Introduction to Nuclear medicine

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What is nuclear medicine?

Nuclear medicine is a specialized area of radiology that uses very small amounts of radioactive materials, or radiopharmaceuticals, to examine organ function and structure. Nuclear medicine imaging is a combination of many different disciplines. These include chemistry, physics, mathematics, computer technology, and medicine. This branch of radiology is often used to help diagnose and treat abnormalities very early in the progression of a disease, such as thyroid cancer.

Because X-rays pass through soft tissue, such as intestines, muscles, and blood vessels, these tissues are difficult to visualize on a standard X-ray, unless a contrast agent is used. This allows the tissue to be seen more clearly. Nuclear imaging enables visualization of organ and tissue structure as well as function. The extent to which a radiopharmaceutical is absorbed, or "taken up," by a particular organ or tissue may indicate the level of function of the organ or tissue being studied. Thus, diagnostic X-rays are used primarily to study anatomy. Nuclear imaging is used to study organ and tissue function.

A tiny amount of a radioactive substance is used during the procedure to assist in the exam. The radioactive substance, called a radionuclide (radiopharmaceutical or radioactive tracer), is absorbed by body tissue. Several different types of radionuclides are available. These include forms of the elements technetium, thallium, gallium, iodine, and xenon. The type of radionuclide used will depend on the type of study and the body part being studied.

After the radionuclide has been given and has collected in the body tissue under study, radiation will be given off. This radiation is detected by a radiation detector. The most common type of detector is the gamma camera. Digital signals are produced and stored by a computer when the gamma camera detects the radiation.

By measuring the behavior of the radionuclide in the body during a nuclear scan, the healthcare provider can assess and diagnose various conditions, such as tumors, infections, hematomas, organ enlargement, or cysts. A nuclear scan may also be used to assess organ function and blood circulation.

The areas where the radionuclide collects in greater amounts are called "hot spots." The areas that do not absorb the radionuclide and appear less bright on the scan image are referred to as "cold spots."

In planar imaging, the gamma camera remains stationary. The resulting images are two-dimensional (2D). Single photon emission computed tomography, or SPECT, produces axial "slices" of the organ in question because the gamma camera rotates around the patient. These slices are similar to those performed by a CT scan. In certain instances, such as PET scans, three-dimensional (3D) images can be performed using the SPECT data.

Scans are used to diagnose many medical conditions and diseases. Some of the more common tests include the following:

Renal scans. These are used to examine the kidneys and to find any abnormalities. These include abnormal function or obstruction of the renal blood flow.

Thyroid scans. These are used to evaluate thyroid function or to better evaluate a thyroid nodule or mass.

Bone scans. These are used to evaluate any degenerative and/or arthritic changes in the joints, to find bone diseases and tumors, and/or to determine the cause of bone pain or inflammation.

Gallium scans. These are used to diagnose active infectious and/or inflammatory diseases, tumors, and abscesses.

Heart scans. These are used to identify abnormal blood flow to the heart, to determine the extent of the damage of the heart muscle after a heart attack, and/or to measure heart function.

Brain scans. These are used to investigate problems within the brain and/or in the blood circulation to the brain.

Breast scans. These are often used in conjunction with mammograms to locate cancerous tissue in the breast.

How are nuclear medicine scans done?

As stated above, nuclear medicine scans may be performed on many organs and tissues of the body. Each type of scan employs certain technology, radionuclides, and procedures.

A nuclear medicine scan consists of 3 phases: tracer (radionuclide) administration, taking images, and image interpretation. The amount of time between administration of the tracer and the taking of the images may range from a few moments to a few days. The time depends on the body tissue being examined and the tracer being used. Some scans are completed in minutes, while others may need the patient to return a few times over the course of several days.

One of the most commonly performed nuclear medicine exams is a heart scan. Myocardial perfusion scans and radionuclide angiography scans are the 2 primary heart scans. In order to give an example of how nuclear medicine scans are done, the process for a resting radionuclide angiogram (RNA) scan is presented below.