[Myocardial perfusion scintigraphy 2008 in Germany - results of the fourth query]

Myocardial Perfusion SPECT and ATTR imaging 2021 in Germany: Results of the 9th Survey

AIM

This paper presents the results of the 9th survey of myocardial perfusion SPECT (MPS) from the reporting year 2021.

METHODS

218 questionnaires (131 practices (PR), 58 hospitals (HO), 29 university hospitals (UH)) were evaluated. Results of the last survey 2018 are set in squared brackets.

RESULTS

MPS data from a total of 133,057 [145,930] patients (-8.8%) with 131,868 [143,707] stress and 106,546 [121,899] rest MPS were analysed. A comparison with official data revealed that 54% all MPS were recorded. From 2018 to 2021, official data showed a every year an increase in MPS numbers. On average, 610 [502] MPS patients (+22%) were examined in each department. 74% [69%] of the responders reported an increase or no changes in their MPS patient numbers. Ambulatory care cardiologists represented as always, the mayor referral group (68% [69%]). For the first time, pharmacological stress was more frequently applied than ergometry (42% [51]). Regadenoson was mostly used. The use of the different protocols remained nearly unchanged. Two-day protocols were predominantly applied (49% [48%]). A shift from multi-headed cameras (58% [72%]) to SPECT-CT systems (24% [17%]) was found. Attenuation correction was performed in 33% [26%] of all MPS. 88% [86%] of all stress, 88% [87%] of all rest and 87% [83%] of all stress and rest MPS were acquired as gated SPECT. 72% [67%] of all departments performed scoring by default. The number of departments without scoring decreased to 13% [16%].

CONCLUSIONS

The MPS Study 2021 shows that the long-term positive development of MPS imaging in Germany is continuing. The COVID-19 pandemia did not change this trend. The procedural and technical details of MPS imaging reveal a high level of guideline conformity.

Nuklearmedizin in Deutschland

Aim: To explain the spectrum and number of in-vivo nuclear medicine examinations and therapies based on official statistics about out-patient and in-patient care. Trends in time of the frequency and spectrum of procedures as well as data on the health care structure for nuclear medicine in Germany should be collected. Methods: Data from the Gesundheitsberichterstattung des Bundes, from the frequency statistics of the statutory health insurance for out-patients and from the Bundes - ärztekammer were used. Customized queries were performed to analyse temporal changes. Results: Nuclear medicine physicians are more frequently consulted by out-patients over the last years (2008: 2 024 498; 2009: 2 164 664) and the number of colleagues in private practice increased. For in-patients, the frequency of conventional nuclear medicine procedures (mainly for brain, lymphatic system, lung and heart) increased since 2008 after a decline in previous years (2009: 323 515; +4.6%) and the number of PET(/CT) examinations continued to rise (2009: 25 123; +18%), even if changes in OPS keys may hamper comparisons. Nearly 600 gamma cameras and 76 PET(/CT) scanners were installed in hospitals in 2008. Nuclear medicine procedures are increasingly performed as cross sectional imaging like SPECT(/CT) and PET(/CT). With the supply shortfall with 99Mo, the frequency of thyroid scans with 123I iodine increased as well as the use of 18F PET as a substitute for conventional bone scans. The number of radionuclide therapies, in particular non-thyroid treatments, increased since the mid-nineties and stabilized at nearly 50 000 cases per year with shorter lengths of stay. Conclusion: The details of the present analysis may help to understand the positive evolution of key numbers for nuclear medicine.

Myocardial perfusion SPECT 2015 in Germany. Results of the 7th survey

AIM

The working group Cardiovascular Nuclear Medicine of the German Society of Nuclear Medicine presents the results of the 7th survey of myocardial perfusion SPECT (MPS) of the reporting year 2015.

METHOD

268 questionnaires (173 practices [PR], 67 hospitals [HO], 28 university hospitals [UH]) were evaluated. Results of the last survey from 2012 are set in squared brackets.

RESULTS

MPS of 121 939 [105 941] patients were reported. 98 % [95 %] of all MPS were performed with Tc-99m radiopharmaceuticals and 2 % [5 %] with Tl-201. 78 % [79 %] of all patients were studied in PR, 14 % [15 %] in HO, and 8 % [6 %] in UH. A pharmacological stress test was performed in 43 % [39 %] (22 % [24 %] adenosine, 20 % [9 %] regadenoson, 1 % [6 %] dipyridamole or dobutamine). Attenuation correction was applied in 25 % [2009: 10 %] of MPS. Gated SPECT was performed in 78 % [70 %] of all rest MPS, in 80 % [73 %] of all stress and in 76 % [67 %] of all stress and rest MPS. 53 % [33 %] of all nuclear medicine departments performed MPS scoring by default, whereas 24 % [41 %] did not apply any quantification. 31 % [26 %] of all departments noticed an increase in their counted MPS and 29 % [29 %] no changes. Data from 89 departments which participated in all surveys showed an increase in MPS count of 11.1 % (PR: 12.2 %, HO: 4.8 %, UH: 18.4 %). 70 % [60 %] of the MPS were requested by ambulatory care cardiologists.

