1, you have heard of hospitals have nuclear medicine? Into the hospital, we all know the internal medicine, surgery, will also know the laboratory, radiology, etc., to see a doctor also know which section to go. But when it comes to nuclear medicine, many people may not have heard of. What does nuclear medicine do? Does it examine or treat diseases? What kind of diseases can it treat? Nuclear medicine is a department that diagnoses and treats diseases using modern nuclear medicine techniques. Due to the relative economic backwardness of our country, nuclear medicine departments are mostly concentrated in large hospitals, and there are few nuclear medicine departments in small and medium-sized hospitals. Nuclear medicine is a kind of science of diagnosing and treating diseases by using drugs labeled with radionuclides, which is the product of medical modernization and the application of nuclear technology in the field of medicine. Nuclear medicine is a very rapid development of an emerging discipline, radionuclide tracer technology is the most basic technology of nuclear medicine. 2, radionuclide tracer technology is how? Radionuclide tracer technology is the essence of nuclear medicine, whether diagnosis or treatment are closely related to this technology. In fact, we are not unfamiliar with tracer technology. For example, tracer technology is used to observe the habits of wild pandas in nature. Scientists catch the wild panda, put a radio transmitter on it, people in the room through the instrument can be detected by the whereabouts of pandas, the radio transmitter is a tracer. As you can imagine, as a tracer, it must be very light, very small, and cannot be detected by the panda, nor can it affect and interfere with the panda’s behavior and function. The tracer used in nuclear medicine is not a radio transmitter, but a radionuclide. By attaching the radionuclide to some compound, it becomes a radiopharmaceutical, and by introducing it into the body, we can detect the distribution of that drug in the body through instruments outside the body. If you want to know about the heart, we will put the radionuclide and like to the heart of the drug together, if you want to find the tumor can also be connected to the radionuclide pro-tumor drugs, so the use of radionuclide tracer technology can be observed to the patient’s organs or tissues of the metabolism and function. 3.What kind of examination can nuclear medicine SPECT do? It can understand the function of major organs such as heart, kidney, liver, gallbladder, thyroid, etc.; it can understand the blood flow and perfusion of myocardium, brain, lungs, etc.; it can understand and determine the existence of tumor, lymphatic metastasis and bone metastasis, etc. It can understand and determine the function, blood flow and metabolism of all the relevant organs and tissues. Do different tests to understand the function and metabolism of different purposes using different varieties of radiopharmaceuticals, a very large number of species; and labeled radionuclides are often very few kinds. 4, what is the difference between nuclear medicine imaging and radiography, ultrasound methods? The difference is very big, is fundamentally different. Nuclear medicine imaging depends on the blood flow of organs or tissues, cell function, cell number, metabolic activity and excretion of drainage and other factors, is a functional metabolic imaging. CT, MR, ultrasound and other examinations are mainly through the display of anatomical and morphological changes in the organs or tissues, although the resolution is very high, but the changes in functional metabolism are not as good as nuclear medicine examination. 5. Is it safe to apply radiopharmaceutical examination? It is very safe. There are two main factors that cause the insecurity of various imaging examinations: one is the influence of the chemical composition of the drug, mainly allergic reaction and toxic reaction; one is the radiation caused by radioactivity. As the nuclide tracer technology is very sensitive, the chemical composition of the radioactive drugs used in nuclear medicine is extremely small, almost negligible. Therefore, it will hardly cause allergic and toxic reactions. Nuclides used in nuclear diagnosis mainly emit gamma rays, which are characterized by strong penetrating ability and little damage to the body. For example, to do nuclear medicine vesicoureteral reflux imaging, the absorbed dose received by the patient is only 1% of the X-ray cystography. We all know that X-ray examination is safe for patients, then nuclear medicine imaging examination is even more so. 6, nuclear medicine examination is very expensive ah? Most of the nuclear medicine imaging examination is a few hundred dollars, there are also a few thousand dollars or even about ten thousand yuan examination, intuitive feeling is indeed very expensive ah. The price mainly depends on the cost. Whether or not such an expensive test is worthwhile depends on how useful it is in the overall diagnostic and treatment process and whether it ultimately saves the patient money or costs money. For example, whole-body bone imaging in nuclear medicine is a very sensitive