Guidance Document for Structured Reporting of Diuresis Renography

Abstract

The International Scientific Committee of Radionuclides in Nephro-urology (ISCORN; http://www.iscorn.org) began in the late 1960s as an independent group of physicians and scientists working to facilitate radionuclide renal research and the practice of renal nuclear medicine. This group has subsequently issued a series of Consensus reports and has now developed a Guidance Document for quality assurance and structured reporting of diuresis renography in adults. ISCORN chose diuresis renography for its first Guidance Document for several reasons: suspected obstruction is the most common reason for referral, most radionuclide renal studies are conducted at institutions that perform fewer than 3 studies per week, and a large percentage of radionuclide renal studies are interpreted by physicians with limited training in nuclear medicine. An additional rationale was the observation that diuresis renography reports from ISCORN member institutions showed marked variation in the elements included in the reports as well as considerable variation in how the results were communicated to the referring physicians. Reports that omit the essential components of the procedure, that lack the necessary elements required for quality assurance and interpretation, that fail to indicate the rationale supporting the conclusions, and that fail, in some cases, to even clearly state the conclusions are a disservice to patients and reflect badly on nuclear medicine and radiology. To address these concerns, this Guidance Document was developed through an iterative series of comments and questionnaires regarding the reporting structure and importance of specific elements in the report. Panelists were asked to categorize each element as essential, recommended but not essential, local option (possibly useful but without sufficient data to support a higher ranking), and unnecessary (does not contribute to quality assurance or scan interpretation). Each element was independently scored by panelists without access to the individual scores of the other members or knowledge of the identity of panel members making specific comments. A majority vote was required to place an element in a specific category. The Guidance Document recommends a reporting structure organized into indications, clinical history, study procedure, findings and impression. The Guidance Document also specifies the elements considered essential or recommended in each of the reporting categories and provides a brief discussion of specific elements. Few elements, however, achieved unanimous agreement and the panel recognizes the need for innovation and the possibility of constraints imposed by local circumstances. Consequently, the Guidance Document is not intended to be restrictive but rather to provide a basic structure and rationale for diuresis renography reports in adults so that a report: (1) communicates the results to the referring physician in a clear and concise manner designed to optimize patient care; (2) contains the essential elements required to evaluate and interpre...

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“…Each protocol has its advocates, but all appear to give acceptable results in most patients. 3,21,33,34,36–43 …”

“…3,43,57 In a study using a dual-acquisition protocol, the mean baseline postvoid/max count ratio for kidneys interpreted as having normal drainage was 0.18 ± 0.16. 57 In the same dual-acquisition study, the ratio of counts at 20 minutes after furosemide to the maximum counts at baseline was 0.11 ± 0.12 for nonobstructed kidneys.…”

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“…Greater detail on specific aspects of renal scintigraphy can be found in recent reviews and will be available in an upcoming SNMMI procedure standard/EANM practice guideline for renal scintigraphy in adults. 3,4 …”

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