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NUCLEAR MEDICINE
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NUCLEAR MEDICINE
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FACILITIES
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- SPECT GAMMA CAMERA OF SIEMENS (GERMANY).
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VARIOUS TYPES OF COLLIMATOR FACILITIES FOR IODINE SCAN, TECHNETIUM SCAN, GALLIUM
SCAN.
- APPLE MACINTOSH COMPUTER FOR ACQUISITION WELL
EQUIPPED RIA LAB TO DO T3,T4,TSH.
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| Diagnostics imaging of lungs, brain, thyroid, stomach, salivary glands, liver, kidney, bone, heart adrenal glands as well as sites of occult infection is achieved using a sophisticated Gamma Camera with tomographic facilities linked to the computer system department offers both diagnostic and therapeutic services. Nuclear Medicine increases the depth of diagnostic orkup to accurately and precisely monitor treatment and patient progress.
THE MOST MODERN MEDICAL SPECIALITY, WHICH IS SAFE, PAINLESS, NON INVASIVE AND
COST EFFECTIVE, USING RADIO NUCLIDES OF ADEQUATE HALF LIFE SUCH AS 99MTC 123 I,
131 I ETC. NOT ONLY FOR DIAGNOSTIC PURPOSE BUT ALSO FOR THERAPY. | The way it developed |
Originated from notably the discovery of artificial radioactivity in 1934, first
clinical use of artificial radioactivity was in 1937 for a patient of leukemia
(blood cancer) at the UNIVERSITY OF CALIFORNIA in UNITED STATE OF AMERICA. and
in 1946 it was used for thyroid patients with amazing results.
| Salient features |
- Safe,
painless and cost effective.
- Unique
in giving physiological details.
- Almost
all organs can be imaged.
- Early
detection of fractures and tumors are possible .
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Even hairline fractures can be easily
detected.
- Therapy
is simple procedure and very much cost effective.
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The dose for therapy can be easily determined
using nuclear scan itself.
- The
most developing field in imaging procedures.
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The most used field in
cancer evaluation and follow-up.
| Salient features | - One of the first Nuclear scanning centers in India.
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Carrying out almost all procedures available in nuclear medicine field.
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One of the few centers which do “venogram “ to study the blood flow and hence
potency of superficial and deep veins and to find out thrombosis.
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One of the few centers which carry out RIA &IRMA technique with thyroid scinti
scan for accurate diagnosis and quantitative study.
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Diagnosis is cost effective.
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Availability of service at any time as the patient’s requirement.
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Widely accepted quality of scan and of reporting.
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Availability of facilities like x ray, MRI,CT etc if any comparative study
required.
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Availability of therapy facilities for thyroid cancer, thyrotoxicosis,
hyperthyroidism, bone pain in cancer patients etc.
| Tc 99 m - Technetium-99 |
Chemical symbol Tc-99, is a silver-gray,
radioactive metal. It occurs naturally in minute amounts in the earth's crust,
but is primarily man-made. All isotopes of technetium are radioactive. The most
commonly available isotope is Tc-99m (called metastable Tc-99) and is the
shorter-lived parent of Tc-99. Technetium in the form of technetium-97 was discovered in 1937 by Emilio Segré and Carlo Perrier at the University of California - Berkeley. Technetium-99m, one of the most common isotopes used in modern medicine, was developed by Glenn T. Seaborg and Emilio Segré. | Properties of technetium-99 | Technetium-99 is silver-gray, radioactive metal. It occurs naturally only in very small amounts. Its melting point is 3,942 °F and its boiling point is 8,811 °F. It is also a very dense material--at room temperature, a measure of technetium-99 weighs 11.5 times as much as an equal volume of water. Technetium-99 has a radioactive half-life of 212,000 years. Technetium- 99m (called metastable Tc-99) decays to Tc-99 primarily by gamma emission, and has a half-life of only about 6 hours. Technetium-99 decays to form ruthenium-99, which is stable, by emitting beta and gamma radiation. | Uses of technetium-99 | Technetium-99 has no significant industrial use. Technetium-99 is found in the radioactive wastes from defense-related government facilities, nuclear reactor and fuel cycle facilities, academic institutions, hospitals, and research establishments. Its short-lived parent, Tc-99m, however, is the most widely used radioactive isotope for medical diagnostic studies. Different radiopharmaceuticals are used to produce images from almost all regions of the body: | Part of the Body | Example Radiotracer | | Brain | 99mTc-HMPAO | | Thyroid | Na99mTcO4 | | Lung (Ventilation) | 133Xe gas | | Lung (Perfusion) | 99mTc-MAA | | Liver | 99mTc-Tin Colloid | | Spleen | 99mTc-Damaged Red Blood Cells | | Pancreas | 75Se-Selenomethionine | | Kidneys | 99mTc-DMSA |
Note: That the form of information obtained using this imaging method is mainly
related to the physiological functioning of an organ as opposed to the mainly
medicine therefore provides a different perspective on a disease condition and
generates additional information to that obtained from X-ray images.
