NMTCB 2003 task analysis report

RATIONALE: The Nuclear Medicine Technology Certification Board (NMTCB) undertook a task analysis survey in the summer of 2002 as a part of its ongoing efforts to maintain the validity of its entry-level examination. METHODS: A task analysis survey, including sections on demographics, procedures, equipment, pharmaceuticals, and tasks performed or used by nuclear medicine technologists, was prepared and sent to 1,800 certified nuclear medicine technologists (CNMTs). Survey recipients were asked to indicate the frequency with which specific tasks are performed in their departments and whether these tasks are performed by nuclear medicine technologists or by other professionals. Criticality ratings for each task were determined by the NMTCB Board of Directors. These data were combined using the Kane weighting method to determine an importance rating for each task. Survey recipients were also asked which procedures are performed and which equipment and pharmaceuticals are used in nuclear medicine procedures in their institutions. CONCLUSION: A new task analysis for nuclear medicine technology is presented. It will form the basis for the NMTCB's entry-level examination, beginning in March 2004. Lists of procedures, equipment, and pharmaceuticals used in the practice of nuclear medicine technology are also presented.     

The 2011 nuclear medicine technology job analysis project of the American Registry of Radiologic Technologists

The American Registry of Radiologic Technologists (ARRT) conducts periodic job analysis projects to update the content and eligibility requirements for all certification examinations. In 2009, the ARRT conducted a comprehensive job analysis project to update the content specifications and clinical competency requirements for the nuclear medicine technology examination. ARRT staff and a committee of volunteer nuclear medicine technologists designed a job analysis survey that was sent to a random sample of 1,000 entry-level staff nuclear medicine technologists. Through analysis of the survey data and judgments of the committee, the project resulted in changes to the nuclear medicine technology examination task list, content specifications, and clinical competency requirements. The primary changes inspired by the project were the introduction of CT content to the examination and the expansion of the content covering cardiac procedures.     

A profile of Australian nuclear medicine technologist practice

BACKGROUND: Nuclear medicine in Australia has encountered significant change over the past 30 years, with a move to privately owned practices, technological advances and the transfer of education of the nuclear medicine technologist (NMT) from technical college apprenticeships to university degrees. Currently, shortages of nuclear medicine technologists are reported in some states of Australia. It is not known whether changes in NMT practice or the type of centre in which an NMT works have an influence on retention of staff. AIM: The primary objective of this survey was to establish a profile of NMT practice in Australia, with the aim of producing baseline data that could be used in further research to establish levels of retention and job satisfaction. METHODS: Chief technologists in three states of Australia were invited to respond to a written questionnaire. The questionnaire included data about staffing levels, imaging modalities, procedures performed, and movement of staff. Findings presented will relate to the profile of practice data only. RESULTS: Forty-eight (54%) chief technologists responded to the questionnaire with 73% working in privately owned practices. The majority of centres employ up to two full-time equivalent nuclear medicine technologists and have two gamma cameras and one full-time equivalent nuclear medicine physician. Most centres perform a limited range of studies with bone scans predominating. More than half the centres make some use of a centralized radiopharmacy service. CONCLUSION: Further research is required to determine how these changes may impact on workplace satisfaction and in turn, on retention.     

Pediatric nuclear medicine, Part II: Common procedures and considerations

OBJECTIVE: This paper introduces technologists to pediatric nuclear medicine applications as well as serves as a review of the principles of pediatric imaging for more experienced technologists. After reading this article the nuclear medicine technologist should be able to: (a) identify pediatric populations commonly evaluated with nuclear medicine procedures; (b) state the indications for performing pediatric nuclear medicine procedures; and (c) discuss strategies and tips for performing nuclear medicine procedures on pediatric patients.     

The future of nuclear medicine technology: are we ready for advanced practice?

