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Nuclear Medicine and Positron Emission Tomography PowerPoint Presentation

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Description : Check out this medical PowerPoint presentation titled "NUCLEAR MEDICINE & POSITRON EMISSION TOMOGRAPHY” by Richard S.Kuebler,M.D.,JD.

This medical PowerPoint presentation is about nuclear medicine and Positron emission tomography (PET).

Nuclear medicine is a medical specialty that involves the use of radioactive substances to diagnose and treat various medical conditions. It is a branch of medical imaging that uses small amounts of radioactive materials, called radiopharmaceuticals, to create images of the bodys organs, tissues, and bones.

Positron emission tomography (PET) is a type of nuclear medicine imaging that uses a small amount of a radioactive tracer to create images of the bodys organs and tissues. PET scans can help diagnose a range of medical conditions, including cancer, heart disease, and brain disorders.

During a PET scan, the patient is injected with a small amount of a radioactive substance, called a tracer. The tracer emits positrons, which interact with electrons in the body to produce gamma rays. These gamma rays are detected by a special camera, which creates a three-dimensional image of the bodys internal structures.

PET scans can be used to detect changes in the bodys metabolism, which can be an early sign of disease. They can also be used to monitor the progress of a disease and evaluate the effectiveness of treatment.

Overall, nuclear medicine and PET imaging are powerful tools in the diagnosis and treatment of a range of medical conditions. However, they do involve exposure to radiation, so they must be used judiciously and only when necessary.

Tags : Positron emission tomography, medical imaging, radiopharmaceuticals, nuclear medicine imaging,Nuclear Medicine, Nuclear Medicine PowerPoint presentation

