Trends in nuclear medicine and the radiopharmaceutical sciences in oncology: workforce challenges and training in the age of theranostics.

Although the promise of radionuclides for the diagnosis and treatment of disease was recognised soon after the discovery of radioactivity in the late 19th century, the systematic use of radionuclides in medicine only gradually increased over the subsequent hundred years. The past two decades, however, has seen a remarkable surge in the clinical application of diagnostic and therapeutic radiopharmaceuticals, particularly in oncology. This development is an exciting time for the use of theranostics in oncology, but the rapid growth of this area of nuclear medicine has created challenges as well. In particular, the infrastructure for the manufacturing and distribution of radiopharmaceuticals remains in development, and regulatory bodies are still optimising guidelines for this new class of drug. One issue of paramount importance for achieving equitable access to theranostics is building a sufficiently trained workforce in high-income, middle-income, and low-income countries. Here, we discuss the key challenges and opportunities that face the field as it seeks to build its workforce for the 21st century.

Competency based medical education in nuclear cardiology: A tale of two axes.

BACKGROUND: Across medical specialties, including nuclear cardiology, competency based medical education (CBME) changes the emphasis of learning from a time or experiential emphasis to a proficiency focused approached. Plotted on a learning-curve graph the emphasis on learning has shifted from the duration/ volume-based x-axis to the performance-based y-axis. CURRENT STATUS: It has proven difficult to establish y-axis-based standards within nuclear cardiology to assess learning. As such there is a paucity of data to verify current experiential training targets and only recently is data emerging that seeks to find CBME targets by which proficiency (y-axis units) can be evaluated. Initial reports from such CBME-oriented studies indicate that in current nuclear cardiology practice, the number of studies required to achieve competency is dependent upon the chosen measure of competency that is assessed (summed stress score versus % LV ischemia), the case mix, and the modality being learnt (PET versus SPECT). Recent findings have also suggested that prior levels of experiential training may be an underestimation of the number of supervised studies learners need to interpret before they achieve competency. SUMMARY: Nuclear cardiology training has adopted the concept of CBME and is progressing toward a more modern approach to trainee assessment. This brief review provides the background, current requirements and insights into new developments in nuclear cardiology training.

10-year update to the combined 16-month nuclear medicine and diagnostic radiology residency: The NuRad pathway.

BACKGROUND: The decline in nuclear medicine (NM) residencies in the United States has led to a shortage of NM physicians. To help address this, a 16-month NM pathway for diagnostic radiology (DR) residents was developed in 2010. At the University of Arkansas for Medical Sciences, we matched our first resident into the NuRad (NM + DR) pathway in 2013. Despite our success, we remain one of only five programs in the United States that offers a combined training pathway through the National Resident Matching Program. OBJECTIVES: Review our 10-year experience with the NuRad pathway at UAMS and highlight the key components and significance of the 16-month NM pathway. METHODS: Retrospective review of NRMP applicants to the DR and NuRad pathway from 2013 and 2023 at UAMS. Literature and website review of the educational structure of the 16-month NM pathway. RESULTS: We have seen significant increase in the number of applicants to the NuRad pathway at UAMS over the last 10 years with 184 applicants for 1 position in 2023, up from 18 applicants in 2013. Furthermore, we have seen an increase in the USMLE step scores for applicants during this time. CONCLUSIONS: There is a growing need for NM trained physicians in the United States. Over the last 10 years, we have seen increasing interest in the NM 16-month pathway as a part of DR residency. A wider implementation of this combined training pathway is needed, if we are to realize its full potential.

EANM procedural recommendations for managing the paediatric patient in diagnostic nuclear medicine.

PURPOSE: The manuscript aims to characterize the principles of best practice in performing nuclear medicine procedures in paediatric patients. The paper describes all necessary technical skills that should be developed by the healthcare professionals to ensure the best possible care in paediatric patients, as it is particularly challenging due to psychological and physical conditions of children. METHODS: We performed a comprehensive literature review to establish the most relevant elements of nuclear medicine studies in paediatric patients. We focused the attention to the technical aspects of the study, such as patient preparation, imaging protocols, and immobilization techniques, that adhere to best practice principles. Furthermore, we considered the psychological elements of working with children, including comforting and distraction strategies. RESULTS: The extensive literature review combined with practical conclusions and recommendations presented and explained by the authors summarizes the most important principles of the care for paediatric patient in the nuclear medicine field. CONCLUSION: Nuclear medicine applied to the paediatric patient is a very special and challenging area, requiring proper education and experience in order to be performed at the highest level and with the maximum safety for the child.

The integrated nuclear medicine and radiology residency program in the Netherlands: strengths and potential areas for improvement according to nuclear medicine physicians and radiologists.

