Nuclear Pharmacy: What sets it apart ...
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Sandeep Singh Dhillon
Nuclear Pharmacy: What sets it apart from other pharmacy specialties? – MIMS Malaysia
Pharma Notables

Many healthcare professionals are unaware of this specialty and have vague to no idea of the responsibilities of a nuclear pharmacist. In addition, many may have the preconception that dealing with radiopharmaceuticals carries a high risk of exposure to harmful radiation. In this article, we attempt to explore the pros and cons of being a nuclear pharmacist.

1. You become an expert in the field
A nuclear pharmacist’s daily responsibilities involve the preparation and dispensing of the radiopharmaceuticals in addition to ensuring the safety and quality of such products. In Malaysia, the field is a niche area where pharmacists have the opportunity to further their understanding of the subject and become an expert in their own field. Currently, there are only limited isotopes used in the public hospitals. Familiarising with these new compounds should not be a daunting task.

2. Close interactions with multiple professions
In the nuclear pharmacy department, there are many different professions such as medical doctors, nurses, physicists and nuclear technologists who work closely from preparing the drugs to undertaking the diagnostic or treatment on patients. The field is a multi-disciplinary one, and it functions as a single unit to provide the best treatment to patients. The team is dynamic, where opportunities to learn from other colleagues are plentiful.

3. Supplementary 14 days hazard leaves
Similar to those who work in the cytotoxic drug reconstitution (CDR) unit, nuclear pharmacists enjoy the additional 14 days hazard leave due to the occupational hazard of handling radiopharmaceuticals. However, it is important not to overlook the actual hazard of the job. There are real risks of exposure, either through negligence or accidents, to mutagenic compounds. Thus, pharmacists who are interested in exploring the field must first consider the risks versus benefits before making any transfer application.

4. Advancement opportunity
As this is a specialised area, there are many training opportunities given to nuclear pharmacists to improve their skills and knowledge. New technologies are continuously integrated into the specialty, and more services are expected to be made available to patients in near future. Skilled and experienced pharmacists in this niche area are expected to become highly sought after by both the public and private sector alike.

5. Radiation Safety
Inevitably, a nuclear pharmacist handles radioactive materials. However, proper training will be given before they are allowed to carry out their work. There are many precautions which a nuclear pharmacist can adhere to, such as reducing exposure time, increasing the distance to the radiation sources (e.g. during storage), using an appropriate and effective shield when working with radiopharmaceutical [1].

It is worth to explore further on radiation safety, as this is likely the main concern for most, if not all, interested pharmacists. There are two types of radiation effects: deterministic and stochastic. Deterministic effect rises with increasing doses but if the levels do not exceed a certain “threshold”, the effect will be negligible [2]. In other words, deterministic effects of radiopharmaceuticals can be prevented via appropriate protection and continuous monitoring of the occupational exposure dose limits for each personnel. Physicists are responsible for such radiation protection work. The maximum permissible exposure to radiation is 20 mSv per year averaged over five years, with a maximum of 50 mSv in any one year as recommended by the International Commission on Radiological Protection. On average, studies indicated the annual exposure in the healthcare sector was limited to 0.5mSv [1].

The stochastic effect is inherently unpredictable and does not have a threshold for manifestation. Common examples are the carcinogenic and mutagenic effects of radiopharmaceuticals. Stochastic effects may increase with higher radiation exposure, but surprisingly the severity of such effects may not follow proportionally [3]. Nonetheless, it is unwise to ignore the potential harm of such effects, and pharmacists are recommended to weigh their options before venturing into the field.

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