近日，奥地利国际原子能机构核医学和诊断成像科Diana Paez团队研究了冠状动脉疾病诊断成像中的世界范围辐射剂量。这一研究成果于2026年2月25日发表在《美国医学会杂志》上。

近几十年来，全球范围内冠心病诊断检测显著增长，其中几种常见的影像学检查会使患者暴露于电离辐射。该研究旨在调查全球接受无创冠心病诊断检测患者的辐射剂量。

研究组进行了一项全球性横断面研究，调查了2023年无创冠心病影像检查的辐射剂量。研究采用连续样本，纳入2023年10月至12月某一周内，在101个国家742个中心接受无创冠心病诊断检测的全部19302名成人。参与者接受以下冠心病检测：单光子发射计算机断层扫描（SPECT）或正电子发射断层扫描核心脏成像（PET）、用于冠状动脉钙化评分的心脏计算机断层扫描（CACS），或冠状动脉计算机断层扫描血管成像（CCTA）。主要结局指标是患者接受的辐射有效剂量，以及中心有效剂量中位数达到指南推荐的≤9 mSv标准的百分比。

在19302名患者中，8515名（44%）为女性，中位年龄63岁（IQR 54-71岁）。不同诊断方式的有效剂量差异显著，中位有效剂量（IQR）分别为：CACS 1.2 (0.7-2.2) mSv，PET 2.0 (1.6-2.4) mSv，SPECT 6.5 (3.9-8.6) mSv，CCTA 7.4 (3.5-15.5) mSv。达到剂量中位数≤9 mSv的中心比例，核心脏病学中心显著高于CCTA中心（81% vs 56%；P < .001）；接受检查的患者比例亦是如此（79% vs 56%；P < .001）。同一检查的辐射剂量在世界各地区间存在显著差异：西欧最低（核心脏病学中位剂量[IQR] 4.8 [2.3-7.3] mSv，CCTA 4.6 [2.4-9.8] mSv）；拉丁美洲的核心脏病学剂量最高（中位剂量[IQR] 7.8 [5.3-9.7] mSv），非洲的CCTA剂量最高（中位剂量[IQR] 25.2 [14.7-35.3] mSv）（所有比较P < .001）。回归模型显示，国家收入水平与辐射剂量呈负相关。在中低收入国家，核心脏病学检查的患者剂量比高收入国家高出20%（95% CI 3.6%-38.4%）；而对于CCTA检查，低收入和中低收入国家的患者剂量比高收入国家高出高达96%（95% CI 41.7%-170.8%）（P < .001）。即使在相同收入水平和世界地区内部，也存在显著差异。

鉴于全球冠心病患病率不断上升，研究组发现诊断检测中患者辐射剂量存在显著差异，这凸显了在全球范围内迫切需要开展培训、制定标准化方案并更新设备以减少辐射。这对中低收入国家的患者以及接受CCTA检查的患者影响尤为显著。因此，当前存在改善全球患者冠心病诊断质量的重要契机。

