Rotations
Nuclear
Rotations · Nuclear · Workflows
The three you will reach for
The same cards as the library below, put where they are asked for fifty times a week.
ETT / Stress Test Workflow
How it goes
- Review the study before the patient is on the treadmill: the indication, and enough history and physical to know it can be done safely.
- Check the indication against the safety review, and the contraindications.
- Review the baseline ECG.
- Supervise the exercise itself.
- Watch the symptoms and the hemodynamics through the test.
- Take the patient through recovery.
- Give a preliminary interpretation of the resting and stress ECGs.
- Escalate an abnormal finding rather than leaving it in the report.
Nuclear / PET Pre-Read Workflow
How it goes
- Open the worklist.
- Review the indication, the history and any prior studies.
- Review the raw data and the study quality.
- Work through perfusion and function.
- Check for artifact before you commit to a defect.
- Interpret the risk, not only the pictures.
- Draft a preliminary impression.
- Take it to the reader of the day for feedback and finalization.
Software & Image WorkflowUnverified
The local click paths in CSImport on Citrix and Fuji PACS Web, and how a study moves from acquisition to interpretation. §03 adds one rule about this card specifically: login and password handling stays behind authorized system controls and no credential appears in page markup — which is why nothing about signing in is written here.
Answered by: Program
Structured interpretation
What a nuclear report covers, in order. §05’s own list.
- Indication
- Stress adequacy
- ECG response
- Perfusion
- LV function
- Artifacts and limitations
- Risk impression
- Comparison with prior studies
Stress Testing
The morning half of the rotation, and the one with a patient on a treadmill.
Exercise treadmill test workflowPre-test review through recovery, in order
How it goes
- Review the study before the patient is on the treadmill: the indication, and enough history and physical to know it can be done safely.
- Check the indication against the safety review, and the contraindications.
- Review the baseline ECG.
- Supervise the exercise itself.
- Watch the symptoms and the hemodynamics through the test.
- Take the patient through recovery.
- Give a preliminary interpretation of the resting and stress ECGs.
- Escalate an abnormal finding rather than leaving it in the report.
Pharmacologic stress overviewUnverified
Which agent this lab uses by default, who orders it, who administers it, and what the fellow is responsible for. No dose, infusion rate or reversal threshold is written anywhere in this repository and none should be added without pharmacy.
Answered by: Program
Baseline ECG reviewUnverified
What the baseline review has to cover before a patient exercises, in the lab’s own terms.
Answered by: Program
Contraindications / when to pauseUnverified
The local list, and who decides when a test is held rather than run.
Answered by: Program
Abnormal stress response escalationUnverified
Who is called, in what order, for an abnormal response during the test itself.
Answered by: Program
Post-test recovery and documentationUnverified
How long recovery is monitored, and where the test is documented.
Answered by: Program
Image Acquisition & Processing
What happens between the camera and the worklist.
Morning image processing with the technologistUnverified
What an F1 actually does at the processing station in the morning, step by step.
Answered by: Program
Raw data reviewUnverified
How raw data is opened and what is looked at first.
Answered by: Program
Attenuation / motion artifact checksUnverified
The local check, and what is done about a study that fails it.
Answered by: Program
Gated acquisition basicsUnverified
The acquisition parameters this lab uses and why.
Answered by: Program
Image reconstruction / processing overviewUnverified
The processing sequence, in the software this lab runs.
Answered by: Program
Interpretation
The afternoon half, and the skill the fellowship is measured on.
SPECT myocardial perfusion pre-readWorklist to preliminary impression, in order
How it goes
- Open the worklist.
- Review the indication, the history and any prior studies.
- Review the raw data and the study quality.
- Work through perfusion and function.
- Check for artifact before you commit to a defect.
- Interpret the risk, not only the pictures.
- Draft a preliminary impression.
- Take it to the reader of the day for feedback and finalization.
PET perfusion pre-readUnverified
Where the PET pre-read differs from the SPECT one in this lab — what is reviewed, in what order, and whether flow quantification is part of the routine read.
Answered by: Program
Gated LV functionUnverified
What is reported, and from which software output.
Answered by: Program
ViabilityUnverified
When a viability study is done here, and how it is read.
Answered by: Program
High-risk findingsUnverified
The lab’s own threshold for calling a study high risk, as opposed to the published framework on the Clinical Guide.
Answered by: Program
Compare with prior cath, echo and stress dataUnverified
Where the prior studies are found, and what is compared.
Answered by: Program
Radiation / Lab Operations
The part of the rotation that is a licence rather than a skill.
