Nuclear Medicine

By the technologic developments for the imaging and treatment of the diseases, diseases and physiological events can be imaged at molecular level  and individulaized targeted treatments are planned.

Nuclear medicine examinations are easy examinations that do not 3disturb the patient. It is generally called as scintigraphic examinations. These examinations provide detailed information about the structures and functions of the organs and used for diagnosing the diseases, directing the treatment and patient follow up. According to the examined organ, various radioactive including compounds are given intravenously or in some studies orally in scintigraphic examinations. The radiation dose the patient receives in scintigraphic examinations are not different from radiologic examinations (like lung graph, Computerized Tomography) or even lower. In children examinations can be performed even in newborn period. Except rare cases, examinations are not performed in pregnant women. Imaging is generally performed after a standby period. Standby periods vary between 15 minutes to 2 hours according to the characteristics of the test. Imaging is performed in a specific system called gamma camera. This imaging system does not create radiation; it records the gamma irradiations coming from the radioactive material given to the patient previously. Obtained functional images are evaluated by doctors specialized in Nuclear Medicine. 

Radiation is already available in the nature, environment and at our homes and used in health area for the diagnosis and treatment purposes. In the examinations performed in Nuclear Medicine department, the radiation will be used in minimum doses for your health. 
In Nuclear Medicine department; in order to demonstrate the functioning status, anatomy, physiology and pathology  of the organs such as heart, kidney, lung, thyroid, liver and brain, various imaging medications (Radio pharmaceutical) and cameras with different characteristics (PET/CT, Gamma cameras, SPECT/CT…) are used. 

In many various diseases such as cancer, infection, atherosclerosis, metabolic disorders, renal disorders, brain disorders, age-related changes, information can be gathered about the presence and stage of the disease with Nuclear medicine tests, and interventions for treatment can be performed in some diseases such as thyroid diseases. 

Many diseases give symptoms at molecular level before giving anatomic images yet. By this, early stage diagnosis of the diseases and increasing treatment ratios are provided.

In Nuclear Medicine department, Philips Gemini TF PET/BT (16 slices), GE NM530c Cardiac gamma camera and Philips BrightView SPECT/CT devices are available. PET/CT equipment has Time of Flight technology with high temporal resolution. In these modern systems, better resolution and superior image quality are obtained with PET/CT images with giving lower radiation.

GE NM530c gamma camera is a specified machine only for heart scintigraphy. This system which 3 of them is available in Turkey is separated from other gamma cameras with their superior technology infrastructures. With this technology which is called as semisolid detector structure, received radiation dose of the patients that Myocardium Perfusion Scintigraphy (heart imaging) is reduced 4 folds, the duration they spend in camera decreases 4 folds (Approximately 3 minutes) and the quality of the obtained images are increase tens of folds. 

Philips BrightView SPECT/CT device is equipped with Flat Detector CT on it. SPECT/CT device is available in every Nuclear Medicine department, and mainly for bone scintigraphy and sentinel lymph node examination, increases the  specificities of the tests in many Nuclear Medicine tests. It provides more accurate and crrect imaging.

Imaging and treatment methods applied in our department;

