Nuclear cardiologyBMJ 2007; 335 doi: https://doi.org/10.1136/bmj.335.7615.s61 (Published 18 August 2007) Cite this as: BMJ 2007;335:s61
Avijit Lahiri is consultant cardiologist and director of cardiac imaging and research, Wellington Hospital, London
Nik Sabharwal is specialist registrar in cardiology with an interest in cardiac imaging at the John Radcliffe Hospital, Oxford
“I went into nuclear cardiology by accident. I was influenced by a very good physicist, Norman Dean, who was known as the father of European nuclear medicine, to such an extent that I even went and did a masters in nuclear medicine part time to better understand the subject. I never looked back.
“Nuclear cardiology is the use of radioisotopes as a diagnostic tool; isotopes are tagged to different agents that are carried to cardiac cells, to assess function and coronary disease. Nuclear imaging has a wide range of applications with perfusion tracers such as thallium and technetium-99m. Future applications include radiolabelled antibodies for apoptosis and plaque burden estimation.
“Nuclear cardiology has developed a lot since I started, and has now found its niche. With much validated data it is now part of NICE [National Institute for Health and Clinical Excellence] guidelines, which are strongly in its favour. Although few high volume specialist centres are undertaking such non-invasive imaging at present this is definitely set to increase, as patients with suspected coronary disease, diabetes, and metabolic syndrome increase in developing as well as developed countries.
“It is useful to have some cardiology training beyond MRCP [membership of the Royal College of Physicians] in order to provide clinical correlation. Lateral training in other forms of imaging, particularly cross sectional and two/three dimensions, is extremely useful, as is knowledge of basic physics. Since the United Kingdom is one of the lowest users of nuclear cardiology in Europe, there is scope to go abroad especially to the United States.”
“I am training in nuclear cardiology, alongside complementary imaging techniques such as echocardiography, cardiac computed tomography, and MRI [magnetic resonance imaging]. I think it is an excellent diagnostic tool because it can be used for virtually any patient. In comparison, computed tomography requires a relative bradycardia and echocardiography can be operator dependent. There is a quick turnover and the procedure is non-invasive compared with x ray angiography.
“At present there are three training pathways (in no particular order): (1) cardiology subspecialising in cardiac imaging (focusing on nuclear cardiology); (2) nuclear medicine (focusing on nuclear cardiology); (3) radiology subspecialising in radionuclide radiology (focusing on nuclear cardiology).
“Jobs involving nuclear imaging are likely to increase; however, stand alone nuclear cardiology posts are limited, so it is probably best to undergo imaging training with an interest in nuclear cardiology.
“Interested individuals can do a non-compulsory exam run by the Certification Board of Nuclear Cardiology or courses that run along with the annual meeting of the American Society of Nuclear Cardiology and the biannual International Congress of Nuclear Cardiology. Closer to home, there are several courses in the United Kingdom, of which the Brompton-Harefield course is probably the most recognised. The British Nuclear Cardiology Society website is a good place to start (www.bncs.org.uk).”