A decision support system for stress only myocardial perfusion scintigraphy may save unnecessary rest studies

Aim: It is often a practical question whether to continue with the rest study after termination of a fairly normal stress myocardial perfusion scintigraphy (MPS), in particular for physicians with limited experience. The purpose of this study was to analyze the value of using a decision support system (DSS) to guide less experienced physicians in this situation. Methods: Nine residents from eight different nuclear medicine departments interpreted 100 MPS stress studies, first without and then with access to the advice of a DSS. Each study was interpreted regarding the necessity of adding a rest study for correct interpretation of the MPS. The patients had undergone a gated stress and rest MPS, using a Tc-99m sestamibi protocol. Interpretations made by three nuclear cardiology experts, having access to all available clinical and image information, were used as the gold standard. Results: In the cases where the gold standard interpretation wanted a rest study the 9 residents asked for it in 94% and 95% before and after having access to the DSS, respectively ( p >0.05). The residents did not want a rest study in 57% (without) and 69% (with the advice from the decision support system), in the patients, considered to have a normal stress study by the experts ( p <0.005). The DSS significantly reduced interobserver variation among the residents. Conclusion: The present study shows that with the support of a DSS less experienced physicians get closer to the decisions of highly experienced nuclear cardiologists regarding the need of adding a rest study to a stress MPS.