Gamma Gazette Spring/Summer 2023/2024 edition of the ANZSNM

2023/2024 SPRING/SUMMER EDITION | ISSUE 40

Special Feature

Nuclear Medicine Technologist Workforce Summit

CAREERS Pru Burns Vicky Sigalas

NATIONAL NUCLEAR MEDICINE SCIENTIST/TECHNOLOGIST SHORTAGE An Australian Public Health Perspective

by Travis Pearson

CONTRIBUTIONS Nuclear Medicine in the post-operative Orthopaedic setting

2023/2024 SPRING/SUMMER EDITION ISSUE 40

CONTENTS 32 Nuclear Medicine

Technologists Workforce Summit 2023

38

National Nuclear Medicine Scientist/ Technologist shortage Australian Public Health perspective

32

43

Interview with Karen Jones Summit's Lead and Vice President, ANZSNM

3 From the President 5 Introduction 7 Branch News 14 TSIG Oversight Committee Report / SRC Update

14

18 Special Interest Group / Committee News

22 Meet the new TSIG Chair, Pru Burns 27 2024 ANSTO/ANZSNM Research Grant

7

28 Meet Vicky Sigalas 18

47 Submitted Articles & Papers

Nuclear Medicine in the post-operative Orthopaedic setting

51 Latest EduTrace CPD Webinars 53 Calendar of Events 47

6651

54 Job Vacancies 55 Office Bearers

2 GAMMA GAZETTE 2023/2024 SPRING/SUMMER EDITION | ANZSNM.ORG.AU

FROM THE PRESIDENT

W

elcome to the Spring/Summer edition of the Gamma Gazette Kevin London - MANZSNM President

Hello Comrades, Welcome to the 40th edition of the Gamma Gazette. As we head towards an expected hot summer, the activity occurring within ANZSNM is also heating up as we gather momentum to overcome the challenge of Nuclear Medicine Technologist workforce shortages across Australia and New Zealand. The ANZSNM TSIG has been working in collaboration with the wider nuclear medicine community to tackle this issue and this edition of the Gamma Gazette will highlight and share what has been achieved so far.

It is also the time of the year for membership renewals. I am pleased to share that the Society has put strategies in place to minimise any increases in membership fees which means if you renew your membership before 31st December 2023 then you can renew at a significantly discounted rate. I encourage you all to consider renewing to continue your journey with us and shape the future of nuclear medicine. If you have not yet renewed, then please check your inbox, and follow the instructions in the email.

The ANSTO/ANZSNM Research grant is aimed at encouraging research in nuclear medicine in Australia and New Zealand. Applications for the 2024 grant is now open and in assessing applications for the grant, preference will be given to early career researchers to provide seed funding for pilot investigations that could lead on to further grant applications. This is a great opportunity for members who are starting out in research and looking for a kick start.

As this is the last Gamma Gazette edition for 2023, I would like to wish you a safe and happy summer and remind you to start planning your holiday to the South Island of New Zealand to align with the 54th ASM which will be held in Christchurch in April 2024. It's a wonderful time of the year to explore the natural beauty that New Zealand has on offer.

It’s time to renew your membership for 2024!

RETAIN EXCLUSIVE BENEFITS

GAMMA GAZETTE 2023/2024 SPRING/SUMMER EDITION | ANZSNM.ORG.AU 3 RENEW AND REAP THE REWARDS!

anzsnm.org.au/memberships

OUR CONTRIBUTORS EDITORIAL COORDINATOR Rajeev Chandra General Manager PO Box 6178, Vermont South, VIC 3133 T 1300 330 402 F (03) 8677 2970 gm@anzsnm.org.au

EVENTS & ADVERTISING ENQUIRIES marketing@anzsnm.org.au

Karen Jones The University of Adelaide, Adelaide

Travis Pearson Queensland Health, Queensland

SUBMISSIONS secretariat@anzsnm.org.au

DESIGN & PRODUCTION Enovate Studio www.enovatestudio.com

PUBLISHED IN Winter, Autumn & Spring/Summer

CONTENT SUBMISSIONS Pru Burns Capital and Coast District Health Board, Wellington

Vicky Sigalas Women's and Children's Hospital, Adelaide

SCIENTIFIC SUBMISSIONS ON ALL ASPECTS OF NUCLEAR MEDICINE ARE ENCOURAGED AND SHOULD BE FORWARDED TO THE SECRETARIAT (INSTRUCTIONS FOR AUTHORS PUBLISHED AT HTTPS://WWW.A NZSNM.ORG.AU/AC TI V ITI E S/ GAMMA-GAZETTE-CONTENT-SUBMISSION-ANDGUIDELINES/).

LETTERS TO THE EDITOR OR POINTS OF VIEW FOR DISCUSSION ARE ALSO WELCOME. IF ORIGINAL OR PUBLIC DOMAIN ARTICLES ARE FOUND AND CONSIDERED TO BE OF GENERAL INTEREST TO THE MEMBERSHIP, THEN THEY SHOULD BE RECOMMENDED TO THE EDITOR WHO MAY SEEK PERMISSION TO REPRINT.

Darin O'Keeffe Christchurch Hospital, Christchurch

Kim Jasper Knox Private Hospital, Victoria

THE ANZSNM GAMMA GAZETTE IS PUBLISHED THREE TIMES A YEAR. DEADLINES FOR EACH ISSUE OF THE JOURNAL CAN BE FOUND ON OUR WEBSITE ANZSNM.ORG.AU

DISCLAIMER THE VIEWS EXPRESSED IN ANY SIGNED ARTICLE IN THE JOURNAL DO NOT NECESSARILY REPRESENT THOSE OF THE SOCIETY. THE INDIVIDUAL RIGHTS OF ALL AUTHORS ARE ACKNOWLEDGED.

Karan Singh Nuclear Medicine/PET Advanced Trainee The Children's Hopsital at Westmead, Victoria

Trish Mead Auckland DHB, Auckland

THE AUSTRALIAN AND NEW ZEALAND SOCIETY OF NUCLEAR MEDICINE © 2022 COPYRIGHT IS TRANSFERRED TO THE AUSTRALIAN AND NEW ZEALAND SOCIETY OF NUCLEAR MEDICINE ONCE AN ARTICLE/PAPER HAS BEEN PUBLISHED IN THE ANZSNM GAMMA GAZETTE (EXCEPT WHERE IT IS REPRINTED FROM ANOTHER PUBLICATION).

WWW.ANZSNM.ORG.AU

4 GAMMA GAZETTE 2023/2024 SPRING/SUMMER EDITION | ANZSNM.ORG.AU

INTRODUCTION TO THE SPRING/SUMMER EDITION Welcome to the Spring/ Summer edition of the Gamma Gazette. We hope that wherever you are reading this that you are enjoying the longer days and the warmer weather.

It has been a busy time in the Society with various branch meetings and presentations going on all around the country. It’s a good reminder of how valuable your ANZSNM membership can be in helping members keep up with the latest developments in our field.

Which also makes it a good time to remind everyone to renew their memberships for 2024! Early birds will get 20% so it makes sense to get that out of the way before the Christmas rush.

This issue has been put together by the VIC/TAS branch and I’d like to thank our committee members for all their hard work in sourcing the content for this edition.

We hope that there is something to pique your interest, or chat to a colleague about.

Enjoy the last few months of 2023 and hope that everyone can get some time off to rest and recover in January.

My Linh Diep — MANZSNM Branch Secretary, VIC/TAS

MEMBERS REWARDS PROGRAM EXCLUSIVE OFFERS FOR ANZSNM MEMBERS DISCOUNTS ON FASHION, DINING, ENTERTAINMENT, AUTOMOTIVE, HEALTH & WELL-BEING

SHOP NOW www.anzsnm.org.au

GAMMA GAZETTE 2023/2024 SPRING/SUMMER EDITION | ANZSNM.ORG.AU 5

Saturday

NOVEMBER

9:00 AM - 2:00 PM Crown Plaza Melbourne Morning tea and lunch provided Members $90; Students $80; Non-members $130

EVENT PROGRAM 09:00AM

Welcome

09:05 - 09:25AM

Johanna Ingbritsen “Optimisation of Low and Ultra-low dose TB PET/CT”

09:25 - 09:45AM

Hugh Morgan “Total Body Dynamic PET/CT” (using Quadra)

09:45 - 10:05AM

Nelson Salter –“Meet the GE OmniLegend”

10:05 - 10:10AM

Q & A panel

10:10 - 10:25AM

Morning tea

10:25 - 10:45AM

Reuben Smith - "Nuclear Medicine Imaging in Breast Cancer"

10:45 - 11:05AM

Dr. Rob Ware – "GMP and Tracer Development Initiatives"

11:05 - 11:25AM

Dr. Sidney Levy – "Total Body PET"

11:25 - 11:45AM

Dr. Boon Quan Lee "Dosimetry of radiopharmaceuticals in clinical research"

11:45AM - 12:05PM

Prof. Paul Donnelly - "Theranostics with copper-64 and copper-67 radiopharmauceuticals"

12:05 - 12:15PM

Q & A panel

12:15 - 13:00PM

Lunch break

13:00 - 13:30PM

Radpharm & SOPA Presentations

13:30 - 13:45PM

AGM & Award Finalist announcements

13:45 - 14:00PM

Drinks

6 GAMMA 2023/2024 SPRING/SUMMER EDITION | ANZSNM.ORG.AU This eventGAZETTE is proudly sponsored by:

BRANCH NEWS

VICTORIA/TASMANIA BRANCH NEWS It has been a busy time in the VIC/TAS branch as we put together the final pieces for our Annual Day Symposium on Saturday 18th November 2023.

W

e are in the process of finalising speakers from all around the country (live and in person) on a variety of topics, which we hope will be of interest to those attending on the day, or catching up later on EduTrace. We’d like to thank all the sponsors who have helped us out with holding our first in-person Symposium since 2019. We will be holding the Radpharm and Student Oral Presentation Award (SOPA) State final that afternoon, so a reminder to keep your eyes open for any cases that could be worked up into a presentation.

Jupp from Monash BioMedical Imaging discussed the “Practical Principals for the development and validation of novel PET radio-tracers" which was a great overview on how to get tracers from the lab into patients, and we finished off with Michael De Veer (also from Monash Biomedical Imaging) who presented on “Following drug biodistribution in large animals using PET imaging” and how this assisted in the drug development cycle. It was a great morning of interesting topics and an insight into the other ways Nuclear Medicine can be used.

We held our Master Class online on Sat 29th July, which gave our 80 registrants a great opportunity to see what are the new frontiers in PET and Nuclear Medicine research. We heard from Stephen Taylor who spoke on “Heavy Metal Therapy” and how Lead-212 could be a better isotope to use than Lu-177. Dr Mohammad Haskali from Peter Mac spoke on “Folding Peptides: Optimal Candidates for Theranostics Application against CCK-2 receptor positive cancers”, and how folding peptides in the molecules increased the efficiency of treatment.

Suzanne McGavin gave us an update of the program running at the NT Cyclotron to train NMTs to assist in the production of FDG, which led nicely into the talk by Harris Panopoulos from Austin Health on “How to Make PET Isotopes”.

It was also great to catch up with so many familiar faces at the TSIG Day Symposium in August, held down on the Mornington Peninsula. Congratulations to the organising committee who put together a great day of speakers and gave us an opportunity to catch up in person with techs from around the state and country.

We hope that all our members have a wonderful Christmas and a restful start to 2024.

Kim Jasper - MANZSNM Branch Chair, Victoria/Tasmania

Flora Mansour from ANSTO presented an overview of “Radioisotope research development at ANSTO” which covered the uses of Hg-203 and Tb-161. Dr Bianca

Stephen Taylor AdvanCell

Harris Panopoulos Austin Health

GAMMA GAZETTE 2023/2024 SPRING/SUMMER EDITION | ANZSNM.ORG.AU 7

BRANCH NEWS

VICTORIA/TASMANIA BRANCH NEWS (Continued)

Mo Haskali Peter Mac

Flora Mansour ANSTO

Suzi McGavin Northern Territory Government

Michael De Veer Monash University

Wednesday

DECEMBER

6

Rural Radpharm Presentations SAVE THE DATE Event Details Date: 6 December 2023 Time: 6:30pm AEDT Format: Zoom 8 GAMMA GAZETTE 2023/2024 SPRING/SUMMER EDITION | ANZSNM.ORG.AU

Register Now 1 CPD Hrs

www.anzsnm.org.au

BRANCH NEWS

WESTERN AUSTRALIA BRANCH NEWS The WA Branch held our annual Radpharm Award night just recently, hosted by Envision and Qscan. Our congratulations go to our WA Radpharm Award winner, Murray Wachtel, who will be representing WA and Sir Charles Gairdner Hospital in New Zealand next year.