PURPOSE: To evaluate the Dutch integrated nuclear medicine and radiology residency program from the perspective of nuclear medicine physicians and radiologists. METHODS: A survey was distributed among nuclear medicine physicians and radiologists in hospitals that participate in the Dutch integrated nuclear medicine and radiology training program. RESULTS: A total of 139 completed questionnaires were included. Nuclear medicine physicians (n = 36) assigned a mean score of 5.7 ± 2.0, and radiologists (n = 103) assigned a mean score of 6.5 ± 2.8 (on a 1-10 scale) to the success of the integrated training program in their hospital. On multiple regression, female gender of the survey participant (B = 2.22, P = 0.034), musculoskeletal radiology as subspecialty of the survey participant (B = 3.36, P = 0.032), and the survey participant's expectancy of resident's ability to handle workload after completion of residency were significantly associated with perceived success of the integrated training program (B = 1.16, P = 0.023). Perceived strengths of the integrated training program included broadening of expertise, a better preparation of future imaging specialists for hybrid imaging, increased efficiency in training residents, and increased efficiency in multidisciplinary meetings. Perceived weaknesses of the integrated training program included reduced exposure to nuclear medicine, less time for research and innovation, and concerns about its international recognition. CONCLUSION: This study provided insights into the experiences of nuclear medicine physicians and radiologists with the Dutch integrated nuclear medicine and radiology residency program, which may be helpful to improve the program and similar residency programs in other countries.

Satisfying Program-Level Outcomes by Integrating Primary Literature into the Online Classroom.

Because of the coronavirus pandemic, there has been a paradigm shift from traditional classroom instruction to remote online modalities. To provide the most current and relevant information on nuclear medicine technology to students without access to traditional resources on a college campus, it has become imperative that primary literature within the field be made readily accessible. Nuclear medicine technology students at Bronx Community College are being taught to use the Journal of Nuclear Medicine Technology as the basis for their required presentations, which span the curriculum. Guided by instructors who are armed with a rubric ultimately used as a formative assessment tool, the students are required to explore current articles from the Journal of Nuclear Medicine Technology and ultimately present their findings to their cohort. By design, this article-share project has successfully been implemented as a principal metric in satisfying the program accreditation requirements of the Joint Review Committee on Nuclear Medicine Technology while also being conducive to increasing oral presentation skills and cohort socialization.

COVID-19 Vaccination: An Overview and Education Tool for Nuclear Medicine Technologists.

Some nuclear medicine technologists may be called on to administer COVID-19 vaccines, but many may have never administered a vaccine. This article summarizes COVID-19 vaccination procedures and provides links to additional information, training, and self-assessment.

An Evaluation of the Content of Canadian and American Nuclear Medicine Fellowship Websites.

BACKGROUND: Radiology trainees frequently use the Internet to research potential fellowship programs across all subspecialties. For a field like nuclear medicine, which has multiple training pathways, program websites can be an essential resource for potential applicants. This study aimed to analyze the online content of Canadian and American Nuclear Medicine fellowship websites. MATERIALS AND METHODS: The content of all active Canadian and American Nuclear Medicine fellowship websites was evaluated using 26 criteria in the following subdivisions: application, recruitment, education, research, clinical work, and incentives. Fellowships without websites were excluded from the study. Scores were summed per program and compared by geographic region and ranking. RESULTS: A total of 42 active Canadian and American Nuclear Medicine fellowship programs were identified, of which 39 fellowships had dedicated fellowship websites available for the analysis. On average, fellowship websites contained 34.4% (9 ± 3.3) of the 26 criteria. Programs did not score differently on the criteria by geographical distribution (P = .08) nor by ranking (P = .18). CONCLUSION: Most Canadian and American Nuclear Medicine fellowship websites are lacking content relevant to prospective fellows. Addressing inadequacies in online content may support programs to inform and recruit residents into fellowship programs.

US Trainee and Faculty Perspectives on Exposure to Nuclear Medicine/Molecular Imaging During Medical School.

PURPOSE: (1) To identify key factors, especially during medical school, driving trainees to pursue nuclear medicine/molecular imaging (NM/MI) as a career. (2) To understand the current state of medical student exposure to NM/MI. METHODS: We disseminated 2 surveys by email. The first surveyed NM/MI trainees about motivations for choosing the specialty. The second survey was sent to US medical school faculty responsible for student education and NM/MI residency program directors to gauge the current state of NM/MI didactics at their institution. RESULTS: Seventy-eight trainees and 44 faculty responded. Most trainees reported becoming first interested in NM/MI after medical school (80%, 56/70). Trainees reported little NM/MI exposure during medical school (65%, 49/75), despite faculty reporting that they provide NM/MI didactics (76%, 32/42, P = 0.005). Imaging clerkships, research, and mentorship experiences were important influences for trainee's specialty choice. Most respondents thought that NM/MI should be pursued in conjunction with Diagnostic Radiology training (trainees 67%, 45/69; faculty 80%, 32/40). CONCLUSION: Survey results highlight the need to improve medical student engagement in NM/MI. It also identified factors that motivate current NM/MI trainees to enter the field and highlight a potential opportunity to increase medical student exposure to NM/MI. Targets for curricular and extra-curricular development that may increase effective NM/MI exposure during medical school were identified to guide future outreach efforts.

A Cyclotron Decommissioning Radiological Assessment Exercise Performed by Student Mentees Underrepresented in the Radiation Safety Profession.

