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Estimates of effective doses of standard MPI protocols

Estimates of effective doses of standard MPI protocols
Protocol Injected activity (mCi) Effective doses, mSv
From ICRP tables From manufacturers' Pls
Rest Stress E1 E2 E1 E2
99mTc sestamibi rest-stress 10.0 27.5 11.3 11.4 14.6 NR
99mTc sestamibi stress only 0.0 27.5 7.9 8.0 10.0 NR
99mTc sestamibi 2-day 25.0 25.0 15.7 15.6 20.6 NR
99mTc tetrofosmin rest-stress 10.0 27.5 9.3 9.9 9.7 12.9
99mTc tetrofosmin stress only 0.0 27.5 6.6 7.1 6.7 8.8
99mTc tetrofosmin 2-day 25.0 25.0 12.8 13.5 13.7 18.3
201Tl stress-redistribution 0.0 3.5 22.0 22.0

28.7 (PI 1)

9.3 (PI 2)

28.4 (PI 3)

46.6 (PI 1)

NR (PI 2)

46.6 (PI 3)
201Tl stress-reinjection 1.5 3.0 31.4 31.5

43.0 (PI 1)

14.0 (PI 2)

42.6 (PI 3)

69.9 (PI 1)

NR (PI 2)

69.9 (PI 3)
Dual isotope201Tl-99mTc sestamibi 3.5 25.0 29.2 29.3

37.8 (PI 1)

18.4 (PI 2)

37.5 (PI 3)

NR (PI 1)

NR (PI 2)

NR (PI 3)
99mTc-labeled erythrocytes 22.5 0.0 5.7 5.8 2.3 NR
82Rb 50.0 50.0 13.5 12.6 3.0 NR
13N-ammonia 15.0 15.0 2.4 2.2 NA NA
15O-water* 29.7 29.7 2.5 2.4 NA NA
18F-FDG 10.0 0.0 7.0 7.0 NA NA
E1 indicates effective dose estimated from tissue dose coefficients, using ICRP Publication 60 tissue weighting factors. Calculations were performed with the use of the "splitting rule,"[1] arithmetic averaging rather than mass averaging of individual remainder organ dose contributions,[2] and upper large intestine rather than extrathoracic airways as a remainder organ, as was originally specified in ICRP Publication 60. If dose to the colon was not specified in a data source, then the average of the upper large intestine and lower large intestine doses was substituted. E2 indicates effective dose estimated from effective dose coefficients, using ICRP Publication 60 tissue weighting factors.
NR: not reported in PI (total body dose provided rather than effective dose); NA: not available for cyclotron-produced tracers.
* American Society of Nuclear Cardiology guidelines[3] do not prescribe a recommended dose. Stress and rest doses of 1100 MBq (29.7 mCi) used, as per European Association of Nuclear Medicine/European Society of Cardiology guidelines[4].
References:
  1. 1990 Recommendations of the International Commission on Radiological Protection: ICRP Publication 60 Ann ICRP 1991; 21:1.
  2. Conversion coefficients for use in radiological protection against external radiation: ICRP Publication 74. Ann ICRP 1996; 26:1. 
  3. DePuey EG, ed. Imaging guidelines for nuclear cardiology procedures. J Nucl Cardiol 2006; 13:e21.
  4. EANM/ESC Group. EANM/ESC procedural guidelines for myocardial perfusion imaging in nuclear cardiology. Eur J Nucl Med Mol Imaging 2005; 32:855.
Reproduced with permission from: Einstein AJ, Moser KW, Thompson RC, et al. Radiation Dose to Patients From Cardiac Diagnostic Imaging. Circulation 2007; 116:1290. Copyright © 2007 Lippincott Williams & Wilkins.
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