# Process-Related Incidents in Nuclear Medicine: A Four-Year Single-Center Retrospective Analysis to Support the Implementation of a Scenario-Based Radiopharmacy Training

## TL;DR

This study analyzes nuclear medicine incidents over four years and shows that scenario-based training improves radiopharmacy safety and knowledge.

## Contribution

A novel scenario-based radiopharmacy training program is developed and validated using real incident data.

## Key findings

- 38.6% of incidents involved the radiopharmaceutical circuit, with 28.3% occurring in the radiopharmacy cleanroom.
- Scenario-based training improved NMTs' knowledge scores significantly, especially in hygiene and radioactivity topics.
- No incident exceeded moderate criticality, highlighting the effectiveness of the training in preventing severe issues.

## Abstract

Nuclear medicine is a medical specialty combining parenteral radioactive drug handling and complex clinical workflows, making systematic process-related incident (PRI) analysis essential to support healthcare quality improvement. This study reports a four-year single-center retrospective analysis of PRIs in a nuclear medicine department and describes the development and implementation of a scenario-based radiopharmacy training program for nuclear medicine technologists (NMTs) derived from these findings. PRIs were extracted from the institutional reporting system and categorized according to a structured classification. Training scenarios were designed from recurrent radiopharmacy-related PRIs, and their impact was evaluated using a knowledge questionnaire administered pre and post training. A total of 223 PRIs were analyzed, of which 38.6% (n = 86) were related to the radiopharmaceutical circuit. Among these, 28.3% occurred exclusively within the radiopharmacy cleanroom. Administration (19%), dispensing (15%), delivery and reception (15%), and preparation and quality control (15%) of radiopharmaceuticals were the most frequently involved stages. No PRI exceeded a moderate criticality level. Eight NMTs participated in the training program, consisting of an analysis of videos depicting the developed scenarios. The mean knowledge score increased significantly from 7.51/10 before training to 8.46/10 four weeks after training (p = 0.02), with marked improvements in hygiene- and radioactivity-related topics. These results support the use of retrospective PRI analysis as an operational basis for specific, scenario-based training to strengthen safety practices in radiopharmacy settings.