Mary Beth Farrell

Nationwide Laboratory Adherence to Myocardial Perfusion Imaging Radiation Dose Reduction Practices: A Report From the Intersocietal Accreditation Commission Data Repository.

OBJECTIVES This study sought to examine current laboratory practices for radiation effective doses for myocardial perfusion imaging (MPI) and laboratory adherence to guideline-directed radiation reduction practices. BACKGROUND A recent focus on radiation dose reduction for cardiovascular imaging has led to several published guidelines and consensus statements detailing performance metrics for laboratory practices. We sought to examine laboratory adherence to optimized radiation dose protocol recommendations among 5,216 submitted cases from 1,074 MPI laboratories evaluated for Intersocietal Accreditation Commission accreditation. METHODS Eligible imaging centers included MPI laboratories enrolled in the Intersocietal Accreditation Commission data repository of accreditation applications from 2012 to 2013. Accreditation requires submission of 3 to 5 cases for evaluation of a range of representative cases. Based on standard dosimetry for rest and stress MPI, an effective dose (in millisieverts) was calculated. Model simulations were performed to estimate guideline-directed effective doses. RESULTS The average effective dose was 14.9 ± 5.8 mSv (range 1.4 to 42.4 mSv). A 1-day technetium Tc 99m protocol was used in 82.9% of cases, whereas a 2-day technetium Tc 99m and dual isotope protocol was used in 7.5% of submitted cases. Only 1.5% of participating imaging centers met current guidelines for an average laboratory radiation exposure ≤9 mSv, whereas 10.1% of patient effective doses were >20.0 mSv. A model simulation replacing the radiation exposure of dual isotope MPI with that of a 1-day technetium Tc 99m protocol reduced the proportion of patients receiving an effective dose >20 mSv to only 2.7% of cases (p < 0.0001). CONCLUSIONS Mandatory laboratory accreditation for MPI allows for examination of current radiation dosimetry practices. Current guidelines for reduced patient-specific radiation exposure are rarely implemented, with few laboratories meeting recommendations of ≤9 mSv for 50% of patients. Increased educational efforts and the development of performance measures for laboratory accreditation may be required to meet current radiation dose-reduction standards.

How Do Noninvasive Imaging Facilities Perceive the Accreditation Process? Results of an Intersocietal Accreditation Commission Survey

The Intersocietal Accreditation Commission (IAC) accredits vascular, echocardiography, nuclear medicine, computed tomography, and magnetic resonance imaging laboratories. How facilities involved in the accreditation process view accreditation is unknown. The objective of this study was to examine the perception of laboratory accreditation from those who had undergone the process. An electronic survey request was sent to all facilities that had received IAC accreditation at least once. Demographic information, as well as opinions on the perceived value of accreditation as it relates to 15 quality metrics was acquired. Responses were obtained from 2782 facilities. Of the 15 quality metrics examined, the process was perceived as leading to improvements by a majority of respondents for 10 (67%) metrics including: report standardization, adherence to guidelines, test standardization, report completeness, identification of deficiencies, improved staff knowledge, report timeliness, distinguished facility, correction of deficiencies, and image quality. Overall, the perceived improvement was greater for hospital‐based facilities (global 66% vs 59%; P < 0.001). Survey data demonstrate that the accreditation process has a positive perceived impact on the majority of examined metrics. These findings suggest that those undergoing the process find value in accreditation.

Accreditation status and geographic location of outpatient vascular testing facilities among Medicare beneficiaries: The VALUE (Vascular Accreditation, Location & Utilization Evaluation) Study

Objective: There is limited information on the accreditation status and geographic distribution of vascular testing facilities in the US. The Centers for Medicare & Medicaid Services (CMS) provide reimbursement to facilities regardless of accreditation status. The aims were to: (1) identify the proportion of Intersocietal Accreditation Commission (IAC) accredited vascular testing facilities in a 5% random national sample of Medicare beneficiaries receiving outpatient vascular testing services; (2) describe the geographic distribution of these facilities. Methods: The VALUE (Vascular Accreditation, Location & Utilization Evaluation) Study examines the proportion of IAC accredited facilities providing vascular testing procedures nationally, and the geographic distribution and utilization of these facilities. The data set containing all facilities that billed Medicare for outpatient vascular testing services in 2011 (5% CMS Outpatient Limited Data Set (LDS) file) was examined, and locations of outpatient vascular testing facilities were obtained from the 2011 CMS/Medicare Provider of Services (POS) file. Results: Of 13,462 total vascular testing facilities billing Medicare for vascular testing procedures in a 5% random Outpatient LDS for the US in 2011, 13% (n=1730) of facilities were IAC accredited. The percentage of IAC accredited vascular testing facilities in the LDS file varied significantly by US region, p<0.0001: 26%, 12%, 11%, and 7% for the Northeast, South, Midwest, and Western regions, respectively. Conclusions: Findings suggest that the proportion of outpatient vascular testing facilities that are IAC accredited is low and varies by region. Increasing the number of accredited vascular testing facilities to improve test quality is a hypothesis that should be tested in future research.

