Nuclear Medicine

Nuclear Medicine

6 Doctors
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Overview
Specialities
Diseases Treated
Why Choose Us?
What We Offer?
Services Offered
Fellowship Programmes/Trainings
Diagnostic Tests and Procedure
FAQs for Doctors
FAQs for Patients
Academy
Contact Us
Doctors

Overview

Nuclear medicine is a subspecialty of medicine that uses medically approved radioactive tracers called radiopharmaceuticals to assess bodily functions and to diagnose and treat diseases. Department of Nuclear medicine offers high quality state of the art diagnostic and therapy services with state of the art infrastructure, highly trained doctors and support staff. Nuclear medicine imaging provides superior diagnostic information based on physiological principles. It identifies disease very early at inception. By analysing the distribution of radiopharmaceuticals within the body, the NM physician can assess the organ function, assess abnormalities, and diagnose several diseases, including cancer, heart disease, urogenital abnormalities and neurological disorders by using diagnostic modalities like SPECT and PET imaging. It also provides guidance for initiating management and thereby provides better clinical outcome. All these investigations are safe and can be used in all age groups except in pregnant patients with relative contraindication in breast feeding patients.

Specialities

I. Diagnostic Imaging:

  1. SPECT – Single photon emission computed tomography
  2. SPECT CT - Single photon emission computed tomography – computed tomography
  3. PETCT – Positron emission tomography – computed tomography
  4. PETMR – Positron emission tomography – Magnetic resonance imaging (3 Tesla)
  5. Thyroid uptake probe – for estimating thyroid uptake function using I 131 radiotracer
  6. Intraoperative Gamma probe – gamma probe guided surgeries for parathyroid, sentinel node imaging & biopsy etc
     

II. Therapy Services:

We have AERB approved therapy rooms for procedures using beta and alpha particles

  1. Low dose Radio iodine therapy for hyperthyroidism,
  2. High dose Radiodine therapy for Differentiated thyroid cancers,
  3. MIBG therapy for neuroblastoma,
  4. PRRT therapy : Lutetium / Actinium DOTATATE therapy for Neuroendocrine tumours,
  5. Alpha therapy ( Actinium PSMA) for prostate cancer
  6. Radition synovectomy : Intra articular instillation of Yttrium colloid for arthritis.
     

III. Special Radiotracers for PETMR / PETCT Depending on Availability:

Specific radiotracers for advanced PETCT/ PETMR imaging are also available using molecules like Flurodopa (Parkinsonism, NET, pituitary lesions), Choline (Liver/ Brain cancers) 18F MISO (Hypoxic tracer, prior to radiotherapy planning) and 18F FLT (tumour proliferation).

Diseases Treated

SLName of ProcedureDiseases Treated
1.Low dose Radio iodine therapyfor hyperthyroidism
2.High dose Radiodine therapyfor Differentiated thyroid cancers
3.MIBG therapyfor neuroblastoma
4.PRRT therapy : Lutetium / Actinium DOTATATEfor Neuroendocrine tumours
5.Alpha therapy (Actinium PSMA)for prostate cancer
6.Radiation SynovectomyIntra articular instillation of Yttrium colloid for arthritis
7.TARE procedure Y90 colloid therapy (Transarterial radioembolisation)Liver cancer

Why Choose Us?

Our department is a highly specialized Nuclear medicine department encompassing all the services under one roof. We have one of the best infrastructures and skilled doctors to handle all types of cases both in diagnostic and therapy services. We have grown over the last 24 years to the present ‘state of the art diagnostic and therapy services’ in entire India. The Gamma camera services were launched in this institute in Jan 2000 with addition of High dose I 131 therapies for thyroid cancers in 2005. Department is equipped with latest state of the art imaging instruments and special wards approved for radionuclide therapy. The department has grown in leaps and bounds including National medical council, NMC recognized post graduate (MD) Nuclear medicine programme (started since 2012). State of the art PETCT service was inaugurated in 2008 by then President of India Shri A.P.J Abdul Kalam. The first state of the art whole body PETMR facility in a university hospital and the third in the country was started in March 2018.

What We Offer?

The Department offers therapeutic interventions for various malignancies and certain benign conditions. Radioactive isotopes are administered to patients either orally, intravenously, or via other routes, targeting diseased tissues with precision while minimizing damage to surrounding healthy cells. This approach is particularly effective in treating conditions such as hyperthyroidism, thyroid cancer, certain metastatic cancers like prostatic malignancies, neuroendocrine neoplasms, and bone pain palliation.

Services Offered

  • The Gamma camera services were launched in this institute in Jan 2000 with addition of High dose I 131 therapies for thyroid cancers in 2005. Department is equipped with latest state of the art imaging instruments and special wards approved for radionuclide therapy.

