Distance assisted training in sub-Saharan Africa: a program evaluation.
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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)
Medical ethics, clinical research, and special aspects in nuclear medicine.
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Medical ethics is the science of survival. It studies the working out of judgments on right or wrong referred to the human being as a biological entity interacting with the whole ecosystem. Medical ethics in clinical research raises numerous moral and technical issues. Methodological aspects are essential for carrying out the aim of clinical research. Medical ethics documents are inspired by the Nuremberg Code and culminate in the recently updated Helsinki Declaration of 1964. In Italy 2 ministerial decrees in 1997 and 1998 laid the basis for the work of a medical ethics committee. They acknowledge the European Good Clinical Practice Guidelines and set professional needs within ethical committees. In clinical research the use of ionising radiation merits special consideration. In the recent past, serious human rights abuses in radiation experiments of the 1950s and 1960s have been found. As regards research in this field we can refer to the publication of the International Commission on Radiological Protection (ICRP) and to the report of the World Health Organisation (WHO). Legislative decree no. 187 of May 26, 2000, which transposed the 97/43/ EURATOM Directive represents the most comprehensive and recent normative reference to clinical research using ionising radiation. However, law no. 39 of March 1, 2002 is important for the partial modifications of previous decrees (art. 108 of L.D. no. 230 of March 17, 1995 and, art. 4 and attachment III of L.D. no. 187 of May 26). In this paper medical ethics, research, methodological issues and aspects of ionizing radiation are discussed. (+info)
The present role of nuclear cardiology in clinical practice.
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Many advances have been made in the field of nuclear cardiology in the past decade for enhancing the diagnostic and prognostic value of stress myocardial perfusion imaging and the assessment of myocardial viability using SPECT technology. Gated SPECT for determining regional and global function have provided incremental diagnostic and prognostic information in the evaluation of patients with suspected or known coronary artery disease. Left ventricular ejection fraction and regional myocardial wall thickening can now be simultaneously evaluated with regional perfusion particularly with the use of the (99m)Tc-labeled perfusion agents such as sestamibi and tetrofosmin. Many studies have shown that the extent and severity of stress-induced perfusion defects have incremental prognostic value over exercise electrocardiographic stress test variables alone. Patients with normal perfusion scans have <1% combined cardiac death and myocardial infarction rates per year and thus have an excellent prognosis. Diabetics are particularly benefited from stress perfusion imaging for detection of coronary artery disease and risk assessment. Diabetics have a worse prognosis than nondiabetics for the same amount of hypoperfusion on stress SPECT studies. Quantitative rest perfusion imaging with (201)Tl or with one of the (99m)Tc-labeled imaging agents, or PET imaging with (18)F-deoxyglucose can accurately distinguish viable from irreversibly injured myocardium providing useful information for identifying which patients with ischemic cardiomyopathy benefit most from coronary revascularization with a subsequent improvement in left ventricular function and enhanced survival. Finally, serial stress perfusion imaging can be employed to monitor the efficacy of medical therapy that improves endothelial function and myocardial blood flow reserve. (+info)
Nuclear cardiology in acute coronary syndromes.
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Acute coronary syndromes are a frequent manifestation of coronary artery disease, usually being associated with chest pain and presenting as a medical emergency. Since a considerable number of patients with chest pain, however, have a non cardiac etiology of their pain, properly triaging these patients represents a diagnostic challenge for physicians in the emergency department. As the available diagnostic procedures have limited accuracy, many different diagnostic strategies have been evaluated. Among these, radionuclide myocardial perfusion imaging (MPI) at rest or in combination with stress procedures has been investigated in many trials. MPI has been proven to be useful, especially in a patient population with a low to intermediate probability of an ischemic event. Perfusion scintigraphy has a high sensitivity in the detection of myocardial infarction and reveals an excellent negative predictive value, allowing a safe discharge strategy of patients with a negative scan result. Moreover, it enables risk stratification and provides incremental and independent prognostic information regarding short to long term future cardiac adverse events. Several cost effectiveness studies have shown that perfusion imaging leads to lower overall direct costs, mainly by a reduction of unnecessary hospital admissions and diagnostic angiograms, without worsening of the clinical outcome of these patients. As a possible study endpoint, myocardial perfusion imaging in the acute setting enables the quantification of salvaged myocardium and therefore the evaluation of treatment efficacy. Besides perfusion agents, several infarct avid radiopharmaceuticals have been developed, which in part show promising results. However, larger randomized trials evaluating these tracers in clinical settings are needed to warrant routine clinical application. (+info)
Molecular imaging. A new approach to nuclear cardiology.
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Nuclear cardiology has historically played an important role in detection of cardiovascular disease as well as risk stratification. With the growth of molecular biology have come new therapeutic interventions and the requirement for new diagnostic imaging approaches. Noninvasive targeted radiotracer based as well as transporter gene imaging strategies are evolving to meet these new needs, but require the development of an interdisciplinary approach which focuses on molecular processes, as well as the pathogenesis and progression of disease. This progress has been made possible with the availability of transgenic animal models along with many technological advances. Future adaptations of the developing experimental procedures and instrumentation will allow for the smooth translation and application to clinical practice. This review is intended as a brief overview on the subject molecular imaging. Basic concepts and historical perspective of molecular imaging will be reviewed first, followed by description of current technology, and concluding with current applications in cardiology. The emphasis will be on the use of both single photon emission computed tomography (SPECT) and positron emission tomography (PET) radiotracers, although other imaging modalities will be also briefly discussed. The specific approaches presented here will include receptor-based and reporter gene imaging of natural and therapeutic angiogenesis. (+info)
X-ray imaging physics for nuclear medicine technologists. Part 2: X-ray interactions and image formation.
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The purpose is to review in a 4-part series: (i) the basic principles of x-ray production, (ii) x-ray interactions and data capture/conversion, (iii) acquisition/creation of the CT image, and (iv) operational details of a modern multislice CT scanner integrated with a PET scanner. In part 1, the production and characteristics of x-rays were reviewed. In this article, the principles of x-ray interactions and image formation are discussed, in preparation for a general review of CT (part 3) and a more detailed investigation of PET/CT scanners in part 4. (+info)
Fundamentals of ICANL accreditation.
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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)
Components of preparedness statements to accompany 2003 task analysis.
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The Nuclear Medicine Technology Certification Board presents Components of Preparedness Statements (COPS) to accompany its recently revised task list. The COPS expand the tasks identified as important to the practice of nuclear medicine technology. These tasks are developed through an extensive process called a task analysis, which is reviewed in the article. The COPS represent the final step in this process. The COPS presented in this special report complement the task analysis published in 2003. (+info)