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NUCLEAR MEDICINE
ProfMAzizul KahharProfessor of Medicine Dhaka Medical College Hospital
NUCLEAR MEDICINE [NM]
Nuclear medicine apply unsealed radionuclide amp nuclear techniques to diagnose amp treat diseases
Nuclear medicine techniques use a carrier molecule selected to target the organtissue of interest tagged with a gamma-emitting radioisotope
Nuclear medicine studies using radioactive labelled isotopes as the ligandand a gamma camera can be used to produce perfusion imaging scans of the various organs
NUCLEAR MEDICINE CONThellip Nuclear medicine procedures detect the earliest physiological
response to disease processes generally before structural changes have taken placeScintigraphy is often more sensitive than conventional radiology in early disease
Nuclear medicine procedures are non-invasive and allow the whole body to be imaged during a single examination
Nuclear Medicine is essentially the use of atomic energy for peaceful purposes
Three types of radiations are emitted from the atoms 1 Alpha rays Least penetrating but most powerful once they
are inside the body
2Beta rays More penetrating than alphas but less than gammas Energy varies Useful in therapeutic applications
3Gamma rays Most penetrating and hence relatively less harmful Mainly used for diagnostic purposes Important gamma emitting isotopes include Technetium 99m Thallium 201 and Iodine 131
RADIOPHARMACEUTICALS
The radionuclide used in NM are called radiopharmaceuticals as they are introduced into the body
Radionuclide Radioactive isotope of an element eg Iodine-131 is one of the radionuclide of several isotopes of iodine Isotopes are same element with different atomic weight due to different neutron content
Unsealed radioactive source Sealed source remain sealed amp are used in teletherapy amp brachytherapy by radiotherapy departmentNM use unsealed radiation which is introduced into the body
Several radiopharmaceuticals are used for both diagnosis and treatment
99mTechnetium I-131 111 Indium I-123 113 m Indium C-11 67 Gallium N-13 201 Thallium O-15 18 Fluorine Xe-127
Organ Pharmaceutical
Brain
Tc-99m pertechnetateTc-99m DTPATc-99m glucoheptonate
CSF
In-111 DTPATc-99m DTPA
Cardiac
Tc-99m pyrophosphateTc-99m pertechnetateTc-99macirceuroldquolabeled RBCsTc-99m sestamibi
Liver
Tc-99m sulfur colloidTc-99m DISIDA
Lung
Xe-127Xe-133Tc-99m MAA aerosol
Kidney
Tc-99m DTPATc-99m DMSATc-99m glucoheptonate
Thyroid
I-131 HippuranI-123 HippuranTc-99m pertechnetateI-123I-125I-131
WBC
In-111 oxineTc-99m Ceretec
Organ specific Radiopharmaceutical
NUCLEAR MEDICINE IMAGING
Nuclear Medicine Scan - imaging the distribution of radioactivity inside the organ of interest
The labeled drug (radiopharmaceutical) is given PO or IV Its distribution is then mapped in vivo using a gamma camera or for non-imaging tests in using a radiation counter
Gamma rays emitted by them are scanned with a state of the art Gamma Camera
Static Imaging Dynamic Imaging
Whole body scanning by automatic sweep SPECT imaging cut section (Single Photon Emission Computed Tomography)
EQUIPMENTS IN NM [NUCLEAR MEDICINE ]
Nuclear Medicine is heavily equipment dependent
Major equipment
Thyroid uptake system Probe renogram Rectilinear scanner Gamma well counter Liquid scintillation counter Planner gamma camera Gamma probe
Single photon emission computed tomography (SPECT) Single head Dual head Triple head
Positron emission tomography (PET)
Hybrid camera (SPECT amp CT PET amp CT)
Thyroid uptake system
Gamma camera
Single head SPECT
Triple head SPECT
Modern PET camera
Gamma probe for sentinel lymph node detection
SPECIFIC INFORMATION REQUIRED WHEN REQUESTING NUCLEAR MEDICINE TESTS INCLUDES
1 Patient identification details2 Examination requested3 Relevant clinical history including
results of other investigations4 Pregnancylactation details where
relevant5 Special
needsmdashvisualhearinglearning difficulties needle phobia
H orm o ne D ru gs
T u m or M a rker D isea se M arker
R adio Im m uno Assay H eam ato log ica l Applica tions
In-v itro
P lanar S P E C T
Im aging
C a T hyro id80 - 200 m Ci
T hyrotoxicosis5 - 20 m Ci
131 Iod ine 32 P 89 S rP a llia tio n T h erapy
R adio N uclide T herapy
In-v ivo
Nuclear M edicine Applications
CLINICAL APPLICATIONS
BONES AND JOINTS
BRAIN SPECT
ENDOCRINOLOGY
LUNG - VENTILATION amp PERFUSION
NUCLEAR NEPHRO ndash UROLOGY
CARDIO VASCULAR SYSYTEM
GASTRO ndash ENTEROLOGY
BONE SCINTIGRAPHY BONE SCAN
Indications Tumour stagingmdasheg to assess skeletal
metastases(from prostate breastkidney thyroid lung)
Intractable Bone pain
Traumamdashwhen radiographs unhelpful
Prosthetic loosening eg THR
Infection - eg osteomyelitis
Avascular necrosis (AVN)
Pagetrsquos to assess extent
SKULL METASTASES IN CA PROSTATE
PHASE BONE SCAN - MUTILPLE MYELOMAACTIVE LESIONS IN LEFT FEMUR AND DV10
SECONDARY VERTEBRAL METASTESES
BRAIN SCANIndications
Dementia characterisation
Epilepsy for localisation of epileptogenic focus
Metastatic work-ups
Determination of blood flow (in brain death or atherosclerotic disease)
Evaluation of space-occupying lesions (tumor hematoma abscess [AV] malformation) and
Encephalitis
Suspected VP shunt obstruction
Distinguishes Parkinsonrsquos syndrome (PS) from benign essential tremor
INTER ICTAL ICTAL amp POST-ICTAL SPECT SHOWING HYPERPERFUSION OF RT TEMPORAL LOBE
9H POST ICTAL CT AND RCBF SPECT IN A 58YF (NORMAL CT ALTERED PERFUSION IN SPECT)
PERSISTENT HYPOPERFUSION DEFECTS THROUGH RIGHT HEMISPHERE IN A PATIENT OF TIA
99m Tc labelled ECD is used Assessment of Stroke detection of Epileptic focus evaluation of dementia etc
Figure Patient with acute ischemic stroke treated with hypertensive therapy a Positron emission tomography images of cerebral blood flow at 2 h (top) and 6 h (bottom)after the onset of symptoms PET cerebral blood flow(CBF) images demonstrate a significant reduction in blood flow affecting a substantial portion of the left middle cerebral artery territoryb PET images of regional cerebral metabolic rate of oxygen at 2 h (top) and 6 h (bottom) after the onset of symptomsOxygen metabolism is abnormal in the left middle cerebral artery (MCA)territory but in an area substantially smaller than the defect seen on the CBF imagesThis reduction in tissue at risk was presumably due to hypertensive therapyc Follow-up CT scan of the head in the patient demonstrating that the ultimate cerebral infarct size most closely approximates the oxygen metabolism defect(b) than the CBF defect (a)
THYROID amp PARATHYROID SCINTIGRAPHY
Indications Characterisation of thyrotoxicosis
a Diffuse toxic goitre (Gravesrsquodisease) b Toxic multinodular goitre (Plummerrsquos disease)
Autonomous nodule
Acute thyroiditis
Evaluation of upper mediastinal mass
Localisation of parathyroid adenoma in proven hyperparathyroidism
Na99mTcO4 Thyroid Scintigraphy - Avid Uptake with increased T3 and T4
FD - Thyrotoxicosis
Na99mTcO4 Thyroid Scintigraphy - A large Cold nodule involving the RtLobe
US - Cyst
Parathyroid Adenoma - 99mTc Sesta MIBI Scan
Thyroid in 5 min scan
20 min scan No wash out in Parathyroid Adenoma
LUNG SCANA Ventilationperfusion imaging (VQ Scan)
Indications Suspected pulmonary embolism Pre-operative lung function assessment
B Lung shunt studies
Indications
Suspected pulmonary AV shuntingInterpretation
1 Segmental perfusion loss with preserved ventilationmdash
pulmonary embolism2 Segmental matched perfusion and ventilation lossmdash
pulmonary infarctioninfection3 Segmentalsubsegmental ventilation loss with preserved
perfusionmdashinfection4 Non-segmental patchy matched perfusion and ventilation
LOSSmdashCOPD
NORMAL 99M TC DTPA AEROSOL STUDY
PERFUSION DEFECTS IN PULMONARY EMBOLISM
RENAL AND ADRENAL SCINTIGRAPHY
1 Static cortical renographyDMSA imaging
Urinary tract infection lsquogold standardrsquo for renal scarring Measurement of relative renal function Renal duplication assessment Ectopic kidney localisation Renal trauma Renal vein thrombosis Pre-biopsy
2 Dynamic renography
Assessment of renal drainagemdashdiscrimination between
renal dilatation and outflow obstruction Measurement of relative renal function Loin pain Post-pyeloplasty follow-up Renal artery stenosismdash1048585Captopril renography
3Adrenal Scan Used to accurately localize a pheochromocytoma when MRI or CT is
equivocal Uses labeled MIBG
Plain Renal Dynamic Studies
Tc-99m labelled DTPA is used for Renal scintigraphy (1) RENOGRAM - PLAIN STUDY amp WITH DIURETIC INTERVENSION
Useful for evaluation of obstructive uropathies to know whether obstruction is due to functional or organic causes
Contracted left kidney Scars over both poles of the Right Kidney
99mTc DMSA- Renal Cortical Image
HEART SCINTIGRAPHY
Myocardial perfusion imaging (MPI)
Indications
In ischaemic heart disease
1 Pre-angiography ndash When conventional stress testing fails eg
bundle branch blockndash Left ventricular hypertrophyndash Atypical chest painndash Recurrent chest pain post-intervention
2 Post-angiography
ndash Assess functional significance of known stenosesndash Identify critical vascular territory for
intervention
99MTC MIBI SPECT IMAGES - NORMAL STUDY
Short Axis
Vertical Long Axis
Horizontal Long Axis
Polar Map
3D image of LV
99MTC MIBI SPECT IMAGES - INFARCTION
Short Axis
Vertical Long Axis
Horizontal Long Axis
Polar Map
3D image of LV
LIVER AND GASTROINTESTINAL TRACT SCINTIGRAPHY
Hepatobiliary scintigraphy (HIDA-Scan BIDA-Scan)
Indications1 Acute cholecystitis2 Trauma3 Post-operative leak detection4 Bile ductstent patency5 Gallbladder emptying6 Bile reflux7 Neonatal biliary atresia
Gastrointestinal bleeding labelled red cell imaging
Helps localise source of active GI haemorrhage when other techniques(eg endoscopy or angiography) have failed
Gastric emptying studie
Altered GI motilitymdashdelayed or accelerated gastric emptying
Meckelrsquos scan ectopic gastric mucosa localisation Unexplained abdominal pain or GI hemorrhagemdashafter endoscopycontrast radiology
Meenakshi Isotope Scan and Thyroid Care Centre
99mTc Mebrofenin (Trimethyl Bromo Imino Diacetic Acid) Hepato Biliary Scan
5 min
2 h
Post meal
4 h 24 h
40 min
10 min
20 min
Total Biliary Channel Obstruction
G I BLEED STUDY
Blood Pool Scan 99m Tc labelled RBCs are used
To differentiate Hemangioma of the Liver from Hepatoma amp evaluation of G I Bleeding
Meenakshi Isotope Scan and Thyroid Care Centre
99mTc Mebrofenin Hepato Biliary Scan
20 min
5 min
10 min
30 min
4 hPost Meal
4 h
5 min 10 min
20 min 40 min 2 h
Post meal
24 h
Normal Biliary Atresia
RADIONUCLIDE THERAPY
131 I Therapy for Thyrotoxicosis
131 I Therapy for Ca Thyroid
32 P Therapy for pain palliation
OTHERS NUCLEAR SCANSSomatostatin scintigraphy
Localise and stage neuroendocrine tumours (NETs) eg carcinoid insulinoma gastrinoma phaeochromocytoma and medullary thyroid cancer
Lymphoscintigraphy
Unexplained limb swelling eg lymphatic hypoplasia
Urea breath test
Helicobacter pylori detectionmdashdiagnosis and confirmation of eradication
B12 absorption studies
Vitamin B12 malabsorption pernicious anaemia
Labelled leukocyte imaging
Sepsis localization Inflammatory bowel disease to help determine extent and severity
Dacroscintigraphy
Epiphora
MIBG (meta iodobenzylguanidine)imaging Localisation staging and response monitoring of neuroectodermal tumours Phaeochromocytoma (imaging investigation of choice) Neuroblastoma Carcinoid tumours Medullary thyroid cancer
SUMMARY NUCLEAR MEDICINE IMAGING IS
IMPORTANT IN FUNCTIONAL ASSESSMENT OF VARIOUS ORGANS
SIMPLE AND NON INVASIVE PROCEDURES
COST EFFECTIVE
RADIO IMMUNO ASSAY IS GOLD STANDARD
RADIO NUCLIDE THERAPY INCREASES SURVIVAL
RATE
THANK YOU
NUCLEAR MEDICINE [NM]
Nuclear medicine apply unsealed radionuclide amp nuclear techniques to diagnose amp treat diseases
Nuclear medicine techniques use a carrier molecule selected to target the organtissue of interest tagged with a gamma-emitting radioisotope
Nuclear medicine studies using radioactive labelled isotopes as the ligandand a gamma camera can be used to produce perfusion imaging scans of the various organs
NUCLEAR MEDICINE CONThellip Nuclear medicine procedures detect the earliest physiological
response to disease processes generally before structural changes have taken placeScintigraphy is often more sensitive than conventional radiology in early disease
Nuclear medicine procedures are non-invasive and allow the whole body to be imaged during a single examination
Nuclear Medicine is essentially the use of atomic energy for peaceful purposes
Three types of radiations are emitted from the atoms 1 Alpha rays Least penetrating but most powerful once they
are inside the body
2Beta rays More penetrating than alphas but less than gammas Energy varies Useful in therapeutic applications
3Gamma rays Most penetrating and hence relatively less harmful Mainly used for diagnostic purposes Important gamma emitting isotopes include Technetium 99m Thallium 201 and Iodine 131
RADIOPHARMACEUTICALS
The radionuclide used in NM are called radiopharmaceuticals as they are introduced into the body
Radionuclide Radioactive isotope of an element eg Iodine-131 is one of the radionuclide of several isotopes of iodine Isotopes are same element with different atomic weight due to different neutron content
Unsealed radioactive source Sealed source remain sealed amp are used in teletherapy amp brachytherapy by radiotherapy departmentNM use unsealed radiation which is introduced into the body
Several radiopharmaceuticals are used for both diagnosis and treatment
99mTechnetium I-131 111 Indium I-123 113 m Indium C-11 67 Gallium N-13 201 Thallium O-15 18 Fluorine Xe-127
Organ Pharmaceutical
Brain
Tc-99m pertechnetateTc-99m DTPATc-99m glucoheptonate
CSF
In-111 DTPATc-99m DTPA
Cardiac
Tc-99m pyrophosphateTc-99m pertechnetateTc-99macirceuroldquolabeled RBCsTc-99m sestamibi
Liver
Tc-99m sulfur colloidTc-99m DISIDA
Lung
Xe-127Xe-133Tc-99m MAA aerosol
Kidney
Tc-99m DTPATc-99m DMSATc-99m glucoheptonate
Thyroid
I-131 HippuranI-123 HippuranTc-99m pertechnetateI-123I-125I-131
WBC
In-111 oxineTc-99m Ceretec
Organ specific Radiopharmaceutical
NUCLEAR MEDICINE IMAGING
Nuclear Medicine Scan - imaging the distribution of radioactivity inside the organ of interest
The labeled drug (radiopharmaceutical) is given PO or IV Its distribution is then mapped in vivo using a gamma camera or for non-imaging tests in using a radiation counter
Gamma rays emitted by them are scanned with a state of the art Gamma Camera
Static Imaging Dynamic Imaging
Whole body scanning by automatic sweep SPECT imaging cut section (Single Photon Emission Computed Tomography)
EQUIPMENTS IN NM [NUCLEAR MEDICINE ]
Nuclear Medicine is heavily equipment dependent
Major equipment
Thyroid uptake system Probe renogram Rectilinear scanner Gamma well counter Liquid scintillation counter Planner gamma camera Gamma probe
Single photon emission computed tomography (SPECT) Single head Dual head Triple head
Positron emission tomography (PET)
Hybrid camera (SPECT amp CT PET amp CT)
Thyroid uptake system
Gamma camera
Single head SPECT
Triple head SPECT
Modern PET camera
Gamma probe for sentinel lymph node detection
SPECIFIC INFORMATION REQUIRED WHEN REQUESTING NUCLEAR MEDICINE TESTS INCLUDES
1 Patient identification details2 Examination requested3 Relevant clinical history including
results of other investigations4 Pregnancylactation details where
relevant5 Special
needsmdashvisualhearinglearning difficulties needle phobia
H orm o ne D ru gs
T u m or M a rker D isea se M arker
R adio Im m uno Assay H eam ato log ica l Applica tions
In-v itro
P lanar S P E C T
Im aging
C a T hyro id80 - 200 m Ci
T hyrotoxicosis5 - 20 m Ci
131 Iod ine 32 P 89 S rP a llia tio n T h erapy
R adio N uclide T herapy
In-v ivo
Nuclear M edicine Applications
CLINICAL APPLICATIONS
BONES AND JOINTS
BRAIN SPECT
ENDOCRINOLOGY
LUNG - VENTILATION amp PERFUSION
NUCLEAR NEPHRO ndash UROLOGY
CARDIO VASCULAR SYSYTEM
GASTRO ndash ENTEROLOGY
BONE SCINTIGRAPHY BONE SCAN
Indications Tumour stagingmdasheg to assess skeletal
metastases(from prostate breastkidney thyroid lung)
Intractable Bone pain
Traumamdashwhen radiographs unhelpful
Prosthetic loosening eg THR
Infection - eg osteomyelitis
Avascular necrosis (AVN)
Pagetrsquos to assess extent
SKULL METASTASES IN CA PROSTATE
PHASE BONE SCAN - MUTILPLE MYELOMAACTIVE LESIONS IN LEFT FEMUR AND DV10
SECONDARY VERTEBRAL METASTESES
BRAIN SCANIndications
Dementia characterisation
Epilepsy for localisation of epileptogenic focus
Metastatic work-ups
Determination of blood flow (in brain death or atherosclerotic disease)
Evaluation of space-occupying lesions (tumor hematoma abscess [AV] malformation) and
Encephalitis
Suspected VP shunt obstruction
Distinguishes Parkinsonrsquos syndrome (PS) from benign essential tremor
INTER ICTAL ICTAL amp POST-ICTAL SPECT SHOWING HYPERPERFUSION OF RT TEMPORAL LOBE
9H POST ICTAL CT AND RCBF SPECT IN A 58YF (NORMAL CT ALTERED PERFUSION IN SPECT)
PERSISTENT HYPOPERFUSION DEFECTS THROUGH RIGHT HEMISPHERE IN A PATIENT OF TIA
99m Tc labelled ECD is used Assessment of Stroke detection of Epileptic focus evaluation of dementia etc
Figure Patient with acute ischemic stroke treated with hypertensive therapy a Positron emission tomography images of cerebral blood flow at 2 h (top) and 6 h (bottom)after the onset of symptoms PET cerebral blood flow(CBF) images demonstrate a significant reduction in blood flow affecting a substantial portion of the left middle cerebral artery territoryb PET images of regional cerebral metabolic rate of oxygen at 2 h (top) and 6 h (bottom) after the onset of symptomsOxygen metabolism is abnormal in the left middle cerebral artery (MCA)territory but in an area substantially smaller than the defect seen on the CBF imagesThis reduction in tissue at risk was presumably due to hypertensive therapyc Follow-up CT scan of the head in the patient demonstrating that the ultimate cerebral infarct size most closely approximates the oxygen metabolism defect(b) than the CBF defect (a)
THYROID amp PARATHYROID SCINTIGRAPHY
Indications Characterisation of thyrotoxicosis
a Diffuse toxic goitre (Gravesrsquodisease) b Toxic multinodular goitre (Plummerrsquos disease)
Autonomous nodule
Acute thyroiditis
Evaluation of upper mediastinal mass
Localisation of parathyroid adenoma in proven hyperparathyroidism
Na99mTcO4 Thyroid Scintigraphy - Avid Uptake with increased T3 and T4
FD - Thyrotoxicosis
Na99mTcO4 Thyroid Scintigraphy - A large Cold nodule involving the RtLobe
US - Cyst
Parathyroid Adenoma - 99mTc Sesta MIBI Scan
Thyroid in 5 min scan
20 min scan No wash out in Parathyroid Adenoma
LUNG SCANA Ventilationperfusion imaging (VQ Scan)
Indications Suspected pulmonary embolism Pre-operative lung function assessment
B Lung shunt studies
Indications
Suspected pulmonary AV shuntingInterpretation
1 Segmental perfusion loss with preserved ventilationmdash
pulmonary embolism2 Segmental matched perfusion and ventilation lossmdash
pulmonary infarctioninfection3 Segmentalsubsegmental ventilation loss with preserved
perfusionmdashinfection4 Non-segmental patchy matched perfusion and ventilation
LOSSmdashCOPD
NORMAL 99M TC DTPA AEROSOL STUDY
PERFUSION DEFECTS IN PULMONARY EMBOLISM
RENAL AND ADRENAL SCINTIGRAPHY
1 Static cortical renographyDMSA imaging
Urinary tract infection lsquogold standardrsquo for renal scarring Measurement of relative renal function Renal duplication assessment Ectopic kidney localisation Renal trauma Renal vein thrombosis Pre-biopsy
2 Dynamic renography
Assessment of renal drainagemdashdiscrimination between
renal dilatation and outflow obstruction Measurement of relative renal function Loin pain Post-pyeloplasty follow-up Renal artery stenosismdash1048585Captopril renography
3Adrenal Scan Used to accurately localize a pheochromocytoma when MRI or CT is
equivocal Uses labeled MIBG
Plain Renal Dynamic Studies
Tc-99m labelled DTPA is used for Renal scintigraphy (1) RENOGRAM - PLAIN STUDY amp WITH DIURETIC INTERVENSION
Useful for evaluation of obstructive uropathies to know whether obstruction is due to functional or organic causes
Contracted left kidney Scars over both poles of the Right Kidney
99mTc DMSA- Renal Cortical Image
HEART SCINTIGRAPHY
Myocardial perfusion imaging (MPI)
Indications
In ischaemic heart disease
1 Pre-angiography ndash When conventional stress testing fails eg
bundle branch blockndash Left ventricular hypertrophyndash Atypical chest painndash Recurrent chest pain post-intervention
2 Post-angiography
ndash Assess functional significance of known stenosesndash Identify critical vascular territory for
intervention
99MTC MIBI SPECT IMAGES - NORMAL STUDY
Short Axis
Vertical Long Axis
Horizontal Long Axis
Polar Map
3D image of LV
99MTC MIBI SPECT IMAGES - INFARCTION
Short Axis
Vertical Long Axis
Horizontal Long Axis
Polar Map
3D image of LV
LIVER AND GASTROINTESTINAL TRACT SCINTIGRAPHY
Hepatobiliary scintigraphy (HIDA-Scan BIDA-Scan)
Indications1 Acute cholecystitis2 Trauma3 Post-operative leak detection4 Bile ductstent patency5 Gallbladder emptying6 Bile reflux7 Neonatal biliary atresia
Gastrointestinal bleeding labelled red cell imaging
Helps localise source of active GI haemorrhage when other techniques(eg endoscopy or angiography) have failed
Gastric emptying studie
Altered GI motilitymdashdelayed or accelerated gastric emptying
Meckelrsquos scan ectopic gastric mucosa localisation Unexplained abdominal pain or GI hemorrhagemdashafter endoscopycontrast radiology
Meenakshi Isotope Scan and Thyroid Care Centre
99mTc Mebrofenin (Trimethyl Bromo Imino Diacetic Acid) Hepato Biliary Scan
5 min
2 h
Post meal
4 h 24 h
40 min
10 min
20 min
Total Biliary Channel Obstruction
G I BLEED STUDY
Blood Pool Scan 99m Tc labelled RBCs are used
To differentiate Hemangioma of the Liver from Hepatoma amp evaluation of G I Bleeding
Meenakshi Isotope Scan and Thyroid Care Centre
99mTc Mebrofenin Hepato Biliary Scan
20 min
5 min
10 min
30 min
4 hPost Meal
4 h
5 min 10 min
20 min 40 min 2 h
Post meal
24 h
Normal Biliary Atresia
RADIONUCLIDE THERAPY
131 I Therapy for Thyrotoxicosis
131 I Therapy for Ca Thyroid
32 P Therapy for pain palliation
OTHERS NUCLEAR SCANSSomatostatin scintigraphy
Localise and stage neuroendocrine tumours (NETs) eg carcinoid insulinoma gastrinoma phaeochromocytoma and medullary thyroid cancer
Lymphoscintigraphy
Unexplained limb swelling eg lymphatic hypoplasia
Urea breath test
Helicobacter pylori detectionmdashdiagnosis and confirmation of eradication
B12 absorption studies
Vitamin B12 malabsorption pernicious anaemia
Labelled leukocyte imaging
Sepsis localization Inflammatory bowel disease to help determine extent and severity
Dacroscintigraphy
Epiphora
MIBG (meta iodobenzylguanidine)imaging Localisation staging and response monitoring of neuroectodermal tumours Phaeochromocytoma (imaging investigation of choice) Neuroblastoma Carcinoid tumours Medullary thyroid cancer
SUMMARY NUCLEAR MEDICINE IMAGING IS
IMPORTANT IN FUNCTIONAL ASSESSMENT OF VARIOUS ORGANS
SIMPLE AND NON INVASIVE PROCEDURES
COST EFFECTIVE
RADIO IMMUNO ASSAY IS GOLD STANDARD
RADIO NUCLIDE THERAPY INCREASES SURVIVAL
RATE
THANK YOU
NUCLEAR MEDICINE CONThellip Nuclear medicine procedures detect the earliest physiological
response to disease processes generally before structural changes have taken placeScintigraphy is often more sensitive than conventional radiology in early disease
Nuclear medicine procedures are non-invasive and allow the whole body to be imaged during a single examination
Nuclear Medicine is essentially the use of atomic energy for peaceful purposes
Three types of radiations are emitted from the atoms 1 Alpha rays Least penetrating but most powerful once they
are inside the body
2Beta rays More penetrating than alphas but less than gammas Energy varies Useful in therapeutic applications
3Gamma rays Most penetrating and hence relatively less harmful Mainly used for diagnostic purposes Important gamma emitting isotopes include Technetium 99m Thallium 201 and Iodine 131
RADIOPHARMACEUTICALS
The radionuclide used in NM are called radiopharmaceuticals as they are introduced into the body
Radionuclide Radioactive isotope of an element eg Iodine-131 is one of the radionuclide of several isotopes of iodine Isotopes are same element with different atomic weight due to different neutron content
Unsealed radioactive source Sealed source remain sealed amp are used in teletherapy amp brachytherapy by radiotherapy departmentNM use unsealed radiation which is introduced into the body
Several radiopharmaceuticals are used for both diagnosis and treatment
99mTechnetium I-131 111 Indium I-123 113 m Indium C-11 67 Gallium N-13 201 Thallium O-15 18 Fluorine Xe-127
Organ Pharmaceutical
Brain
Tc-99m pertechnetateTc-99m DTPATc-99m glucoheptonate
CSF
In-111 DTPATc-99m DTPA
Cardiac
Tc-99m pyrophosphateTc-99m pertechnetateTc-99macirceuroldquolabeled RBCsTc-99m sestamibi
Liver
Tc-99m sulfur colloidTc-99m DISIDA
Lung
Xe-127Xe-133Tc-99m MAA aerosol
Kidney
Tc-99m DTPATc-99m DMSATc-99m glucoheptonate
Thyroid
I-131 HippuranI-123 HippuranTc-99m pertechnetateI-123I-125I-131
WBC
In-111 oxineTc-99m Ceretec
Organ specific Radiopharmaceutical
NUCLEAR MEDICINE IMAGING
Nuclear Medicine Scan - imaging the distribution of radioactivity inside the organ of interest
The labeled drug (radiopharmaceutical) is given PO or IV Its distribution is then mapped in vivo using a gamma camera or for non-imaging tests in using a radiation counter
Gamma rays emitted by them are scanned with a state of the art Gamma Camera
Static Imaging Dynamic Imaging
Whole body scanning by automatic sweep SPECT imaging cut section (Single Photon Emission Computed Tomography)
EQUIPMENTS IN NM [NUCLEAR MEDICINE ]
Nuclear Medicine is heavily equipment dependent
Major equipment
Thyroid uptake system Probe renogram Rectilinear scanner Gamma well counter Liquid scintillation counter Planner gamma camera Gamma probe
Single photon emission computed tomography (SPECT) Single head Dual head Triple head
Positron emission tomography (PET)
Hybrid camera (SPECT amp CT PET amp CT)
Thyroid uptake system
Gamma camera
Single head SPECT
Triple head SPECT
Modern PET camera
Gamma probe for sentinel lymph node detection
SPECIFIC INFORMATION REQUIRED WHEN REQUESTING NUCLEAR MEDICINE TESTS INCLUDES
1 Patient identification details2 Examination requested3 Relevant clinical history including
results of other investigations4 Pregnancylactation details where
relevant5 Special
needsmdashvisualhearinglearning difficulties needle phobia
H orm o ne D ru gs
T u m or M a rker D isea se M arker
R adio Im m uno Assay H eam ato log ica l Applica tions
In-v itro
P lanar S P E C T
Im aging
C a T hyro id80 - 200 m Ci
T hyrotoxicosis5 - 20 m Ci
131 Iod ine 32 P 89 S rP a llia tio n T h erapy
R adio N uclide T herapy
In-v ivo
Nuclear M edicine Applications
CLINICAL APPLICATIONS
BONES AND JOINTS
BRAIN SPECT
ENDOCRINOLOGY
LUNG - VENTILATION amp PERFUSION
NUCLEAR NEPHRO ndash UROLOGY
CARDIO VASCULAR SYSYTEM
GASTRO ndash ENTEROLOGY
BONE SCINTIGRAPHY BONE SCAN
Indications Tumour stagingmdasheg to assess skeletal
metastases(from prostate breastkidney thyroid lung)
Intractable Bone pain
Traumamdashwhen radiographs unhelpful
Prosthetic loosening eg THR
Infection - eg osteomyelitis
Avascular necrosis (AVN)
Pagetrsquos to assess extent
SKULL METASTASES IN CA PROSTATE
PHASE BONE SCAN - MUTILPLE MYELOMAACTIVE LESIONS IN LEFT FEMUR AND DV10
SECONDARY VERTEBRAL METASTESES
BRAIN SCANIndications
Dementia characterisation
Epilepsy for localisation of epileptogenic focus
Metastatic work-ups
Determination of blood flow (in brain death or atherosclerotic disease)
Evaluation of space-occupying lesions (tumor hematoma abscess [AV] malformation) and
Encephalitis
Suspected VP shunt obstruction
Distinguishes Parkinsonrsquos syndrome (PS) from benign essential tremor
INTER ICTAL ICTAL amp POST-ICTAL SPECT SHOWING HYPERPERFUSION OF RT TEMPORAL LOBE
9H POST ICTAL CT AND RCBF SPECT IN A 58YF (NORMAL CT ALTERED PERFUSION IN SPECT)
PERSISTENT HYPOPERFUSION DEFECTS THROUGH RIGHT HEMISPHERE IN A PATIENT OF TIA
99m Tc labelled ECD is used Assessment of Stroke detection of Epileptic focus evaluation of dementia etc
Figure Patient with acute ischemic stroke treated with hypertensive therapy a Positron emission tomography images of cerebral blood flow at 2 h (top) and 6 h (bottom)after the onset of symptoms PET cerebral blood flow(CBF) images demonstrate a significant reduction in blood flow affecting a substantial portion of the left middle cerebral artery territoryb PET images of regional cerebral metabolic rate of oxygen at 2 h (top) and 6 h (bottom) after the onset of symptomsOxygen metabolism is abnormal in the left middle cerebral artery (MCA)territory but in an area substantially smaller than the defect seen on the CBF imagesThis reduction in tissue at risk was presumably due to hypertensive therapyc Follow-up CT scan of the head in the patient demonstrating that the ultimate cerebral infarct size most closely approximates the oxygen metabolism defect(b) than the CBF defect (a)
THYROID amp PARATHYROID SCINTIGRAPHY
Indications Characterisation of thyrotoxicosis
a Diffuse toxic goitre (Gravesrsquodisease) b Toxic multinodular goitre (Plummerrsquos disease)
Autonomous nodule
Acute thyroiditis
Evaluation of upper mediastinal mass
Localisation of parathyroid adenoma in proven hyperparathyroidism
Na99mTcO4 Thyroid Scintigraphy - Avid Uptake with increased T3 and T4
FD - Thyrotoxicosis
Na99mTcO4 Thyroid Scintigraphy - A large Cold nodule involving the RtLobe
US - Cyst
Parathyroid Adenoma - 99mTc Sesta MIBI Scan
Thyroid in 5 min scan
20 min scan No wash out in Parathyroid Adenoma
LUNG SCANA Ventilationperfusion imaging (VQ Scan)
Indications Suspected pulmonary embolism Pre-operative lung function assessment
B Lung shunt studies
Indications
Suspected pulmonary AV shuntingInterpretation
1 Segmental perfusion loss with preserved ventilationmdash
pulmonary embolism2 Segmental matched perfusion and ventilation lossmdash
pulmonary infarctioninfection3 Segmentalsubsegmental ventilation loss with preserved
perfusionmdashinfection4 Non-segmental patchy matched perfusion and ventilation
LOSSmdashCOPD
NORMAL 99M TC DTPA AEROSOL STUDY
PERFUSION DEFECTS IN PULMONARY EMBOLISM
RENAL AND ADRENAL SCINTIGRAPHY
1 Static cortical renographyDMSA imaging
Urinary tract infection lsquogold standardrsquo for renal scarring Measurement of relative renal function Renal duplication assessment Ectopic kidney localisation Renal trauma Renal vein thrombosis Pre-biopsy
2 Dynamic renography
Assessment of renal drainagemdashdiscrimination between
renal dilatation and outflow obstruction Measurement of relative renal function Loin pain Post-pyeloplasty follow-up Renal artery stenosismdash1048585Captopril renography
3Adrenal Scan Used to accurately localize a pheochromocytoma when MRI or CT is
equivocal Uses labeled MIBG
Plain Renal Dynamic Studies
Tc-99m labelled DTPA is used for Renal scintigraphy (1) RENOGRAM - PLAIN STUDY amp WITH DIURETIC INTERVENSION
Useful for evaluation of obstructive uropathies to know whether obstruction is due to functional or organic causes
Contracted left kidney Scars over both poles of the Right Kidney
99mTc DMSA- Renal Cortical Image
HEART SCINTIGRAPHY
Myocardial perfusion imaging (MPI)
Indications
In ischaemic heart disease
1 Pre-angiography ndash When conventional stress testing fails eg
bundle branch blockndash Left ventricular hypertrophyndash Atypical chest painndash Recurrent chest pain post-intervention
2 Post-angiography
ndash Assess functional significance of known stenosesndash Identify critical vascular territory for
intervention
99MTC MIBI SPECT IMAGES - NORMAL STUDY
Short Axis
Vertical Long Axis
Horizontal Long Axis
Polar Map
3D image of LV
99MTC MIBI SPECT IMAGES - INFARCTION
Short Axis
Vertical Long Axis
Horizontal Long Axis
Polar Map
3D image of LV
LIVER AND GASTROINTESTINAL TRACT SCINTIGRAPHY
Hepatobiliary scintigraphy (HIDA-Scan BIDA-Scan)
Indications1 Acute cholecystitis2 Trauma3 Post-operative leak detection4 Bile ductstent patency5 Gallbladder emptying6 Bile reflux7 Neonatal biliary atresia
Gastrointestinal bleeding labelled red cell imaging
Helps localise source of active GI haemorrhage when other techniques(eg endoscopy or angiography) have failed
Gastric emptying studie
Altered GI motilitymdashdelayed or accelerated gastric emptying
Meckelrsquos scan ectopic gastric mucosa localisation Unexplained abdominal pain or GI hemorrhagemdashafter endoscopycontrast radiology
Meenakshi Isotope Scan and Thyroid Care Centre
99mTc Mebrofenin (Trimethyl Bromo Imino Diacetic Acid) Hepato Biliary Scan
5 min
2 h
Post meal
