Nuclear Medicine Technologists Research Articles

Insights into handling and delivery of Y-90 radioembolization therapies.

The use of Y-90 radioembolization techniques has become a standard tool for the treatment of liver cancer and metastatic diseases that result in liver lesions. As there are only two approved forms of radioembolization therapy, the procedures for use are also fairly standardized even though exact international and interdepartmental procedures can vary. What has been less published over the years are the nuanced differences in delivery techniques and handling of the two available Y90 radioembolization therapies. This paper seeks to examine various aspects of delivery techniques, product handling, and radiation exposure that differ between the available and approved products. Understanding these differences can assist with providing more efficient treatment, confirmation of accurate therapy, more informed handling of the products, and improved training of physicians and other hospital staff. Two commercially available and approved radioembolization devices were compared to assess nuanced, but key differences between the available products regarding therapy delivery, handling of the products, and radiation exposure to patients and staff. This work is broken into two sections: (1) Therapy Delivery, (2) Radiation Safety. Therapy delivery characteristics were assessed by using an external radiation detector system with detectors placed inside of each delivery system facing the dose vial and on the output catheter lines to the patient. Additional detectors were placed near the liver of the patient and on top of the foot to measure extremities. Data were acquired continuously throughout therapy delivery to collect time activity curves (TACs) for the characterization of each therapy. These data were analyzed to assess if (a) real-time monitoring of radiation could be used to provide an accurate assessment of residual dose before the patient leaves the procedure room, and (b) can dose delivery characteristics be observed that enable improved training and quality control. Calculation of residual dose using the external detector TACs was performed by analyzing initial and final activity peaks to determine measured count rate differences. Radiation safety aspects were assessed by monitoring radiation exposure to staff handling each of the available therapy products. Nuclear medicine technologists and interventional radiology physician body and hand doses were measured for each delivered therapy using standard body and ring dosimeters. The TACs noted above collected for the liver and extremities were used to assess if any off-target or leached Y90 activity could be detected for each therapy. Blood was collected at times before, during, and after treatment and then counted on a gamma counter to assess differences in free Y90 circulating in the blood. Each patient in this study also received a post-treatment whole-body PET/CT at 2-4 h post-infusion to assess for any aggregate free Y90 deposition that may have resulted from circulating free Y90 in the subject following therapy. Calculations of residual dose in the vial following therapy using the real-time detection methods resulted in values that were not statistically different from the values calculated by nuclear medicine following the procedure ( ). Real-time collection of dose delivery data enabled observation of key characteristics related to each delivery method. For SIR-spheres procedures, the cycle of pushing the dose and visualizing with fluoro can easily be seen with each push resulting in a smaller and smaller peak with intermittent fluoroscopy pulses. TheraSpheres infusions show a rapid bolus with nearly all of the measurable injected activity being infused in the first push of the dose. Staff radiation exposure assessments showed statistically significant differences between glass and resin spheres for hand doses of physicians and technologists (p > 0.05), but no statistical difference between body doses for both products ( ). Assessments of free Y90 circulating during therapy showed that patients undergoing therapies with resin spheres had post-infusion blood levels that were 120% higher than pre-infusion levels while glass sphere therapy patients only saw a 7% rise in post-infusion blood levels. The coefficients of variation (COVs) across glass sphere measurements pre, during, and post, were only 0.008 while resin sphere measures saw much greater variability with a COV of 0.45. Both glass and resin therapies showed blood levels at 2-4 h post-injection to be similar to levels measured pre-injection. Neither therapy showed any signs of focal aggregation at 2-4 h post-infusion on whole-body PET/CT. Although glass and resin radioembolization therapies are similar, they both have unique characteristics related to their administration and handling by staff. Understanding the nuances can assist in providing more efficient delivery, better staff education, and reducing radiation exposure to everyone involved with these therapies. The use of near real-time monitoring is feasible and can be used to obtain critical information about the delivery success of a therapy and can inform physicians on their techniques to optimize their practice as well as provide more consistent training to residents.