method for early detection of bone metastases from tumors, and it costs several hundred dollars to do one. However, it can detect bone metastases and avoid many unnecessary surgeries. And the expense of reducing the number of wrong surgeries is far greater than the expense of doing bone imaging. Not to mention that the damage caused to the patient by the surgery that should not have been done is incalculable. For example, patients with coronary artery disease will avoid unnecessary catheterization interventions after nuclear medicine myocardial perfusion imaging. While nuclear medicine exams cost about$2,000, catheterization interventions often cost tens of thousands of dollars. Reducing the risk of restenosis from catheterization and post-procedure restenosis is critical to the patient’s prognosis. 7.What is whole body bone imaging? Bone imaging is one of the most commonly used imaging tests in nuclear medicine, with a history of more than 30 years, accounting for one-third of the workload of nuclear medicine imaging in general hospitals at home and abroad. It is a technique of injecting osteophilic radiopharmaceuticals into the body from a vein and then imaging the whole body with special equipment. It can clearly show the morphology of bones in the whole body, and can reflect the blood supply and metabolism of bones, so it has a very important value for the diagnosis of various bone diseases and the observation of treatment effect. 8.What problems can whole body bone imaging help us solve? For patients with malignant tumors, it can detect bone metastases at an early stage, as well as some malignant tumors such as prostate cancer, breast cancer and lung cancer patients’ pre-treatment staging and post-treatment follow-up; for the diagnosis of unexplained bone pain (to exclude bone tumors); in addition, for the fine fractures that are difficult to be found by X-ray, such as fractures of the ribs, phalanges, and phalanges; Bone image can also observe the survival of the transplanted bone as well as follow-up of the artificial joints after replacement, and so on. The follow-up of artificial joint replacement and so on. 9.What do patients need to do before whole-body bone imaging examination? After the injection of imaging agent, the patient needs to drink more water, generally within two hours after the injection of about 500-1000ml of water, urination should be to prevent urine contamination of clothing and body, if found contaminated should be replaced in a timely manner of contaminated clothing and contaminated skin should be cleaned locally and then do the examination, and before the examination of the exhaustion of urine, and at the same time, the removal of the body of the metal objects such as necklaces, keys, coins in order to prevent the impact of the results of the examination. If the patient has used barium during the radiology examination in recent days, the patient should drain it before the examination. 10.What are the advantages and disadvantages of whole-body bone imaging compared with X-ray bone film? The main advantage is that it has a high sensitivity in the detection of bone disease and can show the presence of lesions much earlier than the abnormalities on X-ray. In most cases, bone imaging can detect bone metastases at an early stage, usually 3-6 months or even earlier than X-ray; because a single imaging can understand the situation of the whole body bones, so it can detect lesions beyond the scope of X-ray examination, in addition, in some hidden or subtle fracture such as crack fracture of ribs and fracture of the navicular bone of the wrist, which can not be detected by the X-ray at the beginning, and can be detected only in the follow up review. In addition, some hidden or subtle fractures such as cracked rib fractures and wrist navicular fractures cannot be detected initially by X-ray, but only during follow-up examinations. The main disadvantage is that the specificity is not high, that is to say, almost all bone diseases will show abnormal distribution of radioactivity on bone imaging, so it is difficult to make a clear diagnosis of bone disease only based on the isolated localized increased (or decreased) radioactivity area on bone imaging. 11.Do all patients with malignant tumors need to undergo whole body bone imaging before surgery? For most of the patients diagnosed with malignant tumors outside bone, especially some tumors that most often metastasize to bone, such as breast cancer, lung cancer, gastric cancer, thyroid cancer, prostate cancer, rectal cancer, etc., no matter whether there are symptoms of bone pain or not, those who have the condition should carry out the preoperative bone imaging examination, to know whether there is bone metastasis, in order to decide the treatment plan. 12.Is it necessary to do whole body bone imaging examination for malignant tumor patients even though they do not have bone pain symptoms after treatment? For the above malignant tumor patients with the most frequent bone metastasis, once bone pain occurs, everyone can think of doing bone imaging as early as possible to exclude bone metastasis. However, is it necessary to do bone imaging for patients without bone pain? The answer is still necessary. The answer is that it is still necessary because about 19%-34% of patients have bone metastasis without bone pain. Therefore, in the first few years after the onset of the primary tumor, do not wait until bone pain occurs to think of bone imaging. 