Part 9 Quality Assurance IAEA Training Material Radiation
Protection in Nuclear Medicine Slide 2 Nuclear Medicine Part 9.
Quality Assurance2 OBJECTIVE To become familiar with the concepts
of Quality Assurance in radiation protection in nuclear medicine
and procedures for reviewing and assessing the overall
effectiveness of radiation protection Slide 3 Nuclear Medicine Part
9. Quality Assurance3 Content Content l General principles General
principles General principles l Organization of QA Organization of
QA Organization of QA l Administrative routines Administrative
routines Administrative routines l Occupational and Medical
exposure Occupational and Medical exposure Occupational and Medical
exposure l Instrumentation Instrumentation l Education and training
Education and training Education and training Slide 4 Part 9.
Quality Assurance IAEA Training Material on Radiation Protection in
Nuclear Medicine Module 9.1. General principles Slide 5 Nuclear
Medicine Part 9. Quality Assurance5 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. BSS Slide 6 Nuclear
Medicine Part 9. Quality Assurance6 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. Slide 7
Nuclear Medicine Part 9. Quality Assurance7 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 Slide 8 Nuclear Medicine Part 9. Quality Assurance8 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. Slide 9 Nuclear Medicine Part 9. Quality
Assurance9 QUALITY ASSURANCE (definition) all those planned and
systematic actions necessary to provide adequate confidence that a
product or service will satisfy given requirements for quality
(ISO) Slide 10 Nuclear Medicine Part 9. Quality Assurance10 QA and
QC l Quality Assurance is the overall process which is supported by
Quality Control activities l Quality Control describes the actual
mechanisms and procedures by which one can assure quality Slide 11
Nuclear Medicine Part 9. Quality Assurance11 QUALITY Quality of a
practice is to fulfil the expectations and demands from: Patient
Clinician Yourself Slide 12 Nuclear Medicine Part 9. Quality
Assurance12 QUALITY ASSURANCE Protection Safety OVERALL QUALITY
Diagnostics Therapy Slide 13 Nuclear Medicine Part 9. Quality
Assurance13 QUALITY DEFINE OBJECTIVES How many times should the
nurse be allowed to drop the child? What is an acceptable sens-
itivity and specificity? Slide 14 Nuclear Medicine Part 9. Quality
Assurance14 NUCLEAR MEDICINE SERVICE Primary service Secondary
service Nuclear medicine examination or treatment facilities
patient care waiting time staff reporting competence experience
optimisation radiopharmaceuticals methods examination technique
instrumentation etc Slide 15 Nuclear Medicine Part 9. Quality
Assurance15 QUALITY ASSESSMENT Communication with the client
(patient, clinician). Expectations Acceptable level Reality Slide
16 Nuclear Medicine Part 9. Quality Assurance16 Clinical problem
Radiopharmaceutical Instrumentation Diagnosis and therapy with
unsealed sources NUCLEAR MEDICINE Slide 17 Nuclear Medicine Part 9.
Quality Assurance17 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 Slide 18
Module 9.2. Organization Part 9. Quality Assurance IAEA Training
Material on Radiation Protection in Nuclear Medicine Slide 19
Nuclear Medicine Part 9. Quality Assurance19 International bodies
Recommendations. Interlaboratory comparison programmes. Education
and training. National organizations National guidelines, codes of
practice etc. Interlaboratory comparison programmes. Education and
training. Industry Assistance in acceptance tests. Documentation.
