Journey Through Imaging Innovation From X-Rays to Radiopaedia with Dr. Sally Ayesa of NSLHD

Episode Overview

Episode Topic: In this episode of Skeleton Crew – The Rad Tech Show,  we delve into the discussion that extends to the rapid evolution of nuclear medicine, with Dr. Sally Ayesa, a radiologist and Nuclear Medicine Specialist @NSLHD. She takes us on a captivating journey into the world of radiology and nuclear medicine. The focus is on education, training, and the exciting developments in nuclear medicine, providing listeners with valuable insights into the dynamic field of medical imaging.

Lessons You’ll Learn: Listeners gain a deep understanding of the passion driving Dr. Ayesa’s commitment to education in radiology. She shares strategies for creating engaging learning environments, discusses effective exam preparation methods, and highlights the rewards of balancing clinical practice with mentoring the next generation of healthcare professionals. The episode offers practical advice for aspiring radiologists and nuclear medicine specialists, providing a roadmap to navigate challenges and seize opportunities in these evolving fields.

About Our Guests: Dr. Sally Ayesa, a dual-trained radiologist and Nuclear Medicine Specialist at NSLHD, brings a wealth of experience from her roles at Royal North Shore, Gosford & Wyong Hospitals in Sydney. Recognized with the HR Sear Prize, Dr. Ayesa is a leader in radiology education and an active contributor to the field through her involvement with Radiopaedia. Her passion for nuclear medicine and targeted molecular therapy is evident, offering listeners a unique perspective on the exciting advancements in this specialized medical discipline.

Topics Covered: Delve into Dr. Ayesa’s journey and her role in shaping the future of radiology. From the HR Sear Prize to her involvement with Radiopaedia, listeners will explore the milestones that have influenced her approach to teaching. The discussion extends to the rapid evolution of nuclear medicine, specifically theranostics and targeted molecular therapy. Dr. Ayesa highlights the transformative impact of these advancements on the diagnosis and treatment of cancers, providing a glimpse into the promising future of nuclear medicine.

Our Guest: Dr. Sally Ayesa – A Beacon of Educational Excellence in Radiology

Episode Transcript

Sally Ayesa: A subset of these patients that had escaped conventional therapy because these tumors weren’t particularly sensitive to conventional radiotherapy or chemotherapy. Now, all of a sudden, we’ve got these pharmaceuticals that can attack these cells on a molecular level. They’ll bind to a specific part of the cell, and they’ll sit there and deliver radiation within a couple of millimeters to where it needs to go. Targeted molecular therapy and a lot of what we’re doing with looking at the genetics of certain cancers, that’s where a lot of the growth is going to be. And as an oncology radiologist and nuclear medicine specialist, I find that really exciting.

Jennifer Callahan: Welcome to the Skeleton Crew. I’m your host, Jen Callahan, a technologist with ten-plus years of experience. In each episode, we will explore the fast-paced, ever-changing suburbs, the completely crazy field of radiology. We will speak to technologists from all different modalities about their careers and education, the educators and leaders who are shaping the field today, and the business executives whose innovations are paving the future of radiology. This episode is brought to you by xraytechnicianschools.com. If you’re considering a career in X-ray, visit xraytechnicianschools.com to explore schools and to get honest information on career paths, salaries, and degree options. Hey, everybody, welcome back to another episode of The Skeleton Crew. I’m Jen Callahan, your host. And tonight and today, where she currently is, I have a great guest, doctor Sally. She is a dual-trained radiologist and also a nuclear medicine specialist. So two great things going on right there. She is located in Sydney, Australia, and she’s taking the time out of her Saturday afternoon to be with me tonight on Friday where I am. So thank you so much doctor Sally.

Sally Ayesa: No worries. Thank you so much, Jen, for inviting me along it’s a real pleasure to be part of the podcast.

Jennifer Callahan: Yeah. So I named two different things that what your profession is. So can we start there? What are you currently doing? And then maybe just lead into how did you get to be trained in two great things.

