RADIOPHARMACY AND INSTRUMENTATION
Location: University Health Network
Contact: Mihaela Ginj (mihaela.ginj@uhn.ca)
GENERAL COMMENTS:
Residents spend a minimum of 4 weeks in the Radiopharmacy and Instrumentation in their first year.
The resident will be under the direct supervision of the radiopharmacist during this rotation. Throughout
the time spent in the Radiopharmacy, the Resident should relate their activities to the clinical
applications in Nuclear Medicine. Our Residents also participate in an instructor-led radiopharmacy
course at Toronto General Hospital.
The Resident will also have learned the clinical and laboratory skills required for the understanding,
interpretation, and performance of the gamut of in vitro procedures pertinent to nuclear medicine. The
resident will demonstrate the ability to work side-by-side with the laboratory technologists and also
function independently, at a level appropriate for the level of training. The resident will gain proficiency
at the solo performance of in vitro tests as performed in the nuclear medicine department.
SPECIFIC OBJECTIVES:
While this rotation focuses on the CanMEDS roles of Medical Expert, Health Advocate and Professional,
the trainee is expected to demonstrate proficiency in all spheres.
Medical Expert
By the end of the rotation the resident will be able to:
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Demonstrate an understanding of fundamental radiopharmacy principles, including
radiolabelling procedures and quality control of radiopharmaceuticals
Recognize the production and characteristics of various radionuclides (Technetium-99m,
Indium-111, Iodine-131, Iodine-123, Gallium-67)
Recognize the properties that are unique to the preparation of, and the basis of the clinical
applications of various radiopharmaceuticals (MDP, MAA, DTPA, Sulphur Colloid, MAG3, etc)
Recognize the characteristics unique to the availability, preparation, quality control and use of
PET radiopharmaceuticals
Practise routine radiopharmaceutical preparation and quality control procedures
Demonstrate a detailed understanding of the function and operation of nonimaging detectors
used in nuclear medicine (counting probe, well counter, and gas filled detectors)
Recognize the appropriate indications for nuclear medicine nonimaging investigations.
Demonstrate a detailed approach to performance and interpretation of the gamut of nuclear
nonimaging studies, including red cell mass determination, GFR determination, Schillings, Urea
breath test, ferrokinetics, and radioiodine uptake
Demonstrate an understanding of laboratory procedures, including white cell labeling, red cell
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labeling, heat damaged RBC, GFR determination, and other procedures
Demonstrate proficiency in the general laboratory skills pertinent to nuclear medicine (e.g.
accurate pipetting, accurate solution making, safe venipuncture, and safe radioactivity handling)
Demonstrate an understanding of instrument QC procedures as appropriate on nonimaging
diagnostic instruments
Function at the level of a consultant nuclear physician in the application and performance of
nonimaging diagnostic nuclear tests
Apply aseptic techniques in the safe handling of radiopharmaceuticals
Communicator
By the end of the rotation the resident will be able to:
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Effectively communicate with patients and their families
Exhibit well organized and complete radiopharmacy documentation
Obtain informed consent, providing sufficient information regarding risks and benefits of
treatment alternatives
Obtain and synthesize relevant information from patients and their families, with patients’
consent
Collaborator
By the end of the rotation the resident will be able to:
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Obtain, discuss and communicate an understanding of radiopharmacy procedures in
interactions with Radiopharmacy personnel.
Obtain, discuss and communicate an understanding of instrumentation with Radiopharmacy
personnel.
Demonstrate an understanding of the importance of communication between the
Radiopharmacy and the NM physicians, NM technologists and other staff in NM departments for
the delivery of appropriate services for the patient.
Interact with other nuclear medicine department staff, technologists, referring clinical services
and support staff, demonstrating a team approach to the care of the patient
Use appropriate consultation skills when interacting with other physicians and health team
members
Manager/Leader
By the end of the rotation the resident will be able to:
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Demonstrate an understanding of the basic workings and the general management of the
Radiopharmacy Department, including the time-sensitive logistics and the generation and
storage of records
Demonstrate familiarity with the principles and requirements of Good Laboratory Practices
Describe the ‘Transport of Dangerous Goods’ regulations as they relate to reception and
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dispatch of radioisotopes and radiopharmaceuticals
Demonstrate an understanding of the Canadian Nuclear Safety Commission regulations as they
apply to Radiopharmacy staff and operations
Demonstrate a critical eye with respect to Radiopharmacy practices and procedures, with a view
to suggesting improvements where appropriate.
Triage physician requests regarding the urgency of an imaging study
Demonstrate appropriate time management skills when completing assigned rotation duties
Health Advocate
By the end of the rotation the resident will be able to:
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Practise safe handling of blood and biological products
Apply the ALARA principle in the safe handling of radioisotopes
Recognize and manage adverse effects that may be associated with use of
radiopharmaceuticals.
Describe known drugs and other agents that may interact and affect biological profiles of
radiopharmaceuticals in patients.
Make appropriate adjustments required for specific patient populations (i.e. pregnant or
lactating women, children).
Recognize situations in which imaging or treatment would be detrimental to the health/safety of
a patient
Advise and educate on the use and misuse of radiopharmaceuticals in Nuclear Medicine
Scholar
By the end of the rotation the resident will be able to:
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Obtain and present appropriate information from literature, corroborating these with practical
experiences during the training in Radiopharmacy and Instrumentation
Develop a personal continuing education strategy
Critically appraise medical information by asking relevant questions and determining which
information is reliable. Successfully integrate information from a variety of sources
Facilitate learning of students and other health professionals
Professional
By the end of the rotation the resident will be able to:
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Demonstrate a commitment to excellence in clinical care and personal ethical conduct. Exhibit
proper professional behaviour, including adhering to legal and ethical codes of practice when
interacting with patients, colleagues, and other health professionals
Demonstrate an awareness of own strengths and weaknesses
Accept constructive criticism
Demonstrate good work ethic with enthusiasm and motivation for learning
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Demonstrate professional work habits with punctuality, organization and efficiency
EVALUATIONS:
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Rounds performance
Resident should have mid-unit discussion with supervisor
Formal ITER at end rotation
OSCE and oral examination
SUGGESTED READING:
Saha GB. Fundamentals of Nuclear Pharmacy, 6th edition. Springer-Verlag, New York 2010.
Ilse Zolle, Technetium Radiopharmaceuticals. Springer Berlin 2007.
S. Vallabhajosula, Molecular Imaging: Radiopharmaceuticals for PET and SPECT, Springer-Verlag Berlin
Heidelberg 2009.
Kowalsky RJ, Falen S. Radiopharmaceuticals in Nuclear Pharmacy & Nuclear Medicine. APhA
Publications, 2004
Sampson CB. Textbook of Radiopharmacy, 2nd edition. Taylor & Francis 1998
Radiopharmacy Department S.O.Ps
Review articles and journal references.