4 h 24 h
40 min
10 min
20 min
Total Biliary Channel Obstruction
G I BLEED STUDY
Blood Pool Scan 99m Tc labelled RBCs are used
To differentiate Hemangioma of the Liver from Hepatoma amp evaluation of G I Bleeding
Meenakshi Isotope Scan and Thyroid Care Centre
99mTc Mebrofenin Hepato Biliary Scan
20 min
5 min
10 min
30 min
4 hPost Meal
4 h
5 min 10 min
20 min 40 min 2 h
Post meal
24 h
Normal Biliary Atresia
RADIONUCLIDE THERAPY
131 I Therapy for Thyrotoxicosis
131 I Therapy for Ca Thyroid
32 P Therapy for pain palliation
OTHERS NUCLEAR SCANSSomatostatin scintigraphy
Localise and stage neuroendocrine tumours (NETs) eg carcinoid insulinoma gastrinoma phaeochromocytoma and medullary thyroid cancer
Lymphoscintigraphy
Unexplained limb swelling eg lymphatic hypoplasia
Urea breath test
Helicobacter pylori detectionmdashdiagnosis and confirmation of eradication
B12 absorption studies
Vitamin B12 malabsorption pernicious anaemia
Labelled leukocyte imaging
Sepsis localization Inflammatory bowel disease to help determine extent and severity
Dacroscintigraphy
Epiphora
MIBG (meta iodobenzylguanidine)imaging Localisation staging and response monitoring of neuroectodermal tumours Phaeochromocytoma (imaging investigation of choice) Neuroblastoma Carcinoid tumours Medullary thyroid cancer
SUMMARY NUCLEAR MEDICINE IMAGING IS
IMPORTANT IN FUNCTIONAL ASSESSMENT OF VARIOUS ORGANS
SIMPLE AND NON INVASIVE PROCEDURES
COST EFFECTIVE
RADIO IMMUNO ASSAY IS GOLD STANDARD
RADIO NUCLIDE THERAPY INCREASES SURVIVAL
RATE
THANK YOU
RADIOPHARMACEUTICALS
The radionuclide used in NM are called radiopharmaceuticals as they are introduced into the body
Radionuclide Radioactive isotope of an element eg Iodine-131 is one of the radionuclide of several isotopes of iodine Isotopes are same element with different atomic weight due to different neutron content
Unsealed radioactive source Sealed source remain sealed amp are used in teletherapy amp brachytherapy by radiotherapy departmentNM use unsealed radiation which is introduced into the body
Several radiopharmaceuticals are used for both diagnosis and treatment
99mTechnetium I-131 111 Indium I-123 113 m Indium C-11 67 Gallium N-13 201 Thallium O-15 18 Fluorine Xe-127
Organ Pharmaceutical
Brain
Tc-99m pertechnetateTc-99m DTPATc-99m glucoheptonate
CSF
In-111 DTPATc-99m DTPA
Cardiac
Tc-99m pyrophosphateTc-99m pertechnetateTc-99macirceuroldquolabeled RBCsTc-99m sestamibi
Liver
Tc-99m sulfur colloidTc-99m DISIDA
Lung
Xe-127Xe-133Tc-99m MAA aerosol
Kidney
Tc-99m DTPATc-99m DMSATc-99m glucoheptonate
Thyroid
I-131 HippuranI-123 HippuranTc-99m pertechnetateI-123I-125I-131
WBC
In-111 oxineTc-99m Ceretec
Organ specific Radiopharmaceutical
NUCLEAR MEDICINE IMAGING
Nuclear Medicine Scan - imaging the distribution of radioactivity inside the organ of interest
The labeled drug (radiopharmaceutical) is given PO or IV Its distribution is then mapped in vivo using a gamma camera or for non-imaging tests in using a radiation counter
Gamma rays emitted by them are scanned with a state of the art Gamma Camera
Static Imaging Dynamic Imaging
Whole body scanning by automatic sweep SPECT imaging cut section (Single Photon Emission Computed Tomography)
EQUIPMENTS IN NM [NUCLEAR MEDICINE ]
Nuclear Medicine is heavily equipment dependent
Major equipment
Thyroid uptake system Probe renogram Rectilinear scanner Gamma well counter Liquid scintillation counter Planner gamma camera Gamma probe
Single photon emission computed tomography (SPECT) Single head Dual head Triple head
Positron emission tomography (PET)
Hybrid camera (SPECT amp CT PET amp CT)
Thyroid uptake system
Gamma camera
Single head SPECT
Triple head SPECT
Modern PET camera
Gamma probe for sentinel lymph node detection
SPECIFIC INFORMATION REQUIRED WHEN REQUESTING NUCLEAR MEDICINE TESTS INCLUDES
1 Patient identification details2 Examination requested3 Relevant clinical history including
results of other investigations4 Pregnancylactation details where
relevant5 Special
needsmdashvisualhearinglearning difficulties needle phobia
H orm o ne D ru gs
T u m or M a rker D isea se M arker
R adio Im m uno Assay H eam ato log ica l Applica tions
In-v itro
P lanar S P E C T
Im aging
C a T hyro id80 - 200 m Ci
T hyrotoxicosis5 - 20 m Ci
131 Iod ine 32 P 89 S rP a llia tio n T h erapy
R adio N uclide T herapy
In-v ivo
Nuclear M edicine Applications
CLINICAL APPLICATIONS
BONES AND JOINTS
BRAIN SPECT
ENDOCRINOLOGY
LUNG - VENTILATION amp PERFUSION
NUCLEAR NEPHRO ndash UROLOGY
CARDIO VASCULAR SYSYTEM
GASTRO ndash ENTEROLOGY
BONE SCINTIGRAPHY BONE SCAN
Indications Tumour stagingmdasheg to assess skeletal
metastases(from prostate breastkidney thyroid lung)
Intractable Bone pain
Traumamdashwhen radiographs unhelpful
Prosthetic loosening eg THR
Infection - eg osteomyelitis
Avascular necrosis (AVN)
Pagetrsquos to assess extent
SKULL METASTASES IN CA PROSTATE
PHASE BONE SCAN - MUTILPLE MYELOMAACTIVE LESIONS IN LEFT FEMUR AND DV10
SECONDARY VERTEBRAL METASTESES
BRAIN SCANIndications
Dementia characterisation
Epilepsy for localisation of epileptogenic focus
Metastatic work-ups
Determination of blood flow (in brain death or atherosclerotic disease)
Evaluation of space-occupying lesions (tumor hematoma abscess [AV] malformation) and
Encephalitis
Suspected VP shunt obstruction
Distinguishes Parkinsonrsquos syndrome (PS) from benign essential tremor
INTER ICTAL ICTAL amp POST-ICTAL SPECT SHOWING HYPERPERFUSION OF RT TEMPORAL LOBE
9H POST ICTAL CT AND RCBF SPECT IN A 58YF (NORMAL CT ALTERED PERFUSION IN SPECT)
PERSISTENT HYPOPERFUSION DEFECTS THROUGH RIGHT HEMISPHERE IN A PATIENT OF TIA
99m Tc labelled ECD is used Assessment of Stroke detection of Epileptic focus evaluation of dementia etc
Figure Patient with acute ischemic stroke treated with hypertensive therapy a Positron emission tomography images of cerebral blood flow at 2 h (top) and 6 h (bottom)after the onset of symptoms PET cerebral blood flow(CBF) images demonstrate a significant reduction in blood flow affecting a substantial portion of the left middle cerebral artery territoryb PET images of regional cerebral metabolic rate of oxygen at 2 h (top) and 6 h (bottom) after the onset of symptomsOxygen metabolism is abnormal in the left middle cerebral artery (MCA)territory but in an area substantially smaller than the defect seen on the CBF imagesThis reduction in tissue at risk was presumably due to hypertensive therapyc Follow-up CT scan of the head in the patient demonstrating that the ultimate cerebral infarct size most closely approximates the oxygen metabolism defect(b) than the CBF defect (a)
THYROID amp PARATHYROID SCINTIGRAPHY
Indications Characterisation of thyrotoxicosis
a Diffuse toxic goitre (Gravesrsquodisease) b Toxic multinodular goitre (Plummerrsquos disease)
Autonomous nodule
Acute thyroiditis
Evaluation of upper mediastinal mass
Localisation of parathyroid adenoma in proven hyperparathyroidism
Na99mTcO4 Thyroid Scintigraphy - Avid Uptake with increased T3 and T4
FD - Thyrotoxicosis
Na99mTcO4 Thyroid Scintigraphy - A large Cold nodule involving the RtLobe
US - Cyst
Parathyroid Adenoma - 99mTc Sesta MIBI Scan
Thyroid in 5 min scan
20 min scan No wash out in Parathyroid Adenoma
LUNG SCANA Ventilationperfusion imaging (VQ Scan)
Indications Suspected pulmonary embolism Pre-operative lung function assessment
B Lung shunt studies
Indications
Suspected pulmonary AV shuntingInterpretation
1 Segmental perfusion loss with preserved ventilationmdash
pulmonary embolism2 Segmental matched perfusion and ventilation lossmdash
pulmonary infarctioninfection3 Segmentalsubsegmental ventilation loss with preserved
perfusionmdashinfection4 Non-segmental patchy matched perfusion and ventilation
LOSSmdashCOPD
NORMAL 99M TC DTPA AEROSOL STUDY
PERFUSION DEFECTS IN PULMONARY EMBOLISM
RENAL AND ADRENAL SCINTIGRAPHY
1 Static cortical renographyDMSA imaging
Urinary tract infection lsquogold standardrsquo for renal scarring Measurement of relative renal function Renal duplication assessment Ectopic kidney localisation Renal trauma Renal vein thrombosis Pre-biopsy
2 Dynamic renography
Assessment of renal drainagemdashdiscrimination between
renal dilatation and outflow obstruction Measurement of relative renal function Loin pain Post-pyeloplasty follow-up Renal artery stenosismdash1048585Captopril renography
3Adrenal Scan Used to accurately localize a pheochromocytoma when MRI or CT is
equivocal Uses labeled MIBG
Plain Renal Dynamic Studies
Tc-99m labelled DTPA is used for Renal scintigraphy (1) RENOGRAM - PLAIN STUDY amp WITH DIURETIC INTERVENSION
Useful for evaluation of obstructive uropathies to know whether obstruction is due to functional or organic causes
Contracted left kidney Scars over both poles of the Right Kidney
99mTc DMSA- Renal Cortical Image
HEART SCINTIGRAPHY
Myocardial perfusion imaging (MPI)
Indications
In ischaemic heart disease
1 Pre-angiography ndash When conventional stress testing fails eg
bundle branch blockndash Left ventricular hypertrophyndash Atypical chest painndash Recurrent chest pain post-intervention
2 Post-angiography
ndash Assess functional significance of known stenosesndash Identify critical vascular territory for
intervention
99MTC MIBI SPECT IMAGES - NORMAL STUDY
Short Axis
Vertical Long Axis
Horizontal Long Axis
Polar Map
3D image of LV
99MTC MIBI SPECT IMAGES - INFARCTION
Short Axis
Vertical Long Axis
Horizontal Long Axis
Polar Map
3D image of LV
LIVER AND GASTROINTESTINAL TRACT SCINTIGRAPHY
Hepatobiliary scintigraphy (HIDA-Scan BIDA-Scan)
Indications1 Acute cholecystitis2 Trauma3 Post-operative leak detection4 Bile ductstent patency5 Gallbladder emptying6 Bile reflux7 Neonatal biliary atresia
Gastrointestinal bleeding labelled red cell imaging
Helps localise source of active GI haemorrhage when other techniques(eg endoscopy or angiography) have failed
Gastric emptying studie
Altered GI motilitymdashdelayed or accelerated gastric emptying
Meckelrsquos scan ectopic gastric mucosa localisation Unexplained abdominal pain or GI hemorrhagemdashafter endoscopycontrast radiology
Meenakshi Isotope Scan and Thyroid Care Centre
99mTc Mebrofenin (Trimethyl Bromo Imino Diacetic Acid) Hepato Biliary Scan
5 min
2 h
Post meal
4 h 24 h
40 min
10 min
20 min
Total Biliary Channel Obstruction
G I BLEED STUDY
Blood Pool Scan 99m Tc labelled RBCs are used
To differentiate Hemangioma of the Liver from Hepatoma amp evaluation of G I Bleeding
Meenakshi Isotope Scan and Thyroid Care Centre
99mTc Mebrofenin Hepato Biliary Scan
20 min
5 min
10 min
30 min
4 hPost Meal
4 h
5 min 10 min
20 min 40 min 2 h
Post meal
24 h
Normal Biliary Atresia
RADIONUCLIDE THERAPY
131 I Therapy for Thyrotoxicosis
131 I Therapy for Ca Thyroid
32 P Therapy for pain palliation
OTHERS NUCLEAR SCANSSomatostatin scintigraphy
Localise and stage neuroendocrine tumours (NETs) eg carcinoid insulinoma gastrinoma phaeochromocytoma and medullary thyroid cancer
Lymphoscintigraphy
Unexplained limb swelling eg lymphatic hypoplasia
Urea breath test
Helicobacter pylori detectionmdashdiagnosis and confirmation of eradication
B12 absorption studies
Vitamin B12 malabsorption pernicious anaemia
Labelled leukocyte imaging
Sepsis localization Inflammatory bowel disease to help determine extent and severity
Dacroscintigraphy
Epiphora
MIBG (meta iodobenzylguanidine)imaging Localisation staging and response monitoring of neuroectodermal tumours Phaeochromocytoma (imaging investigation of choice) Neuroblastoma Carcinoid tumours Medullary thyroid cancer
SUMMARY NUCLEAR MEDICINE IMAGING IS
IMPORTANT IN FUNCTIONAL ASSESSMENT OF VARIOUS ORGANS
SIMPLE AND NON INVASIVE PROCEDURES
COST EFFECTIVE
RADIO IMMUNO ASSAY IS GOLD STANDARD
RADIO NUCLIDE THERAPY INCREASES SURVIVAL
RATE
THANK YOU
Organ Pharmaceutical
Brain
Tc-99m pertechnetateTc-99m DTPATc-99m glucoheptonate
CSF
In-111 DTPATc-99m DTPA
Cardiac
Tc-99m pyrophosphateTc-99m pertechnetateTc-99macirceuroldquolabeled RBCsTc-99m sestamibi
Liver
Tc-99m sulfur colloidTc-99m DISIDA
Lung
Xe-127Xe-133Tc-99m MAA aerosol
Kidney
Tc-99m DTPATc-99m DMSATc-99m glucoheptonate
Thyroid
I-131 HippuranI-123 HippuranTc-99m pertechnetateI-123I-125I-131
WBC
In-111 oxineTc-99m Ceretec
Organ specific Radiopharmaceutical
NUCLEAR MEDICINE IMAGING
Nuclear Medicine Scan - imaging the distribution of radioactivity inside the organ of interest
The labeled drug (radiopharmaceutical) is given PO or IV Its distribution is then mapped in vivo using a gamma camera or for non-imaging tests in using a radiation counter
Gamma rays emitted by them are scanned with a state of the art Gamma Camera
Static Imaging Dynamic Imaging
Whole body scanning by automatic sweep SPECT imaging cut section (Single Photon Emission Computed Tomography)
EQUIPMENTS IN NM [NUCLEAR MEDICINE ]
Nuclear Medicine is heavily equipment dependent
Major equipment
Thyroid uptake system Probe renogram Rectilinear scanner Gamma well counter Liquid scintillation counter Planner gamma camera Gamma probe
Single photon emission computed tomography (SPECT) Single head Dual head Triple head
Positron emission tomography (PET)
Hybrid camera (SPECT amp CT PET amp CT)
Thyroid uptake system
Gamma camera
Single head SPECT
Triple head SPECT
Modern PET camera
Gamma probe for sentinel lymph node detection
SPECIFIC INFORMATION REQUIRED WHEN REQUESTING NUCLEAR MEDICINE TESTS INCLUDES
1 Patient identification details2 Examination requested3 Relevant clinical history including
results of other investigations4 Pregnancylactation details where
relevant5 Special
needsmdashvisualhearinglearning difficulties needle phobia
H orm o ne D ru gs
T u m or M a rker D isea se M arker
R adio Im m uno Assay H eam ato log ica l Applica tions
In-v itro
P lanar S P E C T
Im aging
C a T hyro id80 - 200 m Ci
T hyrotoxicosis5 - 20 m Ci
131 Iod ine 32 P 89 S rP a llia tio n T h erapy
R adio N uclide T herapy
In-v ivo
Nuclear M edicine Applications
CLINICAL APPLICATIONS
BONES AND JOINTS
BRAIN SPECT
ENDOCRINOLOGY
LUNG - VENTILATION amp PERFUSION
NUCLEAR NEPHRO ndash UROLOGY
CARDIO VASCULAR SYSYTEM
GASTRO ndash ENTEROLOGY
BONE SCINTIGRAPHY BONE SCAN
Indications Tumour stagingmdasheg to assess skeletal
metastases(from prostate breastkidney thyroid lung)
Intractable Bone pain
Traumamdashwhen radiographs unhelpful
Prosthetic loosening eg THR
Infection - eg osteomyelitis
Avascular necrosis (AVN)
Pagetrsquos to assess extent
SKULL METASTASES IN CA PROSTATE
PHASE BONE SCAN - MUTILPLE MYELOMAACTIVE LESIONS IN LEFT FEMUR AND DV10
SECONDARY VERTEBRAL METASTESES
BRAIN SCANIndications
Dementia characterisation
Epilepsy for localisation of epileptogenic focus
Metastatic work-ups
Determination of blood flow (in brain death or atherosclerotic disease)
Evaluation of space-occupying lesions (tumor hematoma abscess [AV] malformation) and
Encephalitis
Suspected VP shunt obstruction
Distinguishes Parkinsonrsquos syndrome (PS) from benign essential tremor
INTER ICTAL ICTAL amp POST-ICTAL SPECT SHOWING HYPERPERFUSION OF RT TEMPORAL LOBE
9H POST ICTAL CT AND RCBF SPECT IN A 58YF (NORMAL CT ALTERED PERFUSION IN SPECT)
PERSISTENT HYPOPERFUSION DEFECTS THROUGH RIGHT HEMISPHERE IN A PATIENT OF TIA
99m Tc labelled ECD is used Assessment of Stroke detection of Epileptic focus evaluation of dementia etc
Figure Patient with acute ischemic stroke treated with hypertensive therapy a Positron emission tomography images of cerebral blood flow at 2 h (top) and 6 h (bottom)after the onset of symptoms PET cerebral blood flow(CBF) images demonstrate a significant reduction in blood flow affecting a substantial portion of the left middle cerebral artery territoryb PET images of regional cerebral metabolic rate of oxygen at 2 h (top) and 6 h (bottom) after the onset of symptomsOxygen metabolism is abnormal in the left middle cerebral artery (MCA)territory but in an area substantially smaller than the defect seen on the CBF imagesThis reduction in tissue at risk was presumably due to hypertensive therapyc Follow-up CT scan of the head in the patient demonstrating that the ultimate cerebral infarct size most closely approximates the oxygen metabolism defect(b) than the CBF defect (a)
THYROID amp PARATHYROID SCINTIGRAPHY
Indications Characterisation of thyrotoxicosis
a Diffuse toxic goitre (Gravesrsquodisease) b Toxic multinodular goitre (Plummerrsquos disease)
Autonomous nodule
Acute thyroiditis
Evaluation of upper mediastinal mass
Localisation of parathyroid adenoma in proven hyperparathyroidism
Na99mTcO4 Thyroid Scintigraphy - Avid Uptake with increased T3 and T4
FD - Thyrotoxicosis
Na99mTcO4 Thyroid Scintigraphy - A large Cold nodule involving the RtLobe
US - Cyst
Parathyroid Adenoma - 99mTc Sesta MIBI Scan
Thyroid in 5 min scan
20 min scan No wash out in Parathyroid Adenoma
LUNG SCANA Ventilationperfusion imaging (VQ Scan)
Indications Suspected pulmonary embolism Pre-operative lung function assessment
B Lung shunt studies
Indications
Suspected pulmonary AV shuntingInterpretation
1 Segmental perfusion loss with preserved ventilationmdash
pulmonary embolism2 Segmental matched perfusion and ventilation lossmdash
pulmonary infarctioninfection3 Segmentalsubsegmental ventilation loss with preserved
perfusionmdashinfection4 Non-segmental patchy matched perfusion and ventilation
LOSSmdashCOPD
NORMAL 99M TC DTPA AEROSOL STUDY
PERFUSION DEFECTS IN PULMONARY EMBOLISM
RENAL AND ADRENAL SCINTIGRAPHY
1 Static cortical renographyDMSA imaging
Urinary tract infection lsquogold standardrsquo for renal scarring Measurement of relative renal function Renal duplication assessment Ectopic kidney localisation Renal trauma Renal vein thrombosis Pre-biopsy
2 Dynamic renography
Assessment of renal drainagemdashdiscrimination between
renal dilatation and outflow obstruction Measurement of relative renal function Loin pain Post-pyeloplasty follow-up Renal artery stenosismdash1048585Captopril renography
3Adrenal Scan Used to accurately localize a pheochromocytoma when MRI or CT is
equivocal Uses labeled MIBG
Plain Renal Dynamic Studies
Tc-99m labelled DTPA is used for Renal scintigraphy (1) RENOGRAM - PLAIN STUDY amp WITH DIURETIC INTERVENSION
Useful for evaluation of obstructive uropathies to know whether obstruction is due to functional or organic causes
Contracted left kidney Scars over both poles of the Right Kidney
99mTc DMSA- Renal Cortical Image
HEART SCINTIGRAPHY
Myocardial perfusion imaging (MPI)
Indications
In ischaemic heart disease
1 Pre-angiography ndash When conventional stress testing fails eg
bundle branch blockndash Left ventricular hypertrophyndash Atypical chest painndash Recurrent chest pain post-intervention
2 Post-angiography
ndash Assess functional significance of known stenosesndash Identify critical vascular territory for
intervention
99MTC MIBI SPECT IMAGES - NORMAL STUDY
Short Axis
Vertical Long Axis
Horizontal Long Axis
Polar Map
3D image of LV
99MTC MIBI SPECT IMAGES - INFARCTION
Short Axis
Vertical Long Axis
Horizontal Long Axis
Polar Map
3D image of LV
LIVER AND GASTROINTESTINAL TRACT SCINTIGRAPHY
Hepatobiliary scintigraphy (HIDA-Scan BIDA-Scan)
Indications1 Acute cholecystitis2 Trauma3 Post-operative leak detection4 Bile ductstent patency5 Gallbladder emptying6 Bile reflux7 Neonatal biliary atresia
Gastrointestinal bleeding labelled red cell imaging
Helps localise source of active GI haemorrhage when other techniques(eg endoscopy or angiography) have failed
Gastric emptying studie
Altered GI motilitymdashdelayed or accelerated gastric emptying
Meckelrsquos scan ectopic gastric mucosa localisation Unexplained abdominal pain or GI hemorrhagemdashafter endoscopycontrast radiology
Meenakshi Isotope Scan and Thyroid Care Centre
99mTc Mebrofenin (Trimethyl Bromo Imino Diacetic Acid) Hepato Biliary Scan
5 min
2 h
Post meal
4 h 24 h
40 min
10 min
20 min
Total Biliary Channel Obstruction
G I BLEED STUDY
Blood Pool Scan 99m Tc labelled RBCs are used
To differentiate Hemangioma of the Liver from Hepatoma amp evaluation of G I Bleeding
Meenakshi Isotope Scan and Thyroid Care Centre
99mTc Mebrofenin Hepato Biliary Scan
20 min
5 min
10 min
30 min
4 hPost Meal
4 h
5 min 10 min
20 min 40 min 2 h
Post meal
24 h
Normal Biliary Atresia
RADIONUCLIDE THERAPY
131 I Therapy for Thyrotoxicosis
131 I Therapy for Ca Thyroid
32 P Therapy for pain palliation
OTHERS NUCLEAR SCANSSomatostatin scintigraphy
Localise and stage neuroendocrine tumours (NETs) eg carcinoid insulinoma gastrinoma phaeochromocytoma and medullary thyroid cancer
Lymphoscintigraphy
Unexplained limb swelling eg lymphatic hypoplasia
Urea breath test
Helicobacter pylori detectionmdashdiagnosis and confirmation of eradication
B12 absorption studies
Vitamin B12 malabsorption pernicious anaemia
Labelled leukocyte imaging
Sepsis localization Inflammatory bowel disease to help determine extent and severity
Dacroscintigraphy
Epiphora
MIBG (meta iodobenzylguanidine)imaging Localisation staging and response monitoring of neuroectodermal tumours Phaeochromocytoma (imaging investigation of choice) Neuroblastoma Carcinoid tumours Medullary thyroid cancer
SUMMARY NUCLEAR MEDICINE IMAGING IS
IMPORTANT IN FUNCTIONAL ASSESSMENT OF VARIOUS ORGANS
SIMPLE AND NON INVASIVE PROCEDURES
COST EFFECTIVE
RADIO IMMUNO ASSAY IS GOLD STANDARD
RADIO NUCLIDE THERAPY INCREASES SURVIVAL
RATE
THANK YOU
NUCLEAR MEDICINE IMAGING
Nuclear Medicine Scan - imaging the distribution of radioactivity inside the organ of interest
The labeled drug (radiopharmaceutical) is given PO or IV Its distribution is then mapped in vivo using a gamma camera or for non-imaging tests in using a radiation counter
Gamma rays emitted by them are scanned with a state of the art Gamma Camera
Static Imaging Dynamic Imaging
Whole body scanning by automatic sweep SPECT imaging cut section (Single Photon Emission Computed Tomography)
EQUIPMENTS IN NM [NUCLEAR MEDICINE ]
Nuclear Medicine is heavily equipment dependent
Major equipment
Thyroid uptake system Probe renogram Rectilinear scanner Gamma well counter Liquid scintillation counter Planner gamma camera Gamma probe
Single photon emission computed tomography (SPECT) Single head Dual head Triple head
Positron emission tomography (PET)
Hybrid camera (SPECT amp CT PET amp CT)
Thyroid uptake system
Gamma camera
Single head SPECT
Triple head SPECT
Modern PET camera
Gamma probe for sentinel lymph node detection
SPECIFIC INFORMATION REQUIRED WHEN REQUESTING NUCLEAR MEDICINE TESTS INCLUDES
1 Patient identification details2 Examination requested3 Relevant clinical history including
results of other investigations4 Pregnancylactation details where
relevant5 Special
needsmdashvisualhearinglearning difficulties needle phobia
H orm o ne D ru gs
T u m or M a rker D isea se M arker
R adio Im m uno Assay H eam ato log ica l Applica tions
In-v itro
P lanar S P E C T
Im aging
C a T hyro id80 - 200 m Ci
T hyrotoxicosis5 - 20 m Ci
131 Iod ine 32 P 89 S rP a llia tio n T h erapy
R adio N uclide T herapy
In-v ivo
Nuclear M edicine Applications
CLINICAL APPLICATIONS
BONES AND JOINTS
BRAIN SPECT
ENDOCRINOLOGY
LUNG - VENTILATION amp PERFUSION
NUCLEAR NEPHRO ndash UROLOGY
CARDIO VASCULAR SYSYTEM
GASTRO ndash ENTEROLOGY
BONE SCINTIGRAPHY BONE SCAN
Indications Tumour stagingmdasheg to assess skeletal
metastases(from prostate breastkidney thyroid lung)
Intractable Bone pain
Traumamdashwhen radiographs unhelpful
Prosthetic loosening eg THR
Infection - eg osteomyelitis
Avascular necrosis (AVN)
Pagetrsquos to assess extent
SKULL METASTASES IN CA PROSTATE
PHASE BONE SCAN - MUTILPLE MYELOMAACTIVE LESIONS IN LEFT FEMUR AND DV10
SECONDARY VERTEBRAL METASTESES
BRAIN SCANIndications
Dementia characterisation
Epilepsy for localisation of epileptogenic focus
Metastatic work-ups
Determination of blood flow (in brain death or atherosclerotic disease)
Evaluation of space-occupying lesions (tumor hematoma abscess [AV] malformation) and
Encephalitis
Suspected VP shunt obstruction
Distinguishes Parkinsonrsquos syndrome (PS) from benign essential tremor
INTER ICTAL ICTAL amp POST-ICTAL SPECT SHOWING HYPERPERFUSION OF RT TEMPORAL LOBE
9H POST ICTAL CT AND RCBF SPECT IN A 58YF (NORMAL CT ALTERED PERFUSION IN SPECT)
PERSISTENT HYPOPERFUSION DEFECTS THROUGH RIGHT HEMISPHERE IN A PATIENT OF TIA
99m Tc labelled ECD is used Assessment of Stroke detection of Epileptic focus evaluation of dementia etc
Figure Patient with acute ischemic stroke treated with hypertensive therapy a Positron emission tomography images of cerebral blood flow at 2 h (top) and 6 h (bottom)after the onset of symptoms PET cerebral blood flow(CBF) images demonstrate a significant reduction in blood flow affecting a substantial portion of the left middle cerebral artery territoryb PET images of regional cerebral metabolic rate of oxygen at 2 h (top) and 6 h (bottom) after the onset of symptomsOxygen metabolism is abnormal in the left middle cerebral artery (MCA)territory but in an area substantially smaller than the defect seen on the CBF imagesThis reduction in tissue at risk was presumably due to hypertensive therapyc Follow-up CT scan of the head in the patient demonstrating that the ultimate cerebral infarct size most closely approximates the oxygen metabolism defect(b) than the CBF defect (a)
THYROID amp PARATHYROID SCINTIGRAPHY
Indications Characterisation of thyrotoxicosis
a Diffuse toxic goitre (Gravesrsquodisease) b Toxic multinodular goitre (Plummerrsquos disease)
Autonomous nodule
Acute thyroiditis
Evaluation of upper mediastinal mass
Localisation of parathyroid adenoma in proven hyperparathyroidism
Na99mTcO4 Thyroid Scintigraphy - Avid Uptake with increased T3 and T4
FD - Thyrotoxicosis
Na99mTcO4 Thyroid Scintigraphy - A large Cold nodule involving the RtLobe
US - Cyst
Parathyroid Adenoma - 99mTc Sesta MIBI Scan
Thyroid in 5 min scan
20 min scan No wash out in Parathyroid Adenoma
LUNG SCANA Ventilationperfusion imaging (VQ Scan)
Indications Suspected pulmonary embolism Pre-operative lung function assessment
B Lung shunt studies
Indications
Suspected pulmonary AV shuntingInterpretation
1 Segmental perfusion loss with preserved ventilationmdash
pulmonary embolism2 Segmental matched perfusion and ventilation lossmdash
pulmonary infarctioninfection3 Segmentalsubsegmental ventilation loss with preserved
perfusionmdashinfection4 Non-segmental patchy matched perfusion and ventilation
LOSSmdashCOPD
NORMAL 99M TC DTPA AEROSOL STUDY
PERFUSION DEFECTS IN PULMONARY EMBOLISM
RENAL AND ADRENAL SCINTIGRAPHY
1 Static cortical renographyDMSA imaging
Urinary tract infection lsquogold standardrsquo for renal scarring Measurement of relative renal function Renal duplication assessment Ectopic kidney localisation Renal trauma Renal vein thrombosis Pre-biopsy
2 Dynamic renography
Assessment of renal drainagemdashdiscrimination between
renal dilatation and outflow obstruction Measurement of relative renal function Loin pain Post-pyeloplasty follow-up Renal artery stenosismdash1048585Captopril renography
3Adrenal Scan Used to accurately localize a pheochromocytoma when MRI or CT is
equivocal Uses labeled MIBG
Plain Renal Dynamic Studies
Tc-99m labelled DTPA is used for Renal scintigraphy (1) RENOGRAM - PLAIN STUDY amp WITH DIURETIC INTERVENSION
Useful for evaluation of obstructive uropathies to know whether obstruction is due to functional or organic causes
Contracted left kidney Scars over both poles of the Right Kidney
99mTc DMSA- Renal Cortical Image
HEART SCINTIGRAPHY
Myocardial perfusion imaging (MPI)
Indications
In ischaemic heart disease
1 Pre-angiography ndash When conventional stress testing fails eg
bundle branch blockndash Left ventricular hypertrophyndash Atypical chest painndash Recurrent chest pain post-intervention
2 Post-angiography
ndash Assess functional significance of known stenosesndash Identify critical vascular territory for
intervention
99MTC MIBI SPECT IMAGES - NORMAL STUDY
Short Axis
Vertical Long Axis
Horizontal Long Axis
Polar Map
3D image of LV
99MTC MIBI SPECT IMAGES - INFARCTION
Short Axis
Vertical Long Axis
Horizontal Long Axis
Polar Map
3D image of LV
LIVER AND GASTROINTESTINAL TRACT SCINTIGRAPHY
Hepatobiliary scintigraphy (HIDA-Scan BIDA-Scan)
Indications1 Acute cholecystitis2 Trauma3 Post-operative leak detection4 Bile ductstent patency5 Gallbladder emptying6 Bile reflux7 Neonatal biliary atresia
Gastrointestinal bleeding labelled red cell imaging
Helps localise source of active GI haemorrhage when other techniques(eg endoscopy or angiography) have failed
Gastric emptying studie
Altered GI motilitymdashdelayed or accelerated gastric emptying
Meckelrsquos scan ectopic gastric mucosa localisation Unexplained abdominal pain or GI hemorrhagemdashafter endoscopycontrast radiology
Meenakshi Isotope Scan and Thyroid Care Centre
99mTc Mebrofenin (Trimethyl Bromo Imino Diacetic Acid) Hepato Biliary Scan
5 min
2 h
Post meal
4 h 24 h
40 min
10 min
20 min
Total Biliary Channel Obstruction
G I BLEED STUDY
Blood Pool Scan 99m Tc labelled RBCs are used
To differentiate Hemangioma of the Liver from Hepatoma amp evaluation of G I Bleeding
Meenakshi Isotope Scan and Thyroid Care Centre
99mTc Mebrofenin Hepato Biliary Scan
20 min
5 min
10 min
30 min
4 hPost Meal
4 h
5 min 10 min
20 min 40 min 2 h
Post meal
24 h
Normal Biliary Atresia
RADIONUCLIDE THERAPY
131 I Therapy for Thyrotoxicosis
131 I Therapy for Ca Thyroid
32 P Therapy for pain palliation
OTHERS NUCLEAR SCANSSomatostatin scintigraphy
Localise and stage neuroendocrine tumours (NETs) eg carcinoid insulinoma gastrinoma phaeochromocytoma and medullary thyroid cancer
Lymphoscintigraphy
Unexplained limb swelling eg lymphatic hypoplasia
Urea breath test
Helicobacter pylori detectionmdashdiagnosis and confirmation of eradication
B12 absorption studies
Vitamin B12 malabsorption pernicious anaemia
Labelled leukocyte imaging
Sepsis localization Inflammatory bowel disease to help determine extent and severity
Dacroscintigraphy
Epiphora
MIBG (meta iodobenzylguanidine)imaging Localisation staging and response monitoring of neuroectodermal tumours Phaeochromocytoma (imaging investigation of choice) Neuroblastoma Carcinoid tumours Medullary thyroid cancer
SUMMARY NUCLEAR MEDICINE IMAGING IS
IMPORTANT IN FUNCTIONAL ASSESSMENT OF VARIOUS ORGANS
SIMPLE AND NON INVASIVE PROCEDURES
COST EFFECTIVE
RADIO IMMUNO ASSAY IS GOLD STANDARD
RADIO NUCLIDE THERAPY INCREASES SURVIVAL
RATE
THANK YOU
EQUIPMENTS IN NM [NUCLEAR MEDICINE ]
Nuclear Medicine is heavily equipment dependent
Major equipment
Thyroid uptake system Probe renogram Rectilinear scanner Gamma well counter Liquid scintillation counter Planner gamma camera Gamma probe
Single photon emission computed tomography (SPECT) Single head Dual head Triple head
Positron emission tomography (PET)
Hybrid camera (SPECT amp CT PET amp CT)
Thyroid uptake system
Gamma camera
Single head SPECT
Triple head SPECT
Modern PET camera
Gamma probe for sentinel lymph node detection
SPECIFIC INFORMATION REQUIRED WHEN REQUESTING NUCLEAR MEDICINE TESTS INCLUDES
1 Patient identification details2 Examination requested3 Relevant clinical history including
results of other investigations4 Pregnancylactation details where
relevant5 Special
needsmdashvisualhearinglearning difficulties needle phobia
H orm o ne D ru gs
T u m or M a rker D isea se M arker
R adio Im m uno Assay H eam ato log ica l Applica tions
In-v itro
P lanar S P E C T
Im aging
C a T hyro id80 - 200 m Ci
T hyrotoxicosis5 - 20 m Ci
131 Iod ine 32 P 89 S rP a llia tio n T h erapy
R adio N uclide T herapy
In-v ivo
Nuclear M edicine Applications
CLINICAL APPLICATIONS
BONES AND JOINTS
BRAIN SPECT
ENDOCRINOLOGY
LUNG - VENTILATION amp PERFUSION
NUCLEAR NEPHRO ndash UROLOGY
CARDIO VASCULAR SYSYTEM
GASTRO ndash ENTEROLOGY
BONE SCINTIGRAPHY BONE SCAN
Indications Tumour stagingmdasheg to assess skeletal
metastases(from prostate breastkidney thyroid lung)
Intractable Bone pain
Traumamdashwhen radiographs unhelpful
Prosthetic loosening eg THR
Infection - eg osteomyelitis
Avascular necrosis (AVN)
Pagetrsquos to assess extent
SKULL METASTASES IN CA PROSTATE
PHASE BONE SCAN - MUTILPLE MYELOMAACTIVE LESIONS IN LEFT FEMUR AND DV10
SECONDARY VERTEBRAL METASTESES
BRAIN SCANIndications
Dementia characterisation
Epilepsy for localisation of epileptogenic focus
Metastatic work-ups
Determination of blood flow (in brain death or atherosclerotic disease)
Evaluation of space-occupying lesions (tumor hematoma abscess [AV] malformation) and
Encephalitis
Suspected VP shunt obstruction
Distinguishes Parkinsonrsquos syndrome (PS) from benign essential tremor
INTER ICTAL ICTAL amp POST-ICTAL SPECT SHOWING HYPERPERFUSION OF RT TEMPORAL LOBE
9H POST ICTAL CT AND RCBF SPECT IN A 58YF (NORMAL CT ALTERED PERFUSION IN SPECT)
PERSISTENT HYPOPERFUSION DEFECTS THROUGH RIGHT HEMISPHERE IN A PATIENT OF TIA
