IAEA Human Health Series

The Quality Management Audits in Nuclear Medicine (QUANUM) programme has proven to be applicable to many nuclear medicine services across a variety of economic circumstances. It considers the diversity of nuclear medicine practices around the world and covers multidisciplinary contributions. The present revision, QUANUM 3.0, follows the principle of continuous quality improvement and reflects new scientific developments. It draws on valuable lessons learned from more than a decade of global implementation of QUANUM with the assistance of experienced nuclear medicine professionals.

Medical imaging is crucial in a variety of medical settings and at all levels of health care. In public health and preventive medicine as well as in both curative and palliative care, effective decisions depend on correct diagnoses. This edition addresses the most current needs and offers guidance on clinical practice, radiation safety and patient protection, human resource development and training required for the overall practice of nuclear medicine.

This publication examines the special characteristics of the pathophysiology of coronary artery disease (CAD) and its clinical presentation in women, which differ from those of men. While coronary obstruction and multi-vessel disease are more common in men, non-ischemic heart disease (IHD) best encompasses the spectrum of the disease in women. The publication provides a critical review of the existing literature, covering some general aspects of the disease as well as how to make a diagnosis/prognosis of IHD, both clinical and by means of cardiac imaging. The specific situation of cardiac imaging in the management of IHD in low- or middle- income countries is surveyed. In addition, reference is made to cardiotoxicity and radiotherapy-induced disease in breast cancer.

Fluorodeoxyglucose (FDG) has proven benefits as a positron emission tomography (PET) radiopharmaceutical in oncology. However, it has limitations in the assessment of certain tumours, above all (but not only) prostate cancer. Therefore, several non-FDG PET radiopharmaceuticals have been introduced into the clinical arena over the last few years, and this trend will continue to spread. The use of PET/CT with different PET radiopharmaceuticals that tailor to the type of tumour and biologic process that needs to be assessed is part of personalized precision medicine. The objective of this publication is to provide a case-based way of understanding normal biodistribution, variants, and pitfalls, including several examples of typical patterns for the main indications for each of the new non-FDG PET radiopharmaceuticals. This should facilitate the interpretation of images to support accurate diagnosis. This Atlas will allow professionals interested in non-FDG PET/CT imaging to embrace the variety of oncological imaging by providing clinically relevant teaching files on the effectiveness and diagnostic quality of non-FDG-PET/CT imaging in routine applications.

This publication provides a framework for the quality control (QC) of radiographic and mammographic imaging systems using remote and automated tools. The methodology provided in this publication is designed to be easy to implement, in order to support initiation of remote/automated QC programmes. It is based on simple, inexpensive test objects and promotes collection of data in a uniform, harmonized manner allowing for intercomparison and benchmarking. These tests are not intended to replace the comprehensive performance evaluation of the radiographic systems by a CQMP. They can, however, detect deficiencies in system performance before they become clinically significant. Furthermore, frequent QC testing promotes a culture of quality in imaging.

Single photon emission computed tomography (SPECT) has been used in routine diagnostic applications and in research since the 1980s. In the following decades, as the clinical application of hybrid imaging has grown, SPECT–computed tomography (SPECT–CT) has demonstrated improved patient management and become fully integrated in the routine diagnostic approach to a variety of clinical indications, including both oncologic and non-oncologic diseases. This IAEA Human Health Series publication presents a review of the published data from recent applications of SPECT–CT across nine different clinical scenarios including neurology, orthopaedics, endocrinology and cardiology, to demonstrate the variety of hybrid imaging in nuclear medicine and support decision making when allocating resources in the health care system. It provides a relevant source of information for nuclear medicine physicians, radiologists and clinical practitioners.

This publication provides a general overview of interventional radiology (IR). It presents an evidence-based rationale for establishing, improving and maintaining an IR service consistent with current clinical knowledge benchmarks. A summary is provided of necessary elements for the establishment of an IR clinical service and to ensure its sustainability. The publication includes information on specific challenges faced especially but not uniquely in emerging nations, as well as a defined list of expert recommendations. Safety and quality standards are emphasized in addition to necessary funding, human resources, education, training and certification/recertification, as well as involvement of the main professional societies.

Accurate measurement of radiation dose received by patients undergoing radiotherapy or medical imaging is essential for ensuring effective and safe healthcare. Equally, accurate measurement of radiation dose is required to guide employers in protecting their workforce from the harmful effects of ionizing radiation. Secondary Standards Dosimetry Laboratories (SSDLs) are specialist laboratories used to provide calibration and guidance for end users in hospitals and industry. This publication provides detailed technical information for countries on how to establish an SSDL, including planning processes, cost estimates and timelines. The technical descriptions and guidelines may also be helpful to existing SSDL radiation metrology staff when upgrading calibration facilities or purchasing new equipment.

While the use of positron emission tomography–computed tomography (PET–CT) is a standard of care in oncological practice in many developed countries, it is still limited in many low to middle income nations. To make reliable information more widely available, the IAEA convened an expert consultant group to review, based on the most recent developments of PET radiopharmaceuticals, Human Health Series No. 9, Appropriate Use of FDG-PET for the Management of Cancer Patients. This, the resulting publication, provides up to date recommendations on the optimal use of PET–CT imaging procedures in oncology. It is written for policy makers and decision makers who allocate resources dedicated to the health care system, a critical issue in the development of nuclear medicine in low and middle income countries. It will also benefit medical imaging practitioners as well as referring physicians.

A quality health service, as defined by the World Health Organization, ‘is one which organizes resources in the most effective way to meet the health needs of those most in need, for prevention and care, safely, without waste and within higher level requirements’. As health care standards improve globally, providing an optimal service that meets international standards and public expectations requires effective quality management. The process of quality improvement aims at defining, measuring and setting quality standards, and overcoming the associated challenges that include rising costs and skills shortages. The objective of this publication is to provide a framework for quality management systems (QMSs) to be implemented, managed and sustained holistically in nuclear medicine departments. It builds upon the IAEA’s QUANUM program, which has successfully been implemented in more than 80 countries worldwide.

Medical X-ray equipment technology has evolved exponentially in the last decades, shifting steadily from analogue to digital radiology, from single slice to multidetector-row computed tomography or from fluoroscopy to complex angiography systems. This, however, comes with associated radiation risk for patients and staff. It is therefore vital that all X-ray equipment is monitored in terms of performance to ensure accurate and safe use. Quality control (QC) represents the basic level of managing safety and quality in diagnostic radiology. This publication compiles all existing QC tests in literature for all X-ray modalities. To facilitate the use of this handbook, spreadsheets and video tutorials have been developed to help with the execution of tests.

Digital mammography offers fundamental advantages over film-based mammography. These include the possibility for acquiring quality images at lower radiation dose image recording, processing and archiving as well as the use of artificial intelligence for improving diagnostic outcome. Other practical advantages include cost reduction, use of environmentally friendly technology, and the option of obtaining remote expert diagnostic opinion. Image quality in mammography is critical. A switch from screen-film technology to a digital system is preferable only if high quality images can be guaranteed. This publication provides guidance on the establishment of digital mammography facilities and the upgrade of existing facilities. It focuses on planning, designing and operating the high quality mammography service within available resources.