Sally Ayesa: I’m actually surprised I ended up here myself, to be honest. But in Australia, so we’re a little bit different from North America. After medical school, we do a couple of years of general training and then you will specialize. Clinical radiology is a five-year training program in Australia, which you do to become a radiologist. And then nuclear medicine. Interestingly, you can become a nuclear medicine specialist through a pathway of being a physician. So the same way that we train cardiologists, gastroenterologists, but also through radiology. So back when I was in medical school, I had absolutely no idea I wanted to do radiology. I had never met a radiologist who had a kind of looked like me, but I always loved physics and I loved science, and that kind of part of medicine really spoke to me. So going through my years post becoming a doctor, I started to get a little bit more involved. I really liked radiation oncology for those reasons, but found it just really wasn’t for me and then ended up finding radiology. And it was completely by accident because in Australia as well, radiologists and radiation oncologists are trained through the same college. I’m not quite sure why. I think it’s got some historical origins through that way, but we share a conference, and so I ended up going there, interested in radiation oncology and stumbling into a head and neck radiology lecture and falling in love with it. So which was amazing. So that’s how I ended up pursuing radiology. And in the year before I got on to training, I ended up in a nuclear medicine job, getting a little bit of imaging experience, beefing up my resume to try and get onto the radiology training program, and ended up coming back after I finished radiology or finished my radiology exams four years later to come back and do advanced training at the same department. So I ended up qualified in both. I still work at that nuclear medicine department. I’ve been was there and then went away for five years and then came back and did my training. I’m there at Royal North Shore Hospital in Sydney. Gosh, ten years later and I also work as a specialist radiologist at Clinical Radiologist in the Central Coast, which is about probably about an hour north of Sydney. For those who know Australia, which is near the coast, near the beach, it’s very beautiful. Yeah. And I also do a little bit of academic work at the University of Sydney as well. So I’m a bit of a mismatch, but I really like teaching, I supervise registrars, I get to work, I get to teach at all levels, all the way from medical school, right up to fellow consultants with some of the other things I do. So yeah, I really enjoy it. And that’s how in a nutshell, is how I ended up where I am today.

Jennifer Callahan: Yeah, that’s a lot. Wow. So a question for you nuclear medicine specialists. Are you specializing in looking at the imaging for nuclear medicine? And then also do you possibly help with the exams?

Sally Ayesa: Oh, that’s a great question. And there’s a lot of overlap in what we do. But there’s also a lot of misconceptions about where the technologists, the nuclear medicine technologists, and even the radiographers where we stop in the radiologists begin. Primarily, my role is in interpreting the images, but we also have a role in patient assessment. Usually, it’s the nuclear medicine technologists who administer the tracers, but in some of the procedures that involve a little bit more kind of clinical involvement, we also do assessing the patients. We do cardiac stress testing. So if as we are doing that stress test, it’s usually myself or my registrars who are giving the radioactive tracer at the time to get a snapshot of the blood flow to the heart. We do something called lymphoscintigraphy. With the injection, I do the injections where you inject under the skin for breast cancer patients or patients with melanoma, for example, looking for sentinel nodes or looking for lymphatic drainage. That’s something I do. But the technologists like they primarily do a lot of the tracer injections. But the communication between our teamwork is just so important when it comes to this because they’ll be greeted by one of our techs who will pop them in the room, get the cannula in myself, or the registrars will come in and say, “hi”, take some clinical history. And that’s really one of the great things about nuclear medicine compared to diagnostic and clinical radiology, is you have that patient interaction. And sometimes we see patients very briefly, sometimes a bit more. And because we do treatments as well, you’ve got that real. It’s almost that you can see the physician roots of the specialty there with that patient contact. So we’ll go in. We’ll have a chat with them, flag any issues. So for example, if we’re doing a bone scan we’ll ask them if they’ve had any recent fractures, where their pain is, if they’ve had any surgery pins, plates, metal hardware, that kind of thing. If they’re coming in to do a PET scan. So particularly for our oncology patients and my subspecialty interest has a lot to do with oncology. So say if a patient comes in with and we’re doing a PET scan for a lung cancer, I want to know, is this the first time you’ve come in? Is this a new diagnosis? Have you had chemo? Have you had surgery? Have you had radiotherapy? How long ago was that? Because all of that information is so important in reading the scans and giving the patients and the referrers the best and most accurate information. So, yeah, we’re a team pretty much. a lot of the kind of the very technical stuff, the quality assurance is done by our technologists. But we have a supervisory role. We’ll check the scans, report the scans, communicate with the referrers, and we all form really equally important parts in the patient’s journey, along with a whole lot of other people, secretaries, physicists, and radio chemists. We’re a big department.

