IN THE NAME OF
GOD
THYROCX
.
A RADIOACTIVE IODINE THERAPY MOBILE APPLICATION: PATIENT
EDUCATION, SIMULATION, E-RECORD AND E-PLANNING
BY N.KARAMZADE,
MD.
SHIRAZ UNIVERSITY
OF MEDICAL SCIENCES, RESEARCH COMMITTEE
CHRONIC DISEASE
• Thyroid cancer as a chronic disease need
• Regular follow up
• Ordered documents
• Enough Knowledge
A TREATMENT METHOD…
A DIAGNOSTIC METHOD…
Radioactive Iodine (
131
I) therapy
• Thyroid cancer
• Hyperthyroidism
IODINE RADIATION
• I-127 vs. I-131
•
Beta ray
606 KeV
Therapy
• Gamma ray
364 KeV
Diagnosis
• Ionizing Effect
RADIATION SAFETY
• Linear Non-Threshold model
Model for carcinogenicity of radiation
PRE-TREATMENT PERCUSSIONS
• Pregnancy:
• Fetus radiation
• Fetus thyroid uptake
• Lactation and breast feeding:
• Breast overdose
• Infant radiation
• Infant thyroid
• Iodine free diet
• Hormone withdrawal
• …
POST-TREATMENT PERCUSSIONS
• Restricted Period
• Distance consideration
• Public transportation
• Patients’ hygiene
• …
MEDICAL MOBILE APP.
• Chronic Disease
• Radiation Safety
• Pre-Treatment Percussion
• Post-Treatment Percussion
• Documents
• Follow up
FDA DEFINITION
• An accessory to a regulated medical device or transforming mobile platform
into a medical device
• Image reviewer
• E-record
• Diagnosis, cure, treatment or prevention which suggest patients the next
medical plan according to the patients’ condition
• Fuzzy Expert System
•
Patient education, electronic copies of medical sources or educational tools
for medical training are not defined as medical mobile application
•
Patient education
1.
Patient Education
2.
Data importing and storage
3.
Data recovery
PATIENT EDUCATION
• Pre- treatment
• In a text format
• Hospitalization duration
• Simulation
• Post- treatment
• In a text format
PATIENT EDUCATION – SIMULATION
Simulation is the imitation of a real situation
and has a proven role in teaching learning
the situation in which patients should receive radioiodine
therapy, be hospitalized and undergo scintigraphy
SIMULATION SCENARIO
Goals
and
Objective
To provide less radiation from treated patients to others.
To provide good orientation for patients to have a better compliance.
Characters
Patient
Patient attendant
Personnel
Other patients
Setting
Nuclear medicine departments with reception and report room, hot lab, waiting room for patients, scan room, clinic and
hospitalization ward.
Strategy
Step1:
Ones should enter dose and date of receiving iodine and the aim of coming to the department (hospitalization vs. whole body scan).
“Hospitalization”
Step2:
Entrance to the department, listening to the
explanations,
receiving
iodine,
going
for
isolation.
Step3:
Calling nurse, attention to alarming symptoms,
personal hygiene, receiving food.
Step4:
Dosimetry, discharging.
“Whole body scan”
Step1:
Going to the waiting room, changing the cloth, waiting for call
Step2:
Going to the scan room, lying down for whole bode iodine scan, receiving the report
receipt, going to home
Feedback
If patient enter the wrong room or go near to the nurse and personnel after receiving iodine, not regarding personal hygiene, not
paying attention to alarming symptoms, not changing the cloth before the scan, he/she will receive negative feedback.
If patient perform in a proper way, he/she will receive positive feedback.
DATA IMPORTING AND STORAGE
• HTML
H
yper
T
ext
M
arkup
L
anguage
Searchable
• DICOM
D
igital
I
maging and
CO
mmunications in
M
edicine
Reliable
DATA RECOVERY
• Plugged in programs:
• HTML readers
• DICOM viewers
ARTIFICIAL INTELLIGENCE
Fuzzy Expert System
History
•
Lactation
•
Sex
Lab data
•
Thyroglobulin
•
Anti Thyroglobulin Antibody
•
TSH
•
Beta-HCG
Pathology report
Operation Note
Key points of radioiodine scintigraphy reports
•
lymph node involvement,
•
metastasis,
•
remnant tissue
Key points of neck sonography reports:
•
Lymph node
•
Key points of CT scans
•
Metastasis
•
Lymphnode
Recommendation
Last Dose
•
Therapeutic
•
Diagnostic
ARTIFICIAL INTELLIGENCE
-VARIABLES
ARTIFICIAL INTELLIGENCE- RULES
• By Expert Opinion
• Reviewing References: American Thyroid Association
Guideline, Text books of Nuclear Medicine
First Page:
PATIENT EDUCATION: PRE-TREATMENT
Part1
What
is
radioactive
iodine therapy?
This treatment can be used to ablate (destroy) any thyroid tissue
not removed by surgery or to treat some types of thyroid cancer
that have spread to lymph nodes and other parts of the body.
