ASNC Releases Dose-Reduction Guidelines for Nuclear Cardiology
Technological improvements in image acquisition and software processing in nuclear cardiology should allow physicians to shave patient imaging times dramatically or cut radiation doses fourfold, according to a new preferred practice statement from the American Society of Nuclear Cardiology (ASNC). Newer SPECT and PET cameras with lower photon-counting statistics can trim study times down to three or four minutes, while better software can yield a fourfold cut to radiation or radiopharmaceutical doses, says E. Gordon DePeuy, MD, FASC, a lead author of the ASNC Patient-Centered Imaging document. “This is a big savings in terms of patient radiation exposure,” DePeuy says. “We are encouraging all of our constituency to consider these new techniques.” It’s no secret to say that the drive for new lowered-dosing techniques is a common push in the imaging world. ASNC guidelines assert a 9-milliSievert (mSv) guideline in radiation exposure for at least 50% of patients; whereas, right now, DePeuy says, “it’s around 12 or so, or greater.” Reducing patient body burden is contingent upon: decreasing the pharmaceutical and camera doses dispersed in individual procedures; performing only those studies which are medically necessary and low-risk; and, eventually, monitoring cumulative patient dose across multiple studies in multiple settings. “Tracking this is a very difficult thing,” DePeuy says. “We all use the ASNC appropriate-use criteria as a bible, [and] it seems like there’s been a huge educational effort [to these ends] through a variety of bodies.” As far as guidance on specific device models or software versions that can effect these reductions, DePeuy said, “stay tuned.” He did recommend software from an Israeli vendor called Ultraspect, which provides a retrofit solution for practices that can’t afford the outlay of a million-dollar camera. “I think the sales are increasing logarithmically as people are becoming aware [of the product],” DePeuy said. DePeuy is also working on a report card for ASNC members, whereby physicians could audit their own practices with self-reporting mechanisms for patient dosimetry as well as their adherence to the ASNC appropriateness criteria. Until such time as that mechanism is enacted, he said, position statements like the Patient-Centered Imaging document will help to shape the evolving boundaries of care.