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The ICANL office is fully staffed with knowledgeable technical and support professionals who are ready to answer any questions you may have on completing the application for accreditation or reaccreditation or maintaining your ICANL accreditation. Below is a listing of some of the most frequently asked questions:
Don't see the question you were looking for? Contact the ICANL staff for assistance.
How long does the ICANL accreditation review process take?
Once the application is submitted online and the supporting documentation (case studies, final reports, etc.) from the facility are received in the ICANL office, the accreditation review process generally takes approximately 12 to 16 weeks to complete and the decision returned to the facility. This date is contingent upon when the application is received in the office. There are no fixed deadlines to submit the application. For details on complete review process, visit the ICANL Application Review section»
What are major changes in the 2010 ICANL Standards?
The ICANL Standards are reviewed and revised by the ICANL Board of Directors every two years. Major changes were made to the following areas:
- Technical Director qualifications
- Stress test supervision
- Imaging and Nonimaging Equipment Quality Control
- Appropriate Use Criteria
For a detailed overview of these changes and other key revisions made within the Standards, download Changes: The Latest Revisions to the ICANL Standards.
What is involved in reaccreditation?
The reaccreditation process is very similar to the original accreditation process. However, most labs find it easier because they’ve been through the process and their protocols and procedures now just need to be updated.
For complete information about ICANL reaccreditation, visit the Reaccreditation section of the website.
When should a laboratory submit application for reaccreditation?
Applications are accepted at any time throughout the year. In order to be processed within the upcoming month, applicant laboratories will be required to submit their application by the first of the month and case studies must be received in the ICANL office no later than the 5th of the month. Materials received after those dates will be processed with the next month’s deadline.
For more information, go to Timeline for Applying in the Reaccreditation Process section»
Where do I find the forms for change of ownership or change of address?
You may find links to documents associated with laboratory changes in the Changes Within the Lab section.
Mail the original completed form to:
ICANL
6021 University Blvd, Suite 500
Ellicott City, MD 21043
My laboratory performs stress-only myocardial perfusion imaging. Will we be able to get accredited if we use this protocol?
The ICANL recognizes that stress-only imaging is appropriate in many clinical situations and supports actions by facilities to reduce radiation exposure to patients. You laboratory may become accredited using the stress-only protocol. For more information please see the ASNC Information Statement: Recommendations for Reducing Radiation Exposure in Myocardial Perfusion Imaging - 2010. Read the statement»
What is a site-specific protocol?
A site-specific protocol reflects the detailed practices actually performed in the laboratory. Frequently, labs submit protocols that are too generic or not specific to the equipment used. As a general rule, protocols should contain significant detail so that any competent technologist can follow the protocol and obtain the exact same results. Therefore the protocol should have step-by-step instructions detailing every nuance of procedure. Protocols must include:
- Indications
- Contraindications
- Patient preparation (food and medication restrictions)
- Approved radiopharmaceutical dose and route of administration
- Nonradioactive pharmaceuticals used and the route of administration including timing
- Camera setup (type of camera, collimator, energy, window, etc.)
- Patient and camera position (supine, prone, upright, arm up, etc.)
- Acquisition setup (number of frames, time/frame, matrix, orbit, start and end angle, etc.)
- Processing instructions (filters, ROI, checking patient motion, motion correction etc.)
- Display (views, color scale, etc.)
- Labeling (short axis, VLA for vertical long axis, Ant for anterior, etc.)
What is the process to change the Medical or Technical Director?
Laboratories are required to notify the ICANL in writing within 30 days of any change in Medical Director, Technical Director, laboratory name or address. If notification is not made, the laboratory is not complying with the terms of the Accreditation Agreement and risks temporary suspension of the accreditation status.
The laboratory must submit the Medical or Technical Director Change Form along with Change of Operations Form, if applicable. Note: If the new Medical or Technical Director was not evaluated as part of the original accreditation process, the new staff member meet the qualification and CME/CE requirements and submit documentation.
Original forms must be mailed to (do not fax):
ICANL
6021 University Blvd, Suite 500
Ellicott City, MD 21043
You may find complete instructions and links to download the documents associated with laboratory changes in the Changes Within the Lab section»
What do we need to add a medical/technical staff if we are already an accredited lab?
While you are not required to inform us when new interpreting medical or technical staff members are hired during the accreditation period, it is highly recommended. More and more frequently, insurance payers contact us to verify accreditation details especially as reimbursement regulations change. At the time of reaccreditation, all interpreting and technical staff must be included in the application. Remember, the ICANL must be notified if there is a change in Medical Director or Technical Director.
