D. A. López et al.: Radioprotection 2025, 60( 4), 318 – 327 319
in their practices and, it is esential part for the patient safety in a quality management system( IAEA Safety Standards Series No. SSG-46, 2018; Renha et al., 2022; IAEA, 2023), including medical physics and nuclear medicine related profesionals.
To address these gaps, ALFIM’ s 2022-2025 Strategic Plan( ALFIM 2023a), developed by its Continuing Education and Training Committee( ALFIM-CETC), provides a framework for advancing education and accreditation in medical physics. This includes a comprehensive manual outlining the requirements for accrediting courses, collaboration with international organizations, and stringent ethical data management and privacy standards( ALFIM, 2023b). These efforts aim to ensure high-quality, and accessible continuing education across the region, including radiation protection issues for medical physicists but also for related health professionals, considering that several studies have shown their knowledge deficit on these issues( Housni et al., 2023; Bayatiani, Farzanegan, and Seif 2023; Rincón, González, and Sánchez. 2024; Alomairy 2024). However, this could be difficult to set up, especially in small countries with limited means or in large countries with a low population density, requiring long travel to attend such courses, specially considering the Latin- American and Caribean scenario described before. In that case,“ a distance learning aproach” system may be a good answer to these difficulties and a cost-effective alternative( Azlan et al., 2020; Tabakova, 2020; Delungahawatta et al., 2022; Ibbott et al., 2022; Kavuma et al., 2023; Varkey et al., 2023).
Nuclear medicine( NM) procedures account for 1.9 % of the total medical imaging procedures; however, their contribution to the collective effective dose represents 8.6 %, resulting in an average effective dose of 0.12 mSv per caput( UNSCEAR, 2022). Nuclear Medicine plays a vital role in clinical practice, with increased procedures and advancements in radiopharmaceuticals and multimodality imaging( O’ Brien and Mankoff, 2024). Latin American countries also show an increase in nuclear medicine studies and equipment, mainly hybrid technologies and PET radiopharmaceutical production( Orellana et al., 2021; Peix et al., 2022). This growth points to the need for an exposure optimization process and also to Diagnostic Reference Levels( DRLs) establishment, considering the international recommendations( IAEA, 2022, 2023). Even when DRLs are included in the regulatory requirements, implementation remains limited in many countries for various reasons, such as lack of resources, in particular clinically qualified medical physicists( CQMP), insufficient awareness of the importance of optimization of nuclear medicine professionals, insufficient cooperation among key stakeholders( Faj et al., 2023). The DRLs in NM account for 7 % of reported in the literature and paediatric DRLs < 12 % of it( López et al., 2023). Furthermore, Latin American( LA) countries show only a few reports about the use of diagnostic reference levels, only 4 % of reports about DRL originate from this region( López et al., 2023).
For that reason, the first initiative under ALFIM educational strategy was to develop an asynchronous virtual course titled " Reference Levels for Diagnosis in Nuclear Medicine," which delivered via YouTube and Google tools to provide cost-free training for multidisciplinary teams, focusing on establishing Diagnostic Reference Levels( DRLs) in nuclear medicine.
This study evaluates the first course’ s effectiveness by analyzing participant engagement, learning outcomes, and feedback, aiming to assess its impact on addressing the educational needs of medical physicists and related health professionals while identifying opportunities for improvement and the strength of this continuous education approach.
2 Materials and methods
The course titled " Reference Levels for Diagnosis in Nuclear Medicine " was accredited by the Institutional Review Board of ALFIM-CETC, with accreditation codes SFC-ALFIM-2401 and SCF-ALFIM-2402, dated 18 / 02 / 2024. It had two primary objectives:( 1) to provide participants with essential theoretical knowledge( Part 1) and( 2) to offer an optional practical component aimed at developing skills in establishing Diagnostic Reference Levels( DRL) in Nuclear Medicine( Part 2). The course was officially announced through the member societies of IO, the IO website, and its social media platforms. These channels were utilized to ensure broad dissemination and accessibility of information to potential participants. The study procedures follow the ethical standards outlined in the Declaration of Helsinki. Informed consent was obtained from all participants through Google Form questionnaire, who agreed that their course performance and the survey could be utilized for educational research purposes and the quality assessment improvement process.
2.1 Course Design and Delivery
The course employed a distance learning methodology primarily based on asynchronous activities tailored for nuclear medicine professionals. The theoretical component consisted of five recorded lectures and two supporting materials, all available on the IO official YouTube channel. Each video included lecturer notes, instructional guidance, and recommended reading materials( Tab. 1, Part 1). To foster interaction, four live discussion sessions were scheduled, allowing participants to share insights and results.
All course materials were accessible via Google Drive, supporting self-paced learning. The theoretical component was assessed through a 15-question Google Form quiz based on lecture content. Participants had two attempts to complete the quiz. given the substantial differences in regulatory and educational frameworks across countries in the region, the theoretical content and primary bibliography were based on recommendations from international professional organizations, particularly the IAEA Basic Safety Standards and the ICRP recommendations( Vañó et al., 2017; IAEA Safety Standards Series No. SSG-46, 2018; IAEA, 2023), supplemented with additional references. Participants were instructed to research, study, and apply national regulations to develop theoretical knowledge and practical skills and to integrate them dynamically into the practical component of the course. This approach aimed to bridge the gap between students’ understanding of international recommendations and their specific regulatory context.