Nuclear Medicine

Nuclear Medicine

  • gu Wenchao added an answer:
    Why will 18F- combine with the Al-NOTA complex instead of combining with free Al3+? And why 18F- is not free in [18F]AlF complex?

    Why 18F- will combine with the Al-NOTA complex instead of combining with free Al3+ in the method for 18F-labeling of peptides using [18F]AlF (aluminum fluoride) complex formation with 1,4,7-triazacyclononane-1,4,7-triacetic acid (NOTA) derivatives? And why 18F- is not free in [18F]AlF complex?


    gu Wenchao

    But i think only using Al- NOTA-peptide labeling with 18F ,it will has a little bit problem.Because Al 6 position has already bond.So it difficult to bond 18F inside.I am come from shanghai cancer center.Nice to meet you.

  • Per Borghammer added an answer:
    How are PET tracers secreted from the gastro-intestinal (GI) mucosa to the GI-lumen?

    Some molecules are secreted from the gastro-intestinal mucosa to the gastro-intestinal lumen, and eventually ends up in the feces. Some positron emission tomography (PET) tracers may be secreted into the GI-lumen in this fashion, and therefore potentially confound the use of these tracers for imaging cancers and other pathology in  the GI-tract. I would appreciate some good references for papers or book chapters, which describe the principles and mechanisms of this type of secretion. Thanks. 

    Per Borghammer

    Dear Jacek,

    Thanks a lot for these references. I really appreciate it.

    By the way - I found this paper on ivermectin. It is excreted 5-fold more from the intestinal mucosa than through biliary excretion.

    Best wishes - Per

  • Sawsan Taif added an answer:
    What is the best imaging method to detect bone disease in multiple myeloma?

    At present there are several radiological methods and radioisotope available, but what is the most effective in detecting bone disease in multiple myeloma?

    Sawsan Taif

    MRI is the best

  • Maryam Heidari added an answer:
    Do you have a design guide for a nuclear medicine rooms?

    I would like to design the building of department of nuclear medicine in a hospital. What I am looking for is finding a suitable design of location of rooms and laboratories and waiting areas in the building? I would like to have some maps for instance to use ideas of them on my map. Thanks.

    Maryam Heidari

    Dear Dr Rajan

    thanks for your perfect references

  • Ludvik Puklavec added an answer:
    Could MIBI be the only gold standard to rule out arrythmia? Could this be done on ED's arrival?

    Arrythmia is easily identifiable by ECG (EKG). But it is always taken lightly considering the inconsistency and inconclusiveness of the ECG measurements. During patients' arrivals at ED, I saw few patients who were discharged after about 5 rounds of ECG. They were given the appointment to return for MIBI to confirm the aforementioned malady. Some just did not return as one way or another, they died on the next arrival at ED or none at all. Is there any alternative in-situ procedure(s) to help "prolong" their lives upon their ED's entrance?

    Ludvik Puklavec

     MIBI is not at all the gold standard to rull out arrythmia. MIBI is only one of the diagnostic methods to rull out coronary heart disease. Deadly arrythmia is not allways caused by coronary heart disease, especially in young sportsmen where MIBI study would probably be normal and the patients could still have a deadly arrythmia.

  • Hanno Krieger added an answer:
    Are there good documents for practical protection strategies in nuclear medicine buildings?

    For planning the building of nuclear medicine department in a hospital I need good documents. Who can help me to find them quickly?

    Hanno Krieger

    It´s no problem, IAEA report 1160.

  • Andrea F Armstrong added an answer:
    Does anyone know of any commercially available (gallium oxide) targets for producing Ge-68 on a cyclotron?

    Does anyone know of any commercially available (gallium oxide) targets for producing Ge-68 on a cyclotron? Preferably but not necessarily something that is compatible with a GE PET-Trace cyclotron?

    Andrea F Armstrong

    Thank-you so much, that is incredibly helpful!


