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The discovery of X-rays is one of the great discoveries in medicine that changed a lot in the quality of diagnosis and treatment that the patient receives. X-rays enabled doctors and scientists to see inside the human body and determine the cause and source of pain. With the development of medicine, so did the field of medical imaging. Today, thanks to nuclear medicine, we do not see only pictures of the human body’s organs, but we are beginning to see how these organs perform their vital functions inside the human body. We are now seeing what happens to the molecules and cells that perform their functions inside the human body in vivo without hindering them from their function. One of the benefits of this field is the speed of diagnosis of the disease and sometimes even before symptoms of the disease occur, and this is when pathological changes occur at the level of cells and molecules before the organ is completely affected. Table of Contents Nuclear Medicine Uses Some Radioactive Materials (Radioisotopes) Nuclear medicine uses some radioactive materials (Radioisotopes) to diagnose and treat many diseases. It is considered a painless and very safe examination for the patient, which is performed with a small amount of radiation, so there is no need for any concern or fear of the examination. The reason for naming nuclear is due to the fact that the rays used come from the nucleus of the atom. The idea of nuclear medicine in general is to give the patient a radioactive substance that is concentrated in one of the organs of the human body, and then the patient is photographed by a special camera that captures the radiation coming out of the organ, and so we can know what happens inside the patient’s body. The amount of dose of the radioactive material depends on the type of examination and the age of the patient. The most common tests in nuclear medicine are bone, kidney, thyroid, heart, lungs, brain, lymphatic system, etc. Why Nuclear Medicine? Through nuclear medicine, we can obtain information and details about diseases and the human body that we may not be able to obtain in another way or with another device. Nuclear medicine is distinguished from other types of radiography in that it can visualize the function of the body’s organs, not just anatomy. Other types of radiography mostly focus only on anatomy. For example, kidney, CT scans and sound waves can visualize the anatomy of the kidney. With them, we can see the shape of the kidney and measure its dimensions and whether there is a change in its shape, which indicates the presence of illnesses from diseases and others. In nuclear medicine, we can see the function of the kidney, its efficiency, and so on. Another difference between nuclear medicine and the other types is the radiation source. The patient in medical imaging devices receives radiation from an x-ray machine, so the radiation source is external. Whereas in nuclear medicine the patient himself is the source of radiation after he is given a radioactive substance. Imaging Method in Nuclear Medicine In usual diagnostic radiology, the energy source is outside the patient, such as an x-ray tube, a magnetic field, or even sound waves, and this energy is represented by a picture that shows the the bones and tissues of the patient. In nuclear medicine, the energy source is the patient himself, by injecting, drinking, or inhaling a radioactive material, and then this radioactive material is photographed by a gamma camera, SPECT or PET device. But how is this radioactive material sent to the place to be photographed? This is done by pharmaceutical ability to go to the organ to be imaged. For example, MDP, when injected into the human body, is deposited in the bones. If we want the radioactive material to also be concentrated in the bones, then we mix it with MDP and it goes and the radioactive material is concentrated in the bones. The pharmaceutical substance mixed with a radioactive substance is called Radio-pharmaceutical. So the pharmaceutical substance is only a carrier of the radioactive material to the organ to be photographed. How to Give the Radioactive Material to the Patient? Mostly the patient is given the radioactive material by injection into the vein, but there are other ways to take the radioactive material, for example by mouth (capsule or syrup) or even by inhaling the radioactive substance that is in the form of gas. Types of Radioactive Materials There are a group of radioisotopes, each of which has different half-lives, and different radiological and chemical properties that can be used to detect specific diseases in the body. Technetium-99M: one of the most commonly used radioisotopes in diagnosis, accounting for more than 80% of the tests. Bone scan with radioactive technetium. Iodine-123: Diagnosis, especially thyroid gland, and neurological diseases (such as Alzheimer’s and Parkinson’s disease). Iodine-131: Treatment of thyroid diseases, including cancer. Radioactive iodine treatment Fluorine-18: Imaging of malignancies. Thallium-201: Heart monitoring during exercise. Gallium-67: Imaging of tumors and regeneration of inflammation. Indium-111: Identification of blood clots, infections and rare cancers. Xenon 133: Is aspirated to study lung ventilation. Chromium 51: Follow-up of blood cells, diagnosis of gastrointestinal bleeding. Lutetium-177: Diagnosis and treatment of small cancer tumors. Yttrium-90: Treating cancer and relieving pain in arthritis. Possible Risks and Side Effects The amount of radiation in nuclear medicine examinations is very small and is not a cause for concern. This does not mean that there are no risks of exposure to radiation, but it is few like the rest of the other radiological examinations. More about the risks of radiation in this article click here. Also, it is good in nuclear medicine examinations that the risks of allergy to the human body (sensitivity) from the radioactive pharmaceutical substance are very small, and even rare compared to the dye used in CT and MRI scans. So crosses are very safe. Contraindications to the Examination Nuclear medicine scans are performed for all age groups, from children and newborns to the elderly. With the exception of pregnant women, the examination is postponed until after childbirth, because radiation may cause harm to the fetus. And when there is suspicion of a pregnancy, a pregnancy test is performed to ensure that it is not present. Preparing for the Examination Usually the examination does not require preparation, but the patient may sometimes be asked to be fasting, and he may be asked to stop using some medicines or the use of certain medicines, so the instructions given when taking the appointment must be adhered to. Post-examination Instructions The patient must drink sufficient quantities of fluids and go to the toilet continuously to speed up the process of the body getting rid of the radioactive material through urine. A nursing mother must stop breastfeeding for a certain period due to the presence of radiation with breast milk, and she will be informed of the period during which she must stop breastfeeding by the staff of the nuclear medicine unit. After the examination, the patient can go about his daily life normally.
