Technologist’s Guide

Best Practice in Nuclear Medicine 1

Nuclear Medicine departments offer a large diversity of diagnostic and therapeutic procedures, which often play a central role in patient management. At the same time, the field is constantly evolving with new procedures being continuously introduced. In such a rich and developing scenario, adherence to bestpractice guidelines becomes crucial to offer best patient care.

Nuclear Medicine technology is a demanding and sophisticated profession. The continuous developments in technology, radiopharmaceuticals, procedures and patient care make it one of the most rapidly evolving health care professions. For example, novel targets for imaging have emerged, such as labelled glucose for the imaging of cancer, labelled somatostatin tracers for the imaging of neuroendocrine disease, beta CIT homing onto the dopamine transporter for the investigation of patients with movement disorders. Progress is coming in the imaging of the Alzheimer’s disease, the imaging of atherosclerotic plaque and the imaging of angiogenesis and hypoxia. Sentinel lymph node detection has changed the surgical management of patients presenting with early breast cancer.

At the same time, all diagnostic procedures have benefited from major progress in instrumentation; and in the last 5 years, the emergence of multimodality imaging has become routine. Conventional gamma cameras have been linked to advanced CT scanners (SPECT/CT) and modern PET scanners have been linked to multi-slice CT devices (PET/CT). Nuclear Medicine therapy has also been growing far beyond the established treatment of benign and malignant disease of the thyroid. I- 131 when linked to metaiodobenzylguanidine is used in the treatment of neuroendocrine malignancies, such as pheochromocytomas and neuroblastomas. Newer ligands targeting the SS2 receptor subtypes are emerging, labelled with Yttrium 90, Lutetium 177 and other radionuclides. Pain palliation in advanced metastatic and skeletal prostate and breast disease has become available, with one third of patients showing excellent response to a variety of radionuclides, including strontium 89-chloride, rhenium-186 as etidronate, samarium-153 as ethylene-diaminetetramethylene phosphonate.

Several labelled antibodies have been entered in clinical trials and some have now been approved as specific treatment options, such as Zevalin or Yttrium- 90 labelled ibritumomab tiuxetan and Bexxar – I-131 labelled tositumomab. With such continuing developments and innovation, best-practice may become a moving target. Clearly, best-practice guidelines must be developed and implemented at the European level that help Nuclear Medicine departments to provide best patient care. Updated procedural and clinical guidelines are available from the EANM website for many of the well established diagnostic and therapeutic procedures. Adherence to such guidelines is highly desirable to harmonize patient care across the diversity of European countries. European Nuclear Medicine technologists practice Nuclear Medicine in departments where most of these procedures are performed in a patient’s diagnosis or follow-up. As members of their institutional health care team, they also function as patient advocates, educators, health care researchers, technical and therapy specialists, and interdisciplinary consultants and play a key role to offer best clinical practice. Nuclear Medicine must embrace the principles of best-practice as the basis for clinical judgement, within the context of working as part of a multi-disciplinary team in medical diagnosis and therapy. Within such multi-disciplinary teams, Nuclear Medicine technologists must play a leading role in establishing clinical standards and clinical protocols.

In order to offer best practice, continuing education is essential. The education process in Nuclear Medicine includes graduating from an accredited programme, completing a summary of clinical competence and completing a professional certification examination when available. The education process assures that Nuclear Medicine technologists have the knowledge, skills and judgement to be competent health care providers in their highly specialized discipline. In addition, lifelong learning is a core value for all health care professions. Therefore, entry-level education in Nuclear Medicine must be supported by both formal and self-directed professional development programmes. All these programmes, including cognitive, affective and clinical competence, must be part of best-practice codes in any Nuclear Medicine department. Like all healthcare professions, Nuclear Medicine must move with the times, changing and adapting its principles and relationships, acknowledging the expectations of patients and the developing practice of other healthcare disciplines. Like all healthcare professions, only by understanding, accepting and adapting to these changes can Nuclear Medicine offer best-practice and retain its relevance within medicine and society.

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