NUCLEAR MEDICINE FOR DIAGNOSIS AND TREATMENT

Safe, Painless, Cost-effective

0114 524 422

0771 323 288

No. 21, Kirimandala Mw, Narahenpita, Colombo 05, Sri Lanka. Tel : +94 11 4524400 Fax : +94 11 4527311 Email: [email protected] Web: www.asirihealth.com What is Nuclear Medicine?

It is a system of Diagnostic and Therapeutic practice that uses controlled amounts of radioactive material It facilitates diagnosis and treatment of a variety of diseases i.e. many types of cancer, heart disease, gastrointestinal, endocrine, neurological disorders, etc. It is unique because it provides information about both structure and function of the body Nuclear Medicine imaging provides unique information that often cannot be obtained using other imaging procedures Information is retrieved without surgery or expensive diagnostic testing It offers the potential to identify disease in its earliest stages What is unique about the Asiri Nuclear Medicine Unit?

Our team consists of highly qualified, overseas trained and well experienced panel of clinicians Our Nuclear Medicine Unit works in close partnership with and under the supervision of International Atomic Energy Agency (IAEA) and Sri Lanka Atomic Energy Authority (AEA) to ensure international standards are maintained and delivered What are the special services we offer?

For diagnosis of cancer Staging and restaging of cancer with treatment Monitoring of response to treatment For detection of recurrence of cancer Radioactive I131 ablative dose for thyroid remnant ablation in Differentiated Thyroid Cancer following Total Thyroidectomy. Radioactive I131 suppressive dose for patients with Thyrotoxicosis.

ASIRI SURGICAL 0105 Patient Preparation NUCLEAR MEDICINE PET/CT SCANNER The main purpose of the patient preparation is to reduce tracer uptake in normal tissue while maintaining and optimizing tracer uptake in the target Positron Emitting Tomography (PET/CT Scan) structures such as tumor tissues. Hence blood glucose must be within acceptable levels. Also, serum creatinine levels should be within This is a Tomographic Technique that computes the three dimensional acceptable range. distribution of radioactivity based on the annihilation photons that are emitted by Positron Emissions known as radiotracers. PET allows a minimally-invasive, quantitative assessment of biochemical and functional processes.

The most commonly used tracer is the Glucose analogue FDG or Fluorodeoxyglucose. FDG accumulation in tissues is proportional to the amount of Glucose utilization. After administration of an adequate amount of FDG, static images are acquired approximately 40-60 minutes after the administration of FDG. FDG PET/CT is a sensitive imaging modality for the detection, staging, as well as for assessment of therapy response in Oncology.

Indications

Primary presentation: Diagnosis, unknown Primary malignancy Staging on presentation Response evaluation Establishing and localizing disease sites as a cause for elevated serum markers Image guided biopsy and radiotherapy planning

02 ASIRI SURGICAL 02 ASIRI SURGICAL 03 GAMMA CAMERA Dual head high definition Digital SPECT Camera

Enables you to image every patient to get clinical information needed for confident decision-making. Outstanding flexibility for easy patient set up and positioning Accommodates virtually ANY patient Patient-friendly system design – easily accommodates even large patients without claustrophobia Unique cardiac imaging configuration Exceptional detector flexibility HD detector technology – more confidence, improved clinical outcomes, lower re-admission rates Industry’s highest collimation sensitivity Lowest pallet attenuation Best NEMA Reconstruction Resolution Supports gurney and hospital bed imaging Available facilities

DTPA scans – to evaluate kidney functions before and after renal transplantation DMSA scans – to detect and evaluate renal scarring or for the diagnosis of acute pyelonephritis Tc 99 Whole body scans – can help diagnose a number of bone conditions including cancer, bone inflammation, fractures, bone infection. Thyroid scans – to assess thyroid gland size, structure, function and shape toward diagnosing disorders such as tumor, inflammation and cancer Whole body imaging – iodine scan after treatment to evaluate potential spread of thyroid cancer I 131 whole body scans, following I 131 whole body scan dose or ablative or therapy dose for differentiated thyroid cancer patients

