Regulación de los servicios de medicina nuclear: percepción de la problemática y desafíos para el manejo del cáncer en Colombia

Introduction:

Colombia has modified the nuclear medicine norms that impact the administration of radioactive iodine therapy in the treatment of thyroid cancer.

Objective:

To identify the areas of agreement regarding the issue, as well as the current and emergent requirements associated with the normative for the operation of nuclear medicine services that have an impact on the care of patients with thyroid cancer in Colombia.

Materials and methods:

We conducted a two-round Delphi study for each expert, clinical, and regulatory group. The first round explored views on the implications of the regulations that apply to nuclear medicine. The second round rated the statements from the first round by their relevance.

Results:

The issues regarding nuclear medicine services were related to the normative clarity and the lack of synergy and coherence among inspection, surveillance, and control bodies. The demands on the waste management system require a high economic investment that can influence the service offer and have an impact on the integral control of thyroid cancer. Unification of the auditors’ criteria, delimitation of the acting agent functions, technical assistance to the services to comply with the normative, and the oversight of the inspection, surveillance, and control bodies by the regulatory entities are among the current and future needs.

Conclusions:

Our findings suggest that nuclear medicine services are going through a time of multiple institutional, regulatory, and economic challenges that put at risk the development and maintenance of nuclear medicine in cancer care.Key words: Thyroid neoplasms, nuclear medicine, radioactive waste, radioisotopes, health services

La medicina nuclear utiliza radionúclidos con fines diagnósticos y terapéuticos para detectar y tratar tumores y enfermedades benignas. En el contexto de la oncología moderna, esta especialidad involucra el uso de elementos radiactivos para evaluar las funciones corporales, determinar el diagnóstico y el tratamiento, así como la conjunción de los dos (“teragnóstica”) ¹. Hay una gran variedad de radiofármacos utilizados en la medicina nuclear, pero en la mayoría de los procedimientos se recurre al tecnecio 99m (Tc^99m) y al yodo radioactivo (I¹³¹) ².El cáncer de tiroides es la neoplasia endocrina más común (1,0-1,5 %), y es la quinto más frecuentemente diagnosticada en mujeres, con un incremento continuo en su incidencia mundial en los últimos 30 años ³. En el cáncer diferenciado de tiroides, el tratamiento con I¹³¹ se administra con tres propósitos: como tratamiento ablativo para eliminar tejido tiroideo residual sano después de una tiroidectomía; como tratamiento adyuvante para tratar la enfermedad residual microscópica, y como dosis terapéutica para tratar la enfermedad macroscópica o metastásica ⁴. Dependiendo del tipo de tratamiento, los pacientes sometidos a terapia con I¹³¹ son hospitalizados en habitaciones especiales, con el fin de controlar la irradiación a otros pacientes, familiares y cuidadores ⁵.Al igual que en muchos países, en Colombia las habitaciones utilizadas para la terapia con yodo radioactivo están ubicadas en instituciones especializadas de prestación de servicios de salud ⁶, las cuales están sujetas a inspecciones por parte de los organismos de inspección, vigilancia y control de la seguridad radiológica y nuclear. En el último quinquenio, las autoridades nacionales competentes en materia nuclear han modificado las normas que permiten prestar servicios de medicina nuclear debido a las exigencias en el otorgamiento de autorizaciones para el empleo de fuentes radiactivas y la gestión de los desechos radiactivos liberados en el suelo, los cuerpos de agua o los sistemas de recolección de aguas residuales por medio de la orina y las excretas del paciente o la descarga de desechos líquidos hospitalarios ⁷.Dicha regulación está ajustada a las directrices del Organismo Internacional de Energía Atómica (OIEA), del cual Colombia es miembro. Para honrar los compromisos adquiridos con este organismo en torno a una seguridad nuclear que proteja la salud humana, el país estableció desde el 2002 un marco regulador fundamental para el uso seguro de material radiactivo ⁸. En el

Conformational plasticity of ADAMTS13 in hemostasis and autoimmunity

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