FINALS_NUCMED

• IN VITRO


  outside the body
• IN VIVO


  inside the body
• RADIOIMMUNOASSAY (RIA)

  It is considered the gold standard method to determine thyroid hormone levels because RIA exhibits high sensitivity and specificity and low detection limits.

  FT3, FT4, TSH
• TSH

  Thyroid Stimulating Hormone
• TSH

  Best way to initially test thyroid function is to measure the TSH
• High TSH level


  thyroid gland is not making enough thyroid hormone.
• Low TSH level


  thyroid is producing too much thyroid hormone
• FT4

  Free Thyroxine
• FT4


  Affected by medications and medical conditions that change thyroid hormone binding proteins
• High FT4


  increased thyroid hormone binding proteins
• common causes of increased thyroid hormone binding protein

  Estrogen, oral contraceptive pills, pregnancy, liver disease, and hepatitis C virus infection
• Low FT4


  causes of decreased thyroid hormone binding proteins.
• common causes of decreased thyroid hormone binding proteins

  Testosterone or androgens and anabolic steroids
• FT3

  Free Triiodothyronine
• FT3


  Possible but is often not reliable and therefore may not be helpful
• Hyperthyroid patients typically have an elevated Total T3 level
• HOT LAB


  Storage of radiopharmaceuticals
• LEAD PIG


  Container of the radiopharmaceuticals
• L-SHIELD


  This is where the radiopharmaceuticals are dispensed.
• DOSE CALIBRATOR


  Gives the measurement of the activity contained by the radiopharmaceutical
• RADIATION DETECTORS

  • Detects radioactivity coming from the patient
  • Converts radiant energy into an electronic signal (image)
• GANTRY


  Supports the radiation detectors
• BONE SCAN

  RADIOPHARMACEUTICAL:

  • 99mTc- Methylene Diphosphonate (MDP)
  • 99mTc- Hydroxymethylene Diphosphonate (HDP)
• INDICATION(BONE SCAN):


  Metabolic bone diseases
• DOSE (BONE SCAN):

  20-30 mCi (740-1110 MBq)
• COLLIMATOR (BONE SCAN):

  LEHR
• IMAGING (BONE SCAN):


  Whole body and Statics, 2-4 hrs post injection
• BONE SCAN

  
• MYOCARDIAL PERFUSION IMAGING

  CARDIAC SCAN
• RADIOPHARMA (CARDIAC SCAN):

  • 99mTc- Methoxyisobutyl Isonitrile (SESTAMIBI)
  • 99mTc- Tetrofosmin
  • 201Thallium Chloride
• INDICATION(CARDIAC SCAN):


  Diagnosis and localization of Myocardial Infarction, Ischemia, Coronary Artery Disease.
• DOSE (CARDIAC SCAN):

  • 99mTc- Methoxyisobutyl Isonitrile (SESTAMIBI) – 15-30mCi (555-1110 MBq)
  • 99mTc- Tetrofosmin - 15-30mCi (555-1110 MBq)
  • 201Thallium Chloride 2.5-4mCi (92.5-148 MBq)
• COLLIMATOR(CARDIAC SCAN):

  LEHR, LEAP
• IMAGING(CARDIAC SCAN):

  SPECT, REST, STRESS
• STRESS

  Treadmill or Pharmacologic
• TREADMILL:

  85% of maximum heart rate
• PHARMACOLOGIC:

  Adenosine

  Dobutamine

  Dipyridamole
• 99m Tc

  v  REST: inject 15mCi then wait 45mins-1hr

  v  SCAN: 20 mins

  v  STRESS: inject 30mCi then wait for 45mins-1hr

  v  SCAN
• 201 Thallium

  STRESS: 2.4mCi-4mCi

  SCAN: within 15mins: 20mins

  REST: 3hrs rest – heart is well-rested

  SCAN
• Ischemia


  Normal rest, Abnormal stress