DNB Nuclear
Medicine or Diplomate of National Board in Nuclear Medicine also known as DNB
in Nuclear Medicine is a Postgraduate level course for doctors in India
that is done by them after completion of their MBBS. The duration of this
postgraduate course is 3 years, and it focuses on the study of various concepts related to
the field of the use of radioactive substances in the diagnosis and treatment
of diseases.

The course is a full-time course pursued at various accredited institutes/hospitals
across the country. Some of the top accredited institutes/hospitals offering
this course include AIG Hospital Mind Space Road, Gachibowli, Hyderabad, Apollo Hospital- Chennai, Fortis Memorial Research Institute – Gurgaon, and more.

Admission to this course is done through the NEET PG Entrance exam
conducted by the National Board of Examinations, followed by counselling based
on the scores of the exam that is conducted by DGHS/MCC/State
Authorities.

The
fee for pursuing DNB (Nuclear Medicine) from accredited institutes/hospitals is
Rs. 1,25,000 to Rs 3,15,000.

After completion of their respective course, doctors can either join the
job market or pursue a super-specialization course where DNB Nuclear
Medicine is a feeder qualification. Candidates can take reputed jobs at
positions as Senior residents, Junior Consultants, Consultants, etc. with an
approximate salary range of Rs 1,75,000 to Rs. 35,00,000 per year.

DNB is
equivalent to MD/MS/DM/MCh degrees awarded respectively in medical and surgical
super specialties. The list of recognized qualifications awarded
by the Board in various broad and super specialties as approved by the
Government of India are included in the first schedule of the Indian Medical
Council Act, 1956.

The Diplomate
of National Board in broad-specialty qualifications and super specialty
qualifications when granted in a medical institution with the attached hospital or
in a hospital with the strength of five hundred or more beds, by the National
Board of Examinations, shall be equivalent in all respects to the corresponding
postgraduate qualification and the super-specialty qualification granted under
the Act, but in all other cases, senior residency in a medical college for an
additional period of one year shall be required for such qualification to be
equivalent for the purposes of teaching also.

What is DNB in Nuclear Medicine?

Diplomate of National Board in Nuclear
Medicine, also known as DNB (Nuclear Medicine) or DNB in Nuclear Medicine is a three-year postgraduate
programme that candidates can pursue after completing MBBS.

Nuclear Medicine is the branch of
medical science dealing with the study of internal
organs of the human body using radioactive isotopes.

The National Board
of Examinations (NBE) has released a curriculum for DNB in Nuclear Medicine.

The curriculum governs the education and training of DNB in Nuclear Medicine. PG education intends to create
specialists who can contribute to high-quality health care and advances in
science through research and training.

The required training done by a
postgraduate specialist in the field of Nuclear
Medicine would help the specialist to recognize the health needs of the
community. The student should be competent to handle medical problems
effectively and should be aware of the recent advances in their specialty.

The candidate should be a highly
competent specialist in Nuclear
Medicine possessing a broad range of skills
that will enable her/him to practice Nuclear
Medicine independently. The PG candidate should also acquire the basic
skills in teaching medical/para-medical students.

The candidate is also expected to
know the principles of research methodology and modes of the consulting
library. The candidate should regularly attend conferences, workshops, and CMEs
to upgrade her/ his knowledge.

Course Highlights

Here are some of the course highlights of DNB in Nuclear Medicine:

Name of Course

DNB in Nuclear Medicine

Level

Postgraduate

Duration of Course

Three years

Course Mode

Full Time

Minimum Academic Requirement

MBBS degree obtained from any
college/university recognized by the Medical Council of India (now NMC)

Admission Process / Entrance Process /
Entrance Modalities

Entrance Exam (NEET PG)

Course Fees

Rs. 1,25,000 to Rs 3,15,000

Average Salary

Rs 1,75,000 to Rs. 35,00,000 per year

Eligibility Criteria

The eligibility criteria for DNB in Nuclear Medicine are defined as
the set of rules or minimum prerequisites that aspirants must meet in order to
be eligible for admission, which includes:

Candidates must be in possession of an undergraduate
MBBS degree from any college/university recognized by the Medical Council of
India (MCI) now NMC.

Candidates should have done a compulsory rotating internship of one year
in a teaching institution or other institution which is recognized by the
Medical Council of India (MCI) now NMC.

The candidate must have obtained permanent registration of any State
Medical Council to be eligible for admission.

The
medical college’s recognition cut-off dates for the MBBS Degree courses and
compulsory rotatory Internship shall be as prescribed by the Medical Council of
India (now NMC).

Candidates
who have passed the final examination, leading to the award of a Post Graduate
Degree (MD/MS) from an Indian University, which is duly recognized as per
provisions of the National Medical Commission (NMC) Act, 2019 and the first
schedule of the IMC Act can apply for the DNB Final examination in the same
broad specialty.

Admission
Process

The admission process contains a few steps to
be followed in order by the candidates for admission to DNB in Nuclear Medicine. Candidates can view the complete admission
process for DNB in Nuclear Medicine
mentioned below:

The NEET PG or National Eligibility Entrance Test for Post
Graduates is a national-level master’s level examination conducted by the NBE
for admission to MD/MS/PG Diploma Courses.The requirement
of eligibility criteria for participation in counselling towards PG seat
allotment conducted by the concerned counselling authority shall be in lieu of
the Post Graduate Medical Education Regulations (as per the latest amendment)
notified by the MCI (now NMC) with prior approval of MoHFW.

