Intersocietal Accreditation Commission Research Articles

Carotid Disease Classification: Impact of the 2021 Intersocietal Accreditation Commission Updated Recommendations vs. 2003 Society of Radiologists in Ultrasound Consensus Conference Criteria for CME Credit June 2024

Carotid Disease Classification: Impact of the 2021 Intersocietal Accreditation Commission Updated Recommendations vs. 2003 Society of Radiologists in Ultrasound Consensus Conference Criteria for CME Credit June 2024

Carotid Disease Classification: Impact of the 2021 Intersocietal Accreditation Commission Updated Recommendations vs 2003 Society of Radiologists in Ultrasound Consensus Conference Criteria

Introduction: In 2021, the Intersocietal Accreditation Commission (IAC) introduced modified criteria for carotid duplex interpretation based on peak systolic velocity (PSV) and PSV ratio. The most significant change compared to the 2003 Society of Radiologists in Ultrasound (SRU) criteria involved re-defining the thresholds for <50 and 50% to 69% stenosis ranges. Patients identified in <50% vs 50% to 69% ranges may face different disease severity assignments, variable surveillance protocols, medical management approaches, and recommendations for intervention. Facilities may experience altered payment coverage, issues of staff re-training, and questions from referring physicians regarding patient treatment and disease management expectations. The objective of this study was to assess the impact of re-defining these stenosis ranges using the 2021 IAC criteria vs the SRU criteria. Methods: Anonymized patient data from carotid duplex examinations were collected as part of an internal laboratory quality improvement strategy. These data were analyzed in an electronic database using the IAC and SRU threshold criteria to determine the degree of carotid stenosis. Patients with normal arteries, unilateral studies, or complete occlusions were excluded. Results: Of the 1000 patients considered, 850 met the eligibility criteria. Using PSV: for the right carotid, 242 (28.5%) showed a change and 608 (71.5%) showed no change in stenosis classification; for the left carotid, 228 (27%) showed a change and 622 (73%) showed no change. All changes were a downgrading of disease to <50% stenosis. Using PSV ratio: for the right carotid, re-assignment of 53 (22% of changed, 6% of total cohort); for the left carotid, re-assignment of 48 (21% of changed, 5.6% of total cohort). All changes resulted in re-assignment to the 50% to 69% stenosis category. Conclusions: Implementation of the IAC criteria resulted in patients being re-assigned to lower stenosis categories (27% for PSV and 21% for PSV ratio). The impact of these changes on patient care and facility logistics needs careful consideration.

Practical Considerations for Obtaining Perioperative Transesophageal Echocardiography Accreditation: Collective Experiences at Early-Adopting Centers

The Intersocietal Accreditation Commission (IAC) is a non-profit accrediting organization committed to ensuring the quality of diagnostic imaging and related procedures. It is comprised of a collaboration of stakeholders, spanning numerous medical professionals and specialties. In a recent initiative, IAC Echocardiography introduced a new accreditation specifically for Perioperative Transesophageal Echocardiography (PTE). This accreditation process is anchored in rigorous clinical peer review to ensure diagnostic quality and report accuracy, thus maintaining high standards of medical care.The authors represent the inaugural four sites to achieve IAC accreditation for PTE who have collaborated to share their experiences in achieving this accreditation. This review endeavors to offer actionable insights and proven solutions to navigate the accreditation journey for others. Mirroring the IAC Standards and Guidelines for PTE accreditation, this review is divided into three pivotal sections: 1) organization of a perioperative echocardiography service, including stakeholder engagement to facilitate the application for accreditation; 2) performance of examinations and reporting; and 3) instituting quality improvement strategies and establishing a robust program.The pursuit of accreditation in PTE is to transcend a mere compliance exercise. It signifies a dedication to excellence, continual growth, and above all to the well-being of patients.

