In common with all medical specialities, the Radionuclide Radiologist is responsible for the assessment of the patient. He or she may also suggest and perform appropriate nuclear medicine techniques in order to facilitate the patient's clinical management. Radionuclide radiology is now a recognised sub-specialty within clinical radiology.
It comprises those diagnostic-imaging techniques, which use radiolabelled tracers for diagnosis. The consultant radiologist with special expertise in this field will take responsibility for the organisation and delivery of a radionuclide diagnostic imaging often within a department of clinical radiology.
The equipment used, the techniques, and the required range of skills and expertise are identical to those used by nuclear medicine physicians.The radionuclide radiologist is ideally placed to integrate the physiological or functional investigation of disease using tracer techniques with the anatomic investigation of conventional radiology.
Physiological changes in disease generally precede anatomic changes, so radionuclide techniques are in general more sensitive – although less specific – than anatomic imaging techniques, and the combination of both often offers the most effective diagnostic approach. A new illustration of this point is found in the recent development of combined PET/CT scanners, which deliver both anatomic and physiologic data in the same examination.
What training is required?
Training for radionuclide radiology is based on a curriculum, which is identical with the imaging aspects of nuclear medicine physicians’ training. A radionuclide radiologist who wishes to obtain a CCST in nuclear medicine in addition to the clinical radiology CCST can achieve this by undertaking an additional (6th) year of specialist training in a department accredited for this purpose. This additional training includes experience in the use of unsealed radioactive sources for treatment, and non-imaging tests (mostly in vitro) for example in haematology, renal function, and other metabolic investigations.
Core training in clinical radiology up to FRCR level incorporates basic elements of the scientific and clinical aspects of radionuclide imaging, so the initial training in this sub-specialty area is available to all trainees in radiology. More advanced training in radionuclide imaging requires a further period of major commitment to this sub-specialty after completing the FRCR syllabus. This training is available at many of the radiology training centres within the UK, either in the clinical radiology department itself or in departments of nuclear medicine in those institutions where the two specialties exist independently.
What are the career prospects?
Currently there is a shortage of applicants for consultant posts both in nuclear medicine and in radionuclide radiology across the UK. The number of trainees in post is currently much less than that required to fill vacancies that are expected to occur over the next few years, so career prospects in this field are excellent.
Where are the growth areas?
The two major growth areas in radio-tracer techniques are PET and new therapies, both largely related to the diagnosis and treatment of cancer. The possibility of developing expertise in cancer imaging using CT, MRI and radionuclide techniques, and the complementary expertise in unsealed source therapy suggests itself as a new type of oncologic radiologist.