Systemic disregard, demoralising occupational burnout, protective maturity: The ‘lived’ experience of nuclear medicine technologists and the impact of COVID-19

ObjectiveIt has been shown that stress in the workplace can contribute to the development or worsening of mental health conditions, as well as having a negative impact on personal relationships and life outside of work. Therefore, prolonged job stress can be damaging to an individual's mental health and wellbeing, potentially leading to burnout. There is limited research surrounding the wellbeing of nuclear medicine technologists practicing globally, and more specifically in Australia. This interpretative phenomenological study seeks the lived experience of nuclear medicine technologists within a large metropolitan city in Australia, how these experiences and COVID-19 has impacted their wellbeing. MethodsFive participants were recruited who had greater than five years working experience as a nuclear medicine technologist. Data was collected using semi-structured interviews conducted online via Zoom to accommodate COVID-19 restrictions. The data was transcribed and analysed according to interpretative phenomenological analysis (IPA) protocols. ResultsOne superordinate theme: systemic regard, demoralizing burnout, protective maturity, overarched four subordinate themes: staying physically and psychologically safe; risk of burnout; maturity as protective against burnout; and COVID-19 drain. Pressures both prior to and during COVID-19 leave the participants feeling undervalued, discredited, and at risk of burnout. However, maturity brings confidence to incorporate their strengths in a more holistic view of life. Glimmers of positivity come from choices to alter their career path and the unexpected opportunities to spend time with family through COVID-19 restrictions. DiscussionOverall, the participants of this study expressed a lack of positivity about their own individual experiences within their career. Occupational stress, caused by workplace bullying, increased workload and understaffing increased their risk of burnout. Although as the participants matured, their ability to cope with occupational stressors improved. The recent COVID-19 pandemic exacerbated the participants’ risk of burnout. ConclusionDue to a number of contributing workplace factors, exacerbated by the unexpected COVID-19 pandemic, participants in this study appeared to have an increased risk of developing burnout. However, maturity and life experience has helped mitigate this risk.

Radiation dose assessment for nuclear medicine workers in Riyadh, Saudi Arabia

Nuclear medicine (NM) is an essential radiology department in healthcare facilities. In NM procedures, radioactive isotopes are administered intravenously or orally to assess the molecular, metabolic, physiologic, anatomical and pathologic states of the body for diagnostic therapy and research applications. The annual dosimetric records of 269 nuclear medicine technologists (NMTs) and 132 nuclear medicine nurses (NMNs) from 2016 to 2021 are collected in four major medical centres. Personal radiation doses in NM departments are monitored on a quarterly basis using thermoluminescent dosimeters (TLDs). The TLDs used have an approximate tissue equivalence of 8.14 and a density of around 2.64 g cm−3. TLDs are read using WinREMS software and a Harshaw 6600 plus reader. In this study, only Hp (10), which estimates the effective dose, is included in the analysis. The result showed that the NMTs and NMNs’ overall mean effective dose during the study period were 1.06 ± 0.60 mSv (0.06–3.26 mSv) and 0.92 ± 0.70 mSv (0.01–5.52 mSv), respectively. The result of our study found lower values of annual mean effective doses compared to previous studies conducted in Saudi Arabia. The dosimetric records show that the mean effective dose among both workers were below the permissible dose limits, which suggest a safe work environment in term of radiation protection practices.

Evidence of expert clinical practice among nuclear medicine non-medical staff: a scoping review.

This scoping review concerns expertclinical practice (ECP) by nuclear medicine practitioners (NMP), encompassing radiographers, technologists and nurses. ECP is typically demonstrated by clinical skills with higher levels of autonomy and responsibility traditionally fulfilled by physicians. The Advanced Clinical Practice (ACP) framework by Health Education England (2017) specifies ECP as one aspect of advanced role progression. This scoping review aims to identify and categorise the extent and type of the existing NMP ECP evidence to support the establishment of Nuclear Medicine ACP. PubMed, Cumulative Index to Nursing and Allied Health Literature, and Ovid Medline were searched for peer-reviewed literature published between 2001 and 2021 using extended and advanced practice as key terms alongside nuclear medicine and each NMP profession. Due to the sparsity of results, conference abstracts from prominent international societies were also searched. Studies were independently reviewed and graded for inclusion by four NMP. Of the 36 studies that met the inclusion criteria, 80.6% were conference abstracts and 66.7% were single-centres studies. Commonly reported NM ECP activities included image interpretation, cardiac stressing and therapies. Less reported activities include ordering complementary diagnostic procedures, invasive procedures and physical examinations. The United Kingdom presented itself at the forefront of NMP ECP publications. This study demonstrates evidence of NMP ECP across a variety of clinical roles. The dominance of conference abstracts highlights NMP ECP as an emerging area of role extension and a potential preference for information dissemination by NMP. Greater research into specific NMP ECP activities is required particularly studies of greater sample size and robusticity.

