Download PDF
Der Nuklearmediziner 2012; 35(04): 209-214
DOI: 10.1055/s-0032-1327720
Strahlenexposition bei Hybridbildgebung
© Georg Thieme Verlag KG Stuttgart · New York

Strahlenexposition und Minimierung des strahlenbe­dingten Risikos bei kardiovaskulärer Hybrid-­Bildgebung

Radiation Exposure and Minimization of Radiation-induced Risk in Cardiovascular Hybrid Imaging
F. M. Bengel
1   Klinik für Nuklearmedizin, Medizinische Hochschule Hannover
› Author Affiliations
Further Information

Publication History

Publication Date:
12 December 2012 (online)

Also available at
    Permissions and Reprints

Zusammenfassung

Der Erfolg und die konstant hohe Untersuchungsfrequenz in der nichtinvasiven Diagnostik der koronaren Herzerkrankung haben in den letzten Jahren zu einer kritischen Betrachtung der Strahlenexposition durch Nuklearkardiologie und Herz-CT geführt. Vor dem Hintergrund einer zunehmenden Diskussion über die Risiken ionisierender Strahlen in der Medizin muss sich deshalb gerade die kardiovaskuläre Bildgebung anpassen und eine Vorreiterrolle spielen. Technische Weiterentwicklungen haben in den letzten Jahren dazu beigetragen, dass nicht nur in der nuklearmedizinischen Perfusions-Diagnostik, sondern auch in der Kardio-CT, und damit auch in der Hybridbildgebung, trotz Maximierung des diagnostischen (und prognostischen) Informationsgehaltes eine signifikante Reduktion der Strahlenexposition möglich ist.

Abstract

The success and high frequency of noninvasive testing in coronary artery disease have contributed to an increasingly critical perception of radiation exposure from nuclear cardiology and cardiac CT. Given the growing emphasis of radiation-induced risk, cardiovascular imaging must adapt and be a forerunner in addressing concerns. Methodological advances in myocardial perfusion SPECT and PET, as well as in cardiac CT and thus in hybrid imaging have enabled a significant reduction of radiation exposure, while at the same time allowing for maximization of information content of a single test.

Schlüsselwörter

Myokardperfusionsszinti­grafie - kardiale Computertomo­grafie - SPECT/CT - PET/CT - Strahlenexposition

Key words

myocardial perfusion ­scintigraphy - cardiovascular computed tomography - SPECT/CT - PET/CT - radiation exposure
 

