许多变量会影响胃排空闪烁显像(GES)的结果。缺乏标准化会导致可变性,限制比较,降低了研究的可信度。为了提高标准化,2009年,核医学和分子成像协会(SNMMI)发布了一个标准化的指南,基于2008年共识文件,验证了成人的GES方案。实验室必须密切遵循共识指南,以提供有效和标准化的结果,作为实现患者护理一致性的动机。作为认证过程的一部分,社会间认证委员会(IAC)评估对此类准则的遵守情况。对SNMMI指南的遵守率在2016年进行了评估,并显示出相当大的不遵守程度。这项研究的目的是重新评估同一实验室队列对标准化方案的依从性,寻找变化和趋势。方法:IAC核/PET数据库用于从2018年至2021年申请认证的所有实验室中提取GES方案,在初始评估后5年。实验室数量为118(vs.最初评估中为127)。再次评估每个方案是否符合SNMMI指南中描述的方法。以二元方式评估了相同的14个变量:患者准备(4个变量-保留的药物类型,扣留这些药物48小时,血糖≤200mg/dL,血糖记录),膳食(5个变量-共识膳食的使用,没有通过嘴4小时或更长时间,10分钟内食用的膳食,记录膳食消耗百分比,标有18.5-37MBq[0.5-1.0mCi]的膳食),采集(获得的2个变量-前投影和后投影,每小时成像到4小时),和处理(3个变量-使用几何平均值,数据的衰减校正,和保留百分比的测量)。结果:来自118个实验室的协议表明,在某些关键领域的合规性正在改善,但在其他领域仍不理想。总的来说,实验室符合14个变量中的8个的平均值,1个站点的1变量合规性较低,只有4个网站符合所有14个变量。19个站点达到了80%的合规性阈值(11个变量)。依从性最高的变量是患者在检查前4小时或更长时间内不服用任何药物(97%)。具有最低顺应性的变量是血糖值的记录(3%)。值得注意的改进领域包括使用共识餐,现在62%,而以前只有30%的实验室。通过测量保留百分比(而不是排空百分比或半倍)也注意到更高的合规性,65%的网站依从性,而5年前只有35%。结论:SNMMIGES指南发布近13年后,在申请IAC认证的实验室中,方案的依从性有所改善,但仍不理想。GES方案性能的持续变化可能会显著影响患者管理,因为结果可能不可靠。使用标准化的GES协议允许以一致的方式解释结果,允许实验室间比较,并通过推荐临床医生促进测试有效性的接受。
Many variables can influence the results of gastric emptying scintigraphy (GES). A lack of standardization causes variability, limits comparisons, and decreases the credibility of the study. To increase standardization, in 2009 the Society of Nuclear Medicine and Molecular Imaging (SNMMI) published a guideline for a standardized, validated GES protocol for adults based on a 2008
consensus document. Laboratories must closely follow the
consensus guideline to provide valid and standardized results as an incentive to achieve consistency in patient care. As part of the accreditation process, the Intersocietal Accreditation Commission (IAC) evaluates compliance with such
guidelines. The rate of compliance with the SNMMI
guideline was assessed in 2016 and showed a substantial degree of noncompliance. The aim of this study was to reassess compliance with the standardized protocol across the same cohort of laboratories, looking for changes and trends. Methods: The IAC nuclear/PET database was used to extract GES protocols from all laboratories applying for accreditation from 2018 to 2021, 5 y after the initial assessment. The number of labs was 118 (vs. 127 in the initial assessment). Each protocol was again evaluated for compliance with the methods described in the SNMMI guideline. The same 14 variables were assessed in a binary fashion: patient preparation (4 variables-types of medications withheld, withholding of these medication for 48 h, blood glucose ≤ 200 mg/dL, blood glucose recorded), meal (5 variables-use of consensus meal, nothing by mouth for 4 h or more, meal consumed within 10 min, documentation of percentage of meal consumed, meal labeled with 18.5-37 MBq [0.5-1.0 mCi]), acquisition (2 variables-anterior and posterior projections obtained, imaging each hour out to 4 h), and processing (3 variables-use of the geometric mean, decay correction of data, and measurement of percentage retention). Results: Protocols from the 118 labs demonstrated that compliance is improving in some key areas but remains suboptimal in others. Overall, labs were compliant with an average of 8 of the 14 variables, with a low of 1-variable compliance at 1 site, and only 4 sites compliant with all 14 variables. Nineteen sites met an 80% threshold for compliance (11+ variables). The variable with the highest compliance was the patient\'s taking nothing by mouth for 4 h or more before the exam (97%). The variable with the lowest compliance was the recording of blood glucose values (3%). Notable areas of improvement include the use of the consensus meal, now 62% versus previously only 30% of labs. Greater compliance was also noted with measurement of retention percentages (instead of emptying percentages or half-times), with compliance by 65% of sites versus only 35% 5 y prior. Conclusion: Almost 13 y after the publication of the SNMMI GES
guidelines, there is improving but still suboptimal protocol adherence among laboratories applying for IAC accreditation. Persistent variation in the performance of GES protocols may significantly affect patient management, as results may be unreliable. Using the standardized GES protocol permits interpretation of results in a consistent manner that allows interlaboratory comparisons and fosters acceptance of the test validity by referring clinicians.