Assessing the use of nuclear medicine technology in sub-Saharan Africa: the essential equipment list.
OBJECTIVE: The primary aim of the survey was to determine the core equipment required in a nuclear medicine department in public hospitals in Kenya and South Africa, and evaluate the capital investment requirements. METHODS: Physical site audits of equipment and direct interviews of medical and clinical engineering professionals were performed, as well as examination of tender and purchase documents, maintenance payment receipts, and other relevant documents. Originally, 10 public hospitals were selected: 6 referral and 4 teaching hospitals. The 6 referral hospitals were excluded from the survey due to lack of essential documents and records on equipment. The medical and technical staff from these hospitals were, however, interviewed on equipment usage and technical constraints. Data collection was done on-site and counter-checked against documents provided by the hospital administration. RESULTS: A list of essential equipment for a nuclear medicine department in sub-Saharan Africa was identified. Quotations for equipment were provided by all major equipment suppliers, local and international. CONCLUSION: A nuclear medicine department requires eight essential pieces of equipment to operate in sub-Saharan Africa. Two additional items are desirable but not essential. (+info)
Practical methods for reducing radioactive contamination incidents in the nuclear cardiology laboratory.
OBJECTIVE: The purpose of this study was to determine the extent and cause of radioactive contamination in our nuclear cardiology laboratory, and to develop possible solutions to minimize future occurrence. METHODS: We conducted a retrospective review to determine the underlying causes of the 15 minor radioactive contamination events that have occurred in the exercise areas of our laboratory since 1986. Of the 15 documented events, 8 were caused by failure of intravenous apparatus and 7 were due to syringe mishandling. Based on a staff questionnaire, we determined the most prevalent causes of radioactive contamination. Other than problems associated with intravenous setup, the causes were lack of experience by the individual performing the injection, followed closely by radioactive syringe disposal problems, injection technique, and unclear designation of duties during the exercise procedure. RESULTS: Based on these findings, we formulated a 4-part plan: a training program; a closely inspected intravenous apparatus; a mobile radioactive waste container; and a clear designation of duties for personnel to be included in the exercise procedure protocol. CONCLUSION: We have implemented a sensible and practical plan for reducing radioactive contamination, which is currently being evaluated. (+info)
Nuclear pharmacy, Part I: Emergence of the specialty of nuclear pharmacy.
OBJECTIVE: Nuclear pharmacy was the first formally recognized area in pharmacy designated as a specialty practice. The events leading to nuclear pharmacy specialty recognition are described in this article. After reading this article the nuclear medicine technologist or nuclear pharmacist should be able to: (a) describe the status of nuclear pharmacy before recognition as a specialty practice; (b) describe the events that stimulated pharmacists to organize a professional unit to meet the needs of nuclear pharmacists; and (c) identify the steps by which nuclear pharmacists become board certified in nuclear pharmacy. (+info)
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. (+info)
Radiation disaster response: preparation and simulation experience at an academic medical center.
OBJECTIVES: A mass casualty disaster drill involving the simulated explosion of a radiation dispersal device (dirty bomb) was performed with the participation of multiple hospitals, emergency responders, and governmental agencies. The exercise was designed to stress trauma service capacities, communications, safety, and logistic functions. We report our experience and critique of the planning, training, and execution of the exercise, with special attention to the integrated response of the Departments of Nuclear Medicine, Health Physics, and Emergency Medicine. METHODS: The Health Physics Department presented multiple training sessions to the Emergency Medicine Department, Operating Room, and ancillary staff; reviewing basics of radiation biology and risk, protection standards, and detection of radiocontamination. Competency-based simulations using Geiger-Muller detectors and sealed sources were performed. Two nuclear medicine technologists played an important role in radiation discrimination-that is, assessment of radioactive contamination with survey meters and radionuclide identification based on gamma-spectroscopy of wipe smears from patients' clothing, skin, and orifices. Three Health Physics personnel and one senior Nuclear Medicine staff member were designated the radiation control officers for assigned teams triaging or treating patients. Patients were triaged and, when indicated, decontaminated. RESULTS: Within a 2-h period, 21 simulated victims arrived at our institution's Emergency Room. Of these, 11 were randomized as noncontaminated, with 10 as contaminated. Decontamination procedures were implemented in a hazardous materials (HAZMAT) decontamination trailer and, for the 5 patients with simulated serious injuries, in a designated trauma room. A full debriefing took place at the conclusion of the exercise. Staff largely complied with appropriate radiation protection protocols, although decontamination areas were not effectively controlled. The encountered limitations included significant lapses in communications and logistics, lack of coordination in the flow of patients through the HAZMAT trailer, insufficient staff to treat acute patients in a radiation control area, additional personnel needed for transport, and insufficient radiation safety personnel to control each decontamination room. CONCLUSION: Nuclear Medicine personnel are particularly well qualified to assist Health Physics and Emergency Medicine personnel in the preparation for, and management of, mass casualty radiation emergencies. Simulation exercises, though resource intensive, are essential to an institution's determination of response capability, performance, and coordination with outside agencies. (+info)
Distance assisted training in sub-Saharan Africa: a program evaluation.
