Back to Nuclear Medicine Business

After a turbulent time for me personally since losing mammy in February, this month I’m getting back to Nuclear Medicine business, and to be honest, it feels good. I would like to say thank you to everyone who took the time to send me a message after my last blog. Hearing your stories of similar experiences and reading your condolences made me feel less alone and really helped a lot. So thanks – it was a lovely example of what a close community we are fortunate to be part of within the BNMS.

Something else that highlighted the unique strength of our organisation to me came from an invitation from the Dutch Embassy to speak at an event they were organising in London. Excitingly, this was called ‘Innovation Mission to London, United Kingdom’ and was organised by the Netherlands Enterprise Agency. It sounded like something straight out of Star Trek, which I love, so immediately felt right up my street. (I was raised on a solid diet of Sci-Fi by my dad, with a healthy dollop of John Wayne / Clint Eastwood westerns thrown into the mix and a side order or Rogers and Hammerstein. It was an eclectic mix.)

The event took place at the London Institute of Healthcare Engineering, which is located right next to the Thames. After a short introduction we were served lunch on the 3rd floor which led onto outside tables overlooking Westminster Palace and Big Ben. Happily, the sun came out and gave a welcoming impression for our visitors and for the first time in several weeks, brought a smile to my face.

The afternoon talks were designed to promote knowledge exchange and discussion, and as part of this I was asked to give a presentation on the BNMS. At first, I wasn’t quite sure how to pitch it, but once I started talking about what BNMS does, I realised afresh how much our Society actually does.

Whilst we have good links with the European Association of Nuclear Medicine, we also have a very strong individual identity and community of our own. The BNMS provides guidance and leadership, and I’ll give you a couple of good examples. I try not to mention the B-work (Brexit – there, I said it), but we worked hard with our Industry colleagues and the Royal College of Radiologists to successfully engage the government in the lead up to the change in our border controls. This minimised the disruption to patients that Brexit could have caused. And although it wasn’t perfect, and there were financial implications, we didn’t see the chaos that was definitely possible. Moving to flights for shipment of radioisotopes from abroad has its challenges but was definitely preferable to deliveries being stuck in a queue for the channel tunnel or the short straits ferry crossings.

I hope you found the guidance we wrote during covid useful, which was another good example of the benefits of having a national Society providing helpful leadership and of how engaged, proactive and helpful our members are. This was a collaborative piece of work put together by colleagues at Birmingham City Hospital and Liverpool Royal along with BNMS Council members.

The BNMS has important links to other partners organisations, which we utilise to take forward the Nuclear Medicine agenda. Hopefully these links have benefitted you, even if you’ve not been aware of the work being done behind the scenes. In both the above examples, they were vitally important. Currently we are trying our best to take forward registration for technologists and to maintain standards for PET CT commissioning, amongst other things.

As well as our main Council, we also have a number of special interest groups. These include the Professional Standards Committee, which brings you our guidelines, amongst other things. Although we do cross-reference EANM guidelines, we also write our own BNMS guidelines, tapping into experts practicing within the UK and they’re really good.

We have our Scientific and Education Committee which as well as overseeing a year-round programme of regional educational meetings and webinars, they bring you your brilliant national meetings. These give us a valuable opportunity to share good practice and develop our own networks, as well as being interesting and generally good fun. Many other countries in Europe don’t have this. Of course, they have the EANM conference, which is amazing, but there’s a lot to be said for something that is smaller and more focused on local practice and issues.

We have our Research and Innovation Committee which aims to bring together new and experienced researchers from different departments across the UK, establishing research champions and linking in with other bodies who promote research. This important group provides support to researchers, who may otherwise be a little isolated as well as encouraging trainees and leading on registries. They are looking at setting up a database of Nuclear Medicine clinical trials, which will provide a valuable overview on work taking place in our country.

