Worldwide Radiation Dose in Coronary Artery Disease Diagnostic Imaging
Authors' conclusion
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.
Study context
- Population
- Adults undergoing noninvasive coronary artery disease (CAD) diagnostic testing during a single week, October–December 2023
- Participants
- 19,302 adults742 centers101 countries
- Exposure
- Radiation dose across noninvasive CAD imaging modalities
- Outcome
- Radiation effective dose to patients and % of centers with median effective dose ≤9 mSv (guideline recommendation)
Methodological detailsworldwide, consecutive sample, 742 centers in 101 countries
- Worldwide
- Consecutive sample
- 742 centers in 101 countries
Main finding
As reported in the abstract
Effective dose
Centers achieving median dose ≤9 mSv
81% vs 56%
P < 0.001
Nuclear cardiology vs coronary computed tomography angiography (CCTA)
Patients achieving median dose ≤9 mSv
79% vs 56%
P < 0.001
Nuclear cardiology vs CCTA
Observational data: associations, not effects.
Further findings
| Outcome | % higher dose (95% CI) | P value |
|---|---|---|
| Dose by country income level (regression)Low- and middle-income countries vs High-income countries · nuclear cardiology | 20% (3.6%–38.4%) | |
| Dose by country income level (regression)Low- and lower-middle-income countries vs High-income countries · CCTA | 96% (41.7%–170.8%) | P < 0.001 |
Dose by world region
- Lowest in Western Europe, nuclear cardiology (median [IQR], mSv)
- 4.8 [2.3-7.3]
- Lowest in Western Europe, CCTA (median [IQR], mSv)
- 4.6 [2.4-9.8]
- Highest in Latin America, nuclear cardiology (median [IQR], mSv)
- 7.8 [5.3-9.7]
- Highest in Africa, CCTA (median [IQR], mSv)
- 25.2 [14.7-35.3]
- P < .001 for all
Dose by country income level (regression)
- Inverse relationship between country income level and dose; marked variation within income levels and regions
Original publication
Worldwide Radiation Dose in Coronary Artery Disease Diagnostic Imaging. JAMA. Published 7 April 2026. doi:10.
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