Now is a good time for radiology to cement its long-term relationship with nuclear medicine in a more formal way.

As radiology travels down the two-lane highway of anatomical and functional imaging, there is no more important navigator to have along than nuclear medicine. While radiologists bring their mastery of anatomy and the technology used to image it, nuclear medicine physicians possess the keys to the biochemistry required to unlock the toolkit of probes used in imaging cell function and viability.

Considering that radiology is currently reading significantly more than half of all nuclear studies and is poised to read even more with the deployment of dual-modality scanners that fuse functional and anatomical images, this is an excellent time to solidify what has been a long-term, but less than ideal relationship, and to make plans for a closer collaboration in the future.

The road signs clearly point in this direction. There are, however, some significant barriers in the way.

1. Practice patterns and that compelling force of inertia. Writing in favor of including nuclear medicine physicians in the radiology practice, Graham and Fajardo explain in a recent issue of the Journal of the American College of Radiology why this previously was not practicable and why it is today. ¹ It is no longer accurate to raise the old saw that nuclear medicine physician time is not well used in the morning. As the authors write, "lymphatic mapping for sentinel lymph nodes, bone densitometry, thyroid, biliary, gastric emptying, renal studies, and PET" are done all day long.
2. Logistics. Many practices are plagued by disagreements over who is and who is not pulling their RVUs, as well as differences in the valuation of various subspecialty forms of imaging. The practice president will need tremendous communications and management skills in order to smooth the entry for a nuclear medicine physician and then acclimate this person to practice culture.
3. Supply. A brave new world in therapy is just dawning in nuclear medicine, illuminating a third, preexisting lane in radiology already paved by interventionalists. With reimbursement assured for many oncological imaging applications of fluorine 18-labeled deoxyglucose with PET, the availability of this radiopharmaceutical is widespread. Other, less commercial medical radionuclides are not only less available, they are only sporadically available, limiting the ability of clinical trials on promising new therapies to proceed. Tenforde ² writes of the sad state of the Isotope Programs Office of the United States Department of Energy in an opinion piece in the American Journal of Roentgenology , and urges that the program be transferred to the National Institutes of Health to assure proper funding.

Our cover story this month on the nuclear medicine service at William Beaumont Hospitals offers interesting insight into the dynamics and possibilities inherent in a close integration of radiology and nuclear medicine. Bringing nuclear medicine into the fold simply enhances a practice's ability to meet the evolving needs of its customers.

The possibilities are literally nuclear.

Cheryl Proval

References:

1. Graham MM, Fajardo LL. Radiology and nuclear medicine: building a stronger partnership. JACR. 2004;4:237-238.
2. Tenforde TS. Medical radionuclide supplies and national policy: time for a change? AJR. 2004;3:575-577.