And last but definitely not least, we have our recently established BNMS UK MRT Consortium, which was formed after a merger of the BNMS Molecular Radiotherapy Group and the UK MRT Consortium. This new group is working to engage stakeholders to improve equity of access to MRT across the country, to provide a space for knowledge exchange, shared learning and collaboration, including development of MRT guidance, to monitor MRT services across the country, to help with expansion and training of the workforce and to link in with research groups to promote MRT research. This is an ambitious ask, and we are only at the beginning of what needs to be done. To take this forward, we have established a number of workstreams, each led by a passionate MRT advocate, with the aspiration that this country will be a world leader in MRT in the future.

We try to ensure we have good links with all our craft groups, and although I think this is something that could be improved even further, the links we have with the Radiographers, Technologists and Nurses through the BNMS RTN Group, with the Clinical Scientists and Clinical trainees, and with the UK Radiopharmacy Group are very good. I would like us to improve on our 2-way communication, so it is a little less top down and makes better provision for listening to members. Nuclear Medicine is a team sport and within the BNMS we all get to play an equally important and recognised part. As a Radiopharmacist I’ve always felt valued within the society, and I hope all of you feel the same. If not, please let us know how we could do this better.

We have our BNMS website, which provides a platform for us to share guidance and news with our members, as well as being a good vehicle for administering our scientific and educational agenda. And unlike many other countries, we have our own official journal, Nuclear Medicine Communications. I must give a huge thank you to all our contributors, editors and our wonderful editor-in-chief.

I have to conclude with a mention for our brilliant permanent staff, without whom none of the above would be possible. Our CEO, Charlotte Weston, our BNMS Committees Secretary, Caroline Oxley and our newest staff member, Angelica Spina who is providing valuable admin support. They are all fantastic and work so hard on behalf of all of us.

Please don’t underestimate how good this all is. If you can remember my first ever blog, I made reference to BNMS being good for your health. This is because I’m grateful to our society for so many things, and being grateful is good for your wellbeing. After the events of recent weeks, reminding myself of this has given me a welcome lift. I hope it does the same for you. And talking about positive things, our Spring conference is just round the corner. Please do try to join me in Belfast next month and be part of the BNMS Community!

Ms Jilly Croasdale

BNMS President

Nuclear Medicine and the LGBTQ+ Community

The title of this month’s blog may raise a few eyebrows, as many of you may not realise that we in Nuclear Medicine have much of a link with the LGBTQ+ community. But we do. An important part of our job in Nuclear Medicine is to make sure we abide by good radiation protection practices and that we maximise the benefits of radiation exposure to our patients. And that applies to all our patients. This includes those whose gender identity does not fit into what is considered societal norms of ‘male’ and ‘female’. 

When I first started thinking about writing a blog on this subject, I was going to say that you may have an opinion on the subject, but that your opinion really doesn’t matter. I was going to say that what matters is that we don’t irradiate any unborn babies unnecessarily, that we don’t have any babies fed breast milk which may contain radiation, and that we are able to ensure we report our scans accurately, without confusion about unusual uptake arising from the unexpected presence of organs aligned to a patient’s sex at birth. 

However, I’ve changed my mind about that, for a number of reasons. I feel like we are reaching a point in our society where neutrality isn’t an option any more. The brutal murder of Brianna Ghey has deeply upset me, as I’m sure it has many of you. There is an ongoing commentary in some parts of our national media on the Trans community particularly which I find divisive and upsetting. Language is important, and I feel to have our NHS Constitution changed to remove more inclusive wording is wrong. 

We should be providing compassionate care to our patients. To all our patients. We should be striving to be compassionate leaders. And compassion should mean without judgement. It should mean making everyone feel included. It should be about provision of not only the best care, but also support, acceptance and understanding. If we in the caring professions cannot do that, then who will?   

