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Nuclear Medicine: Introduction to U.S. & International Regulations and Clinical Practice Resources: Practice Guidelines

Practice Guidelines Overview

Nuclear Medicine Practice Guidelines provide practitioners with peer-reviewed information regarding important elements of nuclear medicine procedures.  Conducting a procedure in a manner that is not within the guidelines is not evidence of malpractice.  However, guidelines are examples of the community standard of care.  A physician who chooses to deviate from accepted guidelines should document the reason for the variance.

The major nuclear medicine professional societies promulgate practice guidelines.  Additionally, other medical specialty organizations will collaborate with nuclear medicine professionals on guidelines that involve nuclear medicine procedures. 

Guidelines are often published in specialty journals and most are also made available for free on society Web sites.

American Society of Nuclear Cardiology Guidelines

The American Society of Nuclear Cardiology (ASNC) has very detailed guidelines that include recommendations for best practices. In addition, ASNC has issued statements regarding special topics of interest to the nuclear cardiology community.  All of the guidelines and statements are available for free on the ASNC Web site. The ASNC guidelines include:

First-Pass Radionuclide Angiography (FPRNA)

Equilibrium Radionuclide Angiocardiogrphy (ERNA)

Stress Protocols and Tracers

Myocardial Perfusion and Planar Imaging

Single Photon Emission Computed Tomography

PET Myocardial Perfusion and Glucose Metabolism Imaging

Standardized reporting of Radionuclide Myocardial Perfusion and Function

Along with these guidelines, the ASNC site has appropriate use criteria for various cardiac procedures, clinical updates, information statements, position statements, clinical cardiology practice guidelines, and joint society statements concerning topics relevant to cardiac imaging.

European Association of Nuclear Medicine Guidelines

The European Association of Nuclear Medicine has procedure guidelines for diagnostic and therapeutic nuclear medicine.  These are available for free via their Web site.  These include all aspects of general diagnostic nuclear medicine, radionuclide therapy, dosimetry, nuclear medicine physics, radiopharmacy procedures, and technologist guidelines.

While the clinical topics are very similar to the SNM guidelines, nuclear medicine practice in Europe differs from in the United States.  Europe has a wider range of radiopharmaceuticals available for clinical use.  Dosages may also vary somewhat from those used in the United States.  The types of equipment used are similar.

Society of Nuclear Medicine Guidelines

The Society of Nuclear Medicine has an extensive set of guidelines. These guidelines include most areas of general nuclear medicine, nuclear cardiology, PET imaging and therapeutic nuclear medicine.  The most up-to-date editions of these guidelines are available for free on the SNM Web site.  Topics include:

Myocardial Perfusion Imaging

Gated Equilibrium Radionuclide Ventriculography

Scintigraphy for Differentiated Papillary and Follicular Thyroid Cancer

Thyroid Uptake Measurement

Parathyroid Scintigraphy

Thyroid Scintigraphy

Gastric Emptying

Hepatic and Splenic Imaging

C-14 Urea Breath Test

Gastrointestinal Bleeding/Meckel's Diverticulum Scintigraphy

Guideline Development

Use of Radiopharmaceuticals

Performance and Responsibility Guidelines for NMT (Nuclear Medicine Technologists)

Telenuclear Medicine

Diagnosis of Renovascular Hypertension

Gallium Scintigraphy in Inflammation

Tc-99m Exametazime (HMPAO)-Labeled Leukocyte Scintigraphy for Suspected Infection/Inflammation

In-111 Leukocyte Scintigraphy for Suspected Infection/Inflammation

Sodium 18-F Fluoride with PET/CT Bone Scans

Bone Scintigraphy

FDG-PET Brain Imaging

Brain Perfusion Single Photon Emission Computed Tomography (SPECT) Using Tc-99m Radiopharmaceuticals

Brain Death Scintigraphy

Breast Scintigraphy with Breast-Specific Gamma Cameras

Procedure Guideline for SPECT/CT Imaging

Procedure Guidelines for Tumor Imaging with 18F-FDG PET/CT

Therapy of Thyroid Disease with Iodine-131 (Sodium Iodide)

Breast Scintigraphy

Palliative Treatment for Painful Bone Metastases

Lymphoscintigraphy and the Use of Intraoperative Gamma Probe for Sentinel Lymph Node Localization in Melanoma of Intermediate Thickness

Gallium Scintigraphy in the Evaluation of Malignant Disease

Somatostatin Receptor Scintigraphy with In-111 Pentetreotide

Tumor Imaging Using F-18 FDG

Diuretic Renography in Children

Renal Cortical Scintigraphy in Children

Pediatric Sedation in Nuclear Medicine

Radionuclide Cystography in Children

Lung Scintigraphy

American College of Radiology Guidelines

The American College of Radiology (ACR) has several nuclear medicine practice guidelines available. Many of these guidelines were prepared in collaboration with other professional societies including the Society of Nuclear Medicine (SNM), the Society for Pediatric Radiology (SPR), and the American Society of Therapeutic Radiology and Oncology (ASTRO).  The most current edition of these guidelines are available for free on the ACR Web site.  Guidelines include:

ACR Practice Guideline for the Performance of Single Photon Emission CT SPECT) Brain Perfusion and Brain Death Studies

ACR–SNM–SPR Practice Guideline for the Performance of Cardiac Scintigraphy

ACR Practice Guideline for Performing FDG-PET/CT in Oncology

ACR–SNM–SPR Practice Guideline for the Performance of Gastrointestinal Scintigraphy

ACR–SPR Practice Guideline for the Performance of Adult and Pediatric Hepatobiliary Scintigraphy

ACR–SNM–SPR Practice Guideline for the Performance of Scintigraphy for Inflammation and Infection

ACR–SNM–SPR Practice Guideline for the Performance of Liver and Spleen Scintigraphy

ACR–SNM–SPR Practice Guideline for the Performance of Pulmonary Scintigraphy in Adults and Children

ACR–SNM–SPR Practice Guideline for the Performance of Parathyroid Scintigraphy

ACR–SNM–SPR Practice Guideline for the Performance of Adult and Pediatric Radionuclide Cystography

ACR–SPR Practice Guideline for the Performance of Adult and Pediatric Renal Scintigraphy

ACR Practice Guideline for the Performance of Adult and Pediatric Skeletal Scintigraphy (Bone Scan)

ACR–SNM–SPR Practice Guideline for the Performance of Thyroid Scintigraphy and Uptake Measurements

ACR–SPR Practice Guideline for the Performance of Tumor Scintigraphy (with Gamma Cameras)

ACR-ASTRO Practice Guideline for the Performance of Therapy with Unsealed Radiopharmaceutical Sources

ACR Technical Standard for Diagnostic Procedures Using Radiopharmaceuticals

Australia and New Zealand SNM Guidelines

The Australian and New Zealand Society of Nuclear Medicine has developed some technical standards in nuclear medicine instrumentation that are available for free on their Web site.  Topics include

Dose Calibrator Survey reports since 1998

Dose calibrator guidelines for I-123

Requirements for PET Accreditation (Instrumentation and Radiation Safety)

Minimum QC requirements for Nuclear Medicine Equipment.

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