Seminars in nuclear medicine
-
Nuclear medicine practice and work force demographics reflect the historically diverse evolution of this specialty. The most pressing problem for nuclear medicine is a projected shortage of fully trained physicians due to practitioner retirement that is unmatched by residency program output. During the past decade the number of 2-year nuclear medicine residency programs (average of 90) and the total number of residents (average of 191 in both years) have remained remarkably stable. ⋯ Cardiologists certified by American Board of Internal Medicine-Cardiovascular Specialization account for approximately 4% of nuclear medicine (15% of total cardiovascular nuclear medicine) FTE work load. Work force shortage of nuclear medicine technologists remains a chronic problem in spite of extensive study: however, recent predictions suggest some improvement in the future. Solutions to work force problems facing nuclear medicine will require ongoing data surveys, aggressive recruitment of trainees, expansion of training positions, and socioeconomic initiatives that promote desirable future practice models.
-
As a consequence of recent studies that have (1) established the role for ventilation-perfusion lung scanning in the diagnosis of pulmonary embolism, (2) clarified the contribution of clinical assessment to the diagnostic utility of lung scans, and (3) established a role for the noninvasive assessment of the lower extremities for deep venous thrombosis in patients suspected of having pulmonary embolism, we can now manage clinically stable patients suspected of pulmonary embolism without need for invasive diagnostic procedures. The various studies establishing this approach are reviewed, and an algorithm is presented that allows for the noninvasive workup of clinically stable patients suspected of having pulmonary embolism.
-
Sources of ionizing radiation are being used with increasing frequency in a wide spectrum of applications in society. These uses are accompanied by the possible occurrence of accidents resulting in persons exposed to radiation and contaminated with radioactivity. ⋯ Planning should include identification of a radiation emergency area within the hospital, delineation of a radiation emergency response team of individuals knowledgeable about radiation and radioactivity, and development of protocols for the medical care and decontamination of patients involved in radiation accidents. Various agencies, including the Joint Commission on Accreditation of Hospitals, have stressed the need for preparation and periodic testing of radiation emergency response plans for hospitals.
-
Computerized axial transmission tomography and radionuclide imaging are complementary procedures, and the following recommendations are made as to their use. Where there is no real clinical suspicion of intracranial disease, either modality can be used for "rule out" screening; the choice can frequently be made on the basis of which modality is cheaper or more quickly available. It should be remembered that "quicker" is often "cheaper". ⋯ Such examples might include the fresh cerebral hemorrhage demonstrated by CT imaging, the AV malformation defined by dynamic-static radionuclide imaging, or multifocal metastatic lesions defined by either. However, when the clinical picture is not totally and satisfactorily explained by the demonstrated disease, the other modality should also be employed. Under many circumstances, neither study will be so reliable, specific, and free of false-negative or false-positive findings as to warrant ignoring the additional information potentially available from the other study.
-
This article is meant to serve as a simple introduction to diagnostic ultrasound, explaining the nature of sonar and the basic equipment for its production and use. A scans, B scans, time-position scans, and Doppler-shift techniques are described, with some examples of the clinical applications of each. ⋯ The limitations of the technique are indicated, with measures that can be adopted to reduce them. The safety of the procedure is emphasized, with its freedom from the known biological effects of ionizing radiation.