Nuclear Medicine Consultant

Job responsibilities

We are a large nuclear medicine department in South West England, with 3 consultants (including this post),dedicated medical physics and technologist staff and 4 gamma cameras. We provide the full range of imaging,non-imaging and therapy procedures, including for children, and undertake some work for patients fromneighbouring hospitals. PET is outsourced to Alliance Medical until 2026, with consultants providing medicalsupport and reporting within NHS time.The department has a good track record of introducing new procedures and practices and optimising existingones. Since 2002 we have introduced whole-body bone SPECT, SPECT-guided CT for bone scans, cardiac MIBGscans, 111In transferrin, 99mTc-DPD, 111In erythrocytes and platelets, HIDA scans with morphine provocationand 131I-MIBG, 223Ra and 177Lu-DOTATATE treatments. We are currently working to introduce 99mTc PSMAand 177Lu PSMA. We started technologist reporting of bone, renal and sentinel node scans as well as phoneclinics for our thyroid patients. The new post holder would be very welcome to make a significant contributionto continuing innovation.Over the last few years, the department has come under pressure from staff retirements, expansion of non-clinical work and ageing equipment. These problems are now being addressed with the recruitment ofadditional staff: 3 clinical technologists, 2 medical secretaries, 1 booking clerk/receptionist. There is a plan tomove the department to ground floor level, currently scheduled for 2023, and install 3 Siemens SPECT/CTcameras, together with dedicated treatment rooms and better separation between cold and hot areas.