Training. Maintenance. Professional associations Supporting
QA-programmes Establishing working groups Education and training
ORGANIZATIONS Slide 20 Nuclear Medicine Part 9. Quality Assurance20
LOCAL ORGANIZATION Hospital manager (licensee) QA committee
QA-group nuclear medicine (chief technician, physicist, physician,
pharmacist) Slide 21 Nuclear Medicine Part 9. Quality Assurance21
QA Committee Membership l l Must represent the many disciplines
within the department l l Should be chaired by the Head of
Department l l As a minimum must include a medical doctor, a
physicist, a technologist and an engineer responsible for service
and maintenance l l Must be appointed and supported by senior
management l l Must have sufficient depth of experience to
understand the implications of the process l l Must have the
authority and access to the resources to instigate and carry out
the QA process Slide 22 Nuclear Medicine Part 9. Quality
Assurance22 Quality Assurance Committee l l Should represent the
department l l Should be visible AND accessible to staff l l
Oversees the entire Quality Assurance program l l Writes policies
to ensure the quality of patient care l l Assists staff in
tailoring the program to meet the needs of the Department (using
published reports as a guide) l l Monitor and audit the program to
ensure that each component is being performed and documented Slide
23 Module 9.3. Administrative routines Part 9. Quality Assurance
IAEA Training Material on Radiation Protection in Nuclear Medicine
Slide 24 Nuclear Medicine Part 9. Quality Assurance24
ADMINISTRATIVE ROUTINES Request Patient id and care Patient id and
care Computer evaluation Diagnostic report Diagnostic report
Examination Method Slide 25 Nuclear Medicine Part 9. Quality
Assurance25 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. Slide 26 Nuclear Medicine Part 9.
Quality Assurance26 PATIENT 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. Slide 27 Nuclear Medicine Part 9. Quality
Assurance27 YOUNG PATIENTS..should also be informed and motivated
Slide 28 Nuclear Medicine Part 9. Quality Assurance28 PATIENT
MOVEMENT Slide 29 Nuclear Medicine Part 9. Quality Assurance29
PATIENT MOVEMENT moving Slide 30 Nuclear Medicine Part 9. Quality
Assurance30 Policies and Procedures Manual l l Reviewed (typically)
