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Intersocietal Commision for the Accreditation of Nuclear Medicine Laboratories (ICANL) position statement on standardization and optimization of nuclear cardiology reports
INTERSOCIETAL COMMISSION FOR THE ACCREDITATION OF NUCLEAR MEDICINE LABORATORIES (ICANL) POSITION STATEMENT Intersocietal Commission for the Accreditation of Nuclear Medicine Laboratories (ICANL) position statement on standardization and optimization of nuclear cardiology reports Frans J.Th. Wackers, MD, PhD
Substantial progress has been made in the last few years with regard to the standardization of the acquisition, display, and interpretation of nuclear cardiology procedures. It is presumed that standardization will ultimately lead to uniformly improved quality of cardiac imaging. However, the quality of the “end product” (ie, the nuclear cardiology report) has not received the attention it deserves. Nevertheless, it is clear that the quality of reports to the referring physician determines the overall image, appreciation, and clinical value of nuclear cardiology in mainstream clinical cardiology. Although Cerquiera1 and the ASNC Guidelines2 part 2 detailed the required components of an optimized nuclear cardiology report, no examples of standard reports that can be used as a reference have been published. Thus individual nuclear cardiologists prepare nuclear cardiology reports in their own style. As a result, reports are highly variable in form and content among different laboratories. Reports may range from a few dictated sentences to computer-generated database printouts or a personalized letter to referring physicians. They may contain merely a description of images, or they may be prepared as a mini cardiology President, Intersocietal Commission for the Accreditation of Nuclear Laboratories. Reprint requests: Sandra Katanik, Intersocietal Commission for the Accreditation of Nuclear Medicine Laboratories, 8840 Stanford Blvd, Ste 4900, Columbia, MD 21045 J Nucl Cardiol 2000;7:397-400. Copyright © 2000 by the American Society of Nuclear Cardiology. 1071-3581/2000/$12.00 + 0 43/1/108576 doi:10.1067/mnc.2000.108576
consultation. A poor-quality report, which is purely descriptive and ambiguous, is at best of little value to the referring physician and at worst, confusing, useless, and potentially harmful for patient care. In addition, in many laboratories, the stress electrocardiogram report is a completely separate entity from the nuclear imaging report. This is a potential problem when the results of the 2 tests are discordant. The most important purpose of a nuclear cardiology report is to communicate the findings and clinical implications of the stress test and nuclear images to a referring physician. Thus the report should help a referring physician in making clinical management decisions. The referring physician is entitled to a clear conclusion: normal or abnormal and if abnormal, how severely abnormal. The report may indicate, when appropriate, whether the risk for future cardiac events is low, moderate, or high. Certain imaging findings may have different clinical implications, depending on the clinical context and the results of stress testing. These nuances should be conveyed in an optimal report. If there were technical limitations to the study that have an impact on the final interpretation, such limitations need to be stated. The second purpose of a report is to document for reimbursement purposes the kind of services provided. In reviewing laboratory applications for accreditation in Nuclear Cardiology, the reviewers of the Intersocietal Commission for the Accreditation of Nuclear Laboratories (ICANL) frequently observed that the quality of reports was suboptimal, even in laboratories that were in compliance with standards for accredi397
398
Wackers Standardization and optimization of nuclear cardiology reports
Journal of Nuclear Cardiology July/August 2000
Journal of Nuclear Cardiology Volume 7, Number 4;397-400
Wackers Standardization and optimization of nuclear cardiology reports
399
400
Wackers Standardization and optimization of nuclear cardiology reports
tation in all other aspects. Because no published standards for the reporting of nuclear cardiology studies exist, the Board of Directors of the ICANL thought it opportune to publish these suggested templates of standard reports. Figures 1 to 3 provide sample templates for standard nuclear cardiology reports, as far as form and content are concerned. Obviously, reports can be individualized to personal style and needs. For more information about accreditation visit the ICANL website at www.icanl.org.
Journal of Nuclear Cardiology July/August 2000
References 1. Cerqueira MD. The user-friendly nuclear cardiology reports: what needs to be considered and what is included (editorial point of view). J Nucl Cardiol 1996;3:350-5. 2. Port SC, editor. Imaging guidelines for nuclear cardiology procedures. Part 2. J Nucl Cardiol 1999;6:G47 - G84.
