Mark Crosthwaite, CNMT
Office Hours - Wednesdays - 8:30 am to 10:00 pm and 3:00 PM to 4:30 PM

Phone (804) 828 - 3264 - Office
Phone (804) 855 - 3264 - Cell

 CRS 319 NUCLEAR MEDICINE PROCEDURES III
Summer Semester 2023

Dates:   Starts May 24 and ends July 26
Meeting Time: Wednesday 1000 - 1150 hours and 1300 to 1450 hours
Location: Room 3003

Course Description
This is a 3 credits course. The prerequisites are CLRS 318 and CLRS 322. Presentation of the techniques employed in the performance of routine nuclear medicine imaging procedures. Topics of discussion will be in the areas of renal imaging, CNS imaging, thyroid imaging, therapy, and a brief introduction to monoclonal antibodies.   Each imaging are will include an in depth view of:   anatomy and physiology, pathology, patient preparation, contra indications, radiopharmaceutical application, route of administration, biodistribution, imaging protocols, equipment setup, and common findings.

Required Textbooks
Christian, PE, KM Waterstram-Rich.  Nuclear Medicine and PET/CT Technology and Techniques, Mosby/Elsevier, St. Louis , 2016, 8^th Edition

Procedure Standards Binder - SNMMI

Reading Assignments

Chapter 17 Endocrine System: pp. 431
Thyroid uptake, imaging, and therapy
Neuroendocrine
Parathyroid
Adrenal
SNMMI Procedures for the Endocrine System - https://www.snmmi.org/ClinicalPractice/content.aspx?ItemNumber=6414#Endocrine

Chapter 21 Genitourinary System
Section on Renal pp.556
SNMMI Procedures for Genitourinary System - https://www.snmmi.org/ClinicalPractice/content.aspx?ItemNumber=6414#Genitourinary

Chapter 16 Central Nervous System
Entire chapter pp. 407
SNMMI Procedures for the Central Nervous System - https://www.snmmi.org/ClinicalPractice/content.aspx?ItemNumber=6414#CNS

 Use VCU Libraries to find and access library resources, spaces, technology and services that support and enhance all learning opportunities at the university.

Grading Policy:

Grades will be based on objective tests consisting of registry type multiple choice questions as well as discussion questions and fill in the blank.

The grading scale is as follows:

Students are expected to score at least a cumulative grade of 70% according to the weighting factors described below.

1. Exams will encompass information discussed during lectures, handouts given in class, and homework/reading assignment.  Failure to take an exam on a scheduled exam day will automatically cause a 5% deduction on the make-up exam.  Make-up must be scheduled and completed ASAP, so that the entire class has the opportunity to review the results the following week.  The only exception given to this policy will be if the student has made prior arrangements with the instructor.
2. There will be unannounced quizzes and Kahoots given throughout the semester and will occur at the beginning of class. Make-up quizzes will not be given.  A quiz will be completed within the first 5 minutes of class. You will be allowed to drop your lowest quiz or homework grade.
3. Kahoots will also be planned. If you are attending class you will get credit for taken the Kahoot quiz.
4. The Department Chair establishes policies and schedules for the CLRS final exams. The Department Chair must approve any changes regarding scheduling the course final exam. A penalty may be imposed for missing a scheduled final exam.

5. Any assignment or homework given in class must be completed in a time designated by the instructor.  Late assignments will not be accepted.
6. This is one of the professional courses in which the lowest passing grade is “C”.
7. One additional percent will be added your final grade if you complete the course evaluation, before the last day of the class.

Attendance is mandatory for all classes.

 Teaching/Learning Methods:

1. Class lectures will center around assigned reading material. A set of lecture notes with salient information will be distributed each week. These lecture notes are not all inclusive. Test material may be derived from any of the assigned reading material or from the lecture. The technical procedures from Sodee and Early are to be considered the appropriate technique for test purposes unless another technique is presented in the lecture notes and stated to be the technique of choice.
2. The student must be prepared for class. The reading assignments will be the basis for class discussions; therefore, the student must complete all reading assignments including handouts and notes before they are discussed in class.
3. Clinical assignments are due on the final class meeting. A complete set of instructions will be provided to each student.
4. Pop quizzes can be given at anytime. The quizzes may consist of any number of questions. The quizzes will be over any material which has been assigned regardless of whether or not the topic has been discussed in lecture.
5. Deadline to notify the instructor of any observed religious holidays is May 26^th.
6. Academic calendar

