; E. del Giudice ; S. Halliwell ; M.J. Hansson ; C. Harrison ; F. Homans ; F. Horton ; D. Jędrzejuk ; J. Jogi ; A. Johansen ; H. Johansson ; M. Kalnina ; M. Kaminek ; A. Kiss ; M. Kobylecka ; M. Kostkiewicz ; J. Kropp ; R. Kullenberg ; T. Lahoutte ; O. Lang ; Y.H. Larsson ; M. Lá ; zá ; r ; L. Leccisotti ; N. Leners ; O. Lindner ; R.W. Lipp ; A. Maenhout ; L. Maffioli ; C. Marcassa ; B. Martins ; P. Marzullo ; G. Medolago ; C.G. Mendiguchí ; a ; S. Mirzaei ; M. Mori ; B. Nardi ; S. Nazarenko ; K. Nikoletic ; R. Oleksa ; T. Parviainen ; J. Patrina ; R. Peace ; C. Pirich ; H. Piwowarska-Bilska ; S. Popa ; V. Prakash ; V. Pubul ; L. Puklavec ; S. Rac ; M. Ratniece ; S.A. Rogan ; A. Romeo ; M. Rossi ; D. Ruiz ; N. Sabharwal ; B.G. Salobir ; A.I. Santos ; S. Saranovic ; A. Sarkozi ; R.P. Schneider ; R. Sciagra ; S. Scotti ; Z. Servini ; L.R. Setti ; S.-Å ; . Starck ; D. Vajauskas ; J. Veselý ; A. Vieni ; A. Vignati ; I.M. Vito ; K. Weiss ; D. Wild ; M. Zdraveska-Kochovska ; R.N. Agü ; ro ; N. Alvarado ; C.M. Barral ; M. Beretta ; I. Berrocal ; J.F. Batista Cuellar ; T.-M. Cabral Chang ; L.O. Cabrera Rodrí ; guez ; J. Canessa ; G. Castro Mora ; A.C. Claudia ; G.F. Clavelo ; A.F. Cruz Jú ; nior ; F.F. Faccio ; K.M. Ferná ; ndez ; J.R. Gomez Garibo ; U. Gonzalez ; P. Gonzá ; lez E. ; M.A. Guzzo ; J. Jofre ; M. Kapitá ; n ; G. Kempfer ; J.L. Lopez ; T. Massardo V. ; I. Medeiros Colaco ; C.T. Mesquita ; M. Montecinos ; S. Neubauer ; L.M. Pabon ; A. Puente ; L.M. Rochela Vazquez ; J.A. Serna Macias ; A.G. Silva Pino ; F.Z. Tá ; rtari Huber ; A.P. Tovar ; L. Vargas ; C. Wiefels ; A. Aljizeeri ; R.J. Alvarez ; D. Barger ; W. Beardwood ; J. Behrens ; L. Brann ; D. Brown ; H. Carr ; K. Churchwell ; G.A. Comingore ; J. Corbett ; M. Costello ; F. Cruz ; T. Depinet ; S. Dorbala ; M. Earles ; F.P. Esteves ; E. Etherton ; R.J. Fanning Jr. ; J. Fornace ; L. Franks ; H. Gewirtz ; K. Gulanchyn ; C.-L. Hannah ; J. Hays ; J. Hendrickson ; J. Hester ; K. Holmes ; S. Jerome ; A. Johnson ; C. Jopek ; H. Lewin ; J. Lyons ; C. Manley ; J. Meden ; S. Moore ; W.H. Moore ; V. Murthy ; R. Nace ; D. Neely ; L. Nelson ; O. Niedermaier ; D. Rice ; R. Rigs ; K. Schiffer ; E. Schockling ; T. Schultz ; T. Schumacker ; B. Sheesley ; A. Sheikh ; B. Siegel ; A.M. Slim ; J. Smith ; M. Szulc ; N. Tanskersley ; P. Tilkemeier ; G.D. Valdez ; R. Vrooman ; D. Wawrowicz ; D.E. Winchester ; A. Alcheikh ; B. Allen ; E. Atkins ; J. Bevan ; C. Bonomini ; J. Christiansen ; L. Clack ; E. Craig ; H. Dixson ; I. Duncan ; S. Fredericks ; S. Gales ; R. Hampson ; T. Hanley ; K. Hartcher ; J. Hassall ; B. Kelley ; S. Kelly ; T. Kidd ; T. de Kort ; G. Larcos ; W. Macdonald ; C. McGrath ; E. Murdoch ; S. O'Malley ; M. O'Rourke ; M. Pack ; R. Pearce ; R. Praehofer ; S. Ramsay ; L. Scarlett ; K. Smidt ; F. Souvannavong ; K. Taubman ; G. Taylor ; K. Tse ; S. Unger ; J. Weale
• 关键词：gender ; nuclear cardiology ; radiation exposure
• 刊名：JACC: Cardiovascular Imaging
• 出版年：2016
• 出版时间：April 2016
• 年：2016
• 卷：9
• 期：4
• 页码：376-384
• 全文大小：1029 K

文摘

The aim of this study was to investigate gender-based differences in nuclear cardiology practice globally, with a particular focus on laboratory volume, radiation dose, protocols, and best practices.

Background

It is unclear whether gender-based differences exist in radiation exposure for nuclear cardiology procedures.

Methods

In a large, multicenter, observational, cross-sectional study encompassing 7,911 patients in 65 countries, radiation effective dose was estimated for each examination. Patient-level best practices relating to radiation exposure were compared between genders. Analysis of covariance was used to determine any difference in radiation exposure according to gender, region, and the interaction between gender and region. Linear, logistic, and hierarchical regression models were developed to evaluate gender-based differences in radiation exposure and laboratory adherence to best practices. The study also included the United Nations Gender Inequality Index and Human Development Index as covariates in multivariable models.

Results

The proportion of myocardial perfusion imaging studies performed in women varied among countries; however, there was no significant correlation with the Gender Inequality Index. Globally, mean effective dose for nuclear cardiology procedures was only slightly lower in women (9.6 ± 4.5 mSv) than in men (10.3 ± 4.5 mSv; p < 0.001), with a difference of only 0.3 mSv in a multivariable model adjusting for patients’ age and weight. Stress-only imaging was performed more frequently in women (12.5% vs. 8.4%; p < 0.001); however, camera-based dose reduction strategies were used less frequently in women (58.6% vs. 65.5%; p < 0.001).

Conclusions

Despite significant worldwide variation in best practice use and radiation doses from nuclear cardiology procedures, only small differences were observed between genders worldwide. Regional variations noted in myocardial perfusion imaging use and radiation dose offer potential opportunities to address gender-related differences in delivery of nuclear cardiology care.