About AANMS

The AANMS (Australasian Association of Nuclear Medicine Specialists ) is the peak body representing nuclear medicine and molecular imaging in Australia and New Zealand. The Association was formerly known as the Australian and New Zealand Association of Physicians in Nuclear Medicine (ANZAPNM).

Ordinary Members of the AANMS must be actively practising nuclear medicine, and must be Fellows of either the Royal Australasian College of Physicians (RACP) or the Royal Australian and New Zealand College of Radiologists (RANZCR).

The AANMS has a range of objectives that include: promotion and advancement of the practice of nuclear medicine and molecular imaging, the development and delivery of practice and training site accreditation programs, research coordination, training and CPD program development, trainee support, referrer education, representation of the specialty at Commonwealth and State levels and close involvement in all matters concerning the sustainability of nuclear medicine and molecular imaging, including liaison with a range of organisations such as ANSTO and the Australian and New Zealand Society of Nuclear Medicine (ANZSNM).

In supporting quality nuclear medicine and molecular imaging, the AANMS's Members and Fellows follow a Code of Conduct.

The AANMS is a not-for-profit organisation and is governed by a Board that is elected biannually by the membership. A copy of the Association's Constitution can be viewed here


SPECIAL ACCESS SCHEME CATEGORY C- INFORMATION and FORMS - Download AANMS advice to members

Further information about the Special Access Scheme arrangements that apply for the radiopharmaceutical substitution effective 17 September 2019 can be found below.  The substitute radiopharmaceuticals have been included on the relevant TGA list and part of the TGA's contribution to addressing the current technetium shortage has been to fast-track placing some radiopharmaceuticals on the TGA Special Access Scheme Category C list.

Special Access Scheme (SAS) Category C

The TGA's Special Access Scheme: Guidance for Health Practitioners and Sponsors Version 1.1 September 2017 (available here) sets out the process for notifying the TGA of the use of a substitute radiopharmaceutical.  The notification process, which appears on page 18 of this guidance document, is also set out below (see text in BLUE).

The Category C Codes referred to in the notification process are set out on pp 2-7 of the SAS Category C form. The relevant codes for the radiopharmaceutical substitution are on p 3 of the form (i.e. the specific code should be used rather than the boxes for medicine, biological or device).  The SAS Category C form may be found here (Word) and here (PDF).

The following radiopharmaceuticals are currently  on the Category C list of products:

F-18 NaF (sodium fluoride), injection, intravenous

F-18 myocardial perfusion trace (18F flurpiridaz), injection, intravenous (Note: this product is not yet available in Australia, but may be available later this year)

Gallium-68 (Ga-68) Galligas, Aerosol, Inhalation

Galliium-68 (Ga-68) MAA, injection, intravenous

The AANMS has also asked for Ga-68 EDTA to be added to the SAS Category C Codes as this unfortunately was omitted in the initial changes. We will advise when this occurs.

The following is copied from the guidance notes for notification of the use of one of the substitute radiopharmaceuticals (page 18) under the current Radiopharmaceutical Substitution Arrangements (extract):

Notification process

The prescribing health practitioner or someone acting on their behalf (e.g. pharmacist) needs to complete and submit the SAS Category C form available on (the TGA's) website after the unapproved therapeutic good has been supplied through the SAS Category C pathway. The form does not need to be completed before the good is supplied or to effect the supply of the product.

Prior approval is not required before unapproved therapeutic goods used in accordance with the 'rules' of the legislative instruments can be accessed. However, a copy of the completed Category C form must be sent to the TGA within 28 days of the therapeutic goods being supplied. Failure to do so is an offence and carries a financial penalty.

A copy of the completed form should also be kept with the patient's medical record.

It is the notifying prescriber's responsibility to ensure they meet the legislative and regulatory requirements associated with the SAS Category C pathway.

Supplying unapproved therapeutic goods in a manner that is not in accordance with the 'rules' of the legislative instruments such as using a product on the instrument for an indication different to that on the instrument may constitute an offence and attract penalties.

Using the Category C form

·  The form is completed by an appropriate health practitioner (the submitter) and submitted to TGA. The submission may be done on behalf of the treating health practitioner (e.g. a pharmacist may submit the form on behalf of a medical practitioner) or the treating health practitioner may complete and submit the form themselves (thus also acting as the submitter). In either case, only a single signature - from the person submitting the form (the submitter) - is required.

·  To reduce administrative burden while also enhancing compliance, the paper form requests a code to be used in place of describing the good and the conditions of supply. The codes, which match the entries on the legislative instruments, are located on the back of the form.

·  If the unapproved good, indication, and health practitioner do not all match an entry for a code on the back of the form, this pathway cannot be used. You may potentially still be able to access this good for the particular indication through one or more of the existing unapproved therapeutic goods schemes, including: SAS Category A, SAS Category B (application) or the Authorised Prescriber Scheme.

