Dear Editor:

I read the article by Chris Wolski, "The Case for BMD Testing" (March 2003), with interest. In the last page of the article, under the heading "Anybody's Game," Wolski makes the assumption that there is a lack of specialty ownership regarding bone mineral densitometry [BMD]. This, however, is incorrect.

The specialty of nuclear medicine, as well as the specialty of endocrinology and metabolism, has specific guidelines within their Royal College [RCPSC] training program concerning BMD. Nuclear medicine specialists bought BMD to Canada in the early 1980s. Nuclear medicine specialists train for 5 years in the specialty with extensive training in the performance, supervision, and interpretation of BMD. Nuclear medicine residents are also tested at the Royal College level. Therefore, nuclear medicine specialists have ownership of this procedure from both a historical and Royal College examination perspective. Other specialties have obtained training in the field as well, but as of yet, only nuclear medicine has such an extensive training program covering all aspects of bone mineral densitometry.

In addition, Chris Wolski quotes Dr Lentle as stating "it is not rocket science." I would agree that BMD does not meet the level of expertise required in neurosurgery, for instance. However, there is an exceedingly important amount of detail required in the performance and interpretation of BMD studies. The technologist must be able to demonstrate a high level of precision in their positioning. In addition, the reporting physician must pay attention to the positioning as well as the clinical history and medication. The physician should also make recommendations on treatment management, though this is variable from province to province, based on provincial regulation.

Though I agree that technical quality and positioning are of utmost importance, the ultimate evaluation of this procedure rests with the physician. Nuclear medicine specialists bring a particular understanding of patient positioning and precision determinations due to our extensive training in both in vivo and in vitro procedures.

Christopher J.M. O'Brien, MDCM

President, Canadian Association of Nuclear Medicine