ABNM Maintenance of Certification Part IV Survey: Lung Scintigraphy for Diagnosis of Pulmonary Embolism
Completing this Practice Guideline based survey satisfies the ABNM requirement for an MOC Part IV quality improvement (Improvement in Medical Practice) activity for the calendar year in which the survey is completed.

Instructions

1. Read the SNMMI procedure standard, “SNMMI Procedure Standard for Lung Scintigraphy 4.0, July 19, 2011.” by visiting the following url: http://interactive.snm.org/docs/lung_scintigraphy_v4_final.pdf.

2. Review 10 Lung scans that you interpreted to answer the following questions. Scans may be selected randomly or consecutively.

After submitting the survey, participants will receive a summary of the answers provided by all other physicians who participated. The summary is provided so that you can compare your practice with others and consider making practices changes if your practice does not conform to guidelines and/or the majority of physicians participating.

How often is the referring physician’s estimate of the prior probability of pulmonary embolism (low, medium, high) documented in the procedure request/order, or documented in the patient’s medical record and available to you at the time of study interpretation? *
Section VI.A.2. The referring physician’s estimate of the prior probability of pulmonary embolism may be helpful. Use of validated tools such as the Wells (1) score is preferred. Section VA.A.3. Results of D-dimer test, if obtained, should be noted.
How often has a chest radiograph or CT scan been performed within the preceding 24 hours before the lung scan when a patient presents with acute symptoms? *
Section VIB.1. A standard chest radiograph in both posterior–anterior and lateral projections is preferred. A portable anterior–posterior chest radiograph is acceptable only if the patient cannot tolerate a routine chest radiographic examination. In patients who have no changes in signs or symptoms, a chest radiograph within a few days may be adequate.
How often is SPECT imaging obtained in addition to, or instead of, planar images in multiple projections? *
Section VI.D.6. SPECT can be used to obtain a 3-dimensional evaluation of the perfusion and is recommended by some investigators. Section VI.D.7. Lung scintigraphy for pulmonary embolism may be performed using SPECT/low-dose CT. The low-dose CT portion of the study provides information for attenuation and, compared with a chest radiograph, also provides improved anatomic information.
Which criteria do you use for interpretation? *
Section VI.E.1. The modified PIOPED criteria were derived from a retrospective analysis of the PIOPED data- base (2,3). The criteria were prospectively tested and shown to be more accurate than the original PIOPED criteria (4). In an attempt to reduce the number of non-diagnostic studies, the PIOPED II criteria were modified using fewer categories. The performance of the modified PIOPED II criteria was evaluated on the PIOPED II database (5). The modified PIOPED II and PISAPED criteria using information from chest radiograph and perfusion scans have been shown to perform equivalently to those including ventilation scintigraphy, with fewer non-diagnostic studies (6). Section VI.E.2. The experienced nuclear medicine physician may be able to provide a more accurate interpretation of the ventilation–perfusion study than is provided by the criteria alone; however, the physician’s opinion is usually informed by detailed knowledge of the various lung image interpretive criteria given in E.1 (2).
How are the study results reported? *
Section VII.D.6. The report may include an assessment of the post-test probability of pulmonary embolism based on the result of lung scintigraphy and an estimate of the prior probability of disease (7,8). Many experts believe limiting reporting to 3 categories—pulmonary embolism present, pulmonary embolism absent, and non-diagnostic (intermediate likelihood ratio)— facilitates communication. Some believe more accurate categorization provides more information to referring physicians (9). The outcome of patients with low-likelihood-ratio lung scans is good (10-12).
How often is direct (verbal, or other methods accepted by your hospital) communication of results documented in the study report or the medical record? *
Section VII.B. Refer to the SNM Guideline for General Imaging
Next
This form was created inside of The American Board of Nuclear Medicine. Report Abuse - Terms of Service