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Extraordinary pharmacy: specialising in the field of radiopharmaceuticals

By Francesca Rivers

Paul Maltby
Paul Maltby: trying to ensure that we have a commonality between pharmacy and healthcare science (Crown copyright/Antony Medley)

Extraordinary you’, a book celebrating the work of healthcare scientists, is due to be published soon by the Department of Health. Francesca Rivers spoke to the only pharmacist to feature in the publication, Paul Maltby, about his work in the field of radiopharmacy


After an enjoyable foray into radiopharmacy during his preregistration training year, Paul Maltby chose to apply his pharmacy degree to a career in this specialist area.

Now chief radiopharmacist at Royal Liverpool and Broadgreen University Hospitals NHS Trust, Mr Maltby specialises in the development, preparation and administration of radioactive drugs.

Radiopharmaceuticals, he explained, are broadly divided into two categories: diagnostic and therapeutic (see Panel).

Most radiopharmaceutical compounds used in the UK are diagnostic — used to detect disease, monitor the success of its treatment or plan radiotherapy — but a small number also used have therapeutic applications.

At the nuclear medicines department in Liverpool, Mr Maltby uses radiopharmaceuticals for both diagnostic and therapeutic purposes and is involved both in their preparation and administration to patients.

“I have an extended role in that, as well as producing and preparing the radiopharmaceuticals for therapy, I’m also directly involved in administration to patients and preparation of patient care pathways,” he told The Journal.

Part of planning radiotherapy includes evaluating the medicines a patient is already taking, assessing potential drug-drug interactions and giving the patient any necessary advice. Often patients will need to stop taking one or more of their other medicines while radiotherapy is under way, and then continue taking them once the treatment is complete.

Mr Maltby is also involved in research into and development of new therapeutic compounds. By the end of this month his hospital will be endowed with a new scanner that will allow his team to detect radioactive compounds with far greater sensitivity and resolution than their existing equipment allows.

Rather than being used for routine diagnosis, this new positron emission tomography/computerised tomography (PET/CT) scanner will initially be used in a series of clinical trials, to evaluate proposed treatments for diseases such as pancreatic cancer.

“Say we’ve got a new medicine that would supposedly treat pancreatic tumours better than the existing medicine; we will administer a course of the therapy then evaluate using a PET/CT scan and see if there is an increase or decrease in the metabolic activity in the tumour, and thus see whether it is worth continuing treatment,” he explained.

“Part of the role I will have will be to develop new radiopharmaceuticals to help with those trials and, in the longer term, introduce them into clinical practice,” he said. Hopes are for the new scanner to be ready for clinical trials to begin in May.

Radiopharmacy plays a key role in the pharmaceutical industry, emphasised Mr Maltby, with nuclear medicines research projects fundamental to the development of new medicines.

“Pharmaceutical companies use radio-labelled versions of products that are in the pipeline to establish their pharmacokinetics and metabolism in ‘first-in-man’ studies”.

From those studies they can determine whether the compound is going to the organ they want to treat, quantify the uptake, and decide whether it is worth taking the research forward, he said.

Developing healthcare science careers

In addition to his work at the NHS trust, Mr Maltby is involved in a Department of Health workstream that is focused on supporting scientific careers. He is featured in ‘Extraordinary you’, a book commissioned by the DoH to celebrate the work of healthcare scientists across the UK and due to be published imminently. He was also involved in the recent development of a set of proposals aimed at advancing and modernising healthcare science careers.

Discussions are now under way with the DoH team responsible for the proposals and Keith Ridge, chief pharmaceutical officer for England, to try to build bridges between the healthcare science and pharmacy communities, Mr Maltby revealed.

“We’re trying to ensure that we have a commonality between the two scientific disciplines — pharmacy and healthcare science. Small areas, such as radiopharmacy and technical services, could fall between the two, so we’re trying to build links between both professions,” he explained.

Healthcare science specialists also need to be given due consideration by the new professional body, he added. “[Radiopharmacists are] part of a series of special interest groups that meet regularly,” said Mr Maltby, who is chairman of the UK Radiopharmacy Group. “I urge for that work to continue, and would consider leaving the Royal Pharmaceutical Society if those specialist groups were marginalised,” he said.

As a member of the Institute of Physics and Engineering in Medicine (IPEM), Mr Maltby could bow out of the pharmacy profession and still continue his work as a healthcare scientist, he told The Journal. However, he is loathe to do so and prefers for radiopharmacy to be supported and promoted by pharmacy’s professional body.

“I would want to ensure that my specialty has representation — I would like to keep that representation from the pharmacy side, as well as from the IPEM on the healthcare science side,” he said.

Radiopharmacy: how it works

Paul MaltbyRadiopharmaceuticals are radiolabelled compounds which, when injected into patients, accumulate in an organ or tissue of interest and can be detected using scanning machines, such as positron emission tomography/computerised tomography (PET/CT) and single photon emission computerised tomography (SPECT) scanners.

Diagnostic radiopharmaceuticals are routinely used to detect disease, monitor disease treatment and evaluate proposed treatments. For example, they can be used to determine whether it is appropriate to put a patient on a particular course of medication, using a scan to determine the uptake of the medicine in the target area and thus establish whether the treatment is appropriate for that individual patient.

Mr Maltby explained: “We have diagnostic radiopharmaceuticals that will indicate whether treatment with expensive medicines is appropriate, for instance in Alzheimer’s and Parkinson’s disease. We can use a brain tracer — a radiopharmaceutical — to look at patterns of uptake in the brain, to determine whether it’s worth using.”

Therapeutic procedures are also a part of radiopharmacy. Radiopharmaceuticals that emit beta particles as part of their radioactive decay are used for therapeutic purposes in so-called “targeted therapy”, explained Mr Maltby.

Following active uptake into the organ or tumour, the physical decay of the radioactive atom attached to the radiopharmaceutical releases a beta particle that damages or kills the adjacent cells. This can be used, for example, to reduce the production of thyroxine by an overactive thyroid.

Radiopharmaceutical products are controlled by regulations under the 1968 Medicines Act, and are also covered by the Medicines (Administration of Radioactive Substances) Regulations 1978, which dictate that only a medical consultant may authorise their administration to a patient, Mr Maltby told The Journal.

Combined with Environment Agency regulations and other directives pertaining to obtaining, storing and disposing of radioactive materials, radiopharmacy is a highly specialist discipline that can be practised only at certain sites.

Approximately 100 radiopharmacies are currently in operation in the UK, about 40 per cent of which are run by pharmacists under section 10 of the Medicines Act, with the remainder licensed by the Medicines and Healthcare products Regulatory Agency. MHRA licensed units can be run by pharmacists or scientists from other fields.

Citation: The Pharmaceutical Journal URI: 11002400

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