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Patel KK, Peri-Okonny PA, Giorgetti A, Shaw LJ, Gimelli A. Value of Ischemia and Coronary Anatomy in Prognosis and Guiding Revascularization Among Patients With Stable Ischemic Heart Disease. Circ Cardiovasc Imaging 2024; 17:e016587. [PMID: 39247957 PMCID: PMC11439561 DOI: 10.1161/circimaging.123.016587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2024] [Accepted: 08/12/2024] [Indexed: 09/10/2024]
Abstract
BACKGROUND The value of physiological ischemia versus anatomic severity of disease for prognosis and management of patients with stable coronary artery disease (CAD) is widely debated. METHODS A total of 1764 patients who had rest-stress cadmium-zinc-telluride single-photon emission computed tomography myocardial perfusion imaging and angiography (invasive or computed tomography) were prospectively enrolled and followed for cardiac death/nonfatal myocardial infarction. The CAD prognostic index (CADPI) was used to quantify the extent and severity of angiographic disease. Prognostic value was assessed using Cox models, adjusted for pretest risk, known CAD, stressor, left ventricular ejection fraction, %ischemia and infarct, CADPI, and early (90-day) revascularization. Incremental prognostic value was evaluated using net reclassification index. RESULTS The mean age was 69.7±9.5 years, 24.4% were women, and 29.3% had known CAD. Significant ischemia (>10%) was present in 28.4%. Nonobstructive, single, and multivessel disease was present in 256 (14.5%), 772 (43.8%), and 736 (41.7%), respectively. Early revascularization occurred in 579 (32.8%). Cardiac death/myocardial infarction occurred in 148 (8.4%) over a 4.6-year median follow-up. Both %ischemia and CADPI provided independent and incremental prognostic value over pretest clinical risk (P<0.001). In a model containing both ischemia and anatomy, ischemia was prognostic (hazard ratio per 5% ↑, 1.35 [95% CI, 1.11-1.63]; P=0.002) but CADPI was not (hazard ratio per 10-unit ↑, 1.09 [95% CI, 0.99-1.20]; P=0.07). Early revascularization modified the risk associated with %ischemia (interaction P=0.003) but not with CADPI (interaction P=0.6). %Ischemia and single-photon emission computed tomography variables added incremental prognostic value over clinical risk and CADPI (net reclassification index, 20.3% [95% CI, 9%-32%]; P<0.05); however, CADPI was not incrementally prognostic beyond pretest risk, %ischemia, and single-photon emission computed tomography variables (net reclassification index, 3.1% [95% CI, -5% to 15%]; P=0.21). CONCLUSIONS Ischemic burden provides independent and incremental prognostic value beyond CAD anatomy and identifies patients who benefit from early revascularization. The anatomic extent of disease has independent prognostic value over clinical risk factors but offers limited incremental benefit for prognosis and guiding revascularization beyond physiological severity (ischemia).
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Affiliation(s)
- Krishna K Patel
- Department of Medicine (Cardiology) and Population Health Science and Policy, Blavatnik Family Women's Health Research Institute, Zena and Michael A. Weiner Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York (K.K.P., L.J.S.)
| | - Poghni A Peri-Okonny
- Department of Medicine (Cardiology), Yale University School of Medicine, New Haven, CT (P.A.P.-O.)
| | - Assuero Giorgetti
- Department of Imaging, Fondazione Toscana Gabriele Monasterio, Pisa, Italy (A. Giorgetti, A. Gimelli)
| | - Leslee J Shaw
- Department of Medicine (Cardiology) and Population Health Science and Policy, Blavatnik Family Women's Health Research Institute, Zena and Michael A. Weiner Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York (K.K.P., L.J.S.)
