Nuclear medicine physicians work under a tight legislative framework with frequent inspections and visits from agencies such as the Environment Agency (EA), Medicines and Healthcare products Regulatory Authority (MHRA) and ARSAC.
Departments must be led by a substantive consultant with an ARSAC certificate.
In addition, some centres have ISO 9001 accreditation and recognition from the European Union of Medical Specialists (UEMS)/European Board of Nuclear Medicine.
Diagnostic imaging for nuclear medicine and PET-CT can be assessed and accredited by the UK Accreditation Service (UKAS) against Imaging Services Accreditation Scheme (ISAS) standards, which have now been recognised by the Care Quality Commission (CQC).
Departments undergo regular inspection visits to ensure compliance with a range of legal requirements, including:
- the safe handling and administration of radioactive materials
- selection of the correct radiopharmaceutical for the correct investigation
- provision of a safe environment for staff and patients.
Feedback from these inspections improves the quality and safety of services. Before a new test or treatment can be introduced a licence must be obtained; this can only happen if the consultant applying for the licence can show adequate training. This is specified in Administration of Radioactive Substances Advisory Committee (ARSAC) guidance (opens PDF, 1.2MB) from January 2016.
By law each administration must follow a protocol, which, though locally derived, is based on guidelines issued by the BNMS, the EANM or the SNMMI, as appropriate. UK nuclear medicine physicians are very active in writing and revising these guidelines.
Patient satisfaction surveys are performed on a regular basis within nuclear medicine providing an insight into how services can be improved. The BNMS performs a peer organisational audit of a nuclear medicine department. This has a safety aspect looking at compliance with legislation but also provides feedback concerning any improvements in practice.
At the request of the British and Irish Neurologists-Movement Disorders (BRING-MD) Group, the BNMS is conducting an audit of 123 I-ioflupane (DaTSCAN) imaging undertaken in the UK and in Ireland. In addition, 10% of PET-CT studies commissioned by NHS England undergo external audit with feedback directly to the reporter, a system which is unique in imaging in the UK and ensures an equitable standard. The above occur in addition to the general requirements to maintain the standards required for revalidation and continuous professional development, which applies to all consultants.
Nuclear medicine specialists regularly take part in discrepancy meetings and in multidisciplinary team meetings. Quality improvement initiatives are undertaken by use of a number of tools including the BNMS version of QUANUM, the Imaging Services Accreditation Scheme (ISAS) or iCEPPS, a recently developed accreditation standard and quality improvement tool commissioned by the Academy for Healthcare Science.
The BNMS website has more information about education, training and integrated research in clinical practice.