RESUMO
Background: The IAEA recommends a quality assurance program in radiotherapy to ensure safe and effective treatments. In this study, radiotherapy departments were surveyed on their current practice including the extent and depth of quality assurance activities.Methods: Radiotherapy departments were voluntarily surveyed in three stages, firstly, in basic facility information, secondly, in quality assurance activities and treatment techniques, and thirdly, in a snapshot of quality assurance, departmental and treatment activities.Results: The IAEA received completed surveys from 381 radiotherapy departments throughout the world with 100 radiotherapy departments completing all three surveys. Dominant patterns were found in linac-based radiotherapy with access to treatment planning systems for 3D-CRT and 3D imaging. Staffing levels for major staff groups were on average in the range recommended by the IAEA. The modal patient workload per EBRT unit was as expected in the range of 21-30 patients per day, however significant instances of high workload (more than 50 patients per day per treatment unit) were reported. Staffing levels were found to correlate with amount of treatment equipment and patient workload. In a self-assessment of quality assurance performance, most radiotherapy departments reported that they would perform at least 60% of the quality assurance activities itemized in the second survey, with particular strength in equipment quality control. In a snapshot survey of quality assurance performance, again equipment quality control practice was well developed, particularly for the treatment equipment.Conclusions: The IAEA surveys provide a snapshot of current radiotherapy practice including quality assurance activities.
Assuntos
Auditoria Médica/estatística & dados numéricos , Neoplasias/radioterapia , Serviço Hospitalar de Medicina Nuclear/organização & administração , Radioterapia (Especialidade)/organização & administração , Humanos , Auditoria Médica/organização & administração , Auditoria Médica/normas , Serviço Hospitalar de Medicina Nuclear/normas , Serviço Hospitalar de Medicina Nuclear/estatística & dados numéricos , Aceleradores de Partículas/normas , Radioterapia (Especialidade)/instrumentação , Radioterapia (Especialidade)/normas , Radioterapia (Especialidade)/estatística & dados numéricos , Dosagem Radioterapêutica , Planejamento da Radioterapia Assistida por Computador/normas , Planejamento da Radioterapia Assistida por Computador/estatística & dados numéricos , Radioterapia Conformacional/normas , Radioterapia Conformacional/estatística & dados numéricos , Inquéritos e Questionários/estatística & dados numéricosRESUMO
External-beam radiotherapy treatments are delivered by a linear accelerator (linac) in a series of high-energy radiation sessions over multiple days. With the increase in the incidence of cancer and the use of radiotherapy (RT), the problem of automatically scheduling RT sessions while satisfying patient preferences regarding the time of their appointments becomes increasingly relevant. While most literature focuses on timeliness of treatments, several Dutch RT centers have expressed their need to include patient preferences when scheduling appointments for irradiation sessions. In this study, we propose a mixed-integer linear programming (MILP) model that solves the problem of scheduling and sequencing RT sessions considering time window preferences given by patients. The MILP model alone is able to solve the problem to optimality, scheduling all sessions within the desired window, in reasonable time for small size instances up to 66 patients and 2 linacs per week. For larger centers, we propose a heuristic method that pre-assigns patients to linacs to decompose the problem in subproblems (clusters of linacs) before using the MILP model to solve the subproblems to optimality in a sequential manner. We test our methodology using real-world data from a large Dutch RT center (8 linacs). Results show that, combining the heuristic with the MILP model, the problem can be solved in reasonable computation time with as few as 2.8% of the sessions being scheduled outside the desired time window.
