Nuclear medicine is a branch of medical imaging that uses radioactive product called a tracer to check how well organs and tissues function within the body.

The radiation risk involved in these procedures is very low compared with the potential benefits. There are no known long-term adverse side effects from nuclear medicine procedures, which have been performed for more than 50 years. Rarely, allergic reactions may occur but are extremely rare and usually mild.

How does it work?

For most procedures, you will receive a small amount of a radioactive “tracer” through a vein in your arm, by mouth or occasionally by breathing it in as a mist. The amount of radioactivity is very small, and it is unlikely that you will experience any side effects or discomfort.

When the radioactive tracer travels to the part of the body to be examined, pictures (scans) are obtained using a gamma camera. A gamma camera sees radioactivity in a similar way that an ordinary camera sees light. The procedure will feel no different from having your photograph taken but the exposure time will be longer.

While having the pictures taken you will need to sit or lie still on a special table. The camera may come close to you but will not touch you.

You will hear the noise of machinery moving the camera and other electronic sounds. It is like having an X-ray taken, but no radiation comes from the camera

A technologist will be in the room with you for most of the time in order to operate the gamma camera, attend to your needs and answer your questions. He or she may leave the room briefly but will let you know when this is necessary.

Before you leave the department, the technologist will check the pictures to be sure that the test is complete and has provided the most useful results possible.

What is it used for?

Most often, radioactivity is used to show the presence and extent of a disease or condition. This information will help your doctor with diagnosis and treatment. Less often, radioactivity is used for treatment i.e. thyroid disease, prostate disease.

We carry out Nuclear Medicine tests and treatments only at the request of your doctor.

Radioactive materials have been used in this way for more thanfifity years. Many conditions and diseases are investigated by Nuclear Medicine techniques.

Very small quantities of radioactivity are used in diagnostic tests. The tests are like the familiar x-ray procedures and usually involve obtaining pictures (scans) of the affected part of the body.

• There are different types of nuclear medicine images:
• Dynamic – a series of images that captures movement or activity (such as blood flow to an organ)
• Planar (static) – a 2-dimensional view that shows one image at a time
• Whole body – front and back views of the body in 2 dimensions
• Single photon emission computed tomography (SPECT) – a 3- dimensional view of the process or function of the organ being studied
• Positron Emission Tomography (PET) – a 3-dimensional view of the body
• CT – CT imaging may be used in some examinations for accurate localization

Nuclear Medicine Clinical Uses

• It helps in early diagnosis.
• Determines severity of disease.
• Helps select the most effective therapy.
• Identifies recurrence of disease.
• Assesses and evaluates the progression of disease.

Different radioactive isotopes are used depending on the type of test and the tissue or organ being studied, including:

• Technetium-99m (Tc-99m)
• Radioactive iodine
• Gallium
• Thallium
• Radium 223
• FDG (PET)

We are able to perform 2 imaging studies at the same time, such as SPECT/CT and PET/CT

Generally, no special preparations are required, but for some studies it is necessary to go without breakfast or to stop taking certain medications. If special preparation is required in your case, you will receive instructions. If in doubt, telephone us at the location (campus) where your procedure is scheduled.

If you are or think that you might be pregnant, or if you are breastfeeding, please notify us. The procedure may have to be modified, postponed or cancelled.

You may save time by wearing loose, comfortable clothing such as a sweat suit. Please do not wear jewelry, hairpins or metal belt buckles. If your schedule requires that you arrive in more formal attire you may be asked to change into a hospital gown.

Many Nuclear Medicine procedures are divided into different phases separated by an hour or more (may be days) waiting period after the injection of a radioactive “tracer” before pictures (scans) can be obtained. You may want to bring something to read. In some cases, you may leave the department or the hospital.

What if I must cancel or reschedule my appointment?

If you are unable to keep your appointment, please let us know as soon as possible by calling the location where your appointment is scheduled. Should you be admitted to the hospital, please inform your doctor about your appointment.

Will I be OK to drive or go home on my own?

