Molecular Radiotherapy: Looking forward to a bright future 
Like some of you, I’m doing dry January (bear with me – I’ll get to MRT eventually!) and have gone on a diet after the indulgences of December - Christmas AND my birthday was not good for the waistline! But rather than being the house that fun forgot, me and my partner both feel a sense of renewed motivation - although he may disagree. The living room may even get decorated as a result. Don’t get me wrong – I will enjoy having a beer with my curry when my sister comes to visit in February (she thinks I’m too boring to visit in January, so maybe we are less fun) but I’m really enjoying the positives for now. 

I know many of us don’t like January that much, but I think it’s a bit of a misunderstood month. But although outside it’s cold and dark, I think this month presents a good opportunity to reset and refocus. 

So, what will 2025 hold for us in Nuclear Medicine? Among the many things which lie ahead, I want to focus here on MRT. See, I got there in the end!

MRT, along with the associated diagnostic imaging really does have the potential to change a lot of people’s lives and certainly could change the landscape of Nuclear Medicine in the future. As more treatments are approved for use, the demand will naturally increase and we are not ready for it. 

As you probably know by now, the UK MRT Consortium merged with the BNMS MRT Group partway through 2023 and over the last 18 months the new BNMS MRT Consortium has made definite progress. The Consortium is now fully established, with representation from all professional groups, the major centres and stakeholders such as ARSAC, IPEM and IDUG. We continue to try to engage key players, including government ministers, to lobby for equitable access to services across the OK. As part of this, I have written to the Secretary of State for Health. I am hoping that Wes Streeting can provide us with some much-needed help and support. 

We have gathered information about surveys being undertaken across the country with a view to providing a single survey to measure and track gaps in service provision. 

Clearly workforce is an important factor in any service provision, and we have made progress in developing training for clinicians which will lead the way to training for other staff groups. 

We have set up an MRT page on the BNMS website where we have signposted existing guidance which could be of use to those of you working in MRT, more recently have started to look at the information being given to patients post-therapy with a view to providing more consistency in this area. 

However, there is still much to be done and in recent weeks, I’ve started to feel we’re not being quite clear enough about what we want and need. 

I chaired a meeting at the House of Lords in December, organised by Novartis and hosted by Baroness Ritchie of Downpatrick (I was so glad when she said ‘call me Margaret!) This was a very useful meeting where I came away with a bit more clarity. MRT services are clearly more advanced in some areas than others and I feel a hub and spoke approach is the right way to go. Like the recently published Welsh strategy, government involvement and support is critical. I would like to see a central ‘hub’ providing leadership and consistency for services across the UK, but with implementation being done regionally by the people who know the local landscape. 

So, in my letter to Wes Streeting, I asked for support in establishing this hub and spoke model. I also asked for help with our infrastructure, our workforce and our Radiopharmacy supply chains. 

I am now on a train heading back to the Midlands from London, where BNMS have hosted an event at the Royal College of Radiologists to review the plan for MRT. As I said, January seems like a good time to review, reset and re-energise. 

These are the headlines: We need a new focus on lobbying, and there were some good suggestions on how we could do this more effectively. We need to consider how we communicate and how we could best ‘market’ the concept of MRT, which is easier said than done. Infrastructure and workforce remain an important factor for development of services, as does ensuring a robust and consistent supply of therapeutic radiopharmaceuticals. Certainly, data collection to foster equitable provision of services remains a high priority. 

It will probably not surprise you to hear there was a fair bit of talk about dosimetry. Not being a physicist, this isn’t something I have previously spent an awful lot of time thinking about (sorry, Physicists!) However, today was a real eye opener for me. It links so clearly, not just with health economics, but with ethical delivery of treatment. I learnt today that some patients show really good tumour uptake after their first treatment, but that the second may be significantly less, with sometimes hardly any by the third treatment. People are individuals and will often respond differently. When you hear of patients re-mortgaging their house to pay for a course of treatments, surely, we need to be absolutely sure they are benefitting from all the doses being given to them? The same goes if they are having a treatment funded by the NHS. I’m sure we all want the money we pay in taxes to be used as effectively as possible. So, we need to make sure that when research shows dosimetry is necessary, that it happens. I think we need to re-write the narrative. It shouldn’t be about limiting access; rather it is about focusing access to the people who need it. For that to happen, dosimetry needs to be included in patient pathways where appropriate and properly resourced.  

To bring this back to our patients - please have a look at our patient stories on the MRT Consortium section of the BNMS website.  These are very powerful and really help focus the mind on what we were trying to achieve. We need more of them to help us lobby for services in the future, so if you know of anyone who could talk to us, please e-mail our patient representative, Adrian Hardy, at apaulhardy@aol.com

I am travelling home now with a renewed enthusiasm. For me, the January MRT reset has worked. There is real potential here to make a difference to people. And we need just a little help. Oh, and a few million, but what’s that between friends? 

If you feel you can help us achieve our goals for MRT, please get in touch. Until next time.