13. Are all abnormalities in bone imaging of tumor patients bone metastases? Since bone imaging has the characteristics of high sensitivity and low specificity in detecting osteogenic lesions, some benign bone diseases can also be manifested as abnormal bone imaging. Commonly seen in fractures caused by trauma; various inflammatory diseases such as osteomyelitis, bone abscess, etc.; benign bone tumors such as osteoid osteoma, bone cysts, osteochondroma; some arthritis can also appear abnormal manifestations, such as degenerative osteoarthritis, rheumatoid arthritis and so on. In addition, some soft tissues outside the bone can also take bone imaging agent. In conclusion, when the tumor patient’s bone image appears abnormal, don’t be too nervous, combine with the medical history and related imaging data to make a correct judgment. 14.What is nuclear myocardial perfusion imaging? Nuclide myocardial perfusion imaging is a diagnostic imaging method, which has the advantages of simplicity, non-invasiveness, safety and high diagnostic accuracy. Through nuclear myocardial perfusion imaging, the perfusion of the myocardium and the functional status of the myocardial cells can be observed, that is to say, it is possible to directly see whether there is ischemia in the myocardium. 15.How can nuclear myocardial perfusion imaging help patients with symptoms such as precordial discomfort, pain, and breathlessness? These symptoms may be caused by myocardial ischemia in coronary artery disease. Therefore, nuclear myocardial perfusion imaging can help patients with these symptoms to accurately diagnose with or without coronary artery disease, the accuracy rate is more than 90%, or even more than 95%, so that they can get timely treatment. 16.What else can nuclear myocardial perfusion imaging do for patients with coronary artery disease? For patients who have been diagnosed with coronary artery disease, nuclear myocardial perfusion imaging can help assess your prognosis and estimate your risk. That is, if your myocardial perfusion is normal, the prognosis for a cardiac event (myocardial infarction, sudden cardiac death, etc.) within one year is less than 1%, which means that the prognosis is good and relatively safe. 17.How can nuclear myocardial perfusion imaging help patients with coronary artery disease choose treatment? Nuclear myocardial imaging can help you determine the treatment plan. That is: if your myocardial perfusion image is normal, preferred internal medicine treatment; if there is myocardial ischemia, you should carry out coronary stenting or coronary artery bypass grafting. 18.What is the role of nuclear myocardial perfusion imaging for patients who have been stented or had bypass surgery? Nuclear myocardial perfusion imaging can evaluate the efficacy of treatment; it can see whether there is new myocardial ischemia. 19. Why is it necessary to perform a load test at the same time as nuclear myocardial perfusion imaging? Generally speaking, even if the stenosis of coronary artery reaches 70-80%, myocardial ischemia may not be manifested under resting condition, but only when the oxygen consumption of the heart increases, i.e., under load (exercise, exertion, emotional excitement, etc.) myocardial ischemia will be manifested. Therefore, in order to accurately diagnose myocardial ischemia in coronary artery disease, in nuclear myocardial perfusion imaging to do load test. 20, what is the load myocardial perfusion imaging? It is to intervene in the myocardial perfusion imaging load test. Load test is divided into exercise load test and drug load test two kinds, the purpose is to make the patient in the heart in the load state, if there is myocardial ischemia occurs, it can be reflected by myocardial perfusion imaging, in order to get an accurate diagnosis. 21.What should the patient pay attention to before the load test? Before the load test, patients should stop using vasodilating drugs and heart rate inhibiting drugs (e.g. nitrates, angiotensin inhibitors, beta blockers, etc.), which may affect the load test and thus the accuracy of the diagnosis of myocardial ischemia. 22. What is the procedure of nuclear myocardial perfusion imaging? Nuclide myocardial perfusion imaging generally takes two days to complete, load and resting imaging are performed separately. The load test or resting state intravenous injection of imaging agent (radionuclide), 20 minutes – half an hour after eating a fatty meal (fried eggs, whole milk, chocolate, etc.), 90 minutes or so myocardial perfusion imaging. 23.What should the patient pay attention to during nuclear myocardial perfusion imaging? The patient should pay attention to: eat vegetarian food for breakfast on the day of the imaging examination, stop using vasodilating drugs and beta-blockers 1-2 days before the examination, bring fat meals such as fried eggs or milk to the Department of Nuclear Medicine on the day of the examination; it is not recommended to do the drug-loading test (adenosine, Pansentin) for those with bronchial asthma. 