THE SNMMI-TS NEWSLETTER
Volume 19 No. 2
March/April 2013
SNMMI-TS is dedicated to the advancement of molecular and nuclear medicine technologists by
providing education, advocating for the profession, and supporting research to achieve clinical
excellence and optimal patient outcomes.
Appropriate Use Criteria in Practice Today
By Mary Beth Farrell, MS, CNMT, NCT, FSNMMI-TS
H
opefully, most people have heard of
appropriate use criteria (AUC) and
can appreciate their benefits in the
field of nuclear medicine. AUC are developed by professional societies for several of
the commonly performed diagnostic imaging
procedures.
The basic premise of AUC assumes that diagnostic imaging procedures are performed
only when necessary and when likely to produce useful information for managing the
patient. AUC help guide physician decisionmaking about when and how often to do an
imaging study by identifying patients who
will most appropriately benefit from having a
procedure done from those who will not. The
ultimate goal of AUC is to make sure the right
patient receives the right test at the right time.
The inaugural set of nuclear medicine AUC
was published in 2005 for cardiology. Currently, AUC are available for cardiac radionuclide imaging including SPECT, PET and equilibrium radionuclide studies; cardiovascular
CT; cardiovascular magnetic resonance; and,
echocardiography.1-5
SNMMI, along with the Alzheimer’s Association, released AUC for amyloid brain imaging
in January of this year.6 The American College
of Radiology also has many published AUC for
radiologic and nuclear medicine procedures.7
The criteria represent typical clinical scenarios or indications for why a specific test may
be performed. The criteria are ranked from 9
to 1, with 9 being the most appropriate and 1
being the least appropriate. The indications are
grouped into three categories: “appropriate”
(ranked 9 - 7), “uncertain” (ranked 6 - 4) and
“inappropriate” (ranked 3 - 1).
Indications designated as “appropriate” suggest use of a study is generally acceptable and
a reasonable approach. Indications designated
to be “uncertain” may be acceptable and a reasonable approach, but evidence or experience
is insufficient to definitively be categorized.
Indications designated as “inappropriate” are
generally not a reasonable approach. (Fig 1)
A more thorough explanation of how the
cardiac radionuclide criteria were created and
SNMMI-TS In the Big Easy
2
Advocacy Corner
3
SNMMI-TS Elections
4
Choosing Wisely
5
VOICE Box
5
Nuclear Cardiology
6
Annual Meeting
7
how to apply them was previously published in the Uptake, Vol 17, No. 3.8
More recently, a continuing education
article titled, “Understanding Appropriate Use Criteria in Nuclear Medicine”
was published in The Journal of Nuclear
Medicine Technology in June 2012.9
Both of these documents contain examples of patient scenarios designated
as “appropriate,” “uncertain” and “inappropriate.” In addition, they explain
some of the terms and concepts nuclear
medicine technologists may not be fa-
Continued on page 3, see Appropriate Use Criteria
Message from the President
By Brenda King, CNMT, FSNMMI-TS
I began my term as SNMMI-TS president with great
FSNMMI-TS, current president-elect of the Technoloexpectations. My goals of reaching out to other profesgist Section. Scott, Ann Marie Alessi, BS, CNMT, NCT,
sional societies, assisting in creating new career pathRT(N), immediate past president, and I—along with
ways for the imaging professional, and engaging in
many others on the leadership team—have started the
conversations with international peers are coming into
strategic planning process for the next 5-10 years and
focus. These far-reaching goals may not all be completed
beyond for the SNMMI-TS. This is a very exciting proBRENDA KING, CNMT,
FSNMMI-TS
by the end of my leadership year, but the door has been
cess. By including stakeholders from industry, research,
opened. I know that many will choose to step forward
optical imaging, education, management, and advanced
and nurture the seeds that have been planted.
practice, as well as students, leadership and staff, we can stretch
When you read this article, I will have only a few more
our collective imagination to the sky.
months until the torch is passed to Scott Holbrook, BS, CNMT,
The Nuclear Medicine Week 2012 campaign was used to focus
Continued on page 2, see Message from the President
Message from the President continued from page 1
on YOU. This initiative’s goal was to highlight what you do every day to impact patients’
lives. We must continue to educate our patients and our community regarding our
industry and how it is vital to their lives. Develop a “10-second elevator speech.” Begin
your conversation with each patient by providing your name and stating that you are a
certified/licensed molecular imaging professional. It is important that we project pride in
our profession. We do make a difference every day in our patients’ lives.
