Baron J M, Chouraqui P
Nuclear Medicine Department, Tel Aviv Medical Center, Israel.
J Nucl Cardiol. 1996 Mar-Apr;3(2):157-66. doi: 10.1016/s1071-3581(96)90008-2.
In this era of cost constraints in health care and the growing demand for cost-effective clinical strategies, the nuclear cardiologist is under increasing pressure to show clear evidence that myocardial imaging studies compete favorably with other modalities. This underlines the need for ensuring consistently high image quality and accuracy using optimally chosen standardized protocol. Nuclear medicine imaging has not yet reached the level of standardization, automation, and built-in quality control of imaging modalities such as ultrasound or x-ray computerized tomography, where the press of a button guarantees a consistent high-quality image. This is due to the large number of parameters and other factors affecting image quality that each individual operator still has to choose or be aware of before commencing imaging. Of crucial importance is ensuring the correct collection of the raw data. Processing can be repeated, but errors in the raw data, if detected at all, require repeating the entire study. These errors can cause artifacts that are difficult or impossible to recognize and are the major causes of incorrect reporting. Examples are a poorly prepared radiopharmaceutical, a poor injection, scatter from "hot" areas outside myocardium, an undetected change in the photopeak window, uniformity, or center of rotation, insufficient acquisition time, camera too far from the patient, etc. The first step to guarantee consistent image quality and accuracy is the preparation and strict implementation of a quality assurance program covering all the individual stages of the procedure starting from preparation of the radiopharmaceutical and ending with processing, display, and reporting. The next step is the standardization of optimally chosen protocols with maximization of automation. Rapid built-in automated software-driven equipment quality control checks should be developed. Finally, attenuation and scatter correction, gated single-photon emission computed tomography, and the advent of digital cameras will no doubt improve quantitation and accuracy even further following clinical evaluation in close cooperation with manufacturers who have the incentive to accelerate all the above steps.
在这个医疗保健面临成本限制且对具有成本效益的临床策略需求不断增长的时代，核心脏病专家面临着越来越大的压力，需要拿出明确证据证明心肌成像研究与其他检查手段相比具有优势。这凸显了使用精心挑选的标准化方案来确保始终如一的高图像质量和准确性的必要性。核医学成像尚未达到超声或X射线计算机断层扫描等成像方式所具有的标准化、自动化和内置质量控制水平，在那些成像方式中，按下一个按钮就能保证获得始终如一的高质量图像。这是因为在开始成像之前，每个操作人员仍需选择或了解大量影响图像质量的参数和其他因素。至关重要的是要确保正确采集原始数据。处理过程可以重复，但原始数据中的错误（如果能被检测到的话）需要重复整个研究。这些错误会导致难以识别或无法识别的伪影，是报告错误的主要原因。例如放射性药物准备不佳、注射不当、心肌外“热点”区域的散射、光电峰窗口、均匀性或旋转中心未被检测到的变化、采集时间不足、相机离患者太远等。保证图像质量和准确性一致的第一步是制定并严格实施一项质量保证计划，该计划涵盖从放射性药物准备到处理、显示和报告的整个操作过程的各个阶段。下一步是使精心挑选的方案标准化并最大限度地实现自动化。应开发快速的内置自动软件驱动的设备质量控制检查程序。最后，衰减和散射校正、门控单光子发射计算机断层扫描以及数码相机的出现，无疑将在与有动力加速上述所有步骤的制造商密切合作进行临床评估之后，进一步提高定量分析和准确性。