Radiation exposure to nuclear medicine technologists performing a V/Q PET: Comparison with conventional V/Q scintigraphy, [18F]FDG PET and [68Ga]Ga DOTATOC PET procedures.

Ventilation/Perfusion (V/Q) PET/CT is an emerging imaging modality for regional lung function evaluation. The same carrier molecules as conventional V/Q scintigraphy are used but they are radiolabelled with gallium-68 (68Ga) instead of technetium-99m (99mTc). A recurrent concern regarding V/Q PET imaging is the radiation dose to the healthcare workers. The aim of this study was to evaluate the total effective dose and the finger dose received by the technologist when performing a V/Q PET procedure, and to compare them with the radiations doses received with conventional V/Q scintigraphy, FDG PET and Ga DOTATOC PET procedures. The whole body dose measurement was performed 10 times for each of the evaluated procedures using an electronic personal dosimeter (ED). For V/Q PET and V/Q scintigraphy procedures, ventilation and perfusion stages were separately evaluated. Internal exposure was measured for ventilation procedures. Finger dose measurements were performed 5 times for each of the PET procedures using Thermoluminescence (TL) pellets. The technologist effective dose when performing a V/Q PET procedure was 2.83 ± 0.67 μSv, as compared with 1.16 ± 0.34 μSv for conventional V/Q scintigraphy, 2.13 ± 0.77 μSv for [68Ga]Ga-DOTATOC, and 2.86 ± 1.79 μSv for FDG PET procedures, respectively. The finger dose for the V/Q PET procedure was similar to the dose for a [68Ga]Ga-DOTATOC scan (0.35 mSv and 0.32 mSv, respectively). The technologist total effective dose for a V/Q PET procedure is ~2.4 higher than the dose for a conventional V/Q scintigraphy, but in the same range than the radiation exposure when performing common PET procedures, both in terms of total effective dose or finger dose. These results should be reassuring for the healthcare workers performing a V/Q PET procedure.

Development and Implementation of a Professional Practices Evaluation during Radiopharmaceuticals Administration.

Securing both the patient and radiopharmaceuticals (RPs) circuit is an essential concern in nuclear medicine (NM). These circuits converge at the RP administration phase, a key step in patient management in NM. In a continuous quality improvement approach, we developed and implemented an evaluation of professional practices (EPPs) methodology focused on RPs injection to identify and correct deviations from good practices. The nuclear medicine technologists (NMTs) of a single center were evaluated. A specific audit grid was designed for this purpose, covering 4 main themes. Following the audit campaign, an improvement action plan was set up to address the non-conformities observed. Nine NMTs were audited on 4 RPs injections each. The mean total score was 93.36% with, on average, 7.01% and 3.00% of unmet and partially met criteria, respectively. In view of the non-compliance rates of hygiene and radiation protection items, theoretical reviews of these themes were included in the improvement action plan. As a part of the quality assurance system of a healthcare unit, EPPs are useful for identifying and correcting practice deviations at an early stage. They should be regularly repeated and combined with rigorous training and qualification of operators involved in RPs injection.

Modification of [18F]-FDG PET/CT imaging protocols in obese oncology patients: A nationwide survey

IntroductionThe use of medical imaging for diagnosis, staging and follow-up in Oncology context is incredibly important, being the use of [18F]-FDG PET/CT particularly advantageous in specific contexts like the case of obese patients. However, imaging the latter can be challenging sometimes, since their own body size may affect overall image quality and adds technical difficulties for the operator(s) performing the examination. MethodsThis research project was developed with the aim of analysing the current personal practices of Portuguese Nuclear Medicine Technologists (NMTs) in the adaptation of 18F-FDG PET/CT oncological protocols for obese patients and comparing the results with parameters referenced in literature. A non-experimental research study was conducted using a survey delivered online to NMTs through social media platforms (Facebook® and LinkedIn®) and by sending the link directly to contacts within the research team professional and personal networks. ResultsAnswers from a total of 26 participants were obtained, with 88.5% of participants admitting modifying technical protocols in examinations for obese patients. Changes in PET protocols included an increase in the administered activity (60.9%), an increase in scan time per individual bed position (69.6%) and the use of Time-of-Flight (TOF) technology whenever available. Protocol changes in CT included increasing the mA (82.6%), raising the KVp (47.8%), the application of iterative reconstruction (69.6%) and the use of automatic exposure control (AEC) (52.2%). The remaining parameters (pitch, algorithm, slice thickness, display FOV, gantry rotation time and energy acceptance window) were claimed not to be modified by around 90% of professionals. ConclusionPortuguese NMTs tend to change the [18F]-FDG PET/CT protocols for obese patients. However, while some of the parameters appear to be contradictory or redundant, others require further optimisation, especially in the CT component. Implications for practiceEfforts should be made to optimize acquisition protocols used in [18F]-FDG PET/CT scans for obese patients.

