Mahajan Ashish, Bal Susan, Hahn Harvey
Department of Internal Medicine, Kettering Medical Center, 3535 Southern Boulevard, Kettering, OH, 45429, USA.
J Nucl Cardiol. 2015 Feb;22(1):66-71. doi: 10.1007/s12350-014-9995-0. Epub 2014 Oct 2.
Inappropriate cardiac imaging has been a significant cost concern and cause of radiation burden to patients.
To assess if a smartphone application (app) based on 2009 Appropriate Use Criteria (AUC) for Cardiac Radionuclide Imaging published by American College of Cardiology would be feasible at the point of order.
We evaluated stress myocardial perfusion imaging (MPI) (N = 403) (mean age = 62.23 years; 47.89% males) over a 4 month period using a smartphone app to determine whether the study ordered was Appropriate, Inappropriate, or Uncertain per 2009 AUC. We also monitored the time needed to use the app to determine the level of appropriateness of each stress MPI. The results of the stress MPI were noted.
Of the 403 stress MPIs evaluated, 267 (66.25%) were noted to be Appropriate, 118 (29.28%) were Inappropriate, and 13 (3.23%) were Uncertain, per AUC; 5 (1.25%) remained unclassified. Average time needed to use the app to assess each stress MPI for appropriateness was noted to be 44 (±9) seconds. Non-teaching physicians ordered 70 (38.89%) inappropriate stress MPIs as compared to 20 (23.53%) ordered by physicians on resident teaching service, and 28 (23.33%) by cardiologists (P = .0045). Among inappropriately ordered stress MPIs, 87 (42.65%) were ordered in females as compared to 31 (17.13%) in males (P < .0001). 70 (26.22%) stress MPIs among appropriately ordered were abnormal (reversible ischemia or fixed perfusion defect) as compared to 15 (12.17%) among inappropriately ordered stress MPIs (P = .0032).
A free and convenient smartphone app provides an easy-to-use tool to assist physicians in determining the level of appropriateness of stress MPI in a time- and cost-effective manner at the point of order. The smartphone app may have potential to promote the usage of the AUC and possibly aid reduction of healthcare cost and ionizing radiation burden.
不恰当的心脏成像一直是一个重大的成本问题，也是患者辐射负担的一个原因。
评估一款基于美国心脏病学会发布的2009年心脏放射性核素成像适宜使用标准（AUC）的智能手机应用程序（app）在开单时是否可行。
我们在4个月的时间里使用一款智能手机应用程序评估了403例负荷心肌灌注成像（MPI）（平均年龄 = 62.23岁；47.89%为男性），以根据2009年AUC确定所开的检查是适宜、不适宜还是不确定。我们还监测了使用该应用程序确定每次负荷MPI适宜性水平所需的时间。记录了负荷MPI的结果。
根据AUC，在评估的403例负荷MPI中，267例（66.25%）被认为是适宜的，118例（29.28%）是不适宜的，13例（3.23%）是不确定的；5例（1.25%）仍未分类。使用该应用程序评估每次负荷MPI适宜性所需的平均时间为44（±9）秒。非教学医生开出了70例（38.89%）不恰当的负荷MPI，而住院医师教学服务的医生开出了20例（23.53%），心脏病专家开出了28例（23.33%）（P = 0.0045）。在不恰当开出的负荷MPI中，女性有87例（42.65%），而男性有31例（17.13%）（P < 0.0001）。在适宜开出的负荷MPI中，70例（26.22%）异常（可逆性缺血或固定灌注缺损），而在不恰当开出的负荷MPI中为15例（12.17%）（P = 0.0032）。
一款免费且便捷的智能手机应用程序提供了一个易于使用的工具，可协助医生在开单时以具有时间和成本效益的方式确定负荷MPI的适宜性水平。该智能手机应用程序可能有潜力促进AUC的使用，并可能有助于降低医疗成本和电离辐射负担。
