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Home All issues Volume 60 / No 4 (Octobre-Décembre 2025) Radioprotection, 60 4 (2025) 318-327 Full HTML
Open Access
Issue
Radioprotection
Volume 60, Number 4, Octobre-Décembre 2025
Page(s) 318 - 327
DOI https://doi.org/10.1051/radiopro/2025014
Published online 15 December 2025

© A. López et al., Published by EDP Sciences 2025

Licence Creative CommonsThis is an Open Access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

1 Introduction

The Latin American Association of Medical Physics (ALFIM) is a professional, non-profit society dedicated to advancing medical physics in the Latin American region. Its mission includes promoting scientific and technical knowledge, fostering education and professional development, and enhancing the quality of patient care. ALFIM unites 16 national member organizations (NMOs) across the region, addressing significant disparities in resources and healthcare contexts (López, Mora and Hernández, 2023a). Those disparities varing from the differences of regulatory frameworks, economical and social status, technical equipments, to the qualify and accredited human resources availabilities (Peix, Claudio T. Mesquita et al., 2022; UNSCEAR, 2022; Elbanna et al., 2023; Mojeed Omotayo Adelodun and Evangel Chinyere Anyanwu, 2024). A 2022 survey by Renha et al. highlighted critical challenges, including an insufficient number of medical physicists, especially in diagnostic radiology and nuclear medicine, limited training programs, and a lack of formal recognition for medical physicists within healthcare teams, restricting their roles in essential areas like radiation safety and optimization (Renha et al., 2022).

A continuous education system for health profesions is highly recommended in order to make professionals up-to-date 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 LatinAmerican 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.

Table 1

Schedule and program.

2.2 Practical Component

The optional practical component involved a project involving the establishment of a typical DRL in a Nuclear Medicine department for at least one diagnostic procedure (Tab.1, Part II). The practical exercise included all steps to obtain the typical reference levels, including the proper selection of study and patient data. This involved conducting a critical analysis report that compared their findings with existing similar DRL studies, especially identifying national reference levels, if available, and proposed action plans based on their analyses. Participants were provided with an Excel-based data collection template, aligned with the methodological recommendations of the ICRP regarding the minimum number of studies to be collected (20), as well as patient information variables and study data (Vañó et al., 2017). The template required, at a minimum, the inclusion of patient weight, age, and administered activity for the procedure. Participants also received guidelines outlining the essential requirements for their final reports, along with bibliographic references that could be useful for their analysis.

2.3 Data Analysis

Educational outcomes were analyzed both quantitatively and qualitatively. The flow of digital information was monitored through participant engagement with pre-recorded theoretical activities on YouTube. Quantitative results from the theoretical assessments were gathered via the Google questionnaire, while competencies acquired during practical exercises were evaluated through the submitted reports.

Additionally, an anonymous and voluntary quality survey was developed using Google Forms to gather participant feedback on several aspects of the course (Tab. 2). This survey included seven Likert-scale questions (1–5 scale) ranging from 1 (strongly disagree) to 5 (strongly agree), evaluating usefulness and course quality (Ankur, 2015); and one open-ended question to suggest improvements.

The survey results were analysed with SPSS version 20 (IBM SPSS Statistics 20 Documentation. Product Documentation, 2016), employing descriptive statistics to calculate absolute and relative frequencies. The mean scores were categorised as follows:

  • Scores between 4-5 indicated strong satisfaction or effectiveness.

  • A score of 3 suggested sufficient but improvable criteria.

  • Scores of 1-2 highlighted areas needing significant enhancement.

This comprehensive approach ensured that both theoretical knowledge acquisition and practical skill development were rigorously evaluated, providing valuable insights into the effectiveness of this innovative educational initiative. This revised methods section improves clarity by breaking down each component into distinct subsections, enhancing readability while maintaining detailed descriptions of the processes involved. It also emphasizes participant engagement and feedback mechanisms, which are crucial for evaluating educational effectiveness.

To ensure the representativeness of the survey results, given a finite number of students (Np), the minimum required answer sample size (n) was determined based on a 95% confidence level, corresponding to a standard normal coefficient of Zα=1.96. An estimated absolute error (ξ) of less than 15% was considered acceptable, with a probability of p=0.05 of obtaining erroneous data. The sample size was calculated using the following equation (Nicolás Ramón Cruz Pérez, 2014):

n=Zα2.Np.p.(1−p)ξ2(Np−1)+Zα2.p(1−p).(1)

Table 2

Quality survey with quantitative and qualitative questions. 5-point Likert scale.