99m Tc labelled ECD is used Assessment of Stroke detection of Epileptic focus evaluation of dementia etc
Figure Patient with acute ischemic stroke treated with hypertensive therapy a Positron emission tomography images of cerebral blood flow at 2 h (top) and 6 h (bottom)after the onset of symptoms PET cerebral blood flow(CBF) images demonstrate a significant reduction in blood flow affecting a substantial portion of the left middle cerebral artery territoryb PET images of regional cerebral metabolic rate of oxygen at 2 h (top) and 6 h (bottom) after the onset of symptomsOxygen metabolism is abnormal in the left middle cerebral artery (MCA)territory but in an area substantially smaller than the defect seen on the CBF imagesThis reduction in tissue at risk was presumably due to hypertensive therapyc Follow-up CT scan of the head in the patient demonstrating that the ultimate cerebral infarct size most closely approximates the oxygen metabolism defect(b) than the CBF defect (a)
THYROID amp PARATHYROID SCINTIGRAPHY
Indications Characterisation of thyrotoxicosis
a Diffuse toxic goitre (Gravesrsquodisease) b Toxic multinodular goitre (Plummerrsquos disease)
Autonomous nodule
Acute thyroiditis
Evaluation of upper mediastinal mass
Localisation of parathyroid adenoma in proven hyperparathyroidism
Na99mTcO4 Thyroid Scintigraphy - Avid Uptake with increased T3 and T4
FD - Thyrotoxicosis
Na99mTcO4 Thyroid Scintigraphy - A large Cold nodule involving the RtLobe
US - Cyst
Parathyroid Adenoma - 99mTc Sesta MIBI Scan
Thyroid in 5 min scan
20 min scan No wash out in Parathyroid Adenoma
LUNG SCANA Ventilationperfusion imaging (VQ Scan)
Indications Suspected pulmonary embolism Pre-operative lung function assessment
B Lung shunt studies
Indications
Suspected pulmonary AV shuntingInterpretation
1 Segmental perfusion loss with preserved ventilationmdash
pulmonary embolism2 Segmental matched perfusion and ventilation lossmdash
pulmonary infarctioninfection3 Segmentalsubsegmental ventilation loss with preserved
perfusionmdashinfection4 Non-segmental patchy matched perfusion and ventilation
LOSSmdashCOPD
NORMAL 99M TC DTPA AEROSOL STUDY
PERFUSION DEFECTS IN PULMONARY EMBOLISM
RENAL AND ADRENAL SCINTIGRAPHY
1 Static cortical renographyDMSA imaging
Urinary tract infection lsquogold standardrsquo for renal scarring Measurement of relative renal function Renal duplication assessment Ectopic kidney localisation Renal trauma Renal vein thrombosis Pre-biopsy
2 Dynamic renography
Assessment of renal drainagemdashdiscrimination between
renal dilatation and outflow obstruction Measurement of relative renal function Loin pain Post-pyeloplasty follow-up Renal artery stenosismdash1048585Captopril renography
3Adrenal Scan Used to accurately localize a pheochromocytoma when MRI or CT is
equivocal Uses labeled MIBG
Plain Renal Dynamic Studies
Tc-99m labelled DTPA is used for Renal scintigraphy (1) RENOGRAM - PLAIN STUDY amp WITH DIURETIC INTERVENSION
Useful for evaluation of obstructive uropathies to know whether obstruction is due to functional or organic causes
Contracted left kidney Scars over both poles of the Right Kidney
99mTc DMSA- Renal Cortical Image
HEART SCINTIGRAPHY
Myocardial perfusion imaging (MPI)
Indications
In ischaemic heart disease
1 Pre-angiography ndash When conventional stress testing fails eg
bundle branch blockndash Left ventricular hypertrophyndash Atypical chest painndash Recurrent chest pain post-intervention
2 Post-angiography
ndash Assess functional significance of known stenosesndash Identify critical vascular territory for
intervention
99MTC MIBI SPECT IMAGES - NORMAL STUDY
Short Axis
Vertical Long Axis
Horizontal Long Axis
Polar Map
3D image of LV
99MTC MIBI SPECT IMAGES - INFARCTION
Short Axis
Vertical Long Axis
Horizontal Long Axis
Polar Map
3D image of LV
LIVER AND GASTROINTESTINAL TRACT SCINTIGRAPHY
Hepatobiliary scintigraphy (HIDA-Scan BIDA-Scan)
Indications1 Acute cholecystitis2 Trauma3 Post-operative leak detection4 Bile ductstent patency5 Gallbladder emptying6 Bile reflux7 Neonatal biliary atresia
Gastrointestinal bleeding labelled red cell imaging
Helps localise source of active GI haemorrhage when other techniques(eg endoscopy or angiography) have failed
Gastric emptying studie
Altered GI motilitymdashdelayed or accelerated gastric emptying
Meckelrsquos scan ectopic gastric mucosa localisation Unexplained abdominal pain or GI hemorrhagemdashafter endoscopycontrast radiology
Meenakshi Isotope Scan and Thyroid Care Centre
99mTc Mebrofenin (Trimethyl Bromo Imino Diacetic Acid) Hepato Biliary Scan
5 min
2 h
Post meal
4 h 24 h
40 min
10 min
20 min
Total Biliary Channel Obstruction
G I BLEED STUDY
Blood Pool Scan 99m Tc labelled RBCs are used
To differentiate Hemangioma of the Liver from Hepatoma amp evaluation of G I Bleeding
Meenakshi Isotope Scan and Thyroid Care Centre
99mTc Mebrofenin Hepato Biliary Scan
20 min
5 min
10 min
30 min
4 hPost Meal
4 h
5 min 10 min
20 min 40 min 2 h
Post meal
24 h
Normal Biliary Atresia
RADIONUCLIDE THERAPY
131 I Therapy for Thyrotoxicosis
131 I Therapy for Ca Thyroid
32 P Therapy for pain palliation
OTHERS NUCLEAR SCANSSomatostatin scintigraphy
Localise and stage neuroendocrine tumours (NETs) eg carcinoid insulinoma gastrinoma phaeochromocytoma and medullary thyroid cancer
Lymphoscintigraphy
Unexplained limb swelling eg lymphatic hypoplasia
Urea breath test
Helicobacter pylori detectionmdashdiagnosis and confirmation of eradication
B12 absorption studies
Vitamin B12 malabsorption pernicious anaemia
Labelled leukocyte imaging
Sepsis localization Inflammatory bowel disease to help determine extent and severity
Dacroscintigraphy
Epiphora
MIBG (meta iodobenzylguanidine)imaging Localisation staging and response monitoring of neuroectodermal tumours Phaeochromocytoma (imaging investigation of choice) Neuroblastoma Carcinoid tumours Medullary thyroid cancer
SUMMARY NUCLEAR MEDICINE IMAGING IS
IMPORTANT IN FUNCTIONAL ASSESSMENT OF VARIOUS ORGANS
SIMPLE AND NON INVASIVE PROCEDURES
COST EFFECTIVE
RADIO IMMUNO ASSAY IS GOLD STANDARD
RADIO NUCLIDE THERAPY INCREASES SURVIVAL
RATE
THANK YOU
Thyroid uptake system
Gamma camera
Single head SPECT
Triple head SPECT
Modern PET camera
Gamma probe for sentinel lymph node detection
SPECIFIC INFORMATION REQUIRED WHEN REQUESTING NUCLEAR MEDICINE TESTS INCLUDES
1 Patient identification details2 Examination requested3 Relevant clinical history including
results of other investigations4 Pregnancylactation details where
relevant5 Special
needsmdashvisualhearinglearning difficulties needle phobia
H orm o ne D ru gs
T u m or M a rker D isea se M arker
R adio Im m uno Assay H eam ato log ica l Applica tions
In-v itro
P lanar S P E C T
Im aging
C a T hyro id80 - 200 m Ci
T hyrotoxicosis5 - 20 m Ci
131 Iod ine 32 P 89 S rP a llia tio n T h erapy
R adio N uclide T herapy
In-v ivo
Nuclear M edicine Applications
CLINICAL APPLICATIONS
BONES AND JOINTS
BRAIN SPECT
ENDOCRINOLOGY
LUNG - VENTILATION amp PERFUSION
NUCLEAR NEPHRO ndash UROLOGY
CARDIO VASCULAR SYSYTEM
GASTRO ndash ENTEROLOGY
BONE SCINTIGRAPHY BONE SCAN
Indications Tumour stagingmdasheg to assess skeletal
metastases(from prostate breastkidney thyroid lung)
Intractable Bone pain
Traumamdashwhen radiographs unhelpful
Prosthetic loosening eg THR
Infection - eg osteomyelitis
Avascular necrosis (AVN)
Pagetrsquos to assess extent
SKULL METASTASES IN CA PROSTATE
PHASE BONE SCAN - MUTILPLE MYELOMAACTIVE LESIONS IN LEFT FEMUR AND DV10
SECONDARY VERTEBRAL METASTESES
BRAIN SCANIndications
Dementia characterisation
Epilepsy for localisation of epileptogenic focus
Metastatic work-ups
Determination of blood flow (in brain death or atherosclerotic disease)
Evaluation of space-occupying lesions (tumor hematoma abscess [AV] malformation) and
Encephalitis
Suspected VP shunt obstruction
Distinguishes Parkinsonrsquos syndrome (PS) from benign essential tremor
INTER ICTAL ICTAL amp POST-ICTAL SPECT SHOWING HYPERPERFUSION OF RT TEMPORAL LOBE
9H POST ICTAL CT AND RCBF SPECT IN A 58YF (NORMAL CT ALTERED PERFUSION IN SPECT)
PERSISTENT HYPOPERFUSION DEFECTS THROUGH RIGHT HEMISPHERE IN A PATIENT OF TIA
99m Tc labelled ECD is used Assessment of Stroke detection of Epileptic focus evaluation of dementia etc
Figure Patient with acute ischemic stroke treated with hypertensive therapy a Positron emission tomography images of cerebral blood flow at 2 h (top) and 6 h (bottom)after the onset of symptoms PET cerebral blood flow(CBF) images demonstrate a significant reduction in blood flow affecting a substantial portion of the left middle cerebral artery territoryb PET images of regional cerebral metabolic rate of oxygen at 2 h (top) and 6 h (bottom) after the onset of symptomsOxygen metabolism is abnormal in the left middle cerebral artery (MCA)territory but in an area substantially smaller than the defect seen on the CBF imagesThis reduction in tissue at risk was presumably due to hypertensive therapyc Follow-up CT scan of the head in the patient demonstrating that the ultimate cerebral infarct size most closely approximates the oxygen metabolism defect(b) than the CBF defect (a)
THYROID amp PARATHYROID SCINTIGRAPHY
Indications Characterisation of thyrotoxicosis
a Diffuse toxic goitre (Gravesrsquodisease) b Toxic multinodular goitre (Plummerrsquos disease)
Autonomous nodule
Acute thyroiditis
Evaluation of upper mediastinal mass
Localisation of parathyroid adenoma in proven hyperparathyroidism
Na99mTcO4 Thyroid Scintigraphy - Avid Uptake with increased T3 and T4
FD - Thyrotoxicosis
Na99mTcO4 Thyroid Scintigraphy - A large Cold nodule involving the RtLobe
US - Cyst
Parathyroid Adenoma - 99mTc Sesta MIBI Scan
Thyroid in 5 min scan
20 min scan No wash out in Parathyroid Adenoma
LUNG SCANA Ventilationperfusion imaging (VQ Scan)
Indications Suspected pulmonary embolism Pre-operative lung function assessment
B Lung shunt studies
Indications
Suspected pulmonary AV shuntingInterpretation
1 Segmental perfusion loss with preserved ventilationmdash
pulmonary embolism2 Segmental matched perfusion and ventilation lossmdash
pulmonary infarctioninfection3 Segmentalsubsegmental ventilation loss with preserved
perfusionmdashinfection4 Non-segmental patchy matched perfusion and ventilation
LOSSmdashCOPD
NORMAL 99M TC DTPA AEROSOL STUDY
PERFUSION DEFECTS IN PULMONARY EMBOLISM
RENAL AND ADRENAL SCINTIGRAPHY
1 Static cortical renographyDMSA imaging
Urinary tract infection lsquogold standardrsquo for renal scarring Measurement of relative renal function Renal duplication assessment Ectopic kidney localisation Renal trauma Renal vein thrombosis Pre-biopsy
2 Dynamic renography
Assessment of renal drainagemdashdiscrimination between
renal dilatation and outflow obstruction Measurement of relative renal function Loin pain Post-pyeloplasty follow-up Renal artery stenosismdash1048585Captopril renography
3Adrenal Scan Used to accurately localize a pheochromocytoma when MRI or CT is
equivocal Uses labeled MIBG
Plain Renal Dynamic Studies
Tc-99m labelled DTPA is used for Renal scintigraphy (1) RENOGRAM - PLAIN STUDY amp WITH DIURETIC INTERVENSION
Useful for evaluation of obstructive uropathies to know whether obstruction is due to functional or organic causes
Contracted left kidney Scars over both poles of the Right Kidney
99mTc DMSA- Renal Cortical Image
HEART SCINTIGRAPHY
Myocardial perfusion imaging (MPI)
Indications
In ischaemic heart disease
1 Pre-angiography ndash When conventional stress testing fails eg
bundle branch blockndash Left ventricular hypertrophyndash Atypical chest painndash Recurrent chest pain post-intervention
2 Post-angiography
ndash Assess functional significance of known stenosesndash Identify critical vascular territory for
intervention
99MTC MIBI SPECT IMAGES - NORMAL STUDY
Short Axis
Vertical Long Axis
Horizontal Long Axis
Polar Map
3D image of LV
99MTC MIBI SPECT IMAGES - INFARCTION
Short Axis
Vertical Long Axis
Horizontal Long Axis
Polar Map
3D image of LV
LIVER AND GASTROINTESTINAL TRACT SCINTIGRAPHY
Hepatobiliary scintigraphy (HIDA-Scan BIDA-Scan)
Indications1 Acute cholecystitis2 Trauma3 Post-operative leak detection4 Bile ductstent patency5 Gallbladder emptying6 Bile reflux7 Neonatal biliary atresia
Gastrointestinal bleeding labelled red cell imaging
Helps localise source of active GI haemorrhage when other techniques(eg endoscopy or angiography) have failed
Gastric emptying studie
Altered GI motilitymdashdelayed or accelerated gastric emptying
Meckelrsquos scan ectopic gastric mucosa localisation Unexplained abdominal pain or GI hemorrhagemdashafter endoscopycontrast radiology
Meenakshi Isotope Scan and Thyroid Care Centre
99mTc Mebrofenin (Trimethyl Bromo Imino Diacetic Acid) Hepato Biliary Scan
5 min
2 h
Post meal
4 h 24 h
40 min
10 min
20 min
Total Biliary Channel Obstruction
G I BLEED STUDY
Blood Pool Scan 99m Tc labelled RBCs are used
To differentiate Hemangioma of the Liver from Hepatoma amp evaluation of G I Bleeding
Meenakshi Isotope Scan and Thyroid Care Centre
99mTc Mebrofenin Hepato Biliary Scan
20 min
5 min
10 min
30 min
4 hPost Meal
4 h
5 min 10 min
20 min 40 min 2 h
Post meal
24 h
Normal Biliary Atresia
RADIONUCLIDE THERAPY
131 I Therapy for Thyrotoxicosis
131 I Therapy for Ca Thyroid
32 P Therapy for pain palliation
OTHERS NUCLEAR SCANSSomatostatin scintigraphy
Localise and stage neuroendocrine tumours (NETs) eg carcinoid insulinoma gastrinoma phaeochromocytoma and medullary thyroid cancer
Lymphoscintigraphy
Unexplained limb swelling eg lymphatic hypoplasia
Urea breath test
Helicobacter pylori detectionmdashdiagnosis and confirmation of eradication
B12 absorption studies
Vitamin B12 malabsorption pernicious anaemia
Labelled leukocyte imaging
Sepsis localization Inflammatory bowel disease to help determine extent and severity
Dacroscintigraphy
Epiphora
MIBG (meta iodobenzylguanidine)imaging Localisation staging and response monitoring of neuroectodermal tumours Phaeochromocytoma (imaging investigation of choice) Neuroblastoma Carcinoid tumours Medullary thyroid cancer
SUMMARY NUCLEAR MEDICINE IMAGING IS
IMPORTANT IN FUNCTIONAL ASSESSMENT OF VARIOUS ORGANS
SIMPLE AND NON INVASIVE PROCEDURES
COST EFFECTIVE
RADIO IMMUNO ASSAY IS GOLD STANDARD
RADIO NUCLIDE THERAPY INCREASES SURVIVAL
RATE
THANK YOU
Gamma camera
Single head SPECT
Triple head SPECT
Modern PET camera
Gamma probe for sentinel lymph node detection
SPECIFIC INFORMATION REQUIRED WHEN REQUESTING NUCLEAR MEDICINE TESTS INCLUDES
1 Patient identification details2 Examination requested3 Relevant clinical history including
results of other investigations4 Pregnancylactation details where
relevant5 Special
needsmdashvisualhearinglearning difficulties needle phobia
H orm o ne D ru gs
T u m or M a rker D isea se M arker
R adio Im m uno Assay H eam ato log ica l Applica tions
In-v itro
P lanar S P E C T
Im aging
C a T hyro id80 - 200 m Ci
T hyrotoxicosis5 - 20 m Ci
131 Iod ine 32 P 89 S rP a llia tio n T h erapy
R adio N uclide T herapy
In-v ivo
Nuclear M edicine Applications
CLINICAL APPLICATIONS
BONES AND JOINTS
BRAIN SPECT
ENDOCRINOLOGY
LUNG - VENTILATION amp PERFUSION
NUCLEAR NEPHRO ndash UROLOGY
CARDIO VASCULAR SYSYTEM
GASTRO ndash ENTEROLOGY
BONE SCINTIGRAPHY BONE SCAN
Indications Tumour stagingmdasheg to assess skeletal
metastases(from prostate breastkidney thyroid lung)
Intractable Bone pain
Traumamdashwhen radiographs unhelpful
Prosthetic loosening eg THR
Infection - eg osteomyelitis
Avascular necrosis (AVN)
Pagetrsquos to assess extent
SKULL METASTASES IN CA PROSTATE
PHASE BONE SCAN - MUTILPLE MYELOMAACTIVE LESIONS IN LEFT FEMUR AND DV10
SECONDARY VERTEBRAL METASTESES
BRAIN SCANIndications
Dementia characterisation
Epilepsy for localisation of epileptogenic focus
Metastatic work-ups
Determination of blood flow (in brain death or atherosclerotic disease)
Evaluation of space-occupying lesions (tumor hematoma abscess [AV] malformation) and
Encephalitis
Suspected VP shunt obstruction
Distinguishes Parkinsonrsquos syndrome (PS) from benign essential tremor
INTER ICTAL ICTAL amp POST-ICTAL SPECT SHOWING HYPERPERFUSION OF RT TEMPORAL LOBE
9H POST ICTAL CT AND RCBF SPECT IN A 58YF (NORMAL CT ALTERED PERFUSION IN SPECT)
PERSISTENT HYPOPERFUSION DEFECTS THROUGH RIGHT HEMISPHERE IN A PATIENT OF TIA
99m Tc labelled ECD is used Assessment of Stroke detection of Epileptic focus evaluation of dementia etc
Figure Patient with acute ischemic stroke treated with hypertensive therapy a Positron emission tomography images of cerebral blood flow at 2 h (top) and 6 h (bottom)after the onset of symptoms PET cerebral blood flow(CBF) images demonstrate a significant reduction in blood flow affecting a substantial portion of the left middle cerebral artery territoryb PET images of regional cerebral metabolic rate of oxygen at 2 h (top) and 6 h (bottom) after the onset of symptomsOxygen metabolism is abnormal in the left middle cerebral artery (MCA)territory but in an area substantially smaller than the defect seen on the CBF imagesThis reduction in tissue at risk was presumably due to hypertensive therapyc Follow-up CT scan of the head in the patient demonstrating that the ultimate cerebral infarct size most closely approximates the oxygen metabolism defect(b) than the CBF defect (a)
THYROID amp PARATHYROID SCINTIGRAPHY
Indications Characterisation of thyrotoxicosis
a Diffuse toxic goitre (Gravesrsquodisease) b Toxic multinodular goitre (Plummerrsquos disease)
Autonomous nodule
Acute thyroiditis
Evaluation of upper mediastinal mass
Localisation of parathyroid adenoma in proven hyperparathyroidism
Na99mTcO4 Thyroid Scintigraphy - Avid Uptake with increased T3 and T4
FD - Thyrotoxicosis
Na99mTcO4 Thyroid Scintigraphy - A large Cold nodule involving the RtLobe
US - Cyst
Parathyroid Adenoma - 99mTc Sesta MIBI Scan
Thyroid in 5 min scan
20 min scan No wash out in Parathyroid Adenoma
LUNG SCANA Ventilationperfusion imaging (VQ Scan)
Indications Suspected pulmonary embolism Pre-operative lung function assessment
B Lung shunt studies
Indications
Suspected pulmonary AV shuntingInterpretation
1 Segmental perfusion loss with preserved ventilationmdash
pulmonary embolism2 Segmental matched perfusion and ventilation lossmdash
pulmonary infarctioninfection3 Segmentalsubsegmental ventilation loss with preserved
perfusionmdashinfection4 Non-segmental patchy matched perfusion and ventilation
LOSSmdashCOPD
NORMAL 99M TC DTPA AEROSOL STUDY
PERFUSION DEFECTS IN PULMONARY EMBOLISM
RENAL AND ADRENAL SCINTIGRAPHY
1 Static cortical renographyDMSA imaging
Urinary tract infection lsquogold standardrsquo for renal scarring Measurement of relative renal function Renal duplication assessment Ectopic kidney localisation Renal trauma Renal vein thrombosis Pre-biopsy
2 Dynamic renography
Assessment of renal drainagemdashdiscrimination between
renal dilatation and outflow obstruction Measurement of relative renal function Loin pain Post-pyeloplasty follow-up Renal artery stenosismdash1048585Captopril renography
3Adrenal Scan Used to accurately localize a pheochromocytoma when MRI or CT is
equivocal Uses labeled MIBG
Plain Renal Dynamic Studies
Tc-99m labelled DTPA is used for Renal scintigraphy (1) RENOGRAM - PLAIN STUDY amp WITH DIURETIC INTERVENSION
Useful for evaluation of obstructive uropathies to know whether obstruction is due to functional or organic causes
Contracted left kidney Scars over both poles of the Right Kidney
99mTc DMSA- Renal Cortical Image
HEART SCINTIGRAPHY
Myocardial perfusion imaging (MPI)
Indications
In ischaemic heart disease
1 Pre-angiography ndash When conventional stress testing fails eg
bundle branch blockndash Left ventricular hypertrophyndash Atypical chest painndash Recurrent chest pain post-intervention
2 Post-angiography
ndash Assess functional significance of known stenosesndash Identify critical vascular territory for
intervention
99MTC MIBI SPECT IMAGES - NORMAL STUDY
Short Axis
Vertical Long Axis
Horizontal Long Axis
Polar Map
3D image of LV
99MTC MIBI SPECT IMAGES - INFARCTION
Short Axis
Vertical Long Axis
Horizontal Long Axis
Polar Map
3D image of LV
LIVER AND GASTROINTESTINAL TRACT SCINTIGRAPHY
Hepatobiliary scintigraphy (HIDA-Scan BIDA-Scan)
Indications1 Acute cholecystitis2 Trauma3 Post-operative leak detection4 Bile ductstent patency5 Gallbladder emptying6 Bile reflux7 Neonatal biliary atresia
Gastrointestinal bleeding labelled red cell imaging
Helps localise source of active GI haemorrhage when other techniques(eg endoscopy or angiography) have failed
Gastric emptying studie
Altered GI motilitymdashdelayed or accelerated gastric emptying
Meckelrsquos scan ectopic gastric mucosa localisation Unexplained abdominal pain or GI hemorrhagemdashafter endoscopycontrast radiology
Meenakshi Isotope Scan and Thyroid Care Centre
99mTc Mebrofenin (Trimethyl Bromo Imino Diacetic Acid) Hepato Biliary Scan
5 min
2 h
Post meal
4 h 24 h
40 min
10 min
20 min
Total Biliary Channel Obstruction
G I BLEED STUDY
Blood Pool Scan 99m Tc labelled RBCs are used
To differentiate Hemangioma of the Liver from Hepatoma amp evaluation of G I Bleeding
Meenakshi Isotope Scan and Thyroid Care Centre
99mTc Mebrofenin Hepato Biliary Scan
20 min
5 min
10 min
30 min
4 hPost Meal
4 h
5 min 10 min
20 min 40 min 2 h
Post meal
24 h
Normal Biliary Atresia
RADIONUCLIDE THERAPY
131 I Therapy for Thyrotoxicosis
131 I Therapy for Ca Thyroid
32 P Therapy for pain palliation
OTHERS NUCLEAR SCANSSomatostatin scintigraphy
Localise and stage neuroendocrine tumours (NETs) eg carcinoid insulinoma gastrinoma phaeochromocytoma and medullary thyroid cancer
Lymphoscintigraphy
Unexplained limb swelling eg lymphatic hypoplasia
Urea breath test
Helicobacter pylori detectionmdashdiagnosis and confirmation of eradication
B12 absorption studies
Vitamin B12 malabsorption pernicious anaemia
Labelled leukocyte imaging
Sepsis localization Inflammatory bowel disease to help determine extent and severity
Dacroscintigraphy
Epiphora
MIBG (meta iodobenzylguanidine)imaging Localisation staging and response monitoring of neuroectodermal tumours Phaeochromocytoma (imaging investigation of choice) Neuroblastoma Carcinoid tumours Medullary thyroid cancer
SUMMARY NUCLEAR MEDICINE IMAGING IS
IMPORTANT IN FUNCTIONAL ASSESSMENT OF VARIOUS ORGANS
SIMPLE AND NON INVASIVE PROCEDURES
COST EFFECTIVE
RADIO IMMUNO ASSAY IS GOLD STANDARD
RADIO NUCLIDE THERAPY INCREASES SURVIVAL
RATE
THANK YOU
Single head SPECT
Triple head SPECT
Modern PET camera
Gamma probe for sentinel lymph node detection
SPECIFIC INFORMATION REQUIRED WHEN REQUESTING NUCLEAR MEDICINE TESTS INCLUDES
1 Patient identification details2 Examination requested3 Relevant clinical history including
results of other investigations4 Pregnancylactation details where
relevant5 Special
needsmdashvisualhearinglearning difficulties needle phobia
H orm o ne D ru gs
T u m or M a rker D isea se M arker
R adio Im m uno Assay H eam ato log ica l Applica tions
In-v itro
P lanar S P E C T
Im aging
C a T hyro id80 - 200 m Ci
T hyrotoxicosis5 - 20 m Ci
131 Iod ine 32 P 89 S rP a llia tio n T h erapy
R adio N uclide T herapy
In-v ivo
Nuclear M edicine Applications
CLINICAL APPLICATIONS
BONES AND JOINTS
BRAIN SPECT
ENDOCRINOLOGY
LUNG - VENTILATION amp PERFUSION
NUCLEAR NEPHRO ndash UROLOGY
CARDIO VASCULAR SYSYTEM
GASTRO ndash ENTEROLOGY
BONE SCINTIGRAPHY BONE SCAN
Indications Tumour stagingmdasheg to assess skeletal
metastases(from prostate breastkidney thyroid lung)
Intractable Bone pain
Traumamdashwhen radiographs unhelpful
Prosthetic loosening eg THR
Infection - eg osteomyelitis
Avascular necrosis (AVN)
Pagetrsquos to assess extent
SKULL METASTASES IN CA PROSTATE
PHASE BONE SCAN - MUTILPLE MYELOMAACTIVE LESIONS IN LEFT FEMUR AND DV10
SECONDARY VERTEBRAL METASTESES
BRAIN SCANIndications
Dementia characterisation
Epilepsy for localisation of epileptogenic focus
Metastatic work-ups
Determination of blood flow (in brain death or atherosclerotic disease)
Evaluation of space-occupying lesions (tumor hematoma abscess [AV] malformation) and
Encephalitis
Suspected VP shunt obstruction
Distinguishes Parkinsonrsquos syndrome (PS) from benign essential tremor
INTER ICTAL ICTAL amp POST-ICTAL SPECT SHOWING HYPERPERFUSION OF RT TEMPORAL LOBE
9H POST ICTAL CT AND RCBF SPECT IN A 58YF (NORMAL CT ALTERED PERFUSION IN SPECT)
PERSISTENT HYPOPERFUSION DEFECTS THROUGH RIGHT HEMISPHERE IN A PATIENT OF TIA
99m Tc labelled ECD is used Assessment of Stroke detection of Epileptic focus evaluation of dementia etc
Figure Patient with acute ischemic stroke treated with hypertensive therapy a Positron emission tomography images of cerebral blood flow at 2 h (top) and 6 h (bottom)after the onset of symptoms PET cerebral blood flow(CBF) images demonstrate a significant reduction in blood flow affecting a substantial portion of the left middle cerebral artery territoryb PET images of regional cerebral metabolic rate of oxygen at 2 h (top) and 6 h (bottom) after the onset of symptomsOxygen metabolism is abnormal in the left middle cerebral artery (MCA)territory but in an area substantially smaller than the defect seen on the CBF imagesThis reduction in tissue at risk was presumably due to hypertensive therapyc Follow-up CT scan of the head in the patient demonstrating that the ultimate cerebral infarct size most closely approximates the oxygen metabolism defect(b) than the CBF defect (a)
THYROID amp PARATHYROID SCINTIGRAPHY
Indications Characterisation of thyrotoxicosis
a Diffuse toxic goitre (Gravesrsquodisease) b Toxic multinodular goitre (Plummerrsquos disease)
Autonomous nodule
Acute thyroiditis
Evaluation of upper mediastinal mass
Localisation of parathyroid adenoma in proven hyperparathyroidism
Na99mTcO4 Thyroid Scintigraphy - Avid Uptake with increased T3 and T4
FD - Thyrotoxicosis
Na99mTcO4 Thyroid Scintigraphy - A large Cold nodule involving the RtLobe
US - Cyst
Parathyroid Adenoma - 99mTc Sesta MIBI Scan
Thyroid in 5 min scan
20 min scan No wash out in Parathyroid Adenoma
LUNG SCANA Ventilationperfusion imaging (VQ Scan)
Indications Suspected pulmonary embolism Pre-operative lung function assessment
B Lung shunt studies
Indications
Suspected pulmonary AV shuntingInterpretation
1 Segmental perfusion loss with preserved ventilationmdash
pulmonary embolism2 Segmental matched perfusion and ventilation lossmdash
pulmonary infarctioninfection3 Segmentalsubsegmental ventilation loss with preserved
perfusionmdashinfection4 Non-segmental patchy matched perfusion and ventilation
LOSSmdashCOPD
NORMAL 99M TC DTPA AEROSOL STUDY
PERFUSION DEFECTS IN PULMONARY EMBOLISM
RENAL AND ADRENAL SCINTIGRAPHY
1 Static cortical renographyDMSA imaging
Urinary tract infection lsquogold standardrsquo for renal scarring Measurement of relative renal function Renal duplication assessment Ectopic kidney localisation Renal trauma Renal vein thrombosis Pre-biopsy
2 Dynamic renography
Assessment of renal drainagemdashdiscrimination between
renal dilatation and outflow obstruction Measurement of relative renal function Loin pain Post-pyeloplasty follow-up Renal artery stenosismdash1048585Captopril renography
3Adrenal Scan Used to accurately localize a pheochromocytoma when MRI or CT is
equivocal Uses labeled MIBG
Plain Renal Dynamic Studies
Tc-99m labelled DTPA is used for Renal scintigraphy (1) RENOGRAM - PLAIN STUDY amp WITH DIURETIC INTERVENSION
Useful for evaluation of obstructive uropathies to know whether obstruction is due to functional or organic causes
Contracted left kidney Scars over both poles of the Right Kidney
99mTc DMSA- Renal Cortical Image
HEART SCINTIGRAPHY
Myocardial perfusion imaging (MPI)
Indications
In ischaemic heart disease
1 Pre-angiography ndash When conventional stress testing fails eg
bundle branch blockndash Left ventricular hypertrophyndash Atypical chest painndash Recurrent chest pain post-intervention
2 Post-angiography
ndash Assess functional significance of known stenosesndash Identify critical vascular territory for
intervention
99MTC MIBI SPECT IMAGES - NORMAL STUDY
Short Axis
Vertical Long Axis
Horizontal Long Axis
Polar Map
3D image of LV
99MTC MIBI SPECT IMAGES - INFARCTION
Short Axis
Vertical Long Axis
Horizontal Long Axis
Polar Map
3D image of LV
LIVER AND GASTROINTESTINAL TRACT SCINTIGRAPHY
Hepatobiliary scintigraphy (HIDA-Scan BIDA-Scan)
Indications1 Acute cholecystitis2 Trauma3 Post-operative leak detection4 Bile ductstent patency5 Gallbladder emptying6 Bile reflux7 Neonatal biliary atresia
Gastrointestinal bleeding labelled red cell imaging
Helps localise source of active GI haemorrhage when other techniques(eg endoscopy or angiography) have failed
Gastric emptying studie
Altered GI motilitymdashdelayed or accelerated gastric emptying
Meckelrsquos scan ectopic gastric mucosa localisation Unexplained abdominal pain or GI hemorrhagemdashafter endoscopycontrast radiology
Meenakshi Isotope Scan and Thyroid Care Centre
99mTc Mebrofenin (Trimethyl Bromo Imino Diacetic Acid) Hepato Biliary Scan
5 min
2 h
Post meal
4 h 24 h
40 min
10 min
20 min
Total Biliary Channel Obstruction
G I BLEED STUDY
Blood Pool Scan 99m Tc labelled RBCs are used
To differentiate Hemangioma of the Liver from Hepatoma amp evaluation of G I Bleeding
Meenakshi Isotope Scan and Thyroid Care Centre
99mTc Mebrofenin Hepato Biliary Scan
20 min
5 min
10 min
30 min
4 hPost Meal
4 h
5 min 10 min
20 min 40 min 2 h
Post meal
24 h
Normal Biliary Atresia
RADIONUCLIDE THERAPY
131 I Therapy for Thyrotoxicosis
131 I Therapy for Ca Thyroid
32 P Therapy for pain palliation
OTHERS NUCLEAR SCANSSomatostatin scintigraphy
Localise and stage neuroendocrine tumours (NETs) eg carcinoid insulinoma gastrinoma phaeochromocytoma and medullary thyroid cancer
Lymphoscintigraphy
Unexplained limb swelling eg lymphatic hypoplasia
Urea breath test
Helicobacter pylori detectionmdashdiagnosis and confirmation of eradication
B12 absorption studies
Vitamin B12 malabsorption pernicious anaemia
Labelled leukocyte imaging
Sepsis localization Inflammatory bowel disease to help determine extent and severity
Dacroscintigraphy
Epiphora
MIBG (meta iodobenzylguanidine)imaging Localisation staging and response monitoring of neuroectodermal tumours Phaeochromocytoma (imaging investigation of choice) Neuroblastoma Carcinoid tumours Medullary thyroid cancer
SUMMARY NUCLEAR MEDICINE IMAGING IS
IMPORTANT IN FUNCTIONAL ASSESSMENT OF VARIOUS ORGANS
SIMPLE AND NON INVASIVE PROCEDURES
COST EFFECTIVE
RADIO IMMUNO ASSAY IS GOLD STANDARD
RADIO NUCLIDE THERAPY INCREASES SURVIVAL
RATE
THANK YOU
Triple head SPECT
Modern PET camera
Gamma probe for sentinel lymph node detection
SPECIFIC INFORMATION REQUIRED WHEN REQUESTING NUCLEAR MEDICINE TESTS INCLUDES
1 Patient identification details2 Examination requested3 Relevant clinical history including
results of other investigations4 Pregnancylactation details where
relevant5 Special
needsmdashvisualhearinglearning difficulties needle phobia
H orm o ne D ru gs
T u m or M a rker D isea se M arker
R adio Im m uno Assay H eam ato log ica l Applica tions
In-v itro
P lanar S P E C T
Im aging
C a T hyro id80 - 200 m Ci
T hyrotoxicosis5 - 20 m Ci
131 Iod ine 32 P 89 S rP a llia tio n T h erapy
R adio N uclide T herapy
In-v ivo
Nuclear M edicine Applications
CLINICAL APPLICATIONS
BONES AND JOINTS
BRAIN SPECT
ENDOCRINOLOGY
LUNG - VENTILATION amp PERFUSION
NUCLEAR NEPHRO ndash UROLOGY
CARDIO VASCULAR SYSYTEM
GASTRO ndash ENTEROLOGY
BONE SCINTIGRAPHY BONE SCAN
Indications Tumour stagingmdasheg to assess skeletal
metastases(from prostate breastkidney thyroid lung)
Intractable Bone pain
Traumamdashwhen radiographs unhelpful
Prosthetic loosening eg THR
Infection - eg osteomyelitis
Avascular necrosis (AVN)
Pagetrsquos to assess extent
SKULL METASTASES IN CA PROSTATE
PHASE BONE SCAN - MUTILPLE MYELOMAACTIVE LESIONS IN LEFT FEMUR AND DV10
SECONDARY VERTEBRAL METASTESES
BRAIN SCANIndications
Dementia characterisation
Epilepsy for localisation of epileptogenic focus
Metastatic work-ups
Determination of blood flow (in brain death or atherosclerotic disease)
Evaluation of space-occupying lesions (tumor hematoma abscess [AV] malformation) and
Encephalitis
Suspected VP shunt obstruction
Distinguishes Parkinsonrsquos syndrome (PS) from benign essential tremor
INTER ICTAL ICTAL amp POST-ICTAL SPECT SHOWING HYPERPERFUSION OF RT TEMPORAL LOBE
9H POST ICTAL CT AND RCBF SPECT IN A 58YF (NORMAL CT ALTERED PERFUSION IN SPECT)
PERSISTENT HYPOPERFUSION DEFECTS THROUGH RIGHT HEMISPHERE IN A PATIENT OF TIA
99m Tc labelled ECD is used Assessment of Stroke detection of Epileptic focus evaluation of dementia etc
