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
  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. 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 1-131 for treatment of hyperthyroidism and thyroid malignancies, including protocol for hospitalization and monitoring of patients who receive over 30 mCi of activity.

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 radiologists.
  2. Assist with radioactive therapy treatments, making sure the consent form is completed 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 biweekly resident noon film review.

Rotations 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.

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.
  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. Comment on anatomical findings, scanning technique, and reasons for doing the study to RAD 401 students in such a way that the students will be able to develop an appreciation for the value of nuclear radiology procedures in patient management.

Rotation 5

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, and findings in:
    1. Myocardial perfusion studies (rest and stress)
    2. Myocardial infarct imaging
    3. Multigated acquisition imaging and function studies
  2. Describe the radiopharmaceuticals used in cardiac nuclear studies, including the methods of red cell labeling, patient dosages, and physical properties of the isotopes.
  3. Discuss patient conditions and patient monitoring requirements, particularly in relation to exercise and drug stress studies.
  4. Process computer data obtained in each of the different cardiac studies.
  5. Discuss the range of invasive and noninvasive tests, test characteristics, and the prognostic value of tests used to evaluate cardiac disease.

Technical Skills

At the end of the rotation, the resident should be able to:
  1. Select test for evaluation of cardiac disease on the basis of patient condition and clinical symptoms.
  2. Correlate the results from various tests with interpretation of nuclear cardiology exams.

Rotation 6

Knowledge Based Objectives

At the end of the rotation, the resident should be able to:
  1. Discuss the following information regarding all radiopharmaceuticals used in nuclear radiology studies:
    1. Production of isotopes
    2. Physical properties of isotopes
    3. Generator elution and quality control
    4. Compounding of radiopharmaceuticals
    5. Radiochemical quality control
    6. Biodistribution and mechanisms of localization
  2. Calculate patient doses, using information related to decay factors, volume concentration, and patient parameters.
  3. Describe the procedures and rationale for instrument quality control in nuclear medicine.
  4. Discuss rules and regulations that apply to the practice of nuclear radiology as outlined in 10CFR20 and other appropriate sources.
  5. Describe the types of records that must be maintained in order to comply with federal/state guidelines for radiation safety and radioisotope receipt/use/disposal.
  6. Demonstrate an in-depth understanding of the physics of nuclear radiology.

Technical Skills

At the end of the rotation, the resident should be able to:
  1. Compound radiopharmaceuticals from kits and do appropriate quality control procedures.
  2. Elute a generator and do appropriate quality control procedures
  3. Calculate and draw up patient doses.
  4. Demonstrate appropriate use of a survey meter to monitor radioactivity spills or other sources.
  5. Perform a wipe test
  6. Perform quality control procedures on cameras, well / uptake probes, and dose calibrators.
  7. Handle radioactive sources according to the established guidelines.

Decision-Making and Value Judgment Skills

At the end of the rotation, the resident should be able to:
  1. Carry out the practice of nuclear radiology with due regard to quality control, quality Assurance, and radiation safety for the patient and personnel.

State University of New York at Stony Brook
Department of Radiology
Nuclear Medicine Curriculum

 

LECTURES SESSIONS
General Nuclear Medicine 2
Endocrine 2
Cardiac Imaging 2
CNS 1
Genitourinary 2
Gastrointestinal Tract Imaging 2
Infection and Inflammation 1
Muscoloskeletal: Bone/Soft Tissues and Lymphatics 3
PET 1
Pulmonary 1
Tumor Imaging and Radionuclide Therapy 1
Radioscintigraphic Assay and Volumetry (RIA) 1
Radiation Biology 1

LECTURE 1 - General Nuclear Medicine

Session 1

Characteristics of radionuclides
Production of radionuclides
Generators
Radiopharmaceutical Quality Control
Sterility
Chemical purity
Radionuc1ide purity
Radiochemical purity
Radiation Detection
Ionizations
Geiger Counter
Dose Calibrator
Constancy
Linearity
Accuracy
Geometry
Scintillators
Well counter
Scintillation counter
Thyroid uptake probe
Camera

Session 2

Gamma Camera Characteristics
Spatial Resolution
Sensitivity
Temporal Resolution
Collimators
Resolution and Sensitivity
Types of collimators
Parallel hole
Converging and diverging
Pinhole
SPECT Imaging
Camera Quality Control
Field Uniformity
Center of Rotation
Spatial Resolution
Temporal Resolution
Detector Alignment
Patient Motion
Tomographic Reconstruction
Attenuation Correction
Filtered back-projection
Iterative reconstruction
Object Size Correction (finite resolution effects)

LECTURE 2 - Endocrinology

Session 1 - Thyroid

Physiology
Indications for uptake/scan
Imaging protocols
Uptake and scan
Normal values
Findings
Factors affecting
Thyroid survey
Dose
Patient prep
Hormone withdrawal
Thyrogen stimulation
When to skip initial survey
Stunning
Artifacts
Radiopharmaceuticals
1123
1131
Tc99m-pertechnetate
FDG
Precautions
Patient prep
Congenital Lesions of the Thyroid Gland
Thyroiditis
Thyroid Nodules
Hyperthyroidism: Graves/MNG
Therapy
Thyroid Neoplasms
Therapy
Other thyroid conditions and Hypothyroidism

