MCCCD Official Course Competencies:

DMI267  2008 Fall – 2009 Summer II

Nuclear Medicine Imaging I

1.

Apply knowledge of bone, and lung system anatomy and physiology to nuclear medicine imaging indications and procedures. (I, X)

2.

Describe characteristics and causes of common bone, and lung pathologies and related potential treatments. (II, XI)

3.

Describe the radiopharmaceuticals used for bone, and lung imaging including their physical and chemical properties, biorouting, route and method of administration, and advantages and disadvantages of each agent. (III, XII, XIII, XIV)

4.

Specify the dose range for bone, and lung imaging agents and the resulting radiation dose to various organs and tissues. (III, XII)

5.

Discuss any physical or pathological conditions or medications that would interfere or contraindicate bone, and lung imaging. (IV, XII)

6.

Describe patient preparation for a bone, and lung scan. (V, XII)

7.

List the indications for bone, and lung scans. (VI, XII, XIII, XIV, XVI)

8.

Discuss why nuclear medicine study would be preferable to or complement other diagnostic modalities in various cases. (VI, XII, XIII, XIV, XVI)

9.

Describe the procedures for routine static planar and whole body bone imaging and lung imaging including equipment, protocols, dose and administration technique, administration- to-acquisition times, acquisition parameters, standard positioning and views, special imaging adaptations, image formatting and potential pitfalls. (VI)

10.

Discuss the indications for a 3-phase, 4-phase, and SPECT and SPECT/CT bone scan including why a nuclear medicine study would be preferable to, or complement other diagnostic modalities. (VII, VIII)

11.

Describe the protocols for a 3-phase, 4-phase, and SPECT and SPECT/CT bone imaging including equipment, protocols, dose and administration technique, administration-to-acquisition times, acquisition parameters, standard positioning and views, special imaging adaptations, imaging formatting and potential pitfalls. (VII, VIII)

12.

Recognize normal distribution, normal variants and various artifacts seen on bone, and lung imaging, and on printed images. (IX, XII, XIV, XVI)

13.

Identify structures on bone images and SPECT slices. (IX)

14.

Recognize the appearance of various pathologies seen on bone images. (IX)

15.

Discuss the diagnostic and prognostic value of bone, and lung imaging studies. (IX, XII, XIII, XIV, XV, XVI)

16.

Explain some common causes of false-negative and false- positive bone studies. (IX)

17.

Discuss possible adverse reactions and contraindications and regulations associated with gas ventilation and aerosol ventilation imaging. (XIII, XIV)

18.

Discuss special radiation safety considerations associated with gas ventilation and aerosol ventilation imaging. (XIII, XIV)

19.

Discuss advantages and disadvantages associated with ventilation/perfusion and perfusion/ventilation sequences. (XV)

20.

Describe the interpretive criteria for the ventilation/perfusion study including the probability table for pulmonary embolism. (XV)

MCCCD Official Course Outline:

DMI267  2008 Fall – 2009 Summer II

Nuclear Medicine Imaging I

I. Review of Anatomy and Physiology of the Bone

A. Matrix structure and composition

B. Bone growth

C. Bone repair

D. Hormonal control of blood/bone calcium

II. Skeletal System Pathology

A. Low back pain

B. Fracture

C. Osteitis fibrosa cystica

D. Osteomalacia/rickets

E. Osteomyelitis

F. Tuberculosis (Pott's Disease)

G. Legg-Perthes disease

H. Osteoporosis

I. Acute arthritis

J. Rheumatoid arthritis

K. Osteoarthritis

L. Alkylosing arthritis

M. Gout

N. Fibrous dysplasia

O. Paget's disease (osteitis deformans)

P. Osteosarcoma

Q. Ewing's sarcoma

R. Chondrosarcoma

S. Metastatic tumors to bone

T. Multiple myeloma

U. Giant cell tumor

V. Benign osteoma (osteois osteoma)

W. Benign chondroma

X. Bone cyst

III. Radiopharmaceuticals

A. Historical tracers

1. Strontium-90 (Sr-90)

2. Technetium-99m (Tc-99m) pyrophosphate (PYP)

B. Current tracers

1. Tc-99m MDP (methylene diphosphonate)

2. Tc-99m HDP (hyddroxymethylene diphosphonate)

C. Physical and chemical characteristics

D. Dose range and route of administration

E. Biorouting

1. Uptake

2. Distribution

3. Excretion

F. Dosimetry

IV. Contraindications and adverse reactions

A. Physical or pathologic conditions

B. Interfering studies

C. Interfering drugs

D. Precautions

E. Adverse reactions

V. Patient preparation

VI. Routine bone imaging

A. Indications

B. Equipment

1. Camera

2. Collimators

C. Basic procedure and processing

1. Protocols

2. Dose and administration technique

3. Acquisition parameters

4. Positioning and views, including adaptations

5. Image formatting

6. Pitfalls

VII. 3-phase and 4-phase imaging

A. Indications

B. Equipment

1. Camera

2. Collimator

3. Computer

C. Basic procedure and processing

1. Protocols

2. Dose and administration and technique

3. Acquisition parameters

4. Positioning and views, including adaptations

5. Image formatting

6. Pitfalls

VIII. SPECT and SPECT/CT

A. Indications

B. Equipment

1. Camera

2. Collimator

3. Computer

C. Basic procedure and processing

1. Protocols

2. Dose and administration and technique

3. Acquisition parameters

4. Positioning and views, including adaptations

5. Data processing

6. Image formatting

7. Pitfalls

IX. 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

X. Review of anatomy & physiology

A. Gross anatomy

B. Cellular anatomy and function

C. Blood flow

XI. Pathology of the Respiratory System

A. Pulmonary embolism

B. Primary and secondary neoplasms

C. Chronic obstructive pulmonary disease

1. Asthma

2. Emphysema

3. Pneumoconiosis

4. Chronic bronchitis

D. Infectious diseases

1. Tuberculosis

2. Pneumonia

E. Pulmonary edema

F. Pleural effusion

G. Sarcoidosis

H. Atelectasis

I. Congenital heart disease involving right-to-left cardiac shunt

XII. Perfusion

A. Indications

B. Radiopharmaceuticals

1. Tc-99m Macroaggregated albumin (MAA)

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 and 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

a. Standard lung imaging

b. Right-to-left

5. Data processing

6. Image formatting

7. Pitfalls

G. Interpretation of images and data

1. Normal

2. Normal variants

3. Abnormal

4. Artifacts

XIII. Gas Ventilation

A. Indications

B. Radiopharmaceuticals

1. Tracers

a. Xenon-133 (Xe-133)

b. Krypton-81m (Kr-81m)

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. Precautions

4. Adverse reactions

D. Special radiation safety considerations and regulations

E. Patient preparation

F. Equipment

1. Camera

2. Collimators

3. Computer

4. Ventilation trapping system

5. Negative pressure room

6. Room air monitor

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 and data

1. Normal

2. Normal variants

3. Abnormal

4. Artifacts

XIV. Aerosol Ventilation

A. Indications

B. Radiopharmaceuticals

1. Tracers

a. Nebulized Te-99m Diethylenetriaminepentaacetate (DTPA)

b. Others

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. Special radiation safety considerations and regulations

E. Patient preparation

F. Equipment

1. Camera

2. Collimators

3. Computer

4. Aerosol system

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 and data

1. Normal

2. Normal variants

3. Abnormal

4. Artifacts

XV. Combined Ventilation/Perfusion Study

A. Order of studies

B. Interpretative criteria (probabilities)

C. Diagnostic/Prognostic Value of Study

1. Outcomes

2. Treatment decisions

3. Prognostic risk factors based on diagnosis

XVI. Quantitative Lung Study

A. Indications

B. Basic procedure and processing

1. Protocols

2. Acquisition parameters

3. Positioning and views, including adaptations

4. Data processing

5. Image formatting

6. Pitfalls

C. Interpretation of images and data

1. Normal

2. Normal variants

3. Abnormal

4. Artifacts

5. Diagnostic/prognostic value of study

a. Outcomes

b. Treatment decisions

C. Prognostic risk factors based on diagnosis