| | - Alessia Gimelli
- Department of Imaging, Fondazione Toscana Gabriele Monasterio, Pisa, Italy (A. Giorgetti, A. Gimelli)
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Sperry BW, Vamenta MS, Gunta SP, Thompson RC, Einstein AJ, Castillo M, Chaudhary PD, Bremner LI, Cohen YA, Bateman TM, McGhie AI. Influence of Body Mass Index on Radiation Exposure Across Imaging Modalities in the Evaluation of Chest Pain. J Am Heart Assoc 2024; 13:e033566. [PMID: 38591342 PMCID: PMC11262536 DOI: 10.1161/jaha.123.033566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Accepted: 03/07/2024] [Indexed: 04/10/2024]
Abstract
BACKGROUND Essential to a patient-centered approach to imaging individuals with chest pain is knowledge of differences in radiation effective dose across imaging modalities. Body mass index (BMI) is an important and underappreciated predictor of effective dose. This study evaluated the impact of BMI on estimated radiation exposure across imaging modalities. METHODS AND RESULTS This was a retrospective analysis of patients with concern for cardiac ischemia undergoing positron emission tomography (PET)/computed tomography (CT), cadmium zinc telluride single-photon emission CT (SPECT) myocardial perfusion imaging, or coronary CT angiography (CCTA) using state-of-the-art imaging modalities and optimal radiation-sparing protocols. Radiation exposure was calculated across BMI categories based on established cardiac imaging-specific conversion factors. Among 9046 patients (mean±SD age, 64.3±13.1 years; 55% men; mean±SD BMI, 30.6±6.9 kg/m2), 4787 were imaged with PET/CT, 3092 were imaged with SPECT/CT, and 1167 were imaged with CCTA. Median (interquartile range) radiation effective doses were 4.4 (3.9-4.9) mSv for PET/CT, 4.9 (4.0-6.3) mSv for SPECT/CT, and 6.9 (4.0-11.2) mSv for CCTA. Patients at a BMI <20 kg/m2 had similar radiation effective dose with all 3 imaging modalities, whereas those with BMI ≥20 kg/m2 had the lowest effective dose with PET/CT. Radiation effective dose and variability increased dramatically with CCTA as BMI increased, and was 10 times higher in patients with BMI >45 kg/m2 compared with <20 kg/m2 (median, 26.9 versus 2.6 mSv). After multivariable adjustment, PET/CT offered the lowest effective dose, followed by SPECT/CT, and then CCTA (P<0.001). CONCLUSIONS Although median radiation exposure is modest across state-of-the-art PET/CT, SPECT/CT, and CCTA systems using optimal radiation-sparing protocols, there are significant variations across modalities based on BMI. These data are important for making patient-centered decisions for ischemic testing.
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Affiliation(s)
- Brett W. Sperry
- Saint Luke’s Mid America Heart InstituteKansas CityMO
- University of Missouri–Kansas CityKansas CityMO
| | - Mary Stefanie Vamenta
- Saint Luke’s Mid America Heart InstituteKansas CityMO
- University of Missouri–Kansas CityKansas CityMO
| | | | - Randall C. Thompson
- Saint Luke’s Mid America Heart InstituteKansas CityMO
- University of Missouri–Kansas CityKansas CityMO
| | - Andrew J. Einstein
- Seymour, Paul and Gloria Milstein Division of CardiologyNew YorkNY
- Department of MedicineMailman School of Public Health at Columbia University Irving Medical Center/New York Presbyterian HospitalNew YorkNY
- Department of RadiologyMailman School of Public Health at Columbia University Irving Medical Center/New York Presbyterian HospitalNew YorkNY
| | - Michelle Castillo
- Seymour, Paul and Gloria Milstein Division of CardiologyNew YorkNY
- Department of MedicineMailman School of Public Health at Columbia University Irving Medical Center/New York Presbyterian HospitalNew YorkNY
| | - Priyanka D. Chaudhary
- Department of RadiologyMailman School of Public Health at Columbia University Irving Medical Center/New York Presbyterian HospitalNew YorkNY
| | - Luca I. Bremner
- Seymour, Paul and Gloria Milstein Division of CardiologyNew YorkNY
- Vagelos College of Physicians and SurgeonsMailman School of Public Health at Columbia University Irving Medical Center/New York Presbyterian HospitalNew YorkNY
| | - Yosef A. Cohen
- Seymour, Paul and Gloria Milstein Division of CardiologyNew YorkNY
- Department of MedicineMailman School of Public Health at Columbia University Irving Medical Center/New York Presbyterian HospitalNew YorkNY
- Mailman School of Public Health at Columbia University Irving Medical Center/New York Presbyterian HospitalNew YorkNY
| | - Timothy M. Bateman
- Saint Luke’s Mid America Heart InstituteKansas CityMO
- University of Missouri–Kansas CityKansas CityMO
| | - A. Iain McGhie
- Saint Luke’s Mid America Heart InstituteKansas CityMO
- University of Missouri–Kansas CityKansas CityMO
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Saatchi K, Bénard F, Hundal N, Grimes J, Shcherbinin S, Pourghiasian M, Brooks DE, Celler A, Häfeli UO. Preclinical PET Imaging and Toxicity Study of a 68Ga-Functionalized Polymeric Cardiac Blood Pool Agent. Pharmaceutics 2023; 15:pharmaceutics15030767. [PMID: 36986628 PMCID: PMC10052923 DOI: 10.3390/pharmaceutics15030767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2023] [Revised: 02/16/2023] [Accepted: 02/20/2023] [Indexed: 03/03/2023] Open
Abstract
Cardiac blood pool imaging is currently performed almost exclusively with 99mTc-based compounds and SPECT/CT imaging. Using a generator-based PET radioisotope has a few advantages, including not needing nuclear reactors to produce it, obtaining better resolution in humans, and potentially reducing the radiation dose to the patient. When the shortlived radioisotope 68Ga is used, it can be applied repeatedly on the same day—for example, for the detection of bleeding. Our objective was to prepare and evaluate a long-circulating polymer functionalized with gallium for its biodistribution, toxicity, and dosimetric properties. A 500 kDa hyperbranched polyglycerol was conjugated to the chelator NOTA and radiolabeled rapidly at room temperature with 68Ga. It was then injected intravenously into a rat, and gated imaging allowed us to easily observe wall motion and cardiac contractility, confirming the suitability of this radiopharmaceutical for cardiac blood pool imaging. Internal radiation dose calculations showed that the radiation doses that patients would receive from the PET agent would be 2.5× lower than those from the 99mTc agent. A complete 14-day toxicology study in rats concluded that there were no gross pathology findings, changes in body or organ weights, or histopathological events. This radioactive-metal-functionalized polymer might be a suitable non-toxic agent to advance for clinical application.
