OVERVIEW OF A NUCLEAR OVERVIEW OF A NUCLEAR MEDICINE PROCEDUREMEDICINE PROCEDURE

CAUTION

RADIOACTIVEMATERIAL

When you hear the words “Nuclear When you hear the words “Nuclear Medicine”, what comes to mind first?Medicine”, what comes to mind first?

• A) nuclear blastA) nuclear blast• B) radiation therapy for cancer B) radiation therapy for cancer

patientspatients• C) powerful medicineC) powerful medicine• D) radioactive medicineD) radioactive medicine• E) diagnostic imagingE) diagnostic imaging

TYPES OF NUCLEAR TYPES OF NUCLEAR MEDICINE PROCEDURESMEDICINE PROCEDURES

• Diagnostic TestsDiagnostic Tests– Imaging vs. NonimagingImaging vs. Nonimaging

• (Bone, brain, cardiac, etc vs. thyroid (Bone, brain, cardiac, etc vs. thyroid uptake, ERPF, GFR, etc.)uptake, ERPF, GFR, etc.)

– Qualitative vs. QuantitativeQualitative vs. Quantitative• (Image resolution vs. quantifiable (Image resolution vs. quantifiable

numbers)numbers)• TherapyTherapy• TheranosticsTheranostics

Procedure InformationProcedure Information• Procedure NameProcedure Name• Radiopharmaceutical UsedRadiopharmaceutical Used• Clinical IndicationClinical Indication• ContraindicationsContraindications• Patient PreparationsPatient Preparations• Actual ProcedureActual Procedure• ResultsResults

http://radiology.med.sc.edu/4nucmed.htm Normal Bone Scan

Metastatic Bone Cancer – a “superscan”http://radiology.med.sc.edu/4nucmed.htm

A “superscan” is what?A “superscan” is what?• A) positive bone scan studyA) positive bone scan study• B) negative bone scan studyB) negative bone scan study• C) indicative of intense bone C) indicative of intense bone

cancer spreadcancer spread• D) both A and CD) both A and C• E) both B and CE) both B and C

Normal Hepatobiliary Normal Hepatobiliary ExamExam

Scott Williams, MD

Nuclear Medicine Updates

www.auntminnie.com

Tc-99m sulfur colloid - Colloid Tc-99m sulfur colloid - Colloid ShiftShift

Scott Williams, MD

Nuclear Medicine Updates

www.auntminnie.com

Posterior Left Oblique

LiverSpleen

What causes a Colloid shift on a What causes a Colloid shift on a sulfur colloid liver-spleen study?sulfur colloid liver-spleen study?

• A) Improper bound product for the A) Improper bound product for the radiopharmaceuticalradiopharmaceutical

• B) Liver diseaseB) Liver disease• C) Spleen diseaseC) Spleen disease• D) metastatic cancerD) metastatic cancer

Renal TransplantRenal TransplantNormal Function – MAG3Normal Function – MAG3

Crump Institute for Biological Imaging

Obstruction: right kidneyObstruction: right kidney

ICNMP

Nuclear CardiologyNuclear Cardiologyhttp://www.bocaradiology.com/Procedures/cardiac/cardiac_background_files/image011.jpg

Nonimaging TechniquesNonimaging Techniques

• thyroid checksthyroid checks

• urine assayurine assay

NMT NMT RESPONSIBILITIES RESPONSIBILITIES• Identify the patientIdentify the patient• Verify the physician’s orderVerify the physician’s order• Prepare the patientPrepare the patient• Administer the radiopharmaceuticalAdminister the radiopharmaceutical• Wait the appropriate length of timeWait the appropriate length of time• Collect the dataCollect the data• Review the data for technical qualityReview the data for technical quality• Present data to physician for interpretationPresent data to physician for interpretation• Discharge the patient from the deptDischarge the patient from the dept

Identify the patientIdentify the patient

• In-patientsIn-patients

• Out-patientsOut-patients

Verify the physician’s Verify the physician’s order order

No procedure may No procedure may be performed on a be performed on a patient without an patient without an order from a order from a physicianphysician

Correct testCorrect test

This is also a good time for the NMTThis is also a good time for the NMTto check the clinical indication forto check the clinical indication forthe test the test

Which of following is an example of Which of following is an example of a clinical indication?a clinical indication?

