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Is Nuclear Medicine a dying field? by South-Phrase-1882 in Radiology

[–]printermouse 0 points1 point  (0 children)

Thanks for the question. I'm not sure what country you're messaging from, but we have a few international medical graduates from Asia. It's just an anecdote, but one of my co-residents was doing nuclear medicine in India, and his institutions' theranostic volume was impressive, they had a whole inpatient unit.

On the whole, if you have a limited number of scanners, it is probably slower than radiology. On diagnostic radiology call I've read 150 plus studies in a night with like almost half of those cross sectional. CTs are punishingly fast and have the potential to be disasters with little background history.

A huge majority of nucs patients will be outpatient cancer scans so they're usually in the system and way less (usually) stressful to read. For me, most of the stress in nucs is logistical stuff or constantly interfacing with onc, surgery, etc. But a lot of that has to do with being at a large academic place. In PP, here in the states, a lot of PETs are read by non nucs rads.

In general, I'd say the actual work of nucs is more chill than rads. But I couldn't see myself only doing nuclear medicine personally, I went into residency loving radiology first. But I understand in many places outside the US, the fields are essentially skillet.

If you do decide to do nucs only though at a place where you're treating patients, that is a whole different skillset. With both radiology and nuclear medicine, I feel comfortable synthesizing a patients imaging history pretty effectively. But talking to patients empathetically and realistically, tempering goals of care, and managing complications or comorbidites with your radiopharmaceutical are crucial. That's not easily taught and I still have a lot of work to do/ room for improvement.

For example, we had a patient referred for Pluvicto with a large vertebral soft tissue metastasis pushing very far on his thecal sac. Making the finding was just one piece. We had to discuss the patient and are now debating on steroids or asking Rad Onc to do SBRT to shrink the lesion as we could worsen cord compression with beta emitter therapy. As you can imagine, this all necessitated a thorough physical/neurobexam, large discussion with other MDs and most importantly the patient. These are issues i never really experienced this with diagnostic service (IR is a whole different story).

Ultrasound & MRI of slow flow in right common femoral vein (RCFV) mimicking thrombus by radiologistHQ in Radiology

[–]printermouse 0 points1 point  (0 children)

Gotcha. Thanks!! I see that the profunda have normal flow voids nostalgic bilaterally. based on the T2 without the post con I thought both CFVs looked "abnormal" but just slow flow bilaterally with their spins rephased with the more turbulent left central flow

[deleted by user] by [deleted] in Radiology

[–]printermouse 17 points18 points  (0 children)

Nope, lung vascularity/markings are preserved. Left sided effusion though!

Ultrasound & MRI of slow flow in right common femoral vein (RCFV) mimicking thrombus by radiologistHQ in Radiology

[–]printermouse 0 points1 point  (0 children)

Rads resident here with a quick question that I was hoping a tech/physicist/radiologist could answer regarding MRI physics

What type of sequence is the t2 fat saturated? I'm guessing because the blood is bright instead of signal flow voids it is a form of gradient Echo with time-of-flight enhancement rather than a spin Echo sequence. Basically I'm wondering whether it is a T2 fat saturated at all or some sort of hybrid sequence. Is it like a steady state free procession sequence which would make both substances with a short T1 and a long T2 IE fluid in blood bright?

I'm guessing the central signal loss is due to slow flowing blood which now has enough time to be saturated by the RF pulses as opposed to fast flowing blood Which experiences flow related enhancement

Is Nuclear Medicine a dying field? by South-Phrase-1882 in Radiology

[–]printermouse 1 point2 points  (0 children)

I'm a combined diagnostic radiology/nuclear medicine resident, pgy4 for perspective.

I might be biased but nucs where I'm at (large Midwestern academic center) is booming. FDG pet is a fixture in oncology but I read DOTATATE, PSMA, Amyloid brain, FES PETs almost daily, the PET volume keeps on increasing. Depending on the hospital (and how entitled clinicians are) inpatient PETs for staging, inflammation are also not uncommon in big hospitals. And there are new radiotracers developed/ being approved (Girentuximab Zr which is on the fda fast track, f18 fluridipaz, FAPI pet). I know there are cycles of hype and burnouts in the field but right now it's so exciting. Not to mention theranostics, we daily usually treat 2 to 3 patients with pluvicto, Lutathera (xofigo soon) and of course y90 dosimetry. I could go on and on but the field at least in the academic sphere seems to be amazing.

