Our Speciality

Nuclear Medicine differs in many ways from other imaging modalities. Basically the images are formed by the functions of the organs and hence the scans or images give the functional status of the organ at the time of taking the image. The gray / colour scale ( intensity of darkness / colour in the hard copy ) depends on many factors and hence can not be read like a conventional x-ray film. The kinetics of the radio pharmaceuticals used, the time of acquiring the data for the image, computer setting and many other information is required to assess a nuclear medicine image. Some applications showing specific contribution of Nuclear Medicine as compared to other procedures, are given bellow :

Although fine needle aspiration cytology ( FNAC ) and ultrasonography (US ) is useful in many situations, Tc-99m thyroid scan has a distinct role in diagnosis and management of thyroid disorders. Apart from giving morphological information it can differentiate thyroid tissue from other tissues like cancer and identify hot and cold nodules. Radio labeled pentavalent DMSA, MIBG or CEA are used for diagnosis and management of Medullary Thyroid Ca and thallium or Tc-99m MIBI is used for undifferentiated Thyroid Cancer.

ThalliumTechnetium Subtraction Scan offer a unique approach to study parathyroid hyperplasia and adenoma. With the introduction of Tc-99m MIBI the parathyroid imaging has become simpler and more specific. This is important for ectopic localizations which are difficult to identify with any other imaging modality. For the treatment of thyroid disorders Radioiodine is used extensively both in hyperthyroidism and in thyroid cancer. The is most cost effective as compared to other methods of treatment.

Cardiac studies using agents like Thallium-201, Tc-99m MIBI or Tc-99m-Tetrofosmin can diagnose coronary artery disease with greater sensitivity and specificity than TMT and Stress- Echocardiography. It eliminates the need for angiography (and possibly coronary bypass) in many patients. It can accurately assess benefits of coronary artery bypass surgery and can be repeated as and when necessary without any risk. The left ventricular functions can be assessed with greater accuracy in an operator independent way by MUGA study where Tc-99m labeled RBCs are used. It can give information about the global and regional wall motion abnormalities and is also important for patients receiving cardiotoxic drugs in course of their cancer treatment.

As a simple procedure abdominal scan can be used to detect unknown G.I. bleeding site in the abdomen, detect Meckel’s diverticulum and quatify severity of gastro esophageal reflux. Although the presence of cholelithiasis is best seen by ultrasound , hepatobiliary study using radio isotope techniques is the most sensitive method to demonstrate acalculus cholecystitis. This procedure is also the best method for evaluation of biliary atresia, post cholecystectomy syndrome, detection of biliary leak and assessment of sphincter of Oddi dysfunction.

Tc-99m DTPA renal sequential scintigraphy can quantitate absolute and differential renal function. Even 5 to 10% of the renal function can be detected while IVP may report a kidney to be non functional if the function is decreased by 60% . Blood urea and creatinine values continue to remain within normal range even if kidney function has been deranged by 60 to 70 % ! Nuclear Medicine measures directly blood flow and filtration rates in each kidney separately In characterizing subrenal obstruction, renal scintigraphy is superior to the conventional IVP as it can differentiate functional or congenital dilatation of pelvis from real obstructive uropathy. Many unnecessary surgeries in case of functional obstruction can be avoided.

Tc-99m DMSA scan identifies scars in UTI patients much earlier than Ultrasonography.

Captopril renal study is a non-invasive method to screen hypertensive patients for the presence of Renovascular Hypertension (RVH )and to determine whether revascularization is going to control hypertension.

Bone scan is a simple and highly sensitive technique to determine any abnormality in skeleton. It become positive with as little as 2 to 5% alteration in bone metabolism unlike in x-ray which requires alteration of at least 30% of bone mineral content before the lesion can be appreciated. To survey a patient for skeletal metastases, bone scan is the method of choice as it not only looks at the complete skeleton but also imparts less radiation burden as compared to that received in a complete body skeletal survey by x-ray. Skeletal Scintigraphy plays an unique role in detection of sports injuries , avascular necrosis, non-union, viability of a bone graft etc.

Nuclear medicine offers noninvasive method for diagnosis, staging, treatment and follow-up of oncology patients. A technique called scintimammography is more specific in the diagnosis of breast cancer than X-ray mammography or MRI and can provide required information in dense breasts or with previous surgery.

In cerebral glioma follow-up, conventional CT or MRI may not be able to differentiate radiation necrosis from recurrence of the tumor. Brain SPECT using Tc-99m GHA, TI-201 or MIBI can identify functioning cancer tissue in the brain. Introduction of PET has of course revolutionized management of oncological patients.

It is also important to note that nuclear medicine approaches are simple, non invasive and in many cases can provide both morphological and functional information and can be complimentary to various other diagnostic procedures. The radiation dose to the patients and organ in most cases is far less than similar investigations using x-rays.

Because of all these advantages, there has been a quantum jump in Nuclear Medicine facilities in all developed countries including some of our neighboring countries like China, South Korea and Japan. An estimated 10 to 12 million nuclear medicine imaging and therapeutic procedures are performed each year in the United States. This means that about 36,000 diagnostic procedures are performed every day and nearly 100,000,000 laboratory tests using radio isotopes are also conducted. There are approximately 2700 full-time equivalent nuclear medicine physicians and 14,000 certified nuclear medicine technologists working in USA. In Germany having a population of 83 million approx. 126,000 radio nuclide applications for therapeutic purposes alone are performed per year.

In South Korea with a population of 48 mill approx. 300,000 in vivo studies are performed per year with more than 250 Gamma and PET cameras.

China has more than 950 functioning Nuclear Medicine centres with rapid increase in number of in vivo and in vitro investigations.

Orthopedic surgery corrects problems that arise in the skeleton and its attachments, the ligaments and tendons. It may also deal with some problems of the nervous system, such as those that arise from injury of the spine. These problems can occur at birth, through injury, oras the result of aging.

Medical doctors trained to deal with such problems are called orthopedic surgeons or orthopedists (the terms are used interchangeably). With the development modern surgical techniques, orthopedic surgeons expanded their role to include surgery involving the bones and related nerves and connective tissue.Choosing an orthopedist is an important step in seeking treatment. Patients looking for a qualified orthopedist should ask if the physician is "board certified" by his or her accrediting organization.