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Objective: The aim of this study was to assess variation in diuretic renal scintigraphy (DRS) practice patterns and quantify compliance with the national guidance in a large cohort of laboratories from different institutions and practice settings across the United States., Methods: By means of an institutional review board-approved protocol, we extracted 107 facility-specific, adult DRS protocols and associated 174 reports from the Intersocietal Accreditation Commission database, representing all laboratories applying for genitourinary scintigraphy certification during the 2016 to 2018 accreditation cycle. From these, we assessed 40 variables regarding facilities and staffing, patient preparation, examination technique and acquisition, image processing, and reporting., Results: Review of protocols and reports demonstrates a very high degree of variability in DRS practice across the United States and suboptimal compliance with societal guidelines and practice parameters. Some of the more variable or underreported parameters include the use of patient hydration, type and dosage of radiopharmaceutical, dosage and timing of diuretic administration, quantitative parameters assessed, and report content., Conclusion: There is high variability in the performance and reporting of DRS among laboratories applying for accreditation, similar to that seen in studies of other nuclear medicine examinations. The wide degree of practice variance may have a significant impact on diagnostic accuracy and patient management, with inaccurate or incomplete results. This survey impresses the need for standardization and improved quality of this important nuclear medicine examination., (Published by Elsevier Inc.)