THE RESIDENCY REVIEW COMMITTEE FOR NUCLEAR MEDICINE

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THE RESIDENCY REVIEW COMMITTEE FOR NUCLEAR MEDICINE

  1. 1. THE RESIDENCY REVIEW COMMITTEE FOR NUCLEAR MEDICINE 515 N State, Ste 2000, Chicago, IL 60610 • (312) 755-5000 • www.acgme.org FOR CONTINUED ACCREDITATION GENERAL INSTRUCTIONS REVIEW OF AN ACCREDITED PROGRAM OR RE-ACCREDITATION OF A PROGRAM: If the Program Information Form (PIF) is being completed for a currently accredited program, follow the provided instructions to create the correct form. Go to the Accreditation Data System found on the ACGME home page (www.acgme.org) under Data Collection Systems. Using your previously assigned User ID and password, proceed to the PIF Preparation section on the left hand menu and update the Common PIF data. Most data are updated through annual updates, but some information is required at the time of site visit only. Once the data entry is complete, select Generate PIF to review and print the Common PIF (PDF). Once the Common PIF is complete, proceed to the appropriate Residency Review Committee webpage to retrieve the Specialty Specific PIF for CONTINUED ACCREDITATION. Once the forms are complete, enter page numbers for the Continued PIF in the bottom right for each page that consecutively follows the Common PIF numbering, combine the Common PIF and the Continued Accreditation PIF and complete the Table of Contents (found with the Specialty Specific PIF instructions). After completing the PIF/documents, make four copies. They must be identical and final. Draft copies are not acceptable. The forms should be submitted bound by either sturdy rubber bands or binder clips. Do not place the forms in covers such as two or three ring binders, spiral bound notebooks, or any other form of binding. Mail one set of the completed forms to the site visitor at least 14 working days before the site visit. The remaining three sets should be provided to the site visitor on the day of the visit. The program director is responsible for the accuracy of the information supplied in this form and must sign it. It must also be signed by the designated institutional official of the sponsoring institution. Review the Program Requirements for Residency Education in Nuclear Medicine. The Program Requirements or the Institutional Requirements may be downloaded from the ACGME website (www.acgme.org): For word processing questions/problems regarding: -the completion of the form (content), contact the Accreditation Administrator. -the Accreditation Data System, email WebADS@acgme.org. For a glossary of terms, use the following link – http://www.acgme.org/acWebsite/GME_info/gme_glossary.asp Nuclear Medicine Continued Accreditation PIF 1
  2. 2. Please have the following documents available for the site visitor: 1. Overall educational goals for the program 2. Written competency-based goals and objectives for each experience at each educational level (if your Review Committees wishes to see a sample, it will request one to be appended to the PIF) 3. Current Program Letters of Agreement (PLAs) 4. Files for current residents/fellows and most recent program graduates 5. Files of residents/fellows who have transferred into the program (if applicable), including documentation of previous experience and competency-based performance evaluation 6. Program Policy Manual, including: a) policies for resident appointment, eligibility, selection, and promotion b) policies for supervision of residents c) policies and procedures for resident duty hours and the working environment d) moonlighting policy 7. Institutional policy for remediation and dismissal of residents, including due process. 