Nuclear Medicine Therapy & Theranostics

WHAT IS NUCLEAR MEDICINE?

Nuclear medicine is a branch of medicine that uses small amounts of radioactive material (Radiopharmaceutical) in diagnosis and treatment of various diseases

Nuclear Medicine Tests are safe and painless. They allow quick and accurate diagnosis of a wide range of conditions and diseases.

Nuclear Medicine Therapy is used to control, and in some cases cure, a range of conditions such including overactive thyroid (hyperthyroidism) and selective cases of inflamed joints (Radiation synovectomy).

It is also used in treatment of various cancers including Thyroid Cancers, Neuroendocrine tumors, Prostate cancers, Lymphomas and Liver tumors. Few of the radiopharmaceuticals are used for palliation of bone pain in patients with extensive bone metastases.

Nuclear Medicine diagnostic procedures help to identify the disease in early stages and also help to assess immediate response to various therapies. It is because of theirability to exactly pinpoint the molecular activity within the body.

HOW IS NUCLEAR MEDICINE USED FOR DIAGNOSIS?

Nuclear Medicine Imaging Procedures are mostly non-invasive procedures. With the exception of an intravenous injection in some scans these usually do not cause much discomfort. The Radiopharmaceuticals or Radiotracers used in these scansaccumulate at the area of the body being examined and emits energy mostly in the form of gamma rays or positrons. These are detected by a special camera that produces pictures and provides molecular information.

Whenever required doctorscan superimpose nuclear medicine images with Computed Tomography (CT) or Magnetic Resonance Imaging (MRI) to produce special views that provide more precise information and accurate diagnoses.

WHAT ARE SOME COMMON USES OF NUCLEAR MEDICINE IMAGING PROCEDURES?

Nuclear Medicine has applications across a broad spectrum of disease, focusing in particular on Oncology, Cardiology, Nephro-Urology, Orthopaedics, Rheumatology, and Nuropsychiatry. Nuclear Medicine Imaging Procedures are used by Physicians to visualize the function of an organ, tissue, bone of system within the body.

HEART
  • Visualize heart blood flow and function (such as myocardial perfusion scan)
  • Detect coronary artery disease and the extent of coronary stenosis
  • Assess damage to the heart post a heart attack
  • Evaluate treatment options, such as a bypass heart surgery and angioplasty
  • Evaluate the results of revasclularisation (blood flow restoration) procedures
  • Detect heart transplant rejection
  • Evaluate heart function before and after chemotherapy (MUGA)
LUNGS
  • Scan lungs for respiratory and blood flow problems
  • Assess differential lung function for lung reduction or transplant surgery
  • Detect lung transplant rejection
BONES
  • Evaluate bones for fractures, infection and arthiritis
  • Evaluate for metastatic bone disease
  • Evaluate painful prosthetic joints
  • Evaluate bone tumours
BRAIN
  • Investigate abnormalities in the brain in patients with certain symptoms or disorders, such as seizures, memory loss and suspected abnormalities in blood flow
  • Detect the early onset of neurological disorders, such as Alzheimer’s disease
  • Assist in surgical planning and identify the areas of the brain that may be causing seizures
  • Evaluate for abnormalities in a chemical in the brain involved in controlling movement in patients with suspected Parkinson's disease or related movement disorders
  • Evaluation for suspected brain tumour recurrence, surgical or radiation planning or localization for biopsy
CANCER
  • Stage of cancer by determining the presence of spread of cancer in various parts of the body
  • Localise sentinel lymph nodes before surgery in patients with breast cancer or skin & soft tissue tumours
  • Plan treatment
  • Evaluate response to therapy
  • Detect the recurrence of cancer
  • Detect rare tumours of the pancreas and adrenal glands
RENAL
  • Analyse native and transplant kidney blood flow and function
  • Detect urinary tract obstruction
  • Evaluate for hypertension (high blood pressure) related to the kidney arteries
  • Evaluate kidneys for infection versus scar
OTHER SYSTEMS
  • Identify inflammation or abnormal function of the gallbladder
  • Identify bleeding into the bowel
  • Assess post-operative complications of gallbladder surgery
  • Locate the presence of an infection
  • Measure thyroid function to detect an overactive or underactive thyroid
  • Help diagnose hyperthyroidism and blood cell disorders
  • Evaluate spinal fluid flow and potential fluid leaks
WHAT ARE THE BENEFITS OF NUCLEAR MEDICINE?
  • Nuclear Medicine Procedures provide unique information that is often unattainable using other imaging procedures – details on both function and anatomic structure of the body.
  • Nuclear Medicine offers the potential to identify disease in its earliest stage, often even before symptoms occur or abnormalities detected with other diagnostic tests.
  • By detecting whether lesions are likely benign or malignant, PET scans may eliminate the need for surgical biopsy or may identify the best biopsy location.
  • PET CT guided biopsies help in more accurate diagnosis of cancer.
HOW DOES NUCLEAR MEDICINE WORK?