  • Nur Hidayati added an answer:
    I need internal dosimetry software for nuclear medicne. Can anyone provide me any software, except OLINDA/EXM (it's not available at the moment) ?

    I am interested to purchase an internal dosimetry software for nuclear medicine, but OLINDA/EXM is not available at the moment. Please advise me the similar software which I can use for calculation Internal Dosimetry in Nuclear Medicine?

    Nur Hidayati

    Thank you. I will look for it.

  • Sune Høgild Keller added an answer:
    What is a suitable method to calculate the uptakes in nuclear medicine form PET or SPECT images quantitative?

    How can we calculate the uptakes from the images in PET/SPECT images? Is there any available MATLAB toolbox or software?

    Sune Høgild Keller

    I have used Vinci as well and is good for DICOM if you only have a few data sets. For larger DICOM data sets Osirix is better as it has a database as well.

    But for odd data formats and  phantom data ets Vinci is by far the best tool.

  • Reina Jimenez added an answer:
    Has anyone experienced better dosimetric outcomes with symmetric planning in LDR prostate brachy?

    Is there any literature evidence on symmetric planning and its advantages over asymmetric planning in ldr brachy. Thanks

    Reina Jimenez

    After more than 600 patients implanted one thing is certain to me: Each prostate is unique, and despiting more of them are symetric in their external aspect, internal composition,  drive by biopsy results,  made us to plan almost symetric distributions of needles but asymetric distribution of dose. One of the wonders of brachytherapy is the power of intensity modulated therapy design for each prostate form and content.. We also use 0.496 U and D90 is ever greater than planned. More dose in Ca nodules, better local control. All of this happened inside the gland. D90 must ever respect  margins 2-3 mm for rectal wall,  up to 4 mm  outside the capsule in the rest of the gland  

  • Madhur KUMAR Srivastava added an answer:
    Should Cardiac SPECT or coronarography be performed first to distinguish coronary disease?

    Nuclear medicine physicians and cardiologist have disagreement in time of application of cardiac SPECT and coronarography in cases suspected for coronary disease.

    Nuclear physicians consider that cardiac SPECT is one non invasive method with very high efficiency for detection of coronary disease.

    Cardiologists consider that cardiac SPECT is not sufficient for detection of coronary disease and prefer coronarography as first diagnostic method   

    Madhur KUMAR Srivastava

    The choice of test should depend on many things like presenting symptoms, time since start of symptom, associating co-morbidities to name a few.

    In case of classical MI symptoms presenting within the golden hour, angiography followed by definitive management (Stenting/CABG) is the treatment of choice. However, the condition is different with patients who present after 12 hours or present with atypical symptoms or who are diabetic and give history of similar episodes in past or previous CAD patients presenting with new symptoms. In all these cases, it is imperative to know the status of myocardium at risk - whether viable or scarred. So viability study should be done before planning management. In case of only scarred tissue, no need for aggressive surgical management as it would not help the patient, manage it medically, however, if viable myocardium is present, definitely go for surgical management. 

    In patients who have atypical chest pain or have inconclusive TMT, again there is controversy on choice of test, but if Stress Cardiac SPECT study is done and it is normal i.e. there is no evidence of stress induced myocardial ischemia, then we can assure the patient that if the maintain their life style, the chance of having MI in next one year is <1%.

  • Gran Badshah added an answer:
    Which softwares are able to replace a voxel value by another one in a SPECT acquisition ? (files in DICOM format)
    i.e.: replace some hot spots (> X counts/vol unit) by a mean value.
    Gran Badshah

    Hi dears, please can any one help me how to write watermarked frames to a DICOM image back to hide watermarks to be ready for communication?

  • Ronnie C Mease added an answer:
    Does anyone have good comments about Cell tracking with nanoparticles or radiolabeling the cells?

    Does anyone have good comments about Cell tracking with nanoparticles or radiolabeling the cells?