• A) detection of Alzheimer’s diseaseA) detection of Alzheimer’s disease• B) bone fractureB) bone fracture• C) agitated patientC) agitated patient• D) being allergic to eggsD) being allergic to eggs• E) all of the answersE) all of the answers

Prepare the patientPrepare the patient

• ExplainExplain

• ReassureReassure

• Answer Answer questionsquestions

Administer the Administer the radiopharmaceutical radiopharmaceutical

• IntravenousIntravenous

• OralOral

• InhalationInhalation

• OtherOther

InhalationInhalation

RADIOPHARMACEUTICALRADIOPHARMACEUTICAL

RadionuclideRadionuclide: +: +

the radioactive the radioactive portion of the portion of the

drug that drug that permits permits detection in the detection in the bodybody

Chemical compoundChemical compound::

the portion of the the portion of the drug that causes it drug that causes it to be localized in a to be localized in a particular organ of particular organ of the bodythe body

Common Common RadiopharmaceuticalsRadiopharmaceuticals

RadiopharmaceuticalRadiopharmaceutical Clinical UseClinical Use

Tc-99m medronateTc-99m medronate Bone imagingBone imaging

Tl-201 thallous chlorideTl-201 thallous chloride Myocardial Myocardial perfusion imagingperfusion imaging

I-123 sodium iodideI-123 sodium iodide Thyroid imagingThyroid imaging

Radiopharmaceuticals Radiopharmaceuticals may be known by:may be known by:

• Generic nameGeneric name

• Chemical name/Chemical name/ abbreviationabbreviation

• Proprietary nameProprietary name

• Tc-99m Tc-99m exametazimeexametazime

• Tc-99m HMPAOTc-99m HMPAO

• Tc-99m CeretecTc-99m Ceretec

Wait appropriate Wait appropriate length of time length of time

Collect dataCollect data

• ImagesImages– Static Static – Dynamic/FlowDynamic/Flow– Cine/loopCine/loop– PlanarPlanar– TomographicTomographic

• External External countingcounting

• Body fluid Body fluid samplessamples

Static Bone Scan ImageStatic Bone Scan Image

Dynamic/Flow Renal ScanDynamic/Flow Renal Scan

Cine/loop Example SiteCine/loop Example Site

• Examples of Cine

GI Bleed Study

Planar image and also Planar image and also dynamic/flow imagedynamic/flow image

The arrow is pointing at The arrow is pointing at which kidney?which kidney?• A) LeftA) Left• B) RightB) Right

Tomographic DisplayTomographic Displayhttp://www.medical.siemens.com/siemens/en_US/rg_marcom_FBAs/images/press_room_images/2007/043.07_Applications.jpg

Review data Review data for technical quality for technical quality

• Biodistribution – Biodistribution – normal/abnormalnormal/abnormal

• Patient preparationPatient preparation

• Patient positioningPatient positioning

• ArtifactsArtifacts

The physician relies on The physician relies on the NMT for accurate, the NMT for accurate, valid datavalid data

Present data to the Present data to the physician for interpretationphysician for interpretation

Typical Procedure Setup Typical Procedure Setup for each study in NMfor each study in NM• Radionuclide usedRadionuclide used• Indications for studyIndications for study• Contraindications for studyContraindications for study• Patient history takingPatient history taking• Patient preparationPatient preparation• EquipmentEquipment• Actual procedureActual procedure• Normal vs. abnormal resultsNormal vs. abnormal results• ArtifactsArtifacts

Discharge the patient Discharge the patient from your care from your care