Nuclear medicine physician

Short description: Medical specialty

Nuclear medicine physicians, also called nuclear radiologists or simply nucleologists,[1][2] are medical specialists that use tracers, usually radiopharmaceuticals, for diagnosis and therapy. Nuclear medicine procedures are the major clinical applications of molecular imaging and molecular therapy.[3][4][5] In the United States, nuclear medicine physicians are certified by the American Board of Nuclear Medicine and the American Osteopathic Board of Nuclear Medicine.

## Contents

* 1 History
* 2 Practice
* 2.1 Procedures
* 2.2 Instrumentation
* 3 Training
* 4 Other professionals
* 5 See also
* 6 References
* 7 External links

## History

In 1896, Henri Becquerel discovered radioactivity.[6] It was only a little over a quarter of a century (1925) until the first radioactive tracer study in animals was performed by George de Hevesy, and the next year (1926) the first diagnostic tracer study in humans was performed by Herman Blumgart and Otto Yens.[7]

Some of the earliest applications of radioisotopes were therapy of hematologic malignancies and therapy of both benign and malignant thyroid disease. In the 1950s radioimmunoassay was developed by Solomon Berson and Rosalyn Yalow. Dr. Yalow was co-winner of the 1977 Nobel Prize in Physiology or Medicine (Dr. Berson had already died so was not eligible). Radioimmunoassay was used extensively in clinical medicine but more recently has been largely replaced by non-radioactive methods.

In 1950, human imaging of both gamma and positron emitting radioisotopes was performed. Benedict Cassen's work with a directional probe lead to the development of the first imaging with a rectilinear scanner.[8] Gordon Brownell developed the first positron scanner.[9] In the same decade (1954) the Society of Nuclear Medicine (SNM) was organized in Spokane, Washington (US),[10] and (1958) Hal Anger developed the gamma scintillation camera,[11] which could image a whole region at the same time.

Initial introduction of radioisotopes into medicine required individuals to acquire of a considerable background information which was foreign to their medical training. Often a particular application drove the introduction of radioisotopes into a health care facility. As other applications developed the physician or group that had developed knowledge of and experience with radioisotopes usually provided the new service. Consequently, the radioisotope service found homes in several established specialties – commonly in radiology due to an interest in imaging, in pathology (clinical pathology) due to an interest in radioimmunoassay, and in endocrinology due to the early application of 131I to thyroid disease.[12]

Nuclear medicine became widespread and there was a need to develop a new specialty. In the United States, the American Board of Nuclear Medicine was formed in 1972.[13] At that time, the specialty include all of the uses of radioisotopes in medicine – radioimmunoassay, diagnostic imaging, and therapy. As use of and experience with radioisotopes became more widespread in medicine, radioimmunoassay generally transferred from nuclear medicine to clinical pathology. Today, nuclear medicine is based on the use of the tracer principle applied to diagnostic imaging and therapy.

## Practice

### Procedures

This article is in list format, but may read better as prose. You can help by converting this article, if appropriate. Editing help is available. (January 2011)

|

Some of the most common clinical nuclear medicine procedures are: glucose metabolic imaging with F-fluorodeoxyglucose (FDG) for cancer, myocardial perfusion imaging for coronary artery disease, and skeletal imaging for both benign and malignant bone disease. Other non clinical, common procedures they perform include: brain perfusion and glucose metabolic imaging for seizure and dementia, blood pool imaging for myocardial function and gastrointestinal bleeding, gastric emptying studies for gastroparesis, hepatobiliary imaging for acute cholecystitis and gallbladder dysfunction, lymphoscintigraphy for sentinel lymph node biopsy, parathyroid imaging for hyperparathyroidism, pulmonary perfusion and ventilation imaging for pulmonary embolism, renal function imaging for various renal disorders, thyroid imaging for hyperthyroidism, thyroid whole body imaging for thyroid cancer, urinary tract imaging for vesicoureteral reflux, and white blood cell studies for infection. Less commonly preformed procedures include: octreotide (pentetreotide) or NETSPOT (gallium 68) imaging for somatostatin receptors found on the surface of many tumors, meta-iodobenzylguanidine (MIBG) imaging for neuroendocrine tumors, heat-damaged red blood cell imaging for identifying ectopic splenic tissue, and gastric mucosa imaging for Meckel's diverticulum (especially in pediatric medicine). Radionuclide therapeutic procedures include things such as: treatment of hyperthyroidism, treatment of thyroid cancer, radioimmunotherapy with Y ibritumomab tiuxetan (Zevalin) & tositumomab (Bexxar) therapy of low-grade non-Hodgkin's lymphoma, and Re (Rhenium) as Rhenium-SCT for treatment of Non-Melanoma Skin Cancer (basal cell carcinoma or squamous cell carcinoma).

