Consultant physicians working with patients - Royal College of ...

Consultant physicians working with patientsscans are often planned in advance. However, someunits have limited instant access to some tests such aslung scintigraphy. Direct access to services without areferral from a medical or IR(ME)R-approvedpractitioner is, therefore, inappropriate for bothpractical and safety reasons.The majority of diagnostic nuclear medicineinvestigations are undertaken as outpatient procedures,whereas high-activity radionuclide therapy may requireinpatient admission for between 1 and 7 nights in asingle room with separate washing and toilet facilities.Written information is required for all procedures andis, ideally, developed in collaboration with patientrepresentatives. The Joint Specialty Committee forNuclear Medicine and the British Nuclear MedicineSociety have developed central information resourcesfor patients and their carers. The significance of testresults and potential implications for management areusually discussed with patients by their referringclinician.4 Interspecialty and interdisciplinaryliaisonMultidisciplinary team workingNon-medical personnel are essential to routine nuclearmedicine service provision. The skill mix varies betweendepartments but will usually include physicists andother clinical scientists, medical technical practitioners,radiographers, radiopharmacists and nuclear medicinenurse specialists. Play specialists and cardiac technicianscontribute to specialist services in centres with a highpaediatric or cardiac workload. Provision of a medicalphysics expert and a radiation protection adviser is alegal requirement.Nuclear medicine clinicians liaise closely with mostother specialties and are often core members of cancermultidisciplinary team (MDT) meetings. Review ofnuclear medicine imaging should be undertaken byappropriately trained specialists who are able to provideadvice reflecting new information arising from MDTdiscussions. The Royal College of Physicians (RCP) haspublished new guidance for nuclear medicinephysicians working within MDTs.Most nuclear medicine specialists undertakeradionuclide therapy and many are the lead clinicians injoint clinics managing benign and malignant disease.5 Delivering a high-quality serviceA high-quality service is patient centred and producesaccurate results in a timely manner in accordance withexplicit service standards. Nuclear medicine servicesshould be led by a specialist trained to CCT level (or onthe specialist register), or equivalent, in nuclearmedicine. Service quality is jeopardised in hospitalswhere there is no sessional commitment to nuclearmedicine, particularly if a small nuclear medicinecaseload is divided between a large numbers ofconsultants, diluting individual experience. The nuclearmedicine physician liaises closely with scientists andclinical colleagues to ensure that new evidence-basedtechniques are introduced safely.Reciprocal rota commitments with colleagues in otherunits are recommended to avoid professional isolationfor consultants working single-handedly. Telemedicinelinks improve communication between large andsmaller departments and facilitate audit but are not asubstitute for local clinical involvement. Scan readingand issuing reports is only part of the role of the nuclearmedicine specialist. As many of the studies performedare not well known by the general medical professionproviding an expert opinion and guidance is alsoessential.The facilities required to deliver a high-quality serviceinclude: dedicated patient waiting areas to separate patientswho have received radiopharmaceuticals frompatients and carers not receiving them separate area for administration ofradiopharmaceuticals dedicated toilet facilities which will need to complywith trust’s disabled access and personal dignityrequirements examination rooms and quiet counselling room fordiscussion with any patient, including any pregnantand breastfeeding women, appropriate to thecasemix secure radiopharmaceutical storage area area for image analysis data-reporting room educational and library area separate paediatric waiting or play area, asappropriate cardiac stressing facility – this may be shared withcardiology if it is organisationally more appropriate182 C○ Royal College of Physicians 2013