NUCLEAR MEDICINE

DEPARTMENT OF NUCLEAR MEDICINE, PET- CT& RADIONUCLIDE THERAPY

Dr RASHMI ANGADI MBBS DNB

CONSULTANT & INCHARGE
RADIATION SAFETY OFFICER
DEPT OF NUCLEAR MEDICINE, PET-CT & RADIONUCLIDE THERAPY
KLES DR PRABHAKAR KORE HOSPITAL& MRC


Nuclear Medicine

Nuclear Medicine is a rapidly developing branch of medicine which uses radioisotopes for diagnostic imaging and therapy purpose. It is older than CT, MRI and ultrasound, first used on patients over 60 years ago. Nuclear Medicine is part of the hospital’s constant effort to update its services and offer the latest medical technology at economical rates to the needy. The hospital has sophisticated latest generation SPECT gamma camera, PET-CT and therapy wards which constitute backbone of the Department of Nuclear Medicine and PET –CT.

SPECT(Gamma Camera) SCAN

SPECT (Gamma Camera) Facility

Nuclear Medicine imaging or Scintigraphy utilizes a dual-head gamma camera to record the physiological activity of selected organs or body systems, by using minute quantities of radiopharmaceuticals which are administered by intravenous, oral or inhalation routes. This imaging is fundamentally different from magnetic resonance imaging (MRI) and computed tomography (CT), for these methods only convey anatomic information. In most diseases, physiological changes precede anatomic changes, so scintigraphic evidence of a disease process can be diagnosed at an earlier stage. After administering radiotracers the areas of interest are then imaged by the gamma camera which captures the gamma rays emitting from the patient.


Gamma Camera Procedures Performed

PROCEDURE INDICATIONS
 THYROID SCAN  To assess thyrotoxicosis, Graves disease, toxic MNG, thyroiditis, thyroid nodule evaluation, lingual thyroid etc
 PARATHYROID SCAN To assess parathyroid adenoma, hyperplasia, ectopic parathyroid adenomas
MYOCARDIAL PERFUSION/ THALLIUM SCAN To evaluate IHD, physiological significance of known coronary stenosis, Risk stratification of CAD, Presurgical cardiac evaluation, to assess myocardial viability before CABG prior to surgery, congenital heart disease, follow-up of Kawasaki disease
MUGA SCAN To evaluate accurate LVEF, regional wall motion abnormalities in CAD, prior to adriamycin and other cardiotoxic drug therapy
 RENOGRAM To assess GFR of individual kidneys esp. in donors, neonatal hydronephrosis, PUJ obstructions, obstructed megaureter, relative function evaluation in patients with renal malignancy prior to nephrectomy, ectopic kidneys, post renal transplant evaluation, renal artery stenosis(pre/post captropril)
DMSA SCAN To assess UTI (Renal scars), ectopic kidneys, accurate function assessment of individual kidneys
DIRECT / INDIRECT RADIONUCLIDE MCU SCAN To assess VU reflux, UTI, hydroureteronephrosis
 WHOLE BODY BONE SCAN To evaluate skeletal mets, bone malignancy, low backache, tuberculosis of bone, avascular necrosis, metabolic bone disease, stress fracture, osteomyelitis versus cellulitis.
GALLIUM SCAN Assessment of prosthetic infections, evaluation of lymphoma (Hodgkin’s & non Hodgkin’s)
LUNG PERFUSION & VENTILATION Pulmonary embolism, lung vascularity assessment in children with congenital heart disease, predict FEV1 in patients planned for pneumonectomy/lobectomy
LIVER-SPLEEN SCAN Alcoholic hepatitis, cirrhosis, portal hypertension, hemangioma, jaundice, Budd chiari syndrome
HEPATOBILIARY SCAN Differentiate neonatal hepatitis vs biliary atresia, post-op bile leak, choledochol cyst, post-liver transplant cases, gall bladder dyskinesia, acute/chronic cholecystitis
MECKEL’S SCAN Evaluation of  meckels diverticulum (Ectopic gastric mucosa), malena, GI bleed
GASTRO INTESTINAL BLEEDING To evaluate occult GI bleed and localize the site of bleed
GASTRIC EMPTYING Diabetic gastroparesis
GASTRO ESOPHAGEAL REFLUX ( Milk scan) Recurrent respiratory infections, heart burns
Lymphangiogram To evaluate lymphatic duct patency