Intersocietal Accreditation Commission Accreditation Status of Outpatient Cerebrovascular Testing Facilities Among Medicare Beneficiaries The VALUE Study

Accreditation of cerebrovascular ultrasound laboratories by the Intersocietal Accreditation Commission (IAC) and equivalent organizations is supported by the Joint Commission certification of stroke centers. Limited information exists on the accreditation status and geographic distribution of cerebrovascular testing facilities in the United States. Our study objectives were to identify the proportion of IAC‐accredited outpatient cerebrovascular testing facilities used by Medicare beneficiaries, describe their geographic distribution, and identify variations in cerebrovascular testing procedure types and volumes by accreditation status.

HOW DO NON-INVASIVE IMAGING FACILITIES PERCEIVE THE ACCREDITATION PROCESS? RESULTS OF AN INTERSOCIETAL ACCREDITATION COMMISSION (IAC) SURVEY

Background: The Intersocietal Accreditation Commission (IAC) accredits vascular, echocardiography, nuclear medicine, PET, CT and MR imaging facilities. How those involved in the accreditation process view accreditation is unknown. We sought to examine the perception of accreditation from those who underwent the process successfully. Methods: An electronic survey was sent to all IAC accredited facilities. Demographic information, as well as opinions on the value of accreditation as it relates to various quality metrics were acquired. Results: Responses were obtained from 2782 (7%) facilities including 1004 (36%) echocardiography, 832 (30%) vascular, 641 (23%) nuclear/PET, 164 (6%) CT and 141 (5%) MR facilities of which 42% were hospital-based and 58% office-based. Of the 15 quality metrics examined, the process was perceived as leading to improvements by a majority of respondents for 10 metrics (Table) including: report standardization, adherence to guidelines, test standardization, report completeness, identification of deficiencies, improved staff knowledge, report timeliness, correction of deficiencies, facility distinction and image quality. Overall, the perceived improvement was greater for hospital-based facilities (global 65% vs. 59%; p<0.001). Conclusion: Results of the IAC survey indicate that the accreditation process has a positive perceived impact on the majority of examined metrics. These findings suggest that those undergoing the process find value in accreditation. : Category (Complete): 15. Non Invasive Imaging: Echo Prevention Pathway Abstracts (Complete): My study will help enable cardiovascular clinicians to . . . . : Not applicable. None of the above statements relate to the research described in my abstract. Clicking this answer will not jeopardize the review of my abstract. Keyword (Complete): Quality ; Diagnostic performance ; Practice management Institution Information (Complete): *Responsible Institution 1: : Intersocietal Accreditation Commission *City: : Ellicott City *State: Maryland *Country: USA * : No * : No Page 1 of 2 Oasis, The Online Abstract Submission System 11/19/2013 http://www.abstractsonline.com/submit/SubmitPrinterFriendlyVersion.asp?ControlKey=... Need Technical Assistance? OASIS Helpdesk American College of Cardiology 2400 N Street, NW Washington, DC 20037 Leave OASIS Feedback Powered by OASIS, The Online Abstract Submission and Invitation System SM

Characteristics of Accredited Transcranial Doppler Ultrasound Laboratories in the United States: IAC TCD Laboratory Characteristics

The aim of this study was to describe in detail the characteristics and accreditation compliance of laboratories in the United States applying for Intersocietal Accreditation Commission (IAC) transcranial Doppler (TCD) accreditation.

Accreditation Is Perceived to Improve Echocardiography Laboratory Quality: Results of an Intersocietal Accreditation Commission Survey:

The Intersocietal Accreditation Commission (IAC) began accrediting echocardiography laboratories in 1996 to improve quality in diagnostic imaging facilities. With no existing data linking accreditation to improved outcomes, the aim of this study was to examine the perceived value of accreditation among individuals who have successfully achieved IAC echocardiography accreditation. An electronic survey was sent to accredited facilities soliciting demographic data along with questions regarding the perceived value of accreditation related to 15 quality indicators; 10.455 emails were sent with 999 responses (9.6%), and 63% of respondents reported improvement in results due to accreditation. Of the 15 quality indicators, the process was perceived as leading to improvement by a majority for 10 of the quality indicators. Nonphysicians tended to report more improvement compared with physicians (64% vs. 54%, P = .056). The perceptions from hospital-based respondents were more favorable than nonhospital-based respondents (67% vs. 59%, P < .001). More than 90% of respondents reported that maintaining accreditation was important for improved quality and better reimbursement. The study showed that IAC echocardiography facility accreditation is perceived by most facilities to improve operations for most quality indicators, particularly regarding study quality and reporting.

