Nuclear Medicine

DEPARTMENT OF NUCLEAR MEDICINE AT OKAN UNIVERSITY HOSPITAL

Nuclear medicine is a medical branch that makes both imaging (scintigraphy, SPECT, PET) and treatment (radionuclide treatment / molecular treatment) by giving tiny amounts of radioactive drugs (radiopharmaceuticals) to the patient’s body.

Department of Nuclear Medicine at Okan University Medical Faculty Hospital, offers all kinds of scintigraphic imaging including PET/CT and SPECT, by using the newest generation equipment as well as the current radionuclide therapies under the guidance of experienced nuclear medicine physicians.

One of the primary missions of the Nuclear Medicine Department of Okan University Hospital is to apply the standards at the highest level requested by JCI and Turkish Atomic Energy Agency (TAEK) accreditation programs for both patient and employee safety.

Scintigraphic imaging was done at our department:

• Oncological Scintigraphies
  • PET/CT scanning with Fluorine-18 FDG
  • PET/CT scanning with Gallium-68 DOTATATE
  • PET/CT scanning with Gallium-68 PSMA PET/BT
  • SPECT scintigraphies with Iodine -123 MIBG or Iodine-131 MIBG
  • Whole-body scintigraphies with Iodine-131 or Iodine-123
• Endocrine System Scintigraphies
  • Thyroid scan and uptake with Tc-99m pertechnetate or Iodine-I-123
  • Parathyroid scan
• Cardiac Scintigraphies
  • Myocardial Perfusion SPECT (Gated)
  • Myocardial PET with Fluorine-18 FDG
• Respiratory System Scintigraphies
  • Lung perfusion scan
  • Quantitative Lung Perfusion scan
  • Lung Ventilation scan (Technetium-99m DTPA aerosols)
• Central Nervous System Scintigraphies
  • Brain PET scan (Fluorine-18 FDG)
  • Brain Perfusion SPECT (Tc-99m HMPAO or Tc-99m ECD)
  • Ventricular Shunt Patency Scanning
  • Radionuclide Cysternography
• Gastrointestinal System Scintigraphies
  • Gastrointestinal Bleeding Scan
  • Gastroesophageal Reflux Scan
  • Gastric Emptying Scan
  • Esophagus Transit Time Scanning
  • Meckel Scintigraphy
• Genitourinary System Scintigraphies
  • Dynamic Renal Scintigraphy (Tc-99m DTPA or Tc-99m MAG3)
  • Static Renal Cortical Scintigraphy - SPECT (Tc-99m DMSA)
  • Captopril-enhanced Dynamic Renal Scintigraphy
  • Testicular Scintigraphy
  • Direct - Indırect Vesicoureteral Reflux Scintigraphy
• Skeletal System Scintigraphies
  • Bone scans (Triple phase, Whole-body, SPECT)
  • Skeletal PET (Fluorine-18 NaF)
• Others
  • Lymphoscintigraphy
  • Salivary Glands Scintigraphy
  • Dacrioscintigraphy

Positron Emission Tomography / Computed Tomography (PET/CT)

Positron Emission Tomography (PET) is a three-dimensional (tomographic) scintigraphic imaging technique that can be done by using a specific group of radionuclides called “positron emitters”. At present, PET scanning is done in the PET scanner with CT integration, what is called PET/CT scanner. Thus, the diagnostic accuracy of the modality is improved by combining metabolic data obtained from the PET part with morphological information gathered from the CT portion of the system.

PET/CT imaging has an important role in the diagnosis and follow-up of cancer patients and is done by using radioactive drugs that are sensitive to different types of cancer. Radioactive drugs used in PET/CT are summarised as follows:

1. Fluorine-18 fluorodeoxyglucose (FDG): It is a kind of radioactive sugar molecule labelled with F-18 radioisotope. It is given to the patient’s body via an antecubital vein, and its distribution within the patient's body is imaged by PET/CT device. Cancer cells use much more sugar than normal cells due to increased energy requirement, so cancerous tissues appear brighter (being higher counted areas) on the PET images (Figure 1). FDG-PET scanning has been used in most of the malignancies to determine; a) disease extension status (staging and re-staging), b) treatment response evaluation and c) early recurrence development, as well as d) to help to diagnose cancer in an indeterminate mass lesion.

In addition, FDG-PET is widely used in the diagnosis and follow-up of some brain diseases such as dementia and epilepsy, and also in demonstrating the viability of cardiac muscles with impaired contractility.

1. F-18 Sodium Fluoride (NAF): A bone-seeking PET radiopharmaceutical can only accumulate in active bone tissue. It is again injected into the patient's body through a vein and imaging is done with PET/CT device in the same way. It is used for diagnosing metastatic bone disease in patients with malign cancers and follow-up of the disease outcome in such patients (Figure 2).
2. Ga-68 DOTA-TATE (Ga-68 octreotate): This is another PET radiopharmaceutical that is a very useful and effective agent for neuroendocrine tumours (NETs). As neuroendocrine tumours consist of an abundant amount of octreotide sensing somatostatin receptors on their cell surface, any octreotide derivative peptide (TATE, TOC, NOC, etc.) labelled with Ga-68 via DOTA linker molecule will be able to accumulate into such tumours, allowing a successful PET imaging.

Ga-68 octreotide derivatives are used in the diagnosis, staging and follow-up of neuroendocrine tumors in which FDG-PET is often ineffective. Neuroendocrine tumours can result from a wide variety of organs and tissues. Neuroendocrine tumours and metastases can be detected with very high accuracy by PET/ CT with Ga-68 DOTA-TATE.

In addition, since the therapeutic equivalent of this radiopharmaceutical (Lutetium-177 DOTA-TATE) is present, Ga-68 DOTA-TATE PET/CT imaging is also important in the selection of patients who are eligible for Lu-177 DOTA-TATE treatment.

1. Ga-68 PSMA (Prostate-specific membrane antigen): PSMA is a building protein block found in the majority of prostate cancer cells. In recent years, the PSMA molecule has been effectively labelled with the Ga-68 radionuclide, making it possible to demonstrate prostate cancer and metastases very efficiently with PET/CT imaging.

At the same time, PSMA can also be labelled with Lutetium-177 radionuclide and thus is being used in the treatment of metastatic prostate cancers where other treatment options are not effective. Many studies have shown that Ga-68 PSMA PET / CT can accurately demonstrate prostate cancer and metastases over 90%.

Radionuclide treatment is done at our department (Clinical indications):

• Iodine-131 treatment –low-dose             (Hyperthyroidism)

• Iodine-131 treatment – high dose           (Thyroid cancer)
• Yttrium - 90 Microsphere treatment         (Liver tumours)
• Lutetium-177 DOTA-TATE treatment      (Neuroendocrine tumours)  
• Lutetium-177 PSMA treatment               (Metastatic prostate cancer)
• Radium 223 (Xofigo) treatment               (Bone metastasis of prostate cancer)
• Iodine-131 MIBG treatment                    (Pheochromocytoma, Paraganglioma,Neuroblastoma)

Department Doctors

Specialist Dr. Mustafa Aras

Appointment