On-line Application Form1 Accreditation of Nuclear Medicine Training Centers Questionnaire for Nuclear Medicine Training Centres Applying for UEMS / EBNM Accreditation General Information 1/7 Details of the training centre:Accreditation Type *New-AccreditationRe-Accreditation Hospital: * Department: Address: * Zipcode: City: Country *AfghanistanAlbaniaAlgeriaAndorraAngolaAntigua & DepsArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBhutanBoliviaBosnia HerzegovinaBotswanaBrazilBruneiBulgariaBurkinaBurundiCambodiaCameroonCanadaCape VerdeCentral African RepChadChileChinaColombiaComorosCongoCongo {Democratic Rep}Costa RicaCroatiaCubaCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFijiFinlandFranceGabonGambiaGeorgiaGermanyGhanaGreeceGrenadaGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHungaryIcelandIndiaIndonesiaIranIraqIreland {Republic}IsraelItalyIvory CoastJamaicaJapanJordanKazakhstanKenyaKiribatiKorea NorthKorea SouthKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMoroccoMozambiqueMyanmar, {Burma}NamibiaNauruNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNorwayOmanPakistanPalauPanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalQatarRomaniaRussian FederationRwandaSt Kitts & NevisSt LuciaSaint Vincent & the GrenadinesSamoaSan MarinoSao Tome & PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth SudanSpainSri LankaSudanSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad & TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamYemenZambiaZimbabwe Telephone: * Telefax Email contact: * Items markes with an asterisk (*) must be filled in Proceed On-line Application Form Accreditation of Nuclear Medicine Training Centers Questionnaire for Nuclear Medicine Training Centres Applying for UEMS / EBNM Accreditation Faculty and staff 2/7 Head of department / Senior and/or Responsible for training:Are you asking for Training Center in the whole field of Nuclear Medicine including PET and therapy or for a limited field, if so which areas? *YesNo Area 1. Area 2. Area 3. Area 4. Head of department / Senior consultant Name: * Specialty: E-mail address: * Telephone: * Responsible for training Name: Specialty: E-mail address: Telephone: Is the training centre accredited by a national professional authority for full training in Nuclear Medicine or in a limited area? *YesNo If YES: - Which authority: * - Year of accreditation: * Please upload a confirmation of approval: * Was the centre visited by this authority? *YesNo If YES: - Year of visitation: * List up to 10 (ten) other specialties that are recognized as training centres in your hospital Specialty 1. Specialty 2. Specialty 3. Specialty 4. Specialty 5. Specialty 6. Specialty 7. Specialty 8. Specialty 9. Specialty 10. Which medical specialists are involved in the Nuclear Medicine training? Name: Specialty: Which of the followings are currently employed in the centre?* Full Time Equivalent "some of fractions" Medical staff – fully approved specialists including chief Radiochemist Physicist Radiation protection officer Quality assurance officer Software engineer Number FTE* Which of the following paramedical workers are currently employed in the centre? Nuclear medicine technologists Laboratory technicians Nurses Medical receptionists Other Number FTE* Trainees How many positions for trainees are currently at your centre? How many trainees do you have? Trainees in full time position Number FTE* What training is required for specialisation in nuclear medicine? Nuclear Medicine * mandatory Duration (months) Clinical bedside training * Diagnostic Radiology * Clinical Physiology * Others (please specify) Others (please specify) Others (please specify) In vitro procedures * Quality control * Radiation protection and dosimetry * Administration and financing * Health care legislation * Does the centre offer theoretical education? * YesNo YesNo YesNo YesNo YesNo - If yes, number of hours/month * - If no, where do the trainees follow theoretical education (name of institution) * Is the knowledge and skill of the trainees evaluated regularly? *YesNo Frenquency (months): Do trainees participate in any of the following? Clinical presentations * Nuclear medicine seminars/congresses * Research activities * YesMandatoryNo YesMandatoryNo YesMandatoryNo Items markes with an asterisk (*) must be filled in back proceed On-line Application Form Accreditation of Nuclear Medicine Training Centers Questionnaire for Nuclear Medicine Training Centres Applying for UEMS / EBNM Accreditation Equipment available in the centre 3/7 Dose Calibrator Single-head gamma camera (SPECT n = ): Dual-head gamma camera (SPECT n = ): Dual-head gamma camera (SPECT-CT n = ): Triple-head gamma camera: Gating for myocardial SPET studies: PET camera: PET-CT: Cyclotron: Operating theatre Probe: DEXA: ECG: Treadmill: Bicycle ergometer: Others (please specify): Beds How many beds does the hospital possess? * How many of these beds are available for nuclear medicine therapy? * Items markes with an asterisk (*) must be filled in back proceed On-line Application Form Accreditation of Nuclear Medicine Training Centers Questionnaire for Nuclear Medicine Training Centres Applying for UEMS / EBNM Accreditation Other facilities 4/7 Do the trainees have access to the following?Medical library: *YesNo Scientific journals: *YesNo Reference books: *YesNo Internet: *YesNo Laboratory facilities: *YesNo Separate working place: *YesNo Items markes with an asterisk (*) must be filled in back proceed On-line Application Form Accreditation of Nuclear Medicine Training Centers Questionnaire for Nuclear Medicine Training Centres Applying for UEMS / EBNM Accreditation Quality 5/7 Is the quality control performed according to the current national guidelines? *YesNo Items markes with an asterisk (*) must be filled in back proceed On-line Application Form Accreditation of Nuclear Medicine Training Centers Questionnaire for Nuclear Medicine Training Centres Applying for UEMS / EBNM Accreditation Procedures 6/7 How many of the following procedures were performed during the past 12 months: Central nervous system: * - of which PET: - or SPECT: - or SPECT-CT: Skeletal system: * - of which DEXA: Cardiovascular system: * - of which PET: - or SPECT: - or SPECT-CT: - or Gated SPECT: Pulmonary system: * - of which combined V / Q: - of which SPECT? Gastrointestinal system: * Urogenital system: * Endocrine system: * Haematopoietic and lymphatic systems: * - of which how many SLN: Tumours and inflammation: * - of which PET: - or SPECT: - or SPECT-CT: Radioimmunoassays: * Non radioactive laboratory tests: * Other studies: * Intravascular therapy * Thyroid therapy, benign disease: * Thyroid therapy, malignant disease: * Other radionuclide therapy: * Items markes with an asterisk (*) must be filled in back proceed On-line Application Form Accreditation of Nuclear Medicine Training Centers Questionnaire for Nuclear Medicine Training Centres Applying for UEMS / EBNM Accreditation Specifications 7/7 Is the trainee able to fulfil the Syllabus (on this website in the section: Committees->Education & Syllabus) within the national training time? *YesNo Or has he/she performed part of it in a cooperating center?* 11 please send a copy of the agreement to the UEMS/EBNM office *YesNo Which one? 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