Nuclear Medicine

The Nuclear Medicine Department of St. Luke’s Medical Center operates three imaging laboratories: General Nuclear Medicine on the 26th floor of the Hospital, Cardiovascular Nuclear Medicine (CVNM) on the 3rd floor of the Hospital, and Outpatient (Cardiac) Nuclear Medicine on the 11th floor of the St. Luke’s Medical Tower (SLMT). The Department also serves the Texas Heart^® Institute (THI).

The Department is staffed by nuclear medicine physicians and scientists who are affiliated with the Nuclear Medicine Section of the Department of Radiology of Baylor College of Medicine and by technologists and other support personnel who are Hospital employees.

Members of the Nuclear Medicine Section faculty who are active at SLMC/THI include:

Warren Moore, M.D. - Dr. Moore is Chief of Nuclear Medicine and CVNM Director. He is certified by ABIM and ABNM.
Ramesh Dhekne, M.D. - Dr. Dhekne is Associate Chief of Nuclear Medicine and Director of General Nuclear Medicine. He is certified by ABNM.
Patrick Ford, M.D. - Dr. Ford is a faculty nuclear medicine physician. He is certified by ABNM.
Edwin Giles, M.S. - Mr. Giles is the Radiation Safety Officer at SLEH/THI. He is certified by the American Board of Radiology in Diagnostic Radiologic Physics.
Charles Dodge, PhD. - Dr. Dodge is the Assistant Radiation Safety Officer.

Other supervisory personnel in the Department you may encounter during your rotation include:

Eric J. Ladwig, B.S., CNMT, Nuclear Medicine Manager
Randy Barker, B.S., Technologist Supervisor for General Imaging
Marly Pulvirenti, B.S., Technologist Supervisor for CVNM
Edward Cronin, Radiation Safety Technician

Routine diagnostic and therapeutic Nuclear Medicine services are available in the SLMC and/or OQMT laboratories, 8 a.m. to 5 p.m., Monday–Friday except for official Hospital holidays. Cardiac perfusion studies for Chest Pain Clinic patients are available 8 a.m. to 10 p.m. Monday-Friday and 8 a.m. to 8 p.m. Saturday and Sunday. Most medically urgent cardiac and noncardiac services are available 24 hours/day, 7 days/week and can be arranged by contacting the Nuclear Medicine Department (832-355-3126) or the Nuclear Medicine Technologist and/or physician on call through the Hospital page operator (832-355-4146).

Certain nuclear medicine procedures can be performed at the patient’s bedside in the ICUs, but there are significant regulatory and technologic restrictions on some of these studies. Because the quality of the study is usually much better when performed in the Nuclear Medicine laboratory, “portable” studies should only be ordered when it is really medically necessary that the patient not be moved from the ICU.  A summary of available tests, indications, physiologic mechanisms, and patient preparations is available in a booklet entitled “Nuclear Medicine Department Reference Manual,” available from Mrs. Concepcion in Room Y2601-C.

Interpretations and final reports of all Nuclear Medicine studies are prepared on the day the study is completed. The reports are available through the Hospital’s HBOC Hospital Information System (HIS) as soon as they are read (except when the computer system is down). During regular business hours (8-5, M-F), reports are also available in the Nuclear Medicine Department office on the 26th floor or by calling 832-355-2270. Any physician with a question regarding nuclear medicine services in general or with respect to a particular patient or clinical problem is encouraged to contact one of the Nuclear Medicine physicians.

Contacts

Department Mission

The mission of the Nuclear Medicine Department of St. Luke’s Medical Center is to provide high-quality diagnostic and therapeutic nuclear medicine services for patients and physicians at the Hospital and its Medical Tower and to promote the science and practice of nuclear medicine by providing educational opportunities for trainees in nuclear medicine and by participation in research involving the use of non-sealed sources of radioactive materials.