You may find links to download documents associated with laboratory changes in the Changes Within the Lab section»
Are we required to notify the ICANL of any equipment changes during the accreditation period?
Laboratories are not required to notify the ICANL of any equipment changes once accreditation is granted. However, all facilities are required to perform studies and have protocols that are in compliance with the guidelines published by professional societies such as the Society of Nuclear Medicine or the American Society of Nuclear Cardiology. In addition facilities must maintain compliance with the ICANL Standards.
New equipment may be added at any time on the Online Accreditation Application. Deactivation of the old camera system is encouraged. The new protocols that you establish for your lab for the new equipment will be reviewed at the time of reaccreditation.
You may find links to download documents associated with equipment changes in the Changes Within the Lab section»
How do you add on a new or additional site to an already accredited facility?
For an accredited lab, an additional site can easily be added anytime. The accreditation period for the new site will be the same as the main site with the same expiration date. The requirement for multi-sites include:
- All sites must have the same Medical Director and Technical Director.
- All physicians performing and/or interpreting any examinations at any of the sites must be included in the application for accreditation in the Organization section.
- All technologists performing any examinations at any of the sites must be included in the application for accreditation. All physicians and technologists from all sites must participate together in quality assurance and education programs, including in-house conferences.
- Two additional cases per site must be submitted for review following same case selection guidelines listed in the application.
Upon receipt of all required materials, the accreditation decision will be made at the next monthly ICANL Board of Director’s meeting.
Visit the Multiple Site section for complete details»
What examples of administrative, technical and physician performance quality improvement measures?
- Administrative: Patient satisfaction is a great administrative quality improvement measure. Laboratories can also measure the amount of time from completion of procedure to distribution of final report.
- Technical: Evaluation of image quality is an example of a quality improvement study that can lead to definite improvement in image quality. To perform this study, cine data of MPI studies, for instance, can be retrospectively evaluated for patient motion, count statistics, extra cardiac activity, etc. Upon evaluation of the results, protocols can then be modified to improve image quality. Another technical quality improvement example is measurement of accurate patient preparation at the time of the study. For instance, are the patients NPO if required? Are medications withheld? Inappropriate patient preparation prior to an imaging study can have significant effects on the quality.
- Physician performance: Physician performance does not translate directly to mean that cath correlation must be done. There are many types of physician performance measures. Inter-observer variability (comparing two or more physicians on the interpretation of the same study) and intra-observer variability (measuring the physician’s agreement with the original interpretation after a period of time) can be measured.
For more suggestions of quality improvement measures for all three areas, please see the ICANL Standards, Part C.
In our laboratory the imaging and stress portions are reported separately. Do they have to be integrated?
The final reports must meet the ICANL Standards and ASNC guidelines requiring that the imaging and stress reports for MPI studies are fully integrated. It is acceptable to have the details/tables of the stress test reported separately; however, the imaging report must include certain components in order to be considered a complete and integrated final report. The following should be documented in the imaging report:
- The rest and maximum blood pressure and heart rate
- The patient’s symptoms (or lack of) during stress
- Whether the ECG was normal or abnormal at rest and during the stress test
In addition, if the stress details or tables are separate from the imaging report, both documents should reference each other. The article listed below is excellent resource:
www.asnc.org/imageuploads/ImagingGuidelinesReportingJuly2009.pdf
How do I calculate the fee for a multiple site laboratory?
The fee for each additional multiple site is $750. The fee may be paid by credit card online or check mailed at the time of application submission.
The Fee Calculator located in the Accreditation Fee section of the website is a great tool to use during the application process to calculate the accreditation costs. For more details or to use the Fee Calculator, visit the Accreditation Fee section.
If a physician meets the CME waiver by either completion of fellowship within the past three years or certification by a relevant board, how is this documented in the online application?
To indicate in the online application system that a physician meets the CME waiver simply select edit next to the staff member’s name under the Manage Staff link, scroll to the bottom of the screen and enter the reason for the waiver in the “course name” field. In the completion date field, you enter the date exam or fellowship completed and then enter 15 for the number of hours into the “ICANL” field.
For more information on CME/CE waivers see ICANL Standard A1.3.4 and A1.4.3.
What CME/CE credit can be used to meet the ICANL continuing education requirements?
The CME/CE hours for physicians and technologists must be directly related to the performance and interpretation of nuclear medicine studies or directly related to one of the ICANL Standards. In addition, courses for physicians must be approved for AMA Category I credit and courses for technologist must be approved by a RCEEM (Recognized Continuing Education Evaluation Mechanism) organization.