Technologist exposure weekThe F2 requirement, and the three areas it has to cover
How it goes
- Radiopharmaceutical handling and dose preparation, with the technologist.
- Camera quality control.
- Image acquisition and processing.
How the week is scheduled and who signs it off. The requirement itself is stated — at least one week of technologist-guided exposure across all three areas — and is what the steps above are.
Answered by: Program
Radiopharmaceutical handling exposureUnverified
What a fellow may and may not handle, and under whose licence. No tracer, activity or preparation step is written here.
Answered by: Program
Dose preparationUnverified
The same question, for dose preparation specifically. This is a radiation-safety boundary, not a workflow to sketch.
Answered by: Program
Camera quality controlUnverified
The daily QC routine, and what a fellow observes versus performs.
Answered by: Program
Radiation-safety basicsUnverified
The local badge, monitoring and contamination procedure, and who to tell when something goes wrong.
Answered by: Program
Authorized User / Level II requirementsUnverified
What Authorized User status requires here, how the 80-hour course is arranged, and who tracks it. The published Level I and Level II numbers are on Quick Reference and Progress, from a dated table.
Answered by: Program
Communication & Safety
Half of this rotation’s obligations end in a telephone call.
Critical result communicationRecognize it, reach the ordering physician, and document that you did
How it goes
- Recognize the finding as one that has to be communicated rather than reported.
- Identify the requesting or ordering physician.
- Contact them directly.
- Document that the communication happened.
Stress-test complication escalationUnverified
Who responds to a complication in the testing lab, and how they are called.
Answered by: Program
When to contact the ordering or referring physicianUnverified
Where the line sits between a result that is reported and one that is telephoned. The rule that an abnormal result is communicated is stated; the threshold is not.
Answered by: Program
How to document result communicationUnverified
Where the call is documented, and the exact template or SmartPhrase name if one exists.
Answered by: Program
Tracking & Requirements
What has to be logged, and where it is not yet logged anywhere.
Log studies interpretedUnverified
Whether the count comes from MedHub, from CSImport, or from manual entry. No total appears on Progress until one of them is connected.
Answered by: Program
Log exercise tests performed and supervisedUnverified
Where performed, supervised and observed are recorded separately.
Answered by: Program
Track PET volumeUnverified
Whether PET studies are logged apart from SPECT anywhere today.
Answered by: Program
Level II course statusUnverified
Which 80-hour Nuclear Physics and Radiation Safety course the program uses, how a fellow enrolls, who pays, and where completion is recorded.
Answered by: Program
Oak Ridge and other education optionsUnverified
What the Oak Ridge option actually is, whether it is offered every year, and how a fellow asks for it.
Answered by: Program
Software & Image Access
Three systems, named by the program. No click path is written here.
CSImport on CitrixThe Nuclear and PET processing and reporting systemUnverified
How it is reached on Citrix, what a fellow does in it, and how a report is started. Login handling stays behind authorized system controls and no credential belongs on this page.
Answered by: Program
Fuji PACS WebImage and PACS accessUnverified
The access route, and what is looked up here rather than in CSImport.
Answered by: Program
PET ECGs on PACSUnder UR Cardiac PET ECGS — worth adding to favoritesUnverified
The exact path to the folder, and the pop-up setting that has to be allowed for it to open.
Answered by: Program
How a study reaches the readerUnverified
The path a study takes from acquisition, through processing, to the worklist a fellow pre-reads from.
Answered by: Program
Still needed from the program
Listed rather than guessed. These are the facts this page cannot answer.
- Software click pathsHow CSImport is reached on Citrix, how Fuji PACS Web is accessed, the exact PACS path to UR Cardiac PET ECGS, and how a study moves from acquisition to the worklist. The systems are named by the program; nothing about using them is.
- Stress supervisionWhich tests a fellow may supervise alone, which need an attending present, and who responds to a complication in the testing lab. §02 says an F1 performs and supervises and does not say under what.
- Pharmacologic stressWhich agent this lab uses by default, who orders and administers it, and what the fellow is responsible for. No dose or infusion rate is written here and none should be added without pharmacy.
- Radiation boundariesWhat a fellow may handle and under whose licence, and the local badge, monitoring and contamination procedure. This is the one category on the page where a plausible guess is a regulatory problem as well as a wrong answer.
- Documenting a callWhere a critical-result telephone call is documented, and the template or SmartPhrase name if one exists. The rule that abnormal results are communicated is stated; where the record of it goes is not.
Last updated 2026-09-24 · Program, Nuclear Work Guide specification, 2026-09-24
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