  • Literatur

  • 1 The 1977 Recommendations of the International Commission on Radiological Protection. ICRP publication 26. Ann ICRP 1977; 1: 1-53
    PubMedSearch in Google Scholar
  • 2 Radiation dose to patients from radiopharmaceuticals (ICRP publication 53). Ann ICRP 1987; 18: 1-377
    CrossrefPubMedSearch in Google Scholar
  • 3 The 1990 Recommendations of the International Commission on Radiological Protection. ICRP publication 60. Ann ICRP 1991; 21: 1-201
    PubMedSearch in Google Scholar
  • 4 Radiation dose to patients from radiopharmaceuticals (addendum 2 to ICRP publication 53). Ann ICRP 1998; 28: 1-126
    PubMedSearch in Google Scholar
  • 5 The 2007 Recommendations of the International Commission on Radiological Protection. ICRP publication 103. Ann ICRP 2007; 37: 1-332
    PubMedSearch in Google Scholar
  • 6 Radiation dose to patients from radiopharmaceuticals. Addendum 3 to ICRP Publication 53. ICRP Publication 106. Approved by the Commission in October 2007. Ann ICRP 2008; 38: 1-197
    PubMedSearch in Google Scholar
  • 7 Achenbach S, Goroll T, Seltmann M et al. Detection of coronary artery stenoses by low-dose, prospectively ECG-triggered, high-pitch spiral coronary CT angiography. JACC Cardiovasc Imaging 2011; 4: 328-337
    CrossrefPubMedSearch in Google Scholar
  • 8 Bateman TM, Heller GV, McGhie AI et al. Multicenter investigation comparing a highly efficient half-time stress-only attenuation correction approach against standard rest-stress Tc-99 m SPECT imaging. J Nucl Cardiol 2009; 16: 726-735
    CrossrefPubMedSearch in Google Scholar
  • 9 Borges-Neto S, Pagnanelli RA, Shaw LK et al. Clinical results of a novel wide beam reconstruction method for shortening scan time of Tc-99 m cardiac SPECT perfusion studies. J Nucl Cardiol 2007; 14: 555-565
    CrossrefPubMedSearch in Google Scholar
  • 10 Brenner DJ, Hall EJ. Computed tomography – an increasing source of radiation exposure. N Engl J Med 2007; 357: 2277-2284
    CrossrefPubMedSearch in Google Scholar
  • 11 DePuey EG, Gadiraju R, Clark J et al. Ordered subset expectation maximization and wide beam reconstruction “half-time” gated myocardial perfusion SPECT functional imaging: a comparison to “full-time” filtered backprojection. J Nucl Cardiol 2008; 15: 547-563
    CrossrefPubMedSearch in Google Scholar
  • 12 Duvall WL, Croft LB, Ginsberg ES et al. Reduced isotope dose and imaging time with a high-efficiency CZT SPECT camera. J Nucl Cardiol 2011; 18: 847-857
    CrossrefPubMedSearch in Google Scholar
  • 13 Einstein AJ. Effects of radiation exposure from cardiac imaging: how good are the data?. J Am Coll Cardiol 2012; 59: 553-565
    CrossrefPubMedSearch in Google Scholar
  • 14 Einstein AJ, Henzlova MJ, Rajagopalan S. Estimating risk of cancer associated with radiation exposure from 64-slice computed tomography coronary angiography. JAMA 2007; 298: 317-323
    CrossrefPubMedSearch in Google Scholar
  • 15 Einstein AJ, Knuuti J. Cardiac imaging: does radiation matter?. Eur Heart J 2012; 33: 573-578
    CrossrefPubMedSearch in Google Scholar
  • 16 Einstein AJ, Moser KW, Thompson RC et al. Radiation dose to patients from cardiac diagnostic imaging. Circulation 2007; 116: 1290-1305
    CrossrefPubMedSearch in Google Scholar
  • 17 Einstein AJ, Weiner SD, Bernheim A et al. Multiple testing, cumulative radiation dose, and clinical indications in patients undergoing myocardial perfusion imaging. JAMA 2010; 304: 2137-2144
    CrossrefPubMedSearch in Google Scholar
  • 18 Fazel R, Krumholz HM, Wang Y et al. Exposure to low-dose ionizing radiation from medical imaging procedures. N Engl J Med 2009; 361: 849-857
    CrossrefPubMedSearch in Google Scholar
  • 19 Flotats A, Knuuti J, Gutberlet M et al. Hybrid cardiac imaging: SPECT/CT and PET/CT. A joint position statement by the European Association of Nuclear Medicine (EANM), the European Society of Cardiac Radiology (ESCR) and the European Council of Nuclear Cardiology (ECNC). Eur J Nucl Med Mol Imaging 2011; 38: 201-212