8. Documentation of resident evaluation including: a) Resident evaluation at the end of each rotation or similar educational experience b) Written or electronic semiannual evaluation of the resident with feedback c) A final (summative) evaluation for each resident that documents the resident’s performance during the final period of education and verifies that the resident has demonstrated sufficient competence to enter practice without direct supervision (files for the most recent year’s graduates for review by the site visitor) 9. Completed evaluations of the faculty by the residents 10. Completed evaluations of the program by the residents 11. The written improvement action plan the program prepared after a review of the aggregated results of residents’ performance and/or other program evaluation results 12. Documentation of resident duty hours 13. Documentation of internal review (date, participants’ names and titles, type of data collected, when reviewed by the GMEC) 14. The resident supervision policy that addresses the following: a) Residents’ responsibilities for patient care b) Progressive responsibility for patient management c) Supervision of patient care 15. For single-program institution (e.g., an institution that sponsors just one accredited program) or an institution with multiple residencies accredited by the same Review Committee: A copy of the resident contract/agreement with the items required by the ACGME numbered according to Institutional Requirement II.D.) Nuclear Medicine Continued Accreditation PIF 2
  3. 3. THE RESIDENCY REVIEW COMMITTEE FOR NUCLEAR MEDICINE 515 N State, Ste 2000, Chicago, IL 60610 • (312) 755-5000 • www.acgme.org 10 Digit ACGME Program I.D. #: Program Name: TABLE OF CONTENTS When you have the completed forms, number each page sequentially in the bottom right hand corner. Report this pagination in the Table of Contents and submit this cover page with the completed PIF. Common PIF1 Page(s) Accreditation Information Participating Sites Sponsoring Institution/Single or Limited Residency Institution (If applicable) Faculty/Teaching Staff Program Director Information Physician Faculty Roster Faculty Curriculum Vitae Non Physician Faculty Roster Resident Appointments Number of Positions Actively Enrolled Residents (if applicable) Aggregated Data on Residents Completing or Leaving the Program for the last 3 years (if applicable) Residents Completing Program in the Last 3 years (if applicable) Transferred, Withdrawn, and Dismissed Residents (if applicable) Evaluation Resident Duty Hours Specialty Specific PIF Page(s) Patient Care Adult Diagnostic Nuclear Imaging Studies Adult Radionuclide Therapy Pediatric Diagnostic Nuclear Imaging Studies Pediatric Radionuclide Therapy Diagnostic Nuclear Nonimaging Studies (Pediatric and Adult) Medical Knowledge Basic Science Clinical Didactic: Other Organization In Vivo (Imaging) Training Therapy Training Non Imaging Training Pediatric Nuclear Medicine Quality Control and Assurance Research Resident Duty Hours and the Working Environment Practice-Based Learning & Improvement Nuclear Medicine Continued Accreditation PIF 3
  4. 4. Specialty Specific PIF Page(s) Interpersonal & Communication Skills Professionalism Systems-Based Practice Training Other Learners Facilities Appendix A - Goals and Objectives Appendix B - Bibliography Sample Monthly Clinical Conferences Nuclear Medicine Continued Accreditation PIF 4
  5. 5. RESIDENCY REVIEW COMMITTEE FOR NUCLEAR MEDICINE 515 N State, Ste 2000, Chicago, IL 60610 • (312) 755-5000 • www.acgme.org SPECIALTY SPECIFIC PROGRAM INFORMATION FORM I. PATIENT CARE A. Adult Diagnostic Nuclear Imaging Studies CPT Codes Site #1 Site #2 Site #3 Site #4 THYROID AND ENDOCRINE 1. Thyroid Uptake and Thyroid Imaging 78000-78011 2. Thyroid Carcinoma Metastases Imaging 78015-78018 3. Parathyroid Imaging 78070 4. Adrenal Imaging 78075 5. Other Endocrine 78099 TOTALS: HEMATOLOGIC 1. Bone Marrow Imaging 78102-78104 2. Spleen Imaging, Platelet Survival 78185-78191 3. WBC Localization Imaging 78192-78193 4. Lymphatic System Imaging and Sentinel Node Imaging 78195 TOTALS: GASTROINTESTINAL 1. Liver and Spleen Imaging 78201-78220 2. Hepatobiliary Imaging 78220-78223 3. Salivary Gland Imaging, GE Reflux, Esophageal Motility Gastric Mucosa Imaging, Gastric Emptying 78230-78264 4. GI Blood Loss Imaging 78278 5. Bowel