Nuclear Cardiology Rotation

Educational purpose and learning objectives

  • Clinical experience with nuclear cardiology imaging
  • For certain fellows interested in ASNC certification, additional training in physics, instrumentation, radiation safety, radiation biology are provided.

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Teaching methods

  • Didactic lectures on physics, instrumentation, radiation safety, radiation biology
  • Didactic lectures on Clinical applications in Cardiac SPECT and PET
  • Attending reading sessions with fellows

Disease mix/patient characteristics

  • Cardiac Perfusion Imaging: Patients with low-to-moderate likelihood for significant CAD
  • Cardiac Viability Imaging: End stage cardiomyopathy

Type of clinical encounters/procedures/services

CPT Procedure
78428 Cardiac shunt detection
78459 Myocardial Imaging PET metabolic evaluation
78461 Myocardial perfusion imaging (planar)
78452 Myocardial perfusion imaging SPECT
78466 Myocardial perfusion infarct avid imaging
78472 Cardiac blood pool imaging (MUGA)
78481 Cardiac blood pool imaging planar (first pass)
78491 Myocardial perfusion imaging PET

Level of fellow supervision by faculty

Cardiac stress test monitoring (treadmill and pharmacologic testing) is performed by the nuclear medicine faculty. The cardiology fellows assist on this procedure when available. The interpretation of the images are performed under direct supervision of a nuclear medicine attending.

Reading list

  1. Diagnostic Nuclear Medicine, Sandler MP, Coleman RE, Wackers FJT, Patton JA, Gottschalk A, Hoffer PB. Williams & Wilkins, Baltimore, MD
    • Section II, Chapters: 2-13, Physics and Instrumentation
    • Section III, Chapters: 14-20, Radiopharmaceuticals, radiation protection, and dosimetry
    • Section IV, Chapters: 21-29, Cardiovascular
  2. Nuclear Cardiology: Practical Applications, 2nd Edition Heller G, Hendel R, McGraw Hill Professional

Pathological material and other educational resources

Clinical Correlation: Cardiology catheterization conference

Method of evaluation

  • Attending evaluation forms
  • Written multiple choice physics examination.

First-year fellows are expected to understand the basic physics of nuclear imaging and assist in the interpretation of cardiac nuclear perfusion studies.

Second-year fellows are expected to understand the nuances of cardiac nuclear imaging and to act as primary interpreter of nuclear perfusion scans (under attending supervision).

Educational purposes and ACGME Core Competencies

Specific activities during this rotation that will enhance the fellows’ skills in the 6 core competencies:

  1. Patient Care: This rotation does not include a large amount of direct patient care. Fellows will learn, however, how to maximize patient comfort during exercise and pharmacologic nuclear perfusion imaging.
  2. Medical Knowledge: Fellows will gain experience and knowledge in nuclear cardiology during the performance of exercise and pharmacologic nuclear perfusion imaging, during daily teaching rounds with attending faculty, during review of teaching files, and during self-directed learning and reading.
  3. Interpersonal and Communication Skills: Fellows will interact with nuclear medicine physicians, nuclear technologists, and nursing staff. They will be expected to keep accurate, timely-signed medical records and procedure reports.
  4. Professionalism: Fellows will gain experience in the respectful treatment of all the above-mentioned groups, and will also maintain accurate procedure logs and hospital privileges.
  5. Practice-Based Learning: Fellows are expected to gain knowledge from self-directed literature and on-line review concerning interesting echo cases they encounter, and facilitate the education of internal medicine residents. Fellows may present cases during journal club and weekly catheterization conference, and discuss pertinent literature.
  6. Systems-Based Practice: There is not substantial activity in this Competency during the Nuclear Cardiology rotation. Fellows will, however, be exposed to issues of cost-effectiveness when deciding on the most appropriate noninvasive tests for patients with coronary artery disease.