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Scintigrafija je dijagnostička slikovna metoda koja se koristi u nuklearnoj medicini za snimanje raspodjele radiofarmaka (radioaktivnih markera) u tijelu. Metoda se koristi od 1960. godine. Nuklearna je medicina odjel na kojem se koriste radioizotopi, najčešće u neinvazivnim dijagnostičkim postupcima. Radioizotopi su, istini za volju, ipak radioaktivne čestice, no smiju se unositi u organizam bolesnika gotovo bez štetnosti po zdravlje. Obično je to radioaktivna tekućina koja se unosi u organizam injekcijom u venu na ruci. Upravo to da se pri takvim dijagnostičkim pretragama daje samo jedna «mala injekcija», i to je sve što može biti «neugodno» tijekom cijelog ispitivanja, svrstava nuklearnu medicinu u neinvazivnu dijagnostiku. Ozračenje bolesnika pri ispitivanju vrlo je malo, no ipak postoji. Unesena radioaktivna tekućina rasprostranjuje se po cijelom organizmu i ne izaziva alergijske reakcije. U ovisnosti o kemijskom sastavu, u pojedinim se organima duže zadržava ili nakuplja te se na taj način dokazuju ili isključuju različite bolesti. Značajan dio radioaktivne tvari se, ubrzo nakon injiciranja, izluči mokraćom. Zbog toga je važno da bolesnik, prije ispitivanja i nakon njega, pije dosta tekućine kako bi čim prije ispraznio radioizotop koji se skuplja u mokraćnom mjehuru. Za razliku od drugih aparata koji koriste zračenje, u dijagnostičkim postupcima u nuklearnoj medicini izvor zračenja je, barem neko vrijeme, radioaktivna tekućina (radioizotop) koju koristimo do injiciranja. Nakon injiciranja izvor zračenja postaje čovjek – pacijent. Zato korištenje radioizotopa u medicini nazivamo «otvorenim izvorima zračenja». Srećom, zračenje je relativno malo i relativno brzo prestaje. Važno je također znati da najčešće korišteni radioizotopi, raspadanjem ili «gašenjem», postaju potpuno neradioaktivni unutar nekoliko sati ili jednog dana. Scintigrafijom se mogu pregledavati gotovo svi organi ljudskoga tijela te procijeniti njihov izgled i funkcija pa tako zaključiti da li su zdravi: mozak, štitnjača, pluća, srce, jetra, bubreg, kosti, krvne žile i mnogi drugi. Vrlo često na scintigrafiju štitnjače dolaze bolesnici s promijenjenom funkcijom ili povećanjem štitne žlijezde (guša). Scintigram kosti «prepoznaje» i najmanje promjene različitih bolesti. Takve se promjene mogu scintigrafijom uočiti znatno ranije nego bilo kojim drugim dijagnostičkim postupkom. Kako se kosti cijeloga tijela mogu jednostavno pregledati jednim jedinim scintigramom, scintigrafija kosti često se radi prije ili nakon operacije dojke. Kod muškaraca je to češće kod bolesti prostate, pluća itd. Koliko je velika korist od takvih ispitivanja pokazuje podatak da se scintigrafija vrlo često koristi i u male djece, čak i u novorođenčadi. ojedine pretrage rade se odmah nakon injekcije, a druge tek nakon nekoliko sati. Pacijent relativno udobno i mirno leži ispod aparata, gama kamere. Vrijeme ležanja je od nekoliko minuta do više sati, što ovisi o tome što se ispituje. Važno je napomenuti da nema nikakve razlike niti povećanja ozračenja bolesnika ležao on pod aparatom jednu minutu ili nekoliko sati. Ozračenje ispitanika ovisi o količini injiciranog radioizotopa, njegovom rasprostranjenju u organizmu te dužini zadržavanja, kao i količini koja se izluči iz organizma, a ne o dužini ležanja «pod aparatom». Potrebu ispitivanja radioizotopima uvijek posebno procjenjuje liječnik koji upućuje na pregled, ali i specijalist nuklearne medicine. Kao i kod svih dijagnostičkih postupaka u medicini kod kojih postoji zračenje, takva ispitivanja treba posebno izbjegavati kod trudnica i majki koje doje. Kada na takvo ispitivanje dolazi žena, neophodno je provjeriti datum posljednje mjesečnice (menzesa). Ako postoji vjerojatnost trudnoće, ispitivanje se odgađa. Scintigrafija se odgađa i za vrijeme dojenja, kad se moraju primijeniti posebni postupci prekida dojenja od nekoliko dana. Dio uputstava i objašnjenja o scintigrafiji dobit ćete od svoga liječnika. Ponajviše će vas poučiti osoblje odjela za nuklearnu medicinu: savjetovati o čemu trebate voditi brigu, kako se ponašati u ovisnosti o tipu pretrage, koliko ćete trebati sačekati od injekcije do pregleda i koliko ćete vremena provesti pod aparatom. Naime, svaka je scintigrafija drukčija. Kod ispitivanja srca, na primjer, pacijent će morati učiniti i test opterećenja, odnosno «voziti bicikl», a tek nakon toga će dobiti injekciju s radioizotopom.Uspoređujući s drugim dijagnostičkim pretragama kod kojih se koristi ionizantno zračenje, nuklearna medicina, odnosno scintigrafija u pravilu manje ozrači bolesnika, ponekad manje i od «obične» rendgenske snimke pluća. Nema nikakvog razloga da se plašimo scintigrafije, no kao što je to i kod drugih dijagnostičkih ispitivanja, i scintigrafiju treba indicirati samo onda kada je to medicinski opravdano jer svako ozračenje bolesnika, pa bilo ono i vrlo maleno, treba izbjegavati kada nije potrebno.