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Affiliation(s)
- Katayoun Saatchi
- Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC V6T 1Z3, Canada
- Correspondence: (K.S.); (U.O.H.)
| | - François Bénard
- Department of Radiology, University of British Columbia, Vancouver, BC V5Z 1M9, Canada
- BC Cancer, Vancouver, BC V5Z 4E6, Canada
| | | | - Joshua Grimes
- Department of Radiology, University of British Columbia, Vancouver, BC V5Z 1M9, Canada
| | - Sergey Shcherbinin
- Department of Radiology, University of British Columbia, Vancouver, BC V5Z 1M9, Canada
| | | | - Donald E. Brooks
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC V6T 1Z3, Canada
| | - Anna Celler
- Department of Radiology, University of British Columbia, Vancouver, BC V5Z 1M9, Canada
| | - Urs O. Häfeli
- Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC V6T 1Z3, Canada
- Correspondence: (K.S.); (U.O.H.)
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McMahon SR, Patel EK, Duvall WL. Stress-First Myocardial Perfusion Imaging. Cardiol Clin 2023; 41:163-175. [PMID: 37003674 DOI: 10.1016/j.ccl.2023.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/25/2023]
Abstract
Stress-first approaches to myocardial perfusion imaging provide diagnostically and prognostically accurate perfusion data equivalent to a full rest-stress study while saving time in the imaging laboratory and reducing the radiation exposure to patients and laboratory staff. Unfortunately, implementing a stress-first approach in a nuclear cardiology laboratory involves significant challenges such as the need for attenuation correction, triage of patients to an appropriate protocol, real-time review of stress images, and consideration of differential reimbursement. Despite it being best practice for both the patient and the laboratory, these impediments have kept the proportions of studies performed stress-first relatively unchanged in North America and world-wide in the last 10 years.
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Affiliation(s)
- Sean R McMahon
- Division of Cardiology, Hartford Hospital, 80 Seymour Street, Hartford, CT 06102, USA
| | - Etee K Patel
- Division of Cardiology, Hartford Hospital, 80 Seymour Street, Hartford, CT 06102, USA
| | - W Lane Duvall
- Division of Cardiology, Hartford Hospital, 80 Seymour Street, Hartford, CT 06102, USA.
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Garcia EV. Deep learning, another important tool for improving acquisition efficiency in SPECT MPI Imaging. J Nucl Cardiol 2021; 28:2780-2783. [PMID: 32419070 DOI: 10.1007/s12350-020-02188-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 05/04/2020] [Indexed: 12/18/2022]
Affiliation(s)
- Ernest V Garcia
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, 101 Woodruff Circle, Room 1203, Atlanta, GA, 30322, USA.
