This is my final blog so I write it with a teary eye and a reflective air. It has been my privilege to lead our society for the past 2 years. I inherited a good position from my predecessor John Buscombe but we will were still bearing the scars from covid. The BNMS has risen like a phoenix out of the covid ashes with our most successful meetings in recent memory. The energy at Glasgow was palpable and so many of you enjoyed such a great meeting in a vibrant city. Swansea sold out – need I say more. I am looking forward to Harrogate as there is much to discuss and learn about nuclear medicine at the moment. The programme has been well put together by the Science and Education Committee and Harrogate is a great environment with a particularly fine tea room – Bettys!
 
During my tenure there have been several big themes:
 
• Continuity of radiotracer supply. This continues to be an issue with the UK not possessing our own medical isotope reactor and the vagaries of world supply. The BNMS have advised government and departments on how best navigate this. We are also supporting a review to radio pharmacy provision in England with the aim of improving tracer availability and baking more redundancy into our system.
• Theranostics . This is the buzz word in nuclear medicine circles around the globe. We have yet to see mass adoption in the UK and we still wait for NICE to approve Lu177-PSMA. Once this occurs our theranostic journey will have really begun and then building our people and infrastructure will be the next challenge.
• PET-CT. PET-CT continues to grow exponenially with annual growth of 15-20%. The wave 1 national contract is coming up for retender and the BNMS is influencing this space to ensure that our patients get the scans they need going forward. We are also in a stakeholder in the decision as to where to place two Total Body PET-CTs in the UK which is a really exciting development.
• Workforce.  We are challenged in all craft groups. We have been working to unblock the barriers to training, recruitment and retention and will continue to do so as the much to do in this space. 

There are too many people for me to thank by name. I would like to thank all of you for the support you have given me which has enabled me to do my best for us. I would specifically like to thank the BNMS office, the BNMS officers and all those who serve on BNMS committees. I was excited to see the recent contest for a vacant council seat from 4 great contenders. I would urge the three unsuccessful people to get involved with the BNMS in another way such as serving on one of our other committees. If anyone wants to get more involved please contact the BNMS office and they will direct you to correct person to talk to.

Finally, I am confident that Jilly Croasdale will be an excellent President and will take our society further. I am confident she will cut a dash in the Harry Potteresque robes of office!

Prof Richard Graham

BNMS President

Last week we had face to face Council and Professional Standards Committee where we got through a large amount of important work. While virtual meeting are OK face to face ones are better. More can be achieved in person. Relationships are key to making things happen and these are harder to make and reinforce in the virtual world. This was the last council meeting that I will chair (Jilly Croasdale will be President by the next council meeting) and was the last council meeting for Glenn Flux and Chris Mayes. I would like to thank Glenn and Chris for their hard work and excellent service to the BNMS and British Nuclear Medicine.

I represented us at the Royal College of Physicians Joint Specialist Committee last week where much was discussed about the nuclear medicine community’s response to NICE not approving Lu-177 PSMA and the response we would make. These responses are now in and I hope NICE will reconsider its position. Thank you to everyone who responded individually or contributed to corporate responses.

The council election is now live so please vote. The spring meeting in Harrogate is filling up so get your registrations in now so you can attend the annual BNMS dinner and after party which will sell out. EANM annual congress is September 9-13 in Vienna. I have seen the program and it looks excellent, so I recommend attending this as well as our Harrogate meeting. Registration and abstract submission are open now. I had a meeting least week with the President and Secretary of EANM about how we can mutually support each other. EANM is very grateful for the support given from the UK and don’t hold BREXIT against us! They plan to improve their guidelines further and increase the evidential rigor and involve partner clinical societies in each guideline going forward which should produce even better guidance.

The finalists for most innovative team of the year have been announced and they are Glasgow, Bath and Cardiff and the Vale. It was great to see so many great entries and you need to attend our Harrogate meeting to cast your vote for the winner. Look forward to seeing you all there.

Prof Richard Graham

BNMS President

There is seat coming up on BNMS council and I would encourage anyone who wants to get more involved with the BNMS to stand. We are also always looking for people for our science and education committee and professional standards committees so if you feel the calling in these directions, please get in touch with the BNMS office. From my perspective the BNMS is really thriving, and we currently heavily involved with MRT and PET-CT commissioning. On the subject of MRT it was disappointing that NICE did not approve Lu177 PSMA and we will continue to argue for this for the benefit of our patients.

The programme for our Harrogate meeting looks great and registrations are flowing in. I really enjoyed our Glasgow meeting and I hope this meeting will be just as good. Get you registration in now so you don't miss out, our Swansea meeting was sold out. It is only 94 days to go! We are in a good financial position as a society, and we have been looking at making sure or membership/meeting registration fees are good value for the lower paid members and trainees particularly. Charnie is working with Charlotte to make our fees equitable across all our membership groups.  

As you know I send out EANM draft guidelines to the membership when they become available, and I have been really impressed with the thorough reviews many of you have been sending back to me which I have passed onto the EANM. It is great to see so much interest in contributing to the European guidance. These guidelines are important as the national practice often references them. Thank you to all those who have contributed to make these guidelines better.

Finally, the NHS national clinical impact awards are out. Congratulations to all those in nuclear medicine who received them - these are really hard to get represent a significant achievement across a range of professional medical activities. Those who were unsuccessful please apply again next time and use the feedback scores to improve your application. Going forward the scheme is changing and there will no longer be citations from nominating bodies like the BNMS or Royal Colleges as the scheme has determined they make very little difference in the outcome. The BNMS are now not allowed to review applications but can offer generic advice which Stewart will be putting on our website.

Prof Richard Graham

BNMS President

I hope you have all had a good Christmas break and are settling into the new year. The NHS is under the biggest pressure since its foundation and I am sure you will all be feeling it. Delivering healthcare in the UK has never been harder. Thank you for all that you are doing to support the care of our patients.

NHS England has initiated a PET-CT Specification working group which I am representing the BNMS on and progress has been made on the future parameters of the next round of PET-CT commissioning. This is likely to be national commissioning which over time will transfer to local integrated care boards. The work the BNMS has been doing on PET-CT standards, led by Gary Cook, is very useful and is being considered by NHS England in the process.

Molecular radiotherapy (MRT) continues to have a high profile with the expectation that NICE will approve Lu177 PSMA. There are a multitude of groups working on increasing access to MRT and also considering research angles. The BNMS has representation on all these groups with Sabina Dizdarevic and Glenn Flux centre stage in this.

The abstract submission is now open for the spring BNMS meeting in Harrogate. The programme looks great and Harrogate is an excellent venue where I have attended memorable BNMS meetings. I would urge you to submit your abstracts now and register for the meeting. Our recent BNMS meetings have been brilliant and I would not want anyone to miss out on the learning, networking and social opportunities our meetings afford!

Prof Richard Graham

BNMS President

The molybdenum shortage has mostly abated which is great for our patients. I was interviewed on BBC radio Northern Ireland about it as they were interested about the implications of a nuclear reactor fault and was this another Chernobyl! I was able to reassure the people of Northern Ireland and explain the importance of nuclear medicine.

The molecular radiotherapy consortium continues to develop and the BNMS is a key stakeholder in this. We are well represented by Glen Flux and Sabina Disdarevic on its steering committee. We hope that NICE will approve Lu177 PSMA in January and that then we can treat our patients on the NHS.  Once approved we will need to build staffing and infrastructure to deliver this new service. Industry partners will be keen to support this, I think.

NHS England has started to work on the service specification for the next round of PET-CT commissioning. The BNMS is stakeholder in this and I will keep you posted as this develops. I would like to congratulate Wai-Lup Wong who has been appointed as the National Speciality Advisor for Nuclear Medicine at NHS England.  This extends his previous PET-CT role to encompass all of diagnostic and therapeutic nuclear medicine.

Abstract submission is opening for our BNMS Spring meeting so I would encourage you to submit and attend the meeting which I am sure will be a great success given the form of our recent meetings.

I wish you all a merry Christmas and a Happy New Year! I hope you all get a well-earned break and have some time to recharge before the onslaught of ever-increasing demand we will all experience next year.

Prof Richard Graham

BNMS President

The autumn BNMS meeting in Swansea was fantastic. Neil Hartman and team delivered a truly memorable meeting from both the perspective of the program and the entertainment! The program would not have looked out of place at an international meeting. The impromptu Welsh choir and clog dancing were a welcome addition not seen a BNMS in my time as a member! The meeting was sold out which I think may be a first for the BNMS but is a good barometer about the health of British nuclear medicine. I would like to thank industry for the support they gave the meeting. There was lots of delegate interaction with our industry colleagues which was great to see. The tour of Swansea nuclear medicine department was a popular event where people saw the first GE Starguide 360 CZT scanner in the UK in operation.

 
Theranostics was a key theme at the meeting with a lot of excitement about future possibilities. I learnt about the idea of giving a parent radionuclide for MRT to achieve the effect through the daughter which is something as a jobbing imager I hadn’t really considered. The formed Medial Director for Practice at the RCR gave a talk on Duty of Candour in imaging which had standing room only and prompted much debate.
 
I spoke in a session on 360 CZT imaging where initial experiences from the two available systems: the Vertion CT from Spectrum Dynamics and the GE Starguide were communicated. It was interesting to see how the systems delivered similar advantages but also differences in the way the two centres, Bath and Swansea had chosen to implement them. The session stimulated a lot of questions and good quality discussion. In my view 360 CZT will become the mainstream way we do SPECT CT. When was the last time you did a planar PET-CT?
 
The nuclear reactor that supplies Mo in Belgium has broken and there is currently a Mo shortage. The BNMS has put guidance on our website about what to do. Please read it if you have not already done so. We will update this as the shortage continues about how to prioritise your work and radiology alternative studies that can be done to off load nuclear medicine pathways.
Thank you all once again for all you are doing both directly and indirectly for our patients at this really challenging time to be delivering healthcare.

Prof Richard Graham

BNMS President

The autumn BNMS meeting in Swansea was fantastic. Neil Hartman and team delivered a truly memorable meeting from both the perspective of the program and the entertainment! The program would not have looked out of place at an international meeting. The impromptu Welsh choir and clog dancing were a welcome addition not seen a BNMS in my time as a member! The meeting was sold out which I think may be a first for the BNMS but is a good barometer about the health of British nuclear medicine. I would like to thank industry for the support they gave the meeting. There was lots of delegate interaction with our industry colleagues which was great to see. The tour of Swansea nuclear medicine department was a popular event where people saw the first GE Starguide 360 CZT scanner in the UK in operation.

 
Theranostics was a key theme at the meeting with a lot of excitement about future possibilities. I learnt about the idea of giving a parent radionuclide for MRT to achieve the effect through the daughter which is something as a jobbing imager I hadn’t really considered. The formed Medial Director for Practice at the RCR gave a talk on Duty of Candour in imaging which had standing room only and prompted much debate.
 
I spoke in a session on 360 CZT imaging where initial experiences from the two available systems: the Vertion CT from Spectrum Dynamics and the GE Starguide were communicated. It was interesting to see how the systems delivered similar advantages but also differences in the way the two centres, Bath and Swansea had chosen to implement them. The session stimulated a lot of questions and good quality discussion. In my view 360 CZT will become the mainstream way we do SPECT CT. When was the last time you did a planar PET-CT?
 
The nuclear reactor that supplies Mo in Belgium has broken and there is currently a Mo shortage. The BNMS has put guidance on our website about what to do. Please read it if you have not already done so. We will update this as the shortage continues about how to prioritise your work and radiology alternative studies that can be done to off load nuclear medicine pathways.
Thank you all once again for all you are doing both directly and indirectly for our patients at this really challenging time to be delivering healthcare.

Prof Richard Graham

BNMS President

I have recently returned from the European Association of Nuclear Medicine annual Congress in Barcelona. This was very well attended with over 7000 delegates, there was a real buzz at the meeting with much enthusiasm for the future opportunities within our Specialty. Barcelona is always a great venue in October with weather not that different from our summer. I saw many UK colleagues at the meeting and it was great to see many of our members holding positions with the within the EANM, presenting posters and speaking in sessions.

I attended the world Federation of Nuclear Medicine meeting where we were discussing initiatives to improve Nuclear Medicine access throughout the world and the benefits this would give to worldwide cancer survival. A recent analysis demonstrated that improvement in diagnostics would make more impact than simply improving treatment.

There were a number of talks on whole body PET/CT and the opportunities that the systems will afford for research. The whole body dynamic images are something to behold and it will be interesting to see the benefits particularly in drug design and pharmacokinetics that the scanners should be able to support. Very short scan times in a matter of a single digit number of minutes are possible as are very low doses of tracer to allow multiple serial tracer studies in the same patient.

In more mainstream PET/CT the systems are becoming ever more sensitive with routine PET/CT possible in certainly under 10 minutes and even under five minutes. Getting the patient on and off the scanner will take more time now than perhaps the scan itself. We will potentially be able to use smaller doses of traces which will improve radiation protection for both patients and staff alike. We are definitely in a very exciting era of PET/CT development. This should be able to support the ever increasing demands in the referral base but of course this work still needs to be reported which is an area we need to grow a lot so patients get the timely service they deserve.

PSMA and PSMA directed therapy occupied a large amount of the program at EANM. This is an area which is likely to impact the UK and we will need to build the infrastructure and train the staff to deliver this service. Much work is being done on using PSMA to study other cancers, the one thing PSMA is not his prostate specific! This may lead to other mainstream clinical applications for this tracer.

We have a large number of registrations for the Swansea BNMS meeting and with some of the sessions being fully booked already the meeting is likely to be excellent. In summary, despite the significant operational pressures in the NHS currently I think the future is bright for Nuclear Medicine and we are fortunate to be working in this exciting Specialty.

Prof Richard Graham

BNMS President

Winter has arrived in the NHS. Ambulances are queuing to off load patients and we are failing to achieve cancer targets. The elective backlog has never been so great. This is a difficult time to lead in healthcare and I wish our new Secretary of State – Dr Thérèse Coffey good luck in her endeavours. It is interesting for us that Dr Coffey’s PhD was in molybdenum so at least we have something in common! Maybe this will mean a new ear era of political understanding in nuclear medicine.
 
This month the BNMS has been supporting the foundation of the Molecular Radiotherapy Consortium. We are in negotiations to host it and I think this avenue of work for us will be very important going forward. The predictions for the amount of  prostate carcinoma MRT we will be undertaking in the future are large and we will need significant resourcing in people and infrastructure if we are to deliver this for our patients.
 
We continue to support he national review of radiopharmacy being undertaken by DHSC to help the formulation of the future radiopharmacy strategy. Radiopharmacy is such a key constituent of our services and it hasn’t been given the attention it deserves by government in recent times so this new found attention is greatly appreciated.
 
