Distance Assisted Training Programme

for
Nuclear Medicine Professionals

Course Syllabus
The objectives of the course are to offer basic knowledge and skills to the nuclear medicine
technologist whereupon they can achieve a common basic standard of practice.
The Regional Advisory Committee for RCA DAT project endorsed the following syllabus (with
addition of subjects by the IAEA in 2003 indicated by * below)
DAT Part 1: Basic and Advanced modules
DAT Part 2: SPECT/CT and PET/CT
In total there are 16 modules and 33 units / subjects with a total of 850 hours (approx) of study
which include more than 200 exercises.
As most students are working full time, 5 - 6 hours of study per week has been considered reasonable
over a 3 year period. Where English is a second language or a lack of resources hinders practical
exercises, study time may take longer. However this can be accelerated with more study time per week.
It is recommended that the student studies the subjects following the ‘sequence of learning’ as indicated
by the unit and module number.
Basic Science:
Unit
1 Basic Physics ( 8 hrs includes 3 practical exercises)
AIM:
This subject introduces the basic principles in nuclear medicine procedures
OBJECTIVES:
To provide students with a general understanding of the basic physical principles so that they will be
able to:
 use equipment with understanding and care
 demonstrate the basic concepts of radiation and its danger
Introduction to Basic Physics
 Mechanism of Radioactive Decay
- beta & gamma emission
- decay schemes and energy level diagrams
 The Laws of Radioactive Decay:
- physical, biological and effective half lives
- units of activity, the becquerel, curie
- specific activity, radioactive concentration
- parent - daughter relationship
 Properties of Radiation - with relevance in nuclear medicine
- properties of beta and gamma radiation
- interaction of beta and gamma radiation with matter.
- compton scattering.
2 Radiation Protection, Safety and Biology (20 hrs includes 6 practical exercises)
AIM:
To provide the student with the understanding and appreciation of the hazards of radioactivity and the
precautions taken to minimise risk.
OBJECTIVES:
On completion of this unit on radiation protection and safety the student will be able to:
 demonstrate a knowledge of the need for safe storage and disposal of radioactive material and waste.
 describe the need for and performance of radiation monitoring of the work place and personnel
 understand the design and application of radiation protection procedures.

19
 Radiation Safety
 Radionuclide hazards, precautions against:
internal exposure - contamination control
external exposure - shielding, distance, time
 Safe handling of radioactive sources
Radiopharmaceuticals:
unpacking, record keeping, storing. dispensing
administration to patients and waste disposal
Patients:
scanning and nursing procedures
activity in body fluids - urine, blood, breast milk, etc.
 Radiation measurement
Personal monitoring: TLD's, film
Exposure monitoring: Survey meters
Contamination monitoring: Survey instruments, wipe tests.
 Accidents and emergencies
Spills and Personnel contamination
Misadministrations
Medical emergencies, including death of patient
2c Radiation Biology*
OBJECTIVES:
On completion of this unit on radiation biology the student will be able to:
 Understand the general functions of body organs and how inhaled and ingested materials may
eventually be deposited in them.
 Understand the basic structure of body cells and how direct and indirect radiation can alter and
damage them.
 Be able to identify and give examples of deterministic and stochastic effects
 Be able to describe the possible effects of ionizing radiation on a developing foetus, members of
the public, radiation workers and in accident situations.
 The Human Body – an introduction
Summary of Body Systems
 Cells and the Biological Damage from Radiation
Cell Structure and division
Radiation Damage, Cell damage, repair and survival
 Effects of Radiation on Humans
Doses from natural background radiation
Deterministic Effects
Response of skin to radiation, gastrointestinal tract to radiation
Cataract induction and Fertility effects
Stochastic Effects
Hereditary effects
Radiation carcinogenesis
Tissue weighting factors
Exposure of the Foetus
Wholebody radiation effects
 Radiobiology in Nuclear Medicine

20
3 Radiopharmacy: (11 hrs includes 2 practical exercises)
AIM:
This subject has been designed to provide the student with an introductory knowledge of
radiopharmaceuticals. The emphasis is on practical issues such as quality control, sterile techniques, a
knowledge of drug interaction and adverse reactions.
OBJECTIVES:
On completion of this unit on radiopharmacy the student will be able to: -
 describe the methods of production of radiopharmaceuticals
 perform sterile dose dispensing techniques
 undertake quality control of commonly used radiopharmaceuticals
 describe physiological pathways of radiopharmaceuticals
 use relevant laboratory equipment
Introduction to Radiopharmacy
 Introduction to Radiopharmaceutical Principles.
- radionuclide and pharmaceutical requirements for clinical imaging
- radionuclide decay principles
- production of radionuclides (reactor vs cyclotron)
- radionuclide generator systems (99mTc/99Mo)
- chemistry of technetium
- pertechnetate for thyroid scintigraphy
 Quality Control
- generator system, chromatography,
- adverse reactions, drug interaction
 Laboratory Techniques
- dose calibration, aseptic and syringe handling,

4a Introduction to Instrumentation: (40 hrs includes 20 practical exercises)

PRE-REQUISITE:
An Introduction to Basic Physics
AIM:
This subject covers the theory and use of Nuclear Medicine instrumentation. It emphasizes the factors
which contribute to effective routine use of equipment including quality control.
OBJECTIVES:
To provide the student with a theoretical knowledge and practical aptitude in utilizing nuclear medicine
equipment to enable the student to:-
 use equipment to produce reliable images
 adopt a problem solving approach during daily routine procedures
 demonstrate quality control procedures for nuclear medicine counting and imaging equipment
Introduction to Instrumentation:
- Dose calibrators - theory of operation and QC
- Probe systems - basic components,
- system setup and calibration,
- basic counting experiments
Rectilinear scanner - basic outline of operation
 Gamma Camera and basic QC
- highlight main features/points to find in "own" operation manual
 Theory of operation
- photopeak, energy window width
- collimation, distance, countrate
- total counts, exposure
 Basic QC
- uniformity, resolution
Film processing
- film characteristics, processor QC

21
4b Imaging Techniques: (6hrs includes 4 practical exercises)
AIM:
This subject has been designed to introduce basic imaging techniques with emphasis on good practice.
The practical exercises will help the student to demonstrate their ability to prepare for and perform an
imaging study efficiently The student is required to read the study text and examples, answer questions
to evaluate understanding and perform several exercises.

