Vía clínica de terapia metabólica con 131I en cáncer diferenciado de tiroides / Clinical pathway of metabolic therapy with 131I in differentiated thyroid cancer

Las vías clínicas son planes asistenciales que se aplican a procesos clínicos de curso predecible con la intención de protocolizarlos y disminuir la variabilidad en su manejo. Nuestro objetivo ha sido desarrollar una vía clínica para la terapia metabólica con 131I, proceso asistencial aplicado a los pacientes con carcinoma diferenciado de tiroides. Se organizó un equipo de trabajo formado por médicos (endocrinología y medicina nuclear), personal de enfermería (unidad de hospitalización y medicina nuclear), de radiofísica y del servicio de apoyo a la gestión clínica y continuidad asistencial. Para el diseño de la vía clínica se realizaron varias reuniones del equipo, en las que se pusieron en común las revisiones bibliográficas y se abordó el diseño y el desarrollo de la vía, respetando las guías clínicas vigentes. Este equipo ha logrado mediante consenso la elaboración del plan asistencial, estableciendo sus puntos clave y redactando los distintos documentos que componen la vía clínica: matriz temporal, documento de registro de variaciones de la vía clínica, documentos de información al paciente, encuesta de satisfacción del paciente, folleto de pictogramas, indicadores de evaluación de calidad. Por último, la vía clínica se ha presentado a todos los servicios clínicos involucrados y a la dirección médica del hospital, procediendo a su implementación en la práctica clínica (AU)

Clinical pathways are care plans that are applied to clinical processes with a predictable course, with the intention of protocolizing them, and reducing the variability in their management. Our objective was to develop a clinical pathway for 131I metabolic therapy, in its application to differentiated thyroid cancer. A work team was organised consisting of doctors (Endocrinology and Nuclear Medicine), nursing staff (Hospitalisation Unit and Nuclear Medicine), Radiophysics and the Clinical Management and Continuity of Care Support Service. For the design of the clinical pathway, several team meetings were held, in which the literature reviews were pooled and the design and development of the clinical pathway was undertook, in accordance with current clinical guidelines. This team has achieved consensus on the development of the care plan, establishing its key points and drafting the different documents that make up the clinical pathway: timeframe-based schedule, clinical pathway variation record document, patient information documents, patient satisfaction survey, pictogram brochure, quality assessment indicators. Finally, the clinical pathway was presented to all clinical departments involved and to the medical director of the hospital, and it is now being implemented in clinical practice (AU)

Clinical pathway of metabolic therapy with 131I in differentiated thyroid cancer.

Clinical Pathways are care plans that are applied to clinical processes with a predictable course, with the intention of protocolizing these processes and reducing the variability in their management. Our objective was to develop a clinical pathway for 131I metabolic therapy in its application to differentiated thyroid cancer. A work team was organized consisting of doctors (Endocrinology and Nuclear Medicine), nursing staff (Hospitalization Unit and Nuclear Medicine), Radiophysics and the Clinical Management and Continuity of Care Support Service. For the design of the clinical pathway, several team meetings were held, in which the literature reviews were pooled and the design and development of the clinical pathway was undertaken in accordance with current clinical guidelines. This team achieved consensus on the development of the care plan, establishing its key points and drafting the different documents that make up the Clinical Pathway: Timeframe-based schedule, Clinical Pathway Variation Record Document, Patient Information Documents, Patient Satisfaction Survey, Pictogram Brochure, Quality Assessment Indicators. Finally, the clinical pathway was presented to all the clinical departments involved and to the Medical Director of the Hospital and is now being implemented in clinical practice.

