Twenty million nuclear medicine procedures that detect and evaluate heart disease, brain disorders and cancer—and that use radiopharmaceuticals to treat overactive thyroids and some cancers—are performed each year. While health care providers in many facilities do provide patients with adequate information about nuclear medicine procedures, there's room for improvement, says a study supported by the Centers of Disease Control and Prevention and the Agency for Healthcare Research and Quality that appears in the December Journal of Nuclear Medicine.
"Patients undergoing diagnostic procedures are less likely than patients undergoing therapeutic procedures to be informed that they could activate radiation alarms in public places," said Armin Ansari, a health physicist in the radiation studies branch of the Centers for Disease Control and Prevention in Atlanta, Ga. "We also found that many health care professionals who administer radiopharmaceuticals to patients—or who communicate with them regarding the radiation safety aspects of their procedures—have not had any formal or systematic training in patient education, communications or counseling," he added.
"Before we began the study, casual conversations with patients who received diagnostic procedures (largely stress tests) suggested that many receive neither documentation nor counseling. Some are even unaware that their procedure involved trace amounts of radioactive materials and that they could indeed trigger radiation detection equipment in public places," said Ansari. The study, done in collaboration with the Nuclear Regulatory Commission (NRC), examined the range of patient release procedures and practices among 66 health care facilities in 12 states. Participating facilities perform a range of diagnostic and therapeutic procedures including cardiac stress tests; positron emission tomography (PET), bone, lung and renal scans; thyroid uptake studies; whole body scans; I-131 hyperthyroid treatments; I-131 Bexxar cancer treatments; and brachytherapy. For the study, 89 health care professionals (including doctors, nuclear medicine technologists, radiation safety officers and physicists) were interviewed at large and small hospitals and outpatient-only clinics.
The study indicates that health care professionals—especially in outpatient facilities and those performing only diagnostic procedures—can benefit from an outreach program, detailing the need to inform and counsel all released patients. "Some standardization of basic instructions and documentation given to released patients would also be helpful," said Ansari. "Patients should know the importance of following the instructions given to them by their caregivers. They should feel comfortable asking questions and be forthcoming if there are some instructions they may have difficulty following (such as minimizing time in public). If patients plan to travel, they should make sure they have documentation on hand specifying their procedure and that the documentation includes a contact phone number for verification, if necessary," he explained.
"SNM has long advocated that its members—in offering high-quality care—provide patients with adequate information. This is particularly necessary in today's high-security environment, where patients of some procedures could incidentally trigger radiation alarms in urban centers, federal buildings or while traveling," said SNM President Alexander J. McEwan, who represents more than 16,000 doctors, technologists and scientists. "This study shows that while many do provide information and special instructions to patients, there is still room for improvement and increased awareness," said the professor and chair of the Department of Oncology, Faculty of Medicine, at the University of Alberta, and director of oncologic imaging at Cross Cancer Institute in Edmonton, Canada. He noted that the society works closely with the CDC and the U.S. government on the issues discussed within the report and to increase awareness in the medical community.
"As this study points out, not all facilities are as well informed as they should be, and they are not doing the best they can to inform patients," says Henry Royal, former SNM president and an expert in radiation safety. "It is important that patients who find themselves in these rare situations are fully informed and have contact cards to work cooperatively with security officials," added Royal. "At Washington University, we have three preprinted wallet-size travel cards (radioiodine, sestamibi/thallium, miscellaneous) that we give to patients who receive therapeutic doses of I-131 or who are planning to travel in the days to weeks following a diagnostic procedure," said Royal, a professor of radiology at Washington University School of Medicine in St. Louis and associate director of nuclear medicine at its Mallinckrodt Institute of Radiology.
Federal regulations and guidelines describe when and how licensed health care facilities can release patients following a nuclear medicine procedure and address the safety instructions that facilities must provide to patients or to their parents or guardians to ensure that doses to other individuals remain "as low as is reasonably achievable." Since 2003, NRC supplemented these guidelines with a notice reminding health care professionals that released patients need to know the importance of following instructions so that a dose to other individuals can be maintained low and that the likelihood of triggering radiation alarms is reduced. The NRC suggests voluntary actions that health care professionals can take with every released patient whose body contains detectable amounts of radiation after receiving diagnostic or therapeutic quantities of radiopharmaceuticals or brachytherapy implants. These actions should include explaining to patients the potential to trigger radiation monitoring alarms and providing them with written information for law enforcement use.
Ansari and Luba Katz of Abt Associates in Cambridge, Mass., reported their results in "Survey of Patient Release Information on Radiation and Security Checkpoints," which appears in the December issue of the Journal of Nuclear Medicine, which is published by SNM, the world's largest molecular imaging and nuclear medicine society.
Nuclear medicine—a vital component of the rapidly emerging field of molecular imaging—is a medical specialty that uses small amounts of radioactive materials bound to special compounds (radiopharmaceuticals) in combination with imaging scans that examine molecular processes in the body to detect and evaluate heart disease, brain disorders and cancer. In addition, radiopharmaceuticals are used to treat overactive thyroids and some cancers.