CLRS 303 - ORIENTATION TO NUCLEAR MEDICINE

Summer 2022

Course Description

Semester course; 1 lecture and 2 clinical hours. 2 credits. Prerequisites: CLRS 208 and CLRS 232 both with a minimum grade of C. Designed to acquaint the student with the field of nuclear medicine in general and the Program in Nuclear Medicine Technology in particular. It also provides an introduction to clinical practice.

Course Goals

This course is designed to acquaint the student with the field of Nuclear Medicine through classroom, laboratory exercises, and clinical experiences. Classroom instruction will introduce the student to the major subject areas that constitute Nuclear Medicine Technology that include: radiation safety, applied technical mathematics, instrumentation, radiopharmacy, In vivo/in vitro procedures, and radiation physics. (Virtual) Laboratory time will be utilized to orient the student to the proper applications of radiation safety and patient care through demonstration, role-play, and competency assessment techniques. Laboratory simulations will allow the student to gain experience in radiation safety principles, dose preparation, injection techniques, patient education/ positioning, and equipment set-up.

Class/Lab/Clinic Schedule

Lecture and Lab will meet on Tuesdays 10 am to 12N and 1 pm to 3 pm (5/24 to 7/19)
Clinic meets on Wednesdays for 8.5 hours. Starting time may vary. Refer to Cinical Rotation Schedule.
Clinic Dates - 6/8 to 7/20
Class room 3003

Program Director : Mark Crosthwaite
Clinical Coordinator: Paul Riley

There will be an additional clinical syllabus that will be available to you prior to 6/9/21. Link to be provided.

Required Text and Society of Nuclear Medicine and Molecular Imaging SNMMI

Practical Mathematics is available at a membership discount at the SNMMI bookstore for $69.
Basic Science of Nuclear Medicine: The Bare Bone Essentials is recommended and its discount price is $69.
Both books can be purchased for $120.

All students have been granted a free SNMMI membership. For more information please visit http://www.snmmi.org/Membership/MemeberBenefit.aspx?ItemNumber=6570

Course Requirements

• Completion of all exams, including the final exam
• Completion of all assigned readings
• Participation in class discussion and laboratory projects
• Timely completion of homework and laboratory assignments
• Attendance for classroom, laboratory, and clinic

Grading

Seventy percent of the course grade will come from lecture and lab.  This will be divided up as follows: 

• Labs/assignments - 10%
• Quizzes (Weekly) - 40%
• Final Exam - 20%

Thirty percent of the course grade will come from the clinical component of the course.  Evaluations are done as follows:

• Facility Competency - 10%
• Clinical/CI Evaluations and procedures forms- 20%

Exam Policy

1. After each week's lecture there will be an Online quiz over the material. It will be made available on Canvas, Tuesday, after class and will go off-line the following Monday at 12M. You must complete the quiz within this time-frame or an automatically reduction of 7-points will be assessed on the quiz when it is completed.

2. Final exam: the final exam will be given on July 26^th. A seven-point reduction will automatically be made to the final exam score if it is not taken on the scheduled date. A make-up exam should be scheduled in advance of the absence when possible. Additional point reductions may be imposed for failing to notify the Department of your absence and/or failing to arranging an agreed date for the make-up exam.

4. This is one of your professional courses which means the lowest passing grade is "C."

Since there is a limited amount of time schedule for this course (lecture, lab, and clinic) students are expected to attend every aspect of this course. If an unexcused absence occurs during the lecture/lab, clinical education activity or the clinical portions of the course, the student's final grade will be reduced as follows: For every 1/2 day missed in clinic or class the final grade will be lowered 2.5%, per occurrence.

Please contact the course instructor is you know that you will be missing class or lecture. Exceptions to the above rule can be made.

Deadline to notify the instructor of any observed religious holidays is May 25^th.

ADA Policy

Section 504 of the Rehabilitation Act of 1973 and the Americans with Disabilities Act of 1990 require VCU to provide academic adjustments or accommodations for students with documented disabilities. Students seeking academic adjustments or accommodations must self-identify with the Coordinator of Services for Students with Disabilities on the appropriate campus. After meeting with the Coordinator, students are encouraged to meet with instructors to discuss their needs and, if applicable, any laboratory safety concerns related to their disabilities. There are two sites suggested for additional information: Student Accessibility and Educational Opportunity (SAEO) and/or Division of Academic Success (DAS).

Provost Syllabus Statement

Our goal and the goal of the University is for You to be successful! There are many resources available to students through the Office of the Provost. You are highly encouraged to visit this site https://provost.vcu.edu/resources/studentsupport/. In addition the following information are components required to be in the syllabus and recommended by the Provost. This information can be found at https://provost.vcu.edu/faculty/faculty-resources/syllabus/#Emergency. Certain components are highlighted below:

1. Campus emergency information
2. Class registration required for attendance
3. Honor System: upholding academic integrity
4. Important dates
5. Managing stress
6. Mandatory responsibility of faculty members to report incidents of sexual misconduct
7. Military short-term training or deployment
8. Student conduct in the classroom
9. Student email standard
10. Student financial responsibility
11. Students representing the university - excused absences
12. Students with disabilities
13. Withdrawal from classes
14. Faculty communication about students

Policy Regarding Calculators
The Department of Radiation Sciences will only allow use of non-programmable (non-graphing) calculators.  Students will not be allowed to use programmable (graphing) calculators during any type of examination.  In addition, students will not be allowed to share calculators during any examination.