OBJECTIVE: The purpose of this study was to identify the clinical skills, commonly performed by nuclear medicine technologists (NMTs), that are beyond the entry-level practice guidelines and to determine NMTs' interest in the development of an advanced practice career pathway for nuclear medicine technology. METHODS: The Society of Nuclear Medicine Technologist Section (SNMTS) conducted a survey of 1000 technologists certified by the Nuclear Medicine Technology Certification Board (NMTCB) to determine which advanced clinical skills were being performed by NMTs and the level of training required to perform these skills. RESULTS: Those who responded to the survey were older and tended to have more years of experience and a higher level of responsibility as compared to the average technologist. Sixty-two percent of the respondents thought the SNMTS should develop an advanced practice career pathway, and 85% thought that advanced practice education should be delivered in nontraditional formats such as nights, weekends, and by distance education. CONCLUSION: NMTs reported a high level of interest in an advanced practice career pathway that could be completed while they remained employed.     

AHRA survey. Staff utilization: Part II

Part II of this AHRA membership survey reports on information relating to staff utilization in computed tomography, ultrasound and magnetic resonance. The average volume of procedures per full-time-equivalent staff is provided for technologists, clerical staff and physicians. Part III, to be published in the fall issue, will provide reports on radiation therapy and nuclear medicine.     

UK nuclear medicine survey 2003-2004

OBJECTIVES: This survey was designed to assess the trends in the frequencies of nuclear medicine procedures in the UK and to determine their contributions to the annual collective effective dose to the UK population. The average activities administered by nuclear medicine departments were compared with guidance on diagnostic reference levels issued by the Administration of Radioactive Substances Advisory Committee. METHOD: The survey was carried out by e-mailing a questionnaire to every known nuclear medicine centre in the UK. RESULTS: The total number of procedures performed annually has increased by 36% over the last 10 years to a level of about 11 procedures per 1000 head of population in the financial year 2003-2004. Seventy-three per cent of all nuclear medicine administrations are for planar imaging, with single-photon emission computed tomography and positron emission tomography contributing 16% and 2%, respectively. Non-imaging diagnostic procedures represent 7% of all nuclear medicine administrations, and therapy 2%. Bone scans continue to be the most frequent procedure. The UK annual collective effective dose from diagnostic nuclear medicine is about 1600 man Sv, resulting in an annual per caput dose of nearly 0.03 mSv. Bone scans are the largest contributor to the collective dose, but myocardium scans are close behind. Planar imaging is responsible for 62% of the total collective effective dose from diagnostic nuclear medicine in the UK, with single-photon emission computed tomography, positron emission tomography and non-imaging contributing 33%, 5% and 0.3%, respectively. CONCLUSIONS: The practice of nuclear medicine is still expanding in the UK with single-photon emission computed tomography imaging of the myocardium rapidly approaching bone scans as the main contributor to population exposure. The activities administered for most procedures have remained substantially unchanged and adhere closely to those recommended by the Administration of Radioactive Substances Advisory Committee.     

Communicating radiation exposure: a simple approach

OBJECTIVE: The aim of this article is to provide a general method to help explain radiation exposure to patients presenting for nuclear medicine procedures. The concept is to convert the effective dose from any nuclear medicine procedure to the equivalent time in months or years to obtain the same effective dose from background radiation. METHODS: The effective dose of each common diagnostic nuclear medicine procedure was obtained from the literature and the corresponding background equivalent radiation time (BERT) was calculated assuming an average background radiation of 3 mSv/y. RESULTS: A table of the BERT has been compiled for common nuclear medicine procedures. CONCLUSION: The BERT table provides a simple approach to help physicians and technologists effectively communicate radiation exposure information and perhaps potential radiation risk.     

Nuclear pharmacy, Part II: Nuclear pharmacy practice today

OBJECTIVE: Nuclear pharmacy is a specialty within the profession of pharmacy that focuses on the proper use of radiopharmaceuticals. This article reviews various features of contemporary nuclear pharmacy practice. After reading this article the nuclear medicine technologist should be able to: (a) describe nuclear pharmacy training and certification; (b) discuss nuclear pharmacy practice settings; (c) discuss nuclear pharmacy practice activities; (d) list professional organizations; and (e) describe activities associated with job satisfaction. In addition, the reader should be able to discuss regulatory issues of current concern.     

