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Nuclear Medicine and Osteoporosis Center

Nuclear medicine is a medical specialty which uses safe, painless and cost-effective techniques both to image the body and treat disease.

Nuclear medicine imaging is unique in that it documents organ function, structure and quantification, in contrast to diagnostic radiology which is based upon anatomy. It is a way to gather medical information that may otherwise be unavailable, require surgery, or necessitate more expensive diagnostic tests.

As an integral part of patient's care, nuclear medicine is used in the diagnosis, treatment and prevention of serious disease. Nuclear medicine imaging procedures often identify abnormalities very early in the progression of a disease –long before some medical problems are apparent with other diagnostic tests. This early detection allows a disease to be treated early when there may be a more successful prognosis.

Nuclear medicine uses very small amounts of radioactive materials to diagnose and treat disease. These radiopharmaceuticals are substances that are attracted to specific organs, bones, or tissues. When introduced into the body, they produce gamma emissions. A provide information about the area of the body being imaged.

Although Nuclear Medicine is commonly used for diagnostic purposes, it also provides valuable therapeutic applications such as treatment of hyperthyroidism, thyroid cancer, types of bone cancer.
Today, there are nearly 100 different nuclear medicine imaging procedures which provide information about virtually every major organ system within the body. Nuclear medicine now is an integral part of patient's care, and an important diagnostic and therapeutic specialty in medical science. 
Clinical applications
Nuclear medicine imaging uniquely provides information about both the function and structure of virtually every major organ system within the body. Some of common applications are as follows :

Nuclear Endocrinology:

A. Thyroid isotope scan:

  • Assessment of goiter.
  • Detection and evaluation of thyroid nodules.
  • Diagnosis of cause of thyrotoxicosis.
  • Diagnosis of cause of hypothyroidism.
  • Location of ectopic thyroid tissue.
  • Diagnosis of thyroiditis.
  • Evaluation of substernal masses.
  • Postoperative search for functioning thyroid metastases in differentiated thyroid carcinoma (I 131 whole body scan).

B. Parathyroid isotope scan:

  • Diagnosis of cause of hyperparathyroidism (parathyroid adenoma, hyperplasia, etc.).
  • Problems of parathyroid localization.

C. Drenal gland isotope scan:

  • I 131 MIBG scan for evaluation of functional adrenergic tumors.
  • Pheochromocytoma, neuroblastoma, MEN syndrome ) I 131 – iodocholesterol for adreno-cortical disorders.
  • Bone isotope scan.
  • Benign bony tumors and tumor-like lesions such as osteoid osteoma, bony islands, fibrous dysphasia, etc.).
  • Primary bone tumors such as osteogonic sarcoma, Ewing's sarcoma, chordrosarcoma, etc.).
  • Bone metastases.
  • Response to radio therapy or chemotherapy.
  • Osteomyelitis/ cellulitis / septic arthritis.
  • Evaluation of prosthetic joints (loosening, infection).
  • Detection of avascular necrosis (perth's disease, bony infarction, etc.).
  • Metabolic bone disease (pagets disease, hyperparathyroidism, osteomalcia, osteoporosis, etc.).
  • Bone trauma and sport injuries (traumatic, stress and insufficiency fractures, shin splints, meniscal tears in knee trauma).
  • Chronic low back pain.
  • Reflex sympathetic dystrophy syndrome.
  • Arthritis.
  • Bone marrow scan.
  • Assessment of marrow extension, e.g. in polycythemia rubra vera, chronic hemolytic anemis, myelofibrosis, etc.).
  • Metastases to bone marrow.
  • Bone marrow infarction.

Kidney Isotope Scan:

A. Dynamci renal scan and diuretic renagram (DTPA, -MAG-3)
B. Static renal scan (DMSA):

  • Assessment of renal function.
  • Evaluation of obstructive uropathy.
  • Reflux nephropathy.
  • Evaluation of pyeloephritis and renal scrring.
  • Detection and evaluation of renal masses.
  • Ectopic and congenital renal abnormalities.
  • Detection of renovascualr hypertersion (captopril renal scinitigraphy).
  • Assessment of renal transplants.
  • Evaluation of renal trauma.
  • Lung ventilation - perfusion scan (V/Q scan).
  • Diagnosis of pulmonary embolism (P.E) and evaluation of treatment.
  • Evaluation of treatment of COPD.
  • Inhaled foreign body, especially in children.
  • Evaluation of lung function prior to thoracotomy.

Nuclear Cardiology:

A. Myocardial Stress- Rest perfusion scan (Sestamibi, Thallium201):

  • Detection and evaluation of CAD.
  • Evaluation of functional significance of coronary abnormalities.
  • Evaluation of patients with falsely abnormal or equivocal ECG.
  • Identify patients with physiological angina pectoris.
  • Assessment of effectiveness of PTCA and CABG surgery.
  • Assessment of efficacy of thrombolysis.
  • Assessment of post infraction myocardial viability.
  • Identify patients at high risk of heart attacks going to surgery for other reason.