Policies Regarding the Academic Calendar and Course Schedule

• The Department of Radiation Sciences abides by the VCU academic calendar for the MCV campus (see http:www.vcu.edu/academiccalendars/)

How to Prepared for Emergencies at VCU

1. Sign up to receive VCU text messaging alerts (https://alert.vcu.edu/signup/index.php).  Keep your information up-to-date.
2. Know the safe evacuation route from each of your classrooms. Emergency evacuation routes are posted in on-campus classrooms.
3. Listen for and follow instructions from VCU or other designated authorities.
4. Know where to go for additional emergency information (https://alert.vcu.edu/signup/index.php)
5. Know the emergency phone number for the VCU Police (828-1234).
6. Report suspicious activities or objects.

Course Outline and Timeline

1. Welcome - Nuclear Medicine students - 5/24-31/22
2. Syllabus/Purpose of Course
1. Required Text
2. Course Requirements
3. Office hours and location
4. Grading
3. Clinical Outline - 5/24-31/22
1. Schedule
2. Expected appearance and behavior
3. Locations
4. Physics Review - 5/24-31/22
1. Atomic Structure
2. Iso - bar, tone, mer, and tope
3. Defining radioactivity
5. Detecting radiation - units - 5/24-31/22
1. R - C/kg
2. Rad - Grays
3. REM - Sieverts
4. Ci - dps/m Bq
6. Models of Decay and how radiation interacts with matter - 5/24-31/22
1. Alpha
2. Beta
3. Gamma
1. Electron Capture
2. Isomeric Transition
3. Positron Emission
4. Gamma interactions with matter
1. Compton effect
2. Photoelectric effect
3. Pair production
4. Internal conversion
5. Auger electron
7. Radiation protection (this is also a lab) - 5/24-31/22
1. Time
2. Distance
3. Shielding
8. Radioactive decay problems - 5/24-31/22
1. Solve for original activity
2. Solve for new activity
3. Relationship of T 1/2 physical, biological, and effective
9. Review of instrumentation and their basic functions - 5/24-31/22
1. GM meters
2. Dose calibrator
3. Well counters
4. Uptake probes
5. Gamma cameras
1. Collimation
2. Parts of a gamma camera
6. Radiopharmaceutical
1. Defining its characteristics
2. Determining the idea radionuclide
3. Mechanisms of uptake
10. Pulmonary System - 6/7/22
1. Radiopharmaceuticals used in V/Q lung imaging
2. Ventilation
3. Perfusion
4. Split Lung
5. Overview of diseases
11. Skeletal System - 6/7/22
1. Static
2. Whole body
3. Three phase
4. Overview of diseases
12. SNMMI Annual meeting. Paul and Mark will be attending this meeting 6/9 to 6/14
13. Gastrointestinal system - 6/21/22
1. Liver/spleen (RES)
2. Hepatobiliary
3. Gastric emptying
14. Endocrinology system - 6/21/22
1. Brief look at the iodines
2. Thyroid uptake/scan
3. Pinhole and whole body imaging
4. Therapy
5. Overview of diseases
15. Cardiac system 6/28/22
1. Radiopharmaceuticals used in cardiac imaging
2. Pharmacological vs. stress imaging
3. One vs. two day protocol
4. MUGA
5. First pass
6. Types of diseases
16. Renal 7/5/22
    1. Radiopharmaceuticals
    2. GFR
    3. ERPF
    4. Perfusion
    5. ROIs and related diseases
17. Brain 7/5/22
    1. Radiopharmaceuticals
    2. BBB agents
    3. Perfusion agents
    4. Types of disease
18. PET - 7/12/22
1. Oncology
2. Neurology
3. Cardiology
19. Course Review 7/19/22
20. Final Exam 7/26/22

PM SCHEDULE

Week 1- Calculation Part I "can be fun' (May 24)

• Do we need to review some basic math?
• Looking at exponents and prefixes
• English to SI conversions

Week 2 - Calculation Part II (May 31)

• What did we learn last week?
• Radioactive decay and attenuation
• Radiopharmacy - Decays and dilutions

Week 3 - Clinical Orientation (June 7)

• Instrument orientation
• Orientation Packages for surrounding healthcare facilities
• Student Clinical Handbook
• E-value
• Lunch with the Seniors
• Tour of MCV

Week 4 - Nuclear Medicine Equipment (June 21)

• Review of Hot Lab Log Book. Download
• Application of the dose calibrator will completed by the student.  This exercise will include the daily required testing of this instrument and the measurement of sealed sources. 
• Student will  learn to operate a GM meter to include:  battery check, source check, and identification of radioactive spill(s) [Operations of GM meter will also be taught in clinic]
• Demonstrate the use of equipment that scintillates:  uptake probe, well counter, and gamma camera
• Student will have some hands-on with the equipment (time permitting) being displayed

Week 5 – Simulation of Dose Administration (June 28)

• Rules and regulations NRC and Agreement State

Week 6 - Part III Calculations (July 5)

Week 7- A Look into Patient Care (July 12)

Week 8 - Nuclear Medicine In Review (July 19)

• So how are you with your calculations?
• Need help with regulations?
• What do you know about instrumentation?
• How do you clean up a radioactive spill?
• Can you operate a GM meter?
• What requirements are there in the AM before you scan your first patient?
• Did you log in all your radioactive packages?
• As a Nuclear Medicine Technologist, how do you apply the three rules of radiation safety?