Figure Patient with acute ischemic stroke treated with hypertensive therapy a Positron emission tomography images of cerebral blood flow at 2 h (top) and 6 h (bottom)after the onset of symptoms PET cerebral blood flow(CBF) images demonstrate a significant reduction in blood flow affecting a substantial portion of the left middle cerebral artery territoryb PET images of regional cerebral metabolic rate of oxygen at 2 h (top) and 6 h (bottom) after the onset of symptomsOxygen metabolism is abnormal in the left middle cerebral artery (MCA)territory but in an area substantially smaller than the defect seen on the CBF imagesThis reduction in tissue at risk was presumably due to hypertensive therapyc Follow-up CT scan of the head in the patient demonstrating that the ultimate cerebral infarct size most closely approximates the oxygen metabolism defect(b) than the CBF defect (a)
THYROID amp PARATHYROID SCINTIGRAPHY
Indications Characterisation of thyrotoxicosis
a Diffuse toxic goitre (Gravesrsquodisease) b Toxic multinodular goitre (Plummerrsquos disease)
Autonomous nodule
Acute thyroiditis
Evaluation of upper mediastinal mass
Localisation of parathyroid adenoma in proven hyperparathyroidism
Na99mTcO4 Thyroid Scintigraphy - Avid Uptake with increased T3 and T4
FD - Thyrotoxicosis
Na99mTcO4 Thyroid Scintigraphy - A large Cold nodule involving the RtLobe
US - Cyst
Parathyroid Adenoma - 99mTc Sesta MIBI Scan
Thyroid in 5 min scan
20 min scan No wash out in Parathyroid Adenoma
LUNG SCANA Ventilationperfusion imaging (VQ Scan)
Indications Suspected pulmonary embolism Pre-operative lung function assessment
B Lung shunt studies
Indications
Suspected pulmonary AV shuntingInterpretation
1 Segmental perfusion loss with preserved ventilationmdash
pulmonary embolism2 Segmental matched perfusion and ventilation lossmdash
pulmonary infarctioninfection3 Segmentalsubsegmental ventilation loss with preserved
perfusionmdashinfection4 Non-segmental patchy matched perfusion and ventilation
LOSSmdashCOPD
NORMAL 99M TC DTPA AEROSOL STUDY
PERFUSION DEFECTS IN PULMONARY EMBOLISM
RENAL AND ADRENAL SCINTIGRAPHY
1 Static cortical renographyDMSA imaging
Urinary tract infection lsquogold standardrsquo for renal scarring Measurement of relative renal function Renal duplication assessment Ectopic kidney localisation Renal trauma Renal vein thrombosis Pre-biopsy
2 Dynamic renography
Assessment of renal drainagemdashdiscrimination between
renal dilatation and outflow obstruction Measurement of relative renal function Loin pain Post-pyeloplasty follow-up Renal artery stenosismdash1048585Captopril renography
3Adrenal Scan Used to accurately localize a pheochromocytoma when MRI or CT is
equivocal Uses labeled MIBG
Plain Renal Dynamic Studies
Tc-99m labelled DTPA is used for Renal scintigraphy (1) RENOGRAM - PLAIN STUDY amp WITH DIURETIC INTERVENSION
Useful for evaluation of obstructive uropathies to know whether obstruction is due to functional or organic causes
Contracted left kidney Scars over both poles of the Right Kidney
99mTc DMSA- Renal Cortical Image
HEART SCINTIGRAPHY
Myocardial perfusion imaging (MPI)
Indications
In ischaemic heart disease
1 Pre-angiography ndash When conventional stress testing fails eg
bundle branch blockndash Left ventricular hypertrophyndash Atypical chest painndash Recurrent chest pain post-intervention
2 Post-angiography
ndash Assess functional significance of known stenosesndash Identify critical vascular territory for
intervention
99MTC MIBI SPECT IMAGES - NORMAL STUDY
Short Axis
Vertical Long Axis
Horizontal Long Axis
Polar Map
3D image of LV
99MTC MIBI SPECT IMAGES - INFARCTION
Short Axis
Vertical Long Axis
Horizontal Long Axis
Polar Map
3D image of LV
LIVER AND GASTROINTESTINAL TRACT SCINTIGRAPHY
Hepatobiliary scintigraphy (HIDA-Scan BIDA-Scan)
Indications1 Acute cholecystitis2 Trauma3 Post-operative leak detection4 Bile ductstent patency5 Gallbladder emptying6 Bile reflux7 Neonatal biliary atresia
Gastrointestinal bleeding labelled red cell imaging
Helps localise source of active GI haemorrhage when other techniques(eg endoscopy or angiography) have failed
Gastric emptying studie
Altered GI motilitymdashdelayed or accelerated gastric emptying
Meckelrsquos scan ectopic gastric mucosa localisation Unexplained abdominal pain or GI hemorrhagemdashafter endoscopycontrast radiology
Meenakshi Isotope Scan and Thyroid Care Centre
99mTc Mebrofenin (Trimethyl Bromo Imino Diacetic Acid) Hepato Biliary Scan
5 min
2 h
Post meal
4 h 24 h
40 min
10 min
20 min
Total Biliary Channel Obstruction
G I BLEED STUDY
Blood Pool Scan 99m Tc labelled RBCs are used
To differentiate Hemangioma of the Liver from Hepatoma amp evaluation of G I Bleeding
Meenakshi Isotope Scan and Thyroid Care Centre
99mTc Mebrofenin Hepato Biliary Scan
20 min
5 min
10 min
30 min
4 hPost Meal
4 h
5 min 10 min
20 min 40 min 2 h
Post meal
24 h
Normal Biliary Atresia
RADIONUCLIDE THERAPY
131 I Therapy for Thyrotoxicosis
131 I Therapy for Ca Thyroid
32 P Therapy for pain palliation
OTHERS NUCLEAR SCANSSomatostatin scintigraphy
Localise and stage neuroendocrine tumours (NETs) eg carcinoid insulinoma gastrinoma phaeochromocytoma and medullary thyroid cancer
Lymphoscintigraphy
Unexplained limb swelling eg lymphatic hypoplasia
Urea breath test
Helicobacter pylori detectionmdashdiagnosis and confirmation of eradication
B12 absorption studies
Vitamin B12 malabsorption pernicious anaemia
Labelled leukocyte imaging
Sepsis localization Inflammatory bowel disease to help determine extent and severity
Dacroscintigraphy
Epiphora
MIBG (meta iodobenzylguanidine)imaging Localisation staging and response monitoring of neuroectodermal tumours Phaeochromocytoma (imaging investigation of choice) Neuroblastoma Carcinoid tumours Medullary thyroid cancer
SUMMARY NUCLEAR MEDICINE IMAGING IS
IMPORTANT IN FUNCTIONAL ASSESSMENT OF VARIOUS ORGANS
SIMPLE AND NON INVASIVE PROCEDURES
COST EFFECTIVE
RADIO IMMUNO ASSAY IS GOLD STANDARD
RADIO NUCLIDE THERAPY INCREASES SURVIVAL
RATE
THANK YOU
Modern PET camera
Gamma probe for sentinel lymph node detection
SPECIFIC INFORMATION REQUIRED WHEN REQUESTING NUCLEAR MEDICINE TESTS INCLUDES
1 Patient identification details2 Examination requested3 Relevant clinical history including
results of other investigations4 Pregnancylactation details where
relevant5 Special
needsmdashvisualhearinglearning difficulties needle phobia
H orm o ne D ru gs
T u m or M a rker D isea se M arker
R adio Im m uno Assay H eam ato log ica l Applica tions
In-v itro
P lanar S P E C T
Im aging
C a T hyro id80 - 200 m Ci
T hyrotoxicosis5 - 20 m Ci
131 Iod ine 32 P 89 S rP a llia tio n T h erapy
R adio N uclide T herapy
In-v ivo
Nuclear M edicine Applications
CLINICAL APPLICATIONS
BONES AND JOINTS
BRAIN SPECT
ENDOCRINOLOGY
LUNG - VENTILATION amp PERFUSION
NUCLEAR NEPHRO ndash UROLOGY
CARDIO VASCULAR SYSYTEM
GASTRO ndash ENTEROLOGY
BONE SCINTIGRAPHY BONE SCAN
Indications Tumour stagingmdasheg to assess skeletal
metastases(from prostate breastkidney thyroid lung)
Intractable Bone pain
Traumamdashwhen radiographs unhelpful
Prosthetic loosening eg THR
Infection - eg osteomyelitis
Avascular necrosis (AVN)
Pagetrsquos to assess extent
SKULL METASTASES IN CA PROSTATE
PHASE BONE SCAN - MUTILPLE MYELOMAACTIVE LESIONS IN LEFT FEMUR AND DV10
SECONDARY VERTEBRAL METASTESES
BRAIN SCANIndications
Dementia characterisation
Epilepsy for localisation of epileptogenic focus
Metastatic work-ups
Determination of blood flow (in brain death or atherosclerotic disease)
Evaluation of space-occupying lesions (tumor hematoma abscess [AV] malformation) and
Encephalitis
Suspected VP shunt obstruction
Distinguishes Parkinsonrsquos syndrome (PS) from benign essential tremor
INTER ICTAL ICTAL amp POST-ICTAL SPECT SHOWING HYPERPERFUSION OF RT TEMPORAL LOBE
9H POST ICTAL CT AND RCBF SPECT IN A 58YF (NORMAL CT ALTERED PERFUSION IN SPECT)
PERSISTENT HYPOPERFUSION DEFECTS THROUGH RIGHT HEMISPHERE IN A PATIENT OF TIA
99m Tc labelled ECD is used Assessment of Stroke detection of Epileptic focus evaluation of dementia etc
Figure Patient with acute ischemic stroke treated with hypertensive therapy a Positron emission tomography images of cerebral blood flow at 2 h (top) and 6 h (bottom)after the onset of symptoms PET cerebral blood flow(CBF) images demonstrate a significant reduction in blood flow affecting a substantial portion of the left middle cerebral artery territoryb PET images of regional cerebral metabolic rate of oxygen at 2 h (top) and 6 h (bottom) after the onset of symptomsOxygen metabolism is abnormal in the left middle cerebral artery (MCA)territory but in an area substantially smaller than the defect seen on the CBF imagesThis reduction in tissue at risk was presumably due to hypertensive therapyc Follow-up CT scan of the head in the patient demonstrating that the ultimate cerebral infarct size most closely approximates the oxygen metabolism defect(b) than the CBF defect (a)
THYROID amp PARATHYROID SCINTIGRAPHY
Indications Characterisation of thyrotoxicosis
a Diffuse toxic goitre (Gravesrsquodisease) b Toxic multinodular goitre (Plummerrsquos disease)
Autonomous nodule
Acute thyroiditis
Evaluation of upper mediastinal mass
Localisation of parathyroid adenoma in proven hyperparathyroidism
Na99mTcO4 Thyroid Scintigraphy - Avid Uptake with increased T3 and T4
FD - Thyrotoxicosis
Na99mTcO4 Thyroid Scintigraphy - A large Cold nodule involving the RtLobe
US - Cyst
Parathyroid Adenoma - 99mTc Sesta MIBI Scan
Thyroid in 5 min scan
20 min scan No wash out in Parathyroid Adenoma
LUNG SCANA Ventilationperfusion imaging (VQ Scan)
Indications Suspected pulmonary embolism Pre-operative lung function assessment
B Lung shunt studies
Indications
Suspected pulmonary AV shuntingInterpretation
1 Segmental perfusion loss with preserved ventilationmdash
pulmonary embolism2 Segmental matched perfusion and ventilation lossmdash
pulmonary infarctioninfection3 Segmentalsubsegmental ventilation loss with preserved
perfusionmdashinfection4 Non-segmental patchy matched perfusion and ventilation
LOSSmdashCOPD
NORMAL 99M TC DTPA AEROSOL STUDY
PERFUSION DEFECTS IN PULMONARY EMBOLISM
RENAL AND ADRENAL SCINTIGRAPHY
1 Static cortical renographyDMSA imaging
Urinary tract infection lsquogold standardrsquo for renal scarring Measurement of relative renal function Renal duplication assessment Ectopic kidney localisation Renal trauma Renal vein thrombosis Pre-biopsy
2 Dynamic renography
Assessment of renal drainagemdashdiscrimination between
renal dilatation and outflow obstruction Measurement of relative renal function Loin pain Post-pyeloplasty follow-up Renal artery stenosismdash1048585Captopril renography
3Adrenal Scan Used to accurately localize a pheochromocytoma when MRI or CT is
equivocal Uses labeled MIBG
Plain Renal Dynamic Studies
Tc-99m labelled DTPA is used for Renal scintigraphy (1) RENOGRAM - PLAIN STUDY amp WITH DIURETIC INTERVENSION
Useful for evaluation of obstructive uropathies to know whether obstruction is due to functional or organic causes
Contracted left kidney Scars over both poles of the Right Kidney
99mTc DMSA- Renal Cortical Image
HEART SCINTIGRAPHY
Myocardial perfusion imaging (MPI)
Indications
In ischaemic heart disease
1 Pre-angiography ndash When conventional stress testing fails eg
bundle branch blockndash Left ventricular hypertrophyndash Atypical chest painndash Recurrent chest pain post-intervention
2 Post-angiography
ndash Assess functional significance of known stenosesndash Identify critical vascular territory for
intervention
99MTC MIBI SPECT IMAGES - NORMAL STUDY
Short Axis
Vertical Long Axis
Horizontal Long Axis
Polar Map
3D image of LV
99MTC MIBI SPECT IMAGES - INFARCTION
Short Axis
Vertical Long Axis
Horizontal Long Axis
Polar Map
3D image of LV
LIVER AND GASTROINTESTINAL TRACT SCINTIGRAPHY
Hepatobiliary scintigraphy (HIDA-Scan BIDA-Scan)
Indications1 Acute cholecystitis2 Trauma3 Post-operative leak detection4 Bile ductstent patency5 Gallbladder emptying6 Bile reflux7 Neonatal biliary atresia
Gastrointestinal bleeding labelled red cell imaging
Helps localise source of active GI haemorrhage when other techniques(eg endoscopy or angiography) have failed
Gastric emptying studie
Altered GI motilitymdashdelayed or accelerated gastric emptying
Meckelrsquos scan ectopic gastric mucosa localisation Unexplained abdominal pain or GI hemorrhagemdashafter endoscopycontrast radiology
Meenakshi Isotope Scan and Thyroid Care Centre
99mTc Mebrofenin (Trimethyl Bromo Imino Diacetic Acid) Hepato Biliary Scan
5 min
2 h
Post meal
4 h 24 h
40 min
10 min
20 min
Total Biliary Channel Obstruction
G I BLEED STUDY
Blood Pool Scan 99m Tc labelled RBCs are used
To differentiate Hemangioma of the Liver from Hepatoma amp evaluation of G I Bleeding
Meenakshi Isotope Scan and Thyroid Care Centre
99mTc Mebrofenin Hepato Biliary Scan
20 min
5 min
10 min
30 min
4 hPost Meal
4 h
5 min 10 min
20 min 40 min 2 h
Post meal
24 h
Normal Biliary Atresia
RADIONUCLIDE THERAPY
131 I Therapy for Thyrotoxicosis
131 I Therapy for Ca Thyroid
32 P Therapy for pain palliation
OTHERS NUCLEAR SCANSSomatostatin scintigraphy
Localise and stage neuroendocrine tumours (NETs) eg carcinoid insulinoma gastrinoma phaeochromocytoma and medullary thyroid cancer
Lymphoscintigraphy
Unexplained limb swelling eg lymphatic hypoplasia
Urea breath test
Helicobacter pylori detectionmdashdiagnosis and confirmation of eradication
B12 absorption studies
Vitamin B12 malabsorption pernicious anaemia
Labelled leukocyte imaging
Sepsis localization Inflammatory bowel disease to help determine extent and severity
Dacroscintigraphy
Epiphora
MIBG (meta iodobenzylguanidine)imaging Localisation staging and response monitoring of neuroectodermal tumours Phaeochromocytoma (imaging investigation of choice) Neuroblastoma Carcinoid tumours Medullary thyroid cancer
SUMMARY NUCLEAR MEDICINE IMAGING IS
IMPORTANT IN FUNCTIONAL ASSESSMENT OF VARIOUS ORGANS
SIMPLE AND NON INVASIVE PROCEDURES
COST EFFECTIVE
RADIO IMMUNO ASSAY IS GOLD STANDARD
RADIO NUCLIDE THERAPY INCREASES SURVIVAL
RATE
THANK YOU
Gamma probe for sentinel lymph node detection
SPECIFIC INFORMATION REQUIRED WHEN REQUESTING NUCLEAR MEDICINE TESTS INCLUDES
1 Patient identification details2 Examination requested3 Relevant clinical history including
results of other investigations4 Pregnancylactation details where
relevant5 Special
needsmdashvisualhearinglearning difficulties needle phobia
H orm o ne D ru gs
T u m or M a rker D isea se M arker
R adio Im m uno Assay H eam ato log ica l Applica tions
In-v itro
P lanar S P E C T
Im aging
C a T hyro id80 - 200 m Ci
T hyrotoxicosis5 - 20 m Ci
131 Iod ine 32 P 89 S rP a llia tio n T h erapy
R adio N uclide T herapy
In-v ivo
Nuclear M edicine Applications
CLINICAL APPLICATIONS
BONES AND JOINTS
BRAIN SPECT
ENDOCRINOLOGY
LUNG - VENTILATION amp PERFUSION
NUCLEAR NEPHRO ndash UROLOGY
CARDIO VASCULAR SYSYTEM
GASTRO ndash ENTEROLOGY
BONE SCINTIGRAPHY BONE SCAN
Indications Tumour stagingmdasheg to assess skeletal
metastases(from prostate breastkidney thyroid lung)
Intractable Bone pain
Traumamdashwhen radiographs unhelpful
Prosthetic loosening eg THR
Infection - eg osteomyelitis
Avascular necrosis (AVN)
Pagetrsquos to assess extent
SKULL METASTASES IN CA PROSTATE
PHASE BONE SCAN - MUTILPLE MYELOMAACTIVE LESIONS IN LEFT FEMUR AND DV10
SECONDARY VERTEBRAL METASTESES
BRAIN SCANIndications
Dementia characterisation
Epilepsy for localisation of epileptogenic focus
Metastatic work-ups
Determination of blood flow (in brain death or atherosclerotic disease)
Evaluation of space-occupying lesions (tumor hematoma abscess [AV] malformation) and
Encephalitis
Suspected VP shunt obstruction
Distinguishes Parkinsonrsquos syndrome (PS) from benign essential tremor
INTER ICTAL ICTAL amp POST-ICTAL SPECT SHOWING HYPERPERFUSION OF RT TEMPORAL LOBE
9H POST ICTAL CT AND RCBF SPECT IN A 58YF (NORMAL CT ALTERED PERFUSION IN SPECT)
PERSISTENT HYPOPERFUSION DEFECTS THROUGH RIGHT HEMISPHERE IN A PATIENT OF TIA
99m Tc labelled ECD is used Assessment of Stroke detection of Epileptic focus evaluation of dementia etc
Figure Patient with acute ischemic stroke treated with hypertensive therapy a Positron emission tomography images of cerebral blood flow at 2 h (top) and 6 h (bottom)after the onset of symptoms PET cerebral blood flow(CBF) images demonstrate a significant reduction in blood flow affecting a substantial portion of the left middle cerebral artery territoryb PET images of regional cerebral metabolic rate of oxygen at 2 h (top) and 6 h (bottom) after the onset of symptomsOxygen metabolism is abnormal in the left middle cerebral artery (MCA)territory but in an area substantially smaller than the defect seen on the CBF imagesThis reduction in tissue at risk was presumably due to hypertensive therapyc Follow-up CT scan of the head in the patient demonstrating that the ultimate cerebral infarct size most closely approximates the oxygen metabolism defect(b) than the CBF defect (a)
THYROID amp PARATHYROID SCINTIGRAPHY
Indications Characterisation of thyrotoxicosis
a Diffuse toxic goitre (Gravesrsquodisease) b Toxic multinodular goitre (Plummerrsquos disease)
Autonomous nodule
Acute thyroiditis
Evaluation of upper mediastinal mass
Localisation of parathyroid adenoma in proven hyperparathyroidism
Na99mTcO4 Thyroid Scintigraphy - Avid Uptake with increased T3 and T4
FD - Thyrotoxicosis
Na99mTcO4 Thyroid Scintigraphy - A large Cold nodule involving the RtLobe
US - Cyst
Parathyroid Adenoma - 99mTc Sesta MIBI Scan
Thyroid in 5 min scan
20 min scan No wash out in Parathyroid Adenoma
LUNG SCANA Ventilationperfusion imaging (VQ Scan)
Indications Suspected pulmonary embolism Pre-operative lung function assessment
B Lung shunt studies
Indications
Suspected pulmonary AV shuntingInterpretation
1 Segmental perfusion loss with preserved ventilationmdash
pulmonary embolism2 Segmental matched perfusion and ventilation lossmdash
pulmonary infarctioninfection3 Segmentalsubsegmental ventilation loss with preserved
perfusionmdashinfection4 Non-segmental patchy matched perfusion and ventilation
LOSSmdashCOPD
NORMAL 99M TC DTPA AEROSOL STUDY
PERFUSION DEFECTS IN PULMONARY EMBOLISM
RENAL AND ADRENAL SCINTIGRAPHY
1 Static cortical renographyDMSA imaging
Urinary tract infection lsquogold standardrsquo for renal scarring Measurement of relative renal function Renal duplication assessment Ectopic kidney localisation Renal trauma Renal vein thrombosis Pre-biopsy
2 Dynamic renography
Assessment of renal drainagemdashdiscrimination between
renal dilatation and outflow obstruction Measurement of relative renal function Loin pain Post-pyeloplasty follow-up Renal artery stenosismdash1048585Captopril renography
3Adrenal Scan Used to accurately localize a pheochromocytoma when MRI or CT is
equivocal Uses labeled MIBG
Plain Renal Dynamic Studies
Tc-99m labelled DTPA is used for Renal scintigraphy (1) RENOGRAM - PLAIN STUDY amp WITH DIURETIC INTERVENSION
Useful for evaluation of obstructive uropathies to know whether obstruction is due to functional or organic causes
Contracted left kidney Scars over both poles of the Right Kidney
99mTc DMSA- Renal Cortical Image
HEART SCINTIGRAPHY
Myocardial perfusion imaging (MPI)
Indications
In ischaemic heart disease
1 Pre-angiography ndash When conventional stress testing fails eg
bundle branch blockndash Left ventricular hypertrophyndash Atypical chest painndash Recurrent chest pain post-intervention
2 Post-angiography
ndash Assess functional significance of known stenosesndash Identify critical vascular territory for
intervention
99MTC MIBI SPECT IMAGES - NORMAL STUDY
Short Axis
Vertical Long Axis
Horizontal Long Axis
Polar Map
3D image of LV
99MTC MIBI SPECT IMAGES - INFARCTION
Short Axis
Vertical Long Axis
Horizontal Long Axis
Polar Map
3D image of LV
LIVER AND GASTROINTESTINAL TRACT SCINTIGRAPHY
Hepatobiliary scintigraphy (HIDA-Scan BIDA-Scan)
Indications1 Acute cholecystitis2 Trauma3 Post-operative leak detection4 Bile ductstent patency5 Gallbladder emptying6 Bile reflux7 Neonatal biliary atresia
Gastrointestinal bleeding labelled red cell imaging
Helps localise source of active GI haemorrhage when other techniques(eg endoscopy or angiography) have failed
Gastric emptying studie
Altered GI motilitymdashdelayed or accelerated gastric emptying
Meckelrsquos scan ectopic gastric mucosa localisation Unexplained abdominal pain or GI hemorrhagemdashafter endoscopycontrast radiology
Meenakshi Isotope Scan and Thyroid Care Centre
99mTc Mebrofenin (Trimethyl Bromo Imino Diacetic Acid) Hepato Biliary Scan
5 min
2 h
Post meal
4 h 24 h
40 min
10 min
20 min
Total Biliary Channel Obstruction
G I BLEED STUDY
Blood Pool Scan 99m Tc labelled RBCs are used
To differentiate Hemangioma of the Liver from Hepatoma amp evaluation of G I Bleeding
Meenakshi Isotope Scan and Thyroid Care Centre
99mTc Mebrofenin Hepato Biliary Scan
20 min
5 min
10 min
30 min
4 hPost Meal
4 h
5 min 10 min
20 min 40 min 2 h
Post meal
24 h
Normal Biliary Atresia
RADIONUCLIDE THERAPY
131 I Therapy for Thyrotoxicosis
131 I Therapy for Ca Thyroid
32 P Therapy for pain palliation
OTHERS NUCLEAR SCANSSomatostatin scintigraphy
Localise and stage neuroendocrine tumours (NETs) eg carcinoid insulinoma gastrinoma phaeochromocytoma and medullary thyroid cancer
Lymphoscintigraphy
Unexplained limb swelling eg lymphatic hypoplasia
Urea breath test
Helicobacter pylori detectionmdashdiagnosis and confirmation of eradication
B12 absorption studies
Vitamin B12 malabsorption pernicious anaemia
Labelled leukocyte imaging
Sepsis localization Inflammatory bowel disease to help determine extent and severity
Dacroscintigraphy
Epiphora
MIBG (meta iodobenzylguanidine)imaging Localisation staging and response monitoring of neuroectodermal tumours Phaeochromocytoma (imaging investigation of choice) Neuroblastoma Carcinoid tumours Medullary thyroid cancer
SUMMARY NUCLEAR MEDICINE IMAGING IS
IMPORTANT IN FUNCTIONAL ASSESSMENT OF VARIOUS ORGANS
SIMPLE AND NON INVASIVE PROCEDURES
COST EFFECTIVE
RADIO IMMUNO ASSAY IS GOLD STANDARD
RADIO NUCLIDE THERAPY INCREASES SURVIVAL
RATE
THANK YOU
SPECIFIC INFORMATION REQUIRED WHEN REQUESTING NUCLEAR MEDICINE TESTS INCLUDES
1 Patient identification details2 Examination requested3 Relevant clinical history including
results of other investigations4 Pregnancylactation details where
relevant5 Special
needsmdashvisualhearinglearning difficulties needle phobia
H orm o ne D ru gs
T u m or M a rker D isea se M arker
R adio Im m uno Assay H eam ato log ica l Applica tions
In-v itro
P lanar S P E C T
Im aging
C a T hyro id80 - 200 m Ci
T hyrotoxicosis5 - 20 m Ci
131 Iod ine 32 P 89 S rP a llia tio n T h erapy
R adio N uclide T herapy
In-v ivo
Nuclear M edicine Applications
CLINICAL APPLICATIONS
BONES AND JOINTS
BRAIN SPECT
ENDOCRINOLOGY
LUNG - VENTILATION amp PERFUSION
NUCLEAR NEPHRO ndash UROLOGY
CARDIO VASCULAR SYSYTEM
GASTRO ndash ENTEROLOGY
BONE SCINTIGRAPHY BONE SCAN
Indications Tumour stagingmdasheg to assess skeletal
metastases(from prostate breastkidney thyroid lung)
Intractable Bone pain
Traumamdashwhen radiographs unhelpful
Prosthetic loosening eg THR
Infection - eg osteomyelitis
Avascular necrosis (AVN)
Pagetrsquos to assess extent
SKULL METASTASES IN CA PROSTATE
PHASE BONE SCAN - MUTILPLE MYELOMAACTIVE LESIONS IN LEFT FEMUR AND DV10
SECONDARY VERTEBRAL METASTESES
BRAIN SCANIndications
Dementia characterisation
Epilepsy for localisation of epileptogenic focus
Metastatic work-ups
Determination of blood flow (in brain death or atherosclerotic disease)
Evaluation of space-occupying lesions (tumor hematoma abscess [AV] malformation) and
Encephalitis
Suspected VP shunt obstruction
Distinguishes Parkinsonrsquos syndrome (PS) from benign essential tremor
INTER ICTAL ICTAL amp POST-ICTAL SPECT SHOWING HYPERPERFUSION OF RT TEMPORAL LOBE
9H POST ICTAL CT AND RCBF SPECT IN A 58YF (NORMAL CT ALTERED PERFUSION IN SPECT)
PERSISTENT HYPOPERFUSION DEFECTS THROUGH RIGHT HEMISPHERE IN A PATIENT OF TIA
99m Tc labelled ECD is used Assessment of Stroke detection of Epileptic focus evaluation of dementia etc
Figure Patient with acute ischemic stroke treated with hypertensive therapy a Positron emission tomography images of cerebral blood flow at 2 h (top) and 6 h (bottom)after the onset of symptoms PET cerebral blood flow(CBF) images demonstrate a significant reduction in blood flow affecting a substantial portion of the left middle cerebral artery territoryb PET images of regional cerebral metabolic rate of oxygen at 2 h (top) and 6 h (bottom) after the onset of symptomsOxygen metabolism is abnormal in the left middle cerebral artery (MCA)territory but in an area substantially smaller than the defect seen on the CBF imagesThis reduction in tissue at risk was presumably due to hypertensive therapyc Follow-up CT scan of the head in the patient demonstrating that the ultimate cerebral infarct size most closely approximates the oxygen metabolism defect(b) than the CBF defect (a)
THYROID amp PARATHYROID SCINTIGRAPHY
Indications Characterisation of thyrotoxicosis
a Diffuse toxic goitre (Gravesrsquodisease) b Toxic multinodular goitre (Plummerrsquos disease)
Autonomous nodule
Acute thyroiditis
Evaluation of upper mediastinal mass
Localisation of parathyroid adenoma in proven hyperparathyroidism
Na99mTcO4 Thyroid Scintigraphy - Avid Uptake with increased T3 and T4
FD - Thyrotoxicosis
Na99mTcO4 Thyroid Scintigraphy - A large Cold nodule involving the RtLobe
US - Cyst
Parathyroid Adenoma - 99mTc Sesta MIBI Scan
Thyroid in 5 min scan
20 min scan No wash out in Parathyroid Adenoma
LUNG SCANA Ventilationperfusion imaging (VQ Scan)
Indications Suspected pulmonary embolism Pre-operative lung function assessment
B Lung shunt studies
Indications
Suspected pulmonary AV shuntingInterpretation
1 Segmental perfusion loss with preserved ventilationmdash
pulmonary embolism2 Segmental matched perfusion and ventilation lossmdash
pulmonary infarctioninfection3 Segmentalsubsegmental ventilation loss with preserved
perfusionmdashinfection4 Non-segmental patchy matched perfusion and ventilation
LOSSmdashCOPD
NORMAL 99M TC DTPA AEROSOL STUDY
PERFUSION DEFECTS IN PULMONARY EMBOLISM
RENAL AND ADRENAL SCINTIGRAPHY
1 Static cortical renographyDMSA imaging
Urinary tract infection lsquogold standardrsquo for renal scarring Measurement of relative renal function Renal duplication assessment Ectopic kidney localisation Renal trauma Renal vein thrombosis Pre-biopsy
2 Dynamic renography
Assessment of renal drainagemdashdiscrimination between
renal dilatation and outflow obstruction Measurement of relative renal function Loin pain Post-pyeloplasty follow-up Renal artery stenosismdash1048585Captopril renography
3Adrenal Scan Used to accurately localize a pheochromocytoma when MRI or CT is
equivocal Uses labeled MIBG
Plain Renal Dynamic Studies
Tc-99m labelled DTPA is used for Renal scintigraphy (1) RENOGRAM - PLAIN STUDY amp WITH DIURETIC INTERVENSION
Useful for evaluation of obstructive uropathies to know whether obstruction is due to functional or organic causes
Contracted left kidney Scars over both poles of the Right Kidney
99mTc DMSA- Renal Cortical Image
HEART SCINTIGRAPHY
Myocardial perfusion imaging (MPI)
Indications
In ischaemic heart disease
1 Pre-angiography ndash When conventional stress testing fails eg
bundle branch blockndash Left ventricular hypertrophyndash Atypical chest painndash Recurrent chest pain post-intervention
2 Post-angiography
ndash Assess functional significance of known stenosesndash Identify critical vascular territory for
intervention
99MTC MIBI SPECT IMAGES - NORMAL STUDY
Short Axis
Vertical Long Axis
Horizontal Long Axis
Polar Map
3D image of LV
99MTC MIBI SPECT IMAGES - INFARCTION
Short Axis
Vertical Long Axis
Horizontal Long Axis
Polar Map
3D image of LV
LIVER AND GASTROINTESTINAL TRACT SCINTIGRAPHY
Hepatobiliary scintigraphy (HIDA-Scan BIDA-Scan)
Indications1 Acute cholecystitis2 Trauma3 Post-operative leak detection4 Bile ductstent patency5 Gallbladder emptying6 Bile reflux7 Neonatal biliary atresia
Gastrointestinal bleeding labelled red cell imaging
Helps localise source of active GI haemorrhage when other techniques(eg endoscopy or angiography) have failed
Gastric emptying studie
Altered GI motilitymdashdelayed or accelerated gastric emptying
Meckelrsquos scan ectopic gastric mucosa localisation Unexplained abdominal pain or GI hemorrhagemdashafter endoscopycontrast radiology
Meenakshi Isotope Scan and Thyroid Care Centre
99mTc Mebrofenin (Trimethyl Bromo Imino Diacetic Acid) Hepato Biliary Scan
5 min
2 h
Post meal
4 h 24 h
40 min
10 min
20 min
Total Biliary Channel Obstruction
G I BLEED STUDY
Blood Pool Scan 99m Tc labelled RBCs are used
To differentiate Hemangioma of the Liver from Hepatoma amp evaluation of G I Bleeding
Meenakshi Isotope Scan and Thyroid Care Centre
99mTc Mebrofenin Hepato Biliary Scan
20 min
5 min
10 min
30 min
4 hPost Meal
4 h
5 min 10 min
20 min 40 min 2 h
Post meal
24 h
Normal Biliary Atresia
RADIONUCLIDE THERAPY
131 I Therapy for Thyrotoxicosis
131 I Therapy for Ca Thyroid
32 P Therapy for pain palliation
OTHERS NUCLEAR SCANSSomatostatin scintigraphy
Localise and stage neuroendocrine tumours (NETs) eg carcinoid insulinoma gastrinoma phaeochromocytoma and medullary thyroid cancer
Lymphoscintigraphy
Unexplained limb swelling eg lymphatic hypoplasia
Urea breath test
Helicobacter pylori detectionmdashdiagnosis and confirmation of eradication
B12 absorption studies
Vitamin B12 malabsorption pernicious anaemia
Labelled leukocyte imaging
Sepsis localization Inflammatory bowel disease to help determine extent and severity
Dacroscintigraphy
Epiphora
MIBG (meta iodobenzylguanidine)imaging Localisation staging and response monitoring of neuroectodermal tumours Phaeochromocytoma (imaging investigation of choice) Neuroblastoma Carcinoid tumours Medullary thyroid cancer
SUMMARY NUCLEAR MEDICINE IMAGING IS
IMPORTANT IN FUNCTIONAL ASSESSMENT OF VARIOUS ORGANS
SIMPLE AND NON INVASIVE PROCEDURES
COST EFFECTIVE
RADIO IMMUNO ASSAY IS GOLD STANDARD
RADIO NUCLIDE THERAPY INCREASES SURVIVAL
RATE
THANK YOU
H orm o ne D ru gs
T u m or M a rker D isea se M arker
R adio Im m uno Assay H eam ato log ica l Applica tions
In-v itro
P lanar S P E C T
Im aging
C a T hyro id80 - 200 m Ci
T hyrotoxicosis5 - 20 m Ci
131 Iod ine 32 P 89 S rP a llia tio n T h erapy
R adio N uclide T herapy
In-v ivo
Nuclear M edicine Applications
CLINICAL APPLICATIONS
BONES AND JOINTS
BRAIN SPECT
ENDOCRINOLOGY
LUNG - VENTILATION amp PERFUSION
NUCLEAR NEPHRO ndash UROLOGY
CARDIO VASCULAR SYSYTEM
GASTRO ndash ENTEROLOGY
BONE SCINTIGRAPHY BONE SCAN
Indications Tumour stagingmdasheg to assess skeletal
metastases(from prostate breastkidney thyroid lung)
Intractable Bone pain
Traumamdashwhen radiographs unhelpful
Prosthetic loosening eg THR
Infection - eg osteomyelitis
Avascular necrosis (AVN)
Pagetrsquos to assess extent
SKULL METASTASES IN CA PROSTATE
PHASE BONE SCAN - MUTILPLE MYELOMAACTIVE LESIONS IN LEFT FEMUR AND DV10
SECONDARY VERTEBRAL METASTESES
BRAIN SCANIndications
Dementia characterisation
Epilepsy for localisation of epileptogenic focus
Metastatic work-ups
Determination of blood flow (in brain death or atherosclerotic disease)
Evaluation of space-occupying lesions (tumor hematoma abscess [AV] malformation) and
Encephalitis
Suspected VP shunt obstruction
Distinguishes Parkinsonrsquos syndrome (PS) from benign essential tremor
INTER ICTAL ICTAL amp POST-ICTAL SPECT SHOWING HYPERPERFUSION OF RT TEMPORAL LOBE
9H POST ICTAL CT AND RCBF SPECT IN A 58YF (NORMAL CT ALTERED PERFUSION IN SPECT)
PERSISTENT HYPOPERFUSION DEFECTS THROUGH RIGHT HEMISPHERE IN A PATIENT OF TIA
99m Tc labelled ECD is used Assessment of Stroke detection of Epileptic focus evaluation of dementia etc
Figure Patient with acute ischemic stroke treated with hypertensive therapy a Positron emission tomography images of cerebral blood flow at 2 h (top) and 6 h (bottom)after the onset of symptoms PET cerebral blood flow(CBF) images demonstrate a significant reduction in blood flow affecting a substantial portion of the left middle cerebral artery territoryb PET images of regional cerebral metabolic rate of oxygen at 2 h (top) and 6 h (bottom) after the onset of symptomsOxygen metabolism is abnormal in the left middle cerebral artery (MCA)territory but in an area substantially smaller than the defect seen on the CBF imagesThis reduction in tissue at risk was presumably due to hypertensive therapyc Follow-up CT scan of the head in the patient demonstrating that the ultimate cerebral infarct size most closely approximates the oxygen metabolism defect(b) than the CBF defect (a)
THYROID amp PARATHYROID SCINTIGRAPHY
Indications Characterisation of thyrotoxicosis
a Diffuse toxic goitre (Gravesrsquodisease) b Toxic multinodular goitre (Plummerrsquos disease)