SPECT SCAN IMAGES

Thyroid scan

Renal scan

Bone scan

Myocardial Perfusion Scan

PET-CT SCAN

PET-CT Facility

The Department of Nuclear Medicine is equipped with a state-of-the-art PET-CT scanner (Positron Emission Tomography – Computed Tomography). It provides superior diagnostic information for patients with cancer, ischemic heart disease and certain neurologic conditions. In the three decades since its development, PET has been demonstrated to be a clinically proven and safe method for imaging a variety of disorders. PET CT can demonstrate certain pathological changes long before they would be evident on CT or MRI alone.

PET-CT is a noninvasive diagnostic whole-body imaging procedure, cost-effective and is used in the early detection, staging, and follow-up for most cancers, including lymphomas, lung, breast, gastrointestinal, gynecological, cartilaginous, head and neck cancers.

PET CT is also used to evaluate treatment response after chemotherapy and radiotherapy. Mid-cycle PET-CT is useful to ascertain if the patient is responding to chemotherapy so that regimes can be modified.

PET CT is also used in Radiotherapy planning.

PET is able to discover these changes in their earliest stages, often before any symptoms appear. With this information on early developing cancers, effective treatment plans can be initiated sooner. PET can most of the times helps to eliminate the need for other invasive procedures and by correctly staging cancers, may prevent unnecessary surgical procedure.

 

ROLE OF 18 F FDG PET/CT IN ONCOLOGY

INDICATIONS:

  • Precise staging of disease: Improved tumor localization as well as detection of distant metastasis.
  • Response Evaluation: During or after completion of the therapy.
  • Restaging: Evaluates both locoregional and distant sites.
  • Better monitoring of cancer recurrence: E.g.  In patients with rising tumor markers E.g.CA 125 in Ca ovary and CEA in Ca colon.
  • Evaluation of Carcinoma of Unknown Primary.
  • For detection of primary site as well as other areas of involvement by the neoplastic process.
  • PET also helps in guiding the biopsy site of active disease.
  • PET CT imaging is also useful in the following infection and inflammation imaging:
  • Infection– Infective endocarditis, Tuberculosis, HIV, Pyrexia of unknown origin, Osteomyelitis, Graft and Prostehtic infection .
  • Inflammation– Inflammatory bowel disease, cardiac sarcoid, Rheumatoid Arthritis, Vasculitis, Polymyalgia Rheumatica, Sarcoidosis.
  • 18F –Fluoride bone scan: Fluoride bone is done on PET scanner .It has better sensitivity and image resolution than the conventional 99m MDP bone scan.
  • Role of 18F FDG PET/CT in Cardiology: For detection of myocardial viability.
  • Role of 18F FDG PET/CT in Neurology : In the evaluation of patients with  dementia , epilepsy, parkinsonism  syndrome.

 

The Ga-68 scan is not offered at every centre. KLES Dr. Prabhakar Kore hospital and MRC, Belagavi, is the first to start the following services in the entire north Karnataka.