Jennifer Callahan: So, you do the injections and you’re part of that. Do you, as part of nuclear medicine or you’re also doing readings on things like PET CTs and PET scans and things like that?

Sally Ayesa: Yeah, definitely. Every single department is different. So to have the qualification to read PET scans to interpret them, in Australia, you have to go through the nuclear medicine training pathway, in addition to either physician training or clinical radiology. So yeah, like in our department we’ll have one specialist we rostered to nuclear medicine. And then depending on how well staffed we are for the day, which is always how it is, 1 or 2 senior doctors who’ll be supporting the registrars. Because we’re a training site, we’ll often get the registrars to have a look at the scans, or we’ll look at the scans together and they’ll pop in a report and we’ll change them up, or we’ll both tackle the list and try and get through the patients as it goes through. But we try and keep that as collaborative as possible. But yeah, PET is a huge part of what we do and it’s such an emerging modality. It’s no longer just about oncology. So cancer patients now as well, like there’s so many applications. We do a lot of dementia imaging like an infection. So there’s been a move towards the more traditional we would do bone gallium or bone and white cell scans, which is general nuclear medicine. And now a lot of patients who have bacteremia. So bacteria in the bloodstream or sepsis may come down and they might have a PET scan for that now because the scans are so much quicker. The dose is less, they’ve got beautiful resolution. The images are just great. And then we do vasculitis scans, which are just so useful for patients with giant cell arteritis. And potentially we can save these patients’ biopsies,patients’f the temporal arteries up here which can be quite invasive and even a little bit disfiguring. So there’s so many different ways that we’re branching into it. And there’s so many different new traces that are emerging. And that’s one of the really exciting things about nuclear medicine is it’s so rapidly evolving, and it’s not just one tracer for every single cancer or infection study, there’s more than you can count. And even in PET, while we’ve traditionally used things like FDG, which is radioactive sugar, we do a lot of imaging for prostate cancer patients with a tracer called PSMA or Prostate-specific membrane antigen, as well as patients with neuroendocrine tumors, which are a rare subset of tumors which have been traditionally quite difficult to treat. And we use a tricycle, gallium 68 Dotatate, for those patients at our center, and being able to give options for imaging as well as pairing these with therapies, it’s just completely revolutionized things. And it’s such an exciting part to work in.

Jennifer Callahan: Not only are you a radiologist and nuclear medicine specialist, but you also do work in academia at Sydney University, so that’s awesome. Is there a particular topic that you teach or a specific class that you teach, or you just hodgepodge like you are in your profession?

Sally Ayesa:I guess it is a bit of a hodgepodge, actually. Yeah. So I started at Sydney University back when I was working in a different hospital in the center of Sydney, Royal Prince Alfred. It’s right next to the Sydney University campus. It’s a very big hospital. It’s probably one of the old ones in Sydney. It’s a lot of tradition. It was a great place to train, with a lot of really interesting pathologies and very senior doctors. So I started there after I finished my radiology exams, and I was asked to come on board and help out with designing a master’s unit of study. And what was really interesting about this master’s unit was it was for doctors who weren’t radiologists. It was for clinicians like general practitioners. I think you call them family doctors in North America, ICU doctors, and physicians of different specialties. How they could improve their medical imaging skills. So I started getting involved with there, and from that, I got involved in another unit that was already established, which was aimed at improving medical education for surgeons. And a lot of what we did, as you say, it’s it is a hodgepodge. It’s across many different disciplines of radiology. We threw in some nuclear medicine there as well because it’s so important that we complement each other and looking at those things that are going to be high yield and relevant for surgeons, for physicians, for family doctors, in terms of improving their not only how they interpret medical imaging, but understand it, how do they talk to the patients in the community? If you’re sending a patient for an MRI of the brain and they’re pregnant, what things do you need to talk about? That kind of stuff. That’s how I started into it, and trying to focus on things, trying to keep in the back of my mind what’s important, what’s relevant, what’s going to be useful for these doctors. From then, 18 months ago, I was brought on very luckily. I’m very happy to be part of the medical school now at Sydney University. We started really. Been looking at how we’re teaching medical students, imaging through the program, and what we could do better. And I think a lot of that is embedded in our accessibility of medical imaging. And if you teach a first-year medical student or even a first-year science student or somebody who doesn’t have a lot of that background knowledge, really high-level radiology, they’re not going to get it. If you teach them MRI physics, they’re going to get quite confused. So we really took it trying to take a step back and go, well, what’s important as a first year, what are the basics? What do we want you to know? What’s a CT? Why is it important? What is radiation? What are these things that are going to fit into the patient journey? So starting with that. And so this year I’ve been focusing a lot on fundamentals. Just a lot of real basic things. What does a fracture look like on an x-ray? Yeah. You can point at it and yeah there’s your problem. But what else does it go into the joint? How is this different from some kind of normal variant, that kind of stuff? So we started out a lot of basics and we’re going to work up. Got some grand plans for doing a bit more about imaging pregnant women and pediatrics. Just so we can give these medical students the skills to be functioning interns and improve their patient care and integrate medical imaging safely and effectively. And I do get to go and lecture the radiographers as well at Sydney Uni sometimes, which I love doing.

