Optimizing Nuclear Medicine Practices using a Dose Management System

Efficient management of radiopharmaceuticals is essential in nuclear medicine (NM) departments for enhancing patient safety, reducing financial losses, improving protocol adherence, and minimizing radionuclide waste. A recent global shortage of technetium-99m [1] has especially highlighted this critical need.

Studies investigating NM department efficiency emphasize clear patient preparation protocols, tracking of cancellations, and comprehensive staff training. For instance, interventions such as educating patients on preparation requirements and streamlining protocol compliance can significantly reduce procedural cancellations and associated financial losses [2]. Clinics implementing the Lean methodology in NM departments found significant improvements, including reduced queuing times, cost savings, and decreased operational defects. Lean practices enhanced patient volume capacity, boosted staff and patient safety, and improved overall satisfaction levels [3]. Another study on Lean management principles emphasized the timely placement of necessary supplies in each room to minimize waste [4].

The International Atomic Energy Agency (IAEA) recommends monitoring NM quality indicators such as productivity (by comparing study volumes over time) and radiopharmaceutical dose tracking (dispensed versus planned) [5].

Optimization indicators in Qaelum’s dose management system DOSE include the following:

1. Diagnostic Reference Levels (DRL) compliance: compare administered radioactivity per radiopharmaceutical against DRLs to ensure that procedures in facilities are performed consistently and according to best practices, leading to better resource use.

Figure 1. DRL compliance to compare administered radioactivity per radiopharmaceutical against DRLs to identify opportunities for optimization in dose management.

2. Usage and Error Analysis: record cases where errors occur, such as mismatched indications or patient preparation failures. Canned comments and customized reporting in DOSE can be used to notify relevant staff and reduce the recurrence of errors. Statistics and usage data can be reviewed to optimize ordering processes and forecast daily or monthly activity more accurately. Figure 2 shows a scatter plot and statistical table of the radioactivity administered (MBq) over two distinct time periods, highlighting the difference in activity between the two periods.

Figure 2. Radioactivity administered (MBq) over two distinct time periods displayed in a scatter plot (top) and statistical table (bottom), highlighting the difference in activity between the two periods.

3. Patient Weight-Based Dose Optimization: monitor protocol-specific radioactivity administered relative to patient weight, to maintain diagnostic accuracy and minimize patient exposure, while conserving radionuclide supplies (Figure 3). Radioactivity per kilogram can also be monitored for DRL compliance, as well as a parameter in all the possible charts and tables of DOSE.

Figure 3. Administered radioactivity can be tracked with respect to patient weight to ensure correct and efficient dosage, allowing to easily spot outliers, as shown above.

4. Wasted Activity Monitoring: compare the prepared and administered radioactivity using trend charts (Figure 4) to optimize administration and enable more efficient appointment scheduling and workflow management.

Figure 4. Daily trends comparing the radioactivity prepared (top) and administered (bottom) to target reasons for differences in activity for optimization.

DOSE also facilitates compliance with requirements of the IAEA quality assurance (QA) program [6] through its Nuclear Medicine Management Logbooks. All radionuclide-specific contamination events, the affected area, and personnel involved are recorded in the Contamination Logbook. Radiopharmaceutical purity, an important indicator that determines the biodistribution and ensures desired image quality, is also tracked, where purity below 95% is highlighted in orange, enabling departments to detect and address batch-specific issues (Figure 5).

Figure 5. Purity is recorded per pharmaceutical LOT number, providing all studies performed under the same LOT number. Purity below 95% is highlighted in orange.

The recent 99m-Tc shortage underscores the importance of resource management in nuclear medicine departments. Tools in DOSE enable nuclear medicine departments to comply with DRLs and IAEA recommendations while effectively managing equipment function and resource use.

References

 [1]          Morton, W. (2024, October 18). Tc-99m shortage expected into November. AuntMinnie. https://www.auntminnie.com/clinical-news/molecular-imaging/article/15706252/tc99m-shortage-expected-into-november

[2]          Al Ahmed A, Al-Surimi K. Improving efficiency management of radiopharmaceutical materials at a nuclear medicine department. BMJ Qual Improv Rep. 2015;4(1):u208970.w3709.

[3]          Burroni L, Bianciardi C, Romagnolo C, Cottignoli C, Palucci A, Massimo Fringuelli F, Biscontini G, Guercini J. Lean approach to improving performance and efficiency in a nuclear medicine department. Clinical and Translational Imaging. 2021; 9:129-139.

[4]          Metello L, Rocha F, Roda A, Capoulas M, Rodrigues A, Macedo R, Cunha L. Modern and Efficient Management in the Nuclear Medicine Department: the Lean Approach. Journal of Nuclear Medicine. 2017; 58 (1) 795.

[5]          International Atomic Energy Agency. Basics of Quality Management for Nuclear Medicine Practices. IAEA Human Health Series No. 43, Vienna: International Atomic Energy Agency, 2023.

[6]          International Atomic Energy Agency. Nuclear Medicine Physics: A Handbook for Teachers and Students. IAEA Non-serial Publications, Vienna: International Atomic Energy Agency, 2015.

Authors: 

Anna Romanyukha received her Ph.D. degree in medical physics from the Centre of Medical Radiation Physics (UOW, Australia) and her M.Sc. degree in health physics from Georgetown University (Washington DC, USA). She worked as a post baccalaureate and pre doctoral fellow at the National Cancer Institute (NIH, Washington DC) on various projects including radiation dose estimation from diagnostic exposures. She now works in Qaelum NV, focusing on advanced software tools in patient radiation dose management and quality.

Niki Fitousi, PhD, is a certified medical physicist with professional experience in all fields of Medical Physics (Radiation Therapy, Diagnostic Radiology, Nuclear Medicine, Radiation Protection). She is currently the Head of Research and Applications in Qaelum, focusing mostly in the fields of radiation dose management, quality and efficiency in medical imaging. She is also a member of the Medical Physics World Board of the International Organization for Medical Physics.