HbA
NH2
H 2O 2
Cl2O7
KClO3
CH2O
PO4
NAOH
KMnO4
MEDICINE
KING SAUD UNIVERSITY
COOH
Co2
MgCl2
H2 O
Endocrine & Metabolism
Doctors slides
Important
Extra Information Doctors notes
Assist. Prof. Ammar Elmajzoup
MST
Introduction to
Nuclear Medicine
SO2
HCN
CCl4
CuCl2
SiCl4
OBJECTIVES
By the end of this lecture, the students
should be able to:
•
Understand the basic terms of Nuclear
Medicine (NM)
•
Discuss Diagnosis and Therapy with nuclear
medicine
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Ammar Elmajzoup
What’s the Nuclear medicine?
 Uses trace amounts of radioactive elements to image certain
organs the body
 Element can be introduced to the body through swallowing,
inhalation, or injection
 Radiopharmaceuticals (radioactive elements) are tracked
through specialized cameras to give detailed images of the
area of the body being treated
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3
What’s the Nuclear medicine? (cont’d)
 Nuclear medicine (NM) imaging can detect abnormalities long
before they can detected through Computed axial tomography
(CAT) scans or Magnetic resonance imaging (MRI) scans
 One of the safest of imaging procedures available today
 Used commonly to detect, track, and treat cancer
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4
Elements Used
 Common radioactive elements includes:
◦
131Iodine,
◦
10Boron,
◦
14Carbon,
◦
99Technetium (99TC),
for Thyroid cancer treatment
which concentration in tumor
for tracing
a synthetic element very widely used for tracing
Most of the elements used for nuclear medicine have very short half lives,
so they don’t stay in the body for long time
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Is it Safe?
 Nuclear medicine is the safest way to scan
 Safer than CAT scans, MRIs, and X-rays
 Amount of radiation a patient is exposed to during a
procedure equivalent to that of an X-ray scan
 Most common side effects of nuclear tracing are nausea and
dizziness, while extreme cases include vomiting and sever
cramps
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6
Is it Safe? (cont’d)
 No deaths directly associated with NM have been reported
 Relatively new technology; not many doctors are trained on
how to react if something goes severely wrong
 Safe enough that children are most common receivers of NM
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7
Outline of NM in endocrinology
 Most common – Bone scan:
Used to reveal……
 Stress fracture
 Fracture
 Infection
 Cancer in the bone or joints
Scanning can only be performed 2 Hrs. afterwards
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Outline of NM in endocrinology
 Cardiac studies:
Several cardiac studies are found with MN
 Myocardial perfusion scan to access
coronary heart disease
 Injection of the tracer is done while the
patient exercising on the treadmill
machine
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9
Outline of NM in endocrinology
 Brain scan:
 Parathyroid (PTH) studies:
Commonly used to diagnose……..
 Alzheimer’s disease
Detect & localize PTH adenoma
in patients with elevated
blood Ca++
 Strokes
 Brain death
 Tumor
 Lung studies:
Commonly used to detect blood
clots in the lungs
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Outline of NM in endocrinology
 Thyroid Studies:
 Evaluate thyroid nodules
 Function of the thyroid
 Thyroid imaging is based on the physiologic process of
thyroid hormone production
 The thyroid tissue cannot differentiate between nonradioactive and radioactive iodine
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Thyroid physiology
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12
Iodine metabolism in thydroid
TSH
Hypothyroidism
High Low
Hyperthyroidism Low
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T4
T3
Iodine uptake
Low
Low
High High
High
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13
Thyroid Imaging
Indications:
•
•
•
•
•
•
•
goiter (palpable, US finding > 10 mm)
hyperthyroidism (Graves disease, autonomous adenoma)
subacute thyroiditis (deQuervain)
ectopic thyroid gland, evaluation of substernal mass
neonatal hypothyroidism
preceding 131I therapy – iodine uptake
postoperative search for functioning metastases
Contraindications:
•
•
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pregnancy
breastfeeding
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14
Normal thyroid scintigraphy
•
•
•
•
normal size
homogenous appearance
sharply defined borders
straight or convex
lateral margins
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15
Multinodular goiter
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Autoimmune thyroid disease is a spectrum
Hyperthyroidism
Grave’s disease
Euthyroidism
Hypothyroidism
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Hashimoto’s
disease
Ammar Elmajzoup
Iodine scintigraphy for differentiated thyroid
carcinoma (DTC)
 131I whole body scintigraphy after ablative radioiodine
therapy – to detect the presence and location of
functioning thyroid tissue (cancer), recurrences and/or
metastases


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DTC (papillary, follicular adenocarcinoma) therapy:
• surgery (possible total thyroidectomy)
• ablative radioiodine therapy – posttherapeutic whole
body scan
• suppressive levothyroxine (LT4) medication
follow up:
• neck US
• serum thyroglobulin level
• whole body 131I scintigraphy
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