Nuclear Medicine

Tammy Angle

Argosy University

Dr. Demeis

In our family we've had seven nurses, and one ER physician, including my Mom, who

worked all of her years at the hospital, and then on island when we moved. I worked in several

clinics including, neurology, urology, and then my specialty, pediatrics. I've ordered every kind

of test imaginable, I've had them done myself due to my health problems, and I've also been with

my Mom during several CT scans. She used to joke saying that she was going to be glowing from

all of the radioactive medicine infused via I.V. Which is quite common with that test. Nuclear

medicine, in my opinion, is a huge reason why people are living much longer today. These tests

can be scary, especially for children, but they're necessary for a doctor to have a complete picture

so that he or she can diagnose their patients accurately. Nuclear medicine is the application of

radionuclide technique to diagnose and treat different types of human disease. It was first used in

the investigation of thyroid disease in 1946 by utilizing radioactive iodine to cure the thyroid

cancer. And, from there nuclear medicine has grown tremendously! Most doctors that were

educated prior to nuclear medicine's debut do not understand how valuable radioisotropic

procedures really are in diagnosing their patients. Radiologists must read the results of the

nuclear medicine applications, so they must stay on top of all new testing that's becoming

available. I do have some experience in reading X-rays, it's easy to see fractures, or perhaps a

quarter stuck in the esophagus of a four year old, but an MRI or PET scan image is far more

detailed, and requires great experience in interpreting them.

Nuclear medicine procedures use radioactive materials called radio pharmaceuticals.

Diseases diagnosed by nuclear medicine are; hypothyroidism, thyroid cancer, lymphomas, and

also bone pain from other forms of cancer. The patient being tested will either inhale, swallow, or

receive an intravenous drip of the radioactive agents. Some patients that are claustrophobic will

need to be sedated, as my Dad has had to do in the past. I've had one also, and it basically feels as

though you are inside a tight tin can, that moves up and down, as loud noises resembling it being

bashed with a baseball bat for a minimum of thirty minutes. I too had to be sedated, I got in there

initially and had a major panic attack!

With that said, I'll begin with my first test that I've chosen, the MRI. “It uses magnetism,

radio waves and a computer to produce images of the body structures. It's painless, and doesn't

involve x-ray radiation. People with pace-makers, metal implants, or chips around or in the eyes

cannot have this test. It's a tube surrounded by a giant circular magnet. It creates a strong

magnetic field that aligns the protons of Hydrogen atoms that are then exposed to beams of radio

waves. This spins various protons of the body and produces a faint signal detected by the

received portion of the MRI scanner. The information is then processed by the computer, then the

image is produced. The image and resolution are extremely detailed and can detect tiny changes

within the structures of the body” (Phelps, 2006). An MRI is used for certain things such as; head

trauma to determine if there's any bleeding or swelling, the spine to determine if stenosis, bulging

or herniated discs, or bone spurs are present, and also the heart, to check for tears in the aorta or

for aneurysms. An MRI can also check the glands and organs within the abdomen, the joints, soft

tissue, as well as the bones. Certain types of cancers can metastasize to the bone, which is very

painful. These nuclear medicine applications help diagnose cancer early, as well as if and when it

spreads. This give doctors and the patient a fighting chance to beat it! This is when say, prostate

cancer is formally diagnosed. The doctor in Kentucky wanted to do the radioactive seed implants

that are inserted around the prostate, approximately 40-100 of them. Well, they decided to get a

second opinion once we moved here, and the new doctor said, “That would be like taking a BB

gun to World War III!” He attacked it aggressively, and my Dad's been in remission ever since. I

wanted to touch briefly on radioactive pharmaceuticals, although it's not one of my three. I also

knew an elderly man that had the seeds implanted. Six months later it had spread to his lower

spine, and he had an 18 hour surgery. Two months later, January 2, after the holidays with family

he passed away, at home, in his sleep. So, I'm not a huge advocate for some radioactive

medications. The ones for lung cancer, as well as the radiation seem to work beautifully, aside

from the horrific side effects.

