Damita Thomas

Yes, it definitely does. They’re both imaging modalities, but radiology evaluates anatomical structures, i.e., bones, organs, muscles, etc., via radiation that the camera produces which subsequently is transmitted through the patient. Nuclear medicine evaluates a particular function. By administering a substance that’s already in our bodies, or one very similar to it,
labeled with a very small amount of a radioactive isotope the function of a particular organ system can be evaluated. This is done by analyzing the pictures made when the radioactive isotope decays, releasing energy that is detected by the camera. Anatomical imaging is often done in conjunction with functional imaging.
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Yes and no. Yes in that all radiologists get some degree of nuclear medicine training. However, it is subpar to what nuclear medicine specialists receive. Nonetheless, because healthcare is now such that paying a specialist has become too inexpensive, a radiologist can state that s/he reads nuclear imaging. Some radiologists actually do a fellowship and become boarded in nuclear medicine as well. There’s also a nuclear medicine competency that radiologists used to be able to obtain, but I’m not sure if that’s still offered.

No in that some nuclear medicine specialists are just trained in nuclear medicine, meaning they competed a 3 year residency in this modality. The job market for this type of physician has dropped precipitously low to the point that it is unwise to go this route if nuclear medicine is your interest. Nuclear medicine only residencies are actually closing in the US because graduates year after year for the last several years have entered an essentially jobless market.

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It’s similar, but different. . .
In Nuclear Medicine, a small dose of a radioactive substance (radioisotope) is attached to a substance that’s similar to a physiologic substance in the body. This tagged radiotracer is either administered by mouth, intravenously, intradermally, via the urethra, or into the cerebral spinal fluid depending on what type of function you’re evaluating. There’s even a study where it’s dropped into the eye to evaluate tear ducts.

A Nuclear Medicine specialist is a physician who specializes in the diagnosis and treatment of various diseases using small amounts of radioactive isotopes. If you’re interested in medicine, I’d advise going into Radiology and completing an additional Nuclear Medicine fellowship as the job market for Nuclear Medicine-only physicians is quite slim. If you’re not interested in a clinical career, there are various fields you can explore that also incorporate nuclear science.

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Radiation oncology is not my specialty, but I do know that radiation therapy is an effective treatment for prostate cancer and can be curative. I suggest you talk more with your radiation oncologist for more specific details.

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Radiation therapy is not my area of expertise, but the radiation to your stomach is not only causing death of the cancer located there, but also damaging some of the normal tissue around it. Both processes cause inflammation of the gastric lining and thus nausea. For a more detailed explanation, I recommend speaking directly to your radiation oncologist.

Radiation therapy is not my area of expertise, but I can say with confidence that with the newer technological advances in radiation oncology, severe damage to normal surrounding tissue is minimized to a greater degree. You’d need to have an in-depth discussion with your radiation oncologist to answer this question in more detail.

A nuclear bone scan is a type of diagnostic imaging study that looks at areas of your skeleton that are overactive in terms of bone production. It’s clinical indications for use are many, including evaluating cancer patients for bone metastases, evaluation of primary bone tumors, evaluation of prosthetic joints (most commonly knee and hip replacements) for patients with persistence pain for infection or prosthetic loosening, evaluation for bone infection (osteomyelitis), and other orthopedic indications (back pain in athletes can reveal pars fractures and shin pain in runners can differentiate shin splints from actual fractures).

These is performed by injecting a small amount of a radioactive substance that is linked to an agent that acts much like calcium deposition in the bony surface to detect areas that are overproducing bony matrix. The test can be performed as either a three phase study in which images are taken immediately following injection to evaluate blood flow to an area of interest with delayed pictures take 3-4 hours after injection. This is typically used to when infection is suspected. A regular bone scan is one in which only the delayed images are taken and is used for almost all other indications.

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This is not a dangerous test. A small amount of radioactive material is used that allows a doctor to see indirect images of the muscular large left chamber of your heart. Patients don’t generally experience side effects, but when they do occur it’s typically mild irritation/pain associated with the injection and possibly headache, nausea, vomiting following injection of the medication used to dilate your blood vessels (that’s only if you cannot walk briskly on a treadmill).