Gamma Camera Procedures available

PROCEDUREINDICATIONS 
 THYROID SCAN  To assess thyrotoxicosis, Graves disease, toxic MNG, thyroiditis, thyroid nodule evaluation, lingual thyroid etc 
 PARATHYROID SCAN To assess parathyroid adenoma, hyperplasia, ectopic parathyroid adenomas 
MYOCARDIAL PERFUSION/ THALLIUM SCAN To evaluate IHD, physiological significance of known coronary stenosis, Coronary artery disease, False positive TMT, Baseline ECG changes like LBBB, Risk stratification of CAD, Presurgical cardiac evaluation, to assess myocardial viability before CABG prior to surgery for congenital heart disease, follow-up of Kawasaki disease 
MUGA SCAN To evaluate accurate LVEF, regional wall motion abnormalities in CAD, patients with obesity, COPD, prior to adriamycin and other cardiotoxic drug therapy 
 RENOGRAM To assess GFR of individual kidneys esp. in donors, neonatal hydronephrosis, PUJ obstructions, obstructed megaureter. Relative function evaluation in patients with renal malignancy prior to nephrectomy, ectopic kidneys, post renal transplant evaluations 
DMSA SCAN To assess UTI (Renal scars), ectopic kidneys, accurate function assessment of individual kidneys 
DIRECT / INDIRECT RADIONUCLIDE MCU SCAN To assess Vesico ureteric reflux, Urinary tract infections, hydroureteronephrosis 
 WHOLE BODY BONE SCAN To evaluate skeletal metastases, bone malignancy, low backache, tuberculosis of bone, condylar hyperplasia, avascular necrosis, metabolic bone disease, stress fracture, osteomyelitis, cellulitis especially in diabetics. 
GALLIUM CITRATE SCAN Assessment of prosthetic infections, evaluation of lymphoma (Hodgkin's & non Hodgkin's), fever of unknown origin 
LUNG PERFUSION & VENTILATION Pulmonary embolism, lung vascularity assessment in children with congenital heart disease, predict FEV1 in patients planned for pneumonectomy/lobectomy 
LIVER-SPLEEN SCAN Alcoholic hepatitis, cirrhosis, portal hypertension, hemangioma, jaundice, Budd chiari syndrome. 
HEPATOBILIARY SCAN Differentiate neonatal hepatitis vs biliary atresia, postop bile leak, choledochol cyst, post liver transplant cases, gall bladder dyskinesia, acute/chronic cholecystitis. 
MECKEL'S SCAN Evaluation of  meckels diverticulum (Ectopic gastric mucosa), malena, GI bleed. 
GASTRO INTESTINAL BLEEDING To evaluate occult GI bleed and localize the site of bleed 
GASTRIC EMPTYING For dyspepsia, vomiting, Diabetic gastroparesis. 
GASTRO ESOPHAGEAL REFLUX (Milk scan) Recurrent respiratory infections, heart burns 
DACRYO SCINTIGRAPHY 
FOR EYES 
To evaluate tear duct patency 
SALIVAGRAM To look for antegrade aspiration in young children 

ONCOLOGY WORKUP 18 FDG (FLURODEOXYGLUCOSE) 1. Cancer staging, restaging, follow-up - Brain tumor relapse, Head and neck cancer, Ca of Unknown Primary, Thyroid carcinoma, Esophageal carcinoma, Lung cancer, Colorectal carcinomas, Breast cancer, Gynecological cancers, Musculoskeletal tumors, Malignant melanoma, Prostate Carcinoma, Lymphomas, 
2. To assess RT / Chemo response, 
3. For Radiotherapy treatment planning. 
4.To evaluate solitary pulmonary nodule (benign vs malignant), 
GALLIUM DOTA PETCT Neuroendocrine tumors
GALLIUM PSMA PETCT Prostate cancer 
MYOCARDIAL PETCT (FDG) 1. Myocardial viability in coronary artery disease patients  
2. To look for myocardial ischemia 
3. To look for Sarcoidosis  
4. To localize prewsence of absence of myocardial inflammation / infective endocardfitis  
5. Intracardiac device infection
BRAIN PETCT (FDG) 1. To evaluate brain space occupying lesion  
2. To look for memory loss causes  
3. To look for parkinsons disease  
4. Evaluation of stroke, epilepsy  
5. Psychiatric illness  
6. Paraneoplastic disease workup  
7. Drug addiction studies 
INFECTION PETCT (FDG) 1. To localize the site of occult infection in Pyrexia of unknown origin  
2. To confirm / rule out vasculitis  
3. To evaluate Prosthetic infection/ aseptic loosening of implants 
4. Diabetic foot complications like osteomyelitis/ charcots arthropathy 

Benefit of PET MRI Scan

We are the only centre in Kerala having state of the art PETMR hybrid imaging. It is the ultimate hybrid imaging technology is the integration of PET and MRI (Magnetic resonance Imaging) providing exquisite structural, functional and metabolic details of suspected sites of cancer thereby increasing the accuracy of cancer detection. Certain tumors benefit by PETMR imaging than mere PETCT like gynecological malignancies, Head & neck tumors, musculoskeletal, brain and liver cancers etc. With highest resolution, PETMR can identify tiny lesions easily. The biggest benefit to the patient is lack of additional radiation when a MRI is done. Like in PETCT, FDG and specific tracers like Gallium PSMA, Gallium DOTA, F DOPA, F MISO etc. can be used to perform a PETMR study. 

Other benefits being: 

  1. Ease of getting two scans (PET & MRI scans) in one sitting with least patient discomfort
  2. Cost effective imaging (PET & MRI scans in one sitting)
  3. Whole-body coverage in integrated PET MRI imaging
  4. Less radiation procedure
  5. Modality of choice for early detection & therapy response of cancers especially in certain organs like brain, liver, uterus, cervix, tongue etc. 


How Hybrid PET/ MRI Scanner Works?

MRI scanner uses a strong magnetic field to produce detailed images of internal structures of the body. They can also provide information about how well these structures are functioning. 

PET scans use minute amounts of radioactive tracers (most of the time FDG Fluro deoxy glucose, a sugar molecule) to highlight cellular metabolic abnormalities indicating diseases like cancer. 

Until now, scientists could not integrate PET and MRI for simultaneous scanning because MRI’s powerful magnets interfered with the imaging detectors on the PET scanner. 

But now this hybrid imaging scanner PET MRI (first manufactured by Siemens Germany) is available worldwide & AIMS is only the third hospital in India to acquire this state of the art hybrid scanner. 

It is possible to perform a whole body PET MRI or an organ specific PET MRI scanning depending on whether the patient is being imaged for cancer / non cancer organ specific diseases. 

Once the radioactive injection is performed, the patient will wait approximately 60 minutes in a quiet area with limited body movement facilitating the distribution of radioactivity molecule. More radio tracer material is expected to accumulate in the cells with higher metabolism thereby identifying cancerous / non-cancerous disease process of specific organs. 

