Table 2

Core Competency Components and Curricular Milestones for Training in Nuclear Cardiology

Competency ComponentMilestones (Months)
1Know the principles of SPECT and radionuclide ventriculography image acquisition and display, including the standard tomographic planes and views.I
2Know the properties and use of standard perfusion tracers.I
3Know the principles of radiation safety and how to minimize radiation exposure.II
4Know the indications for myocardial perfusion imaging and the appropriate selection of exercise versus pharmacologic stress testing.I
5Know the principles and use of pretest probability and sequential probability analysis to assess post-test probability.I
6Know the mechanism of pharmacologic stress agents, methods of their administration, and safety issues in using the agents.I
7Know the protocols for administration of standard perfusion agents and the influence of the clinical situation on choice of imaging protocol.I
8Know the quality control issues, how to review raw data, and recognize artifacts.II
9Know the use of nuclear cardiology in the assessment of ventricular function.I
10Know the protocols for the use of perfusion imaging to assess myocardial viability.I
11Know the indications for PET imaging and use of PET tracers.II
EVALUATION TOOLS: direct observation and in-training examination.
1Skill to select the appropriate imaging study.I
2Skill to integrate perfusion imaging findings with clinical and other test results in the evaluation and management of patients.I
3Skill to identify results that indicate a high-risk state.I
4Skill to perform and interpret gated stress-rest perfusion study.II
5Skill to perform and interpret a radionuclide ventriculography study.II
6Skill to perform and interpret hybrid SPECT/CT and PET/CT imaging.III
7Skill to perform and quantify PET absolute myocardial blood flow and metabolism.III
8Skill to perform and interpret cardiac innervation, first pass, and planar studies.III
EVALUATION TOOLS: conference presentation, direct observation, and logbook.
1Work effectively and efficiently with the nuclear laboratory staff.II
2Incorporate risk/benefit and cost considerations in the use of radionuclide imaging techniques.I
3Participate in laboratory quality monitoring and initiatives.II
EVALUATION TOOLS: chart-stimulated recall, conference presentation, direct observation, and multisource evaluation.
1Identify knowledge and performance gaps and engage in opportunities to achieve focused education and performance improvement.I
EVALUATION TOOLS: conference presentation and direct observation.
1Know and promote adherence to guidelines and appropriate use criteria.I
2Interact respectfully with patients, families, and all members of the healthcare team—including ancillary and support staff.I
EVALUATION TOOLS: chart-stimulated recall, conference presentation, and direct observation.
1Communicate effectively and timely with patients, families, and referring physicians.III
2Communicate test results in a comprehensive and user-friendly manner.II
EVALUATION TOOLS: direct observation and multisource evaluation.

Add = additional months beyond the 3-year cardiovascular fellowship; CT = computed tomography; PET = positron emission tomography; SPECT = single-photon computed tomography.