The role of nuclear pharmacy

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The word ‘nuclear’ may seem out of place next to any health-related term, but nuclear pharmacy plays a vital role in healthcare and diagnostics. Highly specialized professionals study radiopharmaceuticals in preparation for this complex but essential area of pharmacy. In nuclear pharmacy, scientists compound and dispense radioactive materials preparing either medicines or diagnostic substances. 

Although the word ‘radioactive’ conjures up danger and fear, it should be noted that radiation exists in many areas of life. The sun, cellphone masts, air traffic monitoring systems and visible light all emit electromagnetic radiation. Nuclear pharmacy uses radioactive agents to treat and diagnose patients. Nuclear pharmacists combine radioactive materials with a compound to reach a specific body area. 

This article aims to explain what nuclear pharmacy is while outlining its role in healthcare and public safety.

What is nuclear pharmacy?

Nuclear pharmacy uses naturally occurring and man-made radionuclides. If you remember back to your chemistry class, an atom combines neutrons and protons. If a nucleus contains more protons than neutrons or vice versa, it endeavors to return to a stable condition, producing radiation or radionuclides. 

Many radionuclides occur naturally, but nuclear pharmacists also manufacture radionuclides to bombard a specific stable nucleus, thus rendering it unstable. Unstable nuclei emit different types of energy, some intended for treatment while others are used for diagnosing patients. Nuclear pharmacists familiar with the emission type then tag the radioactive source to a compound so that it reaches a specific body area. 

The inception of nuclear pharmacy goes back to the mid-20th century. As the science progressed, it soon became apparent that smaller hospitals could not utilize radiopharmaceuticals safely. They lacked trained staff and expertise, which revealed the need for nuclear pharmacy. In 1978, the U.S. Board of Pharmacy Specialties set up the first official nuclear pharmacy. Pharmacists underwent special training to prepare and dispense radiopharmaceuticals.

Today, there are almost 500 nuclear pharmacies across the United States, with the majority operated by three large corporations. State watch bodies highly regulate the industry. Nuclear Regulatory Commission rules stipulate that all nuclear pharmacists must be certified and complete a specialized training program. Commercial nuclear pharmacies can only operate under the authority of a licensed nuclear pharmacist. 

What’s the role of nuclear pharmacy in healthcare?

Physicians prescribe nuclear medicines for many diseases, including cancer, hyperthyroidism and lymphomas. Increasingly, nuclear medicine imaging is replacing X-rays as it provides improved diagnostics. Patients must ingest, inhale or be injected with radioactive material, which acts as a tracer.

Radiopharmaceuticals help treat various cancer types, including adrenal gland, carotid artery and neuroendocrine tumors. Physicians also prescribe them to ease pain associated with osteoblastic metastatic bone lesions. Most commonly, nuclear medicine comes into play in the fight against the following diseases:

  • Tumors of the adrenal gland
  • Tumors near the carotid artery, along nerve pathways in the head and neck
  • Overactive thyroid
  • Thyroid cancer
  • Neuroendocrine tumors
  • Prostate cancer

In diagnostics, nuclear medicine has become the frontrunner in imaging the heart, thyroid gland, kidneys, gallbladder and lungs. The health professional will provide patients with the radioactive substance known as a tracer in an injection, inhalation or oral solution. Radiation detection is then used to establish the tracer’s absorption and reaction at a specific body site. The results will provide the necessary information to diagnose and treat the patient. 

Nuclear medicine also plays a role in positron emission tomography (PET) scans, which uses a tracer to highlight the functioning of cells and organs. PET scans are essential in treating Alzheimer’s disease, brain disorders, heart disease and cancer. 

Is nuclear medicine safe?

You may be worried about exposure to radioactive agents, and rightly so. Nuclear medicine imaging does produce radiation levels far higher than X-rays. According to the CDC, they slightly increase your cancer risk in later life. However, you can rest assured that nuclear pharmacists are highly trained to minimize patient risks. Nuclear medicine staff minimize exposure and advise patients on possible side effects and preventive measures.

They use protective clothing and leaded glass shields and syringes for patient and staff safety. The radioactive agent stays within the body for one to three days, meaning you will be slightly radioactive during that time without posing a risk to people around you. 

The side effects of oral radiopharmaceuticals include chills, breathing difficulties, drowsiness, fainting, increased heart rate, fever, skin redness, itching, headaches, nausea, swelling and stomach aches, although they are rare.

Nuclear medicine carries risks, especially to pregnant women, those trying to conceive and breastfeeding mothers. An in-depth discussion with a nuclear pharmacist or physician will advise you on your suitability.

How do you train as a nuclear pharmacist?

The path to becoming a nuclear pharmacist is intense, involving programs such as the Pharma D online provided by the University of Findlay, or an Accreditation Council for Pharmacy Education (APCE) accreditation and specialized training. Candidates must hold a license to practice pharmacy in the US or another jurisdiction. 

The nuclear pharmacy-specific training includes working for at least 4,000 hours in a nuclear pharmacy, which must consist of an American Society of Health-System Pharmacists-accredited residency and work experience in a nuclear healthcare setting. To work as a fully qualified nuclear pharmacist, you must hold a Ph.D. or MS in nuclear pharmacy or a certification in nuclear pharmacy.

The outlook for the nuclear pharmacy industry is positive, with market experts forecasting a 13%-compound annual growth rate for the years 2023-2030. Job prospects are less buoyant, with the US Bureau of Labor Statistics predicting little growth in the coming years. As a nuclear pharmacist, you can work in a healthcare setting such as a hospital or a centralized commercial nuclear medicine facility. 

Final thoughts

Broadly speaking, nuclear pharmacists prepare and dispense prescriptions like other pharmacists, but their duties differ considerably from those of a traditional pharmacist. The risks of radioactive materials demand that nuclear pharmacists be highly trained and knowledgeable in their handling. Apart from preparing, testing and dispensing nuclear medicines, they must liaise with other healthcare professionals to provide guidance and safety training. 


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