The main role of the Nuclear Cardiologist is in common with all medical specialties, the assessment of the patient but also whether the appropriate nuclear medicine technique can add to the patient's clinical management. The most commonly used technique is SPECT. PET is available in very limited centers but it is slowly coming to mainstream with newer applications.

The commonest techniques used for diagnosis, include myocardial perfusion scintigraphy (MPS) and radionuclide ventriculography (RNV). The new applications include cardiac neuronal imaging with mIBG and cardiac inflammation imaging with FDG. Very limited centers in UK have ability to perform PET myocardial perfusion imaging.

SPECT MPS is used for functional assessment of relative myocardial blood flow under stress and then compared with resting condition using cardiac specific radiotracers. This allows identification of areas of ischaemia, infarction and contractile function, which helps to provide prognostic information. The stress can be dynamic (e.g. treadmill), or by employing various pharmacological agents. Images are obtained using SPECT gamma camera and analysis is performed using computer software, which is specially created to provide unique functional data. This is then interpreted in conjunction with patient history, stress test performance by experienced clinician to be used in patient management.

This non-invasive, functional assessment technique has been well established based on robust clinical and research evidence and has proven to be cost effective in the management of mainly ischaemic heart disease and also other cardiac conditions.

The nuclear cardiologist role involves organising appropriate test for specific clinical indications, supervising cardiac stress tests, interpretation of images in light of clinical history and helping patient management in multi-disciplinary format.

How to be a Nuclear Cardiologist?

Doctors with a good background in General Medicine, who have specialist training and experience in Nuclear Medicine and special interest and experience in cardiology. Specialists from various disciplines such as nuclear medicine, cardiology and radiology with special interest in nuclear medicine enter the field of nuclear cardiology and based on their experience and training can practice Nuclear Cardiology. ARSAC (Administration of Radioactive Substances Advisory Committee) certificate may be required to practice nuclear cardiology independently. Please see details on ARSAC website.

Recently, there has been a significant change in Nuclear medicine training and curriculum with inclusion of radiology for 3 years in recognition of increasing use of fusion/hybrid imaging (structural with CT/MR + functional SPECT/PET).

From August 2015, new training programme has been implemented by the Joint Royal Colleges. Please see full details on GMC website which includes entry criteria and details of 6 years training programme.

www.gmc-uk.org/education/nuclear_medicine.asp

Nuclear Cardiology Training

Trainees following the new nuclear medicine curriculum will have all the essential competencies to practice nuclear cardiology. However additional training in a high volume, well established nuclear cardiology department is recommended to obtain more specialist knowledge of nuclear cardiology and further understanding of its role amongst other imaging modalities in various clinical scenarios.

Entry from Cardiology Background

Experience of Nuclear Cardiology techniques is an essential requirement for cardiology training programme for core training of cardiology both at a basic and advanced level.

At the end of completing basic cardiology curriculum, trainees can choose for advanced training in nuclear cardiology, which involves at least 6 months of full time attachment at a high volume nuclear cardiology department where they gain knowledge, understanding and practical experience of radiation protection, regulations, various methods of stress, principles of nuclear imaging, range of clinical applications and participation in MDTs. They need to have reported 500 MPS studies, out of 250 could be from an archive.

Please see details on http://www.jrcptb.org.uk

For additional information on meetings courses and educational activities, please visit following websites

British Nuclear Cardiology Society (BNCS): www.bncs.org.uk

British Cardiac Society (BCS)  www.bcs.org.uk

For further advice administration of radioactive substances please refer to ARSAC notes for guidance.

Further information

https://www.bncs.org.uk/