  • Lung Perfusion and Ventilation Perfusion Scintigraphy (Tc99m MAA)
  • Post-Operative FEV1 Calculation (Tc99m MAA)
  • Brain PET examination (18F-FDG)
  • Brain Perfusion examination (Tc99m HMPAO)
  • Ventricle Shunt Openness Evaluation (Tc99m DTPA)
  • Cisternograph (Tc99m DTPA)
  • Myocardial Perfusion Scintigraphy (Thallium201 or Tc99m MIBI imaging)
  • Myocardium PET (Myocardium vitality examination with 18F-FDG)
  • Myocardium Symphatetic Innervation Scintigraphy (I123 or I131 MIBG)
  • Radio nucleoid Ventriculography (MUGA)
  • Three-phase bone scintigraphy
  • Whole body bone scintigraphy
  • Bone PET / CT (F18-NAF)
  • Arthroscintigraphy
  • Thyroid scintigraphy
  • Parathyroid scintigraphy
  • Dacrioscintigraphy
  • Dynamic renal scintigraphy (with DTPA or MAG3)
  • Static renal scintigraphy (DMSA)
  • ACE inhibitor dynamic renal scintigraphy (with DTPA or MAG3)
  • Testicular Scintigraphy
  • Vesicoureteral reflux scintigraphy (direct and indirect)
  • Marked leukocyte scintigraphy
  • Bone Marrow Scintigraphy with nano colloid
  • Spleen imaging (with denatured erythrocytes)
  • Hemangioma Imaging
  • Lymphoid scintigraphy
  • Lodine-131 therapy (low-dose and high-dose treatment)
  • Somatostatin Receptor Treatment
  • Radionuclide Therapy, SR-89
  • Radionuclide Therapy, Sm-153
  • Radionuclide Therapy, Re-186
  • Radionuclide Therapy, P-32
  • Radionuclide Therapy, I-131 MIBG
  • Y90 microsphere therapy
  • Y90 anti-CD-20 antibody
  • Radio synovectomy
  • 18F-FDG PET / CT (Positron Emission Tomography)
  • 18F-NAFTA PET / CT
  • Intraoperative gamma probe (99m colloid, 131I and 18F-FDG compatible)
  • Iodine-131 Scanning
  • Breast scintigraphy
  • Sentinel Lymph Node Examination (breast cancer and malignant melanoma SPECT / CT anatomical mapping)
  • Penta DMSA (V-DMSA) (medullary thyroid cancer)
  • I123 or I131 MIBG imaging
  • Oncologic Purpose PET / CT imaging (18F-FDG)
  • PET imaging for cardiac viability (18F-FDG)
  • PET imaging in viewing brain diseases (18F-FDG)
  • Bone PET / CT imaging (18F-NAFTA)
  • PET/CT combines the obtained information in a single device with PET (Positron Emission Tomography) and CT (Computerized Tomography). By this, anatomic and functional imaging can be evaluated simultaneously.
  • This advanced technology which is used particularly in patients with cancer or suspected cancer in diagnosis, staging and treatment response evaluation, also provides vital information for demonstrating non cancer diseases such as brain diseases (like dementia and epilepsy) and heart tissue vitality.
  • Cancer cells are our own cells growing uncontrolled. They need energy for to grow, reproduce and invasion. They supply this need with simple glucose molecules in the body. By changing one atom of the glucose molecule with radioactive F18, FDG (Flour-Deoxy-Glucose) substance is obtained. This substance is administered to the patient in trace amounts. The medication’s distribution in the body is waited approximately 1 hour. İmaging prolongs about 20 minutes. With the specific structure of Philips PET/CT, there is a space that the patient can watch created artificial sky on the ceiling between the PET and CT unit is present. By this, patients who have claustrophobia (closed area fair) can be easily taken to imaging. In patients who cannot be imaged awaken due to disease, age or personal status; imaging is performed with the assistance of anesthesia doctors.
  • In Nuclear Medicine Department, bone PET/CT image is applied also with F18 marked NAF molecule. NAF molecule is a method that demonstrates the bone invasion of the cancers more sensitive than bone scintigraphy. Proportionally with bone blood supply and remodeling, it is uptake in the bone structure. Imaging durations are similar with PET/CT examination performed with FDG.
  • Half-life of the radioactive F18 atom used in the PET/CT examinations performed with FDG and NAF is 110 minutes and the patient continues to his/her normal life after the procedure With the intravenously given trace amount of FDG, TOF (Time of flight) technology it is decreased significantly when compared to older devices. The used medication does not alter any body function and including renal diseases, it can be used safely in all age groups.
  • With this imaging cancer cells in whole body are investigated and the responses are found for the questions; the place of the disease, its spreading, whether it is spread to other organs or not and its character (benign or malignant?), recurrence of the disease, whether the applied treatment successful or not. Also, in patients that will be applied radiotherapy, it directs the treatment by demonstrating the place of the real tumor tissue.
  • Obtained sectional and 3 dimensional images are evaluated and reported by specialized Nuclear Medicine doctors. In patients that will receive radiotherapy, PET/CT images are used by Radiotherapy specialists and patient specific treatment planning can be done.

    Patient preparation;

  • 4 hours of fasting is required for the patients that imaging will be performed with 18F-FDG PET/CT. Insulin using patients, if they state their conditions, necessary arrangements will be done by our doctors
  • Fasting is not required for the patients that imaging will be performed with 18F-NAF PET/CT.
  • The indications which are currently approved and paid by social security institution are listed below. In the PET/CT shootings performed with these indications there is no extra payment requested from the patients.
http://www.sgk.gov.tr/doc/teblig/SaglikUygulamaTebligi.html

Heart Scintigraphy

Simply, it is an imaging method useful for understanding whether the person has coronary artery disease (CAD) or not by evaluating the blood amount reaching to myocardium.