yearly l l This manual contains clear and concise statements of all
the policies and procedures carried out in the department l l
Updated as procedures change Policies and Procedures Manual Slide
31 Nuclear Medicine Part 9. Quality Assurance31 Policies and
Procedures Manual l l As a minimum, sections should exist for n n
Administrative procedures n n Clinical procedures n n Radiation
safety Slide 32 Nuclear Medicine Part 9. Quality Assurance32
Policies and Procedures Manual l l It must be signed off by the
Head of Department and appropriate section heads l l It is
important that all staff have ownership to the manual - it should
reflect the opinions of all and be agreed to by all l l A list of
all copies of the Manual and their location must be kept to ensure
that each copy is updated Slide 33 Nuclear Medicine Part 9. Quality
Assurance33 Methods should be in accordance with accepted practices
Study name:Bone scan Preparation of patient:Empty bladder
Radiopharmaceutical:Tc99m-MDP Route of administration:IV injection
Activity:400 MBq Type of examination:Whole body scan Views:AP, PA
Scanning speed:10 cm/minute Collimator:Scanning Window
setting:140+/-20% keV Positioning of patient:Supine Presentation of
result:Images in BW on film. Original and filtered. METHODS Slide
34 Nuclear Medicine Part 9. Quality Assurance34 METHODS Static?
Tomographic? Dynamic? Slide 35 Nuclear Medicine Part 9. Quality
Assurance35 METHODS Tl-201 Tc-99m 25 mSv 8 mSv Slide 36 Nuclear
Medicine Part 9. Quality Assurance36 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
QUALITY ASSURANCE COMPUTER EVALUATION Slide 37 Nuclear Medicine
Part 9. Quality Assurance37 l Analysis of the programme code l
Phantom studies l Simulated examinations l Reference data (normal
material) l Clinical evaluation QC Application programmes Slide 38
Nuclear Medicine Part 9. Quality Assurance38 Bone scan phantom
Slide 39 Nuclear Medicine Part 9. Quality Assurance39 Thyroid
phantom Slide 40 Nuclear Medicine Part 9. Quality Assurance40 Slide
41 Nuclear Medicine Part 9. Quality Assurance41 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. Slide 42 Nuclear Medicine Part 9. Quality
Assurance42 Patient follow-up. Correlation with other available
surgical, pathological, clinical and anatomic information. False
positives? False negatives? QUALITY ASSURANCE METHOD Slide 43
Nuclear Medicine Part 9. Quality Assurance43 Society of Nuclear
Medicine Procedure Guideline for General Imaging The final judge of
any analytical method is a clinical audit: the correctness and
impact of the decisions made with respect to any method and
process. Slide 44 Nuclear Medicine Part 9. Quality Assurance44
RECORDS Authorization certificate and documentation supporting the
corresponding application, and also any correspondence between the
licensee and Regulatory Authority; Name of the person authorized
and responsible for the RPP; Individual doses (current and prior
work history); Results of area surveys; Equipment and instrument QC
tests and calibration; Inventory of unsealed and sealed sources;
Incident and accident investigation reports; Audits and reviews of
the radiation safety programme; Installation, maintenance and
repair work; Facility modification; Slide 45 Nuclear Medicine Part
9. Quality Assurance45 RECORDS (cont) Training provided (initial
and continuing), including the following information: Name of the
person(s) who delivered the instruction or training; Name of the
person(s) who received the instruction or training; Date and
duration of the instruction or training; List of the topics
addressed; and Copy of the certificates of training. Evidence of
health surveillance of workers; Waste disposal; Transportation:
Package documentation; Package surveys; Transfer/receipt documents;
and Details of shipments dispatched Patient records; and Patient
discharge surveys for patients receiving radionuclide therapy.
Slide 46 Module 9.4. Occupational and medical exposure Part 9.
Quality Assurance IAEA Training Material on Radiation Protection in
Nuclear Medicine Slide 47 Nuclear Medicine Part 9. Quality
Assurance47 EXAMINATION Request Patient id and care Patient id and
care Computer Evaluation Diagnostic report Diagnostic report
Examination Method Slide 48 Nuclear Medicine Part 9. Quality
Assurance48 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. Slide 49 Nuclear Medicine Part 9. Quality Assurance49
Medical exposure l l Choice of examination l l Determination of
technical parameters l l Optimization of administered activity l l
Methods of reducing the absorbed dose l l Quality control of
equipment and radiopharmaceutical l l Quality assurance of methods
l l Safe routines to avoid misadministration Slide 50 Nuclear
Medicine Part 9. Quality Assurance50 Factors affecting medical and
occupational exposure Receipt and storage Receipt and storage
Preparation Contamination Radioactive waste Radioactive waste
Detection (QC equipment) Detection (QC equipment) Administration
Slide 51 Nuclear Medicine Part 9. Quality Assurance51 QUALITY
CONTROL RADIOPHARMACEUTICALS Radionuclide purity (other
radionuclides?) Radiochemical purity (labelling efficiency)
Chemical purity (toxic substances?) Sterility Absence of pyrogens
Responsibility of the approved manufacturer and supplier Slide 52
Nuclear Medicine Part 9. Quality Assurance52 Quality control of
radiopharmaceuticals. Written and trained procedures in preparation
and safe handling of radiopharmaceuticals Use of a unique code
which guarantee the ability to trace the origin of all components
in the preparation. Records of radionuclides, kits etc. Labeling of
vials and syringes. Measurement of activity. QUALITY ASSURANCE
RADIOPHARMACEUTICALS Slide 53 Nuclear Medicine Part 9. Quality
Assurance53 PREPARATION OF RADIOPHARMACEUTICALS Tc99m-MDP 2237 5
447 SC 1997-09-28 7.40 Use a transparent vial shield Put the kit in
the shield Add Tc99m and finish the preparation Measure the
activity Write the label and put it on the vial shield Check the
kit and the label on the vial shield. Same radiopharma- ceutical?
Slide 54 Nuclear Medicine Part 9. Quality Assurance54 Tc99m-MDP 400
MBq 400928-3336 1997-09-28 07.45 SC Check kit and vial shield label
Correct radiopharmaceutical? Draw the required volume Measure the
activity Write the label and put it on the syringe shield
DISPENSING RADIOPHARMACEUTICALS Slide 55 Nuclear Medicine Part 9.
Quality Assurance55 Patient name? Patient identification number?
