NUCLEAR MEDICINE

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NUCLEAR MEDICINE

  1. 1. May 2007 NUCLEAR MEDICINE Curriculum Guide Developed as a guide for Medical Radiation Technology Education Programs Based on the revised Nuclear Medicine Competency Profile which will be used for exam development effective with the September 2011, Nuclear Medicine certification exam Prepared by the Nuclear Medicine Technology Profile Revision Task Group © CANADIAN ASSOCIATION OF MEDICAL RADIATION TECHNOLOGISTS 1000 - 85 rue Albert Street, Ottawa, Ontario K1P 6A4 Tel: 1-800-463-9729 or (613) 234-0012 / Fax: (613) 234-1097 www.camrt.ca
  2. 2. 2 © Copyright 2007 by Canadian Association of Medical Radiation Technologists All rights reserved. No part of this publication may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopy, recording, or any information storage or retrieval system, without the prior written permission of the Canadian Association of Medical Radiation Technologists.
  3. 3. 3 CURRICULUM GUIDE – NUCLEAR MEDICINE This document is a curriculum guide for Nuclear Medicine education programs. It provides guidelines for the development and redesign of curriculum that is necessary to achieve the competencies in the revised Nuclear Medicine Competency Profile that will be used for exam development effective with the September 2011 certification exams. With the rapid changes in digital technology and the move towards a more inter-professional healthcare practice, educational programs have been requesting guidance in the development of curriculum and the provision of clinical experience required to ensure graduates of medical radiation technology education institutions have an educational experience reflective of the needs of the national healthcare environment. The Curriculum Guide is designed using the format of the revised Nuclear Medicine Competency Profile and provides lists of knowledge, skills and judgments required to successfully achieve many of the essential competencies. Not all competencies are accompanied by lists and these lists are not inclusive. They are provided as a guide ONLY. Based on the format of the Competency Profile, the Curriculum Guide is divided into 14 modules: Module A Professional Practice Module B Patient Management Module C Radiation Health and Safety Module D Quality Management Module E Radiopharmacy and Laboratory Procedures Module F Clinical Procedures - Core Competencies Module G Clinical Procedures - Cardiovascular (CV) Module H Clinical Procedures - Gastrointestinal (GI) Module I Clinical Procedures - Genitourinary (GU) Module J Clinical Procedures - Skeletal (SK) Module K Clinical Procedures - Inflammatory Process/Tumor/Lymph (TU) Module L Clinical Procedures - Central Nervous System (CNS) Module M Clinical Procedures - Endocrine (EN) Module N Clinical Procedures - Respiratory System (RE)
  4. 4. Curriculum Guide – Nuclear Medicine May 2007 4 MODULE A: PROFESSIONAL PRACTICE Wherever both national and provincial regulations/codes of ethics are in place, only the national standards will be tested on the CAMRT certification examination. A 1 Demonstrates critical thinking A 1.1 Apply critical thinking and problem solving strategies to ensure best practices Identify the problem Define objectives Formulate pre-decisions Generate alternatives Evaluate alternatives Make decision Implement decision Evaluate outcomes A 2 Practice in accordance with legislation, regulations and ethical guidelines related to the profession A 2.1 Practice patient care that protects the patient’s legal rights Informed consent Confidentiality Freedom of information Privacy Mandatory Reporting Suspected abuse Suspected malpractice Healthcare directives Do not resuscitate Living wills Restraints Physical Chemical A 2.2 Demonstrate an understanding of the current and emerging issues in the Canadian Healthcare System Accountability to various stakeholders Privatization Access and choice Availability of services Management of resources Policies and procedures to manage risk Partnership opportunities Impact of technology on practice A 2.3 Perform all duties in compliance with sexual abuse prevention guidelines A 2.4 Practice in accordance with national association’s/provincial regulatory body codes of ethics Dignity and respect Trust and confidence Accountability Safe environment Advocacy Confidentiality
  5. 5. Curriculum Guide – Nuclear Medicine May 2007 5 Collaborative care Continuing competence Contribute to the profession A 2.5 Practice within scope of practice in accordance with national association and provincial regulatory body’s legislation requirements A 2.6 Practice in accordance with the national association’s and provincial regulatory body’s standards of practice A 2.7 Practice in accordance with legislation, regulations/by-laws regulating medical radiation technologists Assault Battery Libel Harassment Slander Negligence A 2.8 Provide a diagnostic/therapeutic impression to health care professionals to assist in patient care management A 3 Demonstrate professional behaviours A 3.1 Demonstrate respect and sensitivity in both patient and professional interactions A 3.2 Utilize stress management techniques A 3.3 Utilize conflict management techniques A 3.4 Manage change within the evolving healthcare system A 3.5 Exchange knowledge/skills with other members of health care teams to promote collaborative practice A 3.6 Provide clinical instructions, guidance and evaluation for students A 3.7 Assume a lead role during diagnostic/therapeutic procedure when working with the healthcare team A 3.8 Present a professional appearance and manner A 4 Participate in professional development A 4.1 Engage in reflective practice, self-assessment to identify a learning plan that will promote best practices A 4.2 Demonstrate a basic understanding of current and emerging imaging, planning and therapeutic technologies used by interdisciplinary practices Source of energy Image acquisition Benefits Risks Application Safety Issues A 5 Participate in research for the purpose of evidence based decision-making A 5.1 Demonstrate an understanding of: how to review current literature, research methodology, data collection and analysis of statistics in order to promote evidence based practice Retrospective studies Prospective studies Meta-analysis Survey research
  6. 6. Curriculum Guide – Nuclear Medicine May 2007 6 A 5.2 Participate in a research-based project Literature review Research questions and testable hypotheses Methods and design Qualitative Quantitative Data collection, analysis and interpretation Data presentation A 5.3 Discuss the ethical issues involved with research Ethical foundations Clinical practice A 6 Understand the application of resource management principles A 6.1 Differentiate between capital and operating budgets A 6.2 Recognize implications of practice on budgets A 7 Participate in resource management A 7.1 Prioritize workflow to optimize patient outcomes Patient status Resources (human and material) available Estimated time of procedure Type of procedure A 7.2 Monitor inventory of material and supplies
  7. 7. Curriculum Guide – Nuclear Medicine May 2007 7 MODULE B: PATIENT MANAGEMENT B 1 Provide a safe environment to minimize the risk of adverse events to the patient and to staff B 1.1 Provide a safe, clean and comfortable environment B 1.2 Transport the patient safely using equipment based on resources and the patient’s physical and cognitive status and resources available Wheelchair Stretcher B 1.3 Transfer the patient safely using equipment and techniques based on the patient’s physical and cognitive status Patient transfer devices (e.g., sliding board, sheet, mechanical lift) Three person lift Two person transfer B 1.4 Employ proper body mechanics to prevent harm to self and patient B 1.5 Implement immobilization techniques based on age, physical and cognitive status of patient and type of procedure B 1.6 Adjust patient position to prevent harm, promote comfort and optimize procedure outcomes B 1.7 Verify patient identity following standardized protocol B 1.8 Assess documentation for compliance with legal requirements Verify imaging procedure has been ordered by authorized practitioner B 1.9 Complete documentation for compliance with legal requirements B 2 Interact within the healthcare environment B 2.1 Establish patient rapport Greet the patient with the appropriate salutation and identify self Explain provider role Facilitate translation services Respect patient diversity Interact with the patient in caring and compassionate manner Use appropriate non-verbal communication techniques B 2.2 Use various forms of communication to provide relevant, accurate and complete information Verbal Written Electronic B 2.3 Exchange information regarding details of procedure with patients and their support persons to enable them to make informed decisions B 2.4 Assess and respond to cultural, ethnic, linguistic, religious and socio-economic variables affecting communication B 3 Perform patient assessments and medical interventions within scope of practice in accordance with provincial regulatory body’s legislation requirements B 3.1 Perform patient assessment B 3.2 Assess, monitor and respond to various levels of patient status Physical status Cognitive status Level of consciousness Emotional status Effects of pharmaceuticals administered to patient
  8. 8. Curriculum Guide – Nuclear Medicine May 2007 8 Vital signs Blood pressure Respiration Oxygen saturation Heart rate Body Temperature Medical disorders Neurological disorders Diabetic emergencies Respiratory distress Cardiac distress Vasovagal reaction Shock Traumatic Injuries Post surgical B 3.3 Perform diagnostic interventions (i.e. IV line, saline lock) B 3.4 Perform delegated diagnostic interventions Perform venipuncture Obtain blood samples Obtain biological samples Determine and record blood glucose level Acquire 12 lead ECG B 3.5 Participate in therapeutic interventions (i.e. suction) B 3.6 Perform therapeutic interventions (i.e. CPR, oxygen administration) B 3.7 Assess and monitor patient’s therapeutic and supportive devices and take necessary action to ensure patient safety and comfort B 3.8 Ensure that the patient’s needs are met prior to release from the technologist’s care B 4 Implement infection control practices B 4.1 Understand transmission mode of nosocomial infections (host, agent and environment) B 4.2 Utilize routine practices for preventing the transmission of infection in health care B 4.3 Apply principles of asepsis Hand hygiene Cleaning Disinfection Low Medium High Sterilization Dry Steam Mechanical Sterile tray preparation Sterile fields Gloving and gowning Masks and goggles IV preparation
  9. 9. Curriculum Guide – Nuclear Medicine May 2007 9 B 4.4 Follow established protocols when handling and disposing contaminated and biohazardous materials such as sharps and body fluids B 4.5 Adhere to protective environment protocols with patients who have compromised immunity B 4.6 Adhere to protocols when caring for patients with antibiotic resistant organisms B 4.7 Adhere to transmission based precautions for airborne, droplet, and contact transmissions B 5 Respond to patient hygiene needs B 5.1 Assist the patient with personal care
  10. 10. Curriculum Guide – Nuclear Medicine May 2007 10 MODULE C: RADIATION, HEALTH AND SAFETY The following competency statements relate to the safe handling and application of radioactive substances used for diagnostic and/or therapeutic procedures, including unsealed or sealed sources producing gamma, beta, and/or positron emissions, and including equipment producing x-rays. C 1 Apply radiation safety practices to protect patients, technologists, staff, care givers and general public C 1.1 Use protective devices/apparel appropriately Lead aprons Lead glass Syringe shields Lead pots/vial shields Gloves Recapping devices Barriers and shields Remote manipulation devices C 1.2 Verify patient’s pregnancy/breastfeeding status Consult with patient Consult with radiologist/physician regarding patient management Documentation relevant information C 1.3 Apply ALARA principle Benefit versus risk of using radiation protection devices Time, distance and shielding C 2 Comply with Canadian Nuclear Safety Commission Regulations (CNSC), Standards and Guidelines C 2.1 Comply with CNSC General Nuclear Safety and Control Regulations Licences Obligations of licensees and Nuclear Energy Workers Records and reports C 2.2 Comply with CNSC Radiation Protection Regulations Obligations of licensees and Nuclear Energy Workers Radiation dose limits Dosimetry services Labeling signs Records to be kept C 2.3 Comply with CNSC Nuclear Substances and Radiation Devices Regulations Exemptions from license requirements General exempted activities General obligations Leak tests Transfers Radiation survey meters Accidents Posting of signs at storage areas Records to be kept and retained Nuclear substances