Imaging, Peritoneal-Venous shunt Patency 78290-78291 TOTALS: BONE IMAGING 1. Bone and Joint Imaging (planar) 78300-78310 2. Bone, Triple Phase Imaging 78315 3. Bone and Joint Imaging (Tomographic) 78320 4. Bone Density Measurements 78350-78351 TOTALS: CARDIOVASCULAR (Excluding PET) 1. Cardiac Shunt Detention 78428 2. Vascular Flow Imaging, Venography 78445-78458 3. Myocardial Perfusion Imaging (planar) 78460-78461 4. Myocardial Perfusion Imaging (Tomographic) 78464-78465 5. Myocardial Infarct Avid Imaging 78466-78469 6. Cardiac Blood Pool Imaging 78472-78473 7. ECG-Gated Myocardial Perfusion 78478-78480 Nuclear Medicine Continued Accreditation PIF 5
  6. 6. CPT Codes Site #1 Site #2 Site #3 Site #4 Imaging (tomo) 8. Cardiac Blood Pool First Pass Study 78481-78483 TOTALS: PULMONARY 1. Pulmonary Perfusion 78580 2. Pulmonary Ventilation 78587-78594 3. Pulmonary Quantitative Differential Function 78596 TOTALS: CENTRAL NERVOUS SYSTEM (Excluding PET) 1. Brain Imaging (Planar and Tomographic) 78600-78615 2. Cisternography, CSF Dynamics Shunt, CSF leak 78630-78652 3. Isotope Dacrocystograpy 78660 TOTALS: GENITOURINARY 1. Kidney Imaging/Function 78700-78725 2. Kidney Imaging/Function with Pharm. Intervention 78726 3. Kidney Transplant Evaluation 78727 4. Urinary Bladder Residual/Reflux 78730-78740 5. Testicular Imaging 78760-78761 TOTALS: ONCOLOGY/INFECTION (Excluding PET) 1. Localization of Tumor 78800-78803 2. Localization of Abscess 78805-78806 TOTALS: PET IMAGING 1. Tumor 78810 2. Cardiac 78459 3. Neurologic 78608 4. Other TOTALS: Nuclear Medicine Continued Accreditation PIF 6
  7. 7. B. Adult Radionuclide Therapy Procedure Description CPT Codes Site #1 Site #2 Site #3 Site #4 1. Therapy for Hyperthyroidism 79005 2. Therapy for Thyroid Carcinoma 79030, 79035 3. Therapy with Radiolabeled antibodies 79403 4. Therapy for Painful Bone Disease 79101-77750 5. Therapy for Polycythemia, Chronic Leukemia 79100 6. Intracavitary or Interstitial Radioactive Colloid Therapy 79200-79300 7. Other Non-Thyroid, Non-Hematologic Cancer Therapy (Specify) 79400-79999 6. Intraarticular Therapy 79440 TOTALS: C. Pediatric Diagnostic Nuclear Imaging Studies Procedure Description CPT Codes Site #1 Site #2 Site #3 Site #4 THYROID AND ENDOCRINE 1. Thyroid Uptake and Thyroid Imaging 78000-7811 2. Thyroid Carcinoma Metastases Imaging 78015-78018 3. Parathyroid Imaging 78070 4. Adrenal Imaging 78075 5. Other Endocrine 78099 TOTALS: HEMATOLOGIC 1. Bone Marrow Imaging 78102-78104 2. Spleen Imaging, Platelet Survival 78185-78191 3. WBC Localization Imaging 78192-78193 4. Lymphatic System Imaging 78195 TOTALS: GASTROINTESTINAL 1. Liver and Spleen Imaging 78201-78220 2. Hepatobiliary Imaging 78220-78223 3. Salivary Gland Imaging, GE Reflux, Esophageal Moltility Gastric Mucosa Imaging, Gastric Emptying 78230-78264 4. GI Blood Loss Imaging 78278 5. Bowel Imaging, Peritoneal-Venous shunt Patency 78290-78291 TOTALS: BONE IMAGING 1. Bone and Joint Imaging 78300-78310 2. Bone, Triple Phase Imaging 78315 3. Bone and Joint Imaging (Tomographic) 78320 4. Bone Density Measurements 78350-78351 TOTALS: CARDIOVASCULAR (Excluding PET) Nuclear Medicine Continued Accreditation PIF 7
  8. 8. Procedure Description CPT Codes Site #1 Site #2 Site #3 Site #4 1. Cardiac Shunt Detention 78428 2. Vascular Flow Imaging, Venography 78445-78458 3. Myocardial Perfusion Imaging 78460-78461 4. Myocardial Perfusion Imaging (Tomographic) 78464-78465 5. Myocardial Infarct Avid Imaging 78466-78469 6. Cardiac Blood Pool Imaging 78472-78473 7. ECG-Gated Myocardial Perfusion Imaging 78478-78480 8. Cardiac Blood Pool First Pass Study 78481-78483 TOTALS: PULMONARY 1. Pulmonary Perfusion 78580 2. Pulmonary Ventilation 78587-78594 3. Pulmonary Quantitative Differential Function 78596 TOTALS: CENTRAL NERVOUS SYSTEM (Excluding PET) 1. Brain Imaging (Planar and Tomographic) 78600-78615 2. Cisternography, CSF Dynamics 78630-78652 TOTALS: GENITOURINARY 1. Kidney Imaging/Function 78700-78725 2. Kidney Imaging/Function with Pharm. Intervention 78726 3. Kidney Transplant Evaluation 78727 4. Urinary Bladder Residual/Reflux 78730-78740 5. Testicular Imaging 78760-78761 TOTALS: ONCOLOGY/INFECTION (Excluding PET) 1. Localization of Tumor 78800-78803 2. Localization of Abscess 78805-78806 TOTALS: Nuclear Medicine Continued Accreditation PIF 8
