title: Adult Gamma Camera Myocardial Perfusion Imaging: Diagnostic Reference Levels and Achievable Administered Activities Derived From ACR Accreditation Data.
abstract: OBJECTIVE
  The aim of this study was to glean from accreditation surveys of US nuclear medicine facilities the in-practice radiopharmaceutical diagnostic reference levels (DRLs) and achievable administered activities (AAAs) for adult gamma camera myocardial perfusion imaging (MPI).
  
  
  METHODS
  Data were collected from the ACR Nuclear Medicine Accreditation Program during one three-year accreditation cycle from May 1, 2012, to April 30, 2015. Data elements included radiopharmaceutical, administered activity, examination protocol, interpreting physician specialty, practice type, and facility annual examination volume. Facility demographics, DRLs, and AAAs were tabulated for analysis.
  
  
  RESULTS
  The calculated DRLs and AAAs are consistent with previously published surveys, and they adhere to national societal guidelines. Facilities seeking ACR accreditation are nearly evenly split between hospital based with multiple gamma cameras and office based with single gamma cameras. The majority of facilities use single-day, low-dosage/high-dosage (99m)Tc-based protocols; a small minority use (201)TlCl protocols. Administered activities show a consistency across facilities, likely reflecting adoption of standard MPI protocols.
  
  
  CONCLUSIONS
  This practice-based analysis provides DRL and AAA benchmarks that nuclear medicine facilities may use to refine gamma camera MPI protocols. In general, the protocols submitted for ACR accreditation are consistent with national societal guidelines. The results suggest that there may be opportunities to further reduce patient radiation exposure by using modified examination protocols and newer gamma camera software and hardware technologies.
authors.affiliation: Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey; University Radiology, East Brunswick, New Jersey. Electronic address: mbecker@univrad.com.
authors.forename: Murray D
authors.initials: MD
authors.lastname: Becker
authors.affiliation: American College of Radiology, Reston, Virginia.
authors.forename: Priscilla F
authors.initials: PF
authors.lastname: Butler
authors.affiliation: American College of Radiology, Reston, Virginia.
authors.forename: Mythreyi
authors.initials: M
authors.lastname: Bhargavan-Chatfield
authors.affiliation: Department of Radiology, Henry Ford Health System, Detroit, Michigan.
authors.forename: Beth A
authors.initials: BA
authors.lastname: Harkness
authors.affiliation: Department of Radiology, University of Texas Health Science Center, San Antonio, Texas.
authors.forename: Darlene
authors.initials: D
authors.lastname: Metter
authors.affiliation: American College of Radiology, Reston, Virginia.
authors.forename: Carolyn Richards
authors.initials: CR
authors.lastname: MacFarlane
authors.affiliation: Department of Radiology, New York University School of Medicine, New York, New York.
authors.forename: Munir
authors.initials: M
authors.lastname: Ghesani
authors.affiliation: American College of Radiology, Reston, Virginia.
authors.forename: Pamela
authors.initials: P
authors.lastname: Wilcox
authors.affiliation: Department of Radiology and Medicine, University of Kentucky College of Medicine and UK HealthCare, Lexington, Kentucky.
authors.forename: M Elizabeth
authors.initials: ME
authors.lastname: Oates
mesh_terms: D000068:Accreditation / Q000592:standards; D000328:Adult; D015902:Gamma Cameras; D006801:Humans; D055414:Myocardial Perfusion Imaging / Q000592:standards*; D009683:Nuclear Medicine; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D000069079:Radiation Exposure; D019275:Radiopharmaceuticals / Q000008:administration & dosage; D012016:Reference Values; D012955:Societies, Medical; D012984:Software; D013044:Specialty Boards; D011795:Surveys and Questionnaires; D014481:United States
chemical_list: D019275:Radiopharmaceuticals
keywords: Myocardial perfusion imaging; diagnostic reference levels; patient radiation exposure