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Nuclear Medicine

Nuclear Medicine


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.
PET / CT imaging (18F-FDG and 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. ─░maging 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.
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.
Diagnosis
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.


Treatment
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.


Follow up
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.