Nuclear Cardiology Rotation

The nuclear cardiology rotation at University Hospitals Cleveland Medical Center, in conjunction with Case Western Reserve University, enables fellows to achieve the knowledge, skills and attitudes of competent cardiovascular specialists in the interpretation of nuclear myocardial perfusion images acquired during exercise and pharmacologic stress testing.

Expert Training of Cardiovascular Diseases Diagnosed and Evaluated by Nuclear Cardiology

Fellows are expected to gain proficiency in the diagnosis and management of critical cardiac conditions. Learning occurs through hands-on, supervised clinical experiences, reading studies side-by-side with attending nuclear medicine physicians, and attend divisional and departmental conferences. Attending physicians are expected to reinforce the understanding of the etiology, pathogenesis, clinical presentation and natural history of cardiovascular diseases diagnosed and evaluated by nuclear cardiology. Trainees are expected to develop skills in the following areas that impact patient care:

• Clinical problem solving
• Communication
• Diagnosis
• Interpersonal behavior
• Interviewing
• Navigating system issues
• Therapy

Nuclear Cardiology Rotation Goals and Objectives

The nuclear cardiology rotation should enhance fellows' understanding of the diagnosis and risk stratification of acute cardiac conditions. Fellows will play an integral role in the education of their co-fellows. Fellows are expected to contribute to monthly teaching conferences both by selecting cases to present and discuss and by bringing in appropriate literature to review. Senior fellows are expected to demonstrate increased clinical leadership.

Fellows are expected to be highly involved in patient care and be familiar with the results of procedures and review actual tests as appropriate, including correlation with cardiac catheterization results. Appropriate utilization of the health system resources is particularly important in the section of nuclear imaging. Fellows are expected, when feasible, to come in early to evaluate studies ordered for that day in order to fully participate in decisions regarding additional testing, care and triage. Fellows are expected to communicate effectively with house staff, nursing staff, referring physicians, cardiovascular specialists and other members of the health care team.

ACGME Competencies in Nuclear Cardiology

All fellows are expected to progress in the six Accreditation Council for Graduate Medical Education (ACGME) competencies. The nuclear cardiology rotation is particularly well-suited for practice-based learning and improvement and for understanding a systems-based perspective. Senior fellows, in conjunction with attending staff, are expected to choose one relevant, focused area of nuclear cardiology and endeavor to evaluate and/or improve the overall quality in that area.

Nuclear Cardiology Principle Teaching Methods

Direct supervision of diagnostic testing: Fellows in the nuclear cardiology rotation provide supervision of all patients undergoing exercise and pharmacologic stress testing by being immediately available within the nuclear imaging section while patients are undergoing stress testing. An attending physician provides supervision to all members of the team via direct patient care. The team includes radiology residents and a cardiovascular fellow.

Case-based learning: Fellows are expected to give daily interpretations of nuclear cardiology studies. Attending physicians are expected to teach during study interpretation in addition to discussing routine patient management; teaching time should average 4-5 hours per week. A fellow is expected to take on a leadership and teaching role during study interpretation commensurate with his or her experience and knowledge. The expectation is that fellow leadership and teaching will progress during the training period.

Clinical Nuclear Cardiology Training

Patient characteristics: The mix of patients is typical for a nuclear cardiology program in a tertiary hospital and includes patients with myocardial infarction, unstable angina, congestive heart failure, cardiogenic shock and severe valvular disease.

Procedures: Fellows have the opportunity to learn procedures under the direct supervision of attendings and qualified fellows (fellows who have documented satisfactory competency in these procedures), including single- and dual-isotope nuclear myocardial perfusion imaging (MPI), gated blood pool (MUGA) scans and positron emission tomography (PET).

Principal educational material used: Fellows have 24-hour access to the Core Library located in the hospital. Computer access to literature searching, online journals, UpToDate and textbooks is available. Fellows are expected to be proficient in obtaining requisite information on pathophysiology from standard textbooks and medical literature. Current therapeutics should be guided by medical literature with particular weight given to clinical guidelines and consensus statements issued by the American College of Cardiology, the American Heart Association and similar professional bodies.

Level of supervision by faculty: All fellows are supervised by the attending of record according to the institutional policy on attending supervision that is included in our departmental policies.

An attending physician is immediately available through paging and speaks regularly with the radiology residents and cardiovascular fellows. Fellows and attending physicians are available, usually within 30 minutes, for assistance with patient evaluation and for interpretation of studies. Attending physicians must document their involvement in the evaluation of patients' studies daily. As there are only two one-month blocks of nuclear medicine training, the expectations, objectives and goals are similar for junior and senior fellows (and may occur in the same year).

For More Information

For more information on the Nuclear Cardiology Rotation, please contact:

Norbert Avril, MD
Norbert.Avril@UHhospitals.org