S.No.

Category

Eligibility Criteria

1.

General

50th Percentile

2.

SC/ST/OBC (Including PWD of SC/ST/OBC)

40th Percentile

3.

UR PWD

45th Percentile

Fees Structure

The fee structure for DNB in Nuclear Medicine varies from accredited
institute/hospital to hospital. The fee is generally less for Government Institutes
and more for private institutes. The average
fee structure for DNB in Nuclear
Medicine is Rs. 1,25,000 to Rs 3,15,000.

Colleges offering DNB in Nuclear Medicine

There are
various accredited institutes/hospitals across India that offer courses for
pursuing DNB (Nuclear Medicine).

As per the National
Board of Examinations website, the following accredited institutes/hospitals
are offering DNB (Nuclear Medicine) courses
for the academic year 2022-23.

Hospital/Institute

Specialty

No. of Accredited Seat(s)
(Broad/Super/Fellowship)

DNB- Post Diploma Seat(s)

AIG Hospital
Mind Space Road, Gachibowli, Hyderabad
Telangana-500032

Nuclear Medicine

1

1

Apollo Hospital
21, Greams lane, Off Greams Rd, Thousand
Lights, Chennai.
Tamil Nadu-600006

Nuclear Medicine

1

1

Army Hospital (R and R)
Delhi Cantt, New Delhi
Delhi-110010

Nuclear Medicine

2

2

Dr. Ram Manohar Lohia Institute
of Medical Sciences
Vibhuti khand, Gomti Nagar, Lucknow
Uttar Pradesh-226010

Nuclear Medicine

1

1

Fortis Memorial Research
Institute
Sector-44, Opposite HUDA CITY centre Metro
Station, Gurgaon,
Haryana-122002

Nuclear Medicine

1

1

Indo-American Cancer Institute
and Research Centre
Road No.14, Banjara Hills, Hyderabad
Telangana-500034

Nuclear Medicine

1

1

Jaslok Hospital and Research
Centre
15, Dr. Gopalrao Deshmukh Marg, Mumbai
Maharashtra-400026

Nuclear Medicine

1

1

Lilavati Hospital and Research
Centre
A-791, Bandra Reclaimation, Bandra West,
Mumbai
Maharashtra-400050

Nuclear Medicine

2

2

Narayana Hrudayalaya Hospital
(NH-Narayana Health City, Bangalore)
#258/A, Bommasandra Industrial Area, Anekal Taluk, Bangalore
Karnataka-560099

Nuclear Medicine

3

3

Nizam`s Institute of Medical
Sciences
Punjagutta, Hyderabad
Telangana-500082

Nuclear Medicine

1

1

P.D. Hinduja National Hospital
and Medical Research Centre
Veer Savarkar Marg, Mahim, Mumbai
Maharashtra-400016

Nuclear Medicine

1

1

Seth G.S. Medical College
and KEM Hospital, Parel, Mumbai
Maharashtra-12

Nuclear Medicine

1

0

Sir Ganga Ram Hospital
Rajinder Nagar, New Delhi
Delhi-110060

Nuclear Medicine

2

2

Syllabus

A DNB
in Nuclear Medicine is a three years specialization course that
provides training in the stream of Nuclear
Medicine.

The
course content for DNB in Nuclear Medicine is given in the NBE Curriculum released by the National Board of Examinations, which can
be assessed through the link mentioned below:

1. SCIENTIFIC BASIS OF NUCLEAR MEDICINE

a. Radio Biology, Radiation safety Quality Assurance in Nuclear Medicine

i. Knowledge

• Outline the basic principles of radioactive decay, nuclear reactions, and production of radionuclides, detection, and measurement of ionizing radiation

• Discuss the effects of ionizing radiation on humans

• Describe the legislative control of radiation in India and the world

• Describe the principles and procedures of radiation protection as applied to nuclear medicine, including the as low as reasonably achievable (ALARA) principle

• Describe the principles of operation of SPECT, PET, CT, and hybrid SPECT/CT and PET/CT cameras, including:

• performance characteristics, and differences between cameras

• quality control

• equipment specification and selection

• computer acquisition

• image processing and display

ii. Skills

• Outline the basic principles of radioactive decay, nuclear reactions, and production of radionuclides, detection and measurement of ionizing radiation

• Discuss the effects of ionizing radiation on humans

• Describe the legislative control of radiation in India and the world

• Describe the principles and procedures of radiation protection as applied to nuclear medicine, including the as low as reasonably achievable (ALARA) principle

• Describe the principles of operation of SPECT, PET, CT, and hybrid SPECT/CT and PET/CT cameras, including:

• performance characteristics, and differences between cameras

• quality control

• equipment specification and selection

• computer acquisition

• image processing and display

• Explain and apply principles of radiation safety to:

• adult patients, including pregnant or breastfeeding patients

• pediatric patients

• practice staff

• Advise referring doctors, medical students, nuclear medicine technologists, and junior medical staff about the principles of:

• radiation safety, including legislative requirements

• operation of SPECT, PET, CT, and hybrid cameras

• principles of radiopharmaceutical chemistry

• recent developments and trends in nuclear medicine instrumentation and diagnostic and therapeutic radiopharmaceuticals.

b. Biostatistics

i. Knowledge

• The trainee shall have the basic skills to be able to understand the following parameters used in assessing the research and apply them critically to any relevant scientific paper:

• Ethical basis of research

• Prospective or retrospective

• Sample size

• Appropriate methodology

• How the data is assessed

• Appropriate use of statistics and their meaning

• The use of the terms phase 1, phase 2, and phase 3 trials

• Understanding the requirements and limitations of randomized controlled trials

• How results may affect practice or determine the need for further research

• The importance of looking at levels of evidence such as the Cochrane method

ii. Skills

• The trainee will be able to critically assess the research in the field of nuclear medicine and radiology

• Be able to understand both strengths and weaknesses of research

• Understand the particular limitations which occur in research in imaging

2. DIAGNOSTIC NUCLEAR MEDICINE

a. Cardiovascular Nuclear Medicine

i. Knowledge

• Basic Anatomy of the heart

• Understand the pathophysiology of coronary artery disease, exercise testing, heart failure

• Discuss the appropriateness of using various PET and SPECT techniques to determine myocardial perfusion and viability

ii. Skills

• Supervise and interpret resting and exercise ECGs

• Supervise and interpret stress testing using pharmacological agents

• Assess coronary artery disease using SPECT radiopharmaceuticals

• Assess ventricular function using radionuclide ventriculography

• Assess congenital heart disease using radiolabelled shunt studies

• Perform I-123 MIBG adrenergic cardiac imaging studies

• Discuss the role of complementary imaging techniques for cardiac disease

• Discuss the role of CTCA in the management of coronary artery disease

• Assess myocardial perfusion using SPECT and PET techniques

• Assess myocardial viability using SPECT and PET techniques

• Cardiac transplant evaluation

b. Endocrine Nuclear Medicine

i. Knowledge

• Identify anatomy and common variants of the thyroid and parathyroid glands and explain their anatomical relations in the neck

• Identify the surface anatomy of the thyroid and parathyroid glands

• Understand the pathophysiology of parathyroid disease and its clinical importance.

• Discuss the physiology of the thyroid gland concerning control by TRH/TSH and thyroid hormone synthesis and storage

• Describe thyroid function tests and the results in hyper- and hypothyroidism Describe iodine handling by the thyroid

• Pathophysiology of different causes of hyperthyroidism

• Different treatment options for patients with hyperthyroidism

• Appropriate selection of patients with hyperthyroidism for I-131

• Pathophysiology of thyroid cancer

• Understand both the dosimetric and empirical methods method used in treating hyperthyroidism and thyroid cancer with I-131

• Identify the anatomy of the adrenal glands

• Discuss hormone production and secretion by the adrenal glands

• Understand the pathophysiology of medullary and cortical adrenal tumors. Know the probability of bilateral disease or malignant spread

ii. Skills

• Perform and interpret radioisotope scans for the thyroid gland using both technetium and radioactive iodine

• Assess thyrotoxicosis and thyroid nodules

• Reading pre-therapy radioisotope studies to determine if treatment is appropriate with I-131

• Performing and interpreting parathyroid scintigraphy including both planar and SPECT imaging

• Interpret adrenal cortical imaging

• Perform and interpret I-131 MIBG imaging for detection and staging of pheochromocytomas

• Perform and interpret newer agents for the detection of Pheochromocytoma like FDG PET imaging, Somatostatin receptor PET among others

• Be able to assess and treat a patient with hyperthyroidism with radioactive iodine

• Discuss the appropriate assessment, risk stratification, and management of thyroid cancer

• Discuss the role of complementary imaging techniques for endocrine disease

c. Gastrointestinal Nuclear Medicine

i. Knowledge

• Describe the pathophysiology of GI motility disorders

• Describe the pathology of primary and secondary hepatic tumors

• Describe the pathophysiology of acute and chronic cholecystitis, biliary dyskinesia, sphincter of Oddi dysfunction, cystic duct syndrome, and post cholecystectomy syndrome

• Describe the pathology relating to GI hemorrhage

• Describe the pathology of IBD

• Describe the pathology of intra-abdominal sepsis

ii. Skills

• To assess the diseases of GI motility

• Assess gallbladder and biliary function using hepatobiliary scans

• Assess GI hemorrhage

• Assess inflammatory bowel disease (IBD) and intra-abdominal sepsis

• Assess abnormal splenic function using Tc-99m labeled tracers

• Assess hepatic artery catheters and peritoneal-venous shunts using Tc- 99m labeled tracers

• Describe the use of salivary and lacrimal gland imaging

• Assess GI disease using complementary GI imaging techniques

d. Genitourinary Nuclear Medicine

i. Knowledge

Describe the pathophysiology of:

• renovascular hypertension (RVH)

• types of urinary tract obstruction and the effects of diuretics on these mechanisms

• acute pyelonephritis and renal scarring

• transplant rejection

• vesicoureteric reflux

• renal failure

• acute tubular necrosis (ATN)

• acute epididymitis and testicular torsion

ii. Skill

• Perform and interpret a renal dynamic study with emphasis on obstruction, renovascular hypertension, and renal malformation

