Scope of Practice. For. Nuclear Medicine Technologists / Scientists. Prepared by the Scope of Practice working party on behalf of the ANZSNM

Transcription

1 Scope of Practice For Nuclear Medicine Technologists / Scientists Prepared by the Scope of Practice working party on behalf of the ANZSNM (Revised October 2014)

2 Introduction A Nuclear Medicine Technologist / Scientists (NMT/S) role as part of the health care team is to provide safe and effective patient care while performing a variety of procedures or examinations that aid in the diagnosis and treatment of disease, cancer and illnesses. Nuclear Medicine including molecular imaging is the medical specialty that utilises sealed and unsealed radioactive materials in the diagnosis and treatment of various diseases, ionising radiation apparatus and other medical imaging equipment. This practice also includes the utilisation of ionising radiation apparatus, radiopharmaceuticals and other imaging modalities to enhance the evaluation of physiologic processes at a molecular level. The NMS/T is a health professional who is committed to applying the art and skill of their profession to optimise diagnostic evaluation and therapy through the safe and effective use of radiopharmaceuticals and adjunctive medications. Practice as a NMS/T requires multidisciplinary skills that are needed to use rapidly evolving instrumentation, radiopharmaceuticals and techniques. The NMS/T has responsibility for patient care while performing a wide range of clinical and non-clinical procedures, including but not limited to the preparation, administration, scanning, data analysis and quality control of radiopharmaceuticals, diagnostic procedures, radionuclide diagnostic and therapeutic procedures, hybrid imaging, computerised tomography, radiation safety, PACS management, other instrumentation/it roles, continuing professional development and clinical teaching, research, bone mineral densitometry, sonography, magnetic resonance imaging, and radiation therapy. Context The actual role performed by a Nuclear Medicine Scientist / Technologist in Australia and New Zealand is defined by: National Registration The Australian Health Practitioner Regulation Agency (AHPRA) or The New Zealand Medical Radiation Technologists Board. Professionally (including Scope of Practice) The Australian and New Zealand Society of Nuclear Medicine (ANZSNM). Licencing Various State and local licencing bodies. Challenges The scope of practice of NMS/T is continually evolving as required and is driven by clinical need and technological evolution. It is a core role of the ANZSNM to support and advocate for the role of NMS/T as appropriate, including in the development of in-house or external education and training programs as well as in the regulatory environment.

3 The scope of practice defines the procedures, actions, and processes that are permitted for a registered practitioner. The scope of practice is limited to that which the law allows for specific education and experience, and specific demonstrated competency. The ANZSNM is the Professional body for NMS/T employed to operate imaging systems to their capability involving gamma cameras (including SPECT/CT), PET scanners (including hybrid PET/CT and PET/MRI), radiopharmacy, radionuclide therapy, bone densitometry and ultrasound. The ANZSNM scope of practice includes NMS/T operating a hybrid (SPECT/CT, PET/CT or PET/MRI) and a stand-alone MRI or CT (including on a hybrid scanner) for a procedure that does not directly complement the Nuclear Medicine or PET study for that patient. This is dependent on the State licensing and registration requirements as well as appropriate qualifications of the operating staff. The scope of practice does cover administration of radiopharmaceuticals and nonradiopharmaceutical drugs (including CT and MRI contrast agents) to patients provided they comply with local Regulations. The scope of practice is influenced by the wider environment, the specific setting which and individual works within, legislation, education and development opportunities, legislation, policy, standards and the health needs of the population. ANZSNM and ANZSNM TSIG The ANZSNM is the peak multidisciplinary Professional body for Nuclear Medicine across Australia and New Zealand. The ANZSNM Technologists Special Interest Group (TSIG) exists under the umbrella of the Australian and New Zealand Society of Nuclear Medicine (ANZSNM) and advocates for Nuclear Medicine Scientists / Technologists. Domains The professional capabilities for medical radiation practice have been identified in domains within the Medical Radiation Practice board of Australia documentation. The first four domains are common to the three professions Nuclear Medicine, Radiography and Radiation Therapy. The scope of practice for Nuclear Medicine has been outlined in the same format as the MRPBA for consistency. Domain 1 professional and ethical conduct Domain 2 professional communication and collaboration Domain 3 evidence based practice and professional learning Domain 4 radiation safety and risk management

