Nuclear Medicine

Nuclear Medicine is a rapidly developing branch of medicine which uses radioisotopes for diagnostic imaging and therapy purpose. It is older than CT, MRI and ultrasound, first used on patients over 60 years ago. Nuclear Medicine is part of the hospital’s constant effort to update its services and offer the latest medical technology at economical rates to the needy. The hospital has sophisticated latest generation SPECT gamma camera, PET-CT and therapy wards which constitute backbone of the Department of Nuclear Medicine and PET –CT.

SPECT(Gamma Camera) SCAN

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SPECT (Gamma Camera) Facility

Nuclear Medicine imaging or Scintigraphy utilizes a dual head gamma camera to record the physiological activity of selected organs or body systems, by using minute quantities of radiopharmaceuticals which are administered by intravenous, oral or inhalation routes. This imaging is fundamentally different from magnetic resonance imaging (MRI) and computed tomography (CT), for these methods only convey anatomic information. In most diseases, physiological changes precede anatomic changes, so scintigraphic evidence of a disease process can be diagnosed at an earlier stage. After administering radiotracers the areas of interest are then imaged by the gamma camera which capture the  gamma rays emitting from the patient.

Gamma Camera Procedures Performed

PROCEDURE INDICATIONS
 THYROID SCAN To assess thyrotoxicosis, Graves disease, toxic MNG, thyroiditis, thyroid nodule evaluation, lingual thyroid etc
 PARATHYROID SCAN To assess parathyroid adenoma, hyperplasia, ectopic parathyroid adenomas
MYOCARDIAL PERFUSION/ THALLIUM SCAN To evaluate IHD, physiological significance of known coronary stenosis,Risk stratification of CAD,

Presurgical cardiac evaluation, to assess myocardial viability before CABG prior to surgery ,

congenital heart disease, follow-up of Kawasaki disease

MUGA SCAN To evaluate accurate LVEF, regional wall motion abnormalities in CAD,

prior to adriamycin and other cardiotoxic drug therapy

 RENOGRAM To assess GFR of individual kidneys esp. in donors, neonatal hydronephrosis, PUJ obstructions,

obstructed megaureter, relative function evaluation in patients with renal malignancy prior to

nephrectomy, ectopic kidneys, post renal transplant evaluation, renal artery stenosis(pre/post captropril)

DMSA SCAN To assess UTI (Renal scars), ectopic kidneys, accurate function assessment of individual kidneys
DIRECT / INDIRECT RADIONUCLIDE MCU SCAN To assess VU reflux, UTI, hydroureteronephrosis
 WHOLE BODY BONE SCAN To evaluate skeletal mets, bone malignancy, low backache, tuberculosis of bone,

avascular necrosis, metabolic bone disease, stress fracture, osteomyelitis versus cellulitis.

GALLIUM SCAN Assessment of prosthetic infections, evaluation of lymphoma (Hodgkin's & non Hodgkin's)
LUNG PERFUSION & VENTILATION Pulmonary embolism, lung vascularity assessment in children with congenital heart disease,

predict FEV1 in patients planned for pneumonectomy/lobectomy

LIVER-SPLEEN SCAN Alcoholic hepatitis, cirrhosis, portal hypertension, hemangioma, jaundice, Budd chiari syndrome
HEPATOBILIARY SCAN Differentiate neonatal hepatitis vs biliary atresia, post-op bile leak, choledochol cyst,

post liver transplant cases, gall bladder dyskinesia, acute/chronic cholecystitis

MECKEL'S SCAN Evaluation of  meckels diverticulum (Ectopic gastric mucosa), malena, GI bleed
GASTRO INTESTINAL BLEEDING To evaluate occult GI bleed and localize the site of bleed
GASTRIC EMPTYING Diabetic gastroparesis
GASTRO ESOPHAGEAL REFLUX ( Milk scan) Recurrent respiratory infections, heart burns
Lymphangiogram To evaluate lymphatic duct patency
 Thyroid-scan

Thyroid scan

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Renal scan

 bone_scan

BONE SCAN

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MYOCARDIAL  PERFUSION SCAN

PET-CT SCAN

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PET-CT Facility

The Department of Nuclear Medicine is equipped with the state-of-the-art PET-CT scanner (Positron Emission Tomography - Computed Tomography). It provides superior diagnostic information for patients with cancer, ischemic heart disease and certain neurologic conditions. In the three decades since its development, PET has been demonstrated to be a clinically proven and safe method for imaging a variety of disorders. PET CT can demonstrate certain pathological changes long before they would be evident on CT or MRI alone.