Assuntos
Agendamento de Consultas , Preferência do Paciente , Radioterapia , Humanos , Países Baixos , Serviço Hospitalar de Medicina Nuclear/organização & administração , Aceleradores de Partículas , Programação Linear , Fatores de TempoRESUMO
The global COVID-19 health and economic crisis has forced people to adopt challenging rules of social distancing and self-isolation. Health care staff has been advised to change working routines to keep themselves and their patients safe. Radionuclide therapy has had an increasing role in clinical practice. Most therapeutic radionuclide procedures have applications in oncology. Cancer patients are an especially fragile and vulnerable population with higher risk due to co morbidities and immunosuppression. COVID-19 is another risk that must be considered in treatment planning. Therapeutic, prophylactic, and supportive interventions may require changes for these patients. The most common radionuclide therapies involve patients with differentiated thyroid cancer (DTC) who need radioiodine therapy (RAI), patients with neuroendocrine tumours (NETs) who need peptide receptor radionuclide therapy (PRRT), patients with hepatocellular carcinoma (HCC) who need therapy with radiolabelled microspheres, and patients with prostate cancer and bone metastasis who need radionuclide palliative therapy. If infected, cancer patients could be at a higher risk for serious COVID-19 disease. Treatment decisions for thyroid cancer and NETs are challenging in this environment. Any decision to postpone therapy must be carefully considered, balancing risks and benefits. A risk of worsened prognosis due to delayed or suboptimal cancer treatment must be weighed against the risk of severe COVID-19 illness.
Assuntos
Infecções por Coronavirus/transmissão , Controle de Infecções/normas , Serviço Hospitalar de Medicina Nuclear/normas , Pneumonia Viral/transmissão , Guias de Prática Clínica como Assunto , Radioterapia/normas , COVID-19 , Infecções por Coronavirus/epidemiologia , Humanos , Controle de Infecções/métodos , Neoplasias/radioterapia , Serviço Hospitalar de Medicina Nuclear/organização & administração , Serviço Hospitalar de Medicina Nuclear/provisão & distribuição , Pandemias , Pneumonia Viral/epidemiologia , Radioterapia/métodosRESUMO
The coronavirus disease 2019 (COVID-19) global pandemic poses a significant challenge to the national health systems. Not only China, the first country that experienced the health crisis since last December, but the rest of the world, is facing an unprecedented global health crisis, the most serious crisis in a century, with social and economic impact. However, the most important impact of the new pandemic is the human impact. Till 4th of June 2020, coronavirus SARS-CoV-2, causing COVID-19 disease, has infected more than 65000.000 people and has been responsible for more than 386000 deaths globally. The first priority of public health authorities is to contain and mitigate the spread and infection rate of the coronavirus SARS-CoV-2, distributing the number of infections over time and, if possible, reduce the incidence of the disease (COVID-19) it causes. A critical task for health systems confronted with the spread of the coronavirus is to protect the health of all citizens, so this requires that both diagnosis/testing and appropriate care should be readily available, affordable, and provided in a safe environment. The health care systems of many developed countries failed to demonstrate a satisfactory response to the increased demand for acute care hospital beds, ventilators, emergency services, diagnostics tests, support equipment for their COVID-19 patients, availability of essential medicines, protective equipment for their staff etc. Nuclear Medicine (NM) departments and their staff, in spite of the fact that not being in the front line of the pandemic response, have experienced a dramatic alteration in their daily clinical activity, trying to adapt their clinical routine to the new environment. There are several issued guidance from national and international organizations, trying to help to cope with suspected or verified COVID-19 patients. Patients with cancer are thought to be more susceptible and have higher morbidity and mortality rates from COVID-19 than the general population. In the current article, our aim is to present measures, guidance and thoughts that should be considered for the cancer patients.