General Course Objectives:

Describe:

• The anatomy/physiology and method of radiopharmaceutical localization in the target organ system.
• The common pathologic disorders being diagnosed by the various nuclear exams discussed.
• Normal pathologic distribution of radiopharmaceuticals and image interpretation of such.
• Common abnormal study findings.
• Biologic, physical, and effective half-life as it relates to organ dose and image quality.
• Modifications of the study for use in pediatric patients.

Explain:

• Instrumentation parameters and requirements.
• Acquisition protocol: including views, sequencing, end-point, etc.
• Common artifacts encountered with each study.
• Primary photon energies used for imaging.    

Identify:

• Specific radionuclide for each nuclear medicine procedure presented.
• The rationale for radiopharmaceutical selection. Indications for the study.
• Optimal organ localization time for appropriate imaging sequence. Patient positioning and landmarks.
• Study type for the acquisition: SPECT, dynamic, planar, etc.

State:

• Patient preparation.
• Correct dose amount for an adult.
• Correct route of administration of the appropriate radiopharmaceutical.
• Computer data acquisition and processing parameters.

 ADA Policy:
Section 504 of the Rehabilitation Act of 1973 and the Americans with Disabilities Act of 1990 require VCU to provide academic adjustments or accommodations for students with documented disabilities.   Students seeking academic adjustments or accommodations must self-identify with the Coordinator of Services for Students with Disabilities on the appropriate campus.   After meeting with the Coordinator, students are encouraged to meet with instructors to discuss their needs and, if applicable, any laboratory safety concerns related to their disabilities.

Syllabus Statement - Office of the Provost
Students should visit http://go.vcu.edu/syllabus and review all syllabus statement information. The full university syllabus statement includes information on safety, registration, the VCU Honor Code, student conduct, withdrawal and more.

Campus emergency information
Sign up to receive at alert.vcu.edu/signup/. It is essential to keep your information up-to-date within VCU Alert and to keep your permanent address and emergency contact information current in eServices.

VCU uses a variety of communication methods to alert the campus community about emergency situations and safety threats. Learn more about types of alerts at alert.vcu.edu/know/types-of-alerts/

Know the emergency phone number for the VCU Police (828-1234), and report suspicious activities and objects.

Class registration required for attendance
Students may attend only those classes for which they have registered. Faculty may not add students to class rosters or Blackboard. If students are attending a class for which they have not registered, they must stop attending.

Honor System: upholding academic integrity
The VCU Honor System policy describes the responsibilities of students, faculty and administration in upholding academic integrity. According to this policy, "Members of the academic community are required to conduct themselves in accordance with the highest standards of academic honesty, ethics and integrity at all times." Students are expected to read the policy in full and learn about requirements here: http://conduct.students.vcu.edu/vcu-honor-system/

Important dates
Important dates for the semester are listed in the VCU Academic Calendar: https://academiccalendars.vcu.edu/

Reading Days
No classes or exams are held on these days except in instances where a student is involved in clinical and field placements, practical, co-ops, internships and other work-related experiential learning activities. Faculty may not give an examination or an assignment on those days. Instead, students are encouraged to use these days for relaxation, study and/or review of class materials.

We care about your success!
Virginia Commonwealth University has launched an Early Alert initiative to support student success. As your professor, if I am concerned about your academic performance in the first few weeks of this class, you and your academic advisor may receive a Progress Report email with links to appropriate academic support resources. You are encouraged to reach out to me after class or during my office hours for additional support. Your academic advisor, the Writing Center, and the Campus Learning Center may also follow up to provide additional layers of support to you.

Attendance and consequences of poor attendance
The instructional programs at VCU are based upon a series of class meetings involving lectures, discussions, field experiences, special readings and reporting assignments. Therefore it is important for each student to be in attendance on a regular basis. A student who misses a class session is responsible for completing all material covered or assignments made during the absence.

Students having attendance problems should contact their instructor to explain the reasons for nonattendance and to discuss the feasibility of continuing in the course. If the student has fallen so far behind that the successful completion of the course is impossible, the student should withdraw from the course before the end of the first 10 weeks of classes.