Early forms of imaging system used in this field consisted of a radiation
detector (a scintillation detector for example) which was scanned slowly over a
region of the patient in order to measure the radiation intensity emitted from
individual points within the region. One such device was called the Rectilinear
Scanner. Such imaging systems have been replaced since the 1970s by more
sophisticated devices which produce images much more rapidly. The most common of
these modern devices is called the Gamma Camera and we will consider its
construction and mode of operation. |
| EMISSION TOMOGRAPHY |
The form of imaging which we have been describing is called Planar Imaging. It produces a two-dimensional image of a three-dimensional object. As a result images contain no depth information and some details can be superimposed on top of each other and obscured or partially obscured as a result. Note that this is also a feature of conventional X-ray imaging. The usual way of trying to overcome this limitation is to take at least two views of the patient, one from the front and one from the side for example. So in chest radiography a posterio-anterior (PA) and a lateral view can be taken. And in a nuclear medicine liver scan an antero-posterior (AP) and lateral scan are acquired. This limitation of planar X-ray imaging was overcome by the development of the CAT Scanner about 1970 or thereabouts. CAT stands for Computerized Axial Tomography or Computer Assisted Tomography and today the term is often shortened to Computed Tomography or CT scanning The equivalent nuclear medicine imaging technique is called Emission Computed Tomography. We will consider two implementations of this technique below. -
Single Photon Emission Computed Tomography (SPECT):
This SPECT technique uses a gamma camera to record images at a series of angles
around the patient. These images (click here for an example) are then subjected
to a form of digital image processing called Image Reconstruction in order to
compute images of slices through the patient.
A comparison of these image reconstruction techniques is shown below for a slice through a ventilation scan of a patient's lungs: 
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| OUR FEW PROCEDURES |
We are one of the few centers in India doing almost all the nuclear scanning
modalities and our quality of scans and reporting is widely accepted as the
best. We are carrying out Dynamic –Static Imaging Procedures ,SPECT Procedures, RIA &IRMA Techniques for T3,T4,TSH>Free T3, Free T4, L.H etc, etc. to make our reports the best both quantitatively and qualitatively | NUCLEAR CARDIOLOGY |
- Nuclear Cardiology is one of the3b fast developing field in nuclear medicine to Diagnosis Myocardial Perfusion, Myocardial ischemia ,infract, cardiac blood pool etc
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We are one among the few centers in India using 201 TL (thallous chloride)
Redistribution property for Myocardial imaging ,Which is highly physiological
compared to other radio-nuclides in use.
- We have the facility of 99m Tc- labeled Tetrofosmin or sesta MIBI for Cardiac wall motion abnormality detection.
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SPECT imaging procedure which can be further processed and quantitative values
like Ejection Fraction (both Regional and Global ) can be calculated.
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First pass study of heart to detect the potency and size of right ventricle.
- MUGA or Multi gated Analysis is another technique in use to evaluate cardiac blood pool and to calculate Ejection Fraction.
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Cardiac Shunt, is one of the commonest disease in children which is diagnoised
by us, using First Pass study.
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Stress-Rest protocol, is available both using 201 TL and 99m Tc
radio-pharmaceuticals to differentiate Myocardial ischemia and Infract ,which 9s
unique of Nuclear Medicine.
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Common procedure which we are using to exercise patients is T.M.T(Tread Mill
Test) which is helpful in determining Rest and stress ECG, Heart Rate,
Myocardial Oxygen Demand etc.
- For those patients who are unable to exercise or are known case of coronary artery disease (CAD) we have the provision of Pharmacological stress using Adenosine, Dypyramidole, Dobutamine etc.
| RADIONUCLIDES IN ASSESSING RENAL DISORDERS |
It is well known about the use of radio-nuclides in assessing renal function,
position, shape and size and it is one of the most commonly used technique in
nuclear medicine. - Renal cortical Scan can evaluate not only the size, shape and position of the kidney but the scars in the cortex and quantitatively the renal differential function can be accurately determined.
