The Nuclear Stress application is used to document both routine and Nuclear imaging stress tests. MUGA and PYP reports are also included.
Prerequisites before reading this article:
How do I use EncaptureMD? (basic overview with VIDEO)
History and Exam Tab
The history tab provides a way to document a brief patient history and physical examination. Its use is optional.
- The history section documents patient risk factors, past cardiac events and more. If the patient has been seen before and the history documented, clicking the Copy from Previous button will pull that data from the most recent Nuclear Stress study.
- The testing section is useful to document previous cardiac testing for comparison to the present study.
- The Labs section allows for relevant blood work and testing result to be documented
- The Current Status can be used to document whether the patient is having active symptoms. This is helpful if you are doing an acute chest pain protocol.
- The physical exam documentation allows the staff to show the patient was stable prior to the initiation of stress.
- Data input shows up in the smart sentences on the right of the screen. Additional free texting can be done here.
Stress and Imaging
Stress
- The first column is for input of the stress data (exercise or pharmacologic)
- Routine stress and stress nuclear can be reported.
- Incomplete and complete stress protocols are available. If a patient starts a Bruce protocol but fails to achieve diagnostic stress levels, that data can still be entered along with the successful stress.
- If an interface to the Stress ECG cart is enabled, much of this first column will populate automatically.
- The second column reports the resting and stress ECG
- A complete resting ECG can be entered into the table
- Stress ECG rhythm and ST T changes are reported using the phrase generator. Be sure to click the Accept button.
- The Duke Treadmill Score is optional, but will work not only for Bruce but any exercise protocol.
- The third column documents the imaging protocol being used. Once the Standard Protocol is set up, usually only the doses need be entered.
Imaging
- The Perfusion diagram allows the user to document both graphically and via text the perfusion results of the scan.
- Click on the Normal button at the top if perfusion is normal globally. The diagram will be all green.
- Click on the legend on the left then click on the segments in the diagram to change their color.
- Right click on regions to comment on degree of perfusion decrease and probable cause. (see diagram below)
- The Resting wall motion diagram works the same way as it does in the echo application.
- Functional results cover LV and RV size and function
- Stress results cover the overall diagnosis, risk, general results and location
- Recommendations and complications complete the report.
MUGA Tab
The MUGA tab is used to record the results of a MUGA scan to assess left ventricular ejection fraction. Clicking the Normal MUGA button and then filling out the Tc 99m dose and LVEF is usually all that is required to complete this type of report.
PYP Tab
The PYP tab is used to create 99mTc pyrophosphate reports used to help diagnose ATTR amyloidosis. Filling out the data on the left creates the report on the right.
Note: Data entry should be limited to this tab for this type of report. Study reasons, dose, quality are not the same fields used in the stress part of the application.
Study Type must be set to PYP for the report title to be correct and for the validation to work properly.