• Perform and interpret renal cortical imaging

• Perform and interpret DRCG scans for VUR

• Perform and interpret imaging for renal infection and inflammation

• Assess a renal transplant patient

• Assess renal failure

• Discuss the role of complementary imaging techniques for genitourinary disease

e. Infection and Inflammation Nuclear Medicine

i. Knowledge

• Describe the fundamentals of humoral inflammation and cellular inflammation

• Describe the general characteristics of neutrophils, lymphocytes, monocytes, and macrophages, and their role in the body’s resistance to infection

• Skills

• Assess infection and inflammation using nuclear medicine techniques

• Recognise the emerging role of PET in the assessment of inflammation or infection

f. In Vitro Nuclear Medicine Techniques

• Assess patients using C-14 urea breath tests to evaluate Helicobacter pylori infection

• Assess patients using C-13/14 breath tests to evaluate intestinal absorption

• Assess patients using Cr-51 EDTA, Tc-99m DTPA to evaluate renal function

• Discuss the role and use of Cr-51 RBCs to evaluate GI bleeding

• Discuss radioiodine uptake or the assessment of thyroid function

• Perform and interpret GFR calculation using the Plasma Clearance method of Tc- 99mDTPA and Cr51 EDTA

g. Musculoskeletal Nuclear Medicine

i. Knowledge

• Describe the pathogenesis and pathological features of osteoporosis, Paget’s disease, osteomalacia, hyperparathyroidism, and renal osteodystrophy

• Describe the clinicopathological features of regional migratory osteoporosis

• Describe the effects on bone metabolism of the various physical and pharmacological treatments that are employed in the treatment and prevention of osteoporosis.

• Describe the pathogenesis and pathological features of acute and chronic osteomyelitis (including vertebral osteomyelitis), septic arthritis, and discitis.

• Describe the natural history of periprosthetic bone changes in cemented and non-cemented prosthetic joint replacements Arthritis and Related Conditions:

• List the causes of inflammatory arthritis and describe the basic clinicopathological features of these conditions, including reference to the distribution of joint involvement

• Describe the basic clinicopathological features of osteoarthritis and degenerative disease of the spine

• Describe the etiology of osteonecrosis, including radiation osteonecrosis, and bone infarction

• Describe the clinicopathological features of complex regional pain syndrome/reflex sympathetic dystrophy (CRPS/RSD)

ii. Skills

• Describe techniques of bone scintigraphy and PET imaging

• Assess musculoskeletal trauma

• Assess metabolic bone disease

• Assess skeletal infection

• Assess prosthetic joint replacements

• Assess patients following spinal surgery

• Assess arthritis and related conditions

• Discuss the role of complementary musculoskeletal imaging modalities

h. Neurological Nuclear Medicine

i. Knowledge

• Discuss the anatomy of the brain and spinal cord with particular emphasis on cross-sectional anatomy

• Identify the surface markings of the cerebral lobes

• Identify the intracerebral structures of the brain in transverse, sagittal, and coronal planes

• Identify the cerebral arteries, the territories that they perfuse, and their relations to other cerebral structures

• Identify the cerebral veins and sinuses and their relations to other cerebral structures

• Identify the cerebral ventricles and their relations to other cerebral structures, including the spinal cord

• Discuss the physiology of the brain in normal and abnormal states, with particular attention to regional cerebral perfusion

• Explain the fundamentals of cerebral perfusion and autoregulation

• Describe the relationship between cerebral perfusion and cerebral metabolism in health and disease

• Explain the concepts of cerebral blood volume and luxury perfusion • explain the effect of seizures on cerebral blood flow

• Describe the pathophysiology of atherosclerosis, cerebral ischemia, cerebral infarction, cerebral atrophy, intracranial hemorrhage, intracranial aneurysms, intracranial vascular malformations, cerebral tumors, cerebral vasculitis, drug-induced cerebral injury, cerebral HIV/AIDS, and encephalitis

• Describe the pathophysiology and classification of seizures

• Describe the pathophysiology and classification of dementia

• Describe the physiology of CSF production and flow

• Describe the pathophysiology of normal pressure hydrocephalus, obstructed hydrocephalus, non-obstructed hydrocephalus, and CSF leaks

• Describe the pathophysiology of brain death

ii. Skills

• Perform and interpret cerebral perfusion studies using SPECT and PET

• Assess disorders of CSF flow and suspected CSF leaks using scintigraphic techniques

• Perform and interpret FDG PET /SPECT studies for the classification of Dementias

• Perform and interpret ictal and interictal studies for localizing the epileptogenic focus

• Identify emerging brain SPECT and PET techniques

• Assess impaired neurological function using a complementary imaging technique

i. Evaluation of Osteoporosis

• Describe techniques used to evaluate osteoporosis

• Assess quality assurance procedures in bone mineral density (BMD) estimation

• Interpret and report lumbar spine BMD scans

• interpret and report proximal femur BMD scans

• Assess BMD in the appendicular skeleton

• Assess total body bone mineral and body composition

• Outline absolute fracture risk

j. Oncological Nuclear Medicine

i. Knowledge

• Understand the pathophysiology of cancer

• Be able to take an appropriate history from the patient (or their parents) and examine the patient as required