Encuesta del Grupo de Trabajo de Cirugía Radioguiada (GTCRG) de la Sociedad Española de Medicina Nuclear e Imagen Molecular (SEMNIM): localización radioguiada de lesiones no palpables de mama con o sin indicación de biopsia selectiva de ganglio centinela: ROLL, SNOLL y semillas de 125I / Survey of the Radioguided Surgery Working Group (GTCRG-RGSWG) of the Spanish Society of Nuclear Medicine and Molecular Imaging (SEMNIM): Radioguided localization of non-palpable breast lesions with or without indication for selective sentinel node biopsy: ROLL, SNOLL and 125I seeds

Objetivo: Conocer el estado actual de la técnica de localización radioguiada de lesiones no palpables de mama con o sin indicación de biopsia selectiva de ganglio centinela —ROLL, SNOLL y semillas de 125I— mediante la realización de una encuesta nacional elaborada por el Grupo de Trabajo de Cirugía Radioguiada (GTCRG) de la Sociedad Española de Medicina Nuclear e Imagen Molecular (SEMNIM). Material y métodos: En octubre del 2020 se envió la encuesta, en formato digital, a los distintos servicios de Medicina Nuclear de nuestra geografía. Se dio un tiempo de respuesta de 2meses con prórroga de 15 días. Se ha obtenido el número de procedimientos ROLL/SNOLL de cada centro y la metodología utilizada, recogiendo importantes detalles técnicos. Además, se ha incluido un apartado específico sobre las semillas de 125I. Los resultados se volcaron de forma automática en una hoja de cálculo Excel 2007 para su posterior análisis con el mismo programa. Resultados: La encuesta fue contestada por 55 centros; 21 utilizan arpón mientras que los 34 restantes emplean distintas técnicas de cirugía radioguiada (CRG) para la localización de lesiones no palpables de mama, desglosando los resultados en 13apartados. La dosis de trazador habitualmente utilizada es de 111 MBq para la técnica ROLL y de 222 MBq para la técnica SNOLL, con un volumen de 0,2ml. El protocolo más habitual es el de 2días. El 26% de los centros que realiza CRG utiliza semillas de 125I tanto para la detección de lesiones mamarias como de ganglios sospechosos/patológicos, siendo el tiempo entre la implantación y la extirpación es de unos 3 días, con posterior control radiológico en la mayoría de los casos. Conclusión: La encuesta pone de manifiesto la relevancia de la cirugía radioguiada en el manejo de los pacientes con cáncer de mama en las diferentes etapas de la enfermedad, con disparidad en la implementación de las nuevas técnicas y herramientas (AU)

Objective: To know the current status of the technique of radioguided localisation of non-palpable breast lesions with or without indication for selective sentinel node biopsy -ROLL, SNOLL and 125I seeds- by conducting a national survey developed by the Working Group on Radioguided Surgery (GTCRG) of the Spanish Society of Nuclear Medicine and Molecular Imaging (SEMNIM). Material and methods: In October 2020, the form was sent in digital format to the different nuclear medicine services in Spain. A response time of 2months with an overtime of 15 days was given. The number of ROLL/SNOLL procedures in each centre and the methodology used were obtained, including important technical details. In addition, a specific section on 125I seeds was included. The results were automatically downloaded into an Excel 2007 spreadsheet for subsequent analysis with the same program. Results: The survey was answered by 55 centres; 21 use wire-guided localisation while the remaining 34 use different radioguided surgery techniques (RGS) for the localisation of non-palpable breast lesions, with the results itemized into thirteen sections. The commonly used tracer dose is 111 MBq for the ROLL technique and 222 MBq for the SNOLL technique, with a volume of 0.2ml. The most common protocol is the two-day protocol. 26% of centres performing CRG use 125I seeds for both breast lesion and suspicious/pathological node detection, with the time between implantation and removal being about 3 days, with subsequent radiological control in most cases. Conclusion: The survey shows the relevance of radioguided surgery in the management of breast cancer patients at different stages of the disease, with disparity in the implementation of new techniques and tools, which responds to the multiple healthcare realities of Nuclear Medicine services (AU)

Survey of the Radioguided Surgery Working Group (GTCRG-RGSWG) of the Spanish Society of Nuclear Medicine and Molecular Imaging (SEMNIM): Radioguided localization of non-palpable breast lesions with or without indication for selective sentinel node biopsy: ROLL, SNOLL and 125I seeds.