Document Links

TGA's Special Access Scheme: Guidance for Health Practitioners and Sponsors Version 1.1 September 2017

Special Access Scheme Category C form (Word)

Special Access Scheme Category C form (PDF)

Legislative Instrument and accompanying Explanatory Statement (Note:  these two documents have been circulated previously on 16 September 2019)


RADIOPHARMACEUTICAL SUBSTITUTION:  JOURNAL ARTICLES - Download AANMS advice to members

Further to our advice on 16 September that the Commonwealth Department of Health has approved a number of substitution MBS items, to apply initially for three months during the current technetium supply crisis, please see the following links to abstracts/papers that may be of assistance to those practices able to use substitute tracers.  These are:

68Ga PET/CT Ventilation-Perfusion Imaging for Pulmonary Embolism: A Pilot Study with Comparison to Conventional Scintigraphy *

68Ga MAA - Investigations into a potential PET Lung Perfusion Agent (Paper attached here)

Please also find linked here the SNM NaF bone scan procedure guidelines approved by the Board of SNM 4 June 2010 and published in JNM Vol.51, No 11, November 2010, which have also been endorsed by EANM.

I am also including a link to the abstract for:  Ga-68 EDTA Renal Imaging (Seminars in Nuclear Medicine 2016) *, although please note that this substitution has not been approved by the Department of Health at this time.

The AANMS is pressing for substitutions for renal and infection imaging to be included in the substitution arrangements and is in continuing discussions with the Department of Health on this and related matters.

I would like to thank Prof Michael Hofman from Peter MacCallum Cancer Centre (PMCC), Melbourne, for assisting with references to these papers.

The AANMS will also be working with radiochemists and will disseminate information about manufacturing substitute PET items when this becomes available.

Kind regards

Paul Thomas FRACP FAANMS

President

* If you would like a copy of these articles emailed to you, please advise the Secretariat.

 



22 SEPTEMBER 2019 UPDATE: Urgent Advisory - Tc-99m Generator Supply - Download update

Working Group members were advised by ANSTO on Saturday morning (21 September) that the expected shipment of Mo-99 from NTP (South Africa), that would have been used in generators made today (Sunday) for Monday delivery for most (Tuesday for some), had been cancelled due to lower than anticipated yields from the South African production run out of the Safari reactor. No new Mo-99 was expected to arrive in Australia over the weekend.

The Working Group held an urgent meeting late yesterday with representatives from the NSW Ministry of Health and GMS to discuss the situation for the first few days of the coming week (W/C 23 Sep).

The only Tc-99m that will be available will be that obtained from the generators currently at GMS in the metropolitan areas (i.e., last week's generators) and the small amounts remaining in any generators in regional and rural practices. No generators will be manufactured this weekend and no generators will be distributed to GMS or regional practices in the first part of the coming week.

The Working Group have advised GMS that the priority in metropolitan areas should be to supply radiolabelled products that are to be used in the preparation for subsequent imminent treatments, i.e., radiolabelled colloid for sentinel lymph node studies, radiolabelled MAA for lung scans and SIRT workup, TcO4- for radiolabelling of RBCs for Gated Heart Pool Scans in chemotherapy, etc. In addition, there is a limited supply of Tl-201 available for urgent myocardial perfusion scans (surgical work-up, etc).

GMS have advised that each capital city radiopharmacy have slightly different levels of available Tc-99m and supply procedures and metropolitan practices will be advised as to what sites will be able to order. A small amount of bulk TcO4- may be available sufficient for any of the after-hours services provided.

The situation may improve in the second half of the week if the next shipment from NTP South Africa is delivered, which would be manufactured and distributed from around Wednesday. Details of this proposed extra shipment will be released as soon as we are informed.

At this stage ANSTO still does not have any update on when the ANM facility will come back on line.

We will keep you informed as we continue to meet and receive updates.

NB: This document contains advice given by the Working Group of AANMS/ANZSNM/RAINS to GMS to help prioritise distribution of Tc-99m in the current situation.

AANMS / ANZSNM / RAINS

 


 

Technetium-99m shortage - Radiopharmaceuticals Substitution Available From Tuesday, 17 September 2019

On Saturday 14 September, six temporary items were added to the Medicare Benefits Schedule (MBS) to allow patients to have continued access to common nuclear medicine diagnostic imaging services during the shortage in supply of Technetium-99m (Tc-99m).

Expanding access to these additional services will assist in making more technetium-99 available to those facilities without PET cameras, which will be especially helpful to the smaller practices and those in rural and regional areas.

The items will be eligible for patient rebates from Tuesday 17 September 2019 and will be available for an initial period of three months.