Occupational Exposure in Nuclear Medicine and PET

Purpose: With the increasing use of 18F-fluorodeoxyglucose (FDG) positron emission tomography (PET) for scanning in oncology in our center, a radiation dose survey was performed to determine the impact on staff exposure. Conventional nuclear medicine procedures such as gallium scan, bone scans, and sestamibi cardiac scans are used for comparative purposes.Procedure: Patients were measured using a hand-held radiation monitor (Victoreen 450-P) at various distances and times that replicate typical patient contact scenarios in the Diagnostic Imaging Department.Results: We present our findings from the survey and the implications these have on staff radiation exposure. The data suggest that emerging oncologic techniques such as PET, high dose gallium-67, and high dose Tl-201 do not represent a significantly greater occupational radiation hazard than conventional nuclear medicine procedures.     

Radioactive iodine therapy for malignant and benign thyroid disease: a Canadian national survey of physician practice

BACKGROUND: Radioactive iodine (as Na131I) has been used in the diagnosis and treatment of thyroid disease for more than 60 years, but the various treatment centres in Canada have different practice patterns. AIM: To determine whether there is a definable, nationwide pattern of practice which may be used to elucidate standards of practice and clarify some issues that arise when multiple care-givers are involved. METHODS: A survey questionnaire was mailed to all sites licensed by the Canadian Nuclear Safety Commission to administer Na131I for benign and malignant thyroid therapy. A second mailing was sent to non-responders. The questionnaire addressed the involvement of personnel: i.e., who prescribes, determines doses, obtains informed consent, counsels on radiation safety, administers the therapy, and follows the patient post-therapy. The survey also specifically addressed whether a nuclear medicine physician reviewed laboratory work or met with patients pre-therapy. RESULTS: The overall response rate was 60% (74/123) with representation from all Canadian provinces. The majority of respondents were physicians (78%). The data include 3447 benign thyroid therapies and 1202 malignant thyroid therapies. There are no significant regional differences in the average maximum dose administered for either benign or malignant thyroid therapies. The majority of therapies are administered in community and academic hospital settings. Endocrinologists most commonly prescribe Na131I for malignant thyroid therapies and nuclear medicine physicians for benign thyroid therapies. For all therapies nuclear medicine physicians most commonly obtain informed consent, determine the dose and provide radiation safety counselling. Nuclear medicine technologists most commonly administer the therapy and endocrinologists most commonly provide post-therapy follow-up. In the majority of centres, nuclear medicine physicians review the laboratory results for each patient's blood sample and meet with patients before therapy. CONCLUSIONS: Multiple health care specialists take part in Na131I therapy for both benign and malignant thyroid disease. In most centres, nuclear medicine physicians have major roles in the delivery of the treatments, including reviewing clinical and biochemical information. The findings of this study should provide reassurance to many centres and guidance to others to allow closer harmonization of practice.     

National survey of imaging technologists in nuclear medicine 1998/99

This survey investigated the nature of imaging staff and the distribution and structure of nuclear medicine departments in the UK. Total numbers of cameras and average per department were lower than in 1989/90 but higher than the 1992/93 survey. Total whole time equivalents, average per department and average per camera had increased. Excluding the Isle of Man, Wales had the lowest population per camera and Northern Ireland the highest. This survey identified 237 departments (90 independent, 116 integrated and 31 satellite), radiographers being the chief technologists in 64% and MTOs in 36%. Over half had one single-headed camera but one third had dual- or triple-headed cameras. Chief technologist grades ranged from Basic to Superintendent II and MTO3 to MTO5. The most common grades for other staff were Senior II or MTO3. Of the 786 technologists who provided details, 68% had initially trained as radiographers. Specific nuclear medicine qualifications were held by 67% of all technologists. In 52% of departments at least one member of staff rotated between nuclear medicine and another department or hospitals and 25% had no full-time staff. Survey returns revealed that, although 84% of imaging technologists often or occasionally attended conferences, 5% never attended.     

