利尿剂肾闪烁显像：实践现状及标准化的潜在机遇

摘要(中文译文)

本研究旨在评估利尿剂肾显像（DRS）的实践模式差异，并在来自美国不同机构和实践环境的大型实验室队列中量化其与国家指南的符合程度。通过经机构审查委员会批准的方案，我们从跨学会认证委员会数据库中提取了107份机构特异性成人DRS方案及相关的174份报告，涵盖了2016年至2018年认证周期内所有申请泌尿生殖系统显像认证的实验室。据此，我们评估了40个变量，涉及机构和人员配置、患者准备、检查技术与采集、图像处理及报告。对方案和报告的审查显示，美国各地DRS实践存在高度变异性，且对社会指南和实践参数的符合程度欠佳。变异性较大或报告不足的参数包括患者水化、放射性药物的类型和剂量、利尿剂的剂量和给药时机、所评估的定量参数以及报告内容。申请认证的实验室在DRS实施和报告方面存在高度变异性，与其他核医学检查的研究所见相似。实践差异的广泛程度可能对诊断准确性和患者管理产生显著影响，导致结果不准确或不完整。本调查凸显了对此重要核医学检查进行标准化和提高质量的必要性。

Abstract

The aim of this study was to assess variation in diuretic renal scintigraphy (DRS) practice patterns and quantify compliance with the national guidance in a large cohort of laboratories from different institutions and practice settings across the United States. By means of an institutional review board-approved protocol, we extracted 107 facility-specific, adult DRS protocols and associated 174 reports from the Intersocietal Accreditation Commission database, representing all laboratories applying for genitourinary scintigraphy certification during the 2016 to 2018 accreditation cycle. From these, we assessed 40 variables regarding facilities and staffing, patient preparation, examination technique and acquisition, image processing, and reporting. Review of protocols and reports demonstrates a very high degree of variability in DRS practice across the United States and suboptimal compliance with societal guidelines and practice parameters. Some of the more variable or underreported parameters include the use of patient hydration, type and dosage of radiopharmaceutical, dosage and timing of diuretic administration, quantitative parameters assessed, and report content. There is high variability in the performance and reporting of DRS among laboratories applying for accreditation, similar to that seen in studies of other nuclear medicine examinations. The wide degree of practice variance may have a significant impact on diagnostic accuracy and patient management, with inaccurate or incomplete results. This survey impresses the need for standardization and improved quality of this important nuclear medicine examination.

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