PRANAMS TO THE LOTUS FEET OF LOVING GOD

NUCLEAR MEDICINE ?NUCLEAR MEDICINE ?NUCLEAR MEDICINE ?NUCLEAR MEDICINE ?DR.V.SIVA SUBRAMANIYANDR.V.SIVA SUBRAMANIYAN

DEPT.OF NUCLEAR MEDICINEDEPT.OF NUCLEAR MEDICINESSSIHMS,PSNSSSIHMS,PSN

DEFINITION• Branch of Medicine which utilizes

• Internal administration of Radioactive Isotopes

• For the purpose of Diagnosis and treatment

IN DETAIL This is a vibrant branch of medicine

where open, unsealed and short-lived Radioisotopes are used for diagnosis and treatment.

It gives functional images of the tissues and helps to quantify the micro-metabolic changes in the body.

Radioactivity ?• Naturally occurring Unstable

Nuclei

• Attain Stability by loosing excess Energy

• In the form of Radioactive rays

Radioisotopes for Imaging

Decay is by isomeric transition, electron capture or pair production They mainly emit γ rays or characteristic X – rays that are highly

penetrating

I S O T O P E ?• Molecules with Same Atomic

Number • But different Mass Numbers

• Are Termed as ISOTOPES

11

5

NUCLEAR UROLOGY

• * DTPA RENAL SCINTIGRAPHY• * CAPTOPRIL RENOGRAPHY• *DMSA SCINTIGRAPHY• *DIRECT RADIONUCLEIDE

SCINTIGRAPHY

OBJECTIVES• WHAT IS THE CAUSE ?

• IS INTERVENTION APPROPRIATE ?

• WHAT IS APPROPRIATE ?

• WHAT IS THE OUT COME ?

WRONG WAY

INDICATIONS• IDIOPATHIC HYDRONEPHROSIS

• URINARY CALCULI

• URINARY DIVERSION

Renal Radiopharmaceuticals

RENAL RADIOPHARMACEUTICAL

I - 131 0I H

TC - 99 m-DTPA

TC –99 m- DMSA

TC- 99 m- MAG 3

TC -99 m- EC

Tracer 99 Tc m – DTPA.

Dose : 3-5 mCi

Route : IV injection

Preparation : Proper hydration.

PROCEDURE

SEQUENTIAL ANALYSIS

• IMAGE ANALYSIS

• GFR ESTIAMTION

• RENOGRAPHIC CURVE ANALYSIS

• DIURETIC RESPONSE

NORMAL STUDY

PATHOPHYSIOLOGY OF R.V.H

I N D I C A T I O N SI N D I C A T I O N SI N D I C A T I O N SI N D I C A T I O N S

Accidental invention.

Majid et al 1983

Marked decreased renal uptake

in a patient taking Captopril.

On discontinuation recovery of

renal function.

D I S C O V E R Y

M E T H O D O L O GY• BETA – BLOCKERS AND

ANTIHYPERTENSIVES TO BE STOPPED 48 – 72 HRS. BEFORE THE STUDY BASAL RENOGRAPHY TO BE PERFORMED. CLASSICAL CONVENTIONAL PROCEDURE TO BE FOLLOWED.

Tracer 99 Tc m – DTPA.

Dose : 3-5 mCi

Route : IV injection

Preparation : Proper hydration.

R E N A L S C I N T I G R A P H Y

M E T H O D O L O G Y25 – 50 mg CAPTOPRIL TABLETS TO

BE CRUSHED AND ADMINISTERED

ORALLY ALONG WITH 250 ml OF

WATER. 90min. LATER RENAL

SCINTIGRAPHY IS REPEATED WITH

TWICE THE DOSE OF TC 99 m DTPA

USED FOR BASE LINE.

I N T E R P R E T A T I O N

Image analysis

GFR estimation.

Renographic curve analysis

Captopril response

P O S I T I V E C R I T E R I A

Decrease in % of uptake by > 10%.

