Nuclear medicine is a branch of medicine that uses small amounts of radioactive substances to study the body’s physiology and metabolism in order to identify problems and, in some cases, provide treatment (for example overactive thyroid, joint problems and some cancers). As a consultant nuclear medicine physicians have overall responsibility for the clinical management of the department. There are ample opportunities to interact directly with patients, such as discussing scans with patients, cardiac stressing, and running thyroid, bone, and therapy clinics. However, a significant amount of time is spent in diagnostic imaging and reporting. The nuclear medicine physician will also be required to contribute to multi-disciplinary meetings and be available to discuss indications for scans and the results with referring clinicians. As nuclear medicine is a relatively small speciality, most consultants are also involved in additional local duties such as training and audit and in their career in various national roles. Research is an integral part of the work in most departments. Nuclear medicine is a truly multidisciplinary specialty so the nuclear medicine physician will work with other crafts, such as medical physics, radiopharmacy, nursing and technology, which is both challenging and provides an exciting environment to work in.

Nuclear medicine covers a range of investigations and treatments here are some examples:

Following a small injection of a radioactive tracer, pictures are taken with a special camera (Gamma Camera), which look at the uptake of the tracer in the bones. This can show areas of increased bone turnover for example if the bone is broken, or areas of cancerous deposits. The images give information about physiology, rather than anatomy – as seen on X-rays. Radioactivity injected into joints can treat some forms of arthritis.

Thyroid scans and treatment
Radioactive iodine can be used both to diagnose and treat overactive thyroid disease.

PET and PET/CT

Where is nuclear medicine practiced?

There are 252 nuclear medicine departments in the UK. Around 50 of these are run by nuclear medicine physicians and the rest by radiologists with special interest in nuclear medicine. In many hospitals nuclear medicine is part of imaging department, but in larger teaching hospitals they are often independent departments.

Why become a Nuclear Medicine consultant? Excerpts from a Nuclear Medicine consultant’s career profile

For full details see Royal College of Physicians website: http://www.rcplondon.ac.uk/education-practice/advice/consultant-physicians.

What influenced you/made you decide to choose your specialty?
“ ... Like many trainees, my career choice was determined by working with an inspirational team. ... I managed to write a couple of case reports and learn basic research skills during a relatively short placement. After a post-MRCP registrar rotation, an opportunity arose to embark on specialist nuclear medicine training... ”

Do you work closely with other specialties?
“... Nuclear medicine applications span a broad spectrum of disease, focusing particularly on oncology, cardiology, nephro-urology, orthopaedics, rheumatology and neuropsychiatry ... Nuclear medicine techniques are often used to assess the impact of new developments in other fields ... The nuclear medicine specialist is uniquely able to keep abreast of innovations in almost every other area of medicine. Life is never boring... ”

What are your typical working hours?
“... Nuclear medicine diagnostic services are largely delivered between 8am and 8pm. Specialists undertaking radio isotope therapy will have an on-call commitment, but workload is scheduled electively and can be organised“

What are the best aspects of working in your specialty?
“ ...for me, the main attractions of the specialty are the workload variety, opportunity to interact with virtually all other medical and surgical disciplines and above all, the pace of innovation and change in diagnostic imaging and treatment ... I enjoy enough patient contact to keep my clinical skills up to speed but still have time for research and teaching ... ”

Training to be a Nuclear Medicine Physician
Once a doctor has completed their core medical training, usually they will have sat the exams for membership of the college – MRCP. Run through training from ST3, enables the smooth delivery of a curriculum and provides some stability for trainees.

Due to holistic nature of nuclear medicine training needs to ensure safe practice in all forms of hybrid imaging such as SPECT/CT and PET/CT as well as the ability to deliver a range of effective radionuclide therapies safely. All nuclear medicine trainees must have completed core medical or core surgical training or equivalent and have MRCP/MRCS. Entry is into a 6-year joint Radiology/Nuclear Medicine course. The first 3 years concentrates on the Radiology aspect of training leading up to FRCR. The final 3 years of training will primarily concentrate on nuclear medicine. The first 2 years will emphasis general diagnostic and therapeutic nuclear medicine and PET, and trainees will be expected to complete the nuclear medicine PGD course hosted by KCL in London but delivered both online and in person. The final year will enable further sub specialism and the opportunity to focus on exciting new areas such as theranostic nuclear medicine. Upon completion trainees will have CCTs in Nuclear Medicine and Radiology.


More information

JRCPTB NM physician training
www.bnms.org.uk
https://www.healthcareers.nhs.uk/explore-roles/doctors/roles-doctors/medicine/nuclear-medicine