Jennifer Callahan: So you said that you were doing also two classes for clinicians who are already working in the field, and I feel like that’s great as well to aid them. Possibly same thing in how to explain things to patients and families, and then even to aid them to know what type of exams to order for the diagnosis that they’re looking at.

Sally Ayesa: Yeah. And that’s when we did the curriculum redevelopment. And now we’re with our Master of Surgery unit. We’re probably about to go through a big bit of a change over the next 12 months, changing our assessments, changing, updating a few of our lectures because we’ve had them for, gosh, like six years now. So it’s a good time. But a lot of what I keep in my mind when I’m designing new content or even writing new assessments is that what do I want to get. What do I want the surgeon or the future surgeon to walk out at the end of the master’s subject? And I want them to be able to interpret basic imaging studies so CTs and X-rays with a degree of confidence that they can pick common and life-threatening diagnoses on that examination. And Australia, we’ve got a lot of remote sites, a lot of remote hospitals that may not have access to radiology overnight. And so I think, look, if I’ve got a surgical shrewmouse or a senior resident, there may be 2 or 3 years out of medical school, and they’re sitting in an emergency department in western New South Wales, and there’s no one else to call if a patient has appendicitis or a brain bleed or something that needs immediate intervention overnight, can I give them the skills they need to interpret that study safely? So that’s the first thing common and life-threatening diagnoses so that if they’re on their own, they can make time-critical decisions to keep our patients safe. And then the second part, as you say, like having those conversations, giving them the skills to understand how imaging fits into the patient journey. If a patient’s got renal impairment, should you consider doing a CT pulmonary angiogram to look for a pulmonary embolism, or would you consider a nuclear medicine study such as a ventilation perfusion scan instead? What would be safest? And then also being able to have those conversations. And if they’ve got lower limb neurological symptoms, do they necessarily need a whole MRI of their spine, or is a lumbar spine enough? When should we not be giving gadolinium contrast? Who may need sedation if someone’s if they’re coming in for an MRI if they’ve got risk factors like metal fragments in their eye? If they used to be a welder, for example, what do they need to do? All of those kind of practical skills. So that and also and I guess the third thing is I want to make radiology more accessible. I want to make them look at radiologists and go, look, it’s okay to call them and have a conversation. And radiology technologists as well, or radiographers such as yourself, like, I would much rather them get in contact with us and ask questions rather than just say, I would like a non-contrast CT pulmonary angiogram and then have to have a conversation with an intern who doesn’t quite understand why you can’t do that without contrast. That’s a very extreme example, but it has happened to me once. What we want to avoid is getting into these heated discussions, which unfortunately does happen when we try to go look, maybe have you thought about this from a different perspective? But they’re like, “No, I need this scan. My boss wants this scan. We need to get this scan.” And it’s like, okay, it’s about opening dialogues and just making us more accessible and just showing that radiology where a collaborative specialty, we’re not just a service where you put in a request and it just happens. We are there for consulting, we’re there for growth. We’re there to help our patients together. I guess that’s hopefully we’ll see how we go. But it’s a continued growth, but that’s what we’re aiming to do.

