Calling all Radionuclide Radiologists in training!
19 March 2021
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Posted by: Caroline Oxley
Nuclear Medicine Physician Training Opportunities for Radionuclide Radiologists
Nuclear Medicine Physicians (NMPs) diagnose and treat patients using radionuclide-labelled tracers. Radionuclide Radiologists (RNRs) have equivalent skills and experience in diagnostic imaging but do not provide therapy.
NMPs enjoy the clinical breadth of dealing with a wide range of benign and malignant conditions in patients of all ages and work at the forefront of clinical research. The field of theragnostics in which diagnostic nuclear medicine imaging is linked directly to targeted radio-nuclide treatments is expanding rapidly. NMPs work at the cutting edge of ‘personalised’ medicine.
According to the British Nuclear Medicine Society, increasing demand for radionuclide therapies will necessitate recruitment of 30 additional NMP consultants across the UK over the next 5 years. This has been reflected in the announcement of new funding for 5 short term training opportunities for RNRs who satisfy the entry criteria for NMP physician training and wish to transfer programmes. These posts will allow trainees to gain dual accreditation in both clinical radiology (CR) and nuclear medicine (NM). These posts will be advertised in mid April, with a start date of August 2021.
Background: Nuclear medicine training has undergone some important recent changes, so this background summary has been provided for information. The full 2021 curriculum is available at www.jrcptb.org.uk/specialties/nuclear-medicine.
The NMP training scheme is small, with approximately 20 funded posts across around 20 approved training centres across the UK. Funding and training leadership is from the School of Medicine, the curriculum being developed and maintained by the Joint Royal Colleges of Physicians training board (JRCPTB). There is a national Training Programme Director (currently Charlotte Fowler) who reports to the Dean for Nuclear Medicine (currently Geeta Menon) through the Medical Head of School and is supported by an administrative team from the Health Education England, London and South East Offices.
NMPs are trained in both the diagnostic and therapeutic aspects of nuclear medicine. Having responsibility for day case and inpatient care, NMPs require core medical training (IMT2) and MRCP or equivalent prior to entry at ST3 level to ensure adequate clinical experience to independently assess and treat patients. NMPs also need to complete core diagnostic CR training to allow independent reporting of diagnostic hybrid images and full participation in multidisciplinary team meetings. The JRCPTB and RCR have collaborated closely to facilitate this programme which now results in dual accreditation with CCTs in both NM and CR.
In the UK NMP training can be achieved through two routes (see figure 1):
Route 1: NMP training from ST3 to ST8. NMPs are recruited jointly with CRs. For the first 3 years of training, NMP trainees train alongside their CR colleagues, acquiring core radiology skills and FRCR. During this period the RCR curriculum and e-portfolio are used, the ARCP process being led by CR with separate NM input. NMPs then go on to a further 3 year training period to achieve diagnostic and therapeutic NMP skills and also complete the curriculum mandated Post Graduate Diploma (PGdip) in Nuclear Medicine through Kings College London. In this 3 year period trainees use the JRCPTB curriculum and e-portfolio and the ARCP process is led by NM with separate CR input.
Route 2: Completion of NMP training following transfer from Radionuclide Radiology. Radionuclide radiologists (RNR) are clinical radiologists who have specialised in the diagnostic aspects of NM. They are trained under the curriculum of the Royal College of Radiologists (RCR) and recruited according to the same entry criteria as other CR trainees who enter ST1 from foundation year 2. Subject to funded training opportunities, RNRs who also fulfil the entry criteria for NMP may choose to transfer to a JRCPTB NMP training scheme towards the end of RNR training, extending training from the 5 year CR scheme to the 6 year NMP scheme with completion of training in radionuclide therapies and the PGdip. The transfer between CR and NMP curricula is detailed in the NMP curriculum under the ‘transference of competencies’ section. The limited number of posts across the UK make it necessary for this process to be competitive. During this NMP period, training is funded and directed by NM, with experience and training being logged in the JRCPTB e-portfolio system. ARCPs are led by NM with separate CR input. Many eminent NMP consultants have trained through this route, previously called ‘year 6’ training.
Irrespective of the route of training the PGdip is mandated by the NMP curriculum. It is funded by HEE in England. Those who complete training successfully against the 2021 NMP curriculum will join the specialist register with dual CCT in both NM and CR. 
Figure 1: The two routes to train as a Nuclear Medicine Physician.
Dr Charlotte Fowler Nuclear Medicine TPD and STC Chair
Dr Alp Notghi Nuclear Medicine SAC Chair
With many thanks to: Dr Nitasha Singh, Prof Val Lewington and Dr Amy Eccles Dr Charlotte Fowler, FRCR is the UK Training Programme Director for Nuclear Medicine training who answers some FAQs here: Q1: What's the difference between a Radionuclide Radiologist (RNR) and a Nuclear Medicine Physician (NMP)? A1: When it comes to diagnostic nuclear medicine - nothing! RNRs and NMPs have exactly the same skill sets and expertise whatever their title and training route when dealing with diagnostic studies. The big difference is that NMPs are also trained to offer radionuclide therapy. They need to manage patient care as both inpatients and outpatients which is why they have a different curriculum and different eligibility requirements. They get the professional satisfaction of directing patient care and treatment in what will be a bit growth area.
Q2: If a RNR in training is considering switching training programmes, what advantages will NMP training give them? A2: Firstly: you would get two CCTs in both Nuclear Medicine and Clinical Radiology. Secondly: you would get the Post Graduate Diploma paid for (in England). Thirdly: your training would allow you to work at the forefront of personalised medicine, where therapies are tailored on the basis of diagnostic tracer uptake (theragnostics). Fourthly: Excellent job opportunities. The BNMS predict 30 new consultants will be needed in this area over the next 5 years. Q3: What would make an RNR eligible to apply to train as a NMP? A3: As NMPs are responsible for all aspects of patient care as consultants running their own clinics and in patient beds, they must have broad clinical training and broad clinical qualifications before training in NM therapy techniques. NMP need 2 years of core medical training and MRCP (or equivalent from surgery or paediatrics) so they have enough experience of non selected on calls, inpatient and outpatient care.
Q4: What are the new opportunities? A4: Health Education England has sourced new funding to allow RNRs to transfer programmes to NMP training, following a previously well trodden training route. Many eminent consultants followed this route of training.
Q5: How can I find out more? A4: Check out the curriculum and if it is something you are interested in look out for job adverts at the end of April. The window for applications will be very short so please be prepared to respond quickly!
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An interview with Gerard McKiernan for BNMS2024 https://youtu.be/sP4eRjS1Hb4?si=ZF1RPE5ge2qbu5do
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