Implementation of an electronic medical record order set with an opt-out rule increases utilization of ultrasound enhancing agents with transthoracic echocardiography

Abstract Background Use of ultrasound-enhancing agents (UEA) decreases the frequency of non-diagnostic transthoracic echocardiography (TTE) studies and improves accuracy for identification of potentially life-threatening conditions. However, several logistical barriers have led to UEA underutilization, including the need for a separate order for UEA in electronic medical records (EMR). We sought to determine the impact of implementing an EMR order set on utilization of UEA at the echocardiography laboratory of a tertiary care center. Methods EMR order for all TTE studies (complete, limited) was modified to include the use of UEA by default with an "opt-out" option for ordering physician when UEA is deemed unnecessary. During study performance, sonographers determined the need for UEA use and utilized existing order to dispense perflutren protein-type A microspheres to complete the examination. Internal policy for UEA use was developed in keeping with Intersocietal Accreditation Commission recommendations. We compared rates of UEA utilization 10 months before and after the implementation date (March 2022) for the new EMR rule. Results A total of 10,666 TTE studies were performed prior to, and 11,406 studies after the implementation of the new EMR rule. Of those, 54.3% were performed in outpatient setting, 12% in ICU, and the rest in non-ICU inpatient setting. Prior to the EMR rule implementation, UEA was used in 10% of total studies, 6.0% of outpatient studies, 11.2% of non-ICU inpatient studies, and 24.2% of ICU studies. Following the implementation of the new rule, UEA utilization increased significantly, including 89% increase in total use, 90% increase in outpatient setting, 129% in non-ICU inpatient setting, and 48% increased use in ICU (Figure). No adverse events were reported with UEA during the study period. Conclusions The implementation of a standing order in EMR, including default use of UEA with an "opt-out" option facilitates sonographer-driven use and administration of UEA across all patient care settings. While this approach was safe and significantly increased UEA utilization, whether it would translate to improvement in clinical outcomes or hospital length of stay requires further studies.Impact of EMR rule on UEA utilization

Impact of Advanced Cardiac Sonographers on Exam Completeness in the Echocardiography Laboratory

Objective: Laboratory accreditation has been shown to impact variability and completeness. However, little data exist demonstrating the impact of personnel credentialing on completeness and efficiency. Therefore, the aim of this study was to evaluate exam completeness and efficiency among staff with an advanced cardiac sonographer (ACS) credential, Registered Diagnostic Cardiac Sonographer or Registered Cardiac Sonographer and noncredentialed staff. Materials and Methods: Retrospective review of adult and pediatric echocardiograms at eight facilities in three states. Exam completeness was compared with Intersocietal Accreditation Commission (IAC) standards and completeness by pathology was compared with the American Society of Echocardiography (ASE) standards. Results: This study was based on the review of 1147 patient cases. Of the cases reviewed, 60.3% were performed by credentialed (non-ACS) sonographers, 28.3% were completed by credentialed ACS, and 11.3% by noncredentialed staff. The credentialed staff completed exams ≤ 12 hours. The exams were reviewed for compliance with IAC standards and completed by ACS staff: 80.0% in aortic stenosis and 55.6% in non-ACS staff. Those patient cases for mitral regurgitation (14/19) were 73.7% IAC compliant, cases completed by credentialed non-ACS (20/56) were 35.7% compliant, and those completed by noncredentialed sonographers (2/11) only 18.2% were compliant. Cases specific to patent ductus arteriosus were 92.1% compliant with IAC standards that were completed by ACS compared with 77.9% completed by non-ACS staff. Cases of pulmonary hypertension were also evaluated for IAC compliance and 61.8% met the standard with ASE versus 41.7% completed by non-ACS. Conclusion: Examinations performed by ACS are more often complete in important pathology. Examination efficiency is highest among credentialed sonographers.

Reexamining Compliance with Gastric Emptying Scintigraphy Guidelines: An Updated Analysis of the Intersocietal Accreditation Commission Database.