If the student continues to miss class and does not officially withdraw from the course, the instructor may withdraw the student for nonattendance with a mark of W before the end of the first 10 weeks of classes or may assign an academic grade at the end. Withdrawals are not permitted after the end of the first 10 weeks of classes. For classes that do not conform to the semester calendar, the final withdrawal date occurs when half of the course has been completed. Withdrawal dates for summer session classes are provided at https://rar.vcu.edu/registration/registration-guide/add-drop-or-withdraw/.

Career Services
Looking for ways to tie what you are learning in your class to your future career or professional goals? VCU Career Services provides career planning services for all current VCU students and alumni. Career Services can help students with finding a work-study job on/off campus, resume writing, internship development, interviewing, preparing for graduate school, networking, or job searching,. Students are invited to attend career events and workshops, and schedule individualized career advising appointments. For more information and to make a career advising appointment, visit the VCU Career Services website.

Managing stress
Students may experience situations or challenges that can interfere with learning and interpersonal functioning including stress, anxiety, depression, alcohol and/or other drug use, concern for a friend or family member, loss, sleep difficulties, feeling hopeless or relationship problems. There are numerous campus resources available to students including University Counseling Services (804-828-6200 MPC Campus, 804-828-3964 MCV Campus) which provides brief therapy treatment, University Student Health Services (MPC 804 828-8828, MCV Campus 804 828-9220) and the Health Promotion and Well-Being Center [The Well] (804-828-9355). 24 hour emergency mental health support is available by calling (804) 828-6200 or utilizing the National Suicide Prevention Lifeline (1-800-784-2433).

Mandatory responsibility of faculty members to report incidents of sexual misconduct
All employees, including faculty, department chairs and deans, are required to report any incidents of sexual assault, sexual exploitation and partner or relationship violence to the university's Title IX Coordinator.

Confidential offices which can provide support at VCU are: University Counseling Services, (804) 828-6200

For more information about Title IX, please visit https://equity.vcu.edu/.

Military short-term training or deployment
If military students receive orders for short-term training or for deployment/mobilization, they should inform and present their orders to Military Student Services and to their professor(s). For further information on policies and procedures contact Military Student Services at 828-5993 or access the corresponding policies.

Student email standard
Email is considered an official method for communication at VCU. Students are expected to check their official VCU email on a frequent and consistent basis (the university recommends daily) in order to remain informed of university-related communications. Students are responsible for the consequences of not reading, in a timely fashion, university-related communications sent to their official VCU student email account. Mail sent to the VCU email address may include notification of university-related actions, including disciplinary action. Students must read this standard in its entirety at https://ts.vcu.edu/media/technology-services/content-assets/university-resources/ts-groups/information-security/StudentEmailStandard.pdf

Student financial responsibility
Students assume the responsibility of full payment of tuition and fees generated from their registration, all charges for housing and dining services and other applicable miscellaneous charges. Students are ultimately responsible for any unpaid balance on their account as a result of the University Financial Aid Office or their third party sponsor canceling or reducing their award(s).

Students representing the university – excused absences
Students who represent the university (athletes and others) do not choose their schedules. All student athletes should provide their schedules to their instructors at the beginning of the semester. The Intercollegiate Athletic Council strongly encourages faculty to treat missed classes or exams (because of a scheduling conflict) as excused absences and urges faculty to work with the students to make up the work or exam.

Students with disabilities
Section 504 of the Rehabilitation Act of 1973 and the Americans with Disabilities Act of 1990, as amended, require that VCU provide "academic adjustments" or "reasonable accommodations" to any student who has a physical or mental impairment that substantially limits a major life activity. To receive accommodations, students must register with the Office of Student Accessibility and Educational Opportunity on the Monroe Park Campus (828-2253) or the Division for Academic Success on the MCV campus (828-9782). Please also visit the Student Accessibility and Educational Opportunity website via https://saeo.vcu.edu/ and/or the Division for Academic Success website via https://das.vcu.edu/ for additional information.

Once students have completed the registration process, they should schedule a meeting with their instructor (s) and provide their instructor (s) with an official accommodation letter. Students should follow this procedure for all courses in the academic semester.

