Part 5 - Case Scenarios

The four case scenarios found in this section will help you examine your clinical skills and knowledge. Consider how you might approach each case as a practising Canadian nuclear medicine technologist.

Case Scenario 1: Pediatric Patient

Gillian is a 12-year-old girl with hydronephrosis. She arrives in the nuclear medicine department with her parents. Her attending doctor has requested a renal scan with pharmacologic intervention with furosemide (Lasix®). On her requisition, the doctor has noted that she has tested positive for MRSA.

Things to consider...

  • Do you understand the diagnosis?
  • Do you know which infection control practices should be used in this situation?
  • Do you know what patient preparation is required for the renal scan?
  • What communications techniques should you use when speaking with Gillian and her parents?
  • Do you know the requirements for consent?
  • What contraindications, or reasons not to do the exam, should you check for before starting the renal scan?
  • How should you modify the renal scan procedure?
  • How will you position Gillian for the renal scan?
  • What type of image processing should you perform?

Case Scenario 2: Critically Ill Patient

Trina Smith, a 25-year-old woman, is referred from the medical intensive care unit for a ventilation and perfusion lung scan to rule out a pulmonary embolism. Her symptoms include shortness of breath, chest pain and an increased anxiety level. She is receiving intravenous and oxygen therapy and has a urinary catheter. She arrives in the nuclear medicine department with a nurse and a respiratory therapist.

Things to consider...

  • Do you understand the diagnosis?
  • Do you understand your role as a nuclear medicine technologist in a team setting?
  • What methods can be used to ensure patient comfort/safety?
  • Do you understand the role of the nuclear medicine technologist to provide a standard of quality care?
  • What types of patient assessment might you need to perform?
  • Do you know of any possible contraindications, or reasons not to do the exam? Consider: patient status, pre-existing conditions, surgical interventions.
  • How will you position Trina for the lung scan?
  • What modifications may be needed to optimize procedure outcomes?
  • How should you react if Trina’s condition gets worse?

Case Scenario 3: Geriatric Patient

Gilles Maltais is a 75-year-old man with Type II diabetes who is referred to the nuclear medicine clinic by his cardiologist for a gated myocardial perfusion scan. He had a myocardial infarction three years ago and is now complaining of chest pain and shortness of breath upon exertion.

Things to consider...

  • Do you understand the diagnosis and his symptoms?
  • Is Gilles taking any medications? How might this affect the scan?
  • Are you aware of the necessary patient preparation for the scan?
  • Are you aware of any possible contraindications or reasons not to do the exam?
  • What type of procedure modifications might be needed?
  • Do you know the different imaging protocols? You should consider the radiopharmaceutical, scheduling, and acquisition parameters.
  • Do you know the possible complications which could be encountered during the procedure and how to react?
  • What procedural instructions should you give Gilles?
  • Do you know how to process the images?

Case Scenario 4: Oncology Patient

John Durham is a 45 year old man recently diagnosed with prostate cancer. His oncologist has requested a whole body bone scan prior to starting his treatments to rule out metastatic disease. It is noted on the requisition that the patient is complaining of lower back pain.

Things to consider...

  • Do you understand the diagnosis?
  • Are you able to explain the procedure to the patient? Consider these steps: Outline the details of procedure, verify the patient’s understanding of information, allow the patient to ask questions, respond to the patient concerns.
  • Are you able to plan the procedure? Consider these steps: sequence the procedures, check the availability of resources, and select a radiopharmaceutical.
  • Can you prepare the patient for the scan? Consider hydration and allow the patient to empty bladder prior to scan.
  • Are you able to select the appropriate acquisition parameters?
  • How will you position John for his images?
  • What type of image acquisition(s) should be acquired?
  • Are you able to evaluate anatomy, physiology and patient position on the images to determine if further images are required?
  • Do you know how to process the images?