The nuclear medicine portion of the Image Gently® and Image Wisely® campaigns
were launched at RSNA 2011 and 2012 and supported by our colleagues around the
world to demonstrate that nuclear medicine and molecular imaging respects the patient’s
concerns on risk and benefits. The recommended and published guidelines for the pediatric and adult patient will allow us all to move towards consensus on imaging protocols
and dosing. Check out www.imagegently.org and www.imagewisely.org for more information on how you and your facility can image gently and wisely.
The Choosing Wisely® initiative was also recently launched in February. This initiative was instituted by the American Board of Internal Medicine Foundation and was
designed to help physicians, patients and other health care stakeholders think and
talk about the best use of health care resources. SNMMI has joined this campaign; you
can see SNMMI’s list of “Five Things Physicians and Patients Should Question” at
www.snmmi.org/choosingwisely.
If the last six months are as exciting as the first six months of this leadership term,
I will have some great memories! I have forged some wonderful relationships with so
many of my peers from the east coast to the west coast, on the international stage and
in my own chapter. Let’s continue our work together, marching onward into the undiscovered waters of the future! n
Editorial Board
Jacqueline Allen, CNMT
Bryan Kerr, CNMT, PET, NCT, R.T.(N)(CT) (ARRT)
David J. Perry, CNMT, PET, FSNMMI-TS
Patty Reames, R.T.(R) (ARRT), CNMT, NCT
Kathy Thomas, CNMT, PET, FSNMMI-TS, Chair
Jessica Williams, CNMT, R.T.(N) (ARRT)
Joyce Zimmerman, CNMT
Issue Editor
Bryan Kerr, CNMT, PET, NCT, R.T.(N)(CT) (ARRT)
Managing Editor
Susan Martonik
Graphic Designer
Laura J. Mahoney
Uptake is published six times a year by SNMMI-TS. All
editorial communications should be directed to Kathy
Thomas at 360.241.8869 or ksthomas0412@msn.com
©2013 by SNMMI
SNMMI-TS in the Big Easy
By David Perry, CNMT, PET, FSNMMI-TS
T
he SNMMI 2013 Mid-Winter Meeting was held in New
Orleans, LA, starting with the Second Sino-American
Conference on Wednesday afternoon. There was a full
complement of CE programs on Thursday, including an all-day
program about PET/MRI. This group of sessions included lectures on MR physics, PET/MRI instrumentation, PET/MRI challenges and opportunities in cardiology and clinical applications
of PET/MR. SNMMI continued with programs on Friday, Saturday and Sunday and the SNMMI-TS sponsored technologist-focused programs on Saturday and Sunday. Technologist-focused
courses included Technologist How-To: Improving PET Imaging in Clinical Research; Coding and Reimbursement and PET
Imaging Sensitivity in Oncology; An Evening with Cardiology:
Past, Present and Future; and New PET Pharmaceuticals in Brain
Imaging.
As is the custom, the SNMMI-TS also held some governance
meetings in conjunction with the Mid-Winter Meeting. The National Council of Representatives (NCOR) was gaveled into session on Friday by Speaker Michael Kroeger, MIS, NMAA, PET,
NCT. Once introductions and other formalities were completed,
the group went to work. Ann Marie Alessi, BS, CNMT, NCT,
RT(N) (ARRT), chair of the Nominating Committee, announced
that there will be three candidates for president-elect for the
SNMMI-TS. She also announced a full slate of candidates for
the other open positions, not always an easy task. Look for your
ballots and please vote in early April.
2
This was followed by recognition of the 16 Leadership Academy graduates from this year’s class. Members of the NCOR also
elected five new SNMMI-TS Fellows, who will be presented with
their honors at the SNMMI Annual Meeting in Vancouver, British
Columbia, Canada. The CE Committee presented revised VOICE
guidelines for approval. The revisions are intended to streamline
the approval process for new programs and activities. Also during
the NCOR meeting, Kathy Hunt, MS, CNMT, FSNMMI-TS, presented a PET scope of practice and practice guidelines document
for approval and Brenda King, CNMT, FSNMMI-TS, SNMMI-TS
president, presented a PET/MR white paper for approval. Look
for all three of these documents to be posted on the www.snmmi.
org soon.
The NCOR held a number of breakout sessions to discuss current issues important to the membership including regulations and
reimbursement, membership and leadership development, education and the job market. You will hear more about those from the
leadership in future issues of Uptake.
We cannot have an article about a meeting in New Orleans without a little bit about the city. The Super Bowl was in town and
preparations were in full force during the meeting, from decorations to trailers for all of the sports analysts to stages for concerts.