### Instrumentation

This article is in list format, but may read better as prose. You can help by converting this article, if appropriate. Editing help is available. (January 2011)

|

* Planar imaging

Most radionuclides give off gamma-rays when they decay. A 2-dimensional image of the radionuclide distribution can be made with a gamma camera, often called an Anger scintillation camera after its inventor, Hal Anger.

* Single photon emission computed tomography (SPECT)

Multiple planar images taken from different angles around a patient can be reconstructed to form a stack of cross-sectional, tomographic images.

* Positron emission tomography (PET)[14]

Some isotopes emit positrons (the anti-matter equivalent of an electron) when they decay. The positrons travel a short distance in tissue and then annihilate with an electron giving off two nearly back-to-back gamma rays. Positron emission tomography takes advantage of these back-to-back gamma rays to localize the distribution of the radioisotopes.

* Combined molecular and anatomic imaging: SPECT/CT, PET/CT, and PET/MRI

The advantage of nuclear medicine is that it provides molecular and physiologic information, but it is relatively poor at providing anatomic information and the resolution is relatively poor. In recent years, instruments have been developed which allow both radioisotope and anatomic imaging. Most widespread are PET/CT scanners combining PET and computed tomography. Increasingly common are SPECT/CT scanners. Instruments combining PET with magnetic resonance, PET/MRI, are starting to be used.

* Non-imaging instrumentation

Non-imaging instruments are used for measuring radioisotope doses, for counting samples, for measuring thyroid uptake of radioiodine, for measuring sentinel lymph node uptake during mastectomy procedures to and for radiation safety.

## Training

In the United States, the Accreditation Council for Graduate Medical Education (ACGME) and the American Osteopathic Association Bureau of Osteopathic Specialists (AOABOS) accredit nuclear medicine residency programs, and the American Board of Nuclear Medicine (ABNM) and the American Osteopathic Board of Nuclear Medicine (AOBNM) certify nuclear medicine physicians. After completing medical school, a post-graduate clinical year is followed by three years of nuclear medicine residency. A common alternate path for physicians who have completed a radiology residency is a one-year residency in nuclear medicine, leading to sub-specialty certification by the American Board of Radiology. A less common path for physicians who have completed another residency is a two-year residency in nuclear medicine.[15] Additionally, as is commonly required in medicine, continuing education is also a requirement to stay updated with research and new methods often requiring additional assessment such as that found at the IAEA.[16]

## Other professionals

Nuclear medicine procedures are performed by Nuclear Medicine Radiographers,[17] who require extensive training both in underlying principles (physics, instrumentation) but also in the clinical applications. Nursing support, especially in the hospital setting, is valuable, but may be shared with other services. Nuclear medicine is a technology embedded specialty depending upon a large number of non-physician professional, including medical physicists, health physicists, radiobiologists, radiochemists, and radiopharmacists.

Residency trained nuclear medicine physicians have the most extensive training and highest level of certification, including all aspects of diagnosis and radionuclide therapy. However, current U.S. regulations do not prohibit other physicians from interpreting nuclear medicine studies and perform radionuclide therapy. Radiologists who are not sub-specialty trained in the specialty, nonetheless often limit their practice to practicing nuclear medicine. Some cardiologists, especially non-invasive cardiologists, will interpret diagnostic cardiology studies including nuclear medicine studies. Radiation oncologists perform all forms of radiation therapy, sometimes including radionuclide therapy. Some endocrinologists treat hyperthyroidism and thyroid cancer with 131I. The mix of physicians rendering nuclear medicine services varies both between different countries and within a single country.

