The Cardiac PET Curriculum for Technologists features seven units, each including lectures that highlight a specific area within Cardiac PET. The activity is intended to be taken as a whole and as such comprises 42 Credits/Hours and is recognized by the Nuclear Medicine Technology Certification Board (NMTCB) to meet the requirements for recertification via the alternate pathway. To receive the 42 Hour NMTCB PET Recertification Alternate Certificate of Completion, learners much complete all content in each of the seven units. There is no set order to completion of the units, or of the modules within the units, and learners may proceed as best suits their needs.

Each unit is comprised of lectures, examination questions, resource materials and carries its own credit. To claim credit in a given unit, all content in the unit must be completed and an evaluation submitted. Learners may then claim credit and receive their certificate for the unit. Unit certificates include the ASNC Reference number as required by ARRT. Learners may choose to complete as many units as they choose; however, the NMTCB recertification alternate Certificate of Completion will not be awarded unless and until all units have been completed.

This activity is intended for nuclear medicine and nuclear cardiology imaging technologists who specialize in cardiac PET imaging.

After participating in the Cardiac PET Curriculum for Technologists, learners should be able to:
• Demonstrate understanding of the fundamentals of cardiac PET tracer delivery systems
• Discuss quality measures for PET instrumentation and accurate image acquisition and processing 
• Apply regulatory requirements to establish and safely run a PET facility

Unit 01 The Fundamentals, Part 1
• Identify current and emerging PET tracers, imaging protocols, and tracer quality control
• Outline the stepwise approach to image interpretation, and detection in addition to troubleshooting artifacts
• Explain the differences between net retention and single tissue MBF software programs and how to acquire myocardial blood flow data and quality control procedures associated with each
• List practical considerations for setting up a PET lab

Unit 02 The Fundamentals, Part 2
• Differentiate the clinical value of cardiac PET versus SPECT imaging
• Describe the various hardware and software options for PET imaging and their strengths and limitations, and the procedures necessary to ensure PET studies are acquired appropriately for clinical PET studies
• Explain the various PET imaging protocols and patient preparation critical to performing appropriate PET studies

Unit 03 Opportunities for Dose Reduction
• Demonstrate understanding of Appropriate Use Criteria with respect to cardiac PET applications
• Recognize and apply patient protocols to reduce dose
• Identify instrumentation options and modifications to optimize imaging and decrease radiation exposure

Unit 04 Radiochemistry and Radiopharmaceuticals
• Explain nuclear medicine generators and radiopharmaceutical kit preparation and mandated key quality control measures
• Define what constitutes a radiotracer and a perfusion radiotracer
• Describe the physics, biology and physiology of cardiac PET flow tracers

Unit 05 Diagnostic Procedures
• Describe requirements for patient preparation and camera setup based on cardiac PET protocol used
• Demonstrate understanding of image acquisition and processing as determined by cardiac PET tracer selection
• Describe how to acquire and process a cardiac PET perfusion study with myocardial blood flow information

Unit 06 Instrumentation and Quality Control
• Demonstrate understanding of the physics and instrumentation principles of quality cardiac PET imaging acquisition and protocoling
• Apply knowledge to mitigate cardiac PET imaging artifacts

Unit 07 Regulatory Review and Radiation Protection
• Identify the principles of radiation protection and be able to translate into everyday lab safety for the general public, occupational worker, and patient
• Describe 10 CFR and NUREG requirements for cardiac PET lab personnel and licensee requirements
• Demonstrate knowledge of where to find sources of information, both regulatory and within the providing institutions
• Describe the basic science of ionizing radiation and nuclear decay and energy, activity administered, dose exposures

The overarching goals of this curriculum are to increase learners’ knowledge and competence in cardiac PET perfusion and metabolic imaging critical to provision of quality patient care.

Total of 42 hours of content includes:

• Unit 01: Cardiac PET: The Fundamentals, Part 1 (9.5 CEs)
• Unit 02: Cardiac PET: The Fundamentals, Part 2 (4.5 CEs)
• Unit 03: Cardiac PET: Opportunities for Dose Reduction (6.25 CEs)
• Unit 04: Cardiac PET: Radiation Chemistry and Radiopharmaceuticals (5 CEs)
• Unit 05: Cardiac PET: Diagnostic Procedures (5.75 CEs) 
• Unit 06: Cardiac PET Instrumentation and Quality Control (4 CEs)
• Unit 07: Cardiac PET: Regulatory Review and Radiation Protection (7 CEs)

Content for this course is drawn from the ASNC/SNMMI 80 Hour Radioisotope Authorized User Training Course; the ASNC Cardiac PET Curriculum; and the ASNC Cardiac PET Technologist Workshop.