    Ronnie C Mease

    In-111 oxine and Tc-99m HMPAO are two radiopharmaceuticals that are used clinically to tag white blood cells ex-vivo for reinjection into patients. There are commercial cell membrane intercalating dyes that can be used for optical imaging. There are numerous radiolabeled cell membrane intercalating dyes and phospholipid analogs that also can tag cells. All of these methods have pros and cons which will depend on your particular application.

  • Ali Abdil Razzaq Muhammed Noori Aldallal added an answer:
    What is the difference in parathyroid hormone (PTH) suppression activity between Calcium Carbonate and Calcium Citrate?

    As we know the intake of calcium supplement gradually improves the plasma calcium level and thus suppressing parathyroid secretion. Is there any definite value in what extent calcium carbonate and calcium citrate varies in view of PTH suppression?

  • Teik Hin Tan added an answer:
    Can anyone share with me their experience in paediatrics dose of radioiodine treatment in differentiated thyroid cancer?

    I tried to use the few suggestion of peadiatrics dosing of RAI treatment in the ATA and EANM guidelines. I realised that there was a wide range of dosing after using those suggestion. Please help. Thank you. 

    Teik Hin Tan

    Thanks Dr Lena. We have quite a number of patients in this age group. And, I do agree on giving radioiodine if tumour is >1.0cm. Because, in my experience, almost all patients demonstrated metastasis either lymph node or lungs on our first initial radioiodine whole body scan. They all received radioiodine treatment. Some responded but some were not that lucky. But, both of the two groups were well during follow up until adulthood. It seems likely that radioiodine improves survival outcome in these two groups. Anyway, these patients usually have very good prognosis and long survival whether metastases or not. So, it is very difficult to carry out such cohort.

  • Negri Roberto added an answer:
    Is it possible to conjugate DOTA with DOX (doxorubicine) and under which condition?
    Bioconjugation of bifunctional chelate DOTA with DOX.
    There is increasing interest in the bio-conjugation of peptides and antibody with bi functional chelating agent (DOTA, DTPA), used for RRNT and RIT.

    Is it possible to conjugate DOTA with DOX (doxorubicine) and under which condition?
    Negri Roberto

    It depends what functional group of DOX you want to use to make the bond... If the amino group is your choice, then you just need to use your DOX with any DOTA-like compound with a functional group that reacts with amines (DOTA-SA or DOTA with isothiocyanate mojety). You could find protocols for these reactions in the literature

  • Madhur KUMAR Srivastava added an answer:
    What is the lowest applicable activity with the earliest imaging time for sentinel node biopsy for breast cancer?

    Research for "easy to do Nuclear Medicine with low dose culture"

    Madhur KUMAR Srivastava

    Usually for sentinel node biopsy with surgery to be done same day, 20 MBq is adequate and should be injected at least 2 hours before the surgery. If surgery is planned the next day , then 37-100 MBq is recommended.

    It depends on center to center on type of injection, usually we prefer peri-areolar as peritumoral lymphatics may be heavily laden with tumoral cells so that lymphatics might not flow leading to failure of technique. Peri-areolar injection concept has come up because of unique nature of superficial lymphatics of breast (Sappy plexus).

    Imaging before the surgery, again varies between various centers depending on the time at your disposal. In many busy centers, they do not do imaging and send the patient directly for surgery, but in my opinion, we should do planar imaging and in doubt SPECT- CT for confirmation.

    During surgery, with the use of gamma probe, the injection site is marked and any node having more than 10% of injection site count is considered as positive. This should be taken out for frozen section. Again whole axilla should be surveyed for activity and same principle of 10% should be followed till we do not find anything more than background.

    Hope this would help...Best of luck

  • Jacek Koziorowski added an answer:
    Is it feasible to couple sestamibi (nuclear medicine) with magnetic particles?
    If so, any suggestions on how to couple them?
    Jacek Koziorowski

    If you look on the structure of sestamibi; a small microsphere - and want to coulpe it to a SPION - my guesstimate is that the biological property of Sestamibi (a MPI agent) will be lost. It is like attaching a car to a corn flake and hope to use it in the cereal for breakfast.