I’m putting my head above the parapet on this. My son is at University, and is part of the LGBTQ+ community. That I was unsure about whether to share this with you, rather than saying instead that he knows many people in the LGBTQ+ community says a lot. I shouldn’t be giving it a second thought. It’s not something to be ashamed of; I am proud of my son. He is smart – currently in his 2nd year of a 4-year Physics Masters. He’s kind, thoughtful, loyal, loving and empathic – and great if you want someone to talk things over with. And more, I’m proud of him for living an unapologetically authentic life. And I’m proud of myself for helping to give him the confidence to do so. Apart from his incredible level of untidiness – it genuinely stresses me out to be in his room – he is a pretty all-round wonderful person.  I honestly think that how someone identifies, what their sexuality is, is an irrelevance. To me it’s just part of the spectrum of what is normal. Of what is human. Everyone sits somewhere on a normal distribution curve, so what does it matter whereabouts that is?

I know at least 4 young people who are Trans. They are all dealing with their own struggles around this, and most of that is not because their peers don’t accept them; however much of it is because of our wider society. But the world is changing, whatever some of the headlines may lead us to believe. Especially with younger people, who are generally so much more open about and accepting of variety and individuality.

I know that if you wear the wrong trainers to school then your life can still be made a misery. In my school days, my parents made me wear polyvelt shoes - do you remember them? My dad once cut my hair (how wonky and short can one fringe get?), and my mum made me have a perm. I was a bridesmaid at her cousin’s wedding. It was BAD. So you can imagine what my secondary school years were like. That hasn’t changed all that much really. I have to buy my youngest expensive Nike Air Force One trainers in black as he was getting bullied for his well-fitting but much less cool Clarkes shoes. 

But in terms of sexuality and gender, my experience is that more younger people do accept that for many, this is more fluid and less rigidly defined. And with around 4.5% of the UK population identifying as Trans or Non-Binary, we will see an increase in people attending our departments to whom this applies as time goes on, and we need to be prepared.

To help with this and to hopefully make a small step towards helping all our patients feel included, the BNMS has written some guidance on how to interact with our patients in an inclusive way. This applies particularly when checking for possibility of pregnancy, or the potential for unexpected uptake of a tracer. It’s not about randomly asking granddad John Smith whether he could be pregnant as soon as he walks into the department. I’m sure none of us would do this. It’s about tactfully finding out for whom further enquiries and conversations are needed. We have already done our first pregnancy test on a non-binary patient in the Nuclear Medicine department here, so there is a need to have a process in place sensitively identify and support those individuals who are transgender or non-binary, as well as those with diversity in their sex characteristics whilst at the same time providing compassionate and respectful care for all patients. 

As you may realise, this is a subject I feel passionately about. I saw Miriam Margolyes on the Graham Norton Show a few weeks ago. There’s something about someone who sounds so proper saying such naughty things which really makes me laugh, but during this interview she was talking earnestly about how she became a Trans ally. She said ‘I was very keen on grammar, and so when people started talking about pronouns, and that they wanted ‘them’, and not ‘he’, ‘she’, I thought, what are they talking about? It’s clear, it’s grammar, the structure of language. But I met a wonderful actress in Australia, and she’s Trans, and she had a discussion with me about it. She said, what does it matter to you? If you can make somebody happy by calling them ‘they’ instead of ‘he’ or ‘she’, why not do it? And I thought, that’s right. It doesn’t matter about grammar. If you can make someone happy and give them a sense of themselves, then do it.’ 

You can probably tell I feel exactly the same. I am a bit nervous about how some may perceive what I’ve written this month, but I strongly feel that, as an ally myself, the time has come to stand up and be counted, especially in light of the BNMS guidance soon to be published. I hope that when it comes out in March, you find the document helpful. And thank you for your support. 

Ms Jilly Croasdale

BNMS President

Christmas Challenges and Some Cheer (at last)

As we approach Christmas, it is generally seen as a time of celebration for many. And I sincerely hope this will be the case for you.

However, it would be disingenuous not to acknowledge that many in our Nuclear Medicine community have had a very tough time over the last few months which has inevitably had a negative impact on some of our patients.

Most of you will be aware that there has been a significant and widespread shortage of Technetium-99m radiopharmaceuticals since October, and unlike other shortages, this has not been related to reactor problems or difficulties getting any materials into the country. It has been as a result of a perfect storm of a number of Radiopharmacy closures, for various reasons. And to complicate things even more, some of them were acting as a contingency supplier themselves before closing.

