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One
of the most important goals of the accreditation process is
to provide a method of standardization. In order to ensure that
nuclear medicine studies are of consistent quality, a laboratory
must adhere to "cookbook-style" procedure protocols
that are specific for the laboratory and describe in detail
how procedures are performed in daily practice. Although vendors
usually provide system operating manuals, they are seldom sufficiently
detailed. Each imaging facility therefore tends to institute
modifications and adjustments that work best to achieve a desired
optimum result. These are the "laboratory-specific and
camera-specific protocols." The ICANL Standards
provide guidelines for minimum testing, interpretation and quality
assurance requirements. One of the simplest methods of assuring
adherence to The ICANL Standards, reproducibility of
examination results, and consistent documentation is through
the use of well-written technical protocols.
Technical
protocols should be written for every testing procedure performed
in the laboratory and should define the steps taken in performing
and documenting a complete examination. As well, the protocol
will include a detailed description of the equipment and technical
methods used to obtain the required documentation. When present,
technical limitations and contraindications for the examination
should be listed. There are companies selling prepared protocols
that can be a helpful guide; however, it is imperative that
these be edited to reflect the actual procedures and practices
employed within the individual laboratory.
During
the application review process, it is frequently noted that
the technical protocols submitted are vague, lengthy and cumbersome,
or outdated. Because of frequent changes in technical staff
members in nuclear medicine laboratories, well-written protocols
are invaluable in avoiding confusion among technologists regarding
the laboratory's specific requirements for each testing procedure.
The assurance of consistency among the technical staff members
and in the documentation of examinations can also aid in more
reliable and effective final interpretations that ultimately
affect the quality of patient management.
The
ICANL accreditation process requires facilities to have protocols,
and the Standards outline the elements that must be included;
however, it is the responsibility of each applicant facility
to adopt and customize their documents. The Academy of Molecular
Imaging (AMI), the American Society of Nuclear Cardiology (ASNC),
and the Society of Nuclear Medicine (SNM) are each excellent
sources.
The
ASNC website includes the Journal of Nuclear Cardiology Imaging
Guidelines for Nuclear Cardiology Procedures. In addition,
the Cardiac Positron Emission Tomography (PET) Imaging Guidelines
are available on the ASNC website. The guidelines were developed
by the Quality Assurance Committee of ASNC, and the intended
audience is technologists and physicians who are qualified in
the practice of nuclear cardiology. These guidelines address
state-of-the-art cardiac applications and protocols approved
by experts in the field. The two-part guidelines, addressing
acquisition and processing issues through interpretation and
reporting, have been approved and endorsed by the ASNC Board
of Directors, the Practice Guidelines Committee of the Society
of Nuclear Medicine, and the Academy of Molecular Imaging. To
view or download the guidelines, visit the ASNC website, www.asnc.org,
navigate to the "Manage Your Practice" menu, and select
"Guidelines and Standards" [www.asnc.org/yourpractice/gstandards.cfm].
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