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. 2023 May;50(6):1621-1628.
doi: 10.1007/s00259-023-06129-z. Epub 2023 Feb 13.

Myocardial perfusion SPECT in Germany from 2012 to 2021: insights into development and quality indicators

O Lindner  1 , W Schäfer  2 , C Rischpler  3   4 , S Silber  5 , W Burchert  6 ; Working Group “Cardiovascular Nuclear Medicine” of the German Society for Nuclear Medicine
Affiliations

Myocardial perfusion SPECT in Germany from 2012 to 2021: insights into development and quality indicators

O Lindner et al. Eur J Nucl Med Mol Imaging. 2023 May.

Abstract

Purpose: This paper summarises the results of 4 national surveys on the numbers, utilisation and technique of myocardial perfusion SPECT (MPS) from 2012 to 2021.

Methods: A one-page questionnaire for information on MPS in 2012, 2015, 2018 and 2021 was sent to German centres practising nuclear medicine. To check for representativeness, the numbers obtained were related to official annual data and furthermore to the numbers of invasive coronary angiography procedures (ICA).

Results: MPS examinations increased by > 40% from 2012 to 2021 and showed a centralisation with increasing MPS per centre. In 2020, a mild impact of the COVID-19 pandemic could be observed in the form of only a slight MPS increase, which was compensated in the following year. Outpatient care cardiologists represent the most important referrer (70%). Mostly, 2-day protocols were used. One-day protocols and stress-only protocols showed insignificant changes. The use of exercise stress decreased steadily. In 2021, exercise stress was replaced by pharmacological stress as the most frequent stress modality. Camera systems showed a shift to more SPECT-CT systems. The use of gated SPECT increased to almost 90%. Quantitative scoring showed an increasing acceptance. The ratio of invasive coronary angiographies (ICA) to MPS was between 3.9 and 4.5. A significant proportion of ICA in the context of CCS (chronic coronary syndrome) was performed without prior testing for ischaemia.

Conclusion: The 2012 to 2021 MPS surveys reveal a continuously growing number of examinations with only a mild temporary effect of the COVID-19 pandemic and a centralisation with increasing numbers per centre. Performance and technical data reveal a high-grade adherence of MPS practice to the current ESC guideline. A large potential of non-invasive diagnostics remains for the future.

Keywords: Myocardial perfusion imaging; Survey; Utilisation review; Utilisation statistics.

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Conflict of interest statement

The authors have no relevant financial or non-financial interests to disclose.

Figures

Fig. 1
Fig. 1
MPS examinations of non-hospitalised patients with statutory health insurance according to the National Association of Statutory Health Insurance Physicians (Kassenärztliche Bundesvereinigung) for the fee schedule items (FSI) 17,300 (stress MPS) and 17,331 (rest MPS) from 2012 to 2021
Fig. 2
Fig. 2
Changes in MPS referral (individual estimates of the participating centres)
Fig. 3
Fig. 3
Possible reasons for declining MPS examinations
Fig. 4
Fig. 4
MPS referral structure from 2012 to 2021
Fig. 5
Fig. 5
MPS protocols from 2012 to 2021. Changes between the surveys were not significant
Fig. 6
Fig. 6
MPS stress testing from 2012 to 2022
Fig. 7
Fig. 7
Camera systems for MPS from 2015 to 2021 by centres
See this image and copyright information in PMC

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References

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