Nuclear medicine examinations are unbothersome for patients and are easy. Generally they are called as scintigraphic examinations. These examinations provide detailed information about the structure and functions of the organs and used in diagnosing diseases, determining the direction of therapies and following up patients. In scintigraphic examinations according to the organ to be examined, various compounds that include radioactive substances are given in small amounts either orally or through intravenous injections. The radiation amount that the patient is exposed to in scintigraphic examinations is the same as the radiological examinations such as chest graphies, computer tomography. Examinations can be applied even to newborns. Save for some exceptions, no examinations are performed for pregnant women. Imaging is generally performed after some awating time, which can change between 15 minutes to 4 hours according to the test. For some special examinations the awaiting time is between 3-7 days. Imaging is performed in a special sytem, called gamma camera. This system doesn’t produce radiation, it stores the gamma rays, that come from the radioactive substance which was given to the patient previously. The functional images acquired are then examined by a specialist of neclear medicine. Most organs (brain, thyroid, parathyroid, bone, breast, heart, lung, liver, gull bladder, kidney, etc.) can be scintigraphically examined. Short information about these are given below. Nuclear Medicine Unit of Düzen Laboratory uses the newly built General Electric Millenium MG with double detector body sensor gamma camera system to perform scintigraphic examinations. This modern sytem provides high image quality.
Brain Perfusion scintigraphy
It is used in diagnosis and following up neurological diseases like dementia (Alzheimer’s Disease), diseases of brain vessels (like paralysis), epilepsy, etc.
Thyroid scintigraphy
Thyroid gland, which is located in the neckal region, is an internal gland that regulates the human metabolism. In order to get detailed information about the size, location, structure and function of the gland, thyroid scintigraphy is added to the examination. No preparations are necessary before this examination (like fasting or not taking the drugs).
I-131 Uptake Test
This is an examination that determines the iodine uptake value of the thyroid gland. It is an easy examination which is performed 4 and 24 hours after the oral intake of small amount of I-131 using a device which is put on the neck of the patient and calculates the quantity of I-131. 2 hours of fasting is enough for the examination. It is used in the differential diagnosis of the diseases of the thyroid gland. Additionally, it is used in planning the appropriate I-131 therapy for patients with thyroid cancer or hyperthyroidism.
Parathyroid scintigraphy
Parathyroid glands are small glands which are located in the rear vicinage of the thyroid gland and which regulate the calcium equilibrium of our body. The hyper functioning of these glands cause the calcium depots of our body to run out and so boneloss (osteoporosis) occurs and the blood levels of calcium increase. The cause of this illness is generally the enlargement of the parathyroid glands. The location of the gland, which overfunctions and enlargens, can be determined using parathyroid scintigraphy. There are early and late imaging phases of the examination. The early ones are ready 15-20 minutes after the injection and the late ones are ready in 2-3 hours.
Bone scintigraphy
The nuclear medicine studies which visualize the bone metabolic activity are called bone scintigraphy. This test is primarily used in evaluating the spread of tumors into bones and in directing the therapy. The cancers which spread into the bone tissue are breast cancer, lung cancer and prostate cancer. Generally, bone scintigraphy is used in following up such patients. Additionally, sicntigraphy is used in evaluating and following up the bone traumas (like fracture), stres fractures (hidden fractures), bone and articulation inflammations and metabolic diseases of the bone. No preparations are necessary for this examination. It is waited for 2-3 hours after the injection of the radioactive substance and the patient should drink quite much water in this period. Regional and whole body images are aquired. Whole body scanning is performed using duoble detecter automatic sensors which scan the body in a very short time (30 minutes) staying very close to it. The sytem provides high image detail (resolution).
Heart scintigraphy (Myocardial Perfusion Scintigraphy)
The heart has a special muscle structure. Myocardial perfusion scintigraphy evaluates the blood perfusion and function of the muscle structure which are fed by coronary arteries. Gated analysis, which is performed together with the scintigraphic examination, enables the septum movements and the blood pumping power of the heart to be evaluated. This examination is generally performed on the same day in two sessions. In the first session, under the supervision of a doctor, the heart rate is increased carefully either via excercise or via medicine and Talium and Technetium-mibi is injected into a vein on the arm. Depending on the examination and the radiopharmaceutics (Talium or Technetium-mibi) used, the sequence of the excercise and resting images can vary. The images obtained are evaluated by a doctor who is an experienced specialist in this field. The examinations give information about coronary artery disease, infarct,etc. Moreover, the follow-up of patients, who underwent invasive procedures like coronary by-pass operation, balloon angioplasty (PTCA) or stent implantation, can also be successfully performed. In this examination, the septal movements of the heart and the ejection fraction (power of blood pumping) of the heart can also be evaluated in the same session. The dual detector system stores images by passing very closely to the chest. The advantage of dual detector system enables each imaging procedure to last 13-15 minutes for each session. It is useful to perform the examination fasting. Some of the medicine the patient uses may need to be stopped 2 days prior to the examination.