The Mid-Winter Meeting was also held just two weeks before
Mardi Gras. There were parades Friday and Saturday and I personally came away with over five pounds of beads for the kids. You
really missed out if you missed the meeting in New Orleans this
year! n
(Figure 1).
The inaugural set of appropriate use criteria for single photon
Appropriate Use Criteria, continued from page 1
miliar with, such as ischemic equivalent, pre-test probability and
coronary heart disease risk stratification.
To assist technologists in applying the criteria, there are several
websites with free, easy-to-use tools available to calculate appropriate use. One of the most robust tools was created by the American
College of Cardiology as part of its Formation of Optimal Cardiovascular Utilization Strategies (FOCUS) Innovation Community (www.
cardiosource.org/science-and-quality/quality-programs/imagingin-FOCUS.aspx). Astellas Pharma US, Inc., has an application for
both iPhones and android devices that guides facilities through the
process of determining whether cardiac radionuclide imaging is appropriate (www.asellasapps.com).
The Intersocietal Accreditation Commission (IAC) nuclear/PET
website also contains several webcasts explaining the AUC and
spreadsheets for tracking appropriateness of studies (www.intersocietal.org/nuclear/seeking/sample_qualitycontrol.htm).
Figure 1 – Appropriateness of Cardiovascular imaging ranking of indications
Usin
T
are c
in sy
asym
evalu
Table
Hendel, RC et al. J Am Coll Cardiol 2009;53:2201-2229
AUC in Practice
There are several practical considerations to be considered before
a facility incorporates the AUC into practice. First and foremost,
when is the best time to apply AUC to studies referred to a facility?
Ideally, they should be applied at the time of service or at the time
the study is ordered.
Another consideration is concern about the reaction from the referring physician if the study is not performed. An additional concern is related to the time, personnel and cost of implementing the
AUC into daily practice.
A recent study by the American Society of Nuclear Cardiology
and MedAxiom revealed that approximately half of their members
responding to a survey have not yet begun to measure appropriateness.10 Respondents indicated that it has not been more readily adopted due to limited knowledge, no AUC requirement by all payers
and/or accreditors and busy schedules.
In 2009, the IAC incorporated the measurement of appropriateness of imaging studies into all of its accreditation programs with
the goal of having facilities establish its baseline levels of appropriateness compared to published inappropriate study rates of 10-14
percent.11 computed
Nuclear cardiology
facilities
are required
to measure
apemission
tomography
(SPECT)
myocardial
perfusion
propriateness
at least once
duringbythethe
three-year
accreditation
peimaging
was published
in 2005
ACCF and
the American
riod in consecutive
for 1approximately
five percent
of their
Out of 52 clinical
scenarios,
27
Society
of Nuclear patients
Cardiology.
annual
volume
of patients.
were
rated
appropriate,
1212were rated uncertain and 13 were rated
Although some facilities were resistant at first, most of have come
inappropriate.
to realize
thatthe
application
of AUC
into daily
practice
notradionuas diffiIn 2009,
appropriate
use criteria
were
refinedisfor
cult orimaging,
time-consuming
as assumed,
and theyemission
have realized
benefits
clide
including
cardiac positron
tomography
relatedand
to monitoring
appropriateness.
(PET)
published again,
but this time with the involvement and
2
With a little
the AUC
are easy societies.
to use. They
beendorsement
of knowledge,
many additional
professional
Theare2009
coming more
in the
health care
arena and, it of
is
appropriate
usewidely
criteriaaccepted
comprised
67 common
indications—33
hoped,were
will begin
to play9an
increasingly
role in New
usewhich
appropriate,
uncertain
and prominent
25 inappropriate.
management.
indications
were added to the 2009 criteria for heart failure, atrial
There is some
indication
the application
of AUC
the resulfibrillation,
ventricular
tachycardia,
syncope
with and
high-coronary
tant decrease
in inappropriate
helped to decelerate the
heart
disease risk
and selected studies
elevatedhas
troponins.
13
growth
of advanced
studies.
Moving
healthimagcare
An example
of animaging
appropriate
indication
forforward,
radionuclide
professionals
providing
services
takecoronary
responsibility
ing
would be testing
doneimaging
on a patient
withmust
known
artery
for the studies
in assuring
that they are
appropriate.
disease
by priorperformed
catheterization
with worsening
symptoms.
The criForaffirm
a listthat
of references,
visit http://www.snmmi.org/docs/
teria
performingplease
radionuclide
imaging on a patient with
Uptake_References_March_April_2013.pdf.
this
clinical scenario is a reasonable approachnand likely to improve
the patient’s clinical outcome.
