NUCLEAR MEDICINE

DEFINITION:Nuclear Medicine is a branch of medical practice concerned primarily with the use of unsealed radioactive sources in the study, diagnosis and treatment of disease.

GENERAL OBJECTIVES:The goal of the nuclear medicine resident is to attain the competence to function independently as a medical specialist with the ability to advise on, supervise, perform and interpret imaging and non-imaging diagnostic procedures, and to perform radiotherapy with unsealed radioactive sources to such a level of competence as to function as a consultant to referring physicians. 

The purpose of the clinical training required is to give the resident a degree of independent responsibility for clinical decisions; an opportunity for further development of the skills required in making effective relationships with patients; the consolidation of competence in primary clinical and technical skills across a broad range of medical practice; and an understanding of the nature of the relationships between the referring physician and nuclear medicine consultant.

The resident must establish a habit of life long learning and a recognition of the importance of promoting a team approach to the use of nuclear medicine in diagnosis and therapy.

At first, the resident will be closely supervised, with the opportunity for increasing responsibility, so that the resident near the end of the residency can function as a nuclear medicine consultant, recognizing his or her limitations.

SPECIFIC OBJECTIVES:At the completion of their residency, residents will have acquired and achieved the following:

  1. Knowledge

An adequate understanding of the following:

    1. Basic Sciences:
      1. relevant anatomy, pathology, physiology and pathophysiology
      2. physics and instrumentation
      3. radiopharmacy
      4. radiation biology and protection
      5. computer sciences
      6. statistics
      7. tracer kinetics and basic principles of radioimmunoassay
      8. principles of bone densitometry.
    2. Clinical Sciences:
      1. a broad knowledge of clinical medicine relevant to the practice of nuclear medicine
      2. diagnostic use of radionuclides including principles of their use, techniques, indications, interpretation, and pitfalls for in vivo imaging, non-imaging and in vitro studies including positron emission tomography and other evolving nuclear medicine technologies
      3. therapeutic uses of radionuclides including indications, contraindications, efficacy, dose calculations, adverse effects and radiation protection
      4. complementary and correlative roles of other diagnostic tests relative to nuclear medicine
      5. other quantitative in vivo measurements eg. bone densitometry.
    3. Other:
      1. radiation safety and regulatory requirements including relevant national and international guidelines governing the transport and use of radiopharmaceuticals and radiation protection
      2. quality assurance as it relates to all aspects of nuclear medicine
      3. ethical and medicolegal issues relevant to nuclear medicine practice.
  1. Skills:

The specialist in nuclear medicine is expected to be able to:

    1. Advise the referring physician on the most appropriate investigation and/or sequence of investigations for the presenting clinical problem.
    2. Obtain a history and perform a physical examination relevant to the consultation.
    3. Supervise and administer the investigation as needed including the various physical, physiological and pharmacological interventions required for the nuclear medicine study.
    4. Analyse and interpret nuclear medicine studies incorporating clinical, other diagnostic imaging and nuclear medicine information to arrive at a diagnosis.
    5. Communicate effectively with the referring physicians both orally and by written report. Communicate effectively with patients and their families, and with other members of the health care team.
    6. Undertake patient management for the therapeutic use of unsealed sources of radiation.
    7. Adequately administer and oversee the operation of a nuclear medicine laboratory including the supervision of a quality control program for equipment and radiopharmaceuticals.
    8. Assume responsibility for radiation safety within the department or hospital.
    9. Teach junior colleagues and students.
    10. Critically appraise research methodology and medical literature.
  1. Attitudes:

The specialist is expected to:

    1. Demonstrate acceptance of responsibility as evidenced by punctuality, availability, self-motivation and conscientiousness.
    2. Practice ethically and responsibly with appropriate respect for patients, colleagues and other health care workers.
    3. Show sensitivity to gender and equity issues. 

CONTENT AND ORGANIZATION OF THE RESIDENCY PROGRAM:

There must be an organized program of rotations and other educational experiences, both mandatory and elective, designed to provide each resident with the opportunity to fulfill the educational requirements and achieve competence in the specialty.

The content and organization of each accredited program in nuclear medicine must be consistent with the specialty training requirements.

Residents must be provided with increasing individual professional responsibility, under appropriate supervision, according to their level of training, ability, and experience.

RESOURCES:There must be sufficient resources including teaching faculty, the number and variety of patients, physical and technical resources, as well as the supporting facilities and services necessary to provide the opportunity for all residents in the program to achieve the educational objectives and receive full training as defined by the specialty training requirements in nuclear medicine.

In those cases where a university has sufficient resources to provide most of the training in nuclear medicine but lacks one or more essential elements, the program may still be accredited provided that formal arrangements have been made to send residents to another accredited residency program for periods of appropriate prescribed training.

  1. Teaching Faculty

There must be a sufficient number of qualified teaching staff to supervise residents at all levels and in all aspects of the specialty. The teaching staff should have an appropriate number of faculty certified in nuclear medicine.