CONCLUSION

The 2015 MPS survey reveals a high-grade adherence of routine MPS practice to current guidelines. The positive trend in MPS performance and number of MPS already observed in 2012 continues. Educational training remains necessary in the field of SPECT scoring.

Trends in the utilization of nuclear medicine and radiopharmaceuticals in an aging population

AIM

To investigate the trends in the utilization of nuclear medicine procedures and radiopharmaceuticals in an aging population and to establish the prediction models.

METHODS

Based on Taiwan's National Health Insurance Research Database, a longitudinal study was conducted from 2000 to 2012. Descriptive statistics were adopted to analyze the frequencies and distributions of nuclear medicine procedures. Multiple linear regression analysis was applied to establish the prediction model for the utilization of nuclear medicine.

RESULTS

The utilization of myocardial perfusion imaging increased most significantly, i.e. 250 per million population (pmp) increment annually, followed by the whole-body bone scan (176 pmp) and whole-body PET scan (100 pmp) in Taiwan during the period of 2000-2012. The use rate of nuclear medicine procedure which the first quartile (Q1) of age at examination above 35 years fits the regression model: Use rate expected year = 0.03 Q1 of age at examination × use rate baseline year + 14797 life expectancy expected year / life expectancy baseline year - 15030. Adversely, the use rate of procedure which Q1 of age at examination below 35 years fits the model: Use rate expected year = 0.01 Q1 of age at examination × use rate baseline year - 4565 life expectancy expected year / life expectancy baseline year + 4749. In addition, the similar models were found in the applications of radiopharmaceuticals.

CONCLUSION

This study demonstrates the age at examination and life expectancy can be used to predict the utilities of nuclear medicine procedures and radiopharmaceuticals in an aging population. Nuclear medicine practice applied in the geriatrics would increase significantly with the aging of population.

Use of myocardial perfusion imaging and estimation of associated radiation doses in Germany from 2005 to 2012

PURPOSE

For several years the Working Group Cardiovascular Nuclear Medicine of the German Society of Nuclear Medicine has been performing a regular survey to obtain information on technique, utilization and development of myocardial perfusion scintigraphy (MPS). Currently, data of six surveys from 2005 to 2012 are available. The aim of this paper is to deliver a general and comprehensive overview of all surveys documenting the course of patient doses over time and the development of the method.

METHODS

A one-page questionnaire with number of MPS patients, number of stress and rest MPS, referral structure and several technical issues was sent to all centres performing MPS in Germany and evaluated. With the data on protocol utilization, effective MPS patient doses were estimated.

RESULTS

MPS per million population (pmp) varied between 2,380 and 2,770. In 2012, MPS pmp showed a slight increase for the first time. From 2005 to 2009 the angiography to MPS ratio increased from 3.4 to 4.4, and the revascularization to MPS ratio decreased from 0.66 to 0.53. In 2012, both indices demonstrated an opposite trend for the first time (4.1 and 0.55). A total of 108 centres participated in all surveys. They showed an increase in MPS patients of 4.0 % over the reporting period. In 2012, more than 50 % of the centres experienced no change or an increase in MPS numbers. The leading single competitor was MRI, followed by angiography and stress echocardiography. (201)Tl studies have decreased since 2005 from 20 to 5 %. (99m)Tc MPS studies showed a mild increase in 2-day protocols. In 2012, the average effective dose per patient was estimated at 7.4 mSv. Due to the decreasing use of (201)Tl, a mild decline over the observation period can be documented. Dynamic exercise stress was the most common stress test and adenosine the leading pharmacological stress agent, with a growing percentage. In 2012, the regadenoson percentage was 9 %. Gated single photon emission computed tomography (SPECT) noted an increasing acceptance with >70 % in 2012. The segmental scoring of perfusion studies had a low acceptance. Ambulatory care cardiologists represented the major referral group.

CONCLUSION

Germany has a moderate to moderate-high MPS utilization rate. Nevertheless, coronary artery disease (CAD) diagnosis and disease management are dominated by angiography. The survey data reveal a positive trend in MPS and a decrease in average patient dose reflecting good practice with guideline adherence, the implementation of technical improvements and success in training.

[Myocardial perfusion scintigraphy 2012 in Germany. Results of the 6th Query]

AIM

The working group Cardiovascular Nuclear Medicine of the German Society of Nuclear Medicine presents the results of the 6th survey on myocardial perfusion scintigraphy (MPS) of the reporting year 2012.

METHOD

278 questionnaires (177 private practices (PP), 78 hospitals (HO), 23 university hospitals (UH)) were evaluated.

