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Background

It is recognised by the SCoR that the developing use of multi-detector computerised tomography (MDCT) scanners within nuclear medicine facilities provides a challenge to the non-medical workforce to assure high quality patient services. The Nuclear Medicine Advisory Group (NMAG) of the SCoR has developed this statement to support the non-medical workforce in delivering safe services.

Nuclear medicine facilities employ a range of non-medical professionals from radiographic, nuclear medicine technology and healthcare science backgrounds.  The complementary skills and knowledge of the team supports the safe delivery of the modality.  Evolving hybrid techniques will impact on the team and the SCoR is keen to understand the skills required and psychological challenges for the workforce as change impacts (Griffiths & Dawson 2014, Hogg 2013).

Modern hybrid Single Photon Emission Computed Tomography (SPECT/CT) and Positron Emission Tomography with Computerised Tomography (PET/CT) have revolutionised nuclear medicine imaging where the CT component is used for attenuation correction and image fusion (Jones  2013). Modern systems can also be used as ‘stand alone’ CT scanners to perform conventional CT examinations (CT Scanning) which may not be related to any radionuclide examination but form part of the patient pathway. Griffiths and Dawson (2015) noted that ‘there is a necessity for clear clinical protocols and appropriate use of CT within a hybrid imaging environment’ to ensure that CT radiation doses are optimised and justified.

The Ionising Radiation (Medical Exposure) Regulations (IR(ME)R 2000, Regulation 11(1) (SI 2000/1059) requires operators to be adequately trained.  Schedule 2 of IR(ME)R defines adequate training as having ‘successfully completed training, including theoretical knowledge and practical experience,’ and provides a list of required subjects related to the function and specific area of practice for the operator or practitioner. 

As described in the regulations, all operators must be able to evidence appropriate specialist education, training and competency in order to perform hybrid imaging and, if appropriate or required, conventional CT examinations.  These CT examinations have potential to deliver relatively high radiation doses in very short time frames. 

Nuclear medicine technologists and radiographers follow their own professions’ independently approved training curriculum at graduate and postgraduate level in the UK.  The Health and Care Professions Council (HCPC) maintains the statutory register for diagnostic radiographers who have attained the Standards of Proficiency required for registration purposes (HCPC 2013). Such radiographers will have theoretical underpinning knowledge and be able to perform a standard head CT examination, assist with CT examinations of the spine, chest and abdomen in acute trauma, and contribute effectively to other CT studies (HCPC, 2013). Local training on equipment, additional techniques and protocols is required to supplement the undergraduate competence. 

Nuclear medicine technologists, who make up a large percentage of the workforce, may have no previous or recent training and experience in CT (Griffiths& Dawson 2015). They are able to apply for entry to the Register of Clinical Technologists (RCT) which is a Professional Standards Authority Accredited Register managed by the Institute of Physics and Engineering in Medicine (IPEM), the Association of Renal Technologists (ART) and the Institute of Healthcare Engineering and Estate management (IHEEM). Standards for entry to the Register are defined by Scopes of Practice, which for nuclear medicine technologists do not currently cover x-ray production, CT scanning, anatomy and pathology and radiation protection relevant to diagnostic radiology procedures outside the nuclear medicine examination (RCT 2016).

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