Jafari M, Daus A
Gundersen Lutheran Medical Center, La Crosse, WI.
Med Phys. 2012 Jun;39(6Part5):3645. doi: 10.1118/1.4734806.
To demonstrate how principles and recommendations of the Image Gently® and Image Wisely™ campaigns can be clinically implemented.
Implementation of Image Gently® and Image Wisely™ guidelines was a quality and safety improvement project for our Nuclear Medicine department in 2011. Pediatric administered radiopharmaceutical doses were compared to recommended doses in the North American Consensus Guidelines for AdministeredRadiopharmaceutical Activities in Children and Adolescents and the European Association of Nuclear Medicine Paediatric Dose Card. Adult administered radiopharmaceutical doses were compared to administered doses in NCRP Report No. 160 and IAEA Report No. 40.
Evaluation of site administered radiopharmaceutical doses showed that nearly all doses were comparable to those recommended by national and international advisory bodies. Administered doses for the pediatric renogram and the adult gastric emptying were adjusted to match the recommendations and resultant image quality evaluated.
Radiation dose from nuclear medicine procedures should not be overlooked in the focus on CT dose reduction. An estimated 19.7 million nuclear medicine procedures are done annually in the U.S., with doses comparable to that from CT scans. Nuclear medicine departments should evaluate their pediatric administeredradiopharmaceutical doses against the North American Consensus Guidelines for Administered Radiopharmaceutical Activities in Children and Adolescents and evaluate their adult doses against national and international standards. Administered doses that are not comparable to the recommended values should be adjusted accordingly. Additional steps to reduce patient radiation dose include decision support to reduce inappropriate ordering, technique optimization for the CT scan portion of SPECT/CT and PET/CT, use of vendor's dose reduction camera and software technology, use of shorter lived radiopharmaceuticals, and 'right sizing' patient doses by weight.
展示如何在临床实践中实施“温柔显影”（Image Gently®）和“明智显影”（Image Wisely™）活动的原则及建议。
2011年，实施“温柔显影”和“明智显影”指南是我们核医学科的一项质量与安全改进项目。将儿科患者使用的放射性药物剂量与《北美儿童及青少年放射性药物给药活动共识指南》以及欧洲核医学协会儿科剂量卡中推荐的剂量进行比较。将成人使用的放射性药物剂量与NCRP第160号报告和国际原子能机构第40号报告中的给药剂量进行比较。
对本机构使用的放射性药物剂量评估显示，几乎所有剂量都与国家和国际咨询机构推荐的剂量相当。调整了儿科肾图检查和成人胃排空检查的给药剂量以符合建议，并对由此产生的图像质量进行了评估。
在关注CT剂量降低的同时，不应忽视核医学检查的辐射剂量。在美国，每年约进行1970万次核医学检查，其剂量与CT扫描相当。核医学科应根据《北美儿童及青少年放射性药物给药活动共识指南》评估其儿科放射性药物给药剂量，并对照国家和国际标准评估其成人剂量。与推荐值不符的给药剂量应相应调整。降低患者辐射剂量的其他措施包括提供决策支持以减少不适当的检查申请、优化SPECT/CT和PET/CT中CT扫描部分的技术、使用供应商的剂量降低相机和软件技术、使用半衰期较短的放射性药物以及根据体重“合理确定”患者剂量。
