tional years training in general nuclear medicine in order to image only the heart. The argument that full training in all aspects of nuclear medicine is required to practice high-quality nuclear cardiology is specious and it flies in the face of developments in other areas where subspecialisation is the norm. The average subspecialist in heart failure would not dream of undertaking an electrophysiological investigation or placing a stent in a coronary artery, and even within the subspecialty of electrophysiology there are those who concentrate on arrhythmias and others on pacing. A subspecialist can be trusted to know the boundaries of their expertise.It therefore falls to us to define the knowledge and skills that would be required by the cardiologist who wishes to subspecialise in nuclear cardiology, and to ensure that appropriate training and experience can be provided and assessed. A curriculum for nuclear cardiology already exists in the USA together with a voluntary subspeciality examination [6, 7]. We would do well to note the success of nuclear cardiology in the USA and to recognise that the same must be achieved in Europe if nuclear cardiology is to reach its full potential. Similarly we should encourage nuclear physicians to subspecialise in imaging the heart and to join with the nuclear cardiologist in the middle ground between nuclear medicine and cardiology.The future of nuclear cardiology in Europe is bright. The only thing wrong is that we do not have enough of it. I rest my case.
AgainstThis has been an interesting debate, although I suspect the interest is waning. Who should or is best fit to practice the application of nuclear medicine to cardiology? Let us agree from the start that this is what is under discussion! And if we can agree here then we will also have to agree that this debate could be extended to the question of who is best fit to practice the application of nuclear medicine to oncology (oncologists?),to renal medicine (nephrologists?), to neurology (neurologists?), etc. And so we need to ask ourselves why the fuss about cardiological applications and not other special areas of knowledge...and if a similar fuss is going to develop in respect to other areas, what are the driving forces? Are the motives genuine? Is the debate driven by a concern for patient's interests or simply by financial considerations or a mixture of both? These questions are being asked in most areas of medicine and not only medical professional practice, and ring fencing is often the order of the day. If, however, we were to pose a different set of questions, which have to do with the essential nature of the subject, we may more rapidly achieve some clarification.It might be useful to pose the following questions :1. What are nuclear cardiologists? a) Are they cardiologists who did not pursue a career in cardiology? b) Are they organ imaging specialists who are dedicated to imaging the heart with multiple technologies? c) Are they nuclear medicine specialists who are engaged full time in cardiovascular applica...
