Dr. Harold Pretorius, M.D.

Nuclear medicine does not directly treat viral illness, so the short answer is, "No."; however, this is not the whole answer. Nuclear medicine can help to diagnose abnormal pulmonary perfusion and ventilation which are characteristic of viral illness in more severe cases and it is more sensitive than ordinary x rays, probably even more sensitive than chest CT which has much more radiation risk than the nuclear scans. Care must be taken if patients with viral illness have ventilation lung scans, not only to control the expired radioisotope but to prevent spread of possibly aerosolized or droplet spread of expired and potentially infectious particles. The perfusion scan alone is still helpful when compared to a chest x ray and has very little risk. Even pregnant patients can have perfusion lung scans safely with reduced isotope doses. Patients with long COVID-19 induced dyspnea frequently have minor pulmonary fibrosis which can be objectively diagnosed with perfusion lung scans (relatively inexpensively) or newer (relatively expensive and not generally available) MRI methods.

There are many rules that apply to nuclear medicine, including rules about checking in isotopes, verifying that there are no detectable leaks of the isotopes, keeping track of short or long half-life sources used for instrument calibration, wearing badges to measure radiation exposure of involved staff who interact with the isotopes, informing patients of their isotope dose and how long it will remain in the body and whether any precautions are necessary to protect others who may come in contact with them. In general we cannot inject pregnant patients or those breast feeding with any isotopes but there are infrequent exceptions when procedures may be essential to determine treatments for dangerously ill patients. We follow a principle in using radioisotopes for diagnosis and therapy which is abbreviated ALARA, which stands for "As Low As Reasonably Achievable." There are other rules concerning maintaining education of the staff in the areas in which they are practicing. Some states directly regulate Nuclear Medicine Practices and other states follow Federal guidelines, so the rules differ somewhat from state to state in the U.S., but they are similar and so are most of the international regulations. In order to obtain Certification by the American College of Radiology, typical scans are submitted to ACR experts to verify that the interpreting physician's scan readings are correct and that the equipment is performing according to manufacturer's specifications. We have to identify which technologists gave injections of isotopes and verify that the patient's were informed about the procedures and agreed to them before they were performed. We are only allowed to administer FDA-approved radiopharmaceuticals in the U.S. Also, isotopes must be kept in a secure location with appropriate labels. We must have disaster plans to deal with potential theft of isotopes. Inspectors are allowed to come and check at announced or unannounced times to insure adherence to the regulations. Practitioners of nuclear medicine also have to keep up to date licenses and pay fees for those licenses. In summary, there are many rules, but this is a summary providing an outline of most of the main ones.

Everything is relative. There is risk to being exposed to the public in general when there is an epidemic, especially one spread through droplets or aerosol. People working in the medical field in general have increased risk; however, the risk is greater for repeated or close exposures such as medical personnel involved in resuscitation or ventilation procedures. Most nuclear departments do not do ventilation procedures during the COVID-19 epidemic, which decreases risk to Nuclear technologists. I have about 10 people working for me, and all but one of them got confirmed COVID-19 at some point during the epidemic, but to the best of our knowledge, none of them contracted it in our clinic or nuclear lab and neither did I myself. All of them got it through exposure at home or traveling. This is typical of COVID-19 experience in general, which is primarily through spread from close personal contacts rather than infrequent or limited contacts on the job. There are exceptions to this comment: people who work on a COVID-19 ward or in Emergency Rooms are often infected. Bottom line: there is widespread risk of COVID-19 exposure during any COVID-19 epidemic; however, unless there are unusual circumstances, you are probably safer at your nuclear medicine job than with usual, nonquarantined affairs of daily living at home. When effective vaccines or other therapies such as monoclonal antibodies and antiviral antibiotics are available, they also decrease risks; however, vaccine and other therapy efficacy varies (usually decreases) as new viral strains evolve.

Nobody knows the future for sure! The optimistic view of nuclear medicine is that it will continue to evolve as an integral part of patient diagnosis and therapy. Proponents of Nuclear Medicine point particularly to theranostic precedures that are effective, relatively new, and seem definitely to be helping propel the field forward in areas such as diagnosis and treatment of prostate cancer (the most common though not the most fatal cancer of men) and neuroendocrine cancers, which are less common but also can be treated with usually low risks and good outcomes. Isotopes to help with diagnosis of dementia continue to evolve and are also an area of potential growth and development for the field. The more pessimistic view is that what used to be the Society of Nuclear Medicine, now called the SNMMI for Society of Nuclear Medicine and Molecular Imaging considered fairly recently merging with Radiology, which would have effectively eliminated Nuclear Medicine as a separate entity. Also, there are very few individual practitioners of Nuclear Medicine surviving; nearly all nuclear medicine is practiced as an often underrecognized or underpromoted portion of a hospital or University Radiology Department. If you are 47 years-old and qualified to work in the nuclear medicine field, or thinking of becoming qualified, the future is not so bleak in that not so many people are going into it that it is overcrowded. The nuclear physicians and technologists tend to be more patient oriented and if that is your attitude it can be a wonderful and rewarding field to work in.