A low dose radiation including radioactive medication will be injected intravenously for film at the end of the stress test (exercise or pharmacologic). Radioactive medication reaches to coronary arteries and then to myocardium via blood flow. Then with the aid of a special camera images that show how the given radioactive material is distributed in your heart are obtained. Images are arranged with the aid of a computer and evaluated. Direct proportionally with the amount of blood went to myocardium, amount of radioactive medication increases or decreases. By this, myocardium supplied by coronary arteries is viewed and information obtained about the stenosis and obstructions in coronary arteries.

Ge 530c Gama camera is a new generation gamma camera. There are currently 3 of them in Turkey.

Four folds high sensitivity is obtained with this gamma camera. Shooting duration which is 15 minutes with old cameras is decreased to 3 minutes with these cameras. With the shortening of the shooting duration, the patient’s movement problem that can cause the repetition of the image is eliminated. The device is designed as open for the patient’s comfort, and in a shape that those who have claustrophobia can easily lie

In this system, different from the old images obtained by the turning of two detectors around the patients, 19 detectors are focused on the patient’s heart and high quality images are obtained.

Radioactive material dose applied to patient is decreased four folds with this system

Thyroid Diseases Diagnosis, Treatment and Follow up

Thyroid gland is an internal gland located at neck region that arranges the metabolism in human body. In case of excessive working it can cause findings such as irritability, hair loss, infertility, loss of libido, fever, sweating, palpitation, hypertension, heart disorders, weight loss, increase of appetite, exophthalmos (toxic goiter). In case of less working however; it causes complaints such as sleepy state, comprehension difficulties, gaining weight, weakness, constipation, arrhythmia, cramps, depression, infertility and decreased libido.

Recently, cancer cases are increasing due to environmental factors and life conditions. On the contrary to many cancers, thyroid gland originated cancers are majorly treatable diseases with early diagnosis. In the USG screenings, nodule is detected in one person in every 5 persons of the population. Approximately one out of ten nodules includes cancer.

Thyroid scintigraphy and USG correlation; The study performed in order to obtain detailed information about the size, location, structure and function of this gland is called as thyroid scintigraphy. There isn’t preliminary preparation (fasting, medication etc.) needed for this test. Test lasts approximately 20 minutes. In case of evaluation of the obtained images simultaneously with USG, especially in patients with multiple nodules, it is understood that which nodules are risky and more focused biopsies are performed.

Radioactive Iodine (131I) is the best target focused treatments used in medicine. These treatments can be used safely in all age groups including children in necessary situations. Generally low dose treatment with high dose treatment concepts are confused in the population.

Low dose treatments are used in patients in the treatment of non-cancer thyroid diseases (<20mCi). The patient does not require hospitalization during these treatments. Iodine given for treatment provides silence the active (hot) nodule and excessive working thyroid gland without surgery.

Ablation with high dose iodine is applied in cancer patients postoperatively. In this treatment, the patient requires to stay in specifically designed rooms for two days. There are two iodine treatment rooms in our department. In these rooms all your comfort is thought with; TV, internet connection, DVD player, library, daily newspaper, tea-coffee friendly service. Your relatives can visit you with short durations during two days. After 4-5 days of the treatment, cancer screening will be done in whole your body with the treatment dose.

By performing ablation (high dose iodine treatment) in thyroid cancer, rest of the cancer cells and metastases are eliminated if available. It reduces the recurrence probability of the disease. In the postoperative follow up of your disease; examination, USG, thyroglobulin and iodine screening are the most commonly applied methods. Thyroglobulin level and iodine screening bring benefit in ablation performed patients for the purpose of screening and its benefit for diagnosis decreases in patients who did not receive ablation treatment.

Sentinel Lymph node Scintigraphy and Intra operative Gamma Probe Sentinel lymph node is the first lymph node on the path of the tumor. If there isn’t disease in this lymph node, probably there is no disease in the following lymph nodes. Sentinel lymph node examination is performed in various diseases primarily in breast, thyroid and malign melanoma. Our surgeons can easily detect this lymph node with intraoperative gamma probe during surgery. By this, unnecessary regional lymph node operations are prevented and lymphedema of the extremities are prevented and false lymph node dissections are avoided.

