Curriculum standards
Knowledge guides
LG15: Neurological nuclear medicine
Key presentations and conditions
Trainees will have a comprehensive depth of knowledge of these presentations and conditions.
Less common or more complex presentations and conditions
Trainees will understand these presentations and conditions.
Trainees will understand the resources that should be used to help manage patients with these presentations and conditions.
Epidemiology, pathophysiology, and clinical sciences
Trainees will have a comprehensive depth of knowledge of the principles of the foundational sciences.
Investigations, procedures, and clinical assessment tools
Trainees will know the scientific foundation of each investigation and procedure, including relevant anatomy and physiology. They will be able to interpret the reported results of each investigation or procedure.
Trainees will know how to explain the investigation or procedure to patients, families, and carers, and be able to explain procedural risk and obtain informed consent where applicable.
Important specific issues
Trainees will identify important specialty-specific issues and the impact of these on diagnosis and management and integrate these into care.
Presentations
- Assess brain function, including:
- alterations in cognition
- suspected brain death
Conditions
- Brain death
- Brain tumours
- Cerebrovascular disease, including:
- chronic ischaemia
- moyamoya disease
- stroke
- Epilepsy:
- non-temporal lobe focal epilepsy
- temporal lobe
- Neurodegenerative disorders, including dementia, such as:
- Alzheimer disease
- dementia with Lewy bodies
- frontotemporal dementia
- vascular dementia
- Parkinson disease and other movement disorders
PCH
- Brain death
- Brain tumours and recurrence
- Epilepsy
- VP shunt dysfunction
For each presentation and condition, Advanced Trainees will know how to:
Synthesise
- recognise the clinical presentation
- identify relevant epidemiology, prevalence, pathophysiology, and clinical science
- take a comprehensive clinical history
- conduct an appropriate examination
- establish a differential diagnosis
- plan and arrange appropriate investigations
- consider the impact of illness and disease on patients and their quality of life when developing a management plan
Manage
- provide evidence-based management
- prescribe therapies tailored to patients’ needs and conditions
- recognise potential complications of disease and its management, and initiate preventative strategies
- involve multidisciplinary teams
Consider other factors
- identify individual and social factors and the impact of these on diagnosis and management
Presentations
- Encephalitis
- Suspected cerebrospinal fluid (CSF) shunt complications, such as obstruction or leak
- Suspected normal pressure hydrocephalus
Conditions
- CSF leak
- CSF shunt blockage
- Normal pressure hydrocephalus
PCH
- Vascular disorders, including moyamoya disease
For each presentation and condition, Advanced Trainees will know how to:
Synthesise
- recognise the clinical presentation
- identify relevant epidemiology, prevalence, pathophysiology, and clinical science
- take a comprehensive clinical history
- conduct an appropriate examination
- establish a differential diagnosis
- plan and arrange appropriate investigations
- consider the impact of illness and disease on patients and their quality of life when developing a management plan
Manage
- provide evidence-based management
- prescribe therapies tailored to patients’ needs and conditions
- recognise potential complications of disease and its management, and initiate preventative strategies
- involve multidisciplinary teams
Consider other factors
- identify individual and social factors and the impact of these on diagnosis and management
- Anatomy of the brain and spinal cord, with particular emphasis on cross-sectional anatomy
- Cerebral arteries, the territories that they perfuse, and their relations to other cerebral structures
- Cerebral blood volume and luxury perfusion
- Cerebral veins and sinuses, and their relations to other cerebral structures
- Cerebral ventricles and their relations to other cerebral structures, including the spinal cord
- Describe the pathophysiology of:
- atherosclerosis
- cerebral atrophy and neurodegeneration
- cerebral ischaemia and infarction
- cerebral tumours – primary and secondary
- encephalitis
- Intracerebral structures of the brain in coronal, sagittal, and transverse planes
- Intracranial aneurysms and vascular malformations
- Pathophysiology and classification of dementias
- Pathophysiology and classification of seizures
- Pathophysiology of:
- CSF leaks
- non-obstructed hydrocephalus
- normal pressure hydrocephalus
- obstructed hydrocephalus
- Pathophysiology of acute and chronic cerebral ischaemia
- Pathophysiology of brain death
- Pathophysiology of Parkinson disease and other movement disorders
- Physiology of cerebral perfusion and autoregulation
- Physiology of CSF production and flow:
- types of CSF shunts and reservoirs that are typically used in management of obstruction, and how to access them
- Surface markings of the cerebral lobes
- The basic sciences related to radiotracers used in nuclear medicine imaging of the neural axis
- The relationship between cerebral perfusion and cerebral metabolism in health and disease
- The temporal effect of seizures on cerebral blood flow and metabolism
Investigations
- Incorporating complementary imaging techniques into the evaluation of impaired neurological function:
- carotid doppler ultrasound
- CT
- MRI
- PET brain imaging:
- PET tracers, including:
- amino acid tracers, such as F-18 FET
- beta amyloid tracers
- F-18 FDG
- Tau tracers
- PET tracers, including:
- Scintigraphic assessment of cerebral perfusion:
- SPECT brain imaging, including:
- ictal and interictal cerebral perfusion imaging
- SPECT brain imaging, including:
- Scintigraphic assessment of CSF circulation:
- CSF shunt studies, including:
- CSF leak study and pledget radioactivity
- radionuclide cisternography
- radionuclide shunt scintigram
- CSF shunt studies, including:
Procedures
- Acetazolamide challenge in assessing cerebral perfusion reserve
- CSF shunt access / organising instillation of radiolabelled tracer into shunt reservoir
- Lumbar puncture, as per local practices
PCH
- Cerebral SPECT
- CSF shunt patency
- Epilepsy – ictal and interictal SPECT
- Epilepsy – PET / CT IM
- Patient demographics, including geographic location, socioeconomic status, ethnicity, and cultural background, and the considerations when managing and following up these patients, such as travel from rural to metropolitan areas
- Radiation protection, patient safety and consent
- Radioisotope decay and patient proximity to the procedure