OBJECTIVE: To know the current status of the technique of radioguided localisation of non-palpable breast lesions with or without indication for selective sentinel node biopsy -ROLL, SNOLL and 125I seeds- by conducting a national survey developed by the Working Group on Radioguided Surgery (GTCRG) of the Spanish Society of Nuclear Medicine and Molecular Imaging (SEMNIM). MATERIAL AND METHODS: In October 2020, the form was sent in digital format to the different nuclear medicine services in Spain. A response time of 2 months with an overtime of 15 days was given. The number of ROLL/SNOLL procedures in each centre and the methodology used were obtained, including important technical details. In addition, a specific section on 125I seeds was included. The results were automatically downloaded into an Excel 2007 spreadsheet for subsequent analysis with the same program. RESULTS: The survey was answered by 55 centres; 21 use wire-guided localisation while the remaining 34 use different radioguided surgery techniques (RGS) for the localisation of non-palpable breast lesions, with the results itemized into thirteen sections. The commonly used tracer dose is 111 MBq for the ROLL technique and 222 MBq for the SNOLL technique, with a volume of 0.2 ml. The most common protocol is the two-day protocol. 26% of centres performing CRG use 125I seeds for both breast lesion and suspicious/pathological node detection, with the time between implantation and removal being about 3 days, with subsequent radiological control in most cases. CONCLUSION: The survey shows the relevance of radioguided surgery in the management of breast cancer patients at different stages of the disease, with disparity in the implementation of new techniques and tools, which responds to the multiple healthcare realities of Nuclear Medicine services.

Aportación de la medicina nuclear intervencionista a la cirugía de precisión molecularmente dirigida / nterventional nuclear medicine's contribution to molecularly targeted precision surgery

El abordaje quirúrgico de las distintas enfermedades, no solo oncológicas, ha evolucionado. Como ha sido acuñado de forma muy gráfica por el grupo de Veronesi, estamos pasando de los «tratamientos máximos tolerables a los mínimos eficaces» y este recorrido no puede ser llevado a cabo de otra forma que mediante un planteamiento de trabajo multidisciplinar y multimodalidad. Obligatoriamente multidisciplinar porque es necesaria la colaboración entre cirujanos, oncólogos, radiólogos, médicos nucleares, patólogos y todo aquel relacionado con el seguimiento de los pacientes, y obligatoriamente multimodalidad porque nos debemos encaminar hacia una cirugía de precisión a la medida de cada paciente en la que, por parte de la Medicina Nuclear, tiene mucho que decir la imagen híbrida (SPECT/TC y PET/TC), los trazadores bimodales, el empleo de nuevos aliados como la ecografía o nuestra propia adaptación a la cirugía robótica. Todo un amplio abanico de posibilidades construido a partir de un sólido cimiento como es la gammagrafía preoperatoria, que posibilita la identificación de los tejidos diana y cuyo conocimiento previo a la intervención permite plantear el abordaje quirúrgico necesario para cada paciente (AU)

The surgical approach to different pathologies, not only oncological, has evolved. As Veronesi's group has coined very graphically, we are moving from “maximum tolerable treatments to minimum effective treatments” and this journey cannot be carried out in any other way than through a multidisciplinary and multimodality approach. Multidisciplinary, because collaboration between surgeons, oncologists, radiologists, nuclear physicians, pathologists, and all those involved in patient follow-up is necessary, and multimodality, because we must move towards precision surgery tailored to each patient in which, on the part of Nuclear Medicine, hybrid imaging (SPECT/CT and PET/CT), bimodal tracers, the use of new allies such as ultrasound or our own adaptation to robotic surgery have a great deal to say A wide range of possibilities is built on the solid foundation of preoperative scintigraphy, which makes it possible to identify the target tissues and whose knowledge prior to surgery allows the necessary surgical approach to be considered for each patient (AU)

Interventional nuclear medicine's contribution to molecularly targeted precision surgery.

The surgical approach to different pathologies, not only oncological, has evolved. As Veronesi's group has coined very graphically, we are moving from "maximum tolerable treatments to minimum effective treatments" and this journey cannot be carried out in any other way than through a multidisciplinary and multimodality approach. Multidisciplinary, because collaboration between surgeons, oncologists, radiologists, nuclear physicians, pathologists, and all those involved in patient follow-up is necessary, and multimodality, because we must move towards precision surgery tailored to each patient in which, on the part of Nuclear Medicine, hybrid imaging (SPECT/CT and PET/CT), bimodal tracers, the use of new allies such as ultrasound or our own adaptation to robotic surgery have a great deal to say. A wide range of possibilities is built on the solid foundation of preoperative scintigraphy, which makes it possible to identify the target tissues and whose knowledge prior to surgery allows the necessary surgical approach to be considered for each patient.

