Prac&ce Profile among Nuclear Medicine Technologists in Portugal: findings from a na&onwide survey

Transcription

1 Prac&ce Profile among Nuclear Medicine Technologists in Portugal: findings from a na&onwide survey Diana Neves 1,2,3 Ana Pascoal 1,4 Ana Filipa Vale 1 1- Faculdade de Engenharia, Universidade Católica Portuguesa 2-Diaton S.A. Unidade de Leiria, Hospital de Sto André 3- Escola Superior de Tecnologias da Saúde do Porto, Instituto Politécnico do Porto

2 Introduc&on

3 Nuclear Medicine Mul&disciplinary; Fast development Professionals Nuclear Medicine Technologists (NMT) Prac&ces Permanent review and learning Risk Low doses effects Jus&fica&on Op&miza&on Limita&on

4 NM Technologists Tasks (Competencies for the European Nuclear Medicine Technologist, EANM 1998) Radiopharma ceutical Preparation Radiopharma ceutical Administration Image Acquisition: Conventional and/or PET Therapeutic Related Procedures Radiation Protection ALARA / ALARP

5 Aim of the study Professional and prac&ces characteriza&on of NMT in Portugal, namely: Inves&gate the profile of NMT staff; Usual prac&ce in NM ac&vi&es; Adherence to radia&on protec&on measures.

6 Methods

7 Ques&onnaire: Design Construc&on Pilot study Analyse and op&miza&on Implementa&on/distribu&on Na&onwide Sampling Cluster adapted Anonymous Confiden&al

8 Inclusion criteria: Popula&on : NMT ( ) Clinical work in NM departments With 1 year minimum, of dose records Or previous work in NM department Target popula&on

9 Ques&onnaire PART I (NMT ) Demographic data Professional profile Ac&vi&es/tasks Radioprote&on Measures Individual dose record PROFESSIONAL AND RP PRATICES CHARACTHERIZATION

10 Results / Discussion

11 Technology characteriza0on: - NM departments Installed Technology (NM) in Portugal: - 2 ciclotons (Porto and Coimbra); - 8 PET units(2009); - 62 gama- camaras (2011); - 29 MN departments (2010)*; - 32 MN departments (2012) TMN # Growth tendency/poten&al?? *Dados oficiais DGS 2010: 27 centros # ACSS e Mar&ns et al,2007 Geographical distribution of NM centers in Portugal (2010): 27.6% north, 24.1%- center, 41.4% Lisbon area, 3.4%-south, 3.4% Madeira Island;

12 * Technology characteriza0on: - Evolu0on Belgium 23,2 Greece 9,9 NM dep. 29 Gamma Camera/ Million inhabitants Spain 4,8 5, Comparison Portugal 2,4 4 5,02 6,2 PAÍSES - Goal FREQUÊNCIA ANUAL/MIL HABITANTES DIAGNÓSTICO E TERAPÊUTICA Canadá 65 Alemanha 34 USA 32 Rep. Checa 28 Países Baixos 16 Dinamarca 15 Hungria 15 Suécia 14 Rússia 13 Austrália 12 Japão 12 Argentina 11 Itália 11 Reino Unido 11 Finlândia 10 Suiça 10 Eslováquia 9 Nova Zelândia 8 Taiwan 7 Irlanda 6 Ucrânia 5 Portugal 4 Bulgária 3 Roménia 3 Fonte: Hart D & Wall B F (2005): A survey of Nuclear Medicine in the UK in 2003/04

13 Technology characteriza0on : Região Nr inhabitants (2001) Nr NM dpt (2009) Nr gamma cameres (2004) Gamma- camera/ NM dpt Ratio gamma- camera/ inhabitants# Nr PET equipment (2009) Ratio PET/ inhabitants# Norte ,1 1,2 2 0,5 Centro ,3 1, Lisboa e V.Tejo ,3 1,5 4 1,5 Alentejo Algarve ,6 0 0 Madeira ,0 0 0 Açores ª # Racios by Resolução do Conselho de Ministros n.º 61/95 de 28 de Junho Asymmetries in the NM technology geographic distribu&on; Centralized investments on urban areas (LVT e Centro); NM elevated poten&al to development (mainly PET); Recommenda0ons : - ra&os changes: Carta Equipamentos da Saúde 2003 :(gamma- camera/ inhabitants) - EANM 10 GC/M inhabitants (Portugal (2011)= 6,2)

14 105 ques&onnaires delivered (26 NM departments) 54 ques&onnaires received Response Rate: 51,4% NMT considered the study as relevant (64%) NMT interest/awareness

