Applications of Diagnostic Imaging Nuclear Medicine Gerald R. Aben, MD FACR Department of Radiology College of Osteopathic Medicine In this presentation, I would like to discuss some of the applications of Nuclear Medicine imaging techniques. 11/8/2018 Department of Radiology

Nuclear Medicine / PET Ionizing radiation Radio-isotopes attached to molecules targeting specific organs or metabolic processes Spatial resolution limited Able to evaluate temporal resolution of uptake/ events Our final ionizing radiation modality is nuclear medicine / PET scanning. Radioisotopes are attached to molecules that target specific organs or metabolic processes. Nuclear medicine and PET imaging tend to have limited spatial resolution. We are not able to very accurately place in space where the abnormal activity is, but we are able to evaluate the temporal course of various events by evaluating the course of uptake of the radionuclide product and assigning that to a time scale.

Nuclear Medicine / PET Primary applications: First line evaluation of biliary function evaluation First line evaluation of cardiac perfusion First line evaluation of solid pulmonary nodules First line evaluation for many neoplasms, staging – treatment response Some a primary applications in a first line nature of nuclear medicine is in the evaluation of biliary function using the various hida, ida compounds. Also first-line evaluation of cardiac perfusion. This has been the main-stay for many years for cardiac perfusion evaluation. PET scanning provides first-line evaluation for solid solitary pulmonary nodules and also serves a role in first-line evaluation of many neoplasms for the staging and treatment response.

Nuclear Medicine / PET Primary applications: Head & Neck Thorax Brain death evaluation – cerebral blood flow CSF flow evaluation Bone abnormality evaluation Thorax V-Q Scanning – Ventilation Perfusion scanning for Pulmonary Embolism detection – secondary exam Pulmonary nodule evaluation (PET) Cancer staging (PET) The primary applications of nuclear medicine imaging of the head and neck could include evaluation for brain death by evaluation of cerebral blood flow. CSF flow can be evaluated in an attempt to evaluate for normal pressure hydrocephalus. We can evaluate for abnormalities of bone such as metastases. In the thorax ventilation/perfusion or V/Q scanning still has a role, a secondary role in evaluation of pulmonary embolus. This may be a tool that we will see more use of, as concern about radiation exposure from CT scanning is raised. PET scanning for the evaluation of pulmonary nodules and for cancer staging

Nuclear Medicine / PET Primary applications: Abdomen & Pelvis Liver – spleen scanning Hepatobiliary scanning Renal scanning Bladder & Reflux evaluation GI bleed evaluation Cancer staging (PET) Soft tissues – Bone & Joints Bone scanning Tumor scanning (Gallium, PET) Infection scanning (labeled white cells, Gallium) In the abdomen and pelvis, liver spleen scanning as well as hepatobiliary scanning allows the evaluation of the liver axis. Renal scanning can be utilized to evaluate for perfusion as well as function. Bladder and reflux evaluation can be performed with nuclear medicine techniques to reduce radiation exposure to the patient. a variety of techniques utilizing nuclear medicine allows evaluation for location of GI bleeds. Cancer staging can be performed with PET scanning. Evaluation of the soft tissues, bone and joints include bone scanning, a variety of tumors scanning technologies including gallium scanning and PET scanning and scanning of a variety of infections with labeled white blood cells or perhaps gallium