OBJECTIVES:
On completion of this subject the student should:
 be competent in the drawing up and reconstitution of the radiopharmaceutical using aseptic
techniques and ensuring radiation protection techniques are observed.
 Be able to:
- Interpret the request form and understand what is required.
- Set up a gamma camera correctly for a clinical study.
- Communicate with the patient to ensure cooperation
- Perform a radionuclide imaging study demonstrating correct patient positioning, correct views
and intensities, and correct labeling of views.
- Label and format the films and sufficiently interpret the images to ensure there have been no
technical errors.
- Recognise any artefacts or problems with the final image and know how to rectify the problem

5 Introduction to Computers (16 hrs includes 3 exercises)

AIM:
The aim is to develop confidence in performing data analysis without supervision, with attention paid to
quality assurance and study backup. This subject introduces computing in general with emphasis on
details necessary for routine acquisition and analysis of clinical studies
OBJECTIVES:
On completion of this unit the student will be able to:-
 explain the basic operation of Nuclear Medicine computers.
 select parameters which are important in acquiring, storing and manipulating images
 demonstrate understanding of techniques used for image analysis and possible source of errors.
 demonstrate data acquisition and analysis for commonly used clinical studies.
 produce reliable result for clinical interpretation
Introduction to computers
- highlight main features/points to find in "own" operation manual
- system hardware
- system software
- system management
 Data acquisition
- static, dynamic, gated studies
 Data display
- matrix size, threshold, grey scale, colour
 Data processing
- ROI and curve processing
- basic image processing
 Clinical analysis
- renal studies
- gated blood pool studies
- first pass

22
Units 6 – 11 Clinical Applications
PRE-REQUISITE:
Behavioural Science and Patient Care.
The student will have had at least 1 year working in a hospital department environment and it is
expected that patient management and care will be part of "on-the-job" training.
As an introduction to each clinical subject an anatomy and physiology section will be included
pertaining to the specific nature of the anatomical area under discussion.
Evidence of clinical experience:
For each of the clinical subjects the student is directed to record details of at least five patient studies in
their Workbook. The records must be signed off by their supervisor as having been completed by the
student. Evidence of the case studies is reviewed during the Workbook assessment.
AIM:
To enable the student to develop an understanding of the techniques and technology of organ-imaging
and other in-vivo and in-vitro procedures.
Each clinical area includes:-
Review of anatomy and physiology
Review of relevant pathology
Nuclear medicine procedures - protocols etc.
Interpretation of results
Limitations and advantages - Variations in procedures
OBJECTIVES:
To provide the student with a theoretical knowledge and practical aptitude in confidently performing
imaging techniques. The material format is designed specifically so that the student will be able to:
demonstrate an understanding of organ physiology and its functions with regard to radioisotope uptake.
 demonstrate imaging techniques, practical applications and correct procedures to acquire relevant
data on the following clinical areas:
Endocrine System
Hepatobiliary System
Gastrointestinal Tract
Respiratory/Pulmonary System
Skeletal,
Brain Blood Flow,
Renal/Urinary Tract
Cardiovascular System
6 Endocrinology. ( 19 hrs includes 9 practical exercises)
 Structure and physiology of thyroid, mechanism of isotope uptake, quantitative measurement of
 uptake and imaging procedures
 Clinical topics: hyperthyroidism and cancer
131 99m
 Thyroid uptake I and Tc - use of probe system
 Thyroid Imaging- patient preparation, positioning, anatomical markers, collimation and rectifying
artefacts
 Use of rectilinear scanner as well as camera.
 Wholebody Imaging
131
 I Therapy (low dose) for thyrotoxicosis
7 Hepatobiliary and gastrointestinal ( 17 hrs includes 9 practical exercises)
 Structure and physiology of the liver, its function and perfusion.
Gall bladder, bile ducts, bile formation and secretion.
Oesophageal and gastrointestinal transitory system.
 Liver - Sn colloid, anatomical markers, views, artefacts etc.
 Spleen - views for size, shape, location
 Invivo & invitro red cell labelling
 Haemangiomas - use of blood pool study

23
  Biliary - when and how long to image, intervention
 Gastrointestinal Bleed - how and when to image
 Meckles Diverticulum - how and when to image
 Oesophageal Reflux - transit times and determining reflux
 Gastric emptying – discussion
8 Pulmonary. ( 12 hrs includes 7 practical exercises)
 Anatomy and physiology of the respiratory system
 Pulmonary embolism. Interrelation between alveoli and lung capillaries, ventilation and perfusion.
Importance of mismatching / matching in interpretation of V/P defect. Segmental configuration,
postural effects on pulmonary perfusion and ventilation.
 COAD assessment
 Perfusion - MAA preparation and QC
 Ventilation - DTPA and colloid aerosols - general nebuliser
 Discussion on alternative ventilation imaging methods highlighting the limitations in use of an
 aerosol.
 Effects of varying collimation, counting statistics
9 Skeletal: ( 23 hrs includes 3 practical exercises)
 Bone structure, osteogenesis, tumours and infections
- reference to stress fractures etc.
 3 phase imaging.
 Wholebody imaging and spot views
 Collimators including the use of the pinhole, patient positioning and special views
10 Renal: (20 hrs includes 9 practical exercises)
 Structure of kidneys, renal perfusion, glomerular filtration, tubular function, absorption and secretion.
 Pathological conditions, obstructive uropathy, reflux, renal failure, renal transplantation. Space
occupying lesions and infection.
 Dynamic and static differential kidney function
 Influence of lasix (diuretics)
 Radiopharmaceuticals - DTPA and DMSA - reference to other possible agents
 Discuss various acquisition/processing protocols
11a Cardiovascular: (30 hrs includes 9 practical exercises)
 Myocardium and cardiac chambers. The heart as a pump.
Coronary circulation. Cardiac output. Ejection Fraction and wall movement.
Myocardial perfusion.
 The ECG - its value and emphasis on nuclear medicine procedures.
 Coronary disease and impaired cardiac function.
 Perfusion of organs: The interrelationship of blood pool, flow and function.
 Planar Imaging: First Pass, Gated Blood Pool acquisition and analysis, perfusion
(planar circumferential analysis), infarction (hot spot imaging)
 Invivo & invitro red cell labelling
 Computer acquisition and processing
11b Myocardial Planar Imaging (only) (17hrs includes 7 exercises)
This section on myocardial perfusion imaging is describing Planar Imaging techniques ONLY – it is for
the benefit of students who do not have SPECT equipment and will not be advancing to the level of
myocardial SPECT imaging which will also include planar techniques.
Note: Students continuing to advanced level topics should omit this subject at this stage.
 Cardiac Anatomy and Physiology
 Layers of the Heart
 Coronary arteries
 Clinical Indications and Pathophysiology
 Radiopharmaceuticals

24
 Understand the mechanism of uptake and retention, biodistribution, dosimetry, preparation, quality
control and clinical application of myocardial imaging agents:
- 99mTc-Sestamibi.
- 99mTc-Tetrofosmin
- Thallium–201
- Other Cardiac Imaging Agents
- 99mTc-Teboroxime
- 123I-labelled fatty acids in Myocardial SPECT imaging
- Evaluation of cardiac innervation by MIBG
- 99mTc-labelled diphosphine complexes
- PET tracers for myocardial imaging
 General Guidelines for Radiopharmacy Practicals
- Quality control
- Procedure to prepare injection dose
- Dispensing the radiopharmaceuticals
 Myocardial Perfusion Imaging
- Information obtained from myocardial perfusion study
- Patient Preparation
 Physical Exercise and Pharmacological Stress
- Patient and room preparation
 Exercise Protocols
 Pharmacological Stress
 Planar Image Acquisition
 Analysis of Planar data
- Planar Circumferential analysis

12a Behavioural Science: (10 hrs includes 2 exercises)

AIM:
This unit will help the student to appreciate how to relate to sick patients, respect their privacy and be
careful what is said in front of them. It is to help the technologist become aware of their communication
skills and to recognise how to create an outcome that is satisfactory to them and their patients.
OBJECTIVES:
On completion of this unit the student should be able to:
 Explain the role empathy plays in the care of patients
 Explain the elements that are characteristic of good communication
 Identify the major barriers to effective communication
 Discuss how culture can influence various aspects of the communication process
 Define nonverbal communication and identify the major functions of nonverbal communication
 Explain how nonverbal messages are influenced by culture
 Identify strengths and weaknesses in the area of interpersonal communication
The use of Empathy
- Consider the patient’s point of view
 Effective communication and barriers to communication
- What does it mean to be an effective communicator
- Is effective communication verbal? –vocal? –visual?
 Communication within the clinical environment
 Barriers to effective communication
 Can a person be taught to become an effective communicator?
 Communicating with others
- Communication filters

