NUCLEAR/PET

MSW Nuclear Medicine

Faculty representative: Dr. Onseng/Goldfarb

Hours: 8:00am – until attending dismissal

Location: RH Reading Room in Nuclear Medicine corner

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

Nuclear at SL issues:

For any nuclear issues at SL such as morphine, lasix, CCK administration, lymphoscintigraphy (rare), etc, residents on other rotations will be contacted as follows:

1. Neuro SL

2. VIR SL

BI nuclear medicine

Faculty representative: Dr. Richard Goldfarb

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

Location: BI NM Reading Room or NYHC NM office

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

Expectations:

Nuclear studies from BI, KH, and NYHC
DEXA studies from PACC (DUS), Cancer Center, KH, and NYHC
Obtain consent and administer PO I-131 treatment. Record in log (ACGMErequirement)
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

PET CT

Faculty Representations: Dr. Sherif Heiba

Hours: 9:00am – until attending dismissal

Attendings: Drs. Sheikh, Ghesani, Gavane, Kostakoglu

Location: Nuclear reading room at MC level

Objective: Nuclear medicine/PET-CT curriculum (intranet)

Your station is first computer on the right when you enter RR
PET rotation to be done at MSH
Read BC cases and any MSH cases as assigned
This is a required rotation if you are assigned to PET

MIM 6 INSTRUCTIONS

MIM6 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

On call Procedure

Nuclear Medicine On-Call procedure for MSBI, MSB, MSWEST AND MSSL

A resident On-Call determines that the requested procedure is indicated.
A resident On-Call, or a secretary/On-Call tech manager if available, calls Nuclear Medicine technologist On-Call to come in for the study.

For MSBI, MSB and MSSL call Agency Technologist.
For MS WEST call RH technologists, Igor or Emilia, first. If they are not available then call Agency technologist.

After the study is done the NM technologist sends the images to PACS/remote PACS.
NM technologist notifies the resident On-Call by phone. The NM Technologist stands by while the resident consulting with an attending On-Call.
The On-Call resident calls an attending On-Call to discuss the case.
The resident On-Call calls the NM technologist informing her/him that the study is done or additional images are necessary.
The NM technologist completes the study in IDX.
The On-Call resident dictates the case.

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.
ABR authorized user forms are signed by PD and Dr. Heiba after completing the required hours of training classes and experience in addition to RAI treatment. The RAI treatment experience include a minimum of 3 cases of <33 mCi and 3 cases of > 33 mCi. Residents also have to actively participate in the consultations of hyperthyroid cases (3 cases) and thyroid CA cases (3 cases) in order to get the basic experience in RAI treatment.

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 PET/CT 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.