The upshot of this has not just been delayed or limited supplies. For some Nuclear Medicine departments, it has meant NO supplies. And not just for the occasional day. For some, it has been for several days, running over the weeks and months since the beginning of October.

There was a similar problem a few years ago in 2019, but to a lesser extent because it involved just one large Radiopharmacy. And that was bad enough. After that the BNMS and the UK Radiopharmacy Group highlighted the clear problems we have nationally in the UK with spare capacity to supply and the lack of good contingencies in place for our patients. Whilst some Radiopharmacies around the country have provided some contingency supplies, this has been limited by a number of factors. For example:

• Staffing capacity within individual Radiopharmacy units to supply – Radiopharmacies have a regulatory responsibility to work within defined capacity limits

• Isotope capacity within the limitations of local Permit

• Impact of increased workload on individual radiation exposure

• Availability of trained and approved drivers

The problems experienced in 2019 led to the 2021 national review in England of Radiopharmacy services, which was based on similar principles to a review which had previously been conducted on Pharmacy aseptic services. Unfortunately, there hasn’t been much progress for a number of reasons. Many of the things which need to change or improve need time - for example, improving ageing infrastructures, increasing availability of a suitably trained workforce.

And then we ended up in the position we have seen this year, and I don’t feel it is an exaggeration to say it has come to crisis point for many of us, and it is now very clear that these things, and others, need to be addressed as a matter of urgency.

So to move towards more positive news. We are now finally starting to see light at the end of the tunnel for many of us. One of the large units is starting to resume services from the 27th December onwards, so many of us can look forward to a happier and more plentiful (from a Technetium-99m supply point of view) New Year. This is not the case for all, but for the units who remain affected by other closures, hopefully this will release some capacity for ongoing supplies to them.

Recent months have made it clear that there is a significant risk to patients when the Radiopharmacy itself cannot operate. And because of this, BNMS and the UKRG will continue to work hard behind the scenes with our partners at NHS England and within the devolved nations to try to improve things for our patients and for our community.

So I would like to end this month’s blog by saying thank you to all of you who have kept your services running through such a difficult time. To those of you who have reassured worried patients. Who have had to deliver bad news to surgeons about not being able to support their lists. Who have borne the brunt of disappointed patients when having to deliver the news their scan has had to be delayed.

I’d also like to thank those Radiopharmacy colleagues who have stepped in to try to support services where they can. You’ve been amazing. And to the Radiopharmacy staff at the affected centre who have worked hard to re-open their unit, I know it’s been a tough few months, but I know you’re looking forward to being able to do what you do best – providing a reliable and effective Radiopharmacy service.

I’d like to finish by quoting American writer and artist, Agnes M Pharo, who gave us this definition of Christmas: ‘What is Christmas? It is tenderness for the past, courage for the present and hope for the future. It is a wish that every cup may overflow with blessings rich and eternal and that every path may lead to peace.’ Whether you celebrate Christmas or not, that sounds like a pretty decent aspiration.

Or alternatively, this quote by Maya Angelou, American memoirist, poet and civil rights activist: ‘I’ve learned that you can tell a lot about a person by the way he/she handles these three things: a rainy day, lost luggage, and tangled Christmas tree lights’. And maybe we should add to that ‘Technetium-99m shortages’!

I do hope you manage to have a break to enjoy some time with your friends and family. And please join me in wishing us all a very happy, healthy and successful 2024 (Let’s aim high and hope for the best, as Agnes says!)

Ms Jilly Croasdale

BNMS President

We can all strive to be an Icon of Nuclear Medicine!
I’m in a very reflective mood today. I’m thinking about the legacy we all leave behind us. As a number of you will have heard, sadly Dr. Keith Harding, or ‘LKH’ as he was affectionately known, passed away recently. He was an absolute giant of Nuclear Medicine (and I don’t just mean because he was very tall, which he was) and had huge influence on the practice of Nuclear Medicine in the UK and beyond. 