25
12b Patient Care* ( 7 hrs )
AIM
This unit aims to help the student understand how to provide essential care for patients attending for
nuclear medicine procedures, who can be in any state of health or illness. Descriptions will include
quality assurance, assessment of patient condition and vital signs, moving patients safely, infection
control, venipuncture, interacting and responding appropriately to emergency situations.
 Understanding needs of the patient
Importance of good communication
Psychological, emotional, cultural and spiritual needs
Demonstrating empathy
Reassurance
 Preliminary procedures – Getting ready
Quality assurance,
 Patient Assessment
Vital signs and Medication administration
Special needs group
 Safety and Care
Moving the patient
Managing bodily fluids and Infection control
Emergency Care
- Fundamentals of CPR
 Recommendations for good practice

13. Cerebrospinal Fluid and Brain Blood Flow (15 hrs includes 3 practical exercises)
AIM:
Part 1 introduces the role of Cerebrospinal Fluid (CSF) imaging in the investigation of a variety of
disorders, including hydrocephalus, CSF leaks, shunt patency and miscellaneous intracranial cysts.
In Part 2 of this unit the method of imaging brain blood flow (cerebral angiography) is described, using
a dynamic imaging technique and static brain imaging
Note:
Although these studies may not be performed routinely in the students’ department, they are required to
study these subjects, and answer the questions in their Workbook, however evidence of clinical studies
performed by the student is not essential.
OBJECTIVES:
On completion of these subjects the student will:
 Understand the CSF dynamics
 Identify the clinical indications for performing a CSF imaging study.
 Recognize the need for accurate positioning for best diagnostic value.
 Apply optional manoeuvres where necessary.
 Recognise normal and abnormal images.
 Understand the clinical indications for performing a brain blood flow study.
 Be able to identify the appropriate radionuclides and time delays for imaging the brain.
 Understand the need for accurate positioning of the patient and gamma camera to attain images of
the best diagnostic value.
 Cerebrospinal Fluid
- Anatomy, Physiology and CSF Dynamics
- Clinical Indications Hydrocephalus, CSF Leaks, Shunt Patency
- Cisternography
- Shunt Patency Studies for Ventriculoatrial, Ventriculoperitoneal, Lumboperitoneal and
Ommaya Shunt Patency
 Brain Blood Flow:
- Anatomy and Physiology
- Clinical indications
- Radionuclide Cerebral Angiography – dynamic phase
- Generating Time Activity curves

26
14a. Radioimmunoassay* (12 hrs and includes 1 practical exercise)
AIM:
This unit on radioimmunoassay aims to inform the nuclear medicine technologist on the different aspects
of estimating small levels of ligand or antigens using the radioimmuno assay method.
OBJECTIVES:
On completion of this subject the student will:
 Understand the mechanism of antigen antibody reaction.
 Understand various methods of Radioimmunoassays (RIA).
 Know how to set-up a RIA run.
 Understand the principles of Immunoradiometric assays (IRMA)
 Understand four different separation techniques
 [to separate bound fraction from free fraction]
 Be able to calculate using four different methods of plotting.
 Understand internal and external quality control procedures
 Have an introduction to non-radioactive immuno assays [EIA, FIA CIA etc].
Radioimmunoassays (RIA).
Types of assays
 Materials & Methods Used in RIA.
 Principles of RIA
What is structurally specific immunoassay?
How to set up RIA assays
What is a standard curve? And How to measure ligand concentration?
 Competitive Binding Assays (Equilibrium assays)
Equilibrium, Displacement and Sequential assays
 Non-Competitive assays (IRMA or Sandwich assays)
 Separation Methods.
Charcoal adsorption method
Non-specific precipitation of antigen-antibody complex
Immuno precipitation method
Solid phase antibody method.
 Calculation Methods.
Linear plots
Semi-log plots
Logit-Log plots
 Quality Control Procedures
Internal and External quality control
 Non-radioactive immuno assays
Enzyme Immuno Assays (EIA)
Fluoro Immuno Assays (FIA)
Chemiluminiscent Immuno Assays
 Typical Commercial and research RIA kits.
14b. Liquid Scintillation Counter * ( 4 hrs)
AIM
This unit introduces the student to the basic principles of liquid scintillation counting and instrumentation. This unit is
studied in conjunction with Radioimmunoassay where the use of a Liquid Scintillation Counter is utilised.
OBJECTIVES
On completion of this unit the student will have a basic understanding of
 Basic principle of liquid scintillation counting
 Liquid scintillation counting instrumentation
 Corrections and quantification in liquid scintillation counting
 Sample preparation for liquid scintillation counting
Theory of Liquid Scintillation counting

27
  Instrumentation
- counting coincidence
- multi-channel analyser
- background and noise reduction
 Quantification, Quench and Sample preparation
- quench corrections
- internal standardization
- channel ratio
- auto external standardization

14c Non – Imaging Studies: (12 hrs includes ~ 9 practical exercises)

AIM:
This unit will introduce the technologist to the role of non-imaging tracer studies in the investigation of
a number of disorders. All of the studies use what is known as the tracer principle.
OBJECTIVES:
Upon completion of this module the student will:-
 understand the use of tracers
 understand the principles underlying a number of common tracer studies
 label red cells using 51Cr-sodium chromate
 demonstrate pipetting accuracy
 perform a number of common tracer studies
 Interpret normal and abnormal results.
Note:
The student is required to complete the topics on Shillings Test, Blood volume, Red Cell Volume,
Plasma Volume and Glomerular Filtration Rate. Also 2 of the following optional topics must be
selected: Red Cell Survival, Ferrokinetics/Iron Metabolism, 14CO2 Breath Tests, Gastrointestinal Blood
Loss using 51Cr-Sodium Chromate and Splenic Sequestration
 The Schilling test for vitamin B12 absorption
- Clinical Indications and Physiology
- Vitamin B12 Deficiency
- Interpretation of Schilling Test Results and Pitfalls
 The Dilution Principle for Measuring Fluid Volumes
 Blood Volume Studies
- red cell volume
Radionuclides used to Label Red Cells and Measurement of RCV
- plasma volume
Radionuclides used to Label Plasma Proteins and Measurement of Plasma Volume
Expression of Results and Normal Ranges for PV
- red cell survival (option 1)
Radiopharmaceuticals used for Random Labelling
Red Cell Survival Study and Steps taken to Ensure Accuracy and Correction of Survival Data
- ferrokinetics / iron metabolism (option 2)
Iron Transport and Cellular Uptake
Ferrokinetic and Iron Absorption Studies for Hypoplastic Anaemia, Megaloblastic Anaemia,
Iron Deficiency Anaemia, Haemolytic Anaemia, Polycythemia Vera
 Glomerular Filtration Rate
- Renal GFR Estimation Study
 14
CO2 Breath Tests (option 3)
- 14 C-Glycoholic acid Test
- Carbon-14-Urea Breath Test for Helicobacter pylori
 Gastrointestinal Blood Loss using 51Cr – Sodium Chromate (option 4)
- Causes of Bleeding in the Digestive Tract
- Quantitation of Blood Loss and Calculations