Pregnant? Breastfeeding? Check the request form Check the label of
the syringe. Correct radiopharmaceutical for the required
examination? Correct activity? Inject! INJECTING
RADIOPHARMACEUTICALS Slide 56 Nuclear Medicine Part 9. Quality
Assurance56 The worker should always feel confident that he/she has
the necessary training in order to perform his/her duty. The worker
should feel that he/she gets the necessary support from the
licensee in matters concerning working situation and safety. Slide
57 Nuclear Medicine Part 9. Quality Assurance57 FACTORS AFFECTING
QUALITY Design of facility Safe receipt and storage of unsealed
sources Safe handling of unsealed sources Management of radioactive
waste Safety equipment Personal monitoring Health surveillance
Workplace monitoring Emergency procedures Local rules Training and
experience of staff Slide 58 Nuclear Medicine Part 9. Quality
Assurance58 EDUCATION OF STAFF Correct use of equipment Close 15 cm
Wrong setting of energy window Slide 59 Module 9.5. Instrumentation
Part 9. Quality Assurance IAEA Training Material on Radiation
Protection in Nuclear Medicine Slide 60 Nuclear Medicine Part 9.
Quality Assurance60 How to get a new Gamma camera? Slide 61 Nuclear
Medicine Part 9. Quality Assurance61 PURCHASE GROUP Nuclear
medicine specialist Nuclear medicine technologist Medical physicist
Medical engineer Person from the hospital administration Slide 62
Nuclear Medicine Part 9. Quality Assurance62 How to open the safe?
Careful analysis of the need and state the reasons for the purchase
of the gamma camera Establishment of a nuclear medicine service
Increased volume of patients The technical performance is not good
enough for new methods No spare parts available Unrepairable Slide
63 Nuclear Medicine Part 9. Quality Assurance63 How many cameras?
As an example, let us assume that in a certain region of a country
having a stable population of 150000 there are plans to establish a
nuclear medicine facility. The mean number of examinations in the
country is 15 per 1000 population and year but the new department
should be designed to fulfil a future need of 20 per 1000
population, which means that the total number of examinations will
be 3000 per year or 60 per week Slide 64 Nuclear Medicine Part 9.
Quality Assurance64 Basic calculation *) depends on the type of
camera Slide 65 Nuclear Medicine Part 9. Quality Assurance65 If we
assume that the number of hours per week a gammacamera can be
effectively used for patient examinations to be 28 (70% of 40) then
the number of cameras should be 66/28=2.4. This figure should be
further corrected by taking into account the time needed for
regular maintenance of the equipment as well as unplanned stops due
to different failures. Result Number of cameras Slide 66 Nuclear
Medicine Part 9. Quality Assurance66 End of step 1 Slide 67 Nuclear
Medicine Part 9. Quality Assurance67 Let the vendor define Your
needs and make the selection Write a tender document and distribute
it to the vendors Slide 68 Nuclear Medicine Part 9. Quality
Assurance68 Choice of equipment Type of procedure to be undertaken
Technical specifications Manufacturer Spare parts Service and
maintenance User and service manuals Education and training Local
user Service and maintenance Education and experience of staff
Siting of the instrument Ease, reliability and safety in operation
Cost Slide 69 Nuclear Medicine Part 9. Quality Assurance69 Siting
of equipment Sufficient space Electrical power Environmental
factors (temperature, humidity, air pollution) Structural shielding
Background radiation Slide 70 Nuclear Medicine Part 9. Quality
Assurance70 MAINTENANCE Regular maintenance will result in:
Increased availability of equipment Increased quality by better
performance Increased safety Increased lifetime of equipment Slide
71 Nuclear Medicine Part 9. Quality Assurance71 Maintenance
procedures should include consideration of the following: Overall
management of the maintenance programme. This is often provided by
the medical physicist in co-operation with the RPO; Measures to
prevent the use of equipment during periods of maintenance;
Notification of the medical physicist whenever there is a repair,
regardless of its importance. The physicist must assess whether any
tests or measurements are to be made and whether the equipment is
operating satisfactorily before it is used with patients; Provision
of a service contract covering preventative maintenance,
particularly when equipment parts and expertise are provided by the
manufacturer; Maintenance of a service record during the lifetime
of the equipment or for a duration specified by the Regulatory
Authority. Slide 72 Nuclear Medicine Part 9. Quality Assurance72
EQUIPMENTEQUIPMENT Well trained staff with access to manuals and
other documentation. Quality control program. Regular maintenance.
