WHAT IS NUCLEAR MEDICINE IMAGING?

Nuclear medicine imaging uses small amounts of radioactive materials, also called radiopharmaceuticals, to look at specific organs to see if they are functioning properly. After the radiopharmaceutical is given, it goes to the specific organ to be examined. A device called a gamma camera detects the location of the radiopharmaceutical and provides information about the specific organ’s function.

WHEN WOULD I NEED THIS IMAGING?

There are many instances in which nuclear medicine imaging might be appropriate to investigate a particular concern. Below are two examples of fictitious patients who illustrate two common patient pathways.

SCENARIO 1: 60-YEAR-OLD “ANNA” HAS BACK PAIN

Anna suffers from chronic back pain and her doctor is considering pain management injections to alleviate her symptoms. It’s difficult for her physician to pinpoint the location of her back pain, but the presumptive diagnosis is that it’s coming from the facet joints in Anna’s lower back (lumbar spine). In this case, a nuclear medicine bone scan study can be used to help localize potential sites for an injection.

Anna’s doctor faxes a requisition to Mayfair Diagnosis requesting that Anna be booked for a pain management injection and a bone scan with SPECT/CT. A Mayfair booking agent contacts Anna to confirm the details of her appointments, including a reminder that the bone scan is a two-part appointment. She also confirms that Anna is not pregnant and not currently breastfeeding.

Part one of Anna’s bone scan with SPECT/CT appointment 8:30 a.m.: 

• The radiopharmaceutical is injected into an arm vein. This part of her appointment takes 10-15 minutes.
• After this, she is reminded to stay hydrated before she returns for part two.

Part two of Anna’s bone scan with SPECT/CT appointment 11:30 a.m.:

• At this part of her appointment, Anna is positioned under the gamma camera for approximately 30 minutes. During this time, images are taken of her lumbar spine (Figure 1). For the SPECT/CT portion of the scan, the gamma camera takes images while rotating around Anna’s body.
• After this appointment, Anna has completed her test.

The SPECT/CT images are analyzed by a nuclear medicine physician and an area of activity on the scan is identified that could be a cause of her back pain. This finding is relayed back to the referring physician, who agrees it could be a site of her back pain. A pain management injection is then planned at this location.

Figure 1: An area of activity (yellow, boxes E, F, and G) in the lumbar spine facet joint that may be a cause of Anna’s back pain. This is an example of a bone scan SPECT/CT study.

After speaking with her doctor, Anna books a pain management appointment for her back injection.

SCENARIO 2: “JEFF” HAS CHEST PAIN

Jeff’s doctor refers him for myocardial perfusion imaging (MPI) study to determine if his heart could be a cause of his chest pain.

A requisition with a resting electrocardiogram (ECG) result and recent blood work are sent to Mayfair Diagnostics. The booking team then contacts Jeff with details on the date and time for his exam and how to prepare for the two-day procedure. He is also told to come with a small sandwich for a snack on the first appointment day.

Jeff’s appointment day 1 – Tuesday, 2 p.m.:

• Jeff fasts for four hours prior to this appointment, starting at 10:00am.
• At this visit, Jeff receives the radiopharmaceutical injection into an arm vein while he is resting in a chair.
• The imaging is performed 45 minutes later after Jeff has eaten his sandwich. The images take approximately 15 to 20 minutes and show Jeff’s blood flow to his heart muscle while he is resting under the gamma camera.
• The appointment takes two hours, and afterwards Jeff returns to his daily activities.

Jeff’s appointment day 2 – Wednesday, 9 a.m.:

• Jeff prepares for this appointment by having nothing to eat for four hours prior to the appointment, and by wearing exercise clothing for the exercise or stress portion of this study.
• At this appointment, electrodes are placed on Jeff’s chest and an intravenous (IV) line is inserted into his arm. He then meets an internal medicine specialist physician to discuss his medical history and symptoms prior to doing the exercise portion of the study.
• Then, Jeff walks on a treadmill as it gradually increases in speed and inclination. Once he starts to feel tired, the radiopharmaceutical is injected into the IV and he stops walking.
• After the injection, Jeff rests for about 20 minutes. Then he lies under the nuclear medicine gamma camera for another set of images. These images show how Jeff’s heart muscle functions with this stress (Figure 2).
• The appointment takes two hours, and afterwards Jeff returns to his daily activities.

Within a few days, Jeff’s doctor receives the following information:

• A comprehensive consultation report from the internal medicine specialist.
• Results of the exercise stress test.
• Results of the myocardial perfusion imaging study.

In the end, Jeff’s results all come back normal, which is reassuring for him and his physician because it suggests blood flow to his heart muscle is not a cause of his chest pain.

Figure 2: Jeff’s normal MPI study.

Figure 3: Example of an abnormal MPI study.

For more information about nuclear medicine imaging, please visit our services page or speak with your health care practitioner.