Influência da experiência profissional e da função visual do operador no processamento semiautomático da cintigrafia de perfusão do miocárdio: variabilidade intra e interoperador na determinação dos parâmetros quantitativos

Abstract

Introduction – Myocardial perfusion scan (MPS) has an important role in the diagnosis, evaluation and follow-up of patients with coronary artery disease being the semiautomatic processing widely used for routine clinical practice. Since the nuclear medicine technologists (NMT) performance might be affected by individual and environmental factors, different professionals that process the same data will provide different estimations of quantitative parameters (QP). Aim – Evaluate the influence of NMT professional experience and visual function on the MPS semiautomatic processing. Analysis of the intra and inter variability considering the function and perfusion QP measured. Methodology – Twenty subjects were selected and categorized in two groups according to their experience on the Quantitative Gated SPECTTM software: Group A (GA) – NMT ≥600h and Group B (GB) – NMT without experience. All NMT underwent an orthoptic evaluation and processed 21 MPS five times in a non-consecutive mode. It was assumed to be an altered vision when at least one visual function parameter was found abnormal. Coefficient of variation, %, was calculated to evaluate repeatability and reproducibility. Friedman’s and Wilcoxon tests were applied to compare QP between operators and to analyze GA and GB performance, respectively, considering the processing of the same MPS. To compare the NMT with normal and altered vision it was used the Mann-Whitney Test, and to evaluate the visual function influence in each QP was performed the ETA association coefficient. It was assumed statistically significant differences at a significance level of 5%. Results and Discussion – Low intra (<6.59%) and inter (<5.07%) operator variability was achieved. A greater discrepancy in GB was noted, being merely the septal wall (SW) statistical different (zw=-2.051, p=0.040), when compared with GA. Regarding the influence of visual function it was observed significant statistical differences only in left ventricle ejection fraction (LVEF) (U=11.5, p=0.012) between NMT with normal and altered vision, contributing the vision 33.99% for its variation. It was denoted more differences between NMT that have a greater incidence of ocular symptomology and a diminished Binocular Vision. LVEF was the most consistent QP (1.86%) between operators. Conclusion – MPS is presented as a repeatable and reproducible technique, operator independent. It was verified professional experience and visual function influence, on MPS semiautomatic processing, in the SW and LVEF QP, respectively