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Rationale and Interim Guidance

Ionising radiation

Until the advent of SPECT/CT and PET/CT, CT scanners were only found in general diagnostic imaging departments and were operated by HCPC registered radiographers. 

The SCoR does not consider that it is efficient use of skills or scarce human resources to require both a radiographer and a nuclear medicine technologist to be present to initiate a CT (X-ray) exposure as part of a nuclear medicine procedure and supports the appropriate development of the scope of practice of nuclear medicine technologists to perform this aspect of their work. 

The SCoR will work with the nuclear medicine community, in particular, representatives from IPEM and the British Nuclear Medicine Society (BNMS).  A working party is proposed to develop the standards of education and practice required for nuclear medicine technologists to further broaden their scope of practice to perform CT Scans within nuclear medicine facilities as part of the patients’ nuclear medicine procedure.  For nuclear medicine technologists to perform “stand alone” CT scans for conventional diagnostic procedures, the standards of education and practice required should be  equivalent to that required of HCPC registered diagnostic radiographers. The Clinical Imaging Board will be appraised of this work.

Until these standards of practice are developed, nuclear medicine practitioners who are not radiographers and who are required to perform MDCT scanning as part of their  duties are referred to schedule 2, parts A and B, of IR(ME)R2000, (SI 2000/1059) and the National Occupational Standards for the production of CT images for diagnostic purposes.

http://www.legislation.gov.uk/uksi/2000/1059/schedule/2/made

 https://tools.skillsforhealth.org.uk/competence/show/html/id/1210/.  

These two sources will provide the legal requirements and associated guidance relevant to the knowledge and skills required to deliver a CT service in the context of diagnostic radiology.  Any locally developed training packages, including competency frameworks, would need to ensure that they meet the relevant requirements of Schedule 2 of IR(ME)R2000 (SI 2000/1059) as assessed by the employer. Nuclear medicine technologists could undertake CT scanning where and if they have evidence of appropriate education and training equivalent to that required of an HCPC registered diagnostic radiographer (HCPC 2013) , local achievement of CT competence, and entitlement by the IR(ME)R employer as an operator for CT scanning.  IR(ME) Regulation 7(7) requires the practitioner/operator to pay special attention to certain factors in the optimisation process. One such factor is high doses to the patient which is relevant to some CT scanning procedures (COMARE 16, 2014)On-site manufacturer supplied training, at installation of equipment using CT technology, does not provide the required depth of knowledge and competency required by the regulations.   This should be regarded as an introduction to system safety features and practical application for staff that can already evidence the core underpinning knowledge.

In addition, nuclear medicine technologists, in terms of conventional CT practice,  would also be required to comply with the Ionising Radiations Regulations 1999 (for example compliance with local rules; personal dosimetry; use of personal protective equipment and protection of comforter/carers). The Regulations can be accessed at:  

https://www.gov.uk/government/publications/the-ionising-radiation-medical-exposure-regulations-2000

and further information at 

http://www.hse.gov.uk/radiation/ionising/legalbase.htm

Drug administration 

The Human Medicines Regulations 2012 (SI 2012/1916) allows appropriately trained and competent, statutorily registered health care professionals to administer drugs utilising Patient Group Directions (PGDs).  ‘A PGD is a written instruction for the supply or administration of medicines to groups of patients who may not be individually identified before presentation for treatment’ (Care Quality Commission 2014). Radiographers may administer intravenous contrast agents for diagnostic CT scans using a PGD. 

A PGD cannot be used to administer radioactive medicinal products and, therefore, nuclear medicine technologists and radiographers administer radioactive medicinal products and adjunct drugs under exemptions (SI 2012/1916 s240).

The nuclear medicine technologist is not a statutorily registered healthcare professional and is therefore unable to use a PGD to administer drugs to patients for examinations not involving radioactive medicinal products.  

A Patient Specific Direction (PSD) is the traditional written instruction signed by a doctor, dentist, or non-medical prescriber for medicines to be supplied and/or administered to a named patient after the prescriber has assessed the patient on an individual basis. A PSD may be an instruction to administer medicine to a list of named patients where each patient on the list has been individually assessed by the prescriber.  There is no requirement to be a registered health care practitioner to administer medicines using a PSD.  

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