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Many variables can influence the results of gastric emptying scintigraphy (GES). A lack of standardization causes variability, limits comparisons, and decreases the credibility of the study. To increase standardization, in 2009 the Society of Nuclear Medicine and Molecular Imaging (SNMMI) published a guideline for a standardized, validated GES protocol for adults based on a 2008 consensus document. Laboratories must closely follow the consensus guideline to provide valid and standardized results as an incentive to achieve consistency in patient care. As part of the accreditation process, the Intersocietal Accreditation Commission (IAC) evaluates compliance with such guidelines. The rate of compliance with the SNMMI guideline was assessed in 2016 and showed a substantial degree of noncompliance. The aim of this study was to reassess compliance with the standardized protocol across the same cohort of laboratories, looking for changes and trends. Methods: The IAC nuclear/PET database was used to extract GES protocols from all laboratories applying for accreditation from 2018 to 2021, 5 y after the initial assessment. The number of labs was 118 (vs. 127 in the initial assessment). Each protocol was again evaluated for compliance with the methods described in the SNMMI guideline. The same 14 variables were assessed in a binary fashion: patient preparation (4 variables-types of medications withheld, withholding of these medication for 48 h, blood glucose ≤ 200 mg/dL, blood glucose recorded), meal (5 variables-use of consensus meal, nothing by mouth for 4 h or more, meal consumed within 10 min, documentation of percentage of meal consumed, meal labeled with 18.5-37 MBq [0.5-1.0 mCi]), acquisition (2 variables-anterior and posterior projections obtained, imaging each hour out to 4 h), and processing (3 variables-use of the geometric mean, decay correction of data, and measurement of percentage retention). Results: Protocols from the 118 labs demonstrated that compliance is improving in some key areas but remains suboptimal in others. Overall, labs were compliant with an average of 8 of the 14 variables, with a low of 1-variable compliance at 1 site, and only 4 sites compliant with all 14 variables. Nineteen sites met an 80% threshold for compliance (11+ variables). The variable with the highest compliance was the patient's taking nothing by mouth for 4 h or more before the exam (97%). The variable with the lowest compliance was the recording of blood glucose values (3%). Notable areas of improvement include the use of the consensus meal, now 62% versus previously only 30% of labs. Greater compliance was also noted with measurement of retention percentages (instead of emptying percentages or half-times), with compliance by 65% of sites versus only 35% 5 y prior. Conclusion: Almost 13 y after the publication of the SNMMI GES guidelines, there is improving but still suboptimal protocol adherence among laboratories applying for IAC accreditation. Persistent variation in the performance of GES protocols may significantly affect patient management, as results may be unreliable. Using the standardized GES protocol permits interpretation of results in a consistent manner that allows interlaboratory comparisons and fosters acceptance of the test validity by referring clinicians., (© 2024 by the Society of Nuclear Medicine and Molecular Imaging.)

Objective: The aim of this study was to assess variation in diuretic renal scintigraphy (DRS) practice patterns and quantify compliance with the national guidance in a large cohort of laboratories from different institutions and practice settings across the United States., Methods: By means of an institutional review board-approved protocol, we extracted 107 facility-specific, adult DRS protocols and associated 174 reports from the Intersocietal Accreditation Commission database, representing all laboratories applying for genitourinary scintigraphy certification during the 2016 to 2018 accreditation cycle. From these, we assessed 40 variables regarding facilities and staffing, patient preparation, examination technique and acquisition, image processing, and reporting., Results: Review of protocols and reports demonstrates a very high degree of variability in DRS practice across the United States and suboptimal compliance with societal guidelines and practice parameters. Some of the more variable or underreported parameters include the use of patient hydration, type and dosage of radiopharmaceutical, dosage and timing of diuretic administration, quantitative parameters assessed, and report content., Conclusion: There is high variability in the performance and reporting of DRS among laboratories applying for accreditation, similar to that seen in studies of other nuclear medicine examinations. The wide degree of practice variance may have a significant impact on diagnostic accuracy and patient management, with inaccurate or incomplete results. This survey impresses the need for standardization and improved quality of this important nuclear medicine examination., (Published by Elsevier Inc.)

The purpose of this document is to assist nuclear medicine practitioners in recommending, performing, interpreting, and reporting the results of gated equilibrium radionuclide angiocardiography (ERNA)., (© 2020 by the Society of Nuclear Medicine and Molecular Imaging.)

