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Radionuclide Imaging / dental courses


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The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.

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Radionuclide Imaging / dental courses

  1. 1. Radionuclide Imaging – An overview INDIAN DENTAL ACADEMY Leader in continuing Dental Education
  2. 2. RADIONUCLIDE IMAGING Radionuclide Imaging is a Diagnostic modality in which RADIOPHARMACEUTICALS are used to get the image. Radiopharmaceuticals are administered intravenously in the body and they reach the affected bone and bind with pathological lesion by tagging with the tissue resulting in the release of gamma rays by the disintegration of radioactive substances. The gamma rays are detected by gamma camera as RADIONUCLIDE IMAGE. This image is recorded as SCINTIGRAPHY
  3. 3. Factors to be studied • Tracer techniques • Radiopharmaceutical • Disintegration of the radiopharmaceutical • Release of Gamma rays • Gamma camera and detection of Gamma rays • Conversion of Gamma rays into image • Recording the image as scintigraph
  4. 4. Radionuclide imaging is one of the investigation with Tracer concept • A tracer is a substance which when introduced into the body, it tracks the course of labeled molecules or cells in Diseased tissue and binds with tissue. • Radioactive tracer has got radioactive isotopes • Radioactive tracer is a tracer which releases radiation on binding with the diseased tissue. • Radiopharmaceutical is a pharmacological preparation in which radioactive substance and other tagging material is present. • Radiopharmaceutical when injected into the body it reaches the diseased cell. And the tagging material binds in the tissue and the radioactive substance disintegrates and releases radiation that is Gamma rays.
  5. 5. Radiopharmaceuticals Different radiopharmaceuticals Gallium 67 Ga – Tumour inflammation Iodine – Thyroid Krypton – lung 18 F Fluorodeoxy glucose(FDG) – PET scan Technetium 99 M Pertecnetate – Saliva & Brain Indium – CSF Thallium – Heart Technetium- 99 M colloid – Liver Technetium 99 M Heat denatured red cells - Spleen Technetium 99 M methyl di phosphonate MDP – Bone and Jaw bone
  6. 6. Radioactive Tracer in Bone • In Bone diseases bone destruction – Osteolysis occurs releasing calcium and to compensate the destruction, Osteogenesis occurs to form the bone. Calcium and Phosphate combine to form calcium phosphate apatite crystals to form bone. IF RADIOPHARMACEUTICAL IS INJECTED 1. Increased tracer uptake – disease with Osteogenesis – hot spot 2. Decreased tracer uptake – disease with inactive bone , lack of vascularity , lack of Osteogenesis – cold
  7. 7. Technetium methyl di-phosphonate(TcMDP) Tc MDP 1.This Radiopharmaceuticals is used mainly for jaw bone disease 2.It has short half life. 6.5 hours 3.It minimizes the patients radiation exposure. 4.The release of gamma rays by TcMDP is suitable for detection by Gamma camera
  8. 8. RELEASE OF GAMMA RAYS Technetium 99 MDP Technetium Methyl di –Phosphonate (Radioactive) (Tagging) Tc MDP Injected intravenously in the body Reaches the diseased bone Calcium and phosphate in the diseased bone combine and form calcium di - phosphonate apatite crystals During this process the Radioactive substance disintegrates & release Gamma Rays
  9. 9. Detection of gamma rays by Gamma camera Gamma rays Picked up by the Sodium Iodide crystal Detectors Fluorescence Photo multiplier tube of Gamma Camera Fluorescence light change into electrical signal This signal is converted into radionuclide image in the computer monitor Recorded as
  10. 10. GAMMA CAMERA
  16. 16. Three Phase Radionuclide Image • Technetium 99 MDP is injected intravenously to the body I phase : - Flow Phase Image is obtained 2 – 5 seconds for the first 30 seconds to see vascularity. II Phase :- Blood Pool and Tissue Phase Immediate static image for time 5 minutes. To see blood flow and vascularity III phase :- Skeletal Phase Image is taken at 2 – 4 hours. To see metabolic activity of
  17. 17. SPECT IMAGE SPECT : Single photon emission Computed Tomography This type of Radionuclide Imaging are taken to evaluate trauma, inflammatory disease and primary bone Tumour. In this study the images are obtained in 3 planes. Axial-coronal-Sagittal It allows more accurate interpretation and better localization of bone pathology. Different images from different axis are taken and reconstructed in the computer & SPECT images are developed.
