"Nuclear medicine" session

En la sesión dedicada a la Medicina Nuclear (MN) se identificaron los cinco aspectos que se consideran más problemáticos en la protección radiológica en MN. Estos hacen referencia a: 1. Garantizar que la dosis administrada al paciente sea correcta; 2. Evitar en el trabajador la contaminación e irradiación de las extremidades superiores, cristalino y resto del cuerpo; 3. Asegurar la optimización de dosis en diagnóstico y tratamiento; 4. Promover la justificación de los exámenes en MN; 5. Prevenir incidentes y accidentes. Las soluciones aportadas a estos problemas fueron: 1. Implementar sistemas integrales de calidad y protocolos de control de calidad así como entrenar y capacitar adecuadamente a los trabajadores; 2. Mejorar la capacitación y formación del trabajador, uso sistemático de medios de protección y de protocolos de trabajo y adecuación de los procedimientos de trabajo; 3. Utilización de dosis estandarizadas en diagnóstico y planificar los tratamientos mediante dosimetría interna paciente específica; 4. Capacitación de médicos prescriptores y médicos nucleares y utilización de guías de adecuada solicitud de exámenes de MN; 5. Incorporación efectiva de sistemas de notificación de incidentes para su posterior análisis y aprendizaje mediante la utilización de técnicas de análisis de sucesos. Los indicadores propuestos para la adecuada valoración de los avances obtenidos en cada uno de los aspectos valorados fueron: 1. Número de centros con un Programa de garantía de calidad implementado y grado de cumplimiento del mismo en cada centro 2. Análisis de tendencias de los datos dosimétricos reportados 3. Cantidad de exámenes con protocolos de optimización de dosis o de estimación de la actividad paciente específico 4. Número de programas de estudio de pregrado de medicina que incluyen temas relacionados con Protección Radiológica y número de protocolos clínicos escritos con las indicaciones de cada estudio y porcentaje de exámenes que cumplen con estas guías. 5. Grado de implementación de de sistemas de notificación de incidentes de seguridad, grado de uso de herramientas de análisis pre dictivo y número de reuniones de evaluación de eventos Algunas de las soluciones propuestas son fácilmente incorporables a la práctica diaria. Sin embargo, otras requieren más tiempo y, sobre todo, acciones por grupos internacionales que trabajen conjuntamente para aportar soluciones concretas.In the session dedicated to Nuclear Medicine (NM) the five aspects considered the most problematic in radiation safety in NM were identified. These refer to: 1) Ensure the correct dose is delivered to the patient; 2) Avoid contamination and irradiation of the upper extremities, lens of the eyes and rest of the body; 3) Ensure the optimization of doses in diagnosis and treatment; 4 Promote the justification of the examinations in NM; and 5) Prevent incidents and accidents. The solutions provided to these problems were: 1) To implement quality management systems and quality control protocols as well as to educate and to train adequately the workers; 2) To improve the training and formation of workers, systematic use of personal pro tection equipment (PPE) and standard operation procedures (SOP’s) and adapta tion of working procedures; 3) To use standardized doses in diagnosis and planning each treatment by patient-spe cific dosimetry; 4) To train referring physicians and nuclear medicine physicians and to use referral guidelines for appropriate MN examinations; and 5) To incorporate effectively an incident reporting system for later analysis and learn ing through the use of event analysis techniques. The proposed indicators for an adequate evaluation of the obtained progress in each one of the assessed aspects were: 1) Number of centres with an implemented quality management system and its de gree of compliance in each centre; 2) Continuous trend analysis of dosimetric reports values; 3 Number of studies with dose optimisation protocols and/or patient-specific dosimetry; 4) Number of undergraduate medical programs that include subjects related to radia tion safety and number of written standard operation procedures with indications of each study and percentage of studies that comply with these guidelines; 5) Degree of implementation of security incident reporting systems, degree of use of predictive analysis tools and number of incident evaluation meetings; Some of the proposed solutions can be easily incorporated into daily practice. However, others require more time and, additionally, actions by international groups working together to provide concrete solutions.Na sessão dedicada à Medicina Nuclear (MN) consideraram-se cinco aspetos mais problemáticos na proteção contra as radiações em MN: 1. Garantia que a dose administrada ao paciente é correta; 2. Evitar a contaminação e irradiação das mãos, cristalino e resto do corpo do trablhador na área; 3. Assegurar a otimização das doses de diagnóstico e terapêutica; 4. Justificação de exames em MN; 5. A prevenção de incidentes e acidentes. Foram apresentadas as seguintes soluções para esses problemas: 1. Implementação de protocolos e regras de funcionamento bem definidas associadas a sistemas de controle de qualidade dos equipa mentos e à formação continua dos trabalhadores; 2. Melhorar a formação e treinamento dos trabalhadores na utilização sistemática dos meios de proteção e protocolos adequados aos procedimentos de trabalho; 3. Padronização das doses de diagnóstico e planificação das terapêuticas por dosimetria interna específica dos doentes; 4. Formação dos médicos prescritores e nucleares para utilização adequada de “Guidelines” para exames de MN; 5. Incorporação efetiva de sistemas de registo de incidentes e acidentes para posterior análise e melhoria das práticas utilizadas; Os indicadores propostos para avaliação dos avanços em cada um dos aspectos foram definidos como: 1. Número de centros com programa de garantia de qualidade utilizado e o grau de cumprimento em cada centro 2. A análise de tendência dos dados de dosimetria relatados. 3. Número de exames com os protocolos de otimização de dose ou estimativa da actividade específica para o paciente. 4. Número de currículos de graduação médica que incluam radioproteção, número de protocolos clínicos escritos com as indicações de cada estudo e porcentagem de testes que estejam em conformidade com estas diretrizes. 5. Grau de implementação da sistemas de informação sobre incidente, grau de utilização de ferramentas de análise preditiva e reuniões de avaliação número de eventos. Algumas das soluções propostas são fáceis de implementar na prática diária. Outras exigem mais tempo e, sobretudo, ações de grupos internacionais que trabalhem em conjunto para fornecer soluções concretas.UCR::Vicerrectoría de Docencia::Ciencias Básicas::Facultad de Ciencias::Escuela de FísicaUCR::Vicerrectoría de Investigación::Unidades de Investigación::Ciencias Básicas::Centro de Investigación en Ciencias Atómicas Nucleares y Moleculares (CICANUM

