[Guest] Elective Extravaganza: Nuclear Medicine in KZN

The second in my series about medical electives, today I share a post written by Stéphan, a medical student from South Africa who has just completed his fourth year. He writes about what may well be the least-known elective and discipline. Enjoy, and feel free to let me know if you would like to share about your elective.

Good day all of BarefootMedStudent’s avid readers! I’m one of the lucky few who were asked to contribute to her new Electrifyingly Entertaining Elective SeriesTM. The field I’m covering isn’t the standard elective fare (which is, by the way, some sort of cardiac super speciality or rural health…) but rather an under-appreciated and often under-used field: Nuclear Medicine.

elective extravaganza nuclear med

Many of the more left-wing, tree hugging, root eating and Democrat-voting readers (who are vital members of society I must add. Without them I would have had nobody to offend) may wish to hit me over the head with a solar panel at this moment, and thus I’ll ask everyone to calm done to a panic and read on.

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Stéphan: Image provided

Nuclear Medicine, whilst very cool, does not involve trips to Chernobyl, Little Boys or Fat Men (though some of the patients were on the roundish side). In med school we usually just get one lecture Nuclear Medicine per organ system. It would be a forty-five minute talk filled with terms like cyclotron and technetium and MIBI. Med students, being the hardworking diligent people they are, would then promptly forget these scraps of information, because it’s only one lecture and “would never appear in the exam anyway”.

This lack of exposure made me decide that I shall brave unknown waters and do my elective in this field. Of course there were competing ideas. Ever since second year, I had great interest in cardiology. The heart is a wonderful organ. It makes sense. Pressure and flow and resistance make its physiology and consequent pathology logical and predictable. Another suggestion was radiology, but we had so many lectures and tutorials on that subject that I didn’t feel that I would benefit me that much.

Cancer: Miscellaneous Cancer-Related Tests and Procedures

Getting this elective organised held a few challenges, but most of them involved the admin departments of the universities. The University of KwaZulu-Natal first thought I was a European exchange student and kept on demanding to see my passport. The other problem was the fact that the Nuclear Medicine Department only opened late this year and thus didn’t have their own admin staff. Thus I had to ask permission directly from UKZN, who promptly refused at first because Nuclear Medicine “doesn’t exist”. After repeated email correspondences and many phone calls they realised it would be easier to just let the insistent bugger do his elective. Of course it took my university three weeks to write a one paragraph letter of recommendation, but that is a story for another day.

When I finally joined the department I learned that this isn’t a rip-and-tear speciality like orthopaedic surgery. It is rather more academic, requiring some reading on particle physics, isotope half-lives and organ physiology before it makes sense. The Inkosi Albert Luthuli Central Hospital’s Nuclear Medicine department is divided into four subdivisions: In Vitro, PET, diagnostic nuclear medicine and therapeutic nuclear medicine.

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The In Vitro section was the most exciting for me (some of my friends have pointed out that I get excited about strange things) for here they could calculate precise measurements of patients’ glomerular filtration rate by using marked red blood cells and foreknowledge of the isotope’s decay rate. This isn’t some chem-path guesstimate, but the real thing!!

Diagnostic nuclear medicine works closely with other specialities. Here scans can be done to access bone pathology, ventricular function, peritoneal leaks and at least another four dozen procedures. A lot of the patients were from oncology and cardiology. The therapeutic side mainly treat thyroid problems.

PET scanning is a wonderful thing. Not only do you get excellent combined images of physiology as well as anatomy, it is one of the few places where you get to work with ANTI-MATTER!!!

On the whole it wasn’t a very hands-on elective. The preparation of the radiopharmaceuticals and imaging is mainly done by radiographers. The consultants and registrars (and lone elective student for that matter) mostly look at the images and interpret what is seen. I also had the opportunity to sit in with their discussions with the cardiology and neurology departments. It was an eye opener to see these tests being used to better patient care, tests that seldom, if ever, get requested in at my school’s training hospital.

The one practical session that was immensely interesting was a sentinel lymph node biopsy. It also gave me the opportunity to appreciate the resources of the IALCH for the surgeon got the biopsy results back whilst she was still operating.

Thus I would recommend this speciality to sort of student who wants to engage with matters that don’t always fall directly in the field of general medicine. It is also a holistic speciality, involving all the organ systems, oncology, infectious diseases and even trauma.

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Stéphan tries out the two-headed gamma camera. Image provided.

As somebody who really enjoyed his time in this department I would really wish I could say that everyone should have an in depth knowledge of Nuclear Medicine, but this would unfortunately be biased propaganda.

Most of the work is done by the specialists, and a GP would never truly have to interpret a scan. But I do believe greater emphasis must be given to this field in the undergraduate course. Students often know when it is indicated to do CTs, blood panels and biopsies, but few know when to utilise Nuclear Medicine.

Students must know this modality is safe, often using less radiation than X-rays, and can give better information. Not only that, but one must remember that physiology changes before anatomy and thus many pathologies can be spotted much earlier.

In a joint session with the Radiologists discussing a malignant melanoma case, one of the Radiology Consultants said of the tiny metastases to the spine and lungs: “If you (Nuclear Medicine) didn’t show them to us, we wouldn’t even have known that they were there!”

And so I hope I have shown you a bit of Nuclear Medicine. It’s there, and it can change lives.

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