Accreditation Status and Geographic Location of Outpatient Echocardiographic Testing Facilities Among Medicare Beneficiaries: The VALUE-ECHO Study

Accreditation of echocardiographic testing facilities by the Intersocietal Accreditation Commission (IAC) is supported by the American College of Cardiology and American Society of Echocardiography. However, limited information exists on the accreditation status and geographic distribution of echocardiographic facilities in the United States. Our study aimed to identify (1) the proportion of outpatient echocardiography facilities used by Medicare beneficiaries that are IAC accredited, (2) their geographic distribution, and (3) variations in procedure type and volume by accreditation status.

Reasons for Delay of Accreditation for Vascular Testing Laboratories Applying for Accreditation by Intersocietal Accreditation Commission

The Intersocietal Accreditation Commission (IAC) vascular testing accreditation process is designed to be educational through a process of self-examination and feedback from peer review. Accreditation is awarded based on compliance with published Standards. The objective of this study was to identify the most common reasons for accreditation delay and noncompliance with the published Standards among vascular laboratories applying for IAC accreditation. The IAC database was used to extract laboratory data and findings of application review for vascular laboratories applying for accreditation in 2016. Most laboratories applying for accreditation (88.7%, 535/603) had 1 or more accreditation delay issues that had to be rectified before accreditation was granted. The most common not compliant findings included reporting issues, discordant findings between the test documentation and final impression, poor image quality, diagnostic criteria issues, and missed diagnostic findings. Most laboratories corrected identified issues (82.2%, 440/535) within 90 days. IAC accreditation recognizes a laboratory as having met minimum quality Standards. For vascular laboratories reviewed by IAC, most accreditation issues were due to deficiencies in reporting, documentation, and image quality.

It’s about time we think about lowering radiation dose in obese patients too

Medical technology has advanced at a rapid pace, particularly, the diagnostic imaging tools relied upon daily to care for patients. Myocardial perfusion imaging (MPI) uses advanced technology and radiopharmaceuticals to detect, assess, and risk-stratify ischemic heart disease. The level of radiation exposure from these scans is often higher than other diagnostic imaging procedures. Patients and health care providers are increasingly more aware of and concerned about the potential health risks associated with radiation exposure. It is, therefore, prudent that the radiation dose from diagnostic imaging scans be kept as low as possible while maximizing image quality. Therein lies the problem. If we were to construct the ideal radiation reduction strategy, it would be adaptable to patients of all ages, body habitus, ambulatory status, and admission state. Protocols should be flexible for both patients and laboratories while hopefully improving workflow. Expensive hardware and software would not be required, and there should be associated cost savings. All of this must be accomplished while concomitantly producing highquality images that can be confidently used to make the correct diagnosis. To address concerns related to radiation, the American Society of Nuclear Cardiology (ASNC) published several recommendations for reducing radiation dose. Suggested approaches include utilization of appropriate use criteria, stress-only imaging, limited use of a dual isotope protocol, and PET imaging, where appropriate. Other approaches rely on recent improvements in camera hardware and software such as highsensitivity cadmium zinc telluride (CZT) solid-state detectors and iterative reconstruction resolution recovery algorithms, which can allow injection of less radiotracer and/or decrease image acquisition time. Along with specific techniques for lowering radiation dose, the many recommendations emphasize patientcentered imaging that tailors the imaging protocol specifically to each patient. ASNC specifically advocated reducing radiation exposure such that [50% of a facility’s MPI patients receive a total effective dose B9 mSv. A recent study published by Jerome et al. reviewed 5216 MPI studies performed at 1074 Intersocietal Accreditation Commission accredited facilities in 2012 and 2013. They found most facilities were not meeting this radiation dose goal. They reported the average effective dose was 14.9 ± 5.8 mSv, far above the B9 mSv goal. Only 1.4% of all laboratories administered B9 mSv in [50% of cases. Additionally, they found that only 0.4% of studies performed were stress-only, and 7.5% of facilities continued to use the dual isotope protocol. These findings suggest that laboratories still encounter difficulties in routinely lowering radiation dose effectively. One particular struggle in reducing radiation exposure is obtaining quality images in obese patients at a lower radiation dose. Considering there are over 300 million obese people in the United States and with the number growing, better options to imaging obese patients are promptly needed. Increased body mass results in photon attenuation which decreases the signalto-noise ratio and increases scatter. The outcome is image noise, artifacts, and nondiagnostic results. See related article, pp. 1912–1921