The work on standards in PET-CT for delivery and commissioning continues. I have heard rumours that PET-CT will be commissioned by Integrated Care Systems in the future. If this is true our guidance will be invaluable for them and will come at an opportune time.
 
The society is financially sound through the careful management of Charlotte Weston and our treasurers past and present in the form of Jilly Croasdale and Charnie Kalirai. I would like to thank them as this is enabling us to work effectively to advocate for our vital speciality and not to be distracted having to solve financial difficulties that some societies are now facing.
 
The autumn BNMS meeting is almost upon us and will be on the 11th and 12th of November in Swansea. The programme looks excellent and I would urge you to register if you have not done so already. I am looking forward to seeing many of you there and I would like to thank Neil Hartman and team for organising this great event which includes dinner in the National Waterfront Museum. Traditional entertainment is promised too if you need another reason to attend!

Prof Richard Graham

BNMS President

As I return from my summer holiday I am stuck by how much has been happening in the NHS in August from the number of emails in my inbox! In years past less happened, we now however are in a permeant winter from an operational perspective.  In the last month much progress has been made in establishing a UK molecular radiotherapy consortium. The idea behind this is to bring together all the key stakeholder from across nuclear medicine, radiology, pharmacy, medical physics, technology/radiography and oncology. This will then enable sufficient advocacy for this vital emerging area to ensure our patients get the services they need and deserve. The initial realisation has been that all these groups reside in the BNMS except oncology and we now are going to welcome oncologists with an interest in MRT to join us. I look forward to this consortium bearing fruit.
 
The expression of interest call from the MRC has been release for the establishment of Total body PET/CT in the UK. This is really exciting and it is likely we will end up with 2 sites that will be a national resource that we can all use for research at the molecular level and at the clinical level. I can see great clinical applications immediately in children with dose and scan time reduction but I am sure this just the beginning of what this technology can deliver.  If your centre would like to host one of these machines please bid.
 
The programme is firming up for our Autumn BNMS meeting in Swansea and it is looking great. I hope to see you all there where Neil Hartman is expecting serious clog dancing…….

Prof Richard Graham

BNMS President

After a week of high stakes political moves you will be pleased to know the leadership team of the BNMS has no similar problems and that council has not resigned on mass! We continue to be fully functioning and are representing you to our best ability.
 
A national review in radiopharmacy is going to take place and the DHSC are working with the BNMS and UKRG as major stakeholders which is good to see. The scope is currently being defined which I will make sure covers our major issues. Importantly we need to get our radiopharmacy provision right sized for both our future diagnostic work and the emerging theranostic services. As I’m sure you will know there are significant risks in radiopharmacy where we have suffered from under provision. In England there are about 5 Ga 68 generators, in France there are 60!
 
As the current covid wave is building our services are coming under covid pressures again. This wave is expected to peak around September. I would like to remind you of the BNMS covid guidance which is on our website and will be useful for this wave. Please read it if you have not already.
 
Following our theme of holding meetings throughout the UK the autumn meeting in Swansea at the National Waterfront Museum. It is open for registration and the outline programme looks great. I would encourage you to attend, you could even combine it with a visit to the beautiful Gower peninsular. It takes place on 11-12 November and will include clog dancing I am told – there are so many reasons to attend! It is currently open for abstract submission.
 
Finally, as schools break up and the summer holidays being I wish all a well-earned break and hope you get some quality relaxation to recharge your batteries as we have much to do in our community in the coming year in our fast-moving discipline.

Prof Richard Graham

BNMS President

I write this as I’m sitting on the train having returned from SNMMI in Vancouver. I am a little jet lagged but also inspired by what is going on in nuclear medicine worldwide and I hope I can communicate my excitement to you. The meeting had about 3000 in person and 3000 virtual delegates which was a good turnout. The commercial exhibition was buzzing with various new pieces of kit being launched. The opening ceremony was something else with native Canadian dancing – roll on the Morris dancers at the next BNMS!
 
Theranostics remains the hottest topic with many sessions on this – particularly Lu177 PSMA. There is great concern worldwide about the infrastructure, equipment and staffing needed to deliver these services if prostate cancer theranostics is as big as predicted. Particularly, if it works better than standard treatment in lower stage patients.
 
The BNMS session on parathyroid imaging was delivered by myself, Stewart Redman and John Buscombe. It was very well received and stimulated a good debate at the end of the session about the optimal way to image parathyroid adenomas with some people arguing for FCH PET-CT as a one stop! I think it is unlikely NHS England would go for that.
 
They say never meet your heroes, but this was impossible at this meeting. Universally they were all very approachable and keen to hear the news from the UK. Richard Whal is the current SNMMI president and wanted to know about BREXIT and the effect on UK nuclear medicine making me give a speech at the international leaders dinner. I was happy to report that our services have not imploded as a result but do continue to have staffing issues which BREXIT has not helped.
 
At BNMS council recently the formal feedback from the Glasgow meeting was reviewed and bar the lunches was universally positive. We even are likely to turn a small profit. Vineet Prakash has now stepped down from his leadership of the SEC and I would like to thank him for the fantastic job that he has done. Brent Drake continues to lead the SEC and is now joined by Ian Armstrong as co-chair. Ian thank you for stepping up, I am sure you will contribute to the continued success of the SEC.
 
We have a joint SPECT-CT meeting with the Royal Free on 6 July which looks to be an excellent virtual study day which I would recommend and the registration for the Autumn BNMS meeting in Swansea is now open and looks great too. Get your dancing clogs on!

Prof Richard Graham

BNMS President

As I return from the BNMS Spring meeting in Glasgow I know UK nuclear medicine is in good shape. The energy was palpable and level of engagement was very high. We had in excess of 500 delegates which really made the meeting feel busy and productive.

It was a honour to present the BNMS awards this year with the BNMS celebrating the great achievements of several of our members. The list of winner can be found on our website. It was great awards dinner in the Glasgow science museum and my voice even held out which was not a given as there was no PA system and I had spent 2 days talking constantly!

Phil Blower, one of our award winners, commented that there was more basic science at the meeting this year than in recent times and that this was a very positive step. This allows the clinicians and the scientists to work in partnership which has to be a good thing. Please keep the science coming to our meeting.

The buzz of the commercial exhibition was good to see  - the ratio of delegates to space was about right. Industry seemed pleased with how the conference worked for them. Thank you to industry for their support, the meeting could not happen without them.

Nick Steven's performance in the fun run is worth a notable mention given he was the oldest competitor and he won it! Nick is role model to us all! Well done Nick.

Glasgow proved to be an excellent venue and I am sure we will return. The benefit of face-to-face were obvious and the after party at Radisson Red would not have worked so well in virtual format!

There are too many people to thank individually but I would like to give honourable mentions to Vineet Prakash, Brent Drake, the SEC committee, Charlotte Weston and Caroline Oxley without whom the meeting could not have happened. This was one of the best BNMS meetings I have been to. I am representing you at SNMMI next month in Vancouver and will report back in next month's blog.

Prof Richard Graham

BNMS President

Our Glasgow meeting is almost upon us, we have over 400 registrants already and our events are reaching capacity too so I would encourage you to register now if you have not done so already. The programme looks great and there is even a fun run so you will effectively be attending a health farm while having your mind expanded in all areas of nuclear medicine!
 
Lu177 PSMA has been given compassionate use approval – there are links on the BNMS website giving the details of this. Great news for our specialty and the prequal to the likely full NICE approval expected in the Autumn. The likely rate limiting step initially will be access to diagnostic PSMA scans. We all need to be doing what we can to build capacity in this regard so that men with prostate carcinoma can have access to the correct treatment.
 
The BNMS is going to establish a visiting professor role for radiologists and nuclear medicine physicians to raise the profile of our discipline to radiology trainees to encourage them to follow our path. All radiology subspecialities are short of trainees now so we need to do everything we can to encourage trainees that nuclear medicine/radionuclide radiology is where they should land. We have much to offer for a future career.
 
Diagnostic waiting times are still a problem in the UK with PET-CT services still struggling to deliver the expected SLAs. I would like to thank you all for your hard work in providing PET-CT capacity. PET-CT is ever more important, particularly in cancer pathways, while this is good for our services it is hard to deliver against the demand. We need to plan for the continued expansion of this vital modality.
 
I look forward to seeing as many of you as I can in person in Glasgow. It will be a BNMS meeting to remember!

Prof Richard Graham

BNMS President

I’m am sure we are very worried about the war in Ukraine and the plight of the Ukrainian people. The European Society of Radiology is running a campaign to support Médecins Sans Frontières work there so please donate if you feel able https://www.myesr.org/article/3430 . Raw materials for radiopharmaceutical production come form both Ukraine and Russia which could be a problem in a few months if the situation does not improve. We are working with Industry on this already.

Jilly Croasdale  who is a senior radiopharmacist in Birmingham is our President elect. Jilly has been an excellent BNMS treasurer and I am sure she will be a brilliant President. I know the BNMS is in safe hands and I would like to give my congratulations to Jilly. I would also like to thank Charnie Kalirai, a senior physicist from Nottingham, who is taking over from Jilly as BNMS Treasurer. Charnie has been a significant contributor to the BNMS during has time on council and I am confident he will keep us in good financial shape. John Buscombe has stepped down as Past President but has kindly agreed to stay on as NICE representative for the BNMS. John has been a fantastic President for our organisation and really advanced the societies’ causes under his expert and energetic leadership. Thank you John so much for all you have done for the BNMS.

We are working hard in the area of PET-CT commissioning to define standards for future commissioning which I thank Gary Cook for leading on. I am leading a working group on the commission of new PET-CT tracers to derive a better process that allows our patients to benefit earlier from new tracers. We will then use this document to lobby the central NHS for a better and more streamlined process.

We continue to push for technologist professional registration, Jon Buscombe and Chirs Mayes have been attending meetings representing the BNMS on this recently. I have also been pressing had on the issue at the NHS National Imaging Workforce Board.

Tomorrow I fly to Glasgow for a preconference visit with the organising team of our spring meeting.  I am sure it will be a great meeting and if you have not registered I would urge you to do that now. Both the academic and social aspects of the program look amazing and it will be great to be together in person. See you in Glasgow.

Prof Richard Graham

BNMS President

We are in the middle of radiopharmaceuticals shortages -both Molybdenum and Iodine 131. The BNMS has been working with DHSC, UKRG and industry to mitigate the supply issues. Molybdenum supply is already improving. I would like to thank Jilly Croasdale for leading the vital work on this for the BNMS. I would also like to congratulate Jilly on becoming BNMS President-elect. Jilly is very experienced in all matters nuclear medicine from her work both as BNMS Treasurer and as a radiopharmacist.  I know Jilly will be a great leader of our community and we are very fortunate that she has found the time to take on this important role. There are statements from the BNMS on our website front page around the current radiopharmaceutical supply situation and suggested mitigations that you my wish to read.
 
Gary Cook from St Thomas’ PET-CT centre has kindly agreed to lead the BNMS task and finish group on defining standards in PET-CT service provision. This is a really important project which we hope will inform the procurement of PET-CT services in the future whether this is national or local. We are keen to make sure our patients get the he quality of service they deserve and that vital aspects of the whole service, such as physics support, are not diminished.
 
We have had a very large number of abstract submissions for spring meeting in Glasgow which is fantastic to see. The meeting is really shaping up to be a memorable event form both a learning and socialising perspective. I urge you to register for the meeting if you have not done so already and I looking forward to seeing you all there.
 
I am speaking on the future if theranostics at the winter SNMMI meeting next week which now sadly I will be attending from my house rather that being in Florida! As a result of giving the talk I have done much reading around theranostics and I really can see this to be a big part of what we will do in the future as a community. This will be a pillar of personalised medicine particularly in cancer care. We hope that NICE will approve Lu177-PSMA for NHS use in the autumn which will potentially be the vanguard for mainstream theranostics in the UK. This is a really exciting time to be working in Nuclear Medicine!

Prof Richard Graham

BNMS President

Everyone is working flat out in nuclear medicine now. With up to 10% absences due to ill-health and covid-19 coupled with unprecedented demand for our services we are all feeling the pressure. The BNMS is working hard on your behalf to increase workforce recruitment and retention to help counteract these pressures. I know you feel dedication to your patients but hope that you do not exhaust yourselves in the process of caring for them. I think there is light at the end of the tunnel – the omicron wave appears to have peaked which will result in us getting back to a more normal situation soon. What I do know is our patients and referring clinicians are unreservedly grateful for the key diagnostic and therapeutic services you all contribute to. It is worth focusing on this when times are hard.
 
The nominations for president of the BNMS will close on 31 January 2022. If you are interested in leading nuclear medicine in the UK this is a great role from which to contribute nationally and internationally. Any prospective candidates are always welcome to talk to me regarding what the role entails.
 
Thank you for taking part in our workforce survey. The results of this will be published in nuclear medicine communications. The BNMS will use these data to help argue for improvements in staffing, services and equipment throughout the UK. Your time completing the survey was well spent and I thank you for that.
 
The professional standards committee continues to work tirelessly on you behalf and has recently approved an update to bone scintigraphy guidelines which will be published shortly. This is just one of the many guidelines that the BNMS publishes annually which define best practice and help you deliver and develop your services.
 
Lots of work is happening regarding the spring meeting in Glasgow. It promises to be a great event and I would encourage you to submit abstracts to increase your stakeholding in the event. I hope to see as many of you as possible there. This will be our first opportunity for a large face to face meeting for some time and is likely to be memorable for that alone. In these covid times one realises the privilege it is to meet up with colleagues and friends to discuss our exciting specialty - something I previously took for granted.

Prof Richard Graham

BNMS President

As we approach the festive season it is good to reflect on what Nuclear Medicine in the UK has achieved over the last year. Under very difficult circumstances of the pandemic we have adapted the services we offer and generated extra capacity, particularly in cancer pathways, to provide the care that our patients need. Nuclear Medicine has never been more important and with the potential growth in theranostics  this will continue grow at a faster rate.
 
The BNMS are significant stakeholders in the recently published Review of molecular radiotherapy services in the UK. This joint document from BNMS, RCR, RCR and IPEM highlights the issue facing the UK and requirement for capacity building and levelling up of patient access. I would like to thank John Buscombe for leading this important piece of work. We are planning to define what the PET-CT service commissioning standards should be and we are looking for some volunteers to establish a multi-disciplinary working group to deliver this. This would lend itself to people who have recently been involved in national tendering processes. Please email your interest to Charlotte Weston.
 
I have just come out of our first meeting of a BNMS led working group to propose a better process for the commissioning of new PET-CT tracers. This groups has wide representation including patient charities and will produce a manifesto which we will use to influence commissioners. This is an important piece of work which we hope will help patients access new PET tracers and received the personalised care that this can enable.
 
We continue to lobby on training and registration of technologists and are continually highlighting this issue to the NHS and HEE. We are also looking for a new host for the Kings’s Nuclear Medicine MSc to enable the training of nuclear medicine physicians and technologists. If you have ideas on this please let Charlotte Fowler know.
 
