Order matters. And when you are starting in a radiology residency, it makes the most sense to learn subjects logically to get the most out of your first year. First, start with rotations that overlap most radiology topics. Then, afterward, get a bit more specific and esoteric. Right? However, as often is the case, many chief residents and program directors only have so many open slots to fill the rotation schedule. And all of them need to get filled. One of those residents has to begin with nuclear medicine. Maybe that person is you.
So, from the mouth of a nuclear radiologist to you, why can beginning with nuclear medicine be such a frustrating specialty rotation? Well, let me give you some reasons why starting with this subspecialty can be formidable. And, then I will provide you with the information you need to resolve the issue!
Reasons Why Starting With This Subspecialty Can Be So Frustrating
Some Nuclear Medicine Attendings Are Not Radiologists
Sometimes, especially in highly academic facilities, nuclear medicine attendings are strictly nuclear medicine trained. These attendings live and breathe a different world than the nuclear radiologist. They can’t take an overnight call as a typical radiologist would do. And, their perspective is very different from a radiologist. Not to say that they are not good doctors. But instead, you may not learn on that first rotation what you need to know to succeed in a radiology residency. Starting off the block in this situation can make your transition to radiology residency that much more difficult.
Lots of Cases Are Off the Beaten Path
In many nuclear medicine departments, most studies have less to do with the rest of radiology. For instance, many facilities perform an overwhelming number of cardiac myocardial perfusion scans. Sure, there is critical information on these studies. But, on-call, you may be very unlikely to see a cardiac perfusion case at nighttime. Or, you will catch lots of other more esoteric sorts of studies like gastric emptying to salivagrams. Although essential, learning these studies do not help much when you are taking cases at noon conference.
Need To Study Information Only Relevant To Nuclear Medicine
Finally, in nuclear medicine, you will need to learn lots of information only applicable to nuclear medicine. Learning about the dosage of radiopharmaceuticals will probably not help you much elsewhere in radiology. And, understanding radiopharmaceutical biodistribution, although critical to grasp the pathophysiology of a disease, in reality, will not go a long way toward helping you read a CT scan. This information takes time to learn and may replace the time you could discover other radiology topics.
How To Resolve The Issues That Come With Starting With Nuclear Medicine
When starting residency on a nuclear medicine rotation, regardless of whether your faculty is nuclear medicine only or a radiologist, make sure to look at nuclear medicine with the lens of how what you see on rotation does overlap with other subspecialties. Even the lowly salivagram has some features that you may find on other imaging modalities. In this case, look at the neck CT and MRI. Check out the anatomy of what you see on the salivagram, such as parotid atrophy, inflammation, or stones. Or, for the cardiac studies, make sure to learn about the angiograms, the cardiac MRI, and the CT scan findings as well. If you stay isolated in your learning and thinking, you will find nuclear medicine more frustrating.
Also, make sure to start learning those areas that you need to know for an independent call. Understanding the relevancy will make it seem like what you are learning has more real-world applications. Check out hepatobiliary scans, V/Q scans, and GI bleeding studies first to increase relevancy. Learning to interpret these studies will have easily observable influences upon patient management. It will make you feel all the more relevant when you are first starting.
Finally, seek mentors and fellow residents who have been in a similar boat to you when you are starting. You are not the one who has had this issue. Other residents have done very well even after starting with nuclear medicine as a first rotation.
Nuclear Medicine Doesn’t Have To Be So Frustrating On That First Rotation!
Well, there you have it. You may not be starting as central to all of radiology as you might have liked. But, you can create an experience that is worthy of a great month. Just follow some of the steps I listed and above, and you will learn a lot and have an excellent experience!
