Introduction to Nuclear Medicine

Dr. Amir BahadurNuclear Medicine Physician

Definition

Branch of medicine which deals with diagnosis and treatment of diseases with the help of un-sealed* radioactive* sources.

Radio-active*

• Radiation emitting substances• Different types of radiations• Beta emitters---- therapeutic purposes• Gamma emitters---- diagnostic purposes• Different from non-radioactive diagnostic

chemicals (iodinated contrast media used in barium studies, CT scan and MRI)

Un-sealed*

• Out of protective shields• Introduced in to the patient’s body• Radiations are coming out of the patient• Different from radiology (sonography, X-ray,

MRI) where sound waves, radiation and magnetic field are outside the patient’s body and in the source

NM DivisionsNuclear Medicine

DIAGNOSTIC

SCANS

RIA

THERAPUTIC

SCANS

Scans

• Scintigram--- more technical name• Scintigraphy ---- technical name for

procedure• Around 200 types of scans in NM• Each organ and system of body imaged

* Primarily FUNCTIONAL IMAGING

* Functional Imaging

• Nuclear Medicine scans target physiological activity/ processes

• Different from radiology which is primarily STRUCTURAL IMAGING.

* HYBRID IMAGING

*Hybrid imaging

• SPECT – CT• PET- CT• SPECT –MRI• PET- MRI

Scan Procedure

• Radioactive tracer (radio-tracer/ radio-pharmaceutical)

• Gamma camera image acquisition • Processesing and image printing • Reporting

Scan Procedure

Radiotracer

Delivery in to patient

Gamma camera

Processesing Reporting

Radio-active tracer

• Radio-active tracer alone or radio-active moiety combined with organ/ system specific pharmaceutical.

• Alone ---- Tc-99m, I-131• Radio-Labeled

pharmaceuticals---- DTPA, DMSA, MDP, HIDA, MIBI, etc.

Delivery of radio-tracer

• Intra-venous injection (most common)

• Orally • Inhaled • Into cavities • Into shunts

Gamma Camera Image Acquisition

• Time interval post delivery

• Proper positioning • Proper time • Interventions like

fatty meal, CCK, Morphine, Lasix, Captopril, etc

Image Acquisition Types

Dimensions

Planar

SPECT

Processing

• Acquired image data is processed on special software

• End images reproduced on page, film or CD/DVD

Reporting

• Nuclear medicine physician

• Review of all available clinical data and images, report is generated.

RIA BASED LABORATORY

Radio-immuno Assay

• Most specific and sensitive method

• Hormones and tumor markers

• Thyroid hormones• Fertility

Hormones• Tumor markers

THERAPEUTIC NUCLEAR MEDICINE

Nuclear Medicine Therapies

• Radioactive Iodine for thyrotoxicosis and differentiated thyroid Carcinoma

• Radioactive Phosphorus for polycythemia and bone pain palliation

• Synovial joints• Pleural effusion• Ascites• Neuro-endocrine

tumors• Targeted therapy

like zevalin

Examples

of

Nuclear Medicine Scans

Thyroid Scan

• Graves disease• MNG• Solitary thyroid nodule • Lingual thyroid • Thyro-glossal fistula• Remnant thyroid

tissue • Thyroiditis

Bone Scan

Renal DTPA Scan

Renal DMSA Scan

HIDA Scan

PET

• Positron emission tomography• Future of nuclear medicine imaging and

cancer care • Also lots of uses in non-malignant disorders

My Mentor’s Slogan

IMAGING LIFE