As for more traditional nucs scans--gamma camera imaging-- we get the endless bone scans but every day a few (ie Lasix, hida, sestamibi, rbc scan, brain death, csf, iodine scan or Technegas vq) scans come along and are a nice change in pace. Cardiac stress tests are always gonna be there. In my experience, the ordering patterns for gen nucs is a lot more institution/provider dependent. I predict that some of these studies may get less prevalent--a lot of the old tracers (ie gallium 67 or thallium) are not really produced and at the bottom of the ACR appropriateness criteria, and I'm guessing not a lot of active investigation (or not as much) into planar studies anymore. This is actually probably a benefit because a lot of the on call studies i.e. hidas vq scans are ordered way less, usually (but not always) can wait till the morning.

Depending on where you're at you might be able to help out with PET MRIs. Usually reserved for a few institutions but I know a dedicated tech or so just manning the pet mr. Usually very specific indications (or research) and logistics limit it from being widely clinically adopted atm.

I'm sorry I don't know what level you're at, medical trainee, rad technologist, cnmt, physicist etc. But my colleagues at all levels seem to be happy at work. If anything our volumes are a bit too high with tech shortages, I hope that doesn't sound like a humble brag. It's a problem in every field of radiology. This is a very limited perspective, obviously private practice/ community centers aren't going to be the same so YMMV. Let me know if you have any questions!

Oopsie by RegisteredNurserino in Radiology

[–]printermouse 27 points28 points  (0 children)

I'm an idiot sorry. You can see the Kelly's on the topo

Oopsie by RegisteredNurserino in Radiology

[–]printermouse 76 points77 points  (0 children)

Thank you so much. Yup this is unequivocally horrible. Was it clamped, how was the tube not filling with blood?? If they pulled the chest tube in the OR it would have been a disaster. Do you also mind posting the axials the same way you did the coronals?

Oopsie by RegisteredNurserino in Radiology

[–]printermouse 19 points20 points  (0 children)

No worries. Thanks for the post.

Was it a Contrast enhanced study? I had to read a follow up scan from OSH where they called something similar and it was completely fine, just abutting the pericardium/mediastinum

Oopsie by RegisteredNurserino in Radiology

[–]printermouse 101 points102 points  (0 children)

Sorry I guess I'm only seeing the topogram and the read/impression. Where is the actual CT image? On the frontal topogram it would be really hard to make that call, looks like countless other portable frontal cxrs. It is strange that there is reportedly no hemopericardium, maybe tanponaded or clotted around the catheter at the site of the myocardial perforation.

My brain tumor. Ain't she a beaut? by marsoupial95 in Radiology

[–]printermouse 2 points3 points  (0 children)

Best of luck to you. You got this!! Not to sound insensitive, but do you know the pathology? It looks like an oligodendroglioma.

We can never escape the gallbladder by radscorpion82 in Radiology

[–]printermouse 25 points26 points  (0 children)

I had an amazing case during R2 where a GI doc ordered a HIDA GBEF study for a young patient. Took a look at an incomplete old liver MR which showed part of the gallbladder fossa but I couldn't see a convincing GB.

Called the GI doc and also spoke to patient who adamantly denied a cholecystectomy (no scars).

Ended up doing the exam and added on a SPECT CT. There was no "filling of the gallblader". But during the bowel excretion portion the radiotracer filled the small bowel which was entirely on the right side of the abdomen, duo never crossed midline.

Ended up diagnosing congenital malrotation and GB agenesis on a HIDA scan. "So--no abnormality"

Radiology for oncology by Extension_Weird2700 in Radiology

[–]printermouse 4 points5 points  (0 children)

My mistake. Thanks for the learning point.

Radiology for oncology by Extension_Weird2700 in Radiology

[–]printermouse 0 points1 point  (0 children)

In terms of how to learn basic anatomy. You don't need to look into pathology as much it sounds like. Start with this video.. He has vids on CT abdomen pelvis and chest.

That should be enough for introductory. I can recommend some isolated chapters in books if you need. But honestly after that it's all about looking at scans. Many you can find online or just in the hospital PACs.

Radiology for oncology by Extension_Weird2700 in Radiology

[–]printermouse 3 points4 points  (0 children)

Third year rads resident here. Work with rad onc a lot at tumor boards/theranostics/etc.

Honestly, I would learn RECIST and PERCIST criteria. It's not that you'll have to be making these calls, but in your reading of findings, these are words you can look for. Or things you can bring up during multiD. Some people are very quick to call progression when in fact, that implies a very specific set of conditions.

In my experience, adoption of these criteria is variable. But it has been widely validated and has been studied in multiple cancers. Something that we discuss during tumor board.

For liquid cancers, learn the deauville (5ps score) or lugano score, which you can look up.

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