E

veryone in attendance thoroughly enjoyed both the Radpharm component as well as a very interesting presentation by Dr. Jeremy Ong on Tumour Heterogeneity and Theranostics. It was such an interesting presentation in the first place and everyone also really enjoyed the opportunity to ask a lot of relevant questions afterwards.

We enjoyed a social event in Fremantle in early September. It was a bit of a cold and blowy day but a group of us met up for an indoor afternoon of drinks, nibbles and chatter and everyone had a great time. Numbers were down on our usual social events so I think we will resume holding our events in a more central Perth location when it’s warmer and go back to bar hopping some of the many rooftop city bars.

As a committee we decided earlier in the year not to proceed with organising our Annual Day Seminar for August.

The decision wasn’t taken lightly but was based on a few reasons. Primarily, there was less enthusiasm than usual to get organised, without a balanced mix of professions on our committee and time felt like it was slipping away from us. Committee members have had additional NM commitments this year, a number of us are involved in other committees too and also our work sites are short staffed so people already feel stretched managing their clinical load. We do hope to hold an event next year because we know our WA members and non-members love having a day to learn, network, connect and socialise. As a committee we like making these occasions happen but they take a lot of work as everyone knows.

We are looking forward to finishing our year with our AGM which will be hosted by SKG in November and we wish everyone a safe and happy lead into the festive season.

Georgina Santich - MANZSNM Branch Chair, Western Australia

GAMMA GAZETTE 2023/2024 SPRING/SUMMER EDITION | ANZSNM.ORG.AU 9

BRANCH NEWS

SOUTH AUSTRALIA/NORTHERN TERRITORY BRANCH NEWS The Royal Darwin Hospital hosted their very first meeting in July, and presented fantastic talks about the logistics of nuclear medicine in the Northern Territory.

D

r Morigi, Suzi McGavin and Dr Consulato Cara spoke about setting up their nuclear medicine department, the different challenges they experience due to their patient demographics, location and the lack of nuclear medicine/PET services in the NT, and the life of a nuclear medicine tech that does it all – general nuclear medicine, PET/CT, and cyclotron production. It was fascinating to hear their perspectives in nuclear medicine and there was a lot of discussion from participants in a very well attended meeting.

Our next meeting was hosted by the Queen Elizabeth which showcased Stephen Tronchin’s PhD work in “Modelling of Actinium-225 and its daughters”, and Associate Professor Gabrielle Cehic explained the next steps for State-Wide Patient Reported Measures and how it relates to nuclear medicine.

In August our technologist branch held a protocol review on Lymphoscintigraphy imaging. Different protocols from across the NT/SA and literature was discussed with interesting variations and tips and tricks shared amongst those who attended. This is available on Edutrace for those who are interested. We welcomed Clair Coat as the secretary of the ANZSNMT branch, while Amanda Ranchodbhai takes leave to welcome her new baby boy. Congratulations to you both!

As the year draws to a close we have some exciting events coming up. ANZSNM is proud to be sponsoring and supporting UniSA in a “Meet and Greet” for the first year nuclear medicine students at the Royal Adelaide Hospital in late October. It will provide the first years an opportunity to see what a nuclear medicine department is, and hear from industry experts before commencing stream specific subjects in their second year. The ANZSNMT SA/ NT Branch AGM, Radpharm Awards and Student Presentations will be held on Wednesday 15th November at the Cathedral Hotel, we are looking forward to hearing all the presentations! Finally, the ANZSNM SA/NT Branch AGM will be held on Friday 1st December at the Lion Hotel. It will be a great night to celebrate the year that was and to test our knowledge in our favourite pop quiz, registrations are open now!

Alessandra Caretti - MANZSNM Branch Chair, South Australia/Northern Territory

10 GAMMA GAZETTE 2023/2024 SPRING/SUMMER EDITION | ANZSNM.ORG.AU

APRIL ŌTAUTAHI CHRISTCHURCH

FRIDAY 26TH APRIL PRE-CONFERENCE SYMPOSIUM AT THE TOWN HALL

SATURDAY 27TH APRIL CONFERENCE SESSIONS EXHIBITORS HALL

ULTRASOUND GUIDED VASCULAR ACCESS FOR NMT’S WORKSHOP AANMS TRAINEE INTEREST GAMMA GAZETTE 2023/2024 SPRING/SUMMER EDITION | ANZSNM.ORG.AU 11 GROUP (TSIG) FORUM learn more at anzsnm.org.au

BRANCH NEWS

NEW ZEALAND BRANCH NEWS The Auckland City Hospital Nuclear Medicine department recently hosted 2023 ANZSNM NZ Symposium at Mövenpick Hotel in Auckland CBD on 9th and 10th September. There were approximately 80 delegates, including a mix of technologists, physicians, physicists from Te Whatu Ora hospitals and private practices throughout NZ, as well as our generous sponsors.

W

e invited notable speakers from the Auckland Region including, Professor Greg O’Grady speaking about Gastric Alimetry: a novel wearable device for mapping gastric function and comparison to gastric emptying scintigraphy testing; Helen Knight who spoke about Clinical Trials and shared with us the ins and outs of clinical research, the role we all play in ensuring the advancement of medicine, and ultimately the impact it has to our patients; and Brian Lunt who presented a summary of Auckland City Hospital’s Lu-177 Theranostics service from a radiation safety perspective including establishing quantitative imaging and performing patient dosimetry.

Other speakers comprised of peers from around the country including Dr Rachelle Steyn speaking on updates in NZ since 2021, Dr Karin Wells who gave a well-received presentation on “Future Liver Remnant Imaging", Karen Roeske who spoke about implicit and explicit bias in healthcare, and Prue Lamerton who gave an account of the Force of Cyclone Gabrielle in the Hawkes Bay. Our Symposium Dinner was held on Saturday evening.

The theme was “Power of the Past. Force of the Future” and The Radium Girls from Auckland City Hospital, and The Marie Curies from Palmerston North Hospital were joint winners of the Best Costume prize.

At the dinner the following speaker awards were presented:

2023 Radpharm Award: Franklin Eze – Mercy Radiology “Increased Sensitivity Of 68Ga-FAPI Over 18F-FDG In The Staging Of Lobular Breast Carcinoma: A Case Study".

2023 Paul Orr Award: Mary Haslam – Auckland City Hospital “Keeping An Eye On Progress – First In Human Trial Of Eye90 (Yttrium) Radiopaque Microspheres In Patients With Liver Tumours".

Trish Mead - MANZSNM Branch Chair, New Zealand

12 GAMMA GAZETTE 2023/2024 SPRING/SUMMER EDITION | ANZSNM.ORG.AU

MEMBERSHIP FOR 2024

NETWORK WITH LOCAL & GLOBAL PEERS

BE PART OF YOUR LOCAL BRANCH & LEAD THE WAY

ACCESS TO GRANTS AND AWARDS

CAREER ADVANCEMENT

EXCLUSIVE OWN & THIRD PARTY EVENTS

AND MANY MORE MEMBER BENEFITS

HOURS OF EDUCATIONAL CONTENT ON EDUTRACE

EVENTS HELD IN 2023

PARTICIPANTS ACROSS ANZSNM EVENTS

SPECIAL INTEREST GROUP/COMMITTEE NEWS

TECHNOLOGIST SPECIAL INTEREST GROUP (TSIG)

Chair TSIG

Chair WFA Committee

Chair CPD&E Committee

University Immediate Past Chair TSIG/ Liaison ANZSNM Vice President

Pru Burns, Suzanne McGavin, Erin Hemingway, and Emma Brook TSIG Oversight Committee

TSIG OVERSIGHT COMMITTEE REPORT Tēnā koutou katoa/Greetings/hello to you all.

I

write this during the much-celebrated Nuclear Medicine and Molecular Imaging Week. The TSIG CPD & Education Committee, led by Erin Hemingway, held a well-attended online webinar “Getting started in research - a guide for technologists”. Four experienced NMT’s spoke on the different pathways they took to enter their careers in research. It was very inspirational to hear each talk with such passion for research. To see an imagine from the talk by Sarah Daniel from an 18F-FDG PET/CT scan of a green turtle and Brittany Emmerson’s data of how many research projects Peter Mac is involved with (and first in human, wow) - we have some amazing work stories.

The TSIG Oversight Committee see supporting the growth of our NMT members as key to its success as a Special Interest Group. Assisting NMTs to find a pathway into research and encouraging NMTs to publish their work, are areas

Images kindly shared by Sarah Daniel, Senior Nuclear Medicine Scientist, Centre for Advanced Imaging, The University of Queensland.

of technologist development that the TSIG see as crucial to keeping engagement in our profession. Adding to the clinical components of our roles is not only personally satisfying, but it also helps to increase the capabilities of our talented workforce. Emma Brook, who has the

University Liaison Representative role on the TSIG OC, is collaborating with the Managing Editor of the Journal of Medical Imaging and Radiation Sciences (JMIRS) for ways that we can introduce our NMT members to the world of publishing.

14 GAMMA GAZETTE 2023/2024 SPRING/SUMMER EDITION | ANZSNM.ORG.AU

SPECIAL INTEREST GROUP/COMMITTEE NEWS

Technologist Special Interest Group (Continued) Providing feedback and commentary on documents and legislation are a large part of the TSIG Workforce Advocacy Committee’s mandate. Led by Suzi McGavin, the WFA have had calls for feedback almost every week for the last eight weeks! This requires reading the document, sharing individual comments (from either all or some members of the WFA), collation, checking, reading again, often adding to ANZNSM letterhead, and finally asking the wonderful Melissa Flannery, at our secretariat, to forward the piece of work to the appropriate email address. The TSIG send all official correspondence through the secretariat email as a way of keeping a record of what has been done on behalf of the Society, creating an archive for future TSIG committee members.

We have taken a huge step forward this week, in having the status of Nuclear Medicine Technologist (ANZSCO 251213) added to the 2023 Skills Priority List I’ll use a phrase my NZ colleagues are used to hearing me saying – "if an NMT’s voice is not in the room, we will not be heard." The TSIG has worked incredibly hard over the past two years, using our voice, to have the skills shortage recognised. This status helps demonstrate what we all know - we are a profession that needs support, from education, to retention, to immigration pathways.

Check out our occupations rating via the dashboard https://www.jobsandskills.gov.au/skills-priority-list As chair of the TSIG, I now have an opportunity to shamelessly promote with you (if you haven’t already heard) that the ANZSNM ASM 2024 is being held in Ōtautahi Christchurch, NZ. Fun fact #1 Did you know that Noble Prize winner, Sir Ernest Rutherford attended Canterbury University in Ōtautahi Christchurch?

Ernest is known for his pioneering studies of radioactivity and the atom. His discovery of alpha and beta particles is now realised in Theranostics today.

Fun fact # 2 2024 will be the 54th time an ANZSNM ASM has been hosted. This gives us an awesome opportunity to liven up the Awards Dinner with a “Studio 54” theme – google for inspiration (think gold sequins and disco!). I know our wonderful past TSIG chair & ANZSNM VP Karen Jones will have something vintage in her wardrobe ready to go.

Ngā mihi nui/Kind regards (with more emphasis on gratitude) Pru Burns - MANZSNM Chair TSIG

GAMMA GAZETTE 2023/2024 SPRING/SUMMER EDITION | ANZSNM.ORG.AU 15

SPECIAL INTEREST GROUP/COMMITTEE NEWS

Technologist Special Interest Group (Continued)

Photos of speakers at the 2023 TSIG Annual Day Symposium at Moonah Links Peppers in the Mornignton Peninsula, VIC.

Above and left to right: Associate Professor Daphne James (2023 Elizabeth Bailey Award winner) and TSIG OC members Pru Burns, Suzi McGavin, Karen Jones and Emma Brooks. Photos taken on the Mornington Peninsula, following the TSIG Annual Day Symposium, August 2023.

