Demonstrate team communication and leadership skills to work effectively with others as a member or leader of a health care team or other professional group.
Demonstrate leadership skills by leading a group project to successful completion.
Communicate with referring physician to assure appropriate examination selection, including actions to be taken if the requested procedure appears to be inappropriate.
Collaborate with other health care team members to improve service delivery.
Protect and preserve personal and confidential information of others to which access is provided.
Adhere to privacy and regulatory standards and requirements regarding the accountability and protection of patient information.
Identify potential abuses of confidential patient information.
Describe the challenges associated with maintaining the confidentiality of patient information stored in computer systems and transmitted via networks.
Use effective listening skills and elicit and provide information using effective nonverbal, explanatory, questioning, and writing skills.
Listen to the “patient’s story,” extract important details from the history taking, and provide information to their patients in an understandable way.
Demonstrate effective interviewing skills for patient assessment.
Demonstrate effective communication skills with and provide psychosocial support to specific groups of people, such as the terminally ill, physically or emotionally impaired, culturally diverse patient, families, and colleagues.
Demonstrate effective age-specific and gender-specific communications.
Be receptive to the clinical significance of the patient’s personal beliefs and values for adaptation of an exam protocol or departmental policies.
Demonstrate emotional resilience and stability, adaptability, flexibility and tolerance of ambiguity and anxiety.
Maintain composure in all situations.
Refrain from negative conversations
Demonstrate self-awareness of personality traits.
Follow appropriate protocol in resolution of conflict, exhibiting proper restraint when presented with potentially volatile situations.
Maintain comprehensive, timely, and legible records for medical, legal, quality improvement and financial purposes.
Maintain appropriate protocol, courtesy, tact, and confidentiality in business communication, both written and oral.
Demonstrate an appropriate level of communication skills when orally presenting professional or scholarly work.
Demonstrate technical writing ability in a variety of venue, including scholarly writing and business communications.
Write an abstract according to published standards.
Prepare a poster for presentation at a professional conference.
Write scholarly articles.
Develop patient procedure protocols.
Develop department policies.
Write business correspondence such as business letters, memos, or internal reports.
Prepare reports, such as a needs assessment or progress report.
Develop action plans for quality improvement projects.
Develop patient education materials.
Apply concepts of teaching and learning theories in design, implementation and evaluation in the education of patient, family, colleagues and the community.
PRACTICE-BASED DECISION MAKING
Track and analyze processes, procedures and outcomes using appropriate statistical and/or qualitative techniques.
Use the evidence-based medicine (EBM) process of asking, acquiring, appraising, applying, and assessing to improve clinical practice.
Analyze practice organization and management and perform practice based improvement activities.
Develop a personal program of self-study and professional growth.
Use benchmarking analysis and adjust processes, procedures and operations for comparison with published standards of care.
Follow a systematic process for identifying and implementing best or better practices.
Follow professional standards of practice and work within the NMAA scope of practice to improve patient care and safety and protect the public.
Critically evaluate current literature and extant research to assess the effectiveness of diagnostic and therapeutic procedures.
Identify credible sources of information.
Determine applicability of information; clarifying patients’ questions and misunderstandings about procedures, conditions, or treatment options based on what they may have read.
Use findings from literature and benchmarks to design and initiate appropriate research to investigate a given clinical situation in order to arrive at an optimal solution.
Apply knowledge of research design and statistical methods to appraise the literature.
Use feedback and observations to verify that changes were implemented to optimize patient care delivery and outcomes were effective
Use information technology to effectively access, collect, analyze and disseminate data.
Use current information technology and other sources to efficiently locate and retrieve relevant information from credible sources.
Follow ethical principles in using information that may be sensitive.
Be aware of appropriate regulations or legislation involving information sharing, storing, protecting, or deleting sensitive information.
Provide discipline-specific education to patients, students, colleagues, and the public.
Use opportunities to teach and learn as facets of professional practice.
Develop learning relationships with clients, patients, students and colleagues.
Assess what needs to be learned and demonstrate effective teaching techniques in settings that may be spontaneous or by design
Select appropriate resources and activities to support teaching.
Use evaluation and feedback to measure and enhance teaching effectiveness.