• Understand how F-18 FDG may be used to diagnose lung cancer in a patient with a single pulmonary nodule or stage a patient which CT suggests is operable

• Understand the role of FDG imaging in a range of cancers

• Know the health economic arguments concerning the use of PET-CT in diagnosing and staging cancer

• Know the causes of a false negative or false positive result

• Be able to identify other unsuspected pathology on the PET or CT study

ii. Skills

• Be able to run a glucose clamp in a diabetic patient if required

• Be able to decide if a study is positive for cancer and also be able to determine if a patient with known cancer is operable

• Recognise issues related to the misregistration of fusion images and be able to determine how the effect of this may be reduced

• Be able to recognize the causes of false positive uptake of F-18 FDG

• and if possible how to differentiate this uptake from cancer

• Know when additional images/tests may be required

• Keep up to date with the latest research findings and recommendations on the use of F-18 FDG PET in cancer

• Be able to confidently present the results in an MDT

• Assess patients with lung cancer

• Assess patients with GI malignancies

• Assess patients with breast cancer

• Assess patients with head and neck malignancies

• Assess patients with melanoma

• Assess patients with neuroendocrine tumors

• Assess patients with lymphoma and other hematological malignancies

• Assess patients with gynecological malignancies

• Assess patients with sarcoma

• Assess primary bone tumors

• Assess skeletal metastatic disease

• Assess patients with brain malignancy

• Assess patients using lymphoscintigraphy

• Explain the use of radiological imaging to assist in the interpretation of oncological nuclear medicine studies

k. Newer Advances in PET

• Understand PET can be used in a variety of different diseases using a variety of PET pharmaceuticals to look at different types of diseases including:

• F-18 skeletal disease

• F-18 FLT cancer cell turnover

• F-18 choline Renal cell cancer/ Prostate cancer

• F-18 DOPA pancreatic neuroendocrine tumors

• Parkinson’s syndrome

• F-18 FMISO Hypoxia

• C-11 or F-18 beta-amyloid for Alzheimer’s disease

• C-11 /F18 agents for Brain primary tumors

• Ga-68/ Somatostatins Neuroendocrine tumors

• Understand the mechanism of uptake of each agent and what may lead to a false negative or false positive study

• Understand the imaging protocol for each agent and each indication

• Be aware of the legal framework in place when using novel tracers

l. Pulmonary Nuclear Medicine

i. Knowledge

• Identify the lobes and fissures of the lungs and their anatomical relations in the thorax

• Identify the bronchopulmonary segments of both lung and their projections in both two-dimensional and three-dimensional imaging

• Describe the physiologic features of ventilatory function, measurement of ventilatory function, and patterns of abnormal function

• Describe the physiologic features of pulmonary circulation, measurement of pulmonary circulation, and patterns of abnormal function

• Describe the physiologic features of gas exchange, measurement of gas exchange, and mechanisms of abnormal function • describe the relationship between pulmonary blood flow and pulmonary ventilation under normal conditions and in PE

• Describe the metabolic functions of the lung and its effects on lung physiology

ii. Skills

• Describe the assessment, management, and outcomes of pulmonary embolism (PE) and deep venous thrombosis (DVT)

• Assess PE using ventilation and perfusion imaging

• Discuss the role of ancillary tests and complementary imaging techniques for PE

• Assess patients by quantitation of lung ventilation and perfusion

• Assess inflammatory lung disease

m. Paediatric Nuclear Medicine Diagnostic

• Describe the basic principles of pediatric nuclear medicine

• Assess musculoskeletal disorders

• Assess genitourinary disorders

• Assess GI disorders

• Assess infection and inflammation

• Assess thyroid disease

• Assess pulmonary disease

• Assess malignancy

• Assess neurological disease

• Assess congenital cardiac disease

n. Sentinel Node imaging

i. Knowledge

• Understand the pathophysiology of malignant disease know how it spreads and in which cancers sentinel node localization is both possible and useful

• Identify and discuss the different techniques available for sentinel node localization

• Know when and if SPET/CT may be of use

• Understand how the images analyzed and are displayed for reading, including the use of a “shadow gram”

ii. Skills

• Inject radiotracers for sentinel node localization

• Use an intra-operative hand-held probe for sentinel lymph node localization

o. Radionuclide Therapy

Basic Knowledge

• Describe the mechanisms of radiation-induced cell damage

• Describe tissue characteristics that modify the response to radiation-induced injury

• Describe the general characteristics of the relationship between cell cycle and radiation-induced injury

• Describe the effects of toxic doses of radiation on normal organs

p. Treatment of Hyperthyroidism with I-131

i. Knowledge

• Pathophysiology of different causes of hyperthyroidism

• Different treatment options for patients with hyperthyroidism

• Appropriate selection of patients with hyperthyroidism for I-131

• Understand appropriate follow-up required for patients having been treated with I-131

• Reading pre-therapy radioisotope studies to determine if treatment is appropriate with I-131

• Understand both the dosimetric and empirical methods method used in treating hyperthyroidism with I-131

• Understand the legislation concerning the safe delivery of I-131 including radiation protection for self, other staff, and the patient’s caregivers

ii. Skills

• Be able to take relevant history and perform relevant clinical examination within the thyroid clinic