Almost any bachelor of science type of program is good but to my knowledge not an absolute requirement. Basic mathematics such as algebra (calculus is even better) and basic biology courses are very helpful. A nuclear medicine physician will need to go to medical school and obtain training in nuclear medicine as a residency thereafter. A nuclear technologist usually needs 2 years of college, such as an associates degree best in any science field, and then a nuclear technology training program which usually takes 1 to 2 years.

Probably the best masks for dealing with radioisotopic contamination are similar to military "gas masks" including activated carbon filters. Since nuclear rays, particularly gamma rays are penetrating, masks alone are not sufficient to protect against all nuclear waste and maintaining short times of exposure and optimal, longer distances are also important. People involved in controlling nuclear waste from larger sources may use heavy metal shielding and also wear suits with their air supply specially filtered. Also monitoring of exposure in real time is important if larger amounts (or higher levels or radioactivity) of waste are involved.

Different training programs may have different requirements, but my advice would be at least some mathematics, such as algebra, and if you are interested and able to manage it, calculus is also helpful as well as statistics. Science courses such as biology, anatomy, chemistry and physics are also very helpful, but the more advanced courses such as differential equations in mathematics, advanced anatomy, or advanced chemistry such as biochemistry, organic chemistry or physical chemistry, are not essential. Such advanced courses are helpful if you want to be a Nuclear Medicine Physician or a nuclear chemist. Computer science continues to be of increasing importance, but except for specialized careers in nuclear medicine, computer programing is not necessary and more ordinary information technology and courses using basic computer skills (which almost all of them do now!) are more important.

To begin with, following your doctor's advice is usually a much better idea than not following it, especially if your doctor is aware of the specific nature of your medical risks and has helped you before. Some positive aspects of nuclear tests include less radiation exposure than most competing CT based x ray tests and a long history of what the results of the nuclear tests mean and how to interpret them. Stress echocardiography is attractive in the literature with no ionizing radiation risk; however, expertise in performing it well is scarce and in everyday practice it is much less attractive than in the literature and tends to have a value closer to what most insurance companies reimburse for it, which is very little. MRI tests of cardiac function are also very attractive in the literature and in centers where they are performed well, such as the University of Alabama Birmingham, are very effective tests. Outside of centers that have dedicated expertise in cardiac MRI, results are much less reliable and cardiac MRI is usually very expensive and more difficult to get insurance covered. Any stress test has some risk, but in the hands of qualified technologists and physicians, these risks are very low. You have also to consider the risk of not doing the stress test. Coronary artery disease remains the number one cause of death in your age group and it is usually preventable or treatable if diagnosed early and much more of a problem, even including fatality, when not properly diagnosed and treated. You could do a plain exercise ECG test, but the accuracy of these tests in women is only about 50% while the nuclear stress test has much higher sensitivity and specificity, near 85%. Nuclear cardiac PET scans have even higher sensitivity and specificity, approaching 95%, and lower radiation exposure when N-13 PET stress tests are available. Many insurances require a routine stress test before a Nuclear PET scan is approved, but if yours does not then the PET cardiac stress test is usually preferable.

This depends on many factors, especially your own interests, but the short answer is, "Yes!." Honestly it is not a very easy job and requires more dedication than average jobs available; however, it pays fairly well, usually does not require weekend or night time work, and since it is a little harder to do, has good job security once you have some experience. The field is rewarding, with more patient interaction than in many other fields and you can see that your efforts are important and make a difference. You are a young woman and the physician supervisors still tend to be men, but you have a risk of men supervising women in many fields and the risks of discrimination or any other inappropriate behaviors toward younger women are much less now than in the past. This is especially so in the medical field where ethical and appropriate behaviors are almost universally required and enforced, regardless of sexual orientations, which I don't add to be offensive, but because studies show a fairly high rate of different sexual orientations among both men and women that may have been just as present historically but are increasingly more recognized and acknowledged.