28
  Splenic Sequestration (option 5)
- Four Patterns of 51Cr Accumulation in Haemolytic Anaemias
- Splenic Sequestration Study and Interpretation of Results
- Sources of Error

15. Paediatric Techniques: (10 hrs includes 6 practical exercises)

PRE-REQUISITES:
The student is required to have studied and / or revised other clinical subjects before commencing the
“Special procedures for Paediatric Studies”. The clinical references are for paediatric consideration and it
is assumed that the student knows the anatomy, physiology, clinical indications, mechanisms of
radiopharmaceutical uptake and analysis procedures for each of the studies.
AIM:
To familiarize the student with special considerations involving the paediatric patient for nuclear medicine
studies.
OBJECTIVES:
 To explore the ways in which children are unique and different, the best ways to approach children and
their parents, tips on how to keep them distracted, and practical issues such as injection and sedation.
 To determine which studies are most commonly performed on children, and how to modify protocols
accordingly.
 Handling the Paediatric Patient
- Assessing the child and parent
- Parent involvement
- The injection and Helpful Hints for paediatric imaging
 Special Considerations in Paediatric Nuclear Medicine
- Dose Calculations and Dosimetry
 Special Procedures for Paediatric Clinical Studies
- Renal Imaging
- Whole Body Imaging - Bone, Thallium, Gallium, 123I / 131I MIBG
- Hepatobiliary Imaging - Hepatic Extraction Fraction (HEF)
- Thyroid Imaging
 Gastro-oesophageal Imaging (milk scans)
- Swallow, Reflux and Aspiration
 Brain Imaging
- HMPAO - considerations for paediatric patients
- Shunt Patency

29
Unit: Advanced Level
16a. Introduction to Human Biology (16 hrs)
AIM:
This subject aims to give the student a background knowledge of the physiology and chemistry that is
fundamental to understanding nuclear medicine studies. It will clarify many points which arise in the
understanding of radiopharmaceutical labelling and uptake mechanisms. An ‘ Introduction to Human
Biology’ is included as an advanced topic to complement the clinical subjects at this level particularly
those involving more recently developed radiopharmaceuticals.
OBJECTIVES:
On completion of Introduction to Human Biology the student will:
 Understand the mechanisms that allow movement of substances around the body.
 Be able to describe cell function and cell components
 Understand the principles of homeostasis
 Understand how the physical properties of radiopharmaceuticals determine biological behaviour
 Body Fluid Compartments
- Body Fluids, intracellular fluid, ICF, extracellular fluid – ECF interstitial fluid: plasma: lymph
- Blood – red blood cells, white blood cells, platelets, plasma
- Lymph
 Chemical level of organisation
- atoms, molecules, chemical bonds, solutions, polar and non-polar molecules, pH and buffers,
chemical reactions and metabolism
 Biological molecules
- water, inorganic molecules, organic molecules, carbohydrates, lipids, proteins, nucleic acids
 Cellular level of organisation
- basic cell structure, the cell membrane, cytoplasm and organelles
- the nucleus – chromosomes, genetic code, protein synthesis
- cell division
- movement of substances across cell membranes
 Tissue, organ and organ system levels of organisation
 Regulation of function
- nervous and endocrine systems
- homeostasis
16b. Sectional Anatomy ( 6 hrs includes 3 exercises)
AIM:
This is an introduction to sectional anatomy to help the student identify anatomical structures when
imaging and reconstructing SPECT studies.
OBJECTIVES:
On completion of this unit the student will be able to
 look at anatomy in a different way
 recognise familiar structures when they are displayed in different sectional planes.
 The language of sectional anatomy
- Planes
- Sections
 Sectional anatomy of the chest
 Sectional anatomy of the abdomen
 Sectional anatomy of the pelvis
 Sectional anatomy of the brain
- Transverse
- Coronal

30
17a. Infection Imaging. (9 hrs)
PRE-REQUISITE:
Prior to studying this unit the student is advised to read an Introduction to Human Biology to assist the
understanding of cell structure and division, and chemical reactions, which influence labelling
mechanisms. Also an overview of both blood and lymph flow which are relevant to the spread of
infection. It also provides an introduction to biological names and terms.
Note: Many of the radiopharmaceuticals described in this subject are not readily available in many
countries. In such cases it is not essential that the student demonstrates clinical experience in infection
imaging.
OBJECTIVES:
At the conclusion of studying Infection Imaging the student will :
 understand the pattern, treatment and pathology of infection
 be able to identify the appropriate radiopharmaceutical and imaging regime for various infective
processes.
 be able to prepare a patient and equipment to perform the appropriate infection seeking nuclear
medicine study.
 Infection Imaging
- the pattern, treatment and control spread of infection
 Pathology of infection
 Radiopharmaceuticals for Infection Imaging
- Considerations for radiopharmaceuticals
- Infection imaging agents
- What to use and when
 White Blood Cell Labelling
 Blood Cell Labelling Precautions & Safety
- Requirements for safe practice in cell labelling
- Necessary precautions during preparation
- Standard operating procedures during cell labelling
- Recommended minimum standards of practice
 Imaging procedures for infection and protocol development

17b. Tumour Imaging. (9 hrs)

PRE-REQUISITE:
Prior to studying this unit the student is advised to read an Introduction to Human Biology to assist the
understanding of cell structure and division, and chemical reactions, which influence labelling
mechanisms. Also an overview of both blood and lymph flow which are relevant to the spread of tumour
cells. It also provides an introduction to biological names and terms.
Note: Many of the radiopharmaceuticals described in this subject are not readily available in many
countries. In such cases it is not essential that the student demonstrates clinical experience in tumour
imaging.
OBJECTIVES:
At the conclusion of studying Infection Imaging the student will:
 understand the difference between cancerous and non-cancerous cells
 be able to identify the appropriate radiopharmaceutical and imaging regime for various tumours
within the body
 be able to prepare a patient and equipment to perform the appropriate tumour seeking nuclear
medicine study.
 Tumour Imaging
- Differences between normal and cancerous cells and examples of carcinogens
 Radiopharmaceuticals for Tumour Imaging
- Considerations for radiopharmaceuticals
- Tumour imaging agents

31
  Receptors
 Monoclonal anti-bodies
- Radiolabelled Mab
 Imaging procedures for tumours
 Special Clinical Procedures
- Scintimammography

17c. Sentinel Node Detection* (15 hrs)

AIM
This unit describes in more detail the lymphatic system, various techniques of sentinel node detection,
their advantages and limitations and the instrumentation used for this investigation.
OBJECTIVES
On completion of this subject the student will be able to:
 Understand the structure of the lymphatic system and the mechanism of lymphatic drainage.
 Understand the current application of lymphatic mapping and SNB.
 Describe the major clinical indications for SN detection.
 Perform lymphoscintigraphy studies for SN detection.
 Prepare protocols suitable for your department.
 Perform data analysis and discuss options for image displays.
Anatomy and Physiology
Clinical Indications
- Pathophysiology - Lymphatic node metastasis
- Sentinel Lymph Node
- Common indications – Melanoma, Breast cancer
Radiopharmaceuticals
99m
Tc–sulphur colloid
99m
Tc– albumin nanocolloid
99m
Tc–antimony trisulfide colloid
99m
Tc–rhenium sulphide colloid
Other radiopharmaceuticals:
Preoperative Lymphoscintigraphy
- Patient preparation and Injection techniques
- Image acquisition and processing
Radioguided Surgery
Intraoperative Gamma Probe
- technical considerations
- gamma probe design and quality control
Lymphoscintigraphy – Pedal Lymph Studies

18. Medical Literature Review (22 hrs includes 7 exercises)

AIM:
This unit introduces the students to the process of reviewing literature so that they can more adequately
find out things for themselves. The student is required to write reviews of some scientific papers which
are supplied with this unit.
Understanding the processes of literature review will help the student to:
 Prepare for higher studies eg. undertaking a university degree and gain higher professional
recognition.
 Understand more of the content in nuclear medicine journals, new techniques and if they are
applicable to their professional needs.
 Prepare for critical assessment of what is being presented in journals
 Prepare to undertake a research role in their department and present data in an acceptable format for
a conference or publication.