For the MRI portion, magnetic fields and radio frequency bursts will move the proton (hydrogen in cell) in the patient's body out of their normal alignment or their normal spinning pattern. As the molecules return to their natural positions, the machine records that activity and medical image computers uses this information to create detailed and precise structural images of organs and tissues. 

The images acquired from both PET-MRI scanners are then processed, aligned, fused and interpreted by trained, highly experienced nuclear & radiology imaging experts to diagnose and stage the cancer spread in the body. 

Advantages of PET – MRI in cancer imaging: 

  1. PET MRI is the ideal tool for staging most of the cancers at the time of detection
  2. MRI is the ultimate imaging technology in the accurate staging of Local disease (T staging). It is especially true for primary cancers of specific sites like Head & neck, pancreas, liver, prostate, gynecological malignancies like cervix, uterus and cancers of muscles and bones especially in children.
  3. In the detection and staging of lymph node spread of tumor the efficiency, sensitivity of PET & MRI added together improves the accuracy of Lymph node (N staging) cancer spread.
  4. PET MRI imaging is routinely performed as a whole body scanning. The biggest advantage of PET MRI scan (being a whole body scanning technique) is in the detection of unsuspected distant spread of cancers to organs like lungs, bones & other sites (M staging)
  5. Effective TNM staging an integral part of cancer staging, treatment & prediction of prognosis is achieved by PET MRI whole-body imaging as a one stop shop procedure
  6. As both (PET MRI) imaging procure is simultaneously performed it is a one time, less expensive, time saving smooth procedure for the patient.
  7. This is an effective tool in the evaluation of response to treatment once cancer is diagnosed. In cases that are unresponsive to treatment, change of therapy makes a positive contribution to the course of the disease. Cancer treatment becomes more cost effective with PET MRI with the earlier evidence of therapy response or failure.
  8. PET MRI Hybrid imaging is the imaging of choice in the evaluation and follow-up of childhood & adolescent patients’ cancers like Lymphoma, Neuroblastoma, brain tumors & sarcomas.


PET MRI in Non-Cancer Diseases Detection:

Brain:

There is a definite role for PET MRI hybrid scan in many non-oncological (Non-cancerous) diseases involving Brain & Heart. The structural changes in brain and heart can be so small that only exquisite structural information providing scans like MRI is imperative in the early detection of brain, heart diseases. Epilepsy and neuro degenerative diseases like dementia (i.e. memory disorders like Alzheimer’s disease), Parkinsonism can be effectively diagnosed early with PET MRI scanning. 

Changes in brain morphology and cognitive impairment are diagnosed early due to the combined effort of PET MRI scanning in dementia evaluation. In epilepsy PETMR is used to localize the site of epileptic focus in medically refractory cases to plan surgery. It can accurately localize of origin of abnormal electrical impulses in brain by demonstrating FDG distribution changes. This is incremental when combined with 3 T MRI. Thereby the functional and anatomical information gathered by this single imaging modality is invaluable. 

Heart:

Detection of viable (living) part of heart muscles is an integral part of coronary bypass surgery decision and this can be effectively & more accurately done by FDG PET MRI scanning. It can also detect inflammation of heart muscles (like cardiac sarcoidosis, viral myocarditis) very easily with utmost sensitivity. This can also be a useful investigation in assessing the treatment response. 

Diagnostic Tests and Procedure

  1. SPECT - Single photon emission computed tomography
  2. SPECT CT - Single photon emission computed tomography - computed tomography
  3. PETCT - Positron emission tomography - computed tomography
  4. PETMR - Positron emission tomography - Magnetic resonance imaging (3 Tesla)
  5. Thyroid uptake probe - for estimating thyroid uptake function using I 131 radiotracer
  6. Gamma probe - gamma probe guided surgeries for parathyroid, sentinel node imaging & biopsy etc
  7. AERB approved therapy rooms for procedures using beta and alpha particles - 
    a) Radio iodine therapy for hyperthyroidism, differentiated thyroid cancers, b) I 131 - MIBG therapy for neuroblastoma, c) Lutetium / Actinium DOTATATE (PRRT) therapy for Neuroendocrine tumours, d) Alpha therapy (Actinium PSMA) for prostate cancer e) Ytrrium colloid for radiation synovectomy. 
  8. Special radiotracers for PETMR/ PETCT: Specific radiotracers for advanced PETCT / PETMR imaging are also available using molecules like Flurodopa (Parkinsonism, NET, pituitary lesions), Choline (Liver/ Brain cancers) 18F MISO (Hypoxic tracer, prior to radiotherapy planning) and 18F FLT (tumour proliferation).

FAQs for Doctors

Preparation instructions vary depending on the specific procedure which the patient is being scheduled to undergo. Patients may be asked to avoid certain medications, remain fasting for a specific period of time, or drink plenty of oral fluids. Typically for a FDG PETCT or PETMR scan, overnight fasting is mandatory along with good control of blood sugar especially in diabetic patients on the day of scan. No morning walk / physical exercise to be done on the day of the test. Patient can continue intake of plain water and can void also. Pregnant and breast feeding mothers need to inform their status Detailed instructions will be provided when the appointment is scheduled.

Requesting you to contact Nuclear medicine reception for appointments. Depending on the scan requested, patient preparation details will be informed. We strive to accommodate patients as quickly as possible, especially for urgent cases.

Some patients may have contraindications or require special precautions or preparations for certain nuclear medicine procedures. Generally, considerations may include pregnancy, breastfeeding, or underlying medical conditions. We will assess each patient individually to ensure their safety and well-being.

When referring a patient for a procedure or treatment, please provide relevant clinical information, including the patient's medical history, current medications, and any specific clinical concerns or queries that you may have. We also request you to specify the type of PET scan you need (FDG, Gallium PSMA/ Gallium DOTA, F DOPA etc.)