I know things will become more difficult for us all in the coming weeks with the Omicron variant but I do hope you remain well and get a well-earned break with your friends and family. I would like to thank the BNMS Office, BNMS officers, council and all our committee members for the hard work that they do on behalf of you, our membership. I would also like to thank you all for the support you show the BNMS and care that you provide to your patients and services.

Prof Richard Graham

BNMS President

We are in good company have chosen Glasgow for our meeting. I think COP26 is a  good warm up act for the key meeting in Glasgow next year: BNMS Spring meeting! Joking aside Glasgow is a great venue and I am sure our meeting will be a great success so I urge you both to submit abstracts by 26 Jan 22 and to attend the meeting. Although in the virtual space you can learn plenty you do miss out on those informal conversations in the wings with colleagues and with industry, and the social aspects of the meeting too. We as community need to make sure we are doing everything we can from a climate change perspective in the practice of nuclear medicine. Time to start thinking about what we should do going forward.
 
Our next Autumn meeting will be in Swansea on 11/12 November 2022 which is being led by Neil Hartman. I know we can expect amazing Welsh hospitality, much dancing as well as great nuclear medicine.  I would like to thank Neil for putting his hand up. This continues are theme of meetings throughout the UK which can be no bad thing.
 
Despite the pandemic the BNMS finances are in good shape as result of careful management by Jilly Croasdale and Charlotte Weston.  Not all societies have been so fortunate and this is nothing we should have taken for granted. The BNMS is well positioned to deliver its mission as we emerge from the pandemic.  
 
We have been working with a group who are keen to establish a nuclear reactor in Wales to provide medical isotopes and ensure UK supply in our post Brexit era. I am sure you would all agree this would be great for UK nuclear medicine if it comes to fruition. We have written to the new Secretary of State for Health – Sajid Javid – highlighting the issue of nuclear medicine technologist professional registration and hope he will be more receptive than his predecessor. We are working with IPEM and SCOR on this campaign too.
 
I attended EANM virtually which was inspiring by virtue of what is going on in European Nuclear Medicine. The biggest topic of the conference was theranostics and potential of our speciality to deliver for patients in this space; selecting the patients who will benefit most from novel therapies and monitoring their response to treatment. There are many potential applications and a lot of excitement around this. There was a call to arms to increase the multidisciplinary therapy workforce and infrastructure  in order to make this a reality.
 
Finally, thank you all for the vital work you continue to do for our patients  in these challenging times. The practice of nuclear medicine has never been more important in patient care.

Prof Richard Graham

BNMS President

The BNMS virtual meeting went as well as a virtual meeting can. There were so many excellent sessions to attend with difficult choices to be made between the 2 streams. We have had excellent feedback about the meeting and I would like to thank Sabina Dizdarevic, Vineet Prakash and Brent Drake for leading the team that delivered it. A huge amount of work but definitely worth it! Sabina is now steeping down from the scientific and education committee which she has served so well for many years.
 
I cannot wait until the Glasgow meeting next spring. While virtual meetings are OK they are just not the same and we are all missing face to face interaction. I am looking forward to seeing you all in person in Glasgow. The venue is excellent, and Glasgow has easy communication links. I would like to thank our industry partners for their continued support of the virtual meetings which have not been as productive for them, and I am sure we are all looking forward to networking with them in person in Glasgow so that we can take nuclear medicine forward together.
The work on pushing the argument for the professional registration of technologists continues as does the campaign to improve access to nuclear medicine therapy. We hope to be successful in both regards! The decision whether to commission Luteitium-177 PSMA is the next big decision the NHS will make in that is in our sphere of practice. Nice plans to issue its verdict in September 2022. We as a community need to get behind this and provide any data and insights, we can that informs this decision.
 
Demand in diagnostic nuclear medicine, particularly in the cancer arena, continues to outstrip capacity. I know many services are trying to generate extra capacity and I tank you all for this important work that you are doing which supports acute care and elective recovery.
 
Finally, nominations are open for President elect and I would encourage anyone who is eligible to stand to consider it as it is a great privilege to lead the BNMS and a position from which you can ultimately improve patient care nationally and internationally.

Prof Richard Graham

BNMS President

The winter seems to have come early in the NHS this year. Last weekend may have been the busiest in NHS history! What we see in acute and emergency care is mirrored in elective care. More patients are waiting than ever and since GPs are still using a high proportion of non-face-to-face appointments imaging demand is climbing disproportionately as we are being used as a surrogate for clinical examination. The ‘so what?’ for us is we will have even more work to do than ever in nuclear medicine. This on a background of tired and exhausted NHS staff is a real issue. Normally as we go into winter we know it will be tough but we are ready for it having had a decent summer break and recharge. This year is different given the last 18 months of the pandemic.
 
We need to support each other and be particularly compassionate to any people we lead. We need to guard against cracking the productivity whip or coercing people in to working lots of extra shifts. All this will do is produce burnout and people in turn leaving our community. Instead we must focus on each other’s welling being as well as the wellbeing of our patients. Fundamentally be kind. Embrace any technology that can help us deliver our jobs more effectively and be realistic in what can be achieved.  
 
The BNMS survey will be landing in your inboxes soon. This collects vital data about the state of nuclear medicine in the UK. Please take the time to complete it as we use these data for many purposes including advocating for you and our patients. The results of the survey will be published so you can reflect on it too.
 
We are making progress on technologist’s professional registration. DHSC have employed KPMG to do a review which includes professional registration so we shall make sure our voice is heard in this. Finally, thank you for all you doing for each other and our patients and I look forward to seeing you virtually at our forthcoming Autumn meeting.

Prof Richard Graham

BNMS President

I hope you have managed to take some leave this summer or at least have some planned for the very near future. I managed some holiday at home and in the Lake District which was great. Unfortunately during my holiday my father was seriously unwell and admitted to hospital. It was really interesting seeing healthcare from the other side of the fence. I found it very hard to find out how my father was – phones was frequently not answered and when they were very limited information was given. The reason I am telling you this is that it has made me realise how important our communication is with relatives and carers. This is now more important than ever due to limited visiting opportunities. We should make sure that we do answer phones and are as helpful as we can be to those who need information from us and advice. At this time while the NHS is under enormous pressure we should not cut our communication as a coping mechanism to find extra capacity.

In our nuclear medicine department in Bath this week we have performed the first 3D dynamic SPECT-CT Mag 3 renogram in the world. This is an interesting development as the paradigm is now shifting in SPECT-CT to easy whole body acquisition and dynamic SPECT. It will be exciting to see where this technology will have the greatest value in improving diagnosis. 

The BNMS is continuing to press for technologist registration and we continue to have dialogue with NHSE and have support from the RCR. Our view is that this will provide the professional recognition that technologists rightly deserve and enhance their career opportunities within the NHS and beyond.

The virtual September BNMS meeting has a great programme and has already attracted a large number of registrants so I urge you not miss out and attend! Plans are now crystallising for our 2022 Spring meeting in Glasgow which I am sure will be also be amazing but will have the added dimension of being able to socialise and network in person – something I am really looking forward to!

Finally, I would like to thank you all for the wonderful work you are doing for our patients and the support you give to the BNMS. There is of course lots more to do but we should not lose sight of the great work that is currently being achieved.

Prof Richard Graham

BNMS President

We have heard from Curium that the surcharge applied to radiopharmaceuticals has not been sufficient to cover the cost due the decreased amount ordered because of COVID-19. They will be returning to road delivery but will still need to charge the surcharge to cover this for the foreseeable future to pay for the airfreight costs they have incurred. The BNMS has written to Prof Powis, Medical Director at NHS England, to ask the NHS to cover this cost for trusts. We will let you know the response as soon as we hear it.

Demand on Nuclear Medicine Departments continue to rise as the bulge of cancer recovery is happening and I am aware that some departments are struggling to deliver with the perfect storm of sickness, isolation from covid contacts and summer annual leave. All we can do is to prioritise the most important studies and do our best. This will be a marathon not a sprint. We must protect ourselves and our teams from burnout. If we don’t our patients will suffer the most in the long term through diminished services.

ARSAC has agreed that virtual training can count towards recognised experience for an ARSAC licences. They have reviewed the experiences of virtual working from the pandemic and concluded that some training can be delivered remotely. They will be issuing guidance on this in 2022 with their net round of notes for guidance.

The autumn 2021 BNMS meeting programme has been finalised and the meeting is open for registration.  The content looks excellent with large array of international and national speakers. This 3-day event features the re-worked programme from the BNMS Annual Spring 2020 meeting which was cancelled. We have now delivered 2 virtual meetings and continue to iterate how we deliver these based on your feedback. I am confident this will be a really excellent virtual meeting and encourage you to register now.  I would like the Scientific & Education Committee ably led by Sabina Dizdarevic and Vineet Prakash who have delivered this.

I am sure many of you are currently grieving and transitioning through the Kubler Ross stages of dying with regard to the England Team’s defeat last night. I think we should reflect on their wonderful achievement of reaching their first international final in 55 years and reframe this as a great success. We in the nuclear medicine community have much to learn from Gareth Southgate’s humble leadership which I am sure has helped achieve the transformation of the England team and sets them on the road to a great outcome in next year’s world cup. This style of leadership will enable our teams and set the conditions for success to allow us to image and treat our patients to the best of our abilities.

Prof Richard Graham

BNMS President

I am very excited and honoured to be your president. I would like to thank John Buscombe for his excellent leadership of our society through these challenging times. He has brought tremendous experience and knowledge coupled with his great dry sense of humour which got us safely through 2 waves of pandemic! John is now immediate past president on council sand I am sure I will be taking his wise council going forward.

The virtual spring meeting was excellent. I learned a number of things and found the quality of the talks to be very high. The platform worked well too. I would like to thank Arum Parthipun and the Royal Free Team for delivering such a great meeting. They have set the bar high! I would also like to thank Charlotte and Caroline from the office for making it all happen behind the scenes. Rhubarb my cat also sends her congratulations as she particularly enjoyed the closing ceremony!

Despite the challenges of the pandemic the societies finances are in good shape thanks to Jilly Croasdale’s attention to details and prudence as the BNMS treasurer. Many societies have really struggled and so this good position was not a given. We owe Jilly a great debt of gratitude for this.

My colleagues in Bath, Stewart Redman, has kept the wheels on the society as secretary and made sure the BNMS is stake holding in many important initiatives. Bev Ellis continues to lead our professional standards with great effect maintaining our position of setting best practice in our discipline nationally. Sabina Dizdarevic and Vineet Prakash have led our research and education admirably with a great autumn  virtual meeting on its way. The BNMS’s research strategy is advancing too.

My current priorities are:

1. Delivering covid recovery through supporting departments nationally to optimimse their capacity in light of the constraints through our guidance. Our patients need us now more than ever, no where more than in cancer pathways where are tests and therapies are often crucial. We have a massive rise in PET-CT throughout the last year (up ~16% cf ~8% in CT/MRI). Some of which has been fuelled by the 5-day service level agreement for a report where patients may waits several weeks in CT. We should all be proud of the PET-CT services that are delivered in the UK. I
2. Gaining professional registration for technologists. We are involved in several initiatives to put pressure on the government to make this happen. We hope by pushing on multiple fronts that one will be successful.
3. Molecular radiotherapy: John Buscombe is leading this initiative to level up access in the UK and make sure we are ready if PSMA therapy becomes licensed. This includes not just the therapy but dosimetry too.

We as a society continue to contribute to EANM guidelines. I will send out these from time to time for comment from the wider society. Thank you all for those who have given of their time recently to improve these guidelines.

I am very keen for wide participation in our society. Diversity is our strength. If you wish to get more formally involved, please let Charlotte Weston know and we will find you a job. We will also regularly advertise positions which I urge you to apply for. Thank you again for all that you do for our specialty and in turn our patients. I look forward to catching up with you in person when that is allowed!

Prof Richard Graham

BNMS President

By the time you read this I will no longer be President of the BNMS and Richard will have taken up the mantle. I wish him every success for his term of office. Richard has previously been the BNMS Secretary and also President-Elect for 2 years so he is probably the best prepared President we have ever had.

In China it was said that the greatest wish was that we be saved from interesting times well clearly that has not been the case for my presidency. We have all lived through probably the most “interesting times” we will experience in our lives. It started with the divisive process of Brexit which left many of our colleagues feeling their contribution to our specialty and country was not fully appreciated. Just as Brexit seemed to be finally settling-down we were hit by the pandemic. I do not think many of us in March 2020 felt we would still be suffering at this present time. The general feeling was it would be over by Christmas not knowing then that for most of us Christmas would be cancelled. A few wise heads looked at the infection curves of the 1918-1920 influenza pandemic with waves of infection rolling round the globe and said this would not be over till 2022 at the earliest. However, at least we can see the end of it here in the UK.

Though, many of our nuclear medicine community have family in South Asia and look on with mixture of horror and helplessness as the infection rips through India, Pakistan and Bangladesh. I have many Facebook friends working in these countries and every day someone posts a relative has died. It is all too awful and we must remember the saying non one is safe until we are all safe.

We have learnt so many lessons over the last 2-3 years but most of all I think we have learnt we need to value and cherish each other. When we can finally meet together hopefully in Glasgow it will be so good to see each other in person.

It is normal at hand over for the President to say a few words of thanks to all those who have made the job workable and remind me of deadlines and what I need to do. Charlotte and Caroline have excelled in this role. Over the past 3 years a lot of work has proceeded to future proof our Society and make it fit and sustainable for the coming years. I had the opportunity of travelling to Nottingham and on a beautiful sunny day in April to share a thank you lunch in a riverside pub garden with Charlotte and Caroline. I am grateful every day for their enthusiasm and encouragement.

The President is just a team leader and the most active of that team are my fellow officers who in my term of office have been Sobhan, Jilly, Richard and Stewart. They have shared the burden of work that needs to be done often at short notice and have always been there to defend and expand the role of nuclear medicine. I think the profile of nuclear medicine is as high as it has ever been within the Department of Health, with Members of Parliament and the Royal Colleges. This has been a joint effort. I thank them all.

Much of the work is done in committees. Bev has led the Professional Standards Committee with efficiency over the past 3 years and turned it into a committee that does things and not just talks about things. Sabina led the Scientific and Education Committee but after passing this to Vineet and Drake became our Scientific Advisor and the first fruits was our COVID paper published in NMC this year. More is to come. The RTN committee has increased in importance under the leadership of Richard and Chris and our fight for technologists registration continues. They have scored a major success over employing non-UK technologists when needed. Long may they continue to thrive. Sarah, Charnie and Andy have been an invaluable link to the Medical Physics community as well as taking on battles concerning reimbursement and starting our mentoring service. A grateful thanks to all of these teams. We as a Society have been blessed with a great Council and many volunteers not on Council who represent us on a variety of Committees, thanks to you all.