  9. 9. D. Pediatric Radionuclide Therapy Procedure Description CPT Codes Site #1 Site #2 Site #3 Site #4 Therapy of Hyperthyroidism 79000-79020 Therapy for Thyroid Carcinoma 79030-79035 Therapy for Polycythemia, Chronic Leukemia 79100 Intracavitary/Interstitial Therapy 79200-79300 Other Non-Thyroid, Non-Hematologic Cancer Therapy 79400 Intravascular Particulate Therapy 79420 Intraarticular Therapy 79440 TOTALS: E. Diagnostic Nuclear Nonimaging Studies (Pediatric and Adult) List the number of each type of Nuclear Medicine procedures performed in those departments which participate in the nuclear medicine residency. Test: CPT Codes Site #1 Site #2 Site #3 Site #4 Glomerular Filtration Rate 78725 Effective Renal Plasma Flow 78725 Schilling Test 78270 Red Cell and Plasma Volume 78120-78122 Other (Specify) TOTALS: Nuclear Medicine Continued Accreditation PIF 9
  10. 10. II. MEDICAL KNOWLEDGE A. Basic Science 1. Instruction that focuses on physical principles, computer applications instrumentation, or techniques of measurement and quantification should be listed under the subheading of BASIC SCIENCE Basic Science Lecture Hrs Lab. Hrs Total Hours per Academic Year Physical Science and Instrumentation Radiation Biology & Radiation Protection Computer Science Mathematics and Statistics Computer Processing of Clinical Images Radionuclide Chemistry and Radiopharmacy Total Basic Science Hours 2. Provide a complete Basic Science didactic schedule (conferences and lectures) for the most recent academic year. The schedule must be complete and accurate, and must provide the title/topic of each session, date, presenter name. Title/Topic Date Presenter Name 3. Provide a description of the Basic Science didactic schedule by diagramming a typical weekly schedule of these conferences with a brief textual explanation. Time Monday Tuesday Wednesday Thursday Friday 7:00 a.m. 8:00 a.m. 9:00 a.m. 10:00 a.m. 11:00 a.m. 12:00 p.m. 1:00 p.m. 2:00 p.m. 3:00 p.m. 4:00 p.m. 5:00 p.m. Nuclear Medicine Continued Accreditation PIF 10
  11. 11. B. Didactic and Clinical Time in supervised clinical training or clinical conferences should not be included in this tabulation. Instruction that deals with biologic principles, in vivo tracer kinetics and clinical applications should be tabulated under the CLINICAL subheading. Clinical Lecture Hours Lab. Hours Total Hours per Academic Year Nuclear Imaging CNS Cardiac Pulmonary GI Infection Endocrine Musculoskeletal Hematology/Oncology Renal PET: Technical aspects & instrumentation Therapy of Hyperthyroidsm Therapy of thyroid cancer Therapy with radiolabeled antibodies Other radionuclide therapy (specify) In Vitro Assays (Methodology and application) GFR, Schilling Test, etc. In Vivo Measurement (Methodology and application) thyroid uptake, bone density, etc. Pediatric Nuclear Medicine Quality Management & Improvement Other (Specify) 1. Provide a complete clinical didactic schedule (conferences and lectures) for the most recent academic year. The schedule must be complete and accurate, and must provide the title/topic of each session, date, presenter name, and number of hours. Title/Topic Date Presenter Name Number of Hours Nuclear Medicine Continued Accreditation PIF 11
  12. 12. 2. Provide a description of the clinical didactic lectures and clinical case conferences listed above, by diagramming a typical monthly schedule of these conferences (a sample schedule is provided at the end of this document) with a brief textual explanation. Time Monday Tuesday Wednesday Thursday Friday 7:00 a.m. 8:00 a.m. 9:00 a.m. 10:00 a.m. 11:00 a.m. 12:00 p.m. 1:00 p.m. 2:00 p.m. 3:00 p.m. 4:00 p.m. 5:00 p.m. 7:00 a.m. 8:00 a.m. 9:00 a.m. 10:00 a.m. 11:00 a.m. 12:00 p.m. 1:00 p.m. 2:00 p.m. 3:00 p.m. 4:00 p.m. 5:00 p.m. 7:00 a.m. 8:00 a.m. 9:00 a.m. 10:00 a.m. 11:00 a.m. 12:00 p.m. 1:00 p.m. 2:00 p.m. 3:00 p.m. 4:00 p.m. 5:00 p.m. 7:00 a.m. 8:00 a.m. 9:00 a.m. 10:00 a.m. 11:00 a.m. 12:00 p.m. 1:00 p.m. 2:00 p.m. 3:00 p.m. 4:00 p.m. 5:00 p.m. Nuclear Medicine Continued Accreditation PIF 12