Published on : Jun 20, 2023 | Views : 731 | Downloads : 2

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Slide 1-

NUCLEAR MEDICINE &POSITRON EMISSION TOMOGRAPHY Richard S.Kuebler,M.D.,J.D. Clinical Assistant Professor Academic Director of Nuclear Medicine LSUHSC Department of Radiology Acknowledgements for Lecture and Images Dan Fertel,M.D. Stephanie Casey,M.D.,M.P.H.
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References Brant and Helms Fundamentals of Diagnostic Radiology Mettler and Guiberteau Essentials of Clinical Nuclear Medicine
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Nuclear Medicine Diagnostic Therapeutic
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Nuclear Medicine Use of radioactive isotopes Most common Technetium-99m which has a 6 hour half life with good detector Others include Iodine-123, Indium-111, Gallium-67. Gamma camera imaging SPECT imaging
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Radionuclides= Isotopes attempting to reach stability by emitting radiation ATOM Tc-99m Gamma ray/photon emission (140KeV)
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Gamma Camera A gamma camera is a device used to image gamma radiation emitting radioisotopes, a technique known as scintigraphy
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Image on PACS
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Uses of Nuclear Medicine Heart: myocardial perfusion imaging where there has been further development for improvement, rather than decrease or replacement by other modalities. Use SPECT evaluation Bone scans, evaluate for metastatic bone cancer, osteomyelitis. Most common changes we see are arthritic, correlate with other studies.
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Radionuclides for Imaging Normal Whole-body distribution Route of excretion Target/critical organ
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Normal Technetium Distribution
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Cardiovascular Nuclear Imaging 1. Heart wall motion 2. Myocardial Perfusion & Viability
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Heart wall motion(Regional & Global Ventricular Function) Tc-99m tagged red blood cells Evaluate left ventricular ejection fraction (nl > 50%) Tagged red blood cells also used for GI bleeding and hemangioma evaluation in the liver
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Equilibrium Radionuclide Angiography Gated equilibrium radionuclide angiograms (MUGA scans) Performed with Tc-99m red blood cells Common indications include assessment of LVEF & regional wall motion
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Myocardial Perfusion & Viability Originally thallium 201 Now use Tc99m Cardiolite or Myoview SPECT Imaging Determine adequacy of blood flow to myocardium, especially in conjunction with exercise or pharmacoliogic stress
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Myocardial Perfusion Stress/Exercise Increased Oxygen demand Dilate coronary arteries
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Normal heart Myocardial Perfusion Rest = baseline perfusion Stress = maximal perfusion s H V Apex to base Sep to Lat Inf to Ant ant inf sep lat Apex LAD Cx RCA
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Ischemia Apical septal
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Ischemia Inferior Wall
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Fixed defect Scar vs Hibernating myocardium Delayed imaging or PET Viability
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Fixed defect vs diaphragm Liver, spleen, bowl activity – reconstruction artifact
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Breast attenuation Anterior or lateral wall defect
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Imaging for infection Ga 67 Citrate: not used as much anymore, former use was for neoplasm (including lymphoma and lung cancer), inflammation, infection Ga-67-----complexes with plasma transferrin----carried to sites of inflammation Incorporated into WBCs—bound by intracellular lactoferrin—then migrate to inflammed areas Taken up by microorganisms by binding to siderophores produced by bacteria In-111 tagged white blood cells. Can also tag with Tc-99, but shorter half life.
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Gallium scan – Ga-67 Photon poor- grainy images Image 24-48 hours Bowel activity Sarcoidosis FUO Diskitis/spinal Osteomyelitis Opportunistic infections Need CXR correlation PCP – intense activity Kaposi’s sarcoma – no activity Normal CXR-Normal Ga-67
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Gallium and FUO Imaging Value in its nonspecificity Will detect pathology other than just infection Neoplasia Initial imaging should be with In-111 WBC and then followed with Gallium,if necessary (especially if FUO for less than two weeks) If patient has had systemic antibiotics,may get false negative with Gallium scan Better in children-WBC require phlebotomy
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In-111 WBC scan Image 12-24 hr No bowel/renal activity Bacterial infections Prosthetic joint infection – map with Tc-sulfur colloid Diabetic foot infection
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In-111 Oxine Leukocytes High sensitivity and specificity for acute infections. Lower for chronic infections Attracted to site of infection by chemotaxis (directed migration) Not specific for infection, accumulates in any inflammatory response that attracts lekocytes. Occasionally in neoplasia
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Bone scan Tc99m-MDP Increased osteoid formation/mineralization of osteoid(osteogenesis) Increased blood flow Can be affected by administed drugs Always obtain radiographic correlation
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Bone Scan - Metastasis Quality of life Therapeutic decision making Multifocal areas increased activity Red marrow: thorax, ribs, pelvis, limbs, skull
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Bone Scan - Metastasis For a lytic lesion to be visualized by radiography localized demineralization of 30-50% must occur Bone scans usually demonstrate metastatic lesions much earlier than radiography False negative bone scan: Multiple Myeloma Renal cell carcinoma Thyroid carcinoma
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Bone Scan - Metastasis 80% of patients with known neoplasms & bone pain have metastasis documented by the bone scan
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Bone scan – Lumbar fracture
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Bone scan 3-phase Flow Blood pool
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Bone scan 3-phase Delay 3–phase positive: Osteomyelitis Acute fractures Bone tumors Cellulitis – 2-phase Shin splints – delay only
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Bone scan - Arthritic
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Uses of Nuclear Medicine Thyroid, Iodine-123 or Technitium-99 Liver-spleen, largely replaced by CT or MRI Biliary, filling gallbladder, biliary ducts Renal scan Brain scans, replaced by CT Others
Slide 40-

Thyroid scan Thyroid Scan using Tc99 pertechnitate or I-123 Radioactive Iodine uptake using I-123 or I-131 Normal uptake in our area 5-15% for 6 hours and 10-30% for 24 hours (10-40% for 24 hours in North and Midwest) Total body I-131 used for thyroid cancer evaluation
Slide 41-

Thyroid scan Hypo or hyperfunction Nodules Ectopic thyroid Organification defect
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Total body I-131 Post-thyroidectomy Postradioiodine Therapy imaging I-131: treatment of Graves’ disease and multinodular goiter
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Hepatobiliary Imaging Tc99 IDA(cholecystokinin injection)
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Hepatobiliary Imaging (morphine injection) 1 hr – Gallbladder not visualized
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Renal scan Tc-99m MAG3 Renal function, images similar to IVP Indications: Renal srtery stenosis Acute tubular necrosis, obstruction, pyelonephritis
Slide 46-

