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NUCMED
Internship
| Term | Definition |
|---|---|
| A medical specialty that uses radioactive substances to diagnose and treat diseases by imaging physiologic functions rather than just anatomy | Nuclear Medicine |
| Nuclear medicine involves the use of radiopharmaceuticals, which are radioactive compounds administered to patients via __________, __________, or _______. | inhalation, injection, orally |
| These substances emit radiation from within the body, which is captured by external detectors such as _______ __________ to create images that reflect the function of organs and tissues, unlike traditional X-rays that image structure | gamma cameras This makes nuclear medicine a physiological imaging modality, focusing on how organs work rather than just their shape |
| Skeletal scintigraphy (bone scan). It is the initial method of choice to detect skeletal metastases, evaluate osteomyelitis, and investigate other bone disorders | Technetium-99m Methylene Diphosphonate (also called Medronate) |
| Skeletal imaging agent. Similar to MDP, it is used to demonstrate areas of altered bone formation (osteogenesis). It is known for having a higher bone uptake than MDP | Technetium-99m Hydroxymethylene Diphosphonate (also called Oxidronate) |
| Lung perfusion imaging. The particles (20–40 μm) temporarily lodge in the lung's capillary bed after IV injection, allowing for an assessment of pulmonary blood flow. It is part of the evaluation for pulmonary thromboembolism (blood clots in the lungs) | Technetium-99m Macroaggregated Albumin (MAA) |
| Static renal (kidney) imaging. It is used to evaluate renal parenchymal disorders, as it collects in the renal cortex to show functional kidney tissue | Technetium-99m Dimercaptosuccinic Acid (DMSA) |
| Renal scintigraphy (kidney function study). It is used to evaluate kidney function and is also utilized in lung ventilation studies and brain imaging | Technetium-99m Diethylenetriaminepentaacetic Acid (DTPA) |
| Cardiac imaging to evaluate myocardial necrosis (heart damage). Its most prominent current use is a "cardiac PYP scan" to diagnose transthyretin amyloidosis (ATTR), a specific type of heart disease | Technetium-99m Pyrophosphate (PYP) |
| A versatile agent with several uses because it distributes similarly to iodine. Used for thyroid and salivary gland imaging, as well as brain scans. It is also the base form of Tc-99m used to prepare other radiopharmaceuticals by chemically altering it | Technetium-99m Pertechnetate (chemical formula: TcO₄⁻) |
| Primarily a therapeutic agent for thyroid conditions. Used to treat hyperthyroidism (Graves' disease) and thyroid cancer. In lower doses, it can also be used for diagnostic thyroid scans | Iodine-131 |
| WHAT COLLIMATOR? - Thicker septa reduce septal penetration for higher-energy isotopes like Iodine-131 | Medium and High Energy Collimators |
| WHAT COLLIMATOR? - Large-diameter holes provide high sensitivity but moderate resolution, suitable for general imaging with Technetium-99m | Low Energy All-Purpose (LEAP) |
| WHAT COLLIMATOR? - Smaller, deeper holes offer higher resolution at the cost of sensitivity, ideal for detailed organ imaging | Low Energy High-Resolution (LEHR) |
| WHAT COLLIMATOR? - have a small aperture that produces high- resolution, magnified images of small structures. - Use: Thyroid imaging, small animal studies, or detailed imaging of small organs where high spatial resolution is critical | Pinhole |
| Essential safety devices designed to contain and remove hazardous fumes, vapors, and airborne contaminants. They protect personnel by pulling contaminated air away from the breathing zone and preventing exposure. | Fumehood |
| - To measure the activity of a radiopharmaceutical before it is administered to a patient. It ensures that the prescribed activity is accurate and safe. - ____________ and ______________ (sealed sources for calibration) | Dose calibrator Cesium 137 (30.17 years) : Barium 133 (10.54 years) |
| Designed to safely store and transport radioactive materials, protecting handlers from radiation exposure | Lead pig |