  13. 13. 3. Describe how residents participate in the conferences listed above. How much responsibility do they have for their preparation and presentation? C. Other Total Hours per Academic Year Journal Club Lectures Presented by Residents Administrative Conferences (i.e., QA) Other (please specify): D. Organization 1. Goals and Objectives a) A complete set of goals and objectives must be available for the site visitor. Choose as a sample the goals and objectives for one clinical rotation and attach as Appendix A (do not append all of the goals and objectives). b) When are the goals and objectives distributed to faculty? ......................................................................( ) Prior to each rotation ( ) Annually ( ) Other 2. Describe the organization of the educational program. 3. Explain the provision for graduated resident responsibility and resident supervision. E. In Vivo (Imaging) Training 1. Describe the provisions made in your program for didactic instruction and for practical experience and training in the full spectrum of in vivo imaging studies, including positron tomography. 2. Describe the arrangement for interdepartmental collaboration regarding in vivo imaging studies when applicable. The description should include, for example, the role of the Nuclear Medicine resident in the performance of cardiac studies and the relationship between Cardiology and Nuclear Medicine in the performance and interpretation of cardiac studies. If collaborative arrangements exist for other organ systems, these should be described as well. Nuclear Medicine Continued Accreditation PIF 13
  14. 14. F. Therapy Training 1. Describe the formal instruction devoted specifically to radionuclide therapy applications including dosimetry, physics, radiobiology and radiation safety. 2. Describe the clinical participation in the therapeutic applications of radionuclides. 3. Describe the provision for resident participation on the follow-up of therapy patients. 4. If the Nuclear Medicine division or department shares the responsibilities for radionuclide therapy with other divisions, please describe the roles of each division and/or each affiliated site. G. Non Imaging Training (Non imaging training includes instruction in the principles of immunology; preparation of radiopharmaceuticals including radiolabeled antibodies; radiopharmaceutical absorption, excretion and dilution studies). 1. Describe the provisions made in your program for didactic instruction and for practical experience and training in the full spectrum of non imaging procedures. 2. If the Nuclear Medicine Department or Division shares the responsibility for non-imaging procedures with other divisions and/or affiliated sites, describe the roles of each division and/or affiliated site by identifying who is responsible for performing and interpreting the results of non-imaging studies. H. Pediatric Nuclear Medicine Describe the arrangements for training in pediatric nuclear medicine. I. Quality Control and Assurance Describe briefly the quality management and improvement for nuclear medicine and the role of the resident in these plans. The quality control plan should include quality control of instrument performance and of radiopharmaceutical preparation. The quality assurance plan should include efficacy assessment and compliance with NRC and JCAHO regulations. Describe how residents participate in quality management and improvement activities. Nuclear Medicine Continued Accreditation PIF 14
  15. 15. J. Research Describe briefly the space and special facilities for Nuclear Medicine research. K. Resident Duty Hours and the Working Environment 1. Describe nuclear medicine residents' work hours including night and weekend call. Indicate the frequency of call and availability of faculty supervision. 2. Explain how the program deals with impaired residents. Limit your response to 200 words. Nuclear Medicine Continued Accreditation PIF 15