CME/CE courses related to MR/MRA, ECHO, CT/CTA, x-ray or general cardiology, etc., are not considered relevant. However, a course related to SPECT and PET imaging techniques is considered relevant. A radiation safety/physics course may be used to meet the CME/CE credit requirement if the course has been approved for AMA Category I credit or approved by RCEEM organization for technologist credit. ACLS or BLS courses may not be used to fulfill the continuing education as they are not approved for AMA Category I credit or RCEEM credit.
The ICANL website has a list of courses which have been submitted to the ICANL for pre-determination of relevance. If you would like to have a course evaluated that is not listed on the pre-determination list, please e-mail the course syllabus to us for evaluation.
Is there a website that lists where physicians and technologists can acquire CME/CE?
The ICANL website has a section dedicated to providing assistance to physicians and technologists looking for CME/CE opportunities. Upcoming live courses, online courses and self study courses are listed. In addition, the professional societies such as the Society of Nuclear Medicine and the American Society of Nuclear Cardiology provide numerous continuing education courses.
For a full listing or CME courses and requirements, visit the CME Resources section.
What are the requirements for submitting ICANL nuclear cardiology case study images?
There are two options for submitting the required case study images
- The preferred method of submitting case study documentation is processed image data in digital format on CD, DVD or flash drive. Optical disks may not be submitted. In the past, labs were able to submit raw digital data for reprocessing at the Yale Core Lab. However, raw digital data may no longer be submitted.
- If labs are not able to submit digital images, they may submit high quality color/black and white paper copies of the required images listed above with the exception of the CINE and movie data.
For full details on submitting case study images, visit the Case Studies section.
How do I view or change protocols uploaded electronically on the Online Accreditation Application? How do I delete a medical staff member entered on the application?
You may re-assign or re-upload your electronic attachments by clicking on the send “electronically” question or radio buttons again and selecting the new or different file you wish to attach to the online application. The original file will be overwritten. If you are trying to attach multiple pages or multiple protocol documents, combine them into one folder (in order to combine your protocols you will need to put them into a zip or compressed file before uploading, if it is more than 4MB) and then attach the folder.
You may not delete a staff member from the list. However, you may deactivate and/or edit the staff member in the Manage Staff section of the application. The Applications section will not reflect staff members that are listed as inactive.
What are the requirements for ICANL QA plan?
All laboratories must have a written Quality Improvement policy that includes annual assessment of at least one measure from each of the following three areas: administrative, technical and interpretive quality (See Standard C1.1 and C2.1). The plan should address the specific quality assurance activities to be performed, the frequency and staff responsibilities.
In addition, there must be minutes or a report documenting the implementation of the Quality Improvement plan that includes a review of the findings and actions for improvement of performance in all three areas. At a minimum, these meetings must occur at least every six months. (See Standard C.1 and C3)
Each laboratory must create a QA policy that works best for them and their busy schedules. The concept of “Keep it simple” was never more appropriate. Examples of quality improvement activities include:
- Administrative: Report turn around time, delay in scheduling, as well as patient and physician satisfaction surveys
- Technical: Processing skills, image quality reviews, patient preparation at time of study
- Physician performance (interpretive): Cath correlation, peer reviews, interobserver variability, or intraobserver variability
And remember, the goal of QI measures is to improve processes and quality. So for example, if the patient satisfaction survey results were found to be above your anticipated threshold results, there is no point in measuring it again and again, move on to another area find areas to improve.
New Appropriate Use Criteria: The quality assurance program must now include measurement of Appropriate Use for all accredited Nuclear Cardiology facilities. There is new information regarding the appropriate use criteria and the ACC’s FOCUS program in the Newsroom.
The ICANL website has a very good sample policy and QA programs for you to review and use in the Sample Documents – Quality Controls & Quality Improvement section.
How does a required site visit decision differ from the random site visit or audit?
As part of the IAC accreditation process, applicant laboratories could potentially be required to undergo a site visit of their laboratory. During the process of rendering an accreditation decision, the Board of Directors may determine that a site visit is required in order to better assess the laboratory and determine the final accreditation decision.
Read more about Accreditation Decisions»
The random site visit or audit will be performed at an undisclosed date and will occur after the laboratory is granted accreditation by the IAC.
Are all accredited laboratories required to undergo a random site visit or random audit?
Yes, in an effort to further substantiate continued compliance by accredited laboratories and in response to the requirements sanctioned by the Centers for Medicare & Medicaid Services (CMS) for CMS appointed Accreditation Organizations as part of the Medicare Improvements for Patients and Providers Act (MIPPA), the IAC has implemented a policy requiring all accredited laboratories to undergo an audit or site visit at some time during their three-year accreditation period. Read more about Random Site Visits and Audits»
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