Terrorist threat intensifies nuclear medicine’s “image” problem

It should come as no shock that the word "nuclear" conjures negative reactions. This is why nuclear magnetic resonance imaging was abridged decades ago and may be why the Society of Nuclear Medicine lately prefers its acronym and a slogan steeped in molecular imaging.

The problem could only get worse if terrorists do as they threaten and explode a dirty bomb. While the physical risk involved in most dirty bomb scenarios is low, the psychosocial impact can be great, said Jonathan M. Links, Ph.D., director of the Center for Public Health Preparedness at Johns Hopkins' Bloomberg School of Public Health.

But the makers of nuclear medicine equipment and radiopharmaceuticals can do a lot to help alleviate potential problems, Links said. He urges industry to work in concert with professional societies and wage a social marketing campaign to educate the public about the benefits of nuclear medicine. An anti-smoking campaign now on the airwaves is an example of one such effort.

"Social marketing means to use marketing techniques to promote societal benefits," Links said. "It uses classic advertising techniques to change behavior. Manufacturers are expert at all of them."

This kind of marketing is needed now to combat terrorists, who use the threat of a dirty bomb - essentially a conventional weapon packed with radioactivity - to create a climate of fear, Links said. From a public health perspective, this is more of a psychological than a physical weapon.

"Radiation is an especially powerful terrorism weapon because it instills considerable fear," he said.

Links is well-positioned to comment. A professional charged with running a CDC-funded center for health preparedness and a past president of the SNM, he bridges the worlds of nuclear threat and nuclear benefit.

"The public's perception of radiation is that it is highly risky," Links said. "They need the scientific facts to understand that, in reality, radiation allows doctors to effectively diagnose and treat disease."

Aside from a public awareness campaign, industry can boost the public image of nuclear medicine by financing and promoting training programs for nuclear medicine professionals in issues surrounding nuclear terrorism. This would allow these professionals to use their knowledge about radiation to assist local police, fire, public safety, and health departments in developing community response plans.

"All preparedness starts locally," Links said. "Nuclear medicine professionals should actively seek out such collaboration and be part of planning and preparedness activities now."

Industry should also reach out to the Department of Homeland Security, volunteering executives to serve as members of expert groups, such as the Nuclear Sector Coordinating Council, Links said. The council was formed two years ago to strengthen security and emergency preparedness at the nation's commercial nuclear facilities.

Breaking down perceptual barriers between medicine and the "war on terror" will grow more important as the government implements more antinuclear safeguards. Already, sensitive radiation detectors are being installed in major cities and public transportation facilities. These detectors may be triggered by patients who have recently undergone nuclear medicine procedures. Common radioisotopes powerful enough to set off alarms include technetium-99m, 18-fluorodeoxyglucose, thallium-201, and therapeutic doses of iodine-131.

Links recommends that nuclear medicine physicians and radiologists recognize these concerns and give letters to their patients that explain the medical procedure. The letters can be provided to security personnel if such alarms are tripped. These measures must be accompanied, however, by a comprehensive effort to reduce public fear of radiation, he said.

As nuclear medicine technologies merge with those of other modalities, a new era in molecular imaging may emerge, adding to the understanding of the molecular basis of disease. To get there, however, will require improved understanding by the public of the benefits to be derived from the use of radiation in medicine.