Referrer Support

Nuclear Medicine is the medical specialty that uses radiopharmaceuticals for diagnosis and therapy. The radiopharmaceutical is usually administered intravenously but, depending on the study, it may also be administered orally or by inhalation.  The radiation dose from a diagnostic study is usually less than that of a CT scan.

Bone Scan

• Skeletal metastates
• Sports injuries (eg shin splints, stress fractures)
• Trauma (eg. scaphoid, sacral & femoral neck fractures not evident on X-Rays)
• Osteoporotic fractures
• Osteonecrosis (avascular necrosis)
• Osteomyelitis
• Painful prosthesis (loosening or infection)
• Back Pain – spondylolysis, pars interarticularis fracture
• Paget’s disease – presence & extent
• Enthesopathy, sacrolitis
• Reflex sympathetic dystrophy

Thyroid Study

• Evaluation of thyrotoxicosis
• Diagnosis of subacute thyroiditis
• Evaluation of functional status of thyroid nodules

Myocardial Perfusion: (“thallium”/”sestamibi”/”MPS”)

Assessment of myocardial ischaemia and viability. For patients unable to exercise dipyridamole or dobutamine (for asthmatics) are used. Rest and post stress images.

• Myocardial Perfusion Study (exercise / dipyridamole / dobutamine)
• Detection of presence, extent & severity of myocardial ischaemia
• Gated SPECT permits evaluation of LV wall motion & thickening & provides LVEF

Lung Scan

Ventilation and perfusion-pulmonary emboli. More sensitive and far less radiation than helical CTPA. Regional quantification. Right to left shunts.

Renal Scan (DTPA):  (+/-captopril or frusemide)

Differential renal functions, renovascular hypertension, ureteric obstruction. MAG3 is substituted in children. Camera based GFR quantification.

Renal Study (MAG3 or DTPA) +/- Lasix

• Evaluation of renal perfusion and excretion
• Diagnosis of pelvi-ureteric junction obstruction & vesico-ureteric junction obstruction
• Follow-up evaluation after pyeloplasty
• Measurement of differential rela function

Renal Scan (DMSA)

Renal scarring and acute pyelonephritis (more sensitive than ultrasound). Differential function (particularly if one kidney is small or ectopic).

Renal Cortical Study (DMSA)

• ‘Gold standard’ test for detection of presence, location & extent of renal cortical scars
• Detection of acute pyelonephritis
• Measurement of differential renal function

Gallium Scan:

Detection of malignancy as a cause of PUO. Sarcoidosis. Chronic infections, eg osteomyelitis and infected joint prosthesis. Lymphoma staging and response to treatment.

Radioactive Iodine (1-131):

Treatment of hyperthyroidism.

White Cell Scan:

Localisation of acute or subacute infection. Assessment of activity of inflammatory bowel disease.

Colloid Liver Scan: 

Diffuse or chronic liver disease. Assessment of liver nodules (FNH). Labelled Red Cell Scan Haemangioma of the liver. Gastrointestinal haemorrhage.

Biliary Study (HIDA):

Acute cholecystitis. Biliary obstruction or dysfunction. Response to a fatty meal or CCK used to assess chronic cholecystitis or sphincter of Oddi dysfunction.

• Chronic cholecystitis, gallbladder dyskinesia, cystic duct syndrome
• Acute cholecystits
• Post-operative biliary leak

Lymphoscintigraphy:

Diagnosis of lymphedema

Evaluation of regional lymphatic drainage prior to surgery (eg. for skin legions and breast carcinoma)

Sentinel node localisation in breast cancer and melanoma. Assessment of lymphoedema and lymphatic drainage.

Cerebral Perfusion Study(Ceretec):

• Dementias and cognitive impairment and cerebrovascular disease.
• Evaluation of dementia
• Localisation of focus of complex partial seizures
• Detection of presence and extent of cerebral infarction not evident on CT

Gastric Emptying:

Quantitative assessment of solid gastric emptying using a labelled egg sandwich. There are alternatives for patients allergic to eggs. Half clearance time and % retained at 4 hours are calculated. Liquid emptying can also be assessed (separate study).

Colonic Transit:

Small and large bowel clearance using sequential images over 5 days.

Lacrimal Scan:

Functional nasolacrimal duct obstruction.

Gated Heart Pool Study

• Evaluation of left & right ventricular size & systolic function, measurement of LVEF & diastolic filling parameters

Ventilation & Perfusion Lung Study

• Detection of pulmonary embolism
• Significantly less radiation than CTPA
• Preferred over CTPA for chronic pulmonary embolism

Parathyroid Study

• Localisation of parathyroid adenoma / hyperplasia in hyperparathroidism

Infection / Inflammation Study

• Both used to detect septic foci

Labelled White Cell

• Detection of active inflammatory bowel disease

GFR measurement (DTPA)

• GFR measurement

Captopril Renal Study

• Diagnosis of hemodynamically significant renal artery stenosis

Meckel’s Study

• Detection of Meckel’s diverticulum which contains ectopic gastric mucosa

Haemangioma Study

• Detection of cavernous haemangioma (eg. in liver)

Tumour Study

For tumour staging, evaluation of response to therapy, detection of residual or recurrent disease:

• Gallium – Lymphoma (HL and NHL), sarcoma
• MIBG (I-123 or I-131) – Phaeochromocytoma, neuroblastoma
• In-111 Pentetreotide – Carcinoid tumour, pancreatic islet cell tumours, medullary thyroid carcinoma, paraganglioma, glomus tumour

Gastrointestinal Transit Studies

• Oesophageal transit. Assessment of gastro-oesophageal reflux
• Gastric emptying. Utilising a labelled egg sandwich
• Colonic transit. Oral gallium-67 is monitored daily over 5 days

Therapy

• I-131 – Grave’s disease, toxic nodules, thyroid carcinoma
• Y-90 colloid – Radiation synovectomy (eg for RA)
• Samarium-153 EDTMP – Palliation of metastatic bone pain
• Strontium-89 – Palliation of metastatic bone pain