Department of Nuclear Medicine
The Department of Nuclear Medicine provides state-of-the-art Diagnostic and Therapeutic facilities. The Department is located on the first floor “B” block of the hospital. It is equipped with a Siemens Bio Graph (PET-CT) Hi Rez PET with 40 slice CT scanner, GE Millennium MG Dual Head Gamma Camera with (SPECT) tomography facilities & Radionuclide therapy facilities. The therapy ward is located on the 2nd floor ‘B’ block
A state-of-the-art PET - CT was installed at RGCI & RC, and is functioning since 18th January 2008. The equipment has a Hi-Rez true point system, integrated into a 40 slice CT scanner. Integrated PET - CT machine allows the acquisition of PET with localization CT. A contrast enhanced CT can also be performed in the same machine giving clinician the benefits of both PET and CT information.
Our strength lies in joint evaluation of a PET - CT study by both Nuclear Medicine Physician and a Diagnostic Radiologist resulting in a comprehensive report for maximum benefit to the patient.
Conventional Diagnostic procedures
Gamma Camera imaging involves the use of certain isotopes like 99mTc, Gallium, Iodine, Thallium etc for the treatment and diagnosis of various diseases. All diagnostic tests involving radionuclides are possible and are carried out routinely for in-house as well as referred OPD patients.
1. Bone Scan for skeletal disorders.
2. 99 Tc MIBI Scintimammography
3. Different types of renal scans like DTPA and DMSA scans for the Kidney Function & Morphological Defects,
4. 99m Tc RBC Gated Blood Pool Scans
5. Myocardial Perfusion Scans for Cardiac Evaluation,
6. Thyroid Scans,
7. Hepatobiliary Scans,
8. Lung perfusion & Ventilation Scans
9. 131 I whole body scans
10. 67 Ga Citrate for infection imaging
11. Ga-PSMA PET-CT Scan.
Tumor imaging for detection and viability, is an integral part of cancer detection, follow up and response to treatment. Tumor imaging is an area, in which we specialize and perform routinely in the Department.
1. Sentinel lymph node mapping and sentinel lymph node biopsy (SLNB) is a minimally invasive technique which allows the surgeon to excise and meticulously examine the primary draining lymph nodes after those have been identified by radionuclide procedure. The principle underlying sentinel node surgery is rooted in the concept that the sentinel node is the first draining lymph node from a tumor and is predictive of lymph nodal metastasis.
The use of radio-nuclide injection close to or into the tumor, nuclear imaging to visualize the sentinel lymphnode, detection and excision with the help of a handheld gamma probe to identify sentinel lymph nodes and its histopathological examination completes the procedure. It is helpful in early breast cancer and head neck malignancies. SLNB provides more accurate prognostic information for these patients and identifies those patients that may benefit from additional treatment to the lymphatics.
2. Pharmacological / Physical stress induced myocardial perfusion scintigraphy performed either with a treadmill or post dobutamine infusion for evaluation of cardiac disorders
Basis of PET-CT scan
Positron emission tomography (PET) is an advanced diagnostic imaging technique that is used for diagnosis, staging and restaging of various cancers. This technique exploits the increased metabolism of glucose in malignant viable cells. 2-[fluorine18-fluoro-2-deoxy-D-glucose (FDG) which is an analogue of glucose detects the difference in glucose metabolism. Like glucose, FDG is transported into tumor cells, by means of glucose transporter protein and subsequently it is phosphorylated by an enzyme hexokinase to FDG-6-phosphate. As FDG-6-phosphate is not a substrate for glucose-6-phosphate isomerase (the next step in glycolysis), it is biochemically trapped within the cell. This process of metabolic trapping in cell constitutes the basis for imaging of distribution of tracer with PET. Since there is many fold increase in glucose metabolism in malignant tumors as compared to normal, it is easy to detect this difference in metabolism using PET. Therefore PET has high sensitivity and high negative predictive value as compared to conventional morphological modalities like computed tomography (CT), ultrasonography (USG), magnetic resonance imaging (MRI), which use size / density changes as the only or major criterion to distinguish between benign and malignant diseases. PET has well-established role in initial staging, restaging and monitoring the response to the therapy in the management of various cancers.
Fusion of PET & CT allows precise localization of the diseased sites, for optimal management of patient with cancer. Co-registration of a structural and functional image provided by PET - CT is essential for accurate planning of surgical procedures. Likewise, PET - CT imaging is becoming a standard of care in Radiation Oncology. PET guided IMRT can selectively target head and neck cancers, while reducing critical normal tissues. Staging, early response evaluation, detection of recurrence and follow-up of most of the malignancies can be done with this modality
We have standardized side by side fusion of PET - MRI images, which provides excellent soft tissue delineation with metabolic parameters, and is now being routinely used in Head & Neck cancers & also in Gynaecological Malignancies.
18 F FDG PET CT is done for the following indications:
1. Detection and staging of disease
2. Early evaluation of response, differentiate between responder & nonresponder
3. Effectiveness of treatment
4. Detection of early recurrence
5. RT planning
Specialised PET CT procedures
68 Ga PET CT is done for Neuroendocrine tumors with DOTATOC and for Prostate cancer with PSMA for the following indications:
1. For detection and staging of disease
2. For early evaluation of response : differentiate between responder & nonresponder
3. Effectiveness of treatment
4. Detection of early recurrence
Radionuclide Therapy :-
The Institute has 3 bed dedicated ward approved by Bhaba Atomic Research Center (BARC ) and Atomic Energy Regulatory Board (AERB), Government of India, for high dose I-131 therapy for Thyroid Carcinoma. I-131 MIBG therapy for neuroendocrine tumors Samarium (153.5m), Strontium & Phosphorus (P-32), for bone pain palliation. Radioactive Iodine treatment for Hyperthyroidism is also performed as an outpatient procedure routinely.
Radionuclide Peptide therapy for neuroendocrine group of tumors will also be started shortly.
The department is manned by qualified and well experienced medical and technical personnel and radiation safety officers. The team consists of 4 Nuclear Physicians, 1 Technical officer, 1 Radiopharmacist, 2 Technologists, 1 designated Radiation Safety Officer and other support staff. All the medical & technical staff members are in possession of qualifications certified by Atomic Energy Regulatory Board (AERB) Department of Atomic Energy, Government of India and committed to perform their duties to the highest level clinical competence and radiation safety.