  16. 16. III. PRACTICE-BASED LEARNING AND IMPROVEMENT Examples of Learning Activities: didactic lecture, assigned reading, seminar, self-directed learning module, conference, small group discussion, workshop, online module, journal club, project, case discussion, one-on-one mentoring, or other examples of learning activities. 1. Describe one learning activity in which residents will engage to identify strengths, deficiencies, and limits in their knowledge and expertise (self-reflection and self-assessment); set learning and improvement goals; identify and perform appropriate learning activities to achieve self-identified goals (life-long learning). Limit your response to 400 words. 2. Describe one example of a learning activity in which residents will engage to develop the skills needed to use information technology to locate, appraise, and assimilate evidence from scientific studies and apply it to their patients’ health problems. The description should include: a) locating information b) using information technology c) appraising information d) assimilating evidence information (from scientific studies) e) applying information to patient care Limit your response to 400 words. 3. Give one example of a planned quality improvement activity or project in which at least one resident will participate that will require the resident to demonstrate an ability to analyze, improve and change practice or patient care. Describe planning, implementation, evaluation and provisions of faculty support and supervision that will guide this process. Limit your response to 400 words. 4. Describe how residents: a) develop teaching skills necessary to educate patients, families, students, and other residents; b) teach patients, families, and others; and c) receive and incorporate formative evaluation feedback into daily practice. (If a specific tool is used to evaluate these skills have it available for review by the site visitor.) Limit your response to 400 words. Nuclear Medicine Continued Accreditation PIF 16
  17. 17. IV. INTERPERSONAL AND COMMUNICATION SKILLS 1. Describe one learning activity in which residents will develop competence in communicating effectively with patients and families across a broad range of socioeconomic and cultural backgrounds, and with physicians, other health professionals, and health related agencies. Limit your response to 400 words. 2. Describe one learning activity in which residents will develop their skills and habits to work effectively as a member or leader of a health care team or other professional group. In the example, identify the members of the team, responsibilities of the team members, and how team members communicate to accomplish responsibilities. Limit your response to 400 words. 3. Explain (a) how the completion of comprehensive, timely and legible medical records will be monitored and evaluated, and (b) the mechanism that will be used for providing residents feedback on their ability to competently maintain medical records. Limit your response to 400 words. Nuclear Medicine Continued Accreditation PIF 17
  18. 18. V. PROFESSIONALISM 1. Describe at least one learning activity, other than lecture, by which residents will develop a commitment to carrying out professional responsibilities and an adherence to ethical principles. Limit your response to 400 words. 2. How will the program promote professional behavior by the residents and faculty? Limit your response to 400 words. 3. How will lapses in these behaviors be addressed? Limit your response to 400 words. Nuclear Medicine Continued Accreditation PIF 18