  18. 18. PET SCAN POSITRON EMISSION TOMOGRAPHY 1. Type of Radionuclide Imaging 2. Functional Imaging 3. It helps to detect a) Squamous cell carcinoma (known and unknown primaries). b) Metastatic carcinoma. c) Nodal involvement of malignancy. d) Nodal involvement before the node enlarges. e) Neural spread. f) Recurrent carcinoma. g) Metastasis of carcinoma in different parts of the body. h) Prognosis of treatment – Surgical and Radiation i) Detection of Primary Carcinoma Note: In PET scan FDG may accumulate in benign neoplastic growth and non- neoplastic growth such as granulation ,inflammation, early scarring, in Tuberculosis and in Sarcoidosis ,and hence it may give false positive and false negative images. History and clinical findings are to be correlated for correct imaging and diagnosis.
  19. 19. PET SCAN RELEASE OF GAMMA RAYS 18 F – Flouoro deoxy glucose (FDG) is the radio pharmaceutical used in imaging of PET Scan 18 –F- Fluoro deoxy Glucose (FDG) Fluorine deoxy Glucose (Radioactive material) (tagging material) FDG Injected intravenously in the body Reaches the carcinoma Deoxy Glucose enter the malignant cell and joins with glucose of malignant cells Cont next..
  20. 20. Fluorine radioactive substance disintegrates and release Positrons Travel short distance in tissue Positron + electron Release Gamma rays During this process Fluorine radioactive substance disintegrates and release Positrons
  21. 21. LYMPHO SCINTIGRAPHY It helps in the treatment of Oral Squamous carcinoma to evaluate the spread in the lymph node. The radio-pharmaceutical Technetium 99-M sulphur colloid is employed in the imaging. Technetium 99-M Sulphur colloid Injected in 4-6 areas in the subcutaneous tissue around the carcinoma The radioactive colloid is carried by the lymphatic channel It reaches the first echelon lymph node draining that area This node is called as Sentinel node Cont next
  22. 22. This node can be imaged by gamma camera The sentinel node is evaluated for metastasis if this node is free ,then the other nodes are not involved If this node is positive for metastasis then other nodes are also involved This helps to remove all Metastatic nodes in surgical treatment
  23. 23. CLINICAL CASES Our observations
  24. 24. CASE 1
  26. 26. RADIOGRAPHS 1. Two dimensional appearance of lesions 2. Showed periphery of bone tumor 3. Do not show initial genesis of the lesion 4. Do not show posterior extension of soft tissue tumor 5. Do not show whether cyst or tumor in radiolucency 6. Lesions could be detected only locally RADIONUCLIDE IMAGING 1. Total deformity caused by the lesion 2. Showed peripheral extension of bone tumor 3. Showed initial lesion of bone with higher tracer uptake 4. Showed posterior extension of soft tissue tumor as there is tracer uptake 5. Showed correctly cyst / tumor tumor – tracer uptake cyst – no tracer uptake 6. Multiple lesions can be detected. COMPARISON BETWEEN RADIOGRAPHS AND RADIONUCLIDE IMAGING
  27. 27. Scope of Radionuclide image in Jaw Disease
  28. 28. Fibro osseous lesions • Paget’s disease • Mono-ostotic Fibrous Dysplasia • Polyostotic Fibrous Dysplasia • Periapical Cemental Dysplasia • Ossifying Fibroma
  29. 29. Inflammatory diseases of Jaw • Osteomyelitis • Osteoradionecrosis • Condensing Osteitis • Garre’s osteomyelitis
  30. 30. Multiple Lesions • Hyper parathyroidism • Multiple Myeloma • Gardner’s Syndrome • Multiple Metastasis • Skeletal Reticulosis
  31. 31. Malignant Tumours • Squamous cell carcinoma • Metastatic carcinoma • Adenoid cystic carcinoma • Nodal involvement of malignancy without enlargement of node and with enlargement of node
  32. 32. TM Joint • Condylar hyperplasia • Degenerative diseases of TM Joint
  33. 33. Impression • Radionuclide imaging is very much useful in oral and Maxillofacial diseases • Fundamentals of Radionuclide imaging, different techniques and correct interpretation of the imaging are very important to the Oral Medicine and Radiology expert for better diagnosis and better treatment. • The science of Radiology has to be studied broadly under the heading of Oral and Maxillofacial Imageology with lot of research activities.
  34. 34. THANK YOU