NUCLEAR MEDICINE

Locations & List

Faculty representative: Dr. Ongseng/Goldfarb (all sites)

PACS worklist: NM ALL (read select studies described below, depending on site)

Mount Sinai Morningside

Attendings: Dr. Ongseng (W/F), Dr. Goldfarb (M/T/Th)

Location: Morningside Nuclear Medicine Reading Room, 5th Floor

Mount Sinai NYRA

Attendings: Dr. Goldfarb (W/F), Dr. Ongseng (M/T/Th)

Location: NYRA office (55 E 34th St, New York, New York 10016, 3rd floor)

Hours:

8:00am – until attending dismissal (~5pm)

Coverage/Lists

Nuc M resident covers West, Morningside, and Brodsky cases (FYI: Brodsky cases do not show up on NucMed-All filter, and require a separate filter on PACS).
Nuc NYRA resident covers BI, KH, NYHC;
DEXA studies from PACC (DUS), Cancer Center, KH, and NYHC

Nuclear at M issues:

For any nuclear issues at Morningside (M) such as morphine, lasix, CCK administration, lymphoscintigraphy (rare), etc, residents on other rotations will be contacted as follows:

Nucs
Neuro M
VIR M

Conferences:

Mandatory attendance

- Monday 9:00am
  Thyroid Conference
  Zoom link here
- Thursday 8:00am
  Nuclear Medicine lecture series
  Zoom link here

Optional attendance

- First Tuesdays 4:00pm
  MSH Thyroid Center Tumor Board
  Zoom link here
- First Thursdays 5:00pm
  MSDUS Thyroid Center Tumor Board
  Zoom link here

For Nuclear medicine Policies & On-call procedure:
Click this link for "NUCS - ON CALL"

Expectations (both sites):

Protocol nuclear medicine cases if at SL/W
- For SL and W: At the beginning and end of each day, call the other site to fax over the order sheets to protocol/sign.
  (Protocol book; intranet only: http://radiology.chpnet.org/physics/protocol/Protocol%20Manual.pdf)
Obtain consent and administer PO I-131 treatment.
- Record in ABR log, click here for pdf form (to read about the ACGME requirement, click here)
  YOU MUST LOG I-131 ADMINISTRATIONS WITH THE ACTUAL DOSE!
IM thyrogen injections
Breast sentinel node injections
- Do AT LEAST ONE lymphoscintigraphy in your R1 year (Be comfortable managing this as an R2+).
Add CCK to IV bag and inject IV morphine for HIDA scans (pick up from IR/pharmacy)
Please don't forget to lock the door at the end of the day

Nucs NYRA - Presentation expectation

Monday 9:00am Thyroid Conference Zoom link here

For thyroid administration (done primarily at NYRA), all patients will have a whole-body scan before their appointment, and their case will be discussed with the clinicians and nuclear medicine team to decide the plan.
New 2021: Contact Dr Ongseng and Dr Golfarb prior to your rotation week to get patient information / look up patients prior to this Monday thyroid meeting.
- Ideally, the resident on the rotation should prepare a few ppt slides about the patient and proposed plan before this Monday meeting.

Graduation Requirement/NRC Authorized User

"Authorized user" status involves a credentialing process administered by the Nuclear Regulatory Commission (NRC) that states that you can oversee the safe and effective medical use of radionuclides in nuclear medicine.
This is very helpful when you are looking for a job, even if you are not reading nuclear medicine studies yourself, as an authorized user needs to be present whenever radionuclides are used at your institution or practice.
ABR authorized user forms are signed by PD and Dr. Nasrin Ghesani after completing the required hours of training classes and experience in addition to RAI treatment.
- Log with ABR Part A and Part B form, click here for pdf form (to read about the ACGME requirement, click here).
  - - Part A -- to get this signed by Dr. Nasrin Ghesani, you FIRST need to get 3 forms signed by Raj, click below for links (Rajnikant Agravat, West Nuclear Medicine supervisor)
      To complete below 3 forms, email Raj your chosen day from Mon-Fri, and arrive earlier at West to meet him (around 7:15/7:30am).
  - Part B -- 3 high-dose and 3 low-dose thyroid administrations, signed by whoever did thyroid administrations with you (Dr. Ongseng or Dr. Goldfarb)
    - The RAI treatment experience must include a minimum of 3 cases of <33 mCi and 3 cases of > 33 mCi. Residents also have to actively participate in the consultations of hyperthyroid cases (3 cases) and thyroid CA cases (3 cases) in order to get the basic experience in RAI treatment.

Resources

Required Readings

Review the attached documents at the bottom of this page
For the updated SLW protocols - click HERE (intranet)
Atomic Agency Tutorial for Lymph Node Stations

Recommended Book

Case in Point

Thyroid: [1], [2], [3], [4]

Dr Fukiat Ongseng

Assistant Professor

Dr Richard Goldfarb

Associate Professor