What is a Stress-Only Protocol?

Stress-only protocol is the directive by which a medical provider performs a cardiac stress test without the complementary resting scan. Traditionally, both a resting scan and a stress scan are performed on patients, which are then compared to more confidently support a diagnosis. Often, what could potentially be an abnormality in one image is disproved by the other, thereby reducing inaccurate conclusions. It does, however, subject the patient to two radiation doses, sometimes unnecessarily.

Those with a low probability of heart disease, typically younger patients who have limited risk factors, are the ideal candidates to forgo the resting scan and follow the stress-only protocol. Not only does the protocol support the global drive to decrease the radiation burden to patients, it also reduces costs, and saves time.

How it works

Once the stress scan is complete, the patient waits for the reading physician to review the results. If the recommendation is to perform an additional resting scan, it can be carried out without any delay.

In an alternate scenario, once the stress scan is complete, the patient may leave the office. Should the reading physician review the results and recommend the resting scan, the patient can return the following day, or shortly after that to complete the process.

Regardless of the logistics, the stress-only protocol can potentially spare your patient an added radiation burden. With that, there are some practical challenges that need consideration, such as the accessibility of the reading physician, clinical confidence in interpreting a low-dose stress-only study, and the flexible scheduling component.

ASNC recommendation

The American Society of Nuclear Cardiology supports the stress-only protocol in low to moderate risk patients and recommends using attenuation correction, if possible. With the reduced attenuation, the images will be more uniform and allow for higher reading and diagnostic confidence.

By helping to deliver the most accurate depiction as possible, the improved image clarity provided by attenuation correction increases the likelihood of achieving the ultimate goal of the stress-only protocol, avoiding an additional study that increases a patient’s radiation burden unnecessarily.


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