32
 OBJECTIVES:
On completion of this subject the students will be able to:
 Read a published scientific or medical paper and understand how conclusions can be drawn from
presented data
 Draw their own conclusions regarding the information presented
 Compare views of different authors
 Present their views in writing
Types of literature
 Structure of scientific papers
 Publishing papers: peer review
 Finding relevant references
 Commencing research
- Controlled experiments
- Planning
- Sources of error
 Proving claimed conclusions
- Presenting data
- Statistical tests
 A basic introduction to statistics
- Errors in data
- Interpreting results: Hypothesis testing
- Statistical tests
 Important measures:
- Reproducibility
- Correlation and regression
- Sensitivity and specificity
 Understanding published papers
 Step-by-step review of an article
19. Understanding SPECT (23 hrs includes 10 practical exercises)
AIM:
The aim is to provide a very basic and practical background to SPECT. The coverage is not mathematical
but is intended to provide the students with an understanding of concepts that will assist in their daily
work.
OBJECTIVES:
On completion of the subject students should be able to:
 discuss the basic principles of SPECT acquisition and reconstruction
 understand the basic concepts of filtering
 choose an appropriate filter for SPECT reconstruction
 recognize potential sources of artifact or potential problems
 perform essential QC for SPECT and recognize other potential sources of problem
 be aware of newer developments in SPECT and their potential application
 What is SPECT?
- SPECT acquisition
- SPECT reconstruction
 Understanding Filters (non-SPECT)
- Fourier Transform
- Smoothing Filter
- Fourier Filtering in practice
- Restoration or resolution recovery
 Understanding SPECT filters
- Which SPECT filter to use
- When to filter

33
  Frequency Units – Nyquist frequency
 General problems
- Loss of resolution and Artifacts
 SPECT Acquisition
 SPECT Quality Assurance
- Uniformity, Centre of Rotation, Acceptance Testing, General Performance
 Quantitation of SPECT performance

20. Brain & General SPECT ( 27hrs includes 12 practical exercises)

PRE-REQUISITE:
The student is expected to have studied ‘Understanding SPECT’ and will need to refer to Instrumentation
Gamma Camera Quality Control
AIM:
This subject will demonstrate the importance of technologist understanding for accurate preparation of
equipment and setup procedures, radiopharmaceutical preparation, patient positioning, patient
cooperation and image acquisition and reconstruction. This knowledge will be applied to brain function
imaging in particular and general Spect imaging.
OBJECTIVES:
On completion of this subject the student will:-
 understand the basic structures, functions and the disease processes that affect the brain.
 be able to perform quality control on brain perfusion agent (HMPAO or ECD)
 be able to perform a COR using either a point or a line source, analyse and compare results.
 understand the importance of daily uniformity flood, differential and integral of uniformity in
relation to gamma camera performance.
 be able to recognize visual and auditory artifacts on a brain SPECT image and be aware how to
avoid unnecessary artifacts.
 be able to acquire a brain SPECT study
 perform attenuation correction on a brain SPECT study
 understand why the need to apply Chang’s attenuation correction.
 identify when to perform 180 or 360 degree SPECT.
 design protocols for SPECT of various organs and body parts.
 Radiopharmaceuticals
- HMPAO
- ECD
- Instant Thin Layer Chromatography
 Preparing the Gamma Camera and Quality Control
- Centre of Rotation, High Count Flood correction, Daily Flood Uniformity
- estimating values of differential and integral uniformity
 Perform a Brain SPECT study
 Tomographic Reconstruction & Image Analysis
- Determine cutoff frequency
- Image Attenuation
- Image Orientation
 General SPECT procedures
- Setup procedures for 3600 and 1800 SPECT
- Perform a 3600 and a 1800 SPECT study
 Overview of Reconstruction Parameters
- SPECT displays
- Volume Render

34
21. Myocardial SPECT and Planar imaging. ( 26hrs includes 8 practical exercises)
PRE-REQUISITE:
The student is expected to have studied ‘Understanding SPECT’ and will need to refer to subjects:
Instrumentation Gamma Camera Quality Control and Cardiovascular Imaging.
Note: Myocardial Planar ‘ONLY’ imaging was included at basic level and should be studied ‘only’ if the
student was not studying advanced level SPECT subjects. (See Unit 11b). Myocardial Planar imaging is
included with this section and should be completed along with the SPECT imaging Unit 21.
AIM:
This subject will demonstrate the importance of technologist understanding for accurate preparation of
equipment and setup procedures, radiopharmaceutical preparation, patient positioning, patient cooperation
and image acquisition and reconstruction. Emphasis will be on the use of SPECT in myocardial perfusion
imaging; planar techniques will be briefly covered.
OBJECTIVES:
On completion of the subject myocardial perfusion scintigraphy the student will:
 understand cardiac structure and the mechanism of myocardial perfusion
 describe the major clinical indications
 be able to perform quality control procedures for optimal results
 understand the difference between exercise and pharmacologic stress
 prepare protocols suitable for their department and perform myocardial perfusion SPECT studies.
 be able to perform data analysis and discuss options for image displays.
 Cardiac Anatomy and Physiology
- Layers of the Heart and Coronary arteries
 Clinical Indications and Pathophysiology
 Radiopharmaceuticals
Understand the mechanism of uptake and retention, biodistribution, dosimetry, preparation, quality
control and clinical application of myocardial imaging agents:
- 99mTc-Sestamibi.
- 99mTc-Tetrofosmin
- Thallium–201
- Other Cardiac Imaging Agents
- 99mTc-Teboroxime
- 123I-labelled fatty acids in Myocardial SPECT imaging
- Evaluation of cardiac innervation by MIBG
- 99mTc-labelled diphosphine complexes
- PET tracers for myocardial imaging
 Myocardial Perfusion Imaging
- Information obtained from myocardial perfusion study and Patient Preparation
 Physical Exercise and Pharmacological Stress
- Patient and room preparation
 Exercise Protocols
 Pharmacological Stress
 Image Acquisition
 Protocols - What do images mean?
 Analysis of Planar and SPECT data
- Planar Circumferential analysis
 SPECT Analysis
- Centre of Rotation, Uniformity correction, Filters and cut-off frequencies
- Reconstruction of transaxial slices
- Reconstruct and display oblique views
 Two Dimensional Polar Maps (Bull’s Eye display)
 Gated SPECT