Well trained staff with access to manuals and other documentation.
Quality control program. Regular maintenance. NEEDS FOR EFFICIENT
USE Slide 73 Nuclear Medicine Part 9. Quality Assurance73 Purpose
of tendering The purpose of tendering for gamma cameras is to
assess the best match between the requirements of the clinical
department and the equipment available and not necessarily to buy
the 'best camera. Slide 74 Nuclear Medicine Part 9. Quality
Assurance74 What do we want? Hardware One, two or three detector
heads? Round, square or rectangular detector? Crystal thickness?
Collimators? Whole body scanning? PET-option? Transmission source?
Slide 75 Nuclear Medicine Part 9. Quality Assurance75 What do we
want? Computer & software Acquisition modes? Application
programmes? Network? Storage capacity? Backup? Slide 76 Nuclear
Medicine Part 9. Quality Assurance76 What do we want? More...
Education and training Payment Warranty Reliability Service and
maintenance List of users Manuals and other documentation Time of
delivery Upgradability Quality control equipment Acceptance test
Slide 77 Nuclear Medicine Part 9. Quality Assurance77 System
overview Contact persons Commercial specifications Technical
specifications Data acquisition and processing Electrical and
mechanical safety (national regulations) Education and training
Documentation Service organization Installation and acceptance
testing The tender document should therefore include: Slide 78
Nuclear Medicine Part 9. Quality Assurance78 Commercial
specifications: Price Payment Warranty Liability insurance for
installers Right to refuse or remove equipment Value of the old
camera What shall the vendor specify? Slide 79 Nuclear Medicine
Part 9. Quality Assurance79 Hardware: Crystal size and shape
PM-tubes Gantry dimension and weight Gantry movements, including
auto- contour Electrical power requirements Imaging table
Collimators and method of change Shielding of detector Operating
console Energy windows Energy range Safety features Motion control
What shall the vendor specify? Slide 80 Nuclear Medicine Part 9.
Quality Assurance80 Technical performance: Linearity Uniformity
(different energies, different angles) Energy resolution Spatial
resolution (intrinsic and system, planar and tomographic) Count
rate performance Center of rotation Multiple window spatial
positioning System sensitivity (planar and tomographic) Point
source sensitivity What shall the vendor specify? Slide 81 Nuclear
Medicine Part 9. Quality Assurance81 Computer system: Acquisition
modes Basic application programmes Clinical application programmes
Quality control programmes DICOM-standard Network and communication
Printers Storage and backup of patient data What shall the vendor
specify? Slide 82 Nuclear Medicine Part 9. Quality Assurance82
..and more: User lists and site visits Reliability (e.g. 95%)
Service response time and follow up Training now and later Service
manuals Upgradability Delivery, setup and installation date Floor
loading, elevators and doors Electrical requirements What shall the
vendor specify? Slide 83 Nuclear Medicine Part 9. Quality
Assurance83 Distribute the tender documents to the vendors RELAX!
End of step 2 Slide 84 Nuclear Medicine Part 9. Quality Assurance84
The decision: Which camera fulfills our requirements? Slide 85
Nuclear Medicine Part 9. Quality Assurance85 Can the camera and the
computer software be used efficiently for all types of intended
examinations? Are the technical specifications satisfactory? Is the
camera easy to handle? Is the price reasonable? Is the
manufacturers service organization satisfactory? Is the required
training OK? The decision Slide 86 Nuclear Medicine Part 9. Quality
Assurance86 Site visits Slide 87 Nuclear Medicine Part 9. Quality
Assurance87 The decision- End of step 3 Manufacturer 1 + price +
technical parameters - service - computer system Manufacturer 2 +
price - technical parameters + service - computer system We want
that one!! Slide 88 Nuclear Medicine Part 9. Quality Assurance88
Make a clear and detailed specification of the implemen- tation
agreement. Which are the users responsibilities? Which are the
vendors responsibilities? Which documents are valid? Date of
delivery? Mode of payment? Warranty? Sign the contract Make the
installation Perform an acceptance test Slide 89 Nuclear Medicine
Part 9. Quality Assurance89 QUALITY CONTROL EQUIPMENT Acceptance /
reference testing. Measurements to assess whether instrumentation
comply with its specifications. Manual available. Routine testing.