• Recognise those complications that would be a contra-indication to treatment with I-131

• Be able to explain the treatment and obtain consent for treatment with special reference to female patient’s concerns about fertility and contraception

• Be able to advise on the management of thyroid eye disease

• Advise on termination and re-commencement of anti-thyroid medication

• Arrange appropriate follow-up and further management of the patient

q. I -131 therapy for the treatment of patients with thyroid cancer

i. Knowledge

• Pathophysiology of thyroid cancer

• Different treatment options for patients with thyroid cancer

• Appropriate selection of patients with hyperthyroidism for I-131. Understand the need for ablation of thyroid remnant

• Understand the long-term prognosis of the disease in patients treated or not with I-131

• Understand appropriate follow-up required for patients having been treated with I-131 for thyroid cancer

• Reading pre-therapy radioisotope studies to determine if treatment is appropriate with I-131 including I-123 and F-18 FDG PET imaging

• Understand both the dosimetric and empirical methods method used in treating thyroid cancer with I-131

• Understand the advantages and disadvantages and methodology of use of withdrawal of thyroid hormone supplementation and/or TSH stimulation in preparation for therapy

• Understand the role of thyroglobulin in the long-term follow-up of patients with thyroid cancer

• Understand the legislation concerning the safe delivery of I-131 including radiation protection for self, other staff, and the patient’s caregivers

• Understand special requirements for the treatment of patients under the age of 18

• Work with the thyroid cancer MDT to determine the best management of the patient

• Recognise those complications that would be a contra-indication to treatment with I-131

ii. Skills

• Be able to prepare the patient for therapy with I-131 including the use of low-iodine diets and side effects of thyroid hormone supplement withdrawal

• Be able to explain the treatment and obtain consent for treatment with special reference to female patient’s concerns about fertility and contraception

• Advise on termination and re-commencement of thyroxine replacement therapy

• Arrange appropriate follow-up and further management of the patient

• Be responsive to the concerns of the patient and their carers concerning the treatment in particular reference to concerns the patient may have about cancer

• Communicate essential information in an appropriate and timely way

• Be aware of issues concerning fertility and contraception in different ethnic cultures and how that impacts patient carer. Radionuclide Synovectomy

i. Knowledge

• Pathophysiology of different causes of inflammatory joint disease Different treatment options with inflammatory joint disease Appropriate selection of patients for treatment with radionuclides

• Understand appropriate follow-up required for patients having been treated with radiation synovectomy including awareness of complications including infection and radionecrosis

• Know the European Association of Nuclear Medicine guidelines on appropriate radio-isotope and activity to be given depending on joint and the number of joints that can be treated at any given time

• Understand the need for immobilization of the joint for 24 hours after treatment

• Understand the legislation concerning the safe delivery of Y-90, Re- 186 and Eu-169 including radiation protection for self, other staff, and the patient’s caregiver

ii. Skill

• Be able to take relevant history and perform a relevant clinical examination of patients with joint disease

• Be able to explain the procedure to the patient and obtain consent

• Be able to ensure the correct activity of radiopharmaceutical has been drawn up

• Be able to have skills to inject joints using a sterile technique or use other clinicians such as radiologists and rheumatologists to obtain access to the joint

• Be able to withdraw an appropriate amount of fluid from the joint and

• give corticosteroids if indicated

• Able to give radioisotopes without contamination of patient, self, or colleagues

• Give advice on post-therapy complications and suggest appropriate actions

• Ensure the patient’s joint is appropriately immobilized for at least 24 hours Arrange appropriate follow-up and further management of the patient

s. Radiolabelled antibodies in hematological malignancy

i. Knowledge

• Pathophysiology of lymphoma, leukemia, and myeloma and when to use radiolabelled antibodies in the treatment of these diseases

• Be aware of the probable success of treatment compared to alternative therapies. In addition, possible side effects compared to alternative treatments and long-term prognosis including the risk of myelofibrosis and acute leukemia

• Appropriate selection of patients for patients with hyperthyroidism with these agents

• Be aware of the use of immunohistochemistry in identifying patients appropriate for treatment

• Know in which clinical situations pre-scanning with a tracer dose is needed for dosimetric assessment or to determine suitability for treatment

• Be aware of the indications for use of Y-90 tiuxetan ibritumomab and other available agents

• Be aware of the dosing regimes for use of Y-90 tiuxetan ibritumomab (or other agents)

• Be aware of the need for conditioning with un-radiolabelled antibodies such as Rituximab and the required timings for these treatments

• Be aware if the treatment will be performed in isolation or combination with other anti-cancer drugs or bone marrow transplant

• Understand the legislation concerning the safe delivery of Y-90 and I- 131 products including radiation protection for self, other staff, and the patient’s careers

• Be able to discuss the appropriate use of Y-90 tiuxetan ibritumomab or alternate agents with hematological colleagues including within an MDT

• Recognise those complications that would be a contra-indication to treatment with these agents

ii. Skills

• Be happy to administer these drugs via a central line catheter using an aseptic technique

• Be able to explain the treatment and obtain consent for treatment with special reference to female patient’s concerns about fertility and contraception

• Communicate to the patient a realistic view of the outcomes of these treatments

