DELHI MRI CENTRE
JABALPUR
DEPT. OF NUCLEAR MEDICINE
-DR.PRADEEP DUBEY, M.D
DIRECTOR
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
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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 scan
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All first diagnosed malignancies.
Ca. Breast, Cx & Uterus etc.
Lung & Prostate cancers.
Hodgkin’s lymphoma & other malign.
Pathological Fractures.
AVN & ? Pelvic girdle pain.
Osteo mylitis.
Stress fracture/ vague boney pain .
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
RENOGRAM.
DTPA / DMSA /EC - Scanning
Indications
 Recurrent UTI & Growth
retardation in children.
 GUT problems & unexplained
Anemia.
 Primary Hyper tension.
 Renal donor evaluation
 Renal Transplant evaluation
Effect of Creatinine
 If level of S.Creatinine is high then
extraction of Tc-99m –DTPA is low and
delayed.
 Background is also very high.
 GFR is low.
 In this case it needs to be inject more
activity.
 EC scan is recommended.
DTPA RENOGRAM
PUJ OBSTRUCTION
DTPA RENOGRAM
RIGHT KIDNEY PUJ- OBST.
Vesico urethral reflux
PYELONEPHRITIS
DMSA - SCAN
DMSA cortical imaging
NON-FUNCTIONING RT KIDNEY
 DMSA has tubular
binding receptor. It binds
with tubular protein for a
longer period.
 Imaging is generally done
after 3 hours delay to
allow time for uptake and
slow background
clearance.
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 noncardiac 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