Performed to maintain high quality and standard of the equipment.
Analysis of results. Is the observed result significantly different
from the reference testing? Is the observed result due to errors in
the QC procedure? Records. Slide 90 Nuclear Medicine Part 9.
Quality Assurance90 Acceptance tests X-ray installations 171 Passed
10 Passed after minor corrections 123 Not passed 38 (SSI 1992)
Slide 91 Nuclear Medicine Part 9. Quality Assurance91 Acceptance
Daily Weekly Yearly UniformityPTTP Uniformity, tomographyPP
Spectrum displayPTTP Energy resolutionPP SensitivityPTP Pixel
sizePTP Center of rotationPTP LinearityPP ResolutionPP Count
lossesPP Multiple window posPP Total performance phantomPP P:
physicist, T: technician QC GAMMA CAMERA Slide 92 Module 9.6.
Education and training Part 9. Quality Assurance IAEA Training
Material on Radiation Protection in Nuclear Medicine Slide 93
Nuclear Medicine Part 9. Quality Assurance93 How to achieve a high
standard of safety in a hospital? Safety culture Support from the
hospital management Well educated staff Local radiation protection
organization Quality assurance programme Use of authorized services
Continuing education and training Arrangements for individual
monitoring and health surveillance Records Documented local rules
and procedures Slide 94 Nuclear Medicine Part 9. Quality
Assurance94 Education and Training are essential for a radiation
protection programme l As part of a the implementation of a
Radiation Protection Programme (IAEA TECDOC 1040, 2.2.1): Early in
the process a decision should be made about additional training
required for the hospital staff l The relevant plan should include
who, where and when shall be trained. Slide 95 Nuclear Medicine
Part 9. Quality Assurance95 Responsibility of the licensee l BSS
2.30.: Provision shall be made for reducing as far as practicable
the contribution of human error to accidents and other events that
could give rise to exposures, by ensuring that: (a)all personnel on
whom protection and safety depend be appropriately trained and
qualified so that they understand their responsibilities and
perform their duties with appropriate judgement and according to
defined procedures; Slide 96 Nuclear Medicine Part 9. Quality
Assurance96 Education l All staff in nuclear medicine must have
appropriate education to perform their duties l For radiation
protection purposes this affects particularly: n Radiation
Protection Officer n Physician n Qualified Expert (Medical
Physicist) n Nuclear Medicine Technician n . Slide 97 Nuclear
Medicine Part 9. Quality Assurance97 Personnel shall be instructed
in radiation protection before assuming duties: the conditions of
the licence; safe use and operation of equipment; instructions that
should be provided to patients and patient helpers; institutional
radiation protection policies and procedures (including emergency
practice drills); the local QA programme and QC procedures; the
results of review and analysis of incidents and accidents that have
occurred in the institution or elsewhere. Education and training
Slide 98 Nuclear Medicine Part 9. Quality Assurance98 A note of
qualifications of others l There should also be a process in place
which ensures that outside contractors on whom radiation protection
may depend (e.g. service engineers) are appropriately trained and
qualified. Slide 99 Nuclear Medicine Part 9. Quality Assurance99
EDUCATION AND TRAINING In addition to the staff working within the
nuclear medicine department, the following staff should receive
instruction from the RPO: nurses in wards with radioactive
patients; staff who do not belong to the nuclear medicine practice
but need to enter controlled areas; and staff who transport
radioactive patients or radioactive materials within the
institution. Slide 100 Nuclear Medicine Part 9. Quality
Assurance100 EDUCATION AND TRAINING * Basic and continuing training
for those who have responsibilities for the operation of the
equipment or for preparations of radio- pharmaceuticals. * Advanced
training for physicians, physicists and radiochemists. * Continuing
education for those who have operational responsibilities in a
nuclear medicine facility. Slide 101 Nuclear Medicine Part 9.
