Nuclear Medicine...
is the medical specialty that uses radiopharmaceuticals for diagnosis and therapy. The radiopharmaceutical is usually administered intravenously but, depending on the study, may also be administered orally or by inhalation.

The radiation dose from a diagnostic study is usually less than that of a CT scan.



NCNM EXAMINATIONS:


Bone Scan

  • Skeletal metastases
  • Sports injuries (eg shin splints, stress fractures)
  • Trauma (eg. scaphoid, sacral & femoral neck fractures not evident on X-Rays)
  • Osteoporotic fractures
  • Osteonecrosis (avascular necrosis)
  • Osteomyelitis
  • Painful prosthesis (loosening or infection)
  • Back Pain - spondylolysis, pars interarticularis fracture
  • Paget's disease - presence & extent
  • Enthesopathy, sacrolitis
  • Reflex sympathetic dystrophy


Myocardial Perfusion Study
(exercise / dipyridamole /dobutamine)

  • Detection of presence, extent & severity of myocardial ischaemia
  • Gated SPECT permits evaluation of LV wall motion & thickening & provides LVEF

Gated Heart Pool Study
  • Evaluation of left & right ventricular size & systolic function, measurement of LVEF & diastolic filling parameters

Ventilation & Perfusion Lung Study
  • Detection of pulmonary embolism
  • Significantly less radiation than CTPA
  • Preferred over CTPA for chronic pulmonary embolism


Thyroid Study
  • Evaluation of thyrotoxicosis
  • Diagnosis of subacute thyroiditis
  • Evaluation of functional status of thyroid nodules

Parathyroid Study
  • Localisation of parathyroid adenoma / hyperplasia in hyperparathroidism



Infection / Inflammation Study
  • Both used to detect septic foci

Gallium
  • Detection of malignancy as a cause of PUO

Labelled White Cell
  • Detection of active inflammatory bowel disease


Renal Cortical Study (DMSA)
  • 'Gold standard' test for detection of presence, location & extent of renal cortical scars
  • Detection of acute pyelonephritis
  • Measurement of differential renal function

Renal Study (MAG3 or DTPA) +/- Lasix
  • Evaluation of renal perfusion and excretion
  • Diagnosis of pelvi-ureteric junction obstruction & vesico-ureteric junction obstruction
  • Follow-up evaluation after pyeloplasty
  • Measurement of differential rela function

GFR measurement (DTPA)
  • GFR measurement

Captopril Renal Study
  • Diagnosis of hemodynamically significant renal artery stenosis


Cerebral Perfusion Study
  • Evaluation of dementia
  • Localisation of focus of complex partial seizures
  • Detection of presence and extent of cerebral infarction not evident on CT


Biliary Study
  • Chronic cholecystitis, gallbladder dyskinesia, cystic duct syndrome
  • Acute cholecystits
  • Post-operative biliary leak


Meckel's Study
  • Detection of Meckel's diverticulum which contains ectopic gastric mucosa


Haemangioma Study
  • Detection of cavernous haemangioma (eg. in liver)


Lymphoscintigraphy
  • Diagnosis of lymphedema
  • Evaluation of regional lymphatic drainage prior to surgery (eg. for skin legions and breast carcinoma)


TUMOUR STUDIES
  • For tumour staging, evaluation of response to therapy, detection of residual or recurrent disease
Gallium - Lymphoma (HL & NHL), sarcoma
MIBG (I-123 or I-131) - Phaeochromocytoma, neuroblastoma
In-111 Pentetreotide - Carcinoid tumour, pancreatic islet cell tumours, medullary thyroid carcinoma, paraganglioma, glomus tumour


THERAPY
I-131 - Grave's disease, toxic nodules, thyroid carcinoma
Y-90 colloid - Radiation synovectomy (eg for RA)
Samarium-153 EDTMP - Palliation of metastatic bone pain
Strontium-89 - Palliation of metastatic bone pain


Gastrointestinal Transit Studies
  • Oesophageal transit. Assessment of gastro-oesophageal reflux
  • Gastric emptying. Utilising a labelled egg sandwich
  • Colonic transit. Oral gallium-67 is monitored daily over 5 days