Jennifer Callahan: So you obviously teach to a big audience. You’re doing students and then you’re doing clinicians who are already in the field. Is there a teaching style that you’ve come up with at this point that you feel like can address both groups, and something that you have found has, is received well, I guess?

Sally Ayesa: It’s such an interesting question because we’re all so different, aren’t we? And I always get back to thinking that we’re not taught to be educators. Like when you’re training as a radiographer or a technologist. You’re not taught how to teach. And the same with us doctors. it’s just something that we’ve been expected to be able to do in terms of looking. And we’re doing a project at the moment, looking back at the feedback from our units of study for our masters. So our doctor students looking at what they like in educators and the things that kind of keep coming up and coming through, is you want somebody who is enthusiastic, and that has to translate whether you’re sitting next to them, whether you’re sitting at the front of the room, or if you’re trying to convey it through an online video, which often is not as easy as it sounds like, you’ve got to be a bit more of amped up version of yourself, because you may not have your facial expressions. You lose body language, that kind of thing. What I’ve always found works best for me now, regardless of who I’m teaching. Whereas it’s other doctors, radiology trainees, or radiology residents in America, or junior doctors outside of my specialty or medical students, they really do get a sense whether or not what you’re talking about, if the subject matter, and that makes you more comfortable in bringing it through, but also that you like what you do and which can be really hard some days, if you’ve had a terrible morning and you’re reporting this is out of control, and you may have had a difficult interpersonal reaction that morning trying to convey that you want to be there and that you value the experience. And I think that’s been one of the challenges that I’ve sought to address is that the misconceptions there’s that sometimes radiology is inaccessible, that we don’t want to teach. We see this as a burden. We never, ever want to have that across, because that’s the moment that people are going to stop engaging. They’re going to stop being interested and they’re not going to want to,  keep going with us. So I try and bring that through. I like color pink chair behind me. I’m often taken with pink headphones. I try and make sure that my slides are designed in a certain way like I like a bit of color on them, but at the same time, I’m quite mindful that I don’t want to make them overwhelming and distracting. If I’m recording videos, I make sure I have a pointer because that can be really tough. Like if you’re trying good animations with arrows, because trying to teach through a video, your viewer might not actually know if you’re like, “Oh yes, there is a nodule in the right upper lobe of the lung.” They might be going, “Oh??, where?” And then the next thing the slides gone. So you need to really have that interactive part. So when I do my online videos, I’m always very conscious of animations and cursors to indicate what I’m saying, as well as making sure if I am recording, I’m in a quiet environment. My audio equipment is okay, I don’t have distracting phones going off alarms in the background, so my dogs to the park like I have this morning. So that we don’t have too much noise because that can detract from the experience too when you’re using that different media. I think also things like Radiopaedia I teach with on and off, and I also do some lecturing for them as well through their conferences, where the ability to use scrollable cases in education has just been a complete revolution in how we teach, and whether that’s a screen capture going up and down or teaching somebody, whether that be a medical student or a first-year radiology trainee or radiology resident, how to approach a CT of the abdomen. Even some of our radiographer colleagues showing them how to scroll through a brain to look for blood. If they need to. If there’s a bleed to escalate to the doctor or to consider doing an angiogram. That systematic approach and those communication of practical imaging skills is so much more important than just going, here’s a picture. Here’s the abnormality. Next slide. It’s got to be more than that. It’s like well here’s the abnormality. What can you tell me about it? What does it look like? How big is it? What is it doing to the surrounding structures? What might have caused it? What else do you need to look at? So marrying it into clinical problem-solving is also something I like to try and do. At the end of the day, though, a lot of it is practice, I’m super lucky. People ask me to teach, and so I get to try different things and see what works and see what doesn’t. But at the end of the day, I think if you enjoy what you do, it comes through and people are and your learners are going to be really happy to engage with you. And hopefully, they might not love the content as much as you do, but they’ll certainly appreciate it.

Jennifer Callahan: So I wanted to roll into you had mentioned Radiopaedia, you work with them, you’re editorial, but you are also to saying that you use them sometimes to assist in teaching. So can you explain to us what Radiopaedia is?

