Approaches to minimize patient dose in nuclear cardiology

Despite the undeniable patient benefits from medical imaging, there has been growing public concern about radiation exposure from medical imaging and its potential associated health risks. The latest report from the National Council on Radiation Protection and Measurements estimated that nuclear cardiology studies account for around 9% of the entire radiation burden from medical imaging to the U.S. population in 2016. The International Atomic Energy Agency (IAEA) has identified “8 best practices” that would help reduce the global radiation burden from cardiac radionuclide imaging. Likewise, the American Society of Nuclear Cardiology (ASNC) has set the goal of limiting the total radiation effective–dose of patients referred for single photon emission computed tomography (SPECT) or positron emission tomography (PET) myocardial perfusion imaging (MPI) to less than or equal to 9 mSv. Nevertheless, recent studies have reported that most of the dosereduction approaches and best practices, especially adequate radiopharmaceutical and protocol selection, are still underutilized in clinical practice with most SPECT MPI studies still exceeding the 9 mSv benchmark. This chapter will review new technology and strategies that are available to reduce radiation exposure to patients without affecting image quality or diagnostic information from nuclear cardiology studies.