Part2
Pre-treatment
precautions
~ Stopping Levothyroxin/Levothyronin
~ Diet Consideration
~ Female Reproduction Consideration: Infertility, when
to be pregnant, contraception, unwanted pregnancy,
~ Male Reproduction Consideration: Infertility, when to
produce pregnancy
~ Breastfeeding/ Lactation Considerations
~ Work up should be obtained before iodine therapy
lab, sono, patho, op note
PATIENT EDUCATION: POST-TREATMENT
Part3a
Hospitalization
duration
~ Dyspnea
~ Nausea/ vomiting
~ Bad taste
~ Gastritis
~ Sialadenitis
Part3b
Post-treatment
precautions
(After discharge)
~ Restricted Period
~ Distance consideration: Day time, Night time, Post therapy travel,
Radiation detectors at ports of entry, post therapy living situation,
~ Duration of safe travel by public transportation
~ Travelling to home
~ Radiation detectors at ports of entry
~ Starting Levothyroxine/Levothyronine
~ Post treatment complications
~ Patients’ hygiene: Urine, stool, saliva, blood and wound,
perspiration, vomitus, waste bag.
FEEDBACK POINTS
•
G
oing to a wrong room
•
C
hoosing a wrong path
•
T
alking to others in Nuclear Medicine
ward
•
N
ot paying attention to alarming
symptoms
•
N
ot paying attention to personal
hygiene
•
G
oing to a right room
•
C
hoosing a right path
•
P
aying attention to alarming
symptoms
•
P
aying attention to personal hygiene
E-RECORD
• HTML
Text
• DICOM
Image
a)
Lab data: TSH, Thyroglobulin,
Anti Thyroglobulin Antibody and Beta-HCG,
b) Neck sonography,
c) Operation note,
d) Pathology report,
e) Whole body
131
I scan,
f) CT scans,
E-PLANNING:
VALUE
Variable Value
Linguistic value
Notation
Beta-HCG (b)
Negative
N
Positive
P
TSH level (tsh)
Ad. hormone w.
Ad
N. ad. hormone. w.
NAd
Tg level (tg)
High
H
Suspicious
S
Low
L
ATA level (ata)
Low
L
High
H
Remnant (r)
No
N
Yes
Y
Regional Lymph node (l)
Yes
Y
No
N
Metastasis (m)
No
N
Suspicious
S
Yes
Y
Variable Value
Lactation/Breast feeding (lb)
No
N
Yes
Y
Pathology (p)
No Need
N
Good response.
G
Int. response
I
Poor. response
P
Operation (o)
Total Thyroidectomy
T
Lobectomy
L
Recommendation (rec)
F/U Scan 6m
FS6m
F/U for Scan 1y
FS1y
F/U for Scan 2y
FS2y
Next F/U for
treatment
FT
No need for F/U
N
Contraindication
C
Need for radiological
correlation
R
Need for surgery
S
Last Dose (d)
Diagnostic
D
Therapeutic
T
• Possible probabilities:
9216
• Meaningful probabilities:
1728
E-PLANNING:
RULES
• If (Lactation-Breast-feeding is Y) then (Recommendation is C)
• If (Beta-HCG is P) then (Recommendation is C)
• If (Pathology is N) then (Recommendation is N)
• If (Metastasis is Y) and (Last-Dose is D) then (Recommendation is
FT)
• If (Metastasis is N) and (Last-Dose is D) then (Recommendation is
FS1y)
• If (Metastasis is Y) and (Last-Dose is T) then (Recommendation is
FS6m)
• If (Regional-Lymph-Node is Y) and (Last-Dose is T) then
(Recommendation is FS1y)
• If (Regional-Lymph-Node is Y) and (Last-Dose is D) then
(Recommendation is FT)
• If (Remnant is N) and (Metastasis is N) and
(Regional-Lymph-Node is N) and (Tg-Level is L) and (Pathology is G)
then (Recommendation is FS1y)
• If (Remnant is Y) and (Metastasis is Y) and (Operation is
L) and (Last-Dose is T) then (Recommendation is FS6m)
CONCLUSION:
• The application can help in:
• Patient Education
• Patient Safety
• Personnel Safety
• Increasing Patient Compliance
• Better Treatment Outcome
REFERENCE LIST
• Haugen BR, et al. 2015 American Thyroid Association Management guidelines for adult patients with thyroid nodules and differential thyroid cancer: The American Thyroid Association Guidelines Task Force on thyroid nodules and differential thyroid cancer. Thyroid. 2015 Jul;25(7):716-59
• Henkin RE, et al. Nuclear Medicine. 2nd edition. Elsevier. 2006. Chapter 90. The treatment of thyroid malignant neoplasm.
• Ogbera AO, Ekpebegh C, Eregie A, Kuku SF. The role of radioactive iodine usage in the management of thyroid disorders with emphasis on sub-Saharan Arica. West Afr J Med. 2008 Oct;27(4):211-7
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