Radionuclide Ventriculography (MUGA)
The movement defects of the heart as a whole or regional defects are evaluated. The ejection fraction of the heart is determined. It can be performed in coronary artery diseases, diseases of the heart muscle which are called cardiomyopathy and before and after starting some chemotherapies which are potentially dangerous for the heart.
Lung Perfusion and Ventilation Scintigraphy
These are examinations which provide detailed information about the blood circulation and ventilation of the lungs. They are especially used in patients, who are suspected of obstruction of pulmonary vessels (embolism), for not only the diagnosis but the follow-up as well. Moreover, the functional capacity of the lungs is evaluated for the patients who will undergo an operation because of a mass in the lungs or for other pathologies. Before the pulmonary scintigraphy, low dose of radioactive compound is injected and after waiting for a few minutes the images of the lungs are obtained. If ventilation scintigraphy is to be performed, low dose of radioactive compound is filled into the reservoir of the ventilation device and is inhaled by the patient. Afterwards, images of the lungs are stored using computerized gamma camera. No preparations are necessary before this examination.
Kidney Scintigraphy (Dinamic Static Renography)
It is an imaging method which examines the kidney function in detail. Dynamic renographic examination evaluates all the functions of the kidneys (perfusion, concentration, filtration). It is especially used in determining the importance of the obstructions occur in the kidney outflow, the follow-up after kidney operations, in evaluating the patients having frequent urinary tract infections and other diseases of kidneys. It gives valuable information for the follow-up of the patients who undergone kidney transplantation. Computer aided digital analysis (the contribution of kidneys to the total function, kidney filtration curves) give guiding information about patients’ follow-up and therapies. No special preparations are necessary for the examination. The patient shouldn’t fast and should drink at least 2-3 glasses of water before coming here for the examination.
Kidney Scintigraphy (DMSA)
One of the frequently demanded examinations in children and adults is static kidney scintigraphy (DMSA). It is performed to check if the urinary tract infection has caused any damages to the kidneys. No special preparations or fasting are necessary for the examination. Imaging is performed 2,5-3 hours after the injection.
Liver and Spleen Scintigraphy
Liver/spleen scintigraphy gives information about the anatomic shape, structure, size and function of these two organs. The examination is performed with the gamma camera after the intravenous injection of a radioactive compound. No special preparations or fasting are necesary for the examination.
Bile Duct Scintigraphy
It is a functional imaging procedure that enables the examination of liver, bile duct,gall bladder and the evaluation of gall bladder inflamation (cholecystitis). 4 hours of fasting is necessary for the test. The examination is performed following the intravenous injection. Sometimes it is necessary to take images in intervals of 3-4 hours.
Liver Blood Pool Scintigraphy
It is an examination which is used in differential diagnosis of lesions in liver, especially in diagnosis of hemangiomas, which are lumps made up of capillary vessels.
Meckel’s Diverticulum
Scintigraphy It is especially used in examination of Meckel’s diverticulum which causes bleeding in gastrointestinal system of children.
Gastrointestinal Bleeding Scintigraphy
It is especially used in determining the bleeding part of the intestinal system.
Gastroesophageal Reflux Scintigraphy
It is especially performed to examine the presence of the reflux(the backwards flow from the stomach to the esophagus) in children.
Testicular Scintigraphy
It is one of the sensitive tests which can be helpful for the diagnosis in the evaluation of painful testis.
Mammarian Scintigraphy
For some patients that the mammography is difficult to perform, breast scintigraphy can be useful. Additonally, in order to determine the lymphatic drainage of the breast, lymphoscintigraphy of the breast is performed.
Lymphoscintigraphy
It is performed in order to search the reasons for the obstruction in the lymph pathway and to evaluate the lymphatic drainage.
Radioactive Iodine Therapy
It is an easy and effective therapy procedure which is used in diseases of the hyperfunctioning thyroid galnd (Graves, toxic adenoma, Plummer’s Disease, etc.). The optimum dose for the patient is calculated and is then given to the patient orally.