- The physiology of Kidneys can be evaluated by renogram analysis both quantitatively and qualitatively which will give the GFR of each Kidneys ,Global GFR etc.
- The excretory phase of renogram is valuable to assess the obstruction in VUJ (Vesico Ureteric Junction) and PUJ(Pelvic Ureteric Junction)
- Diuretic Renogram Analysis which is used by us is a provocative method to evaluate dilation with out Obstruction and obstructed Nephropathy.
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We evaluate the renal hypertension using Captopril Renogram Method.
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To evaluate the volume of Residual urine and Vesico–Ureteric Reflux common in
babies, we are carrying out Direct Micturation Renogram/Direct Radio nuclide
Cysto urography which is known for its higher sensitivity compared to other
similar scans.
| LUNG VENTILLATION_PERFUSION STUDIES |
Using Radio-nuclides we are carrying out both ventilation study to know the
airways to lung and perfusion study to know the perfusion of blood to the lobes
of lungs and also Lung ventilation-Perfusion Study which is the most helpful
method to evaluate PULMONARY ENMBOLISM (P.E) ,one of the three commonest cause
of death due to disease in European Countries ,for the evaluation of which no
other tests are possible. We are proud to say that which is being carried out by
us here and have accurately diagnosed the cases . - Not only Pulmonary Embolism but also Parenchymal Lung Disease, Pulmonary Odema , Tuberculosis are being diagnosed by this non-invasive technique.
- The scan is also helpful to calculate quantitatively the Ventilation- Perfusion Ratio.
| WHOLE BODY AND REGIONAL SKELETAL SCINTIGRAPHY |
Nuclear Medicine procedures are the common methods in detecting bone tumors
either benign or malignant .bone metastasis ,bone fracture which we are carrying
out in our center. -
With the aid of this procedure the whole body skeleton can be imaged easily and
the spot views if required of the suspected area scan also be acquired.
- Bone Scan is helpful to find out even hairline fractures which is unique of our procedure.
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Nuclear Medicine bone scan is known for early detection of lesion and fracture.
- Bone scan helps to assess the response to therapy in cancer patients to know the spread of disease.
- Three phase bone scan procedure is also available to differentiate Cellulitis and Sinusitis from actual bone lesions
- Quantitative approaches are being used in bone scan and also in Joint Imaging such as Whole body Retention (W.B.R) if Renal Function is proper, Segmental Comparison for accurate idea about Growth Plate Pathology, Sacro-Iliac Joint Index Calculation etc.
| LIVER – SPLEEN IMAGING & CHOLESCINTIGRAPHY |
- Liver, the largest solid organ in body, having two types of vascular supply such as Hepatic and Portal supply and Spleen consisting of Reticulo Endothelial cells can be easily imaged using various techniques available in Nuclear Medicine.
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The size, shape, position and omas of liver and spleen like Hepatoma, Hematoma,
Spleenomegaly etc. can be easily detected
- The blood perfusion to the liver by Hepatic and Portal supply can be studied using Dynamic Imaging Techniques that we are using here.
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Not only the potency of Kuffer Cells or Reticulo endothelial cells but also
Hepatic cells efficiency can also be detected.
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Imaging of the working ability of hepatis Cells usually termed as
Cholescintigraphy, detects function aspects of hepatocites, biliary tree
potency, Gtall bladder ejection fraction, biliarry atresia etc.
- Using quantitative methodes even the differentiation of neonetal hepatitis and biliary atresia is possible.
- The working condition of gall bladder is being evaluated and quantitatively the Ejection Fraction of Gall Bladder is calculated.
| IMAGING OF CENTRAL NERVOUS SYSTEM INCLUDING BLOOD BRAIN BARRIER,BLOOD FLOW TO |
- BRAIN AND CEREBRO -–SPINAL FLUID (C.S.F)
Blood Brain barrier is the name given yto the junction of capilliary walls , Neuroglea and Nerve Cells ,which constitute a barrier to the passage of compounds unnecessary to brain metabolism and thus limit the movement of potentially toxic substansae from blood to brain.hence the potency determination of B>B>B is very important which will be disturbed in many caqses such as fracture , brain tumor etc. |
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