Assuntos
Infecções por Coronavirus/transmissão , Controle de Infecções/métodos , Neoplasias/radioterapia , Serviço Hospitalar de Medicina Nuclear/normas , Pneumonia Viral/transmissão , Radioterapia/métodos , COVID-19 , Infecções por Coronavirus/epidemiologia , Prioridades em Saúde , Humanos , Controle de Infecções/normas , Serviço Hospitalar de Medicina Nuclear/economia , Serviço Hospitalar de Medicina Nuclear/organização & administração , Pandemias , Pneumonia Viral/epidemiologia , Guias de Prática Clínica como Assunto , Radioterapia/normasRESUMO
The outbreak and spreading of the COVID-19 pandemic have affected billions of people around the world, severely disrupting many aspects of their lives. Although not at the frontline of the pandemic response, Nuclear Medicine departments have to adopt their clinical routine to the new environment. A series of protective measures, including among others spatial arrangements to promote social distancing, meticulous hand hygiene and use of personal protective equipment, workload reduction, patient screening at admission and examination protocol adjustments, have to be adopted in order to minimize the risk of spreading the infection and ensure the safety of both their patients and staff. As the pandemic seems to slowly recede, the valuable experience gained should help everyone be much better prepared for a possible new outbreak.
Assuntos
Infecções por Coronavirus/epidemiologia , Controle de Infecções/métodos , Serviço Hospitalar de Medicina Nuclear/organização & administração , Pneumonia Viral/epidemiologia , COVID-19 , Fortalecimento Institucional , Infecções por Coronavirus/diagnóstico por imagem , Infecções por Coronavirus/transmissão , Utilização de Instalações e Serviços/normas , Utilização de Instalações e Serviços/estatística & dados numéricos , Humanos , Controle de Infecções/normas , Serviço Hospitalar de Medicina Nuclear/normas , Serviço Hospitalar de Medicina Nuclear/provisão & distribuição , Pandemias , Pneumonia Viral/diagnóstico por imagem , Pneumonia Viral/transmissão , Guias de Prática Clínica como AssuntoRESUMO
COVID-19 pandemic is having a strong impact on healthcare providers around the world, by refocusing and reducing non-essential medical activities. Nuclear medicine departments among others, have been reorganizing and reprioritizing diagnostic and theragnostic procedures. This reorganizing had a negative impact on the supply of positron emission tomography (PET) services to oncologic patients, whose health was affected. We herein present the PET findings in three different cancer scenarios in which disease course was dramatically affected by the COVID-19 outbreak.
Assuntos
COVID-19/epidemiologia , Neoplasias/epidemiologia , Tomografia por Emissão de Pósitrons , Progressão da Doença , Humanos , Controle de Infecções/métodos , Neoplasias/diagnóstico por imagem , Serviço Hospitalar de Medicina Nuclear/organização & administração , Serviço Hospitalar de Medicina Nuclear/estatística & dados numéricos , Serviço Hospitalar de Oncologia/organização & administração , Serviço Hospitalar de Oncologia/estatística & dados numéricosRESUMO
The Coronavirus Disease 2019 (COVID-19) pandemic is the biggest shock in decades to the well developed healthcare system and resources worldwide. Although there was a wide variation in the level of preparedness, the transition was tough even for the most renowned healthcare systems. Increasing the capacity and adapting healthcare for the needs of COVID-19 patients is described by the WHO as a fundamental outbreak response measure. However, while the system is preoccupied with a pandemic infection, patients suffering from other illnesses are in high risk to get infected, also being compromised by the imperative shift in medical resources and significant restrictions on routine medical care. For example patients with cardiovascular disease and others referred for nuclear cardiology procedures are frequently greater than 60 years of age and have other comorbidities (e.g. hypertension, diabetes, chronic lung disease, and chronic renal disease) that place them at a high-risk for adverse outcomes with COVID-19, providing unique challenges for their management in healthcare facilities, as well as for the care of health care personnel. Numerous medical specialty societies and governmental agencies issued guidelines aiming at the specification of preventive measures and amendments in everyday clinical practice during the escalation and peak of the pandemic. In accordance, the American Society of Nuclear Cardiology (ASNC) and the Society of Nuclear Medicine and Molecular Imaging (SNMMI), issued a common statement in late March 2020, which was provided as an initial response to this pandemic, offering specific recommendations for adapting nuclear cardiology practices at each step in a patient's journey through the lab-for inpatients, outpatients and emergency department patients. One of the main recommendations was cancelling or delaying of all non-urgent nuclear cardiology studies. As COVID-19 follows a different time course in different geographic regions and lockdowns begin to lift in many countries, the issue of re-establishment of non-emergent care, in nuclear cardiology laboratories amongst others, has to be addressed in a watchful and balanced way, keeping in mind that the COVID-19 crisis is far from over. Furthermore measuring what is happening in the current crisis is essential to ensuring preparedness for a possible next wave of the pandemic. Recently the ASNC, SNMMI, the International Atomic Energy Agency (IAEA) and the Infectious Disease Society of America (IDSA), issued an information statement which describes a careful approach to reestablishment of non-emergent care in nuclear cardiology laboratories reflecting diverse settings from the United States and worldwide. In the same spirit it is also the reintroduction guidance issued by North American Cardiovascular Societies. In this paper we provide a synopsis of the basic steps of adapting nuclear cardiology practice in the era of COVID-19 in order to balance between the risk of viral transmission while also providing crucial cardiovascular assessments for our patients.
