Exercise for adults with congenital heart disease poses many unique challenges. In this presentation from August 12, 2021, Sherrin Gallagher, ACNP, AACC, reviews the importance of exercise and current guidelines for adults with congenital heart disease.
Explore This Fellowship
The Nuclear Cardiology Fellowship Program provides training in all aspects of nuclear cardiology practice, including cardiac PET, stress performance and interpretation and image analysis and interpretation. This fellowship is a one-year non-ACGME training program with an optional second-year focusing on advanced training in PET. Currently, the laboratory has six SPECT cameras and two PET cameras and performs over 7,500 imaging procedures per year. The laboratory is located in the main campus at Massachusetts General Hospital and performs tests on both outpatients as well as patients admitted to the hospital.
In addition to providing clinical evaluations, the laboratory is involved in a multi-center trial involving the evaluation of a new tracer for myocardial autonomic function, quantitative physiologically oriented PET studies of the coronary circulation, as well as other clinical investigative protocols both multi-center (ex: new adenosine analog) and individual investigator initiated (ex: neural network analysis of myocardial perfusion images, PET studies of peripheral vascular disease and plaque inflammation).
Ahmed Tawakol, MD
Requirements of the Nuclear Cardiology Fellowship include:
- Completion and passing of all three USMLE steps
- ABIM board certified or board eligible
- The accepted applicant must obtain a full Massachusetts license (limited license if on visa)
- A valid ECFMG certificate for all foreign medical graduates
- Only J1 visas accepted
- Completion of an internal medicine residency is required. The completion of previous cardiology fellowship training is preferred.
- To understand the indications and contraindications for cardiac stress testings, as well as learn the normal and abnormal hemodynamic and electrocardiographic responses to exercise and pharmacologic stress tests
- To be able to take a directed cardiovascular and pertinent medical history and physical examination for patients presenting to the lab
- To become proficient in the safe performance, monitoring and interpretation of exercise and pharmacologic stress tests
- To understand the indications and protocols, for myocardial perfusion imaging, differences amongst various perfusion imaging agents including the physical characteristics, dosimetry, strengths and limitations of each
- To understand the indications and strengths and limitations of PET myocardial perfusion and metabolism imaging for cardiac disease
- To gain proficiency in the interpretation of normal and abnormal gated myocardial perfusion studies, radionuclide angiography, and PET studies of myocardial perfusion and metabolism
- To learn the safe handling of radioactive material and appropriate immediate responses to radiation emergencies
- To learn the basic physics of nuclear cardiology, gamma cameras, quality control, SPECT acquisition and reconstruction protocols
Fellows will be instructed in the medical evaluation and performance of both pharmacological as well as exercise stress testing, including indications, contraindications, safe performance, and treatment of complications, including cardiac and respiratory collapse and resuscitation. It is anticipated that fellows will complete approximately 500 to 750 stress tests during the course of the fellowship.
Fellows will learn the safe handling of radioisotopes, ALARA principles, the proper administration of radioisotopes for diagnostic procedures, as well as handling of radioactive spills and mis-administrations. This information is provided in a required though separate nuclear medicine physics and instrumentation course offered at another Mass General Brigham affiliated hospital or other non-Mass General Brigham affiliated institutions in Boston. It is expected that the fellow will have sufficient experience in tracer administration, acquisition and processing of imaging data during the fellowship to qualify for ACC/ASNC Level III certification.
Fellows will be instructed by staff faculty (both cardiologists and nuclear medicine physicians) in the interpretation of myocardial scans (rest/redistribution thallium for myocardial viability; rest/ stress perfusion imaging for diagnosis of coronary artery disease; radionuclide ventriculograms, gated perfusion imaging, and PET scans for both perfusion and metabolism) The fellow will read approximately 600 scans/mo during the fellowship year under direct attending supervision. Whenever possible, and in the great majority of cases, the scans will be correlated with clinical, other non-invasive, coronary angiographic and operative (CABG or PCI) findings.
(8:00 am to 1:00 pm) The fellow will be responsible for obtaining a directed history and physical examination of patients presenting to the lab; determine the suitability for the ordered test; and medically clear the patient for the test. The fellow will discuss the case with the attending physician, if necessary, and after appropriate training perform the study on his/her own. After completion of the stress test, the fellow will analyze the hemodynamic and EKG response and review them with the attending physician at the afternoon readout session. The fellow will work with a team of RN’s and NP’s who perform the majority of the stress tests. The fellow is expected to serve as a consultant and back-up to the nurses when needed.
(1:00 pm to 5:00 pm) The fellow will participate actively in all afternoon scan readout sessions with the attending physicians. It usually will be possible to excuse the fellow twice/wk for one hour to attend cardiac cath conference (Tue, 0730-0830) and cardiac grand rounds (Wed, 0800-0900) during the academic year.
The fellow will participate in the weekend ETT on-call schedule. In general, this involves taking and approving requests for both imaging and non-imaging stress tests on both Saturday and Sunday as well as Monday holidays (Christmas and New Year’s Day are exempt). The fellow then communicates these requests to the on-call team of technologists and to the attending cardiologist for the weekend. The fellow supervises the test and remains in the lab until all patients have been returned to their ward (out patients are not done on weekends). The intent of the weekend program is to reduce hospital length of stay for those who require stressing for discharge or who will have to have a stress test prior to surgery or cardiac catheterization the following business day.
The nuclear cardiology fellow will prepare and present a conference on the first Thursday of the month (at noon) on a topic relevant to nuclear cardiology or stress testing. This conference along with cardiac grand rounds and cardiac cath conference are the major teaching conferences of the section. Considerable teaching also occurs during the daily readout session in which the fellow is asked to give his/her interpretation of the images before the attending physicians render an opinion.
Two attending physicians are present for every read-out session. All clinical, hemodynamic, EKG and imaging and available catheterization information is reviewed. In addition, attending physicians are active in a variety of basic and clinical research programs and welcome fellow participation in these activities. The American Society of Nuclear Medicine website, as well as Mass General Brigham websites, feature sections from Mass General and Brigham and Women’s on teaching cases which provide an excellent opportunity for self-teaching, and of course can be reviewed with attending staff to answer questions.
Those fellows interested in Nuclear Regulatory Commission licensure and/or nuclear cardiology board certification are encouraged to discuss this with the director of the lab early in the first year. Licensure and certification require specific tasks and course work above and beyond what fellows receive on the general rotation.
How to Apply
Interested applicants should send their CV, personal statement and three letters of reference via e-mail or fax to:
Ahmed Tawakol, MD
Mass General Hospital
55 Fruit Street
Boston, MA 02114
Meet Our Faculty
Learn more about the faculty of the Nuclear Cardiology Fellowship Program.
- Co-Director, Cardiac MR PET CT Program
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