Radioguided surgery in primary hyperparathyroidism: a review of the different available techniques. / Cirugía radioguiada en el hiperparatiroidismo primario: revisión de las diferentes técnicas disponibles.

Parathyroidectomy has evolved over the years from bilateral neck exploration to a single gland approach using minimally invasive surgery. The precise presurgical localization of the problem gland, using functional techniques, such as double-phase scintigraphy with [99mTc] Tc-MIBI including SPECT-CT and PET-CT with [18F]-Choline and morphological ones, such as ultrasound have played a crucial role in this paradigm's shift. Radioguided surgery techniques have also adapted and grown with new contributions known for their indication in other fields. Thus, we currently have a wide range of techniques that have been added to the minimally invasive radioguided parathyroidectomy with [99mTc] Tc-MIBI, which was the first on the stage and for which more experience exists. Among them, in this update, we will discuss parathyroidectomy using ultrasound-guided ROLL technique as well as with the use of 125I seeds and finally, hybrid techniques that use radiotracer and fluorescence.

Actualización en cirugía radioguiada: del consenso internacional en ganglio centinela de cabeza y cuello a los avances en tumores ginecológicos y localización de lesiones no palpables / Update on radioguided surgery: from international consensus on sentinel node in head and neck cancer to the advances on gynaecological tumors and localization of non-palpable lesions

La presente revisión tiene como objetivo brindar una visión actualizada en diferentes campos de la cirugía radioguiada. En lo que se refiere a la biopsia del ganglio centinela en el carcinoma escamoso oral, se exponen los resultados del debate interactivo llevado a cabo en el reciente Congreso de nuestra especialidad sobre los aspectos más relevantes del Consenso de Londres. En los tumores ginecológicos, cáncer de endometrio y cérvix, se detallan las particularidades del drenaje, las indicaciones establecidas según las guías actuales y se presentan nuevos escenarios para el médico nuclear, como pueden ser la cirugía robótica y los trazadores híbridos. Por otra parte, la notable expansión de las indicaciones de la cirugía radioguiada de lesiones no palpables, ampliamente utilizada en patología mamaria, hace conveniente la puesta al día en dos procedimientos que han demostrado resultados satisfactorios, como son el nódulo pulmonar solitario y el osteoma osteoide

The aim of this review is to provide an updated perspective on different fields of radioguided surgery. With reference to the sentinel lymph node biopsy in oral squamous cell carcinoma, we present the results of the interactive debate held at the recent Congress of our specialty about the more relevant aspects of the London Consensus. Drainage peculiarities and indications according to the current guidelines on gynaecological tumours, endometrial and cervical cancer, are detailed and new scenarios for nuclear medicine physicians are presented; robotic surgery and hybrid tracers, for instance. Moreover, the notable growth in radioguided surgery indications for non-palpable lesions, widely used in mammary pathology, make it advisable to update two procedures which have shown satisfying results, such as the solitary pulmonary nodule and the osteoid osteoma

Update on radioguided surgery: from international consensus on sentinel node in head and neck cancer to the advances on gynaecological tumors and localization of non-palpable lesions. / Actualización en cirugía radioguiada: del consenso internacional en ganglio centinela de cabeza y cuello a los avances en tumores ginecológicos y localización de lesiones no palpables.

The aim of this review is to provide an updated perspective on different fields of radioguided surgery. With reference to the sentinel lymph node biopsy in oral squamous cell carcinoma, we present the results of the interactive debate held at the recent Congress of our specialty about the more relevant aspects of the London Consensus. Drainage peculiarities and indications according to the current guidelines on gynaecological tumours, endometrial and cervical cancer, are detailed and new scenarios for nuclear medicine physicians are presented; robotic surgery and hybrid tracers, for instance. Moreover, the notable growth in radioguided surgery indications for non-palpable lesions, widely used in mammary pathology, make it advisable to update two procedures which have shown satisfying results, such as the solitary pulmonary nodule and the osteoid osteoma.

