Nuclear Medicine
It is the first & only ‘fully equipped’ nuclear medicine department in Marathwada region. The department’s infrastructure is at par with latest technological advancements in the field to satisfactorily fulfill all diagnostic as well therapeutic needs of patients.
Positron Emission Tomography with Computed Tomography PET / CT (FDG PET-CT, PSMA PET-CT, DOTANOC PET-CT)
- First PET/ CT center in Marathwada. This scanner has highest sensitivity amongst all clinical PET scanners. It can localize the lesion with <1 cm diameter, at the same time minimizes radiation exposure to the patient.
- FDG PET/ CT is the current “Gold standard” in oncology imaging, providing both functional & anatomical status of the disease. It is modality of choice in cancer staging, treatment response assessment, follow up and recurrence evaluation.
- THE FDG PET/ CT scan is also useful in cardiac viability assessment.
CARDIAC PET is current Gold standard in myocardial viability assessment. Shown in image, large infarct seen in myocardial perfusion imaging (REST MIBI), shown to be viable on PET imaging (FDG Cardiac PET).
THE FDG PET /CT scan is also useful in assessment of neurodegenerative diseases & for infection imaging
- Brain FDG PET-CT in evaluation of dementia & movement disorders. Illustrated above is a case of Fronto-Temporal dementia (FTD).
Gallium 68 PSMA PET/CT & SOMATOSTATIN RECEPTOR IMAGING PET/CT
- Gallium 68 PSMA PET/CT : ONE-STOP-SHOP for carcinoma prostate patients in staging, restaging & therapy planning.
- Gallium 68 SOMATOSTATIN RECEPTOR IMAGING PET/CT : For neuroendocrine tumor evaluation, staging & treatment planning
PEPTIDE RECEPTOR RADIO NUCLIDE THERAPY AVAILABLE FOR METASTATIC NET’S.
- Indication: Somatostatin Receptor Positive neuroendocrine tumours demonstrated on Gallium 68 DOTANOC PET-CT
- metastatic neuroendocrine tumour
- inoperable neuroendocrine tumour
Radio- iodine treatment
- First and only high dose radio- iodine treatment facility for Ca. thyroid patients.
- Well provide isolation room with 24hrs attending staff.
- OPD basis radio- nuclide therapies like radio-iodine ablation for hyperthyroidism, RN bone pain palliation therapy are also available
60 year old male – post high dose radio-iodine therapy scan, showing Iodine -131 uptake in bilateral lung metastases & D1 vertebral metastasis.
Theragnostics
In recent years, there has been growing interest in developing therapeutic radiopharmaceuticals for treating various malignancies that express specific receptors on cancer cells. The concept of “Theragnostics” involves combining therapy and diagnostics by using radiopharmaceuticals that target the same receptors on cancer cells. The diagnostic agent, usually a gamma or positron emitter, is used for imaging, while the therapeutic agent emits beta or alpha radiation that binds to the tumor and destroys it. Because the binding is specific to the target receptors, tissue destruction occurs mainly in cancerous lesions, resulting in fewer side effects compared to external radiation or chemotherapy. The Theragnostics principle is illustrated in Figure 1.
Figure 1- Principle of Theragnostics in cancer therapy
| Cancer | Target for therapy | Diagnostic scan to confirm target | Therapeutic radio pharmaceutical |
| Thyroid cancer | Iodine symporters on thyroid carcinoma cells | Iodine – 131 in low doses |
Iodine – 131 in high doses |
| Castration resistant prostate cancer | Prostate specific membrane antigen in prostate cancer cells | Ga-68 PSMA PET CT or F-18 PSMA PET-CT |
Lu-177 PSMA PRRT |
| Metastatic or inoperable neuroendocrine tumors | Somatostatin / Octreotide receptors in NET cells | Ga-68 DOTANOC / DOTATATE PET CT | Lu-177 DOTATATE PRRT |
| Cancer | Target for therapy | Diagnostic scan to confirm target | Therapeutic radio pharmaceutical |
| Thyroid cancer | Iodine symporters on thyroid carcinoma cells | Iodine – 131 in low doses | Iodine- 131 in high doses |
| Castration resistant prostate cancer | Prostate specific membrane antigen in prostate cancer cells | Ga-68 PSMA PET CT or F-18 PSMA PET-CT |
Lu-177 PSMA PRRT |
| Metastatic or inoperable neuroendocrine tumors | Somatostatin/ Octreotide receptors in NET cells | Ga-68 DOTANOC/ DOTATATE PET CT | Lu-177 DOTATATE PRRT |
18 F DOPA PET-CT
F-18 FDOPA PET-CT for Movement Disorder Evaluation: Idiopathic Parkinson’s Disease and Atypical Parkinsonian Syndromes
Example is shown below-
Patient 1:
Clinical Presentation:
The patient has a history of antipsychotic treatment, prompting the clinician to investigate the possibility of drug-induced parkinsonism versus idiopathic Parkinson’s disease (IPD).
Findings:
F-18 FDOPA PET-CT reveals normal DOPA uptake in the bilateral striatum, ruling out idiopathic Parkinson’s disease. The observed drug-induced symptoms and signs are likely the primary cause of the patient’s complaints.
Patient 2:
Clinical Presentation:
The second patient has been on and off syndopa treatment for the last two years, without a definitive diagnosis.
Findings:
F-18 FDOPA PET-CT indicates severe reduced DOPA uptake in bilateral striatum, suggesting idiopathic Parkinson’s disease (IPD) or atypical parkinsonian syndrome. Further evaluation with FDG PET-CT is recommended, which may provide insights into specific subtype.
