The American Society of Nuclear Cardiology has issued updated practice standards for cardiac stress testing, superseding the 2016 document. The scope is deliberately end to end: patient selection and preparation, the choice of stressor and the protocol for each, safety considerations, and interpretation and reporting — with SPECT and PET myocardial perfusion imaging addressed for each available stress modality, and for testing performed without imaging as well.
The reason a decade-old stress testing guideline needs replacing is not that exercise or vasodilator physiology changed. It is that what surrounds the test did: PET availability, the competing role of CT coronary angiography and CT-derived physiology, and a much stronger expectation that preparation and protocol are adapted to the individual patient rather than run to a single departmental recipe. The document is written for a multidisciplinary audience, which reflects who actually performs and supervises these studies.
Use it as a protocol review rather than as reading. The parts most likely to differ from what a department currently does are patient preparation instructions, the handling of special populations, and reporting content — three things that tend to be set once and then inherited. Compare your written protocols against it section by section, and note that a guideline setting standards for safe conduct is also the document you will be measured against if a stress test goes wrong.
- Review written patient preparation instructions against the new document — that is where local drift accumulates.
- Check protocols for special populations specifically; they are the ones usually inherited unchanged.
- Compare your report template with the guideline's interpretation and reporting section.
- Confirm the emergency drugs and monitoring described for each stressor are actually stocked and checked.
- Circulate it to the technologists and supervising physicians, not only to the reporting radiologists.
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