3 Results

The inaugural course, “Reference Levels for Diagnosis in Nuclear Medicine,” attracted 315 participants from 21 countries, 98% of participants were from 17 Latin American countries (Fig. 1). The professional distribution of registered students included 39% medical physicists, 33% technologists, 23% medical physics students, 4% physicians, and 1% from other related professions.

thumbnail Figure 1

Number of participants per country during registration, theoretical assessment, practical evaluation, and quality survey.

3.1 Engagement Metrics

The theoretical teaching activities garnered significant attention, with views ranging from 207 to 402 on the IO YouTube channel, resulting in an average playlist view time of 5.4 hours per user. Out of the total participants, 99 students (31%) of 17 countries (15 Latinoamerican Countries) completed the theoretical evaluation, which consisted of 15 questions, achieving a remarkable 100% pass rate (Fig. 1). The average score for this evaluation was 13.2 points, with a median score of 14 and a range from 8 to 15 points (Fig. 2). The professional composition of theoretical assessment included 57% medical physicists, 19% technologists, 16% medical physics students, 4% physicians, and 4% from other related professions.

thumbnail Figure 2

Picture of Google form analytic results of one of two theoretical test.

3.2 Practical Component Outcomes

In addition to the theoretical assessments, 43 participants from 15 countries (13 Latinoamerican Countries) successfully completed the practical component (Fig. 1). The professional distribution of the participants in the practical assessment comprised 60% medical physicists, 21% technologists, 9% medical physics students and 9% physicians. During this practical exercise, participants reported and analyzed a total of 78 nuclear medicine studies (Tab. 3)

Table 3

Distribution of NM studies exposure level collected, analyzed, and reported by the participant of the practical part.

3.3 Quality Survey Feedback

A quality survey was completed by 40 attendees from 99 participants (41%), from 12 Latinoamerican countries (Fig. 1), offering insights into their experience with the course. The professional composition of the responses was 60% medical physicists, 13% technologists, 25% medical physics students and 3% physicians. The overall rating averaged between 4.2 and 4.5 on a scale of 5, indicating high satisfaction levels across various aspects of the course (Fig. 3). Participants suggested areas for improvement, particularly emphasizing:

  • The need for more available literature in Spanish.

  • The importance of ongoing follow-up on course content.

  • Suggestions for enhancements in recording quality.

thumbnail Figure 3

Quality survey result using 5 points Likert scale per question

4 Discusion

The asynchronous course "Reference Levels for Diagnosis in Nuclear Medicine" garnered significant attention from the Latin American (LA) nuclear medicine community, with an impressive 97% of participants hailing from this region (Fig. 1). Notably, countries such as Peru and Colombia demonstrated particularly strong participation, reflecting a growing interest in radiation protection and the establishment of Diagnostic Reference Levels (DRLs) among diverse professional backgrounds. The heterogeneous composition of the participants comprising medical physicists, technologists, students, and physicians highlights the potential for interprofessional collaboration in addressing critical issues related to patient safety in nuclear medicine (Ubeda et al., 2019; Lee et al., 2020; Damilakis et al., 2021; Health Information and Quality Authority, 2023; López et al., 2023). The considerable engagement with theoretical activities on the IO YouTube channel (ranging from 207 to 402 views) and an average playlist view time of 5.4 hours per user confirm participants’ interest and indirectly highlight the usefulness of the materials. The development of DRLs involved a multidisciplinary team, which may explain the diverse composition of participants, despite the predominance of medical physicists.

4.1 Engagement Metrics

Despite the high engagement with theoretical materials, only 31% of participants completed the planned theoretical evaluation. This phenomenon aligns with findings from other studies that report high dropout rates in online postgraduate programmes, particularly those involving a diverse array of professional backgrounds (Quintero-Guasca et al., 2021; Xavier and Meneses, 2021; Rahmani, Groot and Rahmani, 2024). The reasons for this dropout can be attributed to several interconnected factors, including personal circumstances, socioeconomic challenges, and academic pressures (Meza Villares et al., 2023; Varkey et al., 2023). In our case, we suggest that these factors are closely linked to the course structure and workload, particularly concerning workload management and time availability in clinical scenarios. Additionally, differences in participants’ national regulatory frameworks, the availability of radiation protection courses, and their curricular backgrounds may have contributed to this trend in different ways.