Dual head GE gamma camera with SPECT & SPECT-CT fusion capabilities
High resolution, dual head detector gamma camera. Best suited for patient comfort with minimum on table scanning time.
All nuclear medicine diagnostic scans like
- Endocrinology – thyroid scan, parathyroid scan, I -131 scan, MIBG scan
- Cardiology – myocardial perfusion imaging (Thallium scan),
- WB Bone scan – evaluation of skeletal metastases and benign conditions like osteomyelitis
- Renal imaging – diuretic renogram, DMSA scan, captopril renogram, VCUG
- Gastroenterology – GI bleed, meckel’s scan, GER / milk scan, HIDA scan etc can be optimally performed on this scanner
Brain imaging – TRODAT SCAN
Left image showing normal DOPAMINE transporters in control subject. Right image severe reduced DOPAMINE transporters in suspected case of Parkinson’s disease.
Thyroid scan
Increased thyroid trapping function demonstrated on Tc 99m thyroid scan in suspected case of Graves’disease.
VENTILATION PERFUSION
Tc 99m- MAA scintigraphy demonstrating perfusion defect involving superior segment of lower lobe of left lung suggesting pulmonary embolism involving segmental artery.
BONE SCAN
Tc 99m MDP Bone scan showing acute osteomyelitis involving mid –distal shaft of right tibia.
| DTPA renogram | PUJ / VUJ obstruction, obstructive nephropathy, GFR estimation |
| EC renogram | ERPF and relative function assessment. Evaluation of obstructive nephropathy in pediatric patients & adult patients with deranged KFTs |
| DMSA scan | Renal scarring, acute & chronic pyelonephritis, ectopic kidney, renal agenesis, relative function assessment. |
| VUR study | Detection & grading of VUR. Suprapubic injection, no risk of ascending infection, less radiation, easy to repeat |
| Captopril renogram | Renovascular hypertension. |
| Bone Scan | Metastatic workup, metabolic bone disease, osteoporosis (at risk sites identification), Sports injuries, avascular necrosis, CRPS, plantar fasciitis etc. |
| Nuclear cardiology Stress MPI / thallium Pharmacological stress MPI (for patients with difficulty in conducting TMT) | Diagnosis and functional assessment of CAD. Pre-operative cardiac risk assessment. Post CABG / angioplasty assessment of re-stenosis. |
| Viability study (Rest MIBI) or FDG cardiac PET) Muga scan V / Q scan | LVEF assessment, wall motion |
| Ventilation / Perfusion scan | Pulmonary thromboembolism,
Predict PFT changes after pneumonectomy / lobectomy, Assess severity of pulmonary artery stenosis & follow up after therapy. |
| Lymphoscintigraphy | Assessment of lymphoedema |
| Endocrinology Parathyroid imaging Thyroid scan | Parathyroid adenoma Primary hyperthyroidism v/s thyroiditis nodule, congenital hypothyroidism, ectopic thyroid |
| MIBG scan | Pheochromocytoma, Paraganglioma & other Neuroendocrine Tumors |
| Radionuclide Therapy Low dose radioiodine therapy | Treatment of Graves’ disease, toxic nodular Goiter & non- toxic nodular goiter |
| Gastroenterology Meckel’s scan HIDA scan (pediatric ) GER study / Milk scan RN Cholescintigraphy | For suspected cases of Meckel’s diverticulum Evaluation of neonatal cholestasis Diagnosing and grading GER Acute / chronic cholecystitis & biliary dyskinesia |
| DTPA renogram | PUJ / VUJ obstruction, obstructive nephropathy, GFR estimation |
| EC renogram | ERPF and relative function assessment. Evaluation of obstructive nephropathy in pediatric patients & adult patients with deranged KFTs |
| DMSA scan | Renal scarring, acute & chronic pyelonephritis, ectopic kidney, renal agenesis, relative function assessment. |
| VUR study | Detection & grading of VUR. Suprapubic injection, no risk of ascending infection, less radiation, easy to repeat |
| Captopril renogram | Renovascular hypertension. |
| Bone Scan | Metastatic workup, metabolic bone disease, osteoporosis (at risk sites identification), Sports injuries, avascular necrosis, CRPS, plantar fasciitis etc. |
| Nuclear cardiology Stress MPI / thallium Pharmacological stress MPI (for patients with difficulty in conducting TMT) | Diagnosis and functional assessment of CAD. Pre-operative cardiac risk assessment. Post CABG / angioplasty assessment of re-stenosis. |
| Viability study (Rest MIBI) or FDG cardiac PET) Muga scan V / Q scan | LVEF assessment, wall motion |
| Ventilation / Perfusion scan | Pulmonary thromboembolism, Predict PFT changes after pneumonectomy / lobectomy, Assess severity of pulmonary artery stenosis & follow up after therapy. |
| Lymphoscintigraphy | Assessment of lymphoedema |
| Endocrinology Parathyroid imaging Thyroid scan | Parathyroid adenoma Primary hyperthyroidism v/s thyroiditis nodule, congenital hypothyroidism, ectopic thyroid |
| MIBG scan | Pheochromocytoma, Paraganglioma & other Neuroendocrine Tumors |
| Radionuclide Therapy Low dose radioiodine therapy | Treatment of Graves’ disease, toxic nodular Goiter & non- toxic nodular goiter |
| Gastroenterology Meckel’s scan HIDA scan (pediatric ) GER study / Milk scan RN Cholescintigraphy | For suspected cases of Meckel’s diverticulum Evaluation of neonatal cholestasis Diagnosing and grading GER Acute / chronic cholecystitis & biliary dyskinesia |
