Download Nuclear Cardiology Rotation - Cardiology Fellow Responsibilities

II. Cardiology Fellow Responsibilities while on Nuclear Cardiology
A. General Clinical Service Responsibilities:
1. Complete an orientation of Nuclear Medicine facilities with a fellow (Cardiology or
Nuclear Medicine) currently on this rotation, and complete the relevant instruction
modules regarding operation of the treadmill/EKG and supervising a stress test.
This initial 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, and the image acquisition,
image analysis and image display computers. A “Stress Test and MPI Guidelines”
manual (http://radinfo.musc.edu/NMwiki/index.php/Main_Page or Cardiology Red
Book), along with computer and EKG 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 completed instruction in (also
available on the above NM Wikipedia site and Cardiology Red Book). Should you
wish to request specific manuals, ask the technical supervisor at ART for copies.
Finally, by the end of the first day or as soon as possible, the Fellow should
complete the Radiation Safety training modules.
2. Obtain computer (Web1000, PAX and Moodle) priviledges from Radiology IS staff
(6-2525, Marilyn Banks).
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 that they are: 1. appropriately requested, 2. completed safely
and accurately, and 3. completed in a timely manner at ART, as well as at MUH.
The Nuclear Cardiology Fellow should prioritize the more challenging, ART inpatients 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,
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 or pharmaceutical agent,
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:
a. Interview and briefly examine each patient before the stress procedure (preferably
during the 60 minute period between radionuclide dosing and the rest image
acquisition)
b. Obtain the informed consent.
c. Carry out the stress test
d. 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 NM Fellow/Resident 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. The chief
technologist at ART must sign the checklist once they have been completed.
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
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 those Cardiology Fellow working on the CBNC/Authorized User
path (Track 2) will complete a clinical research project during their 4-6 month
rotation, and present it during a Nuclear Medicine Journal club or at a meeting.
13. Cardiology Fellow vacation time will be limited to one week during the two month
rotation and two weeks on the Track 2. All leave must be signed off by both a
Cardiology Attending and a Nuclear Medicine Attending using the standard
Cardiology leave form.
B. Specific Requirements for ACC/ASNC/SNM approved certification,
CBNC certification (*I. Cardiology Fellow Nuclear Rotation), 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 12- 24 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. On-line
Training modules encompass the entire required training curriculum, and a
directory of the modules along with directions for obtaining them follows at the
end of this document . 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 examinations administered at the end of
each on-line training module. This may be accomplished by attending
Monday Imaging conference lectures and successfully completing the
Radiology Physics Modules on Moodle and requires documentation provided
by obtaining signature for all activities in the Fellow checklist.
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. The
“Radiopharmacy Training Checklist” must be completed and signed by a
MUSC Radiopharmacist.
6. For each Cardiology (and Nuclear Medicine) Fellow, the required check list
must be printed from the Cardiology Redbook or NM Wikipedia web site
(http://radinfo.musc.edu/NMwiki/index.php/Main_Page ), and then signed by
all designated individuals, with all items checked, prior to a NM Attending
authoring and signing the Fellow’s CBNC or Authorized User letter.