Because no reaction to the radioactive tracer is expected, you may be able to drive home if you wish. Alternatively, a relative or friend may accompany you. For some examinations, you may receive a drug for which driving afterward is prohibited. You will be informed in advance if this is the case for your examination.

Will there be any after-effects?

Nuclear Medicine procedures are not difficult and are very safe. These procedures use small amounts of radioactive materials to image different parts of the body.

It is unlikely. Only a small dose of radiation is used. The dose is kept to the minimum necessary to obtain a useful result. The risk from this radiation is extremely small.

Many Canadians benefit each year from nuclear medicine procedures used to diagnose and treat a wide variety of diseases and conditions

How are radiopharmaceuticals use?

Nuclear Medicine procedures require that a radiotracer be injected, swallowed or inhaled. Each radiotracer is attracted to specific organs, bones, or tissues. A special camera (pet, spect or gamma camera) takes pictures of the distribution of the radiotracer in the body.

The use of radiation in these procedures offers a safe means to provide doctors with diagnostic information that would otherwise require exploratory surgery or more expensive or difficult procedures to obtain the same information.

Radiopharmaceuticals are also used for therapy, to treat overactive thyroids and certain types of cancer.

Radiopharmaceuticals are approved by Health Canada and are tested carefully prior to general use and  prepared with great care.

How much radiation exposure is involved in nuclear medicine procedures?

Because the amount of radiotracer used is nuclear medicine tests are extremely small, the patient’s radiation exposure is minimal.

Nuclear medicine specialists and technologists use the ALARA principle (As Low As Reasonably Achievable) to carefully select the amount of radiopharmaceutical that will provide an accurate test with the least amount of radiation exposure to the patient. The actual dosage is determined by the reason for the study and the body part being imaged.

The amount of radiation in most nuclear medicine tests is comparable to and often less than that of a diagnostic CT scan. Most nuclear medicine procedures expose patients to about the same amount of radiation as they receive in a several months of normal living.

Who performs the exam?

A specially trained Nuclear Medicine technologist will perform the procedure under the direction of the Nuclear Medicine doctor.

How and when will I know the results?

After examining your test results, a Nuclear Medicine physician will send a written report to your physician. Your physician will explain the results to you when you see her/him.

Bone Mineral Density (BMD)

Your physician has requested an examination called a “bone mineral densitometry”. A BMD study is a simple and painless way of measuring the concentration of calcium in your bones using a computerized x-ray scanner. You do not need to be fasting for this examination.

See the Bone Mineral Density (BMD) Booklet for more information.

Bone Scan

Your physician has requested an examination called a bone scan. This is a simple and painless way of taking pictures of your bones and joints using a radioactive tracer.

See the Bone Scan Booklet for more information.

Brain Scan

Your physician has requested an examination called a “Perfusion Brain Scan”. This is a simple and painless way of taking pictures of your brain using a radioactive tracer. You do not need to be fasting for this examination.

See the Perfusion Brain Scan Booklet for more information.

Cisternogram

Your physician has requested an examination called a “Cisternogram”. A radionuclide cisternogram is an imaging test that follows the pathway of spinal fluid in the spinal column and throughout the brain. This test is useful in determining if any obstructions are present in this pathway.

Cardiac Perfusion Stress Test

Your physician has requested a test called a cardiac perfusion scan. A cardiac perfusion scan measures the amount of blood in your heart muscle at rest and during exercise.

See the Cardiac Perfusion Stress Test Booklet for more information.

C-14 Breath Test

This is a simple and painless way of detecting the presence of bacteria called Helicobacter pylori. in your stomach. Excessive amounts of these bacteria in your stomach can sometimes cause pain and other stomach problems.

See the C-14 urea breath test Booklet for more information.

DMSA renal scan

A DMSA scan is a renal scan used to assess Pyelonephritis, renal scarring extent and location, as well as differential renal function in the left and right kidneys.

See the DMSA renal scan Booklet for more information.

Gallium Scan

Your physician has requested an examination called a Gallium Scan. This involves a painless way of taking pictures your body using a radioactive agent. This test is used to investigate various types of potential diseases.

