FOMDWebPartPage

CCI NM Senior

GENERAL OBJECTIVES:

Upon completion of this rotation, the resident will have achieved expert competency in the diagnostic and therapeutic uses of radiopharmaceuticals in the management of patients with cancer.  The resident will be able to consult with referring physicians, supervise and interpret imaging studies and function independently, commensurate with the level of training achieved
 

SPECIFIC OBJECTIVES:

At the completion of this rotation, the resident will have acquired the following competencies and will function effectively as a:
 

Medical expert/clinical decision-maker

·         Understand in detail the concept of molecular imaging
·         understand in detail the operation of the equipment used in nuclear medicine, including, but not limited to, survey meters, dose calibrators, gamma cameras, SPECT/CT and PET/CT machines, and the cyclotron facility
·         understand in detail the principles of image acquisition and the processing of digital images, including image fusion
·         be expert in the use of the departmental imaging software, PACS and radiology information system for both viewing and reporting studies
·         understand in detail the appropriate indications for nuclear medicine investigations, and the strengths/weakness of each study
·         understand in detail the radiopharmaceuticals used routinely in an oncologic imaging practice
·         be proficient with proper patient preparation in both single photon and positron emission examinations
·         understand in detail the importance of, and demonstrate the ability to, correlate the findings on a nuclear medicine study with anatomic imaging studies, in order to improve specificity and optimize patient care
·         understand in detail the role of MDP and F-18 bone scanning in the initial workup and subsequent management of patients with neoplasms that metastasize to bone
·         understand in detail the role of bone imaging in monitoring response to therapy
·         understand in detail the role of gated cardiac blood pool imaging in the evaluation of patients prior to commencing chemotherapy and in monitoring patients while on chemotherapy
·         understand in detail the current indications and limitations of FDG-PET imaging in the evaluation of a wide variety of cancer patients
·         develop an expert approach to the interpretation of PET-CT imaging studies
·         be familiar with imaging pitfalls and normal variants in FDG-PET imaging
·         understand in detail the role, implications, and limitations of diagnostic and post-therapy I-131 imaging in both benign and malignant thyroid disease
·         understand in detail the clinical utility and limitations of mIBG and pentetreotide in the management of patients with various neuroendocrine tumors, both in the diagnostic and therapy setting
·         be familiar in detail with the role of pentetreotide imaging in the evaluation of patients with tumors other than those with a neuroendocrine origin
·         be familiar in detail with common false positive imaging findings in the oncology patient in both PET and single photon imaging, such as degenerative changes, post-traumatic findings, and infectious/inflammatory processes
·         understand in detail the pitfalls in the interpretation of imaging studies in oncology patients, following the administration of external beam radiotherapy or various systemic therapies, such as chemotherapy, hormone therapy, and colony stimulating factors
·         understand in detail the current utility, limitations, and contraindications of monoclonal antibodies and peptide imaging in oncology patients
·         be familiar in detail with the indications, strengths, and weaknesses of gallium, white cell imaging, and FDG-PET in the setting of malignancy and in suspected inflammatory processes
·         understand in detail the quantitative use of ventilation/perfusion imaging in assessing patients prior to surgery for primary and secondary lung neoplasms
·         understand in detail the unique difficulties of interpreting ventilation/perfusion images in patients who have pulmonary metastases
 

Communicator

·         demonstrate an ability to construct a concise, effective report for all nuclear medicine imaging studies, using appropriate terminology
·         be able to expertly correlate and communicate the results of other imaging studies and provide concise conclusions, differential diagnoses, and cost-effective management strategies
·         dictate and verify reports in a timely manner
·         understand the importance of communication with referring physicians at a speed commensurate with clinical urgency
·         be able to obtain informed consent prior to the administration of a radionuclide therapy
·         understand the importance of disclosing radiopharmaceutical misadministration to the patient
·         discuss potential adverse events of radionuclide administration with the patient
 

Collaborator

·         be able to confer expertly with oncology colleagues in a multidisciplinary setting, the relevant clinical details of a patient or the pertinent results of an imaging study
·         be able to function effectively as an expert member of a multidisciplinary health care team
·         demonstrate a willingness to provide consultation on external examinations, including multimodality correlation as needed
 

Manager

·         be available and willing to check the initial images provided by the technologist in order to ensure that diagnostic images have been obtained and to request additional views or other imaging studies as appropriate
·         be able to cordially work together with nursing and technical staff
·         be able to expertly manage the daily workflow of the nuclear medicine department
·         be willing to field telephone calls and appropriately triage emergent potential add-on studies
·         understand the importance of interpreting an adequate volume of cases
·         understand quality assurance issues related to nuclear medicine, including, but not limited to, radiopharmaceutical preparation, instrumentation, and patient preparation
 

Health Advocate

·         describe the risks and benefits of nuclear medicine imaging
·         understand in detail the principles of radiation safety
·         understand the HCFA guidelines for the use of FDG in the evaluation of patients with primary and secondary malignancy
 

Scholar

·         demonstrate competence in evaluating the medical literature
·         be familiar with current literature on the use of PET in the evaluation of patients with a wide variety of malignancies, in the assessment of response to therapy, and as a predictive assay of treatment response
·         be familiar with current literature pertaining to the utility of mIBG and pentetreotide in patients with neuroendocrine tumors, both in the  diagnostic and therapy setting
·         be familiar with differences in sensitivity and specificity as they pertain to both functional and morphological imaging studies
·         demonstrate the ability to be an effective teacher to medical students, resident colleagues, technologists, nurses and clinical colleagues
 

Professional

·         understand the importance of punctuality, attendance, integrity and respect in the workplace
·         be able to accurately assess self performance in terms of strengths, weaknesses, and limitations
·         be able to recognize the need to ask for assistance when appropriate