Clinical Nuclear Medicine

This book on clinical nuclear medicine imaging, edited by experts from the United Kingdom, is the fourth edition. The book has a distinctly European flavor, contains 3 sections and 21 chapters, and is hefty, with a total of 915 pages, including tables, black and white figures, and color plates.

As the editors outline in their preface, they have not subdivided the contents into the type of presentation typical of a classic textbook. The structure of the book does not follow an organ-based classification as used in internal medicine, nor does it follow an anatomic body section–based approach as used in radiology. As expected from a book on a functional imaging modality, the organization of the contents is mixed: a collage of descriptive text, guidelines, clinical protocols, atlases, and case illustrations, with a hint of evidence-based medicine in the chapters on cost and effectiveness.

A list of abbreviations is presented up front because there are so many in the book. Interesting duplicates can be found, such as CSF meaning cerebrospinal fluid or colony-stimulating factor and CEA meaning carcinoembryonic antigen or cost-effectiveness analysis. Functional MRI becomes FMRI. The old-fashioned acronym MUGA has the highly original translation of multiplanar gated angiography. Needless to say, such a list may not provide the desired clarity.

The subdivision into clinical topics, clinical systems, and technical topics is unusual. In particular, the aim of the first section featuring “current relevant topics” is unclear. Although Chapter 1A provides a nice overview of molecular imaging, Chapter 1C ends up as a description of gritty details about the clinical imaging protocol, and Chapter 1D introduces many variables that are not yet used clinically. Chapter 4 covers general points, but several tables and some text are duplicated in Chapter 8C.

The book has 5 pages of contributors, mainly from Europe, with additional authors from the United States, Canada, and Australia. As may be expected from such a variety of authors, the quality of the text, figures, and case examples varies greatly. Moreover, the expertise and know-how emanating from the chapters is highly variable and, for several, not up to par. This does not make for an easy read. Chapters such as those on V/Q (Chapter 7A) and renal scintigraphy (Chapter 8) follow the classic textbook outline and provide information on epidemiology, anatomy, and physiology, as well as study descriptions including preparation, acquisition, processing, and interpretation. This presentation is what most readers expect from a textbook.

In contrast to the well-established scholars and experts, the young or newly added faculty seems to lack expertise and experience, and their text is often a litany of publications without discussion of how good, bad, or relevant these studies are. The new faculty is too focused on the current and recent, thereby losing the educational objective of a textbook on functional imaging. One wonders where the personal touch of the master is.

Many chapters are short and some ultra-short, with just 2 or 3 pages. The utility and yield of these to “current relevant topics” was not immediately clear. The references, on the other hand, are plentiful. Therefore, numerous duplicates exist, and the book could easily have shed some 10% of its pages had the editors sifted through and sorted out key references.

Another aspect of a book with so many authors is the personal viewpoint, which may influence the reader in different ways. Some chapters are quite dogmatic, and one does not need a microscope to detect the conviction of the authors. For instance, PET is believed to be the panacea for functional imaging by some authors, who are quickly distinguishable from those who argue that PET is overrated, whereas others stick to immunoscintigraphy. All agree that more specific tracers need to be developed and that multimodality imaging is here to stay.

The quality of the figures and tables is excellent. The color plates vary in quality; brain SPECT images are not convincing, and it is not clear why curves had to be displayed in color.

As outlined by the editors, this book does not aim to be a classic textbook but a compilation of current relevant topics. The book is a good reference for many routine procedures in nuclear medicine. The chapters related to economic issues and cost benefit are time-sensitive and country-dependent and are expected to have a limited lifespan in the current evidence-based and management-driven health care arena. The references contain many duplicates, but key references for further reading are highlighted.

Clinical Nuclear Medicine will be a welcome contribution to the bookshelf in the nuclear medicine clinic, where it can be used as a manual for currently fashionable procedures and a quick check for nonroutine procedures and their interpretation. The guidelines of the European Association of Nuclear Medicine are frequently quoted, and the consensus of panels and other organizations is reflected in many of the tables.