35
22. Parathyroid Imaging* (10 hrs and includes 3 exercises)
AIM
This unit will introduce the student to the functions of the parathyroid and how imaging procedures can
locate their positions to help the surgeon for minimally invasive radioguided intervention.
OBJECTIVES
On completion of this subject the student will be able to:
 Understand parathyroid physiology and principal pathologic conditions.
 Describe the major clinical indications for parathyroid scintigraphy.
 Understand the difference between existing protocols.
 Prepare a suitable protocol and perform a parathyroid study.
 Perform a parathyroid study.
 Recognise normal and abnormal images.
 Understand operative techniques for radioguided parathyroidectomy
Anatomy, Physiology and Pathophysiology
Clinical Indications
Radiopharmaceuticals
99m
Tc-Sestamibi., 99mTc-Tetrofosmin, 201Thallium
Parathyroid Imaging, Image Processing and Interpretation Criteria
Minimally Invasive Radioguided Parathyroidectomy surgery

23. Guidelines for Radionuclide Therapy* ( 12 hrs )

AIM
The aim is to inform the nuclear medicine technologist and provide guidelines for current treatments that
have been generally accepted worldwide and include the precautions that are necessary, for safety of
both personnel administering the radionuclides and the patient receiving the treatment.
OBJECTIVES
On completion of this unit on Guidelines for radionuclide therapy the student will be able to:
 Appreciate the wide range of diseases in which radionuclide therapy is used.
 Be aware of the spectrum of methods of administration.
 Understand the varied mechanisms of radiopharmaceutical uptake.
 Recognise that the predominant tumouricidal effect is via beta electron decay.
 Appreciate the often palliative role that radionuclide therapy plays as opposed to treatment with a
curative intent. Understand that this is extremely important for patient quality of life.
 Recognise that the diseases treated are often rare and have proven difficult to treat with
conventional chemotherapeutic agents.
 Appreciate the changing role of radionuclide therapy.
 Understand the need for appropriate radiation safety requirements depending on the
radiopharmaceutical used.
 Understand the theory and principles underlying individual radiopharmaceutical treatment.
Clinical Overview, Technical Aspects, Method of administration Patient management Precautions and
Radiation Safety issues are discussed for the following therapies.
 Thyroid Cancer Therapy with Iodine-131
 Iodine-131 MIBG Therapy
 Iodine-131 Lipiodol Therapy
 Yttrium-90 Microspheres (Selective Internal Radiation Therapy)
 Phosphorous-32 Therapy for Myleproliferative Therapy
 Radionuclide Therapy for Painful Bone Metastases
 Radiation Synovectomy for the knee with Yttrium-90 Silicate
 Indium-111 Octreotide Therapy
 Monoclonal Antibody Therapy - General discussion

36
 DAT Part 2 Topics:
With the introduction of DATOL (DAT on-line) the subjects for DAT Part 2 were designed to be
suitable for on-line learning with many web-based complimentary materials and exercises.
Unit
24. SPECT & SPECT/CT Physics (30 hrs)
AIM:
To introduce more advanced topics in SPECT and include integration of SPECT with CT.
OBJECTIVES:
To provide students with a more advanced understanding of the physical principles so that they will be
able to:
 use iterative reconstruction
 understand SPECT/CT and technical issues relating to its use
 perform attenuation correction
 discuss the problems that occur in SPECT due to attenuation, scatter, partial volume effects and
motion and their correction.
Topics covered include:
 Multi‐detector SPECT systems
o Multi-detector SPECT QC
 Iterative reconstruction
o General principles
o Maximum likelihood reconstruction
o Improving speed:
 SPECT/CT
o Types of SPECT/CT and Issues related to SPECT/CT
o SPECT/CT Quality Control
o Software image registration
 Attenuation correction
o General principles
o Chang attenuation correction and Non-uniform attenuation
o Attenuation measurement and correction with measured attenuation
 Other corrections
o Scatter correction
o Limited resolution and partial volume effects
o Motion during SPECT acquisition
 Recent developments in SPECT instrumentation
o Application-specific systems
o Preclinical SPECT systems (pinhole SPECT)

25. Clinical SPECT/CT (20 hrs)

AIM:
To provide a good understanding of clinical SPECT/CT issues.
OBJECTIVES:
On completion of this unit on clinical SPECT/CT the student will be able to:
 Understand how image registration improves the accuracy of many nuclear medicine studies
 Know the various options to integrate anatomy into nuclear medicine, and be aware of their
limitations
 Describe the various hardware options for integrated SPECT/CT imaging
 Know the clinical indications and various scan types that will benefit from the accurate anatomical
localisation provided by SPECT/CT imaging
 Understand how SPECT/CT can be used for attenuation correction
 Understand the relevant radiation dosimetry aspects of SPECT/CT imaging
 Understand the relevant protocols for clinical SPECT/CT studies.

37
 Topics covered include:
 Need for image fusion in clinical imaging SPECT and PET
o Clinical need for SPECT/CT and PET/CT
 Options for image registration
o Visual registration
o Software registration
o Hardware registration
 Hardware options ‐ SPECT/CT
 Clinical Impact of SPECT/CT: Anatomical localisation
o Lymphoma , Infection and inflammation, Skeletal diseases, Neuroendocrine tumours,
Parathyroid tumours, Thyroid cancer, Sentinel node, Liver lesions, Brain disorders
 Clinical Impact of SPECT/CT
o Myocardial perfusion scanning
o Use of SPECT/CT for dosimetric evaluations
 Imaging protocols and study processing
o Study Processing
o Quality Control
 Radiation Safety issues with SPECT/CT
o CT radiation dose
 Training and department planning for SPECT/CT

26a. Introduction to Cross Sectional Anatomy - Part 1 (8 hrs)

AIM:
This module is meant only as an introduction to cross-sectional anatomy to help the student become
familiar with cross sectional anatomy terminology and identify anatomical structures when imaging
and reconstructing SPECT studies.
OBJECTIVES:
On completion of this introductory unit on cross-sectional anatomy the student will be able to:
 look at anatomy as a three-dimensional object
 recognize the structures you are already familiar with when they are displayed in different cross-
sectional planes
 demonstrate interactive control as you move through transverse, coronal and sagittal slices on-line
 identify locations of functioning organs, vessels and tumour sites within the body structures.
Topics covered include:
 Introduction
o The language of cross-sectional anatomy
o Planes and sections
 Cross Sectional Anatomy of the Chest
 Cross Sectional Anatomy of the Abdomen and Pelvis
 Cross Sectional Anatomy of the Brain
o Transverse sections of the brain
o Coronal sections of the brain
26b. Introduction to Cross Sectional Anatomy - Part 2 (6 hrs)
AIM:
On-line interactive practical exercises.
OBJECTIVES:
The web activities step through the slices of transverse, coronal and sagittal views in CT, PET and
fused images with labelled areas of interest to help orientate their locations. Self assessment tests are
provided to assist with your understanding during your study of this Unit followed by ‘online’ multiple
choice questions which will record your results as part of your final assessment.

38
  Web based activities:
Various On-line cross section anatomy websites
Chest Anatomy (narrated powerpoint)
Pelvis and abdominal Anatomy (narrated powerpoint)
SPECT/CT interactive display with labelled anatomy
PET/CT interactive display with labelled anatomy

27a. Principles of CT - Part 1 (25 hrs)

AIM:
This unit introduces some of the fundamental concept of CT scanning. It also describes the CT image
and what it represents. CT number values are discussed, as is windowing for image display.
OBJECTIVES:
On completion of this unit the student should:
 Understand what a CT image represents as a section through the body
 Know the axes and planes referred to in CT
 Be able to describe the CT number scale
 Know about windowing CT numbers for display of images.

