Survey
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 SCOPE OF PRACTICE FOR THE NUCLEAR MEDICINE TECHNOLOGIST 2007 President’s Task Force Society of Nuclear Medicine Technologist Section 33 unsealed radioactive materials in the diagnosis and treatment of disease. 34 This practice includes technique administration, imaging, and/or counting of 35 diagnostic radiopharmaceuticals to enhance organ and molecular 36 function, as well as the delivery of therapeutic radiopharmaceuticals to 37 treat a number of pathologies. A Society of Nuclear Medicine Technologist Section (SNM-TS) presidential task force established in the Summer of 2006 developed the revised SNM-TS Scope of Practice for nuclear medicine technologists. The task force consisted of the following individuals: Giuliana Arcovio BS CNMT RT(N), Michelle Beauvais RPh BCNP, David Gilmore MS CNMT NCT RT(N)(R), Scott Holbrook BS CNMT PET FSNMTS, Art Hall CNMT FSNMTS, Kent Hutchings MS CNMT, Lyn Mehlberg BS CNMT FSNMTS, Robert Pagnanelli BS CNMT NCT RT(N), Dave Perry CNMT PET FSNMTS, George Segall, MD. The task force was chaired by Cindi Luckett-Gilbert BHS CNMT PET RT(N). The documents used in the revision and development of these guidelines were the SNM-TS Performance and Responsibility Guidelines for the Nuclear Medicine Technologist (2003), Nuclear Medicine Technology Certification Board (NMTCB) Report: Equipment and Procedures in Current Practice (2001), NMTCB Critical Task Analysis Report (2000), Joint Review Committee Nuclear Medicine Technologist (JRCNMT) Essentials and Guidelines for an Accredited Educational Program for the Nuclear Medicine Technologist (2000), American Registry of Radiologic Technologists (ARRT) Task Analysis (2000), and American Society of Radiologic Technologists (ASRT) Practice Guidelines (1998). This document is not intended to modify or alter existing tort law, rather it should serve as a concise outline of nuclear medicine technology skills and responsibilities. Nuclear Medicine Technology Nuclear medicine technology is the medical specialty that utilizes sealed and 38 39 The practice of nuclear medicine technology encompasses 40 multi-disciplinary skills, which use rapidly evolving instrumentation, 41 radiopharmaceuticals, and techniques. The responsibilities of the nuclear 42 medicine technologist include but are not limited to an empathetic and 43 instructional approach to patient contact, care and monitoring; the procurement, 44 preparation, quality control, dispensing, dose calibration, administration, and 45 disposal of radiopharmaceuticals and pharmaceuticals including adjunct, oral 46 contrast, and IV contrast (under the direction of an authorized user); the 47 performance of quality control procedures; and the operation of imaging, 48 laboratory, and computer instrumentation. 49 50 In order to perform these tasks, the nuclear medicine technologist must 51 successfully complete didactic and clinical education. Recommended course 52 work includes, but is not limited to: anatomy, physiology, pathophysiology, 53 chemistry, physics, mathematics, computer applications, biomedical 54 sciences, ethics, and radiation health and safety. Direct patient contact 55 hours are obtained by training in clinical education. 56 57 Graduates of accredited programs are eligible for certification examination 58 offered by the Nuclear Medicine Technology Certification Board (NMTCB) and/or 59 the American Registry of Radiologic Technologists (ARRT). 60 61 The spectrum of nuclear medicine technology skills and responsibilities 62 varies widely across the country and often goes beyond the basic skills 63 outlined in the technologist’s initial education and certification. Practice 64 components presented in this document provide a basis for establishing 65 the areas of knowledge and performance for the nuclear medicine technologist. 66 It is assumed that for all activities included in this scope of practice, the 67 nuclear medicine technologist has received the proper education (in 68 compliance with federal, individual state, and institutional requirements) 69 supported with the proper documentation of initial and continued competency in 70 those practices and activities. Continuing education is a necessary component in 71 maintaining the skills required to perform all duties and tasks of the nuclear 72 medicine technologist in this ever-evolving field of new equipment, 73 radiopharmaceuticals, and applications. 74 75 76 77 78 79 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 100 101 102 103 104 105 106 107 108 109 110 111 112 113 114 115 The scope of practice in nuclear medicine technology includes, but is not limited to the following areas and responsibilities: Patient Care: Requires the exercise of judgment to assess and respond to the patient’s needs prior to, during, and after procedures in the nuclear medicine department in addition to patient medication reconciliation. Quality Control: Requires the evaluation and maintenance of a quality control program for all instrumentation to ensure its proper performance and stability. Diagnostic Procedures: Requires the utilization of appropriate techniques and administration of non-radiopharmaceutical agents when part of standard procedures to ensure quality diagnostic images and/or laboratory results. Radiopharmaceuticals: Involves the procurement, preparation, quality control, dispensing, dose