NUCLEAR MEDICINE RESIDENT DUTIES

Transcription

1 NUCLEAR MEDICINE RESIDENT DUTIES General The American Board of Radiology requires four months training in Nuclear Medicine. Residents will be assigned at least 4 rotations on service. Rotations will be one month for the initial rotation and two weeks or one month at a time after the initial rotation. Nuclear Medicine provides 24/7 service with routine hours of operation Monday through Friday from 7:30 a.m. to 6:00 p.m. Residents are to be available on service and ready for duty within 15 minutes of completion of Morning Conference. Residents will be excused from Nuclear Medicine to attend Noon Conference, Visiting Professor lectures and other approved educational activities or departmental service assignments. While on service, residents are expected to (1) review study requests, patient clinical information, including patient interview and examination when indicated, and pertinent study results; (2) assist nuclear medicine technologists and other staff as needed; (3) participate in radiopharmaceutical preparation and study procedures; (4) offer interpretation of studies performed and dictate assigned studies after review with the attending nuclear medicine physician. Specific Routine Hours of Operation Two diagnostic radiology residents will be assigned each rotation. Duties will be shared, to a variable degree depending on the training level, between the nuclear medicine residents. One or two attending physicians, who may supercede the following resident duty guidelines, if indicated, are assigned to service each day. Resident Duty Guidelines 1) Review overnight studies 2) Review the day s study schedule and transfer appropriate radiological studies to the PACS work list 3) Review clinical findings (paper and electronic medical records and patient are available) to determine the indication for the study and the clinical question, exclusive of patients having a stress MPI study cardiology staff interviews these patients. 4) Present clinical findings for cases at each reading session. 5) Delineated daily reading sessions and attending physician(s) schedule posted in reading room i) Overnight studies ii) Previous day PET studies iii) Previous day outpatient cardiac studies iv) General Nuclear Medicine studies

2 v) Inpatient and selected outpatient cardiac studies 6) Dictate assigned patient studies (no imaging study is to be dictated prior to review by attending nuclear medicine physician) in accordance with standardized report format. 7) Interview and examine patients referred for radionuclide therapy; participate in treatment plan and therapy. 8) Maintain a personal log of direct participation in the radiopharmaceutical kit preparation and patient radionuclide therapies. [State Radiation Safety Boards may request this specific information and the VCUHS program director will require the same prior to authenticating your training experience in nuclear medicine]. Your log and Preceptor Forms must be signed by the appropriate preceptor and contain documentation of a minimum of the following: i) Radiopharmaceutical kit preparation ii) Radiopharmaceutical labeling efficiency iii) Radiopharmaceutical dose calculation iv) Patient study acquisition, image processing and display v) Treatment planning and patient radiopharmaceutical therapy (a) Hyperthyroidism (b) Thyroid cancer (c) Bone metastases 9) Of the two residents on service, one resident will be assigned to continue general nuclear medicine studies after noon conference while the other resident will be assigned to review cardiac studies. Specific After Hours The assigned diagnostic radiology imaging resident is responsible for after-hours coverage of nuclear medicine, functioning as the primary consulting and interpreting physician. The imaging resident will discuss with the referring physician the indication for the study and the appropriate level of bedside coverage for the patient while residing in the nuclear medicine facility, as the technologist is unable to perform the study and care for the patient. The resident will record his or her impression in the patient s nuclear medicine chart or the departmental preliminary report form, and will provide the referring physician with a verbal report of the imaging study findings. The on-call attending nuclear medicine physician should be consulted when indicated. See attached Policy and Procedures for After Hours Coverage. RESIDENT TRAINING The U.S. Nuclear Regulatory Commission (NRC) provides a license to a facility for the use of unsealed radioactive material for diagnosis and therapy. Potential authorized users of radiopharmaceuticals you must have completed specified training to ensure the safe and appropriate use of radioactive material. The NRC has delegated the review of training of a potential user to the medical specialty boards in Nuclear Medicine

3 and had adequate training to become an authorized user at a licensed facility. Some states, however, require attestation by a Preceptor or Program Director that the specific classroom, laboratory and supervised clinical experience has been done by the physician who is applying to the state to become an authorized user of radiopharmaceuticals. The MCVH training program in Radiology will provide you with the necessary classroom education and your rotations in Nuclear Medicine will provide you with the opportunity for laboratory training and the hours of required supervised clinical experience. It will be your responsibility to maintain the records of your individual laboratory training and experience with the radiopharmaceutical therapy. Nuclear Medicine will provide you with the forms for documentation of your training and experience.

