Official Course Description: MCCCD Approval: 06/17/03
DMI273 20036-20062	LEC	3 Credit(s)	3 Period(s)
Nuclear Medicine Imaging III
Nuclear medicine imaging studies of the central nervous system (CNS) and immune system. Review of related anatomy, physiology and pathology. CNS imaging studies including cerebral vascular flow, planar brain imaging, functional brain single photon emission computed tomography (SPECT), brain tumor imaging, and cerebral spinal fluid studies. Immune system imaging studies including radiolabeled white blood cell studies, gallium, breast, and sentinel node imaging, radioimmunoscintigraphy, lymphoscintigraphy and Iodine-131 whole body imaging. Introduction to radionuclide therapy including intracavitary palliation, bone marrow palliation, ablation for hyperthyroidism, thyroid carcinoma ablation, palliation of metastatic bone pain and radiolabeled antibody therapies. Prerequisites: DMI271 or permission of Nuclear Medicine Technology program director.

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MCCCD Official Course Competencies:
DMI273   20036-20062	Nuclear Medicine Imaging III

1.	Discuss the gross anatomy and physiology of the central nervous and immune systems as they relate to nuclear medicine studies. (I, VIII, XVII)
2.	Describe the characteristics and causes of common pathologies of the central nervous and immune systems related to nuclear medicine procedures including susceptible populations and potential treatments. (II, IX)
3.	List the indications for performing selected CNS imaging studies. (III-VII)
4.	Compare and contrast the physical and chemical properties, kit and dose preparation, dose and route of administration, biorouting and dosimetry of each radiopharmaceutical used for selected CNS and immune system imaging studies. (III-VII)
5.	Discuss the possible adverse reactions and contraindications for selected CNS imaging studies. (III-VII)
6.	Describe patient preparation for selected CNS imaging studies. (III-VII, X-XV, XVIII-XXIII)
7.	Describe equipment and basic procedures and processing utilized in selected CNS imaging studies. (III-VII)
8.	Recognize normal, normal variants, abnormal findings, and artifacts on CNS imaging studies. (III-VII)
9.	Discuss the diagnostic and prognostic value of selected CNS imaging studies. (III-VII, X-XV, XVIII-XXIII)
10.	Discuss the interventions and additional procedures that may be added to a basic functional brain SPECT study. (V)
11.	List the indications for performing selected immune system imaging studies. (X-XV, XVII-XXIII)
12.	Discuss why a nuclear medicine study would be preferable to or compliment other diagnostic modalities in various cases. (X-XV, XVII-XXIII)
13.	Describe the radiopharmaceuticals used for selected immune system imaging studies including the physical and chemical properties, biorouting dose preparation, and route and method of administration. (X-XV, XVII-XXIII)
14.	Specify the dose range for selected immune system imaging studies and the resulting radiation doses to various organs and tissues. (X-XV, XVII-XXIII)
15.	Describe patient preparation for selected immune system imaging studies. (X-XV, XVII-XXIII)
16.	Describe the procedures for selected immune system imaging studies including equipment, protocol, dose, administration technique, administration-to-acquisition times, acquisition parameters, standard positioning, special imaging adaptations, data processing and potential pitfalls. (X-XV, XVII-XXIII)
17.	Recognize the normal distribution, normal variants and various artifacts seen on selected immune system imaging studies and printed images. (X-XV, XVII-XXIII)
