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:
- 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:
- 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
