Nuclear Medicine

Nuclear medicine, in its simplest definition, is the use of radioactive substances in the diagnosis and treatment of diseases. The history of nuclear medicine dates back to the early 1800s when British chemist John Dalton proposed the atomic theory, German Wilheim Konrad Roentgen discovered X-rays in 1895, and Ernest Lawrence built the cyclotron in America in 1928. The most important step in the development of nuclear medicine was Marie Curie’s discovery of artificial radioactivity in 1934. However, many historians point to the 1940s, when radioactive iodine began to be used in the treatment of toxic goiter (toxic goiter), as the real beginning of nuclear medicine. Technetium, the most commonly used radioactive substance in nuclear medicine imaging, was artificially produced in 1937, and its commercial production, distribution, and use began after 1965. In the following years, agents used in liver-spleen and brain imaging were discovered and nuclear medicine began its rapid development that has continued to the present day. The first specialists in the field of nuclear medicine began to be trained in the United States in 1972.

What are the terminological concepts frequently used in nuclear medicine?

Scintigraphy: It is the name given to the procedure performed in nuclear medicine.

Radiopharmaceutical: It is the name given to substances consisting of very low amounts of radioactivity and chemical drugs attached to it, which can be given to patients in various ways (injection or orally) in nuclear medicine.

Planar Method: If the films taken in nuclear medicine are taken in a single plane and in 2 directions, it is called the planar method.

SPECT: Images are taken from the surroundings of the organ whose film will be taken at an angle of 180 or 360 degrees. As a result of the shooting, the raw images are processed with the help of a computer. In this method, the captured organs are examined in 3 dimensions.

PET: The radioactivity used here is positron emitting rays. The other parts are like SPECT.

In which areas and why is nuclear medicine applied?

Myocardial Perfusion Scintigraphy:Coronary Artery Disease
  1. Evaluation of the presence, location, extent and severity of myocardial ischemia or scarring
  2. Evaluation of the effect of coronary stenosis on regional perfusion on angiography.
  3. Evaluation of the vitality of myocardial tissue and monitoring of functional recovery after revascularization
  4. Evaluation of risk and prognosis after myocardial infarction and before non-cardiac surgery
  5. Monitoring the effectiveness of lifestyle changes and medical treatment within the scope of coronary revascularization procedures.
  6. Differential diagnosis of ischemic cardiomyopathy from cardiomyopathy of unknown cause
  7. Differential diagnosis of coronary and non-coronary causes in acute chest pain syndromes
Dynamic Kidney Scintigraphy:
  1. Evaluation and follow-up of kidney function in kidney pathologies and/or systemic diseases affecting kidney function
  2. Evaluation of kidney function and drainage in obstructive pathologies
  3. Evaluation and follow-up of transplanted kidneys
  4. Description of kidney function of donors before transplantation
  5. Evaluation and follow-up of kidney function in nephrotoxic drug use
  6. Evaluation and follow-up of kidney function in bladder dysfunction and vesicourethral reflux (urine leaking back from the bladder to the ureters and sometimes to the kidneys)
  7. Evaluation of the success of surgical and interventional treatment methods
  8. Evaluation of kidney function in patients with iodine allergy
  9. Renal function that cannot be visualized with IVP detection
Renal Cortical Scintigraphy (DMSA):
  1. Diagnosis of acute pyelonephritis
  2. Identification of Renal Eschar tissues
  3. Solitary or ectopic renal tissue
  4. Horseshoe and pseudo-horseshoe kidneys
Bone Scintigraphy
  1. Search for bone metastases
  2. Staging and follow-up of primary bone tumors
  3. Search for suspicious fractures, including stress fractures
  4. Evaluation of bone and soft tissue infections
  5. Determination of metabolic activity in avascular necrosis and trauma areas
  6. Arthritis
  7. Evaluation of response to chemotherapy and radiotherapy
  8. Reflex sympathetic dystrophy syndrome (RSD)
  9. Search for heterotopic ossification
  10. Search for loosening or infection in orthopedic prostheses
  11. Evaluation of bone infarcts
  12. Evaluation of viability of bone grafts
  13. Location of appropriate biopsy site
  14. Evaluation of bone pain of unknown cause
  15. Investigation of abnormal, non-specific bone pathologies detected on direct radiography
  16. Metabolic bone diseases
  17. Diagnosis of Paget disease and evaluation of its activation
  18. Evaluation of osteoblastic activity distribution before Sr-89 treatment
  19. Demonstration of previous bone and soft tissue trauma in forensic cases
  20. Investigation of osteoid osteoma
Thyroid Scintigraphy
  1. Nodular or diffuse goiter
  2. Ectopic thyroid tissue
  3. Retrosternal goiter
  4. Agenesis, hemiagenesis
  5. Evaluation of residual thyroid tissue after surgery
  6. Examination of neck and upper mediastinal masses
  7. Evaluation of functional status of thyroid nodules
  8. Differential diagnosis of thyrotoxicosis
  9. Diagnosis and follow-up of thyroiditis
  10. Hypothyroidism (congenital or acquired)
Parathyroid Scintigraphy
  1. Primary hyperparathyroidism
  2. Secondary hyperparathyroidism
  3. Lung Perfusion/Vent Scintigraphy
  4. Pulmonary embolism diagnosis
There are no known contraindications for these examinations.

