Day Three

Most of the patients attending the PET centre are lymphoma sufferers, which can be split into either Hodgkin Disease or Non-Hodgkin Lymphomas. As with all cancers treatment decisions are based on the stage of the disease. Stage I and II lymphomas receive reduced cycles of chemotherapy. Previously the standard treatment regime was four cycles of chemo, but there are known problems associated with the toxicity of chemotherapy and a possibility of long term complications such as MI and bone marrow suppression. Consequently any opportunity to reduce with certainty the amount of chemo/radiotherapy a patient receives is beneficial. PET/CT has a significant role to play in this because it is so effective in establishing whether treatment has been effective after only two cycles of treatment.

I was invited to attend an interdisciplinary lymphoma forum meeting yesterday where patient cases are discussed with a view to reaching consensus over future treatment. Oncologists, radiologists and histopathologists were all present with CT, fused PET/CT images, histopathology slides showing germ cells before and after treatment - all presented interactively. An interesting ‘discussion’ broke out between a reader in CT and a reader in PET/CT about what is appropriate baseline imaging for lymphoma, the argument being that whilst PET/CT is the gold standard in this particular trust, CT remains the gold standard elsewhere in the UK. It was really satisfying to gain an insight into the process behind clinical decisions, particularly on patients who had been scanned whilst I was in department.

Other cancers, known as solid tumours - breast, colorectal, oesophageal etc are also scanned for. Today there was a research trial sponsored by GlaxoSmith Kline into whether a drug used for diabetes reduces the chance of Alzheimers developing. There is also bone study/osteoporosis research project taking place, trying t o establish whether the effects from a long acting drug (10yrs) are indeed still maintained when withdrawn.

I was allowed to interview some patients today, the PET/CT questionnaire is as extensive as an MRI safety questionnaire but for different reasons. It was great to do something other than observing and it was a compliment that the staff trusted me to do it. My temporary contract has still not come through so until then I need to limit any time spent with patients post injection. Although I’m finding the whole process really interesting, I have had a couple of moments of doubt about my choice, ie, whether I would have been better working in general radiography and compounding my skills. Next week, however, I should be able to be more of a team member and am looking forward to that.