24.What is the role of nuclear myocardial imaging for myocardial infarction patients? In patients with myocardial infarction, the purpose of nuclear myocardial imaging is to assess the presence or absence of viable myocardium in the infarcted area in order to determine the next step in the treatment program. The best method available is nuclear myocardial metabolic imaging. 25. What is nuclear myocardial metabolic imaging? Surviving myocardium in the infarct zone is ischemic and has an increased ability to take up glucose. Nuclear myocardial metabolic imaging is to detect the presence or absence of glucose uptake cardiomyocytes in the infarcted area and accurately determine the presence or absence of viable myocardium in the infarcted area. 26.What is the difference between nuclear myocardial perfusion imaging and multi-row CT and coronary angiography? Nuclear myocardial perfusion imaging and multi-row CT and coronary angiography can be used to diagnose coronary artery disease. Nuclear myocardial perfusion imaging mainly shows whether the myocardium is ischemic or not, and whether the function of myocardial cells is normal or not. On the other hand, multislice CT and coronary angiography mainly show the presence of plaque, calcification and stenosis in the coronary arteries. Let’s say: the coronary arteries are like irrigation canals, the myocardium is like rice, farmers are more concerned about the growth of rice, if the rice grows well, indicating that the supply of nutrients and water is sufficient, farmers do not need to go to the repair of the canals; once which piece of rice in the paddy field appeared to wither, indicating that the lack of nutrients in this paddy field, the farmers need to go to the repair of the supply of this paddy field of the canal on the can be, but not necessary to repair the entire land canals. Therefore, nuclear myocardial perfusion imaging is to observe the growth of rice (myocardial ischemia or not), while multi-row CT and coronary angiography are to observe whether there is a blockage of the water channel (whether the water channel is blocked or not). 27. What is the importance of understanding myocardial ischemia for coronary patients? Understanding myocardial ischemia can help patients accurately diagnose coronary artery disease, but more importantly: to help patients with coronary artery disease to determine the “criminal vessel”. Because, to determine the site of myocardial ischemia, to determine the diseased coronary arteries. 28. What is the significance of identifying the “offender vessel” of the heart? Atherosclerotic coronary artery disease is a widespread condition that requires early treatment with coronary revascularization to prevent cardiac events once myocardial ischemia has occurred. Before performing coronary revascularization, doctors need to find the “culprit vessel” causing myocardial ischemia in order to place coronary stents and perform bypass surgery. Therefore, before performing coronary revascularization, nuclear myocardial imaging is clinically important to identify the “culprit vessel”. 29. What is nuclear lung perfusion imaging? Nuclide pulmonary perfusion imaging is: through the intravenous injection of a small amount of radioactive protein particles, which enter the pulmonary artery with the blood flow, and temporarily stays in the pulmonary capillaries, through a special imaging equipment (SPECT) can show the smoothness of the pulmonary artery and branches. Nuclide pulmonary perfusion imaging can accurately determine the location, extent and degree of pulmonary artery and branch blockage. 30.Pulmonary embolism is an obstructive disease of the pulmonary arteries, which can be diagnosed by pulmonary perfusion imaging, why do we need pulmonary ventilation imaging? Pulmonary perfusion imaging is a very good way to diagnose pulmonary embolism, but its specificity is low, that is, all the diseases that can cause pulmonary artery obstruction, such as: chronic bronchitis in the elderly, tuberculosis, lung tumors, lung infections, etc., will lead to abnormal pulmonary perfusion imaging, these diseases will also cause abnormal pulmonary ventilation imaging, and pulmonary embolism pulmonary ventilation imaging is mostly normal, therefore, the combination of pulmonary perfusion imaging and pulmonary ventilation imaging can greatly improve the diagnosis of pulmonary embolism. Therefore, the combined application of pulmonary perfusion imaging and pulmonary ventilation imaging can greatly improve the accuracy of the diagnosis of pulmonary embolism. 31.Why should nuclear venous imaging of both lower extremities be performed at the same time when performing nuclear pulmonary perfusion/ventilation imaging for the diagnosis of pulmonary embolism? Most of the emboli that cause pulmonary embolism come from blood clots in the veins of the lower extremities. The advantage is that while diagnosing pulmonary embolism, it also clarifies the source of the emboli in the patient, which makes it easier to treat the cause of the disease. The other is that it can reduce the use of radiopharmaceuticals once, that is to say, it reduces the trouble of the second examination and saves a drug cost. 32.What are the main nuclear medicine methods used to check the genitourinary system? Nephrogram, renal dynamic imaging, renal static imaging, vesicoureteral reflux imaging, scrotal imaging and uterine tubal imaging. The most commonly used are nephrogram and renal dynamic imaging. 