Nuevas perspectivas para la cirugía radioguiada / New approaches in radioguided surgery

No disponible

Osteomalacia hipofosfatémica sintomática secundaria a tratamiento con hierro carboximaltosa objetivada con gammagrafía ósea / Symptomatic hypophosphataemic osteomalacia secondary to the treatment with iron carboxymaltose detected in bone scintigraphy

El desarrollo de osteomalacia hipofosfatémica se ha relacionado con diversos tratamientos, fundamentalmente antirretrovirales y administración de hierro por vía intravenosa. La frecuencia de la hipofosfatemia hace necesario vigilar el fosfato tras la administración de hierro carboximaltosa. Presentamos el caso de una mujer sin antecedentes de alteración del metabolismo fosfo-cálcico a la que se pautó este tratamiento por anemia debida a hipermenorrea e intolerancia al hierro por vía oral. Comenzó con dolor oligoarticular que se generalizó más tarde, con importante impotencia funcional y cuya relación con la administración por vía intravenosa de hierro fue descubierta cuando los hallazgos gammagráficos junto con la analítica orientaron hacia una osteomalacia hipofosfatémica. Respondió de forma satisfactoria al tratamiento con fosfato como se objetivó clínicamente y en la gammagrafía ósea de control (AU)

The development of hypophosphataemic osteomalacia has been linked with several treatments, mainly antiretroviral and intravenous iron administration. The frequency of the hypophosphataemia requires monitoring the phosphate after the administration of iron carboxymaltose. We describe a case of a woman with no calcium-phosphorous metabolism disorder, to whom this treatment was prescribed for anaemia due to menorrhagia and intolerance to oral iron. She started with oligoarticular pain, which was spreading with a significant functional loss. The relationship with the administration of intravenous iron was discovered when scintigraphic findings together with laboratory results led to a diagnosis of hypophosphataemic osteomalacia. The patient responded satisfactorily to treatment with phosphate both clinically and in the follow-up bone scintigraphy (AU)

Symptomatic hypophosphataemic osteomalacia secondary to the treatment with iron carboxymaltose detected in bone scintigraphy. / Osteomalacia hipofosfatémica sintomática secundaria a tratamiento con hierro carboximaltosa objetivada con gammagrafía ósea.

The development of hypophosphataemic osteomalacia has been linked with several treatments, mainly antiretroviral and intravenous iron administration. The frequency of the hypophosphataemia requires monitoring the phosphate after the administration of iron carboxymaltose. We describe a case of a woman with no calcium-phosphorous metabolism disorder, to whom this treatment was prescribed for anaemia due to menorrhagia and intolerance to oral iron. She started with oligoarticular pain, which was spreading with a significant functional loss. The relationship with the administration of intravenous iron was discovered when scintigraphic findings together with laboratory results led to a diagnosis of hypophosphataemic osteomalacia. The patient responded satisfactorily to treatment with phosphate both clinically and in the follow-up bone scintigraphy.

Discrepancies on quality perceived by the patients versus professionals on the quality of a nuclear medicine department / Discrepancias sobre la calidad percibida entre los profesionales y los pacientes de un servicio de medicina nuclear

Purpose: To evaluate the discrepancies between the professionals and outpatients on quality perceived of a Nuclear Medicine Department (NMD). Material and Methods: This cross-sectional study has been carried out using two questionnaires: a validated patient experience questionnaire and a quality perception questionnaire for professionals. Both questionnaires use the same 25 categorical items to measure service quality, 2 Likert scale items to measure satisfaction and willingness to recommend the NMD and 1 open-ended question. The patient questionnaire included 6 socio-demographic items and one job-related question (professionals). The categorical items were classified as 'conformity' or 'non-conformity.' Results: The response rate was 36.7% for outpatients and 100% for professionals. Mean value for satisfaction with the NMD was 9 points for patients and 6.9 points for professionals. Mean number of non-conformity items per person was 2.8 for the patient group and 8.7 for the professional group. Cohen’s Kappa value was 0.112, indicating poor agreement in the classification of items as strong points and areas for improvement. Of the 25 items, the professionals and patients coincided on 12 (48%). Conclusion: Agreement was low between the quality perception of patients and professionals. The patients scored quality of service higher than the NMD professionals did. These instruments are useful aid to help health organizations detect areas for improvement, and to improve the quality of the service provided to patients (AU)