  11. 11. Curriculum Guide – Nuclear Medicine May 2007 11 C 2.4 Adhere to CNSC Guidelines for Handling Packages Containing Nuclear Substances C 2.5 Comply with CNSC Nuclear Substances and Radiation Devices Licence Conditions for diagnostic nuclear medicine procedures Area Classification Laboratory lists Laboratory procedures Thyroid monitoring Thyroid screening Thyroid bioassay Contamination meter criteria Contamination criteria Decommissioning Storage Disposal limits Annual compliance report C 2.6 Comply with CNSC Nuclear Substances and Radiation Devices Licence Conditions for therapeutic nuclear medicine procedures Area classification Laboratory lists Laboratory procedures Thyroid monitoring Thyroid screening Thyroid bioassay Contamination meter requirements Contamination criteria Decommissioning Storage Disposal limits Annual compliance report C 2.7 Adhere to CNSC Radiation Safety Data Sheet information for safe handling of radioactive materials that pose special hazards C 2.8 Adhere to CNSC guidelines for use of personal dosimeters C 2.9 Adhere to an established radiation protection program Thyroid monitoring Wipe testing Area surveys Routine personal monitoring C 2.10 Assess personal radiation exposure dose report with respect to ALARA principles Implement appropriate procedure when reading reaches action level C 2.11 Adhere to CNSC guidelines for spill procedures C 2.12 Adhere to storage and disposal guidelines of radioactive waste Maintain a secure low level storage area to allow for decay of radioactive waste Adhere to established radiation safety protocols for the storage of radioactive waste Adhere to established radiation safety protocols for the disposal of radioactive waste C 2.13 Adhere to CNSC guidelines for the safe handling of unsealed nuclear substances
  12. 12. Curriculum Guide – Nuclear Medicine May 2007 12 C 3 Advocate radiation safety C 3.1 Educate individuals regarding radiation risks Ionizing radiation and properties Risk versus benefit Genetic effects Somatic effects Stochastic effects Deterministic effects C 3.2 Discuss protective practices relevant to administered diagnostic radiopharmaceuticals Hydration Cessation of breast feeding Thyroid blocking In-patient protocols C 3.3 Discuss protective practices relevant to administered therapeutic radiopharmaceuticals In-patient protocols Out-patient protocols C 3.4 Discuss radiation dose of nuclear medicine examinations relative to other imaging procedures Review current radiation safety literature Consult with medical radiation personnel C 4 Apply radiation protection practices with respect to radiation emitting devices to protect patients, technologists, staff, care givers and general public C 4.1 Apply ALARA principles to minimize radiation exposure to technologists, staff, care givers and general public from radiation emitting devices C 4.2 Apply ALARA principles to minimize patient exposure dose with regards to PET/CT and SPECT/CT scanning C 4.3 Apply protective practices according to organ sensitivities C 4.4 Operate the CT scanner adhering to the federal and provincial regulations’ procedural recommendations for reducing occupational doses C 5 Comply with Transport Canada’s requirements for Transportation of Dangerous Goods with respect to radioactive materials
  13. 13. Curriculum Guide – Nuclear Medicine May 2007 13 MODULE D: QUALITY MANAGEMENT D 1 Participate in a quality assurance program D 1.1 Participate in activities that support quality assurance program Ensure that technical protocols are updated as required Ensure that examination protocols are updated as required Optimize patient scheduling Participate in the revision of departmental policies Verify that accurate data is collected, securely stored, and shared only with appropriate persons Analyze data to improve departmental outcomes including Identify trends Monitor repeat/reject rate Monitor calibration of instrument Maintain quality control records and charts Participate in quality assurance surveys Facilitate effective flow and exchange of information with all stakeholders D 1.2 Apply principles of risk management Complete an incident report Maintain accurate record keeping Comply with infection control policies and procedures Practice in a manner that will help prevent workplace injuries Comply with policies to eliminate workplace harassment Promote safe practices to prevent harm to patient and others Direct patient with specific concerns to appropriate resource person Be familiar with emergency disaster plans D 1.3 Adhere to Workplace Hazardous Materials Information System (WHMIS) regulations and Occupational Health and Safety (OH&S) regulations D 2 Perform quality control on ancillary equipment D 2.1 Evaluate the performance of the equipment (e.g. ECG machines, BP cuffs, aerosol units) D 2.2 Evaluate the integrity of protective apparel and devices (e.g. lead aprons, TLDs, N95 masks) D 2.3 Take corrective action when required D 3 Perform quality control on scintillation spectrometers (e.g. well detector, probes) D 3.1 Perform calibration procedures D 3.2 Perform quality control procedures Perform efficiency assessment Perform chi-square test Perform energy resolution test (Full Width Half Max) D 3.3 Evaluate equipment performance D 3.4 Take corrective action when required D 4 Perform quality control on gamma cameras D 4.1 Perform quality control procedures Perform field uniformity check Perform spatial resolution check Perform spatial linearity check Perform centre of rotation Perform ECT uniformity Perform pulse height analyzer photopeak
  14. 14. Curriculum Guide – Nuclear Medicine May 2007 14 D 4.2 Evaluate equipment performance D 4.3 Determine sources of non-uniformity and distortion D 4.4 Take corrective action when required D 5 Describe quality control procedures for bone densitometry equipment D 6 Perform quality control on gas-filled detectors D 6.1 Perform quality control procedures on dose calibrator Perform accuracy test Perform constancy test Perform activity linearity D 6.2 Evaluate dose calibrator performance D 6.3 Perform quality control procedures on survey meter D 6.4 Evaluate survey meter performance D 6.5 Take corrective action when required D 7 Describe quality control procedures on positron emission tomography (PET) systems D7.1 Daily QC Blank Singles D7.2 Normalization scan D 8 Perform quality control on computed tomography (CT) scanners associated with hybrid unit D 8.1 Perform quality control procedures D 8.2 Evaluate equipment performance D 8.3 Take corrective action when required
  15. 15. Curriculum Guide – Nuclear Medicine May 2007 15 MODULE E: RADIOPHARMACY AND LABORATORY PROCEDURES E 1 Store radiopharmaceuticals, non-radioactive supplies and kits according to manufacturers’ recommendations E 2 Perform generator elution procedure E 2.1 Set up generator and shield as required E 2.2 Elute generator using aseptic technique E 2.3 Assay the generator eluate E 2.4 Assess the eluate for radionuclide and chemical purity E 2.5 Calculate generator yield E 2.6 Identify reasons for elution problems and take appropriate actions to rectify E 2.7 Document information relevant to generator elution E 3 Prepare radiopharmaceuticals for administration E 3.1 Prepare radiopharmaceuticals efficaciously and maintain product sterility E 3.2 Determine, within preparation limitations, the total volume and radioactivity to be added to a radiopharmaceutical kit E 3.3 Calculate the specific concentration of radioactive preparations E 3.4 Label radioactive preparations E 3.5 Maintain radiopharmaceutical record forms E 3.6 Schedule generator elutions to meet kit requirements and department needs E 3.7 Prepare radiopharmaceuticals in accordance with work schedule requirements E 3.8 Radiolabel autologous cellular components for re-injection E 3.9 Ensure accurate handling of all labelled blood products E 4 Perform Radiopharmaceutical Quality Control E 4.1 Inspect preparations visually (e.g., colour, clarity) E 4.2 Determine the radiochemical purity of radiopharmaceutical preparations E 4.3 Determine particle size for macroaggregated preparations E 4.4 Access acceptability of maccroaggregated preparations for clinical use E 4.5 Assess results of testing radiopharmaceuticals for either sterility or apyrogenicity E 5 Dispense Radiopharmaceuticals E 5.1 Calculate the activity and volume of the radiopharmaceutical required for diagnostic or therapeutic procedures E 5.2 Verify radiopharmaceutical label information is accurate E 5.3 Check radiopharmaceutical expiration date and time are within acceptable limits E 5.4 Dispense the correct volume of the radiopharmaceutical E 5.5 Verify the radioactivity to be administered using a dose calibrator E 5.6 Document information relevant to dispensing radiopharmaceuticals E 6 Perform General Laboratory Procedures E 6.1 Calculate and prepare standard/stock solutions for the laboratory E 6.2 Maintain acceptable levels of reagents and other supplies in the radiopharmacy
  16. 16. Curriculum Guide – Nuclear Medicine May 2007 16 MODULE F: Clinical Procedures - CORE COMPETENCIES F 1 Review patient data relevant to requested procedure F 2 Assess requisition for compliance with medico-legal requirements F 3 Prioritize examinations according to patient’s medical status and resources available F 4 Review data available from images and/or reports of previous studies F 5 Verify accuracy of patient information F 6 Assess images/quantitative data for diagnostic quality F 6.1 Produce hard/soft copy image F 6.2 Verify visibility and accuracy of markers and/or annotation F 6.3 Identify image artifacts Attenuation Contamination Motion Star artifact Bulls eye artifact Environmental e.g. visual, auditory or physical stimulation F 6.4 Take corrective action to eliminate/minimize image artifacts F 6.5 Critically analyze the diagnostic quality of the image Patient’s pathology and abilities Acquisition parameters Processing parameters Display parameters F 6.6 Assess quantitative data for accuracy and validity F 6.7 Verify completeness and accuracy of documentation F 6.8 Consult with physician as required prior to dismissal of patient F 7 Complete post-procedural tasks F 7.1 Release patient from the technologist’s care when safe to do so Respond to patient’s need for immediate medical attention Ensure continuity of care Collaborate with patient’s family and other health care providers F 7.2 Archive images F 8 Understand basic concepts of correlative imaging modalities (PET, CT, MR, Sonography) F 8.1 Understand basic technical concepts of image acquisition using correlative imaging modalities F 8.2 Explain the relevance of common correlative imaging procedures to the diagnostic process
  17. 17. Curriculum Guide – Nuclear Medicine May 2007 17 Due to regional differences in the practice of nuclear medicine technology it is recognized that candidates may not be clinically competent in 100% of nuclear medicine clinical procedures listed in the competency profile. However candidates must at the least demonstrate competency in a minimum of eleven (11) clinical procedures with a HIGH competency level plus a minimum of eleven (11) clinical procedures with a MEDIUM competency level. Please see Competency Profile for Competency Levels http://www.camrt.ca/english/profession/pdf/Comp_Profile_Nuclear_Medecine06.pdf MODULE G: Clinical Procedures - CARDIOVASCULAR (CV) G 1 Understand pathology and anomalies related to the cardiovascular system in relation to performing a nuclear medicine procedure G 1.1 Vascular disease G 1.2 Congestive heart disease G 1.3 Inflammation G 1.4 Infection G 1.5 Congenital anomalies G 1.6 Hematopoietic disorders G 1.7 Conduction disorders G 1.8 Cardiomyopathy G 1.9 Valvular disease G 1.10 Shunts G 2 Recognize patterns consistent with pathology and anomalies related to the cardiovascular system in relation to a nuclear medicine procedure G 2.1 Vascular disease G 2.2 Congestive heart disease G 2.3 Inflammation G 2.4 Infection G 2.5 Congenital anomalies G 2.6 Hematopoietic disorders G 2.7 Conduction disorders G 2.8 Cardiomyopathy G 2.9 Valvular disease G 2.10 Shunts G 3 Understand the anatomy and physiology of the cardiovascular system G 3.1 Gross anatomy G 3.2 Cross sectional anatomy G 3.3 Relational anatomy G 4 Understand the effects including contraindications, risks and interactions of agents (i.e. pharmacologic, dietary) acting on the cardiovascular system G 4.1 Antiarrhythmics G 4.2 Anticoagulants G 4.3 Diuretics G 4.4 Fluids, electrolytes, nutrients G 4.5 Treatment of acidosis G 4.6 Treatment of angina pectoris