PET-CT is a non invasive diagnostic whole-body imaging procedure, cost-effective and is used in the early detection, staging, and follow-up for most cancers, including lymphomas, lung, breast, gastrointestinal, gynaecological, cartilaginous, head and neck cancers.

PET CT is also used to evaluate treatment response after chemotherapy and radiotherapy. Mid cycle PET-CT is useful to ascertain if the patient is responding to chemotherapy, so that regimes can be modified.

PET CT is also used in Radiotherapy planning.

PET is able to discover these changes in their earliest stages, often before any symptoms appear. With this information on early developing cancers, effective treatment plans can be initiated sooner. PET can most of the times helps to eliminate the need for other invasive procedures and by correctly staging cancers, may prevent unnecessary surgical procedure

ROLE OF   18 F FDG PET/CT IN ONCOLOGY .

INDICATIONS:

Precise staging of disease: Improved tumor localization as well as detection of distant metastasis.

Response Evaluation: During or after completion of the therapy.

Restaging: Evaluates both loco regional and distant sites.

Better monitoring of cancer recurrence: E.g.  In patients with rising tumor markers E.g.CA 125 in Ca ovary and CEA in Ca colon.

Evaluation of Carcinoma of Unknown Primary.

For detection of primary site as well as other areas of involvement by the neoplastic process.

PET also helps in guiding the biopsy site of active disease.

PET CT imaging is also useful in the following infection and inflammation imaging:

Infection- Infective endocarditis, Tuberculosis, HIV, Pyrexia of unknown origin, Osteomyelitis, Graft and Prostehtic infection .

Inflammation- Inflammatory bowel disease, cardiac sarcoid, Rheumatoid Arthritis, Vasculitis, Polymyalgia Rheumatica, Sarcoidosis.

18F –Fluoride bone scan: Fluoride bone is done on PET scanner .It has better sensitivity and image resolution than the conventional 99m MDP bone scan.

Role of 18F FDG PET/CT in Cardiology: For detection of myocardial viability.

Role of 18F FDG PET/CT in Neurology : In the evaluation of patients with  dementia , epilepsy, parkinsonism  syndrome.

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 CT image  PET image  Fused PET CT image
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pretreatment

THERAPEUTIC NUCLEAR MEDICINE

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LOW DOSE I-131 THERAPY Treatment of thyrotoxicosis – Graves disease, Toxic MNG,

Autonomous toxic nodule

HIGH DOSE I-131 THERAPY Treatment of differentiated thyroid carcinoma and metastases
STRONTIUM /SAMARIUM THERAPY Palliative bone pain therapy for cancer patients
MIBG THERAPY Malignant pheochromocytoma, neuroblastoma
Peptide Receptor radionuclide therapy(PRRT) Lu-177 DOTA-NOC/ DOTA-TATE therapy for neuroendocrine tumours
Radiation Synovectomy Chronically inflamed joints, refractory to treatment
Trans Arterial Radio Embolization (TARE) Y90 TheraSpheres/ SIR-spheres therapy
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Radioiodine scan of a thyroid cancer patient

Patient information:

Radionuclide imaging is performed only by prior appointment since the isotopes are procured from far places and have to be made ready as they have very short shelf lives. The procedure to be followed is send to either the patient or his attender to the nuclear medicine department where he is given appointment . He is also explained about the procedure and also given necessary instructions in case prior preparations are required.

Several patients have the fear of exposure to radiation. Thanks to intensive research, the radiopharmaceuticals currently available have short half lives, and the biological half lives are even shorter. Therefore, nuclear medicine imaging is quite safe, even for children and the amount of radioactive material used is very small and the radiation dose is similar to that of diagnostic x-ray tests. Most of the radioactive material leaves the body through the urine. Any retained material loses its radioactivity relatively quickly through breakdown (decay). There are little or no side-effects from the radioactive tracer. However, one should be circumspect in the case of a pregnant women.

