Nuclear Medicine

Body Imaging: Nuclear Medicine

Rotation 1

Knowledge Based Objectives: At the end of the rotation, the resident should be able to:

1. Demonstrate a thorough knowledge of the clinical indications, general procedures (including radiopharmaceutical and dose), and scintigraphic findings in:
   1. pulmonary (emboli) ventilation and perfusion imaging
   2. hepatobiliary imaging and functional studies
   3. GI blood loss imaging
   4. bone imaging
   5. lymphoscintigraphy
   6. nuclear cystograms
2. Discuss the basic physical principles of nuclear medicine imaging and instrumentation.
3. Identify the isotopes (including physical and chemical properties) that are used routinely in the compounding of radiopharmaceuticals for nuclear radiology procedures.

Technical Skills: At the end of the rotation, the resident should be able to:

1. Demonstrate proficiency in the performance of lymphoscintigraphy and nuclear cystograms.
2. Recognize limitations in personal knowledge and skills, being careful to not make decisions beyond the level of personal competence.

Decision-Making and Value Judgment Skills: At the end of the rotation, the resident should be able to:

1. Review histories of patients to be imaged each day to determine the relevance of the study to clinical symptoms, to evaluate for contraindications to the study, and to advise technologists about special views or specific parameters of the study that require special attention.
2. Assist technologists in the determination of the radiopharmaceutical dosage when patient conditions do not fit the criteria of the standard dose.
3. Observe at least one of each of the different scans routinely performed, as well as all the infrequently ordered studies.
4. Make a preliminary review of the images and advise technologists when additional views or repeat views are needed.

Rotation 2

Knowledge Based Objectives: At the end of the rotation, the resident should be able to:

1. Demonstrate a thorough knowledge of the clinical indications, general procedures (including radiopharmaceutical and dose) and scintigraphic findings in:
   1. renal and urinary tract studies
   2. liver/spleen imaging
   3. GI tract imaging and functional studies
   4. thyroid imaging and functional studies
   5. brain imaging and functional studies
   6. tumor and abscess imaging
2. Identify and discuss indications for isotopes used for therapeutic purposes.
3. Describe the protocol for using I-131 for treatment of hyperthyroidism and thyroid malignancies, including protocol for hospitalization and monitoring of patients who cannot receive treatment as an outpatient.

Technical Skills: At the end of the rotation, the resident should be able to:

1. Read and/or dictate films with the assistance/review of the faculty radiologist.
2. Assist with radioactive therapy treatments, making sure the consent form is competed properly and that the appropriate dose is administered, giving particular attention to radiation safety practices during the procedure.
3. Assist with preparation/presentation of cases for resident noon conference.

Decision-Making and Value Judgment Skills: At the end of the rotation, the resident should be able to:

1. Recognize limitations in personal skill and knowledge, always making sure dictations and consultations are checked by the faculty radiologist.
2. Review all scans as they are performed for significant findings that require prompt attention, and make decisions in regard to notification of the referring physician if the faculty radiologist is not available for consultation.

Rotation 3 and 4

Knowledge Based Objectives: At the end of the rotation, the resident should be able to:

1. Identify normal and abnormal findings on all imaging and functional studies, other than nuclear cardiology studies.
2. Discuss all aspects of nuclear studies, including indications, pathologies, protocols, correlative studies, radiopharmaceuticals used for each study, and various parameters that might interfere with the results of the procedure.
3. Demonstrate a thorough knowledge of the clinical indications, general procedures, and findings in:
   1. Myocardial perfusion studies (rest and stress)
   2. Myocardial infarct imaging
   3. Multigated acquisition imaging and function studies
4. Describe the radiopharmaceuticals used in cardiac nuclear studies, including the methods of red cell labeling, patient dosages, and physical properties of the isotopes.
5. Discuss patient conditions and patient monitoring requirements, particularly in relation to exercise and drug stress studies.
6. Process computer data obtained in each of the different cardiac studies.
7. Discuss the range of invasive and noninvasive tests, test characteristics, and the prognostic value of tests used to evaluate cardiac disease.
8. Discuss the indications and isotopes for Positron emission tomography (PET).

Technical Skills: At the end of the rotation, the resident should be able to:

1. Review and dictate with the faculty radiologist all scans performed including PET.
2. Review cases.

Decision-Making and Value Judgment Skills: At the end of the rotation, the resident should be able to:

1. Make preliminary decisions on all matters of film interpretation and consultation, recognizing need for and obtaining assistance in situations that require the expertise of the faculty radiologist.
2. Select tests for evaluation for evaluation of cardiac disease on the basis of patient condition and clinical symptoms