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Aplicação do Controlo Estatístico do Processo para a Monitorização da Dose Administrada em Exames de Medicina Nuclear PET/CT
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Nas últimas três décadas, o desenvolvimento tecnológico e evolução computacional
impulsionaram um progresso e expansão notáveis da imagiologia médica, com uma crescente
aposta dos serviços clínicos em tecnologias de elevada complexidade. Entre estas, destacam-se
as técnicas que aplicam radiação ionizante, como a técnica multimodal de Medicina Nuclear
Tomografia por Emissão de Positrões com Tomografia Computorizada (PET/CT), que tem
vindo a revolucionar o mundo da imagiologia oncológica, através da sua contribuição na
resposta às necessidades de prevenção e diagnóstico desta patologia.
Nas técnicas de imagem de Medicina Nuclear, o paciente é administrado com um composto
radioativo, designado por radiofármaco. Erros na preparação do radiofármaco podem resultar
na administração de uma atividade incorreta ao paciente. De acordo com a Comissão
Internacional de Proteção Radiológica, a dose administrada deve ser tão baixa quanto
razoavelmente praticável, sem comprometer a qualidade da imagem médica.
Neste sentido, a presente dissertação tem como objetivo demonstrar a importância da
integração do Controlo Estatístico do Processo nos serviços de Medicina Nuclear, constituindo
uma arma poderosa na identificação, controlo e prevenção das causas que originam erros na
atividade administrada, com base na investigação de um estudo de caso – o Serviço de
Medicina Nuclear do Hospital Garcia de Orta. De forma a atingir este objetivo, foram aplicadas
cartas de controlo para (1) monitorizar a atividade do radiofármaco
2-deoxy-2-[fluorine-18]fluoro-D-glucose, (2) monitorizar os dias de exame, por forma a
comparar o desempenho dos mesmos. Por fim, (3) foi desenvolvida uma Interface Gráfica do
Utilizador, para a sua utilização
in loco. As abordagens de monitorização desenvolvidas
constituem ferramentas importantes de apoio à tomada de decisão, aquando da deteção de
fontes de variação que comprometem o desempenho expectável do processo.
In the last three decades, technological development and computational evolution have driven remarkable progress and expansion in medical imaging, with an increasing focus of clinical services on highly complex technologies. Among these, the techniques that apply ionising radiation stand out, such as the multimodal technique of Nuclear Medicine Positron Emission Tomography with Computed Tomography (PET/CT), which has been revolutionising the world of oncological imaging, due to its contribution in meeting the needs of prevention and diagnosis of this pathology. In Nuclear Medicine imaging techniques, the patient is administered with a radioactive compound, called radiopharmaceutical. Errors in the preparation of the radiopharmaceutical can result in an incorrect activity being administered to the patient. According to the International Commission on Radiological Protection, the administered dose should be as low as reasonably achievable without compromising the quality of the medical image. Therefore, this dissertation aims to demonstrate the importance of the integration of Statistical Process Control in Nuclear Medicine services, being a powerful weapon in the identification, control and prevention of the causes that lead to errors in administered activity, based on the investigation of a case study – the Nuclear Medicine Service of the Hospital Garcia de Orta. In order to accomplish this objective, control charts were applied to (1) monitor the activity of the radiopharmaceutical 2-deoxy-2-[fluorine-18]fluoro-D-glucose, (2) monitor the examination days, so that performance could be compared. Lastly, (3) a Graphical User Interface was developed for in loco deployment. The monitoring approaches developed consist of important tools to support decision-making, by detecting sources of variation that compromise the expected process performance.
In the last three decades, technological development and computational evolution have driven remarkable progress and expansion in medical imaging, with an increasing focus of clinical services on highly complex technologies. Among these, the techniques that apply ionising radiation stand out, such as the multimodal technique of Nuclear Medicine Positron Emission Tomography with Computed Tomography (PET/CT), which has been revolutionising the world of oncological imaging, due to its contribution in meeting the needs of prevention and diagnosis of this pathology. In Nuclear Medicine imaging techniques, the patient is administered with a radioactive compound, called radiopharmaceutical. Errors in the preparation of the radiopharmaceutical can result in an incorrect activity being administered to the patient. According to the International Commission on Radiological Protection, the administered dose should be as low as reasonably achievable without compromising the quality of the medical image. Therefore, this dissertation aims to demonstrate the importance of the integration of Statistical Process Control in Nuclear Medicine services, being a powerful weapon in the identification, control and prevention of the causes that lead to errors in administered activity, based on the investigation of a case study – the Nuclear Medicine Service of the Hospital Garcia de Orta. In order to accomplish this objective, control charts were applied to (1) monitor the activity of the radiopharmaceutical 2-deoxy-2-[fluorine-18]fluoro-D-glucose, (2) monitor the examination days, so that performance could be compared. Lastly, (3) a Graphical User Interface was developed for in loco deployment. The monitoring approaches developed consist of important tools to support decision-making, by detecting sources of variation that compromise the expected process performance.
Descrição
Palavras-chave
Controlo Estatístico do Processo Cartas de Controlo Tomografia por Emissão de Positrões Tomografia Computorizada Medicina Nuclear Erros de Administração