Pediatric Nuclear Medicine

Indications for nuclear medicine examinations in children are as follows:

1-Renal Cortical Scintigraphy (DMSA)

  1. Diagnosis of acute pyelonephritis
  2. Follow-up of renal eschar
  3. Relative functional renal mass
  4. Solitary or ectopic renal tissue (e.g. pelvic kidney)
  5. Horseshoe and pseudohorseshoe kidneys

2-Standard and Diuretic Dynamic Renal Scintigraphy in Children

  1. All uropathies requiring evaluation (surgical or conservative treatment) at the primary diagnosis stage or in response to treatment (pelvi-ureteric or vesico-ureteric dilatations, bladder dysfunctions, complex double collector systems, post-trauma, asymmetric renal function and reflux nephropathies)
  2. Determination of renal drainage function by administering diuretics in case of dilatation
  3. In hypertension (systemic or renovascular-captopril scintigraphy)
  4. Renal trauma
  5. Monitoring renal transplants

3-Bone Scintigraphy in Children

A-Infection and Inflammation:
    1. Acute osteomyelitis and soft tissue inflammation
    2. Subacute and chronic osteomyelitis
    3. Septic arthritis
    4. Aseptic arthritis
B-Bone Tumors:
    1. Benign bone tumors
    2. Malignant bone tumors
    3. Tumor-like bone lesions (e.g. Langerhans cell histiocytosis)
    4. Bone metastases
C-Aseptic Necrosis:
    1. Legg-Calve-Perthes Disease
    2. Aseptic bone necrosis and bone infarctions other than Perthes disease
    3. Sickle cell disease
D-Traumatic Bone Diseases:
    1. Presence of suspicious x-ray findings after trauma
    2. Stress fractures
    3. Physical abuse (Child Abuse)
    4. Multiple Trauma
    5. Post-fracture complications
E-Sudeck Atrophy (Reflex Sympathetic Dystrophy)
F-To Guide Surgical Resection (Ex: Osteoid Osteoma)
G-Bone Dysplasias
H-Other Indications in Pediatrics:
    1. Investigation of possible bone diseases in the etiology of pain
    2. Presence of limping or back pain
    3. Inability to step on or stand on foot.
    4. Fever of unknown origin height

4-Gastroesophageal Reflux (GER) and Pulmonary Aspiration Study

Radionuclide GER study is the first choice method in the evaluation of pediatric cases because it is a simple and physiological test.

5-Others

    1. Testicular scintigraphy
    2. Thyroid scintigraphy
    3. Mekel diverticulum scintigraphy

Functional imaging is performed in almost every organ system related diseases in our hospital. Diagnostic examinations performed are scintigraphic imaging of thyroid, bone, heart, kidney and many other organs and diseases, and treatment of some tumors and inflammatory diseases, especially thyroid diseases, is also performed by the same department.

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