JNC: Almost 60% of nuke med cardiac labs are non-compliant

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SPECT myocardial perfusion imaging with technetium-99m (Tc99m) shows normal findings. Source: Daniel S. Berman, MD, director of cardiac imaging and nuclear cardiology at Cedars-Sinai Heart Institute

Data from the Intersocietal Commission for the Accreditation of Nuclear Medicine Laboratories (ICANL) suggest that while non-compliance with reporting standards is found in the majority of U.S. nuclear cardiology laboratories, facilities that participate in the accreditation process demonstrate an increase in compliance over time. The retrospective study was published online June 19 in the Journal of Nuclear Cardiology.

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. Thus, Peter L. Tilkemeier, MD, a nuclear cardiologist at Miriam Hospital in Providence, R.I., and colleagues sought 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.

The researchers evaluated site characteristics and the 18 elements of the ICANL nuclear cardiology reporting standards ranked by level of importance in 1,301 labs applying for accreditation from Jan. 1, 2008 to Jan. 1, 2009. 

They found that a majority of labs were non-compliant (57.2 percent) with >1 of the 18 elements, mean number of errors 2.13. There were significant differences among applications with different accreditation decisions, first application and repeat applications and region of the U.S.

Of the 18 report elements, the most frequent non-compliant items were: missing date of report (26.4 percent); separate stress and imaging reports (23.6 percent); missing the route of administration of radiopharmaceutical (22.8 percent); and no mention of the defect size, severity, type and location using standardized terminology (defect quantification; 19.8 percent).

However, the study authors also reported that laboratories with multiple re-accreditations had significantly increased compliance, which were confirmed following analysis of the ranked importance of the non-compliant elements.

Tilkemeier noted that while the ICANL accreditation process has been in existence since 1997, this is the first time that the quantity of nuclear cardiology reports has been evaluated for compliance with the ICANL Standards.

“As the final report is the single most important part of a nuclear cardiology study, it is very powerful to learn through this study that accreditation is contributing greatly to nuclear cardiology facilities’ ability to improve their reports,” he said. “We now know that accredited facilities are more likely to provide referring physicians with the accurate, standardized information they need to provide quality patient care, reducing the need for unnecessary and repetitive testing.”

He concluded: "By identifying specific non-compliant reporting elements and site characteristics associated with non-compliance, we can now target educational activities to help laboratories improve the quality of reporting and facilitate successful accreditation."