Topics covered include:

 The CT Image
o What is CT and How is CT useful in PET and SPECT scanning?
o What do CT images look like and What does it represent?
o The CT number scale
 CT Scanner Requirements
o Generic and ideal CT scanner
 CT Data Measurement
o Attenuation of x-rays
o X-ray detection
o Projections
o Sinogram
 Image Reconstruction
o Back-projection
o Blurring and filtered back-projection
 CT Scanner Components
o X-ray tube, X-ray fan beam geometry and collimation
o X-ray beam filtration
o Detectors
 Spiral Scanning
o The need for faster scan times
o Slip ring scanning
o Spiral (helical) scanning and Interpolation of spiral data
o Spiral versus standard axial CT scanning
 Multi-Row Detector Scanners
o Concept of multi-row detector scanning
o Axial and Spiral MDCT scanning
o Clinical advantages of MDCT
 CT Scanner Acquisition Modes
o Scan projection radiograph
o Axial and Spiral scanning
o Scanning with an Automatic Exposure Control (AEC)
o Extended field of view
o Real-time CT and CT fluoroscopy
o Cardiac CT, Dynamic CT scanning, Dual-source CT

39
  Scan Parameters
o X-ray beam related
o Gantry
o Effective detector width
o Table feed and spiral pitch/packing factor
o Anatomical coverage and Scan field of view
 Reconstruction Parameters
o Convolution kernel
o Matrix size, Reconstruction field of view, Image width, Reconstruction increment
o Other image filters and processing

27b. Principles of CT Part 2 (20 hrs)

AIM:
To familiarize the student with topics such as image quality, artefacts, CT dosimetry and safety, quality
assurance and quality control, and scan protocol design.
OBJECTIVES:
On completion of this unit the student will be able to:
 Define the parameters used to define image quality in CT
 Explain how the CT image quality parameters are measured
 Understand how the CT image quality parameters vary with scan mode, exposure parameters, and
reconstruction options.

Topics covered include:

 Image Quality
o Image noise, Spatial resolution, Z-axis resolution, Low contrast resolution
 Artefacts - Sources and Appearance
o Appearance of artefacts in CT images
o Causes of artefacts in CT images
o Methods for overcoming artefacts
 Patient Radiation Dose
o CT dose index, Weighted and Volumetric CTDI
o Dose length product and Dependence on scan parameters
o CT dose index and dose length product as indicators of patient dose
o Organ absorbed doses and effective dose
o Diagnostic reference levels
 Quality assurance and quality control testing
o Structure of a quality assurance programme
o Quality control testing
o Test methodologies
 Operator Safety
o Distribution of scattered radiation and Dose rates around CT scanners
o Typical shielding requirements for MDCT scanners and SPECT-CT cameras
o Dealing with persons inside the scanner room
 Design of scan protocols
o Level of image quality required in different clinical applications
o Requirements of different imaging tasks
 Balancing Image Quality and Dose
o ALARA principle
o Methods for determining optimal image quality/dose
o Variation of image quality and dose with patient size
o How to use AEC systems optimally

40
27c. Attenuation Correction for SPECT/CT and PET/CT (18hrs)
(Supplementary subject for ANZ_CT licensing)
AIM:
To aid the understanding of attenuation correction as applied to both SPECT/CT and
PET/CT.
OBJECTIVES:
On completion of this unit the student will:
 Understand the use of CT for attenuation correction in SPECT/CT and PET/CT
 Perform attenuation correction using iterative reconstruction
 Discuss the problems that may occur in SPECT and PET when performing attenuation correction.
Topics covered include:
 Iterative Reconstruction
o Filtered Back Projection
o Iterative reconstruction: General principles
o Maximum likelihood reconstruction
o When to stop?
o Improving speed: OS-EM
 SPECT/CT
o Introduction to SPECT/CT
o SPECT attenuation correction
o Attenuation measurement
o Attenuation correction with measured attenuation
 Positron Emission Tomography
o Introduction to basic physics of PET
o Attenuation correction
o PET/CT artefacts

28. Cyclotron and Radiopharmaceutical Production (17 hrs)

AIM:
To provide an overview of the Cyclotron and production of PET radiopharmaceuticals.
OBJECTIVES:
On completion of this unit the student will:
 Have a basic understanding of radionuclides, their history and their production via particle
irradiation
 Have a basic understanding of the principles of a cyclotron & its main components
 Have an understanding of the sequence and procedures involved in performing a production on
the cyclotron.
 Have received revision on radionuclide generator and be familiar with the more common
generators used for producing PET radionuclides
 Have an understanding of the process required for producing 18F-FDG
 Become familiar with the QC requirements of PET radiopharmaceuticals
 Gain some insight into potential failures of the cyclotron and production and their impact on
scanning the scheduled patients
 Gain insight into activity requirements and production scheduling
 Learn how to estimate activity required to scan the scheduled patients
 Have a basic understanding of the radiation hazards, shielding requirements and radioactive waste
associated with a PET cyclotron and radiopharmaceutical production facility
 Gained an introduction to some of the regulatory requirements for producing PET
radiopharmaceuticals.
Topics covered include:
 Introduction to Radionuclides and Their Production
 The Cyclotron
o Basic Principle of Cyclotron Operation

41
  Performing a Production
o Start up of cyclotron, Optional pre-irradiation and Main irradiation
o Shut down of cyclotron
o Activity production yields
o Comparison with radionuclide generator production yields
 PET Tracer Radiochemistry
o Basic steps in the production and synthesis of PET radiopharmaceuticals
o 18F-FDG production and Non-routine tracer production
o Labelling yields, Chromatography and Quality control
 Supply of Cyclotron Produced Radiopharmaceuticals
o Synthesis failures, QC failures, Transport problems and essential Communication
o Routine and preventive maintenance
o Running the cyclotron, cost, staffing and production requirement
 Shielding, Radiation Safety and Regulatory Issues
 Useful Cyclotron Website Links
29. PET Physics (36 hrs)
AIM
To enable an understanding of the physics, technology and methods used in Positron
Emission Tomography
OBJECTIVES
On completion of this subject the student will be able to:
 Discuss the basic science behind PET including positron emission, coincidence detection and the
different types of coincidence seen
 Be aware of the detector configurations, scintillation crystals, and scanning modes used in PET
 Describe the different types of reconstruction used in PET, and why PET acquired in 3D mode
requires a slightly different approach
 Be able to manipulate image displays to present PET and PET/CT data in an optimal way
 Understand the different corrections applied in PET, and how they affect the quality of the image
 Recognise the quantitative power of PET and understand how this can be performed
 Perform routine QC in PET, understand the measures and results obtained, and recognise the type
of artefacts arising in PET.
Topics covered include:
 Basic Science of PET
o Coincidence detection and Types of coincidence
o Positron Emission Tomography imaging
 Instrumentation
o Detector geometry and Block detector
o Scintillation crystals
o 2D PET and 3D PET
o Time of Flight
o Pre-clinical ‘small-animal’ PET scanners
 Corrections
o Randoms, Deadtime, Scatter, Normalisation and Attenuation correction
 Reconstruction
o Filtered Back Projection
o Iterative reconstruction: general principles
o Maximum likelihood reconstruction
o 3D PET reconstruction
 Image Display
o Displaying PET images, CT images and PET/CT images
o Maximum Intensity Projection Images (MIPs)
 Quantification
o From measured disintegration events to activity concentration
o Kinetic modelling and Standardized Uptake Value (SUV)

