Andrew Taylor, David M. Schuster, and Naomi Alazraki
Reston, VA: Society of Nuclear Medicine, Inc., 2000, 400 pages, $45.00
The specialty of nuclear medicine depends on patient referrals from physicians in other disciplines. One of the missions of the nuclear medicine physician is to promote good communication with these clinicians and to educate them about the types and the value of the studies we offer. This task has been recently aided by the release of A Clinician’s Guide to Nuclear Medicine.
Unlike conventional textbooks aimed at nuclear medicine practitioners, which are often subdivided by type of scan, this book seeks to guide clinical problem solving in a format relevant to the clinician. The first 25 chapters are divided by clinical problem, such as cardiovascular diseases, infection imaging, women’s health, and a wide variety of tumors. Two chapters are devoted solely to radionuclide therapy, whereas other chapters (e.g., Thyroid Cancer) incorporate both diagnosis and therapy.
This book does not aim to be encyclopedic. Its focus is on discussing commonly encountered clinical problems rather than on detailed technical exposition. It is thus well suited to the busy clinician (intern, resident, or staff physician) who does not want to wade through a comprehensive nuclear medicine textbook when trying to answer a clinical question. The book is also suitable as an introductory text for prospective or beginning students in radiology or nuclear medicine, as well as for medical students.
Each chapter follows a standard format and, once one familiarizes oneself with this system, the information is easy to find. Each chapter includes 3 major subheadings: 1) Scans reviews radiopharmaceuticals, how each study is performed, patient preparation, understanding the report, and potential confounding factors or problems. 2) Clinical Questions discusses the advantages and limitations of the various nuclear medicine tests in a question-and-answer format of more than 200 clinically relevant questions. Examples of questions posed include “FUO: Should a nuclear imaging study be obtained to identify the cause?” and “Does my patient have a pulmonary embolus?” Some questions are more narrowly focused, such as “Should a patient with Graves’ disease be made euthyroid with PTU before 131I therapy?” This section is highly readable and contains many clinical “pearls.” 3) Patient Information includes information intended for distribution to the patient when the nuclear medicine test is scheduled. This would also be useful to nursing or nonmedical staff who are involved in setting up patient appointments.
The penultimate chapter is designed to educate the clinician about the radiation exposure from nuclear scans and alleviate concerns about risks. It has rudimentary information concerning imaging devices and radiopharmaceuticals. The book ends with a brief section on the comparative costs of diagnostic procedures. A lengthy table is based on representative 1999 Medicare reimbursement fees for various procedures and radiopharmaceuticals and includes those for competing modalities.
The book has a soft cover but is too large for a coat pocket, measuring 7 in. × 10 in. Illustrations are of high quality and have been well chosen to depict classic conditions and typical scintigraphic appearances. Arrows highlight most of the abnormalities and the figure legends are clear and easy to follow.
I have one minor quibble with the layout of this book. Whereas it is clear that the authors wished to limit the book to a manageable length (it runs 378 pages, not including the index) the format seems cramped. The patient preparation sections (which are intended to be copied and distributed) would have been more useful if each began at the top of a separate page. Likewise, the clinical information within each chapter can be overwhelming without page breaks for different major subject headings. However, this minor criticism does not diminish my overwhelming enthusiasm for the book nor my admiration for the authors, who have succeeded in producing a book of value to the entire nuclear medicine community.
As it is in the interests of the nuclear medicine physician to stimulate referrals, I recommend that this book be distributed to key clinicians. It is modestly priced, especially considering the glossy paper and high quality of the printed figures. From a cost-effectiveness point of view, just 1 additional nuclear medicine referral will have more than recouped the investment.