Cyclotrons used in nuclear medicine imaging accelerate protons, deuterons, and helium ions to bombard a target, which produces nuclear reactions that generate positron-emitting radionuclides. Secondary neutrons are nonuniformly emitted in these reactions and induce heterogeneous activation of the cyclotron components and concrete vault enclosure. This poses radioactive waste management complications when decommissioning a cyclotron facility, since the objective is to ensure that exposures are within regulatory limits and as low as reasonably achievable (ALARA). The McGovern Medical School in The University of Texas Health Science Center in Houston housed a Scanditronix MC40 cyclotron that produced short-lived radioisotopes for Positron Emission Tomography (PET) imaging from 1984 to 2001 until Tropical Storm Allison rendered it inoperable. The purpose of this study was to provide underrepresented Science, Technology, Engineering and Mathematics (STEM) students an ALARA experience with a practical problem encountered in the radiation safety profession. Gamma dose rate measurements were performed with both a Mirion InSpector 1000 spectrometer and Fluke 451P survey meter in the vault at locations identified as hotspots based on preliminary scoping surveys with the Ludlum model 44-9 detector. However, gamma spectra were measured with the spectrometer exclusively at hotspots along the west wall. Results indicated the maximum gamma dose rate of 129 ± 31 nSv h was about 2 times background near the central beam transport line of the now inoperable cyclotron. Furthermore, gamma emission peaks were identified in the spectra from trace amounts of Co and Eu in the vault's concrete walls.

An Open Source Solution for "Hands-on" teaching of PET/CT to Medical Students under the COVID-19 Pandemic.

AIMS: Since 2017, medical students at the University of Bergen were taught PET/CT "hands-on" by viewing PET/CT cases in native format on diagnostic workstations in the hospital. Due to the COVID-19 pandemic, students were barred access. This prompted us to launch and evaluate a new freeware PET/CT viewing system hosted in the university network. METHODS: We asked our students to install the multiplatform Fiji viewer with Beth Israel PET/CT plugin (http://petctviewer.org) on their personal computers and connect to a central image database in the university network based on the public domain orthanc server (https://orthanc-server.com). At the end of course, we conducted an anonymous student survey. RESULTS: The new system was online within eight days, including regulatory approval. All 76 students (100 %) in the fifth year completed their course work, reading five anonymized PET/CT cases as planned. 41 (53 %) students answered the survey. Fiji was challenging to install with a mean score of 1.8 on a 5-point Likert scale (5 = easy, 1 = difficult). Fiji was more difficult to use (score 3.0) than the previously used diagnostic workstations in the hospital (score 4.1; p < 0.001, paired t-test). Despite the technical challenge, 47 % of students reported having learnt much (scores 4 and 5); only 11 % were negative (scores 1 and 2). 51 % found the PET/CT tasks engaging (scores 4 and 5) while 20 % and 5 % returned scores 2 and 1, respectively. CONCLUSION: Despite the initial technical challenge, "hands-on" learning of PET/CT based on the freeware Fiji/orthanc PET/CT-viewer was associated with a high degree of student satisfaction. We plan to continue running the system to give students permanent access to PET/CT cases in native format regardless of time or location.

Educational Effect of Remote Lectures for Students Aiming to Become Radiologic Technologists: Questionnaire on Nuclear Medicine Examinations.

In the latter half of 2019, coronavirus disease 2019 (COVID-19) began spreading worldwide. To prevent COVID-19 infection, all teaching at Suzuka University of Medical Sciences from April to June 2020 took place as remote lectures, not in the face-to-face format. This study analyzed postlecture questionnaire responses regarding face-to-face and remote teaching on the subject of nuclear medicine technology examinations. We examined the educational effect of using remote lectures. Methods: We conducted a questionnaire survey among students by means of a 5-point evaluation scale about satisfaction, comprehension, concentration, preparation, reviewing, and the question environment for face-to-face and remote lectures. Results: We present the results as means and SDs. Satisfaction results for face-to-face and remote lectures were 3.30 ± 0.72 and 3.36 ± 0.88, respectively. Comprehension results for face-to-face and remote lectures were 3.30 ± 0.71 and 3.30 ± 0.83, respectively. Concentration results for face-to-face and remote lectures were 3.50 ± 0.69 and 3.05 ± 0.90, respectively. The preparation results for face-to-face and remote lectures were 2.57 ± 0.88 and 2.67 ± 0.94, respectively. The reviewing results for face-to-face and remote lectures were 2.84 ± 0.85 and 3.39 ± 0.89, respectively. The question environment results for face-to-face and remote lectures lessons were 2.94 ± 0.90 and 3.43 ± 0.84, respectively. There were no significant differences between face-to-face and remote lectures in terms of satisfaction, comprehension, or preparation. There were significant differences between face-to-face and remote lectures in terms of concentration, reviewing, and the questioning environment (P < 0.001). Conclusion: This comparative analysis of the postlecture questionnaire responses for face-to-face and remote formats in nuclear medicine technology examinations showed that remote lectures have a strong educational effect. We believe that, in future, remote lectures should be considered a tool in student education.