The residency program in Nuclear Medicine at The University of Alabama at Birmingham (UAB) is accredited by the American Medical Association Board of Medical Specialties. Residents in this program are actively involved in daily triage of patients to insure that the appropriate study is performed and the best scintigraphic data obtainable is collected. The residents in the program play a major role in the evaluation of the scintigraphic data and formulation of the Nuclear Medicine report. The residents are involved in all teaching sessions, play a major role in diagnostic consultation and, first-and-foremost, are always conscious of quality of patient care. The general Nuclear Medicine program includes all areas of scintigraphic imaging, radionuclide therapy, use of radionuclides in the ascertainment of laboratory physiologic values, and proper obtainment of in vivo tracer kinetic studies. The staff of the Division of Nuclear Medicine includes four physicians with both M.D. and Ph.D. degrees, two physicists, two programmers, two research associates, ten technologists and five clerical personnel.

The research section contains two laboratories (one involved with new isotope development for evaluation of cancer and gene therapy, and a second using high field MRI to evaluate fMRI and MRSI protocols). There are four Ph.D. in the division of nuclear medicine who head these laboratories, and can assist you with developing and conduction experiments in these areas.

Instruction is provided through formal lectures, regularly scheduled conferences, and supervised clinical experience. Introductory and review materials are presented in structured training sessions. Conference and journal club topics are selected to complement the curriculum.

Nuclear Medicine residents rotate through the Division of Nuclear Medicine at the University of Alabama Hospital (University Hospital, 12,000 procedures/year), the Nuclear Medicine Service of the Veterans Affairs Medical Center at Birmingham (V.A.), and the Children’s Hospital. These units function in close cooperation with one another.

Research laboratories are available in the University and V.A. Hospital complexes. Our present research interests involve projects associated with bone densitometry, radiopharmaceutical development, molecular imaging, brain SPECT (single, dual and triple head and positron emission tomographic coincidence imaging (PET-CI)), renal and cardiac studies (including renal and heart transplantations), and dedicated PET. Efforts are made to support specific research interests of the residents.

The available Nuclear Medicine equipment at University Hospital include 10 Anger Gamma cameras (mobile, SPECT, large field-of-view), Dynamic 133-Xenon absolute quantitative blood flow measures, dual x-ray absorptiometry, the ADAC MCD positron coincident dual head, as well as cameras for use in the animal imaging laboratory for evaluation of new tracers synthesized in the Molecular Image Development Laboratory. This equipment is interfaced to an ethernet network. Processing and review is done primarily on 15 Sun Sparc workstations positioned in all camera areas as well as in the General, Cardiac, ADAC MCD, and Dynamic Xe-SPECT areas. At the V.A., there are three cameras on an Elscint network.

An RDS 111, and a Siemens ECAT exact are located at the RMI building, and UAB residents will rotate through this facility to become educated on the proper operation and interpretation of dedicated PET imaging.

Routinely performed procedures include not only imaging, cardiac and renal studies but also a variety of in vivo distribution studies (thyroid uptake, hematokinetics, Schilling tests, glomerular filtration rate, renal plasma flow) and in vitro measures (thyroxine, cortisol, folate, digoxin, B-12, etc.).

Cardiac studies (4000) are an integral part of the clinical Nuclear Medicine activities at the University Hospital, the V.A. Hospital, and the Kirklin Clinic. Two Gamma scintillation cameras serve the University Hospital, two serve the Kirklin Clinic, and two serve the V.A. Hospital. Laboratories equipped with treadmills and bicycle ergometers are maintained at the University Hospital, the V.A. Hospital, and the Kirklin Clinic. The routine cardiac studies include rest/exercise myocardial perfusion imaging with Thallium-201, dipyridamole thallium studies, rest/exercise studies of ventricular performance, and regional wall motion studies utilizing first-pass and ECG-gated techniques. Regional wall motion is analyzed by the visual method in cine mode and complemented by quantitative assessment of regional ejection fractions. Sophisticated functional images are developed for all ventricular function studies. An average of 16 to 20 cardiovascular and Nuclear Medicine studies are performed per day assuring that more than an adequate number of studies are available for resident training. Besides the daily reading sessions, there is a weekly cardiac imaging conference.

The Section of Neuro-Nuclear Medicine is involved in routine brain SPECT imaging and many research projects. Routine brain blood flow or F-18 FDG metabolism imaging (as appropriate) are performed for the evaluation of dementia, hemodynamic (carotid or MCA stenosis) vascular constraint, residual viable brain tumor, interictal and ictal epilepsy studies, psychiatric disease, and stroke. The research projects include the evaluation of cerebrovascular disease employing low dose rest and high dose Diamox stress study paradigms, absolute quantification of regional cerebral blood flow (ml/100g/min), thallium-201, F-18 FDG and Tc-99m Sestamibi SPECT for the evaluation of residual and/or recurrent viable brain tumor, and the evaluation of ictal epilepsy using complementary data from video EEG monitoring as well as MRI SPECT fusion algorithms for anatomic localization of the epileptogenic focus identified on ictal SPECT. These research areas are supported by several extramural grant funding sources. There is abundant opportunity for resident participation in any of these areas.

Highest caliber brain SPECT scans are achieved by integration of superb camera and meticulous patient preparation combined with excellent pre- and post- processing techniques using automated software for cortical region of interest analysis with semi-automated comparison of each patient’s rCBF to a normal database. In addition sophisticated software algorithms have been developed for superimposition and registration of the computed tomographic SPECT images with computerized tomography or magnetic resonance image data. Other brain SPECT projects include studies of schizophrenia, (including pre and post therapy effects), narcolepsy, substance abuse, anxiety disorders, abnormal pain syndromes such as Fibromyalgia syndrome, environmental and industrial induced encephalopathic states, learning disabilities and autistic disorders, attention deficit disorder, and post-traumatic brain syndromes.

Two research assistants and two programmers are available for assisting in the analysis of specific brain research projects using state-of-the-art in house quantitative and co-registration software. A research associate is also available to assist in project data acquisition and storage as well as image analysis.

Approximately 150 therapy procedures are performed by the Nuclear Medicine staff. These include I-131 therapies for hyperthyroidism and thyroid carcinoma, Strontium therapy for pain in metastatic disease to the bone, and p-32 therapy for polycythemia vera. The residents also have the opportunity to observe imaging and therapy with labeled monoclonal antibodies under multiple research protocols performed in the Nuclear Medicine laboratory at the UAB Tumor Institute. The division of nuclear medicine is equipped with a state-of-the-art GE Discovery LS PET-CT system, which will enable the resident to obtain experience with positron emission tomography in the clinical areas of cardiac, tumor, and brain. An ADAC coincidence positron annihilation camera is used for cardiac and PET examinations. The primary PET radiopharmaceutical routinely used is 18-F Fluorodeoxyglucose for the evaluation of regional glucose metabolism.