From steel chamber to 5-minute scan: Nuclear Medicine Physics team transforms patient experience

Cardiff and Vale University Health Board is delighted that the Nuclear Medicine Physics team based at the University Hospital of Wales has been highly commended in the Excellence in Diagnostics award at the AHA Cymru Awards last week.

Over the past year, the team has transformed the way patients are tested for bile acid malabsorption, reducing waiting times from around two years to less than two months, improving attendance rates and creating a better experience for patients. Bile acid malabsorption is a condition that causes chronic diarrhoea. Until last year, the Nuclear Medicine Physics team used a rare piece of medical equipment called a Whole Body Counter to diagnose the condition. The Whole Body Counter was installed in the hospital in 1967 and the diagnosis involved patients having 45-minute scans inside the enclosed steel chamber, on two separate occasions over a two-week period.

Rachel Bidder, Head of Nuclear Medicine Physics, said: “The Whole Body Counter provided highly sensitive radiation measurements, but the confined nature of the scanner could make the experience less comfortable for some patients.”

Patients undergoing the test swallow a capsule containing a small amount of radioactive material. They are scanned for a baseline reading and then return after seven days for a second scan. By measuring how much of the substance remains in the body, clinical scientists can determine whether the patient is likely to have bile acid malabsorption.

The lengthy testing process, combined with a high number of missed appointments, meant waiting times had become unsustainable. The service could only accommodate six patients per session, and with missed appointments that became three or four. Around 200 patients were on the waiting list, and referrals were taking up to two years to complete. In addition, each missed appointment also held the risk of wasting a capsule which cost around £300 each and had a limited expiry time.

Determined to improve the service, the Nuclear Medicine Physics team worked closely with colleagues in Radiology to find a new approach.

Patients are now scanned using a gamma camera in the Radiology department. The scans take around five minutes and are carried out in a more open and less intimidating environment.

Alongside the new scanning process, the team also introduced a more proactive booking system. Administrative staff contact every patient before their appointment, helping them prepare for the test and ensuring they are able to attend.

Amie Roberts, Deputy Head of Nuclear Medicine Physics, said: “This group of patients often live with chronic diarrhoea, so moving from a 45-minute scan in an isolated room within confined space to a five-minute scan in a more open environment has really reduced the anxiety patients experience.

The changes have transformed the service. The team can now test up to 25 patients in a session, reducing waiting times from around two years to less than two months. They hope to reduce this even further to around four weeks.

This has dramatically reduced the number of missed appointments, helping the team make the best use of available appointments and reducing waste of the specialist capsules used in the test.

Charlie Willis, Technical Team Lead and Superintendent Radiographer, said: “The whole team are involved in the service, from the clinical scientists, clinical technologists, radiographers to

the administration staff and healthcare support workers. Everyone has contributed somewhere along the line.”

The Whole Body Counter is believed to be one of only two still in working order in the UK. Despite its age, it remains the gold standard for its ability to detect radiation. While it is no longer used for these tests, it will continue to be used in research and forms part of contingency planning.

For Rachel, being highly commended is recognition of the collective effort behind the project. She said: “This is recognition of what a team can achieve when we work together.

“This couldn’t have been achieved by one person. Everybody has played a part in creating a better service for our patients.”