  18. 18. Curriculum Guide – Nuclear Medicine May 2007 18 G 4.7 Treatment of hypertension G 4.8 Adenosine G 4.9 Aminophylline G 4.10 Atropine G 4.11 Insulin G 4.12 Dipyridamole G 4.13 Dobutamine G 4.14 ACD solution G 4.15 Ascorbic acid G 4.16 EDTA G 4.17 Heparin CV 1 Gated Rest Equilibrium Study G 5 Evaluate the correlation between clinical information provided and the requested examination G 6 Modify procedure according to contraindications G 7 Plan the nuclear medicine imaging procedure G 7.1 Ensure the sequence of procedures enables optimum study result while providing for the patient’s comfort and safety G 7.2 Ensure availability of necessary patient care support equipment and resources G 7.3 Select radiopharmaceutical G 8 Perform technical preparation G 9 Perform patient preparation G 9.1 Placement of electrocardiogram leads G 9.2 Establish optimal gating G 9.3 Dispense any pre-medications G 9.4 Administer pre-medications G 10 Exchange information with patients and their support persons to enable them to make informed decisions G 10.1 Explain procedure G 10.2 Verify understanding of information to give an opportunity for patient to ask questions G 10.3 Counsel patients with respect to pre and post procedural care G 10.4 Respond to patients and their support persons concerns G 11 Administer required radiopharmaceuticals in accordance with protocol G 11.1 In vivo G 11.2 Modified in vivo G 11.3 In vitro G 12 Position the patient using anatomical landmarks and knowledge of relational anatomy to best demonstrate anatomical structures/pathologies G 13 Adjust procedure according to patient conditions and factors G 13.1 Age Geriatric Pediatric G 13.2 Cognitive impairment G 13.3 Patient’s pathology and abilities G 13.4 Body habitus
  19. 19. Curriculum Guide – Nuclear Medicine May 2007 19 G 14 Select acquisition parameters G 14.1 Instrumentation/computer parameters G 14.2 Ancillary equipment G 15 Perform procedure in accordance with protocol G 16 Operate equipment for image/data acquisition G 17 Evaluate anatomy, physiology and patient position on the image to determine if further images/data are required G 17.1 Verify adequate demonstration of pathology G 17.2 Verify adequate visualization of required structures G 17.3 Verify visualization of desired physiological phase G 18 Recognize normal results and variants G 19 Recognize pathologies/abnormal results G 20 Process to optimize the image G 20.1 Annotation G 20.2 Reformatting/reframing G 20.3 Window width/contrast G 20.4 Window level/brightness G 20.5 Normalization G 21 Perform image/data analysis and manipulation G 21.1 Regions of interest G 21.2 Ejection fraction G 21.3 Threshold level G 21.4 Time activity curve CV 2 Myocardial Perfusion Non-Gated SPECT (Rest/Stress) G 22 Evaluate the correlation between clinical information provided and the requested examination G 23 Modify procedure according to contraindications G 24 Plan the nuclear medicine imaging procedure G 24.1 Ensure the sequence of procedures enables optimum study result while providing for the patient’s comfort and safety G 24.2 Ensure availability of necessary patient care support equipment and resources G 24.3 Select radiopharmaceutical G 25 Perform technical preparation G 26 Perform patient preparation G 27 Exchange information with patients and their support persons to enable them to make informed decisions G 27.1 Explain procedure G 27.2 Verify understanding of information to give an opportunity for patient to ask questions G 27.3 Counsel patients with respect to pre and post procedural care G 27.4 Respond to patients and their support persons concerns G 28 Administer required radiopharmaceuticals in accordance with protocol G 29 Position the patient using anatomical landmarks and relational anatomy to best demonstrate anatomical structures/pathologies
  20. 20. Curriculum Guide – Nuclear Medicine May 2007 20 G 30 Adjust procedure according to patient conditions and factors G 30.1 Age Geriatric Pediatric G 30.2 Cognitive impairment G 30.3 Patient’s pathology and abilities G 30.4 Body habitus G 31 Select acquisition parameters G 31.1 Instrumentation/computer parameters G 31.2 Ancillary equipment G 32 Perform procedure in accordance with protocol G 33 Operate equipment for image/data acquisition G 34 Evaluate anatomy, physiology and patient position on the image to determine if further images/data are required G 34.1 Verify adequate demonstration of pathology G 34.2 Verify adequate visualization of required structures G 43.3 Verify visualization of desired physiological phase G 35 Recognize normal results and variants G 36 Recognize pathologies/abnormal results G 37 Process to optimize the image G 37.1 Anatomical orientation G 37.2 Annotation G 37.3 Back projection G 37.4 Iterative reconstruction G 37.5 Processing filters G 37.6 Attenuation correction G 37.7 Window width/contrast G 37.8 Window level/brightness G 37.9 Motion correction G 37.10 Normalization G 37.11 Sinograms G 38 Perform image/data analysis and manipulation G 38.1 Tomographic reconstruction CV 3 Myocardial Perfusion Gated SPECT (Rest/Stress) G 39 Evaluate the correlation between clinical information provided and the requested examination G 40 Modify procedure according to contraindications G 41 Plan the nuclear medicine imaging procedure G 41.1 Ensure the sequence of procedures enables optimum study result while providing for the patient’s comfort and safety G 41.2 Ensure availability of necessary patient care support equipment and resources G 41.3 Select radiopharmaceutical G 42 Perform technical preparation G 43 Perform patient preparation G 43.1 Placements of electrocardiogram leads G 43.2 Establish optimal gating
  21. 21. Curriculum Guide – Nuclear Medicine May 2007 21 G 44 Exchange information with patients and their support persons to enable them to make informed decisions G 44.1 Explain procedure G 44.2 Verify understanding of information to give an opportunity for patient to ask questions G 44.3 Counsel patients with respect to pre and post procedural care G 44.4 Respond to patients and their support persons concerns G 45 Administer required radiopharmaceuticals in accordance with protocol G 46 Position the patient using anatomical landmarks and relational anatomy to best demonstrate anatomical structures/pathologies G 47 Adjust procedure according to patient conditions and factors G 47.1 Age Geriatric Pediatric G 47.2 Cognitive impairment G 47.3 Patient’s pathology and abilities G 47.4 Body habitus G 48 Select acquisition parameters G 48.1 Instrumentation/computer parameters G 48.2 Ancillary equipment G 49 Perform procedure in accordance with protocol G 50 Operate equipment for image/data acquisition G 51 Evaluate anatomy, physiology and patient position on the image to determine if further images/data are required G 51.1 Verify adequate demonstration of pathology G 51.2 Verify adequate visualization of required structure G 51.3 Verify visualization of desired physiological phase G 52 Recognize normal results and variants G 53 Recognize pathologies/abnormal results G 54 Process to optimize the image G 54.1 Anatomical orientation G 54.2 Annotation G 54.3 Back projection G 54.4 Iterative reconstruction G 54.5 Processing filters G 54.6 Attenuation correction G 54.7 Window width/contrast G 54.8 Window level/brightness G 54.9 Motion correction G 54.10 Normalization G 54.11 Sinograms G 55 Perform image/data analysis and manipulation G 55.1 Regions of interest G 55.2 Ejection fraction G 55.3 Threshold level G 55.4 Time activity curve G 55.5 Tomographic reconstruction
  22. 22. Curriculum Guide – Nuclear Medicine May 2007 22 CV 4 Myocardial Perfusion Pharmacological Stress SPECT G 56 Evaluate the correlation between clinical information provided and the requested examination G 57 Modify procedure according to contraindications G 58 Plan the nuclear medicine imaging procedure G 58.1 Ensure the sequence of procedures enables optimum study result while providing for patient’s comfort and safety G 58.2 Ensure availability of necessary patient care support equipment and resources G 58.3 Dispense any pre-medication required G 58.4 Administer pre-medications G 58.5 Select radiopharmaceutical G 59 Perform technical preparation G 60 Perform patient preparation G 61 Exchange information with patients and their support persons to enable them to make informed decisions G 61.1 Explain procedure G 61.2 Verify understanding of information to give an opportunity for patient to ask questions G 61.3 Counsel patients with respect to pre and post procedural care G 61.4 Respond to patients and their support persons concerns G 62 Administer required radiopharmaceuticals in accordance with protocol G 63 Position the patient using anatomical landmarks and relational anatomy to best demonstrate anatomical structures/pathologies G 64 Adjust procedure according to patient conditions and factors G 64.1 Age Geriatric Pediatric G 64.2 Cognitive impairment G 64.3 Patient’s pathology and abilities G 64.4 Body habitus G 65 Select acquisition parameters G 65.1 Instrumentation/computer parameters G 65.2 Ancillary equipment G 66 Perform procedure in accordance with protocol G 67 Operate equipment for image/data acquisition G 68 Evaluate anatomy, physiology and patient position on the image to determine if further images/data are required G 68.1 Verify adequate demonstration of pathology G 68.2 Verify adequate visualization of required structures G 68.3 Verify visualization of desired physiological phase G 69 Recognize normal results and variants G 70 Recognize pathologies/abnormal results G 71 Process to optimize the image G 71.1 Anatomical orientation G 71.2 Annotation G 71.3 Back projection G 71.4 Iterative reconstruction G 71.5 Processing filters
  23. 23. Curriculum Guide – Nuclear Medicine May 2007 23 G 71.6 Attenuation correction G 71.7 Window width/contrast G 71.8 Window level/brightness G 71.9 Motion correction G 71.10 Normalization G 71.11 Sinograms CV 5 First Pass Rest G 72 Evaluate the correlation between clinical information provided and the requested examination G 73 Modify procedure according to contraindications G 74 Plan the nuclear medicine imaging procedure G 74.1 Ensure the sequence of procedures enables optimum study result while providing for patient’s comfort and safety G 74.2 Ensure availability of necessary patient care support equipment and resources G 74.3 Select radiopharmaceutical G 75 Perform technical preparation G 76 Perform patient preparation G 77 Exchange information with patients and their support persons to enable them to make informed decisions G 77.1 Explain procedure G 77.2 Verify understanding of information to give an opportunity for patient to ask questions G 77.3 Counsel patients with respect to pre and post procedural care G 77.4 Respond to patients and their support persons concerns G 78 Administer required radiopharmaceuticals in accordance with protocol G 79 Position the patient using anatomical landmarks and relational anatomy to best demonstrate anatomical structures/pathologies G 80 Adjust procedure according to patient conditions and factors G 80.1 Age Geriatric Pediatric G 80.2 Cognitive impairment G 80.3 Patient’s pathology and abilities G 80.4 Body habitus G 81 Select acquisition parameters G 81.1 Instrumentation/computer parameters G 81.2 Ancillary equipment G 82 Perform procedure in accordance with protocol G 83 Operate equipment for image/data acquisition G 84 Evaluate anatomy, physiology and patient position on the image to determine if further images/data are required G 84.1 Verify adequate demonstration of pathology G 84.2 Verify adequate visualization of required structures G 84.3 Verify visualization of desired physiological phase G 85 Recognize normal results and variants G 86 Recognize pathologies/abnormal results