• Understand the experimental nature of some of these treatments

• Be prepared to treat acute anaphylaxis or other less acute immune reactions

• Arrange appropriate follow-up and further management of the patient

t. Radionuclide treatment for bone metastases

i. Knowledge

• Pathophysiology of bone metastases and the methods used to treat bone pain

• Understand the relevance and use of diagnostic imaging with Tc- 99m MDP/HDP in selecting patients for therapy

• Be aware of the probable success of treatment compared to alternative therapies. In addition, possible side effects compared to alternate treatments and long-term prognosis including the risk of bone marrow suppression

• Appropriate selection of patients for treatment via site-specific MDT

• Understand the appropriate preparation of the patient for the treatment of painful bone metastases including whether or not it will be given in combination with chemotherapy drugs and/or bisphosphonates

• Be aware of recommendations for activities to be given for both the beta emitters Sr-89, Sm-153 EDTMP, Re-186/Re-188 HEDP, and the alpha emitter Ra-233

• Understand the appropriate dosing regimes including standard dose and weight-related dosing including minimum time intervals for repeat treatments

• Understand the legislation concerning the safe delivery of these products and the different requirements for radiation protection for self, other staff, and the patient’s carers with each agent

ii. Skills

• Be able to discuss the appropriate use of agents used to treat painful bone metastases with colleagues including within an MDT

• Recognise those complications that would be a contra-indication to treatment with each agent with particular reference to possible hematological toxicity

• Understand that some contra-indications such as the risk of long bone and vertebral fracture may be treated and then the patient presented for therapy

• Be able to explain the treatment and obtain consent for treatment with special reference to female patient’s concerns about fertility and contraception (where relevant)

• Communicate to the patient a realist view of outcomes in this palliative treatment

• Be able to explain the possibility of a flare reaction, the best methods to treat and the expected duration

• Explain how success in treatment is determined including the use of pain diaries the expected duration of treatment and the time when a repeat treatment may be given

• Arrange appropriate follow-up and further management of the patient

u. I -131 mg therapy

i. Knowledge

• Pathophysiology of those tumors including neuroblastoma, phaeochromocytoma, paraganglioma, and neuroendocrine tumors in which I-131 mIBG may be useful

• Understand the relevance and useful of diagnostic imaging with I- 123/I-131 mIBG in selecting patients for therapy

• Be aware of probable success of treatment compared to alternative therapies. In addition, possible side effects compared to alternative treatments and long-term prognosis include risk of bone marrow suppression and effects on the thyroid

• Appropriate selection of patients for treatment with I-131 mIBG

• Understand appropriate follow-up required for patients having been treated with I-131 mIBG with appropriate referring clinician

• In particular, be aware of the dosimetric and empirical approaches to treatment

• Understand the legislation concerning the safe delivery of I-131 mIBG including radiation protection for self, other staff, and the patient’s carers

ii. Skills

• Be able to discuss the appropriate use of I-131 mIBG with oncological colleagues including within an MDT

• Know how patients should be prepared for therapy for example the stopping or reduction of drugs that interfere with uptake and the need to give appropriate cover with potassium iodide

• Recognise those complications that would be a contra-indication to treatment with I-131 mIBG for example when and where cardiovascular monitoring is required

• Be able to deal with any resultant cardiovascular side effect

• Be able to explain the treatment and obtain consent for treatment with special reference to female patient’s concerns about fertility and contraception

• Communicate to the patient a realist view of outcomes in this palliative treatment

• Arrange appropriate follow-up and further management of the patient

• Be able to deal with the special concerns in treating children including the fears and hopes of the patient’s family/guardians

• Be responsive to the concerns of the patient (and parent/guardian) and their carers concerning the treatment and an understanding of expectations and long-term effects of treatment

• When treating children be able to communicate in a manner appropriate for the child’s age and development

v. Radiolabelled Peptide/Radioligand therapy

• Pathophysiology of those tumors including phaeochromocytoma, paraganglioma, prostate cancer, and neuroendocrine tumours among others in which radiolabeled peptides/ligands may be useful

• Understand the relevance and useful of diagnostic imaging with In-

• 111 pentapeptide/Ga-68 DOTATATE/NOC/TOC/PSMA and another agent PET in selecting patients for therapy and how this helps the patient selection

• Understand the relationship between the diagnostic and therapeutic peptides used

• Be aware of the legislation required to perform radiolabelled somatostatin therapy

• Be aware of the different peptides available and the characteristics of Y-90 and Lu-177 and how selections are made on the combination used for therapy

• Be aware of probable success of treatment compared to alternative therapies. In addition, possible side effects compared to alternative treatments and long-term prognosis include risk of bone marrow suppression and renal failure and the need for co-administration of anionic amino acids

• Understand appropriate follow-up required for patients having been treated with radiolabelled somatostatins with the appropriate referring clinician

• In particular be aware of published dosing regimes

• Understand the legislation concerning the safe delivery of both Y-90 and Lu-177 labeled agents including radiation protection for self, other staff, and the patient’s carers

• Be aware of newer advances in radiopeptide therapy including the use of alpha emitters

• Skills

• Be able to discuss the appropriate use of radiolabelled somatostatins with oncological colleagues including within an MDT