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Ma Q, Sridhar G, Power T, Agiro A. Assessing the downstream value of first-line cardiac positron emission tomography (PET) imaging using real world Medicare fee-for-service claims data. J Nucl Cardiol 2021; 28:2126-2137. [PMID: 31820411 DOI: 10.1007/s12350-019-01974-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Revised: 11/19/2019] [Accepted: 11/19/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND Higher imaging quality makes cardiac positron emission tomography (PET) desirable for evaluation of suspected coronary artery disease (CAD). High cost of PET imaging may be offset by reduced utilization and/or improved outcomes. METHODS This retrospective observational study utilized Medicare fee-for-service dataset. Study participants had no CAD diagnosis within 1 year prior to initial imaging. The PET group (PET imaging) and propensity score matched comparison group (single photon emission computed tomography or stress echocardiography) underwent index imaging between January 2014 and December 2016. Outcomes were analyzed using generalized linear models. RESULTS Among 144,503 study subjects, 4619 (3.2%) had PET and 139,884 (96.8%) had conventional imaging. After matching, each group had 4619 patients (mean age 74 years, 59% female). The PET group had lower radiation exposure (3.8 milliSievert less per year, 95% CI - 3.96 to - 3.64, P < .0001) and unstable coronary syndrome (incidence rate ratio (IRR) 0.77, 95% CI 0.64-0.94, P = .008). The PET group experienced more hospital admissions (IRR 1.10, 95% CI 1.06-1.15, P < .0001), more use of percutaneous coronary intervention (IRR 1.24, 95% CI 1.02-1.50, P = 0.03), while similar mortality rate (hazard ratio 0.95, 95% CI 0.78-1.14, P = 0.55). The PET group had higher medical spending ($2358.2 vs $1774.3, difference = $583.9 per patient per month, P < .0001). CONCLUSIONS First-line PET imaging was not associated with reduced levels of utilization and spending. Clinical outcomes were mostly similar.
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Affiliation(s)
- Qinli Ma
- HealthCore Inc., 123 Justison Street, Suite 200, Wilmington, DE, 19801-5134, USA.
| | - Gayathri Sridhar
- HealthCore Inc., 123 Justison Street, Suite 200, Wilmington, DE, 19801-5134, USA
| | | | - Abiy Agiro
- HealthCore Inc., 123 Justison Street, Suite 200, Wilmington, DE, 19801-5134, USA
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Reducing Radiation While Improving the Quality and Efficiency of Nuclear Cardiology Procedures. JACC Cardiovasc Imaging 2021; 14:1829-1831. [PMID: 34274264 DOI: 10.1016/j.jcmg.2021.05.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Accepted: 05/03/2021] [Indexed: 11/21/2022]
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Hirschfeld CB, Mercuri M, Pascual TNB, Karthikeyan G, Vitola JV, Mahmarian JJ, Better N, Bouyoucef SE, Hee-Seung Bom H, Lele V, Magboo VPC, Alexánderson E, Allam AH, Al-Mallah MH, Dorbala S, Flotats A, Jerome S, Kaufmann PA, Luxenburg O, Shaw LJ, Underwood SR, Rehani MM, Paez D, Dondi M, Einstein AJ. Worldwide Variation in the Use of Nuclear Cardiology Camera Technology, Reconstruction Software, and Imaging Protocols. JACC Cardiovasc Imaging 2021; 14:1819-1828. [PMID: 33454257 DOI: 10.1016/j.jcmg.2020.11.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 11/02/2020] [Accepted: 11/05/2020] [Indexed: 10/22/2022]
Abstract
OBJECTIVES This study sought to describe worldwide variations in the use of myocardial perfusion imaging hardware, software, and imaging protocols and their impact on radiation effective dose (ED). BACKGROUND Concerns about long-term effects of ionizing radiation have prompted efforts to identify strategies for dose optimization in myocardial perfusion scintigraphy. Studies have increasingly shown opportunities for dose reduction using newer technologies and optimized protocols. METHODS Data were submitted voluntarily to the INCAPS (International Atomic Energy Agency Nuclear Cardiology Protocols Study) registry, a multinational, cross-sectional study comprising 7,911 imaging studies from 308 labs in 65 countries. The study compared regional use of camera technologies, advanced post-processing software, and protocol characteristics and analyzed the influence of each factor on ED. RESULTS Cadmium-zinc-telluride and positron emission tomography (PET) cameras were used in 10% (regional range 0% to 26%) and 6% (regional range 0% to 17%) of studies worldwide. Attenuation correction was used in 26% of cases (range 10% to 57%), and advanced post-processing software was used in 38% of cases (range 26% to 64%). Stress-first single-photon emission computed tomography (SPECT) imaging comprised nearly 20% of cases from all world regions, except North America, where it was used in just 7% of cases. Factors associated with lower ED and odds ratio for achieving radiation dose ≤9 mSv included use of cadmium-zinc-telluride, PET, advanced post-processing software, and stress- or rest-only imaging. Overall, 39% of all studies (97% PET and 35% SPECT) were ≤9 mSv, while just 6% of all studies (32% PET and 4% SPECT) achieved a dose ≤3 mSv. CONCLUSIONS Newer-technology cameras, advanced software, and stress-only protocols were associated with reduced ED, but worldwide adoption of these practices was generally low and varied significantly between regions. The implementation of dose-optimizing technologies and protocols offers an opportunity to reduce patient radiation exposure across all world regions.