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It depends whether your doctor ordered it as a one day or two day study. If it’s a one day study, it typically takes 4-6 hrs including checking in and both sets of images. If it’s a two day study, each day is about 2-3 hrs.

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A nuclear cardiac stress test won’t show the actual blockages like an invasive coronary catherization. However, it will show if there is diminished blood flow to the left heart muscle which indirectly reflects a blockage in one of the arteries that supplies blood flow to the heart muscle.

A nuclear stress test uses a small amount of a radioactive substance that is similar to potassium that is normally taken up into cardiac muscle. It doesn’t measure blood flow directly, but looks at the heart muscle supplied by a particular coronary artery to determine whether you have a blockage in that vessel. It’s a non-invasive way of determining if you have a significant, flow-obstructing blockage in a coronary artery by looking at the heart muscle supplied by the coronary arteries.

Scintigraphy is simply s generic term describing a type of medical imaging that looks at the function of an organ system instead of anatomy. In your case, lung scintigraphy refers to imaging your lungs to evaluate blood flow (perfusion) to lung tissue. It is commonly done with imaging to evaluate how well your lungs are aerated.

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Indirectly. By that, I mean the test looks at perfusion to the heart muscles supplied by the various major coronary arteries. So, if a perfusion defect is seen in a specific area of the muscle, there is concern that it’s due to obstructive changes in the artery supplying that territory. If the perfusion defect is "fixed" it likely reflects scarring (typically seen in those who’ve had a prior myocardial infarction). If the defect is "reversible," it means that blood flow to that area of cardiac muscle is compromised when you’re active or when the heart muscle requires more blood supply from an increased need for more oxygen.
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Typical side effects are lowered white and red blood cell counts, nausea, vomiting, fatigue, and sometimes skin rash.

Most common radiotherapy is I-131 sodium iodine used to treat thyroid cancer and hyperthyroidism (overactive gland) once it becomes refractory to medication. Less common uses of radiotherapies are for the pediatric condition neuroblastoma (I-131 MIBG) and for certain types of lymphoma (Y-90 ibritumomab tiuxetan or Zevalin).

Just recently, the FDA approved a radiotherapy (Lu-177 DOTATATE or Lutathera) for the relatively rate condition of neuroendocrine malignancies, once referred to as carcinoid.

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Yes, it is okay to be around children after your test. The amount and energy of the radiation you will receive for this test is very small and decays by half every 6 hrs.

Soreness and mild sensation of heaviness is not uncommon following IV administration of a radiotracer. It should subside within a few hours. If it doesn’t or worsens, you should consult your physician.

The length of time nuclear medicine agents, or radiotracers, remain in your body depends on the type of agen you received. It can range from a few hours to a few days and factors that determine this are the half life of the radioisotope being administered and the biological effects (is how the body handles it in terms of distribution in various organs and excretion from the body).

For iodine, there are two radiotracers commonly used in nuclear medicine: the I 123 isotope which is used for diagnostic studies and the I 131 isotope which is used primarily for therapeutic purposes (mainly thyroid cancer and hyperactive thyroid diseases). I124 is also an isotope used in diagnostic imaging but only in the research setting. Although both are
isotopes of iodine, they have different half-lives (i.e., the time it takes the substance to decay to half its quantity). I123 has a half-life of 13 hrs whereas I 131 has a half-life of 8 days. Because radioiodine of both forms is primarily excreted by the kidneys, kidney function also determines how quickly the radiotracer clears the body.

As for side effects, the vast majority of nuclear medicine agents do not really have any. Radioiodine, however, in adult patients in larger quantities can cause salivary gland swelling and dry mouth primarily. It can also damage normal thyroid tissue so if it’s being used for other purposes (in pediatric patients for a particular nuclear medicine scan or therapy for neuroblastoma or in patients undergoing a particular nuclear medicine scan to evaluate movement disorders), thyroid blockade is performed. This entails either drinking a solution or taking an agent that blocks the thyroid from taking up the radioiodine.

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There are no side effects from this scan. You will be given a pill containing a very small amount of radioactive iodine. Since iodine is what the thyroid uses to make thyroid hormone, the radioactive version used for the scan allows imaging of your thyroid. You will have to wait 24 hrs after taking the iodine pill before you’re imaged in order to allow the thyroid to adequately take up the iodine.

I hope this answers your question.