16 GAMMA GAZETTE 2023/2024 SPRING/SUMMER EDITION | ANZSNM.ORG.AU

SPECIAL INTEREST GROUP/COMMITTEE NEWS

Some of the posts on X below

SRC CHAIR REPORT

T

he ANZSNM TSIG Student Representative Council (SRC) has continued to fly the flag for nuclear medicine students, taking part in a number of events in recent months. SRC member Tina Pham provided valuable insights from the student perspective in her presentation ‘The Nuclear Medicine Students Journey’ at the TSIG Annual Day Symposium (Mornington Peninsula). August 12-20 was National Science Week, and SRC members Zara Butler, Tina Pham and I (Jess Watson) undertook a ‘Twitter Takeover’ in collaboration with Women in Nuclear. This was a great way to showcase a day in the life of a nuclear medicine student, highlighting the range of experiences we have at university and on clinical placement. Recently, SRC members have also participated in university open days in our respective states, promoting nuclear medicine programs to prospective students.

With the end of the year just around the corner, final year students are nearing completion of their programs – congratulations to all graduating students! As we farewell our graduates, expressions of interest are now open to students who would like to join the SRC in 2024.

Jess Watson - MANZSNM 3rd Year Nuclear Medicine Student (University of South Australia) SRC Committee Chair

GAMMA GAZETTE 2023/2024 SPRING/SUMMER EDITION | ANZSNM.ORG.AU 17

SPECIAL INTEREST GROUP/COMMITTEE NEWS

QUALITY AND TECHNICAL STANDARDS COMMITTEE (QATSC) Darin O'Keeffe - MANZSNM Chair, Quality and Technical Standards Committee (QATSC) Special Interest Group

A FAREWELL AND A WELCOME

U

nfortunately, we recently farewelled Madhusudan Vyas (TSIG) from the committee. I would like to thank Madhu for his many contributions to the committee and invigorating willingness to stick his hand up to help out – thanks Madhu! Madhu’s position was advertised and Catherine Robson was selected by the TSIG to be their representative on the committee. Welcome Catherine! Catherine is the Chief Nuclear Medicine Technologist and Practice Manager at Wollongong PET and Nuclear Imaging. Her email address in on the membersonly QATSC committee details page on the ANZSNM website.

RESOURCES UPDATE The ANZSNM does not necessarily endorse these resources. They are provided here simply to notify members of their existence. If you come across a useful quality or technical standard, or other resource, please email the details to QATSC@anzsnm.org.au so it can be considered for inclusion in future QATSC updates.

It’s not often these days that you get things for free. Here are a sample of Springer open access books that only indirectly relate to quality and technical standards, but they may be of interest to the ANZSNM community. I take my hat off to Springer for supporting open access books. Please feel free to recommend any you come across.

IAEA Atlas of Cardiac PET/CT - A Case-Study Approach (Marcelo F Di Carli ed et al, 2022) The IAEA has for a long history of supporting human health and this is another example of what the sort of work they do.

18 GAMMA GAZETTE 2023/2024 SPRING/SUMMER EDITION | ANZSNM.ORG.AU

Integrated diagnostics and theranostics of thyroid diseases (Luca Giovanella ed, 2023)

Connect with new colleagues and reconnect with old friends.

Join Special Interest Communities including Technologists, Physics or Paediatric Imaging.

Participate in online discussions with professionals from across the industry.

Stay connected all year round, no matter your location.

Help strengthen our profession with your expertise.

Easily access resources, documents, articles and presentations from meetings and events.

GAMMA GAZETTE 2023/2024 SPRING/SUMMER EDITION | ANZSNM.ORG.AU 19

SPECIAL INTEREST GROUP/COMMITTEE NEWS

Quality and Technical Standards Committee Interest Group (Continued)

Radiobiology Textbook (Sarah Baatout, 2023) At 667 pages, this is a serious look at radiobiology, and I found it very surprising it was an open access textbook. It even includes exercises and self-assessments. It starts out with a history of radiobiology and ends with ethical, legal, and social considerations, and it covers lots of science in between.

A Practical Guide for Pediatric Nuclear Medicine (Zvi Bar-Sever ed et al, 2023) This book starts out with the general principles of paediatric nuclear medicine then goes on to look at the nuclear medicine/PET investigations by organ system, including CNS and cardiovascular.

For each investigation within a chapter, there is snappy combination of clinical indications, pre-exam information, study protocol, study interpretation, any correlative imaging, red flags, take home messages, and representative case examples. At only 231 pages, it is succinct and worth having a look at.

A Guide to Responsible Research (Ana Marušić ed, 2023)

Only a short article this quarter because we are working on some projects behind the scenes that are not quite ready to be discussed yet. But as a sneak peak, one of these is a proposal for a new session at the 2024 Annual Scientific Meeting on “Essential QA in ...”. We had hoped to launch this session at the 2023 meeting in Adelaide, but it didn’t work out this year. We hope to see you at the session in Christchurch, April 2024!

To contact the QATS, email QATSC@anzsnm.org.au

20 GAMMA GAZETTE 2023/2024 SPRING/SUMMER EDITION | ANZSNM.ORG.AU

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GAMMA GAZETTE 2023/2024 SPRING/SUMMER EDITION | ANZSNM.ORG.AU 21

PEOPLE IN NUCLEAR MEDICINE

Meet the new TSIG Chair

Pru Burns

Pru Burns qualified as a MIT in 1993, and completed her post graduate study in Nuclear Medicine in 1999. Pru is currently the Unit Charge of Nuclear Medicine at Wellington Regional Hospital. Pru is the Professional member Nuclear Medicine Technologist on the New Zealand Medical Radiation Technologists Board, joining the Board in 2019.

A member of the ANZSNM since 2000, Pru has held New Zealand branch roles on and off over the years. In 2019 with the hope of networking at ANZSNM Federal Council meetings in Australia, Pru became the New Zealand branch Chair. As meetings moved online in early 2020, she was invited to join the TSIG Oversight Committee and to Chair the Workforce Advocacy. 2023 has been a busy year, as not only is Pru the new Chair of the TSIG, she is co-convener of the ANZSNM ASM in Ōtautahi Christchurch in 2024.

Can you tell us a bit about your career journey in Nuclear Medicine? How did you get started, and what led you to pursue this field?

I started out as an MIT, graduating in 1993. I was at university, failing at a BSc, and saw an advert for “Radiography Training” in the newspaper (yup, old school).

Leap forward to 1997, after an OE, I was working at Rotorua Hospital, and looking for something else. The University of Newcastle had just been approved to provide a Post Graduate Diploma in Nuclear Medicine for NZ based MIT’s, via distance learning. A move back to Wellington, and a clinical placement at Wellington Hospital and there you go.

I’ve spent time working in Melbourne, in private and public departments here in Wellington, and got to work in the first PET/CT department in New Zealand.

What does your role as a Nuclear Medicine Technologist at Wellington Regional Hospital involve on a day-to-day basis?

As Unit Charge of our Nuclear Medicine department, I get to do everything - clinical roles, staff management, talking with nervous patients and whanau (family), stock control, manual and policy writing; plus the less glamorous tasks – i.e. mopping the floor of the hot lab on a Friday when it’s my turn (well I pretend not too).

I have a couple of more administrative roles as well. I am involved with Professional Sterring groups which collaborate across New Zealand on Workforce, Education and Training; there are business cases to prepare; there are departments to work with on new/emerging procedures; and hospital Allied Health, Scientific and Technical group meetings.

2013 ANZSNM Radpharm Award Winner 22 GAMMA GAZETTE 2023/2024 SPRING/SUMMER EDITION | ANZSNM.ORG.AU

PEOPLE IN NUCLEAR MEDICINE

You previously served as the Workforce Advocacy Committee Representative for the ANZSNM Technical Specialist Interest Group (TSIG). Can you share some insights into your experience in this role and the impact it had on the profession?

The Workforce Advocacy Committee has grown into an amazing work horse for our NMT members. Each member comes to our meetings with enthusiasm and is engaged and passionate about supporting our NMT workforce. Reading and contributing to government and MRPBA documents and polices has improved my writing skills considerably. I struggle to write to the audience sometimes, but during my time on the WFA, I think I am improving! We are invited to contribute in other ways, from completing the Skills Priority List Stakeholder Survey for Australian Government Labour Market Research and Analysis to representation in face-to-face meetings with the MRPBA. Helping advocate for members is extremely important. The WFA have provided support and advice to NMT’s returning to the workforce, advocating for them with MRPBA, and connecting them with the wider ANZSNM community.

Could you provide some insights into the current state of the Nuclear Medicine Technologist profession in both Australia and New Zealand?

Our profession is experiencing a period of huge growth and expansion. Not only in technology, radiopharmaceuticals, and workload, but by the growth in the capabilities and skills that the NMT must now demonstrate. As a result, we are feeling the impact on our mental health and wellbeing as the prolonged workforce shortages continue to take its toll.

As the new TSIG chair, what goals or initiatives do you hope to accomplish in the next two years to further advance the profession?

I really want to keep the momentum that has started over the previous couple of years and continue to move us forward. The TSIG oversight committee (Emma Brook, Erin Hemingway, Karen Jones and Suzi McGavin) want to do more to support our students into regional and rural clinical placements; we want to take the outcomes of the Workforce Summit and make critical changes to assist our workforce. We want to collaborate with our international colleagues to raise the profile of the ANZSNM TISG on a larger platform.

How can technologists in the region benefit from being a part of the ANZSNM and specifically the TSIG?

I am most proud of the TSIG Pilot Mentor Program.

Mentorship is a powerful tool, that is proven to provide support and growth to both mentee and mentor.

The ANZNSM has a unique membership, encompassing technologists, radiochemists, physicists and Nuclear Medicine Specialists. This allows members access to all professions within our industry. I think our access to the Nucleus platform, Edutrace and the many CPD events run throughout the year make membership to our Society a must.

GAMMA GAZETTE 2023/2024 SPRING/SUMMER EDITION | ANZSNM.ORG.AU 23

PEOPLE IN NUCLEAR MEDICINE

Welcome to the new TSIG Chair, Pru Burns (continues)

What do you enjoy doing outside of work when you’re not busy with Nuclear Medicinerelated activities?

Can you tell us about a memorable or funny moment from your career that you’d like to share with our readers?

Riding my electric bike, taking our dog to the beach, putting Post-it notes in a new cookbook, having my family around, flicking through Trademe looking for a bach (holiday home).

From long ago, my then boss Prue Lamerton receiving a CV from a 3rd NMT called Pru, and our NMT colleague saying 'no way'!

If you could share one piece of advice with aspiring Nuclear Medicine Technologists, what would it be?

From literally today – putting a survey meter next to a 10-year-old patient and then his mum, demonstrating with audio that yes he was radioactive. He thought it was awesome.

Don’t sweat the small stuff; get excited by the technology and the advancements we are seeing right now - and sometimes, just listen to your elders.

ANZSNM Annual Scientific Meeting, Auckland, 2010

ANZSNM NZ Branch Meeting, Hamilton, 2017

24 GAMMA GAZETTE 2023/2024 SPRING/SUMMER EDITION | ANZSNM.ORG.AU

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20 ANSTO/ANZSNM Research Grant 24 Applications Open

ANSTO/ANZSNM RESEARCH GRANT 2024 ANSTO have reconfirmed their generous sponsorship of this grant in 2024 which is aimed at encouraging research in nuclear medicine in Australia and New Zealand. The grant is up to the value of $20,000 and is expected to run for approximately one year.

ANSTO is Australia’s government-funded nuclear science organisation. Its vision is to deliver excellence in innovation, insight, and discovery through its people, partnerships, nuclear expertise and landmark infrastructure.

Further details of the grant and how to apply can be found by clicking on the links below.

Note: The Applicant or Principal Investigator must be a financial member of the Australian and New Zealand Society of Nuclear Medicine at the time of application.

Closing Date: 15 December 2023

Click to view Research Grant 2024 Invitation and to Apply

Click to read the Research Grant 2024 Guidelines

GAMMA GAZETTE 2023/2024 SPRING/SUMMER EDITION | ANZSNM.ORG.AU 27

PEOPLE IN NUCLEAR MEDICINE

Interview with

Vicky Sigalas Vicky Sigalas is a Nuclear Medicine clinician with over 25 years of experience in clinical Nuclear Medicine management and service delivery. Vicky continues to extend her strategic management skills by maintaining active roles within the broader Nuclear Medicine profession including sitting as the State Representative of SA/NT on the Federal Council of the Australian and New Zealand Society of Nuclear Medicine (ANZSNM), and an Advisory Board Member and Working Party Group Member of the Australian Nuclear and Science Technology Organisation (ANSTO).

Vicky’s project management skills are evident in key leadership roles including her recent work as the Co-Convenor of the 2023 national conference of the ANZSNM. Vicky is considered a leader in the field of paediatric Nuclear Medicine and is consistently invited to speak at conferences and seminars. Her professional interests include dose optimisation in children, paediatric oncology and inclusive service. We talked to Vicky on the eve of her transition from clinical technologist to an executive position with the Federal Government.