  24. 24. Curriculum Guide – Nuclear Medicine May 2007 24 G 87 Process to optimize the image G 87.1 Annotation G 87.2 Reformatting/reframing G 87.3 Window width/contrast G 87.4 Window level/brightness G 88 Perform image/data analysis and manipulation G 88.1 Regions of interest G 88.2 Ejection fraction G 88.3 Time activity curve G 88.4 Ratios G 88.5 Mathematical calculations CV 6 Gated Equilibrium Stress G 89 Evaluate the correlation between clinical information provided and the requested examination G 90 Modify procedure according to contraindications G 91 Plan the nuclear medicine imaging procedure G 91.1 Ensure the sequence of procedures enables optimum study result while providing for patient’s comfort and safety G 91.2 Ensure availability of necessary patient care support equipment and resources G 91.3 Select radiopharmaceutical G 92 Perform technical preparation G 93 Perform patient preparation G 94 Exchange information with patients and their support persons to enable them to make informed decisions G 94.1 Explain procedure G 94.2 Verify understanding of information to give an opportunity for patient to ask questions G 94.3 Counsel patients with respect to pre and post procedural care G 94.4 Respond to patients and their support persons concerns G 95 Administer required radiopharmaceuticals in accordance with protocol G 96 Position the patient using anatomical landmarks and relational anatomy to best demonstrate anatomical structures/pathologies G 97 Adjust procedure according to patient conditions and factors G 97.1 Age Geriatric Pediatric G 97.2 Cognitive impairment G 97.3 Patient’s pathology and abilities G 97.4 Body habitus G 98 Select acquisition parameters G 98.1 Instrumentation/computer parameters G 98.2 Ancillary equipment G 99 Perform procedure in accordance with protocol G 100 Operate equipment for image/data acquisition G 101 Evaluate anatomy, physiology and patient position on the image to determine if further images/data are required G 101.1 Verify adequate demonstration of pathology
  25. 25. Curriculum Guide – Nuclear Medicine May 2007 25 G 101.2 Verify adequate visualization of required structures G 101.3 Verify visualization of desired physiological phase G 102 Recognize normal results and variants G 103 Recognize pathologies/abnormal results G 104 Process to optimize the image G 104.1 Annotation G 104.2 Reformatting/reframing G 104.3 Window width/contrast G 104.4 Window level/brightness G 104.5 Normalization G 105 Perform image/data analysis and manipulation G 105.1 Regions of interest G 105.2 Ejection fraction G 105.3 Threshold level G 105.4 Time activity curve CV 7 Gated Equilibrium SPECT G 106 Evaluate the correlation between clinical information provided and the requested examination G 107 Modify procedure according to contraindications G 108 Plan the nuclear medicine imaging procedure G 108.1 Ensure the sequence of procedures enables optimum study result while providing for patient’s comfort and safety G 108.2 Ensure availability of necessary patient care support equipment and resources G 108.3 Select radiopharmaceutical G 109 Perform technical preparation G 110 Perform patient preparation G 111 Exchange information with patients and their support persons to enable them to make informed decisions G 111.1 Explain procedure G 111.2 Verify understanding of information to give an opportunity for patient to ask questions G 111.3 Counsel patients with respect to pre and post procedural care G 111.4 Respond to patients and their support persons concerns G 112 Administer required radiopharmaceuticals in accordance with protocol G 113 Position the patient using anatomical landmarks and relational anatomy to best demonstrate anatomical structures/pathologies G 114 Adjust procedure according to patient conditions and factors G 114.1 Age Geriatric Pediatric G 114.2 Cognitive impairment G 114.3 Patient’s pathology and abilities G 114.4 Body habitus G 115 Select acquisition parameters G 115.1 Instrumentation/computer parameters G 115.2 Ancillary equipment
  26. 26. Curriculum Guide – Nuclear Medicine May 2007 26 G 116 Perform procedure in accordance with protocol G 117 Operate equipment for image/data acquisition G 118 Evaluate anatomy, physiology and patient position on the image to determine if further images/data are required G 118.1 Verify adequate demonstration of pathology G 118.2 Verify adequate visualization of required structures G 118.3 Verify visualization of desired physiological phase G 119 Recognize normal results and variants G 120 Recognize pathologies/abnormal results G 121 Process to optimize the image G 121.1 Anatomical orientation G 121.2 Annotation G 121.3 Back projection G 121.4 Iterative reconstruction G 121.5 Processing filters G 121.6 Attenuation correction G 121.7 Window width/contrast G 121.8 Window level/brightness G 121.9 Motion correction G 121.10 Normalization G 121.11 Sinograms G 122 Perform image/data analysis and manipulation G 122.1 Regions of interest G 122.2 Ejection fraction G 122.3 Threshold level G 122.4 Time activity curve G 122.5 Tomographic reconstruction CV 8 Myocardial Perfusion SPECT (Rest only) G 123 Evaluate the correlation between clinical information provided and the requested examination G 124 Modify procedure according to contraindications G 125 Plan the nuclear medicine imaging procedure G 125.1 Ensure the sequence of procedures enables optimum study result while providing for patient’s comfort and safety G 125.2 Ensure availability of necessary patient care support equipment and resources G 125.3 Select radiopharmaceutical G 126 Perform technical preparation G 127 Perform patient preparation G 128 Exchange information with patients and their support persons to enable them to make informed decisions G 128.1 Explain procedure G 128.2 Verify understanding of information to give an opportunity for patient to ask questions G 128.3 Counsel patients with respect to pre and post procedural care G 128.4 Respond to patients and their support persons concerns G 129 Administer required radiopharmaceuticals in accordance with protocol
  27. 27. Curriculum Guide – Nuclear Medicine May 2007 27 G 130 Position the patient using anatomical landmarks and relational anatomy to best demonstrate anatomical structures/pathologies G 131 Adjust procedure according to patient conditions and factors G 131.1 Age Geriatric Pediatric G 131.2 Cognitive impairment G 131.3 Patient’s pathology and abilities G 131.4 Body habitus G 132 Select acquisition parameters G 132.1 Instrumentation/computer parameters G 132.2 Ancillary equipment G 133 Perform procedure in accordance with protocol G 134 Operate equipment for image/data acquisition G 135 Evaluate anatomy, physiology and patient position on the image to determine if further images/data are required G 135.1 Verify adequate demonstration of pathology G 135.2 Verify adequate visualization of required structures G 135.3 Verify visualization of desired physiological phase G 136 Recognize normal results and variants G 137 Recognize pathologies/abnormal results G 138 Process to optimize the image G 138.1 Anatomical orientation G 138.2 Annotation G 138.3 Back projection G 138.4 Iterative reconstruction G 138.5 Processing filters G 138.6 Attenuation correction G 138.7 Window width/contrast G 138.8 Window level/brightness G 138.9 Motion correction G 138.10 Normalization G 138.11 Sinograms G 139 Perform image/data analysis and manipulation G 139.1 Tomographic reconstruction CV 9 Myocardial Perfusion Planar G 140 Evaluate the correlation between clinical information provided and the requested examination G 141 Modify procedure according to contraindications G 142 Plan the nuclear medicine imaging procedure G 142.1 Ensure the sequence of procedures enables optimum study result while providing for patient’s comfort and safety G 142.2 Ensure availability of necessary patient care support equipment and resources G 142.3 Select radiopharmaceutical G 143 Perform technical preparation G 144 Perform patient preparation
  28. 28. Curriculum Guide – Nuclear Medicine May 2007 28 G 145 Exchange information with patients and their support persons to enable them to make informed decisions G 145.1 Explain procedure G 145.2 Verify understanding of information to give an opportunity for patient to ask questions G 145.3 Counsel patients with respect to pre and post procedural care G 145.4 Respond to patients and their support persons concerns G 146 Administer required radiopharmaceuticals in accordance with protocol G 147 Position the patient using anatomical landmarks and relational anatomy to best demonstrate anatomical structures/pathologies G 148 Adjust procedure according to patient conditions and factors G 148.1 Age Geriatric Pediatric G 148.2 Cognitive impairment G 148.3 Patient’s pathology and abilities G 148.4 Body habitus G 149 Select acquisition parameters G 149.1 Instrumentation/computer parameters G 149.2 Ancillary equipment G 150 Perform procedure in accordance with protocol G 151 Operate equipment for image/data acquisition G 152 Evaluate anatomy, physiology and patient position on the image to determine if further images/data are required G 152.1 Verify adequate demonstration of pathology G 152.2 Verify adequate visualization of required structures G 152.3 Verify visualization of desired physiological phase G 153 Recognize normal results and variants G 154 Recognize pathologies/abnormal results G 155 Process to optimize the image G 155.1 Annotation G 155.2 Window width/contrast G 155.3 Window level/brightness G 156 Perform image/data analysis and manipulation CV 10 Set-up and Acquire 12-Lead ECG G 157 Evaluate the correlation between clinical information provided and the requested examination G 158 Exchange information with patients and their support persons to enable them to make informed decisions G 158.1 Explain procedure G 158.2 Verify understanding of information to give an opportunity for patient to ask questions G 158.3 Respond to patients and their support persons concerns G 159 Place electrodes using anatomical landmarks structures/pathologies
  29. 29. Curriculum Guide – Nuclear Medicine May 2007 29 G 160 Adjust procedure according to patient conditions and factors G 160.1 Age Geriatric Pediatric G 160.2 Cognitive impairment G 160.3 Patient’s pathology and abilities G 160.4 Body habitus G 161 Perform procedure in accordance with protocol G 162 Operate equipment for data acquisition G 163 Recognize normal results and variants G 164 Recognize abnormal results CV 11 Red Cell Mass/Plasma Volume G 165 Evaluate the correlation between clinical information provided and the requested examination G 166 Plan the nuclear medicine procedure G 166.1 Ensure the sequence of procedures enables optimum study result while providing for patient’s comfort and safety G 166.2 Ensure availability of necessary patient care support equipment and resources G 166.3 Select radiopharmaceutical G 167 Exchange information with patients and their support persons to enable them to make informed decisions G 167.1 Explain procedure G 167.2 Verify understanding of information to give an opportunity for patient to ask questions G 167.3 Counsel patients with respect to pre and post procedural care G 167.4 Respond to patients and their support persons concerns G 168 Administer required radiopharmaceuticals in accordance with protocol G 169 Adjust procedure according to patient conditions and factors G 169.1 Age Geriatric Pediatric G 169.2 Cognitive impairment G 169.3 Patient’s pathology and abilities G 169.4 Body habitus G 170 Perform procedure in accordance with protocol G 171 Operate equipment for data acquisition G 172 Recognize normal results and variants G 173 Recognize pathologies/abnormal results G 174 Perform data analysis and manipulation CV 12 Red Cell Survival G 175 Recognize clinical indications for performing procedure G 176 Describe patient preparation G 177 Identify contraindications for procedure G 178 Identify the radiopharmaceutical