The first time I met LKH, I must admit, I was a bit scared of him. I was in my first job as a trainee Radiopharmacist at City Hospital, Dudley Road. I was very green and wet behind the ears. He was very tall (as I said!) and I really was a bit intimidated by his no-nonsense manner. He always asked questions – as many of you will remember from BNMS conferences, if you were there. Not always easy ones. He challenged things and had an expectation that you would do the same. So ever so slightly terrifying at first!

As I got to know him, however, I realised what a kind and supportive man he was. He would invite the Nuclear Medicine team to BBQs at his house in the summer. He made sure we all had the chance to go to conferences. He was generous with his time and encouraged us all to be better. He raised the standard – in fact, he often set the standard. After finding out he had passed away, so many people responded to say they owed him their entire careers. He was that sort of man.  

He did so many things over the years. He was instrumental in starting up our Nuclear Medicine department, and worked there for his entire career. He was the first chair of ARSAC, and indeed, was instrumental in setting that organisation up. He also led in establishing the carer and comforter regulations, without which treating our benign radioiodine patients on an out-patient basis would have been much more difficult. He had an influence beyond the UK, from sitting on a European Commission to look at early radiation protection law to being instrumental in setting up the IRMER regulations. And I’m sure many other things I don’t know about. 

He was a BNMS Treasurer, and BNMS President – same as me. I don’t think I would have been so involved in the BNMS if it weren’t for him, and my career would have definitely been the worse for that (I love the BNMS, in case you hadn’t already realised!)

There have been many other people who have been role models for me, but he was the first, and he made one hell of an impression. 

Maybe we won’t all go on to be as influential as LKH. We shouldn’t be comparing ourselves with other people anyway. But we can all aim to be the best we can be, within the roles we occupy. We can all challenge the status quo. We can all aim to raise the standard. We can all create our own legacy.

Every single time you go the extra mile for a patient, for another service or for a colleague, you are making a difference. You probably don’t think of it very often, but every day that we come into work we are in a position to encourage or discourage someone else, to be a role model - whatever our job is in the department. How we treat other people can have a huge impact, so if there is a kind way to do something, I think we should be kind. That doesn’t mean to say you shouldn’t challenge poor behaviour or performance, if appropriate, or discuss difficult subjects. It’s hard to say some things, but if messages are delivered with honesty and kindness, they can be something which helps people grow, not knocks them down. Honestly, you don’t ever make yourself look any better by belittling anyone else. But if you support your team, then everybody wins. 

We all have the potential to be an icon of Nuclear Medicine, and I think this is the greatest compliment we can pay to those who have influenced and encouraged us. So my thoughts today are that I want to be more like LKH, and I would highly recommend you try to be too. Ask the questions, challenge the status quo, raise the standards, create your legacy. But above all, be kind. 

So go be iconic!

If you would like to practice some LKH-style BNMS conference questioning, please join me at the Autumn BNMS meeting on Tuesday 31st October. I’d love to see you there!

Ms Jilly Croasdale
BNMS President

What does quality look like? 
Part 1: Communication

I must start by saying that my experience of Nuclear Medicine departments is that we generally look after our patients beautifully while they are in our departments. And if you don’t think that’s true for your department, then you should make your feelings known, whatever your role.

However, I have recently been thinking a lot about how good our patients’ overall experience is. What do they consider to be a quality service? Is there anything that we can do better?

I think it can be easy to forget, when we talk about our patients, that sometimes WE are the patients.  Like many of you, I’ve had this experience. Not in Nuclear Medicine, but in other areas. And in most aspects, our wonderful NHS has been brilliant. But there were some opportunities to improve – for example in communication and the interface between different services and organisations. I’d like to share some of these experiences, as some of it may give some food for thought:

1. I like to think I’m a fairly intelligent woman, and I really don’t like being called sweetheart by someone I don’t know. In fact, I’m not that keen when it’s someone I do know. My brother-in-law, who I like very much, occasionally gets away with it. I’d rather someone used my name – and gave me theirs. This irritates me a lot, and I know I’m not the only one. 