Objetivo: Evaluar las discrepancias entre los profesionales y los pacientes de un Servicio de Medicina Nuclear sobre la calidad percibida. Material y métodos: Se realizó un estudio transversal utilizando 2 tipos de cuestionarios: un cuestionario validado para explorar experiencias y satisfacción de los pacientes y un cuestionario adaptado para evaluar la percepción de los profesionales. Ambos cuestionarios constaron de 25 preguntas categóricas (calidad de servicio), 2 con escala de Likert (satisfacción y recomendación) y una pregunta abierta. Se incluyeron 6 variables sociodemográficas (pacientes) y una sobre ámbito laboral (profesionales). Las preguntas categóricas fueron clasificadas como 'conformidad' o 'no conformidad'. Resultados: La tasa de respuesta fue del 36,7% para los pacientes y del 100% para los profesionales. La satisfacción alcanzó una media de 9 puntos para los pacientes y de 6,9 para los profesionales. La media de no-confomidades por persona fue de 2,8 para el grupo de pacientes y de 8,7 para el de profesionales. El valor Kappa de Cohen fue de 0,112 indicando un pobre acuerdo a la hora de clasificar los ítems en punto fuertes o áreas de mejora. De los 25 ítems, los pacientes y los profesionales coincidieron en 12 (48%). Conclusión: El grado de acuerdo entre los pacientes y los profesionales sobre la percepción de la calidad ofrecida fue bajo. Los pacientes puntuaron mejor la calidad ofrecida que los profesionales. Estos instrumentos son útiles para ayudar a las organizaciones sanitarias a detectar áreas de mejora y mejorar la calidad de servicio que se ofrece a los pacientes (AU)

Discrepancies on quality perceived by the patients versus professionals on the quality of a nuclear medicine department.

PURPOSE: To evaluate the discrepancies between the professionals and outpatients on quality perceived of a Nuclear Medicine Department (NMD). MATERIAL AND METHODS: This cross-sectional study has been carried out using two questionnaires: a validated patient experience questionnaire and a quality perception questionnaire for professionals. Both questionnaires use the same 25 categorical items to measure service quality, 2 Likert scale items to measure satisfaction and willingness to recommend the NMD and 1 open-ended question. The patient questionnaire included 6 socio-demographic items and one job-related question (professionals). The categorical items were classified as "conformity" or "non-conformity." RESULTS: The response rate was 36.7% for outpatients and 100% for professionals. Mean value for satisfaction with the NMD was 9 points for patients and 6.9 points for professionals. Mean number of non-conformity items per person was 2.8 for the patient group and 8.7 for the professional group. Cohen's Kappa value was 0.112, indicating poor agreement in the classification of items as strong points and areas for improvement. Of the 25 items, the professionals and patients coincided on 12 (48%). CONCLUSION: Agreement was low between the quality perception of patients and professionals. The patients scored quality of service higher than the NMD professionals did. These instruments are useful aid to help health organizations detect areas for improvement, and to improve the quality of the service provided to patients.

Evaluación de la eficacia en la detección del ganglio centinela en el cáncer de mama: evolución cronológica e influencia de la incorporación de una gammacámara portátil intraoperatoria / Evaluation of the efficacy of sentinel node detection in breast cancer: chronological course and influence of the incorporation of an intra-operative portable gamma camera