Sally Ayesa: Yes. So Radiopaedia is an online open source, open-edit global radiology resource, and it is probably my go-to resource. It contains tens of thousands of articles, tens of thousands of cases, and every single edit, every single article, every single case goes through an editorial board. So everything is peer reviewed. It really has like over possibly the last decade, has just emerged as one of the leading radiology educational resources around the world. And what’s great is it’s free to access. There are some courses and content which you can subscribe to as well, but that’s one of the other great things. That is the philanthropic angle of it is that while there’s a tiered country system. So, myself in Australia, we’re in tier one, so we will pay, a subscription fee to access these courses. Whereas if you live in a lower socioeconomic country, you can access the resources for free. So if you’re in a country. That might not have a huge amount of budget, or they’re resource-poor in terms of health, you can access world-leading radiology education for free, which I think is fantastic. So it’s something I think members in and subscribers in countries like America and Australia can give back, which is really cool. So I first engaged in Radiopaedia when I was training as a radiologist back when I was learning, and that was in its infancy. What’s really cool about it is and makes me very patriotic, is that it was originated in Melbourne. So Professor Frank Gaillard, who founded Radiopaedia, is a radiologist in Melbourne, in Victoria in Australia, and he started it as a way to store his study notes and his cases when he was going through, and so he could teach, and pulling other people initially from his colleagues in Melbourne and then from all around the world. So it’s now this huge global community of radiologists. One of the highest members of the editorial board is a radiographer from Brisbane, Andrew Murphy, who’s so passionate about radiology education. We’ve got on the editorial board, there are neurologists, there are training orthopedic surgeons, there’s medical student pathways, junior doctors. So it’s just this global community for people who are coming together to build this peer-reviewed, really high-quality resource for people who love to practice radiology. My medical students use it if they’re beautiful summaries. They’ve got beautiful illustrative examples of anything you want. It can be something as simple as a distal radius fracture to something as complicated as a metabolic disorder of the brain. On an MRI, everything is scrollable. If it’s cross-sectional and curated and it’s just a it’s a really phenomenal resource. And I was really lucky to get involved. I always said when I was studying for my exams, when I qualified as a radiologist, that if I got through, I would have to join Radiopaedia to say thank you because I was using it for free at that point. So then I joined and I got in contact with like the academic director, and then more and more members of the editorial board. And when Covid came through, it left this real vacuum for radiology education in Australia and around the world. We lost our ability to sit next to each other and learn. So they started doing virtual tutorials, like using their scrollable online cases and their learning, linking them to articles, and bringing educators from Australia, from the UK to everybody. And then they launched their very first virtual conference in 2020, and they asked me to come on and do a couple of lectures, one on how to prepare for exams, because I was lucky, I did pretty well in my radiology exams. And so we tried to share some of that knowledge and then also on bone scans. So getting a bit of that nuclear medicine knowledge out there, and I’ve been involved with them ever since. So I have to say I don’t edit as much as I should. I’m a bit naughty. But I am convening the conference this year, so I am still pulling my weight. I hope so, yeah. And the conference is still going strong. We’re really excited. It’s five days of full online learning. We try and get online, we build the buzz. There are even posters now and the way that it’s just grown has just been incredible. I’m so honored to be part of this group of educators.

Jennifer Callahan: So one thing I also do want to go over is that you also do partner with Siemens, and not that I so much want to talk about Siemens, but that you do guest speaking or that you recently did, and it was about nuclear medicine, about CT, and about PET, and that seemed really exciting. It was.

Speaker3: Really very cool to be asked.

Sally Ayesa: I think when you get asked by a company like that, I personally was I felt pretty chuffed and I was pretty honored by it, and it was a great opportunity to really consolidate some of the work I was doing in lung cancer. That’s my area of clinical radiology and nuclear medicine that I find most interesting. I sit on the lung cancer multidisciplinary team meetings for the Central Coast and for Royal North Shore Hospital in Sydney, which I think you call them, tumor boards in North America. It was a really nice way to actually also reflect and build resources. So I recently for Siemens did a full day teaching about lung cancer. Different facets. So talking about pulmonary nodules what do lung cancers look like on PET, on CT? What is the important information that you want to make decisions? So going back through and collecting, taking the time to collect cases, and also updating my knowledge. So when I think that’s one of the real when you do teach, it’s a great opportunity to refine your own knowledge. And sometimes you never like to see it. But occasionally you go through and go, oh, I haven’t been doing it that way.

