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To train postgraduate students to be able to practise clinical Nuclear Medicine successfully, undertake basic research and be involved in the training of undergraduate medicine and radiography students. Clinical Nuclear Medicine is the most important component of the programme and is supplemented by applied Nuclear Physics (KDE 802), Applied Physiology (809 FSG 801), Anatomy (ANA 809), Pathology (PAT 801), Radiobiology, Chemistry and Pharmacology (RCF 800). At least six months rotation in the department of Radiology also forms part of the course.

Critical outcomes

 On completion of the learning opportunity the student will be able to:

·           Function effectively in a team context.

·           Identify and solve problems on the basis of critical and creative thinking.

·           Collect information and critically analyse, organise and evaluate it.

·           Communicate effectively.

·           Use science and technology effectively.

 Specific outcomes

On completion of the course the student will be able to:

·           Apply knowledge of physiology, pathophysiology and pathology in the practise of    clinical Nuclear Medicine.

·           Apply basic, applied anatomy knowledge in the practise of clinical Nuclear Medicine.

·           Apply physical, radiation biology, radiation protection, physics and instrumentation principles in the practise of clinical Nuclear Medicine.

·           Select optimal radiopharmaceuticals for nuclear medicine studies.

·           Select the correct nuclear medicine studies (imaging and non-imaging investigations as well as in vitro procedures) for specific disease processes (Appendix 7 contains an overview of the relevant topics).

·           Execute nuclear medicine studies (imaging and non-imaging investigations as well as in vitro procedures) according to internationally acceptable standards (Appendix 7 contains an overview of the relevant topics).

·           Interpret and report correctly on nuclear medicine studies (imaging and non-imaging investigations as well as in vitro procedures) (Appendix 7 contains an overview of the relevant topics).

·           Be skilled in the treatment of relevant disease conditions with unsealed radioactive sources (Appendix 4 contains an overview of the relevant topics).

·           Complete a research project successfully ready for submission to a peer-reviewed journal/submit it as an assignment.

·           Be involved in student training (undergraduate medical students and radiography students).

 Study resources

Compulsory study resources

Any of the new Nuclear Medicine text books that are currently available in the trade, e.g.

·            Textbook of Nuclear Medicine. MA Wilson. Raven Press, Philadelphia, 1998.

·            Diagnostic Nuclear Medicine. Fourth edition). MP Sandler. Lippincott    Williams &         Wilkins Publishers, 2002. .

·            Nuclear Medicine in Clinical Diagnosis and Treatment.Third edition. Gambhir   &Ell

·            Nuclear Medicine. RE Henkin. Mosby, 1996.
·            Principles of Nuclear Medicine. Second edition. HN Wagner. WB  Saunders,1995.     

 

Radiopharmacy:

·            Textbook of Radiopharmacy: Theory and Practice. Third edition. CB Sampson. Dunitz         Martin Ltd, 1999.

 Journals:

·            Seminars in Nuclear Medicine

·            Journal of Nuclear Medicine

·            European Journal of Nuclear Medicine and Molecular Imaging

·            American Journal of Nuclear Cardiology

·            Nuclear Medicine Communications

Optional study resources

·           Medical statistics: A commonsense approach. Third edition. MJ Campbell, D Machin.
Wiley Publishers, 1999.

·           Nuclear Oncology in Diagnosis and Therapy. I Khalkhali, JC Maublant, SJ Goldsmith (eds.). Lippincott Williams & Wilkins, 2001. ISBN 0781719909.

·           Other Nuclear Medicine-related journals that are not listed above

 

Assessment

Methods of assessment

Continuous assessment

·           Evaluation of seminars, presentations during other academic meetings and academic feedback during report-back sessions.

·           Attitude, handling of patients and departmental functioning.

·           Two radiopharmacy and three clinical Nuclear Medicine tests. Radiopharmacy tests: One when half of the syllabus has been completed and a second one at the end of the lecture series and tutorials.

         Clinical tests: One each in the three last years of study.

·           Assignment/publication on research work.

·           Examination.

 

Criteria for assessment

 Continuous assessment

Seminars/Academic presentations

Attitude, handling of patients and departmental functioning.

Assignment/publication

Examination

Written

Clinical Nuclear Medicine, including radiopharmacy

Two papers, 100 marks each

Oral

A number of cases for initial evaluation (60 minutes) and discussion with examiners for
60 minutes
 

Continuous assessment:  During each contact session with the students.

·            Assessment will take place as soon as the student has handed in the assignment.

·            If it has already been accepted for publication in a peer-reviewed journal,         assessment by the examiners will not be necessary.

·            If it has been submitted for publication but not yet been accepted, it will be assessed     by the examiners.

·            Otherwise the research work can be submitted in the form of an article             (preferably) or an assignment.

Examination

·            At the end of the student’s period of study during an official round of examinations    arranged by the University (June or November).

·            Examinations may not be written before 42 months of training have passed.

Topics in Clinical Sessions

The following is a suggested list of topics for coverage in the clinical sessions. The body of knowledge in Nuclear Medicine is open ended. This list identifies the current major topics of interest in Nuclear Medicine and should be used only as a guide to the extent of the field and should not be used to limit the selection of materials for teaching or evaluation.