Many variables can influence the results of gastric emptying scintigraphy (GES). A lack of standardization causes variability, limits comparisons, and decreases the credibility of the study. To increase standardization, in 2009 the Society of Nuclear Medicine and Molecular Imaging (SNMMI) published a guideline for a standardized, validated GES protocol for adults based on a 2008 consensus document. Laboratories must closely follow the consensus guideline to provide valid and standardized results as an incentive to achieve consistency in patient care. As part of the accreditation process, the Intersocietal Accreditation Commission (IAC) evaluates compliance with such guidelines. The rate of compliance with the SNMMI guideline was assessed in 2016 and showed a substantial degree of noncompliance. The aim of this study was to reassess compliance with the standardized protocol across the same cohort of laboratories, looking for changes and trends. Methods: The IAC nuclear/PET database was used to extract GES protocols from all laboratories applying for accreditation from 2018 to 2021, 5 y after the initial assessment. The number of labs was 118 (vs. 127 in the initial assessment). Each protocol was again evaluated for compliance with the methods described in the SNMMI guideline. The same 14 variables were assessed in a binary fashion: patient preparation (4 variables-types of medications withheld, withholding of these medication for 48 h, blood glucose ≤ 200 mg/dL, blood glucose recorded), meal (5 variables-use of consensus meal, nothing by mouth for 4 h or more, meal consumed within 10 min, documentation of percentage of meal consumed, meal labeled with 18.5-37 MBq [0.5-1.0 mCi]), acquisition (2 variables-anterior and posterior projections obtained, imaging each hour out to 4 h), and processing (3 variables-use of the geometric mean, decay correction of data, and measurement of percentage retention). Results: Protocols from the 118 labs demonstrated that compliance is improving in some key areas but remains suboptimal in others. Overall, labs were compliant with an average of 8 of the 14 variables, with a low of 1-variable compliance at 1 site, and only 4 sites compliant with all 14 variables. Nineteen sites met an 80% threshold for compliance (11+ variables). The variable with the highest compliance was the patient's taking nothing by mouth for 4 h or more before the exam (97%). The variable with the lowest compliance was the recording of blood glucose values (3%). Notable areas of improvement include the use of the consensus meal, now 62% versus previously only 30% of labs. Greater compliance was also noted with measurement of retention percentages (instead of emptying percentages or half-times), with compliance by 65% of sites versus only 35% 5 y prior. Conclusion: Almost 13 y after the publication of the SNMMI GES guidelines, there is improving but still suboptimal protocol adherence among laboratories applying for IAC accreditation. Persistent variation in the performance of GES protocols may significantly affect patient management, as results may be unreliable. Using the standardized GES protocol permits interpretation of results in a consistent manner that allows interlaboratory comparisons and fosters acceptance of the test validity by referring clinicians.

Prophylactic Levetiracetam for the Prevention of Seizures in Acute Nontraumatic Intracerebral Hemorrhage: A Retrospective Propensity-matched Patient Outcome Analysis (P7-5.030)

