Nuclear Medicine

Nuclear medicine is a branch of radiology in which specialists use small amounts of a radioactive substance to diagnose, determine the severity of, or treat a variety of diseases such as cancer, infections, and gastrointestinal, neurological, and endocrine disorders.

Nuclear Medicine Imaging

At Columbia and NewYork-Presbyterian, we combine functional nuclear medicine imaging with anatomic radiology imaging, such as computed tomography (CT) or single-photon emission computerized tomography (SPECT). These fused images enable us to interpret both studies as one image, leading to more accurate diagnoses.

Nuclear medicine imaging involves the use of radiopharmaceuticals (also called radiotracers), drugs that include a radioactive substance combined with a biologically active substance. The radiotracer accumulates in diseased tissue, where it emits energy that is detectable by a special camera equipped with a radiation detector. Radioactive elements can also be combined with biologically active agents such as monoclonal antibodies, proteins that mimic those made by the immune system, and iodine, a chemical that concentrates in the thyroid gland. Unlike other types of radiographic studies that show anatomy and structure, nuclear medicine studies show cellular (metabolic) and physiologic activity, information that is not obtainable by any other method.

NewYork-Presbyterian is one of the few places in the country that offers a highly accurate, advanced form of testing called SPECT/4D CT parathyroid imaging to determine the exact location of parathyroid tumors before surgery.

Nuclear Medicine Therapy

In nuclear medicine therapy, specialists use radiopharmaceuticals–drugs that include both a radioactive and biologically active substance–to directly target various forms of cancer with radioactivity. The radiopharmaceutical is designed to be taken up more readily by cancer cells than by normal cells; the cancer cells are destroyed by the energy (in the form of alpha or beta particles) emitted by the radioactive element in the drug.

Radiopharmaceutical production is a complex process. Unlike many other medical centers, Columbia University Irving Medical Center has full-time staff radiochemists and a radiopharmacist, as well as on-site cyclotrons—machines that produce the radioactive elements used in radiopharmaceuticals. We produce radiopharmaceuticals here daily, for research and clinical use.

We provide a variety of personalized nuclear medicine studies of many body systems including:

Brain

• Perfusion SPECT Brain
• DAT scan for Parkinson’s disease

Endocrine

• Thyroid uptake and scan
• Thyroid whole body scan
• Parathyroid scan

Gastrointestinal

• Gastric emptying
• HIDA for gallbladder disease

Genitourinary

• Renogram including Captopril and Lasix for kidney disease
• GFR – kidney function measurement to determine accurate kidney function

Lungs

• Quantitative lung scan for presurgical evaluation
• Lung scan for blood clots

Bones

• Bone scan to evaluate for bone cancer, stress fractures, and infection

Infection imaging

• Gallium
• Tagged white blood cell

Cancer Imaging

• I-123 MIBG for pheochromocytoma
• Octreoscan for neuroendocrine tumor localization

Lymphoscintigraphy

• For breast cancer and melanoma
• For presurgical scanning

We also work collaboratively with endocrinologists, endocrine surgeons, and oncologists to provide the following radiotherapy treatments:

• Radium 223 for prostate cancer
• Zevalin for lymphoma
• I-131 MIBG for neuro-endocrine tumors
• I-131 for thyroid cancer

How do I get ready for the procedure?

Most nuclear medicine procedures do not require patients to limit their food or liquid intake beforehand. If your procedure does include an eating restriction to ensure the highest accuracy and your safety, we will contact you several days beforehand with specific instructions. Remove all jewelry and metal from your body before arriving for your test or treatment, as these can interfere with the procedure.

What will happen during the procedure?

Before your nuclear medicine procedure, a member of the nuclear medicine staff will give you the radiopharmaceutical (radiotracer) intravenously, by mouth, or as a gas that you will inhale. The radiotracer will accumulate in the organ or area of your body being examined or treated. It can take anywhere from several seconds to several days for the radiotracer to accumulate in the target area. For this reason, your imaging test may be done immediately, a few hours later, or even several days after you have received the radioactive material.

Each nuclear medicine test or treatment is different, using specific methods and tool. We will carefully discuss what will happen during your procedure with you, and you can contact members of our team at any time with questions and concerns before, during, and after your procedure.

Are there any risks?

For most nuclear medicine procedures you will receive a small dose of radiopharmaceutical and will be exposed to low levels of radiation. There are no known long-term adverse effects from such low-dose exposure. Higher doses of radioactive elements are used in nuclear medicine therapy, and in some cases, there is a small risk of developing a second cancer years after your initial treatment. We carefully weigh the benefits of nuclear medicine therapy against the risks of the treatment for each patient, and we will share and discuss these risks with you.

After the procedure

Over hours to weeks following your procedure the radiopharmaceutical used in your procedure will become less radioactive through a natural process called radioactive decay. The drug will also pass out of your body through urine or stool during the first few hours or days following the test. Because you may expose those around you to radiation for a short time after the procedure, we may temporarily restrict your activities and contact with other people until the danger of exposing others to radiation has passed. Therapeutic procedures generally use drugs with a higher dose of radiation, so your contact with others is more likely to be restricted if you have undergone nuclear medicine therapy. Our nuclear medicine and radiation therapist will advise you on any restrictions before the procedure so you have time to plan ahead.

If you have undergone a diagnostic procedure, a nuclear medicine specialist will analyze your test results and will share them with the doctor who requested the exam. Your doctor will then discuss the results with you.