| A nuclear medicine imaging procedure used to evaluate skeletal abnormalities such as metastases, fractures, infections, and metabolic bone diseases. | Bone Scan |
| BONE SCAN - The radiopharmaceutical (Tc-99m MDP or HDP) is a diphosphonate compound that binds to the______________ ________ in bone, particularly in areas of increased osteoblastic activity (bone turnover). | hydroxyapatite crystals |
| BONE SCAN RADIOPHARMACEUTICAL? ACTIVITY/DOSE? ROUTE OF ADMINISTRATION? UPTAKE TIME? HALF-LIFE? EXCRETION? | Technetium-99m MDP (Methylene Diphosphonate) or HDP (Hydroxymethylene Diphosphonate) 22–25 mCi (millicuries) Intravenous (IV) injection 2–3 hours (waiting period before imaging) 6 hours Renal (urine) |
| Which prep instruction is correct for a bone scan? A. Fast for 8 hours B. Drink water and void before scan C. Avoid drinking water D. Take calcium supplements | B |
| Which is an absolute contraindication for a bone scan? A. Fracture B. Pregnancy C. Osteoarthritis D. Cancer history | B |
| After injection, how far and how long should patient stay from children and pregnant women? | 6 ft / 6 hrs |
| How many days must pass after contrast media before a bone scan? | 3–5 days |
| Why must the patient void before the bone scan? | Reduce bladder activity obscuring pelvis, sacrum and coccyx |
| Which is NOT a correct prep for bone scan? A. No fasting B. Remove metals and wear gown C. Avoid contrast 3–5 days prior D. Avoid water 4 hours before scan | D |
| A superscan shows: A. Focal hot spots in ribs B. Intense diffuse bone uptake, no kidneys seen C. High soft tissue activity D. Decreased pelvic uptake | B |
| Most superscans are caused by: A. Osteoarthritis B. High-volume bone metastases C. Renal failure D. Recent trauma | B |
| BONE SCAN PRECAUTIONS - Patient must not be _________ - Patient must maintain at least 6 feet distance with children ________ and below and pregnant women within __________. | pregnant : 5 yrs old : 6 hours |
| BONE SCAN INTERPRETATION - Area of increased bone turnover: metastasis, fracture, infection, arthritis, healing lesion | Focal increased uptake ("Hot spot") |
| BONE SCAN INTERPRETATION - Area of reduced blood flow or bone destruction: avascular necrosis, aggressive lytic tumor, bone infarction | Focal decreased uptake ("Cold spot") |
| BONE SCAN INTERPRETATION - Metabolic bone disease: hyperparathyroidism, Paget's disease, renal osteodystrophy | Diffuse increased uptake |
| - Uptake is diffusely and intensely increased throughout the skeleton - The bones appear "hot" and well-defined - The kidneys and bladder are NOT visualized (unlike a normal scan) | Superscan |
| A superscan can occur in a broad range of conditions ,both malignant and metabolic, the vast majority are due to high volume bony ____________ disease. | metastatic |
| A hybrid imaging procedure that pinpoints the exact location of abnormal metabolic or functional activity by overlaying a functional "hot spot" onto a detailed anatomical map. | Single Photon Emission Computed Tomography- CT This solves the ambiguity of a functional scan that might show a "hot spot" without clearly defining its location |
| Utilized in medical imaging, particularly for thyroid scans, where it is trapped by the thyroid in a manner similar to iodide but is not organified. | Thyroid Scan Tc99m Its characteristics, including a short half-life and principal gamma energy, make it advantageous for gamma camera imaging |
| A nuclear medicine procedure used to evaluate the size, shape, position, and function of the thyroid gland. It uses a radioactive tracer to visualize how the thyroid takes up iodine (or pertechnetate, which behaves similarly to iodine). | THYROID SCAN (Tc-99m Pertechnetate) |
| THYROID SCAN RADIOPHARMACEUTICAL? ACTIVITY DOSE? ROUTE OF ADMINISTRATION? UPTAKE TIME? COLLIMATOR USED? HALF LIFE? EXCRETION? | Tc-99m Pertechnetate (TcO₄⁻) 7 mCi Intravenous (IV) injection 15–30 minutes (waiting period before imaging) LEHR (Low-Energy High-Resolution) or Pinhole 6 hours Renal (urine) and salivary glands |
| INSTRUCTIONS - Food does not significantly affect pertechnetate uptake | No fasting |