04 ASIRI SURGICAL ASIRI SURGICAL 05 111In Octreotide SPECT

A normal 111In Octreotide SPECT performed on a 20-year-old male patientAvailable with history facilities (contd.) Procedures we offer of an intestinal neuroendocrine tumor that was treated with surgery. The study shows normal distribution of the tracer in the liver, spleen and gallbladder, with no indication of metastasis. RBC scans – red blood cell scans in the investigation of Asiri Health offers a comprehensive range of medical procedures that gastrointestinal bleeding are therapeutic or help diagnosis. Whole body imaging – iodine scan after treatment to evaluate Brain SPECT (ECD) potential spread of thyroid cancer Brain SPECT (HMPAO) Voiding Cystography – to check urine flow through the bladder Captopril Renal Scan Portocol (Baseline + Captopril) DTPA and urethra. Shows reflux of urine and how well the bladder Cisternography (DTPA) empties Direct Voiding Crystography (DTPA) Parotid Scintigraphy – for evaluation of salivary gland function DMSA Renal Scan Testicular scans – for acute and sub-acute scrotal pain, especially DTPA Renal Scan (GFR, Function, Diuretic) testicular torsion and epididymitis DTPA Renal Scan with MCU Gastric Emptying (COLLOID) GE Reflux Scan (Milk Scan) Scans available on request GI Bleeding Scan Hepatobiliary Scan (HIDA) Brain SPECT scan to evaluate memory loss Leukosite Imaging (Infection scan)Tc 99m HMPAO labelled WBCS Lymphoscintigram – highly sensitive in the localization of sentinel Liver Blood Pool Scan (Haemangloma) nodes and nodal drainable patterns not routinely accessible in Liver Scan (Phytate) Liver Spleen Colloid Scan patients in truncal melanomas, breast cancer and prostate cancer Lung Perfusion Scan (MAA) to determine surgical or radiation therapy Lung Ventilation + Perfusion Scan (MAA & DTPA) Myocardial Perfusion Studies – to detect physiologic and anatomic Lymphoscintigraphy (Sulfur Colloid) abnormalities of the heart and determine prognosis Meckels Scan Hepatobiliary scans – for patients with liver and biliary system Myocardial Perfusion Scan ailments Parathyroid Scan (Tetrofosmin) Lung scans – to determine the likelihood of pulmonary embolism Parotid Scintigraphy Radionuclide Esophageal Transit Study Parathyroid scans – designed to localize parathyroid adenomas or Scintimamography (Sestamibi) parathyroid hyperplasia in patients with hyperthyroidism Testicular Scan determined via elevated parathyroid hormone levels Thyroid Scan

Data courtesy of radprax MVZ, Wuppertal, Germany. Gastric Emptying and Esophageal Reflux to diagnose Hiatal Hernia, Whole Body Radioiodine (Post Therapy) Parameters: injected dose: 673 MBq (18.2 mCi); 64 frames, 20 sec/frame; 3DOSEM reconstruction, 6 iterations/2 subsets/2 bed positions Gastroesophageal Reflux and Esophageal Motility Whole Body Tetrofosmin Scan (Tumor Imaging) Liver Spleen Colloid scan – Assessing the size, shape and position Whole Body Bone Scan (MDP) 23 of the liver and spleen, evaluating hepatic function in acute or Myocardial Perfusion Scan SPECT (with Cardiologist) Myocardial Perfusion Scan SPECT chronic liver disease, identifying functioning splenic tissue, Sentinal Lymphnode Imaging (Sulfur Colloid) evaluating suspected functional asplenia

06 ASIRI SURGICAL ASIRI SURGICAL 07 GAMMA CAMERA Helping to detect: Dual head high definition Digital SPECT Camera Early cancer Renal studies – kidney scarring and function. DTPA and DMSA Brain scans – functional studies studies How does the Gamma Camera work? of brain Thyroid nodule assessment and Bone scans – early bone functional assessment An imaging technique for molecular function of organs (skeleton, infection or subtle fractures in thyroid, kidneys, lung, heart, liver, gallbladder, etc.). Gamma Cameras bones and metastatic bone Lungs – ventilation and image the radiation emitted from a radioactive pharmaceutical disease perfusion study V/Q scans introduced into a patient’s body. It maps early functional changes in disease, compared to other radiological tests like X-ray & CT. Cardiac studies – reversible or Liver – hepatobiliary functions irreversible status of muscle Endocrine assessment – damage (myocardial perfusion e.g. Bone scans become positive six months before X-ray changes occur. parathyroid adrenal, etc. scan) The Gamma Camera offers a range of advantages for both doctors and patients. Advantages for Patients

Advantages for Doctors Early diagnosis

Provides molecular activity (functional scan) of skeleton, thyroid, Easy and comfortable kidneys, lungs, brain, liver, gallbladder, etc. procedure Economical Organ specific study can be performed e.g. Bone and kidney scans, study of heart, muscle & lung, etc.

08 ASIRI SURGICAL ASIRI SURGICAL 09 Myocardial perfusion imaging

Reversible ischemia in a patient with multi-vessel coronary artery disease. The scan is suggestive of severe but reversible myocardial ischemia consistent with triple vessel disease.

Myocardial99m Tc MIBI stress rest myocardial perfusion perfusion scan showsimaging decreased uptake of the Reversibletracer ischemiathroughout in a patient the with entire multi-vessel left ventricle coronary artery at peakdisease. stress, Stress-rest especially in the inferolateral myocardial perfusion SPECT performed on a 46-year-old male with chest pain and breathlessnessand lateral on walls,exertion. but The scanwith is suggestivecomplete of severe, reversibility but reversible, shown by normal tracer uptake myocardial ischemia consistent with triple vessel disease with severe stenosis of the leftthroughout circumflex. the myocardium at rest.

