Nature Of The Work:
Nuclear medicine is the branch of radiology that uses radionuclides unstable atoms that emit radiation spontaneously in the diagnosis and treatment of disease. The radionuclides are purified and compounded like other drugs to form radiopharmaceuticals. When a radiopharmaceutical is injected into a patient or taken orally, the radioactivity can be detected and monitored from outside the body to assess the characteristics or functioning of those tissues or organs in which it settles. Abnormal areas show up as higher or lower concentrations of radioactivity than normal.
Thyroid function studies were among the first clinical medical applications using radionuclides. Since then, diagnostic applications of nuclear medicine have expanded dramatically, with images of bones, brain, liver, and heart function emerging as particularly important. Nuclear medicine today commands a place alongside other highly valued diagnostic disciplines. As is generally the case in medical diagnostics, specially trained technologists perform the tests and procedures under the supervision of physicians, who in turn interpret the results.
Nuclear medicine technologists are trained to use radiopharmaceuticals in a variety of areas. They may conduct laboratory studies, do research, or develop and administer procedures for purchasing, using, and disposing of radioactive nuclides. Implementing safety procedures is another important role. However, most of the time technologists work directly with patients, performing nuclear medicine procedures that are used to diagnose or treat disease.
Nuclear medicine technologists, like radiologic technologists, operate diagnostic imaging equipment. However, the equipment used in these two specialties relies on different principles, and job duties reflect this. Radiologic technologists create an image by shooting a beam of radiation, commonly called an X-ray, through the patient. In nuclear medicine, the technologist prepares the radiopharmaceutical for the patient to take, administers it, and then operates a camera that detects and maps the radioactive drug in the patient's body to create an image.
Preparing the radiopharmaceutical requires laboratory skills as well as strict adherence to safety precautions to keep the radiation dose to workers and the patient as low as possible.
The nuclear medicine technologist calculates and prepares the correct dosage of the radiopharmaceutical and then administers it to the patient by mouth, injection, or other means. Prior to the examination, the technologist explains the test procedure to the patient and tries to relieve any anxiety the patient may be experiencing.
Once the radiopharmaceutical has had time to enter the sys-tem, the technologist is ready to perform the imaging procedure. The technologist positions the patient and then starts the gamma scintillation camera, also known as a scanner, which creates images of the distribution of the radiopharmaceutical as it passes through or localizes in different parts of the patient's body.
Once the imaging has been completed, the technologist views these images on a computer screen or on film. The technologist carefully reviews the image for any additional information to give the physician, who interprets the nuclear medicine study. Some studies, such as cardiac function studies, are processed with the aid of a computer. Technologists who specialize in computer processing may be called nuclear medicine technology computer specialists.
In some facilities, nuclear medicine technologists perform imaging procedures in subspecialties of radiology. Technologists may spend part of the day in the ultrasound or diagnostic radiology departments, performing sonograms, fluoroscopy, or routine X-rays. The amount of time spent on nonnuclear medicine procedures depends on the size of the facility, the amount of specialization, and organizational policy within the institution.
The job of the nuclear medicine technologist encompasses more than diagnostic imaging. Because nuclear medicine is used in certain laboratory tests, technologists must be proficient in clinical laboratory procedures.
In one type of test, a small quantity of a radiopharmaceutical is administered to a patient and then specimens such as blood or urine are collected and measured for radioactivity level. In other words, laboratory testing replaces the image as the means of assessing the behavior of the radioactive substance inside the body. In another kind of test, the technologist adds radioactive substances to blood or serum in a test tube to determine levels of hormones or therapeutic drug content
Other job responsibilities include insuring that radiation safety procedures are carefully followed by all workers in the nuclear medicine laboratory and that complete and accurate records are kept. This includes patient medical records, patient procedures performed, and amounts and types of radionuclides received, used, and disposed of.
Working Conditions:
Nuclear medicine technologists generally work a 40-hour week. This may include evening or weekend hours in hospital departments which operate on an extended schedule. In addition, technologists in some hospitals are required to perform on-call duty on a rotation basis. Depending on the size of the nuclear medicine department and number of technologists employed, the frequency of required on-call duty varies.
The number of times a technologist is actually called to work while on call depends on the size and case mix of the hospital. Technologists in large teaching hospitals may expect to report to the hospital several nights a week to perform emergency procedures, while those in small community hospitals may only be called in once or twice a month. Opportunities for weekend, part-time, and shift work are also available.
Technologists are on their feet much of the day, and may be required to lift or turn disabled patients. Therefore, physical stamina is important. Although there is potential radiation exposure in this field, exposure is kept to a minimum by the use of safe working procedures and safety devices such as instruments that measure radiation exposure rates, shielded syringes, gloves, and other protective devices. Technologists wear special badges that measure radiation levels while they are in the radiation area. The badge measurement rarely approaches or exceeds established safety levels because of safety programs and built-in safety devices.
Employment:
Almost all Nuclear medicine technologists were in hospitals. A comparatively smaller number were employed in medical laboratories, physicians' offices, outpatient clinics, and imaging centers.
Training, Other Qualifications, and Advancement:
Technologists used to be trained on the job, but this is no longer the case. Employers prefer to hire individuals who have completed formal training programs, available in hospitals, community colleges, universities, and Veterans Administration medical centers. Programs vary in a number of respects: Length of training, prerequisites, class size, and cost. They range in length from 1 to 4 years and may lead to a certificate, associate degree, or bachelor's degree.
