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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"
(i.e., 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 Cerqueira 1
and the ASNC Guidelines 2 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 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 accreditation
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. NEXT
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These
templates were endorsed by
the Board Of Directors of ICANL on April 28, 2000.
Copyright
© 2000 by the American Society of Nuclear Cardiology.
REFERENCES
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.
Port
SC, editor, Imaging guidelines for nuclear cardiology procedures.
Part 2. J Nucl Cardiol 1999;6:G47-G84.
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