  • F. Javier de Haro-del Moral added an answer:
    After injecting 99mTc-MIBI how much activity (MBq/ml or mCi/ml) is absorbed by a typical myocardium at peak absorption?

    As far as I know, within several min after injection activity absorption would be in the highest value possible. What is "the" value in (Mbq/ml or mCi/ml) ?

    F. Javier de Haro-del Moral

    The uptake in myocardium in only 2-3%

  • Rame Miftari added an answer:
    What are the advantages of cardiac dynamic SPECT imaging over static (conventional) SPECT imaging?

    In some papers they say dynamic SPECT provides a better contrast between normal and decreased flow regions than can be obtained from static imaging. what are the other advantages,if any?

    Rame Miftari

    The advantage of cardiac dynamic SPECT imaging over conventional SPECT imaging is that cardiac dynamic SPECT imaging allow to estimate the absolute kinetic parameters of left ventricle.
    Dynamic SPECT didn't mean "gated SPECT". In dynamic SPECT the data are collected in time of dose administration.

  • Hanno Krieger added an answer:
    Why internal dosimetry in nuclear medicine is not taken as seriously by doctors as in radiotherapy?
    Prof. Dr. Ljungber, Dr. Stabin, Dr. Flux, Dr. Celler, Dr. Simpkin, Dr. Zazonico, Dr. Sgouros, Dr. Cremonesi, and many others Authors published a lot of papers, softwares, etc. Even so, very few centers apply internal dosimetry for nuclear medicine therapy. Why?
    Hanno Krieger

    Most has been said. I just want to show my experience. If you try to calculate doses, organ doses and especially effective doses, you must exactly know the volume and tissue of distribution. This issue is quite impossible, because each patient shows his own metabolism, anatomy and radio nuclide distribution. 

    Therefore doses are normally calculated by human models with standardised persons. The results can just give some ideas of the radiation exposition of the patients.

    A short remark to the diagnostic use of 131-Iodine. It´s completely out and has been substituated in mots cases to 99m-Tc compounds, which serve in same quality but minimize the dose to the patient. The same holds for 201Tl, it´s replaced for cardiac test by 99mTc (MIBA).

  • Alejandro sanchez crespo added an answer:
    In PET images, with the current methods of reconstruction, it is still a necessary denoising step?
    If so, what is the most common method for denoising?
    Alejandro sanchez crespo

    Not necesary. One can use different filtration methods or even more advance techniques like waveletes but in clinical routine we do not denoise PET images before reconstruction.

  • Stephan Nekolla added an answer:
    What are the real values of cardiac kinetic parameters washin(k1) and washout(k2) for a normal myocardium?

    When using a two compartmental model

    Stephan Nekolla

    In addition to the aforementioned complexities, K1 varies vastly for different (radio)-tracers which are linked to the clinical target, namely the myocardial blood flow - if one uses the Renkin-Crone equation  K1 = E*MBF, E = (1-exp(-PS/MBF)). In other words, for a normal MBF of 0.8, K1 could be 0.8 for 15-O water, 0.75 for N-13 ammonia or 0.5 for 82-Rb (numbers gut feeling...) - depending on the extraction fraction (E) of the particular tracer.

  • Atena Aghaei added an answer:
    What is the lowest applicable activity with the earliest imaging time for sentinel node biopsy for breast cancer?

    Research for "easy to do Nuclear Medicine with low dose culture"

    Atena Aghaei

    we use about 20 MBq for the same day surgery , peri-areolar, intradermal injection, near the tumor side, and we have had good results.

  • Dirk Rattat added an answer:
    What is the acceptable volume (in ml) of Technetium-99m that can be administered to rats?
    I want to tag my extract with technetium-99m and administer it in to the rats tail vein for bioavailability study in rats, but i am finding it difficult to know the volume to administer to the rats.
    Dirk Rattat

    Minor remarks:

    "I want to use Tc-99m for Imaging as well as "cut and count assay". is it possible?"