Staffing:Medical Consultant in Nuclear Medicine (full time), Consultant Radiologist (5 clinical sessions in nuclearmedicine), and this post. There are junior medical staff.Medical Physics 2 Consultant Medical Physicists, 2 medical physicists, 3.2 WTE. Regular rotation of traineephysicists. The physics team are keen to assist in developing the service both in imaging and therapies. Theteam has seen a lot of changes over the last year but is building the groundwork for a great service goingforward. There are many clinical imaging and therapy developments that are wanted by the Trust whichadditional staffing and the new gamma cameras due to be installed in 2023 would be able to support. Withmultidisciplinary working this will involve this is an exciting time to be part of instigating new services andproject work that would be ideal for publication.Technologists Chief Technologist, Deputy Chief Technologist, Advanced Practitioner (Reporting),Radiopharmacy Production Manager, Deputy Radiopharmacy Production Manager, 5 clinical technologists, 3vacancies (of which 2 are filled and 1 is currently being advertised). Following a high number of retirementsover the last few years, we have a relatively junior technologist workforce at the moment and a fair amountof time is spent on training to achieve various competencies. Some technologists have acquired additionalskills, e.g. reporting of bone/renal/sentinel node scans, performing cell labelling, assisting with cardiac stresstests, performing 177Lu-DOTATATE treatments.Nursing we used to have a part-time nurse who could lead cardiac stress tests and assist with performing177Lu-DOTATATE treatments. Re-provision of these activities is under development with the Imagingdepartment and oncology.Clerical 1 clerical co-ordinator/lead medical secretary, 2 medical/support secretaries (1.07 WTE) with 2vacancies about to be advertised, 1 receptionist, 2 booking clerks (1.64 WTE) with 1 vacancy about to beadvertised.Facilities:The department, including the radiopharmacy, has a U-shaped layout around a large light well, with mostrooms having daylight. We have 4 camera rooms, 2 injection rooms (one of which is also used for cardiac stresstests), a general lab and storeroom, mostly shared offices for consultants, medical physicists, technologistsand clerical staff. Treatments are carried out in injection or camera rooms. Clinic patients are seen inconsultants offices; outpatient clinic spaces can be made available if preferred.Cameras GE Millenium VG Hawkeye (2003), GE Infinia (2003), Siemens e.cam single head (2007), SiemensSymbia T (2007). We have tried to replace these cameras since about 2015, so far unsuccessfully. The currentplan is for a relocation of the whole department to ground floor level, with 3 Siemens Intevo Bold SPECT/CTcameras, expected in 2023.Other gamma probe counter, equipment for cardiac stress testsTreatment one shielded on suite treatment room on the oncology ward suitable for 131I and 177Lu, twofurther rooms suitable for 177Lu (but not used recently)RadiopharmacyThe radiopharmacy operates under a Manufacturers Specials Licence to prepare 99mTc radiopharmaceuticalsfor use in-house and for neighbouring departments at Truro, Torbay and Exeter during times of shutdown andmaintenance.It is comprised of two separate suites, one for 99mTc kit preparation and the other for radiolabelled bloodproducts. Both suites are Grade D environments containing negative pressure isolators and served byungraded support rooms. The 99mTc suite also has a microbiological safety cabinet for dispensing of injectionsin a Grade A environment. This is used for all 99mTc radiopharmaceuticals and several others including 223Ra,DaTSCAN and 111In octreotide and chloride.As per the requirements of the Special Licence, the unit is managed by a Radiopharmacy Quality Manager whois a pharmacist and a Radiopharmacy Production Manager and his deputy, both technologists. It is subject toMHRA Good Manufacturing Practice inspections on a three-yearly basis. Most technologists in the departmentrotate through radiopharmacy as part of their duties.The unit was extensively refurbished in 2013-15 and is one of the most technologically advancedradiopharmacies in the UK. Both isolators are capable of being hydrogen peroxide vapour gassed, althoughonly one H2O2 generator is available, and this is dedicated to the 99mTc isolator. The unit is almost entirelypaperless, records being held electronically on a collection of in-house developed databases.In the next few months, these databases will be replaced by two commercial systems following the retirementof the previous Radiopharmacy Quality Manager who developed and supported the databases. There is alsoan ongoing review of staffing and capacity in the radiopharmacy as Derriford to achieve national standards forstaffing.Cell labelling undertaken includes 111In leucocyte and platelet labelling for infection imaging and survivalstudies respectively, 111In plasma labelling for gastrointestinal protein loss and 99mTc denatured erythrocytelabelling for imaging of accessory splenic tissue. An 111In erythrocyte labelling has been developed for red cellmass determination but this has yet to go live.99mTc PSMA has been successfully produced in recent months with a view to clinical use in the not-too-distantfuture.Workload:Common procedures (2021): bone whole-body SPECT 1271, dynamic bone 76, myocardial perfusion 144,DaTScan 123, VQ SPECT 289, MAG3 177, DMSA 120, GFR 269, breast sentinel 347, melanoma/vulval sentinel70, HIDA (morphine, fatty meal, SPECT/CT) 115, gastric emptying 33, SeHCAT 20, Tektrotyd 44, MIBIparathyroid 56, Tc thyroid 42, I-123 thyroid 13, Tc DPD 11; 223Ra 141, Lu-DOTATATE 28, 131I benign 27, 131Imalignant 25Less common procedures (total numbers 2017-2021): HMPAO brain 10, MUGA 23, Tl rest/redistribution 22,cardiac MIBG 4, GI bleed 11, GI reflux 11, Meckels 31, platelet survival 19, denatured red cell 27, In WBC 137,Tc WBC 29, lung lobar quantitation 12, CSF shuntogram 12, lacrimal drainage 6, MAA shunt 22, limblymphatic drainage 4, MIBG 59, In octreotide 87, Tl parathyroid 26, protein loss 3, blood volume 33; P-32 10,Y-90 synovectomy 3Procedures for which we have a license, but which have not been carried out in the last 5 years: 123I IBZM,133Xe, 14C urea, 14C glycocholic acid, 57Co cyanocobalmin, 59Fe chloride, 81mKr, cardiac first pass, MIBItumour imaging, Tc PSMA, Tc ECD; I-131 MIBG, 153Sm EDTMP, 89Sr chloride, 186Re HEDP, 90Y microspheres,90Y ibritumomab, 169Er colloid, 186Re colloid, 177Lu betalutinPET reporting for Alliance Medical within NHS time: FDG 1424, PSMA 109, choline 43

Teaching:The department has successfully trained four Year 5 radiology trainees since 2002. Although we are accreditedfor year 6 and physician training as well, we have never undertaken this and historically have not had sufficientpatient throughput for some of the therapy procedures. We regularly teach radiology trainees in the PlymouthRadiology Academy, and they occasionally rotate through the department, but there is significant scope forexpanding their exposure to nuclear medicine. Our technologists are encouraged to study for higher degrees,and this is supported by medical and medical physics staff as required. The new post holder would be expectedto contribute to teaching and if they are particularly dedicated to this, could make significant improvementshere.