  30. 30. Curriculum Guide – Nuclear Medicine May 2007 30 G 179 Propose procedural modifications G 180 Perform data analysis G 181 Describe image analysis G 182 Recognize normal results and variants G 183 Recognize pathologies/abnormal results CV 13 Gated Equilibrium Pharmacological Intervention G 184 Recognize clinical indications for performing procedure G 185 Describe patient preparation G 186 Identify contraindications for procedure G 187 Identify the radiopharmaceutical G 188 Propose procedural modifications G 189 Perform data analysis G 190 Describe image analysis G 191 Recognize normal results and variants G 192 Recognize pathologies/abnormal results CV 14 First Pass Stress G 193 Recognize clinical indications for performing procedure G 194 Describe patient preparation G 195 Identify contraindications for procedure G 196 Identify the radiopharmaceutical G 197 Propose procedural modifications G 198 Perform data analysis G 199 Describe image analysis G 200 Recognize normal results and variants G 201 Recognize pathologies/abnormal results CV 15 Cardiac Shunt Evaluation G 202 Recognize clinical indications for performing procedure G 203 Describe patient preparation G 204 Identify contraindications for procedure G 205 Identify the radiopharmaceutical G 206 Propose procedural modifications G 207 Perform data analysis G 208 Describe image analysis G 209 Recognize normal results and variants G 210 Recognize pathologies/abnormal results CV 16 Monoclonal Antibody G 211 Recognize clinical indications for performing procedure G 212 Describe patient preparation G 213 Identify contraindications for procedure G 214 Identify the radiopharmaceutical G 215 Propose procedural modifications G 216 Perform data analysis G 217 Describe image analysis G 218 Recognize normal results and variants G 219 Recognize pathologies/abnormal results
  31. 31. Curriculum Guide – Nuclear Medicine May 2007 31 CV 17 Myocardial Infarct (Pyrophosphate) G 220 Recognize clinical indications for performing procedure G 221 Describe patient preparation G 222 Identify contraindications for procedure G 223 Identify the radiopharmaceutical G 224 Propose procedural modifications G 225 Perform data analysis G 226 Describe image analysis G 227 Recognize normal results and variants G 228 Recognize pathologies/abnormal results CV 18 Venogram G 229 Recognize clinical indications for performing procedure G 230 Describe patient preparation G 231 Identify contraindications for procedure G 232 Identify the radiopharmaceutical G 233 Propose procedural modifications G 234 Perform data analysis G 235 Describe image analysis G 236 Recognize normal results and variants G 237 Recognize pathologies/abnormal results CV 19 PET G 238 Recognize clinical indications for performing procedure G 239 Describe patient preparation G 240 Identify contraindications for procedure G 241 Identify the radiopharmaceutical G 242 Propose procedural modifications G 243 Perform data analysis G 244 Describe image analysis G 245 Recognize normal results and variants G 246 Recognize pathologies/abnormal results
  32. 32. Curriculum Guide – Nuclear Medicine May 2007 32 MODULE H: Clinical Procedures – GASTROINTESTINAL (GI) H 1 Understand pathology and anomalies related to the gastrointestinal system in relation to performing a nuclear medicine procedure H 1.1 Vascular disease H 1.2 Neoplasms H 1.3 Inflammation H 1.4 Infection H 1.5 Motility disorders H 1.6 Congenitial disease H 1.7 Trauma H 1.8 Anemia H 1.9 Metabolic disorders H 2 Recognize patterns consistent with pathology and anomalies related to gastrointestinal system in relation to a nuclear medicine procedure H 2.1 Vascular disease H 2.2 Neoplasms H 2.3 Inflammation H 2.4 Infection H 2.5 Motility disorders H 2.6 Congenitial disease H 2.7 Trauma H 2.8 Anemia H 2.9 Metabolic disorders H 3 Understand the anatomy and physiology of the gastrointestinal system H 3.1 Gross anatomy H 3.2 Cross sectional anatomy H 3.3 Relational anatomy H 4 Understand the effects including contraindications, risks and interactions of agents (i.e. pharmacologic, dietary) acting on the gastrointestinal system H 4.1 Laxatives H 4.2 Motility drugs H 4.3 Cholecystokinen/sincalide/CCK H 4.4 Cimetidine/ranitidine/famotidine H 4.5 Glucagon H 4.6 Insulin H 4.7 Morphine H 4.8 Pentagastrin H 4.9 Ascorbic acid H 4.10 Intrinsic factor H 4.11 Vitamin B12 H 4.12 Potassium perchlorate H 4.13 Phenobarbital GI 1 RBC Liver Scan H 5 Evaluate the correlation between clinical information provided and the requested examination H 6 Modify procedure according to contraindications H 7 Plan the nuclear medicine imaging procedure
  33. 33. Curriculum Guide – Nuclear Medicine May 2007 33 H 7.1 Ensure the sequence of procedures enables optimum study result while providing for the patient’s comfort and safety H 7.2 Ensure the availability of necessary patient care support equipment and resources H 7.3 Dispense any pre-medications required H 7.4 Administer pre-medications H 7.5 Select radiopharmaceutical H 8 Perform technical preparation H 9 Perform patient preparation H 10 Exchange information with patients and their support persons to enable them to make informed decisions H 10.1 Explain procedure H 10.2 Verify understanding of information to give an opportunity for patient to ask questions H 10.3 Respond to patients and their support persons concerns H 11 Administer required radiopharmaceuticals in accordance with protocol H 12 Position the patient using anatomical landmarks and relational anatomy to best demonstrate anatomical structures/pathologies H 13 Adjust procedure according to patient conditions and factors H 13.1 Age Geriatric Pediatric H 13.2 Cognitive impairment H 13.3 Patient’s pathology and abilities H 13.4 Body habitus H 14 Select acquisition parameters H 14.1 Instrumentation/computer parameters H 14.2 Ancillary equipment H 15 Perform procedure in accordance with protocol H 16 Operate equipment for image/data acquisition H 17 Evaluate anatomy, physiology and patient position on the image to determine if further images/data are required H 17.1 Verify adequate demonstration of required structures H 17.2 Verify adequate visualization of required structures H 17.3 Verify visualization of desired physiological phase H 18 Recognize normal results and variants H 19 Recognize pathologies/abnormal results H 20 Process to optimize the image H 20.1 Annotation H 20.2 Processing filters H 20.3 Attenuation correction H 20.4 Window width/contrast H 20.5 Window level/brightness H 20.6 Motion correction H 20.7 Normalization H 20.8 Sinograms H 21 Perform image/data analysis and manipulation
  34. 34. Curriculum Guide – Nuclear Medicine May 2007 34 GI 2 Hepatobiliary Scan H 22 Evaluate the correlation between clinical information provided and the requested examination H 23 Modify procedure according to contraindications H 24 Plan the nuclear medicine imaging procedure H 24.1 Ensure the sequence of procedures enables optimum study result while providing for the patient’s comfort and safety H 24.2 Ensure the availability of necessary patient care support equipment and resources H 24.3 Select radiopharmaceutical H 25 Perform technical preparation H 26 Perform patient preparation H 27 Exchange information with patients and their support persons to enable them to make informed decisions H 27.1 Explain procedure H 27.2 Verify understanding of information to give an opportunity for patient to ask questions H 27.3 Respond to patients and their support persons concerns H 28 Administer required radiopharmaceuticals in accordance with protocol H 29 Position the patient using anatomical landmarks and relational anatomy to best demonstrate anatomical structures/pathologies H 30 Adjust procedure according to patient conditions and factors H 30.1 Age Geriatric Pediatric H 30.2 Cognitive impairment H 30.3 Patient’s pathology and abilities H 30.4 Body habitus H 31 Select acquisition parameters H 31.1 Instrumentation/computer parameters H 31.2 Ancillary equipment H 32 Perform procedure in accordance with protocol H 33 Operate equipment for image/data acquisition H 34 Evaluate anatomy, physiology and patient position on the image to determine if further images/data are required H 34.1 Verify adequate demonstration of required structures H 34.2 Verify adequate visualization of required structures H 34.3 Verify visualization of desired physiological phase H 35 Recognize normal results and variants H 36 Recognize pathologies/abnormal results H 37 Process to optimize the image H 37.1 Annotation H 37.2 Window width/contrast H 37.3 Window level/brightness H 38 Perform image/data analysis and manipulation
  35. 35. Curriculum Guide – Nuclear Medicine May 2007 35 GI 3 Hepatobiliary Pharmacological Intervention H 39 Evaluate the correlation between clinical information provided and the requested examination H 40 Modify procedure according to contraindications H 41 Plan the nuclear medicine imaging procedure H 41.1 Ensure the sequence of procedures enables optimum study result while providing for the patient’s comfort and safety H 41.2 Ensure the availability of necessary patient care support equipment and resources H 41.3 Dispense any pre-medications required H 41.4 Administer pre-medications H 41.5 Select radiopharmaceutical H 42 Perform technical preparation H 43 Perform patient preparation H 44 Exchange information with patients and their support persons to enable them to make informed decisions H 44.1 Explain procedure H 44.2 Verify understanding of information to give an opportunity for patient to ask questions H 44.3 Respond to patients and their support persons concerns H 45 Administer required radiopharmaceuticals in accordance with protocol H 46 Position the patient using anatomical landmarks and relational anatomy to best demonstrate anatomical structures/pathologies H 47 Adjust procedure according to patient conditions and factors H 47.1 Age Geriatric Pediatric H 47.2 Cognitive impairment H 47.3 Patient’s pathology and abilities H 47.4 Body habitus H 48 Select acquisition parameters H 48.1 Instrumentation/computer parameters H 48.2 Ancillary equipment H 49 Perform procedure in accordance with protocol H 50 Operate equipment for image/data acquisition H 51 Evaluate anatomy, physiology and patient position on the image to determine if further images/data are required H 51.1 Verify adequate demonstration of required structures H 51.2 Verify adequate visualization of required structures H 51.3 Verify visualization of desired physiological phase H 52 Recognize normal results and variants H 53 Recognize pathologies/abnormal results H 54 Process to optimize the image H 54.1 Annotation H 54.2 Reformatting/reframing H 54.3 Window width/ contrast H 54.4 Window level/ brightness
  36. 36. Curriculum Guide – Nuclear Medicine May 2007 36 H 55 Perform image/data analysis and manipulation H 55.1 Regions of interest H 55.2 Ejection fraction H 55.3 Time activity curve GI 4 Gastric Emptying (Solid) H 56 Evaluate the correlation between clinical information provided and the requested examination H 57 Modify procedure according to contraindications H 58 Plan the nuclear medicine imaging procedure H 58.1 Ensure the sequence of procedures enables optimum study result while providing for the patient’s comfort and safety H 58.2 Ensure the availability of necessary patient care support equipment and resources H 58.3 Select radiopharmaceutical H 59 Perform technical preparation H 60 Perform patient preparation H 61 Exchange information with patients and their support persons to enable them to make informed decisions H 61.1 Explain procedure H 61.2 Verify understanding of information to give an opportunity for patient to ask questions H 61.3 Respond to patients and their support persons concerns H 62 Administer required radiopharmaceuticals in accordance with protocol H 63 Position the patient using anatomical landmarks and relational anatomy to best demonstrate anatomical structures/pathologies H 64 Adjust procedure according to patient conditions and factors H 64.1 Age Geriatric Pediatric H 64.2 Cognitive impairment H 64.3 Patient’s pathology and abilities H 64.4 Body habitus H 65 Select acquisition parameters H 65.1 Instrumentation/computer parameters H 65.2 Ancillary equipment H 66 Perform procedure in accordance with protocol H 67 Operate equipment for image/data acquisition H 68 Evaluate anatomy, physiology and patient position on the image to determine if further images/data are required H 68.1 Verify adequate demonstration of required structures H 68.2 Verify adequate visualization of required structures H 68.3 Verify visualization of desired physiological phase H 69 Recognize normal results and variants H 70 Recognize pathologies/abnormal results H 71 Process to optimize the image H 71.1 Annotation H 71.2 Window width/contrast H 71.3 Window level/brightness
