Nuclear medicine

Nuclear medicine is that physician specialty concerned with diagnosis and treatment involving radioactive substances administered to the patient. There is a lower-level certification for nuclear medicine technologists, who assist nuclear medicine physicians.

The specialty was the first "conjoint board" to be established under provisions of the "Essentials for Approval of Examining Boards in Medical Specialties" of the American Board of Medical Specialties. Nuclear medicine training and certification was created, jointly, by the existing certifying boards in internal medicine, pathology, and radiology, as well as the Society of Nuclear Medicine. It is entirely possible to have joint certifications in some of these related fields, such as both radiology and nuclear medicine. Certification began in 1972.

Conflicts

There is some conflict over the specialty, since many nuclear medicine procedures are routinely done by general radiologists, who, in principle, are preferred by hospitals because they use modalities, such as X-ray, that a pure nuclear medicine physician is not formally trained to do. In practice, many radiologists take additional nuclear medicine training.

Aspects of nuclear medicine also are subspecialties of specialties other than radiology. For example, "nuclear cardiologists" are quite comfortable with cardiac imaging using Single-Photon Emission-Computed Tomography (SPECT), or measuring cardiac output using radioisotopes measurement with radionuclide angiography (RNA), also calledmultiple-gated acquisition (MUGA).

Even more confusing are procedures that combine both external radiation sent through the body, the province of radiology, and radioisotopes injected into the patient, the province of nuclear medicine. Positron emission tomography (PET) scans, which create images of physiologic activity based on the external measurement of positrons, is now commonly combined with computerized tomography (CT), which sends X-rays through the body and gives a more precise anatomical reference for the metabolic information gathered with PET.

Diagnostic procedures and skills

• Bone densitometry
• Gamma/Anger camera
• SPECT
• PET
• MUGA-RNA
• Lung V-Q scan
• Gastric emptying scan
• Octneotride scan

Therapeutic procedures and skills

• Oncology
• Endocrinology