Nuclear medicine

Question 1

What are the 4 main parts of a gamma camera

Answer 1

PPSC

Question 2

What is the purpose of the pulse height analyzer of the gamma camera

Answer 2

• Full width at half maximum, more commonly known as FWHM, is a statistical measure used to describe the width of a normal distribution or Gaussian distribution. Specifically, it represents the width of a curve measured between the two points where the curve’s value is half its maximum.

Question 3

What is Nuclear Medicine?

Answer 3

The branch of medicine that deals with the use of radioactive substances in research, diagnosis, and treatment.

(1) Walker, D. (Nuclear Medicine Physicist)

Question 4

How does nuclear medicine imaging work?

Answer 4

The radiotracer travels through the area being examined and gives off energy in the form of gamma rays which are detected by a special camera and a computer to create images of the inside of your body. Nuclear medicine imaging provides unique information that often cannot be obtained using other imaging procedures and offers the potential to identify disease in its earliest stages.

(2) Walker, D. (Nuclear Medicine Physicist)

Question 5

What are the modalities used in Nuclear Medicine?

Answer 5

Planar Imaging and Single Photon Emission Computed Tomography (SPECT) with variations such as Single Camera Gamma Detector, Double Head Camera Gamma Detector, Triple Head Gamma Camera Detector, SPECT-CT Imaging, and Positron Emission Tomography (PET) – Computed Tomography (CT) PET-CT.

Question 6

What is the operational principle of the Gamma Camera?

Answer 6

A Gamma Camera detects gamma photon emissions and is used to map radioactive incidents in the human body. It can detect gamma rays and X-rays, with the only difference being their source of production. The camera system typically includes the collimator, scintillating crystals, photomultiplier tube, and a pulse height analyser.

Walker, D. (Nuclear Medicine Physicist)

Question 7

What is the purpose of the Pulse Height Analyser?

Answer 7

The pulse height analyser analyses the energy of the incoming signal and the position at which the signal originated in the body. It determines if the signal recorded is within a particular energy window and discards signals outside this window to ensure accurate image resolution.

Walker, D. (Nuclear Medicine Physicist)

Question 8

What types of procedures are done in Nuclear Medicine?

Answer 8

Diagnostic procedures are done for the heart to visualize heart blood flow and function, detect coronary artery disease, assess heart damage following a heart attack, evaluate treatment options, detect heart transplant rejection, and evaluate heart function before and after chemotherapy. Procedures are also done for the lungs to scan for respiratory and blood flow problems and assess differential lung function.

Question 9

What is the purpose of nuclear medicine procedures for the heart?

Answer 9

To assess damage following a heart attack, evaluate treatment options, evaluate blood flow restoration procedures, detect heart transplant rejection, and evaluate heart function before and after chemotherapy (MUGA).

Example: Evaluating the results of revascularization procedures can help determine the success of restoring blood flow to the heart.

Question 10

What types of procedures are done for lungs in nuclear medicine?

Answer 10

Scanning for respiratory and blood flow problems, assessing lung function for surgery, and detecting lung transplant rejection.

Example: Differential lung function assessment is crucial for determining eligibility for lung reduction surgery.

Question 11

What are the types of procedures done for bones in nuclear medicine?

Answer 11

Evaluating bones for fractures, infection, arthritis, metastatic disease, painful joints, bone tumors, and identifying sites for biopsy.

Example: Evaluating for metastatic bone disease helps in determining the spread of cancer to the bones.

Question 12

What procedures are performed for the brain in nuclear medicine?

Answer 12

Investigating brain abnormalities in patients with certain symptoms, detecting early onset of neurological disorders, assisting in surgical planning, and evaluating for suspected brain tumor recurrence.

Example: Identifying areas of the brain causing seizures can help in planning surgical interventions.

Question 13

What types of procedures are done for renal (kidneys) in nuclear medicine?

Answer 13

Analyzing kidney blood flow and function, detecting urinary tract obstruction, evaluating for hypertension, infection, scar, and following up on urinary reflux.

Example: Assessing kidney function is crucial in managing hypertension related to kidney arteries.

Question 14

What are some nuclear medicine therapies used for treatment?