| INSTRUCTIONS - Thyroid hormones (Levothyroxine, Eltroxin, Euthyrox) and antithyroid drugs (Methimazole, Carbimazole) suppress TSH or block uptake, altering test results | Stop thyroid medications for 4 weeks |
| INSTRUCTIONS - Avoids scheduling conflicts and ensures patient availability | No other procedures within the day |
| INSTRUCTIONS - Iodinated contrast can interfere with tracer uptake | No contrast media within 3–5 days prior |
| These drugs are thyroid hormone replacements and suppresses TSH, reducing thyroid uptake. | Levothyroxine, Eltroxin, Euthyrox |
| This drug is an antithyroid drug and blocks thyroid peroxidase, reducing tracer uptake. | Methimazole |
| PRECAUTIONS - Ionizing radiation can harm the developing fetus. Pregnancy is an absolute contraindications? - Tc-99m emits gamma radiation; close contact with vulnerable individuals should be minimized while radioactivity is highest? | - Patient must not be pregnant - Maintain 6 feet distance from children <5 years old and pregnant women for 6 hours |
| Positioning during thyroid scan | Patient lies supine with neck extended (hyperextended) to expose the thyroid area |
| A two-part procedure that combines imaging (to visualize the thyroid structure) and uptake measurement (to assess thyroid function). It is more commonly used for hyperthyroidism evaluation and thyroid cancer follow-up. | Thyroid scan with I-131 uptake |
| THYROID SCAN W/ I-131 UPTAKE - ACTIVITY/DOSE? - ROUTE OF ADMINISTRATION? - UPTAKE TIME? - COLLIMATOR? - HALF LIFE? - EXCRETION? | 500 μCi Oral (capsule or liquid) 2 hours, 4 hours, and 24 hours High-Energy (for I-131's 364 keV gamma) or Pinhole 8 days Renal (urine) and fecal |
| THYROID SCAN W/ I-131 UPTAKE INSTRUCTIONS - Ensures empty stomach for rapid absorption of I-131 | Fasting for 2–4 hours before intake |
| THYROID SCAN W/ I-131 UPTAKE INSTRUCTIONS - Thyroid hormones and antithyroid drugs interfere with uptake | Stop thyroid medications for 4 weeks |
| THYROID SCAN W/ I-131 UPTAKE INSTRUCTIONS - Absolute contraindication | Patient must not be pregnant |
| THYROID SCAN W/ I-131 UPTAKE INSTRUCTIONS - I-131 has a longer half-life (8 days) and higher radiation dose; longer isolation period required | Maintain 6 feet distance from children <5 years old and pregnant women for 3 days |
| Procedure: Fast _____ before I-131 intake (500μCi). Continue fasting 2-4hrs after. Uptake measurements at 2hrs (_____%), 4hrs (_______%), and 24hrs (________%). Imaging done at 24hrs. High-energy collimator used | 2-4hrs : 5-12 : 15-25 : 15-40 |
| Why Is Thyroid Uptake Measurement Important? | - Distinguishes Graves' disease (high uptake) from thyroiditis (low uptake) - Assesses whether the gland is overactive, underactive, or normal - |
| THYROID - A non-functioning nodule that shows reduced or no uptake of tracer - Appears as a photopenic defect (empty area) on the scan - Has a higher risk of malignancy (about 5–15%) - Often requires fine-needle aspiration (FNA) biopsy for evaluation | Cold Nodule |
| THYROID - An autonomously functioning thyroid nodule that produces excess thyroid hormone and appears as a “hot spot” on a thyroid scan, and it is usually benign | Hot Noduke |
| An autoimmune disorder that causes the thyroid gland to produce excessive amounts of thyroid hormone, leading to a condition known as hyperthyroidism | Graves' Disease Associated with hyperthyroidism symptoms: weight loss, tachycardia, heat intolerance, tremors, exophthalmos |
| THYROID - A nodule that functions independently of TSH stimulation - Produces thyroid hormone on its own, suppressing the rest of the thyroid gland - Usually benign | Autonomous Nodule |
| THYROID - A condition with multiple hot nodules which can be solid, fluid-filled, or mixed in composition - Results in hyperthyroidism - Scan shows multiple areas of increased uptake with suppressed normal tissue | Toxic Multinodular Goiter |
| THYROID - Inflammation of the thyroid gland - Scan typically shows decreased or patchy uptake (not increased) - Uptake is usually low because the gland is damaged, not overactive | Thyroiditis Examples: Hashimoto's thyroiditis, subacute (De Quervain) thyroiditis |