Can you tell us about your journey in Nuclear Medicine and how you first became interested in this field?

I accepted an offer to study Nuclear Medicine at Uni SA straight out of high school. Like most young people entering the course, I had no idea what a career in Nuclear Medicine actually looked like! Fortunately, it turned out to be a good fit. I started my career in a large public hospital before accepting a promotion to a 2IC position in private practice. After a couple of years, I went on the become the Chief Technologist of Perrett Medical Imaging and held this role for 16 years! At a time when I felt like I could run a busy, multisite private practice with my eyes closed, I decided to switch things up and make a move into paediatrics.

Best decision ever. I had so much to learn about working with kids, and I loved every second of it. From the moment I started working in the paediatric space, I felt fulfilled. I’ve just clicked over 9 years at the Women’s and Children’s Hospital, and now I’m embarking on my next move – a pivot from NMT to Manager of Nuclear Security and Safeguards with the Federal Government.

You’ve been a member of the Australian and New Zealand Society of Nuclear Medicine for over two decades. How has being part of the Society impacted your career in Nuclear Medicine?

Introducing the Nuclear Medicine Paediatric Colouring Booking to Women’s and Children’s Hospital with book co-author, Ruby Holman.

Being part of the Society has benefited me in two key areas – networking and professional opportunities.

Attending branch meetings as a junior technologist, I sat in the background and observed. I listened to experienced, passionate professionals talk about things I didn’t really understand at the time. I always felt welcome, I often felt inspired. I learned a lot, even from my quiet corner in the back. In an era before the internet and social media, branch meetings helped me get to know people who worked in the same field as me. With time, I became more and more involved with the Society – joining the Federal Council as a

28 GAMMA GAZETTE 2023/2024 SPRING/SUMMER EDITION | ANZSNM.ORG.AU

PEOPLE IN NUCLEAR MEDICINE

State Representative, accepting the ANSTO Liaison role, joining the 2019 ASM LOC and co-convening the 2023 ASM. These were all volunteer roles but the skills I developed in each of these roles are highly valued by employers and have opened doors for me professionally.

overview of where Australia sits globally in terms of Nuclear Medicine production. I am thankful for the perspective this role has afforded me.

Can you tell us about your role as the ANZSNM ANSTO Liaison and how it As a co-convenor for the Adelaide has contributed to the field of Nuclear Annual Scientific Meeting, could you Medicine in Australia? share some highlights or memorable My work with ANSTO is two-fold; firstly, as a member moments from this event? of the Advisory Board and secondly, as a member of A highlight of co-convening the Adelaide ASM was the opportunity to meet our international guests. I was able to spend time with Sharmila Dorbala, Munir Ghesani and Dusty York. It was valuable to discuss local issues and gain an international perspective.

My other highlight was the flash mob. The flash mob was a little secret the LOC kept between themselves for quite a while. It was very satisfying to see it come together so well.

What motivated you to become a member of the Society’s Federal Council, and what role do you play in this capacity?

I became a member of the Federal Council to have a say in the future of my chosen career. There was a distinct moment in time when I realised that my voice was valuable. I knew I had considerable experience in private and public, adult and paediatric Nuclear Medicine and also management skills. I recognised that I could represent a broad range of interests. Additionally, I could see that I was capable of contributing meaningfully to the discussion. I joined as the State Representative for SA and NT. In my first year, Dale Bailey asked for expressions of interest to replace him as the ANZSNM ANSTO Liaison. A key responsibility for the role was to work alongside AANMS and RAINS representation to advise ANSTO in times of radioactivity shortage. I had experienced the impact of activity shortages first-hand so I put my hand up, of course, not appreciating at the time how much work was involved in the role. Nonetheless, it’s a decision I don’t regret. Working as the ANSTO Liaison has helped me think more broadly about the needs of our profession and given me an excellent

the Working Party Group. As a member of the Advisory Board, I act as a liaison between the profession and industry to advise ANSTO of the clinical implications of any reduction in radioactivity. It is an advisory role only – ANSTO ultimately makes the decisions.

As a member of the Working Party Group, I work as a member of a larger team to develop contingency plans in times of planned and unplanned shutdowns.

If your department uses radioactivity, then you will have directly benefited from the work I do with ANSTO. Saying that, however, I am reminded and humbled by something Dale Bailey once said to me – no one thanks you for all the times you get it right, but everyone will remind you of the times you got it wrong!

Awarded Best Presentation at ANZ Paediatric Imaging Conference

PEOPLE IN NUCLEAR MEDICINE

scans etc). The fun we had during scans became the best bits of her life. Hands down, making a difference in the lives of children and families is the most rewarding experience I’ve had as an NMT. The challenges I’ve experienced in Nuclear Medicine are the flip side of that coin. I’ve experienced both the highs and lows of paediatric oncology. The five-year survival rate for high-risk neuroblastoma is around 50% so I’ve had more than my fair share of sad days.

Managing compassion fatigue both for myself and my team has been one of my biggest challenges as a clinical NMT.

You recently transitioned into a new career in Nuclear Security at a Federal Government level. Could you share what inspired this career change and what it entails?

Patient-centred care, fun with kids

You’ve worked as a Nuclear Medicine Technologist for a number of years.

What are some of the most rewarding aspects of this role, and what challenges have you encountered?

Personally, I found my most rewarding experiences as an NMT through working with children. In particular, I found my niche working in paediatric oncology using Nuclear Medicine to diagnose, stage, and treat neuroblastoma. Working with young children and their families during the most vulnerable time of their lives, a cancer diagnosis forms a connection through shared experience. It is a privilege to infuse fun into the grind of treatment. I’ve had tea parties halfway through scans, I’ve colluded in pranks with patients, and I’ve learned Fortnite dances - all in the name of making memories with little people fighting big challenges. The destination in a cancer diagnosis is always a focus, but for a child, the journey is equally important. That really hit home for me recently when I was invited to the funeral of one of my young patients. I told her mum I would be honoured to attend but didn’t want to intrude. She went on to share that she wanted me there because I was one of her daughter’s best friends. Sadly, this beautiful young girl had spent over half her little life in hospital and had seen me every couple of weeks in some capacity (vascular access, GFR studies, MIBG

For better or worse, I’m the type of person who gets satisfaction out of achievement. Unfortunately, as a clinical NMT who has worked as a Chief Technologist for over 20 years, meaningful career challenges are getting harder to come by. When the opportunity to translate my skills and expand into other nuclear industries presented itself, I was intrigued. As someone who has essentially done the same job for years, the opportunity to grow my knowledge, my skills, my career, and my pay cheque was very attractive!

I’m excited to step into an executive role with the Federal Government, managing Nuclear Security and Safeguards. This isn’t restricted to Nuclear Medicine; it encompasses all nuclear materials and facilities in Australia. One major project I will be contributing to is the development of a national radioactive waste management facility. The Department of Industry, Science and Resources has a mission for Australia to be one of the few countries globally that have a purpose-built radioactive waste management facility for the safe and secure disposal of radioactive waste.

In doing so they envision a unique opportunity to make an impact in nuclear research and development and support healthcare at a national level. I’ve had a wonderful career utilising nuclear medicines and I love that I now have the opportunity to meaningfully contribute to an economically, environmentally, and generationally responsible approach to the management of nuclear materials and facilities for future Australians. My kids find it quite amusing that I have security in my new job title. They have taken to calling me Paul Blart (From the movie: Mall Cop) which I know isn’t a compliment!

30 GAMMA GAZETTE 2023/2024 SPRING/SUMMER EDITION | ANZSNM.ORG.AU

PEOPLE IN NUCLEAR MEDICINE

How do you see the field of Nuclear Medicine evolving in the coming years, and what role do you envision playing in its development?

Nuclear industries across Australia are expanding.

ANSTO has secured substantial government funding to expand their facilities over the next ten years and the AUKUS nuclear-powered submarine pathway will see Australia become one of only seven countries that operate nuclear-powered submarines. Additionally, we are all very familiar with the trajectory of theranostics in Australia. I see individuals currently working in the field of Nuclear Medicine in Australia becoming highly valued resources in the future. Our nuclear literacy is high and radiation safety principles are embedded in our DNA. I predict many Nuclear Medicine professionals will expand into other areas and collaborate beyond current boundaries. I’m personally very excited to be working with nuclear engineers in my new role to see what can be achieved when we bring new perspectives together.

As a member of the Society, how do you think the organisation can continue to support and benefit its members in the changing landscape of Nuclear Medicine?

Education. I think the work the Society has put into educational opportunities for members over the past few years has been incredible.

ANZSNM Conference 2023

In my experience, Nuclear Medicine is a very welcoming and collaborative profession. When I reflect on how students are supported at branch meetings and conferences, I am proud to be part of the profession. On a day-to-day basis, collaboration is at the heart of how we work – technologists, physicists, radiopharmaceutical scientists, doctors and nurses all working towards a common goal. I believe that’s a pretty unique working environment.

Genuine collaboration is always the key to unlocking potential. My advice to anyone considering a career in Nuclear Medicine or a transition into other nuclear industries is the same – embrace the opportunity to collaborate and you’ll achieve far more than you would alone.

Looking to the future, what are your aspirations and goals in the field of Nuclear Medicine and your work in national Nuclear Security?

Can you share any advice or insights for individuals considering a career in I’m looking at the next ten years of my career as an opportunity to make an impact at a national level and Nuclear Medicine or contemplating a work on a legacy project. I consider playing an active transition into other nuclear industries? role in developing Australia’s solution to responsible radioactive waste management and securing the future of Nuclear Medicine in Australia, a meaningful step in my career. At the heart of our profession, we all have a desire to care for people. I’m hopeful my new role will set the infrastructure so that NM professionals can continue to care for people well into the future.

ANZSNM Conference 2019 GAMMA GAZETTE 2023/2024 SPRING/SUMMER EDITION | ANZSNM.ORG.AU 31

NUCLEAR MEDICINE TECHNOLOGIST

WORKFORCE SUMMIT Insights from the 2023 Summit An Australian Public Health perspective by Travis Pearson Interview with the Summit Lead, Professor Karen Jones

32 GAMMA GAZETTE 2023/2024 SPRING/SUMMER EDITION | ANZSNM.ORG.AU

2023 Nuclear Medicine Technologist Workforce Summit Report

2023

AUSTRALIAN AND NEW ZEALAND SOCIETY OF NUCLEAR MEDICINE

Addressing the Nuclear Medicine NUCLEAR Technologist Workforce Crisis in MEDICINE Australia and New Zealand www.anzsnm.org.au

TECHNOLOGIST Insights from the 2023 Summit

As the demand for nuclear medicine procedures continues to rise in Australia and New Zealand, a critical shortage of Nuclear Medicine Technologists (NMTs) has emerged, especially in areas lacking local university nuclear medicine programs and rural and regional areas. The 2023 Nuclear Medicine Technologist Workforce Summit Report sheds light on the challenges faced by the sector and proposes collaborative

WORKFORCE SUMMIT

solutions. With only a modest (5.9%) growth in registered NMTs over the past five years in Australia, the workforce is struggling to keep pace with the 104% increase in Medicare rebate positron emission tomography (PET) procedures.

This shortage is exacerbated by the rise in CT scans, theranostic procedures, and the sector's projected expansion, requiring urgent attention and strategic initiatives.

Summit Highlights: On 4th August, 2023, the Australian and New Zealand Society of Nuclear Medicine (ANZSNM) hosted the NMT Workforce Summit, aiming to bring together education providers, regulators, professional bodies, Chief Allied Health Officers and workforce partners. Vice President, Karen Jones, presented a snapshot of recent NMT survey results, revealing concerns and experiences from the NMT workforce. The Summit discussions, structured around education providers, industry representatives, professional bodies, and regulatory bodies, identified key themes and opportunities for addressing the crisis.

REPORT

GAMMA GAZETTE 2023/2024 SPRING/SUMMER EDITION | ANZSNM.ORG.AU 33

P1

Key themes and opportunities included:

Tell Our Stor y Well Observations: Challenges in attracting students to nuclear medicine programs.

Misconceptions about the profession's scope and role within the healthcare sector.

Opportunities: Develop a comprehensive narrative to attract and retain students.

02

Create Diverse, Enriching, and Accessible Learning Experiences Observations: Challenges in clinical placements and fiscal disparities for students.

Growing inequity between urban and regional students.

Opportunities: Leverage private practice for more student placements.

Build a unified voice within Allied Health to advocate for the profession.

