MELBOURNE – Africa and Europe have topped the list of countries employing best practices in nuclear cardiology while North America scored relatively poorly even compared to Latin America, according to a global survey by the International Atomic Energy Agency.
The IAEA Nuclear Cardiology Protocols Study (INCAPS) collected data on the protocols used for more than 7,900 nuclear cardiology procedures performed in 308 laboratories across 66 countries during 1 week, then assessed their procedures against eight prespecified best practices to derive a Quality Index (QI) score for the laboratory.
Bianca Nogrady/Frontline Medical News
Dr. Andrew J. Einstein
The 55 laboratories assessed in the United States and Canada achieved a mean QI score of 4.7, compared with 4.9 for 36 laboratories in Latin America, 6.2 for 102 laboratories in Europe, and 6.3 for 12 laboratories in North Africa, according to the results, presented at the World Congress of Cardiology 2014.
Analysis of the data showed that 75% of the nuclear cardiology laboratories in North Africa met at least six or more best practices, compared to 25% of laboratories in Asia and 31% in North America.
Lead author Dr. Andrew J. Einstein from Columbia University Medical Center, N.Y., said that while he was not surprised that Europe did better than the United States, he didn’t expect the difference to be quite so great.
Dr. Einstein said he was also surprised by the high degree of best practice nuclear cardiology in North Africa.
"I think what we’re taking away from this is that particularly as advanced technologies are introduced to places which don’t have them before, they are concentrating resources in centers of excellence," Dr. Einstein said at the meeting, sponsored by the World Heart Federation.
"Many of those labs have been trained by the IAEA so they got off on the right foot and they’re practicing well."
The eight best practice principles were derived from professional guidelines from around the world, and included practices such as weight-based dosing, avoidance of dual isotope and thallium stress testing in nonelderly patients, and use of stress-only imaging in some patients.
Researchers also included a score for the use of camera-based dose-reduction approaches, to allow for differences in technologies between the regions and avoid penalizing those with less-advanced machinery.
"That includes things as sophisticated as having a SPECT camera or having a cadmium zinc telluride high efficiency camera but it also included simply if a laboratory uses prone imaging in addition to supine imaging," Dr. Einstein said.
"So, even if you have a simple single-head old camera and you’re practicing in a resource-scarce part of the world, you have the potential to improve your image quality with your camera."
Further analysis is now being conducted on the data to look at which practices are more or less likely to be adhered to, Dr. Einstein said.
"We’re also talking about potential interventions and testing interventions to improve best practices and decrease radiation dose without limiting the opportunities for patients to get the valuable diagnostic information that comes from myocardial perfusion imaging."
This study was funded by the IAEA, and grants from the Margaret Q. Landenberger Research Foundation and the Louis V. Gerstner Scholars Program, and Dr. Einstein has received grant support for other research from GE Healthcare, Philips Healthcare, and Spectrum Dynamics.