Assuntos
Serviço Hospitalar de Cardiologia/normas , Infecções por Coronavirus/transmissão , Controle de Infecções/métodos , Serviço Hospitalar de Medicina Nuclear/normas , Pneumonia Viral/transmissão , Guias de Prática Clínica como Assunto , COVID-19 , Serviço Hospitalar de Cardiologia/organização & administração , Infecções por Coronavirus/epidemiologia , Transmissão de Doença Infecciosa/prevenção & controle , Prioridades em Saúde , Humanos , Controle de Infecções/normas , Serviço Hospitalar de Medicina Nuclear/organização & administração , Pandemias , Pneumonia Viral/epidemiologiaRESUMO
Since its outbreak in Wuhan, China the SARS-CoV-2 has become a public health emergency of international concern, impacting all areas of daily life, including medical care. Although not in the front line nuclear medicine practice should adjust their standard operating procedures. The adaptations and the flexibility that nuclear thyroidology, among other fields of nuclear medicine, should show during the pandemic, must focus not only in minimizing the risk of infection to staff, patients, and family members, but also in controlling the transmission of the virus while continuing to provide health care services which do not jeopardize patients' prognosis and quality of life. Favorable prognosis and indolent symptoms of most cases of thyroid diseases, allows postponements and rescheduling as well as alternative procedures, provided that they are cautiously considered for each case individually. The objective of the current paper is to provide guidance on how diagnostic and therapeutic management of patients with thyroid diseases can be safely and effectively adjusted during pandemic, in nuclear medicine settings.
Assuntos
Infecções por Coronavirus/transmissão , Prioridades em Saúde , Controle de Infecções/métodos , Serviço Hospitalar de Medicina Nuclear/organização & administração , Pneumonia Viral/transmissão , Guias de Prática Clínica como Assunto , Doenças da Glândula Tireoide/diagnóstico por imagem , COVID-19 , Infecções por Coronavirus/epidemiologia , Tomada de Decisões , Humanos , Controle de Infecções/normas , Serviço Hospitalar de Medicina Nuclear/normas , Pandemias , Pneumonia Viral/epidemiologia , Doenças da Glândula Tireoide/diagnóstico , Doenças da Glândula Tireoide/radioterapiaRESUMO
In December 2019 a new ß-CoV, Severe Acute Respiratory Coronavirus- 2 (SARS-CoV-2), has been identified in Wuhan Hubei Province, China. Within a few months it spread rapidly to more than 114 countries and the disease, Coronavirus disease 2019 (COVID-19), was declared pandemic on 11th February 2020 by the World Health Organization (WHO). Until 20 June 2020 8:09 am, 8,465,085 cases of COVID-19 were confirmed globally, with 454,258 deaths. The first incidence in Greece was documented on 26 February 2020 in Thessaloniki and up to 20 June 2020 8:09 am, 3,227 confirmed cases of COVID-19 were reported, with 188 deaths. At the time of writing USA and Brazil, are the countries with the highest disease burden. Governments have imposed a variety of suggestions and restrictions in order to control the spread of the virus, focusing mainly on social distancing, self-isolation, personal hygiene and personal protective equipment (PPE). Greece was one of the countries that implemented early drastic measures thus succeeding in controlling the virus transmission; having a profound economical effect though.
