Radiology 6: Nuclear Medicine

Question 1

what is nuclear medicine?

Answer 1

branch of medicine and radiology that uses radioactivity for:

1) diagnostic imaging
2) therapy

Question 2

what are forms of anatomical imaging?

Answer 2

X-ray
US
CT
MRI

Question 3

what is nuclear medicine ?

Answer 3

nuclear medicine is functional imaging of physiological pathways at a molecular level and the affects of disease of these aka molecular imaging.

Question 4

how does functional imaging work?

Answer 4

there is internal radiation which is detected by a camera and the radioactive decay process generates a functional image?

Question 5

why is functional imaging good?

Answer 5

can detect patho-physiological changes of function/metabolism due to disease.
Earlier detection means earlier Rx
molecular events can be be quantified.

Question 6

define the pharmaceutical

Answer 6

the compound which targets the physiological process in question

Question 7

what are the targeting pharmaceuticals for tissue perfusion?

Answer 7

MAA

Question 8

what are the targeting pharmaceuticals for glucose metabolism?

Answer 8

FDG

Question 9

what are the targeting pharmaceuticals for bone metabolism?

Answer 9

MDP

Question 10

what is the radio-isotope label?

Answer 10

attached to pharmaceutical and allows imaging of the distributionof the pharmaceutical.

Question 11

how does nuclear medicine work?

Answer 11

atoms become radioactive when the configuration of protons and neutrons in the nucleus is unstable
a charged particle is emitted from the nucleus to gain stability.
commonly accompanied by the discahrge of excess energy gammy rays.

Question 12

what is the radioisotope for tissue perfusion?

Answer 12

technetium-99m

Question 13

what is the radioisotope for glucose metabolism?

Answer 13

flourine-18-FDG

Question 14

what is the radioisotope for bone metabolism?

Answer 14

technetium-99m

Question 15

what is the ideal radiopharmaceutical relationship?

Answer 15

targets physiological process 
suitable energy level for detection
suitable half life 
low radiation dose 
easy radio-chemistry

Question 16

what is is half life?

Answer 16

the time it takes to half

Question 17

how can we administer radio-pharmaceutical?

Answer 17

IV
Interstitial
inhalation
orally 
intra-vesical

Question 18

what is the camera type for gamma rays ?

Answer 18

gamma camera

Question 19

what is the camera type for positron emitters?

Answer 19

PET camera

Question 20

what is SPE imaging?

Answer 20

this is a planar image that is taken with a gamma camera which provides dynamic imaging where the process happens

Question 21

what is SPECT imaging?

Answer 21

data is collected from many angles around the patient providing depth

Question 22

what are some examples?

Answer 22

bone, renal, infection, pulmonary, thyroid, cardiac, cancers

Question 23

indications for bone scintigraphy

Answer 23

staging and diagnosis of bone mets 
unepxlained bone pain 
suspected bone and prosthetic joint infection
sports injuries 
inflammatory arthropathy 
metabolic bone disease e.g. paget's

Question 24

renal scintigraphy indications

Answer 24

assessment of outflow tract
measurement of differential renal function
diagnosis of reflux nephropathy
screening for reno-vasc disease

Question 25

inflammatory/infective indication

Answer 25

Evaluation of inflammatory bowel disease Diagnosis of chronic osteomyelitis and infected orthopaedic hardware Diagnosis of soft tissue infection Unexplained fever or raised inflammatory markers

Question 26

V/Q indications

Answer 26

PE

Question 27

thyroid scintigraphy indications

Answer 27

Graves disease and toxic nodules

Question 28

myocardial perfusion scintigraphy

Answer 28

dx and mx of CAD

Question 29

tumour imaging indication

Answer 29

Carcinoid

Question 30

what is hybrid imaging ?

Answer 30

Imaging that combines anatomy with function

Question 31

how does PET imaging works?

Answer 31

Uses radiopharmaceuticals that emit positrons during radio-active decay. Positron annihilation with an electron generates 2 simultaneously emitted 511 kev gamma photons travelling in opposite directions Co-incident detection by PET camera

Question 32

which is the most common radiopharmaceutical ?

Answer 32

Most common is Fluorine-18-FDG Glucose analogue Goes to cells with a high glucose requirement (metabolism) i.e. tumour cells, infection/inflammation

Question 33

when do we use PET scanning?

Answer 33

``` Oncology Cancer staging,restaging, residual/recurrent disease Cardiology Perfusion, hibernation assessment Neurology Alzheimers Vasculitis Active large vessel ```