<h3>Objective:</h3> This study aims to determine if prophylactic levetiracetam in nontraumatic intracerebral hemorrhage (nt-ICH) decreases seizure risk and improves mortality. <h3>Background:</h3> Early seizures is a common morbidity in nt-ICH, often associated with worsening neurological outcome. There are conflicting data on the use of prophylactic antiepileptic drugs (AEDs) in the form of levetiracetam in this population. Current guidelines do not endorse prophylactic AED use due to limited evidence for clinical benefit; however, they are routinely prescribed in the acute setting. <h3>Design/Methods:</h3> This was a retrospective cohort study using data collected from TriNetX, a deidentified patient database collated from 71 healthcare organizations. Using ICD-10 codes, we identified nt-ICH patients excluding those with a history of seizure disorders. Patients were dichotomized based on prophylactic levetiracetam use or not. Propensity score adjustment matched cohorts on age, sex, race, significant comorbidities, complications of nt-ICH, location of nt-ICH, and NIHSS score. Associations with mortality; occurrence of seizure, acute kidney injury (AKI), transient ischemic attack (TIA), stroke, myocardial infarction; percutaneous endoscopic gastrostomy and tracheostomy placement at day 30 were measured between groups using unadjusted odds ratios (OR) with 95% confidence intervals (CI). <h3>Results:</h3> This study identified 1,571 patients with nt-ICH who received prophylactic levetiracetam and 9,570 patients who did not. After matching, 1,492 patients remained in each cohort. Our analysis showed that prophylactic levetiracetam in patients with nt-ICH was not associated with decreased seizure occurrence (OR, 1.21 [95% CI, 0.88, 1.68]) or mortality benefit (OR, 1.06 [95% CI, 0.90, 1.25]); was associated with decreased incidence of AKI (OR 0.552 [95% CI 0.344, 0.884]) and TIA [OR 0.496 (95% CI 0.304, 0.807)]. <h3>Conclusions:</h3> This data suggests that prophylactic levetiracetam does not provide a mortality benefit or decrease the occurrence of seizures in the acute setting of nt-ICH. Prospective studies are necessary to confirm these findings and assess the impact on longitudinal functional outcomes. <b>Disclosure:</b> Miss Nguyen has nothing to disclose. Ms. Bhanja has nothing to disclose. Dr. Hallan has nothing to disclose. Kevin Cockroft has received personal compensation in the range of $5,000-$9,999 for serving as an officer or member of the Board of Directors for Intersocietal Accreditation Commission. The institution of Kevin Cockroft has received research support from Intersocietal Accreditation Commission. The institution of Kevin Cockroft has received research support from Nico Corporation. The institution of Kevin Cockroft has received research support from Idorsia Pharmaceuticals . The institution of Kevin Cockroft has received research support from AstraZeneca . Dr. Rizk has nothing to disclose.

Ultrasound Imaging Markers of Carotid Atherosclerosis are Associated with Cognition Through Cerebral Small Vessel Disease on MRI (S15.001)

Ultrasound Imaging Markers of Carotid Atherosclerosis are Associated with Cognition Through Cerebral Small Vessel Disease on MRI (S15.001)

Estimated Pulse Wave Velocity Inversely Associates with Cognition in the Northern Manhattan Study (S8.002)

Estimated Pulse Wave Velocity Inversely Associates with Cognition in the Northern Manhattan Study (S8.002)

SVM Communications: International perspectives on vascular medicine and updates from the Intersocietal Accreditation Commission (IAC).

SVM Communications: International perspectives on vascular medicine and updates from the Intersocietal Accreditation Commission (IAC).

Characteristics, Quality, and Safety Issues Identified During Intersocietal Accreditation Commission (IAC) Assessment of Orthopaedic Facilities Utilizing Cone-Beam CT Equipment

