+ Site Statistics
+ Search Articles
+ PDF Full Text Service
How our service works
Request PDF Full Text
+ Follow Us
Follow on Facebook
Follow on Twitter
Follow on LinkedIn
+ Subscribe to Site Feeds
Most Shared
PDF Full Text
+ Translate
+ Recently Requested

Improving appropriate use of echocardiography and single-photon emission computed tomographic myocardial perfusion imaging: a continuous quality improvement initiative



Improving appropriate use of echocardiography and single-photon emission computed tomographic myocardial perfusion imaging: a continuous quality improvement initiative



Journal of the American Society of Echocardiography 27(7): 749-757



Appropriate use criteria for cardiovascular imaging have been published, but compliance in practice has been incomplete, with persistent high rates of inappropriate use. The aim of this study was to show the efficacy of a continuous quality improvement (CQI) initiative to favorably influence the appropriate use of outpatient transthoracic echocardiography and single-photon emission computed tomographic (SPECT) myocardial perfusion imaging (MPI) in a large cardiovascular practice. In this prospective study, a multiphase CQI initiative was implemented, and its impact on ordering patterns for outpatient transthoracic echocardiography and SPECT MPI was assessed. Between November and December 2010, a baseline analysis of the application of appropriate use criteria to indications for outpatient transthoracic echocardiographic studies (n = 203) and SPECT MPI studies (n = 205) was performed, with studies categorized as "appropriate," "inappropriate," "uncertain," or "unclassified." The CQI initiative was then begun, with (1) clinician education, including didactic lectures and case-based presentations with audience participation; (2) system changes in ordering processes, with redesigned image ordering forms; and (3) peer review and feedback. A follow-up analysis was then performed between June and August 2012, with categorization of indications for transthoracic echocardiographic studies (n = 206) and SPECT MPI studies (n = 206). At baseline, 73.9% of echocardiographic studies were categorized as appropriate, 16.7% as inappropriate, 5.9% as uncertain, and 3.4% as unclassified. Similarly, for SPECT MPI studies 71.7% were categorized as appropriate, 18.5% as inappropriate, 7.8% as uncertain, and 1.9% as unclassified. Separate analysis of the two most important categories, appropriate and inappropriate, demonstrated a significant improvement after the CQI initiative, with a 63% reduction in inappropriate echocardiographic studies (18.5% vs 6.9%, P = .0010) and a 46% reduction in inappropriate SPECT MPI studies (20.5% vs 11.1%, P = .010). This study demonstrates the effective and persistent positive impact of a CQI initiative to reduce inappropriate ordering of cardiovascular imaging.

Please choose payment method:






(PDF emailed within 0-6 h: $19.90)

Accession: 053751533

Download citation: RISBibTeXText

PMID: 24726335

DOI: 10.1016/j.echo.2014.03.002


Related references

Evaluation of myocardial viability in asymptomatic patients early after infarction with perfusion/metabolism single-photon-emission computed tomographic imaging and dobutamine echocardiography. Coronary Artery Disease 11(5): 409-414, 2000

Comparison of contrast echocardiography with single-photon emission computed tomographic myocardial perfusion imaging in the evaluation of patients with possible acute coronary syndromes in the emergency department. American Journal of Cardiology 91(9): 1099-1102, 2003

Ejection fractions determined by cardiac computed tomographic angiography and single photon emission computed tomographic myocardial perfusion imaging are not interchangeable: evidence of significant and sex-associated disparities. Journal of Computer Assisted Tomography 33(4): 489-497, 2009

Assessment of myocardial viability: Dobutamine echocardiography and thallium-201 single-photon emission computed tomographic imaging predict the postoperative improvement of left ventricular function after bypass surgery. American Heart Journal 135(3): 463-475, 1998

Quantitative myocardial perfusion single-photon emission computed tomographic imaging: quo vadis? (Where do we go from here?). Journal of Nuclear Cardiology 1(1): 83-93, 1994

Current Status of Patient Radiation Exposure of Cardiac Positron Emission Tomography and Single-Photon Emission Computed Tomographic Myocardial Perfusion Imaging. Circulation. Cardiovascular Imaging 11(12): E007565, 2018

Accuracy of Computed Tomographic Angiography and Single-Photon Emission Computed Tomography-Acquired Myocardial Perfusion Imaging for the Diagnosis of Coronary Artery Disease. Circulation. Cardiovascular Imaging 8(10): E003533, 2015

Single-photon emission computed tomographic myocardial perfusion imaging in patients with mitral valve prolapse. American Journal of Cardiology 85(4): 516-518, 2000

Prognostic value of thallium-201 single-photon emission computed tomographic myocardial perfusion imaging after intracoronary stenting. European Heart Journal 20(ABSTR Suppl. ): 616, 1999

Quantitative relation of ST-segment depression during exercise to the magnitude of myocardial ischemia as assessed by single-photon emission computed tomographic myocardial perfusion imaging. American Journal of Cardiology 94(6): 703-708, 2004

Prognostic value of thallium-201 single-photon emission computed tomographic myocardial perfusion imaging according to extent of myocardial defect. Study in 1,926 patients with follow-up at 33 months. Journal of the American College of Cardiology 23(5): 1096-1106, 1994

Long-term prognostic value of 201Tl single-photon emission computed tomographic myocardial perfusion imaging after coronary stenting. American Heart Journal 141(6): 999, 2001

Comparison of single-photon emission computed tomographic (SPECT) myocardial perfusion imaging with thallium-201 and technetium-99m sestamibi in dogs. Journal of the American College of Cardiology 20(7): 1612-1625, 1992

New solid state cadmium-zinc-telluride technology for cardiac single photon emission computed tomographic myocardial perfusion imaging. Expert Review of Medical Devices 14(3): 213-222, 2017

Does beta blocker therapy affect the diagnostic accuracy of adenosine single-photon-emission computed tomographic myocardial perfusion imaging?. American Journal of Therapeutics 15(1): 19-23, 2008