Technologist-Based Implementation of Total Metabolic Tumor Volume into Clinical Practice.

Metabolic tumor volume (MTV) is defined as the total metabolically active tumor volume seen on 18F-FDG PET/CT examinations. Calculating MTV is often time-consuming, requiring a high degree of manual input. In this study, the MTV calculations of a board-certified nuclear radiologist were compared with those of 2 nuclear medicine technologists. As part of the technologists' educational program, after their classroom time they were trained by the radiologist for 30 min. The technologists calculated MTV within 7.5% of the radiologist's calculations in a set of patients who had diffuse large B-cell lymphoma and were undergoing initial staging 18F-FDG PET/CT. These findings suggest that nuclear medicine technologists may help accelerate implementation of MTV into clinical practice with favorable accuracy, possibly as an initial step followed by validation by the interpreting physician. The aim of this study was to explore whether efficiency is improved by integrating nuclear medicine technologists into a semiautomated workflow to calculate total MTV.

The Nuclear Medicine Technologist's Role in Theranostics: SNMMI-TS Advocacy's Vision.

SNMMI-TS Advocacy Committee would now like to answer the following questions and cast a level of opinion on Nuclear Medicine Technologists performing theranostics-therapy clinical work: What training does a nuclear medicine technologist (NMT) need to participate and complete theranostics? What does the SNMMI-TS Advocacy Committee feel are important initiatives to have NMTs fully engaged in theranostics today and in the long-term?

SNMMI Clinical Trials Network Research Series for Technologists: Clinical Research Primer- Use of Imaging Agents in Therapeutic Drug Development and Approval.

The process of bringing a new drug to market is complex and has recently necessitated a new drug discovery paradigm for the pharmaceutical industry that is both more efficient and more economical. Key to this has been the increasing use of nuclear medicine and molecular imaging to support drug discovery efforts by answering critical questions on the pathway for development and approval of a new therapeutic drug. Some of these questions include: (i) Does the new drug reach its intended target in the body at sufficient levels to effectively treat or diagnose disease without unacceptable toxicity? (ii) How is the drug absorbed, metabolized, and excreted? (iii) What is the effective dose in humans? To conduct the appropriate imaging studies to answer such questions, pharmaceutical companies are increasingly partnering with molecular imaging departments. Nuclear medicine technologists are critical to this process as they perform scans to collect the qualitative and quantitative imaging data used to measure study endpoints. This article describes preclinical and clinical research trials and provides an overview of the different ways that radiopharmaceuticals are used to answer critical questions during therapeutic drug development.

Interview with Nuclear Medicine Technology Educators on the Impact of COVID-19 on Programs, Outcomes, and Employers

Coronavirus disease 2019 (COVID-19) has influenced changes at health-care facilities. The editors of Journal of Nuclear Medicine Technology were interested in learning how the pandemic has affected nuclear medicine technologists (NMTs) and NMT programs. We (two of the associate editors and NMT educators) invited NMT educators to participate in a qualitative interview study to get perspective on the effects of the pandemic on their programs, institutions, and communities. The interview questions were shared with participants ahead of their scheduled interviews. Four educators were interviewed, and selections from their comments are included in this article. The comments revealed that students seem anxious but inquisitive and ready for the changing health landscape. Most programs have seen changes in student retention, with most programs seeing an increase in enrollment. COVID-19 has made educators and students think about flexibility and how to benefit from hybrid learning. Programs have seen challenges regarding personal protective equipment and vaccine requirements. All interviewed educators noted the excellent job market for students, particularly that many job offers include incentives or sign-on bonuses. The conclusion was that COVID-19 forced programs to adapt to many of these changes, enhancing student learning. NMT educators are excited about the future of molecular imaging and NMTs.