    Perfectly possible. For a reliable procedure make sure not to loose urine, e.g. during scanning (tissues to collect it). Especially when injecting higher volumes, this may happen frequently and can ruin results.

    If the Tc-99m activity of your sample is too low, you can always consider concentrating (depending on the labelled molecule e.g. with spin colums when working with bigger labelled molecules) rather than increasing the volume to inject.

    (Finally, don't forget to have an eye on the pH of your solution, but that's clear anyway.)

  • Yónatan Calderón Pérez added an answer:
    Can multiple radio-labeled probes be used at the same time for PET imaging?
    If different isotopes (11-C, 89-Zr, 64Cu) are used to label different antibodies, can they all be used at the same time during PET imaging? Or because all of them undergo Beta+ decay and produce Gamma rays, is it not possible to distinguish between signals coming from the different probes?
    Yónatan Calderón Pérez
    Hi Virginia.

    In the case of PET, as many of my coleages pointed out, it is not possible to distiguish the gamma photons emited by the different radiotracers. The reason is that all of them share the same energy (511 keV).

    In the case of SPECT it may be possible. But in most of the cases, it is not. The reason is the energy resolution of the scintillator crystals (>10% FWHM). This low energy resolution does not allow to discard scatter events which can amount up to 50% of your signal (and that is using a single radiotracer, imagine using multiple).

    By using semiconductor detectors (Ge,Si,CdTe,...) it is possible to distinguish radiotracers with different energies and use them simultaneously in the case of SPECT or Compton camera.

    Here is a link to an article of the 2007 IEEE NSS/MIC conference where multiple radiotracers are used simultaneously with a mouse. The scanner is a prototype Compton camera.
  • Manish K. Mishra added an answer:
    Why is Radon-222 itself a gas but its decay products solids?
    see above
    Manish K. Mishra
    Radioactivity is a nuclear phenomena. It is number of protons in the nucleus which decides the 'State' of that element. An element can naturally exist in Solid, Liquid or Gas state. So, if by any means the number of protons in the nucleus varies ( be it by Alpha or Beta emission or by EC), the state of the element can also vary. Solid elements can change into Gas/Liquid or Gaseous ones into Solid/Liquid by radioactive transformation.
  • Carl A Wesolowski added an answer:
    What is the value of predictions in nuclear studies?
    Monte Carlo simulations to predict experimental data in the costly nuclear experiments!
    Carl A Wesolowski
    For modeling in general, one has data, and in some sense application of a model to the data extracts features from that data that have should have physical meaning. If we have done everything correctly, the difference between the model and the data should be at the noise limit of the data. It is generally assumed that models that have less than 10% relative error of fitting are good models, although frankly, noise levels are closer to 1% for nuclear studies, and most models are not very good ones.

    Concerning prediction, a very good model has predictive ability only if it has been designed for the prediction of a particular thing. This may seem somewhat confusing. Let us consider ordinary least squares in y of a functional model of concentration in time to some data. If we have measurement time intervals that are exact and invariant, like 1, 2, 3, 4,,,,n-1,n minutes, then we can predict the n+1 st concentration without regression error, and the only error would be modeling error and data noise. However, if we measure concentrations at unequal time intervals, like 5, 7, 11, 20, 23, 30,,,n-1,n. Then ordinary least squares regression yields a prediction tor concentration at the n+1 time that is too large, and the regression equation slope will be too shallow.

    There are many other examples of error types. Consider for example, that we may not be modeling what we think we are. If we model concentration of a bolus IV injected agent, it is common to assume that we are modeling concentration by ordinary least squares fit of an exponential decay function to that concentration.

