American Society of Nuclear Cardiology quality metrics for cardiac amyloid radionuclide imaging

Abstract

This document from the American Society of Nuclear Cardiology develops metrics for the assessment of quality for laboratories that perform cardiac amyloid radionuclide imaging. These metrics are based on clinical guidelines, appropriate use criteria, information and position statements, and expert opinion. The document introduces 15 quality metrics that address current gaps in care organized around 4 axes: A) Appropriate indications; B) Patient experience and workflow; C) Instrumentation and protocols; and D) Interpretation and reporting. With the increasing use of imaging for cardiac amyloid, it is imperative that our laboratories maintain a high level of quality to preserve the value that imaging provides to patients. Laboratories should perform imaging in appropriately selected patients avoiding low-value imaging. Proper education should be provided to patients prior to performing testing, timely access to testing must be available, and periodic assessment of patient experience and satisfaction should be the norm. Strict adherence to established protocols with periodic assessment of laboratory quality control is essential. Laboratory studies to rule out plasma cell dyscrasia should be performed in all patients suspected of having cardiac amyloidosis. Crucially, interpretation should be based on SPECT rather than planar imaging in all patients. The study report should include sufficient technical details to allow for proper interpretation of study findings and its conclusion should be clear and unambiguous to guide clinical management. Laboratories can use data derived from these metrics to identify areas of deficiency and introduce quality improvement initiatives, which will ultimately improve patient outcomes.

Keywords: ATTR; Amyloid transthyretin cardiac amyloidosis; Cardiac amyloid radionuclide imaging; Cardiac amyloidosis; Nuclear cardiology; Pyrophosphate imaging; Quality metrics; SPECT.