Image Reading Course in Nuclear Medicine Ken Holmes Peter Hogg

Overview Practice of Nuclear Medicine Legal and Professional background Our Image Reading Course Performance of our students

Practice of Nuclear Medicine Dynamic Renal Task devolved from Dr in protocols Clinical Justification Administer radiopharmaceutical Radiographer is professionally responsible MARS 1 (Perform scan) Radiographer is professionally responsible PGD or PSD 3 Radiographer takes a clinical decision 2 Diuretic Task devolved from Dr in protocols Interpret the scan Radiographer is professionally responsible BNMS, SCoR 4 1. Medicines Regulations as amended 1978 2. Nuclear Medicine Practice, 2007, Society of Radiographers, ISBN 1871101224 3. Medicines in Radiography: Prescription, Supply and Administration, Hogg et al, 2007, Synergy 4. British Nuclear Medicine Society, 2004; Society of Radiographers 2004 and 2007

Practice of Nuclear Medicine Bone scan Task devolved from Dr in protocols Clinical Justification Administer radiopharmaceutical Radiographer is professionally responsible MARS 1 (Perform scan) Radiographer is professionally responsible Request x-ray Radiographer is professionally responsible IR(ME)R 3 Interpret the scan Radiographer is professionally responsible BNMS, SCoR 4 1. Medicines Regulations as amended 1978 2. Nuclear Medicine Practice, 2007, Society of Radiographers, ISBN 1871101224 3. Ionizing Radiations (Medical Exposure) Regulations 2000, HMSO 4. British Nuclear Medicine Society, 2004; Society of Radiographers 2004 and 2007

Legal and Professional background Radiographers can Justify examinations involving ionising radiation 1 Supply and administer medicines, IV or otherwise 2 Prescribe medicines 3 Request x-ray imaging 1 Interpret medical images and afford a diagnosis 4 1. Ionizing Radiations (Medical Exposure) Regulations 2000, HMSO 2. Health Service Circular (HSC 2000/026), NHS Executive 3. Supplementary Prescribing by Nurses, Pharmacists, Chiropodists/Podiatrists, Physiotherapists and Radiographers within the NHS in England: a guide for implementation 4. British Nuclear Medicine Society, 2004; Society of Radiographers 2004 and 2007

Definitions Interpretation of the scan 1,2 Indication for the investigation Description of the appearances seen Opinion on whether the appearances are normal, abnormal or normal variant If required recommend further imaging / investigations for correlation If abnormal a comment on the significance of the abnormality and an opinion on what the most likely clinical condition is A prognostic indication for the patient British Nuclear Medicine Society Guidelines for the Issue of Reports by Non-Medical Staff, Version 2.2 SCoR

Definitions Interpretation of the scan - double report 1 A number of models exit Independent reporting by 2 ‘practitioners’ Second reporter blind to first Second reporter not blind to first An ‘agreed’ report is issued Disagreements between the reporters can either go to a consensus report or third person Stamatia et al, 2004, Can Computer-aided Detection with Double Reading of Screening Mammograms Help Decrease the False-Negative Rate? Initial Experience Radiology, 232, 2, 578-584

Our Image Reading Course BSc (Hons) Radiography 3 years PGD / MSc Nuclear Medicine 1.5-3 years PETCT CT for NM Technologists Image Reading Course IV Access Course Stress Heart Course 9 months 3 months 6 months

Our Image Reading Course Builds on existing knowledge Only NM qualified people allowed on it Course outcomes Image interpretation, including Report writing Image perception Image optimisation Clinical justification Supply and administration of drugs Requesting x-ray imaging Legal context (negligence)

Course Structure 2 days in university 6 months clinical 1 day in university

Assessment Reflective report Objective Structured Clinical Examination Oral presentations Case studies Clinical portfolio

Clinical Portfolio - purpose Learning exercise Clinical justification Supply and administration of medicines Requesting x-ray imaging Image interpretation Self-audit Audit against what? Each clinical decision must have reference (literature) Comparison to ‘local standard’

Assessment Is it any good – what we think! Formative Clinical portfolio Reflection on reports and ability to report Ownership of procedure and subsequently better quality images Evidence based practice appreciation developed Acknowledgement of errors and an understanding of how these might be minimised

Assessment Is it any good – what we think! Summative OSCE Tests, using clinical scenarios, the range of competencies Reflective essay Reflection upon a practice Linking of evidence to that practice Analysis which leads to a proposal for ‘improvement’ An understanding of ‘the process of reflection’ and how this can improve practice Case study and oral presentation of this Opportunity for case-based learning in a clinical context (integration of the subjects) Opportunity for sharing individual case-based learning with peers

Performance of our students 1 Image interpretation - agreement with local radiological standard Bone 96% Lung 95% Renal 95% 1. Holmes K, Griffiths M and Vivian G (2003) Assessment of the technologist reporting in nuclear medicine Synergy March 10-14

Course Evaluation A reflection Low student numbers 8-10 per year Degree of course difficulty – student comments Intensive Not easy Time consuming Post course Some students are not allowed to report A few are dual reporting Many are single reporting

Any questions? Ken.holmes@cumbria.ac.uk P.Hogg@Salford.ac.uk