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

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

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

4. 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 ).

5. 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)

6. 99Molybdenum Generator

8. 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.

10. 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)

11. 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.

12. 99mTc Dimercaptosuccinic acid (DMSA)- Static scan for kidney structure

13. 99mTc Mercaptoacetyltriglycine (MAG3) Functional dynamic kidney scan.

14. Bone Scan

15. 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

16. 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.

17. Hybrid Operating Theatre

18. Hybrid MRI Radiotherapy

19. My visit to Nuclear Medicine

20. 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

23. Sentinel Node Scintigram

24. Sentinel node marked and protected by Tegaderm

25. New Improved Version!

26. Integrated Images

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