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New guidelines for low-dose myocardial perfusion in effect

by Loren Bonner, DOTmed News Online Editor | January 06, 2014

DMN: How else can labs decrease dose, as recommended by ASNC in the new guidelines?

EGD: Another way to decrease dose, besides the stress-only protocol, is by using new, state-of-the-art equipment that is available only recently. These cameras are more sensitive, counting radiation much faster than standard cameras. By using this new equipment, patient radiation dose can easily be decreased to 5 millisieverts, or even less, with excellent quality myocardial perfusion images. But such new equipment is very expensive. Unfortunately, with decreasing reimbursement, not many departments can afford it.

An alternative is to implement low-count density software, now available from all of the nuclear camera vendors and also from UltraSPECT Ltd., which sells software that can be interfaced to old and new cameras from all vendors. Software methods have been developed that provide maintained or even improved image quality despite only one half or even one quarter the counting statistics. Therefore, instead of a patient dose of 11 millisieverts, the dose is only 5-6 millisieverts. This is a less expensive solution, about 20-30 thousand dollars, compared to the purchase of a new camera

DMN: What do you anticipate most labs will do?

EGD: Most people will probably adopt software solutions. In our lab, we use either stress-only testing or, additionally, UltraSPECT software and routinely afford our patients radiation doses of 5-7 millisieverts. So this puts us well within the ASNC guidelines.

One of the latest studies conducted at our lab showed the difference between the level of radiation exposure vs. a lab without any low-dose technique. We compared 257 patients with the use of full-dose protocol, and our 205 patients using a half-dose protocol, using Wide Beam Reconstruction (WBR™) algorithm-based Xpress.Cardiac™ software from UltraSPECT. Evaluation of the results showed an impressively high number, 77 percent of studies performed with the half dose protocol were below 9mSv while in the other site none of the studies were below 9mSv. Most of the latter were in the range of 12-13 mSv.

DMN: How could dose reduction eventually be tied to reimbursement?

EGD: Right now dose reduction is just a guideline, or a recommendation, but ultimately, with value-based imaging and PQRS requirements, reimbursement from the Centers for Medicare and Medicaid Services and other third party carriers will be tied to quality. One of those quality metrics will certainly be patient radiation dose. So as these value-based parameters are implemented, labs will very likely be rewarded for lowering dose and penalized for exceeding recommended dose guidelines.

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