Nucmed 7

Evolve.
Adapt.
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CEFI is now ready.
CLINICAL NUCLEAR MEDICINE
RT-312: NUCLEAR MEDICINE
DANIELE CLYDE P. CACHA, RRT

College of Radiologic Technology
COLLEGE OF RADIOLOGIC TECHNOLOGY
Calayan Educational Foundation, Inc.

I. BONE SCAN
A bone scan or skeletal scintigraphy helps to find cancer that has started in or
spread to the bones. It can also help monitor how well treatment is working for
cancer in the bone.
It helps to diagnose and evaluate a variety of bone diseases and conditions

using small amounts of radioactive materials called radiotracers that are injected into
the bloodstream.

Indications:
• Find bone cancer or determine whether cancer from another area of the body, such as
the breast, lung or prostate gland, has spread to the bones.
• Diagnose the cause or location of unexplained bone pain, such as ongoing low back
pain.
• Help determine the location of an abnormal bone in complex bone structures, such as
the foot or spine.
• Diagnose broken bones, such as a stress fracture or a hip fracture, not clearly seen on
x-rays.
• Find bone damage caused by infection or other conditions, such as Paget disease.

Patient preparation:
• No special preparation needed.
• Medicines that contain barium or bismuth can affect the test results. The doctor
may advise the patient not to take them before the scan.

Procedure:
• First, a tracer will be injected into patient’s vein usually in the arm. It takes 1 to 4
hours for the bones to absorb the tracer.
• While waiting, instruct the patient to drink several glasses of water. By urinating
frequently, it will remove radioactive material that has not collected in the bones.
The amount of radioactivity in patient’s body is safe for others to be nearby. It is less
than the amount from a normal x-ray.

• Next, lie the patient on his back on an exam table and place the gamma camera
above his body. Instruct the patient to remain still to prevent blurry pictures.
• A whole-body scan takes about 1 hour to complete. The scan is not painful but the
patient may find lying uncomfortable.

Indications: Metabolic bone disease
Radiopharmaceutical: Tc-99m Methylene Diphosphonate
Dose: 20 – 30 mCi
Collimator: LEHR
Imaging Method: Whole body and Static imaging after 2-
4 hours post injection

II. THYROID SCAN
A thyroid scan is a nuclear medicine examination that uses the emissions of

gamma rays from radioactive iodine to help determine whether a patient
has thyroid problems, including hyperthyroidism, cancer, or other growths.

Indications:
• Assessment of the gland anatomy (size and shape)

• Assessment of gland function (hyperthyroidism, hypothyroidism)
• Detection of thyroid nodules (cold spots or hot spots)
• Post-operative assessment (post thyroidectomy)
• Detection of functioning metastatic tissues in known cases of thyroid malignancy
• Detection of retrosternal goiter

• Stoppage of anti-thyroid drugs for 2 days before scanning.

• Stoppage of thyroid hormones 4 weeks prior to examination.
• Patient should not undergo special radiographic procedure that involves iodinated
contrast media for 4 weeks before examination.
• Stoppage of iodine-rich food for 1 week.
• Fasting 4 hours prior to examination.

Radiopharmaceuticals:
1. 99m-Tc Pertechnetate
Used mainly in anatomical assessment

Gamma emitter: 140 KeV
Half-life: 6 hours
Dose: 3-5 mCi
Route: IV
Advantages: cheap and available

2. 131-I Sodium Iodide
• Used in full assessment (function and anatomy)

• Gamma emitter: 364 KeV
• Half-life: 8 days
• Dose: 3-5 mCi
• Route: orally
• Disadvantage: relatively expensive, beta particle emitter

3. 123-I Sodium Iodide
• Used in full assessment (function and anatomy)

• Gamma emitter: 159 KeV
• Half-life: 13 hours
• Dose: 100 mCi
• Route: orally
• Advantage: pure gamma emitter (does not emit beta particles)
• Disadvantage: very expensive with limited availability

Procedure:
• The patient lies supine, with hyper - extended neck and the camera anterior to the
neck.
• Fixed distance between camera and neck (20 cm).
• Radio-opaque landmark (piece of lead or radioactive tracer) is put at chin and suprasternal
notch to help detect actual site of the gland and retrosternal goiter if present.


