PGY5 Nuclear Medicine

Supervisor:                           Dr. Jeff Flemming, Health Sciences Center

Supervisor:                           Dr. Cheryl Jefford, St. Clare’s


The following is an outline of the goals and objectives of the Nuclear Medicine rotation during PGY3 and PGY5, incorporated into CanMEDS format. The CanMEDS roles will be assessed and remain consistent throughout the Nuclear Medicine rotations as a PGY3 and PGY5, with the expectation that skills will be further developed as a PGY5.

The assessment tools utilized during the rotation include global faculty ratings such as the ITER rotation evaluation sheet.  An examination assessing knowledge obtained at each stage of training will be given on the last day.  The examination will assess the acquisition of knowledge throughout the rotation.  A pass mark is 70%.  The inability to pass the exam will render the rotation incomplete, and the rotation will be completed at a later date. 


Duties and Responsibilities

Be aware of the complementary role that Nuclear Medicine provides in the overall imaging of patients with illness. 

Understand the role of functional imaging as opposed to anatomical imaging. 

Have an appreciation of the range of functional studies available within Nuclear Medicine.

Review and supervise all on-going Nuclear Medicine procedures.

Develop an expertise in the palpation of thyroid glands with a particular eye to being able to evaluate size, texture and possible nodularity.

Provide at least two interesting case study reports for the interesting case file.

Participate in research and educational activities as encountered during their rotation.

Possibly act as a consultant to other physicians seeking urgent or verbal reports of cases they have reviewed with a senior Nuclear Medicine physician.

Prepare and present cases at Nuclear Medicine rounds as required.ONE


Required Reading List

-          “Essentials of Nuclear Medicine Imaging” by Fred A Mettler

-          “Clinical Radionuclide Imaging” by Freeman and Johnson 

-          "Nuclear Medicine: The Requisites" by James H Thrall

Please read the corresponding RSNA physics module, as outlined in the physics curriculum




  1. Medical Expert
  2. Communicator

Have a basic understanding of the physics of acquisition of Nuclear Medicine imaging and the workings of a standard gamma camera. This would include the operation of crystals, photo multiplier tubes, as well as the various aspects of collimator usage.

Know the anatomy and physiology of the skeleton as it applies to bone scans.

Understand the anatomy and physiology of the lungs as it applies to VQ scans. As well as understand the categorization of lung scan reports into normal, low, intermediate or high probability results.

Clinically examine the thyroid gland and understand the common diseases affecting the thyroid gland including the significance of hot and cold nodules.

Understand the coronary anatomy and cardiac physiology as it applies to functional studies including stress studies.

Understand the physics behind the production of bone mineral density studies and the application of bone mineral density studies towards the diagnosis and treatment of osteoporosis.

Understand the therapeutic role of nuclear medicine, in particular, thyroid cancer.

Understand the role of PET scanning.

Understand of the physics behind SPECT reconstruction including the recognition of common artefacts such as centre of rotation artefact and other quality assurance matters.

Understand the production of radiopharmaceuticals, particularly the role of the moly 99/technetium 99m generator, as well as a grasp of the understanding of radiopharmaceutical kits and the quality control procedures that must be performed on these kits prior to administration into patients.  Knowledge of the physical characteristics such as half-life photo peak and decay pattern of several of the more common isotopes will be required.

Have a good understanding of the relative risk of radiation to the patient and, in particular, the risks involved in both diagnostic and therapeutic Nuclear Medicine procedures, particularly in the evaluation and treatment of patients with Grave’s disease and thyroid carcinoma.

Understand the nature of digital acquisition images and the role of computers and processing this information particularly as it applies to functional Nuclear Medicine studies.


Communicate effectively with patients/families, referring physicians, and co-workers.

Establish a therapeutic relationship with patients and communicate well with family while providing clear and thorough explanations of diagnosis, investigation and management.

Establish good relationships with peers and other health professionals while effectively providing and receiving information. Handle conflict situations well.

Produce succinct reports that describe: findings, most likely diagnosis and where appropriate, recommends further investigation or management.



  1. Collaborator
  2. Manager

Contribute to interdisciplinary activities and rounds.

Become an effective consultant of radiology.

Interact effectively with house staff and health professionals by recognizing their roles and expertise.

Collaborate effectively and constructively with other members of the health care team.


Understand the quality control procedures related to preparing radiopharmaceuticals for patient administration.

Understand the effective use of allocation and utilization of health care resources.

Demonstrate competence in and makes use of computer science/information technology as it pertains to Diagnostic Radiology.

 Make cost effective use of health care resources based on sound judgment.

Set realistic priorities and use time effectively in order to optimize professional performance.

Understand the principles of practice management.

Understand the fundamentals of quality assurance and recognizes common artifacts. 


  1. Health Advocate
  2. Scholar

Understand and communicate the benefits and risks of nuclear medicine investigations including the relative risk of radiation exposure to patients and environment.

Be able to promote health of the population through the application of radiology.

Recognize the Radiologist’s role to ensure appropriate radiological investigation and to act as an advocate for patients in terms of their diagnostic imaging needs.

Recognize the burden of illness upon the patients served by Radiology.


Have a personal commitment of continued education and understand the importance of self responsibility and the responsibility a radiologist has to patients, referring physicians and the community.

Demonstrate an understanding and a commitment to the need for continuous learning.

Develop and implement an ongoing and effective personal learning strategy.

Be able to critically appraise medical information and demonstrate basic knowledge in biostatistics and experimental design.

Demonstrate an ability to be an effective teacher.


  1. Professional

Understand issues related to age, gender, culture and ethnicity.

Practice radiology in an ethical, honest and compassionate manner while maintaining the highest quality of care and maintain appropriate professional behavior.

Demonstrate integrity, honesty, compassion and respect for diversity.

Fulfill medical, legal and professional obligations.

Demonstrate reliability and conscientiousness.

Understand the principles of ethics and apply these in critical situations.

Demonstrate an awareness of personal limitations, seeking advice when necessary.

Accept advice graciously.