These parallel items use PET and/or alternative radiopharmaceuticals to provide equivalent diagnostic imaging services.  The items have the same request arrangements (i.e. can be requested by any medical practitioner, including GPs) and schedule fee as the items on which they were modelled.

The Department has prioritised in this substitution plan the most common nuclear medicine diagnostic imaging services affected by the shortage.  The AANMS will continue its discussions with the Department in relation to substitution for other nuclear medicine services, notably for infection and renal imaging, and it is hoped they will also be added to the substitution arrangements in the near future.

You can find details of the arrangements, including the substitution item descriptors, in the AANMS's update to members sent on 16 September 2019.

You can also download a copy of the Legislative Instrument detailing the substitutions, and the accompanying Explanatory Statement.

 


Infective Endocarditis Symposium, 26 October 2019, Brisbane

The inaugural Infective Endocarditis Symposium will be held on Saturday, 26 October at The Prince Charles Hospital, Brisbane.  Speakers will include national and international experts in cardiology, medical imaging, cardiac surgery, infectious diseases and pharmacology.  Early bird registration closes on 20 September 2019; standard registration closes on 25 October 2019.  For more information, visit the Symposium website at:  https://metronorth.health.qld.gov.au/tpch/events-meded/infective-endocarditis-symposium.  A flyer, program and registration form for the Symposium can also be downloaded from the links below:

IE Symposium Flyer

IE Symposium Program

IE Symposium Registration Form


ANZBMS Clinical Densitometry Course:  19 and 20 October 2019, Brisbane

The next ANZBMS Clinical Densitometry Course will be held in Brisbane over 19 and 20 October 2019 at QUT Kelvin Grove Campus, Victoria Park Road, Kelvin Grove.  Registration is open until 20 September 2019 unless all places are filled prior to this date; late registration may be open from 21 September to 4 October (final deadline).  A brochure with information about the Course and registration details can be downloaded from this link.  Please see the ANZBMS website for full information.

 


Nuclear Medicine Training Sites for 2019 and 2020

The list of accredited training sites for 2019 can be found here.  The list of accredited training sites for 2020 can be found here.

Prospective trainees should check with the training committee, the Committee for Joint College Training in Nuclear Medicine (formerly known as the Joint Specialist Advisory Committee [JSAC]) in Nuclear Medicine of the RACP and the RANZCR to ensure that their proposed training site will meet their training requirements. The JCTC can be contacted via the RACP at nuclearmedicine[at]racp.edu.a


TECHNICAL STANDARDS FOR PET ACCREDITATION

The ANZSNM's Requirements for PET Accreditation (Instrumentation & Radiation Safety) 2012, 2nd Edition, are available here.


REMINDER FOR NUCLEAR MEDICINE SPECIALISTS: PET TRAINING and CREDENTIALLING

Nuclear medicine specialists who intend to do training in positron emission tomography (PET) must ensure that they submit an application for prospective approval of their PET training to the Committee for Joint College Training (JCTC) in Nuclear Medicine of the RACP and the RANZCR.

All PET training must be prospectively approved by the JCTC in order for this training to be accredited. Following completion of accredited PET training, the nuclear medicine specialist must then apply for credentialling for PET in order that Medicare payments can be made to patients for PET services.

To enquire about prospective approval of PET training and obtain the relevant forms, please contact the RACP at NuclearMedicine[at]racp.edu.au or phone 02 8247 6279.

Following completion of PET training, specialists must also ensure they obtain credentialling for PET in order that Medicare payments can be made for their PET services. For PET credentialling queries, please see the following:

Information for PET credentialling

Application form for PET credentialling


INFORMATION FOR REFERRING DOCTORS AND PATIENTS

Information prepared by the AANMS for doctors requesting nuclear medicine procedures and for patients referred for either a nuclear medicine procedure or for nuclear medicine therapy can be found at the following links; each leaflet can be downloaded in a version for mobile devices and a version for printing/desktop.

Referrer Information

2014_ref_guide_icon_bluesmall

Referrer's Guide to Nuclear Medicine - version for mobile devices

Referrer's Guide to Nuclear Medicine - printable/desktop version

Patient Information

ptinfo_new_print_iconsmall Patient's Guide to Nuclear Medicine - version for mobile devices

Patient's Guide to Nuclear Medicine - printable/desktop version

 


therapy_new_print_iconsmall Nuclear Medicine Therapy Guide - version for mobile devices

Nuclear Medicine Therapy Guide - printable/desktop version.


Please note that we do not provide medical advice or referrals to specialists (please read the disclaimer).

Please note: To avoid attracting spam mail robots, email addresses on the AANMS website are written with [at] instead of the usual @ symbol, and "mail to" links have been removed. Please replace [at] with the @ symbol to get a valid address.


 

 
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