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Four
times a year -- January, April, July, and October -- nuclear
medicine laboratories may submit their applications for accreditation
to the ICANL. The applications are reviewed following a standardized
accreditation protocol of 1) in-house review, 2) paper review
by trained, independent reviewers (one physician and one technologist),
3) an onsite visit by a trained ICANL representative, and 4)
a summarized review of the collected data evaluated by the ICANL
Board of Directors for final decision. The process, from submission
to decision, takes approximately three and one-half months or
14-16 weeks.
Following
its review, the Board of Directors renders a decision to grant
a full three-year accreditation, stating that the laboratory
has successfully met the minimum requirements for ICANL accreditation.
Alternatively, the Board decision may be a provisional grant.
This limited accreditation allows the facility up to one year
to correct minor deficiencies, while benefiting from holding
accredited status. Examples of minor deficiencies that are cause
for a provisional grant include issues found within the laboratory's
operations, the need for clarification of credentials, and incomplete
protocols. The above, of course, are the most desirable results
of an application decision; full three-year accreditation or
provisional grant. However, some laboratories receive a delay
accreditation decision. What does 'delay' mean? What are
the common reasons laboratories receive delayed accreditation
decisions and what do they have to do to become accredited?
First,
if a laboratory is delayed it does not mean that they are denied
accreditation. Delay means that there are significant issues,
deficiencies or lack of adherence to the required ICANL Standards
that must be addressed by the laboratory before it can be granted
ICANL accreditation. Some of the most common reasons for delayed
accreditation are incomplete reports, protocols either missing
or outside of accepted guidelines and poor image quality.
COMMON DEFICIENCIES RELATED TO REPORTS
Report
issues include:
- stamped
reports, not reviewed or signed by the interpreting physician
- missing
integration of stress details such as baseline and peak heart
rate, blood pressure and ECG interpretation
- no
summary of stress findings as related to results of image
interpretation
- no
indication for study or patient gender
- use
of non-standard nomenclature and/or no description of finding
including size, extent and severity of abnormality
The
ICANL requires that all reports conform to the American Society
of Nuclear Cardiology (ASNC) and/or the Society of Nuclear Medicine
(SNM) guidelines for reporting nuclear medicine studies. The
ICANL Standards, Part II Section 6.1 - 6.3, clearly lists
the items that must be included in all reports. Bold type is
used throughout the Standards to identify those items
that must be included in the application for accreditation in
order to meet the minimum requirements. The ICANL website includes
sample reports and provides references with links to the SNM
and ASNC websites for guidelines. The ICANL strongly recommends
that each laboratory review and download the guidelines, reporting
consensus and report matrix for reference and guidance from
the ASNC website at www.asnc.org/yourpractice/gstandards.cfm.
COMMON DEFICIENCIES RELATED TO PROTOCOLS
Protocols
must be submitted with the application for accreditation for
all procedures performed in the laboratory. All protocols must
be site-specific and include the required components listed
in the Standards Part II, Section 2.1 through 2.3. A laboratory
may receive a delay in accreditation if more than one protocol
is missing completely, such as exercise stress or pharmacologic
infusion details and/or if their processing and display protocols
are missing required parameters. All too often, laboratories
submit only their acquisition protocols, frequently omitting
number of projections and time per view. Many delayed laboratories
fail to submit processing protocols or simply state that processing
is automatic, without identifying the site-specific parameters
used in their laboratory. Part II Section 2.2.10 of the ICANL
Standards lists the required components for display and labeling
on the interpretation policy and protocol. These components
should be incorporated by the applicant laboratory, and carefully
reviewed before an application is submitted for review.
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