4 Domain 5: Radiation safety This domain covers the medical radiation practitioners responsibility for the application and safe use of radiation for the benefit of patients/clients, staff and the general public. What registered practitioners must be able to do Ways that this capability will be demonstrated at entry and re-entry to the profession 1. Apply knowledge of radiation biology and radiation dose. a. Employing radiation biology knowledge by following the correct procedures for Nuclear Medicine. b. Performing procedures in accordance with the ALARA Principle. c. Estimating radiation doses and exposure as required within Nuclear Medicine according to ARPANSA guidelines. 2. Implement safe radiation practice for patients, staff, and the environment as a whole. 3. Recognise when equipment is not performing correctly within the prescribed radiation limits. a. Applying knowledge of clinical centre procedures, state and federal radiation safety legislation. b. Understanding of national radiation safety guidelines and international best practice for radiation management. c. Applying safe radiation practice to all procedures. d. Analysing each procedure to ensure justification, optimisation and protection. e. Understanding dose reduction techniques within Nuclear Medicine. f. Performing setup procedures correctly to ensure that the minimum radiation or prescribed dose is used. a. Being aware of the normal operating parameters. b. Recognising when the equipment s operating parameters are abnormal. c. Taking appropriate action when equipment is not functioning correctly. 4. Store and dispose of radiation sources safely. a. Understanding of the thickness of shielding required for safe and legal storage of radioactive material. b. Calculating the decay of the material prior to disposal. c. Understanding occupancy as it pertains to proximity of radioactive storage. 5. Know when to report and how to appropriately deal with a radiation hazard/spill. a. Applying safe decontamination and containment procedures. b. Calculating the decay of the residual material.

5 Domain 6A: Practice in medical radiation sciences This domain covers the knowledge, skills and capabilities a medical radiation practitioner is required to attain to practise independently. Some elements are common to all medical radiation practitioners, taking into account the different requirements between the divisions of registration, while other capabilities are specific to their division of registration. 4 What registered practitioners must be able to do within the context of Nuclear Medicine 1. Deliver appropriate patient/client care within Nuclear Medicine. 2. Interpret the request form and match the selection of procedure to the clinical indicators. Ways that this capability will be demonstrated at entry or re-entry to the profession a. Understanding within Nuclear Medicine the psycho-social factors influencing the behaviour of patients/clients undergoing medical radiation procedures and/or treatment. b. Applying patient/client assessment skills to determine the extent that pre-existing medical and/or physical conditions might impact on the patient/client s capacity to cooperate during the procedure. a. Understanding the structure and function of the human body and the principles of human disease: pathology and physiological processes. b. Understanding medical terminology in the context of the patient s/ client s clinical history and the procedure being requested. c. Having broad and current knowledge of radiation physics relating to Nuclear Medicine. d. Interpreting and analysing information during the initial interaction with the patient/client, including any previous imaging/treatment. e. Adapting and adopting the appropriate protocols for best diagnostic/treatment outcomes during the initial interaction with the patient/client. f. Ensuring that the selection of the imaging projections or protocol takes into account information collected during the initial interaction with the patient/client. 3. Recognise, and practice within, their own expertise and any professional or organisational limits. a. g. Seeking advice when the needs of patients/clients are beyond the abilities and education of the registrant.