Facilitate the transfer of learning.
Demonstrate calm, compassionate, helpful demeanor toward those in need.
Treat others with dignity and respect, demonstrating sensitivity and responsiveness to culture, age, gender, and disability.
Discuss how diversity issues, health literacy or disparity issues might impact patient care and adherence to treatment.
Consistently strive for excellence in professional activities.
Be meticulous and careful in conducting professional tasks.
Work systematically and complete assignments in a timely manner.
Take responsibility for continuity of care.
Recognize how NMAA patient care and professional practices might affect other health care professionals and the health care organization.
Demonstrate ability to reflect on methods of improving professional behavior.
Act with integrity and understand personal limitations.
Refrain from performing tasks beyond personal capabilities or outside of professional scope of practice.
Accept responsibility for mistakes and report mistakes as appropriate.
Accept criticism and make an effort to improve.
Reflect on difficult encounters and analyze how values, skills, and knowledge are affecting care of patients with challenging and/or terminal illnesses.
Recognize and appropriately respond to impairment of self or colleagues.
Demonstrate the professional attitudes that must be considered by the NMAA.
Uphold the goals of the profession by supporting professional organizations, keeping professional confidences, maintaining competency, and exhibiting a professional image.
Exhibit exemplary professional appearance and personal hygiene.
Demonstrate conscientiousness and organization in addressing all professional obligations.
Foster professional relationships with members of the health care team.
Mentor students, technologists, and other members of the health care team.
Enhance the professional relationship by keeping the patient as the main focus.
Manage conflict among health professionals in a constructive manner.
Demonstrate accountability to the health care organization and society by adhering to ethical business principles.
Outline the nature of the special fiduciary relationship between the practitioner and the patient.
Demonstrate a commitment to medico-legal and ethical principles.
Apply the ethical principles of autonomy, non-malfeasance, beneficence, justice, paternalism, fidelity, veracity, altruism, integrity, respect, and compassion.
Practice patient-centered care that encompasses confidentiality, respect, and autonomy via appropriate informed consent and shared decision making.
Describe the structure, governance, financing and operation of the health care system and its facilities and how this influences patient care, research and educational activities at a local, state, regional and national level.
Understand the structure and function of health care delivery systems and medical practices.
Describe the various third-party payer systems, covered health benefits, formularies, preauthorization, appeals, disease management and quality improvement.
Define and describe a patient population.
Practice cost effective healthcare and resource allocation that do not compromise quality of care.
Review and adjust coding practices and procedures to assure optimal and legal reimbursement.
Analyze departmental budget, cost/revenue for optimal efficiency.
Provide documented analysis and data for resource acquisition.
Follow filing and documentation practices for practitioner reimbursement as directed by CMS policies and procedures, state, and federal law.
Ensure compliance for all local, state, regional, and federal requirements for laboratory operations and personnel training and credentialing.
Comply with current federal, regional and local regulations governing the laboratory.
Conduct procedures and provide documentation for laboratory accreditation.
Implement Joint Commission standards.
Partner with health care managers and health care providers to assess, coordinate, and improve health care.
Structure department staffing for quality care delivery and employee satisfaction.
Conduct process for departmental strategic planning per institutional mission.
Advocate for quality patient care and assist patients in dealing with system complexities.
Understand the reciprocal impact of personal professional practice, health care teams, and the health care organization on the community and society.
Identify ways in which an NMAA may interact with health-care professionals, health administrators, and community groups to positively impact the health and well being of one’s community.
Gather information (e.g. demographics and socio-cultural beliefs) about the community in which one works and practices that affect health and disease.
Participate in interdisciplinary team discussions, demonstrating the ability to accept, consider and respect the opinions of the other team members, while contributing an appropriate level of expertise to patient care.
Describe the major legal mechanisms for oversight and regulation of medical practice, including those related to licensure and discipline, negligence, malpractice, risk management, doctor-patient relationships, confidentiality, and patient’s rights.
Compare civil and criminal law.
Explain civil procedures.
Follow the prescribed standard of care for NMAA
Distinguish between the different types of consent.
Understand and comply with the patient’s directives in regard to medical care.
Comply with employer and employee legal obligations.
