1. Technologist should have noticed that there is a gating problem.
2. The examination should have been converted to a non-gated stress test.
3. See the ratio of accepted to rejected heartbeats.
4. This test should not have been post-processed.
5. On reporting- it was reported as the most abnormal stress test ever seen.
6. On an immediate, subsequent echocardiogram the ejection fraction (EF) was normal.
7. Troubleshooting was performed and the gating error was found.
The patient was called back for a repeat stress test and another unnecessary radiation exposure.