The Hidden Healthcare Profession: Intro to Nuclear Medicine Technology

By: Jacinda Taggett

Edited by: Martha Waricoy

“PET? You are not going to need to know PET imaging for cognitive neuroscience. Maybe MRI… so I would focus on the MRI at your job.” I was sitting next to a cognitive neuroscientist at a conference in 2023 when this statement struck me. I had been going around telling everyone of my upcoming position as a positron emission tomography (PET) neuroimaging data analyst, and no one was particularly amused.

Now, nearly three years later, she was right. My expertise and interest in PET imaging was not super valuable to academia, especially in the realm of memory research in which I had been invested in for the past six years. PET scans take a long time to acquire at such a high expense, for low resolution images of the smallest regions necessary for cognitive neuroscience research questions. Although I knew this going into the job, my experience with this unconventional modality has given me new career ideas to consider… now in healthcare.

In order for PET imaging to be conducted, you need a Certified Nuclear Medicine Technologist (CNMT) on your team. This individual is an imaging technologist responsible for injecting radioactive tracers into the patient and then collecting their images via PET scanner. As I currently transition out of the research realm, I spent this past weekend shadowing a nuclear medicine department. Below is what I learned about this hidden healthcare profession.

Career Trajectory

To become a nuclear medicine technologist, you have to go through roughly two years of schooling (with pre-requisites completed) and complete two or more board certification exams. The main board branches are the American Registry of Radiologic Technologists (AART),which is generalized to all modalities (e.g., x-ray, ultrasound, MRI, etc.), and then the Nuclear Medicine Technologist Certification Board (NMCTB) – specific to nuclear medicine. A key difference between the two board examinations to get certified is that the NMTCB examination additionally allows you to also get certified in imaging diagnostic Computed Tomography (CT; another modality particularly necessary for nuclear medicine technologists).

Pay ranges for this radiologic technologist modality differ per location, however, in states like California (where I am from), you can roughly expect a $100k+ starting salary. And the great thing about being in this profession is that after you are certified and working, the main job promotions do not require additional schooling, but prioritize experience level.

Courses throughout schooling typically include radiopharmaceutical chemistry, anatomy, radiation physics, healthcare best practices, and clinical rotations across neighboring hospitals– all of which are outside of how to use the machinery and the numerous tests conducted within  the field. I very quickly learned while in the nuclear medicine unit that there are up to 70 different tests conducted within the facility, below are 3 that I witnessed.

Diagnostic Test 1: Gastric Emptying

My morning consisted of observing four gastric emptying scans, in which patients are monitored and scanned every hour for four hours to see how fast food moves through the gastrointestinal (GI) system.

In order for this study to be conducted, 2 minutes worth of low-dose CT scans (1 frontal, 1 posterior) are completed at every hour for four hours, or until 90% of the food has been excreted from the body. To calculate how much food is excreted over time in a standardized approach, the meals containing the radioactive tracer are prepared not only with the same ingredients, but also the same quantity: an egg sandwich with white bread, strawberry jam, and water. This standardized meal is ideal because the calculated uptake of the tracer can be comparable across patients, ranging from those with normal to dysfunctional GI activity.

In my one hour of shadowing this study, I was able to observe multiple patients get their secondary scans for the day. My overall impression of this was that general nuclear medicine (i.e., the nuclear medicine technologists handling the GI, bone, lung, and other similar scans) is a faster-paced environment and great for individuals that need constant work to be done. Due to this nature of the task, it was my most preferred workflow.

Diagnostic Test 2: Exercise Nuclear Cardiology

The afternoon was split into two separate, but related, tests. Chronologically, individuals suspected of having issues with their hearts will undergo an exercise nuclear cardiology test. The test is administered as follows:

• Patients will exercise for 3 minute intervals with increasing intensity, usually with a nurse leading the procedure. Meanwhile, another technologist monitors the patient’s EKG, heart rate, and blood pressure.

• Once the patient reaches the 80th percentile of their maximum heart rate, the nuclear medicine technologist will inject the radioactive tracer, 30 seconds before stopping the exercise.

• There are three main methods of exercise: moving on a treadmill, lifting a 1-lb weight while sitting, or walking around the clinic.

Some major considerations to keep in mind are that patient safety and comfort always come first. Therefore, the patient themselves can tap out at any time, or the nurse leading the procedure can call an end to the test if the vital signs are too intense.

This is a perfect subspecialty for nuclear medicine technologists who want direct and front-facing patient interaction and who are also comfortable to venipuncture multiple times an hour. Although it is the most intriguing of the three tests, I felt that the specialty is too niche for a career outside of a large metropolitan area like Boston.

Diagnostic Test 3: PET/CT Nuclear Cardiology

The final test, which is what I originally went into hoping to shadow, is PET/CT imaging. As a secondary to the diagnostic exercise test, I shadowed a nuclear cardiology scan. In this circumstance, medication that increases heart rate is administered after conducting baseline PET scans– this is called the stress test. This scan is also conducted 30-60 minutes after the exercise test, therefore, the radioactive tracer from the prior test is what is measured in the scanner. The stress test scan will be conducted for 6 minutes.

My biggest surprise with the PET/CT aspect within nuclear medicine is how much of the process is the technologist waiting for the scans to be completed. There is minimal work to be done during this process, since they must be attentive to any potential problems with the scanner or patient. That being said, this aspect of nuclear medicine was much slower paced than the other tests, which led it to be my least favorite of the three.

Career Risks and Limitations

Although this profession sounds interesting and fun, there are quite a few risks and limitations of pursuing this field. Setting aside the daily exposure to radioactive tracers, materials, and scanners, there are still career-specific considerations to make before pursuing this path. 

Firstly, getting admitted to nuclear medicine programs can be quite challenging, as there are less than 10 spots per year for each of the zero to two available programs per state. After being admitted, most programs are expecting LOTS of clinical hours to the point where having a job outside of school can be difficult for most. In my opinion, this practice is understandable due to the fast-paced nature of the programs, as well as the ability to work full-time in hospitals immediately after board certification. After schooling, it can also be limiting to get a job if you do not plan to stay in your local area, due to the lack of scanners and cyclotrons nationally. Finally, the job can feel repetitive and slow compared to other healthcare specialties,particularly in the PET/CT imaging. I personally prefer this “limitation” due to my recent career pivot after being inspired by the lack of work-life balance in academia. I flourish in my extracurriculars and self-care when I am able to clock in and out without stressors keeping me glued to my work station, and radiologic technology is the healthcare field for that.

Author’s Future Directions

Although there are lots of limitations, these are all perks for me as someone who wants to stay local to cities and desires a competitive but stable career. When I finished shadowing the nuclear medicine department this weekend, I knew it was the path for me. However, it is one of the least understood or even known healthcare professions. Therefore, I hope to document my journey through this process and note my thoughts and revelations along the way.