Owen MA, Pickett MW, Christian PE, Dillehay GL, Fulk LA, Gordon LL, Henkin RE, Smith M, Hubble WL, Thompson K, Keech FK, Nielsen, Stachowiak A. Nuclear medicine practitioner competencies. J Nucl Med Technol. 2007; 35(1):39-41.
Pickett MW, Keech FK, Owen MA, Stachowiak A, Fulk LA, Murphy KH, Christian PE, Hunter K, Hubble WL, Gordon LL, Dillehay GL, Henkin RE. Position paper on the development of a middle level provider in nuclear medicine: The nuclear medicine practitioner. J Nucl Med Technol. 2006; 34(4):236-243.
Competencies for the physician assistant profession. Journal of the American Academy of Physician Assistants. VOL 18. NO. 7. July 2005. pp. 16-18. Accessed Online 8/24/05 [http://www.nccpa.net/pdfs/Definition%20of%20PA%20Competencies%203.5%20for%20Publication.pdf]
National Commission on Certification of Physician Assistants. Physician Assistant Knowledge and Skill Areas. Accessed Online 8/24/05. [http://www.nccpa.net/EX_knowledge.aspx?r=pance]
American Association of Colleges of Nursing. Curriculum Standards. Acute Care Nursing Practitioner. Accessed Online 8/21/05. [http://www.aacn.nche.edu/Education/curriculum.htm]
Accreditation Council of Graduate Medical Education. Outcome Project. Accessed Online 8/8/07 [URL: http://www.acgme.org/outcome/comp/compFull.asp ]
American Board of Internal Medicine. Project Professionalism. Accessed Online 8/5/07 [URL: http://www.abim.org/pdf/profess.pdf]
American Society of Radiological Technologists, Society of Nuclear Medicine. 2004. PET/CT Curriculum. Accessed Online 9/13/05 [http://www.crcpd.org/PET-CT_Fusion_Imaging/PETCT%20Curriculum%20Accepted%20021704.pd.pdf]
Merriam SB, Simpson E L. (1995). A Guide to research for educators and trainers of adults. Malabar, FL: Krieger Publishing Company
Meltzoff J. (1999). Critical thinking about research: Psychology and related fields. Washington, DC: American Psychological Association.
AACE/AAES medical/surgical guidelines for clinical practice: management of thyroid carcinoma. U.S. Department of Health and Human Services. Agency for Healthcare Research and Quality. Accessed Online 5/25/06. [URL: http://www.guideline.gov/summary/summary.aspx?ss=15&doc_id=2848&nbr=2074&string= ]
Competencies and Goals for Radiology Residents. University of Rochester, Department of Imaging Science. Accessed 05/25/06. [URL: http://www.urmc.rochester.edu/smd/Rad/ResidentGoals.pdf ]
`Overview for the Patient Care Curriculum The role of the NMAA is to provide a quality patient care experience at the advanced level in diagnostic and therapeutic environments. The NMAA works under the direction of the supervising physician, making an initial assessment, performing routine and advanced procedures, and ensuring appropriate follow-up as needed. The NMAA synthesizes theoretical, scientific, and contemporary clinical knowledge for the personalized assessment and management of patients to provide efficient and effective patient care. The outcome is improved service delivery for the supervising physician, the referring physician, and the patient in terms of reduced costs or time, improved efficiency, and an enhanced patient experience.
NMAAs are committed to creating a patient centered experience and should be familiar with the clinical pathway the patient can expect to follow. Although working under the direction of the supervising physician, they demonstrate a high level of clinical decision making and autonomy. As part of their comprehensive responsibilities in patient care, NMAAs conduct physical examinations, collect relevant clinical information, address patient’s concerns and answer questions, and facilitate appropriate follow-up care.
The NMAA will build on existing knowledge and skills of a nuclear medicine technologist and is expected to maintain ACLS certification and demonstrate a comprehensive knowledge of anatomy, physiology, pathology and pathophysiology that would have been included in their undergraduate nuclear medicine technology program. In addition to instruction in advanced patient care skills, NMAA students could also be expected to take graduate level instruction in pathophysiology and clinical pharmacology.