Background: Intersocietal Accreditation Commission (IAC) accreditation is granted or delayed depending on the fulfillment of several quality metrics. Investing in up-to-date equipment might reflect a commitment to quality., Methods: Data from echocardiography (n = 3079) and nuclear cardiology (n = 1835) accreditation applications submitted between 2012 and 2014 were evaluated to determine the mean age of laboratory equipment. Laboratory quality was assessed by the number of missing quality metrics, and a composite quality score was calculated as the sum of missing quality metrics. A lower score thus represented better laboratory quality. The relationship between equipment age and quality was explored as an interaction term between equipment age and the composite quality score and was incorporated into regression models for prediction of accreditation status., Results: During the study period, 49% of echocardiography and 42% of nuclear laboratories were granted accreditation without delay. For both echocardiography and nuclear laboratories, there was a statistically significant trend toward an increasing number of missing quality metrics with increasing quartiles of equipment age. The interaction between equipment age and the composite quality score was a significant predictor of delay of accreditation for both echocardiography and nuclear cardiology laboratories, with a stronger association for 1st-time applicants. Among sites applying for accreditation in both modalities simultaneously, accreditation in one modality predicted the accreditation decision for the other., Conclusions: Laboratory quality is an important determinant of IAC accreditation, and equipment age is an effect modifier of this relationship. Contemporary equipment likely reflects a commitment to quality, for both echocardiography and nuclear laboratories., (© 2019 Wiley Periodicals, Inc.)

Background: The aim of this study was to evaluate reporting compliance of laboratories applying for serial accreditation by the Intersocietal Accreditation Commission (IAC) and compare compliance based on laboratory characteristics., Methods: All laboratories applying for IAC accreditation for the first time in 2008 and then twice more (2011-2014) were evaluated for compliance with 18 reporting elements. The elements were ranked into three severity groups (high/moderate/low)., Results: Reports from 523 laboratories were evaluated. The percentage of laboratories with reporting issues by cycle was 66.2% for cycle 1, 36.7% for cycle 2, and 43.8% for cycle 3 (p < .001). For most of the 18 elements, there was a significant decrease in the percentage of labs with issues. Less moderate and high severity errors were seen over time. Also, the mean non-compliant elements per laboratory decreased from 5.78 ± 2.72 at cycle 1, down to 1.25 ± 1.77 at cycle 3., Conclusions: In facilities applying for 3 consecutive IAC accreditation cycles, reporting compliance with IAC Standards improved between cycles 1-2 and 1-3. No significant improvement occurred between cycles 2-3. Although the quality of reports improved overall, problems remain in quantifying myocardial perfusion defects, documenting report approval date, and integrating stress and imaging reports.

In 2015, the Society of Nuclear Medicine and Molecular Imaging Technologist Section (SNMMI-TS) launched a multiyear quality initiative to help prepare the technologist workforce for an evidence-based health-care delivery system that focuses on quality. To best implement the quality strategy, the SNMMI-TS first surveyed technologists to ascertain their perception of quality and current measurement of quality indicators. Methods: An internet survey was sent to 27,989 e-mail contacts. Questions related to demographic data, perceptions of quality, quality measurement, and opinions on the minimum level of education are discussed in this article. Results: A total of 4,007 (14.3%) responses were received. When asked to list 3 words or phrases that represent quality, there were a plethora of different responses. The top 3 responses were image quality, quality control, and technologist education or competency. Surveying patient satisfaction was the most common quality measure (80.9%), followed by evaluation of image quality (78.2%). Evaluation of image quality (90.3%) and equipment functionality (89.4%) were considered the most effective measures. Technologists' differentiation between quality, quality improvement, quality control, quality assurance, and quality assessment seemed ambiguous. Respondents were confident in their ability to assess and improve quality at their workplace (91.9%) and agreed their colleagues were committed to delivering quality work. Of note, 70.7% of respondents believed that quality is directly related to the technologist's level of education. Correspondingly, respondents felt there should be a minimum level of education (99.5%) and that certification or registry should be required (74.4%). Most respondents (59.6%) felt that a Bachelor's degree should be the minimum level of education, followed by an Associate's degree (40.4%). Conclusion: To best help nuclear medicine technologists provide quality care, the SNMMI-TS queried technologists to discern perceptions of quality in nuclear medicine. The results show that technologists believe image quality and quality control are the most important determinants. Most respondents felt that quality is directly related to the level of education of the technologist acquiring the scan. However, the responses obtained also demonstrated variation in perception of what represents quality. The SNMMI-TS can use the results of the study as a benchmark of current technologists' knowledge and performance of quality measures and target educational programs to improve the quality of nuclear medicine and molecular imaging., (© 2017 by the Society of Nuclear Medicine and Molecular Imaging.)

Clinical protocols play an important role in the provision of high-quality care in nuclear medicine. Properly written protocols help to ensure that nuclear medicine procedures are performed in a standardized, reproducible manner so that patients receive high-quality care. The following article is the second in a 2-part series on how to write a protocol. A framework for composing protocols and the components of clinical imaging protocols were detailed in the first article. This article details the framework and components of protocols for cardiac stress testing, therapy, and quality control., (© 2015 by the Society of Nuclear Medicine and Molecular Imaging, Inc.)

