NUCS MSH (PET)

Location & List

Faculty Representations: Dr. Anthony Hafez | Attendings: Drs. Randy Yeh, Anthony Hafez, Munir Ghesani, Nasrin Ghesani, Lewen Stempler, and Sampanna Rayamajhi

Location: HESS Nuclear Medicine Reading Room (Directions Below)

EPIC worklist - "MSH: NM PET SCANS"

Hours:

8:00am – until attending dismissal

Resources:

Radiographics: Intro to PET-CT https://pubs.rsna.org/doi/full/10.1148/rg.242025724
SNMMI: 50 years of radiopharmaceuticals
https://tech.snmjournals.org/content/jnmt/48/Supplement_1/34S.full.pdf
VCU: Nuc Med modules
http://www.people.vcu.edu/~mhcrosthwait/clrs461/index.htm

Conferences:

Mandatory attendance

- Thursday 8:00am
  Nuclear Medicine lecture series
  Zoom link here

Optional attendance

- Monday 8:30am
  Thyroid Conference (mandatory for Nucs residents, optional for PET)
  Zoom link here
- First Tuesdays 4:00pm
  MSH Thyroid Center Tumor Board
  Zoom link here
- First Thursdays 5:00pm
  MSDUS Thyroid Center Tumor Board
  Zoom link here

Nucs MSH (PET Rotation) Expectations

Arrive to the Hess Reading Room (directions below) by 8 AM
If it is your first time on PET, familiarize yourself with the MIM Guide and PET Protocols Guide
NEW STARTING 2026: Protocol all West side cases (see below for Epic protocol lists and instructions) at least 4 days in advance (through and including Tuesday of the following week)
Read from the "MSH: NM PET Scans" Worklist and assign cases to the "PET Teaching AM" Attending on QGenda for cases that you read between 8 AM and 1 PM. Any cases read after 1 PM should be assigned to the "PET Teaching PM" Attending on QGenda.
- R2: Pre-read at least 3-7 cases daily.*
- R3: Pre-read at least 5-10 cases daily.*
- R4: Pre-read at least 5-10 or more cases daily.*

*rest of the cases may need to be read simultaneously with the attending given high volume

- Standardized PET Reporting Instructions
Protocol PET/CT studies, ask Nuclear medicine chief or PET attending any questions about correct protocols throughout the rotation.
Ensure correlation is made with all relevant studies including but not limited to CXR, CT, MRI etc.
Familiarize yourself and read about the oncologic PET imaging, myocardial FDG imaging (for cardiac sarcoidosis), and brain PET imaging (Alzheimer’s).
Demonstrate knowledge of the clinical indications, general procedures and PET/CT findings in Dementia, sarcoidosis, lung cancer, ovarian cancer, uterine cancer, testicular cancer, lymphoma (Deauville scores), melanoma, breast cancer
Any requests for STAT reads or other general questions can go to one of the NM senior residents or "PET MD On Call" Attending on Qgenda.

Directions to HESS Reading Room (Nucs MSH):

Entrance on 1470 Madison Avenue

Take elevators on the left of security desk DOWN to SC2. When you exit, walk towards the side opposite the office with glass doors and make a left through a hallway with two doors. Then, make a right towards the reception desk and make your first right down a long hallway with patient rooms on either side. The reading room is the last door on the left before the big double doors.

PROTOCOLLING PET CASES

Epic Protocol Lists - Favorite the Following 2 Lists Under the Protocolling Tab on Epic:

MSW Nuclear Medicine to Protocol
Chelsea Nuclear Medicine to Protocol

Sort by "Procedure"
Protocol all PET/CTs through and including Tuesday of the following week. Refer to the PROTOCOL GUIDE for more information. Studies other than PET/CTs do not need to be protocolled.

4. When in doubt of which protocol to select, ask a senior nuclear medicine resident or attending.

Non-FDG exams are only performed at MSH/Hess. If you think that an FDG PET/CT was incorrectly ordered/scheduled at MSW or Chelsea, reach out to the clinical team to confirm which tracer they want to use and email #PETScheduling to reschedule the patient at an East side location

**If you get an error when trying to protocol (e.g. patient's weight not entered, or allergies need to be reviewed) change your Epic context to "MSH RAD NUCLEAR MEDICINE"

When in doubt of which protocol to select, please ask a senior nuclear medicine residents or the attendings.

PET Software Instructions

MIM6 Login

user: mim
password hint: state

INTRODUCITON TO MIM!

INTRO TO MIM (PLEASE REVIEW)

To open study:

Patient Data Source window in upper left corner of screen, choose MIMpacs (MIM Server)
Type patient last name, first in the Name field
Click SEARCH button on right
Ctrl-Click choose the CT and PET (AC) series for the current study plus up to three comparisons (do not select the uncorrected images = NAC)
In the Workflow window on the right, make sure the "workflow" tab is selected, then choose the workflow staging protocol from the options to display your studies, then Open
If your station does not have workflows populated, you can install it directly. Look for the nuclear folder on the shared G drive on intranet. Look for mim folder and copy/paste to your desktop. From mim, click "organize" in bottom right and then select the browser link at top to navigate to the mim folder. Choose the options under workflow to add to your mim folder individually. You may need to close and re-open mim to see changes.

MIM6 viewer functions

To adjust PET scale, left click on the scale and choose the color range, left click and drag to change the SUV range, right click and drag to adjust gamma
- Body: 5-6
To zoom in, right click on image, hit magnifying glass and drag
OR use "1" "2" "3" keys to zoom.
To measuring SUVs - "S" is keyboard shortcut, right click to enlarge/shrink ROI
To measure, "T"is for tape measure (but you should really measure on the standard PACs CT images)
Keyboard shortcuts (top numbers)
- 1 = reset zoom
- 2 = zoom 2x
- 3 = zoom 3x
- 4 = soft tissue window
- 5 = brain/liver window
- 6 = lung window
To switch Coronal/Sagittal, use "V"
To see if there is enough RAM to open study, you can use Help>> About MIM>> Refresh free MIM; to open 3 studies (current+2 comps, need >~ 1000)
To Close Study, Session "X" patient, confirm

Sending OUTSIDE studies to MIM viewer from PACS:

Right click on study in PACS
Send series in DICOM
Check off
- CT standard, and
- PET WB 3D AC
- These should have same number of images
Send to Destination: MIM_Enterprise

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