Ensuring safe and quality medication use in nuclear medicine: a collaborative team achieves compliance with medication management standards

As hospital nuclear medicine departments were established in the 1960s and 1970s, each department developed detailed policies and procedures to meet the specialized and specific handling requirements of radiopharmaceuticals. In many health systems, radiopharmaceuticals are still unique as the only drugs not under the control of the health system pharmacy; however, the clear trend--and now an accreditation requirement--is to merge radiopharmaceutical management with the overall health system medication management system. Accomplishing this can be a challenge for both nuclear medicine and pharmacy because each lacks knowledge of the specifics and needs of the other field. In this paper we will first describe medication management standards, what they cover, and how they are enforced. We will describe how we created a nuclear medicine and pharmacy team to achieve compliance, and we will present the results of their work. We will examine several specific issues raised by incorporating radiopharmaceuticals in the medication management process and describe how our team addressed those issues. Finally, we will look at how the medication management process helps ensure ongoing quality and safety to patients through multiple periodic reviews. The reader will gain an understanding of medication management standards and how they apply to nuclear medicine, learn how a nuclear medicine and pharmacy team can effectively merge nuclear medicine and pharmacy processes, and gain the ability to achieve compliance at the reader's own institution.     

Radiation dose to PET technologists and strategies to lower occupational exposure

OBJECTIVE: The use of PET in Australia has grown rapidly. We conducted a prospective study of the radiation exposure of technologists working in PET and evaluated the occupational radiation dose after implementation of strategies to lower exposure. METHODS: Radiation doses measured by thermoluminescent dosimeters over a 2-y period were reviewed both for technologists working in PET and for technologists working in general nuclear medicine in a busy academic nuclear medicine department. The separate components of the procedures for dose administration and patient monitoring were assessed to identify the areas contributing the most to the dose received. The impact on dose of implementing portable 511-keV syringe shields (primary shields) and larger trolley-mounted shields (secondary shields) was also compared with initial results using no shield. RESULTS: We found that the radiation exposure of PET technologists was higher than that of technologists performing general nuclear medicine studies, with doses averaging 771 +/- 147 and 524 +/- 123 microSv per quarter, respectively (P = 0.01). The estimated dose per PET procedure was 4.1 microSv (11 nSv/MBq). Injection of 18F-FDG contributed the most to radiation exposure. The 511-keV syringe shield reduced the average dose per injection from 2.5 to 1.4 microSv (P < 0.001). For the longer period of dose transportation and injection, the additional use of the secondary shield resulted in a significantly lower dose of radiation than did use of the primary shield alone or no shield (1.9 vs. 3.6 microSv [P = 0.01] and 3.4 microSv [P = 0.03], respectively). CONCLUSION: The radiation doses currently received by technologists working in PET are within accepted occupational health guidelines, but improved shielding can further reduce the dose.     

Corporate nuclear medicine: the implementation of a centralized management model

OBJECTIVE: A trend in corporate healthcare is the merging of small community hospitals with larger regional hospitals to expand the patient base. The purpose of this article is to illustrate the benefits of operating several nuclear medicine departments under a centralized management system, rather than operating many decentralized departments. The issues discussed are the development, financial benefits, operations, and structure of a corporate nuclear medicine department. METHODS: Seven nuclear medicine departments were integrated to form one corporate nuclear medicine department from a large hospital organization comprising seven different hospitals. The management team created the concept and advised administration. Training programs were designed and implemented, and committees were formed to ensure the efficient operation of the integrated department. All aspects of the department, such as scheduling and interpretation of studies, are managed at a central location. All technologists rotate to all hospitals. Success was measured by cost savings, study turn-around times, and evaluation of patient and employee satisfaction. RESULTS: It was found that establishing a corporate nuclear medicine department created a greater patient base by servicing a larger geographic area, and resulted in savings of $870,000 annually. Standardizing procedures and protocols allowed for consistency in patient care, an inpatient turnaround time of 24 h, and a dictated report turnaround time of 30 min. Employee relations and satisfaction remained consistent with a 4.76 out of a 5.0 leadership index rating. CONCLUSION: A nuclear medicine department with a centralized management system is a viable option for corporate health care. It is recommended for operations endeavoring to expand the patient base and improve the financial picture.     

Iodinated contrast media and their adverse reactions

Cross-use of technology between nuclear medicine and radiology technologists is expanding. The growth of PET/CT and the increasing use of intravenous contrast agents during these procedures bring the nuclear medicine technologist into direct contact with these agents and their associated complications. A basic understanding of the occurrence, risk factors, clinical features, and management of these procedures is of increasing importance to the nuclear medicine technologist. After reading this article, the technologist will be able to list the factors that increase the risk of contrast reactions; understand ways to minimize the occurrence of contrast reactions; and develop a plan to identify, treat, and manage the reactions effectively.     