Well, this is the end. The last of 37 Presidential blogs. I hope they were useful in giving you all a window onto what I was doing and my thoughts over the past 3 years.

Dr John Buscombe

BNMS Past-President

Well, have you managed to go to the pub or eat outside a restaurant yet? It depends where you live, the weather and if you could get a booking! If you have, well done, if not, sorry, but hopefully soon. Slowly we feel as though we are coming out of hibernation. Though COVID numbers remain high and will be as we test more people and we mix. However, the number of people admitted to hospital continues to drop as do deaths. Some hospitals in COVID hot spots in the Midlands and the North are still having COVID admissions everyday but in many other hospitals with no new COVID admissions there is a return to more normal working including in nuclear medicine. We must hope that with vaccination rates good, the expected 3^rd wave will not result in a large spike in either admissions or deaths.

Maybe your mind is thinking about a well-deserved break either here is the UK or maybe being brave overseas. I am sure we can allow ourselves some hope but this is a cruel and horrid disease so we must be prepared for anything. This year is mine and Mrs B’s 40^th wedding anniversary. She probably deserves a medal for putting up with me for that long but I suspect it will be a simple celebration, maybe a glass of bubbly in the garden if the weather permits as I suspect any place we would which to go will be on the red list. However, we must not be down hearted though as we got through this pandemic with our sanity and health pretty much intact and got our 2 vaccines on time.

Whilst the world has been pre-occupied with Brexit and COVID there have been advances in the world of radionuclide therapy. NICE has approved the use of Y-90 SIRT in hepatocellular cancer and an interim report of the VISION trail suggests that Lu-177 PSMA will be a life extending treatment with registration and hopefully NICE approval on the horizon. However, as I have written before we must ensure this available to ALL eligible patient’s in the UK not just those who live in the lucky post codes. This will entail all of us as the delivery of these treatments as it is a multi-craft endeavour especially with the new requirements for patient based dosimetry. To ensure this can happen ARSAC must modernise the way they look at licencing with the old methods requiring multiple visits to other hospitals providing the required service not sustainable in a COVID and post COVID world.

On the negative side a report for the “Getting It Right First Time (GIRFT)” committee of the Royal College of Radiologists has recommended that cardiac MR and CT be used in patients with chest pain as MPS was not widely available. However, this takes no account of our aging population with increasing rates of renal impairment and the lack of access to cardiac MR. This is something  I know about. The waiting list for my cardiac MR that was considered urgent was 9 months. The scan took 2 hours and required a lot of patient co-operation. I just cannot see how this can be applicable in a routine fashion in the numbers required when a gamma camera can crack through 2 MPSs an hour without breaking sweat. I proposed a better name for name for this report was “Asking Nuclear Medicine to Sort Out the Undiagnostic MR Cardiac Scan Which We Could Not Do Anyway Because of the Patient’s Renal Impairment” programme but I suppose “ANMSOUMRCWWCNABPNI” does not sound as snappy as “GIRFT”

So as spring progressives, the weather warms and we can get out more, visit our loved ones and friends. Maybe share a coffee or a pint of beer or a meal with those we have separated from for the past 6 months let us start to look forwards to what we can do to enhance our nuclear medicine practice in the months ahead.

Dr John Buscombe

BNMS President

How flexible are you? If you have been doing your Joe Wicks exercises you may now be very flexible as well as fit. However, I was thinking not about your physical flexibility but working practices. We in nuclear medicine are what he Piagest psychologists would call “concrete operational”. There is nothing we love more than a standard operating procedure. In fact such an SOP is the cornerstone of good and safe practice. It helps train new staff members and ensures consistency of results. However, they can become an excuse for ossification of practice. How many times have I heard the phrase “we have always done it that way”. It is a mantra of comfort. We know when we go to work we will be following the SOP like a cook follows a recipe. Any variation brings shrieks of distress “its not on the protocol” and can sometimes induce a state of near panic.

However, we live in strange times. I think that we have come to realise we will not go back to what we considered normal. Before the black death in the 1340s if you wanted to eat you had to work unpaid for 3-4 day a a week for the Lord of the manor. He (and was always a he) would then allow you to scratch a living from a small strip of farmland. The black death killed half the population of Britain and such labour could no longer be relied on. The Lord of the manor now had to pay his worked real money which they could spend in shops. This lead to the rise of a merchant class who would sell things from a new invention called shops. Also people had money to spend on services such as medical practitioners, teachers for their children and no longer had to make their own clothes, shoes etc. The rest as they say is history.

Well fortunately coronavirus will not kill 50% of us but its changes on society may be just as profound. The country is deep in debt, the overall cost of the pandemic to all of us will surpass the cost of 2 world wars. The last time Britain owed so much money was after 18 years of war with revolutionary and Napoleonic France. The resulting social crisis was so severe it resulted in the country becoming urbanised and industrialised with the consequence rise of trade unions, general taxation and the welfare state. Will there be similar changes ahead, time alone will tell. We can see some changes already. Instead of having to go to an office for meetings we can zoom* from our desks or even better home. I do agree hospital IT departments generally still live in a pre-pandemic world. There are dangers; none of us relish spending the whole day on zoom* meetings and just because they may be easier does not mean you should have more meetings.*Other videoconferencing platforms are available

Hospital managers seem to finally understand that attendance is not the same as work. Instead of insisting that you travel into the hospital to do your work it is now seen possible you can, if applicable, work from home. Many departments have found innovative ways to do this. I could never understand why a manager thought it was a good a good idea to get their employees to spend 2-3 hours a day exhausting themselves commuting when they wanted people to be productive. Ah you cry this is not for us. Well yes and no. I do agree injecting and scanning patients means you physically have to be with the patient in the department. However, there is a range of things which do not require you to be in the hospital such as booking the scan, ordering radiopharmaceutical doses, reviewing SOPs, writing new SOPs, doing dosimetric calculations or reporting scans. AGH you are now screaming I need the security blanket of my favourite computer or a special screen or talking to colleagues. All are true but not true every hour of every day.

There is another major issue commuting is killing our planet. Whilst some people would like you to feel guilty about taking a holiday for the average family less than 5% of their carbon emissions are spent going on holiday. The vast majority of transport based carbon emissions is going to and coming home from work. We may not be able to stop commuting altogether but a smarter way of working means we can reduce the work travelling we do. It would be wonderful if we were going to “spend” our carbon emissions we did on things that brought us pleasure not just drudgery. Also why are work patterns built so we expect parents to take children to school at the same time as they need to come to work, it is stressful, results on over use of cars and to be honest is straight bonkers. Why not have work patterns which allow one parent/care giver to start late so they can walk their children to school and the over starts and finishes early enough to collect their children for the walk home. Yes I did write walk. Children do not die if they walk to school. From age 5, I walked over a mile to school and back again every day often chatting with friends. In fact not only do children not die walking to school they may actually live longer.

Then there are clinics. We run clinics in a way that has not changed for nearly 200 years when physicians would only see the rich and in their own homes. In the post Napoleonic world social changes saw the rise of the infirmary and provision of health care to the main population. In 1870 it made sense for the doctor to sit in a room and patients queue up to see him (again at this time it was always a him). However, since than we have had telephones. This device enables us to talk to someone who is not in the same room. Whilst a few brave souls would use this technology including our brilliant Clinical Nurse Specialists before COVID it was generally considered not a proper consultation unless the patient suffered a long commute, had to queue to get into the hospital car park, arrange a bank loan to pay for parking (not in Wales I know), sit in a room with other people some of whom can give you a disease you do not already have (some estimates are that 15% of patients get new infections attending hospital), by the time you see the doctor you are both tired. Then the process takes so long you parking ticket has run out (OK not in Wales) and you need to re-mortgage your house so you can get your car out the car park and have the pleasure of sitting in a stationary traffic jam before getting home exhausted. This is not fantasy as a patient I have known this all too well. Therefore it comes as no surprise that when I ran the Friday thyroid clinic by phone on Wednesday my patients were thankful, happy and communicative. They were not so tired they forgot to ask those important questions. To a person they said how much better it was then trapesing up to the hospital. Of course they did need to come for their scan and treatment but that was all done in under an hour with smiles all round.

Now you are a clever lot. I am sure you have worked out ways to work smarter and more effectively during this pandemic. We have coming up the perfect opportunity of sharing that and in September the BNMS will be running the team innovation prize again. Start thinking what you can share with the rest of us. Remember what the French say “plus de la change”.

Dr John Buscombe

BNMS President

February has been cold. Most of the country has been in the grip of storm Darcey. Temperatures have fallen to -23 centigrade in some parts of the UK. Walking to work I have found a surgical mask is an excellent way to keep your nose warm. It is much easier to use than a scarf and can be used if you are walking or cycling. The best thing is everyone thinks you are just being a good citizen and that I am wearing the mask to protect my fellow citizens. Of course, this is just how I appear and our perception of appearances can change. Just a year ago a woman wearing a face mask would be considered a likely terrorist by many, now such a woman would be considered a good example for all to follow.

12 years ago there was a general view that hybrid imaging would be a threat to nuclear medicine physicians and there was a shift in training to ensure the nuclear medicine physician of the future would be equipped to work in the department of the future. The appearance was that training was now right for the nuclear medicine practice as it would evolve in the 21^st century. However, the rise of theragnostics have shown that we need to look again at how we train doctors in nuclear medicine as they will need to both scan and treat patients with radionuclides. So on the outside nuclear medicine clinicians would appear to be like other imaging consultants. Theragnostics mean they will need to attend MDTs, out-patients clinics and treat patients. Also, as theragnostics expand some radionuclide radiologists might like to dust off their old clinical skills and treat patients as well. The profession will have to work through has this can be achieved.

I try not to mention the “B” word again but that thorny topic of Brexit just will not go away. If you live in Northern Ireland you can get hold of any drug used in Europe as long as its imported via the Republic and not the UK. Of course, food is another matter. I am sure someone will have the bright idea of saying the Irish are good at growing potatoes. Well that worked out well last time! We are starting to get reports of delayed deliveries of some therapeutic radiopharmaceuticals and mysterious extra charges for delivery. In England the Department of Health and Social Care seems to have gone for the radio-silence approach. Those civil servants who were keen to talk to us in December all seemed to have switched off their email accounts. Very frustrating.

Clearly, the DHSC has been working on the new white paper on delivery of integrated Health and Social Care. Those of us who are old enough to get a COVID vaccination remember this was how it was before Kenneth Clark’s great ideas in the NHS reforms of 1987. This brings up the old joke “What is the definition of an NHS reform? Answer: The longest distance between point A and point A” Though the white paper does not mention extending registration to health professionals such as nuclear medicine technologists there are vague concepts about safety and accountability (in fact the white paper is just vague terms) so we will have to wait for the actual bill to be published in a couple of months to see what is proposed. Then it will be action stations for all of us.

Keep warm and keep safe.

Dr John Buscombe

BNMS President

Well it is a new year. Hopefully, some of you have received the first dose of the COVID vaccine by now. It does look like this wave may be worse than the first especially related to the new variant of COVID. We may face new disruption to nuclear medicine services as hospitals fill up and resources are diverted from routine care though we hope at least cancer services will be retained. Some of you may volunteer for extra duties to help your hospitals and we as a Society appreciate all you are doing in this difficult time. Also, you may end up as a part-time child carer or teacher. Well hopefully you will be able to teach biology, maths and physics.

It is with a heavy heart I report that this horrible virus has taken the life of Dr Donal O’ Donaghue, the Registrar to the Royal College of Physicians in London. Donal was a true friend of nuclear medicine. He would always tell us his truthful opinion and suggest ways we can proceed with the issues important to the practice of nuclear medicine. He supported the registration of nuclear medicine technologists and his passing is a great loss.

Whilst all this was going on the transition period part of Brexit ended. We will have to see how this will impact on the delivery of radiopharmaceuticals throughout the UK. There were some delays in delivery of some Mo/Tc generators in the first week of January but this appears to be related to the change in the law in the Netherlands. The best answer is for us to have a UK based source of Mo-99 and generator production. A couple of years ago this seemed impossible but there are now two proposals for such production using two different technologies. Maybe in the future the UK can become one of the world’s leaders in radionuclide production as we were in the 20^th century.

We need something to look forward to. In May the team at the Royal Free Hospital, London will host a virtual spring meeting and we hope to expand our offering allowing for 2 streams giving more choice. We will offer hub registration again so all nuclear medicine departments in the UK can participate in the meeting. With over 300 attendees in the last virtual meeting we hope that many more can join this meeting. During this meeting we hope to have some company symposia and we will also have our AGM.

New radiopharmaceuticals are coming our way. We hope to get a HRG for Tc-99m PDP for cardiac amyloid and Tc-99m PSMA. In the world of PET F-18 DOPA has been approved and we expect at least one form of PSMA PET imaging to be authorised and we may also have Lu-177 PSMA therapy so despite everything feeling a bit bleak at the moment there are some really exciting developments coming to us in 2021

Lastly can I wish you all a very happy and healthy 2021.

Dr John Buscombe

BNMS President

Well we have finally made it to December 2020. I think for most of us this is a year we will all remember but not for a good reason. You will all be able to tell your descendants what you did in the plague year of 2020 though we hope it does not end up like the plague year of 1665 which ended up with the Great fire of London. We hope that the next year will be more hopeful and we can return to some activities we have not managed this year including meeting together at our Annual Meeting. To give the maximum time for this to be allowed to happen the BNMS Council has decided to swap the 1 day meeting from autumn to spring and the long meeting from spring to autumn. The team at the Royal Free in London, stars of the BBC series “Hospital” have offered to organise a one day virtual meeting in May. This will include the 2020 Young Investigator’s prize as its highlight and the BNMS AGM. The present plan will be for the 3 day meeting to be held at the end of September as a face to face meeting and have our annual dinner and prize giving.

Anyway this December many things will happen 3000 residents of the United Kingdom will attend their local Emergency Departments with Christmas decoration based injuries and sadly 15 people will die of electrocution from Christmas tree lights. Why do I mention this? Well despite these figures most of us who celebrate Christmas will still put up decorations and put electric lights on our Christmas trees. So we all make a risk assessment and decide that the risk of significant harm is outweighed by the enjoyment our decorations and lights give us and our families.

This will be the same with the coronavirus vaccine. There will be a very few people who should not have a vaccination for medical reasons but for the vast majority of us it will be a brilliant idea which may not only save our lives but the lives of those around us.  I can understand some of the public’s concerns especially in respect of the British public’s very poor understanding of science and risk but what has distressed me are a few members of this Society who have used social media to spread disinformation concerning vaccines in general and the coronavirus vaccine In particular.

