Indications for Nuclear Medicine Scans
MYOCARDIAL PERFUSION SCAN (STRESS THALLIUM):
- Screening for Ischemic Heart Disease
- Baseline ECG abnormalities, Bundle branch blocks etc
- False +ve / -ve Stress (TMT) test; (females, obese patients)
- Pharmacological stress in patients unable to exercise
- High risk individuals (smokers, Family history, hyperlipidemia, thrombogenic states etc.)
- Diabetics
- Hypertensive patients
- Microvascular angina
- Renal failure patients
- Indeterminate Conventional / Coronary CT Angiogram (25-75% stenosis)
- Follow up of patients after Angioplasty/ Bypass surgery
- Preoperative work up of major non cardiac surgeries (joint replacements/organ transplants/Gastrointestinal and genitourinary surgeries etc.)
- Viability Studies*- combined with cardiac FDG PET scan
- After Heart attack
- Before angioplasty / bypass surgery
- Heart Failure Patients: to Differentiate ischemic vs. non-ischemic cardiomyopathy
RADIONUCLIDE VENTRICULOGRAPHY (MUGA) SCAN:
- Baseline study before chemotherapy
- Assessment of LV function and wall motion
- Assessment of Right Ventricular ejection fraction
BONE SCAN:
- Prostate, Breast, Lung, Renal, Urinary bladder and other cancers
- Primary bone tumors: Osteoid osteoma, osteochondroma, Ewing’s sarcoma, Osteosarcoma, multiple myeloma etc.
- Orthopedic Indications
- Backache : Screening for patients without radiculopathy, failed conservative methods, Initial investigations normal but still refractory pain
- Hip pain: Avascular necrosis / transient osteoporosis
- Skeletal trauma
- Sports/Athletic injuries
- Bone infection/Osteomyelitis
- Osteochondritis/Osteonecrosis
- Unexplained limb pain/swelling: Reflex Sympathetic Dystrophy, Complex Regional Pain Syndrome (RSD / CRPS)
- Metabolic bone diseases
- Assessment of Bone Graft Viability
- Suspected Child abuse
- Pain in children with speech/cognitive problems ( Cerebral palsy, Down’s etc)
- Assessment of mandibular growth and asymmetry
- F-18 Bone Scan: NewMedd Diagnostics has whole-body F-18 PET Bone Scan facilities, which has much higher sensitivity and specificity compared to conventional bone scan for all of the above mentioned indications; while conventional bone scan is a planar study, F-18 bone scan is a whole body tomographic study.
RENAL DYNAMIC SCAN (EC / DTPA SCAN):
- Renal perfusion and function
- Diuretic RDS (Lasix renal scan)
- Evaluate functional significance of hydronephrosis
- Determine need for surgery
- obstructive hydronephrosis – surgical Rx
- non-obstructive hydronephrosis – medical Rx
- Renovascular Hypertension (Captopril renal scan)
- Pre-surgical quantitation (nephrectomy)
- Renal transplant evaluation
- Immediate
- Chronic follow up
- Congenital anomalies, masses
- Split (Differential) renal function
Measuring renal function:
- TC-99m DTPA to measure GFR
- TC-99m EC to measure ERPF
RENAL CORTICAL SCAN (DMSA SCAN):
- Infection (renal morphology scan)
- Determine involvement of upper tract in acute UTI (acute pyelonephritis)
- Detect cortical scarring (chronic pyelonephritis)
- Follow-up post treatment
- Congenital anomalies
- Ectopic Kidney, evaluation of single kidney etc
RADIONUCLIDE CYSTOGRAM:
- Evaluation of children with recurrent UTI
- Follow up after initial voiding cystogram (Nuclear MCU)
- Assess effect of therapy / surgery
- Screening of siblings of reflux patients
- UTI in girls
- To calculate Post void residual volume
THYROID SCAN:
- Patients with frank thyrotoxicosis or suppressed TSH on screening tests
- To differentiate Dequervain’s or silent thyroiditis from Grave’s disease
- Solitary thyroid nodules (functioning or non-functioning)
- Search for ectopic thyroid tissue (thyroid hemiagenesis, lingual thyroid etc)
- Diagnosis of congenital athyreosis
- Determination of the nature of abnormal neck or chest (mediastinal) masses
I-131 Thyroid Scan – Whole Body Scan
- Evaluation of thyroid remnants after surgery
- Detection of functioning thyroid metastases
- Perchlorate discharge test
PARATHYROID SCAN:
- Detection of single / multiple / ectopic adenoma before surgery
- Confirmation of adenoma before surgery
