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As the principles related to nuclear medicine continue to evolve and advance, the ICANL is committed to addressing the changing needs of the nuclear medicine, nuclear cardiology and PET communities as it provides an accreditation process that recognizes quality.

The ICANL was created by uniting physicians and technologists from its six sponsoring organizations. These professionals worked together to develop the ICANL Standards, an extensive document that defines the minimum requirements for nuclear laboratory quality. “The Standards are based upon accepted clinical practices that, when properly implemented, create an environment that supports quality care,” explains ICANL President-Elect, Sue H. Abreu, M.D. FACNP. “Because they establish what practices are recognized as acceptable by the nuclear imaging community, guidelines and position statements approved by our sponsoring organizations establish the foundation for the ICANL Standards.”

All laboratories should be knowledgeable of and up to date with the guidelines published by these organizations. In 2008, several existing guidelines were updated and many new guidelines were published. Following is a list and summary of several of the newest guidelines and published statements.

In 2008 the SNM updated its Procedure Guideline for Myocardial Perfusion Imaging 10. The purpose of this guideline is to assist facilities in performing, interpreting and reporting the results of myocardial perfusion imaging studies. The procedure contains instructions for patient preparation, precautions and contraindications, radiopharmaceuticals, image acquisition, processing, interpretation and reporting. Specifically, the procedure has been updated to include PET myocardial imaging.

In September, ASNC released a new clinical update regarding Combined Pharmacologic and Low-Level Exercise Stress Protocols for Radionuclide Myocardial Perfusion Imaging 1. This statement discusses patient selection, contraindications (such as left bundle branch block), and clinical protocols for using exercise with adenosine and dipyridamole stress studies. The statement concludes that when possible, low-level exercise should be performed in combination with pharmacologic stress perfusion imaging, which results in reduced side effects and better image quality than vasodilator stress alone. In addition, this combination provides an objective assessment of functional capacity and heart rate response to exercise.

Over the summer of 2008, the ASNC Board of Directors approved and updated three sections of the Imaging Guidelines for Nuclear Cardiology Procedures: Equilibrium Radionuclide Angiography (ERNA) 4, Stress Protocols and Tracers 5, and Standardized Reporting of Myocardial Perfusion Images 6. These guidelines are an essential tool in the practice of Nuclear Cardiology and represent evidence-based best practices. Stress Protocols and Tracers 5, now includes dosing, indications, contraindications, and known side effects of Regadenoson which was approved by the U.S. Food and Drug Administration for use as a pharmacologic stress agent in April of 2008.

The SNM has published a guideline in conjunction with the Neurogastroenterology and Motility Society for gastric emptying imaging titled: Consensus Recommendations for Gastric Emptying Scintigraphy 9. The guideline recommends a standardized method for measuring gastric emptying using a low-fat, egg-white meal with imaging at 0, 1, 2, and 4 hours after meal ingestion. While gastric emptying scintigraphy has been considered the standard for measuring gastric emptying, a lack of standardization of meals used, patient positioning, and frequency and duration of imaging have led to differences in the data reported and lack of reliable normal values. With the adoption of this new, standardized protocol, the clinical community should realize uniformity of testing, reliability and credibility of results, along with improved clinical utility of the gastric emptying test.

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