Objetivo. Determinar el porcentaje de identificación global del ganglio centinela (GC) en el cáncer de mama, la evolución cronológica de este parámetro y la influencia de la introducción de una gammacámara portátil. Material y métodos. Estudio retrospectivo a partir de una base de datos prospectiva de 754 pacientes a las que se realizó biopsia selectiva del GC de forma consecutiva entre enero de 2003 y diciembre de 2011. La técnica fue mixta en periodo inicial y posteriormente con radiotrazador administrado intra-peritumoralmente. Hasta octubre de 2009 la exéresis del GC fue guiada por sonda y a partir de esta fecha se introdujo una gammacámara portátil para la detección intraoperatoria. Resultados. Se ha biopsiado el GC en 725 de 754 pacientes, siendo por tanto la eficacia global del 96,2%. Según el año de intervención quirúrgica los porcentajes de identificación han sido del 93,5% en 2003, del 88,7% en 2004, del 94,3% en 2005, del 95,7% en 2006, del 93,3% en 2007, del 98,8% en 2008, del 97,1% en 2009 y del 99,1% en 2010 y 2011. Existe una diferencia de proporciones entre el porcentaje de identificación antes y después de la incorporación de la gammacámara portátil del 4,6% que es estadísticamente significativa (IC 95% de la diferencia 2-7,2% con una p asociada de 0,0037). Conclusiones. El porcentaje de identificación global se halla por encima del nivel recomendado por las directrices actuales. Cronológicamente se constata elevación de este parámetro a lo largo del periodo estudiado. Los datos apuntan a que la incorporación de una gammacámara portátil ha tenido un papel en ello (AU)

Aim. To define the sentinel node identification rate in breast cancer, the chronological evolution of this parameter and the influence of the introduction of a portable gamma camera. Material and methods. A retrospective study was conducted using a prospective database of 754 patients who had undergone a sentinel lymph node biopsy between January 2003 and December 2011. The technique was mixed in the starting period and subsequently was performed with radiotracer intra-peritumorally administered the day before of the surgery. Until October 2009, excision of the sentinel node was guided by a probe. After that date, a portable gamma camera was introduced for intrasurgical detection. Results. The SN was biopsied in 725 out of the 754 patients studied. The resulting technique global effectiveness was 96.2%. In accordance with the year of the surgical intervention, the identification percentage was 93.5% in 2003, 88.7% in 2004, 94.3% in 2005, 95.7% in 2006, 93.3% in 2007, 98.8% in 2008, 97.1% in 2009 and 99.1% in 2010 and 2011. There was a significant difference in the proportion of identification before and after the incorporation of the portable gamma camera of 4.6% (95% CI of the difference 2–7.2%, P = 0.0037). Conclusions. The percentage of global identification exceeds the recommended level following the current guidelines. Chronologically, the improvement for this parameter during the study period has been observed. These data suggest that the incorporation of a portable gamma camera had an important role (AU)

[Evaluation of the efficacy of sentinel node detection in breast cancer: chronological course and influence of the incorporation of an intra-operative portable gamma camera]. / Evaluación de la eficacia en la detección del ganglio centinela en el cáncer de mama: evolución cronológica e influencia de la incorporación de una gammacámara portátil intraoperatoria.

AIM: To define the sentinel node identification rate in breast cancer, the chronological evolution of this parameter and the influence of the introduction of a portable gamma camera. MATERIAL AND METHODS: A retrospective study was conducted using a prospective database of 754 patients who had undergone a sentinel lymph node biopsy between January 2003 and December 2011. The technique was mixed in the starting period and subsequently was performed with radiotracer intra-peritumorally administered the day before of the surgery. Until October 2009, excision of the sentinel node was guided by a probe. After that date, a portable gamma camera was introduced for intrasurgical detection. RESULTS: The SN was biopsied in 725 out of the 754 patients studied. The resulting technique global effectiveness was 96.2%. In accordance with the year of the surgical intervention, the identification percentage was 93.5% in 2003, 88.7% in 2004, 94.3% in 2005, 95.7% in 2006, 93.3% in 2007, 98.8% in 2008, 97.1% in 2009 and 99.1% in 2010 and 2011. There was a significant difference in the proportion of identification before and after the incorporation of the portable gamma camera of 4.6% (95% CI of the difference 2-7.2%, P = 0.0037). CONCLUSIONS: The percentage of global identification exceeds the recommended level following the current guidelines. Chronologically, the improvement for this parameter during the study period has been observed. These data suggest that the incorporation of a portable gamma camera had an important role.

[Assessment of the patient satisfaction with a Nuclear Medicine Service]. / Evaluación del grado de satisfacción de los pacientes atendidos en un servicio de Medicina Nuclear.

