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Course, academic year 2023/2024
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Nuclear Medicine - B00078 (Všeobecné lékařství)
Title: Nukleární medicína
Guaranteed by: Institute of Nuclear Medicine First Faculty of Medicine Charles University and General University Hospital in Prague (11-00330)
Faculty: First Faculty of Medicine
Actual: from 2023
Semester: winter
Points: 2
E-Credits: 2
Examination process: winter s.:
Hours per week, examination: winter s.:0/25, C+Ex [HS]
Extent per academic year: 25 [hours]
Capacity: unlimited
Min. number of students: unlimited
4EU+: no
Virtual mobility / capacity: no
State of the course: taught
Language: Czech
Teaching methods: full-time
Teaching methods: full-time
Explanation: Zogala - david.zogala@vfn.cz, martin.samal@lf1.cuni.cz, katerina.hrachova@vfn.cz
Additional information: https://unm.lf1.cuni.cz
Old code: 78
Guarantor: doc. MUDr. David Zogala, Ph.D.
Comes under: Povinné LEK 4.r._23/24
Attributes: Lékařství
Klinický předmět
Pre-requisite : B00003, B00632, B02925, B03161, B03162
Is pre-requisite for: B01254, B02333, B02330
Annotation -
Last update: prof. MUDr. Martin Šámal, DrSc. (09.09.2019)
Nuclear medicine is a medical specialty dealing with diagnostic and therapeutic use of unsealed radionuclides. It is based on a tracer principle: unstable radionuclides of a chemical element react identically as the stable ones and can be used to trace radio-labelled substances in chemical and physiological processes. Molecules labelled with a small amount of radionuclides are administered into the human body and traced by external detection of gamma rays. Amount of a specific tracer accumulated in the tissue provides quantitative information on local function. Radionuclide therapy is similar to radiotherapy. It differs in that the source of radiation is administered into the body and acts locally. The course provides a review of diagnostic medical imaging and explains the specific role of nuclear medicine. Scintigraphic methods are explained with their applications in cardiology, oncology, neurology, nephro-urology, endocrinology, gastro-enterology, pulmonary and inflammatory diseases. Lecture on radionuclide therapy is also included. Technical subjects cover basic science of nuclear medicine, including atomic and nuclear physics, radiation biology and protection, radiopharmaceuticals, instrumentation, interpretation of digital images, functional imaging, and principles of emission tomography. Theory is completed by interactive seminars and clinical demonstrations. Recently, an importance of nuclear medicine methods increases because they are well designed to transfer the results of molecular biology and genetics into clinical practice (molecular imaging).
Aim of the course -
Last update: prof. MUDr. Martin Šámal, DrSc. (09.09.2019)

Educational objectives:

Upon completion of the course, the students will be able to

1) desribe a role of nuclear medicine in medical diagnostics and therapy,
2) explain clinical applications of principal nuclear medicine methods
(their main indications and interpretation of results),
3) understand differences between analogue and digital diagnostic images
and apply basic tools for computer image processing,
4) understand basic principles of emission tomography (SPECT, PET) and
their clinical applications,
5) understand and follow basic principles of radiation protection.
Syllabus -
Last update: prof. MUDr. Martin Šámal, DrSc. (09.09.2019)

Syllabus of the English course in nuclear medicine

*) items 01-03 are supposed to be known from previous education - they are not
fully presented in the course again but they are (in a very basic form) required
for exam

01*) Basic atomic and nuclear physics - organization of the atom, structure of
nucleus, atomic and mass number, nuclides, isobars, isotopes, isotones, isomers

02*) Radioactive decay - alpha decay, beta-plus, beta-minus, gamma emission,
units of activity (Becquerel, Curie), specific activity, kinetics of radioactive decay
(general equation, half life, effective half life), statistics of radiation counting

03*) Interaction of radiation with matter - ionization and excitation, charged particles
(specific ionization, linear energy transfer, range, bremsstrahlung, annihilation),
ionizing electromagnetic radiation (coherent scatter, photoelectric effect, compton
interaction, pair production)

04) Radiation biology - cellular radiation biology (effect of radiation on cells, direct and
indirect action of radiation, radiosensitivity of cells), repair of radiation injury, factors
affecting cell response to radiation (dose rate, linear energy transfer, chemicals,
stage of the cell cycle), short-term effects of total body irradiation (acute radiation
syndrome, hemopoietic death, gastrointestinal death, central nervous system death),
late effects of ionizing radiation (somatic effects, genetic effects, deterministic
effects, stochastic effects), assessment of low dose - low dose rate effects on
human health, hormesis

05) Radiation safety and protection - radiation exposure (quantities and units),
radiation regulations, dose limits, principles of radiation protection, guidelines for
personnel, radiation monitoring, internal radiation dosimetry, radiation dose -
quantities and units, ALARA program

