1. Image Reading Course in Nuclear Medicine
Ken Holmes
Peter Hogg

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

3. 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
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

4. 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
3. Ionizing Radiations (Medical Exposure) Regulations 2000, HMSO
4. British Nuclear Medicine Society, 2004; Society of Radiographers 2004 and 2007

5. 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

6. 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

7. 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,

8. 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

9. 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)

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

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

12. 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’

13. 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

14. 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

15. 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

16. 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

17. Any questions?