The results of nuclear medicine scans will be provided to the referring physician in a timely manner. This will include a formal report with images. Gamma scans are reported and issued on the same day while PET reports will be issued within one or two working days. Direct communication with our nuclear medicine physicians may be sought in case of urgent PET cases for a provisional verbal report on the same day.

Yes, our nuclear medicine specialists are available for consultations and discussions regarding specific cases or patients, if necessary.

We provide ongoing support and follow-up for patients who have undergone nuclear medicine procedures (diagnostic and therapeutic), including coordination of further imaging or treatment, as needed. Regular follow up is being done for patients undergoing radionuclide therapy with radioiodine, lutetium, etc.

Yes, it is possible to schedule a patient for a non-contrast FDG PET/CT scan if the patient has deranged renal parameters. However, in such circumstances, a contrast enhanced scan may not be advisable.

Yes, PET-CT/ PETMR can also be used to evaluate pyrexia of unknown origin (PUO), infection imaging, paraneoplastic syndrome evaluation, certain neurological conditions, such as Alzheimer's disease, epilepsy, Parkinsonism and brain tumours, adrenal pathologies,

vasculitis, hyperparathyroidism, as well as cardiac conditions, such as coronary artery disease, sarcoidosis and myocardial viability.

a) It is a privilege to have both PETCT and PETMR in same centre so that one can decide the right investigation. All cases that require exquisite anatomical details can be obtained by PETMR in a single scanning session.

b) Young patients/ patients who need repeated PET scans, can undergo PETMR as radiation exposure is minimum.

c) Patients with suspected brain lesion.

FAQs for Patients

Firstly, nuclear medicine procedures can be imaging or therapy based. If it is for imaging, then they are Gamma camera based (i.e. SPECT) or PET scans

During a nuclear medicine procedure, a small amount of clinically approved and sterile radiopharmaceutical is injected, swallowed, or rarely inhaled (ventilation scan) by the patient. The radiopharmaceutical then travels to the specific organ or tissue being examined. The radioactive emissions from the radiopharmaceutical creates images of the organ or tissue under evaluation.

Patients are advised to avoid eating or drinking for at least 6 hours before the procedure. However, they may continue to take plain water during this period. For a contrast scan, a recent serum creatinine level (within the last one month) is mandatory. If patient is very sick or uncooperative, please inform front desk for anaesthesia clearance prior to scan.

Nuclear medicine procedures are generally safe and usually have no associated side effects. However, rarely some patients may experience minor discomfort at the injection site or have an allergic reaction to the contrast administered for the CT/MRI. Serious side effects are rare but may include anaphylaxis or a severe allergic reaction. It is important to inform your healthcare provider if you have any allergies or medical conditions before the scan.

However, as with any medical procedure involving radiation, there are some risks to consider. PET scan is not generally undertaken for pregnant women unless patient has terminal illness. If pregnancy is suspected, urine pregnancy test needs to be done prior to scheduling patient for PET scan. Kindly discuss your case with nuclear doctor.

The length of a nuclear medicine procedure can vary depending on the specific test being performed. Some procedures may take only a few minutes, while others may take more time with interval gaps.

Turnaround time for PETCT scan typically is 2 hours from the time of injection to relieving the patient from dept. After injection patient is taken up for imaging after 45 minutes to 60 minutes. Head to mid-thigh imaging is done for hole body scan. Each PETCT takes 15 – 20 min to complete. At times, delayed scans are acquired based on initial PET findings after 1 -2 hours of scan.

The results of nuclear medicine scans will be provided to the patient in a timely manner from the front desk. This will include a formal printed report with images. Gamma scans are reported and issued on the same day while PET reports will be issued within one or two working days. Direct communication with our nuclear medicine physicians may be sought in case of urgent PET cases for a provisional verbal report on the same day.

In most cases, patients can resume normal activities immediately after a nuclear medicine procedure. However, certain specific instructions may be given depending on the test that was performed. It is important to follow any instructions provided to ensure the best possible outcome. Radiation safety precautions may be advised for longer periods of time for therapeutic Nuclear Medicine procedures.

Yes, all nuclear medicine procedures, getting the previous scans/ reports/ CD to the department is important. Patient has to bring all relevant reports on the day of test, failing which it will be very difficult to compare and issue the reports in a timely manner. In PET scan, old reports are extremely important in interpretation of the current scan as the response evaluation will depend on the changes in the initial disease burden. For the patients to be classified to have a good response to treatment or disease progression, reviewing the prior imaging studies are vital.

  • It is a privilege to have both PETCT and PETMR in same centre so that one can decide the right scan. All cases that require exquisite anatomical details can be obtained by PETMR in a single scanning session. There is no need to undergo an additional MR scan.
  • Patients with sarcoma/ lung/ breast cancers etc. are ideal cases for PETMR.
  • Young patients/ patients who need repeated PET scans, can undergo PETMR as radiation exposure is minimum.
  • Patients with suspected brain lesion.

Academy

The Department also gives importance to research and development, continually striving to advance the field of nuclear medicine. Research efforts involving exploring new radiopharmaceuticals, refining imaging techniques, or investigating innovative applications such as theranostics, which is a combination of diagnostics and targeted therapy.

Moreover, the Department provides education and training programs for medical professionals (MD nuclear medicine) and technologists, ensuring the continued advancement and dissemination of knowledge in the field of nuclear medicine which in turn contribute to improved patient outcomes and quality of life.