calculation, identification, documentation, administration, disposal, storage, and safe handling of radioactive materials used by the nuclear medicine technologist. In-Vivo Diagnostic Testing: Involves the procurement, preparation, quality control, dispensing, dose calibration; and oral, inhalation, and intravenous administration. In some cases radiopharmaceuticals may be administered by other routes under the direct supervision of a physician. In-Vitro Diagnostic Testing: Involves the procurement, preparation, quality control, dispensing, dose calibration; oral administration, inhalation, and intravenous administration. Transmission Imaging: Involves, but is not limited to, the operation of gamma cameras with sealed sources of radioactive material for transmission imaging with SPECT or PET, operation of cameras with x-ray tubes for transmission imaging when performed as part of SPECT/CT or PET/CT. Also Diagnostic CT when performed on SPECT/CT or PET/CT cameras, including the administration of oral and intravenous contrast (requires education in CT) and operation of scanners with x-ray tubes for measurement of bone density. Radionuclide Therapy: Involves but is not limited to assisting an authorized user in the application, management, preparation, and administration of radiotherapeutic procedures and administration of non-radiopharmaceutical 116 117 118 119 120 121 122 123 124 125 126 127 128 129 130 131 132 133 134 135 136 137 138 139 140 141 142 143 144 145 146 147 148 149 150 151 152 153 154 155 156 157 158 159 160 161 agents by oral and intravenous routes when part of standard procedures required for treatment. Radiation Safety: Involves but is not limited to educating the public while practicing techniques that will minimize radiation exposure to the patient, general public, and health care personnel through consistent use of protective devices, shields, monitors, and other devices consistent with ALARA (as low as reasonably achievable) as well as decontaminating spills and other inappropriate releases of radiation. I. Patient Care A. A nuclear medicine technologist provides patient care including but not limited to: 1. Providing for proper comfort and care of the patient prior to, during and after a procedure, including but not limited to, the monitoring of intravenous lines (i.e., central lines, Peripherally Inserted Central Catheters [PICC] ), oxygen supplies, drains, and operation of blood pressure cuffs, electrocardiogram (ECG) machines, pulse oximeters, intravenous pumps, and oxygen delivery regulators while in the technologist’s care. 2. Insertion of peripheral intravenous catheters required for performance of a nuclear medicine procedure. 3. Establishing and maintaining proper communication with patients (e.g., proper introduction, appropriate explanation of the procedure, etc.). 4. Behaving in a professional manner in consideration of patients' rights and resulting in the provision of the highest quality patient care possible. 5. Providing a safe and sanitary working environment for patients and the general public, using proper infection control practices in compliance with accepted precaution policies. 6. Recognizing and responding to an emergency situation at a level commensurate with one’s training and competency including cardiopulmonary resuscitation (CPR) and the use of automatic external defibrillators (AED). B. The tasks a nuclear medicine technologist must perform when preparing the patient for an examination include but are not limited to: 1. Verifying patient identification, pregnancy status, breast-feeding status, and written and/or verbal orders for the procedure. 162 163 164 165 166 167 168 169 170 171 172 173 174 175 176 177 178 179 180 181 182 183 184 185 186 187 188 189 190 191 192 193 194 195 196 197 198 199 200 201 202 203 204 205 206 207 2. Ensuring that informed consent has been obtained, in the method prescribed by the institution, whenever necessary in addition to performing patient medication reconciliation. 3. Confirming that the indication for the procedure is appropriate and consulting with the authorized user and/or referring physician whenever necessary in order to ensure that the proper procedure is performed. 4. Obtaining a pertinent patient history. 5. Ensuring that any pre-procedural preparation has been completed, including, but not limited to, fasting, hydration, the taking of thyroid blocking compounds, voiding, bowel cleansing, and suspension of interfering medications. 6. Explaining the procedure to the patient and/or family and, where appropriate, to the parents and/or legal guardian including, but not limited to, the procedure, patient involvement, length of study, and radiation safety issues. 7. Collecting samples for laboratory procedures and performing pertinent waived in-vitro diagnostic testing laboratory procedures including urine pregnancy testing and fasting blood sugar, to measure biodistribution of radiopharmaceuticals. Additional in-vitro diagnostic testing laboratory procedures include but are not limited to, secretions, saliva, breath, blood, and stool. C. A nuclear medicine technologist performs administrative procedures including but not limited to: 1. Maintaining an appropriate inventory of medical/surgical supplies, radiopharmaceuticals, storage media, and other items required to perform procedures in a timely manner. 