    CrossrefPubMedSearch in Google Scholar
  • 20 Fricke E, Fricke H, Weise R et al. Attenuation correction of myocardial SPECT perfusion images with low-dose CT: evaluation of the method by comparison with perfusion PET. J Nucl Med 2005; 46: 736-744
    PubMedSearch in Google Scholar
  • 21 Gaemperli O, Bengel FM, Kaufmann PA. Cardiac hybrid imaging. Eur Heart J 2011; 32: 2100-2108
    CrossrefPubMedSearch in Google Scholar
  • 22 Garcia EV, Faber TL. New trends in camera and software technology in nuclear cardiology. Cardiol Clin 2009; 27: 227-236 Table of Contents
    CrossrefPubMedSearch in Google Scholar
  • 23 Gerber TC, Carr JJ, Arai AE et al. Ionizing radiation in cardiac imaging: a science advisory from the American Heart Association Committee on Cardiac Imaging of the Council on Clinical Cardiology and Committee on Cardiovascular Imaging and Intervention of the Council on Cardiovascular Radiology and Intervention. Circulation 2009; 119: 1056-1065
    CrossrefPubMedSearch in Google Scholar
  • 24 Goetze S, Brown TL, Lavely WC et al. Attenuation correction in myocardial perfusion SPECT/CT: effects of misregistration and value of reregistration. J Nucl Med 2007; 48: 1090-1095
    CrossrefPubMedSearch in Google Scholar
  • 25 Halliburton S, Arbab-Zadeh A, Dey D et al. State-of-the-art in CT hardware and scan modes for cardiovascular CT. J Cardiovasc Comput Tomogr 2012; 6: 154-163
    CrossrefPubMedSearch in Google Scholar
  • 26 Hausleiter J, Martinoff S, Hadamitzky M et al. Image quality and radiation exposure with a low tube voltage protocol for coronary CT angiography results of the PROTECTION II Trial. JACC Cardiovasc Imaging 2010; 3: 1113-1123
    CrossrefPubMedSearch in Google Scholar
  • 27 Hausleiter J, Meyer T, Hermann F et al. Estimated radiation dose associated with cardiac CT angiography. JAMA 2009; 301: 500-507
    CrossrefPubMedSearch in Google Scholar
  • 28 Hawman PC, Haines EJ. The cardiofocal collimator: a variable-focus collimator for cardiac SPECT. Phys Med Biol 1994; 39: 439-450
    CrossrefPubMedSearch in Google Scholar
  • 29 Javadi M, Mahesh M, McBride G et al. Lowering radiation dose for integrated assessment of coronary morphology and physiology: first experience with step-and-shoot CT angiography in a rubidium 82 PET-CT protocol. J Nucl Cardiol 2008; 15: 783-790
    PubMedSearch in Google Scholar
  • 30 Lautamaki R, Brown TL, Merrill J et al. CT-based attenuation correction in (82)Rb-myocardial perfusion PET-CT: incidence of misalignment and effect on regional tracer distribution. Eur J Nucl Med Mol Imaging 2008; 35: 305-310
    CrossrefPubMedSearch in Google Scholar
  • 31 Leipsic J, Heilbron BG, Hague C. Iterative reconstruction for coronary CT angiography: finding its way. Int J Cardiovasc Imaging 2012; 28: 613-620
    CrossrefPubMedSearch in Google Scholar
  • 32 Marcassa C, Bax JJ, Bengel F et al. Clinical value, cost-effectiveness, and safety of myocardial perfusion scintigraphy: a position statement. Eur Heart J 2008; 29: 557-563
    CrossrefPubMedSearch in Google Scholar
  • 33 Schepis T, Gaemperli O, Koepfli P et al. Use of coronary calcium score scans from stand-alone multislice computed tomography for attenuation correction of myocardial perfusion SPECT. Eur J Nucl Med Mol Imaging 2007; 34: 11-19
    CrossrefPubMedSearch in Google Scholar
  • 34 Senthamizhchelvan S, Bravo PE, Esaias C et al. Human biodistribution and radiation dosimetry of 82Rb. J Nucl Med 2010; 51: 1592-1599
    CrossrefPubMedSearch in Google Scholar
  • 35 Senthamizhchelvan S, Bravo PE, Lodge MA et al. Radiation dosimetry of 82Rb in humans under pharmacologic stress. J Nucl Med 2011; 52: 485-491
    CrossrefPubMedSearch in Google Scholar