EXAMINATION CONTENT OUTLINE

Following is a detailed outline of the nine major content areas of the examination, with an indication (in parentheses) of the approximate percentage of the examination devoted to each area:

1. PHYSICS AND INSTRUMENTATION (10%) (5% in Recertification Examination)
   1. Basic physics as applied to clinical imaging (e.g., isotope decay, decay modes, generators, high energy imaging)
   2. Gamma cameras, collimation, and equipment quality control procedures
   3. Interactions of radiation with matter
   4. Attenuation correction, including transmission and CT methods

2. RADIOPHARMACEUTICALS (8%)
   1. Radiotracer kinetics and characteristics (e.g., thallium-201 and technetium-99m)
   2. PET agents
   3. Red blood cell tagging

3. RADIATION SAFETY (10%) (15% in Recertification Examination)
   1. Radiopharmaceutical receiving, handling, monitoring, and containment
   2. Handling radiopharmaceutical spills and waste
   3. Storage and calibration of radiopharmaceuticals
   4. Dosimetry and MIRD
   5. Radiation exposure and ALARA
   6. Governmental regulations

4. NUCLEAR CARDIOLOGY DIAGNOSTIC TESTS AND PROCEDURES/PROTOCOLS (15%)
   1. Image acquisition (e.g., first pass and equilibrium RNA, gating, SPECT)
   2. Image processing (e.g., filtering, reorientation, reconstruction, motion correction)
   3. Standard conventions as to how images are displayed
   4. Exercise and pharmacologic stress protocols
   5. Pharmacologic stress agents
   6. Artifacts and causes of false-positive and false-negative results
   7. Quality control of image processing
   8. Quality assurance of interpretation
   9. Quantitative aids to interpretation

5. GENERAL CARDIOLOGY AS IT RELATES TO IMAGE INTERPRETATION (10%)
   1. Coronary anatomy and pathophysiology
   2. Unique characteristics of patient subgroups (e.g., patients with diabetes, elderly patients, male vs. female patients)
   3. Coronary angiography
   4. Stress physiology and testing; ECG and clinical parameters with rest and stress
   5. Measurements of left ventricle systolic and diastolic function
   6. Valvular disease, cardiomyopathy, hypertension, CHF, myocarditis
   7. Endothelial dysfunction
   8. Coronary artery disease
   9. Medical therapy, percutaneous coronary intervention, and coronary bypass surgery
   10. Indications for the use of alternative diagnostic techniques (Echo, MRI, coronary calcification, CT angiography)
   11. Bayes' theorem, pre- and post-test likelihood, sensitivity, specificity, and referral bias
   12. Statistical analyses (e.g., kappa value, Bland-Altman, ROC curves, Kaplan-Meier)
   13. Cost-effectiveness of diagnostic tests and principles of outcome studies

6. RISK STRATIFICATION (10%)
   1. Coronary artery disease
   2. Unstable angina
   3. Acute myocardial infarction
   4. Acute chest pain
   5. Candidates for noncardiac surgery
   6. Diabetes
   7. Chronic renal disease
   8. Women
   9. Post revascularization: percutaneous coronaryintervention and CABG
   10. Evaluation of medical therapy

7. MYOCARDIAL PERFUSION IMAGING INTERPRETATION (22%)
   1. Interpretation of perfusion images with technetium-99m-labeled tracers and thallium-201
   2. Interpretation of images with rubidium-82 and N-13-ammonia
   3. Relationship of perfusion abnormalities to clinical, hemodynamic, ECG and exercise parameters
   4. Relationship of perfusion abnormalities to coronary anatomy
   5. Combined function-perfusion imaging

8. VENTRICULAR FUNCTION IMAGING (10%)
   1. Rest and stress first-pass radionuclide ventriculography
   2. Rest and rest/stress equilibrium radionuclide ventriculography (planar and SPECT), including volume measurements and systolic and diastolic function
   3. ECG-gated SPECT myocardial perfusion imaging
   4. Effect of arrhythmia on ECG gating
   5. Implications of ventricular function testing for clinical management

9. MYOCARDIAL VIABILITY (5%)
   1. Thallium-201 imaging
   2. Technetium-99m imaging
   3. FDG imaging
   4. Outcome data related to myocardial viability
   5. Relationship to other imaging methods (e.g., echo, MRI)