According to the criteria, an example of an inappropriate indication is performing testing on a patient without symptoms and less
than a year removed from a coronary revascularization procedure.
Radionuclide imaging for this reason is generally not acceptable.
Inappropriate use of cardiovascular imaging has the potential to be
harmful to patients and result in unwarranted radiation and costs
This
partcare
of reciprocity
to
thewas
health
system. legislation that would allow non-radiologic
technologists
(RTs),
licensed
as NMTs,
to perform
CT scans.
An example of an
uncertain
clinical
indication
is imaging
of a
Please
note,
this
legislation
will
not
allow
untrained
individuals
to
patient with a low to intermediate risk of coronary heart disease
perform
these
scans.
The
legislation
allows
the
state
to
recognize
the
with a coronary calcium Agatston score between 100 and 400. It’s
ARRT (CT)tocertification
NMTs anddesignation
the PET certification
for RTs
important
stress that for
an uncertain
for an indication
so that they can perform these studies.
Our SOP has also been used by both plaintiffs and defendants in
lawsuits. Some hospitals have successfully used the nuclear medicine SOP to allow their NMTs to inject adjunctive medications used
in the performance of nuclear medicine and molecular scans.
For many years, the SNMMI-TS has participated with other imaging and related societies to assure that all states license imaging
technologists by supporting the CARE bill. Unfortunately another
Congress ended without its enactment. During this next year, the
Hend
T
appl
defin
nary
tech
crite
T
orde
table
Figur
The SNMMI-TS Advocacy Committee and Its Importance to the Profession
By Lynne Roy, MBA, CNMT, FSNMMI-TS
O
ne primary role of all professional societies is to advocate
and promote the professionals that they serve. Simply put,
that role describes the mission of the Advocacy Committee
of the SNMMI-TS.
A profession is defined by its scope of practice (SOP). States use
SOP documents to allow professionals to perform the tasks that
they are trained to do. A SOP is broad, while the clinical performance standards are more detailed. For the past year, the SNMMITS SOP Task Force has been very busy updating our SOP to reflect
what is trained in accredited nuclear medicine schools and what is
commonly practiced.
Recently, Florida requested a PET-specific SOP document to craft
legislation so that non-nuclear medicine technologists (NMTs) who
were licensed as radiographers could perform PET scans in the state.
ADVOCACY CORNER
Hend
Continued on page 6, see Advocacy Corner
3
Everything You Wanted to Know About the SNMMI-TS Election
Process - But Didn’t Ask!
By Ann Marie Alessi, BS, CNMT, NCT, RT(N)
T
he SNMMI-TS 2013-2014 elections will soon be upon us
and, as chair of the Nominating Committee, I would like to
explain the election process with the hope of increasing voting response from YOU, our membership.
The process began in August with a “Call for Nominations”
eblast sent to the entire SNMMI-TS membership. Nominating Committee members and SNMMI staff quickly went to work soliciting
members within our organization who have shown the desire and
talents to lead the SNMMI-TS. The positions open for the 2013-14
national ballot were president-elect, secretary, Finance Committee
member and two technologist delegates-at-large. All candidates
must be active members of the SNMMI-TS, hold or recently have
held a national position, be endorsed by their chapter’s leadership
and—for the first three positions—obtain an employer letter of
support. Detailed qualifications for each position can be found on
the SNMMI website. “Call for Nominations” continued to be sent to
the SNMMI-TS membership during September and October.
Candidates nominated received a packet containing information on the roles, responsibilities, qualifications of the positions,
financial obligations, letters of support requests and the official format for their position statement and CV. In November and December, the Nominating Committee reviewed all candidate packets for
completeness, eligibility and potential conflicts of interest. At this
point, if we don’t have a full ballot we are forced to start actively
“encouraging” potential candidates to step forward! so that we
can present a full ballot to the SNMMI-TS NCOR and Executive
Board during Mid-Winter Meeting. This year we met that goal.
By the end of March a draft electronic ballot will be created
and reviewed in its entirety by the Nominating Committee for accuracy. The candidates will review their sections. It will then be sent
to a company called Survey and Ballot Systems (SBS) that generates
the actual electronic ballot which will again be reviewed by the
Nominating Committee before sending to the membership. Any
bylaws changes to be voted on will also be entered on the ballot.
