Nuclear Cardiology Rotation Goals - Cardiology Fellow Responsibilities
A. General Clinical Service Responsibilities:
1. Complete an orientation of Nuclear Medicine facilities with a fellow (Cardiology or
Nuclear Medicine) currently on this rotation, at least one day prior to starting this
rotation. This orientation should be long and detailed enough to insure that you are
able to competently stress myocardial perfusion scan patients, and are able to
comfortably operate the treadmills and ECG machines, the image display computers
and the voice dictation stations." A stress manual, along with computer instruction
manuals are available. On your first day on service, the stress NP and one of the
stress nurses will review with you again the equipment and general features of each
stress protocol. They will review with you our check list of the areas you should
have received instruction for (also available on NM Wikipedia). Should you wish to
request specific manuals, ask the technical supervisor at ART for copies.
2. Obtain computer (Web1000, IDXrad & Talk Tech (VR)) priviledges from Radiology
IS staff (6-2525, Marilyn Banks), and complete training on the “Talk Tech” voice
recognition system.
3. It is the responsibility of the Cardiology Fellow (with backup from the Nuclear
Medicine Fellows as scheduled) to supervise all myocardial perfusion imaging stress
tests, to insure 1, that they are appropriately requested, 2. that they are completed
safely and accurately, and 3. that they are completed in a timely manner at ART, as
well as at MUH. The Nuclear Cardiology Fellow should prioritize the more
challenging, ART in-patients for their stress tests, utilizing Nurse Practioners (NP)
and Nuclear Medicine Fellows (NMF) to primarily assist with MUH and Chest Pain
Center patient’s stress tests. The ultimate responsibility to provide and maintain a
timely and efficient clinic nuclear cardiac imaging service is that of the Cardiology
Fellow. Cardiology Attendings and Nuclear Medicine Attendings are available by
beeper for backup as well.
4. The Cardiology Fellow should screen and sign all requests before the rest imaging is
started, having discerned clinical appropriateness of the scan, and to prescribe when
appropriate calcium scoring and the type of stress and agents, as well as the
radiopharmaceutical to be used (e.g. Bruce Threadmill vs Adenosine stress
(AdenEx), and SPECT Thallium perfusion vs FDG PET for viability imaging.)
5. The Cardiology Fellow will interview and briefly examine each patient before the
stress procedure, obtain the informed consent, carry out the stress test, complete
the data entry sheet, and monitor and treat the patient until safely recovered from
this procedure. If the Cardiology Fellow obtains NP or NMF assistance, the
Cardiology Fellow retains the responsibility of insuring that a safe, diagnostically
accurate procedure is obtained, that the paper work is completed and assembled for
the reading session, and that he/she is completely familiar with the patient and the
stress test to facilitate the interpretation session.
6. Image processing (slice construction, attenuation correction and analysis) will be
provided by the NMF and Nuclear Medicine technologists, but the Cardiology Fellow
should complete these procedures on at least five patients during her/his rotation to
insure working knowledge and familiarity with artifacts, and understanding of the
limitations of nuclear imaging procedures.
7. The Cardiology Fellow is responsible for preliminary interpretation of the “Chest
Pain” patient scans, and should as quickly as possible review these studies with the
Nuclear Medicine Attending to reach a consensus before transmitting this
preliminary interpretation to the Chest Pain Center referring attending physician.
8. The Cardiology Fellow is responsible for coordinating the afternoon scan
interpretation session, including arranging appropriate Cardiology Attending and
Nuclear Medicine Attending participation, assembling all MUH, ART and Outpatient
(North Area and West Ashley) paperwork (requisitions, stress sheets, EKG’s etc),
with the completed image files (insuring that all patient’s studies have been analysed
with diagnostic images available on the computer worklist), logging the patient
information and scan interpretations into the Nuclear Cardiology Book and into the
Nuclear Cardiology Data Base Worksheet, and in the absence of NMF or Radiology
resident, dictating the scan interpretation.
9. The Cardiology Fellow must phone all positive scan results to the referring
physician. If repeated efforts at phoning the referring physician fail, then an email
communication detailing the findings must be completed.
10. It is the responsibility of the Cardiology Fellow to assist, train and educate as needed
the NMF, NP, nursing staff and NM technologists to insure safe and diagnostically
accurate Nuclear Cardiac scanning procedures are completed daily.
11. The Cardiology Fellow’s work day begins prior to each 7:30 am Cardiology
conference, with review and signing of study requisitions (this may also be
completed during the late afternoon of the previous day). The first stress tests
begins at approximately 8:30am. The Cardiology Fellow should contact the NM
technologists to coordinate beginning the stress tests, so that there is not more than
5 minutes delay after completion of the rest scan. It is the responsibility of the
Cardiology Fellow to maintain this communication so that smooth, and timely
operation of the Nuclear Medicine service is preserved and patients experience the
shortest possible waiting time. The Cardiology Fellow’s work day ends when all
studies have been interpreted, the paper work completed, and the reports dictated.
12. It is expected that the Cardiology Fellow will complete a clinical research project
during this three month rotation, and present it during the Nuclear Medicine Journal
club.
13. Cardiology Fellow vacation time will be limited to one week during this rotation and
must be signed off by both a Cardiology Attending and a Nuclear Medicine
Attending.
14. When leaving the rotation, the Cardiology Fellow, at least one day prior to
completion of this rotation, must orient and instruct the Cardiology Fellow(s) who
follow, to competently stress myocardial perfusion scan patients, and to be able to
operate the treadmills and ECG machines, the image display computers and the
voice dictation stations.
B. Specific Requirements for ACC/ASNC/SNM approved
certification and NRC “Authorized User” of radioactive materials
designation:
1.
Satisfactory completion of a minimum of four months training in an ACGME
approved program, including combined 700 hours of didactic, clinical study
interpretations and hands on clinical case and radiation safety training.
2.
Nuclear Medicine (both single and positron emitting) Cardiac lectures and self
study should include in-depth details of myocardial perfusion imaging (MPI),
gated blood pool ventriculography(MUGA), stress testing, viability imaging,
infarct imaging, and nuclear cardiac shunt studies, and should include lectures
and study incorporating the physics, instrumentation and clinical role of and
correlative imaging with MR, CT and Echo. This must be completed over a 1224 month concurrent period during fellowship training.
3.
A minimum of 80 hour of Radiation Safety classroom and laboratory (clinic)
training must be completed with extensive review of radiation physics,
instrumentation, radiation protection, and the mathematics required for safe,
competent use and measurement of radioactive compounds. Thorough
understanding of the radiochemistry of, radiobiology of and comprehension of the
physiologic effects of ionizing radiation, as well as a thorough review of the
Federal and SC regulations guiding the use of radiopharmaceuticals will be
required and documented by a satisfactory, passing grade on the annual
examination administered by MUSC Radiology physics staff.
4. During the four month rotation, Cardiology Fellows must be responsible for a
minimum of 300 nuclear cardiac scans, all of which must be interpreted and
reported with attending supervision.
5. During this four month rotation, Cardiology Fellows must have a hands-on,
more direct role in the radiopharmaceutical preparation, stress test, scanning,
data analysis (image processing), interpretation and reporting for a minimum
of 25 MPI and 10 MUGA patients, and must document this experience in a
logbook with study type, date and patient MRN recorded.
6.
For each Cardiology (and Nuclear Medicine) Fellow, the required check list must
be printed from the NM Wikipedia web site, and then signed by all designated
individuals, with all items checked, prior to a NM Attending authoring and signing
the Fellow’s Authorized User letter.