Technologists working in nuclear medicine departments in sub-Saharan African countries do not have access to formal training in nuclear medicine and have been recruited mostly from related fields of radiologic technology. Because of the nature of the specialty, the numbers that require training are small, and it is therefore not cost-effective for higher-education institutions in these countries to set up training programs. There is also a lack of expertise in this field in Africa. Assessing the feasibility of running a distance assisted training program to provide training where none exists was undertaken as part of a project sponsored by the International Atomic Energy Agency and the African Co-Operative Agreement for Research, Development, and Training related to Nuclear Science and Technology. Seven countries were nominated, but only 3 centers in 2 countries, Sudan and Tanzania, had the infrastructure to support training. Twenty-one students received the first modules in November 1999, and 13 completed the course in December 2001. All students except one were examined in their own departments. Students received an IAEA Certificate of Achievement at the end of the course, at which time the program was evaluated. Analysis of the data indicated that the conceptualization and design of the material were excellent. There were, however, some problems with the implementation of the program, notably the lack of preparedness of the supervisors, limited departmental resources, and a range of nuclear medicine investigations inadequate for clinical competency. The course was seen to have a positive impact, as it not only allowed technologists to develop skills necessary for the profession but also encouraged critical thinking, reflection, and problem solving. One third of untrained nuclear medicine technologists working in sub-Saharan Africa have now received cost-effective, structured on-site training. (+info)
A survey of nuclear cardiological practice in Great Britain. The British Nuclear Cardiology Group.
There is little information on the practice of nuclear cardiology in Great Britain. On behalf of the British Nuclear Cardiology Group in October 1988 we sent a postal questionnaire to 143 hospitals with nuclear medicine facilities (at least 70% of such hospitals). Sixty nine replies were received (48%), of which 23 (33%) were from teaching hospitals and 46 (39%) non-teaching. In these hospitals 147,904 isotope investigations were performed annually (mean 2311 per centre) of which 17,298 (12%) (mean 254 per centre) were cardiac studies. Of these, 59% were equilibrium radionuclide ventriculograms, 14% first pass ventriculograms, and 27% thallium-201 scans. Rest studies were performed more commonly by radiographers or technicians (63%) than by doctors (20%), but doctors were more commonly involved in stress studies (48%). Radiologists reported the studies more often (28%) than they performed them (6%). Methods of acquisition and analysis were varied and, for instance, the lower limit of normal left ventricular ejection fraction ranged from 35% to 75% (mean 49%). For thallium imaging 42% of centres used dipyridamole in some patients and 24% used tomography. These data show that nuclear cardiology techniques are used much less frequently in Great Britain than in countries such as the United States and Germany, that the ratio of blood pool to myocardial perfusion imaging is much higher than elsewhere, and that methods are poorly standardised. They may provide the impetus to improve the service and serve as a baseline for future surveys. (+info)
Fundamentals of ICANL accreditation.
The Intersocietal Commission for the Accreditation of Nuclear Medicine Laboratories (ICANL) has become a nationally recognized accreditation program with the primary goal of providing a multidisciplinary peer review program. The purpose of this paper is to review the structure and mission of the ICANL to help increase awareness of the importance of voluntary accreditation. Included is a broad review of the ICANL standards and their relationship to other nationally published standards and guidelines. A mandatory site visit is an integral part of the program, and specifics of the site visit are discussed along with a summary of the strengths and weaknesses of applicant laboratories. The benefits of voluntary accreditation will become clear as more facilities participate in the program. (+info)