Clinical audit in nuclear medicine

Excerpt

Nuclear medicine is one of the most dynamic fields in medicine. It is defined in the new Accreditation Council for Graduate Medical Education (ACGME) program requirements as "Nuclear medicine is the medical specialty that uses the tracer principle, most often with radiopharmaceuticals, to evaluate molecular, metabolic, physiologic and pathologic conditions of the body for the purposes of diagnosis, therapy and research" [1]. Training in nuclear medicine, which comprises a period of 4 to 6 years, has undergone major revisions since its start. The field of investigations has also undergone a more rapid transformation than many other specialties in many areas from instrumentation to radiopharmacy. The radiopharmaceuticals available are fewer but are also more specific than in earlier years, and many of the common procedures performed previously are no longer offered in modern routine clinical nuclear medicine. Many earlier studies have become outdated, such as renal studies with ¹³¹I-orthoiodohippurate, ventilation studies with ¹³³Xe or pancreas imaging with ⁷⁵Se-selenomethionine. Major new procedures and materials that have been incorporated into nuclear medicine in the last three decades include myocardial perfusion imaging with technetium-based agents, thyroid imaging with ¹²³I, hepatobiliary imaging, aerosol ventilation studies, labelled white blood cells, renal scans, somatostatin analogues, β-CIT, meta-iodobenzylguanidine, and parathyroid imaging. The fastest growing new modality is positron emission tomography (PET), especially ¹⁸F-FDG PET. With hybrid SPECT/CT and PET/CT devices, which create coregistered anatomical and functional images, fusion studies have become more accurate than examinations with stand-alone scanners. A significant number of functional imaging procedures have become a part of the routine clinical work-up for different pathologies. However, some have recently been challenged, as was the case for pulmonary scintigraphy, where multislice CT has replaced the pulmonary perfusion scan in some centres to a large extent. It has to be emphasized that this replacement depends strongly on the experience and quality of the nuclear medicine departments. …