  37. 37. Curriculum Guide – Nuclear Medicine May 2007 37 H 72 Perform image/data analysis and manipulation H 72.1 Regions of interest H 72.2 Time activity curve H 72.3 Extrapolation GI 5 Schillings Test H 73 Evaluate the correlation between clinical information provided and the requested examination H 74 Modify procedure according to contraindications H 75 Plan the nuclear medicine imaging procedure H 75.1 Ensure the sequence of procedures enables optimum study result while providing for the patient’s comfort and safety H 75.2 Ensure the availability of necessary patient care support equipment and resources H 75.3 Dispense any pre-medications required H 75.4 Administer pre-medications H 75.5 Select radiopharmaceutical H 76 Perform technical preparation H 77 Perform patient preparation H 78 Exchange information with patients and their support persons to enable them to make informed decisions H 78.1 Explain procedure H 78.2 Verify understanding of information to give an opportunity for patient to ask questions H 78.3 Respond to patients and their support persons concerns H 79 Administer required radiopharmaceuticals in accordance with protocol H 80 Adjust procedure according to patient conditions and factors H 81 Perform procedure in accordance with protocol H 82 Operate equipment for data acquisition H 83 Recognize normal results and variants H 84 Recognize pathologies/abnormal results H 85 Perform data analysis and manipulation GI 6 Esophageal Transit H 86 Evaluate the correlation between clinical information provided and the requested examination H 87 Modify procedure according to contraindications H 88 Plan the nuclear medicine imaging procedure H 88.1 Ensure the sequence of procedures enables optimum study result while providing for the patient’s comfort and safety H 88.2 Ensure the availability of necessary patient care support equipment and resources H 88.3 Select radiopharmaceutical H 89 Perform technical preparation H 90 Perform patient preparation
  38. 38. Curriculum Guide – Nuclear Medicine May 2007 38 H 91 Exchange information with patients and their support persons to enable them to make informed decisions H 91.1 Explain procedure H 91.2 Verify understanding of information to give an opportunity for patient to ask questions H 91.3 Respond to patients and their support persons concerns H 92 Administer required radiopharmaceuticals in accordance with protocol H 93 Position the patient using anatomical landmarks and relational anatomy to best demonstrate anatomical structures/pathologies H 94 Adjust procedure according to patient conditions and factors H 94.1 Age Geriatric Pediatric H 94.2 Cognitive impairment H 94.3 Patient’s pathology and abilities H 94.4 Body habitus H 95 Select acquisition parameters H 95.1 Instrumentation/computer parameters H 95.2 Ancillary equipment H 96 Perform procedure in accordance with protocol H 97 Operate equipment for image/data acquisition H 98 Evaluate anatomy, physiology and patient position on the image to determine if further images/data are required H 98.1 Verify adequate demonstration of required structures H 98.2 Verify adequate visualization of required structures H 98.3 Verify visualization of desired physiological phase H 99 Recognize normal results and variants H 100 Recognize pathologies/abnormal results H 101 Process to optimize the image H 101.1 Annotation H 101.2 Reformatting/reframing H 101.3 Window width/contrast H 101.4 Window level/brightness H 102 Perform image/data analysis and manipulation H 102.1 Regions of interest H 102.2 Time activity curve GI 7 Gastric Emptying (Liquid) H 103 Evaluate the correlation between clinical information provided and the requested examination H 104 Modify procedure according to contraindications H 105 Plan the nuclear medicine imaging procedure H 105.1 Ensure the sequence of procedures enables optimum study result while providing for the patient’s comfort and safety H 105.2 Ensure the availability of necessary patient care support equipment and resources H 105.3 Select radiopharmaceutical
  39. 39. Curriculum Guide – Nuclear Medicine May 2007 39 H 106 Perform technical preparation H 107 Perform patient preparation H 108 Exchange information with patients and their support persons to enable them to make informed decisions H 108.1 Explain procedure H 108.2 Verify understanding of information to give an opportunity for patient to ask questions H 108.3 Respond to patients and their support persons concerns H 109 Administer required radiopharmaceuticals in accordance with protocol H 110 Position the patient using anatomical landmarks and relational anatomy to best demonstrate anatomical structures/pathologies H 111 Adjust procedure according to patient conditions and factors H 111.1 Age Geriatric Pediatric H 111.2 Cognitive impairment H 111.3 Patient’s pathology and abilities H 111.4 Body habitus H 112 Select acquisition parameters H 112.1 Instrumentation/computer parameters H 112.2 Ancillary equipment H 113 Perform procedure in accordance with protocol H 114 Operate equipment for image/data acquisition H 115 Evaluate anatomy, physiology and patient position on the image to determine if further images/data are required H 115.1 Verify adequate demonstration of required structures H 115.2 Verify adequate visualization of required structures H 115.3 Verify visualization of desired physiological phase H 116 Recognize normal results and variants H 117 Recognize pathologies/abnormal results H 118 Process to optimize the image H 118.1 Annotation H 118.2 Window width/contrast H 118.3 Window level/brightness H 119 Perform image/data analysis and manipulation H 119.1 Regions of interest H 119.2 Time activity curve H 119.3 Extrapolation GI 8 Salivary Scan H 120 Evaluate the correlation between clinical information provided and the requested examination H 121 Modify procedure according to contraindications H 122 Plan the nuclear medicine imaging procedure H 122.1 Ensure the sequence of procedures enables optimum study result while providing for the patient’s comfort and safety H 122.2 Ensure the availability of necessary patient care support equipment and resources H 122.3 Select radiopharmaceutical
  40. 40. Curriculum Guide – Nuclear Medicine May 2007 40 H 123 Perform technical preparation H 124 Perform patient preparation H 125 Exchange information with patients and their support persons to enable them to make informed decisions H 125.1 Explain procedure H 125.2 Verify understanding of information to give an opportunity for patient to ask questions H 125.3 Respond to patients and their support persons concerns H 126 Administer required radiopharmaceuticals in accordance with protocol H 127 Position the patient using anatomical landmarks and relational anatomy to best demonstrate anatomical structures/pathologies H 128 Adjust procedure according to patient conditions and factors H 128.1 Age Geriatric Pediatric H 128.2 Cognitive impairment H 128.3 Patient’s pathology and abilities H 128.4 Body habitus H 129 Select acquisition parameters H 129.1 Instrumentation/computer parameters H 129.2 Ancillary equipment H 130 Perform procedure in accordance with protocol H 131 Operate equipment for image/data acquisition H 132 Evaluate anatomy, physiology and patient position on the image to determine if further images/data are required H 132.1 Verify adequate demonstration of required structures H 132.2 Verify adequate visualization of required structures H 132.3 Verify visualization of desired physiological phase H 133 Recognize normal results and variants H 134 Recognize pathologies/abnormal results H 135 Process to optimize the image H 135.1 Annotation H 135.2 Window width/contrast H 135.3 Window level/brightness H 136 Perform image/data analysis and manipulation GI 9 Gastroesophageal Reflux H 137 Evaluate the correlation between clinical information provided and the requested examination H 138 Modify procedure according to contraindications H 139 Plan the nuclear medicine imaging procedure H 139.1 Ensure the sequence of procedures enables optimum study result while providing for the patient’s comfort and safety H 139.2 Ensure the availability of necessary patient care support equipment and resources H 139.3 Select radiopharmaceutical
  41. 41. Curriculum Guide – Nuclear Medicine May 2007 41 H 140 Perform technical preparation H 141 Perform patient preparation H 142 Exchange information with patients and their support persons to enable them to make informed decisions H 142.1 Explain procedure H 142.2 Verify understanding of information to give an opportunity for patient to ask questions H 142.3 Respond to patients and their support persons concerns H 143 Administer required radiopharmaceuticals in accordance with protocol H 144 Position the patient using anatomical landmarks and relational anatomy to best demonstrate anatomical structures/pathologies H 145 Adjust procedure according to patient conditions and factors H 145.1 Age Geriatric Pediatric H 145.2 Cognitive impairment H 145.3 Patient’s pathology and abilities H 145.4 Body habitus H 146 Select acquisition parameters H 146.1 Instrumentation/computer parameters H 146.2 Ancillary equipment H 147 Perform procedure in accordance with protocol H 148 Operate equipment for image/data acquisition H 149 Evaluate anatomy, physiology and patient position on the image to determine if further images/data are required H 149.1 Verify adequate demonstration of required structures H 149.2 Verify adequate visualization of required structures H 149.3 Verify visualization of desired physiological phase H 150 Recognize normal results and variants H 151 Recognize pathologies/abnormal results H 152 Process to optimize the image H 152.1 Annotation H 152.2 Window width/contrast H 152.3 Window level/brightness H 153 Perform image/data analysis and manipulation H 153.1 Regions of interest H 153.2 Time activity curve GI 10 Gastrointestinal Bleed H 154 Evaluate the correlation between clinical information provided and the requested examination H 155 Modify procedure according to contraindications H 156 Plan the nuclear medicine imaging procedure H 156.1 Ensure the sequence of procedures enables optimum study result while providing for the patient’s comfort and safety H 156.2 Ensure the availability of necessary patient care support equipment and resources
  42. 42. Curriculum Guide – Nuclear Medicine May 2007 42 H 156.3 Dispense any pre-medications required H 156.4 Administer pre-medications H 156.5 Select radiopharmaceutical H 157 Perform technical preparation H 158 Perform patient preparation H 159 Exchange information with patients and their support persons to enable them to make informed decisions H 159.1 Explain procedure H 159.2 Verify understanding of information to give an opportunity for patient to ask questions H 159.3 Respond to patients and their support persons concerns H 160 Administer required radiopharmaceuticals in accordance with protocol H 161 Position the patient using anatomical landmarks and relational anatomy to best demonstrate anatomical structures/pathologies H 162 Adjust procedure according to patient conditions and factors H 162.1 Age Geriatric Pediatric H 162.2 Cognitive impairment H 162.3 Patient’s pathology and abilities H 162.4 Body habitus H 163 Select acquisition parameters H 164 Perform procedure in accordance with protocol H 165 Operate equipment for image/data acquisition H 166 Evaluate anatomy, physiology and patient position on the image to determine if further images/data are required H 166.1 Verify adequate demonstration of required structures H 166.2 Verify adequate visualization of required structures H 166.3 Verify visualization of desired physiological phase H 167 Recognize normal results and variants H 168 Recognize pathologies/abnormal results H 169 Process to optimize the image H 169.1 Annotation H 169.2 Window width/contrast H 169.3 Window level/brightness H 170 Perform image/data analysis and manipulation GI 11 Meckel’s Diverticulum H 171 Evaluate the correlation between clinical information provided and the requested examination H 172 Modify procedure according to contraindications H 173 Plan the nuclear medicine imaging procedure H 173.1 Ensure the sequence of procedures enables optimum study result while providing for the patient’s comfort and safety H 173.2 Ensure the availability of necessary patient care support equipment and resources H 173.3 Select radiopharmaceutical