PET/CT

1. Principles of PET/CT imaging

2. PET/CT – Oncology:  Imaging in Diagnosis / Staging / Prognosis/Recurrence/Therapy

3. PET/CT - Neuropsychiatry

4. PET/CT - Cardiology

5. PET/CT – Infection/Inflammation

 

Infection

1. WBC - Basics and Kinetics

2. WBC - Labeling and Scanning Techniques

3. WBC - Scans for Soft Tissue Infections

4. WBC - Scans for Bone Infections

5. Gallium 67 - Mechanisms of Uptake of Gallium

- Scanning in Infection

6. Acquired Immune Deficiency Syndrome

Genitourinary

1. Anatomy, Embryology and Congenital Variations

2. Renal Blood Flow (regulation), Tubular functions and Drug Effects

3. Renal Radiopharmaceuticals (DTPA, DMSA, GH, HIPPURAN, MAG3)

4. Compartmental Analysis and Renal Clearance Techniques (GFR, ERPF)

5. Evaluation of the Hypertensive Patient (include Renin-Angiotensin, other investigations, renography, Captopril renography)

6. Acute and Chronic Renal Failure - Clinical, laboratory and imaging evaluation

7. Radionuclide Assessment of Reflux, Obstruction, Renal Masses, Trauma

8.  Inflammatory/Infectious Renal Disease
     - Clinical
     - Gallium Imaging
     - Biopsy

9. Transplant Evaluation

10. Renal Stone Disease and Calcium Absorption Studies

11. Testicular Scanning

12. Voiding cystograms (nuclear and radiologic)

Thyroid/Parathyroid

1. Embryology, Anatomy and Congenital Anomalies of Thyroid/Parathyroid

2. Iodine Metabolism and Hormone Synthesis and Peripheral Action of Thyroid Hormones

3. Thyroid Hormone Assays and TRH Testing, etc.

4. a) Iodine uptake and scanning

        b) Tc scanning

5. Thyrotoxicosis - Diagnosis and Treatment

6. Thyroid Nodule
     - Radionuclide Evaluation & Clinical Evaluation
     - Suppression Testing
     - Ultrasound and fine needle aspiration

7. Thyroid Cancer - Ablation, I-131 Imaging and Therapy
     - Thyroglobulin

8. Miscellaneous Thyroid Disorders (Hashimotos thyroiditis, peripartum thyrotoxicosis, etc)

9. Parathyroid Disorders and Scanning

Endocrine (Non-Thyroid)

1. Hypothalamic - Pituitary Axis - Anatomy, physiology and clinical disorders

2. Anterior Pituitary Hormones - Measurement and stimulation/suppression testing

3. Adrenal - Anatomy, Embryology, Physiology

4. Adrenal - Biochemistry - Synthesis of Steroid Hormones

     - Catecholamines

5. Adrenal - Hormonal Evaluation and Radiologic Investigation

6. MIBG - Radiopharmacy and Imaging Studies

7. Iodocholesterol - Radiopharmacy and Imaging Studies

Hematology

1. Formation of Normal Blood Elements

2. Iron Metabolism and Ferrokinetics

3. RBC (Platelet) Survival and Sequestration Studies

4. Blood Volume, Plasma Volume, RBC Mass Measurement

5. Polycythemia and Other Myeloproliferative Disorders
         - clinical, diagnosis, and treatment

6. Cell Labeling - cohort versus random
          - RBCs, WBCs, platelets

7. Bone Marrow Scanning

8. Blood Cross Matching
         - Basics (Blood Bank)
         - In vivo Crossmatch

9. Anemia - Clinical and Laboratory
                         - Schillings test
                         - PA versus Malabsorption
                         - Dual versus Single Isotope

Pediatric

1. Special Considerations in Pediatric Nuclear Medicine (eg. sedation protocols, imaging considerations)

2. Aspiration Studies (milk studies)

3. Meckels and other Pediatric GI including IDA Studies

4. Neuroblastoma - Evaluation - MDP
                                                 - MIBG
                                                 - Therapy - Chemo
                                                 - Radionuclide