| A single, butterfly-shaped gland located in the front of the neck, just below the Adam's apple. It has two lobes connected by a central isthmus | Thyroid Gland Its primary function is to regulate the body's metabolism. It produces thyroid hormones (T3 and T4) which control energy generation, heart rate, and body temperature |
| Usually four small, pea-sized glands. They are located on the posterior (back) surface of the thyroid gland. Names meaning "beside the thyroid". | Parathyroid glands These glands are the primary regulators of calcium homeostasis. They produce parathyroid hormone (PTH), which increases blood calcium levels by acting on bones, kidneys, and the intestines |
| They are embedded behind the thyroid lobes, usually within the ___________ _______, and are about the size of a pea (approximately _____ each). Located on the _________ surface of the thyroid gland in the neck | pretracheal fascia : 6 mm : posterior |
| PARATHYROID SCAN RADIOPHARMACEUTICAL? ACTIVITY/DOSE? COLLIMATOR? | TC99m Sestamibi 25-30 mCi LEHR/Pinhole |
| PARATHYROID SCAN PREPARATIONS | - No fasting - No other procedures within the day - No procedure with contrast media prior to the scan (3-5 days) |
| PARATHYROID SCAN PRECAUTIONS | - Patient must not be pregnant - Patient must maintain atleast 6feet distance with children 5yrs old ang below and pregnant women within 6 hours. |
| PTH SCAN PROCEDURE - after injection of radioactive material - 5 mins - _______ - 1 hr - _____ - 3hr | 15 mins : 2hr |
| - Primarily used in the context of thyroid cancer treatment. - It can identify functioning thyroid remnants, recurrent local disease, or distant metastasis, which can influence treatment decisions. | Whole Body Scan I-131 |
| WBS I-131 RADIOPHARMACEUTICAL? ACTIVITY/DOSE? COLLIMATOR? | I-131 2.5 mCi (it could also depend on doctors request) High energy collimator |
| It is performed after the administration of therapeutic dose of I-131 and aims to detect functioning thyroid remnants, persistent, recurrent local disease, or distant metastasis. | Posttherapy/Post-ablation Scan Usually this kind of patients are being admitted into specialized nuclear medicine rooms. |
| - is an electronic instrument for detecting and measuring ionizing radiation with the use of a Geiger–Müller tube. - It is widely used in applications such as radiation dosimetry, radiological protection, experimental physics and the nuclear industry. | Geiger-muller Counter |
| - Evaluates kidney structure and function, particularly useful for detecting scarring or damage. - Being conducted to children with recurrent UTI. | DMSA RENAL SCAN |
| DMSA RENAL SCAN RADIOPHARMACEUTICAL? ACTIVITY/DOSE? COLLIMATOR? | Tc99m DMSA (Dimercaptosuccinic acid) 12 mCi LEAP collimator |
| PROCEDURE FOR DMSA RENAL SCAN | waiting time 3-4 hrs after administration of radioactive material requires 4 views. anterior, posterior and oblique views |
| A complete renal scan evaluates both the structure and function of the kidneys, while a GFR scan specifically measures the glomerular filtration rate to assess kidney filtration efficiency. | GFR SCAN/RENAL SCAN |
| GFR SCAN/RENAL SCAN RADIOPHARMACEUTICAL? ACTIVITY/DOSE? COLLIMATOR? | Tc99m DTPA (Diethylenetriamine pentaacetate) 12 mCi LEAP detector 2 |
| Things to check in GFR SCAN: | If patient still have both kidneys Height and weight Good IV line Patient must drink atleast 500mL of water 30 mins before the procedure |
| Scan to be conducted in GFR SCAN (1&2): | Pre-injection (using the syringe with radioactive material) Dynamic (Scan must be start immediately once the tracer is being administered, late start of scan can affect the result of the examination) |
| Scan to be conducted in GFR SCAN (3&4): | Post-injection ( using the syringe of radioactive material) Antecubital (injection site) - using the injection site (IV line) |
| - to assess how well the kidneys drain urine and function under stress. - Measure split or differential kidney function, determining how much each kidney contributes individually to overall renal function. | RENAL SCAN WITH LASIX Guide clinical decisions, including whether surgical intervention is needed for obstruction or poorly functioning kidneys. |
