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DIAGNOSTIC $ THERAPEUTIC NUCLEAR MEDICINE.
Presented at the KNH Research SymposiumOn 13th April 2012
PRESENTER:
DR. DAVID NDIRANGU THEURI
Nuclear medicine Physician I/C, Nuclear Medicine Unit, Cancer Treatment Centre, Kenyatta National Hospital
DIAGNOSTIC $ THERAPEUTIC NUCLEAR MEDICINE.
WHAT IS NUCLEAR MEDICINE?
It is the branch of medicine that utilises nuclear technology for the diagnosis and treatment of diseases.
PRINCIPLE OF NUCLEAR MEDICINE.
It uses the principle that a certain radiopharmaceutical (tracer) will at a certain point in time have a preferential uptake by a particular body or tissue.
This uptake is then imaged by the use of detectors mounted in gamma cameras or PET (positron emission tomography) devices.
ADVANTAGES OF NUCLEAR MEDICINE
Ability to image the whole body in a single sitting at a comparably short time hence increased patient through fare.
Minimal radiation burden to patients, personnel and environment- the dosages used are very small
Non-invasiveAble to give information on cellular activity at
an early stage.
DISADVANTAGES
Uses very costly and sophisticated equipment.
Requires highly trained personnel.
Higher chances of radiation exposure since the source is unsealed.
Radiation accidents are more likely to occur if safety precautions are compromised.
WHAT IS PECULIAR ABOUT NUCLEAR MEDICINE?
Unlike other radiation applications for medical use, nuclear medicine uses unsealed sources of radiation. The tracer is introduced into the body of the patient through several routes (oral, intravenous, percutaneous, intradermally or inhalation) and he/she becomes the source of radiation.
This radiation can then be detected (for diagnostic use) or used to kill some selected unwanted body cells (therapeutic use).
TYPES OF DIAGNOSTIC PROCEDURES DONE AT KNH
1.Whole body radionuclide bone scan
-To detect skeletal metastases from cancers such as breast, lung, colon, thyroid, prostate.
-To detect the skeleton as the primary source of cancer.
-to detect inflammatory conditions of the connective tissue including infections.
cont…
-to detect degenerative joint diseases such as osteoarthritis.
-to detect sport injuries such as stress fractures
-to determine whether pain from a joint prosthesis is due to loosening or infection.
-to detect areas of ectopic calcification
Cont…
2.Radionuclide thyroid scan - To determine the anatomical position of the
thyroid gland -To determine the functional status of the
thyroid gland i.e hypo or hyper thyroidism -To determine possibility of cancer of the
thyroid gland (“cold’’ areas)- To determine outcome of radioiodine therapy
Cont…
3.Renal scans -Renogram :will delineate the function of
each kidney and the associated collecting system to provide the so-called split kidney function
-Renal perfusion studies :eg after kidney transplant
-Renal function :glomerular filtration rate (GFR)
-Renal anatomy :e.g. ectopic kidneys
Cont…
4.Myocardial perfusion imaging :(MPI)
-For diagnosis of coronary artery disease (CAD) -To differentiate between viable and non-viable
myocardial tissue e.g. after a myocardial infarction (MI) hence deciding on mode of therapy (surgery vs. medical intervention)
-surveillance for those patients known to be at risk of developing CAD eg diabetes
Cont…
5. Lung perfusion studies :to detect pulmonary
embolism.6. Adrenocortical imaging :to detect
pheochromocytoma7. Brain perfusion studies :to detect
epileptic foci, dementias, infarction, Parkinsonism.
Cont…
8. Sentinel lymph node (SLN) mapping and lymphoscintigraphy :especially in breast cancer and melanoma. Will help in determining whether lymphoedema is primary ( congenital ) or secondary ( obstructive ).
9. Hepatobiliary (HIDA) Scan: to determine the anatomical and functional integrity of the liver and the biliary ducts; this scan is of great help in differentiating between biliary atresia (whose management is surgical) and other forms of neonatal jaundice (medical management).
2611 patients have undergone diagnostic nuclear medicine studies up to date ( 10 th March 2012 ) as follows;TYPE OF
PROCEDURE
NO OF CASES
Year 2006 & 2007
Year 2008
Year 2009
Year 2010
Year 2011
Year 2012
Totals
RADIONUCLIDE BONE SCANS
112 101
125 652
521
247
1756
THYROID SCANS 62 86 101 223
125
25 622
RENAL SCANS 14 3 6 64 41 17 145
LUNG PERFUSION SCANS
16 2 _ 2 0 0 20
LYMPHOSCINTIGRAPHY
7 4 2 15 17 0 47
LIVER (HIDA) SCANS
_ _ 1 8 1 0 10
MYOCARDIAL PERFUSION IMAGING (MPI)
- - - 8 0 o 8
MECKLE’S DIVERTICULITIS
0 0 0 0 1 0 1
MIBI PARATHYROID SCANS
0 0 0 1 1 0 2
Totals 211 196
235 973
707
289
2611
Therapeutic radiopharmaceuticalsTherapeutic radiopharmaceuticals
Non-specificNon-specificSr-89, Sm-153, Re-189Sr-89, Sm-153, Re-189Bone pain palliationBone pain palliation
SpecificSpecificI-131I-131
Thyroid cancer, as specific Thyroid cancer, as specific diagnostic if tumor significantly diagnostic if tumor significantly accumulatesaccumulates
Y-90Y-90Zevalin – monoclonal antibody for Zevalin – monoclonal antibody for B-cell lymphomasB-cell lymphomas
CHALLENGES
Delays in procurement of radiopharmaceuticals e.g 99m-Tc generators and radio-iodine from south Africa
Lack of adequate awareness of the existing NM facilities by our colleagues and the public.
Inadequate numbers of trained personnel and equipment
Lack of PET device and PET/CT hybrid devices for image fusion due to the costs involved
Global shortage of Molybdenum -99.
ACKNOWLEDGEMENTS
IAEA & KNH administration for their supportive roles in making nuclear medicine in this country a reality.
T H A N K Y O U.