RE: Who Doses the Patient?

["Vernig, Peter G." <Peter.Vernig@med.va.gov>]

I have resisted answering because the only address was the list or what
appeared to be a medical physics list.  We do not necessarily have a Dr.
present when patients are dosed.  When I first got here, with very little
medical HP experience the Chief of Nuclear Medicine asked me if I wanted to
go up and dose the patient who was receiving a 100 mCi I-131 dose under the
old rules.  I was appalled and said no.  Dragged a Radiology Resident up
with me.  Was the patient any better off because that Resident was in the
room?  We don't do a whole lot of therapy.  Maybe 3, I-131 high dose; 3,
SR-89; and perhaps 10, low dose I-131 in a year.  The Techs do the latter
two and I do the high dose and the doctor is not necessarily present.  BUT
HE IS RESPONSIBLE!  He signs the written directive.  We are responsible for
making sure the dose gets into the right patient and is what was prescribed.

The doctor who is the authorized user is frequently present, may have
consented the patient just prior but if he isn't, he isn't.  If I or the
Techs have any questions we are going to page him before administration of
the dose.

In other areas of treatment, say chemotherapy are the doctors that prescribe
the dose necessarily present when it is administered?  We're much more
concerned that we have a Cardiologist present when we administer diperidimol
[sp?] thallium-201.  Diperidimol is a chemical stimulant which stesses the
heart in lieu of treadmill exercise that some patients may have trouble
with.  For that matter we want one present when they do the treadmill of a
normal "stress thallium".

What are the adverse outcomes that the doctor's being their will alleviate?
Only one I've heard of is vomiting, which thankfully I've been spared.
While it would be an ugly mess to clean up, I don't think the Dr. is going
to do anything the ward personnel or I can't do.

This is my own opinion only and does not necessarily reflect that of my
employer.
 
Peter G. Vernig,
VA Medical Center, Denver
peter.vernig@med.va.gov

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