18.	Discuss common causes of false-negative and false-positive thyroid uptake results. (X-XV, XVIII-XXIII).
19.	Describe the physical properties of radionuclides as they relate to therapeutic applications in nuclear medicine. (XVI)
20.	Discuss the basic concepts of radiobiology. (XVI)
21.	Discuss malignant and metastatic processes. (XVI)

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MCCCD Official Course Outline:
DMI273   20036-20062	Nuclear Medicine Imaging III

I. Review of central nervous system (CNS) anatomy & physiology A. Gross anatomy and function B. Cellular anatomy and function C. Blood Flow D. Cerebral spinal fluid production and flow II. CNS Pathology: Characteristics, Causes, Population, and Treatment A. Inflammatory disease of the brain B. Alzheimer's disease C. Parkinson's disease D. Hematoma and contusion of the brain E. Brain attack (ischemia and infarct due to cerebral vascular disease) 1. Transient ischemic attack 2. Stroke 3. Thrombus and embolus 4. Aneurym and hemorrhage F. Tumors G. Epilepsy H. Traumatic brain injury I. Brian death J. Neurological and psychiatric diseases K. Communicating hydrocephalus L. Non-communicating hydrocephalus M. Otorrhea N. Rhinorrhea III. Cerebral vascular flow A. Indications B. Radiopharmaceuticals 1. Tracers a. Tc-99m sodium pertechnetate b. Tc-99m DTPA (pentetate) c. Tc-99m GH (gluceptate) 2. Physical and chemical characteristics 3. Kit and radiopharmaceutical preparation 4. Dose range and route of administration 5. Biorouting a. uptake b. distribution c. excretion 6. Dosimetry C. Contraindications and adverse reactions 1. Interfering studies 2. Adverse reactions D. Patient preparation E. Equipment 1. camera 2. collimators 3. computer F. Basic procedure and processing 1. Protocols 2. Dose range and administration technique 3. Acquisition parameters 4. Positioning and views, including adaptations 5. Image formatting 6. Pitfalls G. Interpretation of images 1. Normal 2. Normal variants 3. Abnormal 4. Artifacts 5. Diagnostic/Prognostic Value of the Study a. outcomes b. treatment decisions c. prognostic risk factors based on diagnosis IV. Planar Brain Imaging A. Indications B. Radiopharmaceuticals 1. Tracers a. Tc-99m sodium pertechnetate b. Tc-99m DTPA (pentetate) c. Tc-99m GH (gluceptate) 2. Physical and chemical characteristics 3. Kit and radiopharmaceutical preparation 4. Dose range and route of administration 5. Biorouting a. uptake b. distribution c. excretion 6. Dosimetry C. Contraindications and adverse reactions 1. Interfering studies 2. Adverse reactions D. Patient preparation E. Equipment 1. camera 2. collimators 3. computer F. Basic procedure and processing 1. Protocols 2. Dose range and administration technique 3. Acquisition parameters 4. Positioning and views, including adaptations 5. Image formatting 6. Pitfalls G. Interpretation of images 1. Normal 2. Normal vs Abnormal 4. Artifacts 5. Diagnostic/Prognostic Value of the Study a. outcomes b. treatment decisions c. prognostic risk factors based on diagnosis V. Functional Brain SPECT A. Indications B. Radiopharmaceuticals 1. Historical tracer: Iodine-123 (I-123) IMP (d, 1-N-Isoprophyl-p-iodoamphetamine hydrochloride) 2. Current tracers a. Tc-99m HMPAO (exametazime) b. Tc-99m ECD (bicisate) 3. Physical and chemical characteristics 4. Kit and radiopharmaceutical preparation 5. Dose range and route of administration 6. Biorouting a. uptake b. distribution c. excretion 7. Dosimetry C. Contraindications and adverse reactions 1. Physical conditions 2. Interfering studies 3. Interfering drugs 4. Precautions 5. Adverse reactions D. Patient preparation E. Equipment 1. camera 2. collimator 3. computer 4. ancillary equipment 5. monitoring devices F. Basic procedure and processing 1. Protocols 2. Dose range and administration technique 3. Acquisition parameters 4. Positioning and views, including adaptations 5. Data processing (including co-registration and 3-dimensional volumetric display) 6. Image formatting 7. Pitfalls