  43. 43. Curriculum Guide – Nuclear Medicine May 2007 43 H 174 Perform technical preparation H 175 Perform patient preparation H 176 Exchange information with patients and their support persons to enable them to make informed decisions H 176.1 Explain procedure H 176.2 Verify understanding of information to give an opportunity for patient to ask questions H 176.3 Respond to patients and their support persons concerns H 177 Administer required radiopharmaceuticals in accordance with protocol H 178 Position the patient using anatomical landmarks and relational anatomy to best demonstrate anatomical structures/pathologies H 179 Adjust procedure according to patient conditions and factors H 179.1 Age Geriatric Pediatric H 179.2 Cognitive impairment H 179.3 Patient’s pathology and abilities H 179.4 Body habitus H 180 Select acquisition parameters H 181 Perform procedure in accordance with protocol H 181.1 Instrumentation/computer parameters H 181.2 Ancillary equipment H 182 Operate equipment for image/data acquisition H 183 Evaluate anatomy, physiology and patient position on the image to determine if further images/data are required H 183.1 Verify adequate demonstration of required structures H 183.2 Verify adequate visualization of required structures H 183.3 Verify visualization of desired physiological phase H 184 Recognize normal results and variants H 185 Recognize pathologies/abnormal results H 186 Process to optimize the image H 186.1 Annotation H 186.2 Window width/contrast H 186.3 Window level/brightness H 187 Perform image/data analysis and manipulation GI 12 Liver Spleen Scan (Colloid) H 188 Evaluate the correlation between clinical information provided and the requested examination H 189 Modify procedure according to contraindications H 190 Plan the nuclear medicine imaging procedure H 190.1 Ensure the sequence of procedures enables optimum study result while providing for the patient’s comfort and safety H 190.2 Ensure the availability of necessary patient care support equipment and resources H 190.3 Select radiopharmaceutical H 191 Perform technical preparation
  44. 44. Curriculum Guide – Nuclear Medicine May 2007 44 H 192 Perform patient preparation H 193 Exchange information with patients and their support persons to enable them to make informed decisions H 193.1 Explain procedure H 193.2 Verify understanding of information to give an opportunity for patient to ask questions H 193.3 Respond to patients and their support persons concerns H 194 Administer required radiopharmaceuticals in accordance with protocol H 195 Position the patient using anatomical landmarks and relational anatomy to best demonstrate anatomical structures/pathologies H 196 Adjust procedure according to patient conditions and factors H 196.1 Age Geriatric Pediatric H 196.2 Cognitive impairment H 196.3 Patient’s pathology and abilities H 196.4 Body habitus H 197 Select acquisition parameters H 197.1 Instrumentation/computer parameters H 197.2 Ancillary equipment H 198 Perform procedure in accordance with protocol H 199 Operate equipment for image/data acquisition H 200 Evaluate anatomy, physiology and patient position on the image to determine if further images/data are required H 200.1 Verify adequate demonstration of required structures H 200.2 Verify adequate visualization of required structures H 200.3 Verify visualization of desired physiological phase H 201 Recognize normal results and variants H 202 Recognize pathologies/abnormal results H 203 Process to optimize the image H 203.1 Anatomical orientation H 203.2 Annotation H 203.3 Back projection H 203.4 Processing filters H 203.5 Attenuation correction H 203.6 Window width/contrast H 203.7 Window level/brightness H 203.8 Motion correction H 203.9 Normalization H 203.10 Sinograms H 204 Perform image/data analysis and manipulation GI 13 C-14 Urea Breath Test H 205 Evaluate the correlation between clinical information provided and the requested examination H 206 Modify procedure according to contraindications
  45. 45. Curriculum Guide – Nuclear Medicine May 2007 45 H 207 Plan the nuclear medicine imaging procedure H 207.1 Ensure the sequence of procedures enables optimum study result while providing for the patient’s comfort and safety H 207.2 Ensure the availability of necessary patient care support equipment and resources H 207.3 Select radiopharmaceutical H 208 Perform technical preparation H 209 Perform patient preparation H 210 Exchange information with patients and their support persons to enable them to make informed decisions H 210.1 Explain procedure H 210.2 Verify understanding of information to give an opportunity for patient to ask questions H 210.3 Respond to patients and their support persons concerns H 211 Administer required radiopharmaceuticals in accordance with protocol H 212 Adjust procedure according to patient conditions and factors H 213 Perform procedure in accordance with protocol H 214 Operate equipment for data acquisition H 215 Recognize normal results and variants H 216 Recognize pathologies/abnormal H 217 Perform data analysis and manipulation GI 14 Gastric Emptying (Dual Isotope) H 218 Recognize clinical indications for performing procedure H 219 Describe patient preparation H 220 Identify contraindications for procedure H 221 Identify the radiopharmaceutical H 222 Propose procedural modifications H 223 Perform data analysis H 224 Describe image analysis H 225 Recognize normal results and variants H 226 Recognize pathologies/abnormal results GI 15 Meckel’s Pharmacological Intervention H 227 Recognize clinical indications for performing procedure H 228 Describe patient preparation H 229 Identify contraindications for procedure H 230 Identify the radiopharmaceutical H 231 Propose procedural modifications H 232 Perform data analysis H 233 Describe image analysis H 234 Recognize normal results and variants H 235 Recognize pathologies/abnormal results
  46. 46. Curriculum Guide – Nuclear Medicine May 2007 46 MODULE I: Clinical Procedures – GENITOURINARY SYSTEM (GU) I 1 Understand pathology and anomalies related to the genitourinary system in relation to performing a nuclear medicine procedure I 1.1 Vascular disease I 1.2 Inflammation I 1.3 Infection I 1.4 Cystic disease I 1.5 Congenital anomalies I 1.6 Trauma I 1.7 Transplants I 1.8 Reflux disorders I 1.9 Neoplasms I 1.10 Obstructive disorders I 2 Recognize patterns consistent with pathology and anomalies related to genitourinary system in relation to a nuclear medicine procedure I 2.1 Vascular disease I 2.2 Inflammation I 2.3 Infection I 2.4 Cystic disease I 2.5 Congenital anomalies I 2.6 Trauma I 2.7 Transplants I 2.8 Reflux disorders I 2.9 Neoplasms I 2.10 Obstructive disorders I 3 Understand the anatomy and physiology of the genitourinary system I 3.1 Gross anatomy I 3.2 Cross sectional anatomy I 3.3 Relational anatomy I 4 Understand the effects including contraindications, risks and interactions of agents (i.e. pharmacologic, dietary) acting on the genitourinary system I 4.1 Diuretics I 4.2 Fluids, electrolytes, nutrients I 4.3 Treatment of hypertension GU 1 Renal Function Scan I 5 Evaluate the correlation between clinical information provided and the requested examination I 6 Modify procedure according to contraindications I 7 Plan the nuclear medicine imaging procedure I 7.1 Ensure the sequence of procedures enables optimum study result while providing for the patient’s comfort and safety I 7.2 Ensure availability of necessary patient care support equipment and resources I 7.3 Select radiopharmaceutical I 8 Perform technical preparation I 9 Perform patient preparation
  47. 47. Curriculum Guide – Nuclear Medicine May 2007 47 I 10 Exchange information with patients and their support persons to enable them to make informed decisions I 10.1 Explain procedure I 10.2 Verify understanding of information to give an opportunity for patient to ask questions I 10.3 Respond to patients and their support persons concerns I 11 Administer required radiopharmaceuticals in accordance with protocol I 12 Position the patient using anatomical landmarks and relational anatomy to best demonstrate anatomical structures/pathologies I 13 Adjust procedure according to patient conditions and factors I 13.1 Age Geriatric Pediatric I 13.2 Cognitive impairment I 13.3 Patient’s pathology and abilities I 13.4 Body habitus I 14 Select acquisition parameters I 14.1 Instrumentation/computer parameters I 14.2 Ancillary equipment I 15 Perform procedure in accordance with protocol I 16 Operate equipment for image/data acquisition I 17 Evaluate anatomy, physiology and patient position on the image to determine if further images/data are required I 17.1 Verify adequate demonstration of pathology I 17.2 Verify adequate visualization of required structures I 17.3 Verify visualization of desired physiological phase I 18 Recognize normal results and variants I 19 Recognize pathologies/abnormal results I 20 Process to optimize the image I 20.1 Annotation I 20.2 Reformatting/reframing I 20.3 Window width/contrast I 20.4 Window level/brightness I 21 Perform image/data analysis and manipulation I 21.1 Regions of interest I 21.2 Time activity curves I 21.3 Ratios
  48. 48. Curriculum Guide – Nuclear Medicine May 2007 48 GU 2 Renal Scan Pharmacological Intervention I 22 Evaluate the correlation between clinical information provided and the requested examination I 23 Modify procedure according to contraindications I 24 Plan the nuclear medicine imaging procedure I 24.1 Ensure the sequence of procedures enables optimum study result while providing for the patient’s comfort and safety I 24.2 Ensure availability of necessary patient care support equipment and resources I 24.3 Select radiopharmaceutical I 25 Perform technical preparation I 26 Perform patient preparation I 27 Exchange information with patients and their support persons to enable them to make informed decisions I 27.1 Explain procedure I 27.2 Verify understanding of information to give an opportunity for patient to ask questions I 27.3 Respond to patients and their support persons concerns I 28 Administer required radiopharmaceuticals in accordance with protocol I 29 Position the patient using anatomical landmarks and relational anatomy to best demonstrate anatomical structures/pathologies I 30 Adjust procedure according to patient conditions and factors I 30.1 Age Geriatric Pediatric I 30.2 Cognitive impairment I 30.3 Patient’s pathology and abilities I 30.4 Body habitus I 31 Select acquisition parameters I 31.1 Instrumentation/computer parameters I 31.2 Ancillary equipment I 32 Perform procedure in accordance with protocol I 33 Operate equipment for image/data acquisition I 34 Evaluate anatomy, physiology and patient position on the image to determine if further images/data are required I 34.1 Verify adequate demonstration of pathology I 34.2 Verify adequate visualization of required structures I 34.3 Verify visualization of desired physiological phase I 35 Recognize normal results and variants I 36 Recognize pathologies/abnormal results I 37 Process to optimize the image I 37.1 Annotation I 37.2 Reformatting/reframing I 37.3 Window width/contrast I 37.4 Window level/brightness I 38 Perform image/data analysis and manipulation I 38.1 Regions of interest I 38.2 Time activity curve I 38.3 Ratios
  49. 49. Curriculum Guide – Nuclear Medicine May 2007 49 GU 3 Renal Cortical Scan I 39 Evaluate the correlation between clinical information provided and the requested examination I 40 Modify procedure according to contraindications I 41 Plan the nuclear medicine imaging procedure I 41.1 Ensure the sequence of procedures enables optimum study result while providing for the patient’s comfort and safety I 41.2 Ensure availability of necessary patient care support equipment and resources I 41.3 Select radiopharmaceutical I 42 Perform technical preparation I 43 Perform patient preparation I 44 Exchange information with patients and their support persons to enable them to make informed decisions I 44.1 Explain procedure I 44.2 Verify understanding of information to give an opportunity for patient to ask questions I 44.3 Respond to patients and their support persons concerns I 45 Administer required radiopharmaceuticals in accordance with protocol I 46 Position the patient using anatomical landmarks and relational anatomy to best demonstrate anatomical structures/pathologies I 47 Adjust procedure according to patient conditions and factors I 47.1 Age Geriatric Pediatric I 47.2 Cognitive impairment I 47.3 Patient’s pathology and abilities I 47.4 Body habitus I 48 Select acquisition parameters I 48.1 Instrumentation/computer parameters I 48.2 Ancillary equipment I 49 Perform procedure in accordance with protocol I 50 Operate equipment for image/data acquisition I 51 Evaluate anatomy, physiology and patient position on the image to determine if further images/data are required I 51.1 Verify adequate demonstration of pathology I 51.2 Verify adequate visualization of required structures I 51.3 Verify visualization of desired physiological phase I 52 Recognize normal results and variant I 53 Recognize pathologies/abnormal results I 54 Process to optimize the image I 54.1 Annotation I 54.2 Window width/contrast I 54.3 Window level/brightness I 55 Perform image/data analysis and manipulation I 55.1 Regions of interest I 55.2 Ratios