Category: Other Introduction/Purpose: The Intersocietal Accreditation Commission (IAC) began accrediting diagnostic CT facilities in 2007. Recently there has been an increase in the number of outpatient orthopaedic facilities that use cone beam CT (CBCT) equipment seeking accreditation. The accreditation process comprehensively evaluates a facility's daily operation, with quality determined by compliance with the IAC Standards and Guidelines for CT Accreditation. The Standards represent the minimum requirements for staff qualifications, instrumentation, quality assurance, physicist safety surveys, scan procedures, radiation dose optimization, interpretative accuracy, reporting, and quality improvement that a facility must meet to earn accreditation. The Standards are based on the published guidelines of 12 sponsoring professional medical societies, representing various specialties. This investigation aimed to discover characteristics of these facilities and to identify common quality and safety issues. Methods: To become accredited, facilities applying for IAC CT accreditation submit facility demographic data, staff qualifications, policies and procedures, sample quality assurance results, physicist survey reports, radiation dose logs, quality improvement data, and representative case studies via an online application process. The materials are evaluated by trained peer reviewers and findings are reported to the IAC CT Board of Directors for final accreditation decision. The IAC accreditation database was used to extract the characteristics and application findings of all orthopaedic facilities using CBCT that applied for accreditation from 2019-2021. Results: Facility Characteristics Currently, 41 orthopaedic facilities have achieved IAC CT accreditation (see map). The facilities perform a median of 378 scans per site annually (range 75-2400). On average, there were 4 physicians (range 1-20) and 2 technologists (range 0-15) per site. Most sites (n = 32) used CurveBeam CBCT equipment followed by Carestream (n=5) and Planmed (n=4). Facility Deficiencies Identified quality issues included poor scan quality (n=4) such as improper patient positioning or excessive motion artifact and inadequate reporting (n=14) such as inaccurate patient identification information, incomplete exam/technique documentation, or non-compliant report finalization/signature. Identified procedural issues included failure to perform/document routine quality control (n=12) such as phantom testing to ensure the safety of CT scanner operation; missing safety policies such as the medical emergency policy or incomplete clinical scan protocols (n=5); and lack of quality improvement activities (n=5).Finally, facility personnel did not meet staff qualification requirements at 11 sites. Conclusion: In summary, the IAC CT accreditation process rigorously evaluates CT facilities to improve quality and safety. Evaluation of the accreditation findings for outpatient orthopaedic facilities utilizing CBCT equipment and seeking IAC accreditation identified deficiencies at many sites. All facilities were required to rectify the deficiencies prior to being awarded IAC accreditation, and they must continue to monitor quality and safety to remain accredited.

Impact of Use of Intersocietal Accreditation Commission Versus Society of Radiologists in Ultrasound Carotid Interpretation Criteria on Patient Management

The Intersocietal Accreditation Commission (IAC) recently introduced modified criteria for carotid duplex ultrasound interpretation. The most significant change, compared with the Society of Radiologists in Ultrasound (SRU) criteria, involved redefining the ranges of <50% and 50% to 69%. The definitions of 70% to 99%, near occlusion, and occlusion remained unchanged. Patients identified in the <50% vs 50% to 69% ranges could experience different disease severity assignments, surveillance protocols, medical management approaches, and access to intervention (if symptomatic).

Assessing the Quality of Vascular Ultrasound Examinations Using the IAC QI Self-Assessment Tool: Inter-Rater and Intra-Rater Agreement Between Vascular Technologists and Interpreting Physicians

Introduction: Vascular laboratories need to improve efficiency while maintaining examination quality. Vascular ultrasound examinations were retrospectively evaluated using the Intersocietal Accreditation Commission (IAC) Quality Improvement (QI) Self-Assessment Tool to evaluate the quality of the examinations and to determine inter-rater and intra-rater agreement between groups of vascular technologists and interpreting physicians. Methods: Vascular technologists and attending interpreting physicians evaluated 100 carotid Doppler and 100 lower extremity venous Doppler examinations utilizing the IAC QI Self-Assessment Tool. Gwet’s First-Order Agreement Coefficient (AC1) statistic and 95% confidence intervals were calculated to determine both inter-rater and intra-rater agreement. Results: The inter-rater agreement for 91% of all questions ranged from substantial (AC1 = 0.6) to almost perfect (AC1 = 1) for both examination types across all reviewers. Agreement on 2 questions was suboptimal: specifically, the technical quality section for the vascular technologists showed slight agreement for carotid Doppler and venous Doppler examinations (AC1 = 0.108 and 0.087, respectively), and the case review section for the interpreting physicians showed poor agreement for carotid Doppler examinations (AC1 = –0.087) and fair agreement for venous Doppler examinations (AC1 = 0.329). The intra-rater agreement among the interpreting physicians for both examinations was in the almost perfect range (Carotid AC1 = 0.875-1; Venous AC1 = 0.871-1). The intra-rater agreement among the vascular technologists for both examinations ranged from slight to almost perfect (Carotid AC1 = 0.191-1; Venous AC1 = 0.155-1). Conclusion: Substantial to almost perfect agreement among all reviewers was observed for most of the quality review questions. The IAC QI Self-Assessment Tool aided in identifying areas for improvement in vascular studies and the comments captured in the technical quality section of the tool were instrumental in establishing areas for quality improvement.