Assuntos
Infecções por Coronavirus/transmissão , Controle de Infecções/métodos , Serviço Hospitalar de Medicina Nuclear/normas , Pneumonia Viral/transmissão , Tomografia por Emissão de Pósitrons combinada à Tomografia Computadorizada/normas , Guias de Prática Clínica como Assunto , Agendamento de Consultas , COVID-19 , Infecções por Coronavirus/epidemiologia , Tomada de Decisões , Humanos , Controle de Infecções/normas , Serviço Hospitalar de Medicina Nuclear/organização & administração , Pandemias , Pneumonia Viral/epidemiologia , Tomografia por Emissão de Pósitrons combinada à Tomografia Computadorizada/métodosRESUMO
On December 29, 2019, a hospital in the City of Wuhan, Hubei Province, in Central China, admitted four individuals with pneumonia. The hospital reported this occurrence to the local center for disease control (CDC), which lead Wuhan CDC staff to initiate a field investigation with a retrospective search for pneumonia patients. On December 31, 2019, the World Health Organization (WHO) was alerted by the Chinese authorities for several cases of pneumonia of unknown origin in the City of Wuhan. On January 7, 2020, a novel virus was identified as the causative agent, belonging to the Coronaviridae family (Severe Acute Respiratory Syndrome Coronavirus 2, SARS-CoV-2). Within the same month, the virus spread to other provinces of China, as well as a number of neighbouring countries. On February 11, 2020, the WHO announced that the SARS-CoV-2 - caused infection would be called coronavirus disease 2019 (COVID-19). On February 15, 2020, the first death due to COVID-19 in Europe was reported; a Chinese tourist who died in France. The first COVID-19 case was diagnosed in Greece on February 26th. The WHO declared COVID-19 a pandemic on 11 March 2020. On March 12th, movie theaters, gyms and courtrooms were closed in Greece and on March 13th, with 190 confirmed cases and 1 death, malls, cafés, restaurants, bars, beauty parlors, museums and archaeological sites were also closed. So far, COVID-19 pandemic has affected the way people live and work globally, and has resulted in extreme strain on the healthcare systems worldwide. Most of the nuclear medicine studies are performed on an out-patient basis. Therefore, without effective implementation of the required preventive measures, there is a significant risk for viral transmission when visiting nuclear medicine departments, particularly in periods of high community spread.
Assuntos
Infecções por Coronavirus/transmissão , Controle de Infecções/métodos , Serviço Hospitalar de Medicina Nuclear/normas , Pneumonia Viral/transmissão , Guias de Prática Clínica como Assunto , Cintilografia/normas , COVID-19 , Infecções por Coronavirus/epidemiologia , Prioridades em Saúde , Humanos , Controle de Infecções/normas , Pneumopatias/diagnóstico por imagem , Neoplasias/diagnóstico por imagem , Serviço Hospitalar de Medicina Nuclear/organização & administração , Pandemias , Pneumonia Viral/epidemiologia , Cintilografia/métodosRESUMO
INTRODUCTION: Obtaining 68Ga-DOTA-TATE (a radioconjugate consisting of the somatostatin analogue tyrosine-3-octreotate (Tyr3-octreotate or TATE) labelled with the positron emission tomography tracer gallium 68Ga via the macrocyclic chelating agent dodecanetetraacetic acid (DOTA)) is a complex process and, as with any radiopharmaceutical whose basis is a short-lived radionuclide generator, it is based on a sequence of procedures beginning from the 68Ge/68Ga generator elution, labelling ligands with a radioisotope, dispensing doses of 68Ga-DOTA-TATE for patients and finally injection of the preparation to patients. The complexity of this process may contribute to an increased exposure of eye lenses of the staff who perform the above-mentioned procedures, which is especially important at a time when the dose limit on the lens of the eye is being reduced from 150 to 20 mSv yr-1. OBJECTIVE: The work presents the exposure of eye lenses of the personnel of a nuclear medicine department who prepare and inject 68Ga-DOTA-TATE. MATERIALS AND METHODS: Radiochemists and nurses were monitored by dosimetry measurements with thermoluminescent detectors (TLDs). RESULTS: The values of Hp(3)/A-normalised personal eye dose equivalent recorded in the group of radiochemists during the procedure of dispensing the doses of 68Ga-DOTA-TATE for patients exceeded the value of 274 µSv/GBq. CONCLUSIONS: The estimated annual Hp(3) values may exceed 20 mSv, which is particularly important due to the fact that procedures using the 68Ga radioactivity are only a small part of the daily professional activity of the staff, resulting from the performance of other procedures that require the use of other radioisotopes.