Patient Care Curriculum Content
Communicate effectively and demonstrate caring, respectful and ethical behaviors when interacting with patients, their families, physicians and other health care professionals. [see Interpersonal and Communication Skills competency domain)
Counsel and educate patients and their families.
Obtain patient informed consent for required procedures according to state law and institutional policy.
Ethical and legal underpinnings of informed consent.
Autonomy, veracity and confidentiality
Who may give consent
Minors and mentally impaired adults
Types of consent
Implied by law
Components of valid informed consent
Procedure that will be done
Nature or purpose of the treatment or procedure.
The name and qualifications of the person doing the procedure.
The consequences or expected outcome.
The risks involved, except for the very remote.
Exceptions: risk of death or sterility, if applicable
The alternatives to this procedure must be discussed
Responsibilities of physician and health care providers
When consent becomes invalid
The procedure exceeds the consent given
Inadequate information is given to the patient
The nurse or technologist answers medically related questions
The patient is given the consent form and told that it is just “routine papers”
Force of circumstances
Change of circumstances
Capability of patient to give informed consent.
Explanation of procedure to the patient, including all components of a valid informed consent.
Precautions used to reduce risks
Assess patient’s understanding of the risks, benefits and alternatives and follow-up
Responding to questions or directing questions to the appropriate health care professional
Educate patients on pre-procedural preparation and post-procedural care.
Modification of medication
Next step in patient treatment algorithms
Physical activity limitations
Make informed decisions about diagnostic and therapeutic procedures under the direction of the supervising physician and based on patient information and preferences, up-to-date scientific evidence, and clinical judgment.
Gather and evaluate essential information including correlative studies about patients and arrange follow-up as necessary under the direction of the supervising physician.
Pertinent patient laboratory biochemical markers relevant to pathology
Pertinent previous diagnostic imaging studies
Perform history and physical examinations. (See Appendix for History and Physicals for RA curriculum)
Review of systems (See Appendix Review of Systems for RA curriculum)
History of present illness
Past medical history
Perform a focused physical exam
Evaluate findings for contraindications to testing and for indicators of additional patient pathology.
Consult with physician as needed.
Counsel patient and family as indicated.
Determine and implement a plan of care.
Use professional judgment to recommend or adapt protocols for procedures to improve diagnostic quality and outcome.
Consult with the supervising physician or appropriate health care provider to determine a modified action plan when necessary.
Report findings to the supervising physicians and patients per protocol.
Order and administer sedating pharmaceuticals under the direction of the supervising physician and monitor patients who are receiving sedating pharmaceuticals as indicated by patient profile and diagnostic or therapeutic procedure as allowable by institutional, state, and federal statutes.
Implement additional requirements for patient care for diagnostic or therapeutic procedures.
Perform patient bladder catheterizations.
Establish additional routes of radiopharmaceutical administration other than IV injection or oral
Administration into existing catheters or surgical routes
Monitor vital signs and physiological parameters.
Pulse oxygen level
Evaluate the need for contrast media in consultation with the supervising physician.
Manage adverse events
Provide indicated intervention per patient emergency event.
Provide supportive medical management.
Provide basic life support.
Provide advanced life support.
Facilitate transfer to definitive care environment.
Overview for the Clinical Nuclear Medicine Curriculum
Clinical leadership exemplifies one of the most important roles of the NMAA and is integrated throughout the advanced practice curriculum. Those that practice clinical leadership learn to optimize everyone’s role and value in the service, not just their own. An enhanced clinical skill set is an important component of the NMAA practice model. However, advanced practice involves more than performing highly technical procedures; it also requires a high level of clinical decision-making. The successful NMAA internalizes individual and professional qualities that motivate him or her to initiate improvements in service delivery. Improving service delivery implies that each NMAA’s discreet role will be different, depending on the needs of the local practice. Some may choose to practice in a general nuclear medicine department while others may work in specialty areas such as cardiology, pediatrics, or oncology/therapy.
NMAA’s work under the direction of a supervising physician and follow protocols for most of their clinical work. They must clearly understand the types of decisions they can make and those they should not make. As the profession matures, it will become necessary to establish clinical benchmarks and make evidence-based practice decisions. Consequently, NMAA’s will find they will need to distribute and share information to ensure that the patient is cared for in an expeditious, efficient, and ethical manner.