G. Interventions in procedures 1. Vasodilators (acetazolamide) 2. Pyschological stress studies 3. Sensory stimulation studies H. Interpretation of images and data 1. Normal 2. Normal variants 3. Abnormal 4. Artifacts 5. Diagnostic/Prognostic Value of the Study a. outcomes b. treatment decisions c. prognostic risk factors based on diagnosis VI. Brain tumor imaging A. Indications B. Radiopharmaceuticals 1. Tracers a. Thallium-201 thallous chloride b. Tc-99m sestamibi 2. Physical and chemical characteristics 3. Kit and radiopharmaceutical preparation 4. Dose range and route of administration 5. Biorouting a. uptake b. distribution c. excretion 6. Dosimetry C. Contraindications and adverse reactions 1. Interfering studies 2. Adverse reactions D. Patient preparation E. Equipment 1. Camera 2. Collimators 3. Ancillary equipment F. Basic procedure and processing 1. Protocols 2. Radiopharmaceutical administration and technique 3. Acquisition parameters 4. Positioning and views, including adaptations 5. Data processing 6. Image formatting 7. Pitfalls G. Interpretation of images and data 1. Normal 2. Normal variants 3. Abnormal 4. Artifacts 5. Diagnostic/Prognostic Value of the Study a. outcomes b. treatment decisions c. prognostic risk factors based on diagnosis VII. Cerebral Spinal Fluid (CSF) Studies A. Cisternography 1. Indications 2. Radiopharmaceuticals a. Historical tracer: Ytterbium-169 (Yb-169) DTPA (pentetate) b. Current tracer: Indium-111 (In-111) DTPA (pentetate) c. Physical and chemical characteristics d. Radiopharmaceutical preparation e. Dose range and route of administration f. Biorouting 1. uptake 2. distribution 3. excretion g. Dosimetry 3. Contraindications and adverse reactions a. physical and pathologic conditions b. interfering studies c. precautions d. adverse reactions 4. Patient preparation 5. Equipment a. camera b. collimators 6. Basic procedure and processing a. protocols b. dose range and administration technique c. acquisition parameters d. positioning and views, including adaptations e. image formatting f. pitfalls 7. Interpretation of images a. normal b. normal variants c. abnormal d. artifacts e. Diagnostic/Prognostic Value of the Study 1. outcomes 2. treatment decisions 3. prognostic risk factors based on diagnosis B. CSF Leak Study 1. Indications 2. Radiopharmaceuticals a. Historical tracer: Ytterbium-169 (Yb-169) DTPA (pentetate) b. Current tracer 1. In-111 DTPA 2. Tc-99m DTPA c. Physical and chemical characteristics d. Radiopharmaceutical preparation e. Dose range and route of administration f. Biorouting 3. uptake 4. distribution 5. excretion g. Dosimetry 6. Contraindications and adverse reactions a. physical and pathologic conditions b. interfering studies c. precautions d. adverse reactions 7. Patient preparation 8. Equipment a. camera b. collimators c. well counter 9. Basic procedure and processing a. protocols b. dose range and administration technique c. acquisition parameters d. positioning and views, including adaptations e. data processing (including counting of pledgets in well counters) f. image formatting g. pitfalls 10. Interpretation of images and data a. normal b. normal variants c. abnormal d. artifacts e. Diagnostic/Prognostic Value of the Study 1. outcomes 2. treatment decisions 3. prognostic risk factors based on diagnosis C. CSF Shunt Patency 1. Indications 2. Radiopharmaceuticals a. Historical tracer: Yb-169 DTPA b. Current tracer 1. In-111 DTPA 2. Tc-99m DTPA 3. Tc-99m HSA (human serum albumin) c. Physical and chemical characteristics d. Radiopharmaceutical preparation e. Dose range and route of administration f. Biorouting 1. uptake 2. distribution 3. excretion g. Dosimetry 3. Contraindications and adverse reactions a. interfering studies b. precautions c. adverse reactions 4. Patient preparation 5. Equipment a. camera b. collimators 6. Basic procedure and processing a. protocols b. dose range and administration technique c. acquisition parameters d. positioning and views, including adaptations