The American Society of Nuclear Cardiology has issued a full replacement for its 2016 stress testing guideline, covering myocardial perfusion imaging with both single-photon emission computed tomography (SPECT) and positron emission tomography (PET). It is written beginning to end: who to test and how to prepare them, which stressor to use and by what protocol, what to watch for on safety, and how to interpret and report the result. Each available stressor is addressed against both imaging modalities.
The framing is worth noting. Rather than a single protocol, it sets practice standards that expect adaptation — to patient characteristics, to special populations, and to what a given site can actually do. That matters in Indian practice, where PET availability varies enormously between centres and a standard written for a PET-equipped tertiary unit is not usable in a district hospital running SPECT alone.
For a lab, the action is procedural rather than clinical: pull the local stress protocol, the preparation instructions given to patients, and the reporting template, and check each against the new document. Ten years is long enough that at least one of the three will be out of step, and preparation instructions are the usual offender because they are printed once and reused for years.
- Compare the local stress protocol against the new standard, stressor by stressor
- Re-check the written patient preparation instructions — these are typically the most out of date
- Review the reporting template for the interpretation and reporting sections
- Note that the guideline expects site-level adaptation rather than a single protocol
- Involve technologists and nursing staff in the review; most of what changed is procedural
Why it matters
Stress testing protocols tend to be set once and inherited; a decade of drift is invisible until something is compared against a current standard.
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