Autonomous nodule
Acute thyroiditis
Evaluation of upper mediastinal mass
Localisation of parathyroid adenoma in proven hyperparathyroidism
Na99mTcO4 Thyroid Scintigraphy - Avid Uptake with increased T3 and T4
FD - Thyrotoxicosis
Na99mTcO4 Thyroid Scintigraphy - A large Cold nodule involving the RtLobe
US - Cyst
Parathyroid Adenoma - 99mTc Sesta MIBI Scan
Thyroid in 5 min scan
20 min scan No wash out in Parathyroid Adenoma
LUNG SCANA Ventilationperfusion imaging (VQ Scan)
Indications Suspected pulmonary embolism Pre-operative lung function assessment
B Lung shunt studies
Indications
Suspected pulmonary AV shuntingInterpretation
1 Segmental perfusion loss with preserved ventilationmdash
pulmonary embolism2 Segmental matched perfusion and ventilation lossmdash
pulmonary infarctioninfection3 Segmentalsubsegmental ventilation loss with preserved
perfusionmdashinfection4 Non-segmental patchy matched perfusion and ventilation
LOSSmdashCOPD
NORMAL 99M TC DTPA AEROSOL STUDY
PERFUSION DEFECTS IN PULMONARY EMBOLISM
RENAL AND ADRENAL SCINTIGRAPHY
1 Static cortical renographyDMSA imaging
Urinary tract infection lsquogold standardrsquo for renal scarring Measurement of relative renal function Renal duplication assessment Ectopic kidney localisation Renal trauma Renal vein thrombosis Pre-biopsy
2 Dynamic renography
Assessment of renal drainagemdashdiscrimination between
renal dilatation and outflow obstruction Measurement of relative renal function Loin pain Post-pyeloplasty follow-up Renal artery stenosismdash1048585Captopril renography
3Adrenal Scan Used to accurately localize a pheochromocytoma when MRI or CT is
equivocal Uses labeled MIBG
Plain Renal Dynamic Studies
Tc-99m labelled DTPA is used for Renal scintigraphy (1) RENOGRAM - PLAIN STUDY amp WITH DIURETIC INTERVENSION
Useful for evaluation of obstructive uropathies to know whether obstruction is due to functional or organic causes
Contracted left kidney Scars over both poles of the Right Kidney
99mTc DMSA- Renal Cortical Image
HEART SCINTIGRAPHY
Myocardial perfusion imaging (MPI)
Indications
In ischaemic heart disease
1 Pre-angiography ndash When conventional stress testing fails eg
bundle branch blockndash Left ventricular hypertrophyndash Atypical chest painndash Recurrent chest pain post-intervention
2 Post-angiography
ndash Assess functional significance of known stenosesndash Identify critical vascular territory for
intervention
99MTC MIBI SPECT IMAGES - NORMAL STUDY
Short Axis
Vertical Long Axis
Horizontal Long Axis
Polar Map
3D image of LV
99MTC MIBI SPECT IMAGES - INFARCTION
Short Axis
Vertical Long Axis
Horizontal Long Axis
Polar Map
3D image of LV
LIVER AND GASTROINTESTINAL TRACT SCINTIGRAPHY
Hepatobiliary scintigraphy (HIDA-Scan BIDA-Scan)
Indications1 Acute cholecystitis2 Trauma3 Post-operative leak detection4 Bile ductstent patency5 Gallbladder emptying6 Bile reflux7 Neonatal biliary atresia
Gastrointestinal bleeding labelled red cell imaging
Helps localise source of active GI haemorrhage when other techniques(eg endoscopy or angiography) have failed
Gastric emptying studie
Altered GI motilitymdashdelayed or accelerated gastric emptying
Meckelrsquos scan ectopic gastric mucosa localisation Unexplained abdominal pain or GI hemorrhagemdashafter endoscopycontrast radiology
Meenakshi Isotope Scan and Thyroid Care Centre
99mTc Mebrofenin (Trimethyl Bromo Imino Diacetic Acid) Hepato Biliary Scan
5 min
2 h
Post meal
4 h 24 h
40 min
10 min
20 min
Total Biliary Channel Obstruction
G I BLEED STUDY
Blood Pool Scan 99m Tc labelled RBCs are used
To differentiate Hemangioma of the Liver from Hepatoma amp evaluation of G I Bleeding
Meenakshi Isotope Scan and Thyroid Care Centre
99mTc Mebrofenin Hepato Biliary Scan
20 min
5 min
10 min
30 min
4 hPost Meal
4 h
5 min 10 min
20 min 40 min 2 h
Post meal
24 h
Normal Biliary Atresia
RADIONUCLIDE THERAPY
131 I Therapy for Thyrotoxicosis
131 I Therapy for Ca Thyroid
32 P Therapy for pain palliation
OTHERS NUCLEAR SCANSSomatostatin scintigraphy
Localise and stage neuroendocrine tumours (NETs) eg carcinoid insulinoma gastrinoma phaeochromocytoma and medullary thyroid cancer
Lymphoscintigraphy
Unexplained limb swelling eg lymphatic hypoplasia
Urea breath test
Helicobacter pylori detectionmdashdiagnosis and confirmation of eradication
B12 absorption studies
Vitamin B12 malabsorption pernicious anaemia
Labelled leukocyte imaging
Sepsis localization Inflammatory bowel disease to help determine extent and severity
Dacroscintigraphy
Epiphora
MIBG (meta iodobenzylguanidine)imaging Localisation staging and response monitoring of neuroectodermal tumours Phaeochromocytoma (imaging investigation of choice) Neuroblastoma Carcinoid tumours Medullary thyroid cancer
SUMMARY NUCLEAR MEDICINE IMAGING IS
IMPORTANT IN FUNCTIONAL ASSESSMENT OF VARIOUS ORGANS
SIMPLE AND NON INVASIVE PROCEDURES
COST EFFECTIVE
RADIO IMMUNO ASSAY IS GOLD STANDARD
RADIO NUCLIDE THERAPY INCREASES SURVIVAL
RATE
THANK YOU
CLINICAL APPLICATIONS
BONES AND JOINTS
BRAIN SPECT
ENDOCRINOLOGY
LUNG - VENTILATION amp PERFUSION
NUCLEAR NEPHRO ndash UROLOGY
CARDIO VASCULAR SYSYTEM
GASTRO ndash ENTEROLOGY
BONE SCINTIGRAPHY BONE SCAN
Indications Tumour stagingmdasheg to assess skeletal
metastases(from prostate breastkidney thyroid lung)
Intractable Bone pain
Traumamdashwhen radiographs unhelpful
Prosthetic loosening eg THR
Infection - eg osteomyelitis
Avascular necrosis (AVN)
Pagetrsquos to assess extent
SKULL METASTASES IN CA PROSTATE
PHASE BONE SCAN - MUTILPLE MYELOMAACTIVE LESIONS IN LEFT FEMUR AND DV10
SECONDARY VERTEBRAL METASTESES
BRAIN SCANIndications
Dementia characterisation
Epilepsy for localisation of epileptogenic focus
Metastatic work-ups
Determination of blood flow (in brain death or atherosclerotic disease)
Evaluation of space-occupying lesions (tumor hematoma abscess [AV] malformation) and
Encephalitis
Suspected VP shunt obstruction
Distinguishes Parkinsonrsquos syndrome (PS) from benign essential tremor
INTER ICTAL ICTAL amp POST-ICTAL SPECT SHOWING HYPERPERFUSION OF RT TEMPORAL LOBE
9H POST ICTAL CT AND RCBF SPECT IN A 58YF (NORMAL CT ALTERED PERFUSION IN SPECT)
PERSISTENT HYPOPERFUSION DEFECTS THROUGH RIGHT HEMISPHERE IN A PATIENT OF TIA
99m Tc labelled ECD is used Assessment of Stroke detection of Epileptic focus evaluation of dementia etc
Figure Patient with acute ischemic stroke treated with hypertensive therapy a Positron emission tomography images of cerebral blood flow at 2 h (top) and 6 h (bottom)after the onset of symptoms PET cerebral blood flow(CBF) images demonstrate a significant reduction in blood flow affecting a substantial portion of the left middle cerebral artery territoryb PET images of regional cerebral metabolic rate of oxygen at 2 h (top) and 6 h (bottom) after the onset of symptomsOxygen metabolism is abnormal in the left middle cerebral artery (MCA)territory but in an area substantially smaller than the defect seen on the CBF imagesThis reduction in tissue at risk was presumably due to hypertensive therapyc Follow-up CT scan of the head in the patient demonstrating that the ultimate cerebral infarct size most closely approximates the oxygen metabolism defect(b) than the CBF defect (a)
THYROID amp PARATHYROID SCINTIGRAPHY
Indications Characterisation of thyrotoxicosis
a Diffuse toxic goitre (Gravesrsquodisease) b Toxic multinodular goitre (Plummerrsquos disease)
Autonomous nodule
Acute thyroiditis
Evaluation of upper mediastinal mass
Localisation of parathyroid adenoma in proven hyperparathyroidism
Na99mTcO4 Thyroid Scintigraphy - Avid Uptake with increased T3 and T4
FD - Thyrotoxicosis
Na99mTcO4 Thyroid Scintigraphy - A large Cold nodule involving the RtLobe
US - Cyst
Parathyroid Adenoma - 99mTc Sesta MIBI Scan
Thyroid in 5 min scan
20 min scan No wash out in Parathyroid Adenoma
LUNG SCANA Ventilationperfusion imaging (VQ Scan)
Indications Suspected pulmonary embolism Pre-operative lung function assessment
B Lung shunt studies
Indications
Suspected pulmonary AV shuntingInterpretation
1 Segmental perfusion loss with preserved ventilationmdash
pulmonary embolism2 Segmental matched perfusion and ventilation lossmdash
pulmonary infarctioninfection3 Segmentalsubsegmental ventilation loss with preserved
perfusionmdashinfection4 Non-segmental patchy matched perfusion and ventilation
LOSSmdashCOPD
NORMAL 99M TC DTPA AEROSOL STUDY
PERFUSION DEFECTS IN PULMONARY EMBOLISM
RENAL AND ADRENAL SCINTIGRAPHY
1 Static cortical renographyDMSA imaging
Urinary tract infection lsquogold standardrsquo for renal scarring Measurement of relative renal function Renal duplication assessment Ectopic kidney localisation Renal trauma Renal vein thrombosis Pre-biopsy
2 Dynamic renography
Assessment of renal drainagemdashdiscrimination between
renal dilatation and outflow obstruction Measurement of relative renal function Loin pain Post-pyeloplasty follow-up Renal artery stenosismdash1048585Captopril renography
3Adrenal Scan Used to accurately localize a pheochromocytoma when MRI or CT is
equivocal Uses labeled MIBG
Plain Renal Dynamic Studies
Tc-99m labelled DTPA is used for Renal scintigraphy (1) RENOGRAM - PLAIN STUDY amp WITH DIURETIC INTERVENSION
Useful for evaluation of obstructive uropathies to know whether obstruction is due to functional or organic causes
Contracted left kidney Scars over both poles of the Right Kidney
99mTc DMSA- Renal Cortical Image
HEART SCINTIGRAPHY
Myocardial perfusion imaging (MPI)
Indications
In ischaemic heart disease
1 Pre-angiography ndash When conventional stress testing fails eg
bundle branch blockndash Left ventricular hypertrophyndash Atypical chest painndash Recurrent chest pain post-intervention
2 Post-angiography
ndash Assess functional significance of known stenosesndash Identify critical vascular territory for
intervention
99MTC MIBI SPECT IMAGES - NORMAL STUDY
Short Axis
Vertical Long Axis
Horizontal Long Axis
Polar Map
3D image of LV
99MTC MIBI SPECT IMAGES - INFARCTION
Short Axis
Vertical Long Axis
Horizontal Long Axis
Polar Map
3D image of LV
LIVER AND GASTROINTESTINAL TRACT SCINTIGRAPHY
Hepatobiliary scintigraphy (HIDA-Scan BIDA-Scan)
Indications1 Acute cholecystitis2 Trauma3 Post-operative leak detection4 Bile ductstent patency5 Gallbladder emptying6 Bile reflux7 Neonatal biliary atresia
Gastrointestinal bleeding labelled red cell imaging
Helps localise source of active GI haemorrhage when other techniques(eg endoscopy or angiography) have failed
Gastric emptying studie
Altered GI motilitymdashdelayed or accelerated gastric emptying
Meckelrsquos scan ectopic gastric mucosa localisation Unexplained abdominal pain or GI hemorrhagemdashafter endoscopycontrast radiology
Meenakshi Isotope Scan and Thyroid Care Centre
99mTc Mebrofenin (Trimethyl Bromo Imino Diacetic Acid) Hepato Biliary Scan
5 min
2 h
Post meal
4 h 24 h
40 min
10 min
20 min
Total Biliary Channel Obstruction
G I BLEED STUDY
Blood Pool Scan 99m Tc labelled RBCs are used
To differentiate Hemangioma of the Liver from Hepatoma amp evaluation of G I Bleeding
Meenakshi Isotope Scan and Thyroid Care Centre
99mTc Mebrofenin Hepato Biliary Scan
20 min
5 min
10 min
30 min
4 hPost Meal
4 h
5 min 10 min
20 min 40 min 2 h
Post meal
24 h
Normal Biliary Atresia
RADIONUCLIDE THERAPY
131 I Therapy for Thyrotoxicosis
131 I Therapy for Ca Thyroid
32 P Therapy for pain palliation
OTHERS NUCLEAR SCANSSomatostatin scintigraphy
Localise and stage neuroendocrine tumours (NETs) eg carcinoid insulinoma gastrinoma phaeochromocytoma and medullary thyroid cancer
Lymphoscintigraphy
Unexplained limb swelling eg lymphatic hypoplasia
Urea breath test
Helicobacter pylori detectionmdashdiagnosis and confirmation of eradication
B12 absorption studies
Vitamin B12 malabsorption pernicious anaemia
Labelled leukocyte imaging
Sepsis localization Inflammatory bowel disease to help determine extent and severity
Dacroscintigraphy
Epiphora
MIBG (meta iodobenzylguanidine)imaging Localisation staging and response monitoring of neuroectodermal tumours Phaeochromocytoma (imaging investigation of choice) Neuroblastoma Carcinoid tumours Medullary thyroid cancer
SUMMARY NUCLEAR MEDICINE IMAGING IS
IMPORTANT IN FUNCTIONAL ASSESSMENT OF VARIOUS ORGANS
SIMPLE AND NON INVASIVE PROCEDURES
COST EFFECTIVE
RADIO IMMUNO ASSAY IS GOLD STANDARD
RADIO NUCLIDE THERAPY INCREASES SURVIVAL
RATE
THANK YOU
BONE SCINTIGRAPHY BONE SCAN
Indications Tumour stagingmdasheg to assess skeletal
metastases(from prostate breastkidney thyroid lung)
Intractable Bone pain
Traumamdashwhen radiographs unhelpful
Prosthetic loosening eg THR
Infection - eg osteomyelitis
Avascular necrosis (AVN)
Pagetrsquos to assess extent
SKULL METASTASES IN CA PROSTATE
PHASE BONE SCAN - MUTILPLE MYELOMAACTIVE LESIONS IN LEFT FEMUR AND DV10
SECONDARY VERTEBRAL METASTESES
BRAIN SCANIndications
Dementia characterisation
Epilepsy for localisation of epileptogenic focus
Metastatic work-ups
Determination of blood flow (in brain death or atherosclerotic disease)
Evaluation of space-occupying lesions (tumor hematoma abscess [AV] malformation) and
Encephalitis
Suspected VP shunt obstruction
Distinguishes Parkinsonrsquos syndrome (PS) from benign essential tremor
INTER ICTAL ICTAL amp POST-ICTAL SPECT SHOWING HYPERPERFUSION OF RT TEMPORAL LOBE
9H POST ICTAL CT AND RCBF SPECT IN A 58YF (NORMAL CT ALTERED PERFUSION IN SPECT)
PERSISTENT HYPOPERFUSION DEFECTS THROUGH RIGHT HEMISPHERE IN A PATIENT OF TIA
99m Tc labelled ECD is used Assessment of Stroke detection of Epileptic focus evaluation of dementia etc
Figure Patient with acute ischemic stroke treated with hypertensive therapy a Positron emission tomography images of cerebral blood flow at 2 h (top) and 6 h (bottom)after the onset of symptoms PET cerebral blood flow(CBF) images demonstrate a significant reduction in blood flow affecting a substantial portion of the left middle cerebral artery territoryb PET images of regional cerebral metabolic rate of oxygen at 2 h (top) and 6 h (bottom) after the onset of symptomsOxygen metabolism is abnormal in the left middle cerebral artery (MCA)territory but in an area substantially smaller than the defect seen on the CBF imagesThis reduction in tissue at risk was presumably due to hypertensive therapyc Follow-up CT scan of the head in the patient demonstrating that the ultimate cerebral infarct size most closely approximates the oxygen metabolism defect(b) than the CBF defect (a)
THYROID amp PARATHYROID SCINTIGRAPHY
Indications Characterisation of thyrotoxicosis
a Diffuse toxic goitre (Gravesrsquodisease) b Toxic multinodular goitre (Plummerrsquos disease)
Autonomous nodule
Acute thyroiditis
Evaluation of upper mediastinal mass
Localisation of parathyroid adenoma in proven hyperparathyroidism
Na99mTcO4 Thyroid Scintigraphy - Avid Uptake with increased T3 and T4
FD - Thyrotoxicosis
Na99mTcO4 Thyroid Scintigraphy - A large Cold nodule involving the RtLobe
US - Cyst
Parathyroid Adenoma - 99mTc Sesta MIBI Scan
Thyroid in 5 min scan
20 min scan No wash out in Parathyroid Adenoma
LUNG SCANA Ventilationperfusion imaging (VQ Scan)
Indications Suspected pulmonary embolism Pre-operative lung function assessment
B Lung shunt studies
Indications
Suspected pulmonary AV shuntingInterpretation
1 Segmental perfusion loss with preserved ventilationmdash
pulmonary embolism2 Segmental matched perfusion and ventilation lossmdash
pulmonary infarctioninfection3 Segmentalsubsegmental ventilation loss with preserved
perfusionmdashinfection4 Non-segmental patchy matched perfusion and ventilation
LOSSmdashCOPD
NORMAL 99M TC DTPA AEROSOL STUDY
PERFUSION DEFECTS IN PULMONARY EMBOLISM
RENAL AND ADRENAL SCINTIGRAPHY
1 Static cortical renographyDMSA imaging
Urinary tract infection lsquogold standardrsquo for renal scarring Measurement of relative renal function Renal duplication assessment Ectopic kidney localisation Renal trauma Renal vein thrombosis Pre-biopsy
2 Dynamic renography
Assessment of renal drainagemdashdiscrimination between
renal dilatation and outflow obstruction Measurement of relative renal function Loin pain Post-pyeloplasty follow-up Renal artery stenosismdash1048585Captopril renography
3Adrenal Scan Used to accurately localize a pheochromocytoma when MRI or CT is
equivocal Uses labeled MIBG
Plain Renal Dynamic Studies
Tc-99m labelled DTPA is used for Renal scintigraphy (1) RENOGRAM - PLAIN STUDY amp WITH DIURETIC INTERVENSION
Useful for evaluation of obstructive uropathies to know whether obstruction is due to functional or organic causes
Contracted left kidney Scars over both poles of the Right Kidney
99mTc DMSA- Renal Cortical Image
HEART SCINTIGRAPHY
Myocardial perfusion imaging (MPI)
Indications
In ischaemic heart disease
1 Pre-angiography ndash When conventional stress testing fails eg
bundle branch blockndash Left ventricular hypertrophyndash Atypical chest painndash Recurrent chest pain post-intervention
2 Post-angiography
ndash Assess functional significance of known stenosesndash Identify critical vascular territory for
intervention
99MTC MIBI SPECT IMAGES - NORMAL STUDY
Short Axis
Vertical Long Axis
Horizontal Long Axis
Polar Map
3D image of LV
99MTC MIBI SPECT IMAGES - INFARCTION
Short Axis
Vertical Long Axis
Horizontal Long Axis
Polar Map
3D image of LV
LIVER AND GASTROINTESTINAL TRACT SCINTIGRAPHY
Hepatobiliary scintigraphy (HIDA-Scan BIDA-Scan)
Indications1 Acute cholecystitis2 Trauma3 Post-operative leak detection4 Bile ductstent patency5 Gallbladder emptying6 Bile reflux7 Neonatal biliary atresia
Gastrointestinal bleeding labelled red cell imaging
Helps localise source of active GI haemorrhage when other techniques(eg endoscopy or angiography) have failed
Gastric emptying studie
Altered GI motilitymdashdelayed or accelerated gastric emptying
Meckelrsquos scan ectopic gastric mucosa localisation Unexplained abdominal pain or GI hemorrhagemdashafter endoscopycontrast radiology
Meenakshi Isotope Scan and Thyroid Care Centre
99mTc Mebrofenin (Trimethyl Bromo Imino Diacetic Acid) Hepato Biliary Scan
5 min
2 h
Post meal
4 h 24 h
40 min
10 min
20 min
Total Biliary Channel Obstruction
G I BLEED STUDY
Blood Pool Scan 99m Tc labelled RBCs are used
To differentiate Hemangioma of the Liver from Hepatoma amp evaluation of G I Bleeding
Meenakshi Isotope Scan and Thyroid Care Centre
99mTc Mebrofenin Hepato Biliary Scan
20 min
5 min
10 min
30 min
4 hPost Meal
4 h
5 min 10 min
20 min 40 min 2 h
Post meal
24 h
Normal Biliary Atresia
RADIONUCLIDE THERAPY
131 I Therapy for Thyrotoxicosis
131 I Therapy for Ca Thyroid
32 P Therapy for pain palliation
OTHERS NUCLEAR SCANSSomatostatin scintigraphy
Localise and stage neuroendocrine tumours (NETs) eg carcinoid insulinoma gastrinoma phaeochromocytoma and medullary thyroid cancer
Lymphoscintigraphy
Unexplained limb swelling eg lymphatic hypoplasia
Urea breath test
Helicobacter pylori detectionmdashdiagnosis and confirmation of eradication
B12 absorption studies
Vitamin B12 malabsorption pernicious anaemia
Labelled leukocyte imaging
Sepsis localization Inflammatory bowel disease to help determine extent and severity
Dacroscintigraphy
Epiphora
MIBG (meta iodobenzylguanidine)imaging Localisation staging and response monitoring of neuroectodermal tumours Phaeochromocytoma (imaging investigation of choice) Neuroblastoma Carcinoid tumours Medullary thyroid cancer
SUMMARY NUCLEAR MEDICINE IMAGING IS
IMPORTANT IN FUNCTIONAL ASSESSMENT OF VARIOUS ORGANS
SIMPLE AND NON INVASIVE PROCEDURES
COST EFFECTIVE
RADIO IMMUNO ASSAY IS GOLD STANDARD
RADIO NUCLIDE THERAPY INCREASES SURVIVAL
RATE
THANK YOU
SKULL METASTASES IN CA PROSTATE
PHASE BONE SCAN - MUTILPLE MYELOMAACTIVE LESIONS IN LEFT FEMUR AND DV10
SECONDARY VERTEBRAL METASTESES
BRAIN SCANIndications
Dementia characterisation
Epilepsy for localisation of epileptogenic focus
Metastatic work-ups
Determination of blood flow (in brain death or atherosclerotic disease)
Evaluation of space-occupying lesions (tumor hematoma abscess [AV] malformation) and
Encephalitis
Suspected VP shunt obstruction
Distinguishes Parkinsonrsquos syndrome (PS) from benign essential tremor
INTER ICTAL ICTAL amp POST-ICTAL SPECT SHOWING HYPERPERFUSION OF RT TEMPORAL LOBE
9H POST ICTAL CT AND RCBF SPECT IN A 58YF (NORMAL CT ALTERED PERFUSION IN SPECT)
PERSISTENT HYPOPERFUSION DEFECTS THROUGH RIGHT HEMISPHERE IN A PATIENT OF TIA
99m Tc labelled ECD is used Assessment of Stroke detection of Epileptic focus evaluation of dementia etc
Figure Patient with acute ischemic stroke treated with hypertensive therapy a Positron emission tomography images of cerebral blood flow at 2 h (top) and 6 h (bottom)after the onset of symptoms PET cerebral blood flow(CBF) images demonstrate a significant reduction in blood flow affecting a substantial portion of the left middle cerebral artery territoryb PET images of regional cerebral metabolic rate of oxygen at 2 h (top) and 6 h (bottom) after the onset of symptomsOxygen metabolism is abnormal in the left middle cerebral artery (MCA)territory but in an area substantially smaller than the defect seen on the CBF imagesThis reduction in tissue at risk was presumably due to hypertensive therapyc Follow-up CT scan of the head in the patient demonstrating that the ultimate cerebral infarct size most closely approximates the oxygen metabolism defect(b) than the CBF defect (a)
THYROID amp PARATHYROID SCINTIGRAPHY
Indications Characterisation of thyrotoxicosis
a Diffuse toxic goitre (Gravesrsquodisease) b Toxic multinodular goitre (Plummerrsquos disease)
Autonomous nodule
Acute thyroiditis
Evaluation of upper mediastinal mass
Localisation of parathyroid adenoma in proven hyperparathyroidism
Na99mTcO4 Thyroid Scintigraphy - Avid Uptake with increased T3 and T4
FD - Thyrotoxicosis
Na99mTcO4 Thyroid Scintigraphy - A large Cold nodule involving the RtLobe
US - Cyst
Parathyroid Adenoma - 99mTc Sesta MIBI Scan
Thyroid in 5 min scan
20 min scan No wash out in Parathyroid Adenoma
LUNG SCANA Ventilationperfusion imaging (VQ Scan)
Indications Suspected pulmonary embolism Pre-operative lung function assessment
B Lung shunt studies
Indications
Suspected pulmonary AV shuntingInterpretation
1 Segmental perfusion loss with preserved ventilationmdash
pulmonary embolism2 Segmental matched perfusion and ventilation lossmdash
pulmonary infarctioninfection3 Segmentalsubsegmental ventilation loss with preserved
perfusionmdashinfection4 Non-segmental patchy matched perfusion and ventilation
LOSSmdashCOPD
NORMAL 99M TC DTPA AEROSOL STUDY
PERFUSION DEFECTS IN PULMONARY EMBOLISM
RENAL AND ADRENAL SCINTIGRAPHY
1 Static cortical renographyDMSA imaging
Urinary tract infection lsquogold standardrsquo for renal scarring Measurement of relative renal function Renal duplication assessment Ectopic kidney localisation Renal trauma Renal vein thrombosis Pre-biopsy
2 Dynamic renography
Assessment of renal drainagemdashdiscrimination between
renal dilatation and outflow obstruction Measurement of relative renal function Loin pain Post-pyeloplasty follow-up Renal artery stenosismdash1048585Captopril renography
3Adrenal Scan Used to accurately localize a pheochromocytoma when MRI or CT is
equivocal Uses labeled MIBG
Plain Renal Dynamic Studies
Tc-99m labelled DTPA is used for Renal scintigraphy (1) RENOGRAM - PLAIN STUDY amp WITH DIURETIC INTERVENSION
Useful for evaluation of obstructive uropathies to know whether obstruction is due to functional or organic causes
Contracted left kidney Scars over both poles of the Right Kidney
99mTc DMSA- Renal Cortical Image
HEART SCINTIGRAPHY
Myocardial perfusion imaging (MPI)
Indications
In ischaemic heart disease
1 Pre-angiography ndash When conventional stress testing fails eg
bundle branch blockndash Left ventricular hypertrophyndash Atypical chest painndash Recurrent chest pain post-intervention
2 Post-angiography
ndash Assess functional significance of known stenosesndash Identify critical vascular territory for
intervention
99MTC MIBI SPECT IMAGES - NORMAL STUDY
Short Axis
Vertical Long Axis
Horizontal Long Axis
Polar Map
3D image of LV
99MTC MIBI SPECT IMAGES - INFARCTION
Short Axis
Vertical Long Axis
Horizontal Long Axis
Polar Map
3D image of LV
LIVER AND GASTROINTESTINAL TRACT SCINTIGRAPHY
Hepatobiliary scintigraphy (HIDA-Scan BIDA-Scan)
Indications1 Acute cholecystitis2 Trauma3 Post-operative leak detection4 Bile ductstent patency5 Gallbladder emptying6 Bile reflux7 Neonatal biliary atresia
Gastrointestinal bleeding labelled red cell imaging
Helps localise source of active GI haemorrhage when other techniques(eg endoscopy or angiography) have failed
Gastric emptying studie
Altered GI motilitymdashdelayed or accelerated gastric emptying
Meckelrsquos scan ectopic gastric mucosa localisation Unexplained abdominal pain or GI hemorrhagemdashafter endoscopycontrast radiology
Meenakshi Isotope Scan and Thyroid Care Centre
99mTc Mebrofenin (Trimethyl Bromo Imino Diacetic Acid) Hepato Biliary Scan
5 min
2 h
Post meal
4 h 24 h
40 min
10 min
20 min
Total Biliary Channel Obstruction
G I BLEED STUDY
Blood Pool Scan 99m Tc labelled RBCs are used
To differentiate Hemangioma of the Liver from Hepatoma amp evaluation of G I Bleeding
Meenakshi Isotope Scan and Thyroid Care Centre
99mTc Mebrofenin Hepato Biliary Scan
20 min
5 min
10 min
30 min
4 hPost Meal
4 h
5 min 10 min
20 min 40 min 2 h
Post meal
24 h
Normal Biliary Atresia
RADIONUCLIDE THERAPY
131 I Therapy for Thyrotoxicosis
131 I Therapy for Ca Thyroid
32 P Therapy for pain palliation
OTHERS NUCLEAR SCANSSomatostatin scintigraphy
Localise and stage neuroendocrine tumours (NETs) eg carcinoid insulinoma gastrinoma phaeochromocytoma and medullary thyroid cancer
Lymphoscintigraphy
Unexplained limb swelling eg lymphatic hypoplasia
Urea breath test
Helicobacter pylori detectionmdashdiagnosis and confirmation of eradication
B12 absorption studies
Vitamin B12 malabsorption pernicious anaemia
Labelled leukocyte imaging
Sepsis localization Inflammatory bowel disease to help determine extent and severity
Dacroscintigraphy
Epiphora
MIBG (meta iodobenzylguanidine)imaging Localisation staging and response monitoring of neuroectodermal tumours Phaeochromocytoma (imaging investigation of choice) Neuroblastoma Carcinoid tumours Medullary thyroid cancer
SUMMARY NUCLEAR MEDICINE IMAGING IS
IMPORTANT IN FUNCTIONAL ASSESSMENT OF VARIOUS ORGANS
SIMPLE AND NON INVASIVE PROCEDURES
COST EFFECTIVE
RADIO IMMUNO ASSAY IS GOLD STANDARD
RADIO NUCLIDE THERAPY INCREASES SURVIVAL
RATE
THANK YOU
PHASE BONE SCAN - MUTILPLE MYELOMAACTIVE LESIONS IN LEFT FEMUR AND DV10
SECONDARY VERTEBRAL METASTESES
BRAIN SCANIndications
Dementia characterisation
Epilepsy for localisation of epileptogenic focus
Metastatic work-ups
Determination of blood flow (in brain death or atherosclerotic disease)
Evaluation of space-occupying lesions (tumor hematoma abscess [AV] malformation) and
Encephalitis
Suspected VP shunt obstruction
Distinguishes Parkinsonrsquos syndrome (PS) from benign essential tremor
INTER ICTAL ICTAL amp POST-ICTAL SPECT SHOWING HYPERPERFUSION OF RT TEMPORAL LOBE
9H POST ICTAL CT AND RCBF SPECT IN A 58YF (NORMAL CT ALTERED PERFUSION IN SPECT)
PERSISTENT HYPOPERFUSION DEFECTS THROUGH RIGHT HEMISPHERE IN A PATIENT OF TIA
99m Tc labelled ECD is used Assessment of Stroke detection of Epileptic focus evaluation of dementia etc
Figure Patient with acute ischemic stroke treated with hypertensive therapy a Positron emission tomography images of cerebral blood flow at 2 h (top) and 6 h (bottom)after the onset of symptoms PET cerebral blood flow(CBF) images demonstrate a significant reduction in blood flow affecting a substantial portion of the left middle cerebral artery territoryb PET images of regional cerebral metabolic rate of oxygen at 2 h (top) and 6 h (bottom) after the onset of symptomsOxygen metabolism is abnormal in the left middle cerebral artery (MCA)territory but in an area substantially smaller than the defect seen on the CBF imagesThis reduction in tissue at risk was presumably due to hypertensive therapyc Follow-up CT scan of the head in the patient demonstrating that the ultimate cerebral infarct size most closely approximates the oxygen metabolism defect(b) than the CBF defect (a)
THYROID amp PARATHYROID SCINTIGRAPHY
Indications Characterisation of thyrotoxicosis
a Diffuse toxic goitre (Gravesrsquodisease) b Toxic multinodular goitre (Plummerrsquos disease)
Autonomous nodule
Acute thyroiditis
Evaluation of upper mediastinal mass
Localisation of parathyroid adenoma in proven hyperparathyroidism
Na99mTcO4 Thyroid Scintigraphy - Avid Uptake with increased T3 and T4
FD - Thyrotoxicosis
Na99mTcO4 Thyroid Scintigraphy - A large Cold nodule involving the RtLobe
US - Cyst
Parathyroid Adenoma - 99mTc Sesta MIBI Scan
Thyroid in 5 min scan
20 min scan No wash out in Parathyroid Adenoma
LUNG SCANA Ventilationperfusion imaging (VQ Scan)
Indications Suspected pulmonary embolism Pre-operative lung function assessment
B Lung shunt studies
Indications
Suspected pulmonary AV shuntingInterpretation
1 Segmental perfusion loss with preserved ventilationmdash
pulmonary embolism2 Segmental matched perfusion and ventilation lossmdash
pulmonary infarctioninfection3 Segmentalsubsegmental ventilation loss with preserved
perfusionmdashinfection4 Non-segmental patchy matched perfusion and ventilation
LOSSmdashCOPD
NORMAL 99M TC DTPA AEROSOL STUDY
PERFUSION DEFECTS IN PULMONARY EMBOLISM
RENAL AND ADRENAL SCINTIGRAPHY
1 Static cortical renographyDMSA imaging
Urinary tract infection lsquogold standardrsquo for renal scarring Measurement of relative renal function Renal duplication assessment Ectopic kidney localisation Renal trauma Renal vein thrombosis Pre-biopsy
2 Dynamic renography
Assessment of renal drainagemdashdiscrimination between
renal dilatation and outflow obstruction Measurement of relative renal function Loin pain Post-pyeloplasty follow-up Renal artery stenosismdash1048585Captopril renography
3Adrenal Scan Used to accurately localize a pheochromocytoma when MRI or CT is
equivocal Uses labeled MIBG
Plain Renal Dynamic Studies
Tc-99m labelled DTPA is used for Renal scintigraphy (1) RENOGRAM - PLAIN STUDY amp WITH DIURETIC INTERVENSION
Useful for evaluation of obstructive uropathies to know whether obstruction is due to functional or organic causes
Contracted left kidney Scars over both poles of the Right Kidney
99mTc DMSA- Renal Cortical Image
HEART SCINTIGRAPHY
Myocardial perfusion imaging (MPI)
Indications
In ischaemic heart disease
1 Pre-angiography ndash When conventional stress testing fails eg
bundle branch blockndash Left ventricular hypertrophyndash Atypical chest painndash Recurrent chest pain post-intervention
2 Post-angiography
ndash Assess functional significance of known stenosesndash Identify critical vascular territory for
intervention
99MTC MIBI SPECT IMAGES - NORMAL STUDY
Short Axis
Vertical Long Axis
Horizontal Long Axis
Polar Map
3D image of LV
99MTC MIBI SPECT IMAGES - INFARCTION
Short Axis
Vertical Long Axis
Horizontal Long Axis
Polar Map
3D image of LV
LIVER AND GASTROINTESTINAL TRACT SCINTIGRAPHY
Hepatobiliary scintigraphy (HIDA-Scan BIDA-Scan)
Indications1 Acute cholecystitis2 Trauma3 Post-operative leak detection4 Bile ductstent patency5 Gallbladder emptying6 Bile reflux7 Neonatal biliary atresia
Gastrointestinal bleeding labelled red cell imaging
Helps localise source of active GI haemorrhage when other techniques(eg endoscopy or angiography) have failed
Gastric emptying studie
Altered GI motilitymdashdelayed or accelerated gastric emptying
Meckelrsquos scan ectopic gastric mucosa localisation Unexplained abdominal pain or GI hemorrhagemdashafter endoscopycontrast radiology
Meenakshi Isotope Scan and Thyroid Care Centre
99mTc Mebrofenin (Trimethyl Bromo Imino Diacetic Acid) Hepato Biliary Scan
5 min
2 h
Post meal
4 h 24 h
40 min
10 min
20 min
Total Biliary Channel Obstruction
G I BLEED STUDY
Blood Pool Scan 99m Tc labelled RBCs are used
To differentiate Hemangioma of the Liver from Hepatoma amp evaluation of G I Bleeding
Meenakshi Isotope Scan and Thyroid Care Centre
99mTc Mebrofenin Hepato Biliary Scan
20 min
5 min
10 min
30 min
4 hPost Meal
4 h
5 min 10 min
20 min 40 min 2 h
Post meal
24 h
Normal Biliary Atresia
RADIONUCLIDE THERAPY
131 I Therapy for Thyrotoxicosis
131 I Therapy for Ca Thyroid
32 P Therapy for pain palliation
OTHERS NUCLEAR SCANSSomatostatin scintigraphy
Localise and stage neuroendocrine tumours (NETs) eg carcinoid insulinoma gastrinoma phaeochromocytoma and medullary thyroid cancer
Lymphoscintigraphy
Unexplained limb swelling eg lymphatic hypoplasia
Urea breath test
Helicobacter pylori detectionmdashdiagnosis and confirmation of eradication
B12 absorption studies
Vitamin B12 malabsorption pernicious anaemia
