WHEN you hear the word ‘nuclear,' the first thing that you think of is more likely to be associated with war than with medicine. Simon Rose is the Nuclear Medicine Section Head at the King Fahd Armed Forces Hospital in Jeddah, and has been in Saudi Arabia for ten years. He had no specific plans to come to Saudi Arabia, but one day he realized that he had had enough of working in the UK in the National Health sector. He handed in his resignation and registered with an employment agency in Dublin. The first job they offered him was here. Nuclear medicine falls within the radiology specialty. His explanation as to what nuclear medicine is sounds complex at first: “Nuclear medicine is to radiology what physiology is to anatomy.” In other words, radiology itself produces images that show the physical systems of the human body, and nuclear medicine produces images showing how those systems are actually working (or not working). “This is achieved by an intravenous injection of a specifically prepared radio-pharmaceutical. This is radioactive; it emits gamma rays and these are detected by a gamma camera, which is linked to a computer. The software is able to analyze these images in various ways.” Rose's initial radiography training took three years, and then he trained in radio nuclide imaging for an additional eighteen months. “I am fascinated by the function side of the body. The main areas of work that I am involved in here are cardiac (heart) studies, renal (kidney) studies, bone studies, and studies of the endocrine system, particularly thyroid and parathyroid glands. Heart studies are mainly to investigate chest pain and possible heart attacks; we can look at the blood supply to the heart muscle wall and the function of the muscle wall. With bone scanning, we do a lot of work with people who have primary tumors. These may be in the bone, or the primary tumor may be a breast tumor, or a bladder or prostate tumor, and the bone scan helps to stage the disease. Treatment can be guided according to the results of the scan, whether this is surgery, or radiotherapy, or chemotherapy.” The patients he deals with range in age from tiny babies, through to 90 year olds – or more. “The pediatric renal imaging in particular is a good example of how technology has become a victim of its own success: ante-natal ultrasound scans (i.e. on pregnant women) are now so good and of such high quality that you can detect kidney problems in the fetus before it is actually born. This puts an extra work load on imaging departments.” Although Rose and his colleagues do not have to wear protective clothing in their work, they do have to wear a monitoring device to detect radiation levels that they are subjected to. “This monitor is checked every three months. The materials that we handle are low dosage and we are trained to handle it with respect. This involves making up the pharmaceuticals, using the correct injection technique and the correct scanning technique. I have worked in nuclear medicine for 25 years and have never had a problem.” Nonetheless, as part of the Health and Safety regulations, the actual radiology department is well secured behind lead lined walls with warning symbols on the door and the words: ‘Authorized Personnel only.' The main equipment Rose uses is a Gamma camera and, like all the radiology equipment, it is made by Siemens. “It is a very mobile piece of equipment and you can cover images from all angles. It can also do what we call a whole body sweep if we need to scan the patient from head to toe. The great thing now is that most systems have an integrated CT scanner so you gain the benefit of the superior anatomical resolution combined with the superior physiological functional imaging from nuclear medicine. This means you can pinpoint any lesions with great accuracy.” When patients come to the department, they can naturally be nervous. “It is very important to reassure them that the test we are doing is a) safe, and b) that we are trying to help them. We have to be careful with them.” Rose particularly enjoys his work because: “I have an endless fascination with how the human body works, and why it goes wrong. It also makes me feel good that I am helping people get through their problems. It is a also great challenge keeping up with advances in technology, particularly software.” When he talks about the ‘downside' of his job, he bursts out laughing. “You could call it ‘lastminute.com” - nuclear medicine techs hate it when on the last day of the week, the doctor comes down and suddenly says: ‘We have a patient for a gastro intestinal bleed examination'. That can take anything from one to 24 hours. When it happens, you have to remember that you are there for that purpose and get on with it. But that is life.”
