NUCLEAR MEDICINE
Nuclear Medicine is a branch of medicine in which radioactive substances injected into the body via the vascular route are externally detected and imaged using devices and specialized methods to enable diagnosis. It is also used to treat diseased organs and tumors.
For imaging, a low-level radioactive substance (radioisotope) is bound to a chemical (pharmaceutical). This combination is called a “radiopharmaceutical.” Various radiopharmaceuticals specific to different organs are used for imaging those organs. The device used for imaging is called a “gamma camera.” Another method, PET (Positron Emission Tomography), detects gamma rays emitted from positron-emitting radionuclides and converts them into sectional images in three different spatial planes. Increased glycolytic activity in tumor cells forms the basis of PET imaging, most commonly performed with FDG. PET identifies changes in metabolic activity in tumor tissue and enables quantitative assessment of cellular function. PET/CT systems, which combine PET and CT, allow functional and morphological data to be obtained in a single session. The semi-quantitative technique used in evaluation is the Standard Uptake Value (SUV) measurement.
Primary Diagnostic and Therapeutic Methods in Nuclear Medicine
Conventional scintigraphic methods
PET-CT (FDG and Ga-68 DOTA-TATE, Ga-68 PSMA)
Diagnosis and theranostic treatment in differentiated thyroid cancer, hyperthyroidism, and neuroendocrine tumors
Other Therapeutic Applications
Palliative pain treatment in metastatic cancers
Radiosynovectomy
Immunotherapy with monoclonal antibodies in non-Hodgkin lymphoma
Radium-223 treatment for metastatic bone disease
Phosphorus-32 treatment in polycythemia vera
PET/MR
A high-resolution hybrid method where PET detectors and electronics are integrated into a 3-Tesla MR device, allowing simultaneous PET and MR imaging. PET/MR provides high soft tissue contrast and lower radiation exposure compared to PET/CT. It facilitates metastasis detection in organs such as the brain, heart, and liver, and is advantageous in brain imaging for diagnosis and staging of most malignancies.
Bone Mineral Density Measurement
Another diagnostic method in Nuclear Medicine. Using a DEXA device, it is applied to diagnose osteoporosis, assess fracture risk, and follow up patients. Low bone mineral density is associated with increased fracture risk. Detection allows assessment of bone mass loss before fractures, estimation of future fracture risk, and monitoring response to osteoporosis treatment.
At Adıyaman Training and Research Hospital, the Nuclear Medicine Department provides conventional scintigraphic methods, bone densitometry, and outpatient services on the ground floor. Conventional scintigraphic procedures mainly include myocardial perfusion scintigraphy and 3D imaging of the heart (myocardial gated SPECT) as part of nuclear cardiology methods. Three-phase and whole-body bone scintigraphy are used for diagnosis and follow-up of benign and malignant musculoskeletal diseases; functional renal evaluation for upper urinary tract dilation or obstruction, acute pyelonephritis, renal scar assessment, and congenital renal anomalies using dynamic and static renal scintigraphy; pulmonary embolism assessment; differential lung function calculation before surgery using lung perfusion and ventilation scintigraphy; thyroid scintigraphy and uptake test for evaluating thyroid presence and function; parathyroid scintigraphy for parathyroid adenomas and hyperplasia; gastrointestinal reflux scintigraphy in infants and children with persistent vomiting and respiratory symptoms; Meckel diverticulum detection; selective spleen scintigraphy for accessory spleen imaging; dacryoscintigraphy for tear duct obstruction, among other commonly used methods.
Myocardial Perfusion Scintigraphy
Demonstrates myocardial blood flow distribution using an intravenously administered radiopharmaceutical. Indications include myocardial ischemia or scar evaluation, impact of coronary stenosis on regional perfusion, post-myocardial infarction assessment, preoperative risk evaluation for non-cardiac surgery, and differentiation of coronary versus non-coronary causes in acute chest pain syndrome.
The ECG-synchronized version of myocardial perfusion scintigraphy is called gated SPECT. Gated SPECT provides two major contributions: calculation of left ventricular volumes and ejection fraction, assessment of regional wall motion, and identification of attenuation artifacts, improving diagnostic accuracy. SPECT reconstruction techniques generate three-dimensional images from each set of two-dimensional images.
The Nuclear Medicine Department staff includes a Nuclear Medicine Specialist Physician, radiology technicians, paramedics, secretaries, and auxiliary personnel.
Units within the Nuclear Medicine Department
A – Controlled Areas in the Nuclear Medicine Unit:
Imaging Room (dual-head gamma camera)
Exercise Room
Lead Room
Iodine Therapy and Waiting Room
Hot Room (radioactive material preparation)
Injection Room
B – Supervised Areas in the Nuclear Medicine Unit:
Thyroid Outpatient Room
Imaging Room
Reception
Waiting Lounge