Enhance accessibility and affordability of placements, especially in regional areas.

Ensure clear communication with government bodies and decision-makers.

Explore new programs and hybrid learning approaches to bridge location gaps.

Achieve More Through Par tnerships

Invest in Our Workforce

03

Observations: Diverse perspectives among Summit attendees.

Recognition of qualifications through international agreements.

04

Observations: Workforce stress, burnout, and unclear career pathways.

Discrepant pay conditions between public and private practices.

Opportunities:

Opportunities:

Foster partnerships for resource sharing and cost efficiency.

Define and promote clear pathways for career advancement for NMTs.

Strengthen university and industry collaborations for broader training coverage.

Implement mentorship models to support new graduates.

Explore 'passport' concepts for workforce mobility across borders. bridge location gaps.

Explore research as a recognised career pathway.

34 GAMMA GAZETTE 2023/2024 SPRING/SUMMER EDITION | ANZSNM.ORG.AU

05

2023 Nuclear Medicine Technologist Workforce Summit Report

Explore Different Models Care AUSTRALIAN ANDof NEW ZEALAND

SOCIETY OF NUCLEAR MEDICINE

www.anzsnm.org.au

06

2023

Gather Data for Informed Decision-Making Observations:

Observations:

Current NMTs overextended, leading to premature exits.

NUCLEAR MEDICINE Need for strategic decisions based on reliable information.

TECHNOLOGIST Lack of comprehensive, accurate, and transparent workforce data.

Consideration of the 'Assistant' model of care.

WORKFORCE SUMMIT

Opportunities:

Opportunities:

Explore the 'Assistant' model to ease short-term pressure.

Establish nationwide data collection for accurate forecasting.

Recognise and respect different tiers of care within the workforce.

Collaborate with health economists for robust modeling.

Evolve to Endure

07

Observations: Rapidly changing healthcare sector.

Need for agility and flexibility within the Nuclear Medicine workforce.

Opportunities: Embrace emerging technologies for better outcomes.

The 2023 Nuclear Medicine Technologist Workforce Summit marks the beginning of a collaborative effort to address the critical shortage of NMTs in Australia and New Zealand. While challenges persist, the optimism among Summit participants is a testament to the commitment to positive change. The next steps, including prioritisation through participant surveys and the clarification of roles and responsibilities, will be crucial in translating opportunities into solutions. To delve deeper into the Summit outcomes, read the full report on the ANZSNM website and join the ongoing conversation about the future of nuclear medicine in our region.

Click to read the full report

Explore flexible training approaches to support regional and rural living.

REPORT GAMMA GAZETTE 2023/2024 SPRING/SUMMER EDITION | ANZSNM.ORG.AU 35

P1

Summit facilitator, Associate Professor Donna Markham

Summit lead, Professor Karen Jones

Online attendees

Summit attendees 36 GAMMA GAZETTE 2023/2024 SPRING/SUMMER EDITION | ANZSNM.ORG.AU

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GAMMA Limited GAZETTE SPRING/SUMMER EDITION ANZSNM.ORG.AU 37

National Nuclear Medicine Scientist / Technologist shor tage Australian Public Health perspective

by Travis Pearson, Director Nuclear Medicine Technology Queensland Health

Travis Pearson has been the Director of Nuclear Medicine Technology at the Royal Brisbane & Women’s Hospital for the past 20 years. Travis is also the Queensland Practitioner Board member with the Medical Radiation Practice Board of Australia and has attained CHIA certification. Travis was asked by the ANZSNM to prepare and present at the ANZSNM Nuclear Medicine Technologist workforce summit in August 2023 representing the Australian public Nuclear Medicine Technologist perspective.

The ANZSNM initiated a national workforce summit on August 4, 2023, to co-ordinate relevant stakeholders to better understand the current critical workforce shortage of the Nuclear Medicine Scientist/Technologist (NMS)* profession across Australia and New Zealand. In preparation for this event, relevant data was prepared and presented by attendees. The summary of the Australian Public Health NMS perspective presented has been summarised here.

This update is not the report from the summit, nor reflective of what is finally included.

National NMS Registrants: There are approximately 1300 registered NMS in Australia, with about one third of these employed within public health services. There are approximately 13 persons Registered both in NMS as well Diagnostic Radiography.

Recent years have resulted in on average 45 new Graduate NMS Registrants entering the system per annum. Australian accredited university programs have increased their intake recently with the future conversion to practicing Registrants yet to be understood. The impact of overseas trained Registration continues to be negligible.

To maintain existing headcount of Registered NMT in Australia at this rate will require each Australian (public and private) Registrant to remain in workforce for almost 30 years.

Noting this does not allow for any service growth or the increasing part-time proportion of the workforce that is occurring.

*Editor's note: NMS vs NMT is used in public health settings, and this article references NMT and NMS interchangeably.

38 GAMMA GAZETTE 2023/2024 SPRING/SUMMER EDITION | ANZSNM.ORG.AU

2023 Nuclear Medicine Technologist Workforce Summit Report

2023

The Medical Radiation Practice Board of Australia publishes quarterly statistics through their website. The Registrant numbers for the past 10 years are presented below. This presents a concerning trend for the NMT: AUSTRALIAN AND NEW ZEALAND SOCIETY OF NUCLEAR MEDICINE www.anzsnm.org.au NMT Registrations % Change Year on Year (30th June) 6.0%

5.4%

5.1% 5.0%

4.6%

4.5%

4.0%

NUCLEAR MEDICINE TECHNOLOGIST 3.0%

3.0%

2.7%

WORKFORCE SUMMIT 1.8%

2.0%

1.0%

1.7%

0.5%

0.0%

-0.3%

-1.0% 2014

2015

2016

2017

2018

2019

2020

2021

2022

2023

Interrogation of Health Workforce Australia data (taken from 2021 data published in April 2023) demonstrates a clear distinction of patient access to NMS workforce between States with a course and those without (noting NT data was unavailable and ACT is proximal to a NSW course)

NMT Density Percentage per 100,000 capita 2021 7.0% 6.01%

6.0% 5.0%

5.02% 4.48%

4.0%

4.09%

3.69%

3.56% 2.91%

3.0% 2.0% 1.0% 0.0% New South Wales

Victoria

Queensland

Western Australia

South Australia

Tasmania

Australian Capital Territory

As NSW NMS density percentage per 100,000 capita sits between the other two states with an accredited program of study for entry into the profession, it may be considered an appropriate benchmark for other states. In real terms as demonstrated below, this equates to an approximate deficit of 89 Registrants nationally at that point in time.

REPORT

GAMMA GAZETTE 2023/2024 SPRING/SUMMER EDITION | ANZSNM.ORG.AU 39

P1

This deficit should also be understood in context of both continuing growth in demand nationally for NMS services as well as observed changes in employee employment as the proportion of part-time workers transition from predominantly historic fulltime employment.

At the ANZSNM Annual Scientific meeting in 2022, Associate Professor Daphne James presented data reflective of the changes in demand for NMS services in Australia based on published Medicare data.

It was noted that whilst general nuclear medicine (SPECT) demand had remained stable with minimal growth (2010 to 2021), demand for Low Dose CT, increased 233% over the same period (noting the item number for this procedure associated with PET scanning was added during this time).

Demand for PET was reported as having increased by 49% between 2019 and 2021. This figure should be considered in the context that multiple new Medicare numbers for PET have been approved since 2021 (such as breast and prostate imaging) and there continues to be a significant number of PET scans completed that are Medicare ineligible.

States FTE

201NMT

% per 1000Capita

Registrant variance from NSW

NSW

367

5.02%

0

WA

78

3.30%

41

Tas

20

3.91%

6

QLD

186

4.04%

45

Vic

272

4.82%

11

ACT

26

7.09%

-8

SA

89

5.36%

-6

Combined National Deficit

Charles Sturt and Newcastle

RMIT

Uni SA

89

Reliable data for NMS contribution to Bone Densitometry, Diagnostic CT and Theranostics is not available.

The transition of Registrant employment from fulltime to part-time is being experienced across many industries over the past few years. For NMS employed

by Queensland Health there has been a 20% reduction in full-time employment over the past 7 years.

Changes in Nuclear Medicine Scientists/Technologists FTE status over time 100% 90% 80% 70% 60% 50% 40% 26.82%

30% 20% 10%

8.40%

15.61%

14.20%

2019

2020

10.68%

28.97%

18.24%

0% 2017

2018

2021

2022

2023

Fiscal Year

Reliable national data is not available on this change in work arrangements for our profession, however it may be reasonable to propose the Queensland Health experience may be reflective of the experience of other Australian employers. The impact of this change is that to retain the full-time equivalent workforce, an increased number of headcounts of NMS is required to deliver the same services.

40 GAMMA GAZETTE 2023/2024 SPRING/SUMMER EDITION | ANZSNM.ORG.AU

2023 Nuclear Medicine Technologist Workforce Summit Report

2023

Australian Public Health perspective:

The Australian public health services employ approximately one third of the national registered NMS and are generally situated in larger metropolitan areas. Complimenting the private sector, public NMS staff are more likely to: NEW ZEALAND • AUSTRALIAN undertake AND considerable non-Medicare eligible (especially PET) clinical studies.

SOCIETY OF NUCLEAR MEDICINE

•

www.anzsnm.org.au deliver high acuity and complex care, including paediatric nuclear medicine

•

perform studies using high-cost radiopharmaceuticals (including recent high cost 67Ga procedures)

•

be involved in clinical trials and research

•

provide 24/7 on-call services (often by a small cohort of staff)

NUCLEAR MEDICINE TECHNOLOGIST

If there are no private services available or a patient can’t afford the cost of the study privately, the public system continues to provide these clinical services.

WORKFORCE SUMMIT

A census of participating public departments across Australia in July 2023 discovered approximately 17% of existing positions were unfilled at that point in time (66 vacancies out of 384 approved FTE roles).

The impact of vacant positions (through inability to recruit to existing or emerging services) for common

modalities is described in the below table:

Scanner type

#NMS/NMT required

(no blackfill)

#outine patients per day

comments

SPECT/CT

1-2

4 to 8

Study type dependent

PET/CT

2-3

12 to 16

*4 DxCT’s

With each 2-3 vacancies in the Public system and assuming 14 PET/CT scans/day not being performed.

Over 250 scanning days per year this equates to 3,500 less PET scans for the public per annum.

known planned new services include both the planned Western Australian and Queensland cancer centres as well as the multiple regional PET scanner plans in Victoria, as examples.

Approximately 25% of PET patients have a diagnostic CT on the PET scanner, improving access and experience for patients. Thus, approximately 1000 DxCT scans per PET/CT scanner may also need to be performed at a different time for the patient in a Medical Imaging department. This percentage may vary site to site.

It is unclear where NMS staff required to operate these services will be derived.

A view of the current NMS staffing deficits should not only be viewed when compared to capability to continue to deliver existing services, but also importantly the future demand driven needs. These include both new and emerging clinical indications, but importantly demand for clinical services.

Experience has demonstrated that it is common for NMS students to seek future profession employment proximal to where their families reside, normally near where they grew up. Graduating NMS may relocate for short to medium term to regional or interstate employment seeking initial employment, then commonly seek employment options enabling them to return home a few years later. This has been the shared experience especially in jurisdictions without a course such as Tasmania, Northern Territory,

Significant growth of NMS services supporting expansion of existing services as well as establishment of new services are planned until 2023. Significant

To understand the concerns of public health NMS capability to meet current and emergent service needs the workforce needs to be viewed from both a recruitment and retention lens.

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GAMMA GAZETTE 2023/2024 SPRING/SUMMER EDITION | ANZSNM.ORG.AU 41

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Queensland and Western Australia. And more recently noted in greater Sydney where a course no longer exists.

Training for NMS should be enabled to occur in the geographical areas the services will be delivered, this includes where possible regional areas.

Retention of existing trained NMS is equally seen as a key challenge to be addressed for public NMS in Australia.

Whilst Public NMS offer a diverse range of development opportunities for staff, barriers remain that inhibit NMS remaining in the profession. These include: Glass Walls – One example is a NMS who has Diagnostic CT in their scope may be limited to oncology studies on a hybrid PET/CT. The ability to implement a full range of diagnostic CT procedures on a stand-alone CT scanner is commonly inhibited by role descriptions for these positions articulating a Radiographer is required.

Glass ceilings – Many Public Nuclear Medicine Departments sit within a Radiology Department.