    The first error results from the concentration being zero initially, but our model, the exponential decay, is maximum at that time. It would be better to model the concentration as the convolution of a vascular model and a parenchymal model, which then allows one to have both Cobs(t=0)=0 for the concentration and C(t=0)=maximum for the parenchymal model.

    The second error results from assuming an exponential shape where no such thing occurs. An exponential shape does not conserve mass. It comes from C'(t)=-CL*C(t), which is incorrect since C'(t) not only clears (CL) but also dilutes in parencyhmal fluid, and so if the clearance is only renal, then M'(t)=-CL*C(t), which latter is the urinary definition of clearance, and C'(t)>M'(t) leading to inflated CL values, which are even more inflated when there is excess fluid, i.e., when parenchymal fluid is increased in amount.

    Suppose we want to fit this concentration data to find clearance, how do we fit it? As it turns out ordinary least squares would do a poor job of measuring clearance, better would be to use weighted least squares where we minimize Norm[{k*Cobs(t)-C(t)}/{k*Cobs(t)}, best would be to minimize SD(CL)/CL. i.e., it is best to minimize the error of the quantity we wish to measure. Next, it is better to use a fit function that has a shape parameter rather than a fixed, incorrect shape, i.e. a gamma variate rather than an exponential.

    Fine suppose that gets us clearance. Does it get us a model for concentration? No, a concentration model would a convolution of a vascular first pass model, like a gamma distribution and a parenchymal impulse response like a different gamma distribution. Such a model would be expected to match concentration to approximately the level of the noise in the data, e.g., 1%. But, it would not be a model of Clearance. Only the second part of it, the parenchymal impulse response would relate to clearance.

    In summary: 1) The art of finding answers in data is often an inverse problem requiring extensive use of numerical methods chosen for definite reasons, and not chosen by reason of the accidental familiarity to the reader of such methods.
    2) Physical equations must be used, like those that conserve mass, have correct units that balance.

    Using these above principles, predictions and extrapolations can be made accurately, if that is made the explicit purpose of modeling. To do so, requires enough numerical tools in the hands of the modeler, that the correct ones can be discovered by a combination of theory and goodness of fit testing. Moreover, it can take years to solve any single problem type, and there are too few reviewers who can even read the results of such material.
  • Joern Nybo Fog added an answer:
    Where to find a new state of the art nuclear medicine department?
    I have a project establishing a new state of the art nuclear medicine department inclusive at new radiopharmaceutical laboratory and a clean room for blood labeling. The department will have 3 PET/CT, 3 SPECT/CT, 1-2 dedicated cardiac gamma camera and 1 mobile gamma camera.

