Nuclear Medicine Resources Manual 2020 Edition

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• Publisher: International Atomic Energy Agency
• Year: 2021
• ISBN:
  9789201050229
• Topic: Medicine
• Subtopic: Radiology, Radiotherapy & Nuclear Medicine

Medical imaging is crucial in a variety of medical settings and at all levels of health care. In public health and preventive medicine as well as in both curative and palliative care, effective decisions depend on correct diagnoses. This edition addresses the most current needs and offers guidance on clinical practice, radiation safety and patient protection, human resource development and training required for the overall practice of nuclear medicine.

1. Introduction

1.1. Background

In the field of nuclear medicine, trace amounts of radiopharmaceuticals, which are pharmaceutical products containing radioactive atoms, are used for the diagnosis and treatment of many health conditions, such as certain types of cancer, neurological illnesses and cardiovascular diseases by performing: (i) molecular and functional diagnostic investigations, through the visualization, characterization and quantification of biological processes taking place at the cellular and subcellular levels in patients; and (ii) metabolic and immune targeted radiopharmaceutical treatments (see Refs [1–3]).

Establishing a nuclear medicine facility is a major undertaking that requires careful planning, contributions from multiple stakeholders, the support and approval of the relevant authorities, secure funding and a detailed implementation strategy. Detailed strategic planning is particularly important in developing countries, where nuclear medicine may currently be unavailable, and the benefits and complexities of nuclear medicine imaging and therapy may not be clearly appreciated. The accreditation of staff and their departments, with full documentation of procedures to international standards, will soon become a requirement, and this need is addressed in an IAEA publication on quality management [4].

It is essential that the project is consistent with government policies and strategies on health care. Potential stakeholders can include the ministries of health, education and science, agencies involved in the peaceful use of radiation and radioactive substances, universities, clinical specialists (e.g. oncologists, endocrinologists, cardiologists), and medical physicists and radiopharmacists.

1.2. Objective

This publication takes a systematic approach to the needs for nuclear medicine practice with regard to assessment, premises, human resources, equipment and quality assurance and quality control, medical physics and radiopharmacy support, radiation protection and safety, and clinical applications. This publication explores the key elements and the information provided is intended to inform decision making and resource allocation.

1.3. Scope

This publication is intended as a general guide for health care administrators, project and site planners and all professionals involved in providing nuclear medicine services. This updated version covers all the most important, recent evolution of the specialty, including the development of positron emission tomography (PET) services, which was considered beyond the scope of the first version [5]. This 2020 update also includes content from the IAEA publications in Refs [6–15]. Guidance provided here, describing good practices, represents expert opinion but does not constitute recommendations made on the basis of a consensus of Member States.

1.4. Structure

Section 2 assesses the need for a nuclear medicine service in a hospital, and Section 3 describes the planning of a nuclear medicine facility. Section 4 outlines the equipment used, and Section 5 describes information technology, networking, archiving and general office equipment. Section 6 focuses on the human resources aspects, detailing roles and responsibilities and training needs. Sections 7–9 explore aspects of radiopharmacy, medical physics and general clinical applications of nuclear medicine, respectively. Section 10 concludes with radiation protection and safety, and presents the relevant paragraphs to IAEA Safety Standards Series Nos SSG-46, Radiation Protection and Safety in Medical Uses of Ionizing Radiation [6], and GSR Part 3, Radiation Protection and Safety of Radiation Sources: International Basic Safety Standards [9].

2. Needs Assessment

2.1. Background

To successfully complete a nuclear medicine implementation project, an evaluation of expected health care activities, the resulting patient referral patterns and workload is critical. The design of the nuclear medicine facility in terms of buildings, hardware, personnel capabilities and inpatient facilities will depend on local health care requirements. The spectrum of services required may vary over time to complement developments in other medical specialties. Close liaison with the local medical community is essential to predict referral patterns. The profile of existing health care provision will affect both referral streams and the capacity to make use of information provided by the nuclear medicine service. For example, it would be appropriate to develop a dedicated nuclear cardiology service together with a strong clinical and interventional cardiology presence in the local health care system, and to develop a PET–computed tomography (CT) and cyclotron centres within the scope of a comprehensive cancer programme in the country.

In nuclear medicine studies, radiopharmaceuticals can target specific organs or cellular receptors in a given patient to view physiological changes in internal structures for the early diagnosis of disease. This powerful and significant tool provides unique information on a variety of important diseases including cardiovascular disease, cancer, renal, infection and endocrine diseases. Advanced molecular images can be used for initial diagnosis, follo...

Table of contents

• 1. Introduction
• ABBREVIATIONS
• CONTRIBUTORS TO DRAFTING AND REVIEW