This year, the SNMMI-TS national election will open on April
2 and close May 9 at midnight (ET). All eligible SNMMI-TS voting
members who have an email address on file will receive an email
from SBS with specific instructions and individual log-on information to vote. Please note: the log-in information provided is different
than your SNMMI member log-in. For voting members who do
NOT have an email address on file, or for members whose e-mail
bounced back, SBS sends a mailed letter to the address on file with
instructions on how to log-on to vote. Halfway through the elections (around mid-April) SBS will send a reminder email or letter
to all individuals who have NOT voted. The SNMMI staff will send
a reminder email to ALL voting members because we DO NOT
know who has already voted. I can assure you, there is COMPLETE
ANONYMITY in this process!
The staff DOES NOT know who voted or how they voted,
4
there are NO updates given by SBS throughout the process. The
Nominating Committee will be notified of the final results and any
feedback/comments provided by individuals at the end of the voting process.
I am disappointed to report that in the past voting response
from our membership has been extremely poor. Between the years
2005-2011, out of over 9,000 members eligible to vote, the average
voting response has been 8.20% (738 members). This is disheartening and sends the message that members DO NOT care, DO
NOT understand, or DO NOT pay attention to the online voting
process. If you think your vote does not count; you are mistaken!
This response is unacceptable and should NOT exist in a professional organization. Voting is a right and a privilege! The devoted
and talented candidates listed below have stepped up to the challenge of leadership; the least we can do is take the time to vote for
the candidate we feel will help move this organization and the field
FORWARD.
PLEASE TAKE THE TIME TO VOTE!
This notification shall serve as the official announcement of the
2013-2014 SNMMI-TS national election slate of candidates. The
following individuals have been approved:
President-Elect
• Mark H. Crosthwaite, M.Ed., CNMT, PET
• Elizabeth C. Hackett, RT(N), PET, RT(CT)(ARRT), FSNMMI-TS
• April Mann, BA, CNMT, NCT, RT(N)(ARRT)
Secretary
• Anthony W. Knight, MBA, CNMT, RT(N)(ARRT)
• Michele A. Panichi-Egberts, CNMT, FSNMMI-TS
Finance Committee Member (3-year term, serving as chair of Finance
committee in 3rd year)
• Dean L. Rice, CNMT, PET, BS
• James T. Timpe, MS, CRA, RT (N)(MR)(ARRT)
Delegate-at-Large (2 positions)
• Crystal Botkin, MPH, CNMT, PET
• Amy E. Brady, CNMT
• Joel H. Culver, CNMT
• Bryan R. Kerr, AS, CNMT, PET, NCT, RT(N)(CT)(ARRT)
• Anthony J. Sicignano, BS, CNMT, RT(N)(ARRT)
Continuing the Conversation about Choosing Wisely:
SNMMI Releases List of Five Unnecessary Tests or Procedures
O
n February 21, the Society of Nuclear Medicine and
Molecular Imaging (SNMMI) released a list of “Five
Things Physicians and Patients Should Question” in
nuclear medicine and molecular imaging as part of the Choosing
Wisely® campaign, led by the ABIM Foundation. The list identifies
five targeted, evidence-based recommendations that can support
physicians and patients in making wise choices about their care.
Below is SNMMI’s list; supporting points and references can be
found at www.snmmi.org/choosingwisely.
1. Don’t use PET/CT for cancer screening in healthy individuals.
2. Don’t perform routine annual stress testing after coronary artery
revascularization.
3. Don’t use nuclear medicine thyroid scans to evaluate thyroid
nodules in patients with normal thyroid gland function.
4. Avoid using a computed tomography angiogram to diagnose
pulmonary embolism in young women with a normal chest
radiograph; consider a radionuclide lung study (“V/Q study”)
instead.
5.Don’t use PET imaging in the evaluation of patients with
dementia unless the patient has been assessed by a specialist in
this field.
For several months, the SNMMI has been working on its list,
VOICE Box
carefully considering and reviewing the recommendations. To
create its list, SNMMI convened a working group consisting of
the SNMMI leadership, presidents of the SNMMI Brain Imaging, Cardiovascular, General Clinical Nuclear Medicine, Nuclear
Oncology, and Pediatric councils, and several at-large members.
The council presidents worked with their respective members to
identify examples of nuclear medicine procedures that may not be
used appropriately. Members who were not a part of the councils
were encouraged to submit their suggestions by email. After a list
was created, the working group determined the final “Five Things.”
Through the Choosing Wisely campaign and the publication of
this list, SNMMI is sparking a conversation between health care
providers and patients about the need—or lack thereof—for many
frequently requested and/or ordered tests or treatments. SNMMI
joined the campaign because it recognized that physicians have
a professional, moral and ethical responsibility to take the lead in
addressing these challenges. Our work doesn’t stop here. Over the
coming months and years, SNMMI will be working with the ABIM
Foundation, Consumer Reports and a variety of Choosing Wisely
campaign stakeholders to raise awareness of these lists and make
them accessible to patients and the public.
