Fellowship

Kirk Frey, MD
Kirk Frey, MD Nuclear Medicine Chief, Division of Nuclear Medicine and Molecular Imaging

The Department of Radiology at the University of Michigan Hospitals is the primary department responsible for diagnostic imaging at the University's medical center, which includes 865 hospital beds and a large outpatient facility. The range of clinical material available is reflected in the diagnostic patient load of approximately over 500,000 examinations yearly. Inasmuch as The University of Michigan Hospitals is a large tertiary referral center, a very high percentage of cases studied in the radiology department have significant pathology, and the variety of clinical material is outstanding.

The Division of Nuclear Medicine offers two levels of postdoctoral physician training experience directed toward clinical competence: (1) to qualify Radiology Residents for certification in Diagnostic Radiology by the American Board of Radiology (ABR); and (2) to qualify Nuclear Medicine residents (Fellows) for advanced certification in Nuclear Medicine by the American Board of Nuclear Medicine (ABNM).

Radiology Residents receive their Nuclear Medicine training as a regular rotation during their 4-year residency program in the Department of Radiology. For more advanced training, we offer a one-year or two-year fellowship program (i.e. Nuclear Medicine Residency) directed to ABNM certification. To be eligible for admission to this path, preferred candidates must already have completed residency training in diagnostic radiology, internal medicine, or another clinical care discipline. The duration of our NM Fellowship training program is one year after completion of a Radiology Residency and two years after completion of a clinical residency program.

Training directed towards Certification by the American Board of Nuclear Medicine

We offer a one-year or two-year training program (Nuclear Medicine residency) directed to ABNM certification. To be eligible for admission to this path, candidates must have successfully completed a clinical residency in an approved training program in Radiology, Internal Medicine, Family Medicine, Pathology, Neurology, or other relevant specialty. The length of training to become certified by the ABNM is one year after completion of a radiology residency and two years after completion of a clinical residency program.

The principal objective of this clinical training is to prepare physicians to be competent independent practitioners of the full scope of nuclear medicine. The educational program has three parallel requirements: a) satisfactory direct participation in all aspects of clinical patient care, b) satisfactory completion of courses and laboratories in clinical nuclear medicine, physics and instrumentation and radiobiology, and, c) attendance and participation in weekly conferences. Direct participation in clinical patient care is central to the training program. This occurs in the following clinical activities: general nuclear medicine, nuclear cardiology, pediatric nuclear medicine, a formal clinic that includes direct care of patients with thyroid disease and the therapeutic use of radionuclides, radiopharmacy and camera operations, and clinical PET/CT and SPECT/CT. In addition, the educational program provides opportunities for the development of research skills in both basic and clinical nuclear medicine appropriate for trainees to enter academic and research careers in nuclear medicine.

The principal objective of the nuclear curriculum for fellows is to provide trainees with a comprehensive experience in the basics of nuclear medicine practice. This training is intended to prepare for clinical practice involving all aspects of nuclear radiology and nuclear medicine. The training includes mentored experiences in interpretation of adult and pediatric diagnostic radiotracer imaging studies, nuclear cardiology (including stress testing), hybrid dual modality PET/CT and SPECT/CT imaging, radionuclide therapy of hyperthyroidism and cancer and general quality control and radiation protection considerations. Upon successful completion of the clinical, laboratory and lecture series of the program, trainees will qualify for Nuclear Regulatory Commission - authorized user licensure.

In each year, the clinical experience includes duties on general nuclear medicine imaging, which includes prescribing the appropriate imaging study, quality control, and the interpretation and integration with other imaging and laboratory findings of all imaging studies. Separate rotations include pediatric nuclear medicine imaging, nuclear cardiology, positron emission tomography (PET) and the nuclear medicine endocrine and therapy clinic. In the first year, a week-long laboratory rotation in nuclear imaging equipment, nuclear pharmacy practices and the safe handling of radioactive materials is included. In addition to the clinical rotations, a lecture series on nuclear medicine physics and radiobiology is given to first-year fellows.

Eligibility for Nuclear Medicine training is according to ACGME criteria for Nuclear Medicine Residency. One-year of training is offered to candidates who have recently completed American Board of Radiology training requirements. A 2-year Nuclear Medicine training program is available to candidates who have completed an ACGME residency in a discipline other than Diagnostic Radiology. Trainees are expected to be eligible for certification by the American Board of Nuclear Medicine at completion of the program.

Trainees undergo additional experience with on-call nuclear medicine imaging studies (primarily lung scans, hepatobiliary [HIDA] scans, and labeled RBC bleeding studies) when they have mastered the basic skills of diagnostic planning and image interpretation in these areas.

Conferences

Fellows attend and make didactic presentations at a number of regular Divisional, Departmental and Institutional conferences. Regularly occurring Nuclear Medicine and related conferences include:

NM Case Correlation Conference (Thursdays a.m.)
Radiology residents and NM Fellows present interesting or challenging cases for review by faculty, nuclear medicine fellows and radiology residents. Emphasis is placed on studies with known, confirmed pathological diagnostic outcomes, on the indication(s) and appropriateness of the studies and on correlations between nuclear medicine diagnostic appearances and those of other imaging modalities.

