Nuclear Medicine

What ,where, why?
About Nuclear Medicine
Nuclear Medicine is the special branch of radiation medicine which deals with evaluation of organ function and treatment using radio nuclides. The use of Nuclear Medicine in the diagnosis & management of various clinical problems in children and adults has dramatically increased over the past several years. Nuclear Medicine procedures are generally non-invasive and performed without anesthesia or sedation and do not require hospitalization. Absorbed radiation dose from the radio-nuclide studies do not reach a harmful range and usually much lower than comparable radiographic tests. The main advantage of Nuclear Scans is the quantitative functional information, currently not available with other imaging modalities. Furthermore, there is enhanced diagnostic accuracy.

The following investigations are done in our Nuclear Medicine lab
I.Radio-Nuclide Renal studies
A. Renogram –Plain study

  • Evaluation of transplant kidney functions
  • Estimation of G F R
  • Estimation of the function of individual kidneys.

B. Renogram-Diuretic (Frusemide) intervention

  • useful for the evaluation of obstructive uropathies to know whether obstruction is functional or organic

C. Captopril Renogram (Ace inhibitor)

  • useful for evaluation of hypertensive patients not responding to routine antihypertensive drugs.
  • This test evaluates the possibilities of renal artery stenosis in suspected patients.

D. Direct/Indirect radio –nuclide voiding cystogram

  • useful for evaluation of v-u reflux.
  • especially suitable for pediatric patients as it is painless and easy to perform.

E. Renal Scan (DMSA)

  • useful for evaluation of pyelonephrities to see cortical scarring.

II. Cardio Vascular Studies
A. First pass study

  • useful for evaluation of right ventricular function and shunt evaluation.

B. Radio –nuclide Ventriculogram (RNV study)

  • useful for evolution of left and right ventricular function (ejection-fraction& regional wall motion abnormalities)

C. Stress RNV Study.

  • useful for screening of coronary artery diseases.

D. Thallium/Sestamibi/Tetrofosmin Myocardial Perfusion Scan

  • useful for evaluation of the myocardial ischemia & viability.

E. Radio-Nuclicide Venogram

  • useful for evolution of deep vein thrombosis

III. Pulmonary Scan
A. Lung Perfusion Scan

  • for evolution of pulmonary thrombo-embolism.

IV. Gastro –Intestinal studies
A. Oesophageal Transit Time
B. Localization of Gastro-Intestinal Bleeding areas
C. Meckel’s Diverticulum Scan.
D. Liver and Spleen Imaging more useful in detecting cirrhosis & secondaries.
E. Hepato-Bilary Study

  • to evaluate patency of hapato-billary system & post operative complication
  • to evaluate GB dysfunction (Gall bladder)

V. Endocrinology investigation
A. Thyroid Scan
B. Parathyroid Scan
C. Adrenal Imaging

VI. Skeletal Scinitigraphy

A. Whole Body Skeletal survey.

  • very useful for early detection of any bone lesion & screening of secondaries.

B. Solitary lesion bone scan.

  • useful for evaluation of benign bone lesion.

VII. Cerebral Perfusion Scan
A. Evolution of stroke , trauma & epileptic patients.

VIII. Other Special Investigations
A. Scintimammogram
B. Lymphoscinitigraphy.
C. Gallium Study.
D. Testicular Scan
E. 3 & 4 Phase Bone Scan
F. Soft Tissue Perfusion Study.
G. Dacryo Scintigraphy.

IX. Nuclear Therapy

A. Radio Iodine-131(I-131)abalation for

  • Hyperthyroidism / Thyrotoxicosis
  • Functioning type Thyroid Cancer

B. Strontium-89(SR89)phosphorus-32(p32) for

  • Metastatic Bone pain palliation
  • P-32 for polycythemia vera

C. yttrium –90/rhenium-186/erbium-169 for synovitic inflammation and irritations/chronic arthritis.

Where nuclear medicine is necessary?
In order to practice modern medicine it is necessary to obtain quantitative and reproducible parameters of organ functioning. It is also necessary to qualify the results of different treatment modalities to demonstrate objectively the benefits of treatment to patients. In this context the various radioisotope procedure are very useful. A doubt often arises in the minds of the patients and practioners as to whether a developing country like ours, needs Hi-tech medical equipment and if so, who needs it? The single answer to this is “The patients needs it.” The interpretation given by Nuclear Medicine investigations often avoid invasive and more expensive tests and help in better management of patients. Nuclear medicine puts to use the advances in molecular biology ,immunology and genetics to the care of patients. The role of Nuclear Medicine can only be grasped in the context of progress of disease, which visually starts as a local biochemical disturbance and in time tends to alter regional function and eventually produce local anatomic changes. Nuclear Medicine will thus detect early biochemical and functional alterations of disease, long before the later macroscopic anatomical effects are evident in the most advanced radiological study and even before clinical manifestations obvious to patients and doctors. The earlier diagnosis provided by Nuclear Medicine at initial stages of disease, result in better patient care with minimal medicine cost. Nuclear medicine investigations are thus necessary for all the physicians .Surgeons and sub specialists for the management of their patients both for decision making before or/and follow-up of patients after medical or surgical therapy.

Nuclear Imaging Principle
In nuclear imaging a radioactive isotope is administered orally or parentally. When the radioactive substance is tagged to a particular transporting agent and administered into the body, it is carried to the organ of interest by blood stream. It gets distributed in the organ of interest and emits Gamma radiation. This distribution of Isotope is then mapped out by Gamma Camera. We can see both Planar Tomographic Images.

Designation : M.B.B.S., DRM
Area of Expertise : Nuclear Medicine

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