What is true is that no human activity is without risk, most of us will die in bed so the biggest thing we can do to avoid the biggest risk we face is never to go to bed. This is clearly ridiculous and as nuclear medicine people we know in particular there is no such thing as a 100% safe level of radioactivity. However, we all know the risk of a patient coming to harm from the radiopharmaceutical injection is tiny compared to the risk of not having the test and dying from an undiagnosed and treated medical condition. Some armchair observers state that how can we know a vaccine is safe when it has only been given to 10,000 subjects to look at its safety. Here I will let you into a massive secret which I can tell you from my role in assessing the safety of new medicines for the Medicines and Healthcare Regulatory Agency (MHRA). The secret is that before being approved a diagnostic radiopharmaceutical will have its safety assessed in only about 250 subjects and a therapeutic radiopharmaceutical in only about 1000 patients. Does this stop us giving these products to our patients or would it stop you having a nuclear medicine test yourself? The families of the 70,000 people who have died directly or indirectly from COVID and those suffering from long COVID will all tell you getting the virus is not risk free. So when you are offered one of the coronavirus vaccinations I really suggest you get yourself vaccinated for your sake, your family’s sake and your patient’s sake.

If you celebrate Christmas have a very merry one, if you do not celebrate Christmas have a few good, well deserved days off and for us all to have a happy and healthy 2021.

Dr John Buscombe

BNMS President

Well it’s almost the end of the year and almost the end of the transition period. Many of us were involved in a videoconference with the Department of Health and Social Care (DHSC) a couple of weeks ago. It has been decided that radiopharmaceuticals will all be flown after 1^st January 2021 in and it does seem that this time there has been some planning. Issues still exist transhipping product to Scotland, Wales, Northern Ireland, North and South West England but hopefully there should not be too many delays. There is some hope that new drugs and therapeutics can receive MHRA approval at the same time as the EMA, except Northern Ireland that will continue with EMA rules. Maybe we will have to go to Belfast not just for a conference but also some nuclear medicine scan and treatments. There will certainly be an increase in the costs of delivery and whilst NHS England accepted this will be the case but refused to say they would cover these cost increases. We have all been warned. As it is expected the volume capacity of travel between Calais and Dover will decrease by 40% in January so maybe no salad for January.

As I write this blog, we are in the middle of the second English lockdown and my thoughts go out to all of you with children. It must be hard to keep them busy and interested with no where to go and the weather being a bit cold and rainy. For us old people things do not change much if we are in lockdown or not though it is frustrating being unable to visit family. I hope that this will be over soon and we can see family and friends at Christmas though remember the golden rules “wash hands, wear a mask and keep your distance”. Maybe at last there is also good news concerning vaccines.

I have decided to invent a new disease and that is “metastatic zooming”. In the “old days” as we now call the time before COVID it was possible to avoid meetings by physically being somewhere else. You could be in clinic, on holiday or in another country. Now we live in zoom world and no one is allowed to go anywhere all this becomes impossible. It is pretty much impossible to say you are not available for a zoom meeting. Those that love meeting can call them at any time for any length knowing you cannot say you are not available. However, some hospitals are coming to our rescue. Many hospital computers do not have cameras and some have no microphones and of course you are not allowed to plug your own camera and microphone in. One hospital I work in is brilliant. They have put zoom on the computer but this machine has no sound no camera and no microphone and to add to the feeling of isolation no mobile phone signal. Of course, you could use Teams as part of nhs.net but most of us have noticed that since the recent upgrade nhs.net has become almost unusable. It can take 30 minutes to write a 2 line email and the Teams part hardly works at all. Of concern to us nhs.net automatically deletes any email from the BNMS so if you have not had any emails from us in the past month please send a alternate non nhs.net email to the BNMS office so we can use that. Finally another surprise is that on shared computers when you log onto nhs.net with your username and password you do not get your email in box but those of random previous user.

Finally, and most importantly we are getting some good traction in our campaign to ensure nuclear medicine technologists become registered health care professionals. Many of you have written to your local MPs and obtained cross-party support for these plans. The prize goes to Newcastle which has recruited all the cities MPs both Conservative and Labour to support nuclear medicine technologist registration. If you have not received your email asking you to write to your MP then please check with the BNMS office they have your up to date (non nhs.net) email address. This is an important step and will help with professional progression of our members and being able to pressure the Home Office to agree nuclear medicine technologists is a shortage profession. It is totally illogical that art therapists are registered and not our brilliant nuclear medicine technologists.

Dr John Buscombe

BNMS President

Well the barmy days of summer now seem so long ago. The world moves forward, and we are heading into the second wave of COVID-19. We do not know how long this will last but it could be 3-6 months. What must be a priority is non-COVID patients must be seen and treated in a safe way and without delay. We have updated our recovery guidelines with some ideas how out-patient therapies can be done safely within nuclear medicine and we hope this is useful. We in the NHS will need to learn how to live in a COVID world. We may not be able to do everything, but we need to do everything we can.

Due to COVID the government is planning to extend professional registration through the HCPC to more health professionals. The BNMS believe this should include nuclear medicine technologists. We have secured support from various professional bodies, but an Act of Parliament is needed. This is planned but we need to ensure Nuclear Medicine Technologists are included. Here I need the help of every BNMS member and every colleague who works in nuclear medicine who is not a member. This is an issue that affects all of us not just technologists. By now you may have received a letter from me asking you to write to your MP. This is now an essential step and Jilly Croasdale has kindly provided an outline letter you can personalise. Without your support nothing will happen.

It is October so it must be Brexit time again. At the present time it looks as though we are heading into a no deal scenario. We hope this is not the case, but we foresee an extra issue we did not have in 2019.  At that time, it was possible for companies to fly radiopharmaceuticals into a variety of regional airports within the UK using the cargo capacity in passenger aircraft. However, due to COVID-19 the situation is now very different. Most UK commercial airliners are either in a field in Gloucestershire or have been sent to Arizona to be broken up. The pilots have been sacked and pilot Sainsbury delivery vans around Berkshire and Surrey and not Airbus A320s. This could lead to potential delivery issues. We will continue to monitor the situation.

At the AGM last month those present voted that I should continue as President till the next AGM in May 2021 but there will be elections for the next President-Elect in early 2021. You need to think whether you or someone you know would be the correct person. There are a few requirements listed on the BNMS website but remember our President does not need to be medically qualified, but they do need to have a passion for nuclear medicine.

Dr John Buscombe

BNMS President

Well COVID has changed much of what we do. There are three changes coming up for the BNMS. On the 23^rd of September we will be having our first ever virtual scientific meeting. For those interested in research there is a breakfast pre-meeting concerning the prospects for co-operative research with new tracers in PET lead by Prof Phil Blower from Kings College London. In the main meeting the lectures are pre-recorded to ensure they are a high quality and then questions with the speakers will be live. Posters will be available electronically all day and you can ask questions in the mornings and we hope the authors will answer these over lunch time. During all the breaks you can talk to all our brilliant sponsors. We have decided to spend some money on a professional virtual conference organiser, so all these functions are available to our registrants via a single portal. Sadly, you will need to provide your own meals and drinks.

The second unique feature will be the opportunity of having a departmental hub registration. As many of us have been short of CPD intervals this is a great chance for your department to share together the autumn BNMS. We calculate that about 150 nuclear medicine staff will be accessing us via hubs on the 23^rd.

The third change is the AGM will be via zoom at 17.30 on the 23^rd. This is your opportunity to be part of our decision making process and will start with a vote concerning the future of the President and vice President and if you have views on this or any other issue concerning nuclear medicine please ensure you join the AGM.

Stewart Redman, the BNMS secretary, sent me a link which may be very important for all nuclear medicine technologists. On 30^th July Matt Hancock in a speech stated he would like to see registration extended to a wider group of medical professionals. Charlotte Elliott the Chair of the Health and Care Professional Council the same day issued a letter which stated the HCPC will look at this. This is an opportunity for us to state our case for nuclear medicine technologists to be registered health professionals. This will secure the future of many functions including giving i.v. injections and being able to initiate SPECT-CT.  It should help getting nuclear medicine technology put back on the list of shortage medical professionals for recruitment purposes. It will enable further professional progression than is possible at the present time. If you agree with this please contact your MP stating your support, why you think registration would be a good idea and in this COVID time any examples as to why registration  would help nuclear medicine technologists to provide a better service to patients especially in this time of COVID. The officers of the BNMS are sending letters to a series of people who could help make a positive decision and obtaining support from other professional groups.

Well that is all for this month.  Enjoy our virtual conference on the 23^rd.

Dr John Buscombe

BNMS President

Normally August is holiday season but this year for many of us working for the NHS any form of holiday has not been possible. Fortunately, some of you have been able to take some time off maybe with family and/or partners. Some of you have had a staycation and explored parts of this country you may not have been to before. The brave among you may have left the shores of Britain to play quarantine roulette; can you get to and from your holiday destination before quarantine comes down on you.  For those unlike me working through August I hope you get some rest before too long. My own staycation was a lovely week repainting my lounge. My pet hate is ceilings and my hair is definitely a shade whiter (actually its not called white but “polar star”). Anyway, all done now and the furniture is back and after a few washes my hair is back to grey.

A few days after I wrote the July President’s blog I heard about the death of Prof Sanjiv (Sam) Gambhir. He died of cancer just a couple of years after his teenage son also died of cancer. He was one of the true innovators in nuclear medicine he used molecular imaging methods to identify many pathways involved in cancer and its treatment. He found a home at Stamford University and embraced the spirit of innovation coming from the adjacent Silicon Valley. He was an amazingly generous teacher and would take time to talk to his or anyone else’s students. With Peter Ell he edited our standard textbook of Nuclear Medicine. Even though we only met a few times he would always stop and talk to me and discuss what we were doing in Cambridge. He was a leading light for our specialty and his passing leaves us all the poorer.

As the grip of COVID on our world continues we are finding we have to do more in the virtual world. Our Autumn BNMS will be on the same date the 23^rd of September but will now be a virtual meeting. Though it will still be oragnised by the Leeds nuclear medicine team. As an innovation a department can have a group registration so you can all share in with the autumn BNMS together. We hope this new idea will allow more of our members to become involved in the meeting. Later the same day will be our virtual AGM so please remember to log on for this. This year’s EANM will also be a virtual meeting so look out for registration details for this meeting as well. Maybe you could cook your own Sachertorte and eat this during the virtual EANM to get that Vienna feeling. What will happen next year we do not know. I am meant to be in South Korea in January 2021 but will the second wave cause further cancellations. Meanwhile the conference centre that we are meant to be going to in February 2021 for the South African Society Meeting has gone out of business. We must accept we live in a time of uncertainty.

However, we must not be too depressed we still have our patients to look after and they still need our care. We will get out of this horrible disease or just learn how to live with it, things may be a bit different but hopefully we still have our family, friends and extended nuclear medicine family.

Dr John Buscombe

BNMS President

COVID continues to change our society and as a consequence our Society. When we finally emerge from this pandemic we may live in a different world. Charlotte and Caroline have been working from home since March and they have found that not only does it work well but they can be more efficient. Therefore, the Officer’s have decided along with Charlotte and Caroline that this arrangement will be permanent. We will keep our address and rent some storage but Charlotte and Caroline will continue to work from home. We will no longer need to pay an office rent and Charlotte has won a grant from Nottingham City council to update our hardware and software.  In a way we have gone back to the past when the BNMS was run out of Sue Hatchard’s house. I think we can be proud of being part of a Society which is modernising work practices and avoiding making those who work for us having to commute.

I know there is much we cannot do unless face to face but we also need to think if how we can join the 21^st century. Consultations for radioiodine treatment can be done over the phone and even consent taken using secure video-conferencing. It may not suit everybody but it could allow us to be more flexible for our patients. At last some hospitals who have held out like King Canute against the tide have finally allowed doctors to report from home using telemedicine. Maybe one day our employers will understand the difference between work and attendance.

There will be some other changes. In July members will receive an electronic ballot. We have a new council member to elect but also members will be asked to make a temporary amendment to the articles of association (our rules in non-legal terms). Due to the disruption from COVID which may get worse next winter Council has asked that the officers roll over their terms of office for one year. This would mean the President, President-Elect, Treasurer and Secretary remain in post. The consequence of this is that Richard takes over as President in May 2021. We hold elections for a new President-Elect in January 2022. These changes however, needs your agreement before the next AGM in September.

The next area of COVID related change is how do we undertake our scientific meetings. At present Charlotte, Caroline and the SEC are working hard to see if we can have a virtual meeting and AGM in September of this year. It will be a one day event and we do need to charge a registration fee to cover our costs but it will be less than a normal meeting. We will also have a virtual Zoom AGM so you join in wherever you are. At present nothing is settled but we will let everyone know by the end of July what is happening. We still hope to meet in person in May next year but may have to have a hybrid meeting with some on-line content. All these plans remain fluid as we still do not know what is in store for us.

For those able to get away on holiday, I do hope you have a wonderful time and enjoy some rest. If you are stuck at work, keep well and hope your vacation turn comes soon.

Dr John Buscombe

BNMS President

As well as the COVID pandemic the other news item to touch all our lives has been the black lives matter campaign which burst on to our streets again after the murder of George Floyd. We in the NHS are incredibly proud of our ethnically diverse workforce and in the UK we have been very privileged that so many people from around the world have come to work for us. Many of our departments reflect this amazing ethnic diversity but it is true that in many of our hospitals that this diverse ethnic mix is not reflected at senior level.

For those who think we are untouched by racism here in the UK I suspect we have just looked hard enough. I suspect if we ask our black, asian and minority ethnic workmates if they have ever suffered racial discrimination every single one would say yes. We know the situation is chronic but that is not a reason to accept the status quo. 30 years ago my wife was an obs and gynae SHO and her boss was born in the UK but his parents were from Ghana. He drove a second hand BMW and every day on his drive to and from work in London he would be stopped by the police and would have to prove the car was his and undergo a drugs search. Because he worked at the same hospital he would be stopped by the same policemen day after day. 25 years later I had a brilliant Omani trainee. She wore a Hajib but otherwise western clothes. She was with her 3 children in a park when approached by a group of young white men calling her “rag head” and throwing her youngest son and his buggy into a pond. Fortunately, he came to no harm but at my insistence she reported the incident to the Police who said it was just “high jinks” and nothing to worry about. Neither of these stories are meant to be critical of the Police who do a difficult job but they do reflect the underlying attitudes that permeate our society. Now is the time to call a stop.