Brain scan, brain death (TC99)
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Uses of Nuclear MedicineLymphatic mapping 99m-Tc Sulfur Colloid Breast carcinoma and melanoma Injection for lymph node localization for biopsy (sentinal node)
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Liver scan: Tc99 Sulfur colloid Hepatocellular disease Confirmation of specific space occupying lesions – ie, focal nodular hyperplasia
Slide 49-

Radiology Evaluation of Cancer Plain Films and Associated Studies CT Scan MRI Nuclear Medicine Ultrasound PET
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Positron Emission Tomography - PET Radionuclide with excess protons PET detector ring for localization & imaging
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Type of Pet Scanners PET Scanner PET/CT Fusion Scanner
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PET – CT Fusion Scanner Combination of Positron Emission Tomography (PET) and Helical CT PET detects area of increased metabolic activity as indicated by uptake of radioactive glucose (tumor, infection) PET data is then “fused” with CT data to produce an image showing increased glucose uptake superimposed upon the exquisite anatomic detail of helical CT
Slide 53-

Uses of PET Brain Cardiac Oncology
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Cancers evaluated with PET Lung Lymphoma Melanoma Colorectal Breast Esophagus Head and Neck
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Also Thyroid carcinoma: Approved for history of only 1 type of thyroid carcinoma (Follicular) with negative I-131 scan and rising tumor markers GU malignancies (Renal, Prostate, Cervical and Ovarian) Under review for sarcomas Outpatient procedure
Slide 56-

Uses of PET Diagnosis of cancer (especially lung) Staging of cancer Restaging of cancer
Slide 57-

Note Use of PET scan for treatment response may not be covered Except in Breast Cancer and certain type of thyroid carcinoma (follicular)
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F-18 FDG Fluoro-deoxyglucose F-18 on a glucose (sugar) molecule 110 minute half life Cyclotron produced, now commercially available Competes with glucose Cancers are glucose active
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Preparation NPO 4-6 hours, except water May take medications No regular insulin within 4 hours of administration Patients on certain insulin preparations may have half dose Take serum glucose level, needs to be below 200 (Need to reschedule if above 200) Elevated glucose level competes with F-18FDG Elevated insulin levels = increased muscle uptake
Slide 60-

F-18 FDG Tumors – increased # glucose transporters - energy source F-18 FDG: interact with glucose receptors Phosphorylated inside cell: F-18 FDG 6P Blocked from further metabolism and trapped in cell
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PET Image Quantification SUV: Standard Uptake Value Based on ROI radioactivity/administered activity/body weight
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Physiologic uptake or accumulation Brain Salivary glands Pharynx, larynx Liver, Spleen, Bone marrow Heart GI, including colon Renal excretion, ureters, bladder
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Normal
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Normal Brain Heart Liver Bowl Urinary system Bone marrow
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Normal
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Normal
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Artifactual uptake Muscle Fat (Brown Fat)
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Artifactual Larynx activity
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Artifactual, Muscular
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Artifactual Fat
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Increased marrow uptake due to chemotherapy G-CSF – postchemotherapy Marrow stimulation
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Pick’s Disease
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Melanoma
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Melanoma
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Lung Carcinoma
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Lung Carcinoma
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Lung cancer
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Lung carcinoma
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Breast carcinoma
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Breast carcinoma
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Breast carcinoma
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Lymphoma
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Lymphoma
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Lymphoma
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Lymphoma
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Lymphoma
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Liver Mets from Colon Ca
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Liver Mets from Colon Ca
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Liver Mets from Colon Ca
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Rectal carcinoma
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Rectal carcinoma
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Rectal carcinoma
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Rectal carcinoma
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Rectal carcinoma
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Esophageal carcinoma
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Esophageal carcinoma
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Diffuse Metastatic disease
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Note Not all cancers have positive PET Scans Not all positive PET scans are cancers
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