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

Lynn Shi, Sharmila Dorbala, Diana Paez, Leslee J. Shaw, Katherine A. Zukotynski, Thomas N B Pascual, Ganesan Karthikeyan, João V. Vitola, Nathan Better, Nadia Bokhari, Madan M. Rehani, Ravi Kashyap, Maurizio Dondi, Mathew Mercuri, Andrew J. Einstein, A. J. Einstein, T. N B Pascual, D. Paez, M. Dondi, N. BetterS. E. Bouyoucef, G. Karthikeyan, R. Kashyap, V. Lele, V. P C Magboo, J. J. Mahmarian, J. B. Meeks, 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, Claudio Marcassa, INCAPS Investigators Group

Research output: Contribution to journalArticle

6 Citations (Scopus)

Abstract

Objectives 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.

Original languageEnglish
Pages (from-to)376-384
Number of pages9
JournalJACC: Cardiovascular Imaging
Volume9
Issue number4
DOIs
Publication statusPublished - Apr 1 2016

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Cardiology
Registries
Practice Guidelines
Radiation
Myocardial Perfusion Imaging
United Nations
Human Development
Cross-Sectional Studies
Logistic Models
Weights and Measures
Radiation Exposure

Keywords

  • gender
  • nuclear cardiology
  • radiation exposure

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

Cite this

Shi, L., Dorbala, S., Paez, D., Shaw, L. J., Zukotynski, K. A., Pascual, T. N. B., ... INCAPS Investigators Group (2016). Gender Differences in Radiation Dose from Nuclear Cardiology Studies Across the World Findings from the INCAPS Registry. JACC: Cardiovascular Imaging, 9(4), 376-384. https://doi.org/10.1016/j.jcmg.2016.01.001

Gender Differences in Radiation Dose from Nuclear Cardiology Studies Across the World Findings from the INCAPS Registry. / Shi, Lynn; Dorbala, Sharmila; Paez, Diana; Shaw, Leslee J.; Zukotynski, Katherine A.; Pascual, Thomas N B; Karthikeyan, Ganesan; Vitola, João V.; Better, Nathan; Bokhari, Nadia; Rehani, Madan M.; Kashyap, Ravi; Dondi, Maurizio; Mercuri, Mathew; Einstein, Andrew J.; Einstein, A. J.; Pascual, T. N B; Paez, D.; Dondi, M.; Better, N.; Bouyoucef, S. E.; Karthikeyan, G.; Kashyap, R.; Lele, V.; Magboo, V. P C; Mahmarian, J. J.; Meeks, J. B.; Mut, F.; Rehani, M. M.; Vitola, J. V.; Alexanderson, E.; Allam, A.; Al-Mallah, M. H.; Better, N.; Bouyoucef, S. E.; Bom, H.; Flotats, A.; Jerome, S.; Kaufmann, P. A.; Lele, V.; Luxenburg, O.; Mahmarian, J.; Shaw, L. J.; Underwood, S. R.; Vitola, J.; Amouri, W.; Essabbah, H.; Gassama, S. S.; Makhdomi, K. B.; Marcassa, Claudio; INCAPS Investigators Group.

In: JACC: Cardiovascular Imaging, Vol. 9, No. 4, 01.04.2016, p. 376-384.

Research output: Contribution to journalArticle

Shi, L, Dorbala, S, Paez, D, Shaw, LJ, Zukotynski, KA, Pascual, TNB, Karthikeyan, G, Vitola, JV, Better, N, Bokhari, N, Rehani, MM, Kashyap, R, Dondi, M, Mercuri, M, Einstein, AJ, Einstein, AJ, Pascual, TNB, Paez, D, Dondi, M, Better, N, Bouyoucef, SE, Karthikeyan, G, Kashyap, R, Lele, V, Magboo, VPC, Mahmarian, JJ, Meeks, JB, Mut, F, Rehani, MM, Vitola, JV, Alexanderson, E, Allam, A, Al-Mallah, MH, Better, N, Bouyoucef, SE, Bom, H, Flotats, A, Jerome, S, Kaufmann, PA, Lele, V, Luxenburg, O, Mahmarian, J, Shaw, LJ, Underwood, SR, Vitola, J, Amouri, W, Essabbah, H, Gassama, SS, Makhdomi, KB, Marcassa, C & INCAPS Investigators Group 2016, 'Gender Differences in Radiation Dose from Nuclear Cardiology Studies Across the World Findings from the INCAPS Registry', JACC: Cardiovascular Imaging, vol. 9, no. 4, pp. 376-384. https://doi.org/10.1016/j.jcmg.2016.01.001
Shi, Lynn ; Dorbala, Sharmila ; Paez, Diana ; Shaw, Leslee J. ; Zukotynski, Katherine A. ; Pascual, Thomas N B ; Karthikeyan, Ganesan ; Vitola, João V. ; Better, Nathan ; Bokhari, Nadia ; Rehani, Madan M. ; Kashyap, Ravi ; Dondi, Maurizio ; Mercuri, Mathew ; Einstein, Andrew J. ; Einstein, A. J. ; Pascual, T. N B ; Paez, D. ; Dondi, M. ; Better, N. ; Bouyoucef, S. E. ; Karthikeyan, G. ; Kashyap, R. ; Lele, V. ; Magboo, V. P C ; Mahmarian, J. J. ; Meeks, J. B. ; Mut, F. ; Rehani, M. M. ; Vitola, J. V. ; Alexanderson, E. ; Allam, A. ; Al-Mallah, M. H. ; Better, N. ; Bouyoucef, S. E. ; Bom, H. ; Flotats, A. ; Jerome, S. ; Kaufmann, P. A. ; Lele, V. ; Luxenburg, O. ; Mahmarian, J. ; Shaw, L. J. ; Underwood, S. R. ; Vitola, J. ; Amouri, W. ; Essabbah, H. ; Gassama, S. S. ; Makhdomi, K. B. ; Marcassa, Claudio ; INCAPS Investigators Group. / Gender Differences in Radiation Dose from Nuclear Cardiology Studies Across the World Findings from the INCAPS Registry. In: JACC: Cardiovascular Imaging. 2016 ; Vol. 9, No. 4. pp. 376-384.
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abstract = "Objectives 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.",
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T1 - Gender Differences in Radiation Dose from Nuclear Cardiology Studies Across the World Findings from the INCAPS Registry

AU - Shi, Lynn

AU - Dorbala, Sharmila

AU - Paez, Diana

AU - Shaw, Leslee J.

AU - Zukotynski, Katherine A.

AU - Pascual, Thomas N B

AU - Karthikeyan, Ganesan

AU - Vitola, João V.

AU - Better, Nathan

AU - Bokhari, Nadia

AU - Rehani, Madan M.

AU - Kashyap, Ravi

AU - Dondi, Maurizio

AU - Mercuri, Mathew

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 - Meeks, J. B.

AU - Mut, F.

AU - Rehani, M. M.

AU - Vitola, J. V.

AU - Alexanderson, 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 - Marcassa, Claudio

AU - INCAPS Investigators Group

PY - 2016/4/1

Y1 - 2016/4/1

N2 - Objectives 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.

AB - Objectives 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.

KW - gender

KW - nuclear cardiology

KW - radiation exposure

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