4 DEPARTMENT OF RADIOLOGY Nuclear Medicine Division After Hours Coverage for Nuclear Medicine Studies Policies and Procedures General: The Nuclear Medicine Division of the Department of Radiology provides 24- hour service 7 days/week at MCV Hospitals. A nuclear medicine physician is assigned as attending physician and is the responsible physician for all clinical activities during his/her duty hours, 7:45 a.m. until completion of the day s work. After hour coverage nights and weekends by an attending physician is available by pager/phone and is on site for study interpretation at least once per day on Saturday and Sunday. A nuclear medicine technologist is on site after hours or on call. Diagnostic radiology residents (imaging resident) who are assigned to cover nuclear medicine after hours will function as the primary consulting and interpreting physician for requested studies and the oncall attending nuclear medicine physician will be available for consultation and study interpretation. Using the following guidelines, the imaging resident is expected to consult with the attending physician at his/her discretion, depending on the complexity of the study and his/her experience in nuclear medicine. Specific procedures and guidelines: For on call add on studies, the on-call or after hours on-site technologist will be responsible for radiopharmaceutical preparation and administration. In all cases, the person who administers the radiopharmaceutical is responsible for inquiring about possible patient pregnancy. In all cases, the technologist will perform the imaging study and must have an attendant present during the study to provide patient care if needed. The imaging resident, in consultation with the referring physician, will determine the level of training that would be appropriate for the attendant(s). In all cases, a nuclear medicine imaging study requested for a known pregnant woman must have the approval of both the patient s attending physician and the nuclear medicine attending physician. The resident must inform the pregnant patient that she will receive a radioactive material, explain the potential benefits and risks of the study, and obtain signed consent from the patient (forms available in the radiopharmaceutical lab). In all cases, the attending nuclear medicine physician must be notified of a request to perform a cerebral perfusion study to evaluate brain death and the study must be done in the presence of the attending physician. The attending physician should be consulted regarding the performance of after hour studies if any question exists regarding the necessity of the study. With the exception of the following studies myocardial perfusion, V/Q lung, hepatobiliary, GI bleeding and testicular imaging studies the indication for an after hours study should be discussed with the attending.

5 All imaging residents should have adequate training and experience to accurately interpret the routine after hour studies. However, if any uncertainty exists, the resident is expected to consult with the on-call attending physician. If the on-call attending physician does not respond in a reasonable time governed by the severity of the situation, the imaging resident should sequentially call the on-call senior resident or any nuclear medicine staff attending physician until the problem is resolved.

6 Rotation 1 Knowledge Based Objectives: At the end of the rotation, the resident should be able to: 1) Demonstrate a thorough knowledge of the clinical indications, general procedures (including radiopharmaceutical and dose), and scintigraphic findings in: a) pulmonary (emboli) ventilation and perfusion imaging b) hepatobiliary imaging and functional studies c) GI blood loss imaging d) bone imaging e) PET Oncology 2) Discuss the basic physical principles of nuclear medicine imaging and instrumentation. 3) Identify the isotopes (including physical and chemical properties) that are used routinely in the compounding of radiopharmaceuticals for nuclear radiology procedures. Technical Skills: At the end of the rotation, the resident should be able to: 1) Recognize limitations in personal knowledge and skills, being careful to not make decisions beyond the level of personal competence. Decision-Making and Value Judgment Skills: At the end of the rotation, the resident should be able to: 1) Review histories of patients to be imaged each day to determine the relevance of the study to clinical symptoms, to evaluate for contraindications to the study, and the advise technologists about special views or specific parameters of the study that require special attention. 2) Assist technologist in the determination of the radiopharmaceutical dosage when patient conditions do not fit the criteria of the standard dose. 3) Observe at least one of each of the different scans routinely performed, as well as all the infrequently ordered studies. 4) Make a preliminary review of the images and advise technologists when additional views or repeat views are needed.

