02.02.08. Accountability for accurate dose to patient
RTs ensure radiopharmaceutical doses are appropriate and accurate
Importance of accurate dosing
- An accurate dose is defined as the appropriate radiopharmaceutical selection that falls within the limits of ±10% of the prescribed dose that is set by institutional policies and procedures.1
- Accurate radiopharmaceutical dose is important for1:
- the quality of the procedure to ensure appropriate dose for the desired therapeutic or diagnostic outcome,
- reproducibility of studies for patients requiring follow-up imaging, and
- patient safety.
- The radiopharmaceutical dose administered to the patient reflects the balance between optimal study/therapy and patient safety.2
- The dose is kept as low as reasonably achievable (ALARA) to obtain the optimal diagnostic/therapeutic outcome for the patient.
- Administration of a dose below the minimum of the recommended range for a procedure can lead to a suboptimal study, compromise reproducibility, and require the exam to be repeated.
- Administration of a dose above the maximum of the recommended range will increase radiation exposure to the patient and does not correlate with improvements in study outcomes or diagnostic information in most circumstances.
MRT responsibilities
- MRTs consistently assess radiopharmaceuticals prior to administration to patients to ensure the dose and product being given is accurate for the study proposed, including3,4:
- The quantity of radioactivity to be administered reflects the dose prescribed (either individually by prescription or in a standard protocol).3,4
- Radioactive decay calculations confirm the volume necessary to deliver the prescribed radioactive dose.2
- MRTs ensure a radiopharmaceutical is not being used beyond the manufacturer’s recommended expiration date/time unless specific quality control testing demonstrates that the product still meets applicable specifications at the time of use.5
- MRTs ensure adherence to a regular quality assurance program on all equipment responsible for calculating accurate patient doses (i.e., dose calibrator, INTEGO PET infusion system).
- The dosage of radiopharmaceuticals given in therapeutic procedures should be verified by a second MRT or physician prior to administration.6
- MRTs follow dose charts and make dose adjustments based on patient factors, including:
- patient body habitus (usually ±10% of prescribed dose);
- pregnancy (a lower dose for pregnant women may be advised by the supervising radiologist or physician7; MRTs can consult the SNMMI Nuclear Medicine Radiation Dose Tool as needed); and
- pediatric patients (doses reduced based on weight, taking into consideration department-set minimums for pediatric patients).
Documentation
- Documentation in the patient’s record (in accordance with the requirements established by each facility) may include3,4:
- name of MRT or physician administering dose,
- study performed,
- date and time,
- radiopharmaceutical administered,
- administered dose,
- route/site of administration,
- difficulties encountered (e.g., interstitial administration),
- deviations from standard procedure.
- It is the MRT’s responsibility to document/report inaccurate dosing (by themselves or by others) that they are aware of through the appropriate mechanisms (i.e., report to the RSO).
References
- Statkiewicz Sherer MA, Visconti P, Ritenour ER, Welch Haynes K. Radiation protection in medical radiography. 7th ed. Mosby Elsevier; 2015. Accessed August 7, 2020. https://www.elsevier.com/books/radiation-protection-in-medical-radiography/statkiewicz-sherer/978-0-323-17220-2
- ICRP. The 2007 recommendations of the International Commission on Radiological Protection. ICRP publication 103. Ann ICRP. 2007;37(2-4):1-332. doi:10.1016/j.icrp.2007.10.003
- American College of Radiology and Society of Nuclear Medicine. ACR-SNM technical standard for diagnostic procedures using radiopharmaceuticals. Published online 2011. Accessed August 8, 2020. https://s3.amazonaws.com/rdcms-snmmi/files/production/public/docs/ACR-SNM_Technical_standards_for_diagnostic_procedures_using_radiopharmaceuticals_1382731756580_2.pdf
- Force S-TS of PT. Nuclear medicine technologist scope of practice and performance standards. J Nucl Med Technol. 2017;45(1):53-64.
- Callahan RJ, Chilton HM, Ponto JA, Swanson DP, Royal HD, Bruce AD. Procedure guideline for the use of radiopharmaceuticals 4.0. J Nucl Med Technol. 2007;35(4):272-275. doi:10.2967/jnmt.107.044156
- Australian Radiation Protection and Nuclear Safety Agency. Safety guide: Radiation protection in nuclear medicine.; 2008. Accessed August 8, 2020. https://www.arpansa.gov.au/sites/default/files/legacy/pubs/rps/rps14_2.pdf
- Bural GG, Laymon CM, Mountz JM. Nuclear imaging of a pregnant patient: Should we perform nuclear medicine procedures during pregnancy? Mol Imaging Radionucl Ther. 2012;21(1):1-5. doi:10.4274/Mirt.123
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