• Know how patients should be prepared for therapy for example the stopping or reduction of short-acting or long-acting somatostatins and starting amino acid infusions at least 1 hour prior to therapy and providing anti-emetics

• Be able to explain the treatment and obtain consent for treatment with special reference to female patients’ concerns about fertility and contraception. Also, explain the dosing regime (normally 3-4 cycles every 6-12 weeks)

• Communicate to the patient a realist view of outcomes in this palliative treatment

• Arrange appropriate follow-up and further management of the patient

• Be able to deal with the special concerns in treating children including the fears and hopes of the patient’s family/guardians

w. Intra-arterial therapy of liver primary cancer/metastatic disease

i. Knowledge

• Pathophysiology of primary and secondary cancers within the liver

• Understand the relevance and use of diagnostic imaging with CT/MRI and PET in selecting patients for therapy

• Be aware of probable success of treatment compared to alternative therapies. In addition, possible side effects compared to alternate treatments and long-term prognosis including risk of bone marrow suppression and effects on the thyroid

• Appropriate selection of patients for treatment including size and site of the tumor(s) and the presence or absence of portal vein thrombosis

• Understand appropriate follow-up required for patients having been treated with these agents with appropriate referring clinician

• Be aware of guidelines for treatment with Y-90 particulates

• In particular, be aware of the dosimetric and empirical approaches to treatment

• Understand that TARE with Y-90 labeled or other agents particulates a pre-dosing intra- arterial Tc-99m MAA scan should be performed to determine both the possibility of shunting to the lungs (must be less than 20%) and the effect on the administered activity

• Understand the legislation concerning the safe delivery of Y-90 labeled products including radiation protection for self, other staff and the patient’s caregivers

ii. Skills

• Be able to discuss the appropriate use of Y-90 particulates and other agents with colleagues including within an MDT

• Know how patients should be prepared for therapy for example the

• requirements for intra-arterial cannulation including clotting screen and platelet count

• Be able to give product safely within the sterile facilities of the X-ray special suite

• Be able to explain the treatment and obtain consent for treatment with special reference to female patient’s concerns about fertility and contraception

• Communicate to the patient a realistic view of outcomes in this palliative treatment

• Be able to deal with the special concerns in treating children including the fears and hopes of the patient’s family/guardians Topics to be included in all subjects:

• Biostatistics, Research Methodology and Clinical Epidemiology

• Ethics

• Medico-legal aspects relevant to the discipline

• Health Policy issues as may be applicable to the discipline

Career Options

After
completing a DNB in Nuclear Medicine,
candidates will get employment opportunities in Government as well as in the
Private sector.

In the Government sector, candidates have various options to
choose from, including Registrar, Senior Resident, Demonstrator, Tutor, etc.

While in the Private sector the
options include Resident Doctor, Consultant, Visiting Consultant (Nuclear Medicine), Junior Consultant, Senior
Consultant (Nuclear Medicine), Consultant Nuclear
Medicine Specialist, etc.

Courses
After DNB in Nuclear Medicine Course

DNB in Nuclear Medicine is a specialization course that can be pursued after
finishing MBBS. After pursuing a specialization in DNB (Nuclear Medicine), a candidate could also pursue super specialization
courses recognized by NMC, where DNB (Nuclear
Medicine) is a feeder qualification.

Frequently Asked Questions (FAQs) – DNB in Nuclear Medicine Course

Question: What is a DNB in Nuclear Medicine?

Answer: DNB Nuclear Medicine or
Diplomate of National Board in Nuclear Medicine also known as DNB in Nuclear
Medicine is a Postgraduate level
course for doctors in India that is done by them after completion of their MBBS.

Question: Is DNB in Nuclear Medicine equivalent to MD in Nuclear
Medicine?

Answer: DNB in Nuclear Medicine is equivalent to MD in Nuclear
Medicine, the list of recognized qualifications
awarded by NBE in various broad and super specialties as approved by the
Government of India are included in the first schedule of the Indian Medical
Council Act, 1956.

Question: What is the duration of a DNB in Nuclear Medicine?

Answer: DNB in Nuclear Medicine is a
postgraduate programme of three years.

Question: What is the eligibility of a DNB in Nuclear Medicine?

Answer: Candidates must be in possession of an undergraduate
MBBS degree from any college/university recognized by the Medical Council of
India (now NMC).

Question: What is the scope of a DNB in Nuclear Medicine?

Answer: DNB in Nuclear
Medicine offers candidates various employment opportunities and career
prospects.

Question: What is the average salary for a DNB in Nuclear Medicine postgraduate
candidate?

Answer: The DNB in Nuclear Medicine candidate’s average salary is between Rs 1,75,000 to Rs. 35,00,000 per year depending on the experience.

Question: Are DNB Nuclear Medicine and MD Nuclear Medicine
equivalent for pursuing teaching jobs?

Answer: The Diplomate of National Board in broad-speciality
qualifications and super speciality qualifications when granted in a medical
institution with attached hospital or in a hospital with the strength of five
hundred or more beds, by the National Board of Examinations, shall be
equivalent in all respects to the corresponding postgraduate qualification and
the super-speciality qualification granted under the Act, but in all other
cases, senior residency in a medical college for an additional period of one year
shall be required for such qualification to be equivalent for the purposes of
teaching also.

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