Assuntos
Cristalino/efeitos da radiação , Serviço Hospitalar de Medicina Nuclear , Exposição Ocupacional/efeitos adversos , Compostos Organometálicos/efeitos adversos , Exposição à Radiação/efeitos adversos , Humanos , RadiometriaAssuntos
Infecções por Coronavirus , Planejamento em Desastres/organização & administração , Serviço Hospitalar de Medicina Nuclear/organização & administração , Pandemias , Pneumonia Viral , Equipamentos de Proteção , Agendamento de Consultas , COVID-19 , Teste para COVID-19 , Técnicas de Laboratório Clínico , Contenção de Riscos Biológicos/instrumentação , Contenção de Riscos Biológicos/métodos , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/prevenção & controle , Infecções por Coronavirus/transmissão , Planejamento em Desastres/métodos , Arquitetura Hospitalar , Humanos , Higiene , Controle de Infecções/métodos , Controle de Infecções/organização & administração , Transmissão de Doença Infecciosa do Paciente para o Profissional/prevenção & controle , Transmissão de Doença Infecciosa do Profissional para o Paciente/prevenção & controle , Doenças Profissionais/prevenção & controle , Pandemias/prevenção & controle , Equipamento de Proteção Individual/provisão & distribuição , Recursos Humanos em Hospital , Pneumonia Viral/diagnóstico , Pneumonia Viral/epidemiologia , Pneumonia Viral/prevenção & controle , Pneumonia Viral/transmissão , Equipamentos de Proteção/provisão & distribuição , Avaliação de Sintomas , TelemedicinaAssuntos
Betacoronavirus , Infecções por Coronavirus , Neuroimagem/métodos , Serviço Hospitalar de Medicina Nuclear/organização & administração , Pandemias , Pneumonia Viral , Encéfalo/diagnóstico por imagem , Encéfalo/virologia , COVID-19 , Ensaios Clínicos como Assunto , Infecções por Coronavirus/complicações , Infecções por Coronavirus/diagnóstico por imagem , Infecções por Coronavirus/epidemiologia , Atenção à Saúde , Demência/terapia , Acessibilidade aos Serviços de Saúde , Necessidades e Demandas de Serviços de Saúde , Humanos , Doenças do Sistema Nervoso/complicações , Doenças do Sistema Nervoso/diagnóstico por imagem , Doenças do Sistema Nervoso/virologia , Neuroimagem/estatística & dados numéricos , Estudos Observacionais como Assunto , Transtornos do Olfato/etiologia , Transtornos do Olfato/virologia , Pneumonia Viral/complicações , Pneumonia Viral/diagnóstico por imagem , Pneumonia Viral/epidemiologia , Tomografia por Emissão de Pósitrons , Quarentena , SARS-CoV-2 , Trombofilia/etiologia , Trombofilia/virologia , Tomografia Computadorizada de Emissão de Fóton ÚnicoRESUMO
The article deals with materials on radiation hygienic evaluation of radiologic diagnostic departments in various medical institutions of Moscow. The studies covered work of medical staffers in X-ray examination and in contact with short-lived isotope generators. The authors outlined the examination types and stages with maximal radiation danger. Disimetric information obtained during the study helped to calculate values of equivalent, effective doses of radiation for medical personnel and maximal potential doses.
