Nuclear Medicine Service, San Antonio Military Medical Center, San Antonio, Texas; Department of Radiology, Uniformed Services University, Bethesda, Maryland.
Intersocietal Accreditation Commission, Ellicott City, Maryland.
J Am Coll Radiol. 2021 Nov;18(11):1556-1563. doi: 10.1016/j.jacr.2021.07.011. Epub 2021 Aug 8.
The aim of this study was to assess variation in diuretic renal scintigraphy (DRS) practice patterns and quantify compliance with the national guidance in a large cohort of laboratories from different institutions and practice settings across the United States.
By means of an institutional review board-approved protocol, we extracted 107 facility-specific, adult DRS protocols and associated 174 reports from the Intersocietal Accreditation Commission database, representing all laboratories applying for genitourinary scintigraphy certification during the 2016 to 2018 accreditation cycle. From these, we assessed 40 variables regarding facilities and staffing, patient preparation, examination technique and acquisition, image processing, and reporting.
Review of protocols and reports demonstrates a very high degree of variability in DRS practice across the United States and suboptimal compliance with societal guidelines and practice parameters. Some of the more variable or underreported parameters include the use of patient hydration, type and dosage of radiopharmaceutical, dosage and timing of diuretic administration, quantitative parameters assessed, and report content.
There is high variability in the performance and reporting of DRS among laboratories applying for accreditation, similar to that seen in studies of other nuclear medicine examinations. The wide degree of practice variance may have a significant impact on diagnostic accuracy and patient management, with inaccurate or incomplete results. This survey impresses the need for standardization and improved quality of this important nuclear medicine examination.
本研究旨在评估美国不同机构和实践环境的大量实验室中利尿剂肾闪烁扫描（DRS）实践模式的变化，并量化其对国家指南的遵从性。
通过机构审查委员会批准的方案，我们从协会间认证委员会数据库中提取了 107 项特定于机构的成人 DRS 方案和相关的 174 份报告，这些报告代表了在 2016 年至 2018 年认证周期中申请泌尿生殖系统闪烁成像认证的所有实验室。从这些报告中，我们评估了 40 个关于设施和人员配备、患者准备、检查技术和采集、图像处理以及报告的变量。
对方案和报告的审查表明，美国 DRS 实践存在很大程度的变异性，并且不符合社会指南和实践参数的要求。一些更具变异性或报告不足的参数包括患者水化的使用、放射性药物的类型和剂量、利尿剂给药的剂量和时间、评估的定量参数以及报告内容。
在申请认证的实验室中，DRS 的性能和报告存在很大的变异性，这与其他核医学检查的研究相似。实践差异的广泛程度可能对诊断准确性和患者管理产生重大影响，导致结果不准确或不完整。这项调查强调了对这一重要核医学检查进行标准化和提高质量的必要性。