| NEEDS IN RENAL SCAN WITH LASIX: | 12 mCi Furosemide(lasix) 2 ampule/20mg per ampule Diaper Height and Weight Good IV line Patient must drink 500mL/1L of water LEAP |
| to evaluate if the transplanted kidney is functioning properly. | RENAL SCAN POST KIDNEY TRANSPLANT SCAN |
| RENAL SCAN PKTS RADIOPHARMACEUTICAL? ACTIVITY/DOSE? COLLIMATOR? | Tc99m DTPA (Diethylenetriamine pentaacetate) 12 mCi LEAP detector 1 |
| - Primarily used to identify Meckel's diverticulum, a congenital pouch in the small intestine that can contain stomach or pancreatic tissue. - This ectopic tissue can secrete acid, leading to ulceration, bleeding, or obstruction. | Meckel's Scan |
| - Most commonly performed in children and young adults who present with unexplained abdominal pain or blood in the stool | Meckel's Scan |
| MECKEL'S SCAN RENAL SCAN PKTS RADIOPHARMACEUTICAL? ACTIVITY/DOSE? COLLIMATOR? FASTING? | Tc04 12mci LEAP 2 hrs fasting |
| a nuclear medicine test that uses radioactive material to label red blood cells, allowing detection and localization of active or intermittent bleeding, particularly in the gastrointestinal tract. | RBC TAGGING / GI BLEEDING SCAN |
| RBC TAGGING/GI BLEED SCAN RADIOPHARMACEUTICAL? ACTIVITY/DOSE? COLLIMATOR? | Tc99m with PYP (Pyrophosphate) 25 to 30 mCi LEAP |
| PROCEDURE FOR RBC TAGGING (1&2) | Prepare/mix PYP in 5ml sodium chloride and shake for 2 mins Inject PYP to the patient and wait for 10-15 mins. |
| PROCEDURE FOR RBC TAGGING (3&4) | Extract 3-4mL of blood from the patient, the blood must be combined with Tc99m, shake for 10 mins. Re-inject the blood combined with tracer then start the scan. |
| Test used primarily to diagnose blood clots in the lungs (pulmonary embolism) | Lung Perfusion Scan |
| LUNG PERFUSION SCAN RADIOPHARMACEUTICAL? ACTIVITY/DOSE? COLLIMATOR? WHAT XRAY IS NEEDED? | Tc99m MAA (macrogregate albumin) 10-13 mCi LEAP with latest chest xray (6 hrs before scan) |
| PROCEDURE FOR V/Q SCAN | Inject the tracer slowly then scan. Images requires anterior and posterior, oblique views and lateral view |
| Often referred to as a DXA scan, is a quick and painless procedure that measures the strength and mineral content of your bones to assess the risk of osteoporosis and fractures. | BONE DENSITOMETRY |
| A healthcare provider might use a DXA scan to check your bones in a few situations, including to: | Diagnose osteoporosis. Diagnose osteopenia. Check your bone fracture risk. |
| Groups who need regular DXA scans include (1): | - Females older than 65. - Males older than 70. - People older than 50 who've broken a bone in the past. |
| Groups who need regular DXA scans include (2): | - People whose biological parents or grandparents have osteoporosis. - People who've lost an inch and a half or more of height from their tallest height (usually when you're in your 20s). |
| PREPARATIONS FOR DXA SCAN | No calcium tablet and multivitamins including milks within 24 hrs No procedure with contrast media/radioactive material within 7days |
| 3 PROCEDURES IN DXA SCAN | Dexa scan Wholebody bone densitometry VFA (Vertebral fracture assessment) |
| DXA SCAN RANGE | Lumbar L1-L4 Both hips Radius ⅓ (forearm) non dominant |
| Reading of result (Menopause, Male 50 and above T-score): ________< -1.1 ______________> -1.0- -2.4 _____________> -2.5 or less | Normal Osteopenia Osteoporosis |
| Reading of result (Pre-menopause, male 49 yrs old and below Z score): ______ < -2.0 and above _____ _____________ ________ > -2.0 and below | Normal Below expected range |
| - It provides whole body and regional estimates of the three main body components: fat, lean soft tissues and bone mineral mass. - Some software can estimate visceral fat from the android/abdominal region (validated only in adults). | WHOLE BODY BONE DXA |
| - Strong predictors of future fractures, independent of BMD. - Many fractures are asymptomatic, so VFA helps identify patients at high risk who may benefit from osteoporosis treatment even if their bone density is not severely reduced | VERTEBRAL FRACTURE ASSESSMENT |
Created by:
yulyae