Other Cardiovascular
Testing Supplement (Add On)
(e.g., myocardial sympathetic innervation imaging (i.e., Adreview),
cardiac molecular imaging, cardiac shunt studies, first pass, venogram/thrombus localization )
An additional testing area (or areas) may be added to a facility’s current accreditation at any time during the threeyear accreditation cycle. Accreditation is granted only for the specific testing areas for which a facility has applied
and submitted an application. Though facilities may be performing other testing in the facility, those areas are not
covered under the accreditation until an application for the specific testing type is submitted and granted
accreditation.
Please answer all questions, required attachments will be indicated by the  symbol. Case studies requirements are
listed on the last page. (If new staff is being added, please also submit the required staff forms.)
Name of institution (as listed in the Accreditation Agreement):
(This institution name will be tracked in the IAC database and will receive all IAC correspondence)
Application #:
Department:
Street address 1:
Street address 2:
City:
State:
Zip code:
Location of Nuclear Cardiology facility:
Hospital
Private office
Free-standing imaging center
Independent facility
Other (please specify):
1) Indicate the annual volume this site performs in the following nuclear cardiology testing area (Applicable Standard:
2.1B):
Other Cardiovascular (cardiac molecular imaging, cardiac shunt, first pass, venogram/thrombus localization):

Please submit a copy of the facility-specific Other Cardiovascular protocol(s) that includes: indications,
patient prep, radiopharmaceutical, camera set up, patient position, acquisition parameters, processing
instructions, and display/labeling information. (Applicable Standard: 2.4B):
EQUIPMENT PROTOCOLS

Please submit a copy of the facility-specific Intrinsic or Extrinsic Uniformity (flood) protocol(s):
Images/documentation (hard copy or electronic) of the most recent uniformity test for all cameras must
submitted with the case study materials. (Applicable Standard: 1.3.1.2B)
(Only submit if new equipment is being added.)

Please submit a copy of the facility-specific Spatial Resolution/Linearity (bar phantom) protocol(s):
Images/documentation (hard copy or electronic) of the most recent resolution test for all cameras must
submitted with the case study materials. (Applicable Standard: 1.3.1.3B)
(Only submit if new equipment is being added.)

Please submit a copy of the facility-specific Center of Rotation (COR) protocol(s): Images/documentation
(hard copy or electronic) of the most recent resolution test for all cameras must submitted with the case study
IAC Nuclear/PET Other Cardiovascular Testing Supplement – Add On
Reviewed 6/2015
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materials. (Applicable Standard: 1.3.1.4B)
(Only submit if new equipment is being added.)

Please submit a copy of the Preventative Maintenance documentation (must be within six months of
submission) for all cameras: (Applicable Standard: 1.3.1.6B)
(Only submit if new equipment is being added.)
CASE STUDIES:
All cases must be selected from within one year prior to the date of submission and at least one case must have been
interpreted by the Medical Director.
OTHER CARDIOVASCULAR:
A total of four other cardiovascular case studies are required (only two other cardiovascular cases will be required if
the facility is seeking accreditation in an additional Nuclear Cardiology section). Only one case may be normal.
For more details on case study requirements, visit intersocietal.org/nuclear/seeking/case_studies_NC.htm.
IAC Nuclear/PET Other Cardiovascular Testing Supplement – Add On
Reviewed 6/2015
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