SUMMARY FOR RADIOLOGISTS

Michelle Mujoomdar; Erin Russell; François Dionne; Kristen Moulton; Christine Murray; Sarah McGill; Kimberlee Lambe

Warning: The NCBI web site requires JavaScript to function. more...

NCBI Bookshelf. A service of the National Library of Medicine, National Institutes of Health.

Mujoomdar M, Russell E, Dionne F, et al. Optimizing Health System Use of Medical Isotopes and Other Imaging Modalities [Internet]. Ottawa (ON): Canadian Agency for Drugs and Technologies in Health; 2012.

Cover of Optimizing Health System Use of Medical Isotopes and Other Imaging Modalities

Optimizing Health System Use of Medical Isotopes and Other Imaging Modalities [Internet].

Show details

Contents

< PrevNext >

SUMMARY FOR RADIOLOGISTS

Key Findings for Radiologists

The optimal allocation of ^99mTc in the event of a supply disruption requires the consideration of local context.
Through the use of the CADTH web-based prioritization tool, the unique characteristics of a facility or organization can be considered in the production of a customized prioritization list.
If there is no alternative for a particular clinical use, then that use would be, by default, a priority and should be excluded from the prioritization process. CADTH identified five clinical indications for which there was no reliable alternative to ^99mTc-based imaging. You may have more at your institution — in particular, if certain imaging modalities are not available to you.
By using the CADTH web-based tool, users are provided with an evidence-based method to consistently make informed resource allocation decisions.
The national guidance final report contains an example of a prioritization list, which has been informed from a national perspective. For a context-specific prioritization list, the web-based tool should be used.
The web-based tool provides users with the ability to inform emergency preparedness protocols, which can be called upon in the event of a supply disruption.
By selecting multi-criteria decision analysis (MCDA), CADTH has provided users with a tool that was developed using explicit and transparent methodology.

The following is based on the Canadian Agency for Drugs and Technologies in Health (CADTH) report Optimizing Health System Use of Medical Isotopes and Other Imaging Modalities.

Technetium-99m (^99mTc) is the radioisotope used in approximately 80% to 90% of nuclear medicine procedures and is integral for imaging various clinical indications. Molybdenum-99 (⁹⁹Mo), the precursor to ^99mTc, is produced at major nuclear reactors globally. Due to their ages, the reactors are experiencing an increasing number of scheduled (for maintenance) and unscheduled shutdowns and, because of this, ⁹⁹Mo is subject to unplanned supply disruptions.

The use and allocation of ^99mTc in facilities comes under pressure when supply disruptions occur, so how do you decide where ^99mTc should be used in a facility with many diagnostic needs? How do you determine what the most suitable alternative to using ^99mTc is, or if there even is one? How do you optimize the use of ^99mTc in the health system, while still recognizing the variation in needs and available equipment in each facility and organization?

To address these questions, CADTH carefully reviewed the available research and assembled a national panel of experts to help provide some answers. In particular, CADTH:

worked with the Medical Isotopes and Imaging Modalities Advisory Committee^* (MIIMAC) to identify a list of common clinical uses of ^99mTc.
with the guidance of MIIMAC, identified which clinical uses of ^99mTc had suitable diagnostic imaging alternatives, and identified those options.
produced a prioritization list for the use of ^99mTc, from a national perspective.
developed a web-based tool to allow users to generate customized priority lists guided by evidence and expert opinion, which are unique to the user’s context.

A list of uses, which are included in the web tool as possible clinical uses of ^99mTc, are provided in Table 1. The order in which the clinical uses appear does not reflect priority.

Table 1Clinical Uses of ^99mTc Included in Multi-Criteria Decision Analysis

Detection of ischemia

Assessment of prognosis post-myocardial infarction

Preoperative assessment prior to vascular, non-cardiac surgery

Implantable cardiac defibrillator decision-making

Assessment of drug-induced cardiotoxicity

Evaluation of renal function — post-transplant

Evaluation of renal function — suspected obstructive uropathy (in children and adults)

Evaluation of renal function — renovascular hypertension

Diagnosis of acute osteomyelitis (in children and adults)

Evaluation of painful prosthesis (loosening and infection)

Imaging for metastatic disease (breast, lung, and prostate cancer)

Diagnosis of avascular necrosis

Diagnosis of fracture (osteoporotic and stress)

Detection of lower gastrointestinal bleeding

Diagnosis of acute cholecystitis

Assessment of bile leak

Detection of pulmonary embolism

Identification of the sentinel lymph node in patients with breast cancer

Table 2^99mTc Clinical Uses Excluded from the Multi-Criteria Decision Analysis Due to Lack of Reliable Imaging Alternatives

Evaluation of reflex sympathetic dystrophy

Diagnosis of Meckel’s diverticulum in pediatric patients

Imaging suspected cases of brain death

Diagnosis of acute pyelonephritis in pediatric patients

Evaluation of the limping child (excluding suspected cases of abuse)

For complete reports and intervention tools on this topic, please visit www.cadth.ca.

This summary is based on the Optimizing Health System Use of Medical Isotopes and Other Imaging Modalities report.

Footnotes

*: The Medical Isotopes and Imaging Modalities Advisory Committee (MIIMAC) consisted of representatives from health professions, institutions, regions, ministries of health, the public, and experts in scientific research and methodology. This committee was convened specifically to provide advice to CADTH on a project that led to a guidance document on the optimization of health system use of medical isotopes and other imaging modalities. MIIMAC provided guidance that considered the outputs and impact of CADTH work in meeting the needs of the Canadian health care system.

Except where otherwise noted, this work is distributed under the terms of a Creative Commons Attribution-NonCommercial- NoDerivatives 4.0 International licence (CC BY-NC-ND), a copy of which is available at http://creativecommons.org/licenses/by-nc-nd/4.0/

Bookshelf ID: NBK174856

Contents

< PrevNext >

PubReader
Print View
Cite this Page
Mujoomdar M, Russell E, Dionne F, et al. Optimizing Health System Use of Medical Isotopes and Other Imaging Modalities [Internet]. Ottawa (ON): Canadian Agency for Drugs and Technologies in Health; 2012. SUMMARY FOR RADIOLOGISTS.
PDF version of this title (13M)

Other titles in this collection

CADTH Optimal Use Reports

Recent Activity

Clear Turn Off Turn On

SUMMARY FOR RADIOLOGISTS - Optimizing Health System Use of Medical Isotopes and ...
SUMMARY FOR RADIOLOGISTS - Optimizing Health System Use of Medical Isotopes and Other Imaging Modalities
Homo sapiens cDNA FLJ46472 fis, clone THYMU3023400
Homo sapiens cDNA FLJ46472 fis, clone THYMU3023400
gi|34535648|dbj|AK128330.1|
Nucleotide

Your browsing activity is empty.

Activity recording is turned off.

Turn recording back on

Bookshelf

Optimizing Health System Use of Medical Isotopes and Other Imaging Modalities [Internet].

SUMMARY FOR RADIOLOGISTS

Key Findings for Radiologists

Table 1Clinical Uses of 99mTc Included in Multi-Criteria Decision Analysis

Table 299mTc Clinical Uses Excluded from the Multi-Criteria Decision Analysis Due to Lack of Reliable Imaging Alternatives

Footnotes

Views

Other titles in this collection

Recent Activity

Table 1Clinical Uses of ^99mTc Included in Multi-Criteria Decision Analysis

Table 2^99mTc Clinical Uses Excluded from the Multi-Criteria Decision Analysis Due to Lack of Reliable Imaging Alternatives