Presentations
- Dyspnoea and/or pleuritic chest pain – suspected pulmonary embolism (PE)
PCH
- Congenital pulmonary and cardiac abnormalities
- PE
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
- Lung segment quantitation prior to lung volume reduction surgery
- Suspected hepatopulmonary, intrapulmonary, and pleuroperitoneal shunt
Conditions
- Chronic obstructive pulmonary disease (COPD)
- Inflammatory and infective lung disease
- Pulmonary hypertension
PCH
- Suspected right to left shunt
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
Pulmonary anatomy and physiology
- Arterial blood supply to the lungs
- Bronchopulmonary segments and their appearance on both two-dimensional and three-dimensional (cross-sectional) imaging
- Knowledge of radiotracers and imaging protocols used in pulmonary nuclear medicine imaging, including:
- advantages and disadvantages
- biological half-life and pharmacokinetics, including in breast milk
- dosimetry estimates for patients (and in pregnancy, for fetus and breast tissue)
- method of administration
- Lobes and fissures of the lungs and their anatomical relations within the thorax
- Metabolic functions of the lung and its effects on lung physiology
- Pathophysiology of left to right shunts and pulmonary hypertension, including hepatopulmonary and pleuroperitoneal shunts, and the risks of injecting MAA particles in these settings
- Physiologic features:
- gas exchange, measurement of gas exchange, and mechanisms of abnormal function
- pulmonary circulation, measurement of pulmonary circulation, and patterns of abnormal circulation
- ventilatory function, measurement of ventilatory function, and patterns of abnormal function
- Relationship between pulmonary blood flow and pulmonary ventilation under normal conditions and in PE
Investigations
- Novel PET tracers used in ventilation / perfusion scintigraphy, such as Galligas (Ga-68carbon nanoparticles) and Ga-68 MAA
- Ventilation perfusion (VQ) lung scintigraphy:
- planar
- quantitative planar
- SPECT
- SPECT / CT
- Managing unstable PE patients
- Utilisation of low dose CT in conjunction with VQ SPECT
- VQ lung scanning in specific patient populations:
- breastfeeding and pregnant women with suspected PE
- contrast allergies
- kidney impairment
Ancillary tests and complementary imaging techniques for PE
- Supplementary investigations in assessing and stratifying PE, such as:
- arterial blood gas measurements
- chest radiography
- CT pulmonary angiography
- ECG
- serum D-dimer assays
Assessment of oncological disorders with SPECT
- Bayesian analysis principles applied to diagnostic tests
- Clinical signs and symptoms of DVT and PE, their sensitivity and specificity in detection, and exclusion of PE and clinical scoring systems, including role of physician bias
- Describe strengths and weaknesses of planar and SPECT imaging
- Identification and assessment of VQ mismatch on SPECT and planar imaging
- Interpretation criteria for planar imaging interpretation, such as Biello or PIOPED II
- Interpretation of SPECT / CT studies correlating functional and anatomical imaging appearances, including guidelines recommendations, such as EANM
- Mortality and morbidity of treated and untreated DVT and PE
- Non-scintigraphy methods of DVT detection, including:
- compression ultrasound
- contrast venography
- Recurrence rate of DVT and PE and long-term sequelae
- Risk factors for DVT and PE
