Nuclear Medicine

It use of radioactive elements for the purpose of diagnosis and treatment. It traces the physiology of any organ system and detects the abnormally behave of manifest as structural change
1.    Diagnostic purposes
2.    Therapeutic purposes

Nuclear Medicine for Diagnosis

This is important in the accurate staging of tumours, identification of relapse or progression of the disease as well as defining metastatic disease. All these processes are done in two ways:

1) Positron Emission Tomography (PET)/Computed tomography (CT)

• F18 FDG-PET: It is a common PET tracer that mimics glucose and assists in the identification of areas where metabolism is increased usually due to the presence of cancerous cells.
• F18 DOPA: A tracer that measures brain function particularly dopamine production which helps identify Parkinson’s diseases and some tumours.
• F18 Choline: Tracer which targets cells with high choline metabolism like prostate and liver cancers.
• F18 FES: A tracer helpful for monitoring hormone-receptor-positive breast cancers including other estrogen-dependent tumours.
• GA68 Ga-68 FAPI: This tracer targets activated fibroblasts leading to inflammation and fibrosis seen in various cancers.
• GA68 DOTANOC: It attaches itself to somatostatin receptors located on the surface of neuroendocrine tumours. These receptors appear specifically on neuroendocrine tumours and certain others.
• GA68 TRIVE XIN: Currently being examined for imaging neuroendocrine tumours it may present superior performance than other previous tracers employed during its development,
• Ga-68 Exendin: A receptor GLP-1-based radiotracer useful for pancreatic neuroendocrine tumour diagnosis and planning treatment options.
• Ga-68 Ubiquicidin: An under-development radiotracer specific for key cellular processes in malignant diseases that can improve the detection and characterization of cancers. 

2) Gamma Camera

• Thyroid Scan: This scan makes use of radioactive iodine or technetician to assess the functioning of the thyroid by identifying nodules, hyperthyroidism or hypothyroidism.
• DTPA Scan (Diethylene Triamine Pentaacetic Acid): This is a test that evaluates kidney function and detects any blockages or abnormalities within the urinary system.
• DMSA Scan (Dimercaptosuccinic Acid): This scan helps doctors determine if there are any scars on kidneys and how well they are working, especially in children.
• Bone Scan: It helps in detection of using bone metastases, tumours, infections or fractures radioactive tracers.
• Myocardial Perfusion Scan: It measures blood supply to the muscles of the heart thereby assisting in the diagnosis of coronary artery disease or evaluation of the heart’s performance after an attack.
• Hepatobiliary Scan: The liver, gallbladder, as well as bile ducts, may all be assessed for inflammation, infection or obstruction using this procedure.
• Octreotide Scan: A nuclear scan where a radioactive material binds somatostatin receptors assessing neuroendocrine tumors and treatment response.
• Salivary Gland Imaging: It is used to check salivary glands for blockage, or swelling due to infection or tumour growth.
• Trodat Brain Scan (Technetium-99m Trodat): It is done when Parkinson's disease is suspected because it helps establish whether dopamine transporters are present within the brain cells thus helping with investigating dementia   cases as  well.
• GI Bleed Scan: To locate the source of bleeding through the gastrointestinal tract radioisotope scanning technique is employed.
• MUGA Scan (Multigated Acquisition Scan): This is a scan that measures the effectiveness of pumping by the left ventricle to evaluate heart function.
• Brain Scan: This scan can have different tracers according to what purpose it is performed for and will help determine the state of brain functioning, and blood flow and also detect abnormalities such as tumours or infections in it.

Therapeutic Nuclear Medicine

Therapeutic nuclear medication is a type of cancer treatment that uses radioactive isotopes to identify and destroy or reduce the size of cancer cells. Small quantities of radioactive materials are introduced into the body, often by injection or swallowing. These substances accumulate in cancer cells or certain organs more than others, discharging focused radiation that damages cancerous cells while avoiding damage to healthy tissues.

1) Low-dose Therapy

•  I-131 Therapy: This treatment cures hyperthyroidism (overactive thyroid gland) and some types of thyroid cancer using radioactive iodine.
•  Samarium Therapy: This treatment eases bone metastases pain from cancers such as multiple myeloma and prostate by use of radioactive samarium.

2) High-dose Therapy

•  I-131 Therapy for Thyroid Cancer: After surgery, this high-dose therapy employs radioactive iodine to obliterate thyroid tissue, especially in differentiated thyroid cancer cases.
•  Lu-PSMA Therapy (Luthetium-PSMA): It targets prostate-specific membrane antigen (PSMA) on prostate cancer cells with radioactive lutetium, seeking to eliminate them.
•  Lu-DOTA Therapy for Neuroendocrine Tumors: By binding somatostatin receptors on neuroendocrine tumours this therapy utilizes radioactive lutetium linked with a DOTA chelator.
•  Actinium-PSMA Therapy (Actinium-225 PSMA): Radioactive actinium is used by this emerging therapy to target PSMA on prostate cancer cells which could offer stronger treatment options.
•  Ac-PRRT (Astatine-211 PRRT): Potential benefits over conventional therapies are provided by this under-development therapy that utilizes radioisotope astatine combined with peptides targeting neuroendocrine tumours.
•  I-131 MIBG Therapy: Certain kinds of neuroendocrine tumours notably pheochromocytomas can be destroyed with this method where radioactive iodine is attached to metaiodobenzylguanidine (MIBG).