Assuntos
Pessoal de Saúde , Serviço Hospitalar de Medicina Nuclear , Exposição Ocupacional/análise , Monitoramento de Radiação/normas , Proteção Radiológica/normas , Serviço Hospitalar de Radiologia , Humanos , Moscou , Serviço Hospitalar de Medicina Nuclear/normas , Exposição Ocupacional/prevenção & controle , Exposição Ocupacional/normas , Doses de Radiação , Serviço Hospitalar de Radiologia/normasRESUMO
Quality management systems (QMS) in nuclear medicine is an essential component of the Quality program and is instrumental in the safe delivery of a high standard clinical service. The IAEA QUANUM program is a nuclear medicine specific audit program that can be used to assess the standards of a nuclear medicine department and its service delivery. Regular internal and external audits are encouraged as part of the QMS.
Assuntos
Medicina Nuclear , Medicina Nuclear/normas , Humanos , Serviço Hospitalar de Medicina Nuclear/normas , Serviço Hospitalar de Medicina Nuclear/organização & administração , Garantia da Qualidade dos Cuidados de Saúde/normasRESUMO
PURPOSE: The aim of this paper is to explain how University Hospitals of Leicester's Nuclear Medicine service managers needed to reduce waiting times to comply with internal clinical requirements and with external local primary care trust (PCT) and national Department of Health targets. DESIGN/METHODOLOGY/APPROACH: The team undertook a comprehensive service review to identify problem areas and potential improvements, including: process mapping; data gathering (activity and demand, equipment and staff availability/utilisation); external practice reviews, searching evidence bases; and financial implications. This case study describes how an inter-disciplinary team redesigned the service and used new working methods to reduce waiting times. Their aim was to discuss a service's practical elements and show how innovation leading to sustainable change can be implemented effectively. FINDINGS: The review highlighted service delivery bottlenecks for myocardial perfusion imaging, which were linked to medical staff shortages, staff use and equipment between hospital sites, and a silo approach to referrals rather than a coordinated organisation-wide approach. PRACTICAL IMPLICATIONS: Introducing enhanced roles allowed nurses, radiographers and technologists to undertake work previously performed by medical staff thus removing a key service bottleneck. Modifications to service delivery and a cultural change in nuclear medicine resulted in a service that was more efficient, flexible and able to cope with increased demand. ORIGINALITY/VALUE: These changes meant that minimum waiting-time targets were achieved, in particular waiting for myocardial perfusion imaging (reduced from 42 weeks in 2005 to two weeks by 2009). Changes allowed service managers to maintain short waiting times in the current, challenging healthcare climate.
Assuntos
Eficiência Organizacional , Imagem de Perfusão do Miocárdio/estatística & dados numéricos , Serviço Hospitalar de Medicina Nuclear/organização & administração , Melhoria de Qualidade/organização & administração , Listas de Espera , Humanos , Estudos de Casos Organizacionais , Equipe de Assistência ao Paciente/organização & administração , Avaliação de Processos em Cuidados de Saúde , Papel Profissional , Análise e Desempenho de Tarefas , Reino UnidoRESUMO
The neuroendocrine tumors (NET) of the gastro-entero-pancreatic area (GEP) represent a heterogeneous group of malignancies from the histologic, clinico-laboratoristic (functioning and non-functioning variants), and therapeutic point of view. It is an issue becoming more frequent for the diagnostic imager, being radiologist as well as nuclear physician. Imaging (together with biopsy) plays a key role in the diagnostic assessment and staging (including grading and prognostic definition), in evaluating response to treatment, and in follow-up of GEP-NET. Multislice computed tomography (MSCT), octreoscan and PET-CT are the most widely diffuse and accurate imaging modalities employed in this setting. Other methods, such as Magnetic Resonance and Endoscopic Ultrasound, may also play a significant role.
