For SPECT studies, protocols should describe the type of reconstruction, i.e. whether filtered rear-projection or iterative reconstruction is used. Other reconstruction parameters such as filter type and cut-off value, image reorientation and display (e.g., transaxial/longitudinal/oblique images for general nuclear medicine versus short-axis/long-horizontal axis/vertical longitudinal images for myocardial perfusion imaging) should be explained. The protocols should also describe any damping or motion correction steps and procedures that can be performed. The administration of a radiopharmaceutical to a patient must be prescribed by an authorized user, either by means of an individual written prescription or by means of a standardized protocol. The standard protocol acts as a standing order and specifically specifies the prescribed radiopharmaceutical name, dose amount or range, and route of administration (e.g., oral, inhaled, subcutaneous, intramuscular, intravenous, or intradermal). Additional processing details that must be included in the log include camera- and computer-specific instructions for displaying images and data. The protocol should include instructions on how images should be labelled (e.g., patient name, date of birth, patient identifier, study date, time interval, laterality, and anatomical markers). There should also be instructions on how to present images for medical interpretation, for example from a hard copy or uploaded to a PACS. Finally, if support from other departments is needed, for example: for intrathecal injection of 111in-diethylenetriaminepentaacetic acid for cisternography or intradermal injection of sulfur colloid 99mTc for lymphoscintigraphy, the coordination steps between departments should be described in the protocol. High- and low-density lipoprotein (LDL) cholesterol is a major risk factor for heart attack, stroke and atherosclerotic cardiovascular disease (ASCVD). The use of evidence-based protocols is a strategy for managing and lowering cholesterol levels in patients with established ASCVD and patients at risk of heart attack, stroke or ASCVD.
The importance of standardization can be clearly illustrated by PET. The standardized intake value, which is used to distinguish benign from malignant tumors and to assess response to treatment, requires precision and reproducibility. Accuracy starts with accurate data, including patient height and weight (measured on the day of imaging), dose activity, timing of measurement, and timing of injection. Normalized intake levels change over time (1). A comparable quantification of standardised absorption values at different points in time is based on the production of point-to-point reproducible data. A standardized protocol defines the steps for collecting accurate and reproducible data to support optimal patient care. Create your own hypertension treatment protocol with our template, guidance document, interactive guide, and ideas from established stakeholders in the heart disease and stroke prevention and treatment community. The use of the radiopharmaceutical package leaflet and prescribing information is useful in the preparation of protocols as well as monographs and educational materials published by the manufacturer. For example, 123I-ioflupane (DaTscan; GE Healthcare) imaging for Parkinson`s disease is a relatively new procedure that has no published guidelines. Still, there is a wealth of imaging information on the manufacturer`s website.
(10) When the Food and Drug Administration approves new devices or technologies, there is often not a large published literature and the manufacturer`s recommendations should be considered reliable. This was the case when wide-beam reconstruction software was initially available. A protocol is defined as a detailed plan for an experiment, treatment, or medical procedure. The goal of each protocol is to provide a detailed structure for the treatment of the patient and the realization of the procedure. There should be specific instructions on what to do, how, when, who and why. Protocols define workflow, create consistency, help eliminate omissions and avoid confusion. When a procedure is performed in a standardized and reproducible manner, variability between and intraoperators is reduced, ensuring that each patient study is of optimal quality and that each patient receives the same quality of service. Find standardized, evidence-based protocols to use in your practice. When integrated into electronic health records, treatment protocols can be used to support clinical decision-making at the point of care, so no opportunity is missed to take control. In 2018, the American College of Cardiology (ACC) and the American Heart Association (AHA) published new clinical guidelines for the treatment of blood cholesterol to reduce the risk of ASCVD in adults.
You can create your own cholesterol management journal using the guidelines flowchart. You can also customize one of the evidence-based protocols listed below. It is useful to include other training or instructions for patients in the protocol. This could include instructions on how to wear comfortable shoes instead of high heels for a stress test or instructions to warn the patient that follow-up scans are needed at 24, 48 or 72 hours after injection for 131I for full body scans. The external symbol of the ASCVD risk estimator calculates the estimated risk of ASCVD over 10 years and for life in patients without ASCVD. By entering basic demographic data and medical information, you can use the calculator to determine your patient`s estimated risk of ASCVD. ASCVD risk estimates can also be used to facilitate a discussion between you and your patients about how to reduce the risk of ASCVD. Protocols should be evidence-based and based on recognized references (6).
In particular, published imaging guidelines from the Society of Nuclear Medicine and Molecular Imaging, the American Society of Nuclear Cardiology and the American College of Radiology should be used (7-9). In the absence of imaging guidelines, peer-reviewed articles from relevant published journals should be used. For example, there are currently no published guidelines for myocardial sympathetic innervation imaging with 123I-metaiodobenzylguanidine. However, there are several published journal articles on which a protocol is based. Create your own smoking cessation protocol using our template and implementation guide, which includes the perspectives of stakeholders in the smoking cessation community. This applies in particular to the administration of radiopharmaceuticals. If a facility does not have approved protocols that prescribe the identity, amount or range of doses, and route of administration of each radiopharmaceutical for each imaging procedure, each patient must have a written prescription from an authorized user (13). The American Medical Association (AMA) protocol focuses on treating high blood pressure medications for adults without congestive heart failure, coronary artery disease, pregnancy, or stage 3 chronic kidney disease.
It is designed to meet the needs of a wide range of patients and be cost-effective in achieving the best evidence-based outcomes. The camera position such as launch angle, detector configuration and tilt should be included in the log. This is the case during an examination of equilibrium radionuclides, for which the protocol should include instructions for the use of a slight tail tilt of 10°–15° in the left anterior oblique position to separate the left atrium from the left ventricle. The protocol should indicate whether the target organ or area of interest should be centered or off-center. There are many procedures in which the target organ is positioned off-center or at the edge of the field of view to monitor a physiological process, such as hepatobiliary imaging, where the liver is positioned above in the field of vision. In addition, the camera is placed as close to the patient as possible during most procedures. However, for some procedures, such as thyroid gland sampling or any procedure with a hole collimator, a standard distance between the patient and the detector is desirable, and this distance must be specified in the protocol. The components required for a log vary depending on the type of log. The components required for a clinical imaging protocol are different from the components of a therapeutic protocol.
For example, informed consent or written instructions are not required during diagnostic imaging, but are essential for therapy. The components required for clinical imaging protocols are listed below, while protocols for cardiac stress testing, therapy, and quality control are included in Part 2 of this article. The VA/DoD protocol focuses on critical decision points in the treatment of hypertension in primary care. The protocols presented are examples of a variety of evidence-based protocols that health practices and systems may consider adopting and using. Links to non-federal websites do not imply endorsement by the Department of Health and Human Services, the Centers for Disease Control and Prevention, or any of their employees of the sponsors or the information or products presented on the sites.