gms | German Medical Science

Background: Technetium-99m is used in a variety of diagnostic imaging procedures affecting approximately 24,000 Canadians weekly. Following recent shortages in its supply, national guidance on its optimal use in times of supply disruption was sought.

Context: A Multi-Criteria Decision Analysis (MCDA) approach was implemented to develop a priority ranking of clinical uses of Technetium-99m. MCDA was selected because of the complexity of the situation: access to alternative imaging modalities varies across Canada and Technetium-99m is used across a number of clinical areas. The MCDA process also allowed for consistency when comparing the clinical uses. The 24 clinical uses accounting for a large portion of all Technetium-99m-based imaging procedures performed in most diagnostic imaging centres were identified. Eleven criteria were selected with which to evaluate the Technetium-99m-based test and its alternative(s), for each of the clinical uses. The relative importance, or weight, of each criterion was established. The 24 clinical uses were scored to generate a priority ranking (guidance).

Description of best practice: The guidance provides a rank ordered list of the clinical uses for which Technetium-99m should be first allocated in the event of a shortage by assessing the performance of Technetium-99m-based imaging, compared to other imaging alternatives. It offers clinicians an evidence-informed priority ranking, along with the next-best imaging alternative for each of the clinical uses examined.

Lesson for guideline users: The value of MCDA in incorporating multiple considerations into guideline implementation.