06) Production of radionuclides and radiopharmaceuticals - cyclotron-produced
radionuclides, reactor-produced radionuclides, radionuclide generators, methods of
radiolabeling, diagnostic radiopharmaceuticals, PET radiopharmaceuticals, quality
control (radionuclide purity, radiochemical purity, chemical purity, sterility,
apyrogenicity, toxicity), examples of most frequently used radiopharmaceuticals
including their most important clinical applications

07) Nuclear medicine instrumentation - radiation detection and instrumentation, gas-
filled detectors, scintiallation and semi-conductor counters, imaging devices,
scintiallation or gamma cameras, multicrystal cameras, performance parameters of
imaging devices (spatial resolution, sensitivity, uniformity, contrast, quality control),
whole-body imaging, tomographic imaging devices, hybrid systems ET/CT

08) Computers and data processing in nuclear medicine - acquisition (static,
dynamic, whole-body, tomographic, list mode, matrix mode, gated mode), storage,
processing, and display of image data, analogue and digital images, image filtering,
image arithmetic, background subtraction, functional or parametric images, regions
of interest, curve generation, tomographic image reconstruction - simple
backprojection, filtered backprojection, iterative techniques, quantitative imaging,
image fusion or registration (correlative imaging), information storage and retrieval,
statistical decision theory (sensitivity, specificity, diagnostic accuracy)

09) Principles of emission tomography - single-photon emission tomography, positron
emission tomography, radiopharmaceuticals, principles of detection, instruments,
tomographic image reconstruction, whole-body imaging, spatial resolution,
sensitivity, principles of clinical applications, examples of clinical applications

10) Cardiovascular system - anatomy and physiology, radionuclide ventriculography
(first pass, blood pool), myocardial perfusion imaging, infarct-avid imaging, metabolic
imaging, new methods (neuronal imaging, atherosclerosis, thrombus imaging,
apoptosis), lymphoangioscintigraphy, radionuclide phlebography

11) Central nervous system - anatomy and physiology, cisternography, brain perfusion
study - SPECT, clinical applications (acute stroke, brain trauma, focal epilepsy,
dementia and depression, Parkinson's disease and parkinsonian syndromes,
tumours, receptor systems, brain death)

12) Endocrine system - anatomy and physiology, thyroid imaging, parathyroid imaging

13) Gastrointestinal system - anatomy and physiology, gastric emtpying study,
gastrointestinal bleeding study, gastroesophageal reflux, detection of Meckel's
diverticulum, hepatobiliary study

14) Genitourinary system - anatomy and physiology, static imaging (renal cortical
scintigraphy), dynamic imaging (basis renogram), pharmacological intervention
studies (diuretics, ACE inhibition), renal transplant scintigraphy, radionuclide
cystography, scrotal imaging (testicular scan)

15) Pulmonary system and thromboembolism - anatomy and physiology, lung
ventilation scintigraphy, lung perfusion scintigraphy, venography

16) Skeletal system - anatomy and physiology, bone scintigraphy (planar, SPECT),
three (multiple) -phase bone imaging

17) Inflammatory processes - gallium scintigraphy, leukocyte scintigraphy, labelled
antibodies, 18F-fluorodeoxyglucose (FDG)

18) Tumour imaging - cancer staging, evaluation of treatment response, imaging of the
sentinel nodes, a role of PET in cancer diagnosis

19) Radionuclide therapy - benign disease, thyroid carcinoma, myeloproliferative
disease, MIBG therapy, palliative therapy of painful skeletal metastases,
logoregional applications of radionuclide therapy, radioimmunotherapy, peptide
therapy, antisense radiotherapy, new radionuclides
Literature - Czech
Last update: prof. MUDr. Martin Šámal, DrSc. (26.09.2023)

Povinná:

  • Kupka, Karel, Kubinyi, Jozef, Šámal, Martin. Nukleární medicína. V Praze: P3K, 2015, 161 s. ISBN 978-80-87343-54-8.

  • Kupka, Karel, Kubinyi, Jozef, Šámal, Martin. Nukleární medicína. [online]. Dostupné z: https://unm.lf1.cuni.cz

Volitelná:
Teaching methods -
Last update: prof. MUDr. Martin Šámal, DrSc. (29.08.2023)

The dates of individual courses and lesson times can be found at https://unm.lf1.cuni.cz (English).
Entry requirements -
Last update: prof. MUDr. Martin Šámal, DrSc. (29.08.2023)

In order to facilitate learning for exam at the end of the course (Friday), it is recommended to go through the lectures on the web (https://unm.lf1.cuni.cz) before the course.
Course completion requirements -
Last update: prof. MUDr. Martin Šámal, DrSc. (26.09.2023)

Nuclear medicine course is closed by oral exam. A condition for the exam is credit subject to the student's presence in the course. During the exam, each student replies two questions - one clinical question and one question from the basic science of nuclear medicine (medical physics, radiobiology, radiation protection, radiopharmacy,...). Part of the exam are also additional questions asked to verify overall orientation of the examined student in nuclear medicine and its understanding. Final mark reflects the answers to all questions asked during the exam. Substantial ignorance manifested by the student's failure to answer one of the questions is the reason to finish the exam with classification 'failed'.