Educational Scope

The educational portion of the Department’s mission specifically includes the education of health care providers and others in various aspects of nuclear medicine. In accomplishing this mission, members of the Department routinely participate in Baylor College of Medicine training programs for medical students, residents, and fellows and in the Houston Community College Nuclear Medicine Technology Program. From time to time, trainees from other institutions, private practitioners, commercial representatives, and members of the public may also be present in the Department and attend interpretation and other teaching sessions.

Overview of Cardiac Nuclear Medicine Training

Specific goals, objectives, and curricula have been developed for Nuclear Medicine rotations and will be provided to the fellow at the beginning of the rotation.

GENERAL GOALS
The primary goal of training in cardiac nuclear medicine is to allow the fellow to develop an understanding of the applications, advantages, and pitfalls of radioisotope imaging as they apply to patients with known or possible cardiac disease. More specifically, the goal of the training program is that all fellows should understand the basic principles of radioisotope imaging and how to choose the best test to order to answer a specific clinical question for an individual patient.

For trainees seeking radioactive materials (RAM) licensure, the additional goal is to develop further knowledge of the performance of radioisotope procedures, procedure interpretation, and operation of a clinical radioisotope laboratory and to develop a more extensive theoretical and practical understanding of basic sciences and radiation safety pertinent to diagnostic use of non-sealed radiopharmaceuticals.

IMPLEMENTATION
To accomplish the primary goal, a combination of didactic lectures and practical experience are provided for each fellow. The Core Lecture Series includes a brief overview of the most  commonly used techniques in cardiac nuclear medicine including perfusion and functional imaging. Additional topics are covered over the course of the year in the Nuclear Cardiology portion of the Noninvasive Cardiology lecture series. Review sessions are held during the Nuclear Medicine rotations, in conjunction with a structured text reading and written quiz schedule over both months.

For practical experience, each fellow will spend two months in the CVNM Laboratory at St. Luke’s Episcopal Hospital. This basic curriculum will meet American College of Cardiology (ACC) “COCATS 2” Level 1 training requirements for radioisotope imaging and will meet the minimal requirements for eligibility for the American Board of Internal Medicine - Cardiovascular Disease subspecialty examination. This level of training will not meet the requirements for licensure to use radioactive materials.

Any fellow who wishes to obtain a license to use radioactive materials (RAM) should contact the Chief of the Nuclear Medicine Service (Dr. Warren Moore, 832-355-3126) as soon as possible during the fellowship to discuss the requirements for such licensure. Though likely to change in the relatively near future, current requirements for licensure in Texas include 200 hours of didactic training in the use of radioactive materials and approximately 600 hours (4-5 months) of clinical training. (Specific requirements vary from state to state and are subject to change by the licensing agencies. For example: Texas requires that all training be obtained in an ACGME-approved facility and does not accept CBNC certification for automatic licensure; original licensure in Georgia requires six months of training in an ACGME-approved program.) The additional training that is required for RAM licensure is not a required part of the fellowship and acceptance for such training is not guaranteed (due to space, personal performance, and other considerations). A research project and other local requirements exist for ACC Level 2 training at SLMC. Depending on federal and state guidelines as well as the fellow’s overall curriculum, limits may exist on leave and absences during nuclear medicine rotations.

Any fellow who wishes to pursue ACC Level 3 training (12 months) should also contact Dr. Moore as early as possible in the course of the fellowship to discuss this matter in detail. A maximum of one position is available at this level and requests may come from inside or outside of Baylor.

Purposes and Goals

PURPOSES
There are two purposes for the “Nuclear Medicine I” (“Nuc I”) rotation in the Cardiovascular Nuclear Medicine (CVNM) Laboratory at St. Luke’s Medical Center (SLMC): Patient Safety and Education.

(1)   The Nuc I Cardiology fellow, as the representative of the Cardiology Section, is responsible for the immediate medical safety of patients being examined in the CVNM Laboratory during regular hours. (After hours coverage is provided by the Cardiology House Officer covering the Chest Pain Clinic.) This applies primarily to patients undergoing exercise or pharmacologic stress tests, but includes all patients who may be seen in the laboratory.