Inter-reader variability of SPECT MPI readings in low- and middle-income countries: Results from the IAEA-MPI Audit Project (I-MAP)

Background: Consistency of results between different readers is an important issue in medical imaging, as it affects portability of results between institutions and may affect patient care. The International Atomic Energy Agency (IAEA) in pursuing its mission of fostering peaceful applications of nuclear technologies has supported several training activities in the field of nuclear cardiology (NC) and SPECT myocardial perfusion imaging (MPI) in particular. The aim of this study was to verify the outcome of those activities through an international clinical audit on MPI where participants were requested to report on studies distributed from a core lab. Methods: The study was run in two phases: in phase 1, SPECT MPI studies were distributed as raw data and full processing was requested as per local practice. In phase 2, images from studies pre-processed at the core lab were distributed. Data to be reported included summed stress score (SSS); summed rest score (SRS); summed difference score (SDS); left ventricular (LV) ejection fraction (EF) and end- diastolic volume (EDV). Qualitative appraisals included the assessment of perfusion and presence of ischemia, scar or mixed patterns, presence of transient ischemic dilation (TID), and risk for cardiac events (CE). Twenty-four previous trainees from low- and middle-income countries participated (core participants group) and their results were assessed for inter-observer variability in each of the two phases, and for changes between phases. The same evaluations were performed for a group of eleven international experts (experts group). Results were also compared between the groups. Results: Expert readers showed an excellent level of agreement for all parameters in both phase 1 and 2. For core participants, the concordance of all parameters in phase 1 was rated as good to excellent. Two parameters which were re-evaluated in phase 2, namely SSS and SRS, showed an increased level of concordance, up to excellent in both cases. Reporting of categorical variables by expert readers remained almost unchanged between the two phases, while core participants showed an increase in phase 2. Finally, pooled LVEF values did not show a significant difference between core participants and experts. However, significant differences were found between LVEF values obtained using different software packages for cardiac analysis. Conclusions: In this study, inter-observer agreement was moderate-to-good for core group readers and good-to-excellent for expert readers. The quality of reporting is affected by the quality of processing. These results confirm the important role of the IAEA training activities in improving imaging in low- and middle-income countries

Inter-reader variability of SPECT MPI readings in low- and middle-income countries: Results from the IAEA-MPI Audit Project (I-MAP)

Background: Consistency of results between different readers is an important issue in medical imaging, as it affects portability of results between institutions and may affect patient care. The International Atomic Energy Agency (IAEA) in pursuing its mission of fostering peaceful applications of nuclear technologies has supported several training activities in the field of nuclear cardiology (NC) and SPECT myocardial perfusion imaging (MPI) in particular. The aim of this study was to verify the outcome of those activities through an international clinical audit on MPI where participants were requested to report on studies distributed from a core lab. Methods: The study was run in two phases: in phase 1, SPECT MPI studies were distributed as raw data and full processing was requested as per local practice. In phase 2, images from studies pre-processed at the core lab were distributed. Data to be reported included summed stress score (SSS); summed rest score (SRS); summed difference score (SDS); left ventricular (LV) ejection fraction (EF) and end- diastolic volume (EDV). Qualitative appraisals included the assessment of perfusion and presence of ischemia, scar or mixed patterns, presence of transient ischemic dilation (TID), and risk for cardiac events (CE). Twenty-four previous trainees from low- and middle-income countries participated (core participants group) and their results were assessed for inter-observer variability in each of the two phases, and for changes between phases. The same evaluations were performed for a group of eleven international experts (experts group). Results were also compared between the groups. Results: Expert readers showed an excellent level of agreement for all parameters in both phase 1 and 2. For core participants, the concordance of all parameters in phase 1 was rated as good to excellent. Two parameters which were re-evaluated in phase 2, namely SSS and SRS, showed an increased level of concordance, up to excellent in both cases. Reporting of categorical variables by expert readers remained almost unchanged between the two phases, while core participants showed an increase in phase 2. Finally, pooled LVEF values did not show a significant difference between core participants and experts. However, significant differences were found between LVEF values obtained using different software packages for cardiac analysis. Conclusions: In this study, inter-observer agreement was moderate-to-good for core group readers and good-to-excellent for expert readers. The quality of reporting is affected by the quality of processing. These results confirm the important role of the IAEA training activities in improving imaging in low- and middle-income countries