NM Journal Club (2- 3 Sessions/year, Tuesdays)
Nuclear medicine fellows lead the journal club discussion. A focused review of recent published literature is presented by an assigned fellow, together with a faculty mentor.

NM Protocol Review (Periodically, Thursdays a.m. – interspersed in the NM Correlation Conf schedule)
These sessions take place beginning in September and continue through the year and are led by a nuclear medicine fellow and an assigned faculty mentor. The current indications, procedures and interpretation schemes for studies performed in the Division are reviewed and updated.

Radiology Noon Conference (12:00 p.m. - 1:30 p.m. daily)
This conference is the major didactic source of training for radiology residents. Nuclear medicine fellows are invited to attend, and are responsible for preparing and delivering a topical NM lecture approximately once per year. NM faculty give presentations in rotation approximately twice per month. Nuclear Medicine fellows are particularly encouraged to attend the Radiology Noon Conference when the topic being presented is one of the “Beyond Imaging” topics, dealing with ethical, practice-based and career-related issues.

CT Conference (Fridays a.m.)
This conference focuses on interesting and “classic” examples of cross-setional anatomic findings and is presented by CT Fellows and Radiology Residents throughout the year. Nuclear Medicine Fellows are encouraged to attend to expand knowledge of structural anatomic imaging. In addition, each NM fellow delivers one conference session per year on a hybrid imaging topic (PET/CT or SPECT/CT).

Tumor Boards (various times, usually weekly meetings)
A variety of Multidisciplinary Tumor Boards are held at the University of Michigan Hospitals as well as one at the VA to review data and make diagnostic and therapeutic recommendations for management of individual patient cases. When on an appropriate clinical rotation, NM fellows attend at least one Tumor Board on a regular basis together with a faculty mentor.

Didactic Courses

Several formal didactic courses are offered primarily for NM Fellows. These include the following:

A. Introduction to Nuclear Medicine. This course is currently presented on a 2 year cycle. Year 1 consists of required readings and didactic introductory lectures (see below); Year 2 consists of case-based material covering the same topics.

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B. Basic Science in Nuclear Medicine. This annual course includes NRC required instruction in radionuclide handling, safety and regulation as well as basic aspects of radionuclide physics, isotope production, radiation detection and emission imaging. An advanced continuation of the course specifically for NM Fellows includes additional topics: radiobiology, management of radiation accidents, radioimmunoassay, determination of body composition, radiochemistry of radiotracers, tracer kinetics and distribution modeling, radiotracer dosimetry, advanced radionuclide imaging (tomography, scatter and attenuation correction, hybrid imaging) and statistics.

Recommended Reading Material

Introductory and background reading for NM Fellows is recommended from the following sources:

  • Ziessman HA, O’Malley, Thrall JH:  Nuclear Medicine.  The Requisites, 3rd Edition.  St Louis, MO:  Mosby, Inc.; 2005
  • Cherry SR, Sorenson JA, Phelps ME:  Physics in Nuclear Medicine, 3rd Edition.  Philadelphia, PA:  Saunders; 2003
  • Treves ST:  Pediatric Nuclear Medicine/PET, 3rd Edition. New York, NY: Springer Science+Business Media, LLC; 2007
  • UM Nuclear Cardiology House Officer Handbook (provided on first rotation)
  • Zaret BL, Beller GA:  Nuclear Cardiology.  State of the Art and Future Directions, 3rd Edition.  St. Louis, MO: Mosby Inc. 2004
  • Oehr P, Biersak H-J, Coleman RE:  PET and PET-CT in Oncology.  London:  Springer-Verlag; 2003
  • Valk PE, Bailey DL, Townsend DW, Maisey MN:  Positron Emission Tomography.  Basic Science and Clinical Practice.  London:  Springer-Verlag; 2003

Research Opportunities

The Nuclear Medicine research program is a broad one, but it is especially strong in introducing new radiotracer imaging methods to detect earliest neurochemical alterations in degenerative brain disorders.

Space dedicated for Nuclear Medicine research (18,000 square feet) is in the adjacent Medical Science buildings, which house a complete cyclotron/radioassay chemistry laboratory plus laboratories for image analysis, image instrument development and small animal study. MicroPET, primate PET, and SPECT units provide for research animal imaging.

Research grants within the Division of Nuclear Medicine total about $6,000,000 annually.

Apply

Thank you for your interest in our Nuclear Medicine Residency Program.  In order to be eligible for our program you must have completed one of the following:

  1. Completed a 4-year, ACGME-accredited Diagnostic Radiology residency.  You are then eligible for a 1-year Nuclear Medicine residency
    OR – (in unusual or exceptional circumstances)
  2. Competed an ACGME-accredited residency in Internal Medicine, Surgery or another clinical care discipline. You are then eligible for a 2-year Nuclear Medicine residency.

If you qualify for one of the above, please fill out the fellowship application at the bottom of this page.

For more information, please contact:

Morgan DeLuca-Myers
Department of Radiology
Division of Nuclear Medicine
Michigan Medicine
1500 East Medical Center Dr., B1G505
Ann Arbor, MI 48109-5028
734-936-5385

mmdeluca@med.umich.edu