Labelled leukocyte imaging
Sepsis localization Inflammatory bowel disease to help determine extent and severity
Dacroscintigraphy
Epiphora
MIBG (meta iodobenzylguanidine)imaging Localisation staging and response monitoring of neuroectodermal tumours Phaeochromocytoma (imaging investigation of choice) Neuroblastoma Carcinoid tumours Medullary thyroid cancer
SUMMARY NUCLEAR MEDICINE IMAGING IS
IMPORTANT IN FUNCTIONAL ASSESSMENT OF VARIOUS ORGANS
SIMPLE AND NON INVASIVE PROCEDURES
COST EFFECTIVE
RADIO IMMUNO ASSAY IS GOLD STANDARD
RADIO NUCLIDE THERAPY INCREASES SURVIVAL
RATE
THANK YOU
SECONDARY VERTEBRAL METASTESES
BRAIN SCANIndications
Dementia characterisation
Epilepsy for localisation of epileptogenic focus
Metastatic work-ups
Determination of blood flow (in brain death or atherosclerotic disease)
Evaluation of space-occupying lesions (tumor hematoma abscess [AV] malformation) and
Encephalitis
Suspected VP shunt obstruction
Distinguishes Parkinsonrsquos syndrome (PS) from benign essential tremor
INTER ICTAL ICTAL amp POST-ICTAL SPECT SHOWING HYPERPERFUSION OF RT TEMPORAL LOBE
9H POST ICTAL CT AND RCBF SPECT IN A 58YF (NORMAL CT ALTERED PERFUSION IN SPECT)
PERSISTENT HYPOPERFUSION DEFECTS THROUGH RIGHT HEMISPHERE IN A PATIENT OF TIA
99m Tc labelled ECD is used Assessment of Stroke detection of Epileptic focus evaluation of dementia etc
Figure Patient with acute ischemic stroke treated with hypertensive therapy a Positron emission tomography images of cerebral blood flow at 2 h (top) and 6 h (bottom)after the onset of symptoms PET cerebral blood flow(CBF) images demonstrate a significant reduction in blood flow affecting a substantial portion of the left middle cerebral artery territoryb PET images of regional cerebral metabolic rate of oxygen at 2 h (top) and 6 h (bottom) after the onset of symptomsOxygen metabolism is abnormal in the left middle cerebral artery (MCA)territory but in an area substantially smaller than the defect seen on the CBF imagesThis reduction in tissue at risk was presumably due to hypertensive therapyc Follow-up CT scan of the head in the patient demonstrating that the ultimate cerebral infarct size most closely approximates the oxygen metabolism defect(b) than the CBF defect (a)
THYROID amp PARATHYROID SCINTIGRAPHY
Indications Characterisation of thyrotoxicosis
a Diffuse toxic goitre (Gravesrsquodisease) b Toxic multinodular goitre (Plummerrsquos disease)
Autonomous nodule
Acute thyroiditis
Evaluation of upper mediastinal mass
Localisation of parathyroid adenoma in proven hyperparathyroidism
Na99mTcO4 Thyroid Scintigraphy - Avid Uptake with increased T3 and T4
FD - Thyrotoxicosis
Na99mTcO4 Thyroid Scintigraphy - A large Cold nodule involving the RtLobe
US - Cyst
Parathyroid Adenoma - 99mTc Sesta MIBI Scan
Thyroid in 5 min scan
20 min scan No wash out in Parathyroid Adenoma
LUNG SCANA Ventilationperfusion imaging (VQ Scan)
Indications Suspected pulmonary embolism Pre-operative lung function assessment
B Lung shunt studies
Indications
Suspected pulmonary AV shuntingInterpretation
1 Segmental perfusion loss with preserved ventilationmdash
pulmonary embolism2 Segmental matched perfusion and ventilation lossmdash
pulmonary infarctioninfection3 Segmentalsubsegmental ventilation loss with preserved
perfusionmdashinfection4 Non-segmental patchy matched perfusion and ventilation
LOSSmdashCOPD
NORMAL 99M TC DTPA AEROSOL STUDY
PERFUSION DEFECTS IN PULMONARY EMBOLISM
RENAL AND ADRENAL SCINTIGRAPHY
1 Static cortical renographyDMSA imaging
Urinary tract infection lsquogold standardrsquo for renal scarring Measurement of relative renal function Renal duplication assessment Ectopic kidney localisation Renal trauma Renal vein thrombosis Pre-biopsy
2 Dynamic renography
Assessment of renal drainagemdashdiscrimination between
renal dilatation and outflow obstruction Measurement of relative renal function Loin pain Post-pyeloplasty follow-up Renal artery stenosismdash1048585Captopril renography
3Adrenal Scan Used to accurately localize a pheochromocytoma when MRI or CT is
equivocal Uses labeled MIBG
Plain Renal Dynamic Studies
Tc-99m labelled DTPA is used for Renal scintigraphy (1) RENOGRAM - PLAIN STUDY amp WITH DIURETIC INTERVENSION
Useful for evaluation of obstructive uropathies to know whether obstruction is due to functional or organic causes
Contracted left kidney Scars over both poles of the Right Kidney
99mTc DMSA- Renal Cortical Image
HEART SCINTIGRAPHY
Myocardial perfusion imaging (MPI)
Indications
In ischaemic heart disease
1 Pre-angiography ndash When conventional stress testing fails eg
bundle branch blockndash Left ventricular hypertrophyndash Atypical chest painndash Recurrent chest pain post-intervention
2 Post-angiography
ndash Assess functional significance of known stenosesndash Identify critical vascular territory for
intervention
99MTC MIBI SPECT IMAGES - NORMAL STUDY
Short Axis
Vertical Long Axis
Horizontal Long Axis
Polar Map
3D image of LV
99MTC MIBI SPECT IMAGES - INFARCTION
Short Axis
Vertical Long Axis
Horizontal Long Axis
Polar Map
3D image of LV
LIVER AND GASTROINTESTINAL TRACT SCINTIGRAPHY
Hepatobiliary scintigraphy (HIDA-Scan BIDA-Scan)
Indications1 Acute cholecystitis2 Trauma3 Post-operative leak detection4 Bile ductstent patency5 Gallbladder emptying6 Bile reflux7 Neonatal biliary atresia
Gastrointestinal bleeding labelled red cell imaging
Helps localise source of active GI haemorrhage when other techniques(eg endoscopy or angiography) have failed
Gastric emptying studie
Altered GI motilitymdashdelayed or accelerated gastric emptying
Meckelrsquos scan ectopic gastric mucosa localisation Unexplained abdominal pain or GI hemorrhagemdashafter endoscopycontrast radiology
Meenakshi Isotope Scan and Thyroid Care Centre
99mTc Mebrofenin (Trimethyl Bromo Imino Diacetic Acid) Hepato Biliary Scan
5 min
2 h
Post meal
4 h 24 h
40 min
10 min
20 min
Total Biliary Channel Obstruction
G I BLEED STUDY
Blood Pool Scan 99m Tc labelled RBCs are used
To differentiate Hemangioma of the Liver from Hepatoma amp evaluation of G I Bleeding
Meenakshi Isotope Scan and Thyroid Care Centre
99mTc Mebrofenin Hepato Biliary Scan
20 min
5 min
10 min
30 min
4 hPost Meal
4 h
5 min 10 min
20 min 40 min 2 h
Post meal
24 h
Normal Biliary Atresia
RADIONUCLIDE THERAPY
131 I Therapy for Thyrotoxicosis
131 I Therapy for Ca Thyroid
32 P Therapy for pain palliation
OTHERS NUCLEAR SCANSSomatostatin scintigraphy
Localise and stage neuroendocrine tumours (NETs) eg carcinoid insulinoma gastrinoma phaeochromocytoma and medullary thyroid cancer
Lymphoscintigraphy
Unexplained limb swelling eg lymphatic hypoplasia
Urea breath test
Helicobacter pylori detectionmdashdiagnosis and confirmation of eradication
B12 absorption studies
Vitamin B12 malabsorption pernicious anaemia
Labelled leukocyte imaging
Sepsis localization Inflammatory bowel disease to help determine extent and severity
Dacroscintigraphy
Epiphora
MIBG (meta iodobenzylguanidine)imaging Localisation staging and response monitoring of neuroectodermal tumours Phaeochromocytoma (imaging investigation of choice) Neuroblastoma Carcinoid tumours Medullary thyroid cancer
SUMMARY NUCLEAR MEDICINE IMAGING IS
IMPORTANT IN FUNCTIONAL ASSESSMENT OF VARIOUS ORGANS
SIMPLE AND NON INVASIVE PROCEDURES
COST EFFECTIVE
RADIO IMMUNO ASSAY IS GOLD STANDARD
RADIO NUCLIDE THERAPY INCREASES SURVIVAL
RATE
THANK YOU
BRAIN SCANIndications
Dementia characterisation
Epilepsy for localisation of epileptogenic focus
Metastatic work-ups
Determination of blood flow (in brain death or atherosclerotic disease)
Evaluation of space-occupying lesions (tumor hematoma abscess [AV] malformation) and
Encephalitis
Suspected VP shunt obstruction
Distinguishes Parkinsonrsquos syndrome (PS) from benign essential tremor
INTER ICTAL ICTAL amp POST-ICTAL SPECT SHOWING HYPERPERFUSION OF RT TEMPORAL LOBE
9H POST ICTAL CT AND RCBF SPECT IN A 58YF (NORMAL CT ALTERED PERFUSION IN SPECT)
PERSISTENT HYPOPERFUSION DEFECTS THROUGH RIGHT HEMISPHERE IN A PATIENT OF TIA
99m Tc labelled ECD is used Assessment of Stroke detection of Epileptic focus evaluation of dementia etc
Figure Patient with acute ischemic stroke treated with hypertensive therapy a Positron emission tomography images of cerebral blood flow at 2 h (top) and 6 h (bottom)after the onset of symptoms PET cerebral blood flow(CBF) images demonstrate a significant reduction in blood flow affecting a substantial portion of the left middle cerebral artery territoryb PET images of regional cerebral metabolic rate of oxygen at 2 h (top) and 6 h (bottom) after the onset of symptomsOxygen metabolism is abnormal in the left middle cerebral artery (MCA)territory but in an area substantially smaller than the defect seen on the CBF imagesThis reduction in tissue at risk was presumably due to hypertensive therapyc Follow-up CT scan of the head in the patient demonstrating that the ultimate cerebral infarct size most closely approximates the oxygen metabolism defect(b) than the CBF defect (a)
THYROID amp PARATHYROID SCINTIGRAPHY
Indications Characterisation of thyrotoxicosis
a Diffuse toxic goitre (Gravesrsquodisease) b Toxic multinodular goitre (Plummerrsquos disease)
Autonomous nodule
Acute thyroiditis
Evaluation of upper mediastinal mass
Localisation of parathyroid adenoma in proven hyperparathyroidism
Na99mTcO4 Thyroid Scintigraphy - Avid Uptake with increased T3 and T4
FD - Thyrotoxicosis
Na99mTcO4 Thyroid Scintigraphy - A large Cold nodule involving the RtLobe
US - Cyst
Parathyroid Adenoma - 99mTc Sesta MIBI Scan
Thyroid in 5 min scan
20 min scan No wash out in Parathyroid Adenoma
LUNG SCANA Ventilationperfusion imaging (VQ Scan)
Indications Suspected pulmonary embolism Pre-operative lung function assessment
B Lung shunt studies
Indications
Suspected pulmonary AV shuntingInterpretation
1 Segmental perfusion loss with preserved ventilationmdash
pulmonary embolism2 Segmental matched perfusion and ventilation lossmdash
pulmonary infarctioninfection3 Segmentalsubsegmental ventilation loss with preserved
perfusionmdashinfection4 Non-segmental patchy matched perfusion and ventilation
LOSSmdashCOPD
NORMAL 99M TC DTPA AEROSOL STUDY
PERFUSION DEFECTS IN PULMONARY EMBOLISM
RENAL AND ADRENAL SCINTIGRAPHY
1 Static cortical renographyDMSA imaging
Urinary tract infection lsquogold standardrsquo for renal scarring Measurement of relative renal function Renal duplication assessment Ectopic kidney localisation Renal trauma Renal vein thrombosis Pre-biopsy
2 Dynamic renography
Assessment of renal drainagemdashdiscrimination between
renal dilatation and outflow obstruction Measurement of relative renal function Loin pain Post-pyeloplasty follow-up Renal artery stenosismdash1048585Captopril renography
3Adrenal Scan Used to accurately localize a pheochromocytoma when MRI or CT is
equivocal Uses labeled MIBG
Plain Renal Dynamic Studies
Tc-99m labelled DTPA is used for Renal scintigraphy (1) RENOGRAM - PLAIN STUDY amp WITH DIURETIC INTERVENSION
Useful for evaluation of obstructive uropathies to know whether obstruction is due to functional or organic causes
Contracted left kidney Scars over both poles of the Right Kidney
99mTc DMSA- Renal Cortical Image
HEART SCINTIGRAPHY
Myocardial perfusion imaging (MPI)
Indications
In ischaemic heart disease
1 Pre-angiography ndash When conventional stress testing fails eg
bundle branch blockndash Left ventricular hypertrophyndash Atypical chest painndash Recurrent chest pain post-intervention
2 Post-angiography
ndash Assess functional significance of known stenosesndash Identify critical vascular territory for
intervention
99MTC MIBI SPECT IMAGES - NORMAL STUDY
Short Axis
Vertical Long Axis
Horizontal Long Axis
Polar Map
3D image of LV
99MTC MIBI SPECT IMAGES - INFARCTION
Short Axis
Vertical Long Axis
Horizontal Long Axis
Polar Map
3D image of LV
LIVER AND GASTROINTESTINAL TRACT SCINTIGRAPHY
Hepatobiliary scintigraphy (HIDA-Scan BIDA-Scan)
Indications1 Acute cholecystitis2 Trauma3 Post-operative leak detection4 Bile ductstent patency5 Gallbladder emptying6 Bile reflux7 Neonatal biliary atresia
Gastrointestinal bleeding labelled red cell imaging
Helps localise source of active GI haemorrhage when other techniques(eg endoscopy or angiography) have failed
Gastric emptying studie
Altered GI motilitymdashdelayed or accelerated gastric emptying
Meckelrsquos scan ectopic gastric mucosa localisation Unexplained abdominal pain or GI hemorrhagemdashafter endoscopycontrast radiology
Meenakshi Isotope Scan and Thyroid Care Centre
99mTc Mebrofenin (Trimethyl Bromo Imino Diacetic Acid) Hepato Biliary Scan
5 min
2 h
Post meal
4 h 24 h
40 min
10 min
20 min
Total Biliary Channel Obstruction
G I BLEED STUDY
Blood Pool Scan 99m Tc labelled RBCs are used
To differentiate Hemangioma of the Liver from Hepatoma amp evaluation of G I Bleeding
Meenakshi Isotope Scan and Thyroid Care Centre
99mTc Mebrofenin Hepato Biliary Scan
20 min
5 min
10 min
30 min
4 hPost Meal
4 h
5 min 10 min
20 min 40 min 2 h
Post meal
24 h
Normal Biliary Atresia
RADIONUCLIDE THERAPY
131 I Therapy for Thyrotoxicosis
131 I Therapy for Ca Thyroid
32 P Therapy for pain palliation
OTHERS NUCLEAR SCANSSomatostatin scintigraphy
Localise and stage neuroendocrine tumours (NETs) eg carcinoid insulinoma gastrinoma phaeochromocytoma and medullary thyroid cancer
Lymphoscintigraphy
Unexplained limb swelling eg lymphatic hypoplasia
Urea breath test
Helicobacter pylori detectionmdashdiagnosis and confirmation of eradication
B12 absorption studies
Vitamin B12 malabsorption pernicious anaemia
Labelled leukocyte imaging
Sepsis localization Inflammatory bowel disease to help determine extent and severity
Dacroscintigraphy
Epiphora
MIBG (meta iodobenzylguanidine)imaging Localisation staging and response monitoring of neuroectodermal tumours Phaeochromocytoma (imaging investigation of choice) Neuroblastoma Carcinoid tumours Medullary thyroid cancer
SUMMARY NUCLEAR MEDICINE IMAGING IS
IMPORTANT IN FUNCTIONAL ASSESSMENT OF VARIOUS ORGANS
SIMPLE AND NON INVASIVE PROCEDURES
COST EFFECTIVE
RADIO IMMUNO ASSAY IS GOLD STANDARD
RADIO NUCLIDE THERAPY INCREASES SURVIVAL
RATE
THANK YOU
INTER ICTAL ICTAL amp POST-ICTAL SPECT SHOWING HYPERPERFUSION OF RT TEMPORAL LOBE
9H POST ICTAL CT AND RCBF SPECT IN A 58YF (NORMAL CT ALTERED PERFUSION IN SPECT)
PERSISTENT HYPOPERFUSION DEFECTS THROUGH RIGHT HEMISPHERE IN A PATIENT OF TIA
99m Tc labelled ECD is used Assessment of Stroke detection of Epileptic focus evaluation of dementia etc
Figure Patient with acute ischemic stroke treated with hypertensive therapy a Positron emission tomography images of cerebral blood flow at 2 h (top) and 6 h (bottom)after the onset of symptoms PET cerebral blood flow(CBF) images demonstrate a significant reduction in blood flow affecting a substantial portion of the left middle cerebral artery territoryb PET images of regional cerebral metabolic rate of oxygen at 2 h (top) and 6 h (bottom) after the onset of symptomsOxygen metabolism is abnormal in the left middle cerebral artery (MCA)territory but in an area substantially smaller than the defect seen on the CBF imagesThis reduction in tissue at risk was presumably due to hypertensive therapyc Follow-up CT scan of the head in the patient demonstrating that the ultimate cerebral infarct size most closely approximates the oxygen metabolism defect(b) than the CBF defect (a)
THYROID amp PARATHYROID SCINTIGRAPHY
Indications Characterisation of thyrotoxicosis
a Diffuse toxic goitre (Gravesrsquodisease) b Toxic multinodular goitre (Plummerrsquos disease)
Autonomous nodule
Acute thyroiditis
Evaluation of upper mediastinal mass
Localisation of parathyroid adenoma in proven hyperparathyroidism
Na99mTcO4 Thyroid Scintigraphy - Avid Uptake with increased T3 and T4
FD - Thyrotoxicosis
Na99mTcO4 Thyroid Scintigraphy - A large Cold nodule involving the RtLobe
US - Cyst
Parathyroid Adenoma - 99mTc Sesta MIBI Scan
Thyroid in 5 min scan
20 min scan No wash out in Parathyroid Adenoma
LUNG SCANA Ventilationperfusion imaging (VQ Scan)
Indications Suspected pulmonary embolism Pre-operative lung function assessment
B Lung shunt studies
Indications
Suspected pulmonary AV shuntingInterpretation
1 Segmental perfusion loss with preserved ventilationmdash
pulmonary embolism2 Segmental matched perfusion and ventilation lossmdash
pulmonary infarctioninfection3 Segmentalsubsegmental ventilation loss with preserved
perfusionmdashinfection4 Non-segmental patchy matched perfusion and ventilation
LOSSmdashCOPD
NORMAL 99M TC DTPA AEROSOL STUDY
PERFUSION DEFECTS IN PULMONARY EMBOLISM
RENAL AND ADRENAL SCINTIGRAPHY
1 Static cortical renographyDMSA imaging
Urinary tract infection lsquogold standardrsquo for renal scarring Measurement of relative renal function Renal duplication assessment Ectopic kidney localisation Renal trauma Renal vein thrombosis Pre-biopsy
2 Dynamic renography
Assessment of renal drainagemdashdiscrimination between
renal dilatation and outflow obstruction Measurement of relative renal function Loin pain Post-pyeloplasty follow-up Renal artery stenosismdash1048585Captopril renography
3Adrenal Scan Used to accurately localize a pheochromocytoma when MRI or CT is
equivocal Uses labeled MIBG
Plain Renal Dynamic Studies
Tc-99m labelled DTPA is used for Renal scintigraphy (1) RENOGRAM - PLAIN STUDY amp WITH DIURETIC INTERVENSION
Useful for evaluation of obstructive uropathies to know whether obstruction is due to functional or organic causes
Contracted left kidney Scars over both poles of the Right Kidney
99mTc DMSA- Renal Cortical Image
HEART SCINTIGRAPHY
Myocardial perfusion imaging (MPI)
Indications
In ischaemic heart disease
1 Pre-angiography ndash When conventional stress testing fails eg
bundle branch blockndash Left ventricular hypertrophyndash Atypical chest painndash Recurrent chest pain post-intervention
2 Post-angiography
ndash Assess functional significance of known stenosesndash Identify critical vascular territory for
intervention
99MTC MIBI SPECT IMAGES - NORMAL STUDY
Short Axis
Vertical Long Axis
Horizontal Long Axis
Polar Map
3D image of LV
99MTC MIBI SPECT IMAGES - INFARCTION
Short Axis
Vertical Long Axis
Horizontal Long Axis
Polar Map
3D image of LV
LIVER AND GASTROINTESTINAL TRACT SCINTIGRAPHY
Hepatobiliary scintigraphy (HIDA-Scan BIDA-Scan)
Indications1 Acute cholecystitis2 Trauma3 Post-operative leak detection4 Bile ductstent patency5 Gallbladder emptying6 Bile reflux7 Neonatal biliary atresia
Gastrointestinal bleeding labelled red cell imaging
Helps localise source of active GI haemorrhage when other techniques(eg endoscopy or angiography) have failed
Gastric emptying studie
Altered GI motilitymdashdelayed or accelerated gastric emptying
Meckelrsquos scan ectopic gastric mucosa localisation Unexplained abdominal pain or GI hemorrhagemdashafter endoscopycontrast radiology
Meenakshi Isotope Scan and Thyroid Care Centre
99mTc Mebrofenin (Trimethyl Bromo Imino Diacetic Acid) Hepato Biliary Scan
5 min
2 h
Post meal
4 h 24 h
40 min
10 min
20 min
Total Biliary Channel Obstruction
G I BLEED STUDY
Blood Pool Scan 99m Tc labelled RBCs are used
To differentiate Hemangioma of the Liver from Hepatoma amp evaluation of G I Bleeding
Meenakshi Isotope Scan and Thyroid Care Centre
99mTc Mebrofenin Hepato Biliary Scan
20 min
5 min
10 min
30 min
4 hPost Meal
4 h
5 min 10 min
20 min 40 min 2 h
Post meal
24 h
Normal Biliary Atresia
RADIONUCLIDE THERAPY
131 I Therapy for Thyrotoxicosis
131 I Therapy for Ca Thyroid
32 P Therapy for pain palliation
OTHERS NUCLEAR SCANSSomatostatin scintigraphy
Localise and stage neuroendocrine tumours (NETs) eg carcinoid insulinoma gastrinoma phaeochromocytoma and medullary thyroid cancer
Lymphoscintigraphy
Unexplained limb swelling eg lymphatic hypoplasia
Urea breath test
Helicobacter pylori detectionmdashdiagnosis and confirmation of eradication
B12 absorption studies
Vitamin B12 malabsorption pernicious anaemia
Labelled leukocyte imaging
Sepsis localization Inflammatory bowel disease to help determine extent and severity
Dacroscintigraphy
Epiphora
MIBG (meta iodobenzylguanidine)imaging Localisation staging and response monitoring of neuroectodermal tumours Phaeochromocytoma (imaging investigation of choice) Neuroblastoma Carcinoid tumours Medullary thyroid cancer
SUMMARY NUCLEAR MEDICINE IMAGING IS
IMPORTANT IN FUNCTIONAL ASSESSMENT OF VARIOUS ORGANS
SIMPLE AND NON INVASIVE PROCEDURES
COST EFFECTIVE
RADIO IMMUNO ASSAY IS GOLD STANDARD
RADIO NUCLIDE THERAPY INCREASES SURVIVAL
RATE
THANK YOU
9H POST ICTAL CT AND RCBF SPECT IN A 58YF (NORMAL CT ALTERED PERFUSION IN SPECT)
PERSISTENT HYPOPERFUSION DEFECTS THROUGH RIGHT HEMISPHERE IN A PATIENT OF TIA
99m Tc labelled ECD is used Assessment of Stroke detection of Epileptic focus evaluation of dementia etc
Figure Patient with acute ischemic stroke treated with hypertensive therapy a Positron emission tomography images of cerebral blood flow at 2 h (top) and 6 h (bottom)after the onset of symptoms PET cerebral blood flow(CBF) images demonstrate a significant reduction in blood flow affecting a substantial portion of the left middle cerebral artery territoryb PET images of regional cerebral metabolic rate of oxygen at 2 h (top) and 6 h (bottom) after the onset of symptomsOxygen metabolism is abnormal in the left middle cerebral artery (MCA)territory but in an area substantially smaller than the defect seen on the CBF imagesThis reduction in tissue at risk was presumably due to hypertensive therapyc Follow-up CT scan of the head in the patient demonstrating that the ultimate cerebral infarct size most closely approximates the oxygen metabolism defect(b) than the CBF defect (a)
THYROID amp PARATHYROID SCINTIGRAPHY
Indications Characterisation of thyrotoxicosis
a Diffuse toxic goitre (Gravesrsquodisease) b Toxic multinodular goitre (Plummerrsquos disease)
Autonomous nodule
Acute thyroiditis
Evaluation of upper mediastinal mass
Localisation of parathyroid adenoma in proven hyperparathyroidism
Na99mTcO4 Thyroid Scintigraphy - Avid Uptake with increased T3 and T4
FD - Thyrotoxicosis
Na99mTcO4 Thyroid Scintigraphy - A large Cold nodule involving the RtLobe
US - Cyst
Parathyroid Adenoma - 99mTc Sesta MIBI Scan
Thyroid in 5 min scan
20 min scan No wash out in Parathyroid Adenoma
LUNG SCANA Ventilationperfusion imaging (VQ Scan)
Indications Suspected pulmonary embolism Pre-operative lung function assessment
B Lung shunt studies
Indications
Suspected pulmonary AV shuntingInterpretation
1 Segmental perfusion loss with preserved ventilationmdash
pulmonary embolism2 Segmental matched perfusion and ventilation lossmdash
pulmonary infarctioninfection3 Segmentalsubsegmental ventilation loss with preserved
perfusionmdashinfection4 Non-segmental patchy matched perfusion and ventilation
LOSSmdashCOPD
NORMAL 99M TC DTPA AEROSOL STUDY
PERFUSION DEFECTS IN PULMONARY EMBOLISM
RENAL AND ADRENAL SCINTIGRAPHY
1 Static cortical renographyDMSA imaging
Urinary tract infection lsquogold standardrsquo for renal scarring Measurement of relative renal function Renal duplication assessment Ectopic kidney localisation Renal trauma Renal vein thrombosis Pre-biopsy
2 Dynamic renography
Assessment of renal drainagemdashdiscrimination between
renal dilatation and outflow obstruction Measurement of relative renal function Loin pain Post-pyeloplasty follow-up Renal artery stenosismdash1048585Captopril renography
3Adrenal Scan Used to accurately localize a pheochromocytoma when MRI or CT is
equivocal Uses labeled MIBG
Plain Renal Dynamic Studies
Tc-99m labelled DTPA is used for Renal scintigraphy (1) RENOGRAM - PLAIN STUDY amp WITH DIURETIC INTERVENSION
Useful for evaluation of obstructive uropathies to know whether obstruction is due to functional or organic causes
Contracted left kidney Scars over both poles of the Right Kidney
99mTc DMSA- Renal Cortical Image
HEART SCINTIGRAPHY
Myocardial perfusion imaging (MPI)
Indications
In ischaemic heart disease
1 Pre-angiography ndash When conventional stress testing fails eg
bundle branch blockndash Left ventricular hypertrophyndash Atypical chest painndash Recurrent chest pain post-intervention
2 Post-angiography
ndash Assess functional significance of known stenosesndash Identify critical vascular territory for
intervention
99MTC MIBI SPECT IMAGES - NORMAL STUDY
Short Axis
Vertical Long Axis
Horizontal Long Axis
Polar Map
3D image of LV
99MTC MIBI SPECT IMAGES - INFARCTION
Short Axis
Vertical Long Axis
Horizontal Long Axis
Polar Map
3D image of LV
LIVER AND GASTROINTESTINAL TRACT SCINTIGRAPHY
Hepatobiliary scintigraphy (HIDA-Scan BIDA-Scan)
Indications1 Acute cholecystitis2 Trauma3 Post-operative leak detection4 Bile ductstent patency5 Gallbladder emptying6 Bile reflux7 Neonatal biliary atresia
Gastrointestinal bleeding labelled red cell imaging
Helps localise source of active GI haemorrhage when other techniques(eg endoscopy or angiography) have failed
Gastric emptying studie
Altered GI motilitymdashdelayed or accelerated gastric emptying
Meckelrsquos scan ectopic gastric mucosa localisation Unexplained abdominal pain or GI hemorrhagemdashafter endoscopycontrast radiology
Meenakshi Isotope Scan and Thyroid Care Centre
99mTc Mebrofenin (Trimethyl Bromo Imino Diacetic Acid) Hepato Biliary Scan
5 min
2 h
Post meal
4 h 24 h
40 min
10 min
20 min
Total Biliary Channel Obstruction
G I BLEED STUDY
Blood Pool Scan 99m Tc labelled RBCs are used
To differentiate Hemangioma of the Liver from Hepatoma amp evaluation of G I Bleeding
Meenakshi Isotope Scan and Thyroid Care Centre
99mTc Mebrofenin Hepato Biliary Scan
20 min
5 min
10 min
30 min
4 hPost Meal
4 h
5 min 10 min
20 min 40 min 2 h
Post meal
24 h
Normal Biliary Atresia
RADIONUCLIDE THERAPY
131 I Therapy for Thyrotoxicosis
131 I Therapy for Ca Thyroid
32 P Therapy for pain palliation
OTHERS NUCLEAR SCANSSomatostatin scintigraphy
Localise and stage neuroendocrine tumours (NETs) eg carcinoid insulinoma gastrinoma phaeochromocytoma and medullary thyroid cancer
Lymphoscintigraphy
Unexplained limb swelling eg lymphatic hypoplasia
Urea breath test
Helicobacter pylori detectionmdashdiagnosis and confirmation of eradication
B12 absorption studies
Vitamin B12 malabsorption pernicious anaemia
Labelled leukocyte imaging
Sepsis localization Inflammatory bowel disease to help determine extent and severity
Dacroscintigraphy
Epiphora
MIBG (meta iodobenzylguanidine)imaging Localisation staging and response monitoring of neuroectodermal tumours Phaeochromocytoma (imaging investigation of choice) Neuroblastoma Carcinoid tumours Medullary thyroid cancer
SUMMARY NUCLEAR MEDICINE IMAGING IS
IMPORTANT IN FUNCTIONAL ASSESSMENT OF VARIOUS ORGANS
SIMPLE AND NON INVASIVE PROCEDURES
COST EFFECTIVE
RADIO IMMUNO ASSAY IS GOLD STANDARD
RADIO NUCLIDE THERAPY INCREASES SURVIVAL
RATE
THANK YOU
PERSISTENT HYPOPERFUSION DEFECTS THROUGH RIGHT HEMISPHERE IN A PATIENT OF TIA
99m Tc labelled ECD is used Assessment of Stroke detection of Epileptic focus evaluation of dementia etc
Figure Patient with acute ischemic stroke treated with hypertensive therapy a Positron emission tomography images of cerebral blood flow at 2 h (top) and 6 h (bottom)after the onset of symptoms PET cerebral blood flow(CBF) images demonstrate a significant reduction in blood flow affecting a substantial portion of the left middle cerebral artery territoryb PET images of regional cerebral metabolic rate of oxygen at 2 h (top) and 6 h (bottom) after the onset of symptomsOxygen metabolism is abnormal in the left middle cerebral artery (MCA)territory but in an area substantially smaller than the defect seen on the CBF imagesThis reduction in tissue at risk was presumably due to hypertensive therapyc Follow-up CT scan of the head in the patient demonstrating that the ultimate cerebral infarct size most closely approximates the oxygen metabolism defect(b) than the CBF defect (a)
THYROID amp PARATHYROID SCINTIGRAPHY
Indications Characterisation of thyrotoxicosis
a Diffuse toxic goitre (Gravesrsquodisease) b Toxic multinodular goitre (Plummerrsquos disease)
Autonomous nodule
Acute thyroiditis
Evaluation of upper mediastinal mass
Localisation of parathyroid adenoma in proven hyperparathyroidism
Na99mTcO4 Thyroid Scintigraphy - Avid Uptake with increased T3 and T4
FD - Thyrotoxicosis
Na99mTcO4 Thyroid Scintigraphy - A large Cold nodule involving the RtLobe
US - Cyst
Parathyroid Adenoma - 99mTc Sesta MIBI Scan
Thyroid in 5 min scan
20 min scan No wash out in Parathyroid Adenoma
LUNG SCANA Ventilationperfusion imaging (VQ Scan)
Indications Suspected pulmonary embolism Pre-operative lung function assessment
B Lung shunt studies
Indications
Suspected pulmonary AV shuntingInterpretation
1 Segmental perfusion loss with preserved ventilationmdash
pulmonary embolism2 Segmental matched perfusion and ventilation lossmdash
pulmonary infarctioninfection3 Segmentalsubsegmental ventilation loss with preserved
perfusionmdashinfection4 Non-segmental patchy matched perfusion and ventilation
LOSSmdashCOPD
NORMAL 99M TC DTPA AEROSOL STUDY
PERFUSION DEFECTS IN PULMONARY EMBOLISM
RENAL AND ADRENAL SCINTIGRAPHY
1 Static cortical renographyDMSA imaging
Urinary tract infection lsquogold standardrsquo for renal scarring Measurement of relative renal function Renal duplication assessment Ectopic kidney localisation Renal trauma Renal vein thrombosis Pre-biopsy
2 Dynamic renography
Assessment of renal drainagemdashdiscrimination between
renal dilatation and outflow obstruction Measurement of relative renal function Loin pain Post-pyeloplasty follow-up Renal artery stenosismdash1048585Captopril renography
3Adrenal Scan Used to accurately localize a pheochromocytoma when MRI or CT is
equivocal Uses labeled MIBG
Plain Renal Dynamic Studies
Tc-99m labelled DTPA is used for Renal scintigraphy (1) RENOGRAM - PLAIN STUDY amp WITH DIURETIC INTERVENSION
Useful for evaluation of obstructive uropathies to know whether obstruction is due to functional or organic causes
Contracted left kidney Scars over both poles of the Right Kidney
99mTc DMSA- Renal Cortical Image
HEART SCINTIGRAPHY
Myocardial perfusion imaging (MPI)
Indications
In ischaemic heart disease
1 Pre-angiography ndash When conventional stress testing fails eg
bundle branch blockndash Left ventricular hypertrophyndash Atypical chest painndash Recurrent chest pain post-intervention
2 Post-angiography
ndash Assess functional significance of known stenosesndash Identify critical vascular territory for
intervention
99MTC MIBI SPECT IMAGES - NORMAL STUDY
Short Axis
Vertical Long Axis
Horizontal Long Axis
Polar Map
3D image of LV
99MTC MIBI SPECT IMAGES - INFARCTION
Short Axis
Vertical Long Axis
Horizontal Long Axis
Polar Map
3D image of LV
LIVER AND GASTROINTESTINAL TRACT SCINTIGRAPHY
Hepatobiliary scintigraphy (HIDA-Scan BIDA-Scan)
Indications1 Acute cholecystitis2 Trauma3 Post-operative leak detection4 Bile ductstent patency5 Gallbladder emptying6 Bile reflux7 Neonatal biliary atresia
Gastrointestinal bleeding labelled red cell imaging
Helps localise source of active GI haemorrhage when other techniques(eg endoscopy or angiography) have failed
Gastric emptying studie
Altered GI motilitymdashdelayed or accelerated gastric emptying
Meckelrsquos scan ectopic gastric mucosa localisation Unexplained abdominal pain or GI hemorrhagemdashafter endoscopycontrast radiology
Meenakshi Isotope Scan and Thyroid Care Centre
99mTc Mebrofenin (Trimethyl Bromo Imino Diacetic Acid) Hepato Biliary Scan
5 min
2 h
Post meal
4 h 24 h
40 min
10 min
20 min
Total Biliary Channel Obstruction
G I BLEED STUDY
Blood Pool Scan 99m Tc labelled RBCs are used
To differentiate Hemangioma of the Liver from Hepatoma amp evaluation of G I Bleeding
Meenakshi Isotope Scan and Thyroid Care Centre
99mTc Mebrofenin Hepato Biliary Scan
20 min
5 min
10 min
30 min
4 hPost Meal
4 h
5 min 10 min
20 min 40 min 2 h
Post meal
24 h
Normal Biliary Atresia
RADIONUCLIDE THERAPY
131 I Therapy for Thyrotoxicosis
131 I Therapy for Ca Thyroid
32 P Therapy for pain palliation
OTHERS NUCLEAR SCANSSomatostatin scintigraphy
Localise and stage neuroendocrine tumours (NETs) eg carcinoid insulinoma gastrinoma phaeochromocytoma and medullary thyroid cancer
Lymphoscintigraphy
Unexplained limb swelling eg lymphatic hypoplasia
Urea breath test
Helicobacter pylori detectionmdashdiagnosis and confirmation of eradication
B12 absorption studies
Vitamin B12 malabsorption pernicious anaemia
Labelled leukocyte imaging
Sepsis localization Inflammatory bowel disease to help determine extent and severity
Dacroscintigraphy
Epiphora
MIBG (meta iodobenzylguanidine)imaging Localisation staging and response monitoring of neuroectodermal tumours Phaeochromocytoma (imaging investigation of choice) Neuroblastoma Carcinoid tumours Medullary thyroid cancer
