Fellows who wish to practice the specialty of clinical nuclear cardiology should be required to have at least 4 to 6 months of total training. In training institutions with a high volume of nuclear cardiology procedures, clinical experience may be acquired in a period of time as short as 4 months. In institutions with a lower volume of procedures, a total of 6 months of clinical experience will be necessary for level 2 competency. This additional training should be dedicated to enhancing clinical skills and qualifying for Nuclear Regulatory Commission (NRC) licensure.
Appropriate radiation safety training (currently 200 hours) should be provided to satisfy NRC licensure requirements. The training should provide fellows with a series of lectures and laboratories dealing with basic radiation physics, radiation protection, radiopharmaceutical chemistry, radiation biology and instrumentation according to NRC requirements. This program might be scheduled over a 12- to 24-month period, concurrent with other fellowship assignments.
The fellow should participate in interpretation of all nuclear cardiology imaging data for the 4- to 6-month training period. During the course of the 4- to 6-month training period, it is imperative that the fellow 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 scintigraphic results is an appropriate forum for such an experience. Another appropriate source of interpretative experience can consist of an established teaching file. For level 2 training, a total of 300 cases should be interpreted under supervision, either from direct patient studies or from the teaching file, consisting of diverse types of procedures. Minutes or a written logbook should be kept; cases and diagnoses should also be listed to provide documentation.
Fellows acquiring level 2 training should have additional hands-on experience with patient studies. Additional intensive experience should be acquired in a minimum of 50 patients – optimally, 25 patients for myocardial (perfusion) imaging and 25 patients for radionuclide angiography (total 50 patients). Such supervised experience should include pretest patient evaluation, radiopharmaceutical preparation (including experience with relevant radionuclide generators), performance of the study (rest, exercise dipyridamole or adenosine or other pharmacologic stress), administration of the dosage, calibration and setup of the gamma camera, setup of the imaging computer and processing the data for display after acquisition.
In addition, the training program must provide experience in computer methods for analysis of perfusion imaging studies, including single-photon emission computed tomography (SPECT), and ejection fraction and regional wall motion measurements from radionuclide angiographic studies.
Both the person responsible for the nuclear cardiology training program and the program director should also be responsible for evaluating the competence of the trainee in nuclear cardiology at the completion of the program. This can be accomplished by observing the performance of the fellow during the daily reading sessions, by a formal testing procedure, or both.
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