Radiation dose to nuclear medicine technologists when operating PET/MR compared with PET/CT

Since 2010, positron emission tomography/magnetic resonance (PET/MR) has been increasingly used as clinical routine in nuclear medicine departments. One advantage of PET/MR over PET/computed tomography (CT) is the lower dose of ionising radiation delivered to patients. However, data on the radiation dose delivered to staff operating PET/MR compared with the new generation of PET/CT equipment are still lacking. Our aim was to compare the radiation dose to nuclear medicine technologists performing routine PET/MR and PET/CT in the same department. We retrospectively measured the daily radiation dose received by PET technologists over 13 months by collecting individual dosimetry measurements (from electronic personal dosimeters). Data were analysed taking into account the total number of studies performed with each PET modality (PET/MR with Signa 3T, General Electric Healthcare versus PET/CT with Biograph mCT flow, Siemens), the type of exploration (brain versus whole-body PET), the 18F activity injected per day and per patient as well as the time spent in contact with patients after tracer injection. Our results show a significantly higher whole-body exposure to technologists for PET/MR compared with PET/CT (10.3 ± 3.5 nSv versus 4.7 ± 1.2 nSv per 18F injected MBq, respectively; p < 0.05). This difference was related to prolonged contact with injected patients during patient positioning with the PET/MR device and MR coil placement, especially in whole-body studies. For an equal injected activity, radiation exposure to PET technologists for PET/MR was twice that of PET/CT. To minimise the radiation dose to staff, efforts should be made to optimise patient positioning, even in departments with extensive PET/CT experience.

Australian perspectives on artificial intelligence in medical imaging.

IntroductionWhile artificial intelligence (AI) and recent developments in deep learning (DL) have sparked interest in medical imaging, there has been little commentary on the impact of AI on imaging technologists. The aim of this survey was to understand the attitudes, applications and concerns among nuclear medicine and radiography professionals in Australia with regard to the rapidly emerging applications of AI.MethodsAn anonymous online survey with invitation to participate was circulated to nuclear medicine and radiography members of the Rural Alliance in Nuclear Scintigraphy and the Australian Society of Medical Imaging and Radiation Therapy. The survey invitations were sent to members via email and as a push via social media with the survey open for 10 weeks. All information collected was anonymised and there is no disclosure of personal information as it was de‐identified from commencement.ResultsAmong the 102 respondents, there was a high level of acceptance of lower order tasks (e.g. patient registration, triaging and dispensing) and less acceptance of high order task automation (e.g. surgery and interpretation). There was a low priority perception for the role of AI in higher order tasks (e.g. diagnosis, interpretation and decision making) and high priority for those applications that automate complex tasks (e.g. quantitation, segmentation, reconstruction) or improve image quality (e.g. dose / noise reduction and pseudo CT for attenuation correction). Medico‐legal, ethical, diversity and privacy issues posed moderate or high concern while there appeared to be no concern regarding AI being clinically useful and improving efficiency. Mild concerns included redundancy, training bias, transparency and validity.ConclusionAustralian nuclear medicine technologists and radiographers recognise important applications of AI for assisting with repetitive tasks, performing less complex tasks and enhancing the quality of outputs in medical imaging. There are concerns relating to ethical aspects of algorithm development and implementation.

Determination of optimal regularization factor in Bayesian penalized likelihood reconstruction of brain PET images using [18 F]FDG and [11 C]PiB.