Reduction in GFR by > 10%

Worsening of renographic curves

Increased tracer retention

Increased transit time

SSSIHMS PRASHANTIGRAM__________________________________________________________________

Name: Sudha Sree Purna. A Age / Sex: 37/F Hospital No: 53773/k2 Procedure: Captopril Renography Date: 19/08/02 N.M N0. RD /4658&63/2002 Tracer: Tc-99m DTPA Dose: 10 Mci Route: Intravenous Protocol: Gates Diuretic: Lasix 40 mg i.v Time: F 0 Hydration: plenty of oral fluid Clinical History: ? Renovasular Hypertension. Right Kidney small on Ultra Sound Scan. Renal Scan for functional assessment of the Kidneys. Procedure: After obtaining the Basal study Anti-hypertensives stopped for 2 days. Captopril 50 mg administered orally and after 3 hours Renogram study is repeated. IMAGES

INTERPRETATION K I D N E Y S C O R T E X Site Size Position Visualization Delineation Defect Contour RT. Normal Normal Normal Prompt Fair Nil Smooth LT. Normal Normal Normal Prompt Good Nil Smooth C O L L E C T I N G S Y S T E M U R E T E R Visualisn. Delineation Uptake late fill. Visualisn. Accumulation Insertion RT. Prompt Good Increased Nil Faint Trace Normal LT. Prompt Good Increased Nil Faint Trace Normal R E N O G R A P H I C C U R V E A N A L Y S I S PHASE: Uptake Secretory Excretory Diur.response G.F.R % Function Pre Post Pre Post Pre Post Pre Post Pre Post Pre Post RT. Vertical Verti Blunted Blunt. Step PlateauType I TypeIII 36 ml 32 ml 46 % 43 % LT. Vertical Verti Slope Slope Step Step Type I Type I 42 ml 43 ml 54 % 57 % TOTAL GFR Pre 78 Post 75 ml / min IMPRESSION: The Post Captopril Study reveals evidence of Decrease in the Rt. Kidney GFR with worsening of Curve pattern indicating the High Probabiliy of Rt. Renal Artery Stenosis. DR.V.SIVASUBRAMANIYAN, Consultant Nuclear Medicine Physician ___________________________________________________________________________________

NUCLEAR UROLOGY• *BONE SCAN• *LYMPHOSCINTIGRAPHY• *SCROTAL SCINTIGRAPHY• *MIBI-ONCOSCINTIGRAPHY• * RENAL SPECT

NUCLEAR CARDIOLOGY

• TC99m MIBI OR Tl 201 SPECT / GATED SPECT

• Dobutamine or Adenosine SPECT• MUGA & Exercise MUGA• First Pass Studies• Phleboscintigraphy

NUCLEAR OPTHAL0MOLOGY

• DACRYOSCINTIGRAPHY

• BRAIN SPECT

• THYROID UPTAKE STUDIES

NUCLEAR THERAPY• THYROTOXICOSIS - I131

• METASTATIC BONE PAIN P32

• IMMUNOTHERAPY

S A I V I E WS A I V I E W S A I V I E WS A I V I E W

SRI. S. KANNANSRI. S. KANNAN

DR.V.SIVA SUBRAMANIYANDR.V.SIVA SUBRAMANIYAN

SSSIHMS,PRASHANTHIGRAMSSSIHMS,PRASHANTHIGRAM

W H A T I S S A I V I E W?

• Scintigraphic

• Analytical

• Interpretative S A I V I E W

• VIEW ing and

• Reporting SOFT WARE

What was the Need ?

Patient Preparation• No Full Bladder• No Stoppage drugs – except for • Captopril Scan & MIBI SPECT• No Fasting except for the above• Better Hydration • Bladder Catherisation C drainage

bag

Bladder Catheterisation

• D.R.C.G

• Pelvic Kidney

• Vesico-vaginal Fistula

• Urinary Incontinence

Thank You