Purpose or Case Report: Experience in pediatric nuclear medicine is limited and not uniform across residency and pediatric fellowship training programs. At our tertiary care pediatric hospital, emergent nuclear medicine exams performed after hours are currently read by radiologists with expertise in pediatric nuclear medicine. A decision to shift this responsibility to in-house faculty has prompted creation of a continuing medical education (CME) learning module as part of an institutional comprehensive learning management system (LMS). The goal of this module is to train faculty, fellows and residents in the indications, protocols, diagnostic criteria, potential pitfalls and problem-solving techniques when reading emergent pediatric nuclear medicine exams. The purpose of this study is to better understand the volume of nuclear medicine cases on-call and the potential need for a dedicated pediatric nuclear medicine curriculum.
Methods & Materials: All nuclear medicine gastrointestinal bleeding scans, Meckel’s scans, hepatobiliary scans for biliary leak or acute cholecystitis, brain death scans and renal transplant evaluations performed between July 1, 2017 and June 30, 2018 were reviewed. Exams ordered after 4:30 PM on weekdays or performed on weekends were considered call studies. Faculty were surveyed to assess length of time since reading each type of scan, as well as their level of comfort protocolling and interpreting studies.
Results: Case review revealed 54 emergent pediatric nuclear medicine studies with 13 (24.1%) read after hours. Of all studies performed, 28.6% of gastrointestinal bleeding studies (n= 2/7), 16.7% of Meckel’s scans (n= 5/30), 22.2% of brain death studies (n = 2/9), 33.3% renal transplant scan (n=1/3), 75.0% of acute cholecystitis scans (n=3/4) and 0% of biliary leak scans (n=0/1), were read on-call. 19 (70.4%) of 27 faculty members who take call completed the survey. At least 63.2% have not read any of these types of nuclear medicine study since residency/fellowship or not at all. The percentage of those uncomfortable protocoling studies ranges from 73.7% to 89.5%, greatest with renal scans. The percentage of those uncomfortable interpreting studies ranges from 47.4% to 84.2%, greatest with renal scans.
Conclusions: Even in large academic centers, there is a limited number of radiologists with expertise in pediatric nuclear medicine, making call coverage challenging. There is a need for continued training to provide important emergent nuclear medicine studies for patients after hours.