NUCLEAR/PET

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MSW Nuclear Medicine & PET/CT

Faculty representative: Rosna Mircheva

Hours: 8:00am – until attending dismissal (approximately 5:00 pm)

Location: RH Reading Room in Nuclear Medicine corner

Conference:

GU conference 1st and 3rd Tuesdays at 5 pm

1st floor, pathology conference room

Lymphoma Conference every Thursday at 4 PM

1st floor, pathology conference room

Expectations:

Prepare and read NM studies from RH
PET studies from BI Cancer center
Protocol, consent, prescribe radiotracer
Pre-dictate nuclear studies
Other as per Dr. Mirtcheva

SL Nuclear Medicine & Nuclear Cardiology

Faculty Representative: Dr. Ernest Depuey

Hours: 8:00am – until attending dismissal (approximately 5:00 pm)

Location: SL Nuclear Reading Room, Clark 5

Expectations:

General nuclear studies from SL
Cardiac nuclear studies from RH and SL
SL Dexa scans
Brodsky Dexa scans on Thursdays only
Protocol
Consent patients
Prescribe radiotracer
Pre-dictate nuclear studies
Other as per Dr. DePuey

BI nuclear medicine

Faculty representative: Dr. Richard Goldfarb

Hours: 8:00 am – until attending dismissal (approximately 5:00 pm)

Location: BI NM Reading Room

Attendings: Dr. Goldfarb (M/W/F), Dr. Ongseng (T/Th)

Expectations:

Nuclear studies from BI and KH
DEXA studies from PACC (DUS), Cancer Center
Obtain consent and administer PO I-131 treatment. Record in log (ACGME requirement)
IM thyrogen injections
Breast sentinel node injections
Add CCK to IV bag and inject IV morphine for HIDA scans (pick up from IR/pharmacy)
YOU MUST LOG I-131 ADMINISTRATIONS WITH DOSE!
Please don't forget to lock the door at the end of the day

NRC Authorized User

Credentialing process administered by the Nuclear Regulatory Commission (NRC) that states that you can oversee the safe and effective medical use of radionuclides in nuclear medicine.
This is very helpful when you are looking for a job, even if you are not reading nuclear medicine studies yourself, as an authorized user needs to be present whenever radionuclides are used at your institution or practice.
The full list of requirements will be given to you in a separate folder by the nuclear medicine department.
You have your whole residency to complete this.

MIM6 (PET/CT)

LOGON:

user: mim
password hint: state

To open study:

Patient Data Source window in upper left corner of screen, choose MIMpacs (MIM Server)
Type patient last name, first in the Name field
Click SEARCH button on right
Ctrl-Click choose the CT and PET (AC) series for the current study plus up to three comparisons (do not select the uncorrected images = NAC)
In the Workflow window on the right, make sure the "workflow" tab is selected, then choose the workflow staging protocol from the options to display your studies, then Open
If your station does not have workflows populated, you can install it directly. Look for the nuclear folder on the shared G drive on intranet. Look for mim folder and copy/paste to your desktop. From mim, click "organize" in bottom right and then select the browser link at top to navigate to the mim folder. Choose the options under workflow to add to your mim folder individually. You may need to close and re-open mim to see changes.

MIM viewer functions

To adjust PET scale, left click on the scale and choose the color range, left click and drag to change the SUV range, right click and drag to adjust gamma

Body: 5-6

To zoom in, right click on image, hit magnifying glass and drag
OR use "1" "2" "3" keys to zoom.
To measuring SUVs - "S" is keyboard shortcut, right click to enlarge/shrink ROI
To measure, "T"is for tape measure (but you should really measure on the standard PACs CT images)
Keyboard shortcuts (top numbers)

1 = reset zoom
2 = zoom 2x
3 = zoom 3x
4 = soft tissue window
5 = brain/liver window
6 = lung window

To switch Coronal/Sagittal, use "V"
To see if there is enough RAM to open study, you can use Help>> About MIM>> Refresh free MIM; to open 3 studies (current+2 comps, need >~ 1000)
To Close Study, Session "X" patient, confirm

Sending OUTSIDE studies to MIM viewer from PACS:

Right click on study in PACS
Send series in DICOM
Check off

CT standard, and
PET WB 3D AC
These should have same number of images

Send to Destination: BI_MIM

Resources

Required Readings

Review the attached documents at the bottom of this page
For the updated SLW protocols - click HERE (intranet)
Atomic Agency Tutorial for Lymph Node Stations

Recommended Articles

H:\Dept\RH1\Radiolog\Ghesani\Articles for PETCT rotation
University of Virginia PET website
DePuey, Ernest Gordon. "Advances in cardiac processing software." Seminars in nuclear medicine. Vol. 44. No. 4. Elsevier, 2014.
DePuey, E. Gordon. "Image artifacts." Nuclear cardiac imaging: principles and applications. Oxford, New York, 2008. 137-138.
Hecht, Harvey S. "Coronary artery calcium scanning: past, present, and future." JACC: Cardiovascular Imaging 8.5 (2015): 579-596.

Recommended Book

Case in Point