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Cases are selected as follows: Only one study may be normal. There must be one study demonstrating myocardial infarction, one study demonstrating ischemia, and one study demonstrating significant regional or global wall motion and one must be a pharmacologic stress study. In addition, the cases must have been interpreted by as many different physicians as possible, performed by different technologists and if more than one camera is present in the laboratory, cases must be selected from each camera in use. For instance, if there are five interpreting physicians in the laboratory, three case studies must be from one physician and two case studies from the other physician. For more information, see www.icanl.org.

For laboratories applying in ERNA, five (5) case studies must be submitted. The studies are not selected from any specific schedule and may be selected from any studies performed in the past year. Laboratories should submit as many abnormal studies as possible. The ICANL recognizes that the number and indications for performing ERNA studies has decreased in recent years and therefore it may be difficult to find four abnormal studies.

If the laboratory is applying for cardiac PET, it must include five (5) cardiac PET studies. Only one study may be normal; the other four studies should be abnormal.

GENERAL NUCLEAR MEDICINE or
COMPREHENSIVE ACCREDITATION

Laboratories applying in General Nuclear Medicine only must submit two (2) case studies per body system in which accreditation is being sought (i.e., skeletal, endocrine or tumor); no more than 24 total cases should be submitted.

Comprehensive Nuclear Medicine applications must include two (2) cases per body system for General Nuclear Medicine, three (3) SPECT MPI studies for Nuclear Cardiology, and three (3) ERNA studies.

If the laboratory is applying for PET under the Comprehensive module, three (3) PET cases in each area of oncology, neurology and cardiac must be submitted.

PET and PET/CT

When seeking PET and/or PET/CT accreditation, laboratories may apply in one or all of these areas: oncology, neurology, or cardiac.

A total of ten (10) case studies, based on the laboratory volume of procedures in each area, are required. The majority of cases submitted for review should be selected from the area that is most frequently performed. For example, if the laboratory generally performs oncology studies, 6 to 8 studies should be submitted from oncology and the remaining studies from either neurology or cardiac.

Electronic Data: Change in Policy

Effective with the July 1, 2008 ICANL application deadline, digital raw data is no longer required or accepted for cardiac case study submission. The preferred method for submitting case study documentation is processed image data in digital image format, supplied on CD or DVD. No optical disks will be accepted.

Laboratories may provide screen captures of static images as JPEG (Joint Photographic Experts Group), TIFF (Tagged Image File Format) or BMP (Bitmap Digital Images) files. Or they may submit equipment-specific images with an embedded, image-specific reader (i.e., DICOM viewer) included. Movies may be submitted as MPEG (Moving Picture Expert Group), AVI (Audio Video Interleave), QuickTime or Windows Media Player.

Please remember that images supplied on CD or DVD must be able to be viewed or opened on any computer. It is suggested that laboratories open and test the CDs or DVDs on different computers prior to submission to ensure that the ICANL staff and reviewers will be capable of viewing the cases using various systems.

The ICANL understands that some laboratories may not have the equipment necessary to submit images or screen captures on a CD or DVD. If a laboratory is unable to submit digital images due to lack of equipment, they may submit high quality black-and-white and color copies of all processed images on paper.

The ICANL Standards (B6.1.6.5) require that a laboratory must have the ability to transmit current or archived patient studies to an outside, non-affiliated entity in a format that is of interpretable quality. This transmission may take place in either electronic or hard-copy format.

As stated previously, laboratories are instructed to submit all images utilized in the interpretation of a study. Therefore, for cardiac case studies, laboratories should submit:

• Movies of planar projection images, cine data (if available)
• Reconstructed stress-rest slices (gray scale and color)
• Quantitative data, polar maps, etc.
• Movie-gated SPECT slices (if available)
• Gated SPECT slices in end diastole and end systole
• LV volume curve and calculated LVEF
• EKG tracing

Common Problems

Most often, case study issues noted during the review process are due to incorrect data submission as opposed to procedural or interpretative problems. Incomplete application submission may impede the complete and accurate review of an application. Following are some of the frequently identified problems noted by ICANL staff and reviewers:

• Cases not submitted in duplicate
• CDs or DVDs containing raw (proprietary manufacturer) data that cannot be viewed
• Suboptimal or uninterpretable hard-copy images
• All required components not included (EKG tracings, processed or quantitative data, schedules and logbooks)

The ICANL strives to assist laboratories in providing the most complete application submission possible. A series of webcasts, articles, information and sample documents are posted on the ICANL website in order to provide additional guidance to those seeking accreditation. Laboratories with specific questions regarding the accreditation process are encouraged to contact the ICANL staff at 800-838-2110 or via email using the online directory provided at www.icanl.org/icanl/contact/staff.htm.