Nuclear Radiology

The nuclear radiology (NR) fellowship program at the Hospital of the University of Pennsylvania provides comprehensive experience in all aspects of nuclear medicine, including both diagnostic and therapeutic applications of radionuclides. Fellows receive instruction in theoretical and practical aspects of the field, including relevant basic sciences.

The fellowship includes clinical training in general adult nuclear medicine, pediatric nuclear medicine, nuclear cardiology, positron emission tomography, and radionuclide therapy as well as instruction in medical nuclear physics, radiation biology, radiation protection, instrumentation, radiopharmaceutical chemistry, and statistics. Past fellows have gone on to excellent positions in both clinical and academic programs. The Penn Nuclear Medicine Division is a very active clinical practice and also participates in a wide range of research activities in which fellows are encouraged to participate. The Division has a broad range of capabilities including advanced SPECT and PET/CT imaging, and include a cyclotron facility that produces PET imaging agents for both clinical and research studies. The program meets all of the training requirements recommended by the American Board of Nuclear Medicine (ABNM) and the American Board of Radiology for NR specialty certification.

The principal objectives of the NR Fellowship program are:

  • To teach the safe handling and use of unsealed radioactive preparations for medical purposes.
  • To teach the technical skills required to effectively diagnose and treat patients with radiotracer preparations.
  • To train fellows in the interpretation of diagnostic nuclear medicine imaging studies in the context of correlative imaging and consideration of the clinical and biologic context of the nuclear medicine imaging.
  • To train fellows in all aspects of radionuclide therapy, including evaluating patients for possible treatment, administering treatment, and following the patients post-therapy.
  • To teach trainees a system of self-learning that will allow them to continuously adapt to a constantly changing field of medical science. To prepare the trainees for successful careers in both academic medicine and clinical practice.

Conferences

The didactic teaching component of the fellowship program includes weekly Nuclear Medicine Morning Conferences, which features lectures on clinical nuclear medicine, radiochemistry, physics and instrumentation, and journal clubs. There is also a weekly case conference geared towards fellow teaching. Fellows also attend the Nuclear Medicine Basic Science Course, which is a didactic program given each year to NR fellows. Basic sciences (physics and instrumentation, radiopharmaceutical chemistry, radiation biology, radiation protection, and statistics) are heavily emphasized in this course. Clinical faculties participate in the basic science course to enhance clinical relevance. Fellows also attend a 3-4 day long Nuclear Medicine Practicum with a visit to NDP as well as cyclotron.

Teaching during clinical rotations includes close supervision by the attending staff. Throughout the day, nuclear medicine examinations are reviewed by the faculty physicians and discussed with the trainees. Clinical teaching provides a good opportunity for the trainees to utilize the knowledge they have gained in the classroom towards daily clinical activities in the nuclear medicine clinic. The trainees take the primary responsibility for performing the required examination including interviewing the patients, quality control and reviewing and dictating results.

Clinical Rotations

There are several different monthly rotations for the fellows: cardiac nuclear medicine (HUP), general nuclear medicine (HUP), pediatric nuclear medicine (Children's Hospital of Philadelphia), clinical PET (HUP), and nuclear medicine and PET (Veterans Affairs Medical Center). During a training period of 1 year in nuclear medicine, each fellow spends at least 3 months each in PET and general nuclear medicine, 2 months in nuclear cardiology, and 1 month in pediatric nuclear medicine. In addition, fellows also participate in a weekly radionuclide therapy clinic where patients are seen in office visits prior to or after their treatments. Extensive training is provided during the Basic Science Course and morning conferences with regards to physics, dosimetry, radiobiology, quantitative image analysis, and radiation safety in nuclear medicine.

The program is structured so that the trainee's responsibilities increase progressively throughout the fellowship. During the first 6 months of training, trainees are more closely supervised, but they are progressively allowed more responsibility for the remainder of the program. The program also is sufficiently flexible so that trainees with varied backgrounds can adjust to the rigorous educational activities provided. In each of the rotations assigned, the primary responsibility for the service belongs to the attending faculty physician. The trainees work under the direct supervision of the designated attending physician. However, depending on the degree and the duration of training, trainees are allowed a substantial level of independence. Ultimate responsibility lies with the attending physician, however, and fellows are encouraged to consult them when they are uncertain about decisions that may adversely affect the patient.

Fellows are given ample opportunity and resources to participate in clinical and/or basic science research. The trainees become familiar with a variety of methods of investigation, with a special emphasis on the use of radionuclides. Each trainee is expected to participate in ongoing research activities, choosing from a range of possible projects, under the supervision of clinical and/or basic science faculty.

During their clinical rotations the fellows are exposed to a high volume of clinical studies and wide variety of pathology. The Radiology department at HUP, Perelman Center for Advanced Medicine, Penn Presbyterian Medical Center, Pennsylvania Hospital and Community affiliates have state of art imaging equipment including 5 Time of flight PET/CT scanners, 7 SPECT/CT scanners, 2 dual head Gamma cameras, 1 single head large field and 2 single head portable Gamma cameras.

As of May 2015, NR fellows will have exposure to the following equipment:

HUP:

  • 7 SPECT/CTs
  • One single head large field and two single head portable gamma cameras
  • Uptake probe
  • Gamma well counter system
  • 4 time-of-flight PET/CTs

HUP (PMC studies):

  • One dual head gamma camera

HUP (Radnor studies):

  • One dual head gamma camera

HUP (Valley Forge studies):

  • One time-of-flight PET/CT

Trainees can expect that for the following rotations on each clinical day each trainee will be personally involved in:

  • General nuclear medicine: 20-40 individual patient studies
  • PET/CT: 8-12 studies
  • Cardiac: 6-12 studies

Fellow Responsibilities

Trainees are expected to report to their assigned clinical service at 8:00 a.m. each day. In general, trainees spend 8 hours/day conducting their respective duties. Trainees are on-call every 4-5 weeks for an equivalent period of one week each time, providing early evening coverage but not weekend coverage. An assigned attending physician covers call with the fellows, and they are assisted by the technologist during call periods. Trainees are in some cases able to read studies remotely and are called in when needed.

Learn about requirements and how to apply »

Contact

David A. Mankoff, MD, PhD
Chief Nuclear Medicine and Nuclear Radiology Program Director
Attn: Sandra Carney
Hospital of the University of Pennsylvania
3400 Spruce Street, 110 Donner
Philadelphia, PA 19104
Office: 215-662-3091
Email: sandra.carney@uphs.upenn.edu