Quality Assurance101 Continuing Education l It is essential for all
staff to have regular updates on radiation protection aspects l
Continuing education must be documented Slide 102 Nuclear Medicine
Part 9. Quality Assurance102 Education and Training l If the number
of professionals is too small to justify setting up a training
course, then international co-operation programs may be used l
Distance learning programs may be useful l A course such as the
present may play an important role... Slide 103 Nuclear Medicine
Part 9. Quality Assurance103 EDUCATION AND TRAINING Continuing
education in annual refresher training courses, and whenever there
is a significant change in duties, regulations, terms of the
license, or type of radioactive material or instruments used.
Topics should be selected from a syllabus which has been approved
by the RPC. Today we will talk about Patient safety Slide 104
Nuclear Medicine Part 9. Quality Assurance104 Radiation protection
training programme Basic radiation physics. Biological effects of
radiation. International standards in Radiation Protection
Responsibility and duties. Safe handling of radioactive materials.
Occupational radiation protection. Medical exposure. Management of
radioactive waste. Protection of the public. Emergency
preparedness. Organization of radiation protection Slide 105
Nuclear Medicine Part 9. Quality Assurance105 Training Record The
records should include the following information: (a) Name of the
person(s) who delivered the instruction or training; (b) Name of
the person(s) who received the instruction or training; (c) Date
and duration of the instruction or training; (d) List of the topics
addressed; (e) Copy of the certificates of training Slide 106
Nuclear Medicine Part 9. Quality Assurance106 Education &
Training l The Regulatory Authority should establish training
curricula for (for example) : RPOs members of the RPC relevant
physicians medical physicists laboratory staff Slide 107 Nuclear
Medicine Part 9. Quality Assurance107 The role of Regulatory
Authority Require key personnel (named in RPP) to be duly
accredited/qualified and to have adequate training in radiation
protection. Specify/approve minimum training standards/syllabus
content for radiation protection training courses. Provide training
courses, perhaps in conjunction with other contributors, if courses
are otherwise unavailable in the country. Slide 108 Nuclear
Medicine Part 9. Quality Assurance108 Continuous Quality
Improvement l CQI - many other acronyms are available for this l
Part of virtually all QA systems l Improved methods are documented
in clinical trial reports. l Quality assurance protocols are
continuously under development in many countries l Regular Quality
Assurance meeting for all members of a Section l Continuing
education - lectures, workshops, journal clubs and must be
available for all staff Slide 109 Nuclear Medicine Part 9. Quality
Assurance109 And finally: QA is not a threat, it is an opportunity
l It is essential in a QA program that all staff feel free to
report errors l A non threatening environment must exist l Reward
honesty with encouragement l Education is the key, not punishment
Slide 110 Nuclear Medicine Part 9. Quality Assurance110 What is
this? Communication! Slide 111 Nuclear Medicine Part 9. Quality
Assurance111 Questions? Slide 112 Nuclear Medicine Part 9. Quality
Assurance112 DISCUSSION How should the quality of a nuclear
medicine practice be measured? Slide 113 Nuclear Medicine Part 9.
Quality Assurance113 DISCUSSION Discuss the responsibilities in QA
for the different members of the nuclear medicine staff. Slide 114
Nuclear Medicine Part 9. Quality Assurance114 DISCUSSION Which one
of the following practices has the highest quality of the practice:
1.The most modern equipment and unqualified persons running it.
2.Old equipment and qualified people running it. Slide 115 Nuclear
Medicine Part 9. Quality Assurance115 Where to Get More Information
l Further readings n IAEA TECDOC 602 n Basic Safety Standards n WHO
publications n ISO publications
