There are two portions to your ACR Nuclear Medicine or PET Accreditation Program submission:
Clinical image testing (for details, see our articles on Clinical Image Testing in Nuclear Medicine and Clinical Image Testing in PET)
Phantom testing (for details, see our articles on Phantom Testing in Nuclear Medicine and Phantom Testing in PET)
Clinical and phantom example images can be reviewed using the following (attached below):
- NM/PET Clinical Image Atlas
- NM/PET Phantom Image Atlas
Please contact ACR staff to answer any questions you may have about the process.
Apply all instructions to every unit being reviewed for accreditation. In order to be accredited, a facility must have all units evaluated and approved, and every unit must apply for all modules routinely performed on that unit. Clinical and phantom images must be submitted for each unit. Keep all documents for your records and keep copies of everything you submit to the ACR for your records.
The applications for both ACR Nuclear Medicine and PET Accreditation are found online through ACRedit, the ACR’s online accreditation system. When your application is processed, the ACR assigns your facility a unique identification number (NMAP# or PETAP#). This number appears on all correspondence from the ACR and your online records. Please use this number on all submitted materials and to identify your facility when contacting the ACR for assistance.
You will receive an email stating your testing materials have been sent. You must then log into your account and review all forms for your Testing Package. Generic forms are available as attachments within the relevant articles in this knowledge base. You may print these generic forms so you can fill them out online later, but the data must be submitted online.
Your online testing package, along with email notifications, will indicate when your testing materials are due to the ACR. Failure to meet this due date will jeopardize completion of your accreditation. If your facility is renewing its accreditation, we cannot guarantee completion before your ACR certificate expires. If your site cannot submit the required materials by your due date, contact the ACR immediately.
All clinical and phantom examinations submitted must have been performed within six 6 months of the date that the testing package link was released to the facility. No images will be accepted for review that predate this date by more than six months.
If you decide to change the type of exam you will be submitting, you must notify the ACR to replace that exam prior to the submission of the online testing package. Failure to notify the ACR of a change in examination type will result in a delay of accreditation review.
All Clinical Testing Submissions for Nuclear Medicine and PET:
Clinical images are evaluated for each unit within each module. Clinical images must be submitted for each unit based on the exams you selected in your initial application.
Reviewers assume that all images submitted are examples of your best work. Images will be judged accordingly.
The supervising Nuclear Medicine/PET physician should review and approve all clinical images before they are submitted.
Sites may not submit images performed on models or volunteers. Any clinical image submitted for accreditation review must be of an actual patient who needed the examination. Use of volunteers or models, including staff from your facility, is prohibited and may result in withholding, denial or revocation of accreditation. Attempting to “pass off” images taken from a volunteer or model as clinical images from a patient may constitute fraud.
A full set of images for each exam must be from the same patient. Only processed images (not raw data) should be submitted for accreditation.
Color images must include color scale, and where possible, standard images should include gray scale.
DO NOT upload and submit CT or MR images or fused images.
The parameters that will be scored on the clinical images include: radiopharmaceutical biodistribution, image acquisition, processing, and display, as well as film and report identification.
Complete the Clinical Test Image Data forms (available as attachments within the examination-specific knowledge base articles) for each required examination you submit by logging into your online account and completing your testing package. The forms summarize specific techniques including radiopharmaceutical/dose injected, scan time, acquisition parameters, etc. and must be completed for each exam.
A copy of the written procedure for each exam type must be submitted. The images should reflect use of these protocols.
All images are an important part of the medical record. Routine information, including patient name, ID#, etc., should NOT be deleted from the images and the images should NOT be anonymized. Patient confidentiality is maintained by the ACR. The following image identification must be displayed on each image or available in the DICOM header:
First and last name
Medical record number
Date and time of examination
Date-of-birth or age
Type of examination
Time of acquisition (indicated or easily calculated)
Images labeled as to laterality and orientation: The Nuclear Medicine Accreditation Committee has determined that all images for all submitted studies must be labeled for laterality and orientation. This requirement is necessary to reduce the number of serious treatment errors resulting from the lack of appropriate labeling and to address quality patient care issues raised by the recent focus on patient safety in medicine. This is a pass/fail criterion. We are aware that some of the systems may not allow you to display all of the information listed above. If you have problems with actual image labeling, please contact the ACR, because failure to label images as to laterality and orientation will result in a failure. You may provide a splash page or light box image depicting orientation and laterality of each view if no other method of labeling is available.
For SPECT submissions, Axial only DICOM slices are strongly recommended IF they display in 3 planes using the following steps:
After uploading the DICOM axial slices, you can click on the drop down to the right of View. Click on the NM + Fused 3 x 2
It will open the file in a 3 view display. This only works with DICOM files.
All images for All submitted studies must be labeled for laterality and orientation. The left ventricular walls on the SA, HLA, an VLA slice page MUST be labeled as anterior, inferior, lateral and septal. Additionally, images should include labeling showing direction of slices: apex to base, septal to lateral and inferior to anterior and include stress and rest labels. The ACR understands that some older software does not allow for LV wall labels on the slice splash page. The surface rendered/bullet/caged images, even on older software, does show laterality. While the surface rendered caged/bullet images may show laterality, they are not in the same orientation as the slices. One of two things MUST be shown in order for exams to pass:
The surface rendered caged/bullet images are capable of showing orientation and MUST be oriented to match the orientation of the slices (usually apex at center, 12 and 3 o'clock)
The slices must show wall laterality (i.e., septum, lateral, inferior, anterior, apex and base)
All Phantom Submissions for Nuclear Medicine and PET:
Phantom images will be submitted to a review panel of qualified medical physicists for scoring. The Nuclear Medicine Accreditation Committee has defined acceptable standards for uniformity, spatial resolution, contrast and lesion detection. The standards are based on results obtained from a variety of cameras and PET systems that are operating satisfactorily.
Data must be collected, and images prepared, according to the instructions (see our articles on Phantom Testing: Nuclear Medicine and Phantom Testing: PET). The procedures may differ from those normally used by the applicant but were designed to minimize variability in the images that are submitted. Despite the use of a specific protocol, it is understood that there will be differences in the appearance of the images even when the data are collected on the same type and model of scintillation camera.
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