Lecchi M, Malaspina S, Scabbio C, Gaudieri V, Del Sole A
Health Physics, San Paolo Hospital, Via Antonio di Rudini, 20142 Milan, Italy ; Department of Health Sciences, University of Milan, Milan, Italy.
Nuclear Medicine Unit, Department of Diagnostic Services, ASST Santi Paolo e Carlo, Milan, Italy.
Clin Transl Imaging. 2016;4(6):491-498. doi: 10.1007/s40336-016-0212-9. Epub 2016 Oct 31.
Over the past decade, nuclear medicine experts have been seeking to minimize patient exposure to radiation in myocardial perfusion scintigraphy (MPS). This review describes the latest technological innovations in MPS, particularly with regard to dose reduction.
We searched in PubMed for original clinical papers in English, published after 2008, using the following research criteria: (dose) and ((reduction) or (reducing)) and ((myocardial) or (cardiac) or (heart)) and ((nuclear medicine) or (nuclear imaging) or (radionuclide) or (scintigraphy) or (SPET) or (SPECT)). Thereafter, recent reviews on the topic were considered and other relevant clinical papers were added to the results.
Of 202 non-duplicate articles, 17 were included. To these, another eight papers cited in recent reviews were added. By optimizing the features of software, i.e., through algorithms for iterative reconstruction with resolution recovery (IRRs), and hardware, i.e., scanners and collimators, and by preferring, unless otherwise indicated, the use of stress-first imaging protocols, it has become possible to reduce the effective dose by at least 50% in stress/rest protocols, and by up to 89% in patients undergoing a diagnostic stress-only study with new technology. With today's SPECT/CT systems, the use of a stress-first protocol can conveniently be performed, resulting in an overall dose reduction of about 35% if two-thirds of stress-first examinations were considered definitively normal.
Using innovative gamma cameras, collimators and software, as well as, unless otherwise indicated, stress-first imaging protocols, it has become possible to reduce significantly the effective dose in a high percentage of patients, even when X-ray CT scanning is performed for attenuation correction.
在过去十年中，核医学专家一直致力于在心肌灌注显像（MPS）中尽量减少患者的辐射暴露。本综述描述了MPS的最新技术创新，特别是在剂量降低方面。
我们在PubMed中搜索2008年以后发表的英文原创临床论文，使用以下研究标准：（剂量）和（（降低）或（减少））和（（心肌）或（心脏）或（心脏的））和（（核医学）或（核成像）或（放射性核素）或（闪烁显像）或（单光子发射计算机断层显像）或（单光子发射计算机断层扫描））。此后，考虑了关于该主题的近期综述，并将其他相关临床论文添加到结果中。
在202篇非重复文章中，纳入了17篇。此外，还添加了近期综述中引用的另外8篇论文。通过优化软件功能，即通过具有分辨率恢复的迭代重建算法（IRRs），以及硬件，即扫描仪和准直器，并且除非另有说明，优先使用静息-负荷显像方案，在静息/负荷方案中已能够将有效剂量至少降低50%，在采用新技术进行仅负荷诊断性研究的患者中可降低多达89%。对于当今的SPECT/CT系统，如果三分之二的负荷优先检查最终被判定为正常，使用负荷优先方案可以方便地进行，从而使总体剂量降低约35%。
使用创新的γ相机、准直器和软件，以及除非另有说明的负荷优先显像方案，即使在进行X射线CT扫描进行衰减校正时，也能够在很大比例的患者中显著降低有效剂量。
