UBC Postgraduate Program in Cardiology

UBC Postgraduate Program in Cardiology Goals and Objectives, Nuclear Medicine July 1, 2013

Roles Objectives Strategies Medical  Learn the indications for a variety of  Discuss the expectations and Expert/ nuclear cardiology tests, including responsibilities of the Trainee in the Clinical rest and exercise myocardial Nuclear Cardiology Laboratory with Decision perfusion imaging (sestamibi and/or the supervising Attending Maker thallium), Dipyridamole and Cardiologist. Dobutamine stress studies,  Study appropriate references and/or qualitative and quantitative analysis, do literature searches to become radionuclide cineangiography using familiar with the basic science and gated equilibrium techniques and clinical aspects of Nuclear myocardial infarct imaging with Cardiology. technetium pyrophosphate.  Attend and participate in the  Learn the advantages, performance of a variety of stress disadvantages and limitations of a testing and Nuclear Cardiology variety of nuclear cardiology tests, studies. including rest and exercise  Attend and participate in the myocardial perfusion imaging interpretation sessions with the (sestamibi and/or thallium), Attending Nuclear Cardiologist and Dipyridamole and Dobutamine Nuclear Medicine physician. stress studies, qualitative and quantitative analysis radionuclide cineangiography using gated equilibrium techniques and myocardial infarct imaging with technetium pyrophosphate.  Learn the technique of performance of a variety of nuclear cardiology studies, including rest and exercise myocardial perfusion imaging (sestamibi and/or thallium), Dipyridamole and Dobutamine stress studies, qualitative and quantitative analysis radionuclide cineangiography using gated equilibrium techniques and myocardial infarct imaging with technetium pyrophosphate.  Learn to interpret a variety of nuclear cardiology studies, including rest and exercise myocardial perfusion imaging (sestamibi and/or thallium), Dipyridamole and Dobutamine stress studies, UBC Postgraduate Program in Cardiology Goals and Objectives, Nuclear Medicine July 1, 2013

qualitative and quantitative analysis radionuclide cineangiography using gated equilibrium techniques and myocardial infarct imaging with technetium pyrophosphate. Communicator  To be able to obtain appropriate  When appropriate information from the patient and/or communicates the result of a family relevant to the performance nuclear cardiology study verbally of a planned Nuclear Cardiology to the Referring Physician and/or study. House-Staff Team.  To be able to describe the  When appropriate, discusses the indications, rationale, conduct and findings of the nuclear possible outcomes, including cardiology study with the patient potential complications of the and family. planned Nuclear Cardiology Study to the patient and family.  Learn to write a preliminary Nuclear Cardiology report.  Learn to discuss report of Nuclear Cardiology studies with patients, family and referring physicians, including an assessment of the significance of the findings when appropriate. Collaborator  Learn to work cooperatively with  Respect the roles of all other Health Care Professionals members of the Health Care who are involved in the care of Team in the Nuclear Cardiology patients in the Nuclear Cardiology Laboratory. Laboratory.  Seek consultation from other  Learn to work cooperatively with the members of the Health Care staff in the Nuclear Cardiology Team in the Nuclear Cardiology Laboratory to facilitate appropriate Laboratory when appropriate. and efficient patient care. Manager  Learn the cost effectiveness of the  Review literature and /or discuss various procedures performed in the with the Attending Cardiologist in Nuclear Cardiology Laboratory. the Echocardiography  Learn to manage the Nuclear Laboratory regarding the cost Cardiology Laboratory resources effectiveness of procedures to effectively and efficiently. be done in the Nuclear  To gain an understanding of waiting Cardiology Laboratory. lists for various types of Nuclear Cardiology studies  . UBC Postgraduate Program in Cardiology Goals and Objectives, Nuclear Medicine July 1, 2013

