"Doctor, the hospital has said that I need a nuclear medicine scan. What’s that?"
If a patient has ever asked you something similar then you will be interested to know that there is now a learning resource designed to explain nuclear medicine to healthcare professionals. The answer "It’s just a like a special sort of X-ray" is true to some extent because there are some similarities, but it glosses over some differences that may be important to both the patient and their doctor. Although the word ‘nuclear’ may have unpleasant connotations, it simply means that the radiation used is gamma rays that come from the nucleus of radioactive atoms and these are indeed just like the more familiar X-rays that come from an X-ray machine. The big difference is that instead of shining X-rays through the patient, a nuclear medicine study is performed by giving the patient a small injection of a chemical labelled with a radioactive marker (a ‘radiopharmaceutical’). The chemical is chosen because it concentrates in the organ of interest and the radioactive marker allows it to be detected externally, using either a gamma camera or a positron emission tomography (PET) scanner. These devices produce images showing the organ’s function, so the results are complementary to other imaging techniques, which just show anatomy.
Patients are often worried about the radiation involved, but they can be reassured that the radiation dose that they receive will be no bigger than that from many common X-ray examinations. However a nuclear medicine scan will not usually be carried out on pregnant patients unless it is urgent. If patients are breastfeeding they should mention this to the nuclear medicine department before the scan. Patients will continue to be slightly radioactive for a while after their nuclear medicine imaging studies but they will not usually pose a hazard to others. Hospitals will give individual advice to patients if this is necessary. After some scans radioactivity will be present in the patient’s urine, but normal biological handling precautions will be sufficient to protect carers and nursing staff. Only after large therapeutic treatments will additional restrictions be necessary and in this case patients will be given detailed instructions by the hospital.
Taking the images
One difference that patients tend not to think about but which may be of importance is the way that the images are taken. Unlike X-ray images that can be taken in a few seconds, nuclear medicine images can require the patient to lie still and on their back for up to half an hour. Some patients may not find this easy and so patients referred for bone scans or PET scans in particular may need additional assistance with pain control in order to help them manage this. If patients are claustrophobic they may be worried about the equipment coming close to them. If this is the case they should contact the nuclear medicine department to discuss their concerns, because the type of equipment used varies from one procedure to another.
Explaining to patients
Most referrals for nuclear medicine procedures will come from hospital specialists, but some nuclear medicine departments will accept direct GP referrals if they are relevant. GPs still may sometimes find that they need to explain to their patients what a nuclear medicine scan involves. For this reason a new e-Learning for Healthcare module about nuclear medicine has been created within the College of Radiographers' ‘Image Interpretation’ project. It aims to help GPs, and other healthcare workers, understand what nuclear medicine is, so that better explanations can be offered to patients about examinations they might require. The module covers a range of important subjects and it includes both diagnostic procedures, such as bone scans and PET scans, as well as therapy procedures, including radioiodine thyroid therapy and palliation for pain from bone metastases. There are videos which explain what happens during typical nuclear medicine examinations from the patient’s perspective.
Professor Lawson is honorary consultant physicist, Central Manchester Nuclear Medicine Centre and Professor Hogg is Director, Centre for Health Science Research, University of Salford.
Register for the module here
After registering, from the list of available programmes put a tick against ‘Interpretation of Radiological Images’ which is in the ‘Allied Health Professionals’ group and save the changes. When you have been granted access, log on to the e-LfH portal, from ‘My e-Learning’ select 'Interpretation of Radiological Images' and scroll down to find 'Nuclear Medicine'.
In England, the Nuclear Medicine module is also available through the National Learning Management System, which many NHS staff can already access through their Electronic Staff Record; search for nuclear medicine in the catalogue.