Clinical imaging protocols play an important role in the provision of high-quality care in nuclear medicine. It is imperative that all nuclear medicine facilities have protocols for every procedure performed. However, creating protocols that are detailed, unambiguous, and consistent is often easier said than done. Properly written protocols help to ensure that nuclear medicine procedures are performed in a standardized, reproducible manner so that patients receive high-quality care. This 2-part article provides technologists with a framework for composing comprehensive protocols. Part 1 discusses the secrets to successfully composing protocols ensuring they are detailed and step-by-step along with the importance of basing protocols on evidence from published guidelines and peer-reviewed literature. The components and important aspects of clinical imaging protocols are detailed., (© 2015 by the Society of Nuclear Medicine and Molecular Imaging, Inc.)

Innovations and improvements in the field of nuclear medicine have created remarkable image accuracy and detail, which allow physicians to better diagnose disease. This ability has led to dramatic differences in patient care. To ensure that these diagnoses are reliable, imaging facilities must constantly monitor and seek to improve their practices. Quality improvement is a formal process of examining and improving performance through the analysis of data with the primary goal of enhancing patient care. Quality improvement activities in a nuclear medicine laboratory should emphasize accuracy and efficiency, patient and staff safety, and the patient's experience during care. Quality improvement in the nuclear medicine laboratory can potentially reduce the number of studies that need to be repeated because of poor quality, increase diagnostic accuracy, reduce radiation exposure, increase patient satisfaction, and save resources. This article will review the process of quality improvement; provide detailed, step-by-step instructions with special emphasis on project selection and data collection; and show examples of how to perform quality improvement projects.

There has been a significant increase in cardiac radionuclide imaging over the past decade, leading to a corresponding increase in scrutiny from Federal and private health plans questioning the necessity of these tests. In response to efforts by third-party payers to limit all types of cardiovascular imaging studies, the American College of Cardiology Foundation, in conjunction with other professional societies, developed appropriate use criteria. The goal of this article is to explain how the criteria were created and define the 3 categories of indications: appropriate, inappropriate, and uncertain. Tips for using appropriate use criteria and tables, including a definition of several key terms technologists should be familiar with, will be provided. In addition, reimbursement, benchmark data, and practical considerations for implementation will be discussed. Finally, several tools to aid in calculating appropriateness are suggested. With a basic understanding, the appropriate use criteria are relatively easy to apply. It is important for facilities to begin to voluntarily incorporate them into their practice and document levels of appropriateness now as payers are developing 2 trends that are not favorable for nuclear cardiology: preauthorization and denial of payment for inappropriate studies.

Background: The quality of nuclear cardiology reports is essential for the effective communication of results of cardiac radionuclide imaging and has never been evaluated for compliance with the ICANL standards. This retrospective study was designed to evaluate required reporting elements and site characteristics to determine differences in the compliance of applicant nuclear cardiology laboratories with The ICANL Standards, and identify potential mechanisms for improvement., Methods and Results: Site characteristics and the 18 elements of the ICANL nuclear cardiology reporting standard ranked by level of importance were evaluated in 1,301 labs applying for accreditation from 1/1/08 to 1/1/09. A majority of labs were non-compliant (57.2%) with ≥1 of the 18 elements, mean number of errors 2.13 ± 2.58. There were significant differences among applications with different accreditation decisions, first application and repeat applications, and region of the United States. Laboratories with multiple re-accreditations had significantly increased compliance. These findings were confirmed following analysis of the ranked importance of the non-compliant elements., Conclusions: Nuclear cardiology reports have a high degree of non-compliance with the current ICANL standards. There were identifiable characteristics defining labs more likely to be non-compliant. Feedback from prior applications improves compliance with reporting standards on subsequent applications.

Molecular imaging technologists are faced with statistics on a daily basis because they image patients who have been selected for diagnostic testing based on analysis of how well the test performs, and because technical factors can influence the performance of any diagnostic test. Choosing what test procedure to perform on which patient is a matter of understanding the patient's pretest likelihood of disease, the performance characteristics of the diagnostic test, and other clinical factors which may impact the usefulness of the results. Terms such as sensitivity, specificity, accuracy, and predictive value are used to describe how a diagnostic test performs, or how it compares to other diagnostic tests. While nuclear medicine and PET technologists study these concepts in training programs, applying this learning to daily patient care can be daunting given that new tracers and technologies are continuously moving into clinical practice. Research advances continue to challenge diagnostic paradigms with new patient populations, increasingly sophisticated technology, and the advent of large databases with which to study population outcomes. This article is part I of a two-part series. The purpose of this article is to provide a refresher about basic clinical statistics that are useful in understanding how diagnostic testing is optimally applied in the patient care setting. [ABSTRACT FROM AUTHOR]