Goals and Objectives: Therapeutic Nuclear Medicine
(1 Year Curriculum-Nuclear Residency Program)
Description of Rotation or Educational Experience
The one year curriculum emphasizes nuclear medicine therapy training because the
graduate of radiology residency has only had very basic exposure to this rotation. The
goal is to provide the fundamentals of therapy with unsealed radioactive sources,
including the general principles, patient selection and familiarity with dosage
calculation. There is hands-on experience in the therapy clinic with patient examination
and dose administration, supplemented by lectures in radiobiology. With additional
therapy rotations, there will be increased familiarity with nuclear medicine therapy.
Residents are expected to function with a reduced level of supervision in examining
patients, selecting patients for therapy, calculating dosages and providing radiation
protection instructions.
Patient Care
Goal
Residents must be able to provide patient care that is compassionate, appropriate, and
effective for the treatment of health problems and the promotion of health.
Objectives
In the first 3 months, residents are expected to:
1. Perform a good history and physical examinations with patients who are being
considered for radiopharmaceutical therapy.
2. Learn to effectively obtain information from medical record and clinical
physicians.
3. Learn how elicit symptoms and signs for follow up of patients who have received
therapeutic radiopharmaceuticals.
After the introductory period, residents are expected to:
1. In addition to all the above, become more sophisticated in the evaluation and
treatment of patients who are being considered for, or have received
radiopharmaceutical therapy.
2. Demonstrate more advanced skills in patient care (history, physical examination,
treatment of complications).
3. Demonstrate facility with hospital computer and PACS systems for patient care.
4. In short, be able to take responsibility for almost all routine patient evaluation and
management of therapy patients.
5. By the end of the rotations in therapy, the resident must have been involved in the
treatment of radioiodine in hyperthyroidism (minimum of 10 cases), radioiodine
in thyroid cancer (minimum of 5 cases), radiolabeled antibodies (minimum of 3
cases) and radionuclides for painful bone disease (minimum of 3 cases), including
follow-up of the same number of cases.
Medical Knowledge
Goal
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Residents must demonstrate knowledge of established and evolving biomedical, clinical,
epidemiological, and cognate (e.g. epidemiological and social-behavioral) sciences, and
the application of this knowledge to patient care.
Objectives
In the first three months, residents are expected to:
1. Understand the concepts of nuclear medicine physics and radiobiology, as
they relate to nuclear medicine therapy.
2. Begin to recognize the symptoms and signs of diseases treated by unsealed
sources of radioactivity e.g. Graves’ disease.
3. Understand basic concepts of appropriate patient selection and calculation of
the administered doses.
4. Learn basic concepts of radiation protection.
5. Understand methods to follow up patients who have been treated..
After the introductory period, residents are expected to:
1. Be proficient in the concepts of nuclear medicine physics and radiobiology, as
they relate to nuclear medicine therapy.
2. Learn the symptoms and signs of diseases treated by unsealed sources of
radioactivity.
3. Understand appropriate patient selection, treatment algorithms and dosage
calculations for hyperthyroidism, thyroid cancer, painful metastases, lowgrade lymphoma, etc.
4. Learn the concepts of radiation protection and be proficient in instructing
patients and family members.
5. Learn methods to follow up patients who have been treated, as well as deal
with complications of therapy.
6. Acquire increasingly sophisticated knowledge and demonstrate facility with
independently running a therapy clinic (with reduced level of supervision).
Practice- Based Learning and Improvement
Goal
Residents must demonstrate the ability to perform practice-based learning and
improvement that involves investigation and evaluation of their own patient care,
appraisal and assimilation of scientific evidence, and improvements in patient care.
Objectives
Residents are expected to develop skills and habits to be able to:
1. Utilize available information technology for access to the most recent scientific
data on therapeutic nuclear medicine.
2. Present and contribute to discussion of therapy patients at Tumor Boards.
3. Participate in annual self-assessment exercise, identify strengths and limitations
and develop own learning goals.
Systems Based Practice
Goal
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Residents must be aware of systems-based practice, as manifested by actions that
demonstrate an awareness of and responsiveness to the larger context and system of
health care, and the ability to call effectively on system resources to provide care that is
of optimal value.
Objectives
Residents are expected to:
1. Gain basic knowledge of the role of nuclear medicine therapy in the treatment of
patients with hyperthyroidism, thyroid cancer, painful bone metastases and
lymphoma.
2. Fully understand the relative merits of the different nuclear medicine therapy
techniques and able to make recommendations to the clinical service concerning
the best treatment modalities for an individual case.
3. Demonstrate basic knowledge about the costs of therapy studies.
4. Be aware of the roles of the regulatory agencies such as the Nuclear Regulatory
Commission (NRC).
Professionalism
Goal
Residents must demonstrate professionalism, as manifested through a commitment to
carrying out professional responsibilities, adherence to ethical principles, and sensitivity
to a diverse patient population.
Residents are expected to::
1. Dress appropriately at all times.
2. Interact on a professional level with their therapy patients, demonstrating great
sensitivity toward their patient’s anxiety, and placing appropriate and
compassionate patient care above self-interest at all times.
3. Demonstrate strong ethical principles. This includes good work ethic with prompt
appearance on the service at appropriate times.
4. Establish professional relationships with the nuclear medicine technologists and
student technologists with whom they interact and progressively develop team
leader skills.
5. Demonstrate sensitivity to the needs of the diverse patient population, including
but not limited to cancer patients.
6. Not discriminate based on age, ethnicity, gender, disability or sexual orientation.
7. Act professionally with a responsible work ethic and respect for all members of
the team by directing all aspects of the therapeutic procedures efficiently and
smoothly.
Interpersonal and Communication Skills
Goal
Residents must demonstrate interpersonal and communication skills that result in
effective information exchange and collaboration with patients, their families, and other
health professionals.
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Objectives
Residents are expected to (to be):
1. Gain mastery of dictation of clinical and therapy reports using clear and concise
language. Over the year of training, the resident will be expected to compose the
report with progressively less assistance.
2. Able to verbally communicate about nuclear medicine therapy procedures
concisely and clearly to referring physicians.
3. Develop an ability to calmly and clearly educate patients concerning nuclear
medicine therapy and radiation protection. Demonstrate appropriate patience and
empathy in this communication.
4. Demonstrate appropriate communication skills with technologists on the therapy
service with whom they interact.
Teaching Methods
Formal, didactic lectures on therapy
Small group teaching on individual cases
Conferences and Tumor Boards
Teaching files on service, teaching files on internet
Written material in textbooks; scientific articles provided by faculty
Self education is expected
Assessment Method (residents)
Focused direct observation by the faculty (written quarterly evaluations)
Assessment of residents’ draft reports
Assessment of presentations
In-house examination
In-training ABNM examination
Assessment by clerical and technologist team members
Self-assessment tool
Resident logs (diaries)for documentation of cases
Assessment Method (Program Evaluation)
Annual formal program evaluation
Quarterly meetings with the Program Director
Frequent informal discussions with the Associate Program Director
Level of Supervision
Supervision in the therapy clinic is direct throughout the rotation. Residents take on
greater responsibility including history and physicals and presentation of cases.
Responsibility increases throughout, but all patients, dose calculations and dictated
reports are reviewed by the faculty.
Educational Resources
Textbooks in the Fellow Library
Taubman Medical Library
Electronic Teaching File
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Access to Internet, Medline Search and PubMed
3/09/07
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