Week 9 - Did we miss anything? Time for catch up (July 20)

Week 10 - Final exam (July 27)

For a complete documentation of all NMT courses please visit http://people.vcu.edu/~mhcrosthwait/.

Objectives Radiation Physics - Link

1. Define the parts of an atom.
2. Determine what makes a atom radioactive.
3. Explain isobars, isotones, isomers, and isotopes
4. Compare ev to keV
5. Review and discuss: standard scientific notation. Note how energy is imparted to alpha, beta, and gammas.
6. Identify the different parts of the electromagnetic spectrum.
7. Compare the tri-linear chart to the periodic table.
8. Discuss how alpha/particles, gamma/x-ray interact with matter.

Radiation Units and Radiation Safety - Link

1. Manipulate prefixes in scientific notation.
2. Define and compare all radiation units and give special attention to: Bq, Ci, R, cpm, and dpm.
3. Given efficiency and cps/m calculate the dps/m.
4. Explain and calculate the three components of radiation safety.
5. Consider methods a technologist would use to reduce their radiation exposure.

Instrumentation and Radiopharmaceuticals - Link

1. Identify the process on how radiation is detected with gas-filled detectors.
2. Consider the methods of scintillation detection records radiation and draw/label its components.
3. Calculate a percent window.
4. Name the different types of collimators and define the specific characteristics of each (HR, HS, Converging, Diverging, and Pinhole).
5. Understand the difference between true counts and scatter.
6. Identify the different physiological methods in which a radiopharmaceutical is picked up by an organ or disease state and give an examples.
7. Review and identify the components of that would make an ideal radiopharmaceutical.

Lungs and Bones - Link

1. Discuss the physiology behind ^99mTcMDP.
2. Compare then basic types of imaging procedures used in bone imaging spot, three phase, and whole body.
3. Review bone diseases presented in lecture and identify which ones are positive for disease.
4. Identify the two different lung radiopharmaceuticals and discuss their mode of uptake.
   1. Ventilation
   2. Perfusion
5. Compare match to mis-match defects in lung imaging and apply the diseases (PE and COPD).
6. Identify the basic protocols for lung perfusion and aerosol ventilation.
7. Define the parts of a lung ventilation system (aerosol only).
8. Define the basic steps of lung and skeletal imaging procedures.

Thyroid, Liver, and Spleens - Link

1. Identify the components of the negative biofeedback loop in thyroid physiology.
2. Define hyper/hypothyroidism.
3. Calculate a thyroid uptake.
4. Define the steps required to image a thyroid.
5. Define the pathophysiology for sulfur colloid and IDA tracers.
6. Calculate a gal bladder ejection fraction
7. Identity the disease processes seen in hepatobiliary and liver/spleen imaging.
8. Define the basic steps of a hepatobiliary and liver/spleen scan procedure.

Nuclear Cardiology - Link

1. Identify the radiopharmaceuticals used to image the myocardium and apply the correct pathophysiology.
2. Differentiate ischemia and infarct on a nuclear cardiology stress test.
3. Define the process of stressing a patient: pharmacological and treadmill
4. Compare the different tomographic slices of the myocardium.
5. Understand the concept of a polar maps/bull's eye.
6. Determine how a MUGA and a gated MPI are acquired.
7. Calculate the EF of the LV.
8. Define the types of wall motion seen on a gated cardiac.

Renals, Brains, and SPECT - Link

1. Identify the different types of radiopharmaceuticals used in renal imaging and understand the associated physiology.
2. Calculate ERPF from a known GFR value.
3. Understand the application of a ROIs and their association with time activity curves in a renograms.
4. Define the blood brain barrier (BBB).
5. Compare the radiopharmaceuticals that cross the BBB and those that do not (non-BBB).
6. Apply radiopharmaceuticals used to image brain (BBB and non-BBB) and review several disease processes.
7. Note the uses of: Ioflupane, FDG, and Vizamyl in brain imaging.
8. Discuss the basics components of SPECT in relationship to Filter Backprojection.

Positron Emission Tomography - Link

1. Compare a photon and a gamma ray.
2. Compare the differences in instrumentation between PET vs. gamma camera
3. Define the pathophysiology behind ¹⁸FDG.
4. Review the application of ¹⁸FDG in neurology, oncology, and cardiology
5. Understand the relationship between the amount of energy given to the positron and its effect in resolution. I
6. Identify normal FDG distribution in the human system. Understand the application of CT application and its role in attenuation correction.

clrs303summer2022.doc