(E2) Intro to Nuclear Medicine

what is nuclear medicine?

a diagnostic modality that utilizes radioactive isotopes for imaging the function and structure of various organ systems of the body

what else is nuclear medicine called?

molecular imaging

what is a radioisotope?

a radioactive drug

• referred to as a radiopharmaceutical or radiotracer.

• it is an isotope mixed with a pharmaceutical to assist in imaging the function of organs and evaluate for disease

pharmaceutical is

part specific for the organ system

the radioactive portion is

for the imaging

radioisotope information?

• generated off campus

• many are made in nuclear reactors, radionuclide generators or cyclotrons

• a lead pot enclosing a glass tube containing the radioisotope supply hospitals from the nuclear reactor where the isotopes are made

• deliveries on daily basis, patient specific single doses

• Cardinal Health delivers to RH

commonly utilized isotopes

• technetium

• fluorodeoxyglucose

• gallium

• iodine

• samarium

• indium

what are the types of administration for isotopes

• injection into venous system

• inhalation

• by mouth

  • inside food

  • capsule

types of radiation safety with isotopes

• ALARA

• Time, Distance, Shielding

  • PIGS

  • Geiger counters

  • ring and body badges

  • lead shields/ L block

  • lead bricks

the gamma cameras or scintillation cameras do what?

• detect or “pick up” the radiation emitted from a patient’s body

• not an x-ray machine

what is 1?

photomultiplier tube

what is 2?

sodium iodide thallium activated crystal

what is 3?

collimator

what are the benefits of nuclear medicine?

• studies include detail of function and structure

• less expensive than exploratory surgery

• offers potential to identify disease at earliest stages

• determination of malignancy or benign tumors avoiding biopsy or surgery

• radiation therapy planning

what are the risks of nuclear medicine?

• low radiation exposure to patient

• allergic reactions to radiopharmaceutical

• injection of radiotracer could cause slight pain/redness at site but will resolve quickly

what is a ventilation/perfusion scan (lung scan)

studies air/blood flow of the lungs

• ventilation- air flow

• perfusion- blood flow

what are the indications of a ventilation/perfusion scan

• pulmonary emboli

• chronic obstructive pulmonary disease (COPD)

• asthma

• lung carcinoma

what does cardiovascular system NM evaluate?

evaluates the structure and function of the cardiovascular system

what does cardiovascular system NM assess?

assesses myocardial blood flow, ventricular function, cardiac physiology and pathology

what is this picture showing?

a V/Q scan

common cardiovascular NM studies

• myocardial perfusion

• MUGA scan

what is a myocardial perfusion

performed to show how well blood flows through the heart muscle. it also shows how well the heart muscle is pumping; ay rest and during exercise

what are the indications of myocardial perfusion

• coronary artery disease

• chest pain

• after MI to look at heart muscle damage

• post OP bypass, angioplasty or stent placement

what is this image showing?

myocardial perfusion

• rest and stress

what is a Multi-gated Acquisition (MUGA)

evaluates the pumping function of the ventricles

• intravenous injection

what are the indications of a MUGA

• chemotherapy

• coronary artery disease

• heart lesions in a patient’s valves

• previous or impending surgeries

• heart transplant

what is a bone scan

aids in diagnosis of bone diseases which are not detected on plain radiographs

• intravenous injeciton

indications of a bone scan

• metastasis

• infection

• bone loss

• injury

• unexplainable pain

• leukemia/lymphoma

what does SPECT stand for

• Single

• Photon

• Emission

• Computed Tomography

• detectors will rotated around the patient

advantages of SPECT/ tomography imaging

• Cine 3D info

  • able to analyze conditions that are especially deep in your bone or places that are difficult to see with static of 2D images

• improved superimposition for lesions

• removes superimposition of body structures better localized of abnormal accumulation

what type of radioisotope is used for inflammatory process/ tumor imaging

gallium 67- citrate scan

• intravenous injection

what are the indications of tumor imaging

• infection that is causing fever

• abscess/infections- especially in bone

• monitor response to antibiotic response to antibiotic treatment

• diagnose inflammatory conditions

• detect certain types of canvert

what is lypmhoscintogrpahy?

performed to identify the sentinel lymph node, or the first node to recieve lypmh frainage from a tumor

what is lymphoscintography used for

• used to a biopsy or surgery that will help assess the stage or surgery that will help assess at the same time of cancer and assist increasing points of blockage in the lymphatic system; lymph flow in an arm or leg/ leg lymphedema

what is a lymphoscintigraphy (sentinal node biopsy)

a surgical procedure used to determine whether cancer has spread beyond a primary tumor into your lymphatic system

• most commonly in evaluating breast cancer or melanoma

what is a hepatobiliary scan

visualization of production and flow of bile from the liver to the small intestine

what are the indications of a hepatobiliary scan

• bile duct obstruction

• bile leakage

• congential abnormalities in the bile ducts

• gallbladder inflammation

• gall stones

what is this an image of?

a hepatobiliary scan

what are the indications of GI bleeding

• dark red blood or bright red blood in stool

• ulcers of the stomach and duodenum

• diverticular bleeding

what is gastric emptying

evaluates the motility of the stomach (ingested)

what are the indications of gastric emptying

• bloating

• vomiting

• nausea

• gastroparesis

• anorexia

what is this an image of?

gastric emptying

what is a parathyroid scan

evaluation of parathyroid tissues (intravenous or pill)

what indications are there for a parathyroid scan

• cancer/ adenoma

• neck tenderness

• gland enlargement

• weight loss or gain

what is this an image of?

parathyroid scan

what is 1?

salivary glands

what is 2?

parathyroid

what is a brain SPECT

• diagnose/ clarify tumors

• evaluate cerebrovascular disease within the cerebrum and cerebellum

  • intravenous injection

what is this an image of?

brain SPECT

what is positron emission tomography

enables visualization of body’s cellular metabolic activity

• intravenous injection

indications of PET

• cancer

• brain disorders

• heart disease

CT obtains anatomical information…

detailed info of size and shape of tumors/growths

PET obtains functional information…

metabolic info from cancer cells, cells that are actively growing

What isotope is used with PET and CT scan

• fluorodeoxyglucose

• consumed quickly by cancer cells

what is 1?

normal RT kidney

what is 2?

normal brain

what is 3?

normal heart

what is 4?

normal left kidney

what is 5?

normal bladder

Alzheimer’s

evaluation of areas in the parietal/temporal region of decrease uptake

• detection early to prevent and treat and to keep symptoms from progressing

DATscan (SPECT imaging)

trade name of radiopharmaceutical used for exam

• brain imaging to differentiate between tremors or Parkinson’s disease