Withdrawal from classes
Before withdrawing from classes, students should consult their instructor as well as other appropriate university offices. Withdrawing from classes may negatively impact a student’s financial aid award and his or her semester charges. To discuss financial aid and the student bill, contact the Student Financial Management Center (RAMQ) regarding the impact on your financial aid.

Faculty communication about students
VCU instructional faculty, administrators and staff maintain confidentiality of student records and disclose information in accordance with the Family Educational Rights and Privacy Act (FERPA). This means that VCU officials may disclose student record information without the consent of the student in certain situations. To support university operations, for example, VCU officials share information about students with other educational officials as necessary to perform their job duties. FERPA permits this disclosure to school officials who have a legitimate educational interest in the student information. In addition, VCU officials have obligations to report information shared by a student depending on the content of that information, for example, in compliance with VCU’s policy on the duty to report. Unless FERPA permits a certain disclosure, VCU generally requires consent from a student to disclose information from their education record to another individual. My favorite candy is gummy bears. You may find additional information on the VCU FERPA website: http://rar.vcu.edu/records/family-educational-rights-and-privacy-act/.

Lecture Outline - Dates may overlap
This is a tentative outline of lecture/exam material that may be modified as the semester progresses.

Endocrine Imaging Applied Therapies May 24 to 31

• A and P, Plus biodistribution of the thyroid
• Indications for the procedures
• Patient preparation (if any)
• Radiopharmaceutical/dose amount/route
• Acquisition: Planer SPECT, Dynamic, and/or Whole Body
• Imaging parameters and computer processing
• Uptake and therapy calculations
• Therapeutic applications for hyper/Ca of the thyroid*
• Parathyroid
• Bexxar/Zevalin
• Outcomes

Endocrine System Objectives

1. Compare the iodines and ^99mTc and know the associated physiology.
2. Understand and apply the negative biofeedback loop in thyroid physiology.
3. Know the different diseases in hyper and hypothyroidism.
4. Differentiate the different types of thyroid cancer.
5. Calculate and compare the two different types of thyroid uptake equations. 
6. Define TSH and Cytomel suppression procedures.
7. Have a general understanding on how different agents compete with thyroid uptake and scan.
8. Apply the ideal uses for ¹²³I, ¹³¹I, and ^99mTc in thyroid uptake and imaging.
9. Consider therapeutic applications (nuclear and non-nuclear) of thyroid diseases (hyperthyroidism and cancer)

Exam I - 10AM June 7

Renal Imaging June 14 to June 20

• A and P - plus biodistribution
• Indications for the procedures
• Patient preparation (if any)
• Radiopharmaceutical/dose amount/route
• Acquisition: Planer SPECT, Dynamic, and/or Whole Body
• ERPF and GFR
• ROI application
• Vesicoureteral Reflux
• Adrenal and neuroendocrine tumors
  • MIBG
  • Octreotide
  • NP-59

Renal Objectives

1. Discuss renal anatomy and physiology
2. Identify the types of radiopharmaceuticals used to image the kidneys associated pathophysiology.
3. Assess the diagnostic potential of renal image with kidney diseases.
4. Evaluate quantitative assessment of renal imaging.
5. Compare time-activity curves.
6. Identify the process to evaluate vesicoureteral reflux.

Exam II - June 27

Brian and CSF Imaging July 5 and 12

• A and P, Plus biodistribution
• Indications for the procedures
• Patient preparation (if any)
• Radiopharmaceutical/dose amount/route
• Acquisition: Planer SPECT, Dynamic, and/or Whole Body
• Brain imaging with PET
  • Tracers that do not cross the BBB
  • Tracers that cross the BBB
• Cisternograms
• Alzheimer imaging
• Imaging parameters and computer processing

CNS Objectives

1. Identify basic brain anatomy and physiology (BBB).
2. Compare the radiopharmaceutical applied in brain imaging.
3. Outline imaging protocols used in nuclear medicine to imaging CNS.
4. Review and discuss CSF imaging protocols.
5. Apply SPECT/PET protocols to evaluate brain function and disease.

Exam III - July 19

Review for final exam on July 19

Final Exam on July 26

Return to the Home Page

5/23

clrs319syllabus22.html