Nuclear Medicine

Nuclear medicine uses slightly radioactive materials, or radiopharmaceuticals, in small quantities to diagnose abnormalities early in the progression of various conditions.  Frequently in many diseases, especially in tumors and infectious processes, the functional changes appear before they can be identified by structural changes.  Nuclear medicine images, unlike most obtained in radiology, provide functional information, showing how individual systems of organs and tissues are functioning. 

Hybrid SPECT-CT imaging has dramatically increased the sensitivity and specificity of nuclear medicine imaging. The uses for this nuclear medicine machine are very similar to an X-ray but uses a camera sensitive to gamma rays and X-rays.   As on a radiograph, each of the images obtained is two-dimensional; with the SPECT–CT we combine many images taken from different positions around the patient to obtain a three-dimensional image.

This three-dimensional image can then be manipulated to obtain dimensional body sections in any orientation. As an additional benefit, any findings in nuclear medicine images are immediately correlated with a CT image, dramatically increasing how specific the finding is, and often avoiding unnecessary additional studies.

SPECT-CT imaging provides more information compared to the image obtained by nuclear medicine cameras that use only SPECT without the SPECT-CT. Such information often proves valuable in improving the chances for therapy success.

SPECT-CT studies should be requested by the referring physician.

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All Nuclear Medicine Studies

To reduce radiation exposure, patients should be well hydrated prior to and for at least one day after injection.

Gastrointestinal Studies

The HIDA Scan (Hepatobiliary Scan) is a dynamic study that assesses the gallbladder’s function. An IV is used in order to administer the radioactive material and the pharmaceutical cholecystokinin (CCK) for the second part of the study.
Preparation: Your last meal should be no less than four hours before the study.
Duration: Minimum of two hours.
Indications: acute cholecystitis, chronic cholecystitis, bile duct obstruction, biliary extravasation, biliary atresia, liver transplant evaluation, vague gallbladder (ejection fraction calculation) .

Gastric Emptying is a study where the emptying of the stomach is evaluated. It is a study where the patient eats the egg white stir fry mixed with the radioactive material and images are acquired at 1 minute, 15 minutes, 1hr, 2hr, and 4hr (optional).
Preparation: Your last meal should be no less than four hours before the study. Should bring three raw eggs, bread, jam and juice.
Duration: Minimum of five hours.

Pulmonary Studies

The Lung Ventilation component of the study detects pulmonary embolism (PE).
Preparation: none required.
Duration: 30 to 45 minutes.
Indications: regional ventilation evaluation.

The Lung Perfusion component of the study detects PE. It is performed after the Lung Ventilation Study.
Preparation: none required.
Duration: 30 to 45 minutes.
Indications: possible PE.

Musculoskeletal Studies

The Bone Scan, Three-Phase Bone Scan, and Bone SPECT-CT detect bone fractures, metastases, and osteomyelitis.
Preparation: none required.
Duration 45 minutes to one hour.
Indications: arthritis, primary tumors, metastases, fractures not identified or equivocal in radiology studies.

Infections or Tumors Studies

The Gallium Scan detects inflammation or tumors. This study has been largely replaced by PET-CT which is more sensitive and specific.
Preparation: none required.
Duration: one hour.
Indications: infections, inflammation, or tumors.

Renal Studies

The Renal Scan and Renal Scan without and with diuretic is a dynamic study that assesses the function of the kidneys and the tracer’s excretion through the renal collecting system.
Preparation: Hydration prior to and during the study.
Duration: one hour to one and a half hour.
Indication: kidney failure, renal hypertension, kidney transplant, renal obstruction, and tubular function and secretion.

Cardiac Studies

The MUGA Scan (Multigated Acquisition Scan) is a noninvasive study that accurately evaluates the function of the muscle wall of the ventricles (lower chambers of the heart) in cinematographic format. It requires the injection of a small amount of radioactive tracer into a vein.
Preparation: none required.
Duration: one hour.
Indications: Quantify ventricular function.

The Viability Scan assesses the viability of the heart.
Preparation: Your last meal should be no less than four hours before the study.
Duration: one hour.
Indications: Infarct within the heart walls.