  50. 50. Curriculum Guide – Nuclear Medicine May 2007 50 GU 4 Cystography (Direct) I 56 Evaluate the correlation between clinical information provided and the requested examination I 57 Modify procedure according to contraindications I 58 Plan the nuclear medicine imaging procedure I 58.1 Ensure the sequence of procedures enables optimum study result while providing for the patient’s comfort and safety I 58.2 Ensure availability of necessary patient care support equipment and resources I 58.3 Prepare patient for procedure I 58.4 Select radiopharmaceutical I 59 Perform technical preparation I 60 Perform patient preparation I 61 Exchange information with patients and their support persons to enable them to make informed decisions I 61.1 Explain procedure I 61.2 Verify understanding of information to give an opportunity for patient to ask questions I 61.3 Respond to patients and their support persons concerns I 62 Administer required radiopharmaceuticals in accordance with protocol I 63 Position the patient using anatomical landmarks and relational anatomy to best demonstrate anatomical structures/pathologies I 64 Adjust procedure according to patient conditions and factors I 64.1 Age Geriatric Pediatric I 64.2 Cognitive impairment I 64.3 Patient’s pathology and abilities I 64.4 Body habitus I 65 Select acquisition parameters I 65.1 Instrumentation/computer parameters I 65.2 Ancillary equipment I 66 Perform procedure in accordance with protocol I 67 Operate equipment for image/data acquisition I 68 Evaluate anatomy, physiology and patient position on the image to determine if further images/data are required I 68.1 Verify adequate demonstration of pathology I 68.2 Verify adequate visualization of required structures I 68.3 Verify visualization of desired physiological phase I 69 Recognize normal results and variants I 70 Recognize pathologies/abnormal results I 71 Process to optimize the image I 71.1 Annotation I 71.2 Reformatting/reframing I 71.3 Window width/contrast I 71.4 Window level/brightness I 72 Perform image/data analysis and manipulation
  51. 51. Curriculum Guide – Nuclear Medicine May 2007 51 GU 5 Glomerular Filtration Rate (Blood GFR) I 73 Evaluate the correlation between clinical information provided and the requested examination I 74 Modify procedure according to contraindications I 75 Plan the nuclear medicine imaging procedure I 75.1 Ensure the sequence of procedures enables optimum study result while providing for the patient’s comfort and safety I 75.2 Ensure availability of necessary patient care support equipment and resources I 75.3 Select radiopharmaceutical I 76 Perform technical preparation I 77 Perform patient preparation I 78 Exchange information with patients and their support persons to enable them to make informed decisions I 78.1 Explain procedure I 78.2 Verify understanding of information to give an opportunity for patient to ask questions I 78.3 Respond to patients and their support persons concerns I 79 Administer required radiopharmaceuticals in accordance with protocol I 80 Adjust procedure according to patient conditions and factors I 80.1 Age Geriatric Pediatric I 80.2 Cognitive impairment I 80.3 Patient’s pathology and abilities I 80.4 Body habitus I 81 Select acquisition parameters I 81.1 Instrumentation/computer parameters I 81.2 Ancillary equipment I 82 Perform procedure in accordance with protocol I 83 Operate equipment for data acquisition I 84 Recognize normal results and variants I 85 Recognize pathologies/abnormal results I 86 Perform data analysis and manipulation GU 6 Effective Renal Plasma Flow I 87 Evaluate the correlation between clinical information provided and the requested examination I 88 Modify procedure according to contraindications I 89 Plan the nuclear medicine imaging procedure I 89.1 Ensure the sequence of procedures enables optimum study result while providing for the patient’s comfort and safety I 89.2 Ensure availability of necessary patient care support equipment and resources I 89.3 Select radiopharmaceutical I 90 Perform technical preparation
  52. 52. Curriculum Guide – Nuclear Medicine May 2007 52 I 91 Perform patient preparation I 92 Exchange information with patients and their support persons to enable them to make informed decisions I 92.1 Explain procedure I 92.2 Verify understanding of information to give an opportunity for patient to ask questions I 92.3 Respond to patients and their support persons concerns I 93 Administer required radiopharmaceuticals in accordance with protocol I 94 Position the patient using anatomical landmarks and relational anatomy to best demonstrate anatomical structures/pathologies I 95 Adjust procedure according to patient conditions and factors I 95.1 Age Geriatric Pediatric I 95.2 Cognitive impairment I 95.3 Patient’s pathology and abilities I 95.4 Body habitus I 96 Select acquisition parameters I 96.1 Instrumentation/computer parameters I 96.2 Ancillary equipment I 97 Perform procedure in accordance with protocol I 98 Operate equipment for image/data acquisition I 99 Evaluate anatomy, physiology and patient position on the image to determine if further images/data are required I 99.1 Verify adequate demonstration of pathology I 99.2 Verify adequate visualization of required structures I 99.3 Verify visualization of desired physiological phase I 100 Recognize normal results and variants I 101 Recognize pathologies/abnormal results I 102 Process to optimize the image I 102.1 Annotation I 102.2 Reformatting/reframing I 102.3 Window width/contrast I 102.4 Window level/brightness I 103 Perform image/data analysis and manipulation I 103.1 Regions of interest I 103.2 Time activity curve I 103.3 Ratios GU 7 Renal Transplant I 104 Recognize clinical indications for performing procedure I 105 Describe patient preparation I 106 Identify contraindications for procedure I 107 Identify the radiopharmaceutical I 108 Propose procedural modifications I 109 Perform data analysis
  53. 53. Curriculum Guide – Nuclear Medicine May 2007 53 I 110 Describe image analysis I 111 Recognize normal results and variants I 112 Recognize pathologies/abnormal results GU 8 Testicular Scan I 113 Recognize clinical indications for performing procedure I 114 Describe patient preparation I 115 Identify contraindications for procedure I 116 Identify the radiopharmaceutical I 117 Propose procedural modifications I 118 Describe image analysis I 119 Recognize normal results and variants I 120 Recognize pathologies/abnormal results
  54. 54. Curriculum Guide – Nuclear Medicine May 2007 54 MODULE J: Clinical Procedures – SKELETAL SYSTEM (SK) J 1 Understand pathology and anomalies related to the skeletal system in relation to performing a nuclear medicine procedure J 1.1 Vascular disease J 1.2 Metabolic disease J 1.3 Inflammation J 1.4 Infection J 1.5 Hemopoietic disorders J 1.6 Neoplasms J 1.7 Trauma J 1.8 Degenerative diseases J 2 Recognize patterns consistent with pathology and anomalies related to skeletal system in relation to a nuclear medicine procedure J 2.1 Vascular disease J 2.2 Metabolic disease J 2.3 Inflammation J 2.4 Infection J 2.5 Hemopoietic disorders J 2.6 Neoplasms J 2.7 Trauma J 2.8 Degenerative diseases J 3 Understand the anatomy and physiology of the skeletal system J 3.1 Gross anatomy J 3.2 Cross sectional anatomy J 3.3 Relational anatomy J 4 Understand the effects including contraindications, risks and interactions of agents (i.e. pharmacologic, dietary) acting on the skeletal system J 4.1 Medications for treatment of osteoporosis SK 1 Three Phase Local Bone Scan J 5 Evaluate the correlation between clinical information provided and the requested examination J 6 Modify procedure according to contraindications J 7 Plan the nuclear medicine imaging procedure J 7.1 Ensure the sequence of procedures enables optimum study result while providing for the patient’s comfort and safety J 7.2 Ensure the availability of necessary patient care support equipment and resources J 7.3 Select radiopharmaceutical J 8 Perform technical preparation J 9 Perform patient preparation
  55. 55. Curriculum Guide – Nuclear Medicine May 2007 55 J 10 Exchange information with patients and their support persons to enable them to make informed decisions J 10.1 Explain the procedure J 10.2 Verify understanding of information to give an opportunity for patient to ask questions J 10.3 Respond to patients and their support persons concerns J 11 Administer required radiopharmaceuticals in accordance with protocol J 12 Position the patient using anatomical landmarks and relational anatomy to best demonstrate anatomical structures/pathologies J 13 Adjust procedure according to patient conditions and factors J 13.1 Age Geriatric Pediatric J 13.2 Cognitive impairment J 13.3 Patient’s pathology and abilities J 13.4 Body habitus J 14 Select acquisition parameters J 14.1 Instrumentation/computer parameters J 14.2 Ancillary equipment J 15 Perform procedure in accordance with protocol J 16 Operate equipment for image/data acquisition J 17 Evaluate anatomy, physiology and patient position on the image to determine if further images/data are required J 17.1 Verify adequate demonstration of pathology J 17.2 Verify adequate visualization of required structures J 17.3 Verify visualization of desired physiological phase J 18 Recognize normal results and variants J 19 Recognize pathologies/abnormal results J 20 Process to optimize the image J 20.1 Anatomical orientation J 20.2 Annotation J 20.3 Window width/contrast J 20.4 Window level/brightness J 21 Perform image/data analysis and manipulation J 21.1 Regions of interest J 21.2 Ratios SK 2 Whole Body Bone Scan J 22 Evaluate the correlation between clinical information provided and the requested examination J 23 Modify procedure according to contraindications J 24 Plan the nuclear medicine imaging procedure J 24.1 Ensure the sequence of procedures enables optimum study result while providing for the patient’s comfort and safety J 24.2 Ensure the availability of necessary patient care support equipment and resources J 24.3 Select radiopharmaceutical
  56. 56. Curriculum Guide – Nuclear Medicine May 2007 56 J 25 Perform technical preparation J 26 Perform patient preparation J 27 Exchange information with patients and their support persons to enable them to make informed decisions J 27.1 Explain the procedure J 27.2 Verify understanding of information to give an opportunity for patient to ask questions J 27.3 Respond to patients and their support persons concerns J 28 Administer required radiopharmaceuticals in accordance with protocol J 29 Position the patient using anatomical landmarks and relational anatomy to best demonstrate anatomical structures/pathologies J 30 Adjust procedure according to patient conditions and factors J 30.1 Age Geriatric Pediatric J 30.2 Cognitive impairment J 30.3 Patient’s pathology and abilities J 30.4 Body habitus J 31 Select acquisition parameters J 31.1 Instrumentation/computer parameters J 31.2 Ancillary equipment J 32 Perform procedure in accordance with protocol J 33 Operate equipment for image/data acquisition J 34 Evaluate anatomy, physiology and patient position on the image to determine if further images/data are required J 34.1 Verify adequate demonstration of pathology J 34.2 Verify adequate visualization of required structures J 34.3 Verify visualization of desired physiological phase J 35 Recognize normal results and variants J 36 Recognize pathologies/abnormal results J 37 Process to optimize the image J 37.1 Anatomical orientation J 37.2 Annotation J 37.3 Window width/contrast J 37.4 Window level/brightness J 38 Perform image/data analysis and manipulation J 38.1 Ratios SK 3 Bone Scan SPECT J 39 Evaluate the correlation between clinical information provided and the requested examination J 40 Modify procedure according to contraindications J 41 Plan the nuclear medicine imaging procedure J 41.1 Ensure the sequence of procedures enables optimum study result while providing for the patient’s comfort and safety

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