A Level student presented at BNMS 2017

rsz portia smith

Submitted by sixth form student Portia Smith

Apparently, I’m the youngest person ever to present at a BNMS conference. I’m in my first year of sixth form college, and have just presented a poster at the Spring Meeting, 2017. Thanks to the nuclear medicine department at the Royal Sussex County Hospital, led by Dr Sabina Dizdarevic, I had the opportunity to raise awareness for Tc-99m-MIBI accumulation in axillary apocrine sweat glands. In this region, high sudation levels can mimic lymphadenopathy in patients with parathyroid adenoma and malignancy, potentially prompting unnecessary intervention or surgery.

 

Dr Sabina Dizdarevic and Portia Smith and her poster 'Don't forget sweat gland MIBI accumulation' at BNMS2017.

I first met Dr Dizdarevic at a school event for prospective medics, where medical professionals talked to students about their work in groups or one-on-one. Scanning the list of names, I was immediately intrigued by her job description. The term ‘Nuclear Medicine’, a field I hadn’t even heard of before that evening, showed me that medicine can be a combination of all three core sciences, strengthening the notion of medicine as a future career for me. I immediately set about finding Dr Dizdarevic and, having been found, she gave me a brief overview of the field. Faced with my obvious interest, she invited me to visit her department to get a better understanding of what is done there. 

Sitting behind her and her colleague, Dr Fowler, on the morning of my visit, I was utterly engrossed. Studying Computing at the time, the systems used multiple imaging types at your fingers for better diagnostics - impressed me. It was also in that room that I began to associate medical professionals with their particular combination of knowledge and compassion/care. They explained to me the grey areas of the grading system and how the phrasing of their reports can affect the patient’s care down the line. They often turned to each other to ask, ‘what would you want to happen if this was your nephew, aunt, friend etc.’ This was a thought process echoed by prof Ralph McReady during the Thyroid Cancer masterclass on Saturday. They were constantly aware of the image as a person, not just organ systems and bright spots. 

Apparently, most visitors leave after half an hour. When Dr Dizdarevic returned at around six o'clock, having left me under the wing of colleagues as her work took her elsewhere, she was shocked to see me still there. Having impressed with my ‘ambition’, I was invited back the next day. This was when I met Guglielmo La Torre, who helped me explore the hospital, as well as explaining his current research project, looking into impulsivity in patients with Parkinson’s Disease. It was great to see how it has progressed as he was shortlisted for this year’s BNMS Young Investigator’s Prize. Before I left, Dr Dizdarevic mentioned some sort of project, although she was still unsure a year 11 student was up to it.

Months later we met by chance. I bumped into her at a Medico-Chirurgal Society meeting in Brighton. Having put on a series of lectures open to patrons, professionals and medical and college students, the society held a Student essay prize for reflective pieces on the talks. My submission, on Trauma Medicine and Landmine Clearance (inspired by Dr Ransom’s presentation) won me the sixth-form student prize. Seeing this, Dr Dizdarevic decided I was up to the task of the project - the poster I presented a couple of weeks ago. She helped me apply for student membership of the BNMS, explained the need for this poster - a reminder that could reduce the risk of unnecessary procedures - and gave me access to the relevant literature. When reviewing the diagnosis of one of the patients later used as case studies for the presentation, she noticed that the ‘lymphadenopathy’ was slightly more superficial than she would expect, and eventually suggested that the bright spot was down to metabolic activity in unusually deep sweat glands, later backed up by clinical examination. There was also a very small amount of literature on the subject of false positives due to sudation levels in the axillary region - both a symptom of and contributor to this gap in medical knowledge. The most recent article she could find was published in the same year as I was born! Over the course of this project, I was helped along not just by Dr Dizdarevic, but also Dr Nicolas Eftychiou and Guglielmo La Torre, who ensured that my own lack of medical knowledge wouldn’t detract from my work to add to others, looking over my many drafts.

The conference itself was an amazing opportunity for me. I had the chance to attend some talks, ducking out occasionally to do a past paper in preparation for an AS examination. Dr Dizdarevic pointed out that this time juggling was ‘just the start’ for a prospective medic. Highlights for me included the ‘President’s Reception’, with Adrian Hardy's talk as the patient representative particularly interesting to me as I had included a section on the ‘Patient’s Perspective’ in my own poster; the Thyroid Cancer Masterclass chaired by Dr Dizdarevic, particularly Prof Ralph McReady’s ‘History of Iodine’, which gave an overview of where Iodine treatment has been and where it might go in the future; and Tamar Willson, another shortlisted for the Young Investigator’s Prize, whose talk on quantifying staff extremity doses in PET dispensing/administration was very accessible and opened my eyes to difficulties faced in measuring such doses. Over the weekend I was exposed to the culture of nurturing students. A wealth of educational material was made available, such as by the BIR, which gives free access to 3D anatomical images for their student members, and the Amyvid exhibition’s highly informative animation on Dementia. I was shocked at the ream of referenced studies at the end and it achieved the feat of combining them all into a format that made sense to a student with no formal medical training.

These experiences - seeing a nuclear medicine department in action, attending presentations and even giving one of my own - have convinced me to apply to medical school and, perhaps in the future, to specialise in nuclear medicine.