Nuclear Medicine in the Acute Clinical Setting

Targeted CE per ARRT’s Discipline, Category, and Subcategory classification:
[Note: Discipline-specific Targeted CE credits may be less than the total Category A credits approved for this course.]

Nuclear Medicine Technology: 3.75
Procedures: 3.75
Radionuclides and Radiopharmaceuticals: 1.25
Cardiac Procedures: 0.50
Gastrointestinal and Genitourinary Procedures: 1.00
Other Imaging Procedures: 1.00

Registered Radiologist Assistant: 2.50
Procedures: 2.50
Abdominal Section: 1.25
Thoracic Section: 0.25
Neurological, Vascular, and Lymphatic Sections: 1.00

Outline

1. Introduction
2. Hepatobiliary Scintigraphy
   1. Clinical Indications in the Acute Care Setting
   2. Imaging Modalities and Radiopharmaceuticals
   3. Scintigraphic Findings and Pitfalls
      1. Acute Cholecystitis
      2. Perforated Cholecystitis
      3. Bile Leak
      4. Choledocholithiasis
3. GI Tract Scintigraphy
   1. Clinical Indications in the Acute Care Setting
   2. Imaging Modalities and Radiopharmaceuticals
   3. Scintigraphic Findings and Pitfalls
      1. Gastric Bleeding
      2. Small Bowel Bleeding
      3. Colonic Bleeding
4. Scintigraphy of the Native Kidney
   1. Clinical Indications in the Acute Care Setting
   2. Imaging Modalities and Radiopharmaceuticals
   3. Scintigraphic Findings and Pitfalls
5. Renal Transplant Scintigraphy
   1. Clinical Indications in the Acute Care Setting
   2. Imaging Modalities and Radiopharmaceuticals
   3. Scintigraphic Findings and Pitfalls
6. Myocardial Perfusion Scintigraphy
   1. Clinical Indications in the Acute Care Setting
   2. Imaging Modalities and Radiopharmaceuticals
   3. Scintigraphic Findings and Pitfalls
7. Lung Scintigraphy
   1. Clinical Indications in the Acute Care Setting
   2. Imaging Modalities and Radiopharmaceuticals
   3. Scintigraphic Findings and Pitfalls
8. Central Nervous System Scintigraphy
   1. Brain Scintigraphy for Cerebral Perfusion Assessment
      1. Clinical Indications in the Acute Care Setting
      2. Imaging Modalities and Radiopharmaceuticals
      3. Scintigraphic Findings and Pitfalls
   2. CSF Shunt Scintigraphy
      1. Clinical Indications in the Acute Care Setting
      2. Imaging Modalities and Radiopharmaceuticals
      3. Scintigraphic Findings and Pitfalls
9. Conclusion

Objectives

Upon completion of this course, students will:

1. be familiar with the advantages of nuclear medicine imaging when compared to other common imaging modalities
2. identify the imaging techniques associated with nuclear medicine imaging
3. be familiar with the combined use of CT with SPECT and PET imaging
4. understand which nuclear imaging procedure is indicated for acute cholecystitis
5. understand the advantages of US as a first-line imaging study for acute gallbladder disease
6. be familiar with causes of false-positive findings on hepatobiliary scintigraphy
7. be familiar with the physiological effects of cholecystokinin
8. identify the risk factors for gallbladder disease
9. understand the patient preparation for hepatobiliary scintigraphy
10. be familiar with single photon emission computed tomography
11. identify the primary indication for GI tract scintigraphy
12. identify the initial diagnostic tests for upper GI tract bleeding
13. be familiar with the radionuclide used to tag RBCs for GI tract scintigraphy
14. understand the sensitivity of GI tract scintigraphy
15. be familiar with the active bleeding detection levels for GI tract scintigraphy
16. understand the potential false-positive findings due to Crohn disease
17. identify the causes of colonic bleeding
18. identify the radiopharmaceuticals used for GI tract scintigraphy
19. be familiar with the use of US as the first-line modality to evaluate the urinary system
20. be familiar with the most commonly used radiopharmaceutical for diuretic renal scintigraphy
21. identify the potential causes of false-positive findings of urinary system obstruction while performing renal scintigraphy
22. be familiar with detector positioning when performing renal scintigraphy on native kidneys
23. be familiar with the dynamic acquisitions performed during renal scintigraphy
24. identify the normal residual radiotracer amount at 20 minutes post-injection when performing renal scintigraphy
25. identify the clinical manifestations of renal graft dysfunction and/or acute rejection
26. be familiar with the preferred radiopharmaceutical for renal transplant scintigraphy
27. identify why post-operative ureteral obstruction commonly occurs at the ureterovesical anastomosis in renal transplant patients
28. be familiar with radiotracer activity that can mimic a urine leak during renal transplant scintigraphy
29. be familiar with the camera detector position used during renal transplant scintigraphy
30. be familiar with the indications for using MPI in the acute setting
31. identify the radiopharmaceuticals used for perfusion lung scintigraphy
32. be familiar with the MPI imaging set performed in the acute setting
33. be familiar with the ino/chronotropic drug use for pharmacological MPI
34. identify the MPI radiopharmaceutical that redistributes and has the highest cardiac extraction fraction
35. be familiar with the sensitivity and specificity of pulmonary CT angiography
36. be familiar with the radiopharmaceutical used for perfusion lung scintigraphy
37. be familiar with the proper patient position during the injection of ^99mTc MAA
38. be familiar with the nuclear medicine imaging test used to evaluate brain death
39. be familiar with the two most common CSF shunts
40. identify the radiopharmaceuticals that cross the intact blood brain barrier