SUMMARY NUCLEAR MEDICINE IMAGING IS
IMPORTANT IN FUNCTIONAL ASSESSMENT OF VARIOUS ORGANS
SIMPLE AND NON INVASIVE PROCEDURES
COST EFFECTIVE
RADIO IMMUNO ASSAY IS GOLD STANDARD
RADIO NUCLIDE THERAPY INCREASES SURVIVAL
RATE
THANK YOU
Figure Patient with acute ischemic stroke treated with hypertensive therapy a Positron emission tomography images of cerebral blood flow at 2 h (top) and 6 h (bottom)after the onset of symptoms PET cerebral blood flow(CBF) images demonstrate a significant reduction in blood flow affecting a substantial portion of the left middle cerebral artery territoryb PET images of regional cerebral metabolic rate of oxygen at 2 h (top) and 6 h (bottom) after the onset of symptomsOxygen metabolism is abnormal in the left middle cerebral artery (MCA)territory but in an area substantially smaller than the defect seen on the CBF imagesThis reduction in tissue at risk was presumably due to hypertensive therapyc Follow-up CT scan of the head in the patient demonstrating that the ultimate cerebral infarct size most closely approximates the oxygen metabolism defect(b) than the CBF defect (a)
THYROID amp PARATHYROID SCINTIGRAPHY
Indications Characterisation of thyrotoxicosis
a Diffuse toxic goitre (Gravesrsquodisease) b Toxic multinodular goitre (Plummerrsquos disease)
Autonomous nodule
Acute thyroiditis
Evaluation of upper mediastinal mass
Localisation of parathyroid adenoma in proven hyperparathyroidism
Na99mTcO4 Thyroid Scintigraphy - Avid Uptake with increased T3 and T4
FD - Thyrotoxicosis
Na99mTcO4 Thyroid Scintigraphy - A large Cold nodule involving the RtLobe
US - Cyst
Parathyroid Adenoma - 99mTc Sesta MIBI Scan
Thyroid in 5 min scan
20 min scan No wash out in Parathyroid Adenoma
LUNG SCANA Ventilationperfusion imaging (VQ Scan)
Indications Suspected pulmonary embolism Pre-operative lung function assessment
B Lung shunt studies
Indications
Suspected pulmonary AV shuntingInterpretation
1 Segmental perfusion loss with preserved ventilationmdash
pulmonary embolism2 Segmental matched perfusion and ventilation lossmdash
pulmonary infarctioninfection3 Segmentalsubsegmental ventilation loss with preserved
perfusionmdashinfection4 Non-segmental patchy matched perfusion and ventilation
LOSSmdashCOPD
NORMAL 99M TC DTPA AEROSOL STUDY
PERFUSION DEFECTS IN PULMONARY EMBOLISM
RENAL AND ADRENAL SCINTIGRAPHY
1 Static cortical renographyDMSA imaging
Urinary tract infection lsquogold standardrsquo for renal scarring Measurement of relative renal function Renal duplication assessment Ectopic kidney localisation Renal trauma Renal vein thrombosis Pre-biopsy
2 Dynamic renography
Assessment of renal drainagemdashdiscrimination between
renal dilatation and outflow obstruction Measurement of relative renal function Loin pain Post-pyeloplasty follow-up Renal artery stenosismdash1048585Captopril renography
3Adrenal Scan Used to accurately localize a pheochromocytoma when MRI or CT is
equivocal Uses labeled MIBG
Plain Renal Dynamic Studies
Tc-99m labelled DTPA is used for Renal scintigraphy (1) RENOGRAM - PLAIN STUDY amp WITH DIURETIC INTERVENSION
Useful for evaluation of obstructive uropathies to know whether obstruction is due to functional or organic causes
Contracted left kidney Scars over both poles of the Right Kidney
99mTc DMSA- Renal Cortical Image
HEART SCINTIGRAPHY
Myocardial perfusion imaging (MPI)
Indications
In ischaemic heart disease
1 Pre-angiography ndash When conventional stress testing fails eg
bundle branch blockndash Left ventricular hypertrophyndash Atypical chest painndash Recurrent chest pain post-intervention
2 Post-angiography
ndash Assess functional significance of known stenosesndash Identify critical vascular territory for
intervention
99MTC MIBI SPECT IMAGES - NORMAL STUDY
Short Axis
Vertical Long Axis
Horizontal Long Axis
Polar Map
3D image of LV
99MTC MIBI SPECT IMAGES - INFARCTION
Short Axis
Vertical Long Axis
Horizontal Long Axis
Polar Map
3D image of LV
LIVER AND GASTROINTESTINAL TRACT SCINTIGRAPHY
Hepatobiliary scintigraphy (HIDA-Scan BIDA-Scan)
Indications1 Acute cholecystitis2 Trauma3 Post-operative leak detection4 Bile ductstent patency5 Gallbladder emptying6 Bile reflux7 Neonatal biliary atresia
Gastrointestinal bleeding labelled red cell imaging
Helps localise source of active GI haemorrhage when other techniques(eg endoscopy or angiography) have failed
Gastric emptying studie
Altered GI motilitymdashdelayed or accelerated gastric emptying
Meckelrsquos scan ectopic gastric mucosa localisation Unexplained abdominal pain or GI hemorrhagemdashafter endoscopycontrast radiology
Meenakshi Isotope Scan and Thyroid Care Centre
99mTc Mebrofenin (Trimethyl Bromo Imino Diacetic Acid) Hepato Biliary Scan
5 min
2 h
Post meal
4 h 24 h
40 min
10 min
20 min
Total Biliary Channel Obstruction
G I BLEED STUDY
Blood Pool Scan 99m Tc labelled RBCs are used
To differentiate Hemangioma of the Liver from Hepatoma amp evaluation of G I Bleeding
Meenakshi Isotope Scan and Thyroid Care Centre
99mTc Mebrofenin Hepato Biliary Scan
20 min
5 min
10 min
30 min
4 hPost Meal
4 h
5 min 10 min
20 min 40 min 2 h
Post meal
24 h
Normal Biliary Atresia
RADIONUCLIDE THERAPY
131 I Therapy for Thyrotoxicosis
131 I Therapy for Ca Thyroid
32 P Therapy for pain palliation
OTHERS NUCLEAR SCANSSomatostatin scintigraphy
Localise and stage neuroendocrine tumours (NETs) eg carcinoid insulinoma gastrinoma phaeochromocytoma and medullary thyroid cancer
Lymphoscintigraphy
Unexplained limb swelling eg lymphatic hypoplasia
Urea breath test
Helicobacter pylori detectionmdashdiagnosis and confirmation of eradication
B12 absorption studies
Vitamin B12 malabsorption pernicious anaemia
Labelled leukocyte imaging
Sepsis localization Inflammatory bowel disease to help determine extent and severity
Dacroscintigraphy
Epiphora
MIBG (meta iodobenzylguanidine)imaging Localisation staging and response monitoring of neuroectodermal tumours Phaeochromocytoma (imaging investigation of choice) Neuroblastoma Carcinoid tumours Medullary thyroid cancer
SUMMARY NUCLEAR MEDICINE IMAGING IS
IMPORTANT IN FUNCTIONAL ASSESSMENT OF VARIOUS ORGANS
SIMPLE AND NON INVASIVE PROCEDURES
COST EFFECTIVE
RADIO IMMUNO ASSAY IS GOLD STANDARD
RADIO NUCLIDE THERAPY INCREASES SURVIVAL
RATE
THANK YOU
THYROID amp PARATHYROID SCINTIGRAPHY
Indications Characterisation of thyrotoxicosis
a Diffuse toxic goitre (Gravesrsquodisease) b Toxic multinodular goitre (Plummerrsquos disease)
Autonomous nodule
Acute thyroiditis
Evaluation of upper mediastinal mass
Localisation of parathyroid adenoma in proven hyperparathyroidism
Na99mTcO4 Thyroid Scintigraphy - Avid Uptake with increased T3 and T4
FD - Thyrotoxicosis
Na99mTcO4 Thyroid Scintigraphy - A large Cold nodule involving the RtLobe
US - Cyst
Parathyroid Adenoma - 99mTc Sesta MIBI Scan
Thyroid in 5 min scan
20 min scan No wash out in Parathyroid Adenoma
LUNG SCANA Ventilationperfusion imaging (VQ Scan)
Indications Suspected pulmonary embolism Pre-operative lung function assessment
B Lung shunt studies
Indications
Suspected pulmonary AV shuntingInterpretation
1 Segmental perfusion loss with preserved ventilationmdash
pulmonary embolism2 Segmental matched perfusion and ventilation lossmdash
pulmonary infarctioninfection3 Segmentalsubsegmental ventilation loss with preserved
perfusionmdashinfection4 Non-segmental patchy matched perfusion and ventilation
LOSSmdashCOPD
NORMAL 99M TC DTPA AEROSOL STUDY
PERFUSION DEFECTS IN PULMONARY EMBOLISM
RENAL AND ADRENAL SCINTIGRAPHY
1 Static cortical renographyDMSA imaging
Urinary tract infection lsquogold standardrsquo for renal scarring Measurement of relative renal function Renal duplication assessment Ectopic kidney localisation Renal trauma Renal vein thrombosis Pre-biopsy
2 Dynamic renography
Assessment of renal drainagemdashdiscrimination between
renal dilatation and outflow obstruction Measurement of relative renal function Loin pain Post-pyeloplasty follow-up Renal artery stenosismdash1048585Captopril renography
3Adrenal Scan Used to accurately localize a pheochromocytoma when MRI or CT is
equivocal Uses labeled MIBG
Plain Renal Dynamic Studies
Tc-99m labelled DTPA is used for Renal scintigraphy (1) RENOGRAM - PLAIN STUDY amp WITH DIURETIC INTERVENSION
Useful for evaluation of obstructive uropathies to know whether obstruction is due to functional or organic causes
Contracted left kidney Scars over both poles of the Right Kidney
99mTc DMSA- Renal Cortical Image
HEART SCINTIGRAPHY
Myocardial perfusion imaging (MPI)
Indications
In ischaemic heart disease
1 Pre-angiography ndash When conventional stress testing fails eg
bundle branch blockndash Left ventricular hypertrophyndash Atypical chest painndash Recurrent chest pain post-intervention
2 Post-angiography
ndash Assess functional significance of known stenosesndash Identify critical vascular territory for
intervention
99MTC MIBI SPECT IMAGES - NORMAL STUDY
Short Axis
Vertical Long Axis
Horizontal Long Axis
Polar Map
3D image of LV
99MTC MIBI SPECT IMAGES - INFARCTION
Short Axis
Vertical Long Axis
Horizontal Long Axis
Polar Map
3D image of LV
LIVER AND GASTROINTESTINAL TRACT SCINTIGRAPHY
Hepatobiliary scintigraphy (HIDA-Scan BIDA-Scan)
Indications1 Acute cholecystitis2 Trauma3 Post-operative leak detection4 Bile ductstent patency5 Gallbladder emptying6 Bile reflux7 Neonatal biliary atresia
Gastrointestinal bleeding labelled red cell imaging
Helps localise source of active GI haemorrhage when other techniques(eg endoscopy or angiography) have failed
Gastric emptying studie
Altered GI motilitymdashdelayed or accelerated gastric emptying
Meckelrsquos scan ectopic gastric mucosa localisation Unexplained abdominal pain or GI hemorrhagemdashafter endoscopycontrast radiology
Meenakshi Isotope Scan and Thyroid Care Centre
99mTc Mebrofenin (Trimethyl Bromo Imino Diacetic Acid) Hepato Biliary Scan
5 min
2 h
Post meal
4 h 24 h
40 min
10 min
20 min
Total Biliary Channel Obstruction
G I BLEED STUDY
Blood Pool Scan 99m Tc labelled RBCs are used
To differentiate Hemangioma of the Liver from Hepatoma amp evaluation of G I Bleeding
Meenakshi Isotope Scan and Thyroid Care Centre
99mTc Mebrofenin Hepato Biliary Scan
20 min
5 min
10 min
30 min
4 hPost Meal
4 h
5 min 10 min
20 min 40 min 2 h
Post meal
24 h
Normal Biliary Atresia
RADIONUCLIDE THERAPY
131 I Therapy for Thyrotoxicosis
131 I Therapy for Ca Thyroid
32 P Therapy for pain palliation
OTHERS NUCLEAR SCANSSomatostatin scintigraphy
Localise and stage neuroendocrine tumours (NETs) eg carcinoid insulinoma gastrinoma phaeochromocytoma and medullary thyroid cancer
Lymphoscintigraphy
Unexplained limb swelling eg lymphatic hypoplasia
Urea breath test
Helicobacter pylori detectionmdashdiagnosis and confirmation of eradication
B12 absorption studies
Vitamin B12 malabsorption pernicious anaemia
Labelled leukocyte imaging
Sepsis localization Inflammatory bowel disease to help determine extent and severity
Dacroscintigraphy
Epiphora
MIBG (meta iodobenzylguanidine)imaging Localisation staging and response monitoring of neuroectodermal tumours Phaeochromocytoma (imaging investigation of choice) Neuroblastoma Carcinoid tumours Medullary thyroid cancer
SUMMARY NUCLEAR MEDICINE IMAGING IS
IMPORTANT IN FUNCTIONAL ASSESSMENT OF VARIOUS ORGANS
SIMPLE AND NON INVASIVE PROCEDURES
COST EFFECTIVE
RADIO IMMUNO ASSAY IS GOLD STANDARD
RADIO NUCLIDE THERAPY INCREASES SURVIVAL
RATE
THANK YOU
Na99mTcO4 Thyroid Scintigraphy - Avid Uptake with increased T3 and T4
FD - Thyrotoxicosis
Na99mTcO4 Thyroid Scintigraphy - A large Cold nodule involving the RtLobe
US - Cyst
Parathyroid Adenoma - 99mTc Sesta MIBI Scan
Thyroid in 5 min scan
20 min scan No wash out in Parathyroid Adenoma
LUNG SCANA Ventilationperfusion imaging (VQ Scan)
Indications Suspected pulmonary embolism Pre-operative lung function assessment
B Lung shunt studies
Indications
Suspected pulmonary AV shuntingInterpretation
1 Segmental perfusion loss with preserved ventilationmdash
pulmonary embolism2 Segmental matched perfusion and ventilation lossmdash
pulmonary infarctioninfection3 Segmentalsubsegmental ventilation loss with preserved
perfusionmdashinfection4 Non-segmental patchy matched perfusion and ventilation
LOSSmdashCOPD
NORMAL 99M TC DTPA AEROSOL STUDY
PERFUSION DEFECTS IN PULMONARY EMBOLISM
RENAL AND ADRENAL SCINTIGRAPHY
1 Static cortical renographyDMSA imaging
Urinary tract infection lsquogold standardrsquo for renal scarring Measurement of relative renal function Renal duplication assessment Ectopic kidney localisation Renal trauma Renal vein thrombosis Pre-biopsy
2 Dynamic renography
Assessment of renal drainagemdashdiscrimination between
renal dilatation and outflow obstruction Measurement of relative renal function Loin pain Post-pyeloplasty follow-up Renal artery stenosismdash1048585Captopril renography
3Adrenal Scan Used to accurately localize a pheochromocytoma when MRI or CT is
equivocal Uses labeled MIBG
Plain Renal Dynamic Studies
Tc-99m labelled DTPA is used for Renal scintigraphy (1) RENOGRAM - PLAIN STUDY amp WITH DIURETIC INTERVENSION
Useful for evaluation of obstructive uropathies to know whether obstruction is due to functional or organic causes
Contracted left kidney Scars over both poles of the Right Kidney
99mTc DMSA- Renal Cortical Image
HEART SCINTIGRAPHY
Myocardial perfusion imaging (MPI)
Indications
In ischaemic heart disease
1 Pre-angiography ndash When conventional stress testing fails eg
bundle branch blockndash Left ventricular hypertrophyndash Atypical chest painndash Recurrent chest pain post-intervention
2 Post-angiography
ndash Assess functional significance of known stenosesndash Identify critical vascular territory for
intervention
99MTC MIBI SPECT IMAGES - NORMAL STUDY
Short Axis
Vertical Long Axis
Horizontal Long Axis
Polar Map
3D image of LV
99MTC MIBI SPECT IMAGES - INFARCTION
Short Axis
Vertical Long Axis
Horizontal Long Axis
Polar Map
3D image of LV
LIVER AND GASTROINTESTINAL TRACT SCINTIGRAPHY
Hepatobiliary scintigraphy (HIDA-Scan BIDA-Scan)
Indications1 Acute cholecystitis2 Trauma3 Post-operative leak detection4 Bile ductstent patency5 Gallbladder emptying6 Bile reflux7 Neonatal biliary atresia
Gastrointestinal bleeding labelled red cell imaging
Helps localise source of active GI haemorrhage when other techniques(eg endoscopy or angiography) have failed
Gastric emptying studie
Altered GI motilitymdashdelayed or accelerated gastric emptying
Meckelrsquos scan ectopic gastric mucosa localisation Unexplained abdominal pain or GI hemorrhagemdashafter endoscopycontrast radiology
Meenakshi Isotope Scan and Thyroid Care Centre
99mTc Mebrofenin (Trimethyl Bromo Imino Diacetic Acid) Hepato Biliary Scan
5 min
2 h
Post meal
4 h 24 h
40 min
10 min
20 min
Total Biliary Channel Obstruction
G I BLEED STUDY
Blood Pool Scan 99m Tc labelled RBCs are used
To differentiate Hemangioma of the Liver from Hepatoma amp evaluation of G I Bleeding
Meenakshi Isotope Scan and Thyroid Care Centre
99mTc Mebrofenin Hepato Biliary Scan
20 min
5 min
10 min
30 min
4 hPost Meal
4 h
5 min 10 min
20 min 40 min 2 h
Post meal
24 h
Normal Biliary Atresia
RADIONUCLIDE THERAPY
131 I Therapy for Thyrotoxicosis
131 I Therapy for Ca Thyroid
32 P Therapy for pain palliation
OTHERS NUCLEAR SCANSSomatostatin scintigraphy
Localise and stage neuroendocrine tumours (NETs) eg carcinoid insulinoma gastrinoma phaeochromocytoma and medullary thyroid cancer
Lymphoscintigraphy
Unexplained limb swelling eg lymphatic hypoplasia
Urea breath test
Helicobacter pylori detectionmdashdiagnosis and confirmation of eradication
B12 absorption studies
Vitamin B12 malabsorption pernicious anaemia
Labelled leukocyte imaging
Sepsis localization Inflammatory bowel disease to help determine extent and severity
Dacroscintigraphy
Epiphora
MIBG (meta iodobenzylguanidine)imaging Localisation staging and response monitoring of neuroectodermal tumours Phaeochromocytoma (imaging investigation of choice) Neuroblastoma Carcinoid tumours Medullary thyroid cancer
SUMMARY NUCLEAR MEDICINE IMAGING IS
IMPORTANT IN FUNCTIONAL ASSESSMENT OF VARIOUS ORGANS
SIMPLE AND NON INVASIVE PROCEDURES
COST EFFECTIVE
RADIO IMMUNO ASSAY IS GOLD STANDARD
RADIO NUCLIDE THERAPY INCREASES SURVIVAL
RATE
THANK YOU
Na99mTcO4 Thyroid Scintigraphy - A large Cold nodule involving the RtLobe
US - Cyst
Parathyroid Adenoma - 99mTc Sesta MIBI Scan
Thyroid in 5 min scan
20 min scan No wash out in Parathyroid Adenoma
LUNG SCANA Ventilationperfusion imaging (VQ Scan)
Indications Suspected pulmonary embolism Pre-operative lung function assessment
B Lung shunt studies
Indications
Suspected pulmonary AV shuntingInterpretation
1 Segmental perfusion loss with preserved ventilationmdash
pulmonary embolism2 Segmental matched perfusion and ventilation lossmdash
pulmonary infarctioninfection3 Segmentalsubsegmental ventilation loss with preserved
perfusionmdashinfection4 Non-segmental patchy matched perfusion and ventilation
LOSSmdashCOPD
NORMAL 99M TC DTPA AEROSOL STUDY
PERFUSION DEFECTS IN PULMONARY EMBOLISM
RENAL AND ADRENAL SCINTIGRAPHY
1 Static cortical renographyDMSA imaging
Urinary tract infection lsquogold standardrsquo for renal scarring Measurement of relative renal function Renal duplication assessment Ectopic kidney localisation Renal trauma Renal vein thrombosis Pre-biopsy
2 Dynamic renography
Assessment of renal drainagemdashdiscrimination between
renal dilatation and outflow obstruction Measurement of relative renal function Loin pain Post-pyeloplasty follow-up Renal artery stenosismdash1048585Captopril renography
3Adrenal Scan Used to accurately localize a pheochromocytoma when MRI or CT is
equivocal Uses labeled MIBG
Plain Renal Dynamic Studies
Tc-99m labelled DTPA is used for Renal scintigraphy (1) RENOGRAM - PLAIN STUDY amp WITH DIURETIC INTERVENSION
Useful for evaluation of obstructive uropathies to know whether obstruction is due to functional or organic causes
Contracted left kidney Scars over both poles of the Right Kidney
99mTc DMSA- Renal Cortical Image
HEART SCINTIGRAPHY
Myocardial perfusion imaging (MPI)
Indications
In ischaemic heart disease
1 Pre-angiography ndash When conventional stress testing fails eg
bundle branch blockndash Left ventricular hypertrophyndash Atypical chest painndash Recurrent chest pain post-intervention
2 Post-angiography
ndash Assess functional significance of known stenosesndash Identify critical vascular territory for
intervention
99MTC MIBI SPECT IMAGES - NORMAL STUDY
Short Axis
Vertical Long Axis
Horizontal Long Axis
Polar Map
3D image of LV
99MTC MIBI SPECT IMAGES - INFARCTION
Short Axis
Vertical Long Axis
Horizontal Long Axis
Polar Map
3D image of LV
LIVER AND GASTROINTESTINAL TRACT SCINTIGRAPHY
Hepatobiliary scintigraphy (HIDA-Scan BIDA-Scan)
Indications1 Acute cholecystitis2 Trauma3 Post-operative leak detection4 Bile ductstent patency5 Gallbladder emptying6 Bile reflux7 Neonatal biliary atresia
Gastrointestinal bleeding labelled red cell imaging
Helps localise source of active GI haemorrhage when other techniques(eg endoscopy or angiography) have failed
Gastric emptying studie
Altered GI motilitymdashdelayed or accelerated gastric emptying
Meckelrsquos scan ectopic gastric mucosa localisation Unexplained abdominal pain or GI hemorrhagemdashafter endoscopycontrast radiology
Meenakshi Isotope Scan and Thyroid Care Centre
99mTc Mebrofenin (Trimethyl Bromo Imino Diacetic Acid) Hepato Biliary Scan
5 min
2 h
Post meal
4 h 24 h
40 min
10 min
20 min
Total Biliary Channel Obstruction
G I BLEED STUDY
Blood Pool Scan 99m Tc labelled RBCs are used
To differentiate Hemangioma of the Liver from Hepatoma amp evaluation of G I Bleeding
Meenakshi Isotope Scan and Thyroid Care Centre
99mTc Mebrofenin Hepato Biliary Scan
20 min
5 min
10 min
30 min
4 hPost Meal
4 h
5 min 10 min
20 min 40 min 2 h
Post meal
24 h
Normal Biliary Atresia
RADIONUCLIDE THERAPY
131 I Therapy for Thyrotoxicosis
131 I Therapy for Ca Thyroid
32 P Therapy for pain palliation
OTHERS NUCLEAR SCANSSomatostatin scintigraphy
Localise and stage neuroendocrine tumours (NETs) eg carcinoid insulinoma gastrinoma phaeochromocytoma and medullary thyroid cancer
Lymphoscintigraphy
Unexplained limb swelling eg lymphatic hypoplasia
Urea breath test
Helicobacter pylori detectionmdashdiagnosis and confirmation of eradication
B12 absorption studies
Vitamin B12 malabsorption pernicious anaemia
Labelled leukocyte imaging
Sepsis localization Inflammatory bowel disease to help determine extent and severity
Dacroscintigraphy
Epiphora
MIBG (meta iodobenzylguanidine)imaging Localisation staging and response monitoring of neuroectodermal tumours Phaeochromocytoma (imaging investigation of choice) Neuroblastoma Carcinoid tumours Medullary thyroid cancer
SUMMARY NUCLEAR MEDICINE IMAGING IS
IMPORTANT IN FUNCTIONAL ASSESSMENT OF VARIOUS ORGANS
SIMPLE AND NON INVASIVE PROCEDURES
COST EFFECTIVE
RADIO IMMUNO ASSAY IS GOLD STANDARD
RADIO NUCLIDE THERAPY INCREASES SURVIVAL
RATE
THANK YOU
Parathyroid Adenoma - 99mTc Sesta MIBI Scan
Thyroid in 5 min scan
20 min scan No wash out in Parathyroid Adenoma
LUNG SCANA Ventilationperfusion imaging (VQ Scan)
Indications Suspected pulmonary embolism Pre-operative lung function assessment
B Lung shunt studies
Indications
Suspected pulmonary AV shuntingInterpretation
1 Segmental perfusion loss with preserved ventilationmdash
pulmonary embolism2 Segmental matched perfusion and ventilation lossmdash
pulmonary infarctioninfection3 Segmentalsubsegmental ventilation loss with preserved
perfusionmdashinfection4 Non-segmental patchy matched perfusion and ventilation
LOSSmdashCOPD
NORMAL 99M TC DTPA AEROSOL STUDY
PERFUSION DEFECTS IN PULMONARY EMBOLISM
RENAL AND ADRENAL SCINTIGRAPHY
1 Static cortical renographyDMSA imaging
Urinary tract infection lsquogold standardrsquo for renal scarring Measurement of relative renal function Renal duplication assessment Ectopic kidney localisation Renal trauma Renal vein thrombosis Pre-biopsy
2 Dynamic renography
Assessment of renal drainagemdashdiscrimination between
renal dilatation and outflow obstruction Measurement of relative renal function Loin pain Post-pyeloplasty follow-up Renal artery stenosismdash1048585Captopril renography
3Adrenal Scan Used to accurately localize a pheochromocytoma when MRI or CT is
equivocal Uses labeled MIBG
Plain Renal Dynamic Studies
Tc-99m labelled DTPA is used for Renal scintigraphy (1) RENOGRAM - PLAIN STUDY amp WITH DIURETIC INTERVENSION
Useful for evaluation of obstructive uropathies to know whether obstruction is due to functional or organic causes
Contracted left kidney Scars over both poles of the Right Kidney
99mTc DMSA- Renal Cortical Image
HEART SCINTIGRAPHY
Myocardial perfusion imaging (MPI)
Indications
In ischaemic heart disease
1 Pre-angiography ndash When conventional stress testing fails eg
bundle branch blockndash Left ventricular hypertrophyndash Atypical chest painndash Recurrent chest pain post-intervention
2 Post-angiography
ndash Assess functional significance of known stenosesndash Identify critical vascular territory for
intervention
99MTC MIBI SPECT IMAGES - NORMAL STUDY
Short Axis
Vertical Long Axis
Horizontal Long Axis
Polar Map
3D image of LV
99MTC MIBI SPECT IMAGES - INFARCTION
Short Axis
Vertical Long Axis
Horizontal Long Axis
Polar Map
3D image of LV
LIVER AND GASTROINTESTINAL TRACT SCINTIGRAPHY
Hepatobiliary scintigraphy (HIDA-Scan BIDA-Scan)
Indications1 Acute cholecystitis2 Trauma3 Post-operative leak detection4 Bile ductstent patency5 Gallbladder emptying6 Bile reflux7 Neonatal biliary atresia
Gastrointestinal bleeding labelled red cell imaging
Helps localise source of active GI haemorrhage when other techniques(eg endoscopy or angiography) have failed
Gastric emptying studie
Altered GI motilitymdashdelayed or accelerated gastric emptying
Meckelrsquos scan ectopic gastric mucosa localisation Unexplained abdominal pain or GI hemorrhagemdashafter endoscopycontrast radiology
Meenakshi Isotope Scan and Thyroid Care Centre
99mTc Mebrofenin (Trimethyl Bromo Imino Diacetic Acid) Hepato Biliary Scan
5 min
2 h
Post meal
4 h 24 h
40 min
10 min
20 min
Total Biliary Channel Obstruction
G I BLEED STUDY
Blood Pool Scan 99m Tc labelled RBCs are used
To differentiate Hemangioma of the Liver from Hepatoma amp evaluation of G I Bleeding
Meenakshi Isotope Scan and Thyroid Care Centre
99mTc Mebrofenin Hepato Biliary Scan
20 min
5 min
10 min
30 min
4 hPost Meal
4 h
5 min 10 min
20 min 40 min 2 h
Post meal
24 h
Normal Biliary Atresia
RADIONUCLIDE THERAPY
131 I Therapy for Thyrotoxicosis
131 I Therapy for Ca Thyroid
32 P Therapy for pain palliation
OTHERS NUCLEAR SCANSSomatostatin scintigraphy
Localise and stage neuroendocrine tumours (NETs) eg carcinoid insulinoma gastrinoma phaeochromocytoma and medullary thyroid cancer
Lymphoscintigraphy
Unexplained limb swelling eg lymphatic hypoplasia
Urea breath test
Helicobacter pylori detectionmdashdiagnosis and confirmation of eradication
B12 absorption studies
Vitamin B12 malabsorption pernicious anaemia
Labelled leukocyte imaging
Sepsis localization Inflammatory bowel disease to help determine extent and severity
Dacroscintigraphy
Epiphora
MIBG (meta iodobenzylguanidine)imaging Localisation staging and response monitoring of neuroectodermal tumours Phaeochromocytoma (imaging investigation of choice) Neuroblastoma Carcinoid tumours Medullary thyroid cancer
SUMMARY NUCLEAR MEDICINE IMAGING IS
IMPORTANT IN FUNCTIONAL ASSESSMENT OF VARIOUS ORGANS
SIMPLE AND NON INVASIVE PROCEDURES
COST EFFECTIVE
RADIO IMMUNO ASSAY IS GOLD STANDARD
RADIO NUCLIDE THERAPY INCREASES SURVIVAL
RATE
THANK YOU
LUNG SCANA Ventilationperfusion imaging (VQ Scan)
Indications Suspected pulmonary embolism Pre-operative lung function assessment
B Lung shunt studies
Indications
Suspected pulmonary AV shuntingInterpretation
1 Segmental perfusion loss with preserved ventilationmdash
pulmonary embolism2 Segmental matched perfusion and ventilation lossmdash
pulmonary infarctioninfection3 Segmentalsubsegmental ventilation loss with preserved
perfusionmdashinfection4 Non-segmental patchy matched perfusion and ventilation
LOSSmdashCOPD
NORMAL 99M TC DTPA AEROSOL STUDY
PERFUSION DEFECTS IN PULMONARY EMBOLISM
RENAL AND ADRENAL SCINTIGRAPHY
1 Static cortical renographyDMSA imaging
Urinary tract infection lsquogold standardrsquo for renal scarring Measurement of relative renal function Renal duplication assessment Ectopic kidney localisation Renal trauma Renal vein thrombosis Pre-biopsy
2 Dynamic renography
Assessment of renal drainagemdashdiscrimination between
renal dilatation and outflow obstruction Measurement of relative renal function Loin pain Post-pyeloplasty follow-up Renal artery stenosismdash1048585Captopril renography
3Adrenal Scan Used to accurately localize a pheochromocytoma when MRI or CT is
equivocal Uses labeled MIBG
Plain Renal Dynamic Studies
Tc-99m labelled DTPA is used for Renal scintigraphy (1) RENOGRAM - PLAIN STUDY amp WITH DIURETIC INTERVENSION
Useful for evaluation of obstructive uropathies to know whether obstruction is due to functional or organic causes
Contracted left kidney Scars over both poles of the Right Kidney
99mTc DMSA- Renal Cortical Image
HEART SCINTIGRAPHY
Myocardial perfusion imaging (MPI)
Indications
In ischaemic heart disease
1 Pre-angiography ndash When conventional stress testing fails eg
bundle branch blockndash Left ventricular hypertrophyndash Atypical chest painndash Recurrent chest pain post-intervention
2 Post-angiography
ndash Assess functional significance of known stenosesndash Identify critical vascular territory for
intervention
99MTC MIBI SPECT IMAGES - NORMAL STUDY
Short Axis
Vertical Long Axis
Horizontal Long Axis
Polar Map
3D image of LV
99MTC MIBI SPECT IMAGES - INFARCTION
Short Axis
Vertical Long Axis
Horizontal Long Axis
Polar Map
3D image of LV
LIVER AND GASTROINTESTINAL TRACT SCINTIGRAPHY
Hepatobiliary scintigraphy (HIDA-Scan BIDA-Scan)
Indications1 Acute cholecystitis2 Trauma3 Post-operative leak detection4 Bile ductstent patency5 Gallbladder emptying6 Bile reflux7 Neonatal biliary atresia
Gastrointestinal bleeding labelled red cell imaging
Helps localise source of active GI haemorrhage when other techniques(eg endoscopy or angiography) have failed
Gastric emptying studie
Altered GI motilitymdashdelayed or accelerated gastric emptying
Meckelrsquos scan ectopic gastric mucosa localisation Unexplained abdominal pain or GI hemorrhagemdashafter endoscopycontrast radiology
Meenakshi Isotope Scan and Thyroid Care Centre
99mTc Mebrofenin (Trimethyl Bromo Imino Diacetic Acid) Hepato Biliary Scan
5 min
2 h
Post meal
4 h 24 h
40 min
10 min
20 min
Total Biliary Channel Obstruction
G I BLEED STUDY
Blood Pool Scan 99m Tc labelled RBCs are used
To differentiate Hemangioma of the Liver from Hepatoma amp evaluation of G I Bleeding
Meenakshi Isotope Scan and Thyroid Care Centre
99mTc Mebrofenin Hepato Biliary Scan
20 min
5 min
10 min
30 min
4 hPost Meal
4 h
5 min 10 min
20 min 40 min 2 h
Post meal
24 h
Normal Biliary Atresia
RADIONUCLIDE THERAPY
131 I Therapy for Thyrotoxicosis
131 I Therapy for Ca Thyroid
32 P Therapy for pain palliation
OTHERS NUCLEAR SCANSSomatostatin scintigraphy
Localise and stage neuroendocrine tumours (NETs) eg carcinoid insulinoma gastrinoma phaeochromocytoma and medullary thyroid cancer
Lymphoscintigraphy
Unexplained limb swelling eg lymphatic hypoplasia
Urea breath test
Helicobacter pylori detectionmdashdiagnosis and confirmation of eradication
B12 absorption studies
Vitamin B12 malabsorption pernicious anaemia
Labelled leukocyte imaging
Sepsis localization Inflammatory bowel disease to help determine extent and severity
Dacroscintigraphy
Epiphora
MIBG (meta iodobenzylguanidine)imaging Localisation staging and response monitoring of neuroectodermal tumours Phaeochromocytoma (imaging investigation of choice) Neuroblastoma Carcinoid tumours Medullary thyroid cancer
SUMMARY NUCLEAR MEDICINE IMAGING IS
IMPORTANT IN FUNCTIONAL ASSESSMENT OF VARIOUS ORGANS
SIMPLE AND NON INVASIVE PROCEDURES
COST EFFECTIVE
RADIO IMMUNO ASSAY IS GOLD STANDARD
RADIO NUCLIDE THERAPY INCREASES SURVIVAL
RATE
THANK YOU
NORMAL 99M TC DTPA AEROSOL STUDY
PERFUSION DEFECTS IN PULMONARY EMBOLISM
RENAL AND ADRENAL SCINTIGRAPHY
1 Static cortical renographyDMSA imaging
Urinary tract infection lsquogold standardrsquo for renal scarring Measurement of relative renal function Renal duplication assessment Ectopic kidney localisation Renal trauma Renal vein thrombosis Pre-biopsy
2 Dynamic renography
Assessment of renal drainagemdashdiscrimination between
renal dilatation and outflow obstruction Measurement of relative renal function Loin pain Post-pyeloplasty follow-up Renal artery stenosismdash1048585Captopril renography
3Adrenal Scan Used to accurately localize a pheochromocytoma when MRI or CT is
equivocal Uses labeled MIBG
Plain Renal Dynamic Studies
Tc-99m labelled DTPA is used for Renal scintigraphy (1) RENOGRAM - PLAIN STUDY amp WITH DIURETIC INTERVENSION
Useful for evaluation of obstructive uropathies to know whether obstruction is due to functional or organic causes
Contracted left kidney Scars over both poles of the Right Kidney
99mTc DMSA- Renal Cortical Image
HEART SCINTIGRAPHY
Myocardial perfusion imaging (MPI)
Indications
In ischaemic heart disease
1 Pre-angiography ndash When conventional stress testing fails eg
bundle branch blockndash Left ventricular hypertrophyndash Atypical chest painndash Recurrent chest pain post-intervention
2 Post-angiography
ndash Assess functional significance of known stenosesndash Identify critical vascular territory for
intervention
99MTC MIBI SPECT IMAGES - NORMAL STUDY
Short Axis
Vertical Long Axis
Horizontal Long Axis
Polar Map
3D image of LV
99MTC MIBI SPECT IMAGES - INFARCTION
Short Axis
Vertical Long Axis
Horizontal Long Axis
Polar Map
3D image of LV
LIVER AND GASTROINTESTINAL TRACT SCINTIGRAPHY
Hepatobiliary scintigraphy (HIDA-Scan BIDA-Scan)
Indications1 Acute cholecystitis2 Trauma3 Post-operative leak detection4 Bile ductstent patency5 Gallbladder emptying6 Bile reflux7 Neonatal biliary atresia
Gastrointestinal bleeding labelled red cell imaging
Helps localise source of active GI haemorrhage when other techniques(eg endoscopy or angiography) have failed
Gastric emptying studie
Altered GI motilitymdashdelayed or accelerated gastric emptying
Meckelrsquos scan ectopic gastric mucosa localisation Unexplained abdominal pain or GI hemorrhagemdashafter endoscopycontrast radiology
Meenakshi Isotope Scan and Thyroid Care Centre
99mTc Mebrofenin (Trimethyl Bromo Imino Diacetic Acid) Hepato Biliary Scan
5 min
2 h
Post meal
4 h 24 h
40 min
10 min
20 min
Total Biliary Channel Obstruction