Health  Learn strategies to effectively  Initiate discussion or be Advocate educate patients who have cardiac available for patients and their pathology and their families families to discuss the patient’s regarding the pathophysiology of illness with regards to the patient’s illness and the pathophysiology of their disease importance of compliance and the and the importance of potential for future risk. compliance to the prescribed  Learn strategies to educate patients regimen as it relates to their and their families regarding healthy procedure in the Nuclear cardiac behaviors. Cardiology Laboratory.  Initiate or be available to discuss with patients and their families regarding healthy cardiac behaviors as appropriate. Scholar  Enhance knowledge base regarding  Establish and maintain reference a variety of cardiac conditions seen resources including textbooks, in the Nuclear Cardiology journals and internet (e.g. Laboratory. Medline) relevant to the care of  Develop a strategy for literature patients undergoing nuclear review/search for a variety of cardiology studies. cardiac conditions seen in the  Establish and adhere to a study Nuclear Cardiology Laboratory. program as it relates to the care of patient undergoing nuclear cardiology studies. Professional  To deliver care of the highest quality  Maintain professional with integrity, honesty and relationships with all members of compassion. the Health Care team.  To learn the ethical, legal and  When appropriate seek advice professional obligations in the and assistance. context of patient management in  Present and discuss case/s the Nuclear Cardiology Laboratory. seen in the Nuclear Cardiology Laboratory at Cardiology Rounds with a focus on the legal or ethical aspects of the case. UBC Postgraduate Program in Cardiology Goals and Objectives, Nuclear Medicine July 1, 2013 Nuclear Medicine, Revised Rotation

Monday Tuesday Wednesday Thursday Friday 0830-1200hr 0800-0900hr 0830-1200hr 0730-0830 0800-0900hr ETT (a) Nuclear ETT (a) CVS Rounds, SPH Designated Reading (d) 12 lead ECG Rounds, VGH 12 lead ECG 0830-1200hr ETT Rounds preparation time (e) Holter 0900-1200 Holter (a) 0900-1100hr Tech/Blood 12 lead ECG Interpretation of Congenital Pool Holter Echocardiograms Scan/lecture (b) 1100-1200hr Resident presentation of topic 1200-1300hr Cardiology Rounds

1300-1400hr 1400-1530hr 1300-1700hr 1300-1700hr 1300-1700hr Office(f) Nuclear Academic half- Cardiology Nuclear Interpretation (j) 1400-1530hr Interpretation (i) day(h) Academic Half Nuclear Dr. Kiess Day, (protected Interpretation (i) time) Dr. Kiess

a) Residents supervise ETT, Exercise, Dobutamine and Persantine MIBI scans.  Practical experience, indications for termination of test, side effects, etc.  Allow residents to correlate exercise electrogram to perfusion scan and understand relative merits of the two tests. b) Tech/Blood Pool  Residents assigned to a technician - learns protocol aspects of imaging, i.e. need for patients to have hands over head etc, learns about artifacts etc. Some time for nuclear lectures are available. c) Designated reading time and time to prepare Residents’ Rounds d) Residents will prepare one topic for presentation to Dr. Kiess or one of the other nuclear physicians every week. Should attempt to have other cardiology residents booked at SPH attend this session. e) Residents will see 1-2 new patients during each clinic. Patients will only be booked if they undergo a nuclear imaging test. This will allow the resident to correlate the Hx/PE/ECG and clinical pretest likelihood of CAD to the nuclear imaging results, and provide a clinical context to nuclear imaging. UBC Postgraduate Program in Cardiology Goals and Objectives, Nuclear Medicine July 1, 2013

f) Academic Half-day  A number of nuclear didactic and graphics sessions have been incorporated.  Attendance at half-day is mandatory. g) Nuclear Interpretation - Dr. Kiess  Emphasis on perfusion scans and clinical correlation. h) Nuclear Interpretation - Nuclear Physicians  Different emphasis.  Focus on methodological issues etc.  Will also incorporate V/Q scans etc. which are highly relevant to the cardiologists as these tests are often ordered in the differential of chest pain/SOB/pathological hypertension etc.

Residents shall not follow in-hospital patients with the exception of congenital heart patients and pregnant women with heart disease. This is the only opportunity the residents have to deal with hospitalized congenital patients.

Residents will review a set of 5 videotapes produced by the ACC. Those are of excellent quality; begins at a very basic level and progresses to a high level of knowledge. These tapes are available through Dr. Tony Fung (VGH).

A reading list will also be provided by Dr. Marla Kiess.