The unique and vital advantage of nuclear medicine scans are its usefulness in providing vital functional information in addition to anatomical details, unlike other imaging modalities like MRI, where patients with metallic prosthesis/implants, aneurysm clips, pacemakers etc are not contraindicated. Therefore radionuclide imaging is an excellent complement to other imaging modalities like CT scan, ultrasonography, MRI etc.

IMG-20161007-WA0029Dr. Rashmi Angadi is a Consultant and Incharge of the dept. of Nuclear Medicine and PET-CT at KLES Dr Prabhakar Kore Hospital and MRC, Belagavi, Karnataka. She has gained extensive experience in the speciality of Nuclear Medicine with expertise across wide spectrum of various Nuclear Medicine services including Diagnostic Radionuclide applications in SPECT-CT and PET-CT molecular imaging in Nuclear Oncology, Cardiology, Neurology, Endocrinology, Nephrology etc and PET-CT guided Radiation Therapy Planning and as well in therapeutic radionuclide applications including thyroid disorders, neuroendocrine tumors, bone pain palliation, radioembolisation procedures for hepatocellular cancer and liver metastasis.

Her areas of interest includes Nuclear Cardiology especially FDG PET imaging for myocardial viability, Nuclear Neurology with special attention towards Epilepsy, Nuclear Nephrology, and various other general Nuclear Medicine Procedures.

She completed her Post Graduate Degree in the speciality of Nuclear Medicine, Diplomate of National Board, New Delhi. She underwent her training at Narayana Hrudayalaya Institute of Medical Sciences, Bangalore, a premier multi-speciality hospital accredited for Post Graduate Medical Courses (DNB) under National Board of Examinations.

She qualified the Radiation Safety Officer Examination, conducted by Atomic Energy Regulatory Board (AERB), Bhaba Atomic research Centre (BARC), Mumbai, India.

She received specialised training at AIIMS, New Delhi and PGI Chandigarh towards Radiolabelled Peptide Receptor Therapy for Neuroendocrine cancer, Lu-177 DOTA-NOC therapy, Y90 Synovectomy, Y90 theraspheres therapy and I-131 mIBG therapy etc.

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She completed her M.B.B.S from Karnataka Institute of Medical Sciences, Hubballi, achieving five gold medals to her honour. She is trained in various fields of medicine for an overview of diseases and disorders, and hands on insight towards various treatments and management protocols for better vision and understanding in the field of diagnostics and therapeutic Imaging.

She has worked as a tutor in the department of community medicine at Belgaum Institute of Medical Sciences, Belagavi.

Affiliations:

Society of Nuclear Medicine India (SNMI)

Association of Nuclear Medicine Physicians of India (ANMPI)

Research and publications:

Submitted a Dissertation titled “Assessment of Myocardial viability: Comparison of Tc-99m Sestamibi Myocardial Perfusion Scintigraphy and cardiac F-18 FDG PET CT”

Scientific Papers presentation at State and National Conferences:

  • Paper titled “FDG PET CT in T cell lymphoma” at Annual Conference of Association of Nuclear Medicine Physicians of India, at Delhi.
  • Case report titled “FDG PET CT in Neurolymphomatosis” at the Annual Conference of Southern Chapter, Society of Nuclear Medicine, India at Calicut.

Invited Talks / Lectures:

  • As a speaker for the session “PET CT in Neurology”
    Symposium on Nuclear Oncology and PET CT.
    Apollo Hospitals Bangalore
  • As a chairperson for the session “PET CT in Urogenital malignancies” CME on Uroradiology.

Participant in following workshops:

  • 17th annual conference of SNM(I)- southern chapter scientific programme at Thirupathi.
  • 43rd annual conference of the society of nuclear medicine, India held at Chennai.
  • CME on therapeutic applications of nuclear medicine at PGI Chandigarh.
  • Poster presenetation on “FDG PET CT in T cell lymphoma” in ANMPI conference held at Delhi.
  • Paper presentation on “FDG PET CT in Neurolymphomatosis” in Kozhikode, Kerala 18th annual conference of the southern chapter of SNM(I).
  • 3rd hands-on-training in nuclear medicine therapy being conducted at AIIMS, Delhi.

Physics practical session at Tata Memorial Hospital, Mumbai and Manipal, Karnataka