{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,6]],"date-time":"2026-11-06T22:51:32Z","timestamp":1794005492304,"version":"4.8.0"},"reference-count":39,"publisher":"American Medical Association (AMA)","issue":"13","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA"],"published-print":{"date-parts":[[2026,4,7]]},"abstract":"\n Importance<\/jats:title>\n 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.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n To examine worldwide radiation doses for patients undergoing noninvasive CAD diagnostic testing.<\/jats:p>\n <\/jats:sec>\n \n Design, Setting, and Participants<\/jats:title>\n This worldwide, cross-sectional study was conducted of radiation dose from noninvasive CAD imaging in 2023, using a consecutive sample of all 19\u202f302 adults undergoing noninvasive CAD diagnostic testing at 742 centers in 101 countries during a single week in October to December 2023.<\/jats:p>\n <\/jats:sec>\n \n Exposures<\/jats:title>\n 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 angiography (CCTA).<\/jats:p>\n <\/jats:sec>\n \n Main Outcomes and Measures<\/jats:title>\n 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.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n Of 19\u202f302 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%;\n P<\/jats:italic>\n \u2009&amp;lt;\u2009.001) and patients undergoing nuclear cardiology studies than CCTA (79% vs 56%;\n P<\/jats:italic>\n \u2009&amp;lt;\u2009.001) 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 (\n P<\/jats:italic>\n \u2009&amp;lt;\u2009.001 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\u2013income countries than in high-income countries for CCTA (\n P<\/jats:italic>\n \u2009&amp;lt;\u2009.001). Marked variation was observed within income levels and world regions.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions and Relevance<\/jats:title>\n 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.<\/jats:p>\n <\/jats:sec>","DOI":"10.1001\/jama.2026.0703","type":"journal-article","created":{"date-parts":[[2026,2,25]],"date-time":"2026-02-25T16:30:36Z","timestamp":1772037036000},"page":"1148","source":"Crossref","is-referenced-by-count":13,"title":["Worldwide Radiation Dose in Coronary Artery Disease Diagnostic Imaging"],"prefix":"10.1001","volume":"335","author":[{"given":"Andrew J.","family":"Einstein","sequence":"first","affiliation":[{"name":"Seymour, Paul and Gloria Milstein Division of Cardiology, Department of Medicine, Vagelos College of Physicians and Surgeons, NewYork-Presbyterian Hospital\/Columbia University Irving Medical Center, New York, New York"},{"name":"Department of Radiology, Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center and NewYork-Presbyterian Hospital, New York, New York"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michelle C.","family":"Williams","sequence":"additional","affiliation":[{"name":"British Heart Foundation Centre for Research Excellence, University of Edinburgh, United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jonathan R.","family":"Weir-McCall","sequence":"additional","affiliation":[{"name":"School of Biomedical Engineering and Imaging Sciences, King\u2019s College London, United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Leslee J.","family":"Shaw","sequence":"additional","affiliation":[{"name":"Department of Medicine (Cardiology), Blavatnik Family Women\u2019s Health Research Institute, Icahn School of Medicine at Mount Sinai, New York, New York"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ganesan","family":"Karthikeyan","sequence":"additional","affiliation":[{"name":"All India Institute of Medical Sciences, New Delhi, 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