附：英文原文

Title: Worldwide Radiation Dose in Coronary Artery Disease Diagnostic Imaging

Author: Andrew J. Einstein, Michelle C. Williams, Jonathan R. Weir-McCall, Leslee J. Shaw, Ganesan Karthikeyan, Nathan Better, Joo V. Vitola, Rodrigo J. Cerci, Sharmila Dorbala, Salah E. Bouyoucef, Andrew D. Choi, Gianluca Pontone, Elgin Ozkan, Lee D. Yang, Luca Bremner, Michelle Castillo, Yosef A. Cohen, Eli Malkovskiy, Ismaila Ayoola, Anna Veduta, Danylo Yurystovskyi, Yaroslav Pynda, Thomas N. B. Pascual, Peter Knoll, Maurizio Dondi, Diana Paez, INCAPS Investigators Group, Juan Lopez-Mattei, Purvi Parwani, Edward Nicol, Chiara Bucciarelli-Ducci, Artan Goda, Ervina Shirka, Roxana Campisi, Tomas Vita, Kim Taubman, John Younger, Christian Loewe, Siroos Mirzaei, Shankar Kumar Biswas, Azamal Kabir Sharker, Stephane Carlier, Rodrigo Salgado, Tim Van Den Wyngaert, Amela Begi, Nejra Latic, Marina Garcheva-Tsacheva, Metodi Mihaylov, Stéphane Sanou, Rob Beanlands, Benjamin Chow, Teresa Massardo, Tamara Palavecino, Jesus Urbina, Xiaoli Zhang, Claudia T. Gutierrez Villamil, Alejandro Zuluaga Santamaria, Maja Ilic Tomas, Slavica Kovai, Yamilé Marcos Gutiérrez, Amalia Peix, Leonel Torres Aroche, Savvas Frangos, Milena Henzlova, Lars Christian Gormsen, Bjarne Nrgaard, Kasper Kyhl, Mayra Sanchez Vélez, Adel Hassan Allam, Ilona Muoni, Daniel Zewdneh Solomon, Farzana Bano, Juhani Knuuti

Issue&Volume: 2026-02-25

Abstract:

Importance  In recent decades, there has been marked worldwide growth in diagnostic testing for coronary artery disease (CAD), with several common imaging modalities exposing patients to ionizing radiation.

Objective  To examine worldwide radiation doses for patients undergoing noninvasive CAD diagnostic testing.

Design, Setting, and Participants  This worldwide, cross-sectional study was conducted of radiation dose from noninvasive CAD imaging in 2023, using a consecutive sample of all 19302 adults undergoing noninvasive CAD diagnostic testing at 742 centers in 101 countries during a single week in October to December 2023.

Exposures  Participants underwent CAD testing with single-photon emission computed tomography (SPECT) or positron emission tomography (PET) nuclear cardiac imaging, cardiac computed tomography for coronary artery calcium scoring (CACS), or coronary computed tomography angiograph (CCTA).

Main Outcomes and Measures  The primary outcomes were radiation effective dose to patients and the percentage of centers with median effective dose less than or equal to 9 mSv, as recommended in guidelines.

Results  Of 19302 patients, 8515 (44%) were females and the median (IQR) age was 63 (54-71) years. Effective dose varied considerably across diagnostic modalities, with median (IQR) effective dose of 1.2 (0.7-2.2) mSv for CACS, 2.0 (1.6-2.4) mSv for PET, 6.5 (3.9-8.6) mSv for SPECT, and 7.4 (3.5-15.5) mSv for CCTA. Significantly more centers performing nuclear cardiology than CCTA (81% vs 56%; P<.001) and patients undergoing nuclear cardiology studies than CCTA (79% vs 56%; P<.001) achieved median dose of less than or equal to 9 mSv. Doses for the same procedure differed significantly between world regions, being lowest in Western Europe (median [IQR], 4.8 [2.3-7.3] mSv for nuclear cardiology and 4.6 [2.4-9.8] mSv for CCTA) and highest in Latin America for nuclear cardiology (median [IQR], 7.8 [5.3-9.7] mSv) and Africa (median [IQR], 25.2 [14.7-35.3] mSv) for CCTA (P<.001 for all). In regression modeling, there was an inverse relationship between country income level and dose. Patient dose was 20% (95% CI, 3.6%-38.4%) higher in low- and middle-income countries than in high-income countries for nuclear cardiology, and as much as 96% (95% CI, 41.7%-170.8%) higher in low- and lower-middle–income countries than in high-income countries for CCTA (P<.001). Marked variation was observed within income levels and world regions.

Conclusions and Relevance  Given increasing rates of CAD worldwide, these findings of marked variation in radiation dose to patients from diagnostic testing identify a critical need for training, standardized protocols, and updated equipment to reduce radiation worldwide. This especially affects patients in low- and middle-income countries and patients undergoing CCTA. There are therefore important opportunities to improve the quality of CAD diagnosis for patients across the globe.

DOI: 10.1001/jama.2026.0703

Source: https://jamanetwork.com/journals/jama/fullarticle/2845479