It is important to recognize that adding clinical knowledge is not simply a matter of adding more technical skills and or adding advanced technical skills. The NMAA will be expected to provide clinical nuclear medicine technology services and will build on those skill sets to improve service delivery and provide an exceptional patient experience. The NMAA will review requests for imaging or radiotherapy procedures to ensure the appropriate study has been requested for the clinical presentation. This will entail an evaluation of collaborative laboratory results for indications and contraindications and may require the NMAA to order or facilitate adjunctive pharmaceuticals for the imaging procedure under the direction of the supervising physician. The NMAA may prescribe and administer pharmacologic and nonpharmacologic interventions or order complimentary diagnostic procedures as allowable by state and federal statutes. The NMAA may also prepare a comprehensive report for the supervising physician. NMAA students should expect to spend extensive time in the clinical setting and the classroom in order to master these skills.
Clinical Nuclear Medicine Curriculum Content
Review requests and physician directives for nuclear medicine procedures.
Review request for imaging procedures per protocol.
Ensure the appropriate diagnostic study has been requested for the clinical presentation in consultation with the referring physician.
Evaluate collaborative laboratory for indications/contraindications.
Order or facilitate adjunctive pharmaceuticals for the imaging procedure under the direction of the supervising physician.
Cardiac stress agents
CCK or analog
Competently perform clinical nuclear medicine procedures considered essential in the area of practice.
Perform routine nuclear medicine procedures.
Perform sentinel node imaging and lymphatic mapping.
Anatomy and physiology of lymphatic system
Contains greater concentration than any other part of the body
Lymph node or gland
Parasternal (internal mammary)
Head and neck levels
Submandibular triangle (I)
Upper jugular (II)
Middle jugular (III)
Lower jugular (IV)
Spinal accessory nerve lymph chain (V)
Head and neck lymph drainage patterns
Lower lip: Submental
Scalp: parotid, suboccipital
Parotid : levels I, II
Oral cavity: levels I, II, III
Oral pharynx: levels II, III, retro & parapharyngeal
Nasopharynx: levels II, III, V
Hypopharynx: levels Ii, III, IV, retro & parapharyngeal
Supraglottis: levels II, III
Glottis: levels III, IV, VI
Thyorid: levels III, IV, V, VI
Esophagus:levels III, IV, V, VI
Torso/trunk (2) above umbilicus
Pelvis (below umbilicus)
Para-trochlear (interval node sometimes present)
Superficial inguinal nodes
Solid organ (e.g, biopsy-proven colorectal cancer)
Local systemic route
Agent: Tc99m sulfur colloid (filtered)
Route of administration (see injection technique)
Pharmaceutical intervention: anesthetic
Patient positioning and immobilization devices
Therapy planning table
Positioning devices (e.g. wedges)
Prepare patients and ancillary equipment for radiation therapy planning using positron and multimodality imaging systems.
Therapy planning table
Other ancillary equipment
Laser positioning and reference marking
Prescribe and administer pharmacologic and nonpharmacologic interventions under the direction of the supervising physician and as indicated by patient profile and diagnostic procedure as allowable by state and federal statutes.
Perform pre-procedure requirements and interventions as may be required.
Recommendations for follow-up diagnostic or therapeutic procedures, as indicated
Recommend appropriate follow-up, as needed
In conjunction with referring and supervising physician, monitor patient and provide post therapy intervention as needed for adverse side effects.
Bone marrow suppression
Supportive care for symptoms
Elective Competencies These procedures consist of those tasks that are infrequently performed in most practice settings but might be particularly useful to some NMAAs in some settings.
Administer radiopharmaceuticals for radionuclide cisternography, cerebrospinal fluid shunt evaluations, cerebrospinal fluid leaks or for intraperitoneal procedures using aseptic technique and radiation safety standards at the discretion of the supervising physician
Explain complete procedure to patient/ family.
Ensure scheduled imaging timeline compliance.
Prepare injection site adhering to predetermined aseptic/ sterile technique.
Conduct a Joint Commission recommended “time out” procedure.
Monitor room, contents and personnel as per institutional Radiation Safety Guidelines.