Nuclear Medicine RCP Specialty of the Month

Nuclear medicine is a vibrant specialty at the forefront of medical science. It utilises tiny amounts of radioactive substances (tracers) to visualise physiological processes in the body. As physiological changes tend to precede anatomical changes, nuclear medicine imaging techniques can often diagnose and determine response to treatments before other imaging modalities.

This facilitates optimal patient care with quicker diagnoses and fine tuning treatment. Via molecular targeting, nuclear medicine physicians can also treat patients with an ever-expanding range of conditions (including thyrotoxicosis, arthritic joints, thyroid cancer, neuroendocrine tumours and metastases).

What do nuclear physicians do?

Nuclear medicine physicians tend to enter the specialty from a variety of medical backgrounds and this breadth is important, as we see patients and liaise with clinicians from all other specialties. No two days are the same and it is this diversity which makes it such an exciting and challenging specialty to be part of. The workload may include reporting (general NM, SPECT CT, PET CT or PET MRI), outpatient clinics, ward rounds and research. Nuclear medicine physicians deal with a wide scope of diseases including cancer, lung and heart disease, dementias, endocrine disorders, renal, gastrointestinal and many more. Being at the cutting edge of technology there is ample opportunity to develop your own research projects while keeping patient interactions through clinics, therapies and ward work. Rewardingly, we often see considerable improvement in quality of life following therapies, and survival benefits in a significant number of our cancer patients treated.

In short, nuclear medicine combines an interest in science and technology with ongoing patient contact at both diagnostic and therapeutic levels. There are strong academic and research opportunities, and excellent career prospects. I strongly recommend nuclear medicine and feel privileged to work in this varied and rewarding career.

Dr Brent Drake, consultant in nuclear medicine and radiology, Plymouth Hospitals NHS Trust.

Why did I choose nuclear medicine and why would I recommend it?

It is both intellectually challenging and satisfying, requiring knowledge of physics, physiology, anatomy, clinical medicine and radiology. It also has the benefit of being truly multidisciplinary, requiring close work with nuclear medicine technologists, radiopharmacists and medical physicists. Nuclear medicine has a good balance of patient and non-patient contact time and the (major!) advantage of very little out-of-hours work as it is rarely used acutely, which makes for a very good work-life balance.

There is an excellent new training scheme for nuclear medicine, which combines training in radiology and nuclear medicine for those who have completed core medical training and obtained MRCP. I would definitely recommend it as an enjoyable, interesting and growing specialty.

Dr Deborah Pencharz, ST5 in nuclear medicine at Royal Free Hospital.

What is the most unique thing about your specialty?

Only by training in nuclear medicine will the government give you a licence to give both diagnostic and therapeutic radio-isotopes – even 007 does not get one of those!

Dr John Buscombe, chair of the Joint Specialty Committe for Nuclear Medicine and clinical lead and consultant in the Department of Nuclear Medicine, Addenbrookes.

Dr Deborah Pencharz, ST5 in nuclear medicine, talks about why she chose nuclear meds, what the training is like and why trainees should choose it as a career.

Training in nuclear medicine

Key facts about training in nuclear medicine

The training is holistic, as we need to look at the whole patient and not just a system.
The second 3 years trains you in all aspects of diagnostic and therapeutic nuclear medicine using radio-isotopes while maintaining radiology skill. This information is combined in hybrid imaging such as PET/CT, PET/MR and SPECT/CT.
By using different isotopes it is possible to offer true personalised medicine in both imaging a problem and then treating it.
Offers a new 6-year comprehensive structured training programme starting with 3 years of clinical radiology followed by 3 years of higher and advanced nuclear medicine training.
During this training you complete the FRCR and the diploma in nuclear medicine, and have the opportunity to enrol for the King's College MSc in nuclear medicine.
On completion of training you are eligible to apply for entry to the GMC Specialist Register in nuclear medicine and in clinical radiology.
In the last 3 years of training there is ample opportunity to develop your academic interests with research, presentations at national and international meetings and publications in the field of molecular imaging and in nuclear medicine therapy.
It offers the opportunity to train in an exciting and developing medical specialty, to hone your physician skills in outpatient and inpatient settings, to lead multidisciplinary team meetings and to apply your skills to image reconstruction and interpretation.

Dr Alp Notghi, president of the Nuclear Medicine Society and consultant physician in nuclear medicine, Sandwell and West Birmingham Hospitals NHS Trust; Dr John Buscombe, chair of the Joint Specialty Committee for Nuclear Medicine and clinical lead and consultant in the department of nuclear medicine, Addenbrookes.