Accreditation: RPVI, RVT, IAC Accreditation, and ACR Accreditation

Personnel and department accreditation are means by which institutions can evaluate, demonstrate, and maintain the highest level of patient care. In this article, we will discuss the certification and the resources for physicians (RPVI) and technologists (RVT) who provide care to patients in the vascular lab (VL) as well as information about certification by the two accrediting bodies - the Intersocietal Accreditation Commission (IAC) and the American College of Radiology (ACR) - that accredit VLs. Noninvasive vascular testing provides timely delivered valuable information to healthcare providers. Accreditation recognizes quality vascular testing services, but also facilitates a process of education and the quality assurance to improve the overall quality of vascular labs (VL).

Variation in additional testing and patient outcomes after stress echocardiography or myocardial perfusion imaging, according to accreditation status of testing site

BackgroundThe purpose of the present study was to determine whether patients receiving a stress echocardiogram or myocardial perfusion imaging (MPI) test have differences in subsequent testing and outcomes according to accreditation status of the original testing facility. Methods and resultsAn all-payer claims dataset from Maine Health Data Organization from 2012 to 2014 was utilized to define two cohorts defined by an initial stress echocardiogram or MPI test. The accreditation status (Intersocietal Accreditation Commission (IAC), American College of Radiology (ACR) or none) of the facility performing the index test was known. Descriptive statistics and multivariate regression were used to examine differences in subsequent diagnostic testing and cardiac outcomes.We observed 4603 index stress echocardiograms and 8449 MPI tests. Multivariate models showed higher odds of subsequent MPI testing and hospitalization for angina if the index test was performed at a non-accredited facility in both the stress echocardiogram cohort and the MPI cohort. We also observed higher odds of percutaneous coronary interventions (PCI) performed (OR 1.68, 95% CI 1.13-2.50), if the initial MPI test was done in a non-accredited facility. ConclusionCardiac testing completed in non-accredited facilities were associated with higher odds of subsequent MPI testing, hospitalization for angina, and PCI.

Diuretic Renal Scintigraphy: The State of Practice and a Potential Opportunity for Standardization.

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.

Optimization of Duplex Velocity Criteria for Diagnosis of Internal Carotid Artery (ICA) Stenosis: A Report of the Intersocietal Accreditation Commission (IAC) Vascular Testing Division Carotid Diagnostic Criteria Committee

Optimization of Duplex Velocity Criteria for Diagnosis of Internal Carotid Artery (ICA) Stenosis: A Report of the Intersocietal Accreditation Commission (IAC) Vascular Testing Division Carotid Diagnostic Criteria Committee

Optimization of duplex velocity criteria for diagnosis of internal carotid artery (ICA) stenosis: A report of the Intersocietal Accreditation Commission (IAC) Vascular Testing Division Carotid Diagnostic Criteria Committee.

