title: Nuclear medicine technologists are able to accurately determine when a myocardial perfusion rest study is necessary.
abstract: BACKGROUND
  In myocardial perfusion scintigraphy (MPS), typically a stress and a rest study is performed. If the stress study is considered normal, there is no need for a subsequent rest study. The aim of the study was to determine whether nuclear medicine technologists are able to assess the necessity of a rest study.
  
  
  METHODS
  Gated MPS using a 2-day 99mTc protocol for 121 consecutive patients were studied. Visual interpretation by 3 physicians was used as gold standard for determining the need for a rest study based on the stress images. All nuclear medicine technologists performing MPS had to review 82 training cases of stress MPS images with comments regarding the need for rest studies, and thereafter a test consisting of 20 stress MPS images. After passing this test, the nuclear medicine technologists in charge of a stress MPS study assessed whether a rest study was needed or not or if he/she was uncertain and wanted to consult a physician. After that, the physician in charge interpreted the images and decided whether a rest study was required or not.
  
  
  RESULTS
  The nuclear medicine technologists and the physicians in clinical routine agreed in 103 of the 107 cases (96%) for which the technologists felt certain regarding the need for a rest study. In the remaining 14 cases the technologists were uncertain, i.e. wanted to consult a physician. The agreement between the technologists and the physicians in clinical routine was very good, resulting in a kappa value of 0.92. There was no statistically significant difference in the evaluations made by technicians and physicians (P = 0.617).
  
  
  CONCLUSIONS
  The nuclear medicine technologists were able to accurately determine whether a rest study was necessary. There was very good agreement between nuclear medicine technologists and physicians in the assessment of the need for a rest study. If the technologists can make this decision, the effectiveness of the nuclear medicine department will improve.
authors.affiliation: Department of Clinical Physiology and Nuclear Medicine, Skåne University Hospital, Lund University, Inga Marie Nilssons gata 49, 205 05, Malmö, Sweden. Elin.tragardh@med.lu.se
authors.forename: Elin
authors.initials: E
authors.lastname: Trägårdh
authors.forename: Liselott
authors.initials: L
authors.lastname: Johansson
authors.forename: Camilla
authors.initials: C
authors.lastname: Olofsson
authors.forename: Sven
authors.initials: S
authors.lastname: Valind
authors.forename: Lars
authors.initials: L
authors.lastname: Edenbrandt
mesh_terms: D019985:Benchmarking / Q000706:statistics & numerical data*; D002983:Clinical Competence / Q000592:standards; D003327:Coronary Disease / Q000175:diagnosis / Q000000981:diagnostic imaging*; D020000:Decision Support Systems, Clinical; D005080:Exercise Test / Q000379:methods / Q000523:psychology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D055414:Myocardial Perfusion Imaging / Q000379:methods*; D009683:Nuclear Medicine / Q000639:trends*; D015588:Observer Variation; D009943:Organophosphorus Compounds; D015609:Organotechnetium Compounds; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data; D011237:Predictive Value of Tests; D017064:Process Assessment, Health Care / Q000592:standards / Q000706:statistics & numerical data*; D019275:Radiopharmaceuticals; D012680:Sensitivity and Specificity; D013548:Sweden
chemical_list: D009943:Organophosphorus Compounds; D015609:Organotechnetium Compounds; D019275:Radiopharmaceuticals; C078700:technetium tc-99m tetrofosmin