Contact Us

Phone: 0484-2852001, 2852002 
Email: nuclearmed@aims.amrita.edu

Doctors

Dr. P. Shanmuga Sundaram
Clinical Professor and Head (Consultant)
DRM, DNB (NMed), MNAMS, FANMB, FICNM
Dr. Padma Subramanyam
Clinical Professor (Consultant)
DRM, DNB (NMed), MNAMS, FANMB
Dr. Manjit Sarma
Clinical Associate Professor
DRM, DNB (NMed), FEBNM, FANMB
Dr. Parvathy Pavithran
Clinical Assistant Professor
MD (NMed)
Dr. Ramkesh R
Assistant Professor

Overview

Nuclear medicine is a subspecialty of medicine that uses medically approved radioactive tracers called radiopharmaceuticals to assess bodily functions and to diagnose and treat diseases. Department of Nuclear medicine offers high quality state of the art diagnostic and therapy services with state of the art infrastructure, highly trained doctors and support staff. Nuclear medicine imaging provides superior diagnostic information based on physiological principles. It identifies disease very early at inception. By analysing the distribution of radiopharmaceuticals within the body, the NM physician can assess the organ function, assess abnormalities, and diagnose several diseases, including cancer, heart disease, urogenital abnormalities and neurological disorders by using diagnostic modalities like SPECT and PET imaging. It also provides guidance for initiating management and thereby provides better clinical outcome. All these investigations are safe and can be used in all age groups except in pregnant patients with relative contraindication in breast feeding patients.

Specialities

I. Diagnostic Imaging:

  1. SPECT – Single photon emission computed tomography
  2. SPECT CT - Single photon emission computed tomography – computed tomography
  3. PETCT – Positron emission tomography – computed tomography
  4. PETMR – Positron emission tomography – Magnetic resonance imaging (3 Tesla)
  5. Thyroid uptake probe – for estimating thyroid uptake function using I 131 radiotracer
  6. Intraoperative Gamma probe – gamma probe guided surgeries for parathyroid, sentinel node imaging & biopsy etc
     

II. Therapy Services:

We have AERB approved therapy rooms for procedures using beta and alpha particles

  1. Low dose Radio iodine therapy for hyperthyroidism,
  2. High dose Radiodine therapy for Differentiated thyroid cancers,
  3. MIBG therapy for neuroblastoma,
  4. PRRT therapy : Lutetium / Actinium DOTATATE therapy for Neuroendocrine tumours,
  5. Alpha therapy ( Actinium PSMA) for prostate cancer
  6. Radition synovectomy : Intra articular instillation of Yttrium colloid for arthritis.
     

III. Special Radiotracers for PETMR / PETCT Depending on Availability:

Specific radiotracers for advanced PETCT/ PETMR imaging are also available using molecules like Flurodopa (Parkinsonism, NET, pituitary lesions), Choline (Liver/ Brain cancers) 18F MISO (Hypoxic tracer, prior to radiotherapy planning) and 18F FLT (tumour proliferation).

Diseases Treated

SLName of ProcedureDiseases Treated
1.Low dose Radio iodine therapyfor hyperthyroidism
2.High dose Radiodine therapyfor Differentiated thyroid cancers
3.MIBG therapyfor neuroblastoma
4.PRRT therapy : Lutetium / Actinium DOTATATEfor Neuroendocrine tumours
5.Alpha therapy (Actinium PSMA)for prostate cancer
6.Radiation SynovectomyIntra articular instillation of Yttrium colloid for arthritis
7.TARE procedure Y90 colloid therapy (Transarterial radioembolisation)Liver cancer

Why Choose Us?

Our department is a highly specialized Nuclear medicine department encompassing all the services under one roof. We have one of the best infrastructures and skilled doctors to handle all types of cases both in diagnostic and therapy services. We have grown over the last 24 years to the present ‘state of the art diagnostic and therapy services’ in entire India. The Gamma camera services were launched in this institute in Jan 2000 with addition of High dose I 131 therapies for thyroid cancers in 2005. Department is equipped with latest state of the art imaging instruments and special wards approved for radionuclide therapy. The department has grown in leaps and bounds including National medical council, NMC recognized post graduate (MD) Nuclear medicine programme (started since 2012). State of the art PETCT service was inaugurated in 2008 by then President of India Shri A.P.J Abdul Kalam. The first state of the art whole body PETMR facility in a university hospital and the third in the country was started in March 2018.

What We Offer?

The Department offers therapeutic interventions for various malignancies and certain benign conditions. Radioactive isotopes are administered to patients either orally, intravenously, or via other routes, targeting diseased tissues with precision while minimizing damage to surrounding healthy cells. This approach is particularly effective in treating conditions such as hyperthyroidism, thyroid cancer, certain metastatic cancers like prostatic malignancies, neuroendocrine neoplasms, and bone pain palliation.

Services Offered

  • The Gamma camera services were launched in this institute in Jan 2000 with addition of High dose I 131 therapies for thyroid cancers in 2005. Department is equipped with latest state of the art imaging instruments and special wards approved for radionuclide therapy.