The Myocardial Perfusion SPECT (MPI), Sestamibi Scan, Thallium Scan is a study that evaluates heart function.
MEDFLIX performs a CT coronary calcium score study at no additional cost to MPI patients who do not have coronary stents and who have not undergone coronary artery bypass grafting. This improves the specificity of MPI findings.
Preparation: Your last meal should be no less than four hours before the study. No coffee, chocolate, tea, or soda drinks 12 hours prior to the study.
Duration: half day.
Indications: Possible cardiac ischemia or infarction.

Neuro/Brain Studies

Brain SPECT (single emission computed tomography) is a study that shows brain function. This exam uses a radiotracer (radioactive compound) that is given via injection through an intravenous line.
Preparation: none
Duration: one hour
Indications: neurodegenerative dementia and epilepsy

DaTscan (Dopamine Transporters) – Images of this study demonstrate the pattern of accrual of I-123 tracer in the basal ganglia. The study complements the neurologist assessment differentiating between the two principal categories of tremor producing conditions: essential tremors and parkinsonian syndromes. The study does not differentiate among the diseases that fall under parkinsonian syndromes category such as PSP (progressive supranuclear palsy), MSA (multiple system atrophy), and PD (idiopathic Parkinson’s disease).

Before scheduling the appointment the patient has to come in person to MEDFLIX to pay a deposit for the tracer which is flown from the United States and to provide a list of all current medications to verify if any have to be stopped for the exam.
Preparation: Discontinue medications, if applicable.
Duration: six to eight hours.
Indications: To differentiate between essential tremors and parkinsonian syndromes.

Endocrine Studies

The Thyroid Scan is a study to assess the structure and function of the thyroid gland. To perform the study, a small amount of radioactive material is administered through a vein, this material concentrates in the thyroid.
Preparation: A week prior to the study, stop taking all thyroid medications.
Duration: 30 minutes.
Indications: hyperthyroidism, hypothyroidism, detect nodules, chronic thyroiditis, Hashimoto, hyperfunctional adenoma, thyroid cancer, and evaluation of ectopic thyroid tissue

The Parathyroid Scan with SPECT-CT is for the localization of parathyroid adenomas in the setting of overactive parathyroid glands.

Preparation: none.

Duration: three hours.

Indications: Detect parathyroid adenomas.

Iodine 131 Therapy (I-131) effectively treats patients with hyperthyroidism and toxic thyroid nodules. It is also used, in higher doses, to complement thyroid cancer therapy.
The images obtained with I-131 in a SPECT-CT scanner provide significantly more information than conventional planar studies, including those using pinhole collimation, thanks to the anatomic localization studies and precision that a CT image offers when superimposed in the traditional nuclear medicine image.

Iodine 131 Therapy (I-131)
Preparation and Duration: Depends if the I-131 is used for treatment or to perform a scan. For details please contact our Communications Center.
Indications: hyperthyroidism and cancer therapy

OCTREOSCAN: (Indium-111 pentetreotide) is a somatostatin analog that binds to somatostatin receptors. This radioisotope concentrates on neuroendocrine and some non-neuroendocrine tumors containing those receptors. 
Preparation: The use of laxatives should be considered when the abdomen is the area of interest. A mild oral laxative may be administered the evening prior to injection and the evening following injection. The need for bowel preparation should be assessed on an individual basis.  

OCTREOSCAN
Duration: Whole body images are obtained at four and 24 hours after tracer injection. SPECT-CT images are obtained at 24 hours. 

Indications: 1. Detection and localization of a variety of suspected neuroendocrine and some non-neuroendocrine tumors and their metastases, such as: • Adrenal medullary tumors (pheochromocytoma, neuroblastoma, ganglioneuroma) • GEP (gastroenteropancreatic) tumors, e.g. gastrinoma, insulinoma, glucagonoma, VIPoma • Carcinoid tumors • Medullary thyroid carcinoma Indications:
2. Staging patients with neuroendocrine tumors. 
3. Follow-up of patients with the known disease to evaluate potential recurrence. 