MCCCD Official Course Competencies:

ICE279  2003 Fall – 2009 Summer II

Nuclear Medicine Cardiac Imaging II

1.

Describe patient preparation, indications, contraindications, sequencing of procedures in cardiovascular imaging. (I)

2.

Explain the injection techniques and imaging times used for cardiovascular imaging. (I)

3.

Describe the acquisition protocols for cardiovascular imaging to include patient positioning, stopping parameters, matrix size, single photon emission computed tomography (SPECT) parameters, gating parameters and collimation. (I)

4.

Describe the processing of cardiac exams including cineangiograms, ejection fraction determination, functional images, heart-lung ratio, image manipulation techniques, image filtering, polar plot analysis, wall motion analysis, and time-activity curves. (I)

5.

Explain the rationale for quality control of the camera and system performance. (I)

6.

Explain the reason for artifacts from radiopharmaceutical distribution and artifacts created by acquisition parameters and artifacts created by processing techniques. (I)

7.

Describe radiopharmaceuticals used in cardiovascular imaging to include rationale for selecting specific radiopharmaceuticals based on indications, dosages, biodistribution and localization. (II)

8.

Describe interventional drugs according to classifications, dosages and indications. (II)

9.

Explain the different pharmacologic stress protocols. (II)

10.

Discuss contraindications, adverse effects and medication interactions in cardiac imaging. (II)

11.

Discuss contraindications to exercise stress testing. (III)

12.

Explain the physiologic measures of exercise capacity or performance. (III)

13.

Explain the rationale for electrocardiogram (ECG) acquisition, treadmill tower operation and related patient care and monitoring. (III)

14.

Describe bicycle and isometric exercise protocols. (III)

15.

Appropriately answer patient questions regarding risks of nuclear medicine procedures and comparison to correlative imaging techniques. (IV)

16.

Describe emergency intervention protocols. (IV)

17.

Explain the rationale and technique for selected cardiovascular procedures. (V)

18.

Explain the rationale and technique for use of selected pharmaceuticals. (VI)

MCCCD Official Course Outline:

ICE279  2003 Fall – 2009 Summer II

Nuclear Medicine Cardiac Imaging II

I. Instrumentation/Procedures/Processing

A. Acquisition

B. Processing

C. Quality control

1. Camera/system performance

2. Assessment of filtering techniques

3. Image assessment

D. Artifacts

1. Radiopharmaceutical distribution

2. Artifacts created by acquisition parameters

a. Uniformity

b. Energy window

c. Gating

d. Motion

e. Center-of-rotation correction errors

f. Attenuation

II. Radiopharmaceuticals and Interventional Drugs

A. Radiopharmaceuticals

1. Indications

2. Dosages

3. Biodistribution and localization

4. Radiopharmaceutical problems

B. Interventional drugs

1. Types and dosages

2. Indications

3. Pharmacologic stress protocols

4. Contraindications, adverse effects and medication interactions

III. Non-Pharmacologic (Exercise) Stress Testing

A. Contraindications to exercise stress testing

B. Physiologic measures of exercise capacity/performance

C. Electrocardiogram acquisition

D. Treadmill tower operation

E. Patient monitoring

F. Bicycle and isometric exercise protocols

G. Patient assessment and monitoring

H. Endpoints

IV. Patient Care

A. Anticipated patient questions

1. Risks of nuclear medicine procedures

2. Comparison to correlative imaging techniques

B. ECG's

1. Patient preparation, electrode placement and leads

2. Rate calculation

3. Normal and abnormal rhythms

4. Heart blocks

5. Indicators of ischemia and infarction

C. Emergency care

1. Cardio-Pulmonary Resuscitation (CPR)

2. Emergency medications

3. Diabetic complications

V. Procedures

A. Myocardial perfusion studies

1. Treadmill, bicycle or isometric exercise

2. Pharmacologic stress

3. Planar

4. SPECT

5. Gated SPECT

6. Positron emission tomography (PET)

B. Equilibrium Radionuclide Angiogram (ERNA/MUGA/RVG)

1. Rest

2. Exercise

3. SPECT

C. Left-to-right cardiac shunt study

D. Right-to-left cardiac shunt study

E. First pass study using a multicrystal system

F. Gated first pass study

VI. Radiopharmaceuticals/Pharmaceuticals

A. I-123 medical internal radiation dose meta- iodobenzylguanidine (MIBG)

B. Tc-99m sestamibi,

C. Tc-99m tetrofosmin

D. TI-201 thallous chloride

E. Tc-99m labeled RBC's

F. F-18 fluorodeoxyglucose (FDG)

G. N-13 ammonia

H. O-15 water

I. Rb-82 chloride

J. C-11 fatty acid

K. Adenosine

L. Dipyridamole

M. Aminophylline

N. Dobutamine

O. Esmolol

P. Acetylsalicylic acid

Q. Anticoagulants

R. Antiarrythmics

S. Beta blockers

T. Calcium channel blockers

U. Angiotensin converting enzyme (ACE) inhibitors

V. Nitrates

W. Cholesterol lowering agents

X. Diuretics

Y. Angiotensin receptor blockers

Z. Digoxin