 

 

 

 

 
Requirements to the exam -
Last update: prof. MUDr. Martin Šámal, DrSc. (27.09.2023)

Questions

Each candidate will answer 2 questions: 1 clinical topic (1 - 15) and 1 physical topic (16 - 22).

Please note that a complete answer to a clinical question includes 6 parts - (a) major clinical indications, (b) radiopharmaceuticals, (c) pharmacodynamics, (d) patient preparation, (e) the course of the examination, and (f) interpretation, i.e. explanation of normal and abnormal results. Additional questions may be asked by the examiner to assess candidate's knowledge.


Clinical Section 

01) Nuclear Cardiology 1 – Myocardial Perfusion Scintigraphy, Myocardial Viability 

02) Nuclear Cardiology 2 – Cardiac Amyloidosis, Cardiovascular Inflammations (Infective Endocarditis, Vasculitides), Equilibrium Gated Ventriculography, Cardiac Shunts Detection

03) Radionuclide Diagnostics in Pulmonology – V/P Scan (Perfusion Pulmonary Scintigraphy, Ventilation Pulmonary Scintigraphy), Examination of Pulmonary Malignancies, Sarcoidosis

04) Nuclear Neurology – Diagnosis of Extrapyramidal Disorders, Diagnosis of Dementias, Perfusion Brain Imaging, Brain Death

05) Diagnostics of Digestive Tract Diseases – Examination of Food Transport by the Esophagus, Gastric Emptying, Localization of Bleeding Site in the Gastrointestinal Tract, Identification of Ectopic Gastric Mucosa (Meckel's Diverticulum), Gastrointestinal Tumors, Static Liver Scintigraphy
 
06) Nuclear Nephrology – Dynamic Renal Scintigraphy, Static Renal Scintigraphy, Measurement of Total Kidney Function, Radionuclide Cystography 

07) Skeletal Scintigraphy – Static, Three-Phase Scintigraphy

08) Imaging of Lymphatic and Vascular Systems – Lymphoscintigraphy, Detection of Sentinel Lymph Node, Radionuclide Phlebography

09) Endocrinological Diagnostics – Role of Nuclear Medicine Methods in Endocrinology, Thyroid Scintigraphy, Parathyroid Glands, Adrenal Glands 

10)Diagnostics of Acute Conditions – Role of Nuclear Medicine Methods in Diagnosing Acute Conditions, Ventilation-Perfusion Scintigraphy, Detection of Gastrointestinal Bleeding, Localization of Fever/Sepsis of Unknown Origin, Brain Death, Testicular Torsion 

11) Inflammation Diagnostics – Scintigraphy with Labeled Leukocytes, PET

12) Oncological Diagnostics 1 – Scintigraphic Diagnosis of Tumors (Skeletal Scintigraphy, Neuroendocrine Tumors: Somatostatin Receptors, MIBG), Theranostics

13) Oncological Diagnostics 2 – PET in Malignancies in General, Use of 18F-Fluorodeoxyglucose from a Clinical Perspective, Lymphomas, Prostate Carcinoma, Neuroendocrine Tumors

14) Radionuclide Therapy 1 – Treatment of Malignant and Benign Thyroid Gland Diseases

15) Radionuclide Therapy 2 – Palliative Treatment of Bone Metastases, Theranostics, Radionuclide Synovectomy


Physical Section

16) Basic Physical Terms and Concepts – Radioactivity, Types of Radiation and Their Use in Medicine, Fundamental Quantities and Their Units (Activity, Energy, Doses), Interaction of Ionizing Radiation with Matter 

17) Biological Effects of Ionizing Radiation – Mechanism of Biological Effects, Deterministic Effects, Stochastic Effects, Assessment of Radiation Exposure 

18) Radiation Protection – General Principles, Assessment of Radiation Exposure, Radiation Protection of Patients, Radiation Protection of Radiation Workers  

19) Radiopharmaceuticals – Definition, Production and Preparation, Quality Assessment, Examples of Clinical Use 

20) Principles of Conventional Scintigraphy – Construction of Gamacamera, Function of its Components, Image Formation, Types of Imaging (Planar Scintigraphy vs. SPECT, Static vs. Dynamic Scintigraphy), Differences from PET and Radiological Methods 

21) Principles of Positron Emission Tomography – Construction of the Camera, Function of Components, Image Formation, Comparison with Conventional Scintigraphy and Radiological Methods (Differences, Advantages, Disadvantages)

22) Diagnostic Accuracy of Examinations – Sensitivity, Specificity, Predictive Values, ROC Curves, Clinical Practice Significanceáření s hmotou 



Version 6.0, 26.09.2023
 
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