Transcript VIII.4_1_QA_Programme

Postgraduate Educational Course in Radiation Protection and the Safety of Radiation Sources
VIII.4. Quality Assurance in
Nuclear Medicine
1. QA Programme
The patient shall always be confident
that a nuclear medicine examination
and therapy is performed correctly and
with highest possible quality regarding
both diagnostics/therapy and safety.
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BSS
2.29. Quality assurance programmes shall be established
that provide, as appropriate:
a) adequate assurance that the specified requirements
relating to protection and safety are satisfied; and
b) quality control mechanisms and procedures for
reviewing and assessing the overall effectiveness of
protection and safety.
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Meaning for medical
exposure that:
II.22. Registrants and licensees shall establish a
comprehensive quality assurance programme
for medical exposures with the participation of
appropriate qualified experts in the relevant
fields, such as radiophysics or radiopharmacy,
taking into account the principles established by
the WHO and the PAHO.
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QA-PROGRAMME
OBJECTIVES
* Improvement in the quality of the diagnostic
information.
* Use of minimum amount of radionuclide
activity to ensure the production of the desired
diagnostic information.
* Effective use of available resources
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BSS
II.23. Quality assurance programmes for medical exposures
shall include:
a) measurements of the physical parameters of the radiation
generators, imaging devices and irradiation installations at the
time of commissioning and periodically thereafter,
b) verification of the appropriate physical and clinical factors
used in patient diagnosis or treatment;
c) written records of relevant procedures and results
d) verification of the appropriate calibration and conditions of
operation of dosimetry and monitoring equipment; and
e) as far as possible, regular and independent quality audit
review of the quality assurance programme for radiotherapy
procedures.
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QA and QC
Quality Assurance is the overall process
which is supported by Quality Control
activities
 Quality Control describes the actual
mechanisms and procedures by which
one can assure quality

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QUALITY
Quality of a practice is to fulfil the
expectations and demands from:
Clinician
Patient
Yourself
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QUALITY ASSURANCE
OVERALL QUALITY
Diagnostics
Therapy
Protection
Safety
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QUALITY
DEFINE OBJECTIVES
How many times should the nurse be
allowed to drop the child?
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What is an acceptable sensitivity
and specificity?
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NUCLEAR MEDICINE
Diagnosis and therapy with
unsealed sources
Clinical problem
Radiopharmaceutical
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Instrumentation
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QUALITY ASSURANCE PROGRAMME
A quality assurance programme in nuclear medicine should
ideally include:
Procedure (i.e patient history and signs, diagnostic question,
appropriateness of investigation, contraindications)
Planning of procedure (i.e reliable administrative procedures,
patient information, patient preparation)
Clinical procedure (i.e approved suppliers and materials, storage,
preparation, clinical environment, patient handling and preparation,
equipment performance, acquisition protocols, waste disposal)
Training and experience of nuclear medicine specialists, physicists
and technologists and others involved
Data analysis (i.e processing protocol, equipment performance,
data accuracy and integrity)
Report (i.e. data, image review, results and further advice)
General outcomes (i.e clinical outcome, radiation dose, patient
satisfaction, referring physician satisfaction)
Audit
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ADMINISTRATIVE ROUTINES
Request
Patient id
and care
Examination
Method used
Computer
evaluation
Diagnostic
report
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REQUEST
It is the responsibility of the nuclear medicine specialist
that the study requested by the referring physician is
justified. Special attention must be paid to studies
requested for children and pregnant women. Are there
alternative methods e.g. ultrasound, MRI etc.?
Communication, on a regular basis, between the
referring clinician and the nuclear medicine specialist
is very important.
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PATIENT IDENTIFICATION
• Identification of the patient.
• Information about the examination
including premedications.
• Waiting for the examination
A fully informed and motivated patient is the
basis for a successful examination as well as
a staff well educated in care of the patient.
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YOUNG PATIENTS
..should also be informed and motivated
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PATIENT MOVEMENT
Patient movement during examination will result in inadequate
examinations (false negatives/false positives)
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METHOD USED
Methods should be in accordance with accepted practices
Procedure manuals should be available
NUCLEAR MEDICINE
Uddevalla Hospital
Data acquisition
Patient
•Type of examination: Tomographic
•GENERAL INFO •Preparation:
•Predefined
protocol:
Patient should
rest CBF
about 30 min
•INDICATIONS in a silent •Projections:
room with soft 60
light. During
•Time:
s per should
angle close the
administration
the25
patient
•PATIENT
•Start angle: 0 degree
eyes.
•GAMMACAMERA
•Zoom: 1.23 99mTc-Neurolite
•Radiopharmaceutical:
•DATA ACQUISITION
•Matrix:
128x128 800 MBq,
•Activity and
administration:
•RESULT
•Patient
positioning:
Supine,
head in
intravenous
injection
(adult). Children
5 MBq/kg
•COMMENTS
•Exposure: 0.011 mSv/MBq - 9 mSv (adult)
•Start of examination: 5 min after administration
•Total time: 1.5 h including time for rest
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METHODS
Tl-201
25 mSv
Tc-99m
8 mSv
The method used should be optimized
e.g. in the selection of radiopharmaceutical
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Correct use of equipment
Close
15 cm
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Wrong setting of
energy window
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QUALITY ASSURANCE
COMPUTER EVALUATION
Efficient use of computers can
increase the sensitivity and
specificity of an examination.
•software based on published and
clinically tested methods
•well documented algorithms
•user manuals
•training
•software phantoms
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QC Application programmes

Analysis of the programme code

Phantom studies

Simulated examinations

Reference data (normal material)

Clinical evaluation
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DIAGNOSTIC REPORT
Patient identification
Date and type of study
Radiopharmaceutical and activity
Study results - e.g. a graph or a series of images
Objective description of findings
Diagnostic conclusion and recommendations
Avoid adjectives like ’possible’, ’probable’, ’likely’
etc. They can never be interpretated by the referring
physician. The diagnostic conclusion should be more
quantitative e.g. by using a probability statement.
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QUALITY CONTROL
OF METHOD
Patient follow-up.
Correlation with other available
surgical, pathological, clinical and
anatomic information.
False positives?
False negatives?
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The final judge of any analysis method is a
clinical audit:
the correctness and impact of the
decisions made with respect to any
method and process.
Society of Nuclear Medicine
Procedure Guideline for General
Imaging
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