Diagnostic criteria to classify severity of internal carotid artery (ICA) stenosis vary across vascular laboratories. Consensus-based criteria, proposed by the Society of Radiologists in Ultrasound in 2003 (SRUCC), have been broadly implemented but have not been adequately validated. We conducted a multicentered, retrospective correlative imaging study of duplex ultrasound versus catheter angiography for evaluation of severity of ICA stenosis. Velocity data were abstracted from bilateral duplex studies performed between 1/1/2009 and 12/31/2015 and studies were interpreted using SRUCC. Percentage ICA stenosis was determined using North American Symptomatic Carotid Endarterectomy Trial (NASCET) methodology. Receiver operating characteristic analysis evaluated the performance of SRUCC parameters compared with angiography. Of 448 ICA sides (from 224 patients), 299 ICA sides (from 167 patients) were included. Agreement between duplex ultrasound and angiography was moderate (κ = 0.42), with overestimation of degree of stenosis for both moderate (50–69%) and severe (⩾ 70%) ICA lesions. The primary SRUCC parameter for ⩾ 50% ICA stenosis of peak-systolic velocity (PSV) of ⩾ 125 cm/sec did not meet prespecified thresholds for adequate sensitivity, specificity, and accuracy (sensitivity 97.8%, specificity 64.2%, accuracy 74.5%). Test performance was improved by raising the PSV threshold to ⩾ 180 cm/sec (sensitivity 93.3%, specificity 81.6%, accuracy 85.2%) or by adding the additional parameter of ICA/common carotid artery (CCA) PSV ratio ⩾ 2.0 (sensitivity 94.3%, specificity 84.3%, accuracy 87.4%). For ⩾ 70% ICA stenosis, analysis was limited by a low number of cases with angiographically severe disease. Interpretation of carotid duplex examinations using SRUCC resulted in significant overestimation of severity of ICA stenosis when compared with angiography; raising the PSV threshold for ⩾ 50% ICA stenosis to ⩾ 180 cm/sec as a single parameter or requiring the ICA/CCA PSV ratio ⩾ 2.0 in addition to PSV of ⩾ 125 cm/sec for laboratories using the SRUCC is recommended to improve the accuracy of carotid duplex examinations.

Oral and Maxillofacial Radiology: Evolving Technology and Paradigm Shifts

Click to increase image sizeClick to decrease image size Additional informationNotes on contributorsSanjay M. MallyaSanjay M. Mallya, BDS, MDS, PhD, is an associate professor and the chair of oral and maxillofacial radiology at the University of California, Los Angeles, School of Dentistry. He has authored numerous scientific manuscripts and book chapters on oral radiology, periodontology, endodontology and implantology. He is the editor of “White and Pharoah’s Oral Radiology” and is a past president of the American Academy of Oral and Maxillofacial Radiology. Dr. Mallya is a diplomate of the American Board of Oral and Maxillofacial Radiology and serves on the board of the Intersocietal Accreditation Commission. Conflict of Interest Disclosure: None reported.

U.S. Diagnostic Reference Levels and Achievable Administered Activities for Adult Renal Scintigraphy: An Analysis of the Intersocietal Accreditation Committee Nuclear Laboratories.

The goal of this work was to determine U.S. diagnostic reference levels (DRLs) and achievable administered activities (AAAs) for adult renal scintigraphy. Methods: Under an Institutional Review Board-approved protocol, data were collected from the Intersocietal Accreditation Commission during one 3-y accreditation cycle encompassing 110 facilities. Elements included radiopharmaceutical, administered activity, practice type, and examination volume. DRLs and AAAs were calculated and compared with non-U.S. values and societal recommendations as available. Results: Ninety-three facilities provided data on 99mTc-mercaptoacetyltriglycine (99mTc-MAG3), and 15 provided data on 99mTc-diethylenetriaminepentaacetic acid (99mTc-DTPA) for adult renal scintigraphy exams. Analysis demonstrated a DRL of 392.2 MBq (10.6 mCi) for 99mTc-MAG3 and 531.7 MBq (14.4 mCi) for 99mTc-DTPA, with an AAA of 370 MBq (10 mCi) for 99mTc-MAG3 and 445.9 MBq (12.1 mCi) for 99mTc-DTPA. Conclusion: The resultant calculated novel U.S. DRLs and AAAs may serve as benchmarks that nuclear medicine facilities may use to refine renal scintigraphy protocols, reduce patient doses, and potentially guide future societal guideline recommendations.