6 What registered practitioners must be able to do within the context of Nuclear Medicine Ways that this capability will be demonstrated at entry or re-entry to the profession b. Performing patient/client assessment and medical radiation interventions in accordance with legislation and standards of practice regulating medical radiation practitioners. 4. Demonstrate broad and current understanding of CT as it relates to the practitioner s role. 5. Demonstrate broad and current understanding of information systems within medical radiation science. 6. Demonstrate broad and current understanding of the range of imaging modalities as they relate to Nuclear Medicine. a. Identifying the sectional imaging representation of the musculoskeletal, cardiovascular, respiratory, genito-urinary, gastro-intestinal, endocrine and neurological systems. b. Identifying the sectional imaging representation of common disease conditions affecting the musculoskeletal system, respiratory, cardiovascular, genito-urinary, gastro-intestinal, endocrine and neurological systems. c. Understanding the physical principles applicable to multislice CT image reconstruction and display. a. Understanding the principles underpinning the information systems applicable to the practitioner s division of registration. b. Awareness of the role patient information systems play in the management of patients. a. Understanding the role that radiation therapy, radiography and nuclear medicine may assume within their specific division of registration. b. Understanding the principles and applications of ultrasound imaging relevant to their specific division of registration. c. Understanding the principles and applications (including safety) of MRI relevant to their specific division of registration. d. Understanding the principles of mammography as required by Nuclear Medicine. 7. Demonstrate broad and current understanding of medical radiation practice within paediatric medicine. a. Having knowledge of childhood behavioural development. b. Having knowledge of congenital and acquired paediatric diseases. c. Adapting procedure techniques to achieve the best diagnostic/ therapeutic outcome for paediatric patients/clients. d. Having the capacity to implement evidence based paediatric dose reduction strategies.

7 Domain 6B: Practice in nuclear medicine What nuclear medicine technology practitioners must be able to do, in addition to the capabilities required under domain 6 1. Implement the preparation of common radiopharmaceuticals. 2. Explain normal biodistribution of commonly used radiopharmaceuticals. Ways that this capability will be demonstrated at entry or re-entry to the profession a. Performing the elution and quality control of the Mo 98 Tc 99m generator. b. Having the ability to assay the eluate and prepare the common radiopharmaceuticals including correct volume and assay of eluate. c. Having sound knowledge of dose calibrators. d. Perform safe storage and disposal of radiopharmaceuticals. a. Understanding biodistribution and determining whether it is normal, altered or unexpected. b. Understanding biodistribution as it pertains to breast feeding mothers and be able to give appropriate instructions. c. Understanding biodistribution as it pertains to pregnancy and able to give appropriate advice. 3. Implement the assessment of purity of radiopharmaceuticals. a. Performing quality control on all radiopharmaceuticals and being able to assess the purity of the radioisotope including: radionuclide purity radiochemical purity, and chemical purity. 4. Implement routine planar, SPECT and SPECT/CT imaging. a. Performing planar, SPECT and SPECT/CT studies. b. Knowing the standard nuclear medicine planar projections for each body area. c. Performing patient/client positioning for the best diagnostic outcome. d. Having comprehensive knowledge of patient/client preparation. e. Having comprehensive knowledge of appropriate radiopharmaceutical dose and CT dose for each patient/client. f. Knowing the contraindications or limitations of the particular study. g. Having sound knowledge of the operation of nuclear medicine gamma cameras.

8 What nuclear medicine technology practitioners must be able to do, in addition to the capabilities required under domain 6 Ways that this capability will be demonstrated at entry or re-entry to the profession h. Being skilled in the evaluation and some understanding of the interpretation of nuclear medicine images and their application. i. Having sound knowledge of the principles of SPECT and SPECT/CT reconstruction and processing. j. Being skilled in the processing of dynamic datasets. k. Having sound knowledge of the principles of ECG and stress testing. 5. Implement common PET/CT imaging 5. a. Performing patient/client positioning for the best diagnostic outcome. b. Having comprehensive knowledge of appropriate radiopharmaceutical dose and CT dose for each patient/client. c. Having comprehensive knowledge of patient/client preparation. d. Having sound knowledge of the operation of PET/CT cameras. e. Knowing the contraindications or limitations of the particular study. f. Being skilled in the evaluation and some understanding of the interpretation of PET/CT images and their application. g. Understanding of processing options within the PET/CT modality. h. Understanding of the options for dose administration both manual and automatic. 6. Describe how 3D datasets are produced. a. Being skilled in the construction of 3D images through the manipulation of 3D datasets. b. Understanding the potential of 3D images to be used for quantitative and qualitative purposes. 7. Implement CT imaging for nuclear medicine imaging. a. Understanding the design and operation of CT systems. b. Understanding imaging parameters and scan protocols. c. Understanding post processing techniques, including multi-planar reformats and volume imaging. d. Understanding patient/client preparation. e. Estimating dose levels associated with a variety of CT scans.