Marked Leucocyte Scintigraphy

In our nuclear medicine department, marked leucocyte scintigraphy which can be performed in limited numbers in Turkey is also entered to routine clinical use. By this, correct detection of infection foci can be possible. This examination is being used in a wide range of patient groups from detection of unknown fever to bone and soft tissue infections, prosthesis infections, infection foci around metallic implants.

In leucocyte Scintigraphy; the blood obtained from the patient is underwent several procedures by our doctors and leucocyte cells are decomposed. Decomposed cells are marked with 99mTc - HMPAO and given back to the patient when they are still alive. These cells who have the most important role for combatting infection go to the diseased area and function.

With our SPECT/CT Gamma camera device, place of the leucocyte are detected from outside. With the CT component of the device, exact location of the infection is detected by tomography images and soft tissue bone discrimination can be made easily.

In our hospital there is a private cellular marking room for the marking of leucocyte cells which is available in few hospitals. The walls, ground and floor of this room prepared for this procedure is covered with Epoxy in order to apply decontamination. With class 2A property laminar flow cabin and high capacity cooling centrifuge placed in the room, cell marking procedure is performed in European standards.

Other Scintigraphies

Whole body screening with bone scintigraphy is performed for the diagnosis of benign and malignant bone disorders and bone infection. This procedure is safely applied to the patients of all age. Following intravenous administration of low dose radioactive marked MDP, 2-3 hours waited for eliminating from soft tissue and then images are obtained in 20 minutes. Fasting is not required for this procedure. Ceiling of the shooting room is equipped with artificial sky in order to make patient feel comfortable during shooting.

Since the bone scintigraphy images are obtained with a device that have SPECT/CT property, in necessary cases more accurate diagnoses can be made by obtaining tomographic images.

SPECT/CT is a new hybrid imaging modality that can combine the functional data of SPECT system and detailed anatomic information given by CT. SPECT/CT devices are integrated devices that have both CT screening and SPECT property gamma camera in a single patient bed. Attenuation correction and anatomic localization information provided by CT, increases the spatial resolution of SPECT test and makes the obtained functional information more valuable.

The most common indications of bone scintigraphy are; Cancer diseases, fracture determination, stress fracture, bone infection, metabolic diseases, jaw abnormalities, unexplained regional pains…

Parathyroid glands are small internal glands located posterior neighborhood of thyroid gland that provides the calcium balance of our body. Excessive working of these glands (hyperparathyroidism) causes deployment of the bone calcium storages and osteoporosis occurs and blood calcium level is elevated. The reason of this disease is generally the enlargement of the parathyroid glands. Place of the enlarged and excessively functioning gland is determined with parathyroid scintigraphy. The test has early and late imaging stages. Early images are obtained at 15th – 20th minutes after injection and late images are obtaines at 2nd -3rd hours.

It is a imaging method evaluated renal functions in detail. Dynamic renographic examination evaluates all the renal functions (blood supply, concentrating, filtering). Especially used for evaluating the determination of the importance of stenosis occurred in the kidney outlet, follow-up after kidney surgery, evaluation of the patients with frequent urinary tract infection and other renal diseases. It provides highly valuable information in the follow up of renal transplant patients. Numerical analyses performed via computer (contribution of the kidneys to total function, renal filtration curves) provide information that direct the follow up and treatment of the patient. There isn’t any specific preliminary preparation needed for the test. The patient does not need to fast, however drinking at least 2-3 glasses of water before coming is requested.

Other commonly requested renal examination for children and adults is static renal scintigraphy (DMSA). It is performed to determine whether renal damage occurred or not due to various factors. There isn’t any specific preliminary preparation and fasting needed for the test. Imaging performed 2,5 – 3 hours after the injection.

PET CT

PET CT

Being one of the most advanced methods used today, PET / CT is a combination of two different technologies in the diagnosis of cancer and cancer treatment PET provides information about cell function and the metabolism, while CT provides anatomical data.

SPECT CT

SPECT CT

SPECT / CT, offers the world's first and only flat panel sensors with very low dose-rate and fast shooting with very high image quality With its patient-oriented design, it helps the patient easily breathe. Easy and fast shooting is done.