Nuclear Medicine Advanced Associates: Physician Extenders in Nuclear Medicine-Now Is the Time.

From its inception in 2008 until 2020, the nuclear medicine advanced associate (NMAA) has evolved into a valuable member of the imaging team. Data show that NMAAs perform key services including supervision, interpretation, protocoling of adjunct studies, and management, freeing nuclear medicine physicians to concentrate on more complicated and time-intensive responsibilities. Additionally, the profession has gained ground by becoming recognized by the Nuclear Medicine Technology Certification Board (NMTCB), with the advent of a formal NMAA certification examination and recognition guidelines for institutions interested in establishing NMAA educational programs. Actions are under way for the creation of new NMAA programs with pathways to enhance and expand student recruitment. A special task force has been established by the Society of Nuclear Medicine and Molecular Imaging Advanced Associate Council to raise awareness of the advantages of the physician extender within the practice setting. Practicing NMAAs perform duties that are beyond the scope of nuclear medicine technologists.

Technologist Approach to Global Dose Optimization.

Nuclear medicine technologists are specialized health professionals who cover a wide range of tasks from clinical routine (including image acquisition and processing, radiopharmaceutical dispensing and administration, patient care, and radioprotection tasks) to leading clinical research in the field of nuclear medicine. As a fundamental concern in all radiation sciences applied to medicine, protection of individuals against the harmful effects of ionizing radiation must be constantly revised and applied by the professionals involved in medical exposures. The acknowledgment that nuclear medicine technologists play a prominent role in patient management and several procedural steps, both in diagnostic and in therapeutic nuclear medicine applications, carries the duty to be trained and knowledgeable on the topic of radiation protection and dose optimization. An overview on selected topics related to dose optimization is presented in this article, reflecting the similarities and particularities of dose reduction-related principles, initiatives, and practicalities from a global perspective.

Klein-Nishina electronic cross-section, Compton cross sections, and buildup factor of wax for radiation shielding and protection.

Klein-Nishina scattering cross-sections, Compton scattering, mass attenuation and energy transfer cross-sections, linear attenuation coefficient and buildup factor of 99.99% pure paraffin wax (Carbon = 85.14%, Hydrogen = 14.86%). are calculated using 0.662, 0.835, 1.17 and 1.33 MeV γ-rays. The mentioned γ-rays were obtained from Cs-137, Mn-54 and Co-60 radioisotopes. Gamma rays obtained from these radioisotopes were passed through circular shaped wax slices and allowed to fall on a NaI detector. The thickness of wax slices were 0.33-2.9 cm with 6 cm diameter. Lead collimator of 1 cm diameter hole in the middle was used to obtain a collimated beam for narrow beam geometry. Broad beam geometry was used by removing the collimator to investigate buildup factor. Results show that Klein-Nishina electronic cross-section, Compton mass attenuation coefficient and Compton energy transfer coefficient all decrease with increasing photon energy. Linear attenuation coefficients µ = 0.0532 cm-1 for 1.17 MeV beam and µ = 0.0419 cm-1 for 1.33 MeV γ-rays were obtained for wax. Variations in buildup factors are observed with increasing thickness of wax for 1.17 and 1.33 MeV beams.

Basic Review of Radiation Biology and Terminology.

The purpose of this paper is to review basic radiation biology and associated terminology to impart a better understanding of the importance of basic concepts of ionizing radiation interactions with living tissue. As health care workers in a field that utilizes ionizing radiation, nuclear medicine technologists are concerned about the possible acute and chronic effects of occupational radiation exposure. Technologists should have a clear understanding of what they are exposed to and how their safety could be affected. Furthermore, technologists should be knowledgeable about radiation effects so that they can adequately assuage possible patient fears about undergoing a nuclear medicine procedure. After reading this article, the nuclear medicine technologist will be familiar with basic radiation biology concepts; types of interactions of radiation with living tissue, and possible effects from that exposure; theoretic dose-response curves and how they are used in radiation biology; stochastic versus nonstochastic effects of radiation exposure, and what these terms mean in relation to both high- and low-dose radiation exposure; and possible acute and chronic radiation exposure effects.

Survey on the Use of Nuclear Renal Imaging in the United States.

Throughout the years, the role of nuclear medicine departments in the care of renal patients has changed as a result of technologic advancements and other factors. This study evaluated the current role of nuclear renal imaging. METHODS: A survey was generated with questions about patient populations, the clinical indications most often seen, radiopharmaceutical use, measurement techniques, the average number of scans completed, and medical center/transplant team affiliations. The survey was sent to recipients on a mailing list acquired from the Nuclear Medicine Technology Certification Board. RESULTS: Most of the responses came from departments in the southeastern United States. Most of the patient population is suburban. Nephrologists are the most common referring physicians for renal imaging. Most departments complete fewer than 10 renograms per month, and most departments use 99mTc-mercaptoacetyltriglycine as the radiopharmaceutical of choice. A camera-based measurement technique is used most often. Most departments report being affiliated with a medical center, but only about half of those medical centers perform renal transplantation. The most commonly seen clinical indication for renal imaging is renal obstruction, whereas the least commonly seen is urine leakage. CONCLUSION: These results provide a better understanding of the current role of nuclear medicine in the care of renal patients and how this role has changed over the years.

Historical Patterns in the Types of Procedures Performed and Radiation Safety Practices Used in Nuclear Medicine From 1945-2009.

The authors evaluated historical patterns in the types of procedures performed in diagnostic and therapeutic nuclear medicine and the associated radiation safety practices used from 1945-2009 in a sample of U.S. radiologic technologists. In 2013-2014, 4,406 participants from the U.S. Radiologic Technologists (USRT) Study who previously reported working with medical radionuclides completed a detailed survey inquiring about the performance of 23 diagnostic and therapeutic radionuclide procedures and the use of radiation safety practices when performing radionuclide procedure-related tasks during five time periods: 1945-1964, 1965-1979, 1980-1989, 1990-1999, and 2000-2009. An overall increase in the proportion of technologists who performed specific diagnostic or therapeutic procedures was observed across the five time periods. Between 1945-1964 and 2000-2009, the median frequency of diagnostic procedures performed substantially increased (from 5 wk to 30 wk), attributable mainly to an increasing frequency of cardiac and non-brain PET scans, while the median frequency of therapeutic procedures performed modestly decreased (from 4 mo to 3 mo). Also a notable increase was observed in the use of most radiation safety practices from 1945-1964 to 2000-2009 (e.g., use of lead-shielded vials during diagnostic radiopharmaceutical preparation increased from 56 to 96%), although lead apron use dramatically decreased (e.g., during diagnostic imaging procedures, from 81 to 7%). These data describe historical practices in nuclear medicine and can be used to support studies of health risks for nuclear medicine technologists.