MCCCD Official Course Competencies:

DMI277  2006 Spring – 2009 Summer II

Nuclear Medicine Cardiac Imaging I

1.

Describe the gross anatomy and physiology of the cardiovascular system as it relates to nuclear medicine including heart chambers, heart valves, great vessels, cardiac circulation, electrophysiology, and pathology. (I)

2.

Describe characteristics and causes of common cardiac pathologies as they relate to nuclear medicine studies. (II)

3.

Discuss the relationship between abnormal cardiac output and respiratory function. (II)

4.

State whether a cardiac cycle is normal or abnormal given an electrocardiogram (ECG) tracing obtained with a 3-lead ECG technique. (III)

5.

List the indications, contraindications, and possible adverse reactions associated with exercise stress testing, myocardial perfusion/viability imaging, equilibrium radionuclide angiograph (ERNA) imaging, first pass angiography imaging, infarct imaging, major vessel flow studies and deep vein thrombosis (DVT) detection studies. (III-VIII)

6.

Discuss the patient preparation necessary for exercise stress testing, myocardial perfusion/viability imaging, ERNA imaging, first pass angiography imaging and infarct imaging. (III-VIII)

7.

Discuss the equipment and basic procedures and processing utilized in exercise stress testing, myocardial perfusion/viability imaging, ERNA, first pass angiography, infarct imaging, major vessel flow studies and DVT detection studies. (III-VIII)

8.

Compare and contrast the various exercise stress testing protocols including the advantages and disadvantages of each. (III)

9.

Discuss the skin preparation and electrode placement for a 12 lead electrocardiogram (ECG). (III)

10.

Discuss each of the pharmacological interventions used in cardiac stress testing methods including mechanisms of action, indications, contraindications, adverse effects, administration protocols, patient preparation, antidotes, and the operation of an infusion pump. (III)

11.

Discuss the action of low level exercise to a pharmacologic intervention study including indications, contraindications, adverse effects, positive effects, administration protocols, types of low-level exercise and patient preparation. (III)

12.

Identify normal and abnormal ECG's including arrythmias on a 3-lead ECG tracing. (III)

13.

Compare and contrast the dose and route of administration, biorouting, and dosimetry of each radiopharmaceutical used for myocardial perfusion/viability imaging, ERNA imaging, first pass angiography imaging, infarct imaging, major vessel flow studies and DVT detection studies. (IV-VIII)

14.

Discuss normal variants, abnormal finding, artifacts, and the diagnostic and prognostic value of cardiovascular studies including myocardial perfusion/viability imaging, ERNA imaging, first pass angiography imaging, infarct imaging, major vessel flow studies and DVT detection studies. (IV- VIII)

15.

Identify normal scans and/or procedure results including myocardial perfusion/viability scan, ERNA scan, first pass angiography procedure, infarct scan, major vessel flow study, and DVTscan. (IV-VIII)

16.

Describe the interventions and additional procedures that may be added to the basic ERNA study. (V)

MCCCD Official Course Outline:

