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Annual Scientific Meeting of the Canadian Organization of Medical Physicists — July 9–12, 2014, The Banff Centre, Banff, Alberta, Canada

A Practical Guide To Setting Up A Remote Dose Calibrator Audit

Remote auditing can give a nuclear medicine department a reliable way to review dose calibrator performance without sending an assessor to every site. A well-designed programme checks measurement accuracy, constancy, records, staff practice and corrective actions through secure document exchange, video observation and targeted follow-up. Learn more about A Walking History Tour Of Banff Avenue For Delegates.

The approach is particularly useful for organisations with clinics spread across Australia, from metropolitan hospitals in Sydney and Melbourne to regional services in Queensland, Western Australia and Tasmania. Travel, staffing constraints and different local procedures make a consistent remote model valuable, provided it is built around evidence rather than informal assurances.

A dose calibrator audit should support radiation safety and clinical quality systems. It does not replace required acceptance testing, routine quality control, physicist review or regulator expectations. Instead, it creates a repeatable framework for confirming that each facility is performing those activities properly and responding when results fall outside defined limits.

The most effective programmes are proportionate. A high-volume PET service may need more frequent review than a small diagnostic nuclear medicine unit, while a site with a new radionuclide calibrator or recent relocation may require an early focused audit. Clear scope, standardised records and respectful communication make the process practical for both auditors and local teams.

Establish Governance And Scope

Begin by defining who owns the programme, who can approve an audit report and who is responsible for closing findings. The governance document should identify the lead medical physicist, the site radiation safety officer, the equipment owner and the person authorised to accept corrective actions. It should also set the audit cycle, escalation pathway and rules for handling patient, staff and commercially sensitive information.

Set the scope before requesting evidence. A typical review covers the dose calibrator model and serial number, installation records, constancy testing, accuracy and linearity checks, geometry testing, background measurements, source certificates, maintenance history and action limits. Include the local procedure for measuring radiopharmaceutical activity, especially where the result affects administered activity or waste records.

The programme should distinguish between a remote document review and a remote observation. Some controls, such as a current calibration certificate, can be verified from records. Others, such as correct positioning of a syringe, use of shielding and entry of radionuclide settings, may require a live video session or a carefully recorded demonstration. State these expectations in the audit invitation so the site can prepare without staging an artificial performance.

Build A Defensible Evidence Set

Evidence needs to be traceable to a specific instrument, date and operator. Ask for controlled copies or read-only exports rather than screenshots where possible. A useful submission includes the latest test results, the approved procedure, equipment history, training records and a sample of completed worksheets from different operators and radionuclides.

Review the data for patterns rather than isolated values. A single result within tolerance may conceal a gradual drift, a recurring transcription error or an instrument that is tested correctly only after a problem has been noticed. Check whether failed or borderline results were investigated, whether repeat measurements were justified and whether the final decision was recorded by an appropriately authorised person.

Protect information throughout the exchange. Use an approved document portal, apply retention rules and remove patient identifiers unless they are essential. Confirm how recordings from a remote session will be stored and deleted. Australian organisations should align the process with their privacy obligations, hospital information-security policy and any relevant requirements set by state or territory radiation regulators.

Prepare The Remote Visit

A remote visit works best when it follows a written agenda. Send the evidence request at least two weeks ahead, conduct a short technology check, and provide a list of people who should attend. The auditor should have access to a stable camera, a second device if required, and a method for showing instrument displays, labels, source certificates and relevant procedures clearly.

Use the live session to test understanding, not simply to watch a performance. Ask the operator to explain how the correct radionuclide is selected, how the assay container is positioned and what action follows an out-of-range result. If the site has several calibrators, select one or two records in advance and ask the team to retrieve them during the session.

A concise remote-visit checklist keeps the assessment consistent:

  • Confirm the instrument identity, location and current service status
  • Observe background and constancy testing where appropriate
  • Verify source identification, certificate details and expiry information
  • Review how results, exceptions and corrective actions are recorded
  • Check staff access to current procedures and training evidence

Document any limitation immediately. Poor camera resolution, unavailable source certificates or an inability to observe the test should be recorded as limitations, not silently treated as compliant evidence. A follow-up recording, additional document or targeted on-site check may be needed.