    The department will have about 30 employees technicians, physicians and a physicist.
    So my question is, does anyone know where to visit a modern, state of the art and productive nuclear department?
    Joern Nybo Fog
    Than you Marco, Swen, Willy and Niels.
  • Radu A. Vasilache added an answer:
    Is nuclear medicine beneficial in the long period?
    For quick recovery we are using nuclear medicine. Experts should handle otherwise these technologies are more harmful than beneficial.
    • [Show abstract] [Hide abstract]
      ABSTRACT: Nuclear medicine provides a varied clinical workload without excessive on call commitments. Senior registrar Liz Prvulovich explains how coming across the specialty was good news for her career. Like many nuclear medicine specialists, I discovered nuclear medicine quite late in my career while working towards an MD as a research registrar in cardiology. My project used nuclear medicine techniques to examine left ventricular remodelling after myocardial infarction. Four years later and with an MD, I decided to train in nuclear medicine and I have never regretted it. I enjoy all aspects of nuclear medicine but have made use of my cardiac training by developing my interest in nuclear cardiology both clinically and for research. Cardiology on call, with its stream of emergency patients often requiring acute intervention, is, how- ever, a thing of the past. Limited undergraduate teaching as well as regional differences in the provision and use of nuclear medicine services mean that many junior doctors have only a limited awareness of what nuclear medicine can offer in terms of patient management and as a career. Few actively contemplate a career in nuclear medicine until research projects introduce them to nuclear medicine techniques. What is nuclear medicine? Nuclear medicine has held the status of an independent specialty since 1989 and is concerned with the administration of unsealed radioactive substances to patients for diagnosis, therapy, or research. Departments of nuclear medicine exist in most teaching hospitals and within an increasing number of district general hospitals. The range of nuclear medicine procedures is wide among both adults and children. Examples of common diagnostic procedures include ventilation- perfusion lung scanning for pulmonary embolism, bone scanning in benign and malignant disease, and myocardial perfusion studies in ischaemic heart disease as well as renography in the investigation of renal function and morphology. A recent survey indicated that the number of imaging studies is rising at an annual rate of about 7%. Most patients are dealt with as outpatients; only a few patients require admission for treatment. The most common therapeutic procedure is radioiodine for the treatment of thyrotoxicosis, and others include treatment of thyroid cancer and alleviating bone pain in malignancy. Attractions of a career in nuclear medicine Interesting and varied clinical workloadAcademic stimulus of workHuge research potentialScope to develop a special interest and become a national or international expertExcellent teaching materialSociable working hours as few posts have an on call commitmentLiaison with many other disciplinesAbility to develop management skillsFew inpatientsNo medical takes The unique ability of nuclear medicine techniques to provide physiological information non-invasively means that its methods are used extensively for research. This research includes using established techniques to assess new drugs or procedures-for instance, left ventricular function studies to assess the cardiotoxicity of chemotherapeutic agents-and also to develop new radiopharmaceuticals and procedures for assessment and therapy in specific disease processes. Examples of these include cerebral blood flow studies as well as receptor and antibody imaging. Positron emission tomography has been used in research for 20 years and is now making the transition into clinical practice in oncology, cardiology, and neurology. Potential drawbacks of a career in nuclear medicine Recommendation to take MSc course in nuclear medicineFew junior doctors for consultant supportRelative isolation from medical colleagues in singlehanded departmentsService led specialtyOne of the less glamorous specialties What do nuclear medicine specialists do? Nuclear medicine specialists are responsible for providing the clinical services outlined above and must hold a Department of Health certificate that allows them to administer radioactive substances. Applications for certificates are currently assessed on the basis of experience and training but future requirements will probably be more stringent and allied to appropriate higher medical training. Specific duties of nuclear medicine specialists include the selection, supervision, and reporting of diagnostic investigations, assessing patients for treatment, and providing appropriate follow up as well as the usual triad of audit, research, and teaching. History taking and examination of patients as they pass through the department ensures that detailed clinical information is available for reporting. Many consultants are also heads of departments and so have managerial roles and are budget holders. The precise range of responsibilities varies because of a number of factors, including the size and type of the hospital served, and its commitment to research and teaching. Routes of entry Trainees are drawn from all of the medical specialties, including cardiology, respiratory medicine, and nephrology, as well as from radiology. The specialty attracts as many women as men, and women are well represented at senior level in the profession. Specialist training Training in nuclear medicine starts as a specialist registrar; there are no senior house officer posts. Recruitment to specialist registrar posts is therefore based on an assessment of personality as well as progression