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Overview of Nuclear Cardiology Training

Training in nuclear cardiology at all levels should provide an understanding of the indications for specific nuclear cardiology tests, the safe use of radionuclides, basics of instrumentation and image processing, methods of quality control, image interpretation, integration of risk factors, clinical symptoms and stress testing and the appropriate application of the resultant diagnostic information for clinical management. Training in nuclear cardiology is best acquired in Accreditation Council for Graduate Medical Education (ACGME) approved training programs in cardiology, nuclear medicine or radiology. An exception to this ACGME requirement is the didactic and laboratory training in radiation safety and radioisotope handling that may be provided by qualified physicians/scientists in a non-ACGME program when such a program is not available as part of the clinical ACGME training program.

Didactic, clinical case experience and hands-on training hours require documentation in a logbook and having the trainee's name appear on the clinical report or other specific record. The hours need to be monitored and verified by the nuclear cardiology training preceptor.

Specialized Training - Level 2 (Minimum of 4 Months)

Fellows who wish to clinically practice the specialty of nuclear cardiology are required to have at least 4 months of training. This includes a minimum of 700 hours of didactic, clinical study interpretation, and hands-on clinical case and radiation safety training in nuclear cardiology. In training programs with a high volume of procedures, clinical experience may be acquired in as short a period as 4 months. In programs with a lower volume of procedures, a total of 6 months of clinical experience will be necessary to achieve Level 2 competency. The additional training required of Level 2 trainees is to enhance clinical skills and to qualify to become an authorized user of radioactive materials in accordance with the regulations of the Nuclear Regulatory Commission (NRC) and/or the Agreement States. Requirements do vary among the Agreement States; therefore those seeking licensure are advised to check the Agreement State/NRC internet WebSite at: www.hsrd.ornl.gov/nrc/asframe.htm .

Didactic

Lectures and self-study. The didactic training should include in-depth details of all aspects of the procedures listed in Table 1 (see below). This program may be scheduled over a 12- to 24-month period concurrent and integrated with other fellowship assignments.

Radiation Safety. Classroom and laboratory training needs to include extensive review of radiation physics and instrumentation, radiation protection, mathematics pertaining to the use and measurement of radioactivity, chemistry of byproduct material for medical use, and radiation biology. There should be a thorough review of regulations dealing with radiation safety for the use of radiopharmaceuticals.

Interpretation of Clinical Cases

Fellows should participate in the interpretation of all nuclear cardiology imaging data for the 4-6 month training period. It is imperative that the fellows have experience in correlating catheterization/angiographic data with radionuclide-derived data in a minimum of 30 patients. A teaching conference in which the fellow presents the clinical material and nuclear cardiology results is an appropriate forum for such an experience. A total of 300 cases should be interpreted under preceptor supervision, either from direct patient studies or from a teaching file consisting of diverse types of procedures (see Table 1 below).

Hands-on Experience

Clinical Cases. Fellows acquiring Level 2 training should have hands-on supervised experience in a minimum of 35 patients: 25 patients with myocardial perfusion imaging and 10 patients with radionuclide angiography. Such experience should include pretest patient evaluation, radiopharmaceutical preparation (including experience with relevant radionuclide generators), performance of the study, administration of the dosage, calibration and setup of the gamma camera, setup of the imaging computer, processing the data for display, interpretation of the studies and generating clinical reports.

Work Experience

This experience must be under the supervision of an authorized user who meets the NRC requirements of Part 35.290 or 35.390 or equivalent Agreement State requirements, and must include:

1. Ordering, receiving and unpacking radioactive materials safely and performing the related radiation surveys;
2. Calibrating instruments used to determine the activity of dosages and performing checks for proper operation of survey meters;
3. Calculating, measuring and safely preparing patient or human research subject dosages;
4. Using administrative controls to prevent a medical event involving the use of unsealed byproduct material;
5. Using procedures to safely contain spilled radioactive material and using proper decontamination procedures;
6. Administering dosages of radioactive drugs to patients or human research subjects; and
7. Eluting generator systems appropriate for preparation of radioactive drugs for imaging and localization studies, measuring and testing the eluate for radionuclide purity, and processing the eluate with reagent kits to prepare labeled radioactive drugs.

Additional experience

In addition, the training program for Level 2 training must provide experience in computer methods for analysis. This should include perfusion and functional data derived from thallium or technetium agents and ejection fraction and regional wall motion measurements from radionuclide angiographic studies.

Table: Classification of Nuclear Cardiology Procedures

 For more information on the certification process, visit the CBNC website.