These templates were endorsed by the Board of Directors of ICANL on April 28, 2000.
Substantial progress has been made in the last few years with regard to the standardization of the acquisition, display, and interpretation of nuclear cardiology procedures. It is presumed that standardization will ultimately lead to uniformly improved quality of cardiac imaging. However, the quality of the “end product” (ie, the nuclear cardiology report) has not received the attention it deserves. Nevertheless, it is clear that the quality of reports to the referring physician determines the overall image, appreciation, and clinical value of nuclear cardiology in mainstream clinical cardiology. Although Cerquiera1 and the ASNC Guidelines2 part 2 detailed the required components of an optimized nuclear cardiology report, no examples of standard reports that can be used as a reference have been published. Thus individual nuclear cardiologists prepare nuclear cardiology reports in their own style. As a result, reports are highly variable in form and content among different laboratories. Reports may range from a few dictated sentences to computer-generated database printouts or a personalized letter to referring physicians. They may contain merely a description of images, or they may be prepared as a mini cardiology President, Intersocietal Commission for the Accreditation of Nuclear Laboratories. Reprint requests: Sandra Katanik, Intersocietal Commission for the Accreditation of Nuclear Medicine Laboratories, 8840 Stanford Blvd, Ste 4900, Columbia, MD 21045 J Nucl Cardiol 2000;7:397-400. Copyright © 2000 by the American Society of Nuclear Cardiology. 1071-3581/2000/$12.00 + 0 43/1/108576 doi:10.1067/mnc.2000.108576
consultation. A poor-quality report, which is purely descriptive and ambiguous, is at best of little value to the referring physician and at worst, confusing, useless, and potentially harmful for patient care. In addition, in many laboratories, the stress electrocardiogram report is a completely separate entity from the nuclear imaging report. This is a potential problem when the results of the 2 tests are discordant. The most important purpose of a nuclear cardiology report is to communicate the findings and clinical implications of the stress test and nuclear images to a referring physician. Thus the report should help a referring physician in making clinical management decisions. The referring physician is entitled to a clear conclusion: normal or abnormal and if abnormal, how severely abnormal. The report may indicate, when appropriate, whether the risk for future cardiac events is low, moderate, or high. Certain imaging findings may have different clinical implications, depending on the clinical context and the results of stress testing. These nuances should be conveyed in an optimal report. If there were technical limitations to the study that have an impact on the final interpretation, such limitations need to be stated. The second purpose of a report is to document for reimbursement purposes the kind of services provided. In reviewing laboratory applications for accreditation in Nuclear Cardiology, the reviewers of the Intersocietal Commission for the Accreditation of Nuclear Laboratories (ICANL) frequently observed that the quality of reports was suboptimal, even in laboratories that were in compliance with standards for accredi397
398
Wackers Standardization and optimization of nuclear cardiology reports
Journal of Nuclear Cardiology July/August 2000
Journal of Nuclear Cardiology Volume 7, Number 4;397-400
Wackers Standardization and optimization of nuclear cardiology reports
399
400
Wackers Standardization and optimization of nuclear cardiology reports
tation in all other aspects. Because no published standards for the reporting of nuclear cardiology studies exist, the Board of Directors of the ICANL thought it opportune to publish these suggested templates of standard reports. Figures 1 to 3 provide sample templates for standard nuclear cardiology reports, as far as form and content are concerned. Obviously, reports can be individualized to personal style and needs. For more information about accreditation visit the ICANL website at www.icanl.org.
Journal of Nuclear Cardiology July/August 2000
References 1. Cerqueira MD. The user-friendly nuclear cardiology reports: what needs to be considered and what is included (editorial point of view). J Nucl Cardiol 1996;3:350-5. 2. Port SC, editor. Imaging guidelines for nuclear cardiology procedures. Part 2. J Nucl Cardiol 1999;6:G47 - G84.
These templates were endorsed by the Board of Directors of ICANL on April 28, 2000.