One-year certificate programs in nuclear medicine technology are designed for health professionals or individuals with a previous science background. These programs are ideal for radiologic technologists and ultrasound technologists wishing to specialize in nuclear medicine. They also attract medical technologists, registered nurses, respiratory therapists, and others who wish to change fields or specialize.
People not already trained in one of the health professions have three options: a 2-year certificate program, a 2-year associate program, or a 4-year baccalaureate program. Generally, certificate programs are offered in hospitals; associate programs in community colleges; and baccalaureate programs in universities. Among the topics covered in all programs are physical sciences, the biological effects of radiation exposure, radiation protection and procedures, radiopharmaceuticals and their use on patients, imaging techniques, and computer applications. Programs that grant academic degrees associate or bachelors cover additional topics. The Committee on Allied Health Education and Accreditation (CAHEA) accredits most formal training programs in this field.
Nuclear medicine technologists are among the occupations covered by the Consumer Patient Radiation Health and Safety Act of 1981, which aims to protect the public from the hazards of unnecessary exposure to medical and dental radiation by making sure that personnel involved in administering radioactive drugs or operating radiologic equipment are properly trained. The act requires the Federal Government to set standards that the States, in turn, may use for approving training programs or licensing individuals who use radioactivity elements or radiation in medicine or dentistry.
Procedures for acquiring professional credentials in nuclear medicine technology include licensure and certification or registration, which is voluntary. Registration or certification is available from the American Registry of Radiologic Technologists (ARRT) and from the Nuclear Medicine Technology Certification Board (NMTCB). Credentials from either of these professional bodies qualify applicants for employment in the hospital setting.
Many jobs are open only to registered or registry-eligible technologists. Hospitals, for example, generally require CAHEA-accredited training plus credentials in nuclear medicine technology. Medical group practices and outpatient clinics are more likely to hire technologists without formal credentials.
Career opportunities are diverse. Advancement usually involves promotion to a supervisory position, such as chief technologist or department administrator or manager. Specialization in a clinical area such as nuclear cardiology or computer analysis offers another route for advancement. Some technologists progress by becoming instructors or directors in nuclear medicine technology programs, a step that usually re-quires an associate or bachelor's degree in nuclear medicine technology. Some technologists leave patient care to take positions in research laboratories. Others leave the occupation to work as sales or training representatives with health industry equipment manufacturing firms or radiopharmaceutical companies, or as radiation safety officers in regulatory agencies or hospitals, positions which build upon their background and experience.
Job Outlook:
Employment of nuclear medicine technologists is expected to grow faster than the average for all occupations in response to the health care needs of a growing and aging population. However, most job openings will come from the need to replace experienced technologists who leave the field.
Strong demand for nuclear medicine procedures is expected for several reasons. Substantial growth in the number of middle-aged and older persons will spur demand for diagnostic procedures, including nuclear medicine tests. Advances in medical diagnostics are likely to lead to new applications of nuclear medicine. Moreover, the cost of conducting these exams will continue to be covered, for the most part, by health insurance programs including Medicare and Medicaid.
The growing popularity of modalities such as magnetic resonance imaging could reduce demand for some nuclear medicine procedures, but on balance, technological innovations seem likely to increase rather than decrease the diagnostic uses of nuclear medicine. The use of radiopharmaceuticals in combination with monoclonal antibodies is just one illustration of the field's enormous diagnostic potential. Monoclonal antibodies have an affinity for tumors. When radio actively marked, they are easily followed by scanning equipment as they gather around otherwise invisible parts of the body.
They can be used to detect cancer, for example, at far earlier stages than is customary today, and without resort to surgery. Another illustration is the use of nuclear medicine diagnostics in cardiology. Using radionuclides injected into the bloodstream, nuclear medicine technologists can measure the percentage of the patient's blood pumped by each contraction of the heart. This procedure performed at rest, and during stress, examines the heart's ability to meet the body's needs. In some patients, such a test eliminates the need for cardiac catheterization, a costly and at times risky procedure.
Cost considerations will affect the speed with which new applications of nuclear medicine become widely available. As new medical techniques emerge, insurance companies and other third-party payers decide whether or not they are reimbursable. Some promising nuclear medicine procedures, such as PET (positron emission tomography), are extremely costly, and hospitals contemplating them will have to consider equipment costs, reimbursement policies, and the number of potential users.
Job opportunities for nuclear medicine technologists in offices of physicians, medical laboratories, and free-standing imaging centers are expected to grow substantially in the years ahead. Nonetheless, hospitals will continue to be the dominant employer of these workers.
Employment prospects are excellent at present; reports of a shortage are widespread. The long run outlook is favorable, inasmuch as demand is projected to rise while the supply of new graduates may not keep pace. Enrollment in accredited training programs has declined in recent years. If current enrollment patterns persist, the number of job openings will exceed the number of qualified applicants.
Related Occupations:
Nuclear medical technologists operate sophisticated equipment to help physicians and other health practitioners diagnose and treat patients. Workers in related occupations include radiologic technologists, ultrasound technologists, cardiology technologists, electroencephalographic technologists, clinical laboratory technologists, per fusionists, and respiratory therapists.