Scanning time:
• When Tc-99m is used, imaging should begin 15-30 minutes after injection.
• When I-131 is used, the images should be obtained at 2 hours, 24 hours & 3-4 days after
ingesting the radioiodine.
• When I-123 is used, images can be obtained as early as after 4-6 hours, then at 16-24 hours


Indications: Hyperthyroidism or hypothyroidism,
thyroiditis
Radiopharmaceutical: Tc-99m pertechnetate, I-123,
I-131
Dose: 7 mCi, 100-300 mCi, 1-10 uCi
Collimator: LEHR, HEAP
Imaging Method: Static, Pinhole after 15 minutes,
after 1 day

III. PET SCAN
Positron emission tomography is a functional imaging technique that uses

radioactive substances known as radiotracers to visualize and measure changes in
metabolic processes, and in other physiological activities including blood flow,
regional chemical composition, and absorption.

Indications:
• Brain injuries (hematomas, concussions, stroke, blood clots)

• Brain tumors (benign or malignant, primary or secondary)
• Neurodegenerative diseases (alzheimer’s, huntington’s, parkinson’s)
• Mental disorder (depression, anxiety, bi-polar, PTSD)

• Patient should not consume any food or at least 4 to 6hrs before the scan, but they
should drink plenty of water.
• Patient will probably need to wear a gown, and they may have to remove jewelries.
• If the patient is ready, they will be taken to a special room scan for the scan. They
will lie down on a cushioned examination table.

Radiopharmaceutical:
F-18 Fluorodeoxyglucose
• Chemically, it is a glucose analog, with the positron-emitting radionuclide fluorine-18.
• It is used for the assessment of glucose metabolism in the heart, lungs, and the brain.
• It is also used for imaging tumors.
• Half-life of 110 minutes.

In FDG-PET scanning, the high consumption of the sugar by tumor cells, as

compared to the lower consumption by normal surrounding tissues, identifies these
cells as cancer cells.
FDG is also used to study tumor response to treatment.


Procedure:
• A dose of 18F-FDG in solution (5 to 10 mCi or 200 to 400 MBq) is typically injected rapidly
into a saline drip running into a vein in a patient who has been fasting and who has a
suitably low blood sugar.
• The patient must then wait about an hour for the sugar to distribute and be taken up into
organs which use glucose – a time during which physical activity must be kept to a
minimum, in order to minimize uptake of the radioactive sugar into muscles.
• Then, the patient is placed in the PET scanner for a series of one or more scans which may
take from 20 minutes to as long as an hour (often, only about one quarter of the body
length may be imaged at a time).

Indications: Cancer detection and staging
Radiopharmaceutical: F-18 FDG
Dose: by weight
Imaging Method: Whole Body PET after 55- 60
minutes post injection

IV. LUNG SCAN
A lung scan is a type of nuclear scanning test. It uses a gamma camera to take
pictures of the lungs after a radioactive tracer is put into the body.
It is most often used to find a pulmonary embolism (a blood clot that prevents
normal blood flow in the lung).

Indications:
• To assess activity of disease

• To select an optimal biopsy site
• For investigation of hemoptysis in selected patients
• Pulmonary embolism
• Diffuse metastatic disease

• No patient prep necessary

• The patient must have a chest X-ray within 24 hours prior to the study
• Bring recent chest X-ray

Radiopharmaceuticals:
1. Tc-99m Macroaggregated Albumin (Tc-99m albumin aggregated or Tc-99m MAA)
• This radiopharmaceutical is primarily used in lung imaging. Within a few seconds after
intravenous administration of Tc-99m MAA , 90 to 95 ％ of the injected dosage is trapped
in the capillary and pre-capillary bed of the lungs.
• The biological half life of Tc-99m MAA in the lungs is about 8 to 12 hours.
• Tc-99m albumin macroaggregates are broken down in smaller (micro) particles that are
then taken up by the RE cells of liver and spleen.

