Practice Parameters In Diuretic Renal Scintigraphy Across The United States, A Need For Practice Standardization.

245 Objectives: While diuretic renal scintigraphy (DRS) has been considered integral in evaluating for the presence of obstructive renal pathology, many variables can influence the results. A lack of standardization results in poor consistency, limits comparison of results, and decreases the diagnostic utility of the exam. This is exacerbated by the fact that most DRS exams are conducted at institutions that perform fewer than 2 studies per week, and a large percentage of the studies are interpreted by physicians with limited experience in nuclear medicine.\nThe Intersocietal Accreditation Commission (IAC) evaluates clinical practices as part of the accreditation process. The practice patterns of DRS at a national level has not been assessed. The aim of this study was to assess the performance and reporting of DRS by nuclear medicine (NM) laboratories and providers from different institutions and practice settings across the United States and compare those results to societal references [1-3].\n Methods: Under an IRB approved protocol, the IAC Nuclear database was used to extract 106 unique DRS protocols and associated 174 reports from all laboratories applying for one 3-year accreditation cycle from 2016 to 2018. From these, the following variables were assessed:\nFacility/staff (6 variables): lab type, IAC accreditation decision, general nuclear medicine exam volume, GU specific exam volume, number of NM technologists, number of physiciansPatient preparation (8 variables): patient hydration guidance, type of hydration, volume of hydration, medication restrictions, withholding of prescription diuretics, breastfeeding guidance, prevoiding, bladder catheterizationExam technique/acquisition (14 variables): radiopharmaceutical, RP dose, diuretic, diuretic dose, criteria for diuretic dose increase, time diuretic administration, renal labs reviewed, lab timeliness, acquisition, collimation, patient positioning, post-void imaging, post-void image timing, urine volume measurementImage processing (3 variables): renal regions of interest (ROIs), background ROIs, timing of relative function measurementReporting (14 variables): dose diuretic, timing of diuretic, relative uptake, relative uptake timing, time-to-peak, T-½ emptying, post-void kidney to max, 20-minute to max, tissue/cortical transit time, creatinine clearance, recent labs, hydration, urine volume, urine flow\nVariables were then compared to identify potential associations (ie. practice volume/type and compliance with reporting guidelines).\n Results: Review of protocols and reports demonstrates a very high degree of variability in DRS exam practices across the US and suboptimal compliance with societal guidelines and parameters. Critical missing or highly variable elements include patient hydration, type and dosage of radiopharmaceutical, dosage and timing of diuretic administration, quantitative parameters assessed and report content. There was no significant correlation between facility/staff factors and compliance with guidelines regarding examination technique and reporting.\n Conclusions: There is high variability in the performance and reporting of DRS among laboratories applying for IAC Nuclear accreditation, similar to seen in prior studies of other NM exams [4]. The wide degree of practice variance may have a significant effect on diagnostic accuracy and patient management, as results may be either inaccurate or incomplete. This survey suggests the possibility for improved standardization and quality of this important nuclear medicine exam.