Transcript DIAGNOSING DISEASES USING CLINICAL NUCLEAR MEDICINE

DIAGNOSTIC $ THERAPEUTIC
NUCLEAR MEDICINE.
Presented at the KNH Research Symposium
On 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-invasive
 Able 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
pheochromocytoma
7. 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
TYPE OF
NO follows;
OF CASES
PROCEDURE
Year
2006
&
2007
Ye
ar
20
08
Yea
r
200
9
Year
201
0
Ye
ar
20
11
Ye
ar
20
12
Tota
ls
RADIONUCLIDE
BONE SCANS
112
10
1
125
652
521
247
175
6
THYROID SCANS
62
86
101
223
125
25
62
2
RENAL SCANS
14
3
6
64
41
17
145
LUNG
PERFUSION
SCANS
16
2
_
2
0
0
20
LYMPHOSCINTIG
RAPHY
7
4
2
15
17
0
47
LIVER (HIDA)
SCANS
_
_
1
8
1
0
10
MYOCARDIAL
PERFUSION
IMAGING (MPI)
-
-
-
8
0
o
8
Therapeutic radiopharmaceuticals
Non-specific
Sr-89, Sm-153, Re-189
Bone pain palliation
Specific
I-131
Thyroid cancer, as specific
diagnostic if tumor significantly
accumulates
Y-90
Zevalin – monoclonal antibody for
B-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.