Cardiac positron emission tomography (PET) offers improved diagnostic accuracy and additional benefits over cardiac SPECT in the management of patients with heart disease. In addition to high diagnostic accuracy, these benefits include, consistent high-quality images, low radiation exposure, short acquisition protocols, strong prognostic power, and quantification of MBF.[Bateman 2016; Bateman 2021;Dilsizian 2016] PET in combination with other imaging modalities including computed tomography (coronary artery calcium scoring) [Miller 2022], may enhance clinical decision making. Many nuclear cardiology labs are moving from SPECT to PET and technologists are a critical part of a successful transition, as well as implementing day-to-day performance of high quality studies.

PET and hybrid PET/CT imaging expand the spectrum of patients that can be studied with nuclear cardiology imaging. Myocardial perfusion can be assessed in patients with no known CAD but low-intermediate pretest probability, as well as complicated patients with long histories of CAD, including those with prior revascularizations or infarctions, cardiomyopathies, co-existent valve diseases, and numerous comorbidities. [Patel 2019a, Patel 2019b] In addition, it can be used for non-perfusion indications such as myocardial viability, [Beanlands 2007], device infections, [Kim 2014; McArdle 2013] endocarditis, [Saby 2013; Pizzi 2015] and cardiac sarcoidosis. [Osborne 2014] Cardiac PET also provides the ability to quantitate MBF and assess myocardial blood flow reserve (MFR), improving patient management decisions adding to the enhanced clinical value of PET imaging compared with SPECT imaging. [Bateman 2021; Murthy 2018; deKemp 2016; Schindler 2020] The benefits of cardiac PET can be implemented on both dedicated and PET/CT systems, and multiple software options are available for MBF and MBFR measurements. Cardiac PET does not increase study time or technologist exposure to radiation. [Case 2017] Together, high quality perfusion and blood flow studies provide improved diagnostic accuracy compared with SPECT. The ability to measure MBF in conjunction with perfusion, recognize whether vasodilation has been achieved especially in patients with normal perfusion or fixed defects, identify a low risk population of normal perfusion and normal MBF in which the risk of CAD and cardiac events is minimal, identify a previously missed population of normal perfusion but abnormal blood flow in which CAD has not been excluded, characterize microvascular disease, especially in diabetic, hypertensive and renal failure patients that assists in treatment strategies, and identify patients with more extensive CAD beyond perfusion results positions cardiac PET to enhance the care of patients with heart disease.

Performing high quality PET studies requires training. Motion on PET/CT scans pose different challenges compared to SPECT acquisition. Motion between CT and PET is difficult to recognize and to correct.

Nuclear medicine/nuclear cardiology technologists play a critical role in the successful implementation and everyday performance of a cardiac PET laboratory. Understanding the issues that can impact the quality of the study and how to handle the challenge is an important part of doing cardiac PET appropriately. Training of technologists for precise data acquisition and processing, especially positioning of patients for MBF studies are key to obtaining a high quality cardiac PET study. [Singh 2021]

This curriculum provides the opportunity to learn and enhance understanding of the critical issues facing nuclear imaging technologists to ensure they achieve high quality, clinically relevant patient studies.

Technologists: The American Society of Nuclear Cardiology is a recognized provider of continuing education credit for technologists. ASNC’s Continuing Education (CE) credit is accepted by the NMTCB and ARRT. This enduring materials activity has been approved for a maximum of 42 ARRT Category A credits for Technologists.

As an accredited provider of the Accreditation Council for Continuing Medical Education (ACCME), The American Society of Nuclear Cardiology (ASNC) adheres to the ACCME’s Standards for Integrity and Independence in Accredited Continuing Education.  In compliance with these standards, it is ASNC’s policy to ensure balance, independence, objectivity, and scientific merit of all its educational activities through the disclosure of all relationships with ineligible companies and mitigation of conflicts of interest.  The financial interest or relationships requiring disclosure are outlined in ASNC’s CME Conflict of Interest Policy.  All persons who influenced the content in the units of this curriculum are required to disclose all relationships.  The American Society of Nuclear Cardiology has reviewed these disclosures and resolved or managed all identified conflicts of interest through a peer review process.

Disclosures for the Planners, Reviewers and Faculty are provided within each unit.

To receive a certificate of credit, participants must successfully complete the quiz questions within each lecture and evaluation questions after each unit . The participant selects the single most appropriate answer for each post-test question. A score of 75% or higher is needed to pass the post-test quiz. If less than 75% of the questions were correct, the participant will be notified and may resubmit the quiz.

Release Date: April 4, 2024
Expiration Date: April 3, 2027