An electronic technetium-99m-diethylenetriaminepentaacetic acid glomerular filtration rate spreadsheet with novel embedded quality assurance features. 2019

Ran Klein, and Simin Razavi, and Rayhan Memon, and Lionel S Zuckier
Department of Medicine, Division of Nuclear Medicine, University of Ottawa.

BACKGROUND Critical clinical decisions are made on the basis of the glomerular filtration rate (GFR) measured using technetium-99m-diethylenetriaminepentaacetic acid (DTPA) administration, followed by multiple time-point plasma sampling. As GFR studies rely on few data points and produce a single result, they are prone to technical errors that may remain inconspicuous. OBJECTIVE We describe a data analysis worksheet that provides real-time quality control (QC) indicators and evaluate our initial clinical experience. METHODS Two hundred and forty-six consecutive GFR studies carried out at our clinics were included. Our protocol used plasma samples at 2, 3, and 4 h after injection of technetium-99m-DTPA. Duplicate plasma samples, background samples, and aliquots of an activity dilution standard were counted. Times were logged for injection and dilution standard preparation, blood sampling, and counting. Data were entered into a custom GFR analysis spreadsheet that flagged QC in real time at warning and error levels, including QC of the expected ratio between dilution standard counts-activity ratio (CARs) measurements, which was newly introduced to our clinic. The prevalence of QC events was analyzed in three phases: baseline, training, and evaluation (n=31, 69, and 146, respectively). RESULTS From the baseline and training phases (n=100), CAR reference values were determined for each of two sites. In the absence of the CAR QC indicator, errors were present in 5/31 (16%) examinations, but with QC indication decreased to 7/146 (5%) (P<0.05), suggesting that the real-time QC information guided the technologists to ensure proper standard preparation and sample handling, as intended. Improvements in other QC measures were also noted, resulting in an overall error rate reduction from 23 to 8%. CONCLUSIONS Real-time analysis of redundant information as a component of the GFR worksheet ensures quality results, but training of technologists and interpreting physicians is essential for optimal utilization of these QC indicators.

UI MeSH Term Description Entries
D007677 Kidney Function Tests Laboratory tests used to evaluate how well the kidneys are working through examination of blood and urine. Function Test, Kidney,Function Tests, Kidney,Kidney Function Test,Test, Kidney Function,Tests, Kidney Function
D011786 Quality Control A system for verifying and maintaining a desired level of quality in a product or process by careful planning, use of proper equipment, continued inspection, and corrective action as required. (Random House Unabridged Dictionary, 2d ed) Control, Quality,Controls, Quality,Quality Controls
D005919 Glomerular Filtration Rate The volume of water filtered out of plasma through glomerular capillary walls into Bowman's capsules per unit of time. It is considered to be equivalent to INULIN clearance. Filtration Rate, Glomerular,Filtration Rates, Glomerular,Glomerular Filtration Rates,Rate, Glomerular Filtration,Rates, Glomerular Filtration
D006801 Humans Members of the species Homo sapiens. Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
D000078332 Data Analysis Process of systematically applying statistical and/or logical techniques to describe and illustrate, condense and recap, and evaluate data (https://ori.hhs.gov/education). Analyses, Data,Analysis, Data,Data Analyses
D016284 Technetium Tc 99m Pentetate A technetium imaging agent used in renal scintigraphy, computed tomography, lung ventilation imaging, gastrointestinal scintigraphy, and many other procedures which employ radionuclide imaging agents. Tc 99m-DTPA,Tc-DTPA,Technetium-DTPA,Technetium (99m) Pentetate,Technetium Pentetic Acid,Technetium diethylenetriamine pentaacetic acid,99m-DTPA, Tc,Pentetic Acid, Technetium,Tc 99m DTPA,Technetium DTPA
D057188 Workflow Description of pattern of recurrent functions or procedures frequently found in organizational processes, such as notification, decision, and action. Work Flow,Work Flows,Workflows

Related Publications

Ran Klein, and Simin Razavi, and Rayhan Memon, and Lionel S Zuckier
January 1991, European journal of nuclear medicine,
Ran Klein, and Simin Razavi, and Rayhan Memon, and Lionel S Zuckier
November 1985, Journal of nuclear medicine : official publication, Society of Nuclear Medicine,
Ran Klein, and Simin Razavi, and Rayhan Memon, and Lionel S Zuckier
March 1985, South African medical journal = Suid-Afrikaanse tydskrif vir geneeskunde,
Ran Klein, and Simin Razavi, and Rayhan Memon, and Lionel S Zuckier
September 1967, Nature,
Ran Klein, and Simin Razavi, and Rayhan Memon, and Lionel S Zuckier
January 1986, Clinical nuclear medicine,
Ran Klein, and Simin Razavi, and Rayhan Memon, and Lionel S Zuckier
June 1988, Journal of nuclear medicine : official publication, Society of Nuclear Medicine,
Ran Klein, and Simin Razavi, and Rayhan Memon, and Lionel S Zuckier
March 1987, Journal of nuclear medicine : official publication, Society of Nuclear Medicine,
Ran Klein, and Simin Razavi, and Rayhan Memon, and Lionel S Zuckier
April 1981, American journal of diseases of children (1960),
Ran Klein, and Simin Razavi, and Rayhan Memon, and Lionel S Zuckier
June 1997, Journal of nuclear medicine technology,
Ran Klein, and Simin Razavi, and Rayhan Memon, and Lionel S Zuckier
February 1994, Journal of Korean medical science,
Copied contents to your clipboard!