2001 President's Task Force Society of Nuclear Medicine Technologist Section (updated 5/2002) A Society of Nuclear Medicine Technologist Section (SNM-TS) presidential task force established in the Spring of 2001 developed the revised SNM-TS Scope of Practice for nuclear medicine technologists. The task force consisted of the following individuals: Danny Basso CNMT, Mickey Clarke CNMT, Lenna Deletis-King CNMT, Gary Dillehay M.D., Michele Early CNMT, David Perry CNMT, Richard Tetrault CNMT, Lyn Mehlberg CNMT, Royal Davis CNMT, V. Loveless CNMT. The task force was chaired by Frances Keech RT(N). The documents used in the revision and development of these guidelines were the SNM-TS Performance and Responsibility Guidelines for the Nuclear Medicine Technologist (1998), Nuclear Medicine Technology Certification Board (NMTCB) Report: Equipment and Procedures in Current Practice (2001), NMTCB Critical Task Analysis Report (2000), Joint Review Committee Nuclear Medicine Technologist (JRCNMT) Essentials and Guidelines for an Accredited Educational Program for the Nuclear Medicine Technologist (2000), American Registry of Radiologic Technologists (ARRT) Task Analysis (2000), and American Society of Radiologic Technologists (ASRT) Practice Guidelines (1998). This document is not intended to modify or alter existing tort law, rather it should serve as a concise outline of nuclear medicine technology skills and responsibilities. Nuclear Medicine Technology Nuclear medicine technology is the medical specialty that utilizes unsealed radioactive materials in the diagnosis and treatment of disease. This practice includes the administration, imaging, and/or counting of diagnostic radiopharmaceuticals to demonstrate organ and molecular function, as well as the delivery of therapeutic radiopharmaceuticals to treat a number of pathologies. The practice of nuclear medicine technology encompasses multi-disciplinary skills, which use rapidly evolving instrumentation, radiopharmaceuticals, and techniques. The responsibilities of the nuclear medicine technologist include an empathetic and instructional approach to patient care; the preparation, calibration, and administration of radiopharmaceuticals and pharmaceuticals (under the direction of an authorized user); the performance of quality control procedures; and the operation of imaging, laboratory, and computer instrumentation. In order to perform these tasks, the nuclear medicine technologist must successfully complete didactic and clinical training. Recommended course work includes, but is not limited to: anatomy, physiology, pathophysiology, chemistry, physics, mathematics, computer applications, biomedical sciences, ethics, and radiation health and safety. Direct patient contact hours are obtained by training in a clinical setting. Formal education programs in nuclear medicine technology are accredited by the Joint Review Committee on Educational Programs in Nuclear Medicine Technology (JRCNMT) as well as institutional accreditation programs. Graduates of accredited programs are eligible for certification examination offered by the Nuclear Medicine Technology Certification Board (NMTCB) and/or the American Registry of Radiologic Technologists (ARRT). The spectrum of nuclear medicine technology skills and responsibilities varies widely across the country and often goes beyond the basic skills outlined in the technologist's initial education and certification. Practice components presented in this document provide a basis for establishing the areas of knowledge and performance for the nuclear medicine technologist. It is assumed that for all activities included in this scope of practice, the nuclear medicine technologist has received the proper training (in compliance with individual state and institutional requirements) supported with the proper documentation of initial and continued competency in those practices and activities. Continuing education is a necessary component in maintaining the skills required to perform all duties and tasks of the nuclear medicine technologist in this ever-evolving field of new equipment, radiopharmaceuticals, and applications. The scope of practice in nuclear medicine technology includes, but is not limited to the following areas and responsibilities: Patient Care: Requires the exercise of judgment to assess and respond to the patient's needs prior to, during, and after procedures in the nuclear medicine department. Quality Control: Requires the evaluation and maintenance of a quality control program for all instrumentation to ensure its proper performance and stability. Diagnostic Procedures: Requires the utilization of appropriate techniques to ensure quality diagnostic images and/or laboratory results. Radiopharmaceuticals: Involves the procurement, preparation, quality control, dose calculation, identification, documentation, administration, disposal, storage, and safe handling of radioactive materials used by the nuclear medicine technologist. Radionuclide Therapy: Assists an authorized user in the application and management of radiotherapeutic procedures. Radiation Safety: Educates the public while practicing techniques that will minimize radiation exposure to the patient, general public, and health care personnel consistent with the concept of ALARA (as low as reasonably achievable). Patient Care A nuclear medicine technologist provides patient care: By providing for proper comfort and care of the patient prior to, during, and after a procedure, including, but not limited to, the monitoring of intravenous lines (i.e., central lines, mediports, Peripherally Inserted Central Catheter (PICC) lines), oxygen supplies, drains, and patients who are under sedation. By establishing and maintaining proper communication with patients (e.g., proper introduction, appropriate explanation of the procedure, etc.). By behaving in a professional manner in consideration of patients' rights and resulting in the provision of the highest quality patient care possible. By providing a safe and sanitary working environment for patients and the general