Shafi Asal, Thorsson Ola, Edenbrandt Lars
Clinical Physiology and Nuclear Medicine, Skåne University Hospital, Lund University, Malmö, Sweden.
J Nucl Med Technol. 2014 Mar;42(1):28-32. doi: 10.2967/jnmt.113.132035. Epub 2014 Jan 27.
Bone scintigraphy is usually obtained as a whole-body scan producing 2 images: an anterior view and a posterior view. Sometimes abnormal findings in the spine are difficult to distinguish on whole-body bone scans. SPECT/CT may be performed to localize and interpret a lesion correctly and to help differentiate between benign and metastatic lesions. The assessment of whether SPECT/CT is needed is usually made by a physician. The aim of this study was to evaluate our new routine for nuclear medicine technologists to determine when to add SPECT/CT to whole-body bone scintigraphy.
A 3-part educational course was developed for the nuclear medicine technologists. The first part was to learn criteria for when SPECT/CT should be added to a whole-body bone scan. The second part was to review a selection of training whole-body bone scans illustrating the criteria. The third part was to pass a test of whether whole-body bone scans should be supplemented by SPECT/CT.
The nuclear medicine technologists and the physicians agreed that SPECT/CT was required in 63 cases and not required in 27 cases. The resulting percentage agreement was 90%, and the κ value was 0.77. There was disagreement in 10 cases. In 6 of these cases only the nuclear medicine technologists wanted to add SPECT/CT, and in 4 of these cases only the physicians wanted to add SPECT/CT.
After participating in the training course developed in this project, the nuclear medicine technologists were able to decide whether a SPECT/CT study is needed. An implication of this result is that the effectiveness of the nuclear medicine department should be improved after our new routine is implemented. The successful outcome of this project may stimulate departments to take on similar quality-improvement projects in the future.
骨闪烁扫描通常作为全身扫描进行，生成两张图像：前视图和后视图。有时，脊柱的异常发现很难在全身骨扫描中区分出来。可能会进行单光子发射计算机断层扫描/计算机断层扫描（SPECT/CT），以正确定位和解释病变，并有助于区分良性和转移性病变。是否需要进行SPECT/CT的评估通常由医生做出。本研究的目的是评估我们为核医学技术人员制定的新流程，以确定何时在全身骨闪烁扫描中添加SPECT/CT。
为核医学技术人员开发了一个三部分的教育课程。第一部分是学习何时应在全身骨扫描中添加SPECT/CT的标准。第二部分是回顾一系列说明这些标准的训练全身骨扫描。第三部分是通过一项关于全身骨扫描是否应补充SPECT/CT的测试。
核医学技术人员和医生一致认为，63例需要进行SPECT/CT，27例不需要。达成一致的百分比为90%，κ值为0.77。有10例存在分歧。在其中6例中，只有核医学技术人员希望添加SPECT/CT，在其中4例中，只有医生希望添加SPECT/CT。
参与本项目开发的培训课程后，核医学技术人员能够决定是否需要进行SPECT/CT检查。这一结果的一个影响是，实施我们的新流程后，核医学科的效率应会提高。本项目的成功结果可能会促使各科室在未来开展类似的质量改进项目。
