The Importance of Measurement for Quality Improvement: Submaximal Cardiac Stress Testing

One of the most effective techniques to improve quality is to measure quality. The aim of this article is to defend the importance of quality measurement in nuclear medicine using the long-standing problem of submaximal exercise stress testing. Numerous evidence-based guidelines and research studies establish the importance of maximal stress testing for myocardial perfusion imaging. The 3 cutoffs for adequate cardiac stress that must be met are expenditure of 5 metabolic equivalents of energy, production of symptoms (e.g., fatigue or shortness of breath), and attainment of 85% of the maximum predicted heart rate. Measurement and evaluation of these 3 criteria along with several other metrics can help to validate one aspect of laboratory quality related to myocardial perfusion imaging accuracy.