DELHI MRI CENTREDELHI MRI CENTRE JABALPURJABALPUR

DEPT. OF NUCLEAR MEDICINEDEPT. OF NUCLEAR MEDICINE

-DR.PRADEEP DUBEY, M.D-DR.PRADEEP DUBEY, M.D

DIRECTORDIRECTOR

GAMMA CAMERA GAMMA CAMERA

RADIO ISOTOPE SCAN PRINCIPLES

RADIO ACTIVE TRACER SUBSTANCE IS USED.

COUPLED WITH SPECIFIC KITS FOR VARIOUS ORGANS.

SENSITIVE AND SPECIFIC-PICKS PATHOLIGY AT EARLIEST.

MINIMAL RADIATION.

APPLICATIONS

BONE – METS, AVN, STRESS #,Koch’s THYROID- HYPO / HYPER THYROID. G.U.T- Inf.,HN, PUJ.Obs, etc., CORONARY ARTERY DISEASE LIVER – BILLIARY ATRESIA ETC. NUCLEAR HSG & GER, OTHERS. THERAPY-IODINE 131

PREPARATION No specific preparation for Bone scan &

Renal scan Cardiac scan- to stop coffee, Chocolate,

Ca channel blockers before two days, 6 hrs. fasting

Thyroid scan – To stop Anti thyroid drugs before 2 weeks.

Liver(Hida) scan – NB Phenobarb. for 1wk. To drink lot of water during the scanning. To void frequently during test period.

Indication of bone scanIndication of bone scan

All first diagnosed malignancies.All first diagnosed malignancies. Ca. Breast, Cx & Uterus etc.Ca. Breast, Cx & Uterus etc. Lung & Prostate cancers.Lung & Prostate cancers. Hodgkin’s lymphoma & other malign.Hodgkin’s lymphoma & other malign. Pathological Fractures.Pathological Fractures. AVN & ? Pelvic girdle pain.AVN & ? Pelvic girdle pain. Osteo mylitis.Osteo mylitis. Stress fracture/ vague boney pain .Stress fracture/ vague boney pain . Unexplained backache Unexplained backache ..

BONE SCAN (NORMAL)

BONE SCAN (SKELETAL METS)

BONE SCAN (AVN)

BONE SCAN (#NF WITH AVN)

BONE SCAN (ARTHRITIS)

BONE SCAN(METABOLIC BONE DISEASE)

BONE SCAN (MULTIPLE METS)

THYROID SCAN

INDICATIONS: THYROTOXICOSIS THYROID NODULE MIDLINE NECK SWELLING SUSPECTED ECTOPIA THYROIDITIS THYROID CYST Ca. THYROID

MULTINODULAR GOITER

Solitary Toxic Nodule

THYROID SCAN (GRAVE’S DISEASE)

THYROID SCAN

(THYROIDITIS)

THYROID SCAN (WARM NODULE LEFT SIDE)

Solitary Cold Nodule Tumor image

Ectopic (Submandibular) Thyroid

Parathyroid tumor

PARATHYROID SCAN

Parathyroid Adenoma

RADIO ISOTOPE RADIO ISOTOPE RENOGRAM.RENOGRAM.

DTPA / DMSA /EC - ScanningDTPA / DMSA /EC - Scanning

IndicationsIndications Recurrent UTI & Growth Recurrent UTI & Growth

retardation in children.retardation in children. GUT problems & unexplained GUT problems & unexplained

Anemia. Anemia. Primary Hyper tension. Primary Hyper tension. Renal donor evaluationRenal donor evaluation Renal Transplant evaluationRenal Transplant evaluation

Effect of Creatinine Effect of Creatinine

If level of S.Creatinine is high then If level of S.Creatinine is high then extraction of Tc-99m –DTPA is low and extraction of Tc-99m –DTPA is low and delayed.delayed.

Background is also very high.Background is also very high. GFR is low.GFR is low. In this case it needs to be inject more In this case it needs to be inject more

activity. activity. EC scan is recommended.EC scan is recommended.

PUJ OBSTRUCTION DTPA RENOGRAMDTPA RENOGRAM

RIGHT KIDNEY PUJ- OBST.

DTPA RENOGRAM

Vesico urethral reflux Vesico urethral reflux

PYELONEPHRITIS DMSA - SCAN

DMSA cortical imaging DMSA cortical imaging

DMSA has tubular DMSA has tubular binding receptor. It binds binding receptor. It binds with tubular protein for a with tubular protein for a longer period.longer period.

Imaging is generally done Imaging is generally done after 3 hours delay to after 3 hours delay to allow time for uptake and allow time for uptake and slow background slow background clearance. clearance.

NON-FUNCTIONING RT KIDNEYNON-FUNCTIONING RT KIDNEY

Myocardial Perfusion scan(Stress Thallium)

EASY & SAFE: NON-INVASIVE, OUT PATIENT PROCEDURE, NO DYE NO ALLERGY

FUNCTIONAL IMAGING: SHOWS BLOOD FLOW & VIABILITY; NOT JUST THE MECHANICAL BLOCK

TRUE FLOW PATTERN: REVEALS COLLATERALS & MICROVASCULAR CIRCULATION & CORONARY STEAL PHENOMENON

VIABILITY: STUNNED MYOCARDIUM, HIBERNATING MYOCARDIUM

MOST COMPREHENSIVE INVESTIGATION OFFERING MAXIMUM INFORMATION FROM SINGLE STUDY

PATIENT PREPARATION

6 Hrs. FASTING FOR THALLIUM IS ESSENTIAL. DISCONTINUATION OF BETA-BLOCKERS &

FRUSEMIDE FOR 72-48 HRS BEFORE EXERCISE STRESS

NO THEOPHYLLINE AND CAFFEINE BEFORE ADENOSINE STRESS

NO NITRATES PREFERABLY ON THE DAY OF EXERCISE STRESS

DETAILED HISTORY TAKING

INDICATIONS:

EVALUATION OF CAD (Coronary Artery Disease): in cases with equivocal TMT/ECHO and/or chest pain, high risk group prior to non-cardiac surgery

POST ANGIO PLASTY & POST CAG:

CHRONIC H.T. SPLY. WITH D.M.

CHEST PAIN & UNEXPLAINED DYSPNOEA.

MYOCARDIAL PERFUSION IMAGE Normal Vs Abnormal

NORMAL ISCHEMIA. INFARCT

STRESS THALLIUM (NORMAL)

STRESS THALLIUM (INDUCIBLE ISCHEMIA)

STRESS THALLIUM (INFARCT)

HIDA SCAN (NORMAL)

HIDA SCAN (NORMAL)

HIPATOBILIARY SCAN (BILIARY ATRESIA)

LUNG PERFUSION SCAN (NORMAL)

GE REFLUX / MILK SCAN

GE REFLUX/MILK SCAN

ISOTOPE HSG

Thank you