Using Clinical Audits and Algorithms in the Scintigraphic Imaging of Infection

Objective: We describe how using an audit of clinical practice and producing a clinical algorithm can provide a logical approach to using nuclear medicine in a defined group of patients. In this case, patients are undergoing a scintigraphic study for the investigation of focal infection or inflammation. Methods: A retrospective review was performed on two years of scintigraphic studies used for the localization of infection or inflammation in a community hospital. In each case the indication for the study and the agent used was determined. From this data and a review of current literature, a clinical algorithm was produced which was then applied to all scintigraphic studies over the next year. Changes in the number and pattern of studies performed were then reassessed. Results: In the first two years of the study a total of 94 scintigraphic studies were performed to localize infection or inflammation. The majority of patients had been studied with Ga citrateor 111 ln-labeled leukocytes. This gave a mean radiation burden to the patient of 8.1 mSv (0.81 rad) per patient. After application of the algorithm most studies were performed with mTc-labeled leukocytes or mTc human immunoglobulin. This resulted in an increase in use of the service to 82 studies performed in a single year. The mean radiation dose to the patient was reduced to 3.9 mSv (0.39 rad) per patient. Conclusion: In those areas of nuclear medicine where a choice of agents exists, it is possible to use a combination of clinical audit and algorithm to help decide which is the best agent for each patient, thus providing a better clinical service and, in our case, reducing the mean radiation burden to the patient.