- Localisation of adenoma after unsucceful surgery (ectopic glands)
I-131 MIBG SCAN:
- Suspected Pheochromocytoma
- Evaluation of adrenal incidentalomas/masses
- Neuroblastoma
- Characterization of retroperitoneal/ mediastinal masses (supected neuroendocrine origin)
BRAIN SPECT:
- Neuroreceptor SPECT
- Movement disorders: TRODAT SPECT
- Differentiation of viable brain tumor v/s radiation necrosis
- Work up of dementias
GASTROINTESTINAL SCAN:
- Gastric Emptying and Gastroesophogeal Reflux Studies
- Gastrointestinal Bleeding Studies
- Meckel’s Diverticulum
- Duplication cyst
- Inflammatory Bowel disease
HEPATO-BILIARY (HIDA) SCAN:
- Cholecystitis
- Acute
- Chronic Calculus/Acalculus
- Gallbladder Ejection fraction
- Rt subcostal pain: USG normal
- Rec post prandial dyspepsia
- Further evaluation of pts with Gall stones on USG
- F/u after surgical interventions to evaluation Bile leak
- Spontaneous biliary peritonitis
- Biliary enteric pathway patency
- Neonatal hepatitis vs EHBA/ Inspissated bile syndrome
- Evaluation Congenital anomalies / Choledochal cysts
SULPHUR COLLOID LIVER SCAN
- Early detection of cirrhosis (liver dysfunction)
- Evaluation of portal hypertension
- Hepatic versus extra hepatic causes
- Differentiate Reidel’s lobe versus pathological hepatomegaly
- Accurate liver dimension measurement
LUNG SCAN:
- Pulmonary embolism
- Pre Pneumonectomy Evaluation
OTHER SCANS:
- Lymphoscintigraphy for sentinel lymph node detection,
- detection of Chyluria, Evaluation of Lymphoedema
- Venography for Evaluation of Deep vein thrombosis
- Scintimammography for Breast cancer detection
- Infection imaging
- Fever of unknown origin
- Osteomyelitis
Indications for PET/CT Scans
ONCOPET
- Malignancy of unknown origin (MUO) : to look for primary
- Metastases detected by other limited investigations / FNAC / biopsy / surgery
- Pathological fractures
- PETCT guided biopsy
Suspicion of Malignancy :
- Masses / SOLs in different organs on clinical examination or other investigations (eg. Lung mass on Xray, breast lump on dig mammo, mass in abdomen-pelvic organs on USG etc)
- Regional / Generalized lymphadenopathy / organomegaly
- Suspected myeloma
- Staging work up of patients with several cancers
- Before surgery
- Before Chemotherapy
- Before radiotherapy
- Monitoring response to treatment
- After Surgery
- After or during Chemotherapy
- After or during radiotherapy
- Follow up of treated patients of several cancers
NON-FDG PET
- F-18 Bone Scan
- Metastatic work up of various malignancies
- Diabetic foot
- Stress fracture in spine
- Ga-68 Somatostatin receptor scintigraphy with DOTANOC / TOC etc (Ga-68 SRS PET)
- Suspected neuroendocrine tumors: Pheochromocytoma / Neuroblastoma / carcinoid / Insulinoma / VIPOMA/ Glucaganoma / Gastrinoma – ZE syndrome etc
- Before Radionuclide-Somatostatin receptor therapy in patients with advanced neuroendocrine tumors
- Ga-68 PSMA
- Suspected Prostate cancer
- Known prostate cancer for staging
- Follow up of prostate cancer patients
NEUROPET
- Dementia
- Epilepsy
- Movement disorders
- Head injury
- Psychiatric Disorders– obsessive compulsive disorder, schizophrenia, depression, panic disorder, drug abuse
CARDIOPET
- Viability studies
- After Heart attack; before revascularization procedures
- Heart failure
INFECTION INFLAMMATION IMAGING
- FDG PET in fever of unknown origin / vasculitis / diabetic foot
RADIONUCLIDE THERAPY
- Radio iodine therapy for Hyperthyroidislm
- Grave’s disease / Toxic multi nodular Goiter / Autonomous nodule
- Radioiodine therapy for thyroid cancer
- Remnant ablation
- Lobar ablation
- Treatment for lymph node or lung or skeletal / visceral Metastases
- Pain palliation for skeletal metastases
- 32 Phosphorous / 153Samarium / 89 Strontium therapy
- Radiation Synovectomy for
- Hemophilic Arthropathy
- Rheumatiod Arthritis
- Villonodular Arthritis
- Advanced stage neuroendocrine tumors
- MIBG Therapy: for pheochromocytoma / paragangliomas
- Lu-177 Somatostatin receptor therapy: various other neuroendocrine tumors
- Indium 111 based therapy
- Radioimmunotherapy*