RESULTS

MPS of 105,941 patients were reported. 95% [2005 = 80%] of MPS studies were conducted with (99m)Tc perfusion radiopharmaceuticals and only 5% with 201Tl. 79% [2009 = 76%] of the MPS were performed in PP, 15% [2009 = 17%] in HO, and 6% [2009 = 7%] in UH. Data from 108 centres which participated in all surveys from 2005 to 2012 showed an increase in MPS numbers of 4.0% (PP +6.1%, HO +18.2%, UH -18.3%). 29% of all participants (27% of PP, 31% of HO, and 26% of UH) noticed no change and 26% of all participants (28% of PP, 17% of HO and 35% of UH) an increase in their MPS requests since the 2009 query. The type of stress was pharmacological in 39% [2009 = 31%]. Of these 61% with adenosine (39% with exercise), 22% with regadenoson (51% with exercise), 14% with dipyridamole (60% with exercise), and 3% with dobutamine. Gated SPECT was performed in 73% [2009 = 56%] of all rest, in 70% [2009 = 56%] of all stress and in 67% [47%] of all stress and rest MPS. Only 36% [2009 = 33%] of the centres performed a quantification of all their studies with scores, whereas 41% [2009 = 52%] did not apply any quantification. 60% [2009 = 49%] of the MPS were requested by ambulatory care cardiologists.

CONCLUSION

The survey on MPS in Germany reveals a good conformity of imaging procedures with the current guideline. A positive development in MPS practice and referral can be stated. However, there is still some potential of MPS processing considering the quantitative perfusion analysis.

[Myocardial perfusion scintigraphy - short form of the German guideline]

This guideline is a short summary of the guideline for myocardial perfusion scintigraphy published by the Association of the Scientific Medical Societies in Ger-many (AWMF). The purpose of this guideline is to provide practical assistance for indication and examination procedures as well as image analysis and to present the state-of-the-art of myocardial-perfusion-scintigraphy. After a short introduction on the fundamentals of imaging, precise and detailed information is given on the indications, patient preparation, stress testing, radiopharmaceuticals, examination protocols and techniques, radiation exposure, data reconstruction as well as information on visual and quantitative image analysis and interpretation. In addition possible pitfalls, artefacts and key elements of reporting are described.

Myocardial perfusion scintigraphy in Germany in 2009: utilization and state of the practice

PURPOSE

Since 2006, the working group Cardiovascular Nuclear Medicine of the German Society of Nuclear Medicine, in cooperation with the working group Nuclear Cardiology of the German Cardiac Society, has been surveying the utilization and technical realization of myocardial perfusion scintigraphy (MPS) in Germany. This paper presents the results of the reporting year 2009.

METHODS

A total of 291 centres participated in the inquiry, including 179 private practices (PP), 86 hospitals (HO) and 26 university hospitals (UH).

RESULTS

MPS of 98,103 patients were reported. The MPS numbers per million population (pmp) were estimated at 2,360; 76% of the MPS were performed in PP, 17% in HO and 7% in UH. The ratio of MPS to coronary angiography to revascularization was 0.5 to 2.3 to 1. Data from 134 centres which participated in the surveys from 2005 to 2009 showed a decrease in MPS utilization of 2.2%. Nearly half of the MPS were requested by ambulatory care cardiologists. Of all MPS studies, 89% were conducted with (99m)Tc perfusion tracers. Ergometry was the preferred stress test (69%). Adenosine was used in 16%, adenosine + exercise in 7%, dipyridamole in 3%, dipyridamole + exercise in 5% and dobutamine in <1%. Gated single proton emission computed tomography (SPECT) acquisition was performed in 56% of all rest MPS and in 56% of all stress MPS. Both rest and stress MPS were ECG gated in 41%. Only 33% of the centres always performed a quantification of the perfusion studies, whereas 51% did not apply any quantification; 4% of the MPS studies were corrected for attenuation, and 17 centres used transmission sources of 12 CT-based systems.

CONCLUSION

A scan activity of 2,380 MPS pmp is in the upper third of the European range. The ratios to coronary angiography and to revascularization suggest that angiography dominates diagnosis and management of coronary artery disease (CAD). The clinical and technical realizations reveal that the predominant goals of further trainings to optimize MPS are in the field of gated SPECT and quantitative perfusion SPECT.

[Diagnostic reference value. Critical evaluation of the term with the example of nuclear medicine studies in Austria]

The aim of this study was to collect administered activities of important nuclear medicine diagnostic examinations and to identify frequencies as well as age distributions in the light of hybrid devices in Austria. Based on the survey data a re-evaluation of dose reference levels for nuclear medicine has been published in June 2010 in the novella of the Austrian Medical Radiation Protection Regulation (MedStrSchV) (8), also an estimate of the average individual doses of the total population. Accurate data on nuclear medicine studies of 34% of all Austrian nuclear medicine units could be collected.

RESULTS

Extrapolated there are about 150000 nuclear medicine examinations per year performed in Austria. The median age of patients is thereby 62 years. The results of this study resulted in 65% of the dose reference values to change, whereas 48% had to be revised downwards and 17% upwards. Additionally, 5 new reference values were included in the list; three more were taken out, however. The estimation of the individual effective patient dose for each offered examination was on average 4.7 mSv. An extrapolation based on the total exposure of the population with regard to uninvolved persons and children led to 0.07 mSv per year by nuclear medicine examinations.

CONCLUSION

The published diagnostic reference values correspond to the normal investigative practice in Austria and are compliant with most international recommendations. The term "optimal value" has been removed from the text of the law, because such wording would be misleading.