  1. Number and Variety of Patients

Adequate in-patient and ambulatory care facilities must be available for the clinical investigation, treatment and follow-up of patients so that the complete range of referrals to a nuclear medicine department is obtained.

Residents must have access to a wide variety of patients ranging from those acutely ill to those being investigated on an out-patient basis in order to ensure that residents gain adequate experience in the selection of appropriate techniques and interpretation of studies under a variety of urgent, emergency and ambulatory conditions.

  1. Nuclear Medicine Services

The residency program must ensure that each resident obtains experience in:

    1. Imaging: Qualitative and quantitative analyses of static, dynamic and tomographic patient studies.
    2. Isotopes: Use in common in vivo non-imaging procedures.
    3. Bone Densitometry: An understanding of the principles of bone densitometry and exposure to bone densitometry studies.
    4. Therapy: Residents must assume appropriate responsibility for patients undergoing treatment with radionuclides.
    5. Pediatric Nuclear Medicine.
    6. Consultation: It is essential for residents to gain experience in providing advice to referring physicians.
  1. Supporting Facilities and Services

The following facilities and services must be available, either within the program or by arrangement with other programs or institutions, and closely coordinated with the overall residency program:

    1. An accredited program in diagnostic radiology.
    2. An accredited program in internal medicine.
    3. An active teaching service in surgery providing opportunities for the collaborative management of patients undergoing investigation and treatment.
    4. An active teaching service in pathology with provision for the study of relevant pathological material, and adequate instruction in clinico-pathological correlation with the findings of imaging techniques.
    5. Intensive care units, emergency facilities, and ambulatory care facilities serviced by nuclear medicine.
    6. A radiopharmacy or "hot lab" with dedicated personnel.

ACADEMIC AND SCHOLARLY ASPECTS OF THE PROGRAM:

The academic and scholarly aspects of the program must be commensurate with the concept of a university postgraduate education. The quality of scholarship in the program will in part, be demonstrated by a spirit of enquiry during clinical discussions, rounds, and conferences. Scholarship implies an in-depth understanding of basic mechanisms of normal and abnormal states and the application of current knowledge to practice.

  1. Organized Scholarly Activities

Organized scholarly activities such as lectures and seminars, which may be interdisciplinary in nature, special courses, rounds and conferences, technical demonstrations, and journal clubs must be a regular part of the program.

  1. Basic and Clinical Sciences Relevant to Nuclear Medicine

The academic program must include organized teaching in the basic and clinical sciences and advanced clinical and scientific knowledge related to nuclear medicine, including physics, radiobiology and protection, anatomy, pathology, radiopharmacy, mathematics, instrumentation, statistics, and radiation safety.

  1. Biomedical Ethics

The program must ensure that residents gain an understanding of the basic principles and practice of biomedical ethics as it relates to nuclear medicine.

  1. Communication Skills

The program must ensure that residents learn effective communication skills for interacting with patients and their families, colleagues, co-workers from other disciplines, and students. Clearly defined educational objectives for teaching these skills and mechanisms of formal assessment should be in place.

  1. Patient Care Team

Residents must be given opportunities to develop effective skills in collaborating with all members of the patient care team.

  1. Teaching Skills

Residents must be given opportunities to develop effective teaching skills by teaching junior colleagues and students, as well as through conference presentations, clinical and scientific reports, and patient education.

  1. Management Skills

Residents must be given opportunities to develop skills in management as applied to nuclear medicine such as efficient practice and records management and the ethical use of health care resources. Residents should also be prepared for their role as a health care advocate.

  1. Quality Assurance/Improvement

The program must provide residents with opportunities to gain an understanding of the principles and practice of quality assurance/improvement. Opportunities should be provided for residents to participate actively in such programs in their hospital departments.

  1. Research Opportunities for Residents

There must be a faculty member with the responsibility to facilitate the involvement of residents in research and other scholarly work. The academic program must provide the opportunity for residents to learn biostatistics and the critical appraisal of research methodology and medical literature. Such teaching must include issues related to age, gender, culture, and ethnicity in research protocols and data presentation and discussion. Residents should be encouraged to participate in clinical research during the course of the residency program.

  1. Faculty Research

A satisfactory level of research and scholarly activity must be maintained among the faculty identified with the program.

  1. Life-Long Learning

All programs must promote development of skills in self-assessment and self-directed life-long learning. To promote this end, the program should provide opportunities for residents to attend conferences outside their own university.

SPECIALTY REQUIREMENTS:

Approved residency including:

  1. Basic clinical training.
  2. Comprehensive residency in nuclear medicine.

PROGRAMS (WITH TRAINING REQUIREMENTS):

Doctor of Medicine(M.D):

Eighteen months of approved residency training.

Doctor of Philosophy(Ph.D):

Forty eight months(four years)of approved residency training.