It is well known that effective radiation protection in medical exposure relies on clear regulations, strict enforcement, and proper training (IAEA Safety Standards Series No. SSG-46, 2018; IAEA, 2023; Mojeed Omotayo Adelodun and Evangel Chinyere Anyanwu, 2024c, 2024a). While core principles such as justification, optimization, and dose limits are widely accepted, enforcement varies across countries. Nations with stricter regulations demonstrate higher compliance and fewer incidents, whereas weaker oversight increases risks and leads to lower compliance (Mojeed Omotayo Adelodun and Evangel Chinyere Anyanwu, 2024b). adequate training of medical professionals is crucial, as inadequate education can result in safety failures. Strengthening regulations, enhancing enforcement, and improving training programs through collaboration between regulatory bodies, healthcare institutions, and research organizations can ensure safer medical radiation practices (Frija et al., 2021; Rehani et al., 2022; Mojeed Omotayo Adelodun and Evangel Chinyere Anyanwu, 2024b). Additionally, training plays a key role in human resource development and motivation (Hysa and Rehman, 2019; Kavuma et al., 2023; Santos et al., 2023). This is particularly relevant given that the course was delivered free of cost, and the majority of participants were medical physicists or medical physics students—a profession that exhibits significant variability in status across Latin American countries.

The theoretical evaluation resulted in a 100% pass rate, with an average score of 13.3 points out of 15. These results are promising when compared to existing literature; for instance, a literature review by Delungahawatta et al. (2022) indicated that only 28% of studies reported mean scores below 60% in similar educational interventions (Delungahawatta et al., 2022). Furthermore, Wagner-Menghin et al. (2020) found an average performance of 81%, with a notable preference among medical students for virtual learning environments (Wagner-Menghin et al., 2020). Although various metrics exist to assess learning outcomes, the pass/fail rate remains a fundamental indicator of educational effectiveness (Wagner-Menghin et al., 2020; Varkey et al., 2023; Alkhateeb et al., 2018).

4.2 Practical Component Outcomes

In terms of development of practical skills, 43 participants from 15 countries (13 Latin American countries completed practical exercises, analyzing a total of 78 nuclear medicine studies during the course (1.8 studies per student). The data sets utilized primarily included bone scans and 18F-FDG studies, among the most frequently used procedures in conventional and hybrid nuclear medicine settings (Peix, Claudio T Mesquita et al., 2022). This approach demonstrates Dataset-Based Learning (DBL), an effective active teaching methodology where students use real data to draw conclusions and develop hypotheses. Previous research has shown that working with actual datasets enhances critical thinking and problem-solving skills while fostering competencies such as data management and project planning (Díaz et al., 2023; Meza Villares et al., 2023). Especially in our cases, the students showed in their report the use of their own datasets, understanding their specific particularities, and fostering a culture of safety in their environment (Tabakova, 2020; Meza Villares et al., 2023). In all cases, medical physicist and medical physics students constitute the majority of the total of participants. However, their representation increases during the practical exercise, indicating a higher level of interest and alignment with the topic and their professional role.

4.3 Quality Survey Feedback

The number of responses exceeded the minimum threshold of 8, the minimum sample size required for 99 students, ensuring the representativeness of the survey results (Nicolás Ramón Cruz Pérez, 2014). Participant feedback revealed high satisfaction levels, with average ratings ranging from 4.2 to 4.5 on a scale of 5. survey responses showed that participants found the course highly relevant and well-structured for asynchronous learning environments. Notably, questions regarding the course’s applicability to their work received particularly high scores, suggesting that participants perceived strong value in the course content. The standard deviation ranges from 0.70 to 0.80, indicating moderate variability. This suggests that, while most students are satisfied, there are some differences in perception, possibly due to variations in individual expectations or experiences reported by other authors (Si, 2022; Nyirongo and Mbano, 2024; Yang and Romero-Hall, 2024), in our case also supported by heterogeneous professions of personnel involved (Hysa and Rehman, 2019).

The open question answers identified key areas for improvement, especially the lack of available literature in Spanish, the need for future follow-up on the topic, and improving the quality of the recording, but also reflected the participant satisfaction with learning goals and motivated the organising team to repeat and support these types of educational activities.

