UK audit of left ventricular ejection fraction estimation from equilibrium ECG gated blood pool images

Abstract

Results were received from 63 nuclear medicine centres using 77 computer systems. The vast majority of participants (57) carried out fewer than 10 scans per month. Only two centres performed more than 30 scans per month. Sixteen centres did not quote a minimum normal value for left ventricular ejection fraction (LVEF) and 36 did not record a maximum value. The remainder recorded between 0.40 and 0.60 for the minimum of normal range and 0.60-0.90 for the maximum of normal range. Analysis of returns showed that LVEF estimates for the data sets were highly variable between centres and computer systems. The overall standard deviation of results compared to the mean for each study was 0.076. Approximately half this variation was due to systematic variation between centres. The overall precision taking into consideration this systematic variation, was 0.055. Lower variability was found between studies with higher overall counts and this was highly significant.

Comparison of estimates of left ventricular ejection fraction obtained from gated blood pool imaging, different software packages and cameras : cardiovascular topic

“…The pattern of our results for reproducibility is consistent with previous reports in the literature by van Royen et al ,11 Pfistererer et al ,12 , Hains et al ,13 Hiscock et al ,3 and Skrypniuk et al 4 Van Royen et al 11 found that repeat quantitative radionuclide assessments of LVEF can be expected to be within a 2–4% range if a study is processed twice by the same operator. Pfisterer et al 12 do not state how many times each study was processed, but found studies reprocessed by the same operator to be within a 1–3% range of each other and within a 1.4–5% range of each other if processed by different operators.…”

“…In the studies performed by Skrypniuk4 and Fair et al ,5 it is suggested that there is a need for software suppliers to supply more information on their software packages and to give guidance on data quality requirements as well as on any limits of operation. Fair et al 5 suggested that adequate testing of software packages against phantoms (if possible), and clinical testing on a reasonable number of patients should be done by software manufacturers.…”

Standardization of LVEF values from MUGA scanning

“…This was recently demonstrated in an audit carried out by the Nuclear Medicine Software Quality Group [1]. This study analysed the variability across 77 different centres in the UK.…”

Intersection of Cardiology and Oncology Clinical Practices

“…In comparison to two-dimensional echocardiography, MUGA has lower inter- and intra-observer variability in measurement of LVEF. However, it carries risk of radiation exposure and, like the two-dimensional (2D) echocardiogram, provides limited information regarding cardiac structure and diastolic function, which limits its ability to detect subclinical myocardial damage (15, 16). …”