Gamma Camera Procedures available

PROCEDUREINDICATIONS 
 THYROID SCAN  To assess thyrotoxicosis, Graves disease, toxic MNG, thyroiditis, thyroid nodule evaluation, lingual thyroid etc 
 PARATHYROID SCAN To assess parathyroid adenoma, hyperplasia, ectopic parathyroid adenomas 
MYOCARDIAL PERFUSION/ THALLIUM SCAN To evaluate IHD, physiological significance of known coronary stenosis, Coronary artery disease, False positive TMT, Baseline ECG changes like LBBB, Risk stratification of CAD, Presurgical cardiac evaluation, to assess myocardial viability before CABG prior to surgery for congenital heart disease, follow-up of Kawasaki disease 
MUGA SCAN To evaluate accurate LVEF, regional wall motion abnormalities in CAD, patients with obesity, COPD, prior to adriamycin and other cardiotoxic drug therapy 
 RENOGRAM To assess GFR of individual kidneys esp. in donors, neonatal hydronephrosis, PUJ obstructions, obstructed megaureter. Relative function evaluation in patients with renal malignancy prior to nephrectomy, ectopic kidneys, post renal transplant evaluations 
DMSA SCAN To assess UTI (Renal scars), ectopic kidneys, accurate function assessment of individual kidneys 
DIRECT / INDIRECT RADIONUCLIDE MCU SCAN To assess Vesico ureteric reflux, Urinary tract infections, hydroureteronephrosis 
 WHOLE BODY BONE SCAN To evaluate skeletal metastases, bone malignancy, low backache, tuberculosis of bone, condylar hyperplasia, avascular necrosis, metabolic bone disease, stress fracture, osteomyelitis, cellulitis especially in diabetics. 
GALLIUM CITRATE SCAN Assessment of prosthetic infections, evaluation of lymphoma (Hodgkin's & non Hodgkin's), fever of unknown origin 
LUNG PERFUSION & VENTILATION Pulmonary embolism, lung vascularity assessment in children with congenital heart disease, predict FEV1 in patients planned for pneumonectomy/lobectomy 
LIVER-SPLEEN SCAN Alcoholic hepatitis, cirrhosis, portal hypertension, hemangioma, jaundice, Budd chiari syndrome. 
HEPATOBILIARY SCAN Differentiate neonatal hepatitis vs biliary atresia, postop bile leak, choledochol cyst, post liver transplant cases, gall bladder dyskinesia, acute/chronic cholecystitis. 
MECKEL'S SCAN Evaluation of  meckels diverticulum (Ectopic gastric mucosa), malena, GI bleed. 
GASTRO INTESTINAL BLEEDING To evaluate occult GI bleed and localize the site of bleed 
GASTRIC EMPTYING For dyspepsia, vomiting, Diabetic gastroparesis. 
GASTRO ESOPHAGEAL REFLUX (Milk scan) Recurrent respiratory infections, heart burns 
DACRYO SCINTIGRAPHY 
FOR EYES 
To evaluate tear duct patency 
SALIVAGRAM To look for antegrade aspiration in young children 

ONCOLOGY WORKUP 18 FDG (FLURODEOXYGLUCOSE) 1. Cancer staging, restaging, follow-up - Brain tumor relapse, Head and neck cancer, Ca of Unknown Primary, Thyroid carcinoma, Esophageal carcinoma, Lung cancer, Colorectal carcinomas, Breast cancer, Gynecological cancers, Musculoskeletal tumors, Malignant melanoma, Prostate Carcinoma, Lymphomas, 
2. To assess RT / Chemo response, 
3. For Radiotherapy treatment planning. 
4.To evaluate solitary pulmonary nodule (benign vs malignant), 
GALLIUM DOTA PETCT Neuroendocrine tumors
GALLIUM PSMA PETCT Prostate cancer 
MYOCARDIAL PETCT (FDG) 1. Myocardial viability in coronary artery disease patients  
2. To look for myocardial ischemia 
3. To look for Sarcoidosis  
4. To localize prewsence of absence of myocardial inflammation / infective endocardfitis  
5. Intracardiac device infection
BRAIN PETCT (FDG) 1. To evaluate brain space occupying lesion  
2. To look for memory loss causes  
3. To look for parkinsons disease  
4. Evaluation of stroke, epilepsy  
5. Psychiatric illness  
6. Paraneoplastic disease workup  
7. Drug addiction studies 
INFECTION PETCT (FDG) 1. To localize the site of occult infection in Pyrexia of unknown origin  
2. To confirm / rule out vasculitis  
3. To evaluate Prosthetic infection/ aseptic loosening of implants 
4. Diabetic foot complications like osteomyelitis/ charcots arthropathy 

Benefit of PET MRI Scan

We are the only centre in Kerala having state of the art PETMR hybrid imaging. It is the ultimate hybrid imaging technology is the integration of PET and MRI (Magnetic resonance Imaging) providing exquisite structural, functional and metabolic details of suspected sites of cancer thereby increasing the accuracy of cancer detection. Certain tumors benefit by PETMR imaging than mere PETCT like gynecological malignancies, Head & neck tumors, musculoskeletal, brain and liver cancers etc. With highest resolution, PETMR can identify tiny lesions easily. The biggest benefit to the patient is lack of additional radiation when a MRI is done. Like in PETCT, FDG and specific tracers like Gallium PSMA, Gallium DOTA, F DOPA, F MISO etc. can be used to perform a PETMR study. 

Other benefits being: 

  1. Ease of getting two scans (PET & MRI scans) in one sitting with least patient discomfort
  2. Cost effective imaging (PET & MRI scans in one sitting)
  3. Whole-body coverage in integrated PET MRI imaging
  4. Less radiation procedure
  5. Modality of choice for early detection & therapy response of cancers especially in certain organs like brain, liver, uterus, cervix, tongue etc. 


How Hybrid PET/ MRI Scanner Works?

MRI scanner uses a strong magnetic field to produce detailed images of internal structures of the body. They can also provide information about how well these structures are functioning. 

PET scans use minute amounts of radioactive tracers (most of the time FDG Fluro deoxy glucose, a sugar molecule) to highlight cellular metabolic abnormalities indicating diseases like cancer. 

Until now, scientists could not integrate PET and MRI for simultaneous scanning because MRI’s powerful magnets interfered with the imaging detectors on the PET scanner. 

But now this hybrid imaging scanner PET MRI (first manufactured by Siemens Germany) is available worldwide & AIMS is only the third hospital in India to acquire this state of the art hybrid scanner. 

It is possible to perform a whole body PET MRI or an organ specific PET MRI scanning depending on whether the patient is being imaged for cancer / non cancer organ specific diseases. 

Once the radioactive injection is performed, the patient will wait approximately 60 minutes in a quiet area with limited body movement facilitating the distribution of radioactivity molecule. More radio tracer material is expected to accumulate in the cells with higher metabolism thereby identifying cancerous / non-cancerous disease process of specific organs. 

For the MRI portion, magnetic fields and radio frequency bursts will move the proton (hydrogen in cell) in the patient's body out of their normal alignment or their normal spinning pattern. As the molecules return to their natural positions, the machine records that activity and medical image computers uses this information to create detailed and precise structural images of organs and tissues. 