Information on training in nuclear medicine from the Joint Royal College of Physicians' Training Board (JRCPTB)

Nuclear medicine

There are nine people currently training in nuclear medicine in the UK.
Trainees are based in London, Oxford and Mersey.
Nuclear medicine is a non-acute specialty; there are no trainees dual training in general internal medicine.
Recruitment is coordinated centrally by the London recruitment office.

Information from ST3 recruitment

Nuclear medicine SpRs tend to be based at a single hospital for the majority of their training only rotating to other hospitals for paediatric nuclear medicine, PET/CT and specialised therapy attachments where these are not available locally.

All trainees are required to complete the postgraduate diploma in nuclear medicine which is run by King's College London as a requirement for achieving a CCT – this offers a significant taught programme and an opportunity for regular engagement with fellow trainees.

As few posts include an on-call component, so the specialty may suit those who want a positive work-life balance while pursuing a career in a vibrant and stimulating specialty. Consultant appointments to nuclear medicine in recent years have broadly matched numbers completing the training scheme.

There are opportunities to work as a consultant on a less-than-full-time basis and to organise a job that focuses on your special interests once established in a post.

MRCP(UK) written exam content Part 1 and Part 2.

You can get involved with MRCP(UK) by becoming an examiner or question writer for MRCP(UK) or the SCEs.

Working in nuclear medicine

Revalidation support is available and there is also support for physicians in difficulty. Contact revalidation@rcplondon.ac.uk for more information. Download an example of revalidation for nuclear physicians (PDF).

The RCP-associated CPD diary is used by over 14,000 consultant and SAS grade doctors and lists over 5,000 approved events each year. Access your CPD diary, or join the scheme

Personality traits of a nuclear physician

An inquisitive mind which likes challenges, is interested in the pathophysiology and mechanics behind disease process, trying to unravel the disease process by using and interpreting the nuclear medicine probes.
Leadership and ability to work within a multidisciplinary environment with good communication skills, as they would be working with doctors, nurses, clinical scientists (physicists and computer experts) and clinical practitioners (technologists and radiographers) often in a small environment, taking the leading role.
Should be at ease with – and passionate about – direct patient care, and the ability to improve care through innovation, providing local and national direction for the specialty.
Questioning the normal and not accepting convention.
Maintaining a broad-based knowledge of medicine including paediatrics.
Working well in a team with highly skilled non-medical staff.

Dr Alp Notghi, president of the Nuclear Medicine Society and consultant physician in nuclear medicine, Sandwell and West Birmingham Hospitals NHS Trust and Dr John Buscombe, chair of the Joint Specialty Committee for Nuclear Medicine and clinical lead and consultant in the Department of Nuclear Medicine, Addenbrookes.

RCP and nuclear medicine

Nuclear medicine and the RCP library, archive and museum

Radioactive materials were exploited for supposed therapeutic effects from the earliest times of their discovery. In 1909 a French manual of hydrotherapy for rheumatic conditions devoted a whole section to radioactive mineral waters. The RCP library’s copy of Notions d'hydrologie moderne by Godefroy Bardet records the levels of radioactivity at many famous spas including Bath and Buxton – neither of which had yet been measured, but both of which were believed to be radioactive – and comments upon the benefits of using their waters in treatment:

All doctors who have studied radioactive substances could not fail to be impressed by the remarkable sedation manifested first in their therapeutic use. […] I was able to attend therapeutic experiments at Beaujon Hospital […] on severe acute arthritis, among others on blennorrhagic arthritis. The rapid sedation obtained by the treatment was very remarkable, and certainly the duration of the disease has also changed very successfully by the intervention.

A special issue of The photogram magazine in the library collection includes the English translation of Röntgen’s paper on the discovery of X-rays along with lots of excited comment and X-ray images of things.

The library collections also include several histories of European and British societies devoted to the study of nuclear medicine, including the Institute of Nuclear Medicine, Society of Nuclear Medicine, and European Association of Nuclear Medicine, all available as postal loans.

Clive James Hayter became head of the first independent nuclear medicine department in the NHS and was a founder member and first president of the British Nuclear Medicine Society. Early in his medical career he developed a lifelong interest in the diagnostic and therapeutic uses of radioisotopes in human pathophysiology. He served in the RAF as a pilot during WWII before training in medicine. He maintained his interest in flying throughout his life, becoming a flying instructor and civil pilot.

Resources

RCP resources

Guide for nuclear medicine specialists contributing to multi-disciplinary team meetings and clinico-pathalogical conferences.

Consultant physicians working with patients – nuclear medicine chapter

Census of consultant physicians in the UK 2012 – specialty report: nuclear medicine

BMJ resources

Multiple intestinal haemangiomas presenting as intussusception and bleeding

BMJ Case Reports

Gastroparesis: separate entity or just a part of dyspepsia?

Gut

British Nuclear Medicine Society recommended resources

European Association of Nuclear Medicine (EANM) Guidelines