15 Demographic Characteriza0on: Gender Female: 70,4% Male 29,6% Age (years) Average: 34 (±10,4) Range Moda: 26 Percentage (%) Residence North: 27,8% Centre: 22,2% Lisboa: 50,0 % High Shcool Bachelor Licenciatura Master Academic level Female Male Total Like EU and ACSS data, almost ¾ of the sample are female; Young popula&on: last decade NM growth and PET entrance; Vast majority are graduated;

16 Professional characteriza0on: Average professional experience : 11,6 (±10,6) years 120% 100% 85.7% Academic level and professional experience 100% 80% 60% 40% 45% High school bach licen master 20% 0% 18% 18% 11.4% 0% 3% years years >20 18% Sta0s0cal Associa0on: NMT with experience lower that the average years of work (12 years) (p=0,01) ) and younger than the average age of 34 have higher qualifica&ons (p=0,02). Suggests that younger NMT are more recep&ve to educa&on programmes Growing advances in higher educa&on NM recent development (last decade)

17 Professional characteriza0on (cont.) Sector % Public 46,3% Private: 29,6% Both: 24,1% Working &me 40h / week: 46,3% > 40h/ week:50,0% >60 h/ week:3,7% 90% 80% 70% 68% Working time (per week) per sector 77% 60% 56% hours/week 50% 40% 30% 32% 44% hours/week >60 hours/week 20% 15% 10% 0% 0% 0% Públic Private Both 8% Sector Statistical Association: NMT working in the private sector have higher weekly working &me (p=0,04);

18 Professional characterization (cont.) Doble job Higher work &me Higher exposure RP concerns Centre: 42% Total: 24% 8% 60h/week Total: 4% Private sector associated to higher work &me (p=0,04) IAEA Recommenda&ons: One dosimeter per local job; Aggrega&on of dose records by the Na&onal Dose Registry;

19 Professional Prac0ce Characteriza0on: Performed tasks: Yes No Hogg et al (1996) adiopharmacy procedures 96.3% 3.7% 14 % E.V. administrations 74.1% 25.9% 74 % Therapy procedures 63.0% 37.0% - PET 44.4% 55.6% - % NMT are versa&le professionals; Asymmetries in the NMT ac&vi&es: Specific characteris4cs/ demands of each NM ins4tu4on; Educa4onal differences; Other healthcare professionals;

20 Professional Prac0ce Characteriza0on: Performed tasks: Yes No Hogg et al (1996) adiopharmacy procedures 96.3% 3.7% 14 % E.V. administrations 74.1% 25.9% 74 % Therapy procedures 63.0% 37.0% - PET 44.4% 55.6% - % Sta0s0cal Associa0on: NMT younger than 34 years (p=0,02) and with professional experience <12 years (p=0,02) had higher frequencies of RF prepara&on; NMT higher educa&on; Simpler labelling procedures; Other professionals?

21 Professional Prac0ce Characteriza0on: Performed tasks: Yes No Hogg et al (1996) Dose Rate usv/h adiopharmacy procedures 96.3% 3.7% 14 % 1 E.V. administrations 74.1% 25.9% 74 % 1,6 Therapy procedures 63.0% 37.0% - 0,8 PET 44.4% 55.6% - 6 % Sta0s0cal Associa0on: NMT in the private sector had higher frequency of radiopharmaceu&cal administra&on (p=0,02); More versa&lity in the private sector? Other professionals? Sector with > work &me; e.v administra&on associated to high dose- rate; Administrated ac&vi&es? (Dose Datamed II) Individual dosimetry implica&ons?;

22 Professional Prac0ce Characteriza0on: Performed tasks: Yes No Hogg et al (1996) Dose rate usv/h adiopharmacy procedures 96.3% 3.7% 14 % 1 E.V. administrations 74.1% 25.9% 74 % 1,6 Therapy procedures 63.0% 37.0% - 0,8 PET 44.4% 55.6% - 6 % IAEA Recommenda0ons: - Team planning / Roster duty system; - Extremity dosimeters ; - Ac&ve dosimeters (for real- &me monitoring);

23 Professional Prac0ce Characteriza0on (cont.): Average number of NM procedures per week per NMT (17/ day) Avarege number/thecnologist/week Scan The majority of the sample, refer a work load > 50 pa&ents/week; The majority work between 41-60h/week; Most common scans: bone scan (0,8 usv) and cardiac perfusion (1,0uSv) typically high ac&vi&es; Dosimetry concerns?

