Curriculum standards
Knowledge guides
LG14: Musculoskeletal 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
- Cancer staging with suspected osseous involvement
- Joint pain, stiffness, and swelling
- Musculoskeletal pain and trauma, including sporting injuries and suspected occult fractures
- Complications relating to prosthetic joint replacements and spinal surgery
- Suspected bone and joint infections
- Localising active pathology prior to consideration of targeted interventions / management
- Benign bone lesions:
- incidental findings on structural imaging
Conditions
- Arthritis and related conditions
- Musculoskeletal injuries
- Oncological conditions with bone metastases
PCH
- Bone and joint pain
- Bone trauma including non-accidental injury (NAI)
- Musculoskeletal infection:
- discitis
- osteomyelitis
- septic arthritis
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
- Autonomic dysreflexia
- Complex regional pain syndrome (sympathetic dystrophy)
- Skeletal manifestations of metabolic disorders
Conditions
- Infective conditions, including:
- discitis
- osteomyelitis
- septic arthritis
- Metabolic bone disease, including:
- hyperparathyroidism
- osteomalacia
- Paget’s disease
- renal osteodystrophy
- Post-surgical fusion complications, including:
- infection
- loosening
- peri-prosthetic fracture
- Prosthetic joint complications, including:
- infection
- loosening
- peri-prosthetic fracture
- Soft tissue calcification, including:
- heterotopic ossification
- myositis ossificans
PCH
- Complex regional pain syndrome
- Perthes disease
- Slipped capital epiphyseal injuries
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
- Absorption of calcium and phosphate, and their relationship to bone growth and resorption
- Anatomy of skeletal ligaments, muscles, and tendons
- Anatomy of the bones and joints of the pelvis, skull, spine, thorax, and upper and lower limbs
- Blood pool imaging, pinhole imaging, and SPECT and SPECT / CT in bone scintigraphy
- Bone and joint degeneration with age, and typical ‘normal’ patterns
- Cellular biology of skeletal metastasis
- Differentiate between primary injury and secondary compensatory (adaptive) effects
- Effects of parathyroid hormone and calcitonin on bone metabolism
- Normal and abnormal patterns of lymphatic drainage
- Pathophysiological effect of injury on local bone metabolism and duration of effect
- Patterns of injury associated with sports or practices
- Physiology of normal bone and muscle healing, and pathological changes of post-surgical interventions
- The pathophysiological mechanisms of acute and chronic inflammation with a focus on cell-mediated and humoral immune responses, and their potential application in molecular imaging
- The relationship between extracellular calcium and phosphate concentrations and bone metabolism
- The role of complementary studies, such as:
- bone marrow scintigraphy
- FDG PET
- gallium-67 scintigraphy
- leukocyte scintigraphy
PCH
- Differences that occur in the normal physiology of growth and development and the pathophysiology of common paediatric diseases, including common sites of pathology in bone metastases and osteomyelitis
- Knowledge of typical patterns of stress fracture and apophyseal injury in children and adolescents
- Normal distribution of bone, labelled white blood cell studies and PET isotopes in paediatric patients
- Recognition of non-accidental injury, including knowledge of typical sites and role of radionuclide skeletal survey
Investigations
- Bone scintigraphy:
- pinhole imaging
- planar bone scintigraphy
- SPECT
- SPECT / CT
- three-phase bone scanning
- Infection imaging:
- bone marrow scan
- Ga-67
- In-111 or Tc-99m labelled white cells
- PET / CT
- radiolabelled monoclonal antibodies
- white cell scintigraphy
- Complementary imaging modalities:
- CT
- MRI
- ultrasound
- x-ray
- PET / CT:
- F-18 FDG PET / CT scans
- F-18 NaF PET
- other PET radiopharmaceuticals
- Lymphoscintigraphy (assessment of lymphatic drainage)
PCH
- Bone scintigraphy:
- pinhole imaging
- planar bone scintigraphy
- SPECT
- SPECT / CT
- three-phase bone scanning
- Infection imaging:
- bone marrow scan
- PET / CT
- white cell scintigraphy
- Complementary imaging modalities:
- CT
- MRI
- ultrasound
- x-ray
- PET / CT:
- F-18 FDG PET / CT scans
- F-18 NaF PET
- 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, radiation safety and consent
PCH
- Determine appropriate studies in paediatric patients, and the techniques required
- Understand the legal ramifications and duty of care involved in cases of non-accidental injury for the paediatric population, including mandatory reporting requirements