Reducing Radiation Dose in Radionuclide Myocardial Perfusion Imaging

Targeted CE per ARRT’s Discipline, Category, and Subcategory classification:

Nuclear Medicine Technology: 3.00
Safety: 0.50
Radiation Physics, Radiobiology, and Regulations: 0.50
Procedures: 2.50
Cardiac Procedures: 2.50

Outline

1. Introduction
2. The Vital Importance of Radionuclide MPI to Manage CAD
3. The Need to Reduce Radiation Dose from MPI
4. Radiation Dose Reduction Before MPI: Appropriate Use
   1. Frequency of Appropriate MPI per AUC
   2. Methods to Increase the Appropriate Use of MPI
5. Radiation Dose Reduction During the Test: Optimize MPI
   1. Selection of Radiotracers
   2. Stress-First or Stress-Only Imaging Protocols for Reduced-Dose MPI
   3. Novel Reconstruction Software, Scanners, and Collimators for MPI
   4. Dose Reduction with PET
6. Radiation Dose Reduction After the Test
7. Conclusion

Objectives

Upon completion of this course, students will:

1. identify a group at risk from the overutilization of MPI
2. discuss the goals of appropriate use criteria
3. identify the greatest strength of MPI
4. compare cost effectiveness of MPI to other modalities
5. understand how cancer risk is calculated
6. identify risk of harm from low level radiation exposure
7. compare radiation exposure increase from MPI to other sources
8. compare radiation exposure from ^99mTc MPI to other sources
9. understand other risk from reducing radiation exposure
10. understand where in the MPI process radiation reduction can take place
11. understand the ranges of AUC criteria
12. understand how to reduce radiation exposure after the exam is completed
13. describe populations typically considered inappropriate for MPI testing
14. identify the goal of the Choosing Wisely campaign
15. understand who is involved with successful AUC use
16. identify the goal of ACC’s FOCUS program
17. compare the success of AUC-DST for appropriate and inappropriate tests
18. understand future requirements of AUC and medical imaging
19. describe the best communication for assuring AUC in MPI
20. understand the long term goal of AUC and radiation reduction
21. identify pathways to less than 9mSv MPI studies
22. understand effective radiation dose
23. compare the differences in radiotracers for SPECT MPI
24. compare the differences between SPECT and PET radiotracer exposure
25. identify the utility of a weight or BMI-based dose scale
26. understand the value of a stress first/stress only protocol
27. identify the best patient population for a stress first MPI protocol
28. describe methods of artifact identification in MPI
29. understand the prognostic value of stress only MPI
30. describe the various benefits of iterative reconstruction methods
31. understand the benefit of new solid state MPI scanners
32. understand the benefit of dedicated cardiac scanners
33. understand how PET image quality is achieved
34. describe the limitations of stress only PET MPI
35. identify the steps to reducing layered testing in MPI