The literature supports the importance of various factors that students rated positively here, such as content quality, usefulness, and adequacy of support (Meza Villares et al., 2023; Díaz-Camacho et al., 2022). Studies on course relevance and utility have shown that learners tend to value courses seen as directly applicable to their work or academic goals (Si, 2022; Nyirongo and Mbano, 2024). In this survey, the question about the course’s utility received one of the top ratings, which aligns with these findings.

Satisfaction with asynchronous format: Research from Varkey (2022) and Sinclair (2024) shows that asynchronous formats provide flexibility that appeals to students managing various responsibilities (Varkey et al., 2023; Sinclair et al., 2024). The high rating of this course’s format indicates that the asynchronous structure was well-received, supporting the effectiveness of this design in meeting individual needs.

Adequacy of content and platform: According to Khosla (2023), Meza (2024), Fadumiye (2024) and Yang (2024), the perception of content adequacy and platform ease of use significantly impacts satisfaction (Khosla et al., 2023; Meza Villares et al., 2023; Fadumiye and Li, 2024; Yang and Romero-Hall, 2024). High ratings in these aspects suggest that the course meets standards of clarity and accessibility.

The evaluation of this asynchronous virtual course using YouTube and Google platforms shows a strong satisfaction levels, particularly in terms of relevance, practical utility, and adequacy of format and support materials. This suggests that the course design and content align well with factors that research indicates are essential for satisfaction in virtual environments. However, the variation in responses suggests possible areas for improvement, such as further personalizing content or refining support tools to cover a range of expectations.

4.4 Follow up actions

One of the key recommendations from the survey highlights the importance of taking follow-up actions related to the course content. From an educational perspective, all resources remain freely available on the course’s YouTube channel. Additionally, a collaborative network was formed among participants to provide guidance and address any questions regarding data collection and result analysis, supporting their efforts to carry out studies at their institutions. Participants were also encouraged to present their findings at upcoming scientific events. The course instructors continue to offer supervision and mentor potential research projects.

Furthermore, ALFIM has established strategic alliances with organizations such as Latin Safe, LAPRAM network and the IAEA. The last one through the project IAEA RLA 6091: Enhancing Capacity Building of Medical Physicists in Latin America and the Caribbean (Renha et al., 2022). This collaboration aims to further promote medical exposure optimization, strengthen radiation safety culture, and support the implementation of Diagnostic Reference Levels (DRLs) across the region, including promoting and supporting educational webinars, collaborative networks, research projects, guidelines, etc.

5 Conclusions

This paper demonstrates the course’s effectiveness in reaching the learning objective and competencies, using the asynchronous design and YouTube and Google Tools, confirming the benefits of flexible delivery and relevant content for online education on radiation protection issues.

The results of this first experience suggest the success of the ALFIM educational strategy in developing virtual courses using YouTube and Google tools, which are practical and economical. Incorporating lessons learned and creating continuous quality improvement processes could make this alternative more efficient and scalable, enhancing regional impact in Latin America.

Funding

This research did not receive any specific funding.

Conflicts of interest

The authors declare that they have no conflict of interest.

Data availability statement

All the materials and information of the course are available upon request.

Author contribution statement

A. López: Data curation, Conceptualization, Investigation, Formal Analysis and Writing; D. Coiro: Formal Analysis, Data processing, and curation; P. Mora: Formal Analysis and Supervision; E. Hernández: Formal Analysis and Supervision; L. Rodriguez: Data processing, and curation; M, S. Gallo: Writing − review; I. O’Farril: Data curation.

Ethics approval

Ethical approval was not required.

Informed consent

Written informed consent was obtained from all participants in the course.

References

Cite this article as: López A, Coiro D, Mora P, Hernández EE, Díaz N, Rodríguez L, Gallo MS, O’Farril I. 2025. “Evaluation of an Asynchronous Virtual Course for Continuing Education in Radiation Protection in Nuclear Medicine in Latin America: Outcomes and Lessons Learned”. Radioprotection 60(4): 318–327. https://doi.org/10.1051/radiopro/2025014

All Tables

Table 1

Schedule and program.

In the text
Table 2

Quality survey with quantitative and qualitative questions. 5-point Likert scale.

In the text
Table 3

Distribution of NM studies exposure level collected, analyzed, and reported by the participant of the practical part.

In the text

All Figures

thumbnail Figure 1

Number of participants per country during registration, theoretical assessment, practical evaluation, and quality survey.
In the text
thumbnail Figure 2

Picture of Google form analytic results of one of two theoretical test.
In the text
thumbnail Figure 3

Quality survey result using 5 points Likert scale per question
In the text

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