Original ArticleThe nuclear cardiology report: Problems, predictors, and improvement. A report from the ICANL database
Introduction
The report from any testing facility to the requesting physician is the single most important part of the test as it communicates the result of the test to the patient’s health care provider, allowing them to act on the result and provide meaningful care. The importance of this communication has been emphasized in both the cardiology and the radiology literature for more than a decade and has recently received increased emphasis in an effort to reduce repeat testing and control cost.1, 2, 3, 4, 5, 6 Myocardial perfusion imaging serves as the “gatekeeper” for an increasing number of invasive cardiology procedures that are performed as a result of the myocardial perfusion imaging study. Therefore, it is essential that the results are reported accurately and concisely to reduce the need for unnecessary and repetitive testing and decrease patient risk. To improve quality in nuclear cardiology, leaders in the field of nuclear cardiology, nuclear medicine and positron emission tomography (PET) formed the Intersocietal Commission for the Accreditation of Nuclear Medicine Laboratories (ICANL) in December 1997. ICANL is charged with promoting quality diagnostic nuclear medicine testing, utilizing a peer-review laboratory accreditation process. Well-defined standards of quality serve as the foundation of the program, to improve the quality of testing, and assure that the services provided by the accredited facilities meet minimum levels of care.
The ICANL Standards are based upon published guidelines from the related professional organizations and are an extensive document defining the minimal requirements laboratories must meet in order to achieve accreditation. The Standards are electronically available at www.icanl.org.7,8 Included in the accreditation process is the thorough evaluation of all aspects of laboratory operations inclusive of staff qualifications, policies and procedures, image quality, reporting and outcomes, and quality assessment.
One of the most significant aspects in the assessment of the laboratory is evaluation of the final imaging report. The report must clearly detail useful results to the referring physician and is required to contain standard data elements. The quality of the nuclear cardiology report has never been systematically evaluated across a large sample of nuclear cardiology laboratories in the United States.
This study was designed retrospectively with three aims: (1) identify the compliance of applicant nuclear cardiology laboratories with The ICANL Standards, based on the required reporting elements; (2) to examine characteristics of nuclear cardiology laboratories across the United States to determine whether there were differences in reporting compliance and identify potential mechanisms for improving the quality of the report across laboratories; and (3) to examine the non-compliant reporting elements ranked according to their relative importance in relation to the nuclear cardiology laboratory characteristics.
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Methods
From January 1, 2008 to January 1, 2009, 1,301 laboratories applying for ICANL accreditation were evaluated to determine compliance with the 18 data elements of the ICANL nuclear cardiology reporting standards. Site characteristics for each laboratory were also evaluated. Two trained independent reviewers (one physician and one nuclear medicine technologist) from a pool of 99 with expert knowledge of the ICANL standards performed the review. Each reviewer determined compliance of the reports
Aim 1: Elements of Reporting Standards
Descriptions of the site characteristics are presented in Table 1. A majority of the laboratories were non-compliant with reporting standards, with 57.2% reporting at least one element of non-compliance. The mean number of non-compliant elements per lab was 2.13 ± 2.58 (range 0-12, total possible 0-18). The top four non-compliant elements were: missing date of report (26.4%), separate stress and imaging reports (23.6%), missing the route of administration of radiopharmaceutical (22.8%), and no
Discussion
The compliance of nuclear cardiology laboratories with the ICANL reporting standards has important areas that can be improved. For those laboratories participating in the ICANL accreditation process in 2008, a majority of laboratories across the nation are non-compliant with reporting standards (57.2%). Site characteristics that were associated with non-compliance were: accreditation decision, accreditation cycle, region of the U.S., type of laboratory, and volume of RMPI tests conducted.
Acknowledgments
The authors wish to acknowledge Shira Dunsiger, Ph.D. for her invaluable insight and perspective regarding the statistical analyses conducted as part of this study. We would additionally acknowledge the assistance of Elizabeth Gemignani for graphical design assistance with the figure.
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See related editorial, doi:10.1007/s12350-011-9417-5.