Sally Ayesa: I think I need to change my own practice. So it’s a great professional development exercise. So that was really great. It was only for a small group, but because we’ve got lung cancer screening coming in Australia within the next two years, like there is certainly an interest in upskilling in terms of how we assess lung cancer and how we think about pulmonary nodules. And, oh, look, it was a really cool thing to be asked to do. And I was asked by an old friend who I knew when I was a teenager. We went to science camp together, and now I’m a radiologist and she works in education, a former radiographer who now works for Siemens. And so it was just wonderful to reconnect with her. And I think that’s one of the great things, is opportunities like this bring together people into your community, and you get to work with some really fantastic individuals across different specialties and facets of medicine. And like I really enjoyed it. So they might ask me back again, so that’d be good. let’s roll.

Jennifer Callahan: From there into. So, so many different great developments have happened throughout radiology and with radiation and nuclear medicine and stuff. Is there anything that you know that’s coming up in the world of radiology or nuclear medicine that you’re excited about, or that you know of, or that maybe you’re who you currently work for is going to be implementing?

Sally Ayesa: Oh, there’s so many cool, exciting things. I think when I’ll stick with nuclear medicine just because I think that the evolution of things at the moment is going so quickly, and it’s such an exciting time. And what we’re witnessing, particularly over the last ten years and it’s increasingly being implemented into clinical practice, is something called theranostics. And theranostics is when you have a radiotracer that you compare or you have a pharmacist, a pharmaceutical that you pair with, one radioisotope that will give you the imaging. So it will give you your PET scan, and then you can swap it out for another one that will deliver targeted radiotherapy to those cells. So we’re using that a lot with our neuroendocrine tumors. So there’s rare tumors as well as prostate cancer. And we’re really lucky, in Australia, some of the world leading research groups and clinical groups for PSMA therapy for prostate cancer patients, a lot of that’s coming out of Melbourne as well as Saint Vincent’s Hospital in Sydney. We’ve got some incredible trials which are promoting this therapy. So essentially they’ll have their PET imaging demonstrate where they’re you’ve got a much, much more sensitive and specific evaluation of where the metastatic or spread prostate cancer is, whether it’s in the bones, the lymph nodes outside of the prostate. And previously, it was quite difficult to treat. A subset of these patients that had escaped conventional therapy because these tumors weren’t particularly sensitive to conventional radiotherapy or chemotherapy. And now all of a sudden, we’ve got these pharmaceuticals that can attack these cells on a molecular level. They’ll bind to a specific part of the cell, and they’ll sit there and deliver radiation within a couple of millimeters to where it needs to go. And the therapies don’t always work. But there’s certainly really good results for a group of people or even just slowing things down, giving people better quality of life, improving pain. With that coming out of particularly out of the Melbourne group at Peter Mack, led by Professor Hoffman, down in Melbourne. It’s really exciting and there’s a whole lot of new tracers like F-18, FIP. So the fibroblast activation, which is another tracer which is coming out, there’s a lot of promise for it changing how we image lots of different cancers that the traditional PET scan that we use for the glucose. So FDG, which is our normal PET tracer. The issue with that is it goes to the brain. So you can’t swap that out and give someone radiation therapy. If you’re going to irradiate their brain, that’s just not going to work. But this new tracer takes the brain out of the equation. So all of a sudden now we’re thinking about, can we use this to treat a whole plethora of different cancers. So it’s a watch this space targeted molecular therapy. And a lot of what we’re doing with looking at the genetics of certain cancers, that’s where a lot of the growth is going to be. And as an oncology radiologist and nuclear medicine specialist, I find that really exciting.

Jennifer Callahan: Well, on that note, we’re going to say good night or good day. Doctor Sally Ayesa, thank you so much for taking the time today to speak with me and to go over the wonderful world of nuclear medicine. I hope everyone enjoyed our conversation, and check out this episode and past and future episodes on YouTube, Spotify, and Apple Podcasts. So this is Jen and Doctor Sally. Thank you.

Sally Ayesa: Thank you so much.

Jennifer Callahan: You’ve been listening to the Skeleton Crew, brought to you by xraytech.org, the Rad Tech Career Resource. Join us on the next episode to explore the present and the future of the Rad Tech career and the field of radiology.