5. Pediatric Bone and Joint Disease

Cardiovascular

1. Anatomy, Embryology, Congenital Anomalies

2. Physiology - Electrical and Mechanical
                                - Myocardial Perfusion and Metabolism

3. Heart Catheterization/Echocardiography

4. PET Studies of Heart

5. Exercise Physiology and Stress ECG
 Exercise Protocols
 Pharmacological Stress Testing

6. Cardiac Arrest and Arrhythmias

7. Infarct Imaging

8. Gated Wall Motion Studies (including evaluation of cardiac toxicity and exercise studies)

9. Evaluation of Valvular Insufficiency (Exercise Wall Motion)

10. First Pass Studies, Cardiac Output and Shunts

11. Radionuclide Angiography and Use of Microspheres, MAA and xenon for Blood Flow/Perfusion

12. Myocardial Perfusion Studies (T1201, Tc99m MIBI, Tc99m Teboroxime)

13. Cardiac SPECT and Phase analysis

14. Thrombolytic Agents and Angioplasty in Cardiovascular Disease

Miscellaneous

1. Dacryoscintigraphy (including Clinical Evaluation, Anatomy and other investigations)

2. Intraocular Tumors - P32 Evaluation

3. Nuclear Medicine and the Pregnant and Breast-feeding Patient

4. Lymphoscintigraphy

5. Gallium 67 Scanning in Oncology

6. Neutron Activation Analysis

7. Whole Body Counting, Total Body and Exchangeable K+, Ca++

8. Intracavitary Radionuclide Treatments, Hepatic Y90 Microspheres, Antibody Therapy, CSF Cyst Rx

9. Monoclonal Antibodies

10. MRI for Abdominal, Pelvic and Chest Disorders

Central Nervous System

1. Anatomy, Embryology, Blood Flow, Blood Brain Barrier

2. Conventional Brain Imaging - Techniques, cerebrovascular disease, infections, neoplasms and trauma

3. Blood Flow Studies - SPECT - Usefulness in various disease processes (HMPAO and Xe 133)

4. Cerebral Metabolism - PET studies

5. Cerebral Edema and Brain Death

6. Neuroradiology a) CT (including stable Xenon)
                                b) MRI
                                c) Doppler carotid studies

7. CSF Flow Studies - NPH, Anatomy, Physiology

8. Hydrocephalus - syndromes, shunts and shunt evaluation

Liver/Hepatobiliary and Spleen

1. Anatomy, Embryology, Physiology of Liver/Spleen

2. Radiopharmacy of Radiocolloid, Hepatobiliary and Splenic Imaging (Heat damaged RBC)

3. Hepatic Evaluation - Clinical and Laboratory Assessment

4.a) Evaluation of Mass Lesions in Liver - Sulphur Colloid - HIDA

b) Gallium and RBC Assessment of Liver Lesions

5. Correlative Investigations of Liver Lesions - CT, U/S, MRI

6. Evaluation of Trauma - Liver/Spleen
                                                - HIDA
                                                - Other Investigations

7. Hepatobiliary Imaging - Acute Abdomen
                                                - Bile Leaks
                                                - Pharmacologic Interventions
                                                - Biliary Dyskinesias, Sphincter of Oddi                                                     Dysfunction

8. Radionuclide Evaluation of Splenic Disease

Gastrointestinal System

1. Salivary Gland - Anatomy, Physiology, Disorders and Imaging Studies

2. Esophageal
- Physiology and Anatomy
- Clinical Studies
- Manometry

3. Gastric Emptying
- Anatomy and Physiology
- Radionuclide Evaluation

4. GI Miscellaneous
- Blood and Protein Loss
- Enterogastric Reflux
- Gastroesophageal Reflux
- Small Bowel Transit

5. GI Bleeding Studies - Including Radionuclide and Angiography

6. Malabsorption Syndromes, Testing and Breath Tests

7. WBC and Inflammatory Bowel Disorders

Musculoskeletal

1. Anatomy, Embryology, Physiology and Bone Metabolism

2. Radiopharmacy, Methodology, Uptake Mechanisms

3. Bone Radiology (including CT and MRI)
       - Benign Disease
       - Malignant Disease

4. Primary Bone and Cartilage Tumors

5. Metastatic Bone Disease

6. Osteomyelitis and Septic Arthritis

7. Inflammatory Arthridities

8. Sports Nuclear Medicine

9. Avascular Necrosis, Trauma (including non-union pseudoarthrosis, etc)

10. Miscellaneous
       - Paget’s, Hypertrophic disease, Metabolic Bone Diseases

11. Osteoporosis/Osteomalacia and Bone Mineral Density

12. Soft Tissues
-Heterotopic Bone
- Muscle Necrosis
- Tumors

13. Evaluation of Prostheses and Arthrography

14. Therapy - Y90 Joints
- Sr89, Sm153 EDTMP, etc. for Metastatic Disease

Pulmonary

1. Anatomy, Embryology, Physiology

2. Pulmonary Function Studies and Blood Gases

3. Chest Radiology including CT and MRI

4. Ventilation/Perfusion Scanning, Radiopharmacy, Procedures, Techniques

5. Pulmonary Emboli (Diagnosis and Treatment) including Venography

6. Malignancy, Trauma, Congenital Abnormalities

 7. Interstitial and Inflammatory/Infectious Diseases

 

 

NB: As a guide to student profile/logbook:

 

The registrar must reach a total of 3,000 documented diagnostic procedures. The minimum recommended number for each procedure is as follows:

a)	Central nervous system	100 (80 % SPET or PET)
b)	Bone and joints	600
c)	Cardiovascular system	500 (80% SPET or PET)
d)	Respiratory system	300 (50% combined V/Q)
e)	Gastrointestinal system	50
f)	Urinary and genital system	400
g)	Endocrine system	400
h)	Hematopoietic and lymphatic system	50
i)	Neoplastic processes	550 (80 % SPET, PET or SPET/CT, PET/CT)
j)	Inflammatory and degenerative processes	50

 

 

 

 

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