2. Scheduling patient procedures appropriate to the indication and in the the proper sequence. 3. Maintaining appropriate records of administered radioactivity, quality control procedures, patient reports, and other required records. 4. Developing and revising, when necessary, policies and procedures in accordance with applicable regulations. 5. Actively participating in total quality management/continuous quality improvement programs (i.e., age-specific competencies, patient education, and patient restraint and immobilization). 208 209 210 211 212 213 214 215 216 217 218 219 220 221 222 223 224 225 226 227 228 229 230 231 232 233 234 235 236 237 238 239 240 241 242 243 244 245 246 247 248 249 250 251 252 253 II. Quality Control- Nuclear Instrumentation A nuclear medicine technologist, ensures the proper performance of the imaging systems, storage media, and radiation detection and counting devices, including, but not limited to, scintillation cameras, dose calibrators, survey instruments, scintillation probes and well counters, and data processing and image production devices. III. Diagnostic Procedures A. A nuclear medicine technologist performs imaging procedures, including but not limited to: 1. Preparing, evaluating and properly administering the appropriate radiopharmaceuticals and/or pharmaceuticals and contrast (under the direction of an authorized user). 2. Establishing and/or properly maintaining venous access routes of various configurations (in accordance with hospital policies and procedures). 3. Selecting the appropriate imaging or data collection parameters. 4. Administering radiopharmaceuticals/pharmaceuticals through various routes of administration, including, but not limited to: oral, intravesical, inhalation, intravenous, intramuscular, subcutaneous, and intradermal (under the direction of an authorized user). 5. Positioning the patient for imaging, adapting the protocol to patient limitations, and acquiring diagnostic quality images. 6. Positioning and verifying the proper placement of electrocardiographic leads. 7. Reviewing images to ensure that required information has been acquired, processed properly, and is of the highest quality. 8. Assisting in cardiac stress testing procedures when performed in conjunction with nuclear medicine procedures. 9. Performing data collection, processing, and analysis. 10. Archiving data to and from storage media. B. A nuclear medicine technologist performs non-imaging in vivo and/or radioassay studies including but not limited to: 254 255 256 257 258 259 260 261 262 263 264 265 266 267 268 269 270 271 272 273 274 275 276 277 278 279 280 281 282 283 284 285 286 287 288 289 290 291 292 293 294 295 296 297 298 299 1. Operating laboratory equipment including well counters, probes, and other detection devices to measure the biodistribution of radiopharmaceuticals. 2. Preparing dosages and standards. 3. Collecting the appropriate specimen for procedures using standard precautions. 4.Gathering, validating and documenting the data. 5. Managing biohazardous, chemical, and radioactive waste in accordance with applicable regulations and specific facility policies. IV. Radiopharmaceuticals A. A nuclear medicine technologist procures and maintains radiopharmaceutical products and adjunct supplies. B. A nuclear medicine technologist properly prepares and administers diagnostic radiopharmaceuticals under the direction of an authorized user in accordance with all federal, state and institutional guidelines. V. Radionuclide Therapy A nuclear medicine technologist properly prepares and administers, therapeutic radionuclides, including but not limited to: non-radiopharmaceutical agents by oral and/or intravenous routes when part of standard procedures required for treatment, and radiopharmaceuticals under the direction of an authorized user in accordance with federal, state, and institutional regulations. VI. Radiation Safety A nuclear medicine technologist performs all procedures utilizing ionizing radiation safely and effectively applying institutional, state and federal regulations including but not limited to: 1. Maintaining compliance with all applicable regulations. 2. Performing appropriate radioactive contamination monitoring and decontamination procedures. 3. Disposing of radioactive waste in accordance with federal, state, and and institutional regulations 4. Participating in programs designed to instruct other personnel about 300 301 302 303 304 305 306 307 308 309 310 311 312 313 314 315 316 317 318 319 320 321 322 323 radiation hazards and principles of radiation safety. References 1. Nuclear Medicine Technology Certification Board (NMTCB), Equipment and Procedures in Current Practice (2001) 2. Nuclear Medicine Technology Certification Board (NMTCB), Critical Task Analysis Report. K. Blondeau, S. Hearten, M. Pickett, J. Bridges. (2000) 3. Joint Review Committee Nuclear Medicine Technologist (JRCNMT), Essentials and Guidelines for an Accredited Educational Program for the Nuclear Medicine Technologist (2000) 4. Socieconomic Affairs Committee, SNM-TS, Performance and Responsibility Guidelines for the Nuclear Medicine Technologist, JNMT Volume 28 December 1998. 5. American Registry of Radiologic Technologists (ARRT), Nuclear Medicine Technologist Task Analysis (2000) 6. American Society of Radiologic Technologists (ASRT), Practice Guidelines for Nuclear Medicine Technologists (1998)