  19. 19. VI. SYSTEMS-BASED PRACTICE 1. Describe the learning activity(ies) through which residents will achieve competence in the elements of systems-based practice: work effectively in various health care delivery settings and systems, coordinate patient care within the health care system; incorporate considerations of cost- containment and risk-benefit analysis in patient care; advocate for quality patient care and optimal patient care systems; and work in interprofessional teams to enhance patient safety and care quality. Limit your response to 400 words. 2. Describe an activity that will fulfill the requirement for experiential learning in identifying system errors. Limit your response to 400 words. Nuclear Medicine Continued Accreditation PIF 19
  20. 20. VII.TRAINING OTHER LEARNERS If the program provides rotations for residents or fellows from other specialties either within or from outside the site provide the number of trainees, trainee specialty, whether the rotation is observation or full participation, and length of time spent in your department. Trainee Specialty # of trainees per year at any given time Full Participation Observational Length of Rotation Nuclear Medicine Continued Accreditation PIF 20
  21. 21. VIII. FACILITIES 1. Nuclear Medicine Equipment: List number of units in use in each site. Use institution numbers from. If more than four sites participate in the program, duplicate this table as needed. Site #1 Site #2 Site #3 Site #4 In Vitro Laboratory Gamma Well System Liquid Scintillation System Dose Calibrator Chromotography In Vivo Imaging/Counting Probe Counting Systems Cameras Planar Mobile SPECT (not SPECT/CT) SPECT/CT PET (not PET/CT) PET/CT Computer Access (yes/no) Nuclear Medicine PACS Radiology PACS Radiology Information System Hospital Information System Designated Resident Computers (How many?) Radiopharmaceutical Chemistry Cyclotron Other (Specify) 2. Institutional Patient Data: supply the following data for the most recent 12 month period available. Use institution numbers from. If more than four sites participate in the program, duplicate this table as needed. From To Site #1 Site #2 Site #3 Site #4 Total Number of Active Beds Hospital Admissions: Pediatric Adult Total Outpatient Visits: Pediatric Adult Total 3. Accreditation and Licensure for Nuclear Medicine: Indicate by Yes/No and date.If more than four sites participate in the program, duplicate this table as needed. Nuclear Medicine Continued Accreditation PIF 21
  22. 22. Accreditation and/or Licensure (Indicate by Yes/No and date) Site #1 Site #2 Site #3 Site #4 Quality Assurance Programs Society of Nuclear Medicine/ICANL (Intersocietal Commission for the Accreditation of Nuclear Medicine Laboratories) American College of Radiologists CLIA (Clinical Laboratory Improvement Amendments) Other (Specify) Nuclear Medicine Continued Accreditation PIF 22
  23. 23. APPENDIX A GOALS AND OBJECTIVES Attach a sample of the goals and objectives for one clinical rotation Nuclear Medicine Continued Accreditation PIF 23
  24. 24. APPENDIX B BIBLIOGRAPHY List no more than 10 representative publications from the past three years by members of the nuclear medicine teaching staff and residents. Underline the names of resident participants. Nuclear Medicine Continued Accreditation PIF 24
  25. 25. SAMPLE MONTHLY CLINICAL CONFERENCES Time Monday Tuesday Wednesday Thursday Friday 7:00 a.m. 8:00 a.m. 8-9 NM Conf. (1)* 8-9 NM Conf. (1) 9:00 a.m. 10:00 a.m. 11:00 a.m. 12:00 p.m. 12-1 Rad Onc Conf. (2) 12-1 Endo Conf. (3) 1:00 p.m. 2:00 p.m. 3:00 p.m. 3-4 PET Conf. (1) 4:00 p.m. 5:00 p.m. 7:00 a.m. 8:00 a.m. 8-9 NM Conf. (1)* 8-9 NM Conf. (1) 9:00 a.m. 10:00 a.m. 11:00 a.m. 12:00 p.m. 1:00 p.m. 2:00 p.m. 3:00 p.m. 4:00 p.m. 5:00 p.m. 7:00 a.m. 8:00 a.m. 8-9 NM Conf. (1)* 8-9 NM Conf. (1) 9:00 a.m. 10:00 a.m. 11:00 a.m. 12:00 p.m. 12-1 Endo Conf. (3) 12-1 Neuro Sci Conf. (3) 1:00 p.m. 2:00 p.m. 3:00 p.m. 4:00 p.m. 5:00 p.m. 7:00 a.m. 8:00 a.m. 8-9 NM Conf. (1)* 8-9 NM Conf. (1) 9:00 a.m. 10:00 a.m. 11:00 a.m. 12:00 p.m. 1:00 p.m. 2:00 p.m. 3:00 p.m. 4:00 p.m. 5:00 p.m. * Site Code: 1 – Site #1 A; 2 – Site #2; 3 – Site #3 Nuclear Medicine Continued Accreditation PIF 25

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