Research and audit:Members of the department have previously published original research papers on VQ SPECT, DMSA SPECT/CTfor assessment of renal masses, the use of metoclopramide and various SPECT reconstruction algorithms forreduction of bowel uptake in myocardial perfusion scans, attenuation correction of myocardial perfusion scansand resolution recovery for planar bone scans, although currently we do not actively pursue any researchprojects. We have contributed to several national audit projects. The new postholder would be very welcome to initiate their own research projects, and the introduction of 3 SPECT/CTcameras should provide ample opportunities for publications

Education, Qualification and Special Training

Essential

• Full GMC Registration
• FRCR, MRCP or equivalent
• Entry on specialist register for Nuclear Medicine within 6 months of interview

Desirable

• MD, PhD or other postgraduate degree
• CCT in Radiology

Particular Skills and Experience

Essential

• Clinical experience and training in nuclear medicine (diagnostics and therapeutics) sufficient to practice independently
• Able to supervise and report a broad range of nuclear medicine examinations including non-imaging tests.
• Able to practice independently in the following areas: ? care of thyroid patients with benign/malignant disease: assessment prior to I-131 therapy, delivery of I-131 therapy, follow-up incl. use of antithyroid drugs/thyroid hormones
• Able to practice independently in the following areas: care of neuroendocrine patients: assessment prior to Dotatate therapy, delivery of therapy, follow-up
• Ability to supervise radiology Specialty Trainees and technologists across a broad range of nuclear medicine.
• Able to participate in PET on-call rota. Hold an ARSAC practitioner license within 6 months of interview

Desirable

• Able to practice independently for a range of other therapies: Ra-223, PSMA, P-32, radiosynovectomy, Sm153 EDTMP
• Able to lead pharmacological cardiac stress tests
• Able to supervise and report PET/CT scans Experience in non-FDG PET-CT

Research and Clinical Audit

Essential

• Ability to apply evidence-based approach to management of clinical problems.

Desirable

• Evidence of completed audit projects Completion of clinical research.
• Publications in peer reviewed journals
• Ability to undertake basic science research
• Ability to lead research team
• Previous success in grant applications to national funding bodies

Teaching

Essential

• Ability to teach clinical and practical skills.

Desirable

• Experience of teaching clinical skills to undergraduate and post graduate students
• Ability to supervise postgraduate research.

Communication & interpersonal skills

Essential

• Well-presented CV.
• Ability to communicate well with patients and staff, both orally and in writing. Honesty and reliability. Ability to work in a team.
• Enquiring, critical approach to work.
• Caring attitude to patients, relatives, GP's, nurses, and other agencies
• Commitment to Continuing Medical Education
• Leadership qualities.

Desirable

• Information technology skills
• Willingness to undertake additional professional responsibilities at local, regional or national levels

Management

Essential

• Ability to advise on efficient and smooth running of specialist service
• Ability to participate in Department, Directorate and Trust Management.

Desirable

• Experience in medical management.

Practical Requirements

Essential

• Ability and willingness to work hours of the job, shifts, on-call with any reasonable adjustment to take account of any local requirement or disability
• Ability to move between sites if required

Disclosure and Barring Service Check

This post is subject to the Rehabilitation of Offenders Act (Exceptions Order) 1975 and as such it will be necessary for a submission for Disclosure to be made to the Disclosure and Barring Service (formerly known as CRB) to check for any previous criminal convictions.

Certificate of Sponsorship

Applications from job seekers who require current Skilled worker sponsorship to work in the UK are welcome and will be considered alongside all other applications. For further information visit the UK Visas and Immigration website (Opens in a new tab).

From 6 April 2017, skilled worker applicants, applying for entry clearance into the UK, have had to present a criminal record certificate from each country they have resided continuously or cumulatively for 12 months or more in the past 10 years. Adult dependants (over 18 years old) are also subject to this requirement. Guidance can be found here Criminal records checks for overseas applicants (Opens in a new tab).

UK Registration

Applicants must have current UK professional registration. For further information please see NHS Careers website (opens in a new window).