Answer 14

Radioactive iodine therapy for hyperthyroidism, radioactive antibodies for lymphoma, radioactive phosphorus for blood disorders, and radioactive materials for tumor metastases.

Example: Radioactive iodine therapy is effective in treating overactive thyroid glands.

Question 15

How does nuclear medicine differ from conventional radiology?

Answer 15

Nuclear medicine focuses on physiology (cells, molecules) while radiology focuses on anatomy (shapes, sizes).

Example: Nuclear medicine scans provide unique information on both function and structure of the body.

Question 16

How does nuclear medicine compare to conventional radiology?

Answer 16

Nuclear medicine scans are less expensive, more precise, and can detect diseases in early stages. Each has specific applications but can overlap in certain situations.

Example: PET scans can help determine if lesions are benign or malignant, potentially avoiding the need for surgical biopsy.

Question 17

What are some comparisons between nuclear medicine and conventional radiology procedures?

Answer 17

Sensitivity, radiation dose, image quality, radiologist preference, speed, price, and considerations for renal failure differ between the two.

Example: Ventilation-Perfusion Scan (VQ) is preferred over CT-Pulmonary Angiogram for patients with renal failure due to contrast-induced nephropathy risk.

Question 18

What is the recommended imaging procedure for patients with suspected pulmonary embolism?

Answer 18

Negative chest x-ray with suspected PE should have a V/Q study. Positive chest x-ray showing pneumonia or chronic disease should have a CT pulmonary angiogram.

Example: MDCT offers faster and more accurate results for conditions mimicking PE.

Question 19

How does a nuclear medicine bone scan differ from conventional radiology?

Answer 19

Comparison between nuclear medicine bone scan and conventional radiology bone imaging procedures.

Example: Nuclear medicine bone scans provide functional information about bone activity, unlike conventional radiology imaging that focuses on bone structure.

Question 20

What are the advantages of MDCT over traditional angiogram?

Answer 20

MDCT produces results faster, is more accurate, and offers additional diagnostic capabilities.

Reference: Diagnosing PE — Is V/Q Imaging a Better Choice, Especially for Younger Women? By Beth W. Orenstein. Radiology Today. Vol. 10 No. 17 P. 14

Question 21

What conditions can CT better depict compared to V/Q?

Answer 21

CT is better than V/Q at depicting other conditions that clinically mimic PE, such as acute pneumonia, a lung abscess, pleural or pericardial effusion, aortic disease, cardiovascular disease, an esophageal rupture, and malignancy.

Reference: Diagnosing PE — Is V/Q Imaging a Better Choice, Especially for Younger Women? By Beth W. Orenstein. Radiology Today. Vol. 10 No. 17 P. 14

Question 22

What should be done with a clear chest before conducting a CT scan?

Answer 22

Clear chest with a Chest X-ray first.

Question 23

What is the radiation comparison between Nuclear Medicine Bone Scan and CT Whole Body Scan for bone metastasis?

Answer 23

Bone Scan – 4.2 to 6 mSv

CT Whole Body – 20mSv or more

References: Patient Radiation Exposure in Nuclear Medicine Imaging. radiationsafety.ca, Radiation risk from medical Imaging. www.health.harvard.edu

Question 24

Why is Nuclear Medicine Bone Scan more sensitive than CT Whole Body Scan for targeting cancer cells?

Answer 24

Sensitivity – NM Scan due to targeting of cancer cells.

Question 25

What imaging modality is recommended during renal failure instead of CT, MRI, or IVP?

Answer 25

NM MAG 3 Kidney Scans

Question 26

What imaging modality is preferred in Toxic Goitre of Thyroid?

Answer 26

NM in Toxic Goitre of Thyroid - 0.14mSv

Question 27

What is the conclusion regarding the strengths and weaknesses of different imaging modalities?

Answer 27

Each Modality has their strengths and weaknesses. No modality is 100% perfect (eg. Detection limit, localization, image quality, etc), and as such that is the reason for the new and emerging market for fusion of these modalities. In an age of increasing knowledge re diagnosis and therapy, nuclear medicine will prove instrumental in our future approaches.