## See also

* Radiographer

## References

1. ↑ PET/CT with contrast
2. ↑ Radiology (ACR), Radiological Society of North America (RSNA) and American College of. "Professions in Nuclear Medicine" (in en). https://www.radiologyinfo.org/en/info/professions-nuclear-medicine.
3. ↑ Wagner Henry N. (2006), A Personal History of Nuclear Medicine. Springer. ISBN 978-1-85233-972-2
4. ↑ National Atomic Museum
5. ↑ Potchen, EJ (2000). "Reflections on the early years of nuclear medicine". Radiology 214: 623–624. PMID 10715020. http://radiology.rsnajnls.org/cgi/content/full/214/3/623.
6. ↑ Blaufox, MD (July 1996). "Becquerel and the discovery of radioactivity: early concepts". Semin Nucl Med 26: 145–54. PMID 8829275.
7. ↑ Patton, DD (August 2003). "The birth of nuclear medicine instrumentation: Blumgart and Yens, 1925". J. Nucl. Med. 44: 1362–5. PMID 12902429. http://jnm.snmjournals.org/cgi/content/full/44/8/1362.
8. ↑ Blahd, WH (July 1996). "Ben Cassen and the development of the rectilinear scanner". Semin Nucl Med 26: 165–70. PMID 8829277.
9. ↑ A History of positron imaging
10. ↑ Harris, CC (July 1996). "The formation and evolution of the Society of Nuclear Medicine". Semin Nucl Med 26: 180–90. PMID 8829279.
11. ↑ Gottschalk, A (July 1996). "The early years with Hal Anger". Semin Nucl Med 26: 171–9. PMID 8829278.
12. ↑ Becker, DV; Sawin, CT (July 1996). "Radioiodine and thyroid disease: the beginning". Semin Nucl Med 26: 155–64. PMID 8829276.
13. ↑ Ross, JF (July 1996). "A history of the American Board of Nuclear Medicine". Semin Nucl Med 26: 191–3. PMID 8829280.
14. ↑ PET center of excellence
15. ↑ ABNM brochure
16. ↑ "Nuclear Medicine Physicians Self-Assessment" (in en). http://www.iaea.org/online-learning/courses/749/nuclear-medicine-physicians-self-assessment.
17. ↑ nuclear medicine technologists

## External links

* American Board of Nuclear Medicine
* American Osteopathic Board of Nuclear Medicine
* American Board of Medical Specialties
* International Atomic Energy Agency (IAEA), Division of Human Health, Nuclear Medicine
* Society of Nuclear Medicine and Molecular Imaging, formerly the Society of Nuclear Medicine (SNM)
* About nuclear medicine
* List of nuclear medicine societies

* v
* t
* e

Medicine

Specialties
and
subspecialties|

Surgery

* Cardiac surgery
* Cardiothoracic surgery
* Colorectal surgery
* Eye surgery
* General surgery
* Neurosurgery
* Oral and maxillofacial surgery
* [[[Medicine:Orthopedic surgery|Orthopedic surgery]]
* Hand surgery
* Otolaryngology
* ENT
* Pediatric surgery
* Plastic surgery
* Reproductive surgery
* Surgical oncology
* Thoracic surgery
* Transplant surgery
* Trauma surgery
* Urology
* Andrology
* Vascular surgery

Internal medicine

* Allergy / Immunology
* Angiology
* Cardiology
* Endocrinology
* Gastroenterology
* Hepatology
* Geriatrics
* Hematology
* Hospital medicine|
* Infectious disease
* Nephrology
* Oncology
* Pulmonology
* Rheumatology

Obstetrics and gynaecology

* Gynaecology
* Gynecologic oncology
* Maternal–fetal medicine
* Obstetrics
* Reproductive endocrinology and infertility
* Urogynecology

Diagnostic

* Radiology
* Interventional radiology
* Nuclear medicine
* Pathology
* Anatomical
* Clinical pathology
* Clinical chemistry
* Clinical immunology
* Cytopathology
* Medical microbiology
* Transfusion medicine

Other specialties

* Addiction medicine
* Adolescent medicine
* Anesthesiology
* Dermatology
* Disaster medicine
* Diving medicine
* Emergency medicine
* Mass gathering medicine
* Family medicine
* General practice
* Hospital medicine
* Intensive care medicine
* Medical genetics
* Narcology
* Neurology
* Clinical neurophysiology
* Occupational medicine
* Ophthalmology
* Oral medicine
* Pain management
* Palliative care
* Pediatrics
* Neonatology
* Physical medicine and rehabilitation
* PM&R
* Preventive medicine
* Psychiatry
* Addiction psychiatry
* Radiation oncology
* Reproductive medicine
* Sexual medicine
* Sleep medicine
* Sports medicine
* Transplantation medicine
* Tropical medicine
* Travel medicine
* Venereology

Medical education|

* Medical school
* Bachelor of Medicine, Bachelor of Surgery
* Bachelor of Medical Sciences
* Master of Medicine
* Master of Surgery
* Doctor of Medicine
* Doctor of Osteopathic Medicine
* MD–PhD

Related topics|

* Alternative medicine
* Allied health
* Dentistry
* Podiatry
* Physiotherapy
* Molecular oncology
* Nanomedicine
* Personalized medicine
* Public health
* Traditional medicine
* Veterinary medicine
* Physician
* Chief physician
* History of medicine

* Book
* Category
* Commons
* Wikiproject
* Portal
* Outline

0.00

(0 votes)

Original source: https://en.wikipedia.org/wiki/Nuclear medicine physician. Read more

|

Retrieved from "https://handwiki.org/wiki/index.php?title=Medicine:Nuclear_medicine_physician&oldid=4239341"
*[v]: View this template
*[t]: Discuss this template
*[e]: Edit this template