Unlike ordinary X-ray examinations, an image is made by passing x-rays through a patient’s body, Nuclear Medicine Procedures use a radioactive material, called a Radiopharmaceutical or Radiotracer that is injected into the bloodstream, or swallowed or inhaled as a gas. The radioactive material accumulates in the organ or area of the body being examined, from where it gives off a small amount of energy in the form of gamma rays. Special cameras detect this energy, and with the help of a computer, create pictures that offer details on both the structure and function of the organs and tissues.

Also, unlike other imaging techniques, nuclear medicine imaging exams focus on depicting physiological processes, such as metabolism or levels of various other chemical activity, instead of showing anatomy and structure.

HOW ARE THE VARIOUS NUCLEAR MEDICINE PROCEDURES PERFORMED?

The patient is positioned on an examination table, and depending on the type of Nuclear Medicine Exam, the dose of radiotracer is then injected intravenously, swallowed or inhaled as a gas. It can take anywhere from several seconds to several days for the radiotracer to travel through the body and accumulate in the organ or area that is to be studied. As a result, imaging may either be done immediately, a few hours later, or even several days after receiving the radioactive material.

When it’s time for imaging, the camera or scanner will take a series of images by either rotating around the patient’s body or by staying in one position where the patient is asked to change positions in between images. While the camera is taking pictures, that patient is asked to remain still for brief periods. In certain cases, the camera may come very close to the body to obtain best quality images. If a patient is claustrophobic, he/ she should inform the technologist before the exam begins.

The length of time for Nuclear Medicine Procedures vary greatly depending on the type of exam. The actual scanning time can take from 20 minutes to several hours and may be conducted over several days in some special cases.

HOW IS NUCLEAR MEDICINE USED FOR THERAPY?

Nuclear Medicine Therapy works on a revolutionary concept called “Theranostics”. It is a relatively new field that combines specific targeted therapy based on specific targeted diagnostics. Theranostics uses specific molecular pathways to acquire diagnostic images. And then, it uses the same molecular pathway to deliver a therapeutic dose of molecular level radiation to the disease foci.

Nuclear Medicine Therapy takes the mode of treatment away from the contemporary methods of one-medicine-fits-all and trial & error. Theranostics is about offering the right treatment, for the right patient, at the right time, and with the right dose. Iodine-131 to treat an overactive thyroid gland and thyroid cancer, PRRT for neuroendocrine tumors and PSMA therapy for prostate cancer patients are few examples of this approach.

IS NUCLEAR MEDICINE THERAPY SAFE?

While, there is small amount of radiation used and it largely benefits the patient, but not other people. And therefore, the patient will need to take some safety measures so that the radiation does not affect other people.

If you are pregnant or you think you could be pregnant, or you are breastfeeding, it is important that you tell your doctor and the nuclear medicine service team before they give you the therapy dose. Many Nuclear Medicine Procedures require all women of child-bearing age to have a pregnancy test within 24 hours before therapy. The patient needs to make sure that she does not become pregnant for at least six months after some types of therapy.

BEFORE YOU LEAVE, OUR NUCLEAR MEDICINE TEAM WILL EXPLAIN IN DETAIL THE VARIOUS SAFETY MEASURES THAT A PATIENT NEEDS TO FOLLOW FOR THE TYPE OF THERAPY AND FOR HOW LONG.

PLEASE SPEAK TO YOUR DOCTOR ABOUT THE SAFETY MEASURES.

ARE THERE ANY SIDE-EFFECTS OF NUCLEAR MEDICINE THERAPIES?

Side-effects can occur after nuclear medicine therapy, but usually these are minor. Our Nuclear Medicine Specialist will discuss in detail the side-effects and other complications that could occur. The specialist will also explain the things you can do to reduce or avoid side-effects.