The shared experience is that the lead Medical Radiation Practitioner role has been established as a Radiographer role. This precludes a NMS from applying. At a higher level, most Chief Allied Health Officer roles are occupied by Allied Health professions from the therapy disciplines as opposed to the scientific or technical disciplines in which NMS reside.

As such, there are few genuine leadership roles that are attainable to develop into, nor leaders to follow who have broken that mould.

Lack of Educator support – unlike most allied health professions, the access to dedicated educator resources to assist sharing knowledge, development of staff and student co-ordination is almost nonexistent in Australian public nuclear medicine services.

This impacts development opportunities for staff and students as well as career progression opportunities for staff to remain in the profession.

Implications: The current critical NMS workforce shortage has had and continues to have a significant impact on the public health system in the context of an ongoing increased demand for our services.

The lack of public NMS staff resource has been reported as: 1.

reducing capability to support required clinical placements due to lack of appropriate supervision.

2. causing burnout of staff who are prioritising urgent clinical care over non front-line role requirements during business hours, with many non-clinical tasks being performed in evenings or weekends.

3. becoming challenging for teams in determining how they best allocated their staff. Prioritisation of resources may see PET studies proceeding whilst bone densitometry studies are delayed beyond requested scan date requirement, due to delays in capacity to provide scans for the latter.

In summary the challenges identified by Public Health NMS in Australia include:

Retention: 1.

Barriers preventing NMS staff working to full scope and expanding their scope.

2. Barriers in governance, especially where NMS profession reports to another Profession hierarchically.

3. Accredited programs of study to enter NMS are not offered equitably in locations, Registrants desire to return to practise nearer to their home once a suitable role becomes available.

4. Due to position vacancies, non-frontline roles and tasks are compromised, resulting in lack of education support for growing and emerging capacity in research/quality improvement, education/training and management/ leadership. Many of these tasks are completed out of hours and are causing concerns of burnout of staff.

Recruitment: 1.

There are not enough Registrants to meet current needs. In real terms Registrant numbers are declining (considering total Registrants and increased uptake of part-time work).

2. There are not enough students in the pipeline. Costs to students to complete clinical placements may be a strong driver for students not completing NMS studies and transitioning to registration with the MRPBA.

Acknowledgement: This information has been collated with input from: Dr Elizabeth Bailey, Ross Bevan, Annette Cotter, Simone Culleton, Rachael Dobson, Sarah Frecker, Peter Garcia, Janelle Linton, Suzanne McGavin, Lauren Moon, Katelyn Morris, Kunthi Pathmara, Jennifer Rowe, James Turner.

42 GAMMA GAZETTE 2023/2024 SPRING/SUMMER EDITION | ANZSNM.ORG.AU

2023 2023 Nuclear Nuclear Medicine Medicine Technologist Technologist Workforce Workforce Summit Summit Report Report

Interview with

Karen

AUSTRALIAN AUSTRALIAN AND AND NEW NEW ZEALAND ZEALAND SOCIETY SOCIETY OFOF NUCLEAR NUCLEAR MEDICINE MEDICINE

Jones

www.anzsnm.org.au www.anzsnm.org.au

2023

NUCLEAR NUCLEAR Professor Karen Jones is the William T Southcott Senior Research Fellow in Nuclear Medicine at The MEDICINE MEDICINE University of Adelaide. With an initial training as a Nuclear Medicine Technologist (NMT), she was the top nuclear medicine student in her graduating TECHNOLOGIST year at the University of South Australia and, TECHNOLOGIST subsequently, the first NMT in Australia to be awarded a PhD. Karen is the Vice President of the Vice President, ANZSNM

WORKFORCE WORKFORCE SUMMIT SUMMIT

ANZSNM and Immediate Past Chair of the Executive Committee of ARTnet. For the past two years, she has led the Technologist Special Interest Group and contributed to many of their latest and successful initiatives, including the recent NMT Workforce Summit.

As the Vice President of ANZSNM, could you share your motivation for taking the lead on the 2023 Nuclear Medicine Technologist Workforce Summit? What inspired you to champion this initiative?

be able to continue to do this as Vice President of the ANZSNM, along with my friends and colleagues, Pru Burns, Chair of the TSIG and Suzi McGavin, Chair of the TSIG Workforce Advocacy Committee.

The Summit brought together various I have always been passionate about workforce stakeholders in the nuclear medicine advocacy. In my previous role as Chair of the community. How does ANZSNM perceive Technologist Special Interest Group (TSIG), I, as well as its role in fostering collaboration among members of the Workforce Advocacy Committee, had education providers, regulators, professional been striving for the Nuclear Medicine Technologist bodies, and workforce partners?

(NMT) skills shortage to be recognised on the Australian and New Zealand Standard Classification of Occupations (ANZSCO) Skills Priority List. We were aware that NMTs were experiencing increasing work pressures and stress because of the workforce shortage; particularly in regions without a local NMT university program and in rural and remote areas.

The concept of an ANZSNM-led Workforce Summit was discussed initially during a meeting with the Qld Chief Allied Health Officer, Liza-Jane McBride, which included ANZSNM Qld Branch members, Travis Pearson and James Turner, in April this year. During the ANZSNM Annual Scientific Meeting (ASM) in May, it became readily apparent that individuals were working in isolation to address the problem and that a unified, cohesive approach was required - and the decision to hold a NMT Workforce Summit was made.

What stimulated me to take the lead in convening the Summit, was the recognition that the Summit was important and, if successful, had the high potential to lead to positive, and urgently, required change. As the former Chair of the TSIG, I also recognised the importance of leading by example. I am privileged to

The ANZSNM, and particularly the TSIG, is ideally placed to foster collaboration between stakeholders.

The TSIG is comprised of a broad representation of NMT members spanning the private and public sectors, regional areas, education and research.

We meet regularly with the regulators (MRPBA and NZMRTB), have recently established both a University Liaison position, held by Emma Brook, and Student Representative Council (SRC) to facilitate communication between both education providers and students with the ANZSNM, and have been building and strengthening strategic relationships with other professional bodies in Australia and New Zealand, as well as further afield, e.g. a recent joint initiative with the Rural Alliance in Nuclear Scintigraphy (RAINS) to co-produce a Nuclear Medicine Scientist/ Technologist job kit to attract high school students into the profession, a joint NSW Radpharm Award with the NSW Society of Nuclear Medicine Scientists (NSWSNMS), increased CPD opportunities via joint webinars with Women in Nuclear (WiN) Australia and the SNMMI-Technologist Section.

REPORT REPORT

GAMMA GAZETTE 2023/2024 SPRING/SUMMER EDITION | ANZSNM.ORG.AU 43

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Reflecting on the Summit, what are your personal opinions on the outcomes? Were there any insights or collaborative efforts that stood out to you as particularly promising or impactful?

The Summit, held on 4 August, represented the first step in addressing the critical NMT workforce shortage – and I think it proved to be a very big step forward. Our strategy was to get ‘everyone’ in ‘the room’ to focus on the workforce issue and minimise distractions of work etc. The Summit generated productive discussions that allowed us to identify, from a variety of perspectives, the most important issues and collate potential opportunities for further exploration and collaboration.

The attraction, training and retention of students are, of course, central to our future workforce – accordingly, effective collaborations between the education providers with the public and private health sectors and professional bodies are pivotal, particularly in addressing the necessity to train graduates in their home state/region, while collaboration with the regulators will be essential for accreditation of new training programs. Chief Allied Health Officers have the opportunity to play a key role by communicating the relevant issues to government and supporting a unified strategy by professional bodies, to lobby for support.

It is also essential that we provide prompt assistance to our existing workforce. As indicated by our recent NMT Survey, ‘burnout’ is already a major issue and staff retention will, otherwise, inevitably decline further.

To achieve this, Chief Allied Health Officers could collaborate with public and private health sectors, offering insights into the ‘assistant model of care’, that has been implemented in other allied health professions.

Immediately prior to the conclusion of the Summit, each attendee made a personal commitment to contribute to a solution, attesting to the high levels of goodwill and willingness to explore positive collaborations. From my perspective, the ANZSNM NMT Workforce Summit achieved everything I had hoped – and perhaps, more.

nuclear medicine community. Following distribution of the report, attendees and all NMT ANZSNM members have been invited to complete a survey to identify priorities for collaboration. We are currently collecting these data which will inform future directions.

We have also forwarded the report to all Health Ministers, Education Ministers, Rural Ministers and Unions to communicate the relevant issues and their importance and requesting their support. We plan to follow-up on these communications to increase awareness, build relationships and lobby for positive change.

Considering the success of the 2023 Summit, are there plans for ANZSNM to continue producing similar reports in the coming years? How do you envision the role of these reports in shaping the future of nuclear medicine in Australia and New Zealand?

That the ANZSNM NMT Workforce Summit brought stakeholders from across the nuclear medicine industry, in Australia and New Zealand, to work together for positive change, represents a ‘first’, at least in recent history. The Summit report provides a sound basis to move forward with purpose, explore opportunities through collaboration, and monitor progress.

The Summit has already led to other opportunities. On 27 October, Pru Burns and I represented the ANZSNM at the recent MRPBA Symposium, where Pru presented her perspective on ‘What capabilities will the workforce need in the next 3-5 years, and can it be delivered?’ Pru and Suzi McGavin will represent the ANZSNM at the upcoming Qld Health Nuclear Medicine Scientist Workforce Summit on 22 November.

Given the global shortage of NMTs, issues that were identified in the ANZSNM NMT Summit are highly likely to be relevant to international colleagues, providing further opportunities for collaboration.

In your view, how can individual members of the nuclear medicine community actively engage with and contribute to the ongoing initiatives The report sheds light on critical workforce challenges. From your perspective, how does and discussions sparked by the Summit?

ANZSNM plan to leverage the insights from the Individual ANZSNM members are encouraged to be Summit to address these challenges and make involved in their local ANZSNM Branches, submit an a positive impact on the nuclear medicine expression of interest when committee positions are advertised and to engage with the TSIG. There are workforce?

The Summit report has been distributed to our membership and, via social media, to the wider

numerous, rewarding opportunities to contribute to your profession, including involvement in CPD, mentorship and student programs.

44 GAMMA GAZETTE 2023/2024 SPRING/SUMMER EDITION | ANZSNM.ORG.AU

2023 Nuclear Medicine Technologist Workforce Summit Report

Looking forward, what challenges and opportunities do you anticipate for the nuclear medicine sector in Australia and New Zealand, and how does ANZSNM plan to navigate these in collaboration with the community?

AUSTRALIAN AND NEW ZEALAND

Our greatest, and most immediate, challenge is to SOCIETY OF NUCLEAR MEDICINE provide support to our existing workforce, while we www.anzsnm.org.au train more graduates. While the workforce shortage won’t be fixed overnight, the ANZSNM will work with the nuclear medicine community to identify the relevant issues and address them. The crisis also provides the opportunity to initiate long-term, positive change e.g. we need to explore different training pathways and programs for NMTs. However, it is also essential that we enhance job satisfaction, including providing NMTs with much greater opportunities for leadership roles, appropriate remuneration, and involvement in research.

2023

ongoing collaboration among the various stakeholders to implement the proposed solutions?

The ANZSNM TSIG, through their working committees, will provide the structure for collaborations. Ongoing, strong relationships between ANZSNM and the stakeholders, with active communication and goal setting are essential to ensure that opportunities are explored effectively.

NUCLEAR MEDICINE TECHNOLOGIST

Final Thoughts and Call to Action: As we conclude, is there a particular message or call to action you would like to share with the nuclear medicine community based on the outcomes of the Summit and the report?

WORKFORCE SUMMIT

The ANZSNM NMT Workforce Summit provided a very strong basis from which we will move forward. There is considerable work to be done and we must proceed positively and collegially. Solutions are going to require creativity, initiative, and goodwill – something that I believe our nuclear medicine community possesses in abundance.

Impact on Education and Training: The Summit discussed challenges in attracting students to nuclear medicine programs. How does ANZSNM envision influencing education providers to implement strategies that address these I would like to thank the technologists who took the challenges and enhance the attractiveness of time to complete the ANZSNM NMT Workforce Survey.

We received 188 responses (166 from Australia and 22 nuclear medicine as a career?

The ANZSNM TSIG has recently introduced initiatives to facilitate positive change, including the Student Representative Council (SRC) and University Liaison, providing a voice for students and a direct line of communication between the universities and the ANZSNM. The SRC, which includes student representatives from all universities that offer a nuclear medicine program in Australia (i.e. Charles Sturt University, RMIT, University of Newcastle and University of South Australia) and New Zealand (University of Auckland) in New Zealand is studentdirected and connects students to their professional Society at the beginning of their training. The SRC has presented a successful webinar, assists in Open days to speak to new students, and engaged with the wider community via a Twitter (X) Takeover through Women in Nuclear (WiN) Australia. Led by Jess Watson, Chair of the committee, the SRC plan to develop creative approaches to engage with high school students and attract them into the profession.