Before 2020 zoom was a noun or an adjective. Now it is a verb, I zoom, you zoom, they zoom etc. In the heady days before March a Zoom was a multicoloured ice lolly which looked a bit like a rocket. You could of course zoom through something or like my grand-daughter you could “zoom, zoom we are going to the moon”. Now all of us on Council and many others zoom maybe everyday. It is free as long as you only stay on line for 45 minutes. The BNMS has decided to buy a version so we can work a bit longer. However, zooming has led to a new etiquette. For example it is good to be fashionably late. If you try to join a Zoom call before the host it just will not work. Secondly what do you wear. Should you be formal or relaxed. The best thing is as long as you keep the camera pointed in the correct direction you can mix and match. Shirt, tie and jacket on the top. Surfing shorts and no shoes down below. If you are the host and you really fed up with someone you just mute them. It does not matter how hard they try to unmute or how energetically they wave at the host they are not going to get heard until the host wants to hear from them. On the other hand you have to remember you may be zooming from home and if you do not mute in time everyone will hear the tale of your 4 year old’s metre long poo as she rushes into your room to give you an update. Then there is the hair issue as lockdown progresses the nation’s hair situation is not good. For all of us have started to look as though we live in a 1960s style hippy commune. If you were the type of person who’s hair roots are a different colour from your other hair there is now a good 10cm of hair root colour. Before men think that is not a problem. Do we really want to see hairs growing from eye brows in every direction not to mention ear and nasal hair. Then there is the bald patch. Now many men are what we call “thin on top” Most men when they look in the mirror do not see this but leaning down to try and find the “leave meeting” button the all seeing computer camera sees all. The experts say we will all just have to learn to live with this pandemic for months ahead. If that is the case and there are no barbers or hairdressers we may decide that we can only Zoom with the video off

Where do you zoom from, indoors and your wall paper choice becomes a matter of debate. You could use the supplied backgrounds like a tropical beach which sounds great but Zoom seems to have a defect in its edge detection. I remember talking to a doctor in Australia who for some reason had palm tree eyebrows. There was a report of a poor lady who changed her face into a mouse face but was unable to change it back for the rest of the zoom call. Then there is the issue of band width. In our house you can only have 1 zoom on our broadband so if my wife is using that I have to use my mobile. However, the only good 4G signal is in the garden by the bird table. What is the etiquette of zooming and eating. We know we should not talk with your mouth full of food but what about zooming. I have seen people tuck into a full roast dinner on zoom, not good if you are hungry. My personal bug bear is people zooming from a sunny garden with a very large glass of red wine in hand!

Finally if you know someone who works in Nuclear Medicine who has done something truly extraordinary during the COVID-19 crisis and should be considered for an honour, please contact Charlotte Weston in the office who has an on line form you can fill in. we must have these completed by June 30^th so we can send to the cabinet office.

Keep safe.

Dr John Buscombe

BNMS President

Some surprises are nice, others less so. Who does not like a surprise party? Well me for a start. I never know what to say or do. However, we are in the time of surprises. This was meant to be my last blog. It should be full of homilies thanking the amazing office staff, Charlotte and Caroline. The Officers and Council of the BNMS and you as members for putting up with me however COVID has changed everything. The Annual Meeting and therefore the AGM has been cancelled. It was decided that the Officer, Council and Committee members remain in post until we have a special AGM at the Autumn meeting, that is if we can have an Autumn meeting. It has been suggested that instead of September all office holders stay in post until May 2021. As this would be an amendment to our Articles of Association it would need to be approved by the membership either at a special AGM or if that is not possible a virtual AGM. More details after our next Council meeting which we will have using “zoom” in June.

My wife retired from being a GP in January but has been called back up to work again. She was surprised (but I was not) by the she number of electronic forms she needed to fill in and the number of times she needed to wave her passport and driver’s license before her web cam to get back to work. Evidently, she needed to prove her identity again and again because the results of the previous phone call or video call were always lost. She agreed to worth by video or phone link from home and thought she would go back to work in the London Borough of Newham which as I write has the highest rate of COVID-19 infection, COVID-19 deaths and COVID-19 dead GPs in the whole of the UK (and now Europe) but was surprised to find she was assigned by 111 to the outer suburbs of Manchester!!

I think many of us are also surprised by how COVID-19 has paralysed our other work. Where are the patients whom we normally see? Many of us are particularly concerned about the fall in cancer cases we see either for nuclear medicine or PET imaging. About 2 weeks ago I was asked to propose how we get back to work and subsequently the BNMS published guidelines looking towards at least getting to see our most urgent patients. Since then the government seem to have frozen the expected date for restarting of our services in 5^th May has come and gone. As the number of COVI|D patients fall we need to start work on our routine nuclear medicine otherwise we are in danger this inertia in the health system may kill as many people as the virus itself.  A report today suggested that across the NHS 7 million appointments need to be re-arranged though not all in nuclear medicine

Like almost the whole country I made sure I listened to the Prime Minister announce how the country would get out of lockdown. Like most of England at the end I was unsure what was going to happen. As I write this however, there is no advice on how and when we get back to normal nuclear medicine practice which I hope we can before my June blog.

Dr John Buscombe

BNMS President

We now all live in unprecedented times. In years to come we will all tell our children and great grand children what we did in the pandemic of 2020. We live in such a connected world that we can find out what is happening around the world. For many of this it may be a frightening time for others they may just be exhausted by the work we have to do.

For some members of the BNMS it may mean work as normal with extra precautions slowing procedures as it is required to wear PPE. For others some departments have closed or reduced activity leading to some of you being furloughed. Other of you have been reassigned to help in the fight against COVID-19 working on COVID wards, working in X-ray or CT, repairing ventilators or PAT testing new equipment. Some of you may have even been sent to new hospitals where everything is unfamiliar. For all our members this has been a trying time and I am immensely proud of all you have been doing and continue to endure.

We have started a special COVID page on our web site for people to share any relevant scans, information etc and of course we have our guidelines written primarily by the nuclear medicine teams in Liverpool and Birmingham and this will be updated each week if there is new advice we need to give.

As for the BNMS there have been changes which we have to implement. The office staff now work from home which because of our new web-based systems we installed last year has worked well. The next major issue was the annual meeting of the BNMS we were due to have been held next month in Liverpool. The officers of the BNMS needed to consider what to do. Clearly, we would not be able to meet partly as the lockdown may still be in place and also many of you have had all your leave cancelled. The next question was could we delay the meeting to the autumn and replace the Leeds autumn meeting but we were unable to find a suitable time Liverpool could rebook the conference and in reality, we do not know how the situation will resolve. It was therefore decided with a heavy heart to cancel this years Annual meeting. We will transfer all this year’s lectures and accepted talks and posters to Belfast in May 2021. This decision was not taken lightly we were all aware that this would be a major disappointment to all those who put so much work into their abstracts.

One bit of good news is that the present scientific and education committee have agreed to stay in post for an additional year so the planned changes for May 2020 will take place in May 2021.

We hope to hold the AGM in the autumn meeting in Leeds which we really hope as many of you can come to as possible. This will mean the present BNMS council and Officers will remain in place till then. As a consequence, you are all stuck with me as President till September and elections for council will be held in August. These are just plans. Circumstances may still change everything and we ask for your patience. We will be looking at holding some of our June meetings by teleconferences.

My final wish, keep safe all of you.

Dr John Buscombe

BNMS President

Well it looks as though the government are introducing measures to try and limit the spread of Coronovirus. The important thing is unlike a latter day Corporal Jones (He’s a character from a programme called Dad’s Army for anyone under 40) we must not panic. I think the next few weeks may result in some fairly draconian measures to try and slow the spread of coronavirus. Some of yo will end up self-isolating for 7-14 days. Remember your health and of those you work or live with is much more important than your vital job.

Schools may shut*, cinemas and theatres too. Sporting events have been cancelled. Those of you who have to commute to work may have a few weeks without your face stuck in the arm pit of the commuter in front. So, there may be a silver lining for some. Those travelling by car may finds the roads busier. Home working seems is recommended so those of you who have always wanted to take a gamma camera home with you, this could be your chance. Maybe Tesco direct can add a delivery of radiopharmaceuticals to your ration of 1 roll of toilet paper per week per family.

It is clearly sensible to try and slow the spread of the virus as it will slow the admission rate to hospital for those who need in-patient care and reduce burdens on the NHS. Remember that this year already the NHS has coped with tens of thousands of patients with influenza and over 2000 deaths without a fuss or hardly any press interest. So, we need to get on with our work

What do we need to learn in nuclear medicine;

1. Well you wondered why you did all that mandatory training for hand washing, now is your time to shine, so the watch word is wash early, wash well and wash frequently.
2. Wearing face masks in public places, especially on your chin which seem to be a fashion in London, may make you think you look cool but in fact you look a bit of a prat. It is much better to WASH YOUR HANDS.
3. No need to shake hands or air kiss colleagues a cheery wave from a socially acceptable 2 metres will suffice.
4. Remember patients will be infectious so is you suspect anyone may have ensure you have the correct PPE and wash down surfaces after the patient has left as you would for any patient with an infectious disease.
5. Patients will present with shortness of breath and despite them having a fever and a dry cough you can be sure someone will want a V/Q lung scan. Now the changes that you will see will be similar to influenza. So if you have a normal recent (within the hour) chest X-ray, a normal perfusion and big segment or lobar sized ventilation defects (please only do ventilation with Kr-81m if available and not technegas or aerosol) then the patient MAY have a viral pneumonia such as coronovirus or the more common influenza. Important technical note here, it is vital you don your PPE before scanning them not after you have seen the images.
6. We are also learning about the appearances of coronavirus on FDG PET so keep looking at imaging news feeds

So don’t panic, wash your hands and carry on.

• Correct when written
  

Dr John Buscombe

BNMS President

On the weekend for writing this I visited my Granddaughter who in her own words is just 3. As always my visits are a joy but normally also contains some experimentation. Using some small marsh mellows my grand daughter clearly stated to me that taking way 10 mini marshmallows was not the same as adding 2 marsh mellows. However, like all good experimenters I repeated the procedure 3 times and she provided the same answer, then she got bored and wanted to play with her very nice paw-patrol fire engine. Why do I mention this? Well NHS England are reducing the tariffs we receive for nuclear medicine tests by up to 10%. The reason they say is they need to fund a 2% pay rise. The logical conclusion is the maths being done at NHS England is being done by someone who is not “just 3”. I know many of the BNMS members would find this an illogical and Charnie Kalirai from Nottingham has provided a comprehensive document to NHS England concerning this tariff cut. However, in my experience like maths that could be done by a 3 year old, logic is also in very short supply.

On a different matter I was recently involved in a legal case concerning a patient who had been denied radionuclide therapy for a treatable cancer because she was on renal dialysis. She then suffered disease progression. Radionuclide therapy was again refused on the same grounds, she was given chemotherapy and was dead in a week. The case was won on the principle that someone cannot be denied radionuclide therapy just because they have another illness that makes such treatment difficult and inconvenient.

A further area we are interested in is the post-code lottery for new forms of radionuclide therapy. In some areas of the U.K. it is very difficult for patients to access the radionuclide therapy they need even when it is funded. Sometimes there is no trained ARSAC licence holder at their local or regional hospital and sometimes there may be several such ARSAC licence holders but NHS England have decided that that centre will not be funded on nothing less than an arbitrary decision. Both issues need to be resolved over the next few months especially as the tsunami of Lu-177 PSMA therapy is about to hit these islands! The BNMS, RCP, RCR and IPEM are trying to work together with industry and other partners to find ways we can move forward and solve these issues. You may be asked over the next few months to fill in surveys about radionuclide therapy provision in your area, please fill these in. Only with data can we look at what we can do.

Dr John Buscombe

BNMS President

Most important I hope you all have an interesting and successful 2020.

New Year is of course the time we make resolutions though one wise head said the only New Year’s resolution worth making was to resolve not to make a New Year’s resolution so at least you can keep that one.

Anyway this is my list

1. Do not eat cakes or biscuits left in the department tea room for sharing*
2. Do not get cross when supposedly intelligent doctors cannot order a simple bone scan correctly on the electronic patient record*
3. Do not ask for too many extra SPECT-CTs on a patient study and cause extra stress to the technologists*
4. Do not ask why I cannot have Ga-68 DOTATATE everyday*
5. Cycle a bit faster so to burn off more energy each commute
6. Do not go to Marks and Spencer’s to buy lunch and then end up buying an extra snack for the afternoon* (We have an M&S food store in the hospital now)
7. Do not write snide comments on report of MIBI parathyroid scans when they are negative and Calcium levels are only 2.6*

Ones my wife has requested of me

1. Do not get admitted to hospital and have open heart surgery-I am working on this one but this may not be up to me.
2. Invite her to the Gala Dinner at the Spring Meeting of the BNMS and actually be well enough to go- see above on this one
3. Complete clearing out the garage a true task of Hercules but at least you can see the floor now.
4. Clear out and redecorate the “spare” bedroom (similar to 3 but also includes wall papering and painting)
5. Do not agree to do so much work that I am unable to complete tasks 3 and 4*- This one seems difficult as recently my understanding of retirement is working 6 days a week at different hospitals

Now for some BNMS based resolutions.

1. Remember to register for the spring and Autumn meetings of the BNMS in time to get early bird discount
2. Actually get to Spring meeting (see resolutions 1 and 2 above)
3. Discuss with IPEM, RCR and RCP how we can deliver molecular radiotherapy such as radium-223 Lu-177 DOTATATE and SIRT to patient’s without excessive wait times and distances travelled
4. Try not to get angry with the Department of Health and Social Care over Brexit
5. Try to get NHS England to cough up money for the extra delivery costs of radiopharmaceuticals caused by Brexit
6. Complete a month without using the word Brexit*

The resolutions I have already broken in 2020 are marked with a *

Dr John Buscombe

BNMS President

It comes to this time of the year when people give each other presents. Sometimes these are good for example I myself never decry a pair of socks without holes! Some promise a lot but by the time you can liberate it from its packaging it turns out to be a disappointment. This year we have all been promised everything we could possibly want, trains that run on time and are almost free, free ultrafast broadband and of course more Police and Nurses though strangely some of them are working at present which does push the definition of “more” somewhat. All this will be paid for from some moneys which seems to have been stuffed down the back of the government’s sofa or just borrowed. Maybe government ministers will busk on the tube to raise money. I can imagine the Secretary of State for Health in Piccadilly tube station playing a violin with a hat and a cardboard sign on which is written “Please give, 40 new hospitals to build” though of course the number 40 has been crossed out and the number 6 added in pencil. When asked why the difference the minister will say that it was an insignificant accounting error.

Of course what ever happens on general election day (I am writing this on December 11^th) by the time you will be reading this all those promises will have evaporated. So what can we look forward to in the world of nuclear medicine. There are a few things, we would be looking for more patients to have Ga-68 PSMA or F-18 PSMA scans paid for by NHS England, we should have the results of the EPOCH trial using SIRT in metastatic colon cancer. Assuming whoever wins the election does not tank the economy some of you will get to work with new gamma cameras, SPECT-CT and PET-CT. Some of you who have dedicated your working life to delivering nuclear medicine services to your patients will decide it is time to retire and we thank you all for your service. New blood will come into the profession in all craft groups bring new ideas and enthusiasm.

