Abstracts/Proceedings
Assessing the need for nuclear cardiology and other advanced cardiac imaging modalities in the developing world

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Abstract

Background

In 2005, 80% of cardiovascular disease (CVD) deaths occurred in low- to middle-income countries (i.e., developing nations). Cardiovascular imaging, such as myocardial perfusion SPECT, is one method that may be applied to detect and foster improved detection of at-risk patients. This document will review the availability and utilization for nuclear cardiology procedures worldwide and propose strategies to devise regional centers of excellence to achieve quality imaging around the world.

Methods

As a means to establish the current state of nuclear cardiology, International Atomic Energy Agency member and non-member states were queried as to annual utilization of nuclear cardiology procedures. Other sources for imaging statistics included data from medical societies (American Society of Nuclear Cardiology, European Society of Cardiology, and the European Association of Nuclear Medicine) and nuclear cardiology working groups within several nations. Utilization was calculated by dividing annual procedural volume by 2007 population statistics (/100,000) and categorized as high (>1,000/100,000), moderate-high (250-999/100,000), moderate (100-249/100,000), low-moderate (50-99/100,000) and low (<50/100,000).

Results

High nuclear cardiology utilization was reported in the United States, Canada, and Israel. Most Western European countries, Australia, and Japan reported moderate-high utilization. With the exception of Argentina, Brazil, Colombia and Uruguay, South America had low usage. This was also noted across Eastern Europe, Russia, and Asia. Utilization patterns generally mirrored each country’s gross domestic product. However, nuclear cardiology utilization was higher for developing countries neighboring moderate-high “user” countries (e.g., Algeria and Egypt); perhaps the result of accessible high-quality training programs.

Conclusions

Worldwide utilization patterns for nuclear cardiology vary substantially and may be influenced by physician access to training and education programs. Development of regional training centers of excellence can guide utilization of nuclear cardiology through the application of guideline- and appropriateness-driven testing, training, continuing education, and quality assurance programs aiding developing nations to confront the epidemics of CVD.

Section snippets

The Growing Denominator of High-Risk Patients in Developing Countries

Prior to our examination of current utilization patterns for nuclear cardiology, it is helpful to review whether the population needs are sufficiently high in order that patients may benefit from costly, advanced imaging techniques, such as nuclear cardiology. Throughout the developing world, expanding urbanization and industrialization promote lifestyle changes which accelerate CVD risk. What has been observed in many developing countries is rapid population shifts and epidemic growth rates in

Worldwide Utilization of Nuclear Cardiology

In 2008, a world-wide survey was carried out as to the annual utilization of nuclear cardiology. Sources for this information included data provided by countries and regional scientific societies and working groups, as well as leaders in the field within their respective countries. For utilization calculations, we used the number of annual procedures (i.e., largely myocardial perfusion studies) within a given country divided by the current population statistics (2007 data); expressed per

Contrasting Developed and Developing Countries Utilization of Nuclear Cardiology Services

In the United States as well as in many developed countries, there has been substantial growth in nuclear cardiology services. Growth in imaging has occurred at such a rapid pace that in 2007 Medicare allowable charges were 1.1 billion US dollars for stress myocardial perfusion SPECT including recent utilization statistics of 8.54 million studies.9 This tremendous growth in all imaging sectors has led to demands for more evidence to differentiate appropriate from inappropriate testing.10 Thus,

Growth in Contemporary Diagnostic Tests for CVD

There is an array of diagnostic tests for CVD and nuclear cardiology, notably stress myocardial perfusion SPECT, constitutes one method that may provide a means to improve risk detection in developing countries. One reason for the current report is that many developing countries have existing nuclear cardiology networks with numerous examples of acceptance of this modality. Moreover, the current focus on nuclear cardiology within the International Atomic Energy Agency coincides with numerous

Training in Nuclear Cardiology

While in developed countries the practice of nuclear cardiology is well regulated, this is not the case within the majority of developing countries. The training and practice of nuclear cardiology poses unique challenges, as in most countries, it is a joint effort between radiology, nuclear medicine, and cardiology. As stated in a statement from the European Society of Cardiology (ESC), these three specialties should work collaboratively to foster high-quality nuclear cardiology studies.11

Conclusions

Worldwide urbanization is causing rapid population shifts in CVD risk including near epidemic growth in obesity and diabetes. The vast majority of deaths related to CVD occur in low- to middle-income countries where advanced cardiac imaging technology is less often available. Utilization of nuclear cardiology worldwide generally mirrors a countries’ gross domestic product. The development of programs aimed at creating centralized centers for training, education, research, and service may

Acknowledgments

In addition to data provided by IAEA member states and members of the technical panel, we would like to thank the following physicians for contributing data to this report (in alphabetical order of countries): (1) Argentina: Angel Sandrin; (2) Bangladesh: Luftun Nisa; (3) Bolivia: Raul Araujo; (4) Colombia: Sonia Merlano; (5) Costa Rica: Ulises Gonzalez; (6) Ecuador: Sandra Moreno; (7) Europe and Russian Federation: Ignasio Carrio, Richard Underwood; (8) Israel: Chaim Golan, Arie Wolak; (9)

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