9 8. Implement the delivery of nuclear medicine radioisotopes for therapy. 9. Demonstrate a broad and current knowledge of various delivery systems of radiopharmaceuticals for diagnostic studies/therapy. 10. Demonstrate a broad and current knowledge of the normal biodistribution of radiopharmaceuticals both diagnostic and therapy. 11. Describe how to undertake common in vivo and in vitro lab procedures 12. Demonstrate a broad and current knowledge of operation of ancillary laboratory equipment. 13. Implement Bone Densitometry imaging. 14. Be aware of research methods and how they apply to medical imaging. a. Calculating the dose and decay of therapy radiopharmaceuticals. b. Knowing less common therapy radiopharmaceuticals, such as S.I.R.T., Y 90, MIBG, Sr 89. c. Understanding the difference between a radiation therapy dose and a diagnostic dose, as it affects the patient/client, health practitioner and the general public. a. Understanding appropriate dose delivery methods including, I.V, oral, inhalation and arterial. b. Being able to perform intravenous injections in a safe, aseptic manner. a. Identifying whether the bio-distribution is normal, altered or unexpected. b. Performing safe aseptic blood labelling procedures. c. Understanding in vitro laboratory procedures (refer to appendix A) c. Identifying whether results of in vitro laboratory procedures are normal, altered or unexpected a. Being able to count samples using a well counter. b. Knowing how to use a centrifuge safely. c. Knowing how to use a fume hood safely. a. Understanding the design and operation of BMD systems. b. Perform BMD procedures and analysis. c. Understanding the interpretation and application of BMD results. a. Understanding of the processes and ethics when undertaking clinical and pre-clinical research. d. Understanding patient/client preparation. b. Know the basic principles of good scientific research and how to define the research hypothesis. e. Estimating dose levels associated with a variety of CT scans. c. An understanding of how to write an abstract and present your results.

10 References 1. Canadian Association of Medical Radiation Technologists (CAMRT). Scope of practice The Medical Radiation Practice Board of Australia, Professional capabilities for medical radiation practice, 2013, 3. Last accessed 17/2/ New Zealand Medical Radiation Technologists Board (NZMRTB). MRTB Competencies required for the practice of Nuclear Medicine, November SNMTS Scope of Practice Task Force. Clinical Performance Standards for the nuclear medicine technologist V3.1. May Pharmaceutical Society of Australia, National Competency Standards Framework for Pharmacists in Australia, Australian Sonographers Association, ASA Competency Standards for the Entry Level Sonographer, October Australian Physiotherapy Association, Position Statement Scope of Practice, Occupational Therapy Australia, Australian minimum Competency Standards for New Graduate Occupational Therapists, Australian and New Zealand Society of Nuclear Medicine, Draft Scope of Practice, 4 th June ANZSNM and ANZSNM Accreditation Board. Competency Standards for Nuclear Medicine Science in Australia Entry Level Practitioners. 3 rd Edition SNM Technologist Section Presidential Task Force. SNMTS Scope of Practice for nuclear medicine technologists Scope of Practice Working Party membership Julie Crouch (Chair) (WA) Elizabeth Bailey (ANZSNM Past President, TSIG, NSW) Marcia Wood (TSIG, VIC) Travis Pearson (QLD) Dominic Mensforth (SA) Dianne Cheong (TSIG/WA) Sharon Mosley (ACT)