Gender Differences in Radiation Dose From€Nuclear Cardiology Studies Across€the€World

Fro Me Dia De Ge Ca D Ca Int Ma 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. (J AmColl Cardiol Img 2016;9:376–84)©2016 by the American College of Cardiology Foundation. m the College of Physicians and Surgeons, Columbia University, New York, New York; Division of Cardiology, Department of dicine, Brigham and Women’s Hospital, Harvard University, Boston, Massachusetts; Section of Nuclear Medicine and gnostic Imaging, Division of Human Health, International Atomic Energy Agency, Vienna, Austria; Division of Cardiology, partment of Medicine, and Emory Clinical Cardiovascular Research Institute, Emory University School of Medicine, Atlanta, orgia; Departments of Medicine and Radiology, McMaster University, Hamilton, Ontario, Canada; Department of rdiology, All India Institute of Medical Sciences, New Delhi, India; Quanta Diagnóstico & Terapia, Curitiba, Brazil; epartments of Cardiology and Nuclear Medicine, Royal Melbourne Hospital, Melbourne, Australia; Department of Medicine, rdiology Division, Columbia University Medical Center, New York, New York; Radiation Protection of Patients Unit, ernational Atomic Energy Agency, Vienna, Austria; Department of Radiology, Massachusetts General Hospital, Boston, ssachusetts; Department of Medicine, Cardiology Division, Columbia University Medical Center and New York-Presbyterian AB BR EV I A T I O N S