through a medical career to date, but applicants are not expected to have prior experience of nuclear medicine. Nuclear medicine introduced specialist registrars in January 1997. From that date, UK applicants for higher medical training in nuclear medicine have had to have completed a minimum of two years' general professional training in approved posts and either obtained membership of the Royal College of Physicians (MRCP) or Fellowship of the Royal College of Radiologists (FRCR). Overseas graduates who competefor higher medical training posts must provide evidence of equivalent knowledge, training, and experience. Training is supervised by the Joint Committee on Higher Medical Training and its Specialist Advisory Committee in Nuclear Medicine. Higher medical training in nuclear medicine lasts for up to four years depending on previous experience and leads to the award of a certificate of completion of specialist training (CCST). A relevant research period may contribute up to 12 months towards the total duration of higher medical training. Radiologists entering with FRCR may be exempt for up to two years of the training programme, but will need to do at least two years' whole time equivalent of clinical training in an approved programme. Flexible training is possible. Ideally, both physicians and radiologists would take the approved MSc course in nuclear medicine provided by the University of London during training. The MSc can accommodate up to 20 students and provides instruction in the clinical, scientific, and legal aspects of the specialty covering the core curriculum for higher medical training in nuclear medicine. Trainees attend the MSc part time over two years and the cost is £1270 annually. Lectures are provided in modular blocks to enable trainees from outside London to attend; practicals and tutorials are provided locally. The MSc examination currently comprises two written papers and two vivas which cover scientific principles and clinical nuclear medicine as well dissertation. The pass rate is usually about 80%. A survey of nuclear medicine in the UK in 1993 indicated that there were about 130 whole time equivalent clinicians performing nuclear medicine in the UK. This breaks down into approximately 30 nuclear medicine physicians with the remainder being made up from radiologists providing nuclear medicine services. Although nuclear medicine has only 16 specialist registrar posts, there is a shortage of properly trained doctors wanting to undertake higher medical training in nuclear medicine, and recruitment to existing training posts has been difficult. The recent granting of manpower approval for additional training posts is likely only to exacerbate this problem unless recruitment into the speciality can be stimulated. Senior house officers interested in a career in nuclear medicine may apply to the British Nuclear Medicine Society for funding towards a two week attachment in a nuclear medicine department designed to permit a more informed career choice. Further details are available from the society at the address below. What are characteristics of someone who would enjoy nuclear medicine? Nuclear medicine specialists work as part of a multidisciplinary team which includes physicists, radiopharmacists, nurses, radiographers, and technicians so communication skills and a healthy respect for each team member's contribution to the provision of a high quality service is essential. Doctors who enjoy patient contact but prefer not to maintain responsibility for large numbers of inpatients or have the stress of medical takes and an on call commitment may enjoy nuclear medicine with its regular working hours, largely outpatient workload, and limited or absent on call commitment. For those who enjoy the stimulus of research and academic work, nuclear medicine offers many opportunities, though these do generally have to be combined with significant clinical workloads. The broad range of procedures in nuclear medicine makes it possible for individuals to pursue their clinical interests and develop existing expertise whatever their medical background and there is scope for motivated individuals to develop into either national or international experts. Finally, those with a strong medical grounding and an inquiring mind will enjoy the varied clinical workload and the daily challenge of providing optimal quality studies. Useful addresses The British Nuclear Medicine Society 1 Wimpole Street London W1M 8AA Specialist advisory committee for nuclear medicine (for advice about training and courses) Chairman: Dr A J Coakley JCHMT Office Royal College of Physicians St Andrews Place London NW1 4LE Tel: 0171 935 1174 Fax: 0171 487 4156
      BMJ Clinical Research 06/1997; 314(7096):S2-7096. DOI:10.1136/bmj.314.7096.2
    Radu A. Vasilache
    Nuclear medicine is not really used for quick recovery. It is used in two instances:
    1. for diagnostic (SPECT, PET, old fashioned scintigraphy...), and it is used because some of the techniques are simply the best way for identifying a condition
    2. for therapy of cancer, when we speak about metabolic radiotherapy, but this is not leading to quick recovery.
    For the diagnostic, the doses are higher than in classic radiology, but to the best of my knowledge there is no evidence that SPECT or PET investigations resulted in increased incidence of secondary cancers.
    For metabolic radiotherapy, the dose is lower than when using external radiotherapy and even much better localised and targeted, so in fact it saves dose to the patient.
    Summing all this, I would say developing a nuclear medicine program saves lives, either through precise diagnostic or through therapy.

About Nuclear Medicine

A specialty field of radiology concerned with diagnostic, therapeutic, and investigative use of radioactive compounds in a pharmaceutical form.

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