The Bayesian penalized likelihood (BPL) reconstruction algorithm, Q.Clear, can achieve a higher signal-to-noise ratio on images and more accurate quantitation than ordered subset-expectation maximization (OSEM). The reconstruction parameter (β) in BPL requires optimization according to the radiopharmaceutical tracer. The present study aimed to define the optimal β value in BPL required to diagnose Alzheimer disease from brain positron emission tomography (PET) images acquired using 18 F-fluoro-2-deoxy-D-glucose ([18 F]FDG) and 11 C-labeled Pittsburg compound B ([11 C]PiB). Images generated from Hoffman 3D brain and cylindrical phantoms were acquired using a Discovery PET/computed tomography (CT) 710 and reconstructed using OSEM+time-of-flight (TOF) under clinical conditions and BPL+TOF (β=20-1000). Contrast was calculated from images generated by the Hoffman 3D brain phantom, and noise and uniformity were calculated from those generated by the cylindrical phantom. Five cognitively healthy controls and five patients with Alzheimer disease were assessed using [18 F]FDG and [11 C]PiB PET to validate the findings from the phantom study. The β values were restricted by the findings of the phantom study, then one certified nuclear medicine physician and two certified nuclear medicine technologists visually determined optimal β values by scoring the quality parameters of image contrast, image noise, cerebellar stability, and overall image quality of PET images from 1 (poor) to 5 (excellent). The contrast in BPL satisfied the Japanese Society of Nuclear Medicine (JSNM) criterion of ≥55% and exceeded that of OSEM at ranges of β=20-450 and 20-600 for [18 F]FDG and [11 C]PiB, respectively. The image noise in BPL satisfied the JSNM criterion of ≤15% and was below that in OSEM when β=150-1000 and 400-1000 for [18 F]FDG and [11 C]PiB, respectively. The phantom study restricted the ranges of β values to 100-300 and 300-500 for [18 F]FDG and [11 C]PiB, respectively. The BPL scores for gray-white matter contrast and image noise, exceeded those of OSEM in [18 F]FDG and [11 C]PiB images regardless of β values. Visual evaluation confirmed that the optimal β values were 200 and 450 for [18 F]FDG and [11 C]PiB, respectively. The BPL achieved better image contrast and less image noise than OSEM, while maintaining quantitative standardized uptake value ratios (SUVR) due to full convergence, more rigorous noise control, and edge preservation. The optimal β values for [18 F]FDG and [11 C]PiB brain PET were apparently 200 and 450, respectively. The present study provides useful information about how to determine optimal β values in BPL for brain PET imaging.

Ancillary Finding on Myocardial Perfusion Imaging Due to Urinary Bladder Displacement.

When imaging patients are referred for single-photon emission computed tomography (SPECT) myocardial perfusion imaging (MPI) with technetium 99m (99mTc) agents, the attention is focused on the tracer activity in the myocardium. Apart from myocardial activity, the normal biodistribution of 99mTc Sestamibi and 99mTc Tetrofosmin is seen in the thyroid, liver, gastrointestinal tract, kidneys, and urinary bladder. These structures may be visualized when a large field of view (FOV) gamma camera is used for SPECT imaging. This brief report presents a serendipitous finding of a pelvic mass, which was identified because of the extended field-of-view afforded by the conventional gamma camera used for SPECT MPI and detected because of a review of the raw images by the nuclear medicine technologist (NMT). This case emphasizes the importance of the NMT training to review the raw data in the entire FOV prior to study completion.

131I Intake and Regulatory Compliance Following Administration of Capsular 131I Sodium Iodide for Treatment of Thyroid Disorders.

Intake of 131I by nuclear medicine technologists and physician Authorized Users was evaluated using bioassay data from administration of 131I sodium iodide in capsular form during a 5-year period. Maximum estimated annual intake of 131I sodium iodide, based on bioassay measurements performed at 24 hours post administration, ranged from 10.9 to 35.6 kBq for all staff. Intake by Authorized Users was higher than that by nuclear medicine technologists due to state requirement for Authorized Users to physically administer therapeutic dosages of radiopharmaceuticals. All intake values were less than 10% of the 131I thyroid ALI of 50 microcurie3 (1,850 kBq), indicating that monitoring may be discontinued for staff participating in routine administration of 131I capsules in which volatilization is not suspected. Elimination of bioassay performance has permitted more flexibility in patient scheduling and improved workflow and efficiency.