The images acquired from both PET-MRI scanners are then processed, aligned, fused and interpreted by trained, highly experienced nuclear & radiology imaging experts to diagnose and stage the cancer spread in the body. 

Advantages of PET – MRI in cancer imaging: 

  1. PET MRI is the ideal tool for staging most of the cancers at the time of detection
  2. MRI is the ultimate imaging technology in the accurate staging of Local disease (T staging). It is especially true for primary cancers of specific sites like Head & neck, pancreas, liver, prostate, gynecological malignancies like cervix, uterus and cancers of muscles and bones especially in children.
  3. In the detection and staging of lymph node spread of tumor the efficiency, sensitivity of PET & MRI added together improves the accuracy of Lymph node (N staging) cancer spread.
  4. PET MRI imaging is routinely performed as a whole body scanning. The biggest advantage of PET MRI scan (being a whole body scanning technique) is in the detection of unsuspected distant spread of cancers to organs like lungs, bones & other sites (M staging)
  5. Effective TNM staging an integral part of cancer staging, treatment & prediction of prognosis is achieved by PET MRI whole-body imaging as a one stop shop procedure
  6. As both (PET MRI) imaging procure is simultaneously performed it is a one time, less expensive, time saving smooth procedure for the patient.
  7. This is an effective tool in the evaluation of response to treatment once cancer is diagnosed. In cases that are unresponsive to treatment, change of therapy makes a positive contribution to the course of the disease. Cancer treatment becomes more cost effective with PET MRI with the earlier evidence of therapy response or failure.
  8. PET MRI Hybrid imaging is the imaging of choice in the evaluation and follow-up of childhood & adolescent patients’ cancers like Lymphoma, Neuroblastoma, brain tumors & sarcomas.


PET MRI in Non-Cancer Diseases Detection:

Brain:

There is a definite role for PET MRI hybrid scan in many non-oncological (Non-cancerous) diseases involving Brain & Heart. The structural changes in brain and heart can be so small that only exquisite structural information providing scans like MRI is imperative in the early detection of brain, heart diseases. Epilepsy and neuro degenerative diseases like dementia (i.e. memory disorders like Alzheimer’s disease), Parkinsonism can be effectively diagnosed early with PET MRI scanning. 

Changes in brain morphology and cognitive impairment are diagnosed early due to the combined effort of PET MRI scanning in dementia evaluation. In epilepsy PETMR is used to localize the site of epileptic focus in medically refractory cases to plan surgery. It can accurately localize of origin of abnormal electrical impulses in brain by demonstrating FDG distribution changes. This is incremental when combined with 3 T MRI. Thereby the functional and anatomical information gathered by this single imaging modality is invaluable. 

Heart:

Detection of viable (living) part of heart muscles is an integral part of coronary bypass surgery decision and this can be effectively & more accurately done by FDG PET MRI scanning. It can also detect inflammation of heart muscles (like cardiac sarcoidosis, viral myocarditis) very easily with utmost sensitivity. This can also be a useful investigation in assessing the treatment response. 

Diagnostic Tests and Procedure

  1. SPECT - Single photon emission computed tomography
  2. SPECT CT - Single photon emission computed tomography - computed tomography
  3. PETCT - Positron emission tomography - computed tomography
  4. PETMR - Positron emission tomography - Magnetic resonance imaging (3 Tesla)
  5. Thyroid uptake probe - for estimating thyroid uptake function using I 131 radiotracer
  6. Gamma probe - gamma probe guided surgeries for parathyroid, sentinel node imaging & biopsy etc
  7. AERB approved therapy rooms for procedures using beta and alpha particles - 
    a) Radio iodine therapy for hyperthyroidism, differentiated thyroid cancers, b) I 131 - MIBG therapy for neuroblastoma, c) Lutetium / Actinium DOTATATE (PRRT) therapy for Neuroendocrine tumours, d) Alpha therapy (Actinium PSMA) for prostate cancer e) Ytrrium colloid for radiation synovectomy. 
  8. Special radiotracers for PETMR/ PETCT: Specific radiotracers for advanced PETCT / PETMR imaging are also available using molecules like Flurodopa (Parkinsonism, NET, pituitary lesions), Choline (Liver/ Brain cancers) 18F MISO (Hypoxic tracer, prior to radiotherapy planning) and 18F FLT (tumour proliferation).

FAQs for Doctors

Preparation instructions vary depending on the specific procedure which the patient is being scheduled to undergo. Patients may be asked to avoid certain medications, remain fasting for a specific period of time, or drink plenty of oral fluids. Typically for a FDG PETCT or PETMR scan, overnight fasting is mandatory along with good control of blood sugar especially in diabetic patients on the day of scan. No morning walk / physical exercise to be done on the day of the test. Patient can continue intake of plain water and can void also. Pregnant and breast feeding mothers need to inform their status Detailed instructions will be provided when the appointment is scheduled.

Requesting you to contact Nuclear medicine reception for appointments. Depending on the scan requested, patient preparation details will be informed. We strive to accommodate patients as quickly as possible, especially for urgent cases.

Some patients may have contraindications or require special precautions or preparations for certain nuclear medicine procedures. Generally, considerations may include pregnancy, breastfeeding, or underlying medical conditions. We will assess each patient individually to ensure their safety and well-being.

When referring a patient for a procedure or treatment, please provide relevant clinical information, including the patient's medical history, current medications, and any specific clinical concerns or queries that you may have. We also request you to specify the type of PET scan you need (FDG, Gallium PSMA/ Gallium DOTA, F DOPA etc.)

The results of nuclear medicine scans will be provided to the referring physician in a timely manner. This will include a formal report with images. Gamma scans are reported and issued on the same day while PET reports will be issued within one or two working days. Direct communication with our nuclear medicine physicians may be sought in case of urgent PET cases for a provisional verbal report on the same day.