42
  System Performance
o Spatial resolution, Sensitivity, Count rate performance and Scatter fraction
 Quality Assurance
o Quality assurance and Quality control testing
o Acceptance testing
o Routine quality control
o Quality control of other equipment used in PET imaging
 Artefacts
o PET artefacts and PET/CT artefacts

30. PET/CT Radiation Safety (15 hrs)

AIM:
To cover the radiation safety aspects of PET/CT scanning, building on the student’s knowledge of
radiation protection in general nuclear medicine which an experienced technologist is assumed to have.
OBJECTIVES:
On completion of this subject the student will have a better understanding of-
 Radiation from the decay of clinical PET radionuclides
 Primary and secondary radiation from a modern CT scanner
 Sources of PET radionuclides in a PET centre
 Containment and shielding for PET sources
 Maximizing distance from FDG sources
 Minimizing close contact time with FDG patients
 How the clinical workload and workspace affect your exposure
 How to measure radiation in a PET/CT centre
 How PET/CT clinical protocols determine the patient’s radiation dose
 Radiation advice for the patient, their family and carers
The student will be able to-
 Check if shields for dispensing, calibrating and injecting FDG are adequate
 Assist in preparing the patient for a PET/CT scan
 Safely dispense and inject the correct amount of FDG
 Move and position the patient quickly and efficiently
 Observe radiation safety rules for operation of a CT scanner
 Deal with FDG spills including urinary incontinence
 Evaluate the results of personnel dosimeter reports
 Identify and report any situations which could lead to unplanned exposure or where exposure
could be reduced.
Topics covered include:
 Radiation from PET radionuclides
 Radiation from a CT scanner
 Radiation exposure from handling PET radionuclides
o Vials and injection systems
o How much activity and How accurately do you need to dispense FDG?
o The patient as a source of 18F radiation
o Other radioactive sources in PET centres
 Radiation Exposure Controls for PET sources
o Containment, Shielding, Distance and Time
 How the clinical workload and workspace affect radiation exposure
o Clinical procedures
o Workspace
 How to measure radiation in PET/CT environments
 Radiation safety for the patient
o Pregnant patients
o Lactating patients
o Paediatric patients
o Advice for the patient, their family and carers

43
31. Clinical PET/CT (20 hrs)
AIM:
To provide an understanding of clinical PET/CT issues and the benefits of having fused CT and PET
scans
OBJECTIVES:
On completion of the subject students should be able to:
 Understand what role PET has in the management of patients
 Be able to discuss how PET is useful in particular cancers and some other non-cancer related
illnesses
 Be aware of many of the different PET tracers used in clinical practice
 Be able to recognise, when you are looking at PET images, the normal distribution of FDG
Topics covered include:
 Need for image fusion in clinical imaging PET and SPECT
o Clinical need for PET/CT and SPECT/CT
o Techniques for image registration
 What is FDG and how does it work for imaging cancer?
o PET imaging of cancer cells
o Normal uptake patterns of FDG
o Use of tracers other than FDG in oncology
 PET in the clinical setting
o Is PET is useful for determining whether a patient has cancer?
o Why is PET often better than CT (or MRI)
o The TNM classification system and cancer biology
o Staging and How can PET help with staging?
o Recurrence/re-staging
 Monitoring response to therapy
o Early response assessment
o Radiotherapy planning
 The added value of CT in PET/CT
 FDG - PET imaging in different tumour types
 Clinical PET/CT - Other applications
o Cardiac applications
o Neurology applications
 Infection and inflammation imaging
32. Workflow & Protocols (30hrs)
AIM:
To introduce the important issues related to PET scanning which differs from routine nuclear medicine
thereby changing workflow, scheduling and protocol requirements.
OBJECTIVES:
On completion of this subject the student should be able:
 Understand how to calculate the activity concentration and volume for drawing up of 18F
radiopharmaceuticals.
 Be able to generate a decay chart for 18F, 11C, 13N and 15O using a spreadsheet, for use in a PET
Hot Lab
 Be able to calculate the total amount of 18F radiopharmaceutical required (in GBq) for a typical
daily patient list
 Understand the effects of changing the injected dose, uptake time, scan time, and study order on
the amount of 18F radiopharmaceutical required for the daily patient list
 Understand the effects of interruptions to work flow on the amount of 18F radiopharmaceutical
required for the day
 Understand the effects of limited patient preparation space on daily work flow
 Understand the importance of communication with the patient prior to their appointment and the
best ways of achieving this

44
  Be able to schedule a patient list for PET scanning, with a given set of scan parameters, and to
calculate the minimum required amount of 18F radiopharmaceutical to complete the scans.
Topics covered include:
 Appointment Scheduling and Workflow Issues
o Dose preparation
o Scheduling of PET scans
o Preparation and uptake rooms
 PET Scanner Quality Control, Quality Assurance and Calibration Procedures
o Daily quality control procedures
o Periodic quality control procedures
 Whole Body Oncology PET with 18F 2-fluoro-2-deoxy-D-glucose (18F-FDG)
o Patient preparation for 18F-FDG oncology studies
o 18F-FDG administered activity and injection
o Scanning procedures
o Computed tomography (CT) in PET/CT
 Radiation Safety Issues Specific to PET/CT
o Sources of radiation in PET and in CT
o Patient radiation dose in CT
 Image Reconstruction & Processing
o Image display, printing and archiving
o Patient discharge procedures
 Brain 18F-FDG PET
o Indications for a 18F-FDG brain PET scan
o Patient preparation and Uptake time
o Positioning and scanning
o Image reconstruction and processing
 Myocardial PET
o Patient preparation for a myocardial viability PET
o Radiopharmaceutical activity and Uptake times
o Acquisition parameters and protocols for cardiac PET
o Image reconstruction and processing

33. Normal Variants & Pitfalls (15 hrs)

AIM:
This subject gives an insight into the common normal variations in uptake patterns of 18F-FDG in the
various organs of the body and also some of the more common pitfalls.
OBJECTIVES:
On completion of this subject the student will:
 Be able to recognize the common variations in normal distribution of tracer on FDG PET/CT
 Be familiar with the common hidden traps connected with FDG PET/CT appearance.
Topics covered include:
 Renal Tracts
o Kidneys, Ureters, Bladder and Urinary diversion
 Cardiovascular System
o Heart and Blood vessels
 Gastrointestinal Tract
o Oesophagus, Stomach, Small bowel, Large bowel and Liver
 Musculo-Skeletal System
o Brown fat, Skeletal muscle, Bone and Joints
 Genito-urinary tract
o Female and Male genito-urinary tract
 Haemopoetic System
o Spleen and Bone marrow

45
 Lymphoid System
o Waldeyers ring, Thymus and Lymph nodes
 Endocrine System
o Thyroid and Adrenals
 Malignant Tumours with low FDG uptake
 Benign tumours with intense FDG uptake
o Benign parotid tumours
o Benign thyroid tumours
o Benign colon polyps
o Breasts
o Prostate adenomas
 Inflammatory tissue causing intense FDG uptake
o Granulomatous Disease
 Sequelae of Treatment
o Post chemotherapy
o Radiotherapy
 Factors that influence the ability of FDG to characterize malignant lesions
 Technical Artefacts

46