Role of the technologist in nuclear cardiology

Conclusion  It is the responsibility of all technologists to maintain the level of quality and professionalism the field of nuclear cardiology demands. As health care continues to change and become more complex, it is important that we remain an integral part of the diagnostic process. Technologists need to stay informed and actively involved to ensure the institution they are working in is state of the art, allowing the performance of the most upto-date procedures, and that these procedures are performed with the highest level of quality. The ASNC and the editorial staff at the Journal of Nuclear Cardiology support the addition of this Technologist Section to the Journal. It is our goal as coeditors to use these pages to bring valuable information about our field to the technologists who would otherwise not be receiving it and to encourage all technologists practicing nuclear cardiology to be involved in its success. We will strive to bring you the issues that are concerning technologists today in all aspects of nuclear cardiology. We hope that all technologists will be as interested as we are in maintaining the level of professionalism and respect that our predecessors worked so hard to achieve. We welcome your input. If you are a technologist practicing nuclear cardiology and are interested in writing an article, reviewing articles from your peers, or suggesting topics to be covered, we encourage you to contact us through the editorial office of the Journal of Nuclear Cardiology.     

Nuclear medicine scans in Beijing: insights from the Beijing Quality Control Centre Survey 2005-2006

OBJECTIVE: To survey nuclear medicine scans carried out in Beijing during 2005. METHODS: Forty-two nuclear medicine departments were surveyed by using mailed questionnaires sent during September 2006. RESULTS: By the end of January 2007, 30 out of 42 hospitals had replied to our survey. The estimated annual number of SPECT procedures was 6.72 per 1000 population during 2005. Among SPECT applications, whole-body bone scans (n=23,090) were performed with the highest frequency, followed by myocardial perfusion imaging (n=19,092), and renal function imaging (n=10,287). The estimated number of myocardial perfusion scintigraphy scans was 1530 procedures per million population. The annual number of PET procedures was 0.25 per 1000 population. Most of these PET and SPECT examinations used relative monotonous radiotracers and most patients were in the age group of 40-70 years. However, for each cancer and each type of application, age distributions slightly varied. In addition, the analysis of gender distribution revealed that the number of male patients was higher than for female patients. CONCLUSION: The number of nuclear medicine scans carried out in Beijing during 2005 was considerable, with unbalanced clinical applications. Excluded myocardial perfusion scintigraphy, the frequencies of some applications were still lower than in western countries. Furthermore, most procedures used relatively monotonous radiotracers. Most patients were in the age group of 40-70 years and were male.     

Hospital and office practices of radiology groups.

To obtain information on the characteristics and practices of radiology groups in the United States, the American College of Radiology conducted a group practice survey in 1989; this report presents the main survey findings about the office and hospital practices of such groups. A questionnaire and one follow-up were mailed to all 2,591 radiology groups in the United States. Responses were weighted to reflect all groups. Hospital practices averaged 0.7 diagnostic radiologic procedures (including outpatient procedures) per patient day, with little variation by hospital type. Magnetic resonance (MR) imaging and angioplasty procedures were concentrated in teaching hospitals, but this was not true of other sophisticated procedures such as computed tomography and nuclear medicine. Offices averaged 15,000 diagnostic examinations annually, with less variation than expected according to group size. In both hospitals and offices, more than 90% of technologists were registered. Outsiders (most often, referring physicians and hospitals) had a financial interest in half of all offices. MR imaging and mammography grew faster than any other examinations, but only 44% of hospital practices accepted nonreferred patients for mammography.     

Using personality type to improve clinical education effectiveness

Many nuclear medicine technologists become clinical educators by chance, with little introduction to teaching methodologies and student learning styles. This means that most technologists teach students in the clinic by modeling the way in which they were taught in nuclear medicine school, a method that may not be effective for every student encountered. The purpose of this article is to examine how personality type can be used to improve clinical education effectiveness.