Yes, our nuclear medicine specialists are available for consultations and discussions regarding specific cases or patients, if necessary.

We provide ongoing support and follow-up for patients who have undergone nuclear medicine procedures (diagnostic and therapeutic), including coordination of further imaging or treatment, as needed. Regular follow up is being done for patients undergoing radionuclide therapy with radioiodine, lutetium, etc.

Yes, it is possible to schedule a patient for a non-contrast FDG PET/CT scan if the patient has deranged renal parameters. However, in such circumstances, a contrast enhanced scan may not be advisable.

Yes, PET-CT/ PETMR can also be used to evaluate pyrexia of unknown origin (PUO), infection imaging, paraneoplastic syndrome evaluation, certain neurological conditions, such as Alzheimer's disease, epilepsy, Parkinsonism and brain tumours, adrenal pathologies,

vasculitis, hyperparathyroidism, as well as cardiac conditions, such as coronary artery disease, sarcoidosis and myocardial viability.

a) It is a privilege to have both PETCT and PETMR in same centre so that one can decide the right investigation. All cases that require exquisite anatomical details can be obtained by PETMR in a single scanning session.

b) Young patients/ patients who need repeated PET scans, can undergo PETMR as radiation exposure is minimum.

c) Patients with suspected brain lesion.

FAQs for Patients

Firstly, nuclear medicine procedures can be imaging or therapy based. If it is for imaging, then they are Gamma camera based (i.e. SPECT) or PET scans

During a nuclear medicine procedure, a small amount of clinically approved and sterile radiopharmaceutical is injected, swallowed, or rarely inhaled (ventilation scan) by the patient. The radiopharmaceutical then travels to the specific organ or tissue being examined. The radioactive emissions from the radiopharmaceutical creates images of the organ or tissue under evaluation.

Patients are advised to avoid eating or drinking for at least 6 hours before the procedure. However, they may continue to take plain water during this period. For a contrast scan, a recent serum creatinine level (within the last one month) is mandatory. If patient is very sick or uncooperative, please inform front desk for anaesthesia clearance prior to scan.

Nuclear medicine procedures are generally safe and usually have no associated side effects. However, rarely some patients may experience minor discomfort at the injection site or have an allergic reaction to the contrast administered for the CT/MRI. Serious side effects are rare but may include anaphylaxis or a severe allergic reaction. It is important to inform your healthcare provider if you have any allergies or medical conditions before the scan.

However, as with any medical procedure involving radiation, there are some risks to consider. PET scan is not generally undertaken for pregnant women unless patient has terminal illness. If pregnancy is suspected, urine pregnancy test needs to be done prior to scheduling patient for PET scan. Kindly discuss your case with nuclear doctor.

The length of a nuclear medicine procedure can vary depending on the specific test being performed. Some procedures may take only a few minutes, while others may take more time with interval gaps.

Turnaround time for PETCT scan typically is 2 hours from the time of injection to relieving the patient from dept. After injection patient is taken up for imaging after 45 minutes to 60 minutes. Head to mid-thigh imaging is done for hole body scan. Each PETCT takes 15 – 20 min to complete. At times, delayed scans are acquired based on initial PET findings after 1 -2 hours of scan.

The results of nuclear medicine scans will be provided to the patient in a timely manner from the front desk. This will include a formal printed report with images. Gamma scans are reported and issued on the same day while PET reports will be issued within one or two working days. Direct communication with our nuclear medicine physicians may be sought in case of urgent PET cases for a provisional verbal report on the same day.

In most cases, patients can resume normal activities immediately after a nuclear medicine procedure. However, certain specific instructions may be given depending on the test that was performed. It is important to follow any instructions provided to ensure the best possible outcome. Radiation safety precautions may be advised for longer periods of time for therapeutic Nuclear Medicine procedures.

Yes, all nuclear medicine procedures, getting the previous scans/ reports/ CD to the department is important. Patient has to bring all relevant reports on the day of test, failing which it will be very difficult to compare and issue the reports in a timely manner. In PET scan, old reports are extremely important in interpretation of the current scan as the response evaluation will depend on the changes in the initial disease burden. For the patients to be classified to have a good response to treatment or disease progression, reviewing the prior imaging studies are vital.

  • It is a privilege to have both PETCT and PETMR in same centre so that one can decide the right scan. All cases that require exquisite anatomical details can be obtained by PETMR in a single scanning session. There is no need to undergo an additional MR scan.
  • Patients with sarcoma/ lung/ breast cancers etc. are ideal cases for PETMR.
  • Young patients/ patients who need repeated PET scans, can undergo PETMR as radiation exposure is minimum.
  • Patients with suspected brain lesion.

Academy

The Department also gives importance to research and development, continually striving to advance the field of nuclear medicine. Research efforts involving exploring new radiopharmaceuticals, refining imaging techniques, or investigating innovative applications such as theranostics, which is a combination of diagnostics and targeted therapy.

Moreover, the Department provides education and training programs for medical professionals (MD nuclear medicine) and technologists, ensuring the continued advancement and dissemination of knowledge in the field of nuclear medicine which in turn contribute to improved patient outcomes and quality of life.

Contact Us

Phone: 0484-2852001, 2852002 
Email: nuclearmed@aims.amrita.edu

Doctors

Dr. P. Shanmuga Sundaram
Clinical Professor and Head (Consultant)
DRM, DNB (NMed), MNAMS, FANMB, FICNM
Dr. Padma Subramanyam
Clinical Professor (Consultant)
DRM, DNB (NMed), MNAMS, FANMB
Dr. Manjit Sarma
Clinical Associate Professor
DRM, DNB (NMed), FEBNM, FANMB
Dr. Parvathy Pavithran
Clinical Assistant Professor
MD (NMed)
Dr. Ramkesh R
Assistant Professor