The ANZSNM TSIG has other initiatives that we plan to introduce early in 2024 to enhance student experience. These are currently a work in progress, so ‘what this space’.

The Summit emphasised collaborative models for addressing workforce challenges. How does ANZSNM plan to encourage and facilitate

from New Zealand) from NMTs, sharing their valuable insights and providing a snapshot of the NMT workforce.

Many thanks also to the Summit attendees for their invaluable contributions, both on the day, and in the lead up to the event - and for their commitment to collaboration and to work towards solutions effectively. It is important to also acknowledge the important input from members of the TSIG committees. The TSIG is comprised of numerous, hardworking volunteers who give their time generously to support our profession. There is no ‘I’ in ‘TEAM’ and the work of the TSIG, including the recent, successful ANZSNM NMT Workforce Summit, is very much a team effort.

If you would like more information about the Summit or would like to discuss ways in which you could assist, do not hesitate to contact us via the TSIG email address: tsigchair@ anzsnm.org.au

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Karen Jones Vice President ANZSNM

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On average, ANSTO’s radioisotopes provide 10,000-12,000 nuclear medicine procedures that benefit Australians each week.*

*based on published Medicare statistics combined with non-MBS data 2023/2024 sourced from the nuclear medicine community.

46 GAMMA GAZETTE SPRING/SUMMER EDITION | ANZSNM.ORG.AU

EDUCATION & CPD | Case study

CASE STUDY NUCLEAR MEDICINE IN THE POST-OPERATIVE ORTHOPAEDIC SETTING

Karan Singh

The Children's Hospital at Westmead, Sydney, Australia

I

ntroduction: Alongside other imaging modalities, nuclear medicine plays a significant role in the evaluation of suspected complications in the postoperative orthopaedic arena. The advent of hybrid imaging with SPECT-CT and PET-CT has paved the way for improved specificity (alongside pre-existing high sensitivity) in differentiating complications such as aseptic loosening, infection and periprosthetic fractures.

Its role in this setting is strengthened by its ability to remain largely unaffected by metallic hardware induced artefacts.

It is worth mentioning bone scintigraphy in the introduction as it has long functioned as the workhorse of orthopaedic nuclear medicine. Performed with Tc99m labelled diphosphonates, it is highly sensitive for detecting osteoblastic, peri-prosthetic bone remodelling.

Therefore, a negative bone scan effectively rules out bony pathology.

This essay will aim to discuss the evidence base behind the role of nuclear medicine when assessing the post operative shoulder, hip, knee and spine. This will include a brief outline of common surgical interventions and complications prompting revision surgery, followed by a deliberation of where, why, when and how nuclear medicine is most effectively utilised within each anatomical space. It will also touch on the emerging role of F-18 NaF PET-CT in this setting.

Shoulder: As the prevalence of degenerative diseases such as shoulder osteoarthritis increase with rising life expectancies, prosthetic shoulder replacements are becoming increasingly common.1 Common postoperative complications include glenoid erosion, glenohumeral

loosening, instability, fracture and infection. Should first line assessment with history, clinical examination and conventional radiography (+-MRI) be inconclusive, nuclear medicine can effectively diagnose (or exclude) most of these complications in the setting of late postoperative shoulder pain.

To understand the role of nuclear medicine in this setting, normal scintigraphic patterns should first be appreciated. After hemi or total shoulder arthroplasty, primary osseointegration is typically completed within 3 months.2 However, increased skeletal tracer uptake from normal bone remodelling may persist for up to a year. Thus, Bone SPECT-CT has higher specificity beyond the first few months postoperatively. In considering this time frame, it can successfully detect glenoid or humeral loosening.3 Glenoid loosening can be scintigraphically characterised as focal skeletal tracer uptake at the glenoid bone-prosthesis interface more evident on delayed phase imaging.4 In cases of suspected prosthetic shoulder infection, Bone SPECT-CT is readily available, inexpensive and demonstrates high sensitivity and therefore a negative scan can essentially rules out infection.5 Higher specificity can be achieved by pairing labelled leukocyte imaging alongside sulfur colloid marrow imaging.6 In the latter, an accumulation of labelled white blood cells should mismatch with a photopaenic area seen on the marrow scan in cases of prosthetic shoulder joint infection. In a prospective study of 86 patients, Falstie-Jensen et al concluded that FDG PET-CT had poor diagnostic accuracy in diagnosing chronic, low grade periprosthetic shoulder joint infection.7 This is in keeping with more extensive studies focussing on periprosthetic infections of the lower limb.

GAMMA GAZETTE 2023/2024 SPRING/SUMMER EDITION | ANZSNM.ORG.AU 47

EDUCATION & CPD | Case study

Case Study: Nuclear Medicine in the post-operative orthopaedic setting (Continued) Hip: The incidence of hip arthroplasties has surged in recent years. This trend also brings about the need to accurately diagnose postoperative complications, the most common of which include aseptic loosening, instability, infection and fractures.8 Bone SPECT-CT shines as a supplemental diagnostic imaging modality to assess for these complications many months following operative intervention, out performing SPECT only imaging.4 Nuclear medicine plays a more effective role within this setting when there is an appreciation for variations in surgical hardware. This includes an understanding of the fixation zone of the femoral component as this area is designed to integrate with bone ie. hardware loosening can be inferred from increased skeletal tracer uptake along the fixation zone.9 Bone SPECT-CT can diagnose specific periprosthetic fractures such as pseudoarthrosis of the greater trochanter from an isolated fracture (a complication of a trochanteric osteotomy). This often manifests as linear skeletal tracer uptake at the trochanteric union, which corresponds to a region linked by cerclage wires on CT imaging.4 In similar vain to periprosthetic shoulder infections, prosthetic hip infections can be assessed with Bone SPECT-CT, manifesting as increased blood flow/pool activity with diffuse skeletal tracer uptake demonstrated on delayed imaging. However, one must proceed with caution factoring in the reduced specificity of bone scans alone. Trevailet al, in a retrospective analysis of 235 patients referred for assessment of symptomatic hip prostheses, demonstrated that paired leukocyte and marrow imaging (when viewed alongside bone scintigraphy) demonstrated a specificity of 90%. 10 Within the paediatric space, Bone SPECT-CT plays a significant role in assessing femoral head viability following growth plate stabilisation for slipped capital femoral epiphyses.11 In the immediate post operative phase, avascular necrosis can manifest as decreased skeletal tracer uptake across the femoral epiphysis.

Knee: Knee surgery can be broadly grouped into two categories and nuclear medicine plays a different role in both settings. These include knee joint preserving surgery (eg. osteotomy, ligament reconstruction) and knee arthroplasties, most commonly done for osteoarthritis.

With rising rates of both categories of knee surgery, it has never been more important to accurately diagnose complications such as infection, instability or aseptic hardware loosening.

In patients having undergone knee joint preserving surgery (especially ligament reconstruction), the role of Bone SPECT-CT lies in primarily assessing overloading and biodegradation issues. In patients having undergone total knee arthroplasty, Bone SPECT-CT cements its role (following a thorough clinical history and conventional radiographs and/or MRI) in excluding bony pathology and assisting in the diagnosis of complications outlined above.

Al Nabhani et al, in a retrospective analysis of 105 patients having undergone Bone SPECT-CT for painful knee prosthesis demonstrated that the hybrid imaging modality changed patient management in 85% of cases.12 However, it first vital to understand that physiological skeletal tracer uptake can be demonstrated up to 6-12 months post knee joint replacement. In fact, mild uptake inferior to the tibial component can be visualised for up 3-4 years.13 Once this is factored in, specific pathological scintigraphic patterns can be appreciated ie. increased uptake around the posterior femur in the setting of femoral loosening. In the setting of suspected prosthetic knee infection, paired leukocyte and marrow imaging once again demonstrate the highest specificity (90%) and sensitivity.14 Spine: Spinal fusion surgery aims to restore stability and alleviate pain by connecting two or more vertebrae. It is most commonly indicated in degenerative disc disease, spinal stenosis, scoliosis or herniated discs. Common postoperative complications include pseudoarthrosis, screw loosening, adjacent segment degeneration (which can lead to spondylolysis and spondylolisthesis) or infection.15 Nuclear medicine, often in its hybrid format with Bone SPECT-CT, shines as a supplemental imaging modality in the 3-6 following spine surgery in assessing these complications. Once again, it is first important to appreciate physiological postoperative spine patterns.

Significant healing of spinal fusion is often complete by 6 months but scintigraphy can remain positive for almost 2

48 GAMMA GAZETTE 2023/2024 SPRING/SUMMER EDITION | ANZSNM.ORG.AU

Your continuing educational portal *Exclusive to ANZSNM members

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Contributions from local and world experts.

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EDUCATION & CPD | Case study

Case Study: Nuclear Medicine in the post-operative orthopaedic setting (Continued) years.16 It is also valuable to understand different surgical techniques used in spinal fusion. Increased skeletal tracer uptake along the screws in rigid fusion techniques can suggest loosening though is not uncommonly seen in patients having undergone dynamic fusion.

Heimburger et al, in a retrospective assessment of 54 patients concluded that Bone SPECT-CT had a sensitivity and specificity of 88% and 94% respectively when assessing for adjacent segment degeneration, 82% and 82% respectively for pseudoarthrosis and 69% and 92% respectively for hardware loosening.16 When specifically considering pseudoarthrosis, Rager et al concluded that hybrid imaging demonstrates significantly higher specificity compared with CT alone whilst Sumer et al reinforced its superiority over SPECT imaging alone in a retrospective study of 37 patients.17 18 In contrast to the other anatomical spaces, leukocyte imaging demonstrates poor specificity when suspecting a postoperative spinal infection. Rather, Gallium 67 imaging obtained sequential to bone scintigraphy has been shown to demonstrate greater specificity (and sensitivity) and assist in diagnosing disc space infection when MRI is equivocal or unable to be obtained.19 F-18 Sodium Fluoride (NaF) PET CT Whilst this essay has primarily focussed on SPECT imaging, it is worth mentioning F-18 NaF as a highly

bone specific PET radiotracer which demonstrates similar pharmacological behaviour to diphosphonate bone scanning agents. Small scale studies have demonstrated the efficacy of dual phase NaF PET-CT in diagnosing surgical site infection (of the bone) following orthopaedic surgery. Lee et al in a retrospective assessment of 23 patients having undergone orthopaedic surgery to the spine, femur, knee and skull in the last 1 year (median 2 months) demonstrated a sensitivity and specificity of 93% and 100% respectively for diagnosing acute and chronic surgical site infection. Aside from visual analysis, lesion to blood pool uptake ratios on early phase scans was considered the most suitable parameter for differentiating surgical site infections.20 Larger scale, robust studies are required to explore this more.

Conclusion: In many postoperative orthopaedic settings, Nuclear Medicine (specifically in its hybrid format) serves as a valuable, supplemental diagnostic tool for assessing persistent joint pain months after surgery. Its diagnostic utility lies in the capability to distinguish complications such as loosening, fractures and infections, provided there is a thorough understanding of physiological tracer uptake patterns and appropriate patient selection.

The emergence of novel, cost-effective and evidencebased radiopharmaceuticals (specifically PET agents) is expected to bolster the role of nuclear medicine in postoperative joint assessment in the future.

References 1. Kim, S. H., Wise, B. L., Zhang, Y et al (2011). Increasing incidence of shoulder arthroplasty in the United States. The Journal of bone and joint surgery. American volume, 93(24), 2249–2254.

2. Berth, A., März, V., Wissel, H. (2016). SPECT/CT demonstrates the osseointegrative response of a stemless shoulder prosthesis. Journal of shoulder and elbow surgery, 25(4), e96–e103.

3. Hirschmann, M. T., Davda, K., Rasch, H et al (2011). Clinical value of combined single photon emission computerized tomography and conventional computer tomography (SPECT/CT) in sports medicine. Sports medicine and arthroscopy review, 19(2), 174–181.

4. Vaz, S., Ferreira, T. C., Salgado, L et al (2017). Bone scan usefulness in patients with painful hip or knee prosthesis: 10 situations that can cause pain, other than loosening and infection. European journal of orthopaedic surgery & traumatology : orthopedie traumatologie, 27(2), 147–156.