2. I don’t like things being done ‘to me’. One example of this was when my 3 year old son was in traction for 4 weeks and had to stay in hospital. He was well looked after, and the nursing and medical care was good, but looking after a young child and keeping him occupied in hospital for that length of time was a challenge. We ended up with quite a lot of ‘stuff’ in the bed bay. I kept it very organised and for that time, it essentially became home. However, one day the nurses, without anyone saying anything to me, started moving everything. Suddenly having someone start to handle all our things without knowing why was alarming and upsetting. We were being moved to another bay, which was fine, but a simple conversation beforehand would have alleviated the upset. Letting patients know what is happening to them and why is important.

3. Another thing I really don’t like is when things have to repeated for what seems no good reason – what a waste of resource. My mum has recently been unwell and saw her respiratory consultant at her local hospital. He ran some blood tests and contacted us to say she needed to go to A & E that day. He wanted her put on a drip for severe dehydration and dangerously low potassium levels. We took her in to the emergency department (at the same Trust) and had to wait for hours to be seen, after which time, all the blood tests had to be repeated before anything could be done. My poor little mammy – 86 and confused, waiting all that time, and not going to the toilet even once because she’s so dehydrated (she’s normally a very habitual user of the facilities). She went to A & E at teatime, and it was past midnight before she was put on a drip. Why did it take so long, considering a consultant at the same organisation had said for her to go in, and why did we have to repeat blood tests? I know this isn’t directly relatable to Nuclear Medicine, but the communication between departments within our hospitals and the interface between different organisation is definitely something that can be improved in my experience. And it may be that the poor communication comes from other departments, but as far as the patient is concerned, they don’t see where it arises. It’s worth a review to see if we can affect any improvements. How educated are the ward and medical staff about Nuclear Medicine tests? Could we improve this, and by doing so, improve the experience of our patients? 

I consider the visit to our Nuclear Medicine departments as the meat in the referral sandwich. There is a slice of bread before they arrive, and this is the part where we communicate the details of the test or treatment they are being invited to have. How good is that communication? How many of us are communicating the appointment information in the patient’s own first language, for example? In the area where my Trust is located, for a large proportion of the population we serve, this isn’t English. Wouldn’t it be more reassuring and welcoming if some of our direct communication with them also provided some information in their own language? You may think this is too difficult, or maybe even disagree, but have you asked your patients about it? 

The final slice of the sandwich is what happens after the patient has been for their appointment. If I have a test for something at the hospital and don’t get the result for 5 months, do I really view this as a quality service, even if the people were lovely? If the result is likely to take a long time, are we giving the patient realistic time frames? And if a result slips through the net and for some reason, is late being reported, are we being open about it and apologising?
So going back to the question about whether you have asked your patients – many of us do gather feedback, but it can be quite passive. We sometimes get lovely thank you letters (and occasionally even sweet treats). We may have a box for suggestions, and we respond to any complaints received. But do we actively ask them for feedback? I know it takes time to process when it is returned, so it may not be something we’re able to do continuously, but could you consider how to do this in some way, if you’re not already?

If you’re wondering where to start with this, the BNMS can help. We have a patient advocate named Adrian Hardy on the BNMS Council, and who better to help us gather feedback from patients. He has put together some questions he feels would give us a better overview of how patients feel about their experiences. He has made this available on our website for you to give to your patients. Patients need only answer the questions that they see as relevant to their experience. Adrian would like to co-ordinate the feedback on a national level, so please ask your patients to send their answers to Adrian at apaulhardy@aol.com or if they’d like to speak with Adrian send him a text on 07707 901953 and he will get back to them.  

You can find the information at: 
https://cdn.ymaws.com/www.bnms.org.uk/resource/resmgr/patient_information_leaflets/v2_patient_experience_feedba.pdf

I hope you’ve found this interesting! Find me on X (formerly known as Twitter) @PresBnms

Ms Jilly Croasdale
BNMS President