G I BLEED STUDY
Blood Pool Scan 99m Tc labelled RBCs are used
To differentiate Hemangioma of the Liver from Hepatoma amp evaluation of G I Bleeding
Meenakshi Isotope Scan and Thyroid Care Centre
99mTc Mebrofenin Hepato Biliary Scan
20 min
5 min
10 min
30 min
4 hPost Meal
4 h
5 min 10 min
20 min 40 min 2 h
Post meal
24 h
Normal Biliary Atresia
RADIONUCLIDE THERAPY
131 I Therapy for Thyrotoxicosis
131 I Therapy for Ca Thyroid
32 P Therapy for pain palliation
OTHERS NUCLEAR SCANSSomatostatin scintigraphy
Localise and stage neuroendocrine tumours (NETs) eg carcinoid insulinoma gastrinoma phaeochromocytoma and medullary thyroid cancer
Lymphoscintigraphy
Unexplained limb swelling eg lymphatic hypoplasia
Urea breath test
Helicobacter pylori detectionmdashdiagnosis and confirmation of eradication
B12 absorption studies
Vitamin B12 malabsorption pernicious anaemia
Labelled leukocyte imaging
Sepsis localization Inflammatory bowel disease to help determine extent and severity
Dacroscintigraphy
Epiphora
MIBG (meta iodobenzylguanidine)imaging Localisation staging and response monitoring of neuroectodermal tumours Phaeochromocytoma (imaging investigation of choice) Neuroblastoma Carcinoid tumours Medullary thyroid cancer
SUMMARY NUCLEAR MEDICINE IMAGING IS
IMPORTANT IN FUNCTIONAL ASSESSMENT OF VARIOUS ORGANS
SIMPLE AND NON INVASIVE PROCEDURES
COST EFFECTIVE
RADIO IMMUNO ASSAY IS GOLD STANDARD
RADIO NUCLIDE THERAPY INCREASES SURVIVAL
RATE
THANK YOU
PERFUSION DEFECTS IN PULMONARY EMBOLISM
RENAL AND ADRENAL SCINTIGRAPHY
1 Static cortical renographyDMSA imaging
Urinary tract infection lsquogold standardrsquo for renal scarring Measurement of relative renal function Renal duplication assessment Ectopic kidney localisation Renal trauma Renal vein thrombosis Pre-biopsy
2 Dynamic renography
Assessment of renal drainagemdashdiscrimination between
renal dilatation and outflow obstruction Measurement of relative renal function Loin pain Post-pyeloplasty follow-up Renal artery stenosismdash1048585Captopril renography
3Adrenal Scan Used to accurately localize a pheochromocytoma when MRI or CT is
equivocal Uses labeled MIBG
Plain Renal Dynamic Studies
Tc-99m labelled DTPA is used for Renal scintigraphy (1) RENOGRAM - PLAIN STUDY amp WITH DIURETIC INTERVENSION
Useful for evaluation of obstructive uropathies to know whether obstruction is due to functional or organic causes
Contracted left kidney Scars over both poles of the Right Kidney
99mTc DMSA- Renal Cortical Image
HEART SCINTIGRAPHY
Myocardial perfusion imaging (MPI)
Indications
In ischaemic heart disease
1 Pre-angiography ndash When conventional stress testing fails eg
bundle branch blockndash Left ventricular hypertrophyndash Atypical chest painndash Recurrent chest pain post-intervention
2 Post-angiography
ndash Assess functional significance of known stenosesndash Identify critical vascular territory for
intervention
99MTC MIBI SPECT IMAGES - NORMAL STUDY
Short Axis
Vertical Long Axis
Horizontal Long Axis
Polar Map
3D image of LV
99MTC MIBI SPECT IMAGES - INFARCTION
Short Axis
Vertical Long Axis
Horizontal Long Axis
Polar Map
3D image of LV
LIVER AND GASTROINTESTINAL TRACT SCINTIGRAPHY
Hepatobiliary scintigraphy (HIDA-Scan BIDA-Scan)
Indications1 Acute cholecystitis2 Trauma3 Post-operative leak detection4 Bile ductstent patency5 Gallbladder emptying6 Bile reflux7 Neonatal biliary atresia
Gastrointestinal bleeding labelled red cell imaging
Helps localise source of active GI haemorrhage when other techniques(eg endoscopy or angiography) have failed
Gastric emptying studie
Altered GI motilitymdashdelayed or accelerated gastric emptying
Meckelrsquos scan ectopic gastric mucosa localisation Unexplained abdominal pain or GI hemorrhagemdashafter endoscopycontrast radiology
Meenakshi Isotope Scan and Thyroid Care Centre
99mTc Mebrofenin (Trimethyl Bromo Imino Diacetic Acid) Hepato Biliary Scan
5 min
2 h
Post meal
4 h 24 h
40 min
10 min
20 min
Total Biliary Channel Obstruction
G I BLEED STUDY
Blood Pool Scan 99m Tc labelled RBCs are used
To differentiate Hemangioma of the Liver from Hepatoma amp evaluation of G I Bleeding
Meenakshi Isotope Scan and Thyroid Care Centre
99mTc Mebrofenin Hepato Biliary Scan
20 min
5 min
10 min
30 min
4 hPost Meal
4 h
5 min 10 min
20 min 40 min 2 h
Post meal
24 h
Normal Biliary Atresia
RADIONUCLIDE THERAPY
131 I Therapy for Thyrotoxicosis
131 I Therapy for Ca Thyroid
32 P Therapy for pain palliation
OTHERS NUCLEAR SCANSSomatostatin scintigraphy
Localise and stage neuroendocrine tumours (NETs) eg carcinoid insulinoma gastrinoma phaeochromocytoma and medullary thyroid cancer
Lymphoscintigraphy
Unexplained limb swelling eg lymphatic hypoplasia
Urea breath test
Helicobacter pylori detectionmdashdiagnosis and confirmation of eradication
B12 absorption studies
Vitamin B12 malabsorption pernicious anaemia
Labelled leukocyte imaging
Sepsis localization Inflammatory bowel disease to help determine extent and severity
Dacroscintigraphy
Epiphora
MIBG (meta iodobenzylguanidine)imaging Localisation staging and response monitoring of neuroectodermal tumours Phaeochromocytoma (imaging investigation of choice) Neuroblastoma Carcinoid tumours Medullary thyroid cancer
SUMMARY NUCLEAR MEDICINE IMAGING IS
IMPORTANT IN FUNCTIONAL ASSESSMENT OF VARIOUS ORGANS
SIMPLE AND NON INVASIVE PROCEDURES
COST EFFECTIVE
RADIO IMMUNO ASSAY IS GOLD STANDARD
RADIO NUCLIDE THERAPY INCREASES SURVIVAL
RATE
THANK YOU
RENAL AND ADRENAL SCINTIGRAPHY
1 Static cortical renographyDMSA imaging
Urinary tract infection lsquogold standardrsquo for renal scarring Measurement of relative renal function Renal duplication assessment Ectopic kidney localisation Renal trauma Renal vein thrombosis Pre-biopsy
2 Dynamic renography
Assessment of renal drainagemdashdiscrimination between
renal dilatation and outflow obstruction Measurement of relative renal function Loin pain Post-pyeloplasty follow-up Renal artery stenosismdash1048585Captopril renography
3Adrenal Scan Used to accurately localize a pheochromocytoma when MRI or CT is
equivocal Uses labeled MIBG
Plain Renal Dynamic Studies
Tc-99m labelled DTPA is used for Renal scintigraphy (1) RENOGRAM - PLAIN STUDY amp WITH DIURETIC INTERVENSION
Useful for evaluation of obstructive uropathies to know whether obstruction is due to functional or organic causes
Contracted left kidney Scars over both poles of the Right Kidney
99mTc DMSA- Renal Cortical Image
HEART SCINTIGRAPHY
Myocardial perfusion imaging (MPI)
Indications
In ischaemic heart disease
1 Pre-angiography ndash When conventional stress testing fails eg
bundle branch blockndash Left ventricular hypertrophyndash Atypical chest painndash Recurrent chest pain post-intervention
2 Post-angiography
ndash Assess functional significance of known stenosesndash Identify critical vascular territory for
intervention
99MTC MIBI SPECT IMAGES - NORMAL STUDY
Short Axis
Vertical Long Axis
Horizontal Long Axis
Polar Map
3D image of LV
99MTC MIBI SPECT IMAGES - INFARCTION
Short Axis
Vertical Long Axis
Horizontal Long Axis
Polar Map
3D image of LV
LIVER AND GASTROINTESTINAL TRACT SCINTIGRAPHY
Hepatobiliary scintigraphy (HIDA-Scan BIDA-Scan)
Indications1 Acute cholecystitis2 Trauma3 Post-operative leak detection4 Bile ductstent patency5 Gallbladder emptying6 Bile reflux7 Neonatal biliary atresia
Gastrointestinal bleeding labelled red cell imaging
Helps localise source of active GI haemorrhage when other techniques(eg endoscopy or angiography) have failed
Gastric emptying studie
Altered GI motilitymdashdelayed or accelerated gastric emptying
Meckelrsquos scan ectopic gastric mucosa localisation Unexplained abdominal pain or GI hemorrhagemdashafter endoscopycontrast radiology
Meenakshi Isotope Scan and Thyroid Care Centre
99mTc Mebrofenin (Trimethyl Bromo Imino Diacetic Acid) Hepato Biliary Scan
5 min
2 h
Post meal
4 h 24 h
40 min
10 min
20 min
Total Biliary Channel Obstruction
G I BLEED STUDY
Blood Pool Scan 99m Tc labelled RBCs are used
To differentiate Hemangioma of the Liver from Hepatoma amp evaluation of G I Bleeding
Meenakshi Isotope Scan and Thyroid Care Centre
99mTc Mebrofenin Hepato Biliary Scan
20 min
5 min
10 min
30 min
4 hPost Meal
4 h
5 min 10 min
20 min 40 min 2 h
Post meal
24 h
Normal Biliary Atresia
RADIONUCLIDE THERAPY
131 I Therapy for Thyrotoxicosis
131 I Therapy for Ca Thyroid
32 P Therapy for pain palliation
OTHERS NUCLEAR SCANSSomatostatin scintigraphy
Localise and stage neuroendocrine tumours (NETs) eg carcinoid insulinoma gastrinoma phaeochromocytoma and medullary thyroid cancer
Lymphoscintigraphy
Unexplained limb swelling eg lymphatic hypoplasia
Urea breath test
Helicobacter pylori detectionmdashdiagnosis and confirmation of eradication
B12 absorption studies
Vitamin B12 malabsorption pernicious anaemia
Labelled leukocyte imaging
Sepsis localization Inflammatory bowel disease to help determine extent and severity
Dacroscintigraphy
Epiphora
MIBG (meta iodobenzylguanidine)imaging Localisation staging and response monitoring of neuroectodermal tumours Phaeochromocytoma (imaging investigation of choice) Neuroblastoma Carcinoid tumours Medullary thyroid cancer
SUMMARY NUCLEAR MEDICINE IMAGING IS
IMPORTANT IN FUNCTIONAL ASSESSMENT OF VARIOUS ORGANS
SIMPLE AND NON INVASIVE PROCEDURES
COST EFFECTIVE
RADIO IMMUNO ASSAY IS GOLD STANDARD
RADIO NUCLIDE THERAPY INCREASES SURVIVAL
RATE
THANK YOU
Plain Renal Dynamic Studies
Tc-99m labelled DTPA is used for Renal scintigraphy (1) RENOGRAM - PLAIN STUDY amp WITH DIURETIC INTERVENSION
Useful for evaluation of obstructive uropathies to know whether obstruction is due to functional or organic causes
Contracted left kidney Scars over both poles of the Right Kidney
99mTc DMSA- Renal Cortical Image
HEART SCINTIGRAPHY
Myocardial perfusion imaging (MPI)
Indications
In ischaemic heart disease
1 Pre-angiography ndash When conventional stress testing fails eg
bundle branch blockndash Left ventricular hypertrophyndash Atypical chest painndash Recurrent chest pain post-intervention
2 Post-angiography
ndash Assess functional significance of known stenosesndash Identify critical vascular territory for
intervention
99MTC MIBI SPECT IMAGES - NORMAL STUDY
Short Axis
Vertical Long Axis
Horizontal Long Axis
Polar Map
3D image of LV
99MTC MIBI SPECT IMAGES - INFARCTION
Short Axis
Vertical Long Axis
Horizontal Long Axis
Polar Map
3D image of LV
LIVER AND GASTROINTESTINAL TRACT SCINTIGRAPHY
Hepatobiliary scintigraphy (HIDA-Scan BIDA-Scan)
Indications1 Acute cholecystitis2 Trauma3 Post-operative leak detection4 Bile ductstent patency5 Gallbladder emptying6 Bile reflux7 Neonatal biliary atresia
Gastrointestinal bleeding labelled red cell imaging
Helps localise source of active GI haemorrhage when other techniques(eg endoscopy or angiography) have failed
Gastric emptying studie
Altered GI motilitymdashdelayed or accelerated gastric emptying
Meckelrsquos scan ectopic gastric mucosa localisation Unexplained abdominal pain or GI hemorrhagemdashafter endoscopycontrast radiology
Meenakshi Isotope Scan and Thyroid Care Centre
99mTc Mebrofenin (Trimethyl Bromo Imino Diacetic Acid) Hepato Biliary Scan
5 min
2 h
Post meal
4 h 24 h
40 min
10 min
20 min
Total Biliary Channel Obstruction
G I BLEED STUDY
Blood Pool Scan 99m Tc labelled RBCs are used
To differentiate Hemangioma of the Liver from Hepatoma amp evaluation of G I Bleeding
Meenakshi Isotope Scan and Thyroid Care Centre
99mTc Mebrofenin Hepato Biliary Scan
20 min
5 min
10 min
30 min
4 hPost Meal
4 h
5 min 10 min
20 min 40 min 2 h
Post meal
24 h
Normal Biliary Atresia
RADIONUCLIDE THERAPY
131 I Therapy for Thyrotoxicosis
131 I Therapy for Ca Thyroid
32 P Therapy for pain palliation
OTHERS NUCLEAR SCANSSomatostatin scintigraphy
Localise and stage neuroendocrine tumours (NETs) eg carcinoid insulinoma gastrinoma phaeochromocytoma and medullary thyroid cancer
Lymphoscintigraphy
Unexplained limb swelling eg lymphatic hypoplasia
Urea breath test
Helicobacter pylori detectionmdashdiagnosis and confirmation of eradication
B12 absorption studies
Vitamin B12 malabsorption pernicious anaemia
Labelled leukocyte imaging
Sepsis localization Inflammatory bowel disease to help determine extent and severity
Dacroscintigraphy
Epiphora
MIBG (meta iodobenzylguanidine)imaging Localisation staging and response monitoring of neuroectodermal tumours Phaeochromocytoma (imaging investigation of choice) Neuroblastoma Carcinoid tumours Medullary thyroid cancer
SUMMARY NUCLEAR MEDICINE IMAGING IS
IMPORTANT IN FUNCTIONAL ASSESSMENT OF VARIOUS ORGANS
SIMPLE AND NON INVASIVE PROCEDURES
COST EFFECTIVE
RADIO IMMUNO ASSAY IS GOLD STANDARD
RADIO NUCLIDE THERAPY INCREASES SURVIVAL
RATE
THANK YOU
Contracted left kidney Scars over both poles of the Right Kidney
99mTc DMSA- Renal Cortical Image
HEART SCINTIGRAPHY
Myocardial perfusion imaging (MPI)
Indications
In ischaemic heart disease
1 Pre-angiography ndash When conventional stress testing fails eg
bundle branch blockndash Left ventricular hypertrophyndash Atypical chest painndash Recurrent chest pain post-intervention
2 Post-angiography
ndash Assess functional significance of known stenosesndash Identify critical vascular territory for
intervention
99MTC MIBI SPECT IMAGES - NORMAL STUDY
Short Axis
Vertical Long Axis
Horizontal Long Axis
Polar Map
3D image of LV
99MTC MIBI SPECT IMAGES - INFARCTION
Short Axis
Vertical Long Axis
Horizontal Long Axis
Polar Map
3D image of LV
LIVER AND GASTROINTESTINAL TRACT SCINTIGRAPHY
Hepatobiliary scintigraphy (HIDA-Scan BIDA-Scan)
Indications1 Acute cholecystitis2 Trauma3 Post-operative leak detection4 Bile ductstent patency5 Gallbladder emptying6 Bile reflux7 Neonatal biliary atresia
Gastrointestinal bleeding labelled red cell imaging
Helps localise source of active GI haemorrhage when other techniques(eg endoscopy or angiography) have failed
Gastric emptying studie
Altered GI motilitymdashdelayed or accelerated gastric emptying
Meckelrsquos scan ectopic gastric mucosa localisation Unexplained abdominal pain or GI hemorrhagemdashafter endoscopycontrast radiology
Meenakshi Isotope Scan and Thyroid Care Centre
99mTc Mebrofenin (Trimethyl Bromo Imino Diacetic Acid) Hepato Biliary Scan
5 min
2 h
Post meal
4 h 24 h
40 min
10 min
20 min
Total Biliary Channel Obstruction
G I BLEED STUDY
Blood Pool Scan 99m Tc labelled RBCs are used
To differentiate Hemangioma of the Liver from Hepatoma amp evaluation of G I Bleeding
Meenakshi Isotope Scan and Thyroid Care Centre
99mTc Mebrofenin Hepato Biliary Scan
20 min
5 min
10 min
30 min
4 hPost Meal
4 h
5 min 10 min
20 min 40 min 2 h
Post meal
24 h
Normal Biliary Atresia
RADIONUCLIDE THERAPY
131 I Therapy for Thyrotoxicosis
131 I Therapy for Ca Thyroid
32 P Therapy for pain palliation
OTHERS NUCLEAR SCANSSomatostatin scintigraphy
Localise and stage neuroendocrine tumours (NETs) eg carcinoid insulinoma gastrinoma phaeochromocytoma and medullary thyroid cancer
Lymphoscintigraphy
Unexplained limb swelling eg lymphatic hypoplasia
Urea breath test
Helicobacter pylori detectionmdashdiagnosis and confirmation of eradication
B12 absorption studies
Vitamin B12 malabsorption pernicious anaemia
Labelled leukocyte imaging
Sepsis localization Inflammatory bowel disease to help determine extent and severity
Dacroscintigraphy
Epiphora
MIBG (meta iodobenzylguanidine)imaging Localisation staging and response monitoring of neuroectodermal tumours Phaeochromocytoma (imaging investigation of choice) Neuroblastoma Carcinoid tumours Medullary thyroid cancer
SUMMARY NUCLEAR MEDICINE IMAGING IS
IMPORTANT IN FUNCTIONAL ASSESSMENT OF VARIOUS ORGANS
SIMPLE AND NON INVASIVE PROCEDURES
COST EFFECTIVE
RADIO IMMUNO ASSAY IS GOLD STANDARD
RADIO NUCLIDE THERAPY INCREASES SURVIVAL
RATE
THANK YOU
HEART SCINTIGRAPHY
Myocardial perfusion imaging (MPI)
Indications
In ischaemic heart disease
1 Pre-angiography ndash When conventional stress testing fails eg
bundle branch blockndash Left ventricular hypertrophyndash Atypical chest painndash Recurrent chest pain post-intervention
2 Post-angiography
ndash Assess functional significance of known stenosesndash Identify critical vascular territory for
intervention
99MTC MIBI SPECT IMAGES - NORMAL STUDY
Short Axis
Vertical Long Axis
Horizontal Long Axis
Polar Map
3D image of LV
99MTC MIBI SPECT IMAGES - INFARCTION
Short Axis
Vertical Long Axis
Horizontal Long Axis
Polar Map
3D image of LV
LIVER AND GASTROINTESTINAL TRACT SCINTIGRAPHY
Hepatobiliary scintigraphy (HIDA-Scan BIDA-Scan)
Indications1 Acute cholecystitis2 Trauma3 Post-operative leak detection4 Bile ductstent patency5 Gallbladder emptying6 Bile reflux7 Neonatal biliary atresia
Gastrointestinal bleeding labelled red cell imaging
Helps localise source of active GI haemorrhage when other techniques(eg endoscopy or angiography) have failed
Gastric emptying studie
Altered GI motilitymdashdelayed or accelerated gastric emptying
Meckelrsquos scan ectopic gastric mucosa localisation Unexplained abdominal pain or GI hemorrhagemdashafter endoscopycontrast radiology
Meenakshi Isotope Scan and Thyroid Care Centre
99mTc Mebrofenin (Trimethyl Bromo Imino Diacetic Acid) Hepato Biliary Scan
5 min
2 h
Post meal
4 h 24 h
40 min
10 min
20 min
Total Biliary Channel Obstruction
G I BLEED STUDY
Blood Pool Scan 99m Tc labelled RBCs are used
To differentiate Hemangioma of the Liver from Hepatoma amp evaluation of G I Bleeding
Meenakshi Isotope Scan and Thyroid Care Centre
99mTc Mebrofenin Hepato Biliary Scan
20 min
5 min
10 min
30 min
4 hPost Meal
4 h
5 min 10 min
20 min 40 min 2 h
Post meal
24 h
Normal Biliary Atresia
RADIONUCLIDE THERAPY
131 I Therapy for Thyrotoxicosis
131 I Therapy for Ca Thyroid
32 P Therapy for pain palliation
OTHERS NUCLEAR SCANSSomatostatin scintigraphy
Localise and stage neuroendocrine tumours (NETs) eg carcinoid insulinoma gastrinoma phaeochromocytoma and medullary thyroid cancer
Lymphoscintigraphy
Unexplained limb swelling eg lymphatic hypoplasia
Urea breath test
Helicobacter pylori detectionmdashdiagnosis and confirmation of eradication
B12 absorption studies
Vitamin B12 malabsorption pernicious anaemia
Labelled leukocyte imaging
Sepsis localization Inflammatory bowel disease to help determine extent and severity
Dacroscintigraphy
Epiphora
MIBG (meta iodobenzylguanidine)imaging Localisation staging and response monitoring of neuroectodermal tumours Phaeochromocytoma (imaging investigation of choice) Neuroblastoma Carcinoid tumours Medullary thyroid cancer
SUMMARY NUCLEAR MEDICINE IMAGING IS
IMPORTANT IN FUNCTIONAL ASSESSMENT OF VARIOUS ORGANS
SIMPLE AND NON INVASIVE PROCEDURES
COST EFFECTIVE
RADIO IMMUNO ASSAY IS GOLD STANDARD
RADIO NUCLIDE THERAPY INCREASES SURVIVAL
RATE
THANK YOU
99MTC MIBI SPECT IMAGES - NORMAL STUDY
Short Axis
Vertical Long Axis
Horizontal Long Axis
Polar Map
3D image of LV
99MTC MIBI SPECT IMAGES - INFARCTION
Short Axis
Vertical Long Axis
Horizontal Long Axis
Polar Map
3D image of LV
LIVER AND GASTROINTESTINAL TRACT SCINTIGRAPHY
Hepatobiliary scintigraphy (HIDA-Scan BIDA-Scan)
Indications1 Acute cholecystitis2 Trauma3 Post-operative leak detection4 Bile ductstent patency5 Gallbladder emptying6 Bile reflux7 Neonatal biliary atresia
Gastrointestinal bleeding labelled red cell imaging
Helps localise source of active GI haemorrhage when other techniques(eg endoscopy or angiography) have failed
Gastric emptying studie
Altered GI motilitymdashdelayed or accelerated gastric emptying
Meckelrsquos scan ectopic gastric mucosa localisation Unexplained abdominal pain or GI hemorrhagemdashafter endoscopycontrast radiology
Meenakshi Isotope Scan and Thyroid Care Centre
99mTc Mebrofenin (Trimethyl Bromo Imino Diacetic Acid) Hepato Biliary Scan
5 min
2 h
Post meal
4 h 24 h
40 min
10 min
20 min
Total Biliary Channel Obstruction
G I BLEED STUDY
Blood Pool Scan 99m Tc labelled RBCs are used
To differentiate Hemangioma of the Liver from Hepatoma amp evaluation of G I Bleeding
Meenakshi Isotope Scan and Thyroid Care Centre
99mTc Mebrofenin Hepato Biliary Scan
20 min
5 min
10 min
30 min
4 hPost Meal
4 h
5 min 10 min
20 min 40 min 2 h
Post meal
24 h
Normal Biliary Atresia
RADIONUCLIDE THERAPY
131 I Therapy for Thyrotoxicosis
131 I Therapy for Ca Thyroid
32 P Therapy for pain palliation
OTHERS NUCLEAR SCANSSomatostatin scintigraphy
Localise and stage neuroendocrine tumours (NETs) eg carcinoid insulinoma gastrinoma phaeochromocytoma and medullary thyroid cancer
Lymphoscintigraphy
Unexplained limb swelling eg lymphatic hypoplasia
Urea breath test
Helicobacter pylori detectionmdashdiagnosis and confirmation of eradication
B12 absorption studies
Vitamin B12 malabsorption pernicious anaemia
Labelled leukocyte imaging
Sepsis localization Inflammatory bowel disease to help determine extent and severity
Dacroscintigraphy
Epiphora
MIBG (meta iodobenzylguanidine)imaging Localisation staging and response monitoring of neuroectodermal tumours Phaeochromocytoma (imaging investigation of choice) Neuroblastoma Carcinoid tumours Medullary thyroid cancer
SUMMARY NUCLEAR MEDICINE IMAGING IS
IMPORTANT IN FUNCTIONAL ASSESSMENT OF VARIOUS ORGANS
SIMPLE AND NON INVASIVE PROCEDURES
COST EFFECTIVE
RADIO IMMUNO ASSAY IS GOLD STANDARD
RADIO NUCLIDE THERAPY INCREASES SURVIVAL
RATE
THANK YOU
99MTC MIBI SPECT IMAGES - INFARCTION
Short Axis
Vertical Long Axis
Horizontal Long Axis
Polar Map
3D image of LV
LIVER AND GASTROINTESTINAL TRACT SCINTIGRAPHY
Hepatobiliary scintigraphy (HIDA-Scan BIDA-Scan)
Indications1 Acute cholecystitis2 Trauma3 Post-operative leak detection4 Bile ductstent patency5 Gallbladder emptying6 Bile reflux7 Neonatal biliary atresia
Gastrointestinal bleeding labelled red cell imaging
Helps localise source of active GI haemorrhage when other techniques(eg endoscopy or angiography) have failed
Gastric emptying studie
Altered GI motilitymdashdelayed or accelerated gastric emptying
Meckelrsquos scan ectopic gastric mucosa localisation Unexplained abdominal pain or GI hemorrhagemdashafter endoscopycontrast radiology
Meenakshi Isotope Scan and Thyroid Care Centre
99mTc Mebrofenin (Trimethyl Bromo Imino Diacetic Acid) Hepato Biliary Scan
5 min
2 h
Post meal
4 h 24 h
40 min
10 min
20 min
Total Biliary Channel Obstruction
G I BLEED STUDY
Blood Pool Scan 99m Tc labelled RBCs are used
To differentiate Hemangioma of the Liver from Hepatoma amp evaluation of G I Bleeding
Meenakshi Isotope Scan and Thyroid Care Centre
99mTc Mebrofenin Hepato Biliary Scan
20 min
5 min
10 min
30 min
4 hPost Meal
4 h
5 min 10 min
20 min 40 min 2 h
Post meal
24 h
Normal Biliary Atresia
RADIONUCLIDE THERAPY
131 I Therapy for Thyrotoxicosis
131 I Therapy for Ca Thyroid
32 P Therapy for pain palliation
OTHERS NUCLEAR SCANSSomatostatin scintigraphy
Localise and stage neuroendocrine tumours (NETs) eg carcinoid insulinoma gastrinoma phaeochromocytoma and medullary thyroid cancer
Lymphoscintigraphy
Unexplained limb swelling eg lymphatic hypoplasia
Urea breath test
Helicobacter pylori detectionmdashdiagnosis and confirmation of eradication
B12 absorption studies
Vitamin B12 malabsorption pernicious anaemia
Labelled leukocyte imaging
Sepsis localization Inflammatory bowel disease to help determine extent and severity
Dacroscintigraphy
Epiphora
MIBG (meta iodobenzylguanidine)imaging Localisation staging and response monitoring of neuroectodermal tumours Phaeochromocytoma (imaging investigation of choice) Neuroblastoma Carcinoid tumours Medullary thyroid cancer
SUMMARY NUCLEAR MEDICINE IMAGING IS
IMPORTANT IN FUNCTIONAL ASSESSMENT OF VARIOUS ORGANS
SIMPLE AND NON INVASIVE PROCEDURES
COST EFFECTIVE
RADIO IMMUNO ASSAY IS GOLD STANDARD
RADIO NUCLIDE THERAPY INCREASES SURVIVAL
RATE
THANK YOU
LIVER AND GASTROINTESTINAL TRACT SCINTIGRAPHY
Hepatobiliary scintigraphy (HIDA-Scan BIDA-Scan)
Indications1 Acute cholecystitis2 Trauma3 Post-operative leak detection4 Bile ductstent patency5 Gallbladder emptying6 Bile reflux7 Neonatal biliary atresia
Gastrointestinal bleeding labelled red cell imaging
Helps localise source of active GI haemorrhage when other techniques(eg endoscopy or angiography) have failed
Gastric emptying studie
Altered GI motilitymdashdelayed or accelerated gastric emptying
Meckelrsquos scan ectopic gastric mucosa localisation Unexplained abdominal pain or GI hemorrhagemdashafter endoscopycontrast radiology
Meenakshi Isotope Scan and Thyroid Care Centre
99mTc Mebrofenin (Trimethyl Bromo Imino Diacetic Acid) Hepato Biliary Scan
5 min
2 h
Post meal
4 h 24 h
40 min
10 min
20 min
Total Biliary Channel Obstruction
G I BLEED STUDY
Blood Pool Scan 99m Tc labelled RBCs are used
To differentiate Hemangioma of the Liver from Hepatoma amp evaluation of G I Bleeding
Meenakshi Isotope Scan and Thyroid Care Centre
99mTc Mebrofenin Hepato Biliary Scan
20 min
5 min
10 min
30 min
4 hPost Meal
4 h
5 min 10 min
20 min 40 min 2 h
Post meal
24 h
Normal Biliary Atresia
RADIONUCLIDE THERAPY
131 I Therapy for Thyrotoxicosis
131 I Therapy for Ca Thyroid
32 P Therapy for pain palliation
OTHERS NUCLEAR SCANSSomatostatin scintigraphy
Localise and stage neuroendocrine tumours (NETs) eg carcinoid insulinoma gastrinoma phaeochromocytoma and medullary thyroid cancer
Lymphoscintigraphy
Unexplained limb swelling eg lymphatic hypoplasia
Urea breath test
Helicobacter pylori detectionmdashdiagnosis and confirmation of eradication
B12 absorption studies
Vitamin B12 malabsorption pernicious anaemia
Labelled leukocyte imaging
Sepsis localization Inflammatory bowel disease to help determine extent and severity
Dacroscintigraphy
Epiphora
MIBG (meta iodobenzylguanidine)imaging Localisation staging and response monitoring of neuroectodermal tumours Phaeochromocytoma (imaging investigation of choice) Neuroblastoma Carcinoid tumours Medullary thyroid cancer
SUMMARY NUCLEAR MEDICINE IMAGING IS
IMPORTANT IN FUNCTIONAL ASSESSMENT OF VARIOUS ORGANS
SIMPLE AND NON INVASIVE PROCEDURES
COST EFFECTIVE
RADIO IMMUNO ASSAY IS GOLD STANDARD
RADIO NUCLIDE THERAPY INCREASES SURVIVAL
RATE
THANK YOU
Meenakshi Isotope Scan and Thyroid Care Centre
99mTc Mebrofenin (Trimethyl Bromo Imino Diacetic Acid) Hepato Biliary Scan
5 min
2 h
Post meal
4 h 24 h
40 min
10 min
20 min
Total Biliary Channel Obstruction
G I BLEED STUDY
Blood Pool Scan 99m Tc labelled RBCs are used
To differentiate Hemangioma of the Liver from Hepatoma amp evaluation of G I Bleeding
Meenakshi Isotope Scan and Thyroid Care Centre
99mTc Mebrofenin Hepato Biliary Scan
20 min
5 min
10 min
30 min
4 hPost Meal
4 h
5 min 10 min
20 min 40 min 2 h
Post meal
24 h
Normal Biliary Atresia
RADIONUCLIDE THERAPY
131 I Therapy for Thyrotoxicosis
131 I Therapy for Ca Thyroid
32 P Therapy for pain palliation
OTHERS NUCLEAR SCANSSomatostatin scintigraphy
Localise and stage neuroendocrine tumours (NETs) eg carcinoid insulinoma gastrinoma phaeochromocytoma and medullary thyroid cancer
Lymphoscintigraphy
Unexplained limb swelling eg lymphatic hypoplasia
Urea breath test
Helicobacter pylori detectionmdashdiagnosis and confirmation of eradication
B12 absorption studies
Vitamin B12 malabsorption pernicious anaemia
Labelled leukocyte imaging
Sepsis localization Inflammatory bowel disease to help determine extent and severity
Dacroscintigraphy
Epiphora
MIBG (meta iodobenzylguanidine)imaging Localisation staging and response monitoring of neuroectodermal tumours Phaeochromocytoma (imaging investigation of choice) Neuroblastoma Carcinoid tumours Medullary thyroid cancer
SUMMARY NUCLEAR MEDICINE IMAGING IS
IMPORTANT IN FUNCTIONAL ASSESSMENT OF VARIOUS ORGANS
SIMPLE AND NON INVASIVE PROCEDURES
COST EFFECTIVE
RADIO IMMUNO ASSAY IS GOLD STANDARD
RADIO NUCLIDE THERAPY INCREASES SURVIVAL
RATE
THANK YOU
G I BLEED STUDY
Blood Pool Scan 99m Tc labelled RBCs are used
To differentiate Hemangioma of the Liver from Hepatoma amp evaluation of G I Bleeding
Meenakshi Isotope Scan and Thyroid Care Centre
99mTc Mebrofenin Hepato Biliary Scan
20 min
5 min
10 min
30 min
4 hPost Meal
4 h
5 min 10 min
20 min 40 min 2 h
Post meal
24 h
Normal Biliary Atresia
RADIONUCLIDE THERAPY
131 I Therapy for Thyrotoxicosis
131 I Therapy for Ca Thyroid
32 P Therapy for pain palliation
OTHERS NUCLEAR SCANSSomatostatin scintigraphy
Localise and stage neuroendocrine tumours (NETs) eg carcinoid insulinoma gastrinoma phaeochromocytoma and medullary thyroid cancer
Lymphoscintigraphy
Unexplained limb swelling eg lymphatic hypoplasia
Urea breath test
Helicobacter pylori detectionmdashdiagnosis and confirmation of eradication
B12 absorption studies
Vitamin B12 malabsorption pernicious anaemia
Labelled leukocyte imaging
Sepsis localization Inflammatory bowel disease to help determine extent and severity
Dacroscintigraphy
Epiphora
MIBG (meta iodobenzylguanidine)imaging Localisation staging and response monitoring of neuroectodermal tumours Phaeochromocytoma (imaging investigation of choice) Neuroblastoma Carcinoid tumours Medullary thyroid cancer
SUMMARY NUCLEAR MEDICINE IMAGING IS
IMPORTANT IN FUNCTIONAL ASSESSMENT OF VARIOUS ORGANS
SIMPLE AND NON INVASIVE PROCEDURES
COST EFFECTIVE
RADIO IMMUNO ASSAY IS GOLD STANDARD
RADIO NUCLIDE THERAPY INCREASES SURVIVAL
RATE
THANK YOU
Meenakshi Isotope Scan and Thyroid Care Centre
99mTc Mebrofenin Hepato Biliary Scan
20 min
5 min
10 min
30 min
4 hPost Meal
4 h
5 min 10 min
20 min 40 min 2 h
Post meal
24 h
Normal Biliary Atresia
RADIONUCLIDE THERAPY
131 I Therapy for Thyrotoxicosis
131 I Therapy for Ca Thyroid
32 P Therapy for pain palliation
OTHERS NUCLEAR SCANSSomatostatin scintigraphy
Localise and stage neuroendocrine tumours (NETs) eg carcinoid insulinoma gastrinoma phaeochromocytoma and medullary thyroid cancer
Lymphoscintigraphy
Unexplained limb swelling eg lymphatic hypoplasia
Urea breath test
Helicobacter pylori detectionmdashdiagnosis and confirmation of eradication
B12 absorption studies
Vitamin B12 malabsorption pernicious anaemia
Labelled leukocyte imaging
Sepsis localization Inflammatory bowel disease to help determine extent and severity
Dacroscintigraphy
Epiphora
MIBG (meta iodobenzylguanidine)imaging Localisation staging and response monitoring of neuroectodermal tumours Phaeochromocytoma (imaging investigation of choice) Neuroblastoma Carcinoid tumours Medullary thyroid cancer
SUMMARY NUCLEAR MEDICINE IMAGING IS
IMPORTANT IN FUNCTIONAL ASSESSMENT OF VARIOUS ORGANS
SIMPLE AND NON INVASIVE PROCEDURES
COST EFFECTIVE
RADIO IMMUNO ASSAY IS GOLD STANDARD
RADIO NUCLIDE THERAPY INCREASES SURVIVAL
RATE
THANK YOU
RADIONUCLIDE THERAPY
131 I Therapy for Thyrotoxicosis
131 I Therapy for Ca Thyroid
32 P Therapy for pain palliation
OTHERS NUCLEAR SCANSSomatostatin scintigraphy
Localise and stage neuroendocrine tumours (NETs) eg carcinoid insulinoma gastrinoma phaeochromocytoma and medullary thyroid cancer
Lymphoscintigraphy
Unexplained limb swelling eg lymphatic hypoplasia
Urea breath test
Helicobacter pylori detectionmdashdiagnosis and confirmation of eradication
B12 absorption studies
Vitamin B12 malabsorption pernicious anaemia
Labelled leukocyte imaging
Sepsis localization Inflammatory bowel disease to help determine extent and severity
Dacroscintigraphy
Epiphora
MIBG (meta iodobenzylguanidine)imaging Localisation staging and response monitoring of neuroectodermal tumours Phaeochromocytoma (imaging investigation of choice) Neuroblastoma Carcinoid tumours Medullary thyroid cancer
SUMMARY NUCLEAR MEDICINE IMAGING IS
IMPORTANT IN FUNCTIONAL ASSESSMENT OF VARIOUS ORGANS
SIMPLE AND NON INVASIVE PROCEDURES
COST EFFECTIVE
RADIO IMMUNO ASSAY IS GOLD STANDARD
RADIO NUCLIDE THERAPY INCREASES SURVIVAL
RATE
THANK YOU
OTHERS NUCLEAR SCANSSomatostatin scintigraphy
Localise and stage neuroendocrine tumours (NETs) eg carcinoid insulinoma gastrinoma phaeochromocytoma and medullary thyroid cancer
Lymphoscintigraphy
Unexplained limb swelling eg lymphatic hypoplasia
Urea breath test
Helicobacter pylori detectionmdashdiagnosis and confirmation of eradication
B12 absorption studies
Vitamin B12 malabsorption pernicious anaemia
Labelled leukocyte imaging
Sepsis localization Inflammatory bowel disease to help determine extent and severity
Dacroscintigraphy
Epiphora
MIBG (meta iodobenzylguanidine)imaging Localisation staging and response monitoring of neuroectodermal tumours Phaeochromocytoma (imaging investigation of choice) Neuroblastoma Carcinoid tumours Medullary thyroid cancer
SUMMARY NUCLEAR MEDICINE IMAGING IS
IMPORTANT IN FUNCTIONAL ASSESSMENT OF VARIOUS ORGANS
SIMPLE AND NON INVASIVE PROCEDURES
COST EFFECTIVE
RADIO IMMUNO ASSAY IS GOLD STANDARD
RADIO NUCLIDE THERAPY INCREASES SURVIVAL
RATE
THANK YOU
SUMMARY NUCLEAR MEDICINE IMAGING IS
IMPORTANT IN FUNCTIONAL ASSESSMENT OF VARIOUS ORGANS
SIMPLE AND NON INVASIVE PROCEDURES
COST EFFECTIVE
RADIO IMMUNO ASSAY IS GOLD STANDARD
RADIO NUCLIDE THERAPY INCREASES SURVIVAL
RATE
THANK YOU
THANK YOU
