Career lifetime advances in nuclear medicine

Abstract

When I qualified in 1967, medicine was much simpler, but becoming more interesting. There were new diuretics (ethacrynic acid and furosemide) which really worked ‐ I’m probably one of the last housemen to have used Southey’s tubes for drainage of intractable oedema. We also had new antibiotics such as ampicillin. My surgical skills were minimal, and my first house job was as house surgeon to the cardiothoracic unit at Westminster Hospital, where I clerked the patients, held the retractor and looked after the patients in the postoperative period. This was basically applied physiology ‐ and I enjoyed it. My medical house job was in cardiothoracic medicine, and here I came across my first real taste of what was to become nuclear medicine when we were able to send patients over to University College Hospital (UCH) to have their pulmonary perfusion assessed. 1 Remember, there was no computed tomography (CT), no magnetic resonance imaging (MRI), no ultrasound and little angiography. I enjoyed applied physiology, so I managed to persuade the cardiothoracic unit that they needed a senior house officer in what would now be called intensive care, and they persuaded the Garfield Weston Foundation to fund a post. This included looking after postoperative patients, as well acting as resident doctor to the respiratory and coronary care units (including two hyperbaric tanks). I also found time to go on the course in clinical measurement run by Dr Percy Cliffe’s department, and to teach myself programming in FORTRAN on the IBM 1800 computer. Having decided that a physician’s life was for me, I went to work for Dr Phillip Harvey at St Stephen’s Hospital in Fulham, where I passed MRCP part I, and took part II. I then decided that to be a general physician I needed to learn more neurology, so I got a registrar post in neurology at the Royal Free Hospital ‐ where nuclear medicine re-entered my life. The standard methods of diagnosing intracerebral pathology involved basic ultrasound to look for a shift of the midline structures, followed by angiography, usually by direct carotid puncture. If this did not resolve the issue, the patient went to Queens Square for a pneumoencephalogram. However, the medical physics department at the Royal Free had a rectilinear scanner, and one of my tasks was to inject the patients with the pertechnetate to allow imaging. The images were amazing ‐ it was possible to see a tumour without risk to the patient. I also helped set up and run a Parkinson’s disease clinic for trials of L-DOPA and related agents. 2 Still trying to be a general physician, I went on to a short spell as a locum senior registrar in rheumatology, and then was offered a locum post at Guy’s in endocrinology and nuclear medicine. These were two specialties I had not tried, so I accepted the offer. The nuclear medicine was a revelation. There was exposure to a wide new field. We were measuring glomerular filtration rate using Cr-51-EDTA, looking for pulmonary emboli, carrying out renography using probes to assess kidney function, and localising the placenta in pregnant patients with antepartum haemorrhage using a Sn/In-1113m generator, a probe and a calibrated tea towel. I knew that this felt right for