Session 2 - Parathyroid

Embryology and Anatomy
Physiology/pathology
Methods for localization
Radiopharmaceuticals
Imaging protocols
Sestamibi dual phase exam
Subtraction exam
Sestamibi / pertechnetate
1123/sestamibi
TI201/ pertechnetate
False positives/negatives
Cases

Session 3 - Adrenal cortex / medulla

Anatomy/physiology
Radiopharmaceuticals
Cortex/medulla
Indications
Cortex/medulla
Cortical imaging
Patient preparation
Medullary imaging
Patient Preparation
Drug contraindications
Cases
MIBG
Octreotide

LECTURE 3 - Nuclear Cardiology

Session 1 - Myocardial perfusion

Radiopharmaceuticals
Technetium agents
Thallium
Protocols
Stress
Treadmill
Pharmacologic
Viability
Stress protocol/procedure
Anatomy
Indications
SPECT vs. PLANAR
SPECT alignment
Quantification
False positives/negatives
Cases

Session 2 - Myocardial perfusion (continued)

MUGA
Gating principle
Indications
Positions
Functional imaging
Qualitative data analysis
Cases
First Pass Studies
Characteristics
Anatomy
Curves
Cases
Infarct Avid Imaging
Radiopharmaceuticals
Scan interpretation
Uptake
Cases
Myocardial Viability
Thallium
Protocol
PET
Protocol
Isotopes

LECTURE 4 - CNS Scintigraphic Imaging

SPECT Brain imaging
Radiopharmaceuticals
Patient prep
Normal characteristics
PET
Radiopharmaceuticals
Patient prep
Normal characteristics
Clinical Indications
Dementia
Trauma
Psychiatric disorders
Seizure
Tumors/infection
CSF Imaging
Radiopharmaceutical
Patient prep
Normal characteristics
NPH

LECTURE 5 - Genitourinary System
Session 1.

Renal and Urinary Tract Imaging
Radiopharmaceuticals
Patient prep
Function and anatomy
Clinical indications
Imaging
Lasix Renography
VCUG
Cortical imaging

Session 2.

Captopril Scan
Transplant Evaluation
Testicular Imaging

LECTURE 6 - Gastrointestinal Imaging

Session 1.

Liver/Spleen Imaging
Hepatobiliary Imaging

Session 2.

GI and Hepatic labeled RBC imaging
Gastroesophageal Motility Studies
Salivary Gland Imaging

LECTURE 7 - Infection and Inflammation Imaging

Gallium
Indium WBC Scan
Tc99m HMPAO WBC scan
Immunoglobulin Imaging

LECTURE 8 - Musculoskeletal

Session 1.

Bone Imaging
Pharmacology
Neoplastic diseases

Session 2.

Infection / Inflammation
Fractures/Similar Disorders
Metabolic Bone Disease
Vascular Osseous Disorders
Post-operative Conditions
Reflex Sympathetic Dystrophy

Session 3.

Soft Tissue Abnormalities
Mechanism of tracer uptake Etiologies Myositis Ossificans
Common Findings / Artifacts
Bone Marrow Scanning
Bone Mineral Densitometry
Lymphoscintigraphy
Chemistry/pharmacology
Lymphedema
Sentinel Node Detection

LECTURE 9 - Positron Emission Tomography

Characteristics
Tracers
Clinical indications (Medicare)
Lung nodule
Lung ca, NSC
Lymphoma
Melanoma
Head and neck (except CNS & thyroid)
Colorectal
Breast
Esophageal
Patient prep
Requirements
Artifacts
Cases

LECTURE 10 - Pulmonary

Pulmonary anatomy and physiology
Perfusion and ventilation Examination
Agents
Technique
Artifacts
Pulmonary Embolism
Discussion
PIOPED study
Differential diagnosis
Cases
Pre-op Evaluation of Regional Function
Nuclear Venogram
Radiopharmaceutical
Technique
Cases

LECTURE 11 - Tumor Imaging and Radionuclide Therapy

Gallium
CEA-Scan
Neotect
Octreotide
Prostascint
Tc99m Sestamibi
Thallium
Radionuclide Therapy for Tumors
P32
Strontium89 (Metastron)
Rhenium186 (HEDP)
Samarium153
Monoclonal Antibody Therapy
Zevalin

LECTURE 12 - Radioimmunoassay

  1. Schilling Test
    B12 absorption physiology
    Indications
    Pre-test preparation
    False negatives/positives values
    Schilling I
    Technique
    Calculations
    False negative/positive values
    Schilling II
    Schilling III
    Dual-Isotope Schilling
  2. Blood Volume Determination
    Physiology
    Plasma volume
    Technique
    Calculations
    RBC volume
    Calculations
    Sources of possible error
    Reporting results
    Diagnosis
    Relative polycythemia
    Polycythemia vera
    Secondary polycythemia
  3. Red Blood Cell Survival
    Technique
    Calculations
  4. Splenic Sequestration Study

LECTURE 13 - Radiation Biology

Radiation effects
Stochastic effects
Non-stochastic effects
Potential effects of in utero exposure
Mental retardation
Malignancy
Low level radioactive waste
Acceptable radiation dose levels
Radiation Workers
Non-radiation workers
Acute radiation Sickness
Radiation Posting
Misadministration
Receipt of radioactive materials