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Nuclear Medicine UAH

GENERAL OBJECTIVES:

On completion of this rotation, the resident will have learned to function as a consultant diagnostic imager who is familiar with the full gamut of nuclear medicine, including its various strengths and weaknesses.   The resident should be able to provide consultation to general practitioners and specialists alike, in suggesting the best nuclear medicine study or an alternate imaging study for any given clinical case.  The resident will demonstrate the ability to triage, supervise and provide a preliminary interpretation on most studies performed as a part of general nuclear medicine practice. 

 
Prerequisites:
 
Residents must have some fundamental imaging skills because of the nature of modern nuclear medicine practice and duties/services required of the resident during the nuclear medicine rotation.  They are the following:
·         Cross-sectional imaging skills:             3 months of CT.
·         Planar radiography experience:            3 months of general plain interpretation.
 
 
SPECIFIC OBJECTIVES
 
At the completion of this rotation, the resident will have acquired the following competencies and will function effectively as:
 

Medical expert/clinical decision-maker

 
            Specific Requirements:
             Basic science knowledge:
·         Have a basic understanding of the concept of functional imaging.
·         Have a basic understanding of the function and operation of detectors used in nuclear medicine (gamma camera, PET camera, counting probe, and survey meters)
·         Have an understanding of radiation safety.
·         Have an understanding of the major radiopharmaceuticals used in everyday practice.
·         Have developed an understanding of gamma camera instrumentation, function, operation and quality control.
·         Have an understanding of the different types of image acquisition (planar, SPECT,  PET/CT studies) and basic computer processing of digital nuclear images.
 
Diagnostic nuclear medicine:
1.      Be competent in the use of the department’s specific nuclear imaging software (beyond the regional PACS platform) for viewing and reporting studies.
2.      Understand the appropriate indications for nuclear medicine investigations, and the strengths/weakness of each study.
3.      Have an approach to interpreting most of the gamut of nuclear imaging studies, including bone scans, lung scans, renal scans, and HIDA scans, among others.
4.      When appropriate, be able to directly correlate findings on the nuclear medicine study with those seen on prior anatomic imaging studies.  The goal is to optimize specificity and accuracy for potentially nonspecific results.
5.      Understand the principles of pharmacologic and exercise cardiac stress testing.  Have an approach to interpretation of MIBI scans, and be able to recognize high-risk results.
 
6.      Understand the rationale, performance and outcome of basic I-131 therapy of benign and malignant thyroid disease.
7.      Understand the clinical utility of PET/CT imaging with respect to its indications, strengths and weaknesses for various clinical problems and tumor types.
8.      For the more senior resident doing a dedicated PET/CT rotation, he/she must also be familiar with proper patient preparation. The resident will develop a basic approach to interpretation of  a PET/CT study, including knowledge of imaging pitfalls and normal variants.
9.      Function as a consultant to the level of a qualified general radiologist, with respect to the appropriate use of nuclear medicine in diagnostic imaging.
 

Communicator

 
Specific Requirements:
·         Apply an  appropriate style of reporting for all nuclear medicine studies, using proper terminology.
·         Have the ability to assemble a report that succinctly describes the findings, correlate with other diagnostic imaging results(when appropriate), give the most likely differential diagnoses in view of all available imaging results, and recommend further testing and/or management when indicated.
·         Dictate and verify reports in a timely fashion.
·         Understand the importance of communication with referring clinicians, particularly in a situation when the results of an investigation or procedure should be urgently communicated.
 

Collaborator

 
Specific Requirements:
·         Consult effectively with other physicians and health care professionals.
·         Have the ability to function as a member of a multidisciplinary health care team. The resident should be able to supervise and work together with nursing and technical staff.
·         Be able to suggest alternative imaging modalities when nuclear medicine may not be appropriate in a given clinical situation.
 

Manager

 
Specific Requirements:
·         Understand quality assurance issues related to nuclear medicine, including, but not limited to, radiopharmaceutical preparation, instrumentation, and patient preparation for each study.
·         The resident should be able to manage the daily workflow through the nuclear medicine department.
·         Appropriate for the level of training, the resident should be interpreting or performing an adequate volume of cases.
 

Health Advocate

 
Specific Requirements:
·         Describe and explain the benefits and risk of nuclear medicine imaging, including population screening.
·         Educate and advise on the use and misuse of certain nuclear medicine studies.
 

Scholar

 
Specific Requirements:
·         Competence in evaluation of the medical literature.
·         Demonstrate ability to be an effective teacher to medical students, fellow residents, technologists, and clinical colleagues.
 

Professional

 
Specific Requirements:
·         Punctuality, attendance, reliability and respect in the workplace.
·         Be able to accurately assess one’s own performance, strengths, and weaknesses.
·         The resident should be aware of his/her own limitations, especially with supervision of studies and initial interpretation of clinically relevant results.  The resident should recognize the need to call for help when appropriate.
 
(General Nuclear Medicine) ROTATION  DUTIES FOR RESIDENTS
The resident must understand the rationale for the available protocols for each
The resident will monitor cases and check initial images as they are performed, to ensure that a diagnostically satisfactory study is obtained. Based on the preliminary views, and when appropriate, additional views or other alterations in the flow of the study should be ordered, based on clinical question(s) .
The resident will field telephone calls and written requests for emergent add-on studies and will triage these according to the patient’s clinical status as assessed by the provided clinical information.  When relevant to the case at hand, or when otherwise appropriate, the resident will review the results of diagnostic CT or radiography studies if requested by the referring physician. Other modalities may also be reviewed, subject to the resident’s level of training and expertise.
The resident should either observe or be involved in a few PET/CT cases, to satisfy the objective regarding PET/CT described above.  Further experience in PET/CT can be obtained during  a dedicated PET/CT rotation for senior radiology residents.
The resident will continue to review the cases for the day, correlating each with other pertinent diagnostic imaging studies, and will develop a list of differential diagnoses for the studies. These cases will be checked with the attending radiologist and dictated by the resident.
 
 
(PET/CT) ROTATION  DUTIES FOR RESIDENTS
1.      With nuclear medicine physician staff supervision, the resident will assist with requests from the PET/CT nursing staff  regarding patient preparation.
2.      The resident must field calls and phone consultations from clinicians for PET/CT studies.
3.      The resident must interpret and report a satisfactory volume of clinical (non-research) cases, appropriate for his/her level of experience.
4.      As part of  (2) above, the resident must review all (accessible) clinical, laboratory and pathology results pertinent to each case.  Prior anatomic  imaging studies, especially CT or MRI studies must be reviewed, for correlation.
 
RESIDENT EVALUATIONS
 
The Resident’s day-to-day performance will be evaluated.  The end of rotation evaluation will be done by a committee of nuclear medicine physicians  involved with the rotation during the month.  It is the responsibility of the Resident to ensure that the end of rotation evaluation is both completed by the committee and reviewed with the Resident by the nuclear medicine supervisor within two weeks of completing the rotation.  
 
SUGGESTED READING:
 
·         Essentials of Nuclear Medicine Imaging, 5th Edition Fred A. Mettler.
·         Nuclear Medicine: The Requisites. 3rd Edition. by Harvey A. Ziessman, Janis P. O'Malley, and James H. Thrall