Letter to Editor for “European Association of Nuclear Medicine (EANM) response to the proposed ASTRO’s framework for radiopharmaceutical therapy curriculum development for trainees.”

Dear Sir,

We have read the EANM response to the ASTRO framework for radiopharmaceutical therapy with great interest and endorse that there is a very solid perspective to nuclear medicine’s claim to the ownership of radiopharmaceutical therapy [1, 2]. Generations of physicians have spent their professional and personal life learning and delivering radiopharmaceutical therapies to patients since the first use of P-32 for the treatment of leukemia and polycythemia in California by John H. Lawrence who identified the therapeutic potential of artificial radioisotopes in 1938, even before Saul Hertz in laid foundation of theranostics with radioiodine in 1941 [3, 4].

It is unfortunate that as radiopharmaceutical applications are on the verge of unprecedented expansion, there is a clear and present danger of its balkanization. In not so distant past, similar treatment was meted to PET/CT, another grand success story of scintigraphy since the first [18F]-FDG PET scan by Abass Alavi in 1976 [5]. There is a greater than ever need of mutual respect between the three well-established medical disciplines involved in the usage of radiation, i.e. radiology, nuclear medicine, and radiation oncology. To a curious observer, it would seem that there has been a welcoming attitude from nuclear medicine towards other disciplines to get onto the nuclear medicine turf, with limited reciprocity. The upcoming dual certification pathways in nuclear medicine provide no leverage or a grandfather clause for those who are not just well trained but also have demonstrable experience and competencies in hybrid imaging acquired over 8 to 10 years. Everybody cannot engage in re-inventing the wheel due to a change in the goal post. On the contrary, radiology trainees are being lured into taking up nuclear medicine as a subspecialty interest. The marketability of skills was pre-emptively used on the wrong premise that the need for nuclear medicine physicians will decrease. It has increased, and there is a global shortage of trained nuclear medicine physicians to deliver the services to the patients in need today, and worst is projected. Interestingly, scientists: medical physicists, radiopharmacists, radiochemists, technologists, and cyclotron engineers, all are benefitting from the growth of nuclear medicine, while trained nuclear medicine physicians are being denied to celebrate the “tryst with destiny.”

In Europe, the standard for delivering radiopharmaceutical therapy can be the European Board of Nuclear Medicine (EBNM), besides the national requirements. EBNM has a well-demonstrated resilience and high standards of professionalism. It has an international standing with the capacity to deliver onsite and hybrid examination since the COVID-19 pandemic [6, 7]. Specialists in radiology and radiation oncology can be required to meet the requirements of EBNM for formal dual certification through the summation fellowship examination. Similarly, a nuclear medicine physician keen to practice radiation oncology or non-hybrid diagnostic radiology can undertake a similar course. All clinicians should be equally facilitated with credits for their background knowledge and experience from the preliminary core specialty. The future of nuclear medicine is bright; however, atmosphere, circumstances, and practical demonstration can help create greater cordiality among the diverse group of clinicians practicing radiological sciences, as recognized under the endorsement of IAEA at the global stage [8–10].

Data availability

Data sharing not applicable to this article as no datasets were generated or analysed during the current study.

Declarations

All authors are responsible for the contents of this letter-to-editor manuscript.

Conflict of interest

The authors declare no competing interests.