“10 Tips to Get Prepared for NM OSCE”

Narjess Ayati

MD, IBNM, FEBNM, FANMB, ABNC

Nuclear Medicine Research Centre, Mashhad University of Medical Sciences

Molecular Imaging and Therapy, Austin Health

1

Relaxation

OSCE questions are being prepared using usual cases not

tricky case reports!

2

Patient History

Look at the patient’s history and carefully review the provided information

Try to guess…

The rule is: all provided information should be related to diagnosis and

should not be misleading!

Example

A 35-year-old diabetic woman referred for exercise stress

perfusion imaging (SPECT MPI) to the nuclear medicine

department,

On the morning of imaging study, she felt pleuritic pain in

the left side of the chest of 5 hours duration, and relieved by

sitting forward.

On physical examination, she appears nervous. Her

temperature is 37.8°C.

An electrocardiogram (ECG) was obtained.

Regarding to ECG finding, what is your diagnosis?

You may not remember the EEG pattern of Pericarditis, but you can guess by looking at the history

precisely.

Look at the history again!

A 35-year-old diabetic woman referred for exercise stress

perfusion imaging (SPECT MPI) to the nuclear medicine

department,

On the morning of imaging study, she felt pleuritic

pain in the left side of the chest of 5 hours duration,

and relieved by sitting forward.

On physical examination, she appears nervous. Her

temperature is 37.8°C.

An electrocardiogram (ECG) was obtained.

3

Looking at the image as a whole

Pay attention to all peripheral details:

Names

Dates

Scan type

Markers

…

Example

Describe the scan!

4

Image quality

If the scan type is told and you are asked to describe the

scan and the image quality is not good, first sentence

must be about quality of the scan.

Example

Lung perfusion scan in a 55 y/o patient suspicious for PTE

Describe the scan

Suboptimal scan due to labeled RBC clots…

4 (Cont.)

Image quality

If the scan is suboptimal, think about the common reasons:

Technical errors: Poor labeling

Wrong injection rout, Incorrect radiotracer

Poor count

Wrong photo pick

Patient’s preparation: Interfering drugs, intervention, food

Patient’s condition: (DMSA:RTA , Thyroid: SAT, …)

anterior posterior

A Tc-99m DMSA scan was requested for an 18 m/o boy with small kidneys

Describe the scan and provide differential diagnosis

The quality of scan is poor/Suboptimal Scan

Increased background activity with poor delineation of the kidneys

DDx includes:

• Abnormal tracer preparation

• Renal failure

• Tubular dysfunction

55 y/o F with history of hypothyroidism attended for thyroid scan

Describe the scan and provide differential diagnosis

Increased background activity with poor delineation of the thyroid gland

DDx includes:

• Abnormal tracer preparation/Wrong radionuclide injection

• Sub-acute thyroiditis (Symptoms?/TFT?)

• Interfering drugs/food

5 & 6

Main and Incidental findings

Main finding

Incidental findings

Must be related to referral physician’s question and/or

patient’s history

Do not focus only on main finding

Look for additional findings as well

If the questioned region is normal, you should

pass a comment about it Examples:

-The lumbar region is normal in both planar and SPECT images, however a

focal zone of increased activity is seen in the 1/3-2/3 upper right

humorous…

-No evidence of bone metastasis throughout the skeleton.

-Degenerative changes of both knees

7

Describing, Interpreting & Reporting

Describe the image as detailed as you can.

What is the modality?

In which position?

Which area?

Lesion characteristics?

Image Finding:

Ant-Post radiograph

There is a well defined expansile

lytic lesion with fine trabeculation

In the metaphysis of the fibula.

There is periosteal reaction.

Description

Interpret the study

Severe Myocardial ischemia in the

apex, apical segments, anterior and

anteroseptal walls corresponding to

LAD territory.

SSS=25, SRS=1, SDS=24 (35% of myocardium)

High risk patient

Interpretation

Report the above 99mTc-pertechnetate scan and provide differential diagnosis

20 minutes after IV injection of 74 MBq (2 mCi) 99mTc-Pertechnetate,

the scan was performed in anterior view. The scan showed a large focal

zone of increased tracer uptake in the right side of the neck

corresponding to the right thyroid lobe. The left lobe did not showed any

tracer activity. Differential diagnosis includes:

1- Toxic autonomous single nodule (hot/ hyper functioning nodule)

2- Hemi agenesis

3- Previous lobectomy

4- Tumoral involvement of the left thyroid lobe

Reporting

8

Follow up/Next step Questions

Does he/she need further work up?

Attention: Is there any notice that the patient is

still at the NM department?

Then consider:

Quality check

Motion check Re-Processing

Additional views/SPECT

Inj site checking

Shielding

Repeating the scan History/Ph.E.

Contamination

Removing clothes Bladder emptying

(Voiding, Catheter) Fatty milk

Eye massage

Examples

Repeating the scan Shielding

Reprocessing

Recalibration

Using another

system

9

Keep an eye on the time

Your time is not limitless!

10 Believe in yourself!

HAVING FAITH

IN YOUR OWN ABILITIES

IS

THE SECRET TO SUCCESS

Thanks for your attention!