Many half-lives ago I wrote a blog entitled ‘A Day in the Life of a Radiographer’. Since then it’s become the most-widely-read of my blogs. Ever since I began my training as a nuclear medicine radiographer, back in April 2018, I have been meaning to write a follow-up to my initial blog and to hopefully give an insight into what we, as nuclear medicine radiographers do on a day to day basis. It is not intended to be wholly descriptive of all that takes place in a nuclear medicine department.
Here is said follow-up.
As nuclear medicine radiographers we are used to some of our colleagues in the healthcare professions not knowing what we do, so what chance do members of the public have of understanding our work? Mention the fact that we’re going to inject a small amount of radioactive isotope into them and the de-facto patient response is “am I going to glow in the dark?”
Right, let’s start from the beginning. Not all hospitals, including the one I work at, have a radiopharmacy. This is the place where the radiopharmaceuticals that we use in nuclear medicine are produced. I am not going to go into how this is done, as this is neither the time, nor the place.
Basically, radiopharmaceuticals are the materials that we use on a daily basis to image both form and function of different body parts and systems. As we do not produce these on-site, we have to rely on them coming from another hospital that does have it’s own radiopharmacy. This means we are reliant on them delivering the products we need to image our patients. One advantage of our system is that all our injections arrive pre-packed, patient-specific and ready to use, which is not the case for all nuclear medicine departments. Some have to draw-up their own injections for each patient.
The department opens at 08:30, with the radiographer on an 08:30 start invariably arriving a bit early to kick-off the daily quality control checks. These involve checking the imaging equipment is functioning within normal parameters and is OK to use for the day ahead. Once we are satisfied that is the case, we are then able to inject the first patient; dependent of course on the timely arrival of the delivery from the radiopharmacy. Once this has arrived, we check to make sure that we have received what we ordered and then we are good to go!
As previously mentioned, radiopharmaceuticals are used in the imaging of many different parts of the body and it’s systems. These range from whole body bone scans, where as the name suggests we are looking at all the bones in the body, to scans where we image certain parts of the brain. Commonly we also image kidneys, the liver, and glands such as the thyroid and parathyroid. Once the radiopharmaceutical is injected into the patient, they then become a source of radioactivity. As this radioactivity decays over time the patient emits radiation. It is this radiation that we image using a gamma camera.
So to take a whole body bone scan as an example, this involves injecting a radiopharmaceutical into the patient and giving it time to be taken up by their bones. Before we go ahead and inject a patient with radioactivity however, there are necessary questions to ask them in order to ensure we can go ahead with the examination, as well as aiding in the interpretation of the scans. Without listing all the questions, these include asking the patient if they have any specific aches or pains, any previous falls having resulted in an injury, or any significant medical history, with particular attention to any previous surgery.
Once we are satisfied we have the right patient and there is nothing they have told us about that means we can’t proceed, we go ahead and inject the radiopharmaceutical into the patient. This is the point at which they generally ask if they’ll glow in the dark! ‘Not as a result of what I am about to inject’ is my usual response!
Depending on what type of examination the patient is having, generally a period of time then needs to elapse before we can proceed with imaging the patient, though this is not always the case, with some imaging taking place immediately after the patient is injected. In the case of a whole body bone scan, this is generally about two hours. For example, if we want to get a patient on the scanner for 11:30 then we need to have injected the radiopharmaceutical into them by about 09:30, thus giving the requisite time for the radiopharmaceutical to be circulated around the patient’s body and be taken up by their bones.
The patient either stays with us in the department during this time or goes off and comes back to us in time for their scan. The levels of radioactivity we are dealing with on a daily basis do not require patients to be restricted in their movements or who they may see.
When the patient returns to us at the time we give them, we get them ready, which usually involves getting into one of our ever so attractive hospital gowns. The patient is then asked to lie down on the scanner and can be there for anything up to an hour and a half, depending on what the examination is. For a whole body bone scan, this can typically range from just over 20 minutes to about an hour. We don’t know how long it will be until we start the scan. Lots of things will be taken into consideration in how long the patient needs to remain with us. This can depend on if they have had a similar scan previously, what they have come for on this particular occasion, and what the person who has requested their scan is ultimately looking for.
When a patient’s scan is finished, we explain to them what will happen next and make sure to ask them if they have an appointment to get their results. Once the patient is off the scanner, they get dressed and are free to leave. Some types of examination however, involve patients being with us for several hours, getting on and off the scanner at regular intervals.
At the department in which I work, we usually have a mix of different scans in a day, ensuring that we don’t just do the same kind of scans all day. Generally most injections take place in the morning, with some scanning going on. The afternoon is mostly taken up scanning the patients who have been injected throughout the course of the morning and early afternoon. As well as injecting and scanning our patients, in our department we also vet clinicians’ requests, book patient appointments, order the necessary radiopharmaceuticals and many, many more things!
Once all our patients’ scans are completed it’s then time to clean the department and make sure we are ready for the following day’s work. These checks involve ensuring that no contamination has occurred throughout the day and that supplies are sufficient for the following day’s schedule. The department closes at 17:00 and reopens the following day at 08:30.
That is a day in the life of a nuclear medicine radiographer, well, this one at least.
© Ben Stuttard 2019