Learn more about Choosing Wisely at www.choosingwisely.org.
Michele Egberts, CNMT, FSNMMI-TS, Chair, SNMMI-TS Continuing Education Committee
2013 SNMMI Annual Meeting
VOICE Credit Online Application Submission
ver, British Columbia, Canada. Please make plans to attend this
dynamic meeting which will provide a wealth of information on
SNMMI-TS has moved to an electronic process for all non- emerging technologies. Our goal—from SNMMI’s strategic plan—
commercial VOICE applications. Printed applications will no is to provide educational programs that are essential to the proglonger be accepted. All sponsors of VOICE are required to sub- ress of nuclear medicine and molecular imaging. In addition to
mit applications for live and self-study activities electronically in social activities, exhibits, special workshops and plenary sessions,
By Peggy Squires, BS, CNMT, FSNMTS, and Laurie Mixon, BS, RT(R), CNMT
SNMMI’s CE Center (www.snmmi.org/cecenter). The submission technologists can look forward to many CE opportunities.
Over the course of the meeting 37.5 hours of technologist
process follows the same process as the current hard copy VOICE
continuing
education will be offered! The Technologist Section
application. A training/reference tool is available to sponsors at
program starts on Saturday, June 8, with three superb categoricals.
www.snmmi.org/cecenter.
Payment of the application fee by credit card (American Express, By popular demand, CE sessions will be offered Saturday evening
Visa, Mastercard) is required at the time the application is submit- immediately following the categorical seminars. The opening pleted. If you need to pay by check, please email Thomas Smoak, nary lecture will be held on Sunday, June 9, and the technologist
SNMMI associate program manager, at tsmoak@snmmi.org for tracks will conclude on Tuesday afternoon, June 11. SNMMI-TS
also reviews and approves the physician/scientist CE and scientific
instructions.
sessions for VOICE and VOICE+ credit—so you will have MANY
CEH choices each day!
SNMMI 2013 Annual Meeting, June 8-12, 2013
For a detailed program preview and to access the online meeting
The SNMMI Annual Meeting will be held in beautiful Vancouplanner, visit the SNMMI website: www.snmmi.org/am2013.
5
Managing a Specialty Area of Nuclear Medicine: Nuclear Cardiology
By Maria Mackin, BS, MS, CNMT, RT(N)(ARRT)
I
n recent years, there have been major changes in the specialty of
nuclear cardiology. As the manager of the nuclear cardiology laboratories at the University of Rochester Medical Center, where I have
been employed for the last 19 years, I never thought I would see such
drastic changes take place.
Pre-authorization by insurance companies for nuclear medicine
procedures that were later repealed for general nuclear medicine studies
but not nuclear cardiac testing, the technetium shortage, the “hyped”
information on radiation exposure and the decline in reimbursement
for nuclear stress tests have lead to a substantial decrease in the number
of nuclear cardiology studies performed across the country. The decline
of nuclear cardiology studies has had an impact on outpatient- and
hospital-based nuclear cardiology laboratories. The outpatient nuclear
cardiology laboratories have laid off nuclear medicine technologists
(NMTs) while expecting those who are left to do more with less. Other
practices have been sold to hospitals. Hospital nuclear cardiology laboratories have also succumbed to “downsizing” due to the lack of referrals, something I have experienced firsthand as a manager in nuclear
cardiology. Not only did my nuclear laboratories lose space, a camera
and other equipment, we lost staff through attrition and layoffs. A short
time ago, most NMTs held full time positions. This has changed considerably. Today many NMTs hold several part-time positions in outpatient
practices or hospitals and take call at other hospitals—all in a per-diem
status, receiving little or no benefits.
One could argue that the adaptation of the appropriate use criteria
has decreased the number of nuclear cardiology tests being performed;
however, it has proven to be an effective tool in decreasing the number
of unnecessary nuclear cardiology tests being performed as well decreasing truly unnecessary radiation exposure.
The new cadmium zinc telluride (CZT) technology has added new life
into nuclear cardiology imaging. Claustrophobic, obese and morbidly
obese patients who previously could not be imaged by the standard
sodium iodide crystal SPECT cameras can now be successfully imaged
with the CZT technology. This new population of patients presents
a new set of challenges, including patient and staff safety and a new
thought process of how to obtain the optimal image. The fact that medicines are keeping patients alive much longer presents other imaging
issues as these extremely ill patients are referred to nuclear cardiology
laboratories for imaging studies. The move toward a patient-centered
focus of care in nuclear cardiology has made the one-size-fits-all protocols no longer the standard of practice.
