Variability in cholescintigraphy (HIDA) protocols in hospitals across the state of Alabama

Objectives To assess the variability in HIDA protocols across the state of Alabama. Cholescintigraphy interpretation can be affected by various factors including patient preparation and protocols utilized. Published SNM guidelines do not provide clear cut normal values for ejection fractions and offer choices for CCK infusion parameters. Results of many trials suggest longer infusion methods may be more accurate than slow hand injections. There is a need for updated standardized recommendations and translation of optimized techniques needs to be seen more widely in mainstream use.

Methods 51 Nuclear Medicine departments in hospitals across the state of Alabama were surveyed by phone about various aspects of HIDA scan. Survey questions included, duration of fasting status and opiate withhold, requirements for Cholecystokinin (CCK) pretreatment, stimulation methods to assess gall bladder ejection fraction, duration and technique of CCK administration, normal values of gallbladder ejection fraction (GBEF) and procedures utilized if gallbladder non visualized.

Results There is wide variability in patient preparation and HIDA scan protocols across hospitals in the state of Alabama, most notably with, CCK pretreatment, its duration of administration and the normal GBEF values. Only 5 of the 51 hospitals pretreated with CCK if the patient was fasting for > 24 hours whereas 10 hospitals hand injected CCK in less than 3 minutes. The others used hand injection or CCK infusion over variable time periods. The normal GBEF values varied between 30 and 50% respectively.

Conclusions A wide variability in the HIDA protocol was noted across the state of Alabama which likely reflects patterns elsewhere. This may affect the diagnostic accuracy of cholescintigraphy