Nuclear Medicine
How Nuclear Medicine works
Nuclear Medicine makes use of how cells and organs in our bodies behave through the administration of small quantities of radioactive material (also known as ‘tracers’) to investigate diseases such as cancer, brain and cardiac abnormalities. The tracers follow the same biological pathway as the cells in the body, for example, where a lot of cells are involved in the repair of a bone the tracer will collect in greater quantity in the repairing region. The radioactive properties of the tracers allows imaging to be performed as gamma radiation is emitted during the radioactive decay and picked up by specialised gamma cameras to form an image. This is very useful for doctors who may report that the area of radioactive concentration they can see on an image demonstrates a particular behaviour happening in the body.
The aim of a study is to ensure a diagnostic evaluation can be made while minimising any known harmful effects of ionising radiation.
Nuclear Medicine can also be used to as a form of cancer treatment for thyroid, prostate and neuroendocrine disease through the administration of larger quantities of radiation using beta and alpha radiation.
Our Department
Our Nuclear Medicine department is situated in the Main Hospital East Outpatients, Level 2. The department was refurbished in 2021 and contains 3 state of the art gamma cameras capable of standard planar imaging and more complex 3-dimensional single photon emission tomography (SPECT/CT) which uses additional CT technology to merge anatomical and functional imaging into one study.
All diagnostic imaging is administered on an outpatient basis and on some occasions in an in patient setting where a patient has an acute condition which needs urgent diagnosis. Therapeutic treatments are also given on an outpatient basis however in some cases patients may require a small period of isolation in a specially designed room during their treatment to protects hospital staff, the public and close family members. NNUH Nuclear Medicine also treats patients referred from across the region (James Paget and Queen Elizabeth Hospitals) for benign thyroid diseases such as hyperthyroidism and thyroid goitre using radioactive iodine.
PET/CT
The Hospital has a Positron Emission Tomography service (PET/CT) on site with a state-of-the-art digital PET/CT camera but is managed by an external organisation, see the contact email below for this service. This uses the same technique as Nuclear Medicine to diagnose disease and is primarily used to stage and follow up patients with cancer or undergoing treatments at the Hospital.
GPs cannot refer directly for PET/CT scans. This function is performed by Hospital Consultants only. For any patients awaiting scan times please email Alliance Medical on: Norfolkand.norwich@nhs.net
Alternatively, by phone on: 01603 647820.
The Staff
Nuclear Medicine utilises a unique mix of specialist trained Radionuclide Radiologists, Clinical Technologists and Radiographers, Clinical Nurse Specialists, Pharmacy production staff, HCPC registered Clinical Scientists and Healthcare Assistants.
Referral Guidance
Referrals are justified and/or authorised by Practitioners licenced to administer radioactive materials at the Hospital. Direct referrals from NNUH medical staff can be made via the ICE system. General Practitioners or first contact Practitioners should refer to the relevant specialism in the Hospital before requesting nuclear medicine studies. Please note: bone scans are currently the only nuclear medicine studies that can be referred externally.
All Referrers must be aware of their responsibility under Ionising Radiation (Medical Exposure) Regulations, known as IR(ME)R to provide appropriate, detailed referrals to the Hospital in accordance with the departmental procedures. Further referral guidance can be viewed in this link under section 3.
There are also limited non-medical referrals that can be made. For further details of these please contact the Nuclear Medicine department.
Paper format referrals from other external hospitals including the James Paget Hospitals and Queen Elizabeth Hospitals can provide paper referrals sent directly to the hospital or to specific licenced Practitioners for justification.
Referrals for PET/CT scans can be accepted by Consultants at NNUH, QEH and JPUH hospitals only.
Services available
The following diagnostic studies are performed routinely at the NNUH Nuclear Medicine Department:
Bone scans
- to detect for metabolic bone diseases related to cancer and for the purposes of staging
- identification of occult or stress fractures
- evaluation of osteomyelitis
- evaluation of avascular necrosis
- investigation of unexplained bone pain
- evaluation of abnormalities incidentally found on other imaging studies
- Paget disease or prosthetic hardware complications
Cardiac Ventriculogram (Multiple Gated Acquisition)
- to assess the left ventricular ejection fraction
Gastro-intestinal
- for assessment of bile acid malabsorption
- to assess clearance of stomach contents for
- to assess for the presence of a gastro-intestinal bleed
Glomerular Filtration Rate
- to assess the ability of the kidneys to filter fluid. An essential pre-assessment for kidney viability prior to transplant or to assess kidney function prior to chemotherapy
Lung Ventilation and Perfusion
- to assess for the presence of pulmonary embolism or to assess lung function prior to surgery
Myocardial Perfusion
- for differentiation or evaluation of ischaemia and/or infarction in the heart muscle
Neurological
- differentiation of Parkinsons disease and essential tremor
Renal Scintigraphy
- to assess for renal scarring, ureteric reflux and other kidney dysfunction
Sentinel Lymph Node Biopsy
- for assessment of presence of cancer in the lymphatic system after removal of lymph nodes in surgery
Endocrine/Neuroendocrine
- for assessment of parathyroid adenomas, thyroid diseases and neuroendocrine cancers
The following nuclear medicine therapies are currently available from NNUH:
Thyroid
- Radioiodine ablation for thyroid cancer
- Radioiodine for hyperthyroidism, toxic and multinodular goitres
Prostate
- Radium 223 for metastatic prostate cancer
Patient Information
Patients will be contacted with an appointment letter and further information explaining the scan or treatment they are expecting. Depending on the exam being scheduled, there may be a need to make any medications you are on known to the department prior to the scan or therapy.
Radiation risks and advice
Any administration or injection being given to patients in the department whether this is an oral capsule or injection will involve a quantity of ionising radiation. The amount of radiation you are exposed to depends on the study your doctor has asked for but it is important to state all nuclear medicine tests are considered to be as safe as possible.
Much like giving any medication in a hospital setting nuclear medicine techniques also have associated risks therefore the hospital has a legal duty to ensure;
(a) the test you are being scheduled for is the correct one
(b) the test will be beneficial in determining any future clinical decisions for you
The central risk for nuclear medicine tests relates to being exposed to ionising radiation. Once a Practitioner has decided you should have the exam dedicated nuclear medicine staff will administer the amount of radiation which is low enough to give the doctors a result while keeping the exposure to a very low level. This makes the risk of the exposure and therefore any harm as low as possible to you. You are free to ask questions about this on the day of your exam. Our staff will also check that you are happy to go ahead with the exam before it takes place. Depending on your exam you may be advised to maintain good hydration for 24 hours after the exam and to keep your distance (at least 1 metre) from young children and pregnant people. This will reduce any exposure related effects further.
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