Division of Cardiology, Department of Medicine, University of Ottawa Heart Institute, Ottawa, Canada.
Circ Cardiovasc Imaging. 2013 Sep;6(5):683-91. doi: 10.1161/CIRCIMAGING.113.000585. Epub 2013 Jul 19.
In 2009, the Chalk River nuclear reactor closed for repairs that led to a critical shortage of technetium-99m (Tc-99m). Several centers used thallium-201 (Tl-201) as an alternative radiotracer for myocardial perfusion imaging. Because Tl-201 is considered by many as a suboptimal radiotracer, we sought to understand the impact of using Tl-201 (during the Tc-99m shortage) on downstream resource utilization.
We performed a retrospective study at the Ottawa Heart Institute of 7402 patients (60% men; mean age, 62.6 ± 11.8 years), patients were referred for myocardial perfusion imaging between May 2008 and January 2011 (PRE_Tc-99m [2938 patients]), during (DURING_Tl-201 [2959 patients]), and after (POST_Tc-99m [1505 patients]) the Tc-99m shortage. Patients were followed for 6 months after their index myocardial perfusion imaging to determine subsequent rates of cardiac catheterization or noninvasive imaging. More downstream testing was seen in the Tl-201 cohort (639 [21.4%] patients) than the Tc-99m cohort (537 [12.1%] patients; P<0.001). After adjustment using propensity scores, differences in downstream referral rates were maintained. The downstream investigations resulted in an estimated increase in per-patient costs ($165.22; 95% confidence interval, 153.00-177.42) in the DURING_Tl-201 cohort compared with the Tc-99m cohort ($90.97; 95% confidence interval, 83.42-98.90; P<0.001). As well, the mean effective radiation dose per-patient was higher in DURING_Tl-201 (23.57 mSv; 95% confidence interval, 23.16-23.96) than in Tc-99m (12.92 mSv; 95% confidence interval, 12.55-13.40; P<0.001).
In this single-center study, the use of Tl-201 during the Tc-99m shortage was associated with an increase in downstream testing, cost, and patient radiation exposure, but these findings may not be generalizable to other centers. Although Tl-201 provided a short-term solution to the unexpected Tc-99m shortage, long-term cost-effective solutions should be areas of future study.
2009 年， chalk river 核反应堆因维修而关闭，导致 technetium-99m（Tc-99m）严重短缺。一些中心使用铊-201（Tl-201）作为心肌灌注成像的替代放射性示踪剂。由于许多人认为 Tl-201 是一种不理想的放射性示踪剂，因此我们试图了解在 Tc-99m 短缺期间使用 Tl-201（201 铊）对下游资源利用的影响。
我们在渥太华心脏研究所对 7402 名患者（60%为男性；平均年龄 62.6±11.8 岁）进行了回顾性研究，这些患者在 2008 年 5 月至 2011 年 1 月（Tc-99m 短缺前[2938 例]）、期间（使用 Tl-201 期间[2959 例]）和之后（Tc-99m 短缺后[1505 例]）接受了心肌灌注成像检查。在进行心肌灌注成像后的 6 个月内对患者进行随访，以确定随后进行心脏导管检查或无创影像学检查的比例。在 Tl-201 组（639 例[21.4%]）中，下游检测率高于 Tc-99m 组（537 例[12.1%]；P<0.001）。在使用倾向评分进行调整后，下游转诊率的差异仍得以维持。下游调查导致 Tl-201 组（DURING_Tl-201）每位患者的估计成本增加 165.22 美元（95%置信区间为 153.00-177.42 美元），而 Tc-99m 组（POST_Tc-99m）每位患者的成本增加 90.97 美元（95%置信区间为 83.42-98.90 美元；P<0.001）。此外，在 DURING_Tl-201 组（23.57 mSv；95%置信区间为 23.16-23.96）中，每位患者的有效辐射剂量均高于 Tc-99m 组（12.92 mSv；95%置信区间为 12.55-13.40；P<0.001）。
在这项单中心研究中，在 Tc-99m 短缺期间使用 Tl-201 与下游检测、成本和患者辐射暴露的增加有关，但这些发现可能不适用于其他中心。虽然 Tl-201 为 Tc-99m 的意外短缺提供了短期解决方案，但长期的成本效益解决方案应是未来研究的领域。
