General Nuclear Medicine (GNM)
Testing Supplement (Add On)
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 GNM facility:
Hospital
Private office
Free-standing imaging center
Independent facility
Other (please specify):
1) Choose the type of general nuclear medicine testing/treatment areas that your facility performs at ANY
permanent site. Select (all/each of) the areas in which you want to apply:
Gastrointestinal System Imaging (e.g., gastric emptying, GI bleed, Meckel’s, esophageal or GI motility studies,
hemangioma, hepatobiliary, liver-spleen imaging, salivary)
Central Nervous System Imaging (e.g., brain scans, CSF studies, cisternogram)
Endocrine System Imaging (e.g., thyroid, parathyroid, adrenal studies, includes RAI uptake w/scan)
Endocrine System Non-imaging (option for facilities that perform radioiodine (RAI) uptake only without scans/no
imaging)
Skeletal System Imaging (e.g., whole body, limited, SPECT, planar, 3-phase bone scans)
Genitourinary System Imaging (e.g., renal scans, cystography, testicular scans)
Pulmonary System Imaging (e.g., ventilation, perfusion lung studies)
Infection Imaging (e.g., gallium, indium)
Tumor Imaging (e.g., breast imaging, gallium, I131 whole body scans, ProstaScint scans, monoclonal antibody
imaging)
Infection Imaging (e.g., gallium, indium)
Hematopoetic, Reticuloendothelial and Lymphatic Imaging (e.g., bone marrow imaging, lymphoscintigraphy, red
cell volume/mass/sequestration/survival)
Nuclear Medicine Therapy (e.g. bone pain palliation, iodine/thyroid therapy, P32 therapies)
2) Indicate the annual volume this site performs in the following general nuclear medicine testing areas (Enter “0”
if no tests of this type are done at this site):
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Gastrointestinal system imaging (gastric emptying, GI bleed, meckels, esophageal or GI motility, hemangioma,
hepatobiliary, liver-spleen, salivary):
Central nervous system imaging (brain, CSF, cisternogram):
Endocrine system imaging (thyroid, parathyroid, adrenal):
Endocrine system non-imaging (option for facilities that perform radioiodine (RAI) uptake only, without scans/no
imaging):
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Skeletal system imaging (whole body bone, limited bone, SPECT bone, 3-phase bone):
Genitourinary system imaging (renal, cystography, testicular):
Pulmonary system imaging (ventilation lung, perfusion lung):
Infection imaging (gallium, indium):
Tumor imaging (breast, gallium, I131 whole body scans, ProstaScint, monoclonal antibody imaging):
Hematopoetic, reticuloendothelial and lymphatic imaging (bone marrow imaging, lymphoscintigraphy, red cell
volume/mass/sequestration/survival):
Nuclear medicine therapy (bone pain palliation, I31 Thyroid, P32):
Protocols

Please submit a copy of the facility-specific Gastrointestinal System Imaging 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)

Please submit a copy of the facility-specific Central Nervous System Imaging 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)

Please submit a copy of the facility-specific Endocrine System Imaging 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)
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Please submit a copy of the facility-specific Endocrine System non-Imaging (RAI Uptake) protocol.
(Applicable Standard: 2.4B)

Please submit a copy of the facility-specific Skeletal System Imaging 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)

Please submit a copy of the facility-specific Genitourinary System Imaging 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)

Please submit a copy of the facility-specific Pulmonary System Imaging 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)

Please submit a copy of the facility-specific Infection Imaging 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)

Please submit a copy of the facility-specific Tumor Imaging 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)

Please submit a copy of the facility-specific Hematopoietic Reticuloendothelial and Lymphatic Imaging
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)

Please submit a copy of the facility-specific Nuclear Medicine Therapy protocol(s).
(Applicable Standard: 2.4B)
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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.)
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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
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:
Only one case study per system may be normal. 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.
GENERAL NUCLEAR MEDICINE:
All cases must be abnormal: a minimum of four (maximum of 12) cases will be required (if applying in one GNM
type/group, submit four cases for that type; if applying in more than one type, submit two cases for each type.) The
available General Nuclear Medicine case types are listed below:
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Gastrointestinal System
Genitourinary System
Endocrine System
Endocrine System Nonimaging (RAI Uptake) (Note: Only provide endocrine nonimaging if not applying
for endocrine system)
(If applying for more than one of the above 2 types of GNM, you may select the distribution of cases among the types
performed in order to reach the required 2 or 4 cases.)
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Musculoskeletal System
Infectious Disease Processes
Tumors
(If applying for more than one of the above 3 types of GNM, you may select the distribution of cases among the types
performed in order to reach the required 2 or 4 cases.)
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Central Nervous System
Pulmonary System
Hematopoietic, Reticuloendothelial, Lymphatic
(If applying for more than one of the above 3 types of GNM, you may select the distribution of cases among the types
performed in order to reach the required 2 or 4 cases.)
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Therapy
For more information on case studies instructions, visit intersocietal.org/nuclear/seeking/case_studies_GNM.
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