The role of nuclear medicine in clinical investigation

Assessment of awareness and knowledge regarding nuclear medicine and appropriate use of Nuclear medicine modalities, among medical students and faculty members in two academic medical institutes in North India: A Cross sectional Study

Objectives

Despite significant progress in the field of nuclear medicine, basic nuclear medicine awareness and understanding among clinicians remains unsatisfactory, leading to under utilization of nuclear medicine modalities. To evaluate the awareness and knowledge regarding nuclear medicine and appropriate use of Nuclear medicine modalities, among medical students and faculty members.

Method

In this descriptive cross sectional study, a self timer limited objective questionnaire based on Google forms was distributed to the study population and scores obtained by the participants were analyzed.

Results

Percent scores range for intern, residency trainees, and senior resident/faculty groups for general awareness were 16-46%, 37-58% and 62-91% and for knowledge and appropriate use were 7-21%, 28-43%, and 35-85% respectively. Overall, 61% of the participants had poor awareness and knowledge regarding nuclear medicine modalities. None of the participants had received nuclear medicine exposure or education during their academics or training. Only 49% of the participants considered utilizing nuclear medicine modalities for their patient management.

Conclusion

Undergraduate interns and residency trainees had a poor to fair level of awareness and knowledge regarding nuclear medicine. Hence creating more awareness in early stages of their career by incorporating Nuclear medicine basic education in medical undergraduate curriculum is required. The senior residents/faculty members had a moderate to good level of awareness and knowledge but still improvement in their knowledge would lead to a more appropriate and better utilization of nuclear medicine modalities for optimum patient management in a variety of clinical settings.

The need for nationally accepted guidelines for undergraduate nuclear medicine teaching in MBChB programmes in South Africa

According to the South African Health Professions Act No. 56 of 1974, specific skills outcomes of MBChB programmes are that a medical graduate must be able to utilise diagnostic aids, interpret findings and make diagnoses. Imaging techniques are an integral part of the numerous diagnostic and therapeutic aids used in contemporary medical practice; however, in South Africa, no formal directives exist to guide programme directors or nuclear medicine departments regarding an appropriate undergraduate nuclear medicine educational module. As of 2013, six South African schools of medicine are involved in undergraduate nuclear medicine teaching, in which it forms part of clinical modules taught at varying stages in the academic curriculum. Against this backdrop is the inequitable distribution of nuclear medicine resources, training facilities and staffing in the local state health sector. Inadequate undergraduate teaching and provincial differences in nuclear medicine service provision suggest that many clinicians and graduating medical students are unaware of how radionuclide techniques can facilitate patient management. This high level of imaging illiteracy has been associated with lack of patient referral, poor quality and inadequate referral, poor knowledge of radiation doses and poor awareness of radiation risks. Here we highlight the challenges of undergraduate nuclear medicine teaching in South Africa, emphasising the need for the implementation of guidelines for undergraduate nuclear medicine education. Employing nationally accepted guidelines for undergraduate nuclear medicine teaching in South African MBChB programmes will contribute to the effective utilisation of nuclear medicine and molecular imaging as a diagnostic and therapeutic modality by newly qualified medical practitioners.

Comparison of 99mTc Injected Activity with Prescribed Activity in Four Types of Nuclear Medicine Exams

BACKGROUND

99mTc is a radioactive isotope that is obtained by eluting a 99Mo/99mTc generator. (PINSTECH, Islamabad) and used for radionuclide scanning.

OBJECTIVES

The objective of this work is to study the uncertainties in 99mTc activity that exist due to time delay between injection preparation and administration to patients, during the process of gamma camera scanning.

METHODS

Lead canisters were used for storing elution vials and dose calibrator for measuring 99mTc activity in mCi. The activity of preparing 99mTc injection and its administration to patients were compared with the prescribed values of activity recommended in the Society of Nuclear Medicine procedure guidelines.

RESULTS

This study showed that uncertainty in the activity existed in one thyroid patient, 38 bone patients, 5 renal patients and 45 cardiac patients.

CONCLUSION

This uncertainty in activity exists due to time delay between injection preparation and administration to patients, as well as due to residual radionuclide that is not injected into patients and remains in the syringe.

Back Pain in Children and Diagnostic Value of (99m)Tc MDP Bone Scintigraphy

Aim:

The aim of our study is to assess the diagnostic value of Technituim-^99m-Methyle diphosphonate (^99mTc-MDP) Bone scintigraphy in the assessment of children with back pain.

Methods:

Included in this retrospective study were 68 child referred to us complaining of back pain (mean age of 13+ 2). There were 45 boys and 23 girls. All children have been investigated with conventional x-ray which revealed normal or inconclusive result. All underwent bone scintigraphy after the injection of ^99mTc-MDP with calculated doses according to there body weights.

Results:

Bone scintigraphy revealed 17 (25%) abnormal scans in 11 boys and 6 girls. Scans findings were suggestive of spondylolysis (n=4); malignancy including primary tumors and metastases (n=3); infection including osteomyelitis and discitis (n=3); sacroiliitis (n=2); benign tumors (n=2); pseudo fractures in ribs (n=1); necrosis in femoral head epiphysis(n=1) and nonskeletal-renal retention due to hydronephrosis (n=1). Sensitivity, specificity and accuracy of bone scan in detecting gross skeletal abnormality as a cause for back pain were 94% and 100% and 99% respectively.

Conclusion:

Bone isotope scan is a sensitive imaging modality in the assessment of pediatric patients with back pain. It is a reliable modality to detect and role out most benign and aggressive serious etiologies.

Single Photon Emission Computed Tomography as a diagnostic method in ischemic heart disease - basic technical aspects

Ischemic Heart Disease (IHD) poses an important diagnostic problem. Clinical picture of the disease is often atypical. SPECT is one of the main diagnostic tools in ischemic heart disease. Radioisotope study evaluates distribution of a radiopharmaceutical agent in the heart through a series of scintigraphic images taken by an external gamma camera. This article discusses the technical aspects of cardiac SPECT imaging, starting with a detection system, through image reconstruction, and ending with image filtering.

Diagnostic and therapeutic use of radioisotopes for bony disease in prostate cancer: Current practice

Nuclear medicine techniques continue to be important non-invasive imaging tools assisting the diagnosis, monitoring and--in some cases--treatment of prostate cancer. Bone scintigraphy was the premier modality to have an extensive role in the staging of prostate cancer and has remained an integral tool for over three decades in the assessment of newly diagnosed disease or in follow-up staging. Therapeutic treatment and palliation of disseminated disease, particularly in the skeleton, has also been successful with several radioisotopes including strontium-89 chloride. Despite advances in nuclear medicine techniques and molecular imaging technology such as positron emission tomography and radioimmunoscintigraphy, bone scintigraphy still remains the gold standard in the assessment of osseous metastatic disease in prostate cancer. Thus, it is important to continually review the modalities that have remained important over time and not just to focus on newer technologies. This article summarizes the current diagnostic and therapeutic use of radioisotopes for bony disease in prostate cancer with particular reference to radionuclide bone scintigraphy and positron emission tomography.