B. Gated Blood pool study (MUGA):

  • Estimation of ejection fraction.
  • Detection of wall motion abnormality in ischemic heart disease.
  • Monitoring cardiac function in patients on chemotherapy.
Gastrointestinal isotope scan:

A. Liver – spleen scan:

  • Evaluation of liver size, shape and position.
  • Evaluation of abdominal masses.
  • Parenchymal and metastictic liver disease.
  • Evaluation of splenic disease, splenomegaly, accessory spleen functional asplenia, etc.
  • Liver and spleen trauma.

B. Hepato-biliary (HIDA) scan:

  • Acute and chronic cholecystitis.
  • Evaluation of jaundiced patients.
  • Congenital and space occupying lesion.
  • Evaluation of G.B function and biliary kinetics.
  • Evaluation of neonataljaundice.
  • Biliary artesia.
  • Neonatal hepatitis.
  • Choledochal cyst.
  • Evaluation of post surgical biliary system such as biliaryenteric anastamosis and bile leaks.
  • Bile reflux study.

C. Liver blood pool scan ( labeled RBCs):

  • Liver cavernous hemangioma

D. G.I Bleeding scan ( labeled RBCs)

E. Gastric emptying study


F. Ectopic gastric mucosa scan:

  • Meckle's diverticulum.
  • Barrett's esophagitis.

G. Salivary gland scan:

  • Evaluation of salivary gland swelling.
  • Assessment of salivary gland dysfunction.

Lymphoscintgraphy:

  • Assessment of lymphedema.
  • Testicular isotope scan.
  • Testicular torsion.

Epididymo-orchitis:

  • Traumatic injury.

Tumor imaging:

A. Gallium -67 scan:

  • Hodgkin's and non-hodgkin's lymphoma.
  • Malignant melanoma.
  • Hepatocellular carcinoma.
  • Lung cancer.
  • Soft tissue sarcoma.
  • Others.

B. Thallium -201, Sestumibi (MIBI):

  • Brain tumors.
  • Brain metastases.
  • Bone and soft tissue tumors.
  • Thyroid cancer.
  • Kaposil's sarcoma.
  • Others.

C. Monoclonal Antibodies (Immunoscintigraphy - CEA scan):

  • Colon cancer.

D. Pedtide receptor imaging (indium -111 octreoscan):

  • Neuroendocrine tumors ( carcinoid, medullary thyroid Ca, Vipome, etc).
  • Neo-Tect scan.
  • Pulmonary nodule.

E. MIBG-scan

  • Neuroblastoma.
  • Pheochromocytoma.
  • Medullary thyroid Ca.

Infection imaging 

Galliam -67 scan

99m Tc. HMAPO-WBCs

Radionuclide therapy

A. Radio active idodine therapy (1-131)

  • Hyper thyroidism (Grave's disease, toxic adenoma, etc.).
  • Differentiated thyroid carcinoma (ablation and therapy).

B.Palliative therapy of bone metastases ( strontium 89, samarium 153, yttrium -90)

  • Bone metastases from prostate, breast cancer, etc.

C. 1-131 MIBG therapy

  • Metastic neuroblastoma

D. Radionuclide synovectomy (Y-90)

  • Arthritis

E. Treatment of polycythemia rubra vera

  • Phosphorus -32

Advantages of nuclear medicine

Nuclear medicine uniquely provides information about both the function and structure of organ systems within the body.
Nuclear medicine procedures are among the safest diagnostic imaging tests available. The amount of radiation is comparable to that received during a chest X-ray

Nuclear medicine procedures are painless and do not require anesthesia.
Children commonly undergo NM procedures to evaluate bone pain, injuries, infection, or kidney and bladder function, etc.
In addition to diagnostic imaging, NM provides valuable therapeutic applications such as in hyperthyroidis, thyroid cancers, blood jmblances and pain relief from certain types of bone cancers

Bone densitometry (DEXA)

Indications:

  • Radiological evidence of osteopenia and / or vertebral deformity
  • Previous fragility fracture of the hip, spine or wrist
  • Corticosteroid therapy (>7.5 mg/day for 1 year or more)
  • Premature menopause (<45 years)
  • Prolonged secondary amenorrhoea
  • Primary hypogonadism
  • Anorexia nervosa
  • Malabsorption
  • Primary hyperparathyroidism
  • Post-transplantation
  • Chronic renal failure
  • Myelomatosis
  • Hyperthyroidism
  • Prolonged immobilization
  • Monitoring of therapy

Availability

Nuclear medicine services are available to outpatients as well as inpatients during the following hours:

Saturday to Wednesday 8:30 am to 7:00 pm
Thursday 8:30am to 2:00 pm.

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