e. image formatting f. pitfalls 7. Interpretation of images a. normal b. normal variants c. abnormal d. artifacts e. Diagnostic/Prognostic Value of the Study 1. outcomes 2. treatment decisions 3. prognostic risk factors based on diagnosis VIII. Oncology/Inflammation A. Review of anatomy & physiology 1. Immune process 2. Lymph node distribution 3. Receptor physiology 4. Inflammatory processes 5. Malignant processes IX. Pathology: Characteristics, Causes, Population, and Treatment A. Inflammatory diseases B. Radiopharmaceuticals 1. Tracers a. In-111 oxine tagged white blood cells b. Tc-99m hexametazime (HMPAO) tagged white blood cells 2. Physical and chemical characteristics 3. Kit and radiopharmaceutical preparation 4. Dose range and route of administration 5. Biorouting a. uptake b. distribution c. excretion 6. Dosimetry C. Contraindications and adverse reactions 1. Physical or pathological conditions 2. Interfering studies 3. Precautions 4. Adverse Reactions D. Patient preparation E. Equipment 1. camera 2. collimators 3. computer 4. laboratory equipment for tagging process F. Basic procedure and processing 1. Protocols 2. Dose range and administration technique 3. Acquisition parameters 4. Positioning and views, including adaptations 5. Data processing 6. Image formatting 7. Pitfalls G. Interpretation of images 1. Normal 2. Normal variants 3. Abnormal 4. Artifacts 5. Diagnostic/Prognostic Value of the Study a. outcomes b. treatment decisions c. prognostic risk factors based on diagnosis X. Radiolabeled White Blood Cell Studies A. Indications B. Radiopharmaceuticals 1. Tracers a. In-111 oxine tagged white blood cells b. Tc-99m hexametazime (HMPAO) tagged white blood cells 2. Physical and chemical characteristics 3. Kit and radiopharmaceutical preparation 4. Dose range and route of administration 5. Biorouting a. uptake b. distribution c. excretion 6. Dosimetry C. Contraindications and adverse reactions 1. Physical or pathological conditions 2. Interfering studies 3. Precautions 4. Adverse Reactions D. Patient preparation E. Equipment 1. camera 2. collimators 3. computer 4. laboratory equipment for tagging process F. Basic procedure and processing 1. Protocols 2. Dose range and administration technique 3. Acquisition parameters 4. Positioning and views, including adaptations 5. Data processing 6. Image formatting 7. Pitfalls G. Interpretation of images 1. Normal 2. Normal variants 3. Abnormal 4. Artifacts 5. Diagnostic/Prognostic Value of the Study a. outcomes b. treatment decisions c. prognostic risk factors based on diagnosis XI. Gallium Imaging A. Indications B. Radiopharmaceutical 1. Gallium-67 (Ga-67) citrate 2. Physical and chemical characteristics 3. Radionuclide preparation 4. Dose range and route of administration 5. Biorouting a. uptake b. distribution c. excretion 6. Dosimetry C. Contraindications and adverse reactions 1. Physical conditions 2. Interfering studies 3. Interfering drugs 4. Precautions 5. Adverse Reactions D. Patient preparation E. Equipment 1. camera 2. collimators 3. computer F. Basic procedure and processing 1. Protocols 2. Dose range and administration technique 3. Acquisition parameters 4. Positioning and views, including adaptations 5. Data processing 6. Image formatting 7. Pitfalls G. Interpretation of images 1. Normal 2. Normal variants 3. Abnormal 4. Artifacts 5. Diagnostic/Prognostic Value of the Study a. outcomes b. treatment decisions c. prognostic risk factors based on diagnosis XII. Antibody Receptor Imaging A. Indications B. Radiopharmaceuticals 1. Tracers a. In-111 satumomab penetide (for colon and ovarian cancer) b. Tc-99m arcitumomab (for colon cancer c. In-111 capromab pendetide (for prostate cancer) d. other approval radiopharmaceuticals 2. Physical characteristics a. whole antibody b. antibody fragments c. designer antibodies 3. Chemical characteristics 4. Kit and radiopharmaceutical preparation 5. Dose range and route of administration 6. Biorouting a. uptake b. distribution c. excretion 