  • Ga-68 DOTATATE scan – for neuro endocrine tumors
  • Ga-68 PSMA scan – for prostate tumors
  • Ga-68 Exendin 4- targeting benign insulomas
  • Ga-68 FAPI

PET SCAN IMAGES

CT Image | PET Image | Fused PET CT Image

THERAPEUTIC NUCLEAR MEDICINE

LOW DOSE I-131 THERAPY Treatment of thyrotoxicosis – Graves disease, Toxic MNG, Autonomous toxic nodule
HIGH DOSE I-131 THERAPY Treatment of differentiated thyroid carcinoma and metastases
STRONTIUM /SAMARIUM THERAPY Palliative bone pain therapy for cancer patients
MIBG THERAPY Malignant pheochromocytoma, neuroblastoma
Peptide Receptor radionuclide therapy(PRRT) Lu-177 DOTA-NOC/ DOTA-TATE therapy for neuroendocrine tumours
Radiation Synovectomy Chronically inflamed joints, refractory to treatment
Trans Arterial Radio Embolization (TARE) Y90 TheraSpheres/ SIR-spheres therapy
LOW DOSE I-131 THERAPY Treatment of thyrotoxicosis – Graves disease, Toxic MNG, Autonomous toxic nodule
HIGH DOSE I-131 THERAPY Treatment of differentiated thyroid carcinoma and metastases
STRONTIUM /SAMARIUM THERAPY Palliative bone pain therapy for cancer patients
MIBG THERAPY Malignant pheochromocytoma, neuroblastoma
Peptide Receptor radionuclide therapy(PRRT) Lu-177 DOTA-NOC/ DOTA-TATE therapy for neuroendocrine tumours
Radiation Synovectomy Chronically inflamed joints, refractory to treatment
Trans Arterial Radio Embolization (TARE) Y90 TheraSpheres/ SIR-spheres therapy

Radioiodine Scan Of A Thyroid Cancer Patient

Patient information:

Radionuclide imaging is performed only by prior appointment since the isotopes are procured from far places and have to be made ready as they have very short shelf lives. The procedure to be followed is send to either the patient or his attender to the nuclear medicine department where he is given appointment . He is also explained about the procedure and also given necessary instructions in case prior preparations are required.

Several patients have the fear of exposure to radiation. Thanks to intensive research, the radiopharmaceuticals currently available have short half lives, and the biological half lives are even shorter. Therefore, nuclear medicine imaging is quite safe, even for children and the amount of radioactive material used is very small and the radiation dose is similar to that of diagnostic x-ray tests. Most of the radioactive material leaves the body through the urine. Any retained material loses its radioactivity relatively quickly through breakdown (decay). There are little or no side-effects from the radioactive tracer. However, one should be circumspect in the case of pregnant women.

The unique and vital advantage of nuclear medicine scans are its usefulness in providing vital functional information in addition to anatomical details, unlike other imaging modalities like MRI, where patients with metallic prosthesis/implants, aneurysm clips, pacemakers etc are not contraindicated. Therefore radionuclide imaging is an excellent complement to other imaging modalities like CT scan, ultrasonography, MRI etc.

For more information please contact our department of nuclear medicine and  PET CT or public relations department.

Dr. Rashmi Angadi

Dr. Rashmi Angadi is In-charge and Consultant of the dept. of Nuclear Medicine, PET-CT and radionuclide therapy at KLES Dr.Prabhakar Kore Hospital and MRC, Belagavi.
She completed her M.B.B.S from Karnataka Institute of Medical Sciences, Hubballi, achieving five gold medals to her honour.
She completed her Post Graduate Degree in the specialty of Nuclear Medicine, Diplomate of National Board, New Delhi. She underwent her training at Narayana Hrudayalaya Institute of Medical Sciences, Bangalore.
She qualified as a Radiation Safety Officer by Atomic Energy Regulatory Board (AERB), Bhaba Atomic Research Centre (BARC), Mumbai, India.
She received specialized training at AIIMS, New Delhi and PGI Chandigarh towards Radiolabelled Peptide Receptor Therapy for Neuroendocrine cancer, Lu-177 DOTA-NOC therapy, Y90 Synovectomy, Y90 theraspheres therapy and I-131 mIBG therapy etc.
She has gained extensive experience in the speciality of Nuclear Medicine with expertise across wide spectrum of various Nuclear Medicine services including Diagnostic and therapeutic Radionuclide applications.
Her areas of interest includes Nuclear Cardiology, Nuclear Neurology and various other general Nuclear Medicine Procedures.