24 Radioprotec0on prac0ces Characteriza0on: Shielding tools: No Yes Ocasionaly Lead glasses Lead gloves Lead apron Lead Transporter Syringe shield Sta0s0cal Associa0on: Syringe shield most common within the NMT with professional experience <12 years (p=0,02); Asymmetries in the adopted RP measures: Academic differences?; Rou&ne nega&ve impact?; Need for prac&ce op&miza&on and regular audit; %

25 Radioprotec0on prac0ces Characteriza0on: Shielding tools: No Yes Ocasionaly Lead glasses Lead gloves Lead apron Lead Transporter Syringe shield Sta0s0cal Associa0on: Syringe shield most common within the NMT with professional experience <12 years (p=0,02); % IAEA Recommenda0ons : - Use of others shielding barriers: shielded cervical collar, lead glass; injec&on systems, tungsten tools: - Prac&ce op&miza&on in order to limit de dose;

26 Radioprotec0on prac0ces Characteriza0on (cont.): Shielding tools: lead apron + Dosimeter loca0on when using a lead apron: - Under the apron: 39,6% - Above the apron: 1,9% - Variable: 0% - Don t use apron: 58,5% Depending on the % of use, can reduce dose between 19-82% (25 and 100% of use respec&vely) Racional use of the lead apron; IAEA and DL 167/2002 Recommenda0ons : - Dosimeter used under the apron; - Op&onal use of a second dosimeter above de apron;

27 Individual Monitoring: Dosimeter type TLD: 76,5% Photographic: 19,6% Didn t know: 3,9% Dosimeter body posi0on Neck line 15% Variable 6% Waist 7% Periodicity Monthly: 81,5% Bimonthly: 3,7% Trimestral: 14,8% Chest 72% Individual monitoring asymmetries: Different body posi&oning leads to different records; Limited knowledge about their monitoring: Photographic film discon&nued in % didn t know + 6% NR Educa&onal/ Harmoniza&on needs; IAEA e DL 222/2008 Recommenda0ons : - Body posi&oning at chest level; - NM periodicity typically monthly; - Category A workers (>6mSv/year) with monthly periodicity;

28 Individual Monitoring: Es&mated annual effec&ve dose 3,8(± 2,68) msv; < 2 msv 38% 6-12 msv 14% 2-6 msv 48% Estudo País Período Dose efectiva anual (msv) Thompson, 2001 E.U.A ,0 Martins et al, 2007 Portugal ,5 Valuckas et al, 2007 Lituânia ,1 UNSCEAR 2008 Mundial n.a. Manipulação RF: 5 Doses < legal limit, but superior to other studies; Prudent studies comparison: differences in professional profile and administered ac&vi&es.a Category? Established limit dose : ICRP 107 e DL 222/ whole- body: 100 msv/5 years (50 msv/year máx) New Direc0ve: 20 msv/year and eye lens dose reduc&on; S/ manipulação: 1 Com PET: 4,6-8 Zielinski et al, 2009 Canadá ,9

29 Con0nuous educa0on: Self- perceived knowledge of RP (adequate): No: 5,7% Yes: 94,3% Acendance to RP con0nuous programmes: No: 22,2% Yes: 77,8% Educa&on efficiency? Ar&cula&on between theory and prac&ce? Physical resources in NM departments? Con&nuous educa&on programmes (external e internal); Best Prac&ces Manual;

30 Conclusion

31 This study allowed: Give an insight about NM in Portugal: Poten&al field; Design a NMT profile: Young, female, and with a academic degree; Versa&le professionals; Characterize prac&ces and RP measures adopted by NMT: Asymmetries; Misinforma&on about relevant issues; Average annual dose below legal limits but superior to other studies; Harmoniza&on needs!! Major limita&on: Lack of informa&on about the exis&ng RP tools in the NM departments.

32 Implementa&on of external/internal systems that allows: Collect data (prac&ces) Iden&fica&on of subop&mal prac&ces Educa&on/ Training Support change/ Audit Future: Coopera&on studies and share results Guidelines/Best Prac&ces Manual FOLLOW- UP

33 Obrigada! Thank you!

34 Individual Monitoring (cont.): Overexposure Monthly record > = 2 msv Annual dose > 20 msv No: 98,1% Yes: 1,9% No: 90,6 % Yes: 5,7 % Didn t know: 3,7% No: 96,2% Yes: 0 % Didn t know: 3,8% DL 222/2008 Recommenda0on: - Monthly record > 2mSv reported to DGS; - Immediate medical check- up a er overexposure, and clinic vigilance a er; - Addi&onal RP measures and/or changes on work condi&ons;

35 Individual monitoring (cont.): Monthly records in rela&on with the performed ac&vi&es: Sta0s0cal Associa0on: NMT witch perform RF prepara&on had superior dose records (p=0,04); Records >0,6mSv/month were most common within the NMT who perform PET scans; Specific educa&onal needs in PET?;