Validate Equipment And Measurement Quality

Dose calibrator performance should be considered across the tests required by the manufacturer, local policy and applicable professional guidance. Constancy testing shows short-term stability, while accuracy, linearity and geometry assessments address different failure modes. The audit should confirm that the site understands the purpose of each test rather than treating quality control as a collection of administrative ticks.

Pay attention to radionuclide-specific practice. Settings for technetium-99m, fluorine-18, iodine-131 and other commonly used materials must be selected correctly, and the assay container should match the geometry validated by the department. Review whether the site has assessed unusual volumes, different syringe types or altered vial configurations when these could influence the reading.

Trend analysis is especially valuable in a remote model. Ask for a plot or spreadsheet covering a meaningful period, with instrument changes and service events marked. Investigate step changes after repairs, repeated borderline values and gaps that coincide with staff turnover or public holidays. In Australia, a regional service may also need a practical contingency plan when a physicist or service engineer cannot travel quickly.

Do not use remote auditing to create arbitrary universal tolerances. Acceptance limits should be justified by the applicable procedure, equipment documentation, professional guidance and the clinical risk of the measurement. Where a result is outside tolerance, the report should identify whether the concern is immediate, requires investigation or can be managed through routine monitoring.

Manage Australian Operations

A national programme must account for local geography and operating conditions. A service in Brisbane may have different courier arrangements and ambient-temperature concerns from one in Hobart, while a remote Western Australian clinic may face longer delays for replacement sources or engineering support. Record these factors in the risk assessment without allowing them to weaken the required control.

Use Australian time zones and public holidays when scheduling remote sessions. A meeting planned for Australian Eastern Standard Time can be inconvenient for Perth staff, and daylight-saving changes may affect sites in New South Wales, Victoria, South Australia and Tasmania. Confirm the time zone in every invitation and allow enough time for local staff to retrieve records before the call.

Professional engagement also matters. Invite the local medical physicist, nuclear medicine technologist and radiation safety contact to participate, and explain how findings will be classified. If the programme is associated with a professional meeting or education event, social opportunities can help build trust; delegates attending the archived Banff programme, for example, could consult the accommodation information while planning their travel and networking arrangements.

The report should distinguish a documentation gap from a technical failure. A site may perform a sound test but use an outdated form, or it may have complete records that reveal a genuine instrument problem. Those situations require different actions, owners and deadlines. Clear language reduces defensiveness and improves the chance that the remote audit leads to lasting improvement.

Report Findings And Sustain Control

Issue the draft report promptly while the evidence is still familiar. Each finding should state the requirement, observed evidence, risk, classification and agreed action. Include the responsible role and due date rather than naming an individual unless that is necessary for accountability. Give the site an opportunity to correct factual errors before the report becomes final.

Classify findings consistently. Critical issues might include an unverified calibrator used for patient doses or a failed test with no documented response. Major findings could involve overdue testing, incorrect radionuclide settings or incomplete investigation of a trend. Minor findings may relate to document control or training records that do not indicate an immediate measurement risk.

Track closure through an action register. Accept objective evidence such as a revised procedure, completed training record, service report, repeat test or approved risk assessment. A finding should not be closed merely because the site states that the issue has been fixed. Schedule a focused remote review for significant actions and an on-site assessment when the risk cannot be adequately verified online.

A useful programme also measures itself. Monitor overdue actions, repeat findings, average closure time, technology failures and the proportion of audits requiring escalation. Share anonymised lessons across the network so that one facility’s experience can improve practice elsewhere. Informal professional contact, including a delegate walking history tour, can support the relationships that make quality conversations more open and constructive.

Build the first cycle around a manageable pilot of two or three sites. Refine the evidence request, test the scoring method and record what could not be verified remotely. Then expand gradually, retaining the same core criteria while allowing risk-based additions for PET, therapy or high-throughput services.

Start with a controlled pilot, a secure evidence channel and a clearly defined escalation process. Bring the relevant physicists and technologists together for a short orientation session, using an informal icebreaker event where suitable to establish rapport before technical reviews begin. A disciplined remote programme can then provide credible oversight, support safer dose measurement and make specialist auditing more accessible across Australia.