7. Dosimetry C. Contraindications and adverse reactions 1. Physical or pathologic conditions 2. Interfering studies 3. Precautions 4. Adverse Reactions D. Patient preparation E. Equipment 1. camera 2. collimators 3. computer F. Basic procedure and processing 1. Protocols 2. Dose range and administration technique 3. Acquisition parameters 4. Positioning and views, including adaptations 5. Data processing 6. Image formatting 7. Pitfalls G. Interpretation 1. Normal 2. Normal variants 3. Abnormal 4. Artifacts 5. Diagnostic/Prognostic Value of the Study a. outcomes b. treatment decisions c. prognostic risk factors based on diagnosis 6. Abnormal 7. Artifacts 8. Diagnostic/Prognostic Value of the Study a. outcomes b. treatment decisions c. prognostic risk factors based on diagnosis XIII. Breast Imaging (Scintimammography) A. Indications B. Radiopharmaceutical 1. Tc-99m sestamibi 2. Physical and chemical characteristics 3. Kit and radiopharmaceutical preparation 4. Dose range and route of administration 5. Biorouting a. uptake b. distribution c. excretion 6. Dosimetry C. Contraindications and adverse reactions 1. Physical conditions 2. Interfering studies 3. Precautions 4. Adverse Reactions D. Patient preparation E. Equipment 1. camera 2. collimator 3. computer 4. palette F. Basic procedure and processing 1. Protocols 2. Dose range and administration technique 3. Acquisition parameters 4. Positioning and views, including adaptations 5. Image formatting 6. Pitfalls G. Interpretation of images 1. Normal 2. Normal variants 3. Abnormal 4. Artifacts 5. Diagnostic/Prognostic Value of the Study a. outcomes b. treatment decisions c. prognostic risk factors based on diagnosis XIV. Sentinel Node Imaging A. Indications B. Radiopharmaceuticals 1. Tracers a. Tc-99m sulfur colloid b. Tc-99m human serum albumin 2. Physical and chemical characteristics 3. Kit and radiopharamceutical preparation 4. Dose range and route of administration 5. Biorouting a. uptake b. distribution c. excretion 6. Dosimetry C. Contraindications and adverse reactions 1. Physical conditions 2. Interfering studies 3. Precautions 4. Adverse reactions D. Patient preparation E. Equipment 1. camera 2. collimators 3. computer F. Basic procedure and processing 1. Protocols 2. Dose range and administration technique 3. Acquisition parameters 4. Positioning and views, including adaptations 5. Image formatting 6. Pitfalls G. Interpretation data 1. Normal 2. Normal variant 3. Abnormal 4. Artifacts 5. Diagnostic/Prognostic Value of the Study a. outcomes b. treatment decisions c. prognostic risk factors based on diagnosis XV. Lymphoscintigraphy A. Indications Radiopharmaceutical 1. Tc-99m sulfur colloid 2. Physical and chemical characteristics 3. Kit and radiopharmaceutical preparation 4. Dose range and route of administration 5. Biorouting a. uptake b. distribution c. excretion 6. Dosimetry B. Contraindications 1. Physical conditions 2. Interfering studies 3. Precautions 4. Adverse reactions C. Patient preparation D. Equipment 1. camera 2. collimators 3. computer E. Basic procedure and processing 1. Protocols 2. Dose range and administration technique 3. Acquisition parameters 4. Positioning and views, including adaptations 5. Image formatting 6. Pitfalls F. Interpretation of data 1. Normal 2. Normal variants 3. Abnormal 4. Artifacts 5. Diagnostic/Prognostic Value of the Study a. outcomes b. treatment decisions c. prognostic risk factors based on diagnosis XVI. Introduction to Radionuclide Therapy A. Review of radionuclide physical properties B. Review of radiobiology XVII. Review of immune system anatomy and physiology A. Malignant processes B. Metastatic processes XVIII. Pathology A. Body cavities 1. malignancies 2. cavitary effusions B. Bone and bone marrow 1. leukemia 2. polycythemia vera 3. metastatic bone cancer C. Thyroid 1. hyperthyroidism 2. thyroid carcinoma XIX. Intracavitary Palliation A. Indications B. Radiopharmaceuticals 1. Phosphorus-32 (P-32) chromic phosphate 2. Physical and