IAEA Noninvasive Cardiology Protocols Study - INCAPS 2

Closed for proposals

Project Type

Coordinated Research Project

Project Code




Approved Date

6 May 2020

Start Date

28 May 2020

Expected End Date

1 September 2025

Participating Countries

United Kingdom of Great Britain and Northern Ireland
United States of America


According to World Health Organization (WHO), non-communicable diseases (NCDs) are responsible for 52% of deaths globally. Cardiovascular disease (CVD) is   the leading cause of death from NCDs accounting for 38%, followed by cancer with 27%, respiratory diseases with 8% and diabetes with 4%.   NCDs kill 41 million people each year, equivalent to 71% of all deaths globally.
Each year, 15 million people die from NCDs between the ages of 30 and 69 years; and regrettably over 85% of these "premature" deaths occur in low- and middle-income countries (LMICs).
Cardiovascular diseases, and particularly coronary artery disease (CAD) which may lead to heart attacks and strokes, kills 17.9 million people a year, equivalent to 34% of global deaths, and it is anticipated to cross around 23 million by 2030.The second leading cause of death is cancer responsible for approximately 9.0 million deaths a year.
Despite several efforts to improve primary prevention, reducing well known risk factors associated to CVDs, such as smoke habit, obesity and diabetes among others, substantial number deaths are still occurring and require improved diagnostic tools to improve what is called secondary prevention. To properly diagnose and stratify the risk of patients with coronary artery disease (CAD), medical imaging modalities such MPI-SPECT and CCTA have been widely implemented, significantly improving patient outcomes. Unfortunately, the downside is the exposure to ionizing radiation, which could be reduced by improving clinical protocols and adopting recommenced best practices.
The IAEA Nuclear Cardiology Protocols Study 1 (INCAPS 1), initiated by the IAEA in 2013, was an observational, cross-sectional study of worldwide nuclear cardiology practice. Data were collected on protocols, technology, and best practices on Myocardial Perfusion Imaging (MPI) SPECT studies in 308 nuclear medicine laboratories in 65 countries during a single week in March-April 2013. INCAPS 1 found wide variation in practice of MPI worldwide and identified numerous areas for potential improvement. Numerous publications emanating from INCAPS 1 have addressed, region by region, challenges particularly relevant to low- and middle-income countries, adoption of best practices, and gender and age disparities.
With the dissemination of knowledge learned in INCAPS 1, and potential improvements attributable to these efforts, as well as to the availability of new developments in hardware, software and clinical protocols, the time has come to reexamine worldwide cardiac imaging practice.
More recently, two new non-invasive technologies for cardiac imaging, namely coronary computed tomography angiography (CCTA) and coronary artery calcium scoring (CACS), have grown worldwide and these emerging technologies should also be examined.
We aim to study non-invasive cardiac imaging practice across the globe, obtaining consecutive data from all patients imaged over a one-week period in at least 1000 participating laboratories worldwide, between the weeks beginning 12 October and 16 November 2020, inclusive. Participating sites will have the opportunity to contribute data on their lab’s practices in CCTA and coronary artery calcium scoring, as well as in myocardial perfusion imaging performed with Single Photon Emission Computed Tomography (SPECT) or Positron Emission Tomography (PET). With this data we will better understand practice variation in contemporary practice, including use of protocols and technology in each modality, adherence to best practices, and radiation doses. We thereby will identify potential targets for improvement, and design and test interventions to improve non-invasive cardiac imaging practices.
This CRP focusses on identifying and understanding current applications of nuclear cardiology and cardiac CT worldwide and it will offer opportunities to recognize areas for improving clinical practice


The overall objective of the CRP is to characterize worldwide CAD imaging practice and identify disparities and areas for improvement.

Specific objectives

Describe best practice use and radiation doses from SPECT and PET MPI in 2020, and compare with worldwide practice in 2013;

Describe best practice use and radiation doses from CCTA and CAC CT, and compare with those from MPI; and

Identify disparities between world regions, countries, lower-and middle income vs. upper income countries, and genders, and identify targets for focused interventions to improve the quality of CAD imaging;

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