2. Xenon-133
• Radiopharmaceutical imaging agent primarily used to image lungs and evaluate

pulmonary function.
• Also used to assess cerebral blood flow.
• Xenon gas is inhaled to provide diagnostically relevant images of the lungs to physicians.
• The biological half life of Xenon-133 in the lungs is 5 days.


Procedure:
1. Perfusion Scan
• During this scan, a radioactive tracer is injected into patient’s vein usually in the
arm. It travels through blood and into the lungs.
• Pictures from this scan can show areas of the lungs that aren't getting enough
blood.

2. Ventilation Scan
• During this scan, the patient inhales a radioactive tracer gas or mist.
• Pictures from this scan can show areas of the lungs that aren't getting enough air or
that hold too much air.

Indications: Pulmonary disorders
Radiopharmaceutical:
• Tc-99m MAA (perfusion)
• Xe-133 or Tc-99m DTPA (ventilation)
Dose: 2-6 mCi; 10-20 mCi (IV & Inhalation)
Collimator: LEHR
Imaging Method: Static, Dynamic

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Evolve.

CLINICAL NUCLEAR MEDICINE

RT-312: NUCLEAR MEDICINE

DANIELE CLYDE P. CACHA, RRT

CLINICAL NUCLEAR MEDICINE

It helps to diagnose and evaluate a variety of bone diseases and conditions

CLINICAL NUCLEAR MEDICINE

CLINICAL NUCLEAR MEDICINE

• No special preparation needed.

CLINICAL NUCLEAR MEDICINE

CLINICAL NUCLEAR MEDICINE

CLINICAL NUCLEAR MEDICINE

CLINICAL NUCLEAR MEDICINE

A thyroid scan is a nuclear medicine examination that uses the emissions of

CLINICAL NUCLEAR MEDICINE

• Assessment of the gland anatomy (size and shape)

CLINICAL NUCLEAR MEDICINE

• Stoppage of anti-thyroid drugs for 2 days before scanning.

CLINICAL NUCLEAR MEDICINE

Used mainly in anatomical assessment

CLINICAL NUCLEAR MEDICINE

• Used in full assessment (function and anatomy)

CLINICAL NUCLEAR MEDICINE

• Used in full assessment (function and anatomy)

CLINICAL NUCLEAR MEDICINE

• Fixed distance between camera and neck (20 cm).

CLINICAL NUCLEAR MEDICINE

CLINICAL NUCLEAR MEDICINE

CLINICAL NUCLEAR MEDICINE

CLINICAL NUCLEAR MEDICINE

CLINICAL NUCLEAR MEDICINE

Positron emission tomography is a functional imaging technique that uses

CLINICAL NUCLEAR MEDICINE

• Brain injuries (hematomas, concussions, stroke, blood clots)

CLINICAL NUCLEAR MEDICINE

CLINICAL NUCLEAR MEDICINE

• Chemically, it is a glucose analog, with the positron-emitting radionuclide fluorine-18.

• It is also used for imaging tumors.

• Half-life of 110 minutes.

CLINICAL NUCLEAR MEDICINE

In FDG-PET scanning, the high consumption of the sugar by tumor cells, as

FDG is also used to study tumor response to treatment.

CLINICAL NUCLEAR MEDICINE

CLINICAL NUCLEAR MEDICINE

CLINICAL NUCLEAR MEDICINE

CLINICAL NUCLEAR MEDICINE

• To assess activity of disease

CLINICAL NUCLEAR MEDICINE

• No patient prep necessary

CLINICAL NUCLEAR MEDICINE

1. Tc-99m Macroaggregated Albumin (Tc-99m albumin aggregated or Tc-99m MAA)

CLINICAL NUCLEAR MEDICINE

• Radiopharmaceutical imaging agent primarily used to image lungs and evaluate

• Also used to assess cerebral blood flow.

• The biological half life of Xenon-133 in the lungs is 5 days.

CLINICAL NUCLEAR MEDICINE

CLINICAL NUCLEAR MEDICINE

CLINICAL NUCLEAR MEDICINE

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