(2)  The Nuc I Cardiology fellow, as a trainee in the Nuclear Medicine Service, has an opportunity and responsibility to learn about test procedures and clinical applications of cardiac nuclear medicine.

GOALS
The goals of this rotation are directed at the fulfillment of the purposes listed above.  While patient safety is of great importance, knowledge and skills related to that part of the overall purpose of the rotation are under the auspices of the Cardiology Section and are addressed in many parts of the fellowship. This is therefore not a major educational focus of the nuclear medicine faculty during the rotation. Accordingly, the goals and objectives of this rotation are heavily weighted toward practical and theoretical education in CVNM.

Educational goals of this rotation must satisfy the requirements of the fellowship-accrediting agency (Accreditation Council for Graduate Medical Education – Residency Review Committee of Cardiovascular Diseases (ACGME-RRC-CD)) for training of cardiology follows in "nuclear cardiology."  Specifically, board eligibility in CD requires "competence in the interpretation of radionuclide procedures."  The Nuc I rotations and general lecture series should specifically prepare the fellow for the ABIM-CD subspecialty examination.  It is also a goal of this rotation to satisfy the spirit of the recommendations and guidelines of the American College of Cardiology (Level 1) and the Society of Nuclear Medicine for training of cardiology fellows to the extent that these guidelines can be accomplished within the limited time available.

It is specifically NOT a goal of the Nuc I rotations to train the fellow for licensure to handle radioisotopes, even for use limited to cardiac procedures, as defined by the Nuclear Regulatory Commission (NRC) or agreement states.  This certification requires additional training in radioisotope techniques (part of which is in nonclinical aspects) and is clearly beyond the scope of this rotation.  Fellows should also be aware that the method of counting studies for hospital credentialing purposes is much less stringent than the criteria used by the NRC.  It is also NOT a goal of this rotation to prepare fellows for the examination of the Certification Board of Nuclear Cardiology (CBNC). Again, any fellow interested in additional training to accomplish NRC licensure or additional certification should contact the Dr. Moore.

The specific goals of the Nuc I rotation are to:
(1) provide training and experience so that the fellow can appropriately request radioisotope procedures for patients and so that the fellow can assess the quality and reliability of radionuclide procedures and interpretations performed by others
(2) provide experience with radioisotope procedures as an adjunct to cardiac stress testing by various pharmacologic and exercise methods
(3) meet the requirements of the ACGME-RRC-CD and ABIM-CD for training and board eligibility
(4) provide training and experience necessary to pass radionuclide-related components of the ABIM-CD examination
(5) meet, as far as possible in the time allowed, the recommendations developed by the ACC and SNM for training of cardiology fellows in radioisotope procedures.

Objectives

At the end of the Nuc I rotation, the fellow should be able to perform each of the following tasks.

1) Assess the advisability and selection/modification of stress testing (by exercise or pharmacologic means) in individual patients with respect to the  relative risks and benefits of the test to be performed, particularly with respect to the adjunctive use of radioisotopes in stress tests.

(2) Discuss the basic scientific principles of radionuclide imaging instrumentation and radiopharmacy.

(3) List radionuclide techniques for assessment of known or suspected cardiac conditions.

(4) Discuss the clinical applications and indications for widely available radionuclide techniques (such as myocardial perfusion imaging, first pass and equilibrium blood pool imaging, and infarct imaging) as well as positron emission tomography.  (This will include the indications, contraindications, expected results, and technical and clinical situations that may affect the validity of study results.)

(5) Describe the key procedural and technical components of common radionuclide procedures.

(6) Provide basic interpretations of common radionuclide cardiac procedures. (This will include evaluation of the technical quality of the study as well as an understanding of the physiologic information portrayed and the clinical consequences of this study in the patient’s care.)

(7) Discuss basic principles of radiation safety and appropriate recommendations as they apply to patients undergoing diagnostic radionuclide cardiac procedures.