7 Rotation 2 Knowledge Based Objectives: At the end of the rotation, the resident should be able to: 1) Demonstrate a thorough knowledge of the clinical indications, general procedures (including radiopharmaceutical and dose) and scintigraphic findings in: a) renal and urinary tract studies b) liver/spleen imaging c) GI tract imaging and functional studies d) thyroid imaging and functional studies e) brain imaging and functional studies f) tumor and abscess imaging G) Cardiac Imaging 2) Identify and discuss indications for isotopes used for therapeutic purposes. 3) Describe the protocol for using I-131 for treatment of hyperthyroidism and thyroid malignancies, including protocol for hospitalization and monitoring of patients who receive over 30 mci of activity. Decision-Making and Value Judgment Skills: At the end of the rotation, the resident should be able to: 1) Recognize limitations in personal skill and knowledge, always making sure dictations and consultations are checked by the faculty radiologist. 2) Review all scans as they are performed for significant findings that require prompt attention, and make decisions in regard to notification of the referring physician if the faculty radiologist is not available for consultation. Rotation 3 Knowledge Based Objectives: At the end of the rotation, the resident should be able to: 1) Identify normal and abnormal findings on all imaging and functional studies, other than nuclear cardiology studies. 2) Discuss all aspects of nuclear studies, including indications, pathologies, protocols, correlative studies, radiopharmaceuticals used for each study, and various parameters that might interfere with the results of the procedure. 3) Demonstrate a thorough knowledge of the clinical indications, general procedures, and findings in: a) Myocardial perfusion studies (rest and stress)

8 b) Myocardial infarct imaging c) Multigated acquisition imaging and function studies 4) Describe the radiopharmaceuticals used in cardiac nuclear studies, including the methods of red cell labeling, patient dosages, and physical properties of the isotopes. 5) Discuss patient conditions and patient monitoring requirements, particularly in relation to exercise and drug stress studies. 6) Process computer data obtained in each of the different cardiac studies. 7) Discuss the range of invasive and noninvasive tests, test characteristics, and the prognostic value of tests used to evaluate cardiac disease. Technical Skills: At the end of the rotation, the resident should be able to: 1) Review and dictate with the faculty radiologist all scans performed. 2) Review cases. Decision Making and Value Judgment Skills: At the end of the rotation, the resident should be able to: 1) Make preliminary decisions on all matters of film interpretation and consultation, recognizing need for and obtaining assistance in situations that require the expertise of the faculty radiologist. 2) Comment on anatomical findings, scanning technique, and reasons for doing the study to rotating medical students in such a way that the students will be able to develop an appreciation for the value of nuclear radiology procedures in patient management. 3) Select tests for evaluation of cardiac disease on the basis of patient condition and clinical symptoms. 4) Correlate the results from various tests with interpretation of nuclear cardiology exams.

9 Rotation 4 Knowledge Based Objectives: At the end of the rotation, the resident should be able to: 1) Discuss the following information regarding all radiopharmaceuticals used in nuclear radiology studies: a) production of isotopes b) physical properties of isotopes c) generation elution and quality control d) compounding of radiopharmaceuticals e) radiochemical quality control f) biodistribution and mechanisms of localization 2) Calculate patient doses, using information related to decay factors, volume concentration, and patient parameters. 3) Describe the procedures and rationale for instrument quality control in nuclear medicine. 4) Discuss rules and regulations that apply to the practice of nuclear radiology as outlined in 10CFR20 and other appropriate sources. 5) Describe the types of records that must be maintained in order to comply with federal/state guidelines for radiation safety and radioisotope receipt/use/disposal. 6) Demonstrate an in-depth understanding of the physics of nuclear radiology. Technical Skills: At the end of the rotation, the resident should be able to: 1) Compound radiopharmaceuticals from kits and do appropriate quality control procedures. Hands-on training documents in training packet to be completed by senior year. 2) Perform appropriate quality control procedures. 3) Calculate and draw up patient doses. 4) Demonstrate appropriate use of a survey meter to monitor radioactivity spills or other sources. 5) Perform a wipe test. 6) Perform quality control procedures on cameras, well/uptake probes, and dose calibrators.

10 7) Handle radioactive sources according to the established guidelines. Decision-Making and Value Judgment Skills: At the end of the rotation, the resident should be able to: 1) Carry out the practice of nuclear radiology with due regard to quality control, quality assurance, and radiation safety for the patient and personnel.