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Affiliation(s)
- Cole B Hirschfeld
- Department of Medicine, Columbia University Irving Medical Center/New York-Presbyterian Hospital, New York, New York, USA
| | - Mathew Mercuri
- Division of Emergency Medicine, McMaster University, Hamilton, Ontario, Canada; Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Thomas N B Pascual
- Section of Nuclear Medicine and Diagnostic Imaging, Division of Human Health, International Atomic Energy Agency, Vienna, Austria
| | - Ganesan Karthikeyan
- Department of Cardiology, All India Institute of Medical Sciences, New Delhi, India
| | | | - John J Mahmarian
- Department of Cardiology, Houston Methodist DeBakey Heart and Vascular Center, Houston, Texas, USA
| | - Nathan Better
- Department of Nuclear Medicine, Royal Melbourne Hospital and University of Melbourne, Melbourne, Australia
| | | | - Henry Hee-Seung Bom
- Department of Nuclear Medicine, Chonnam National University Medical School, Gwangju, Korea
| | - Vikram Lele
- Department of Nuclear Medicine and PET-CT, Jaslok Hospital and Research Centre, Mumbai, India
| | - V Peter C Magboo
- Department of Physical Sciences and Mathematics, University of the Philippines, Manila, the Philippines; Department of Nuclear Medicine, University of Santo Tomas Hospital, Manila, the Philippines
| | - Erick Alexánderson
- Departamento de Cardiología Nuclear, Instituto Nacional de Cardiología "Ignacio Chávez," Mexico City, Mexico
| | - Adel H Allam
- Cardiology Department, Al Azhar University, Cairo, Egypt
| | - Mouaz H Al-Mallah
- Department of Cardiology, Houston Methodist DeBakey Heart and Vascular Center, Houston, Texas, USA
| | - Sharmila Dorbala
- Division of Nuclear Medicine, Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Albert Flotats
- Nuclear Medicine Department, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Scott Jerome
- Intersocietal Accreditation Commission, Ellicott City, Maryland; Division of Cardiology, University of Maryland, Baltimore, Maryland, USA
| | - Philipp A Kaufmann
- Department of Nuclear Medicine and Cardiac Imaging, University Hospital Zurich, Zurich, Switzerland
| | - Osnat Luxenburg
- Medical Technology, Health Information and Research Directorate, Ministry of Health, Israel; Israeli Center for Technology Assessment in Health Care, Gertner Institute for Epidemiology and Health Policy Research, Tel Hashomer, Israel
| | - Leslee J Shaw
- New York-Presbyterian/Weill Cornell Medical Center, New York, New York, USA
| | - S Richard Underwood
- National Heart and Lung Institute, Imperial College London, London, United Kingdom; Department of Nuclear Medicine, Royal Brompton and Harefield Hospitals, London, United Kingdom
| | - Madan M Rehani
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Diana Paez
- Section of Nuclear Medicine and Diagnostic Imaging, Division of Human Health, International Atomic Energy Agency, Vienna, Austria
| | - Maurizio Dondi
- Section of Nuclear Medicine and Diagnostic Imaging, Division of Human Health, International Atomic Energy Agency, Vienna, Austria
| | - Andrew J Einstein
- Seymour, Paul, and Gloria Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center/New York-Presbyterian Hospital, New York, New York, USA; Department of Radiology, Columbia University Irving Medical Center/New York-Presbyterian Hospital, New York, New York, USA.
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Mercuri M, Einstein AJ. Good drivers: Achieving dose reduction across a health care system through implementation of multiple radiation-sparing practices. J Nucl Cardiol 2020; 27:795-797. [PMID: 30734221 DOI: 10.1007/s12350-019-01609-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2019] [Accepted: 01/14/2019] [Indexed: 11/26/2022]
Affiliation(s)
- Mathew Mercuri
- Department of Medicine, Division of Emergency Medicine, McMaster University, Hamilton, ON, USA
| | - Andrew J Einstein
- Department of Medicine, Division of Cardiology, and Department of Radiology, Columbia University Irving Medical Center and New York-Presbyterian Hospital, PH 10-203, New York, NY, USA.
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Myocardial perfusion stress test: is it worth? Int J Cardiovasc Imaging 2020; 36:741-748. [DOI: 10.1007/s10554-019-01749-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Accepted: 12/13/2019] [Indexed: 11/25/2022]
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