Evaluation of the annual occupational effective doses in a SPECT/CT department

Staff occupational radiation exposure is limited to 20 mSv annually to preclude tissue reaction and lower risk of cancer effect. Staff occupational exposure arises during the preparation, injection, and scanning of the patients. Recent studies reported that nuclear medicine personnel might exceed the annual dose limit in high workload and poor radiation protection circumstances. Therefore, an accurate estimation of the annual dose limit is recommended. The goal of this research is to calculate the cumulative external effective dose (mSv) per year for nuclear medicine physicians, technologists, and nurses at SPECT/CT department. A total of 15 staff worked in the nuclear medicine department at King Saud Medical City (KSMC), Riyadh, Saudi Arabia were evaluated for the last six years. 99mTc is used more frequently for most of the patients. The procedures include renal, cardiac scintigraphy procedures. Staff dose was quantified using calibrated thermoluminecnt dosimeters (TLD-100) with an automatic TLD reader (Harshaw 6600). Exposure to ionizing radiation was evaluated in terms of deep doses (Hp(10) were evaluated. The overall average and standard deviation of the external doses for nuclear medicine physicians, technologists' and nurses were 1.8 ± 0.7, 1.9 ± 0.6, 2.0 ± 0.9, 2.2 ± 0.8, 6.0 ± 2.8, and 3.6 ± 1.3 for the years 2015,2016,2017,2018,2019, and 2020, respectively. Technologists and nurses received higher doses of compared to the nuclear medicine physicians. Technologists and nurses involved in radionuclide preparation, patients' injection, and image acquisition. Staff annual exposure is below the annual dose limits; however, this external dose is considered high compared to the current workload.

Thyroid Uptake Exceeding 100%: Causes and Prevention.

Background: Radionuclide thyroid uptake measurements reflect the metabolic activity of the thyroid gland. Thyroid uptake is measured as a percentage of radioactivity retained by the gland at a specified time versus the activity administered to the patient; thus, uptake measurements must fall between 0 and 100%. In this study we review sources of errors that can lead to uptake >100% through a case study and describe a novel quality control (QC) indicator to improve the accuracy of uptake measurements in the clinic. Methods: Probe efficiency is determined as the ratio between dose counts of the probe relative to the independent dose calibrator activity readings. The nominal probe efficiency value (M) was calculated as the mean of readings (n≥20) and variance was characterized using the standard-deviation (SD). Warning levels were set at M±1.96×SD and error levels were set to M±2.58×SD. In subsequent routine clinical use, prior to administrating a capsule, the probe efficiency is calculated and compared with the warning and error limits. We derived M for three pairs of probe and dose-calibrator devices using several doses and measured independently by several nuclear medicine technologists. Results: The recorded data indicated that nominal efficiency was statistically different between our old device and the one that replaced it (P = 0.01) but coefficient-of-variation(CV% =SD/M×100%) was not (P = 0.42) when technologists were made aware of the expected efficiency value. Using efficiency measurements of the first 20 first patients acquired on the replacement device new QC values were derived (M= 910, SD =36). In 22 patients measured at our sister site, with the same device models but without technologists being aware of QC initiative, derived QC values were (M =1025, SD =116), demonstrating a significant difference between nominal values of individual devices (p<0.001). Furthermore, variability was significantly lower (p<0.001) when QC was followed compared to when it was not applied. Conclusion: Adding the probe efficiency as a quality control indicator during thyroid uptake measurement is simple, can produce more precise clinical measurement and help mitigate operator and instrumentation errors.

SNMMI Clinical Trials Network Research Series for Technologists: Introduction.

The field of nuclear medicine and molecular imaging has grown tremendously over the past several years with the approval of new imaging agents, diagnostic radiopharmaceuticals, and radiopharmaceutical therapies. Clinical research continues to expand within nuclear medicine and molecular imaging departments. Working as a nuclear medicine technologist on a clinical trial or with investigational radiopharmaceuticals can be quite different from working in an approved-drug setting in the clinic. Nuclear medicine technologists involved in clinical trials can be at the front line of following rigorous trial requirements and ensuring good-quality data. The details of working in clinical research are often not taught in nuclear medicine technologist programs. As such, there is an emerging need for education about clinical research for both experienced and new nuclear medicine technologists, particularly for those working with investigational radiopharmaceuticals. This article is an introduction to the SNMMI Clinical Trials Network Research Series for Technologists. This series of articles aims to provide education on working in the context of a clinical trial within the nuclear medicine department. The following 7 topics will be addressed in the series: ethical issues in clinical research, application of good clinical practice to clinical research in medical imaging, contract research organizations with application in clinical imaging, a clinical research primer on the regulatory process for how and when radiopharmaceuticals can be used and the role of the institutional review board, use of imaging agents in therapeutic drug development and approval, imaging agent trials, and imaging agents with radiopharmaceutical therapies in clinical trials. Other topics may be added over the course of the development of the series.

Advancing leadership in medical radiation sciences: Incorporating systematic leadership education in pre-registration curricula

Advancing leadership in medical radiation sciences: Incorporating systematic leadership education in pre-registration curricula