After the traditional over eating binge there needs to be some serious abstract writing so you share your research and audits with your colleagues in Liverpool. The deadline for sending that abstract is the end of January so make sure you do not miss the deadline.

On a different note the RNT group is one of the livelier groups in the BNMS and has lots of Rs and lots of Ts but very few Ns. Therefore if you have a nurse working in your department please encourage them to join we need more nursing import especially as the therapy work becomes more important and we really need there views in our Society.

If you celebrate Christmas may it be joyous. If you do not celebrate Christmas I hope you get some days off to be with your loved ones and for all of you I wish you a very happy 2020.

Dr John Buscombe

BNMS President

I thought of celebrating the 50^th Anniversary of Sesame Street with another letter in this case the letter “L”. This is because I wanted to write about Liverpool. When I was young ,half a century ago Liverpool was the place everyone wanted to go to. First of all was the Music which was not just the Beatles but by song you could even travel across on the Ferry across the Mersey in your own sitting room. Then each week there would be an episode of the “Liver Birds”. With exotic accents and story lines about living in a flat and having all sorts of fun. Funny how your memory works but it was the favourite programme of my oldest sister. The opening sequence showed the pierhead and the Liver buildings. Then there was one of the very early “pop videos” of what was essentially a film of buses driving up and down Penny Lane as John Lennon and Paul Macartney sang about its residents as though they were most exciting people you could ever want to meet. By my teens Liverpool was already in decline. It became a bye-word for football hooliganism. Television comedians would make fun of Liverpudlians assuming they were all crooks who spoke funny. Then came the Toxteth riots and the closing of the docks. It seemed no-one cared for Liverpool and now if it was in any pop videos it was to show the effects of dereliction and decay normally to some loud punk band.

About 10 years ago I went for the first time to the Conference Centre in Liverpool. All my southern prejudices were blown away. I found an amazing city vibrant, full of friendly and welcoming people. The dockhead was spruced up, Albert Dock was back in business with restaurants and museums. The Beatles were not forgotten but had come alive in their links with different parts of the city. The world’s best collection of pre-Raphaelite art is in the Walker Gallery. I have been back 7 or 8 times since and I always look forward to seeing what is new and finding another amazing building or museum is open. You too can share my excitement by coming to our BNMS Spring meeting in May. If you know Liverpool you will want to come, if you do not know Liverpool an absolute treat awaits you. If you cannot come make sure as many people from your department come. Also remember we have the innovative department award running again and we would love for you to share your research and experience in an oral presentation or poster. Details are in our web site of course.

My second “L” ended up as an “M”. I now mean the M of mandatory training. After 10 years my work in Cambridge draws to a close, my successor has been appointed and she will make a great success of the job. So as they say I am surplus to requirements. I have a great 10 years in Cambridge and I will miss the staff there a great deal, even though I will not miss the daily 140 mile round trip commute. So I need to look for a job. I am considering offers from 2 hospitals closer to home but before I can do anything there is about 20 forms to fill in. HR has been privatised and the people who run those have no idea about anything other than the tick boxes they need to fill in. Whilst I am up to date with my Mandatory Training it all has to be repeated. For example there is Health and Safety. Cambridge does not have this so I asked what it contained and was told Fire training, Manual handling and hand washing. In triumph I showed that I was up to date on all three. Nope that will not do it has to be something called Health and Safety so I have to go on a course so the box can be ticked. My Basic life support is valid till November 2020 but nope it is not the right basic life support. Maybe my Cambridge CPR to “Staying Alive” does not work in London. I must go on a special 3 hour course. The course is free but a certificate to prove I have been costs £50. The privatised HR stated that without the actual certificate from their own course I cannot work. I am beginning to smell a scam here.

My greatest problem however is my MMR certificate. I am clearly not an anti-Vaxxer. Anti-Vaxxers are sadly misinformed by people who generally prey on the natural fears of people to make money. To be honest those who perpetrate these lies about MMR are putting children at risk. My children all had their MMR done all on time and this was at the height of the MMR controversy. However, I myself do not have an MMR vaccination certificate. For the simple reason I am too old. I was already an adult when the MMR vaccine was approved. Also I was the generation that just got Measles, Mumps and Rubella. Unfortunately the HR form has a box on it that cannot remain empty. I was Called into an interview by a very nice person half my age. When I explained this she clearly did not believe me. For some reason I was hiding my MMR certificate from her. I was asked 10 times in a 30 minute interview for my MMR certificate because without that the box could not be ticked. I tried to be helpful and pulled out a yellowed piece of paper. It had on the top the crest of the Royal Navy underneath was my name in copperplate calligraphy and under that the date in 1964 I received my smallpox vaccination. It is the only vaccination certificate I have except for an expired yellow fever certificate from 2009 and a sticker of a smiling bug on my hospital ID to show I have had this year’s flu jab. Nope it would not do. Again I was asked to hand over my MMR certificate sadly again I could not. I fear this will not be resolved. Maybe I can work at the local branch of MacDonald’s but even then I fear the question “Can I see your MMR vaccination certificate”.

Dr John Buscombe

BNMS President

A bit like Sesame Street I thought that this month I would explore a single letter and that letter is “B”

Barcelona:

The EANM this year was held in a rather windy and rainy Barcelona. The conference centre there is well laid out and the distances between rooms, unlike Dusseldorf, was not great so it was possible to go between sessions easily. Charlotte was in charge of our BNMS stand and we were right next to the coffee area so we had a good footfall with many old friends coming to say hello but also able to meet new friends who may come to our meetings and join our society. I think our multi-craft approach was appreciated by many who came to the stand as we could explain that our meeting catered for all in Nuclear Medicine. It was either that or the Werther’s originals that pulled people in. I had decided to get back to work on the Tuesday as there was much to do but leaving Barcelona was less easy than I thought. First of all I needed to walk 2 miles to the airport through 400,000 rioting Catalans, then cross a Police cordon as they fired tear gas canisters, blag my way into the terminal and through security and then get myself on the only flight leaving for the UK on the Monday night whilst having a booking for a different flight and airline. The flight was not overfull as only 30people had also made it.

Be prepared:

OK this is cheating a bit on the “B” theme. We are going to have a great meeting in Liverpool they are some truly world class speakers on a range of “hot topics” including Prostate cancer imaging and artificial intelligence. The meeting is the 18^th-20^th May but the most important deadline is the abstract deadline on 29^th January. This is the time now to think what you want to submit do not leave it to January but get to work now and make sure you are ready to submit for that deadline. Also remember for the best papers and posters there are some brilliant prizes which can be won. Have a look at our web site for details.

Brexit:

Sorry, yes I do have to mention this as the October 31^st deadline looms. There are a range of uncertainties still but our colleagues in the radiopharmaceutical industries have worked very hard to try and ensure there is minimal disruption to supplies. However, we do need to be aware that at least for the first few weeks there could be some disruption so we do need to warn patients their scans and treatments may be cancelled at the last minute. I do hope our patients do not become Mr Gove’s bumps in the road. Also the companies have had to put in place at least 6 months of new delivery methods including air freight. Contracts have had to be signed and these routes will now probably have to be used even if we do not Brexit on October 31^st. This may mean delivery charges will increase. NHS England refuses to acknowledge this but we keep fighting to have any cost increased covered. As companies provide letters with information on Brexit we will post them on our website to keep everyone informed. Anyway what ever happens I wish you all a Happy Halloween and Happy All Saints Day though by November the 5^th we may all think Guy Fawkes had the best idea.

Dr John Buscombe

BNMS President

Firstly I promise not to use the B word in this month’s blog. September brings a new energy to our work. The weather gets colder, the DNA rate falls as patients think that coming to the hospital is more exciting than watching the next episode of “homes under the hammer”. No more do they sit in the gardens or down the park enjoying the sunshine. However, a new season brings new challenges and we need to think about how we will shape our work over the next few months.

Well a great start has been the Autumn BNMS which we have just had in Nottingham. We met at Albert Hall a wonderful Edwardian building that has been beautifully restored by City of Nottingham. We had some excellent session including one on sentinel nodes, another on PET-CT and PET-MR. A session on theranostics and a very well attended session on how new regulations may affect the practice of nuclear medicine. There were 90 delegates which worked very well for the room sizes and there was an excellent commercial exhibition and poster area that could be visited during the coffee, lunch and tea breaks. A massive congratulations to Charnie and Racheal for all their hard work setting the meeting up.

If you are now wishing you could have come to the BNMS meeting after all can I commend an upcoming meeting from one of our sister organisations. The Cyprus Society of Nuclear Medicine is having their 20^th birthday this year and a brilliant conference including nuclear medicine talent from around the world is being held in Cyprus from November 6^th-10^th. Details are on our website.

There has been some good news in that NHS England has agreed at last to fund F-18 Fluciclovene imaging in prostate cancer. We are hoping that funding can also be extended to those sites who perform PSMA PET. There are still some issues with availability of the product across England and training but we do hope that PET imaging of prostate cancer will be as easy to obtain for our patients and FDG imaging for other cancers.

A few of our longer term plans are also coming to completion over the next few weeks. The joint report on molecular radiotherapy will be published. The BNMS fellowships will start, look at the BNMS web site for details. We hope to have the Lutathera web site up and running. We are lobbying the government concerning the proposed 10% cut in nuclear medicine tariffs for next year and working with NICE on guidelines for the treatment of benign and malignant thyroid disease. It has been a busy few months but we are hoping for positive outcomes for the specialty.

See I got through this whole blog without mentioning Brexit. Oops broken my promise.

Dr John Buscombe

BNMS President

Holidays are the talk of the month.

Generally there are two types of people in nuclear medicine. Those with school age children or school age grandchildren to whom August means a couple of weeks away from work and hopefully a chance to relax or do something new. Then there is the rest of us. For this group August is when everyone else is away and depending on staffing may mean extra work or covering colleagues. Sometimes this can give us a very annoying air of moral superiority. It is easy to picture the scene. It is a Monday morning in August. One of our younger staff members staggers in slightly sunburnt from that incident when they confused the toothpaste for sun cream after a night of just a little too much sangria. Of course they have had almost no sleep, the hotel was lovely but sadly the club next door only opened at midnight and there was then 6 hours of heavy technobeat music till 6am. Daytime did not bring relief as there was 12 hours of child care ahead and unlike adults children do not see the need to siesta especially when there is a pool available. The journey home on the day before coming back to work started with promise only to be cruelly dashed by the inevitable delayed flight by 6 hours due to an air traffic strike over France and technical issues. No one tells you what those technical issues are but you always suspect it was something major not helped by those suspicious black streaks on one of the engine covers you spot as you finally take your place on the aircraft seat. When this story is regaled to your stay at work colleagues do you get sympathy? Of course not all you get is a comment that only the mad go away in school holiday time; maybe, true but not helpful.

For those of us who stay behind and work we enjoy an air of moral superiority because without us the service would not run. We see ourselves as the essential members of staff we are the rocks on which the department is built. Well this is what we try to impress on our colleagues but in reality of course we are just jealous. After all Cromer* is a great place for a holiday in November? At least the seagulls won’t steal your chips. No self-respecting bird would fly in that wind and rain!

However, August is not all loss it is in many ways a great month, for those who drive to work the roads are less crowded. For those who travel by underground or train you can have a free sauna twice a day. For those who walk or cycle it can be glorious give or take the odd thunder storm.  The greatest pleasure however is that in mass our managers take the whole month off. This means the normal flood of emails about everything that has nothing to do with you stops as well. Even that annoying person from CT who seems to lose their coffee cup twice a week, and insists on asking all the hospital staff if they have seen it, seems to be away.

Seriously though I hope that if you went on holiday you had a good rest this August and if you stayed at work you enjoyed the manager free time and easier travel.

*This is not anti-Cromer, which as Alan Partridge tells us, is the greatest sea side town in Norfolk. Feel free to substitute any British sea side town of your choice here

Dr John Buscombe

BNMS President

Sally Bowles’ character in the musical cabaret sings that “money makes the world go round” and despite many wishing that was not the case the harsh reality is that for nuclear medicine in 2019 it is very true. Over the past few weeks I have spent many an hour in meetings discussing money and the impact of various pressures on nuclear medicine.  There are significant upcoming price pressures which we all need to be aware of. Their impact will depend on the service you and your department will provide. The one price pressure we all hope for is a staff pay rise though I think we all know that what politicians promise rarely happens unless it is to their advantage. There are other issues one of most fundamental is that the price paid for Mo-99 is only 67% of the cost of production. The rest is made up from government subsidies. This effectively means that a few countries taxpayers are subsidising the rest of us. The unfairness of this system is not the main issue. The primary issue is it discourages other players to invest in the market. Why invest in making something you can only make a loss on? This can be seen in the slowing of investment in accelerator based production of Mo-99 that 5 years ago was going to save us all but in reality may still be 5 years away. As this situation is not sustainable there will be price increases in Mo-99 over the next few years. However, the effect on total costs of any Tc-99m scan will be on average £3 per test which we can probably cope with. Unless ,the economics attract investment the supply of Tc-99m will dry up as aged reactors go off line.

A second cost pressure is that it appears that transporting radiopharmaceuticals around the UK is likewise not sustainable at present costs and we must expect an increase in the cost of delivery over the next few years. Again without this the provision of radiopharmaceuticals will not be sustainable.

I will not even mention Brexit and the possible cost pressures that will bring which at present are unknowns.

So what can the BNMS do? Firstly communicate these likely pressures as pre warned is pre-armed when you are negotiating budgets with your Trust or hospital. Secondly we are actively trying to get NHS England to recognise these price pressures in the tariffs that are offered for tests with hope a similar re-calculation will occur in the devolved nations. The third action is to collect and collate information. So if you find the total cost of radiopharmaceuticals you use changing, please let us know as this data is vital in our fights with our paymasters.

On a more optimistic note, I wish all of you that can get away on holiday a wonderful break and all those who cannot get away not too much additional work.

Dr John Buscombe

BNMS President

I am writing this at the Society of Nuclear Medicine and Molecular Imaging meeting in Anaheim, California. Originally I was thinking that I would give a day by day account of the meeting. However, I think that would not be interesting and to be honest the are no exciting new tracers being launched though hopefully one or two PSMA products will receive approval in the next 12 months. There is an interesting new SPECT-CT camera which uses a technique of multiple detectors which oscillate to produce an image with a sensitivity of at least double that of an Anger camera. Also the Explorer whole body PET scanner (by which I mean the whole body is imaged in 2m of PET detectors) approaches a commercial launch. Again this is a very sensitive machine needing only 10% of the present activity of a PET pharmaceutical or 10% of the present acquisition time to produce an image.

I decided however, to think about a different aspect of the meeting. We were very honoured to have a meeting with the leadership of the SNMMI. We are looking at much closer co-operation which will hopefully include a permanent BNMS session at the SNMMI and a permanent SNMMI session at the BNMS. We hope this will improve links between our 2 societies and encourage a new generation of British nuclear medicine professionals to join the SNMMI and participate in  all they can offer.