5. Love, C., Marwin, S. E., Tomas, M. B et al (2004). Diagnosing infection in the failed joint replacement: a comparison of coincidence detection 18F-FDG and 111In-labeled leukocyte/99mTcsulfur colloid marrow imaging. Journal of nuclear medicine : official publication, Society of Nuclear Medicine, 45(11), 1864–1871.

6. Palestro, C. J., Kim, C. K., Swyer, A. J et al (1990). Total-hip arthroplasty: periprosthetic indium-111labeled leukocyte activity and complementary technetium-99m-sulfur colloid imaging in suspected infection. Journal of nuclear medicine : official publication, Society of Nuclear Medicine, 31(12), 1950–1955.

7. Falstie-Jensen, T., Lange, J., Daugaard, H. et al (2019). 18F FDG-PET/CT has poor diagnostic accuracy in diagnosing shoulder PJI. European journal of nuclear medicine and molecular imaging, 46(10), 2013–2022.

8. Basu, S., Kwee, T. C., Saboury, B et al (2014). FDG PET for diagnosing infection in hip and knee prostheses: prospective study in 221 prostheses and subgroup comparison with combined (111) In-labeled leukocyte/(99m)Tc-sulfur colloid bone marrow imaging in 88 prostheses. Clinical nuclear medicine, 39(7), 609–615.

9. Enge Júnior, D. J., Castro, A. D. A. E., Fonseca, E. K. U. N et al (2020). Main complications of hip arthroplasty: pictorial essay. Radiologia brasileira, 53(1), 56–62.

10. Trevail, C., Ravindranath-Reddy, P., Sulkin, T et al. (2016). An evaluation of the role of nuclear

medicine imaging in the diagnosis of periprosthetic infections of the hip. Clinical radiology, 71(3), 211–219.

11. Song, Y. S., Lee, W. W., Park, M. et al (2022). Usefulness of Bone SPECT/CT for Predicting Avascular Necrosis of the Femoral Head in Children with Slipped Capital Femoral Epiphysis or Femoral Neck Fracture. Korean journal of radiology, 23(2), 264–270.

12. Al-Nabhani, K., Michopoulou, S., Allie, R et al. (2014). Painful knee prosthesis: can we help with bone SPECT/CT?. Nuclear medicine communications, 35(2), 182–188.

13. Palestro C. J. (2014). Nuclear medicine and the failed joint replacement: Past, present, and future.

World journal of radiology, 6(7), 446–458.

14. Verberne, S. J., Sonnega, R. J., Temmerman, O. P et al (2017). What is the Accuracy of Nuclear Imaging in the Assessment of Periprosthetic Knee Infection? A Meta-analysis. Clinical orthopaedics and related research, 475(5), 1395–1410.

15. Bohl, D. D., Webb, M. L., Lukasiewicz, A. M. et al (2015). Timing of Complications After Spinal Fusion Surgery. Spine, 40(19), 1527–1535.

16. Heimburger, C., Hubele, F., Namer, I.-J et al (2015). Bone scan SPECT/CT for the diagnosis of late complications after spinal fusion: Definition and evaluation of interpretation criteria. Medecine Nucleaire Imagerie Fonctionnelle et Metabolique, 39(2), 105-121.

17. Sumer, J., Schmidt, D., Ritt, P., Lell, M et al (2013). SPECT/CT in patients with lower back pain after lumbar fusion surgery. Nuclear medicine communications, 34(10), 964–970.

18. Rager, O., Schaller, K., Payer, M. et al (2012). SPECT/CT in differentiation of pseudarthrosis from other causes of back pain in lumbar spinal fusion: report on 10 consecutive cases. Clinical nuclear medicine, 37(4), 339–343.

19. Hayashi D, Roemer FW, Mian A et al. Imaging features of postoperative complications after spinal surgery and instrumentation. AJR AM J Roentgen. 2012; 199: W123-W129 20. Lee, J. W., Yu, S. N., Yoo, I. D et al (2019). Clinical application of dual-phase F-18 sodium-fluoride bone PET/CT for diagnosing surgical site infection following orthopedic surgery. Medicine, 98(11), e14770.

50 GAMMA GAZETTE 2023/2024 SPRING/SUMMER EDITION | ANZSNM.ORG.AU

EDUTRACE UPDATES

EDUTRACE - LATEST COURSES Don't miss out on the latest webinars and courses uploaded to Edutrace.

2023 DR ELIZABETH BAILEY AWARD

TECHNOLOGIST WINNER'S CIRCLE WEBINAR

Presentation by Associate Professor Daphne James

Presentations by Iliana Angelidakis - ANZSNM Student Award Winner Stephen Tronchin - ANZSNM Student Award Winner Brittany Emmerson - Curium Award Winner Rebecca Wyborn - Radpharm Award Winner Loren Katchel (Co-Author) - GMS Poster Award Winner

TSIG SRC WEBINAR: NUCLEAR MEDICINE THE STUDENT EXPERIENCE Varish Law - Nuclear medicine in WA - student placement and working in WA Elizabeth Inaba-Hill - The future of nuclear medicine from a student's perspective Jaya Jampana - Transitioning from a student to a graduate Nuclear Medicine Technologist

TSIG SRC Webinar: Nuclear Medicine The Student Experience Presentations by Varish Law - Nuclear medicine in WA - student placement and working in WA Elizabeth Inaba-Hill - The future of nuclear medicine from a student's perspective Jaya Jampana - Transitioning from a student to a graduate Nuclear Medicine Technologist

TSIG NUCLEAR MEDICINE & MOLECULAR IMAGING WEEK WEBINAR Presentations by Loren Katchel - Queensland Health Sarah Daniel - Queensland Health/University of Queensland

Brittany Emmerson - Peter Maccallum Cancer Centre

Emily Jeffries - NSW Health

GAMMA GAZETTE 2023/2024 SPRING/SUMMER EDITION | ANZSNM.ORG.AU 51

EDUTRACE UPDATES

EDUTRACE - LATEST COURSES Don't miss out on the latest webinars and courses uploaded to Edutrace.

2023 TSIG ANNUAL DAY SYMPOSIUM

QLD BRANCH MEETING

Presentation by Jason Callahan - Setting up a new PET Service

Presentations by Matthew Griffiths - "Preliminary Investigation of the

Safety, Use and Imaging of Lead 212 in a Nuclear Medicine Department" Nicola Evans - "What is that Lesion" Eoin O'Mahoney - "Providing advice to 177 Lu therapy patients upon discharge A patient specific method"

SA NT BRANCH MEETING Presentation by A/Prof Gabrielle Cehic - “Patient Reported Measures(PRMs) - The what, how and why”

Visit www.nucleus.anzsnm.org.au/edutrace/ home to watch these presentations and more.

52 GAMMA GAZETTE 2023/2024 SPRING/SUMMER EDITION | ANZSNM.ORG.AU

2023 ANZSNM UPCOMING EVENTS

NOV

18 DEC

1

VIC/TAS Annual Symposium, AGM, Radpharm & Student Awards Crowne Plaza Melbourne 9:00am-2:00pm AEDT

SA/NT Branch Meeting AGM & Quiz Night Online & Face to Face 5:30pm-7:00pm ACDT

NOV

2023 TSIG Men's Health Webinar

DEC

Rural Radpharm Presentations

22 6

Via Zoom 6:30pm-7:30pm AEDT

Online & Face to Face 6:30pm-7:30pm AEDT

2 0 2 3 OTH E R U P CO M I N G E V E NTS NOV

17

CHILI Conference on Hybrid Imaging Live Online Free Event 6:30pm-4:00am AEDT

For more details and registrations visit

anzsnm.org.au

Attendo Plus mobile App

26-28 APRIL ŌTAUTAHI CHRISTCHURCH

GAMMA GAZETTE 2023/2024 SPRING/SUMMER EDITION | ANZSNM.ORG.AU 53

JOB VACANCIES

JOB VACANCIES

Nuclear Medicine Technologist

Nuclear Medicine Technologist

Darling Downs Radiology (DDR) DDR is seeking Nuclear Medicine Technologist at our Toowoomba practice working Monday to Friday.

Based at the Southwest Health campus in Bunbury, you'll have the opportunity to work in both public and private hospitals. You'll play a vital role in providing exceptional patient care and contributing to cutting-edge diagnostics.

Applications Close: 31 January 2024

Applications Close: 31 January 2024

Senior Nuclear Medicine Technologist

Nuclear Medicine Technologist We are looking for a Nuclear Medicine Technologist to join our team in Geelong working at the St John of God hospital on our recently upgraded SPECT CTs and digital PET CT with an interesting case mix from in-patients to specialised referred cases.

Join our team at Noosa as we are in the process of installing the latest Siemens Digital PET unit for commencement in April 2024.

Applications Close: 30 November 2023

Applications Close: 31 January 2024

Nuclear Medicine Technologist - Recency of Practice / Return to Practice

Expression of Interest - ANZSNM TSIG Student Representative Council The Australian and New Zealand Society of Nuclear Medicine (ANZSNM) Technologist Special Interest Group (TSIG) Student Representative Council (SRC) consists of two representatives from each university in Australia and New Zealand. Its aim is to engage with students who represent the next generation of technologists.

Are you a Nuclear Medicine Technologist who is currently not working in the profession? Do you have a friend or colleague who might be looking at returning to practice as a NMT? The Technologists SIG are keen to encourage and support NMT’s back into practice.

Applications Close: 17 November 2023

Applications Close: 31 December 2023

54 GAMMA GAZETTE 2023/2024 SPRING/SUMMER EDITION | ANZSNM.ORG.AU

PRESIDENT Dr Kevin London (VIC) Vice President Prof Karen Jones (SA) Immediate Past President Dr Daniel Badger (SA) Treasurer Ms Suzanne McGavin (NT)

GENERAL MANAGER & SECRETARIAT All Correspondence Mr Rajeev Chandra, General Manager ANZSNM Secretariat, PO Box 6178, Vermont South, Victoria 3133 Tel: 1300 330 402 | Fax: (03) 8677 2970 Email: secretariat@anzsnm.org.au

COMMITTEE Ms Prudence Burns (NZ) Mr Christian Testa (VIC/TAS) Mrs Victoria Sigalas (SA) Ms Rosemary Dallen (WA) Mrs Prudence Burns (TSIG) Dr Nigel Lengkeek (RPS) Prof Andrew Scott (IRC)

AIMS AND OBJECTIVES OF THE AUSTRALIAN AND NEW ZEALAND SOCIETY OF NUCLEAR MEDICINE 1.

Promote: The advancement of clinical practice of nuclear medicine in Australia and New Zealand; • Research in nuclear medicine; • Public education regarding the principles and applications of nuclear medicine techniques in medicine and biology at national and regional levels; • Co-operation between organisations and individuals interested in nuclear medicine; and • The training of persons in all facets of nuclear medicine.

2. Provide opportunities for collective discussion on all or any aspect of nuclear medicine through standing committees and special groups: • The Technical Standards Committee sets minimum standards and develops quality control procedures for nuclear medicine instrumentation in Australia and New Zealand.

• The TSIG Committee is the group overseeing the Technologist Special Interest Group (TSIG) and ensures that all projects, committees and activities of the TSIG align with the values and strategic plan of the ANZSNM. It reports directly to the ANZSNM Federal Council and oversees the two TSIG working groups: CPD & Education Working Group and Technologist Workforce Advocacy Working Group.

The committee is able to form working groups to perform specific tasks as required to provide opportunities for the benefit of Technologist members of the ANZSNM after consultation with the ANZSNM Federal Council.

• The Radiopharmaceutical Science SIG and a Physics SIG that maintain standards of practice for their particular speciality and provide a forum for development in Australia and New Zealand.

•

SPECIAL INTEREST GROUPS/COMMITTEES Technologists Chair: Pru Burns Radiopharmaceutical Science Chair: Dr Nigel Lengkeek Physics Chair: Mr George McGill Quality and Technical Standards Committee Chair: Dr Darin O’Keeffe Scientific Advisory Panel Chair: Prof Dale Bailey International Relations Committee Chair: Prof Andrew Scott

BRANCH SECRETARIES New South Wales/Australian Capital Territory Dr Kevin London (Chair) Queensland Ms Neena Sunny and Mr Joel Williams South Australia/Northern Territory Alessandra Caretti Victoria/Tasmania Ms My Linh Diep Western Australia Ms Georgina Santich New Zealand Ms Trish Mead

Archivist Ms Debra Huddleston

GAMMA GAZETTE 2023/2024 SPRING/SUMMER EDITION | ANZSNM.ORG.AU 55