Assuntos
Diagnóstico por Imagem , Tumores Neuroendócrinos/diagnóstico , Radioisótopos de Flúor , Fluordesoxiglucose F18 , Humanos , Imageamento por Ressonância Magnética , Tomografia Computadorizada Multidetectores , Imagem Multimodal , Proteínas de Neoplasias/análise , Tumores Neuroendócrinos/química , Tumores Neuroendócrinos/diagnóstico por imagem , Tumores Neuroendócrinos/epidemiologia , Serviço Hospitalar de Medicina Nuclear , Oligopeptídeos , Tomografia por Emissão de Pósitrons , Compostos Radiofarmacêuticos , Receptores de Somatostatina/análise , Sensibilidade e Especificidade , Somatostatina/análogos & derivados , Tomografia Computadorizada por Raios X , UltrassonografiaRESUMO
AIM: To explain the spectrum and number of in-vivo nuclear medicine examinations and therapies based on official statistics about out-patient and in-patient care. Trends in time of the frequency and spectrum of procedures as well as data on the health care structure for nuclear medicine in Germany should be collected. METHODS: Data from the Gesundheitsberichterstattung des Bundes, from the frequency statistics of the statutory health insurance for out-patients and from the Bundesärztekammer were used. Customized queries were performed to analyse temporal changes. RESULTS: Nuclear medicine physicians are more frequently consulted by out-patients over the last years (2008: 2024498; 2009: 2164664) and the number of colleagues in private practice increased. For in-patients, the frequency of conventional nuclear medicine procedures (mainly for brain, lymphatic system, lung and heart) increased since 2008 after a decline in previous years (2009: 323515; +4.6%) and the number of PET(/CT) examinations continued to rise (2009: 25123; +18%), even if changes in OPS keys may hamper comparisons. Nearly 600 gamma cameras and 76 PET(/CT) scanners were installed in hospitals in 2008. Nuclear medicine procedures are increasingly performed as cross sectional imaging like SPECT(/CT) and PET(/CT). With the supply shortfall with 99Mo, the frequency of thyroid scans with 123I iodine increased as well as the use of 18F PET as a substitute for conventional bone scans. The number of radionuclide therapies, in particular non-thyroid treatments, increased since the mid-nineties and stabilized at nearly 50000 cases per year with shorter lengths of stay. CONCLUSION: The details of the present analysis may help to understand the positive evolution of key numbers for nuclear medicine.
Assuntos
Assistência Ambulatorial/estatística & dados numéricos , Hospitalização/estatística & dados numéricos , Serviço Hospitalar de Medicina Nuclear/estatística & dados numéricos , Cintilografia/estatística & dados numéricos , Radioterapia/estatística & dados numéricos , Encaminhamento e Consulta/estatística & dados numéricos , AlemanhaRESUMO
Quality management (QM) cannot be successfully implemented and performed without audits. The PDCA (Plan-Do-Check-Act) cycle is the core component of QM systems. In this cycle an audit represents the crucial step "check". Audits verify whether the performed actions and their results conform to the requirements. It is especially important to verify whether the principles of QM are omnipresent and fully implemented in a department or institution. The announcement of an audit may cause mixed feelings or even anxiety among the personnel to be audited. Without previous information and training the audit may be perceived as an act of control and intrusion into departmental affairs. The colleagues often fear sanctions if lapses are found or consider the audit to be a cross-examination. However, an audit is rather meant to be a helpful aid and a chance to continuously improve the departmental QM system by means of a constructive communication among colleagues. In the year 2009 the European Commission published guidelines for the performance of clinical audits in medical radiology, including diagnostic radiology, nuclear medicine and radiation therapy (Council Directive 97 / 43 / EURATOM). The aim is an optimal protection of the individual from the hazards of ionizing radiation and the directive expects radiological departments to perform clinical audits in accordance with national procedures.