NUCLEAR CARDIOLOGY
Cedars Sinai Imaging Software Instructions
The Nuclear Radiology software has been upgraded to the Cedars Sinai Imaging system.Use this helpful workflow document created by Rick Rossow to navigate the Cedars Sinai Imaging Software. We now submit the final reports via the RIS system that is used by radiology. Call IT services (206-543-7012) to setup that your account be created. You will need your employee ID and NPI number. You should list Laurie Soine as your supervision. You should ask to have the same account privileges as other fellows that have preceded you, such as Rick Rossow.
Key points:
1) You are responsible for performing cardiac SPECT and PET studies at UWMC with Laurie Soine ARNP AND interpreting the studies with Nuclear Medicine physicians. In addition, you are responsible for interpreting cardiac SPECT studies performed at HMC.
2) Make sure that you document your studies in MedHub. Noting if there is correlative imaging (cath, MRI, CT). You will require 300 stresses for level 2, > 30 cath correlations and > 30 MUGAs
3) During your 3rd year you have the opportunity to take the Nuclear Medicine Physics course required for Nuclear Cardiology board certification.
4) The rotation is typically slower and more flexible than other rotation. Bring your lap top such that you can work on research projects or papers during slow periods. It is expected that you remain in the reading room to field clinical questions, assist referring services/providers in determining the most appropriate study, reviewing images with inpt teams. Most desk top computers in the Reading Room do not have internet access, but there is wireless available for your devises.
Responsibilities:
1) Your primary responsibility is to perform and interpret cardiac SPECT and PET studies. Clinic volume varies but here are typically a total of 4-8 studies a day. In addition, you will read the cardiac SPECT studies performed at HMC remotely (from UWMC). The HMC volume is usually quite low with a total of 1-2 studies each day. In addition during this rotation you will serve as a consultant to referring services regarding myocardial perfusion imaging.
2) The first patient generally arrive at 0730; in order to obtain the full educational experience, which includes reviewing outpatient clinical studies and inpatient/ED add-on requests, the expectation is that you arrive about 0800 (with the exception of conference days - Wednesday and Friday).
3) In order to provide the highest level of care and service to patients seen in our Clinic (Nuclear Medicine calls itself a “clinic”) AND obtain the broadest educational experience it is expected that you:
}a. Review the clinic schedule first thing each morning. Note what patient is undergoing what exam, at what time, and on what camera.
b. Review requests/consults for myocardial perfusion imaging. Assist referring providers in making decisions regarding the appropriateness of studies and selecting the type of study to perform.
c. Review patient’s medical records and study requisition to assure that the clinical question(s) posed by the referring provider is addressed in your summary of findings.
If during your review of the medical record you note that the patient acuity is high, discuss with the technologist a plan for obtaining the highest quality study in the safest manner.
4) Perform exercise and pharmacologic SPECT and PET studies and accurately enter all data into report generating cardiac imaging database (Cedars).
5) You will read studies throughout the day with the Attending Nuclear Medicine physician assigned to UWMC. The Attending will expect that you have reviewed the patient’s past medical history, have knowledge of the clinical question and exam procedure, and have developed a preliminary interpretation of the images.
6) The Department of Radiology is held to a tight report turn-around time – no more than 4hr time periord between study completion (patient leaving clinic) and the Attending signing the final report. This means that knowing when exams are complete, promptly reading the scan, and creating reports are a high priority.
7) If a patient presents for an outpatient study, ordered following an ED stay. It is your responsibility, upon meeting the patient to ascertain how the patient plans to obtain results. We encourage patients to stay if possible and obtain study results immediately following image completion.
8) It is imperative that critical results are communicated to referring providers; noting who was contacted, time and date in the final report.
Practical Tips:
1) This rotation provides exposure to a clinic with a very broad referral source (Family Medicine to Cardiac Surgery) and patient population, spanning normal screening studies to risk stratification of patients with advanced cardiac disease including congenital disease. In addition, you are exposed to differing Attending physician image interpretation styles; imaging equipment and reconstruction software programs.
2) There are many teaching cases loaded on the reading station such that during quiet periods you may pull up the times and correlate you reading with finalized image interpretation found in the medical record.
3) We are primarily using Regadenoson for all pharmocologic stress studies. Regadenson is a standard dose of 0.4mg IV given over 15 seconds. Radiotracer follows one minute following injection. Regadenson is typically infused while pt walks slowly on the treadmill (to minimize symptoms and improve image quality). There are two other vasodilator options.
a. Persantine 0.57mg/kg IV infused over 4 minutes; inject radiotracer 3 minutes following infusion.
b. Adenosine 140mcg/kg/min over 5 minutes; inject radiotracer 2.5 minutes into infusion.
Door Code for the break room: 1559*
Responsibilities:
Run stress tests. Be kind to the patients. Avoid using your smartphone in front of them.
Learning Nuclear Cardiology: It takes some motivation to avoid “just running stresses” all day.
Make sure to become involved with the PET scans. Also, get involved with the techs in terms of isotope preparation, imaging processing, motion correction, etc.
Daily Schedule:
8:00a-5:00p, M-F
UW conferences Tues, Weds and Friday 7:30a.
Friday 12p-1p – Cardiac Imaging Conference. - RR202
Also, consider using this website to supplement your knowledge and give you some background
What to expect:
Our first patient generally arrives at 0730; in order to obtain the full clinical experience, which includes reviewing outpatient clinical studies and inpatient/ED add-on requests, the expectation is that you arrive about 0800 (with the exception of days you have morning conference).
In order to provide the highest level of care and service to patients seen in our Clinic AND obtain the broadest educational experience it is expected that you:
Review the clinic schedule first thing each morning. Determine which patients you will be responsible for during each given day. Note what patient is undergoing what exam, at what time, and on what camera.
Review patient’s medical records and study requisition to assure that the clinical question(s) posed by the referring provider is addressed in your summary of findings.
If during your review of the medical record you note that the patient acuity is high, discuss with the technologist a plan for obtaining the highest quality study in the safest manner.
You will read studies throughout the day with the either the Attending Nuclear Medicine physician assigned to UWMC . The Attending will expect that you have reviewed the patient’s past medical history, have knowledge of the clinical question and exam procedure, and have developed a preliminary interpretation.
Please re-read your final reports carefully prior to sending to IDXrad.
The Department of Radiology expects that there be no more than a 4hr delay between study completion (patient leaving clinic) and the Attending signing the final report. This means that knowing when exams are complete, promptly reading the scan, and creating reports are a high priority.
If a patient presents for an outpatient study, ordered following an ED stay. It is your responsibility, upon meeting the patient to ascertain how the patient plans to obtain results. We encourage patients to stay if possible and obtain study results immediately following image completion.
It is imperative that critical results are communicated to referring providers; noting who was contacted, time and date.