DMI277  2006 Spring – 2009 Summer II

Nuclear Medicine Cardiac Imaging I

I. Review of Cardiac Anatomy and Physiology

A. Heart chambers

B. Cardiac electrophysiology

1. Conduction pathways

2. Normal electrocardiogram

C. Coronary artery distribution

D. Heart valves and great vessels

E. Physiologic responses to stress

II. Cardiac Pathologies - Characteristics/Causes/Population/Treatment

A. Heart and great vessels

1. Coronary artery disease

a. ischemia

b. infarction

c. hibernating or stunned myocardium

d. zones of ischemia, injury, and infarction

e. coronary artery spasm

2. Congenital abnormalities

a. transposition of the great vessels

b. dextracardia

c. septal defects

3. Valve disease

a. mitral valve prolapse/stenosis/regurgitation

b. tricuspid stenosis/regurgitation

4. Infectious disease

5. Pericardial effusion

6. Cardiomyopathy

7. Chemotherapeutic toxicity

8. Congestive heart failure

9. Arrhythmias

10. Transplant rejection

11. Thyroid related hear disease

12. Cardiac

13. Coarctation of aorta

B. Systemic vasculature

1. Arteriosclerosis

2. Aneurysms

3. Phlebitis

4. Deep vein thrombosis

5. Hypertension

III. Cardiac Stress Testing

A. Indications

B. Contraindications and adverse reactions

1. Physical or pathologic conditions

2. Interfering drugs

3. Precautions

4. Adverse reactions

C. Patient preparation (including consent if applicable)

D. Equipment

1. Treadmill

2. Supine cycle

3. Upright cycle

4. Hand ergometer

5. ECG monitor

6. Blood pressure monitor

E. Basic procedure

1. Protocols

2. ECG

a. skin preparation

b. electrode placement

3. Endpoints

F. Interventions and procedures

1. Pharmacologic intervention

a. pharmaceuticals and mechanisms of action

(1). dipyridamole

(2). adenosine

(3). dobutamine

(4). arbutamine

b. indications/contraindications and adverse effects

c. antidotes for the reversal of the adverse effects

d. administration protocols

e. patient preparation

f. infusion pump

2. Pharmacologic intervention with low-level physical exercise

a. indications/contraindications and adverse effects

b. positive effects of introducing low-level physical exercise

c. administration protocols

d. patient preparation

G. Interpretation

1. Normal rhythm

2. Arrythmias

3. Other ECG abnormalities

IV. Myocardial perfusion/Viability Imaging

A. Indications

B. Radiopharmaceuticals

1. Tracers

a. thallium-201 (T1-201)

b. technetium-99m sestamibi

c. technetium-99m tetrofosmin

d. dual nuclide: T1-201 and a Tc-99m agent

2. Dose range and route of administration

3. Biorouting

a. uptake

b. distribution

c. excretion

4. Dosimetry

C. Contraindications and adverse reactions

1. Physical and pathologic conditions

2. Interfering studies

3. Interfering drugs

4. Precautions

5. Adverse reactions

D. Patient preparation

E. Equipment

1. Camera

2. Collimators

3. Computer

4. Cardiac monitor for gating, if applicable

5. Arm boards, Velcro straps, etc.

F. Basis procedure and processing

1. Protocols

2. Dose range and administration technique

3. Acquisition parameters

4. Positioning and views, including adaptations

5. Data processing

a. normalization

b. circumferential profiles

c. polar maps

d. cines of gated studies (wall motion/wall thickening)

e. ejection fraction calculation

f. attenuation and motion correction software

g. filtering and reconstruction techniques

h. 3-D displays

i. heart-lung ratio

6. Dosimetry

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

V. Equilibrium Radionuclide Angiography (ERNA or MUGA or RVG)

A. Indications

B. Radiopharmaceuticals

1. Tc-99m tagged red blood cell (RBC)

2. Physical and chemical characteristics

3. Kit and radiopharmaceutical preparation

a. in vivo

b. in vitro

c. modified in vivo/in vitro

4. Dose range and administration

5. Biorouting

a. uptake

b. distribution

c. excretion

6. Dosimetry

C. Contraindications and adverse reactions

1. Physical or pathologic conditions

2. Interfering studies

3. Interfering drugs

4. Precautions

5. Adverse reactions

D. Patient preparation

E. Equipment

1. Camera

2. Collimators

3. Computer

4. Cardiac monitor for gating

5. Supine bicycle for exercise if applicable

6. Infusion pump if applicable

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

a. ejection fraction calculations

b. cine display

c. other measurements

6. Image formatting

7. Pitfalls

G. Interpretation of images and data

1. Supine bicycle exercise

2. Dobutamine

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. First Pass Angiography

A. Indications

B. Radiopharmaceuticals

1. Tracers

a. Tc-99m DTPA (pentetate)

b. Tc-99m pertechnetate

c. any Tc-99m labeled radiopharmaceutical of at least 15 mCi

2. Dose range and route of administration

3. Biorouting

a. uptake

b. distribution

c. excretion

4. Dosimetry

C. Contraindications and adverse reactions

1. Physical or pathologic conditions

2. Interfering studies

3. Interfering drugs

4. Precautions

5. Adverse reactions

D. Patient preparation

E. Equipment

1. Cameras

a. multicrystal

b. single crystal

2. Collimators

3. Computer

4. Upright bicycle or treadmill if applicable

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

a. ejection fraction calculations

b. functional images

c. cine display

d. left-to-right shunt quantitation

e. other measurements

6. Image formatting

7. Pitfalls

G. Interpretation of images and 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

VII. Infarct Imaging

A. Indications

B. Radiopharmaceuticals

1. Tracers

a. Tc-99m pyrophosphate

b. In-111 antimyosin

2. Dose range and route of administration

3. Biorouting

a. uptake

b. distribution

c. excretion

4. Dosimetry

C. Contraindications

1. Physical conditions

2. Interfering studies

3. Precautions

4. Adverse reactions

D. Patient preparation

E. Equipment

1. Camera

2. Collimator

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

VIII. Deep Vein Thrombosis Detection

A. Indications

B. Radiopharmaceuticals

1. Tracers

a. Tc-99m MAA (macroaggregated albumin)

b. Tc-99m apcitide

2. Dose range and route of administration

3. Biorouting

a. uptake

b. distribution

c. excretion

4. 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 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