33. What are the main clinical problems that nephrogram and renal dynamic imaging are used to examine? Nephrograms or renal imaging can be used to understand the function of the kidneys and the degree of renal impairment, and to determine whether there is obstruction of the urinary tract. Renography also calculates the glomerular filtration rate (GFR) and the effective renal plasma flow (ERPF), which are two important parameters for determining kidney function. 34. How do nuclear medicine methods differ from other renal function tests (e.g., blood creatinine and urea nitrogen measurements)? Nephrogram and renal dynamic imaging both utilize the principle of isotope tracer technology to observe the kidney and urinary tract. The tracer drugs used are excreted from the urinary system and their passage through the kidneys and urinary tract reflects the process of urine production and elimination. The information obtained is more in line with the condition of the urinary system in the physiological state, and the results are more accurate. In addition, some of the commonly used clinical laboratory tests of renal function can only get the function of the sum of the two kidneys, and cannot understand the specific situation of each kidney. However, nephrogram and renal dynamic imaging can observe and judge the function of each kidney and the condition of each side of the urinary tract, which is a very valuable advantage in clinical practice. 35. Which is better, nephrogram or renal imaging? Nephrogram is a non-visualized functional examination method, which is low cost but with higher error and less accurate results. Renal dynamic imaging can get the images of both kidneys and bilateral urinary tracts, the results are informative, and the sensitivity and accuracy are significantly higher than that of nephrogram, so renal dynamic imaging is more often used in clinical practice nowadays. 36.What preparation is needed for renal dynamic imaging? No special preparation is needed before the examination. It should be noted that because renal dynamic imaging is a functional test, it should be performed in the normal physiological state of the human body, so the patient should not be fasting, and should have a normal diet, otherwise it may cause errors in the results. 37. Can dialysis patients undergo renogram and renal dynamic imaging? These two kinds of nuclear medicine examination are very safe and the drugs used have little effect on the kidney. Therefore, patients with severely impaired kidney function can also undergo these tests. 38. Can children undergo renal dynamic imaging? Because the imaging agent used in renal dynamic imaging is cleared from the body quickly, the half-loss period is very short, and it is very safe to the human body, so children and even newborns can receive renal dynamic imaging examination. Since the examinee has to remain motionless during the examination, some sedative drugs need to be applied before the examination for young children who cannot cooperate with the examination. 39. Can renal dynamic imaging be done immediately after intravenous pyelography or enhanced CT examination? Intravenous pyelography or enhanced CT requires injection of contrast medium, which has a transient effect on renal function. If renal dynamic imaging is performed immediately after these examinations, it may cause errors in the results of renal dynamic imaging, so renal dynamic imaging should not be performed on the same day as the above examinations. 40. Can renal dynamic imaging detect renal vascular disease? Part of the image data of renal dynamic imaging is the observation of renal arterial blood flow, which can initially understand the situation of renal blood vessels, and help to infer renal vascular lesions through the judgment of renal function. On the basis of renal dynamic imaging, captopril test can also be performed to improve the diagnosis of renal vascular pathology. 41. Are there any health risks associated with repeated renal imaging? The results of renal dynamic imaging can help to determine the clinical efficacy, so the patient may repeat renal dynamic imaging several times. Currently, the commonly used renal dynamic imaging agents are 99mTc (99mTc)-labeled, the physical half-life of this nuclide is only 6h, plus the agent is rapidly excreted from the urinary system after it enters the bloodstream, and very little is left in the body at the end of the examination. Through the continuous removal and decay, to 24h after the body of the imaging drug has been basically no. 99mTc ray energy is not high (140 keV), and its stay in the body of the time is very short, so the subject to the irradiation is very little, there is no effect on the body. It is safe even for multiple examinations.