The facts can paint a pretty bleak and unsettling picture of nuclear
cardiology but there are always two ways of looking at a situation—is
the glass half empty or half full? I have chosen to look at the glass as
being half full. For managers with nuclear cardiology laboratories that
have been downsized, have lost staff or may have even taken a demotion, words cannot describe the feeling and worries associated with such
a loss. As unsettling as it is, one is forced to look at what you are left with
and how to make it all work as efficiently as possible.
Trying to manage all the changes and expectations from administrators and staff—in addition to keeping patient satisfaction high—can be
overwhelming at times. One of the most challenging aspects after downsizing was trying to keep myself, as well as the rest of the staff, positive
and focused on how to continue to move patients through the system
without our previous flexibility. Another challenge was how to keep the
remaining staff employed and motivated to broaden their skills within
their scope of practice. Following other nuclear cardiology laboratories
throughout the country, we began running the ECG monitor during
nuclear stress testing and have taken on other responsibilities that are
well within our scope of practice.
The recent purchase of the new CZT technology has made my job
both extremely exciting and more challenging. Due to the fast turnaround time in the imaging room, two technologists are constantly
needed; this is a huge plus for staff even though they are working much
harder. Imaging the morbidly obese patients for cardiac studies presents
other unique challenges with positioning and safety for the patient,
as well as staff. The exciting part of the new CZT camera is learning
something new and having to think about how to position the patient
to get the best quality images possible. New protocols based on the
patient’s medical history, weight and age are designed to assure that the
protocol fits the patient rather than attempting to fit a patient into a
pre-established protocol. This can make the schedule hairy at times but
overall patients are happy—especially if they only have to have one set
of images (stress first).
As a manager in a specialty area of nuclear medicine, it is always your
choice to see the glass as half empty or half full. n
Advocacy Corner continued from page 3
Advocacy Committee will focus its attention on obtaining nuclear
medicine licensing in states without such laws. After canvassing the
states without such legislation, the committee is looking at several
states which have enthusiastic TAG members and very supportive
nuclear medicine physicians.
The Advocacy Committee will also be developing a more userfriendly “Advocacy” landing page on the SNMMI website. Tools
and documents such as the SOP, clinical performance standards,
coding tips, position papers, etc. will be catalogued there for easy
access. We hope to have the reorganized web pages completed
by late spring. Also under development are educational tools that
nuclear medicine technologists can use to ensure better reimbursement from both CMS and private insurances.
6
Although many NMTs use unit doses, many others prepare radiopharmaceuticals from bulk technetium and use the Ultratag®
kit for tagging red blood cells. This is considered compounding
by USP <797>. There will be increased legislative scrutiny of compounding labs due to the unfortunate incident involving the meningitis outbreak and deaths from contaminated steroids produced
by a compounding center in New England. The Advocacy Committee will be monitoring national and state legislation to ensure that
nuclear medicine interests are not compromised.
If you would like to become more involved at the state level, we
urge you to consider being part of your state’s TAG team. If you
would like more information regarding legislative issues, please feel
free to email me at Roy@cshs.org. n
Education and Networking Abound in Vancouver
By Kathy Krisak, CNMT, FSNMMI-TS
T
his year’s SNMMI-TS Program Committee has been working
hard to create a meeting of the highest scientific and educational quality for the SNMMI 2013 Annual Meeting in Vancouver, British Columbia, Canada, June 8-12. Come and experience
the latest research across all modalities, presentations from leading
experts, countless networking opportunities, and one of the largest
exhibit halls.
Governance meetings begin prior to the Annual Meeting on
Thursday, June 6. Come get involved and see what it takes to make
our society a success. It is a great way to network with fellow technologists and to get involved with our profession.
Educational opportunities begin on Saturday June 8, with excellent categorical seminars. These sessions include Nuclear Medicine
2013: Back to Basics; Emerging Technology: Discover the Future;
and Nuclear Cardiology in 2013: Preparing for the Future. Additional educational sessions are being offered after the categorical
seminars to help maximize educational offerings for those members
who are unable to attend weekday sessions.