public, using proper infection control practices in compliance with accepted precaution policies. By recognizing and responding to an emergency situation at a level commensurate with one's training and competency. A nuclear medicine technologist prepares the patient for an examination: By verifying patient identification, pregnancy status, breast-feeding status, and written orders for the procedure. By ensuring that informed consent has been obtained, in the method prescribed by the institution, whenever necessary. By confirming that the indication for the procedure is appropriate and consulting with the authorized user and/or referring physician whenever necessary in order to ensure that the proper procedure is performed. By obtaining a pertinent patient history. By ensuring that any pre-procedural preparation has been completed, including, but not limited to, fasting, hydration, the taking of thyroid blocking compounds, voiding, bowel cleansing, and suspension of interfering medications. By explaining the procedure to the patient and/or family and, where applicable, to the parents and/or legal guardian including, but not limited to, the procedure, patient involvement, length of study, and radiation safety issues. By collecting samples for laboratory procedures and performing pertinent waived laboratory procedures (e.g., fasting blood sugar, urine pregnancy tests). A nuclear medicine technologists performs administrative procedures: By maintaining an appropriate inventory of medical/surgical supplies, radiopharmaceuticals, storage media, and other items required to perform procedures in a timely manner. By scheduling patient procedures appropriate to the indication and in the proper sequence. By maintaining appropriate records of administered radioactivity, quality control procedures, patient reports, and other required records. By developing and revising, when necessary, policies and procedures in accordance with applicable regulations. By actively participating in total quality management/continuous quality improvement programs (i.e., age-specific competencies, patient education, and patient restraint and immobilization). Quality Control- Nuclear Instrumentation A nuclear medicine technologist ensures the proper performance of the imaging systems, storage media, and radiation detection and counting devices, including, but not limited to, scintillation cameras, dose calibrators, survey instruments, NaI(Tl) scintillation probes and well counters, and data processing and image production devices. Diagnostic Procedures A nuclear medicine technologist performs imaging procedures: By preparing, evaluating and properly administering the appropriate radiopharmaceuticals and/or pharmaceuticals (under the direction of an authorized user). By establishing and/or properly maintaining venous access routes of various configurations (in accordance with hospital policies and procedures). By selecting the appropriate imaging or data collection parameters. By administering radiopharmaceuticals/pharmaceuticals through various routes of administration, including, but not limited to: oral, intravesical, inhalant, intravenous, intramuscular, subcutaneous, and intradermal (under the direction of an authorized user). By positioning the patient for imaging, adapting the protocol to patient limitations, and obtaining images. By positioning and verifying the placement of electrocardiographic leads. By reviewing images to ensure that required information has been collected, processed properly, and is of the highest quality. By assisting in cardiac stress tests procedures when performed in conjunction with nuclear medicine procedures. By performing data collection, processing, and analysis. By archiving data to and from storage media. A nuclear medicine technologist performs non-imaging in vivo and/or radioassay studies: By operating laboratory equipment. By preparing dosages and standards. By collecting the appropriate specimen for procedures using standard precautions. By collecting, validating and documenting the data. By managing biohazardous, chemical, and radioactive waste in accordance with applicable regulations and specific facility policies. Radiopharmaceuticals A nuclear medicine technologist obtains and maintains radiopharmaceutical products and adjunct supplies. A nuclear medicine technologist properly prepares and administers diagnostic radiopharmaceuticals under the direction of an authorized user in accordance with all federal, state and institutional guidelines. Radionuclide Therapy A nuclear medicine technologist properly prepares and administers therapeutic radionuclides and radiopharmaceuticals under the direction of an authorized user in accordance with federal, state, and institutional regulations. Radiation Safety A nuclear medicine technologist performs all procedures utilizing ionizing radiation safely and effectively: By maintaining compliance with all applicable regulations. By performing appropriate radioactive contamination monitoring and any necessary decontamination procedures. By disposing of radioactive waste in accordance with federal, state, and institutional regulations By participating in programs designed to instruct other personnel about radiation hazards and principles of radiation safety. References Nuclear Medicine Technology Certification Board (NMTCB), Equipment and Procedures in Current Practice (2001) Nuclear Medicine Technology Certification Board (NMTCB), Critical Task Analysis Report. K. Blondeau, S. Hearten, M. Pickett, J. Bridges. (2000) Joint Review Committee Nuclear Medicine Technologist (JRCNMT), Essentials and Guidelines for an Accredited Educational Program for the Nuclear Medicine Technologist (2000) Socieconomic Affairs Committee, SNM-TS, Performance and Responsibility Guidelines for the Nuclear Medicine Technologist, JNMT Volume 28 December 1998. American Registry of Radiologic Technologists (ARRT), Nuclear Medicine Technologist Task Analysis (2000) 6. American Society of Radiologic Technologists (ASRT), Practice Guidelines for Nuclear Medicine Technologists (1998)