Day 5 Nuclear medicine

Patient 1: Testicular Cancer
Symptoms-knee pain and shoulder pain. 
Bone scan-Make sure no bone metastasis
SPEC scan if clear bone scan

Patient 2: Reflux bladder into ureter 
Usually seen in kids as a birth defect in the valve and may go away without surgery or may be serious threat to kidney.
If surgery is needed they inject Teflon to fix the valve (Dr. said was not toxic....hmmm). 

Patient 3: 
DMSA study

Patient 4: 
DTPA renogram
very functional bolus motor image flow per second. 
UPJC obstruction-delayed emptying 

Patient 5: Elder prior meniscus surgery repair

has increase in pain, could be avascular necrosis, if so, the bone scan will appear black in the areas. 

Bone scan: Medial condyle of tibia was black on the bone scan. 

next procedure; SPEC scan.

Possible meniscus tear still.

Patient 6: 

lung cancer with pain in right shoulder 

Bone scan to look for metastasis

Patient 7: increased concentration in kidney-Hydronephrosis

Patient 8: AMUGA-multigated acoustic heart scan.

Used Technitium 99 which binds to blood pool and circulated and concentrates in heart and rest of body. An Echocardiogram is then used to find the ejection precise calculated fraction (EKG not as accurate). Procedure used before and after a cardiac toxic drug is used to monitor the heart physiology. 

Patient 9: Elderly woman with pain in right hip 

Appears traumatic, possible avascular necrosis which is common in head of femur, Bursitis of trocanter also increases uptake of material and shows dark on bone scan. 

Patient 10: Gastroenteritis caused by diabetes

Patient 11: Lung scan for PE

injected 100,000 quantum particles into lung tissue, doesn't cause a problem because there are 3 million small capillaries. 

Scan interpretation: hole in lung field caused by capillaries unable to pick up radio active material suggests area of PE

Patient 12: PE 

ventilation is normal and perfusion abnormal= PE but if both abnormal = Pneumonia or lung parenchymal disease. 

Patient 13: Cirrhosis liver scan

Functional disease of parenchyma. pH shift uptake in macrophages in spleen and bone marrow, so you see an increased uptake in those areas in cirrhosis.

Patient 14: Breast cancer bone scan for metastasis

Patient 15: RBC liver scan;

Label RBC and accumulation in hemangioma. Can be confused with metastasis by US and CT.

Hot spot need SPEC for cross sectional.

Patient 16: Parathyroid adenoma scinctography-hypercalcemia 

Normally can not be seen, but in adenoma there is an increased uptake of material due to increased tumor metabolism.  Sestamibi was used as the nuclear material. At first the thyroid gland hides the uptake of the parathyroid, so will have to wait 2 hours for the washout effect and see just the adenoma remaining on the parathyroid gland. 

Patient 17: Setamibi Scan for e. 

Patient 13: Cirrhosis liver scan

Functional disease of parenchyma. pH shift uptake in macrophages in spleen and bone marrow, so you see an increased uptake in those areas in cirrhosis.

Patient 14: Breast cancer bone scan for metastasis

Patient 15: RBC liver scan;

Label RBC and accumulation in hemangioma. Can be confused with metastasis by US and CT.

Hot spot need SPEC for cross sectional.

Patient 16: Parathyroid adenoma scinctography-hypercalcemia 

Normally can not be seen, but in adenoma there is an increased uptake of material due to increased tumor metabolism.  Sestamibi was used as the nuclear material. At first the thyroid gland hides the uptake of the parathyroid, so will have to wait 2 hours for the washout effect and see just the adenoma remaining on the parathyroid gland. 

Patient 17: Setamibi Scan for heart

Setamibi injected and collected in myocardium and parathyroid and can show ischemic heart disease. 

can decipher if a catheter is needed or not by using a stress test. At the peak heart rate in stress test Setamibi is injected and the myocardium is scanned. At rest the next day the myocardium will also be scanned and compared to the stress test. if there is a void in the myocardium during heavy exercise and not during rest, the patient has ischemic heart disease, and if there is a defect in both stress and exercise, then the patient has or has had a Myocardial Infarction. Stress will show perfusion like angina heart

Setamibi injected and collected in myocardium and parathyroid and can show ischemic heart disease. 

can decipher if a catheter is needed or not by using a stress test. At the peak heart rate in stress test Setamibi is injected and the myocardium is scanned. At rest the next day the myocardium will also be scanned and compared to the stress test. if there is a void in the myocardium during heavy exercise and not during rest, the patient has ischemic heart disease, and if there is a defect in both stress and exercise, then the patient has or has had a Myocardial Infarction. Stress will show perfusion like angina