Compliance with Gastric-Emptying Scintigraphy Guidelines: A Report from the Intersocietal Accreditation Commission Database

Abstract

Many variables can influence the results of the gastric emptying scintigraphy (GES). A lack of methodologic standardization may cause variability, limit comparisons, and decrease the credibility of the test. To address this, in 2009, the SNMMI published Procedure Guideline for Adult Solid-Meal Gastric-Emptying Study 3.0 which describes a standardized, validated GES protocol. Laboratories must closely follow the consensus protocol to provide valid and standardized results and improve patient care. The Intersocietal Accreditation Commission (IAC) evaluates compliance with guidelines as part of the accreditation process. The rate of compliance with the GES guideline at a national level has not been assessed. The aim of this study was to quantify the compliance to the standardized protocol in a large cohort of laboratories from different institutions and practice settings across the United States. Methods: The IAC Nuclear/PET database was used to extract GES protocols from all laboratories applying for accreditation from 2013-2015. Each protocol was assessed for compliance with the methods described in the SNMMI GES procedure guidelines. Fourteen binary variables were assessed: patient preparation (4), meal content (5), acquisition (2) and processing (3). Results: Protocols from 127 labs demonstrated that patient preparation was the least compliant category of variables. Instructions for blood glucose monitoring and withholding of medications were problematic. Overall, 69.3% of protocols were not compliant with the content or preparation of the consensus meal. 47.3% used whole eggs instead of egg whites. Additional ingredients not recommended in the guidelines were also frequently used. Only 3.1% of laboratories were fully compliant with all 14 variables. Over half of all laboratories were compliant with ≤5 variables. Conclusion: Almost eight years after the publication of the SNMMI GES guidelines, there is low protocol adherence among laboratories applying for IAC Nuclear/PET accreditation. This substantial degree of guideline noncompliance is concerning. The variability in GES protocols may have a significant effect on patient management, as results may be inaccurate. Consistent use of the standardized GES protocol permits interpretation of results in a standard manner allowing inter-laboratory comparisons and fosters acceptance of the test validity by referring clinicians.