Anterior Gated stress Stress NonAC

Rest NonAC Inferior

Anterior Gated rest Stress NonAC

Rest NonAC Inferior

Reversibility SA Stress NonAC

Rest NonAC Base

10 ASIRI99mTc MIBISURGICAL stress rest myocardial perfusion scan shows decreased uptake of the tracer ASIRI SURGICAL 11 throughout the entire left ventricle at peak stress, especially in the inferolateral and Data courtesy of radprax MVZ, Wuppertal, Germany. lateral walls, but with complete reversibility shown by normal tracer uptake Parameters: injected dose: stress 443 MBq (11.9 mCi) mTc MIBI 64 frames, 20 sec/frame; throughout the myocardium at rest. The patient was referred for revascularization. rest 444 MBq (12 mCi) mTc MIBI 64 frames, 20 sec/frame; 3DOSEM, 8 iterations/12 subsets

16 17 Brain perfusion imaging Gurney imaging: gastric emtying

An early Parkinson’s disease evaluation on a 78-year-old male with mild tremor and A gastric emptying study performed with gurney imaging on a 34-year-old obese Brainrigidity in the perfusion hand. The SPECT study imaging shows asymmetrical bilaterally decreased Gurneymale patient with limitedimaging: mobility. Initial dynamicgastric images wereemptying followed by a static uptake in the putamen with relatively preserved uptake in the caudate nucleus, image after one hour post-ingestion of radiolabeled meal. The study shows normal Ansuggestive early Parkinson’s of disease early evaluation Parkinson’s with 123I FPCITdisease. SPECT on a 78-year-old male Agastric gastric emptying emptying study performed with negligible with gurney gastricimaging on stasis a 34-year-old after obese one male hour. with mild tremor and rigidity in the hand. The SPECT study shows asymmetrical patient with limited mobility. Initial dynamic images were followed by a static image bilaterally decreased uptake in the putamen with relatively preserved uptake in the after one hour post-ingestion of radiolabeled meal. The study shows normal gastric caudate nucleus, suggestive of early Parkinson’s disease. emptying with negligible gastric stasis after one hour.

Transverse view

Planar 15 min post-ingestion Planar 1 hour post-ingestion

Coronal view Sagittal view

Data courtesy of radprax MVZ, Wuppertal, Germany. Data courtesy of radprax MVZ, Wuppertal, Germany. Parameters: injected dose:196 MBq (5.3 mCi) I FPCIT (DATscan); 120 frames, 25 sec/frame; Parameters: administered dose: 75 MBq (2.1 mCi); initial dynamic planar, 50 frames/1 min per frame; 3DOSEM reconstruction, 8 iterations/16 subsets delayed 1 hour static, 500,000 total counts

12 18 ASIRI SURGICAL ASIRI SURGICAL19 13 Lung perfusion imaging

A lung ventilation/perfusion SPECT study performed on a 29-year-old male patient Lungwith suspected perfusion pulmonary embolism. imaging The SPECT scan shows normal perfusion and A lungventilation ventilation/perfusion in both SPECT lungs. study performed on a 29-year-old male patient with suspected pulmonary embolism. The SPECT scan shows normal perfusion and ventilation in both lungs.

Perfusion coronal Perfusion transverse Perfusion sagittal

Ventilation coronal Ventilation transverse Ventilation sagittal

Data courtesy of radprax MVZ, Wuppertal, Germany. Parameters: perfusion: injected dose135 MBq (3.65 mCi) mTc MAA; 64 frames, 15 sec/frame; 3DOSEM reconstruction, 8 iterations/8 subsets; ventilation mTc DTPA aerosol; 64 frames, 15 sec/frame; 3DOSEM, 6 iterations/8 subsets

1420 ASIRI SURGICAL ASIRI SURGICAL 2115 Bone imaging

BoneA primary imaging bone tumor in the clavicle found in a 62-year-old female patient. The 111In Octreotide SPECT SPECT study shows focal hyper metabolism in an expansible lesion involving the A primarymiddle bone tumorthird in of the the clavicle clavicle. found in No a 62-year-old other skeletal woman. The lesions SPECT studywere visualized. The study is A normal 111In Octreotide SPECT performed on a 20-year-old male patient with history shows focal hypermetabolism in an expansible lesion involving the middle third of the of an intestinal neuroendocrine tumor that was treated with surgery. The study shows clavicle.suggestive No other skeletal of alesions primary were visualized.bone tumor The study in theis suggestive clavicle of a without primary metastases. A biopsy was normal distribution of the tracer in the liver, spleen and gallbladder, with no bone tumor in the clavicle without metastases. A biopsy was required for indication of metastasis. histopathologicalrequired confirmation.for histopathological confirmation.

Data courtesy of radprax MVZ, Wuppertal, Germany. Data courtesy of radprax MVZ, Wuppertal, Germany. Parameters: injected dose: 674 MBq (18.22 mCi); 64 frames, 20 sec/frame; Parameters: injected dose: 673 MBq (18.2 mCi); 64 frames, 20 sec/frame; 16 3DOSEMASIRI reconstruction, SURGICAL 8 iterations/4 subsets 3DOSEM reconstruction, 6 iterations/2 subsets/2 bed positions

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