Compliance with Gastric-Emptying Scintigraphy Guidelines: An Analysis of the Intersocietal Accreditation Commission Database

Many variables can influence the results of gastric emptying scintigraphy (GES). A lack of methodologic standardization may cause variability, limit comparisons, and decrease the credibility of the test. To address this, in 2009, the Society of Nuclear Medicine and Molecular Imaging (SNMMI) published a procedure guideline describing a standardized, validated GES protocol for adults. Laboratories must closely follow the consensus protocol to provide valid and standardized results and improve patient care. The Intersocietal Accreditation Commission (IAC) evaluates compliance with guidelines as part of the accreditation process. The rate of compliance with the GES guideline at a national level has not been assessed. The aim of this study was to quantify compliance with the standardized protocol in a large cohort of laboratories from different institutions and practice settings across the United States. Methods: The IAC Nuclear/PET database was used to extract GES protocols from all laboratories applying for accreditation from 2013 to 2015. Each protocol was assessed for compliance with the methods described in the SNMMI GES procedure guidelines. Fourteen binary variables were assessed: patient preparation (4 variables), meal content (5 variables), acquisition (2 variables), and processing (3 variables). Results: Protocols from 127 labs demonstrated that patient preparation was the category with which the laboratories were least compliant. Instructions for blood glucose monitoring and withholding of medications were problematic. Overall, 69.3% of protocols were not compliant with the content or preparation of the consensus meal: 47.3% used whole eggs instead of egg whites, and additional ingredients not recommended in the guidelines were also frequently used. Only 3.1% of laboratories were fully compliant with all 14 variables. Over half the laboratories were compliant with only 5 variables or less. Conclusion: Almost 8 y after the publication of the SNMMI GES guidelines, there is low protocol adherence among laboratories applying for IAC Nuclear/PET accreditation. This substantial degree of guideline noncompliance is concerning. The variability in GES protocols may have a significant effect on patient management, as results may be inaccurate. Consistent use of the standardized GES protocol permits interpretation of results in a standardized manner that allows interlaboratory comparisons and fosters acceptance of the test validity by referring clinicians.