When we were meeting with the leadership of he SNMMI we looked at what nuclear medicine is doing in terms of public engagement. The SNMMI runs an annual nuclear medicine week but that is often directed to the hospital in which that department is placed. However there was also a forum for patient advocacy groups to interact with the SNMMI. This was run by a committee of interested patients covering a wide range of disease interests including a range of cancers and non-oncological disease.

The Sunday of the conference was “patient day”. A series of talks were set up for patients which were chosen by the patient advocacy groups and the introduction consisted of 2 talks one on “What is nuclear medicine” and an Oncologist talking about clinical trials. This was followed by a Q and A session. There was then a lunch where patients and nuclear medicine doctors could talk in an informal way followed by some disease specific breakout groups. The results of these discussions could then be published on each patient advocacy group’s newsletter and web site. I know all this sounds very American but there is a clear advantage such that when nuclear medicine scans or treatments are needed patients can access good quality information and help to reduce the stress of these procedures for patients and well as their carers. There is a further clear advantage in that nuclear medicine gains important allies who can help in the process of getting our tests both more widely known but also funded. I think this is an approach we should think about within the BNMS.

Dr John Buscombe

BNMS President

Last month I indulged myself by being somewhat political in what I wrote. What I wrote is still true and we still seem to have a political system which has in modern parlance become “not fit for purpose”. However, this month I will write about something very different.

The use of radioisotopic imaging in brain disease remains a bit if a Cinderella area. It has not received the same level of investment as cancer imaging or the clinical exposure of cardiac disease. Partly this is because brain diseases tend to be chronic and patients die with them and not because of them. If they involve symptoms which distress the patients or their carers it is often not talked about openly. This seems to be much more of a problem with us men and much of this has been highlighted in mental illness awareness week in May.

The other silent disease has been the degenerative diseases of the brain. Here nuclear medicine can have a great input though for many working in nuclear medicine it is not an area of great interest. This was changed with the introduction of ioflupane imaging in Parkinson’s disease and Parkinson plus disorders. Nuclear medicine could offer something unique which could not be offered by other modalities. DAT scanning remains a nice money earner for my department with about 5-10 scans a week mainly for outside providers which have to pay handsomely for the service (mainly due to contracts drawn up before tariffs started).

NHS England will also fund FDG imaging in some cases with suspected Alzheimer’s disease despite the fact the product has not been through a randomised controlled trial which the unfunded amyloid agents have! Though not perfect FDG imaging can provide a diagnosis when MRI has been unhelpful. It is clear that PET agents are most useful in early disease and we often find ourselves scanning patients in their 40s and 50s.

Research using PET is helping us to understand more about dementias develop. Tau proteins seem to signal damage in the brain and recent work has shown that even in young people with brain injuries tau can be seen, though in most patients it resolves in 6-12 months. In early dementia the tau seems to persist and increase in a cycle of inflammation signalling but these seems to result in more inflammation which results in neuronal loss as well as amyloid being laid down. We are also beginning to understand that there is a vascular component to the development of dementia which can be seen by increasing T lymphocyte vascular trapping in the brain which can be visualised using C-11 PK11195. New and more precise probes are being developed to try and understand the mechanism by which dementia develops and why its outcome is so devastating.

Though nuclear medicine techniques are not the only method by which these mechanisms and their effect measured it remains a vital tool as absolute quantification remains possible. At present these diseases have no effective treatment but what we can learn from oncology is that effective treatment depend on understanding why a disease occurs and how it progresses.

Therefore, we should embrace fully the role nuclear medicine has in looking at neurology and hopefully in the future allow us to monitor the effectiveness of disease modifying treatment.

Dr John Buscombe

BNMS President

As many of you know I recently have spent a prolonged period in NHS hospitals having major surgery and other treatments. If anyone has been a patient in the NHS you soon become aware how much we depend on staff born outside of the UK who have chosen to make their home here and use their skills to help the NHS.

However, we live in strange times. After 30 years of being an open confident country happy to be a home for talented people from around the world the UK appears to have recently become more xenophobic. Television news can go to a rundown seaside town find a retired couple who will happily give an interview stating immigration must be stopped. This is lazy journalism as there is no balancing view showing the essential work done by people who have come to the UK. This has lead to many non-UK born colleagues feeling insecure.

Sadly there is parallel to this in the 1930s. At this time the world’s problems was blamed on different ethnic groups or immigration. At its worse it occurred in Germany but people forget similar feeling were present in the UK. It is said that for evil to succeed is for good people to do nothing. This was best described by Dietrich Bonhoeffer when he wrote about what happened in Nazi Germany

“First they came for the Communists, but I was not a Communist so I did not speak out. Then they came for the Socialists and the Trade Unionists, but I was neither, so I did not speak out. Then they came for the Jews, but I was not a Jew so I did not speak out. And when they came for me, there was no one left to speak out for me”.

I was taught nuclear medicine by teachers who came from Germany and Portugal so my career was formed by those who chose to come to the UK. For many of our BNMS members that is also true. Our whole specialty is dependent on those born overseas. However, I am not just stating a fact but I am immensely proud to be a President of a Society that represents highly trained colleagues who have chosen to make this country their home and work for the NHS. So I ask all of you to not be passive but when we come across xenophobic comments not to be silent but state clearly and strongly how we celebrate the diverse people from around the globe who come and serve our patients in this wonderful nuclear medicine community.

Dr John Buscombe

BNMS President

It has been a frustrating 2 months for anyone trying to run any of the phase 1 PET services. There have been multiple production issues with the one company who supplies FDG under the contract. I know it will never happen but it would be good if a senior manager from that company could talk to one of our patients who is not well, has to travel a significant distance and finds fasting difficult after his PET was cancelled 3 times. I think as doctors we find it difficult to explain to non-medical commercial people the various ways the actions (or non-actions) of their company causes distress and suffering. Our medical director was forced to issue a letter stating only the most urgent patients such as lymphoma review and those needing FDG for immediate surgery should be referred. However the real blame lies with NHS England in the way they set up the contract and run it without having an understanding of production resilience and contingency planning. Finally giving 45% of the UK provision in a monopoly to a simple company was always going to end badly. At least the government has learnt some lessons and not awarded any post Brexit ferry deals to companies with no ferries using ports too small for current ferries.

A different tack, after 35 years’ service in the NHS I have entered the world of being a patient. I now know what it is like to wait 4 weeks for a 10 minute GP referral. Then you head off with your signed bit of paper to Boots, everyone waits 15 minutes though that can be an 8 minute, 15 minutes (yippee) or a foot hurting 40 minutes, 15 minutes. It is a good thing I am semi-retired there would be no way I could do all this waiting if I actually had a job or a life. Now I am waiting for the hospital appointment letter day after day I get bills but no letter. Surely in the days of email and texts for most patients this could be done more efficiently but then we could not be called patients anymore because we would not have to spend endless hours waiting.

The other message is, if a patient or carer comes to nuclear medicine and is a bit grumpy, they have probably had real problems getting to you through this convoluted referral system.  Remember the old adage of nuclear medicine, Be nice. Be kind.

See you all in a few weeks in Oxford

Dr John Buscombe

BNMS President

We have just had a very successful meeting in Dublin with the Irish Nuclear Medicine Association. We had a sell-out meeting with about 50 delegates from the UK, a handful from overseas and about 90 from Ireland. The meeting’s theme was musculoskeletal disease and there was a variety of talks from radiologists, nuclear medicine physicians and radiologists and radiographers/technologists. There was an additional workshop on PET imaging using F-18 fluviclovine. The meeting was jointly organised by the President of the INMA Dr Martin O’Connell and our very own Dr Richard Graham. The final talk by Prof David Hevey from Trinity College Dublin concerned how non-scientifically trained people perceive risk. For example a third of adults do not know what 40% means with the best guess being that it means one in 4. Also that the majority of adults think that 5 out of 100 is a bigger number than 1 in 10. This may have a real impact on how our patients understand the kind of risks we discuss concerning nuclear medicine imaging and therapy but it does seem using percentages may not be useful and a 10 in a million risk will be seen by patients as risker than a 1 in 100,000 risk.

Dublin proved to be the perfect host city and showed itself to be a dynamic, diverse and optimistic city. The general mood in Ireland seemed so different than we have in the UK where we seem to live in times of uncertainty. Hopefully we will know our future soon so that we can plan ahead but I do hope the technetium shortage we suffered at the beginning of the week is not a portent for what lies ahead.

Thinking ahead, the work on our new website is moving ahead with transfer of data from the old to new system being done systematically. Front page layout and designs are being but together to give our society’s window to the world a welcoming and fresh face. You may all be asked at some time to provide content please respond positively. A massive thanks to Charlotte, Caroline and Lee for all their hard work in this area.

Remember to get writing those abstracts for our spring meeting in April that January deadline will soon be upon us and we want to make sure we have all your best work to share with us in Oxford.

Dr John Buscombe

BNMS President

I am writing this here in a very hot Germany, the nuclear medicine community is meeting at the EANM congress. The meeting has been a huge success over 6000 attendees but in other ways it has become very impersonal the rooms can be so large you can often feel lost. Especially in a very good session on radiopharmaceutical development and authorisation there were 100 of us and 5900 empty chairs which was sad as it was a very good session.

My main problem is the conference centre is just vast it may take 20 minutes to get between two different rooms. There was a very good exhibition where you could look at mock ups of very expensive looking PET/CTs and PET/MRs all seemed to be bathed in blue light. I am not sure they will have blue light in reality, though one manufacturer will let you have mood lighting. Of course the highlight of the exhibition was the BNMS stand where Charlotte Weston our CEO talked to lots of nuclear medicine staff from around the world including many really keen young nuclear medicine people.

Our celebration of European Nuclear Medicine has been tinged with sadness. The same meeting brought confirmation of the closure of the Grove centre by GE Healthcare. There are specific issues about the loss of Cr-51 EDTA and we will need to work on this over the next few months. There is a wider story. The centre was set up 78 years ago to provide thorium needed for the luminescent dials of military aircraft. Then as the Radiochemical Centre during the 1950s and 1960s the Radiochemical Centre was the great innovator in world nuclear medicine. In the 1970s and 1980s it became a world leader in world nuclear medicine. It did not matter if it was the UK, Israel or Cuba nuclear medicine departments all had Amersham generators and Amertech kits. In the 1980s, under its new name Amersham, it was privatised, the first privatisation of Mrs Thatcher’s government. It continued to be the great world leader but more recently other companies seem to have taken on that leadership role. When the Grove Centre closes so will end 78 years of radionuclide production on the Amersham site. We will be 100% dependent on imported Mo-99/Tc-99m generators. We must hope our politicians do not mess up Brexit. We also must feel for those dedicated scientists and engineers whose jobs are at risk, some of whom are members of the BNMS

We must look on the bright side though so we are looking forward to seeing you all in Dublin and you can start to submit those abstracts for the Spring meeting in Oxford.

Dr John Buscombe

BNMS President

Over the Summer many of us have had the chance to go away for a few days, others like us old guys without school age children may choose to take an “out of season” break but for all of us September always has a new term feel.

It is a time we look forward and so we should for the BNMS. The office staff are now working hard to set up the new web site. The old one just no longer works and does not enable us to offer the kind of services we should to our members. We hope that within 8 weeks we will be up and running and you will all benefit from the better and faster website. We will hopefully add more functions to the web site over the next few months.

We hope this will attract more new members to the BNMS especially from departments with little or no contact. To help with this we no longer will require two members to sponsor each application, the officers will be responsible for due diligence but if you work with radionuclides either clinically or in research we will want you to be part of our club. Thinking about it I think we will be happy if you work in nuclear medicine with animals as well. We all face the same kind of issues. Applying will therefore be made much easier through the new web site.

Who remembers 2005? The UN was very excited to call 2005 the year of microcredit! Big events were the death of Pope John Paul II and George Best, Hurricane Katrina hit New Orleans, Angela Merkel become chancellor of Germany. Tony Blair was Prime Minister and we had no financial crisis. It was also the last year the BNMS increased its subscription fees. Since then most of the NHS had a long pay freeze but we as members of the society do need to act in a responsible way to ensure the society survives. Therefore Council has agreed that for 2019 there will be approximately a 5% increase in the subscription fees which will be £7 a year for Full Members. Then for a 3 year trial period we will have annual raises linked to the average “Agenda for change” pay increment still less than inflation but this will help us cover our costs including ensuring we pay our office staff appropriately.

Now looking forward to more interesting and exciting events; remember it is time for your early bird registration to our autumn meeting with the Irish Nuclear Medicine Association on Monday 19^th November. This means you can have a great weekend in Dublin then have a great Monday of nuclear medicine. Wow, the perfect short break. Details on our web site.  Also we are about to announce a call for nominations for the President Elect. Any senior member of the BNMS from any of our craft groups can be nominated so get your thinking caps on and think who you would like to lead the BNMS after 2020.

In the meanwhile you can look at what I am doing on twitter @PresBNMS.  You only need to join twitter if you want to comment on my tweets.

Dr John Buscombe

BNMS President

I must have a whinge more often.  At least some of the phase 2 PET procurement has been settled to the pleasure of some local providers and some not. Time will tell if this works well but always we must be aware the prime requirement is delivery of a high quality and safe service to our patients. There remain deep concerns that the phase 1 and 2 contracts stifle innovation in PET-CT. Maybe we will have to find new ways of expanding services despite these constraints. Also in July Lutathera treatments for gastro-intestinal and pancreatic neuroendocrine tumours was funded by NICE and NHS England. Again there must now be some equity in delivery with patients hopefully receiving treatment not too far from their homes. Locally in Cambridge today we did our first blueteq funded patient so after a 3 year gap we can treat again. By the way I am not claiming any credit for these 2 events but maybe if it works I should whinge about a few more items we need fixing like technologist training.

I am sure like me when you are on your holidays sitting on the beach sipping a pina colada your mind thinks about what work can I present at the BNMS. If you have something ready to go, the abstract submission for our November meeting in Dublin shared with the Irish Nuclear Medicine Association is open. If you still need to do some more work or maybe not yet started this is a good time to prepare what you will present at the Spring BNMS.  September is a better time to think about these things than the first week of January.

Can I also send a big thank you to all of those who filled in the BNMS membership survey, I know it takes time but it really helps us focus on what concerns us all as members of the BNMS. Some things we cannot fix but we will always try if we can. One example was moving the spring meeting away from a weekend as this was particularly difficult for many technologists and radiographers. Concerning the Spring meeting for those thinking of coming and joining us in Oxford we have some accommodation arranged at Worcester College 10 minutes’ walk from the venue and more affordable than a hotel. It may not be the Ritz but you can relive those glory days as a student and we hope the bar (i.e. cheap beer) will be open till late to get a great authentic  Uni feeling back again.

Dr John Buscombe

BNMS President