Specialty spotlight – nuclear medicine

Dr Deborah Pencharz, ST5 in nuclear medicine, and Dr Alp Notghi, president of the British Nuclear Medicine Society and consultant physician in nuclear medicine at the Sandwell and West Birmingham Hospital NHS Trust, talk about why they chose nuclear medicine, what the specialty invovles, what the training is like and why trainees should choose it as a career.

Introduction to nuclear medicine

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, meaning that 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).

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

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.

Training and working in nuclear medicine

Historical highlights from the library, archive and museum collection

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.

RCP fellow 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. Read more in his Munks’ Roll obituary.