1. DELHI MRI CENTRE JABALPUR
DEPT. OF NUCLEAR MEDICINE
-DR.PRADEEP DUBEY, M.D
DIRECTOR

2. GAMMA CAMERA

3. RADIO ISOTOPE SCAN PRINCIPLES
RADIO ACTIVE TRACER SUBSTANCE IS USED.
COUPLED WITH SPECIFIC KITS FOR VARIOUS ORGANS.
SENSITIVE AND SPECIFIC-PICKS PATHOLIGY AT EARLIEST.
MINIMAL RADIATION.

4. APPLICATIONS BONE – METS, AVN, STRESS #,Koch’s
THYROID- HYPO / HYPER THYROID.
G.U.T- Inf.,HN, PUJ.Obs, etc.,
CORONARY ARTERY DISEASE
LIVER – BILLIARY ATRESIA ETC.
NUCLEAR HSG & GER, OTHERS.
THERAPY-IODINE 131

5. PREPARATION No specific preparation for Bone scan & Renal scan
Cardiac scan- to stop coffee, Chocolate, Ca channel blockers before two days, 6 hrs. fasting
Thyroid scan – To stop Anti thyroid drugs before 2 weeks.
Liver(Hida) scan – NB Phenobarb. for 1wk.
To drink lot of water during the scanning.
To void frequently during test period.

6. Indication of bone scan
All first diagnosed malignancies.
Ca. Breast, Cx & Uterus etc.
Lung & Prostate cancers.
Hodgkin’s lymphoma & other malign.
Pathological Fractures.
AVN & ? Pelvic girdle pain.
Osteo mylitis.
Stress fracture/ vague boney pain .
Unexplained backache .

7. BONE SCAN
(NORMAL)

8. BONE SCAN (SKELETAL METS)

9. BONE SCAN
(AVN)

10. BONE SCAN
(#NF WITH AVN)

11. BONE SCAN
(ARTHRITIS)

12. BONE SCAN
(METABOLIC BONE DISEASE)

13. BONE SCAN (MULTIPLE METS)

14. THYROID SCAN INDICATIONS: THYROTOXICOSIS THYROID NODULE
MIDLINE NECK SWELLING
SUSPECTED ECTOPIA
THYROIDITIS
THYROID CYST
Ca. THYROID

15. MULTINODULAR GOITER

16. Solitary Toxic Nodule

17. THYROID SCAN
(GRAVE’S DISEASE)

18. THYROID SCAN
(THYROIDITIS)
THYROID SCAN

19. THYROID SCAN
(WARM NODULE LEFT SIDE)

20. Solitary Cold Nodule Tumor image

21. Ectopic (Submandibular) Thyroid

22. Parathyroid tumor

23. PARATHYROID SCAN

24. Parathyroid Adenoma

25. RADIO ISOTOPE RENOGRAM.
DTPA / DMSA /EC - Scanning

26. Indications Recurrent UTI & Growth retardation in children.
GUT problems & unexplained Anemia.
Primary Hyper tension.
Renal donor evaluation
Renal Transplant evaluation

27. Effect of Creatinine
If level of S.Creatinine is high then extraction of Tc-99m –DTPA is low and delayed.
Background is also very high.
GFR is low.
In this case it needs to be inject more activity.
EC scan is recommended.

28. DTPA RENOGRAM
PUJ OBSTRUCTION

29. RIGHT KIDNEY PUJ- OBST.
DTPA RENOGRAM

30. Vesico urethral reflux

31. PYELONEPHRITIS
DMSA - SCAN

32. DMSA cortical imaging
NON-FUNCTIONING RT KIDNEY
DMSA has tubular binding receptor. It binds with tubular protein for a longer period.
Imaging is generally done after 3 hours delay to allow time for uptake and slow background clearance.

33. Myocardial Perfusion scan (Stress Thallium)
EASY & SAFE: NON-INVASIVE, OUT PATIENT PROCEDURE, NO DYE NO ALLERGY
FUNCTIONAL IMAGING: SHOWS BLOOD FLOW & VIABILITY; NOT JUST THE MECHANICAL BLOCK
TRUE FLOW PATTERN: REVEALS COLLATERALS & MICROVASCULAR CIRCULATION & CORONARY STEAL PHENOMENON
VIABILITY: STUNNED MYOCARDIUM, HIBERNATING MYOCARDIUM
MOST COMPREHENSIVE INVESTIGATION OFFERING MAXIMUM INFORMATION FROM SINGLE STUDY

34. PATIENT PREPARATION 6 Hrs. FASTING FOR THALLIUM IS ESSENTIAL.
DISCONTINUATION OF BETA-BLOCKERS & FRUSEMIDE FOR HRS BEFORE EXERCISE STRESS
NO THEOPHYLLINE AND CAFFEINE BEFORE ADENOSINE STRESS
NO NITRATES PREFERABLY ON THE DAY OF EXERCISE STRESS
DETAILED HISTORY TAKING

35. INDICATIONS:
EVALUATION OF CAD (Coronary Artery Disease): in cases with equivocal TMT/ECHO and/or chest pain, high risk group prior to non-cardiac surgery
POST ANGIO PLASTY & POST CAG:
CHRONIC H.T. SPLY. WITH D.M.
CHEST PAIN & UNEXPLAINED DYSPNOEA.

36. MYOCARDIAL PERFUSION IMAGE Normal Vs Abnormal
NORMAL ISCHEMIA INFARCT

37. STRESS THALLIUM
(NORMAL)

38. STRESS THALLIUM
(INDUCIBLE ISCHEMIA)

39. STRESS THALLIUM
(INFARCT)

40. HIDA SCAN
(NORMAL)

41. HIDA SCAN
(NORMAL)

42. HIPATOBILIARY SCAN
(BILIARY ATRESIA)

43. LUNG PERFUSION SCAN
(NORMAL)

44. GE REFLUX / MILK SCAN

45. GE REFLUX/MILK SCAN

46. ISOTOPE HSG

47. Thank you