Barnes J A, de la Guardia M, Easley T, Downs H, Mims S, Nielson K, Granger M
1Cook Children's Medical Center, Fort Worth, TX.
Health Phys. 2018 Dec;115(6):776-786. doi: 10.1097/HP.0000000000000905.
As a medical center without a pre-existing radiopharmaceutical therapy program, it was a daunting endeavor to implement a I metaiodobenzylguanidine (mIBG) high-dose treatment regimen. It took several years of planning with hospital administration, vendors, and Texas Department of Health Radiological Control regulators to establish a viable program. Effective communication between physicians, nursing, nuclear medicine, environmental services, maintenance, and other support staff is essential and paramount for the successful execution and continued sustainability of the mIBG therapy program. Besides providing an effective treatment for patients, an additional goal for the program is to keep radiation exposure As Low As Reasonably Achievable (ALARA) for staff and patient caregivers. As such, start-up presented many training, logistical, and radiation safety challenges. The location of the isolation room and shielding specifications were designed to keep radiation exposure to public access areas to less than 2 microsieverts per hour. Before the first patient was treated the policies and procedures for training, radiation safety, product quality control, and infusion process needed to be developed, tested, and approved by various committees. Furthermore, a similar process was required for developing room set-up, post therapy cleanup, and waste storage procedures. Throughout the maturation process of the program, the departments involved have found that our safety culture has continually improved by the re-enforcement of knowledge and lessons learned, as both the ancillary and treatment staff grew more confident in each other's ability during more patient treatments are performed. This article describes the process and lessons learned during the time leading up to the startup and early years of the mIBG therapy program.
作为一家此前没有放射性药物治疗项目的医疗中心，实施碘[131I]间碘苄胍（mIBG）高剂量治疗方案是一项艰巨的任务。与医院管理层、供应商以及德克萨斯州卫生放射控制监管机构进行了数年的规划，才建立起一个可行的项目。医生、护士、核医学人员、环境服务人员、维修人员和其他支持人员之间的有效沟通对于mIBG治疗项目的成功实施和持续可持续性至关重要。除了为患者提供有效的治疗外，该项目的另一个目标是使工作人员和患者护理人员的辐射暴露尽可能低（ALARA）。因此，项目启动带来了许多培训、后勤和辐射安全方面的挑战。隔离室的位置和屏蔽规格设计为使公众可进入区域的辐射暴露低于每小时2微希沃特。在第一位患者接受治疗之前，培训、辐射安全、产品质量控制和输液流程的政策和程序需要由各个委员会制定、测试和批准。此外，制定房间设置、治疗后清理和废物储存程序也需要类似的过程。在项目的整个成熟过程中，相关部门发现，随着辅助人员和治疗人员在更多患者治疗过程中对彼此能力越来越有信心，通过强化知识和吸取的经验教训，我们的安全文化不断得到改善。本文描述了mIBG治疗项目启动前及早期阶段所经历的过程和吸取的经验教训。
