Principles for combining radionuclide and echocardiographic stress imaging into a single clinical laboratory service

Physicians who supervise stress-imaging procedures, whether they be stress nuclear or stress echocardiography tests, are increasingly required to incorporate important principles in the interpretation of the test results. Important guiding principles, common to these tests, are reviewed in this article. The principles include the following: avoiding categorical interpretation of test results; identifying equivocal test responses; combining diagnostic and prognostic information in rendering information to referring physicians; integrating the stress test results with other clinical data and using Bayesian analysis as a decision-aid; reporting one's confidence in the interpretation of the results of testing; characterizing both the extent and severity of any induced myocardial ischemia; and analyzing the test results in a blinded fashion, without prior knowledge of patient clinical history