The second test I've chosen is the PET scan (positron emission tomography). “It is mostly

used in fields such as neurology, oncology, and cardiology while others are being studied. It

evaluates the metabolism of certain tissue or organ so that information about the anatomy and

physiology is evaluated, and it's biochemical properties” (John Hopkins Hospital, 2014). In PET

scans of the brain, radioactive atoms applied to glucose to create radionuclide because the brain

uses glucose for metabolism. “Others are used to determine blood flow and perfusion of an organ

or tissue that is of interest. The radionuclide may be radioactive oxygen, carbon, nitrogen, or

Gallium. It is given via intravenous infusion. Gamma rays are created during emission of

positrons. The PET scan has numerous uses, and is actually far more accurate and better than an

MRI due to it's incredibly detailed imaging. “It can assist with the diagnosis of things such as;

Dementia, Alzheimer's disease, Parkinson's disease, stroke, seizures, as well as clots, swelling, or

bleeding in the brain. It can detect the metastasis of cancer, it can evaluate how well the treatment

is working, by measuring the size of tumors. And, it can evaluate the heart, to see if there are any

aneurysms present, as well as tears or blockages. It's a very expensive test, so it is used as needed

and only when absolutely necessary for a doctor to get a conclusive picture of disease or

abnormalities in the body.

My third test is the computed tomography (CT scan), which is a computerized x-ray

imaging. A narrow beam of x-rays are aimed at the patient and then quickly rotate around the

patient's body producing signals that's processed by the machine's computer to generate cross-

sectional images “slices” of the area that's of concern. Then, they are stacked together to form

a 3-D image for an easier diagnosis. It shows the skeleton, organs such as kidneys, brain, liver,

and tissues to help doctors find the problem, diagnose, and then plan treatment. Most CT scans

use contrast agents for better imagery. One, is iodine given via intravenous infusion, barium for

esophageal and stomach problems, which is a thick white substance that the patient drinks.

A fourth one is the Indium white blood cell scans, which I have had done due to my

Lupus which causes my white blood count to be extremely high, at 24-28, and normal range is

5-11. “It's nuclear imaging which looks for infection, inflammation, or abscesses in the body.

Blood is drawn, and the white blood cells attach to the radioactive material, Indium 111. Then,

the blood is re-injected into a vein in the patient's arm. These white blood cells circulate over 18-

24 hours, and then can be seen throughout the body, detecting hidden infections, as well as

abdominal abscesses that can't be detected by other testing” (Dunn, 2012).

Even as a nurse, when people ask me my opinion regarding their health, I first ask a vast

array of questions, and I can narrow it down, however, without tests like these, I can't truly give

them an honest answer. Researching is a tool that I've used to figure out my own illnesses, and I

did actually diagnose my Mom with Achalasia, a rare esophageal disease, when the doctors had

no clue what was wrong, or what to do. I was right, and her doctor was very grateful for all I'd

done. I'm a psychology major, but I still love medicine, and enjoy helping people if I can.

References

Dunn, R. (2012). “Advancing nuclear medicine through innovations” Retrieved from:

http://www.ncbi.nlm.nih.gov/books/NBK11471/

John Hopkins, (2014). “PET scan and nuclear medicine” Retrieved from: http://www.hopkinsmedicine.org/healthlibrary/test_procedures/neurological/positron_emission_tomography_pet_scan_92,p07654/

Phelps, J. (2006). “Nuclear medicine in today's world” Retrieved from:

http://www.world-nuclear.org/info/Non-Power-Nuclear-Applications/Radioisotopes/Radioisotopes-in-Medicine/

Nuclear Medicine, (2014). “Radioisotopes in nuclear medicine” Retrieved from:

http://www.world-nuclear.org/info/Non-Power-Nuclear-Applications/Radioisotopes/Radioisotopes-in-Medicine/