See the Gallium Scan Booklet for more information.

Gastric Emptying Study

Your physician has requested an examination called a “Gastric Emptying Study”. A Gastric Emptying Study is a test to determine the time it takes a meal to move through a person’s stomach. Since this test follows the digestive process, it takes four hours to complete all imaging. It is typically ordered by physicians for patients with frequent vomiting, gastroparesis (slow digestion), abdominal pain, early satiety (getting full quickly) and pre- operative evaluation.

See the Gastric Emptying Study Booklet for more information.

Gated Cardiac Scan (MUGA)

Your physician has requested an examination called a “Gated Cardiac Scan”. This is a simple and painless way of taking pictures of your heart using a radioactive tracer. You do not need to be fasting for this examination.

See the Gastric Cardiac Scan Booklet (MUGA) for more information.

Gastro-Esophageal Transit/Aspiration

Your physician has requested an examination called a “Gastro-Esophageal Transit/Aspiration Study”. This is a simple and painless way of taking pictures of your ability to swallow. You are required to fast for two hours prior to starting this test. Depending on the information that your physician is looking for, this test can take most of the day to complete.

A technologist will ask you to lie on an imaging table. You will then be asked to drink some water mixed with a small amount of radioactivity. You will experience no reactions to this drink. The technologist will take several pictures of the swallowing process. The camera does not produce radiation; it simply picks up signals (gamma rays) from the radioactive tracers which you received.

Once this first part of the test is complete, you will be given some orange juice to drink.

Again the technologist will take several pictures of the swallowing process. In some cases, it may be necessary to take additional pictures at various intervals throughout the day.

You may then return home feeling no ill effects from the examination. The results will be sent directly to your physician.

See the Gastro-Esophageal Transit/Aspiration Booklet for more information.

GFR (Glomerular Filtration Rate) Study

Your doctor has requested a GFR (Glomerular Filtration Rate) of your kidney(s). A GFR study is used to determine how well your kidney(s)

are filtering blood and creating urine. This procedure involves multiple blood samples taken over a period of 4 or more hours.

See the GFR (Glomerular Filtration Rate) Study document for more information.

Patients Treated with Radioactive Iodine

The radioactive iodine used for your treatment will remain in your body only temporarily. Most of the iodine not taken up by your thyroid gland will be eliminated during the first few days after your treatment. The iodine leaves your body mainly in your urine, but small amounts may leave in your saliva, sweat and feces.

See the Patients Treated with Radioactive Iodine Booklet for more information.

Hepatobiliary study (HIDA)

Your physician has requested an examination called a “Hepatobiliary study (HIDA)”. This is a simple and painless way of taking

pictures of your gall bladder function. This procedure can take up to two and a half to three hours on the day of your appointment, but in many cases is finished after one hour. Many patients will require an injection of a synthetic version of the hormone released when you eat. This causes the gall bladder to contract, and you may feel some discomfort after the injection, especially if you have pain after eating. A small percentage of patients will require an injection of morphine to stimulate function within the liver and gallbladder. The amount of morphine used is small but may affect your ability to drive for a few hours following the procedure. For this reason, it is required that someone accompanies you to your appointment or picks you up after your appointment.

See the Hepatobiliary Study (HIDA) Booklet for more information.

Lymphoscintigraphy

The lymphatic system includes lymph vessels, lymph nodes and lymph. Lymph vessels carry lymph throughout your body. Lymph is a colorless fluid that helps your body fight infection. As the

lymph travels through the lymph vessels, it passes through lymph nodes. The lymph nodes act as filters and can trap foreign particles such as bacteria or viruses. The sentinel lymph node is the first lymph node that cancer is likely to travel from the cancer site. This Nuclear Medicine exam is done to help find the first lymph node that drains from the cancer site before surgery.

See the Lymphoscintigraphy Booklet for more information.

Liver Imaging

Your physician has requested an examination called a “Liver scan”. This is a simple and painless way of taking pictures of your liver using a radioactive substance. You do not need to be fasting for this examination.

