Abstract
One of the most effective techniques to improve quality is to measure quality. The aim of this article is to defend the importance of quality measurement in nuclear medicine utilizing the long-standing problem of submaximal exercise stress testing. Numerous evidence-based guidelines and research studies establish the importance of maximal stress testing for myocardial perfusion imaging. The three cutoff thresholds that indicate adequate cardiac stress that must all be met include expenditure of five metabolic equivalents (METs) of energy, production of symptoms (e.g., fatigue or shortness of breath), and attainment of 85 percent of the maximum predicted heart rate. Measurement and evaluation of these three criteria along with several other metrics can help to validate one aspect of laboratory quality related to myocardial perfusion imaging accuracy.