ABC | Volume 110, Nº2, February 2018

Original Article Rodrigues et al Practices in Myocardial Perfusion Scintigraphy Arq Bras Cardiol. 2018; 110(2):175-180 of those practices at 308 nuclear medicine services (NMS) in 65 countries, and only 142 NMS (45%) have shown a satisfactory rate. So far, there are no data on the use of those recommendations in Brazil, which is this study’s objective. Methods This is a cross-sectional study with online self-administered questionnaire, whichwas sent to the email address of the technical managers of the NMS in operation in Brazil (403 NMS on the first trimester of 2016, according to data obtained at the site of the Brazilian Committee of Nuclear Energy (CNEN). The inclusion criterion in the study was that the NMSmust be authorized by the CNEN to operate. The NMS performing fewer than 20 MPS per month, as well as duplicated responses, were excluded from this study, which resulted in 63 respondents (16% of total). The questionnaire was elaborated based on the North American and European guidelines, with questions selected from the following IAEA publications: Quality Management Audits in Nuclear Medicine Practices (QUANUM) 8 and Nuclear Medicine Database (NUMDAB). 9 The questionnaire consisted of 49 questions, divided into the following 7 domains: demographic data of the NMS (5 items); technical team (10 items); patient care (4 items); radiopharmacy (8 items); equipment (7 items); test protocol (20 items); and postprocessing and image interpretation (2 items). The multidisciplinary team of the NMS was considered to be complete when having at least one professional of each category: nuclear physician, medical physicist, pharmacist, biomedical physician scientist, nurse and technician. Quality index (QI) was adopted to measure objectively the quality of the MPS, and comprises the sum of the practices that can be adopted in an NMS. The QI ranges from 0 to 8, a QI ≥ 6 being considered the desirable level for an NMS to have as suggested by the IAEA. 7 Statistical analysis The variables were tested for normality by use of the Kolmogorov-Smirnov method, revealing a non-normal distribution. Thus, descriptive analysis was performed by use of medians and interquartile range, and the Kruskal-Wallis and the Mann-Whitney U tests for independent samples were used. The Statistical Package for the Social Sciences , version 21, was used for the statistical analysis. All hypothesis tests performed considered a significance level of 5%, that is, the null hypothesis was rejected when p value < 0.05. Results The responding 63 NMS reflect the practice of 972 professionals, who account for an estimate of 13,200 MPS per month. Figure 1 shows the histogram of the QI distribution at 63 NMS in Brazil, where themedianQI found was 5. The lowest QI was 3, the lowest quartile equivalent to 25% of the QI scores was 4, and the highest quartile was 5. A QI ≥ 6, which is the desirable index, was only observed in 13 NMS (20.6% of the sample). Table 1 discriminates the QI values according to the major characteristics of the NMS, aiming at identifying those associated with the highest QI values. Two variables showed significant association with an elevated QI: 1) the NMS location inside academic institutions as compared to non‑academic ones (p = 0.046); and 2) presence in the NMS of a complete multidisciplinary team as compared to absence thereof (p = 0.030). Figure 1 – Distribution of the quality index (0 to 8) of good practices of 63 nuclear cardiology services in Brazil, 2016. Frequency Quality Index Mean = 4.86 Standard deviation = 1.045 N = 63 30 20 10 0 2 4 6 8 176