GOAL: To know the perceived quality and the levels of patient satisfaction with the Nuclear Medicine Service (MN). METHODS: A cross-sectional descriptive study was performed. The authors designed a self-applied questionnaire based on a questionnaire from a survey created by the National Health Service of the UK. The answers of 32 items were analyzed, including 4 social-demographic questions and one open question. The authors recoded the variables related to service quality and recorded them as "in accordance" and "not in accordance." The validity of the questionnaire was measured using Cronbach's alpha and determination (R(2)) indexes. The authors used the χ(2), Student's T, ANOVA and linear regression analysis statistical tests. RESULTS: A total of 179 questionnaires were analyzed (response rate: 36.6%, sampling error: 5.8%). Evaluation of general satisfaction and the recommendation of the NM Service obtained a mean score of 8.96 and 9.20 (1-10 scale) points, respectively. The most influential variable regarding general satisfaction was the general impression of the organization of the service. The strong points of the service were courtesy, general organizational image and cleanliness. The main areas for improvement were appointment change process and waiting list. There were no significant differences regarding satisfaction due to the social-demographic variables except for age. CONCLUSION: This satisfaction survey has shown that patients are satisfied with the Nuclear Medicine Service and that it is a useful tool to detect the strong points and areas for improvement of the Service from the user's perspective.

Evaluación del grado de satisfacción de los pacientes atendidos en un servicio de Medicina Nuclear / Assessment of the Patient Satisfaction with a Nuclear Medicine Service

Objetivo. Conocer la calidad percibida y el grado de satisfacción de los pacientes con el servicio de Medicina Nuclear (MN). Metodología. Estudio descriptivo transversal. Se diseñó un cuestionario, adaptando un cuestionario elaborado por el National Health Service. Se analizaron las respuestas de 32 ítems, incluyendo 4 preguntas socio-demográficas y una abierta. Las variables relacionadas con la calidad de servicio se recodificaron en conformidad y no conformidad. Se midió la validez del cuestionario a través de los coeficientes alfa de Cronbach y de determinación (R2). Se utilizaron los test estadísticos χ2, t de Student, ANOVA y análisis de regresión lineal. Resultados. Fueron analizados 179 cuestionarios (tasa de respuesta: 36,6%, error muestral: 5,8%). La valoración de la satisfacción general y la recomendación del servicio de MN obtuvieron una puntuación media de 8,96 y 9,20 puntos respectivamente (escala 1-10). La variable que más influyó en la satisfacción general fue la impresión de la organización del servicio. Los principales puntos fuertes del servicio fueron la cortesía, la impresión de la organización del servicio y la limpieza; y las principales áreas de mejora, el cambio de cita y la lista de espera. No hubo diferencias significativas en la satisfacción en función de las variables sociodemográficas excepto para la edad. Conclusiones. La encuesta de satisfacción realizada nos ha permitido conocer que los pacientes están satisfechos con el Servicio de MN y, al mismo tiempo, constituye un instrumento útil para poder detectar los puntos fuertes y áreas de mejora del servicio desde la óptica del usuario(AU)

Goal. To know the perceived quality and the levels of patient satisfaction with the Nuclear Medicine Service (MN). Methods. A cross-sectional descriptive study was performed. The authors designed a self-applied questionnaire based on a questionnaire from a survey created by the National Health Service of the UK. The answers of 32 items were analyzed, including 4 social-demographic questions and one open question. The authors recoded the variables related to service quality and recorded them as "in accordance" and "not in accordance". The validity of the questionnaire was measured using Cronbach's alpha and determination (R2) indexes. The authors used the χ2, Student's T, ANOVA and linear regression analysis statistical tests. Results. A total of 179 questionnaires were analyzed (response rate: 36.6%, sampling error: 5.8%). Evaluation of general satisfaction and the recommendation of the NM Service obtained a mean score of 8.96 and 9.20 (1-10 scale) points, respectively. The most influential variable regarding general satisfaction was the general impression of the organization of the service. The strong points of the service were courtesy, general organizational image and cleanliness. The main areas for improvement were appointment change process and waiting list. There were no significant differences regarding satisfaction due to the social-demographic variables except for age. Conclusion. This satisfaction survey has shown that patients are satisfied with the Nuclear Medicine Service and that it is a useful tool to detect the strong points and areas for improvement of the Service from the user‘s perspective(AU)