Nuclear medicine procedures use small amounts of radioactive materials, called radiopharmaceuticals, to diagnose and treat diseases. The nuclear medicine technologist is responsible for correctly identifying the patient, verifying the physician's order, preparing the patient, administering the radiopharmaceutical, collecting imaging or non-imaging data, ensuring technical quality, presenting results to the physician, and discharging the patient. Common nuclear medicine procedures include bone scans, renal scans, thyroid scans, and cardiac stress tests.

1. OVERVIEW OF A NUCLEAROVERVIEW OF A NUCLEAR
MEDICINE PROCEDUREMEDICINE PROCEDURE
CAUTION
RADIOACTIVE
MATERIAL

2. When you hear the wordsWhen you hear the words
“Nuclear Medicine”, what comes“Nuclear Medicine”, what comes
to mind first?to mind first?
• A) nuclear blastA) nuclear blast
• B) radiation therapy for cancerB) radiation therapy for cancer
patientspatients
• C) powerful medicineC) powerful medicine
• D) radioactive medicineD) radioactive medicine
• E) diagnostic imagingE) diagnostic imaging

3. TYPES OF NUCLEARTYPES OF NUCLEAR
MEDICINE PROCEDURESMEDICINE PROCEDURES
• Diagnostic TestsDiagnostic Tests
– Imaging vs. NonimagingImaging vs. Nonimaging
• (Bone, brain, cardiac, etc vs. thyroid(Bone, brain, cardiac, etc vs. thyroid
uptake, ERPF, GFR, etc.)uptake, ERPF, GFR, etc.)
– Qualitative vs. QuantitativeQualitative vs. Quantitative
• (Image resolution vs. quantifiable(Image resolution vs. quantifiable
numbers)numbers)
• TherapyTherapy
• TheranosticsTheranostics

4. Procedure InformationProcedure Information
• Procedure NameProcedure Name
• Radiopharmaceutical UsedRadiopharmaceutical Used
• Clinical IndicationClinical Indication
• ContraindicationsContraindications
• Patient PreparationsPatient Preparations
• Actual ProcedureActual Procedure
• ResultsResults

5. http://radiology.med.sc.edu/4nucmed.htm Normal Bone Scan

6. Metastatic Bone Cancer – a “superscan”
http://radiology.med.sc.edu/4nucmed.htm

7. A “superscan” is what?A “superscan” is what?
• A) positive bone scan studyA) positive bone scan study
• B) negative bone scan studyB) negative bone scan study
• C) indicative of intense boneC) indicative of intense bone
cancer spreadcancer spread
• D) both A and CD) both A and C
• E) both B and CE) both B and C

8. Normal HepatobiliaryNormal Hepatobiliary
ExamExam
Scott Williams, MD
Nuclear Medicine Updates
www.auntminnie.com

9. Tc-99m sulfur colloid -Tc-99m sulfur colloid -
Colloid ShiftColloid Shift
Scott Williams, MD
Nuclear Medicine Updates
www.auntminnie.com
Posterior Left Oblique
Liver
Spleen

10. What causes a Colloid shift on aWhat causes a Colloid shift on a
sulfur colloid liver-spleen study?sulfur colloid liver-spleen study?
• A) Improper bound product forA) Improper bound product for
the radiopharmaceuticalthe radiopharmaceutical
• B) Liver diseaseB) Liver disease
• C) Spleen diseaseC) Spleen disease
• D) metastatic cancerD) metastatic cancer

11. Renal TransplantRenal Transplant
Normal Function –Normal Function –
MAG3MAG3
Crump Institute for Biological Imaging

12. Obstruction: right kidneyObstruction: right kidney
ICNMP

13. Nuclear CardiologyNuclear Cardiology
http://www.bocaradiology.com/Procedures/cardiac/cardiac_background_files/image011.jpg

14. Nonimaging TechniquesNonimaging Techniques
• thyroid checksthyroid checks
• urine assayurine assay

15. NMTNMT
RESPONSIBILITIESRESPONSIBILITIES
• Identify the patientIdentify the patient
• Verify the physician’s orderVerify the physician’s order
• Prepare the patientPrepare the patient
• Administer the radiopharmaceuticalAdminister the radiopharmaceutical
• Wait the appropriate length of timeWait the appropriate length of time
• Collect the dataCollect the data
• Review the data for technical qualityReview the data for technical quality
• Present data to physician forPresent data to physician for
interpretationinterpretation
• Discharge the patient from the deptDischarge the patient from the dept