This year joint educational sessions have been organized with
a number of liaison organizations. On Saturday, June 8, there will
be a joint session with with the Conference of Radiation Control
Program Directors (CRCPD) focused on radiation exposure and a joint
session with the American Society of Nuclear Cardiology (ASNC) on
current trends in the nuclear cardiology lab. On Sunday, June 9, a joint
session will be held with the Intersocietal Accreditation Commission
(IAC) on quality improvement in the imaging lab; a second session
with the European Association of Nuclear Medicine Technologists
(EANMT) will focus on dose standards from country to country. On
Tuesday, June 11, a session will be held with the Section for Magnetic Resonance Technologists (SMRT) on PET/MR and a second
international session with the Canadian Association of Medical Radiation Technologists (CAMRT) will look at general nuclear medicine
in Canada. We have also partnered with SNMMI’s Clinical Trials
Network to offer some excellent sessions in clinical research in the
United States and Canada.
Additional sessions will include lectures from the Nuclear Medicine
Road show. These lectures have been designed to offer technologists
information to help address changes in technology (hybrid imaging),
regulatory changes, changes within procedures and changes within
career.
The continuing educations sessions, held Sunday, June 9, through
Tuesday, June 11, will cover several important aspects in our field
today. The program will emphasize the importance of personal and
professional growth, radiation safety, reimbursement, coding and
advocacy. Additional continuing education topics include oncology/
therapy, pediatrics, molecular imaging, and the Nuclear Medicine
Advanced Associate degree.
Once again we wrap up the educational meeting with the SNMMITS hosting the Technologist Party Tuesday, June 11. This year’s
theme is “Soul Tech Train.” If you plan to attend expect to have fun.
Please visit www.snmmi.org/am2013 for the most up to date meeting information including the online meeting planner and a listing
of events and networking opportunities. We are looking forward to
another successful meeting and hope to see you there!
SNMMI-TS Annual Meeting Session Highlights
Saturday, June 8
Monday, June 10
8:00 am - 4:00 pm
Emerging Technology: Discover the Future*
12:30 pm - 2:00 pm 2013 Nuclear Medicine Coding, Policy, and Reimbursement
8:00 am - 4:15 pm
Nuclear Cardiology in 2013: Preparing for the Future*
12:30 pm - 2:00 pm Techniques in Neurological Imaging I
8:00 am - 4:15 pm
Nuclear Medicine 2013: Back to the Basics*
12:30 pm - 2:00 pm Current Problems, Controversies, and Techniques in Nuclear Medicine 2013 - Part II
4:00 pm - 5:30 pm
Molecular Imaging - Part I
2:30 pm - 4:00 pm
Pediatrics Scintigraphy - Part I
4:30 pm - 6:00 pm
Discussions in Radiation Safety
2:30 pm - 4:00 pm
Cardiovascular - Part II: Where Could the Future Take Us?
4:30 pm - 6:00 pm
The Devil is in the Details in Nuclear Cardiology Imaging
2:30 pm - 4:00 pm
What You Didn’t Know about Clinical Research
4:30 pm - 6:00 pm
Sunday, June 9
Current Problems, Controversies, and Techniques in Nuclear Medicine 2013 - Part I
4:30 pm - 6:00 pm
Current Problems, Controversies, and Techniques in Nuclear Medicine 2013 - Part III
4:30 pm - 6:00 pm
The NMAA and Cardiac Stress Testing in the Nuclear Medicine Department - Perceived to Achieved
2:15 pm - 3:45 pm
Quality Improvement Plus Quality Control Equals Quality in the Imaging Laboratory
2:15 pm - 3:45 pm
PET/CT: The Dawning of a New Era - Part I
4:00 pm - 5:30 pm
Technologist Advocacy
4:00 pm - 5:30 pm
New Professionals Task Force - Advancing our Practice
4:30 pm - 6:00 pm Therapy/Oncology - Part I
Tuesday, June 11
9:00 am - 10:30 am Now That I’m a Nuclear Tech, What’s Next? Opportunities for Growth - Part II
4:00 pm - 5:30 pm Molecular Imaging - Part II
Monday, June 10
9:00 am - 10:30 am PET/MR: Taking the Mystery Out of MRI
10:00 am - 11:30 am Now that I’m a Nuclear Tech, What’s Next? Opportunities for Growth - Part I
2:45 pm - 4:15 pm
Clinical Research in Canada: The Tech Experience
2:45 pm - 4:15 pm
Techniques in Neurological Imaging II
2:45 pm - 4:15 pm
Current Problems, Controversies, and Techniques in Nuclear Medicine 2013 - Part IV
10:00 am - 11:30 am Cardiovascular - Part 1: Enhance Skills for Today’s Practice
10:00 am - 11:30 am PET/CT: The Dawning of a New Era - Part II
*Categorical
12:30 pm - 2:00 pm Therapy/Oncology - Part II
12:30 pm - 2:00 pm PET/CT: The Dawning of a New Era - Part III
7
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