See the Liver Imaging Scan Booklet for more information.

Meckel’s Scan

Your physician has requested an examination called a “Meckel’s Scan”. A Meckel’s scan is for detection and localization of a Meckel’s diverticulum containing functioning gastric mucosa. In other words, we are looking for a small section of your bowel that is abnormal.

See the Meckel’s Scan Booklet for more information.

MIBG Scan

Your physician has requested an examination called an “MIBG scan”. An MIBG scan is used for localization of certain types of tumors. This test may also be used to determine the cause of unexplained high blood pressure.

See the MIBG Scan Booklet for more information.

Octreotide Imaging

An Octreotide study is used to detect specific types of tissue within the body that may be causing problems for you. Please speak to your physician if you have additional questions regarding why he would like this test performed.

See the Octreotide Imaging Booklet for more information.

Thyroid Ablation Treatment

After thyroid surgery you will be treated with radioiodine to destroy any remaining thyroid tissue in order to decrease the chances of thyroid carcinoma reoccurring. You will be administered radioactive sodium iodide (radioiodine) by the nuclear medicine department in capsule or liquid form. This type of treatment has been performed for many years with a very high rate of success.

See the Thyroid Ablation Treatment Booklet for more information.

Parathyroid Scan

Your physician has requested an examination called a “Parathyroid scan”. A parathyroid scan is used to examine how your parathyroid

glands are working. It can show conditions that are not seen using other tests or scans. It can also identify parathyroid tissue away from its normal location in the neck.

See the Parathyroid Scan Booklet for

PET/CT Scan

PET scans are a type of nuclear medicine examination. Nuclear medicine examinations are different from X-ray procedures. X-

rays show what your body structure looks like whereas nuclear medicine examinations show how your body’s organs are actually working. First you swallow, inhale, or get injected with a substance called a radioactive tracer. This substance travels to the part of your body we want to examine. It gives off energy waves called gamma rays. A special camera builds these rays into a picture. We can diagnose specific problems by looking at these pictures.

See the PET/CT Scan Booklet for more information.

Renal Scan

Your physician has requested an examination called a “Renal Scan”. This is a simple and painless way of taking pictures of the blood flow and function of your kidneys using a radioactive tracer.

See the Renal Scan Booklet for more information.

Renal Captopril Study

Your physician has requested an examination called a “Captopril renal study”. This procedure is used to determine specific information about the blood supply and function of your kidneys. This procedure usually involves two stages that will take most of the day to complete.

See the Renal Captopril Study Booklet for more information.

Salivary Scan

Your physician has requested an examination called a “Salivary Scan”. The salivary glands are glands located around the mouth, nose

and ears. These are primarily concerned with the production of the clear liquid released into the mouth that lubricates the mouth and starts the breakdown of chewed food. The saliva is made up essentially of water, enzymes, protein and mucin. A salivary gland scan is a medical test that requires the use of a camera specially designed for the purpose and a radioactive chemical that acts as a tracer which together give the required images of the salivary glands. The procedure helps the doctor to better analyze the cause of problems with your salivary glands.

See the Salivary Scan Booklet for more information.

Thyroid Studies

Your doctor has requested an examination called a “thyroid scan”. This is a simple and painless way of taking pictures of your thyroid gland using a radioactive tracer. You do not need to be fasting for this procedure.

See the Thyroid Scan Booklet for more information.

White Blood Cell Imaging

Your physician has requested an examination called a “White Blood Cell Scan”. A white blood cell scan helps us to detect abscesses and infection in soft tissue or bone or to detect fever of unknown origin. You might have heard your doctor mention a WBC scan. This is just another name for a white blood cell scan.

See the White Blood Cell Imaging Booklet for more information.

Whole Body Iodine Imaging

Your physician has requested an examination called a “whole body iodine scan”. This is a simple and painless way of taking pictures of various parts of your body using a radioactive tracer. You do not need to be fasting for this examination.

See the Whole Body Iodine Imagine Booklet for more information.