chemical characteristics 3. Radiopharmaceutical preparation 4. Dose range and route of administration 5. Biorouting a. uptake b. distribution c. excretion 6. Dosimetry C. Contraindications and adverse reactions 1. Physical and pathologic conditions 2. Precautions 3. Adverse Reactions D. Special radiation safety considerations and regulations E. Patient preparation (including consent) F. Equipment (for detection of tracer distribution) 1. camera 2. collimators 3. computer G. Basic procedure and processing 1. Protocols 2. Dose range and administration technique 3. Acquisition parameters 4. Positioning and views, including adaptations 5. Image formatting 6. Pitfalls 7. Interpretation 8. Evaluation of tracer distribution 9. Prognostic Value (outcome) XX. Bone Marrow Palliation A. Indications B. Radiopharmaceuticals 1. P-32 sodium chromate 2. Physical and chemical characteristics 3. Radionuclide preparation 4. Dose range and route of administration 5. Biorouting a. uptake b. distribution c. excretion 6. Dosimetry C. Contraindications and adverse reactions 1. Physical and pathologic conditions 2. Precautions 3. Adverse Reactions D. Special radiation safety considerations and regulations E. Patient preparation (including consent) F. Basic procedures 1. Protocols 2. Dose range and administration technique 3. Pitfalls G. Prognostic Value 1. outcomes 2. treatments decisions 3. prognostic risk factors based on diagnosis XXI. Ablation for Hyperthyroidism A. Indications B. Radiopharmaceuticals 1. Iodine-131 (I-131) sodium iodide 2. Physical and chemical characteristics 3. Radionuclide preparations 4. Dose range and route of administration 5. Biorouting a. uptake b. distribution c. excretion 6. Dosimetry C. Contraindications and adverse reactions 1. Physical and pathologic conditions 2. Interfering studies 3. Interfering drugs 4. Precautions 5. Adverse Reactions D. Special radiation safety considerations and regulations E. Patient preparation (including consent) F. Basic procedure 1. Protocols 2. Dose range and administration technique 3. Pitfalls G. Prognostic Value 1. outcomes 2. treatment decisions 3. prognostic risk factors based on diagnosis XXII. Thyroid Carcinoma Ablation A. Indications B. Radiopharmaceuticals 1. Iodine-131 sodium iodide 2. Physical and chemical characteristics 3. Radionuclide preparation 4. Dose range and route of administration 5. Biorouting a. uptake b. distribution c. excretion 6. Dosimetry C. Contraindications and adverse reactions 1. Physical and pathologic conditions 2. Interfering studies 3. Interfering drugs 4. Precautions 5. Adverse Reactions D. Special radiation safety considerations and regulations E. Patient preparation (including consent) F. Basic procedure 1. Protocols 2. treatment decisions 3. prognostic risk factors based on diagnosis G. Prognostic Value 1. outcomes 2. treatment decisions 3. prognostic risk factors based on diagnosis XXIII. Palliation of Metastatic Bone Pain A. Indications B. Radiopharmaceuticals 1. Tracers a. Strontium-89 (Sr-89) chloride b. Samarium-153 (Sm-153) EDTMP c. Rhenium-186 etidronate (HEDP) 2. Physical and chemical characteristics 3. Dose preparation 4. Dose and route of administration 5. Biorouting a. uptake b. distribution c. excretion C. Contraindications and adverse reactions 1. Physical and pathologic conditions 2. Interfering studies 3. Interfering drugs 4. Precautions 5. Adverse Reactions D. Special radiation safety considerations and regulations E. Patient preparation (including consent) F. Equipment 1. camera 2. collimators 3. computer G. Basic procedure and processing 1. Protocols 2. Dose range and administration technique 3. Acquisition parameters 4. Positioning and views, including adaptations 5. Image formatting 6. Pitfalls H. Interpretation of Images (if applicable) 1. Distribution 2. Artifacts 3. Diagnostic/Prognostic Value of Study a. outcomes b. treatment decisions c. prognostic risk factors based on diagnosis

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