Breast Sentinel Node Scintigraphy My Visit to the Hybrid SPECT/CT Gamma Camera at Invercargill Hospital Barbara MacDonald

Questions What is Nuclear Medicine? How do we get the radioactivity? Hybrid technology?

What is Nuclear Medicine? Nuclear Medicine is a medical specialty involving the use of radioactive substances in the diagnosis, staging and treatment of disease.

What is Nuclear Medicine? Radio-nuclides are combined with different pharmaceuticals which are administered to the patient to localise specific organs or cellular receptors. There are many different radio-nuclides, but the most common is 99mTc (Technetium ).

How do we get the Radioactivity? Technetium- short lived (T1/2 6hours), produced on site every day. Technetium is a decay product of the radioactive isotope 99Molybdenum (T1/2 2.7 days)

99Molybdenum Generator

Pharmaceuticals The pharmaceuticals that we can combine with 99mTechnecium have different properties to allow us to image the structure and /or function of the body.

Radio pharmaceuticals Isotope Pharmaceutical Procedure 99mTc Straight no additive Thyroid scan Sestamibi Myocardial perfusion 99mTC DPD Bone scan Rhenium Sulphide Colloid Lympho-scintigram (Sentinel node) MAG3 Dynamic renal scan (Function and excretion) DMSA Static renal scan (Structure)

Isotope Scan Radionuclide is injected into the patient Targeted organ or system accumulates the isotope. Gamma camera acquires images of the isotope uptake. In dynamic scanning this happens straight away- static scans require a time interval between injection and scan.

99mTc Dimercaptosuccinic acid (DMSA)- Static scan for kidney structure

99mTc Mercaptoacetyltriglycine (MAG3) Functional dynamic kidney scan.

Bone Scan

What examinations do women with Breast Cancer have? Sentinel Node Scintigraphy. Smaller breast cancers(3cm or less), those with clinically normal nodes and also High Grade DCIS. Bone Scan for staging Those patients at higher risk, patients presenting with bone pain MUGA Scan/ Echo Patients assessed prior to Chemotherapy

Hybrid Scanning Modern machines can combine the strengths of different imaging modalities, to give us more information than the separate modalities alone. Computer software is used to superimpose images from different modalities to improve accuracy of functional and anatomical information.

Hybrid Operating Theatre

Hybrid MRI Radiotherapy

My visit to Nuclear Medicine

Sentinel node Scintigraphy Can be performed on the day before or day of the operation. 99Tc-Nanocis Rhenium Sulphide Colloid 2 or 4x 10MBq (same day) or 2 or 4 x 45MBq(day before). Each injection volume is 0.2ml

Sentinel Node Scintigram

Sentinel node marked and protected by Tegaderm

New Improved Version!

Integrated Images

Thanks for Listening Also thanks to Kirsten Worthington and her student Will for their patience and hospitality.