16. Identify the patientIdentify the patient
• In-patientsIn-patients
• Out-patientsOut-patients

17. Verify the physician’sVerify the physician’s
orderorder
No procedureNo procedure
may bemay be
performed on aperformed on a
patient withoutpatient without
an order from aan order from a
physicianphysician

18. Correct testCorrect test
This is also a good time for the NMTThis is also a good time for the NMT
to check the clinical indication forto check the clinical indication for
the testthe test

19. Which of following is an exampleWhich of following is an example
of a clinical indication?of a clinical indication?
• A) detection of Alzheimer’sA) detection of Alzheimer’s
diseasedisease
• B) bone fractureB) bone fracture
• C) agitated patientC) agitated patient
• D) being allergic to eggsD) being allergic to eggs
• E) all of the answersE) all of the answers

20. Prepare the patientPrepare the patient
• ExplainExplain
• ReassureReassure
• AnswerAnswer
questionsquestions

21. Administer theAdminister the
radiopharmaceuticalradiopharmaceutical
• IntravenousIntravenous
• OralOral
• InhalationInhalation
• OtherOther

22. InhalationInhalation

23. RADIOPHARMACEUTICALRADIOPHARMACEUTICAL
RadionuclideRadionuclide: +: +
the radioactivethe radioactive
portion of theportion of the
drug thatdrug that
permitspermits
detection indetection in
the bodythe body
Chemical compoundChemical compound::
the portion of thethe portion of the
drug that causes itdrug that causes it
to be localized in ato be localized in a
particular organ ofparticular organ of
the bodythe body

24. CommonCommon
RadiopharmaceuticalsRadiopharmaceuticals
RadiopharmaceuticalRadiopharmaceutical Clinical UseClinical Use
Tc-99m medronateTc-99m medronate Bone imagingBone imaging
Tl-201 thallous chlorideTl-201 thallous chloride MyocardialMyocardial
perfusionperfusion
imagingimaging
I-123 sodium iodideI-123 sodium iodide Thyroid imagingThyroid imaging

25. RadiopharmaceuticalsRadiopharmaceuticals
may be known by:may be known by:
• Generic nameGeneric name
• Chemical name/Chemical name/
abbreviationabbreviation
• Proprietary nameProprietary name
• Tc-99mTc-99m
exametazimeexametazime
• Tc-99m HMPAOTc-99m HMPAO
• Tc-99m CeretecTc-99m Ceretec

26. Wait appropriateWait appropriate
length of timelength of time

27. Collect dataCollect data
• ImagesImages
– StaticStatic
– Dynamic/FlowDynamic/Flow
– Cine/loopCine/loop
– PlanarPlanar
– TomographicTomographic
• ExternalExternal
countingcounting
• Body fluidBody fluid
samplessamples

28. Static Bone Scan ImageStatic Bone Scan Image

29. Dynamic/Flow RenalDynamic/Flow Renal
ScanScan

30. Cine/loop Example SiteCine/loop Example Site
• Examples of CineExamples of Cine
GI Bleed Study

31. Planar image and alsoPlanar image and also
dynamic/flow imagedynamic/flow image

32. The arrow is pointing atThe arrow is pointing at
which kidney?which kidney?
• A) LeftA) Left
• B) RightB) Right

33. Tomographic DisplayTomographic Displayhttp://www.medical.siemens.com/siemens/en_US/rg_marcom_FBAs/images/press_room_images/2007/043.07_Applications.jpg

34. Review dataReview data
for technical qualityfor technical quality
• Biodistribution –Biodistribution –
normal/abnormalnormal/abnormal
• Patient preparationPatient preparation
• Patient positioningPatient positioning
• ArtifactsArtifacts

35. The physician relies onThe physician relies on
the NMT for accurate,the NMT for accurate,
valid datavalid data

36. Present data to thePresent data to the
physician for interpretationphysician for interpretation

37. Typical Procedure SetupTypical Procedure Setup
for each study in NMfor each study in NM
• Radionuclide usedRadionuclide used
• Indications for studyIndications for study
• Contraindications for studyContraindications for study
• Patient history takingPatient history taking
• Patient preparationPatient preparation
• EquipmentEquipment
• Actual procedureActual procedure
• Normal vs. abnormal resultsNormal vs. abnormal results
• ArtifactsArtifacts

38. Discharge the patientDischarge the patient
from your carefrom your care