Nuclear Cardiology Module: NM (Revised 10-30-2024)

The Nuclear Cardiology module requires SPECT Myocardial Perfusion, plus one of the following:

• Myocardial Perfusion*

• MUGA**

Please see the article on Modalities with Low Volume or Emergency Use as needed. 

Whenever possible, submit normal nuclear medicine exams, however, abnormal exams may be submitted if no high-quality normal studies are available. 

* Myocardial Perfusion: SPECT myocardial perfusion images must include the stress and rest slices (SA slices must include apex to base, VLA and HLA slices must show LV slices "wall to wall" - two pages of slices may be necessary to show the entire LV apex to base and wall to wall), as well as an image of the time activity or volume curve depicting the ejection fraction. In addition, the images depicting the ROIs (end-systole and end-diastole) used to generate the EF must be submitted. If ED/ES ROIs are not available for display on the processing system, 3D surface rendered images (with or without cage overlay) may be substituted. Images MUST show ED and ES and be clearly labeled as such. See the NM/PET Clinical Image Atlas, available in our Testing Overview article, for examples.

Test Image Data Sheets for the Myocardial Perfusion and MUGA exams are attached below. 

ALL images for ALL submitted studies must be labeled for laterality and orientation. The left ventricular walls on the SA, HLA, and VLA slice page MUST be labeled as anterior/inferior, lateral/septal, and apex/base. 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/cages 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).

OR

• The slices must show wall laterality, i.e., septum, lateral, inferior, anterior, apex and base. 

** MUGA: Images of the entire cardiac cycle for each projection must be submitted for the MUGA, as well as an image of the ejection fraction curve with ROIs. Images submitted must match the submitted written procedure. For example, if the written procedure states 3 views are acquired routinely, then a splash page for all 3 views must be included with the curve.

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