The UOSD Nuclear Medicine is a simple departmental structure within the Department of Diagnostics and Pharmaceutical Assistance.
Nuclear medicine tests require the administration of small amounts of radioactive substances, whose metabolic fate is capable of revealing numerous pathologies.
Radioactive substances are usually injected into a vein in the arm. After a more or less long waiting period depending on the type of investigation, the examination is carried out (which in technical terms is called scintigraphy). It is almost never necessary to undress, examinations are almost always performed in a lying position.
The instrument used (the gamma camera), unlike X-ray instruments, does not emit radiation but detects the radiation emitted by the patient after the injection: for this reason, contrary to radiological investigations, the amount of radioactivity absorbed is fixed and does not depend on the duration of the examination, nor on the number of images obtained.
The tests carried out are not dangerous because the amount of radiation received by the patient is very small and the injected substances never have toxic effects and generally do not give rise to allergic reactions.
Pregnancy is an absolute contraindication to performing scintigraphic examinations only in the first three months of gestation. In any case, if you know you are pregnant or believe you may be, it is essential to notify the department staff before the injection of the radioactive substance is carried out.
With regard to breastfeeding, there is a possibility that the injected radioactive substance is secreted with milk. Also in this case it is necessary to inform the doctor of the service before performing the examination, to establish the most correct behavior to follow.
Children can also undergo these tests, in which case small amounts of the radioactive substance are used, in relation to their body weight: usually the dose of radiation absorbed by the child is less than or at most equal to that of a common radiograph.
The waiting time before starting the examination depends on the type of examination to be performed and can vary from a few minutes to a few hours: for this reason it may happen that patients who arrive at the ward later perform the examination first.
Generally, no special preparation is necessary; if the patient must appear fasting, he/she is forewarned at the time the appointment is scheduled.
For some exams it is necessary to stop taking certain medications: this possibility is always agreed with the doctor when booking the exam.
The performance of the tests is not at all painful: the only critical moment is the intravenous injection of the radiopharmaceutical.
The scintigraphic tests and the substances used for them practically never cause any unpleasant or unwanted reaction:it is therefore possible to return to normal activities without any problem. Conversely, it is advisable to avoid having prolonged and close contact with children for the rest of the day.
For most nuclear medicine examinations, no complicated preparation procedure is necessary, although some simple rules make the investigations more technically sound.
Services / Activities provided
The services / activities provided by the UOSD Nuclear Medicine are shown below, together with the method of carrying out the examination:
- Renal scintigraphy;
- Bone scintigraphy;
- Thyroid scintigraphy;
- Scintigraphy of the salivary glands;
- Perfusion lung scintigraphy;
- Perfusion myocardial scintigraphy.
Renal scintigraphy
To prepare for renal scintigraphy it is very important to be well hydrated. To ensure high urine flow, it is recommended to drink a lot in the hours before the test, preferably taking water (at least 3/4 litre). Fasting is not necessary, so you can have breakfast, except when the captopril test is scheduled, which requires fasting. For this examination, there are no known contraindications or significant side effects. In any case, it is good practice, before any intravenous injection, to report any allergic reactions suffered in the past.
Carrying out the examination: it is very important to bring with you the reports of previous instrumental and laboratory investigations (CT scans, urographies, ultrasounds, scintigraphies, blood chemistry dosages) relating to the pathology being studied.
The time required for the examination, which begins at the same time as the injection of the radiopharmaceutical, is approximately 40 minutes. The patient must lie on his back for 30 minutes, after which he is invited to empty his bladder; finally he returns to the bed to perform the last scintiphoto with an empty bladder.
The pharmacological test (when expected) involves an extension of the duration of the examination; in the case of the furosemide test (lasix) the duration reaches 90 minutes, extending the observation beyond the standard sequential scintigraphy; in the case of the captopril test the patient must appear 1 hour before the start of the examination, having to take the drug under controlled conditions.
Bone Scintigraphy
To undergo bone scintigraphy, no specific preparation is required, so you can have breakfast; however, it is necessary to maintain a high state of hydration throughout the morning by taking a large amount of liquids both before and after the examination and trying to urinate frequently; this helps to dispose of excess radioactivity.
Since the time required for the investigation is about 3-4 hours, it seems appropriate to provide a supply of water. If the three-phase method is used, the first two steps immediately follow the administration of the radiopharmaceutical while the late images are acquired after at least three hours, after the total body scan.
It is therefore a good idea to arm yourself with patience and bring something to read with you.
For this examination, there are no known contraindications or significant side effects. In any case, it is good practice, before any intravenous injection, to report any allergic reactions suffered in the past.
Carrying out the examination: it is very important to bring with you the reports of previous instrumental and laboratory investigations (CT scans, urographies, ultrasounds, scintigraphies, blood chemistry dosages) relating to the pathology being studied.
The survey is usually carried out with a total body method with a double-headed gamma camera, that is, with two longitudinal scans of the entire skeleton in a single pass; if necessary, targeted scintigrams are acquired in appropriate positions; the duration of the total body acquisition is about 12-15 minutes; that of the individual segments is variable between 5 and 15 minutes.
In particular cases, such as diagnostic completion, a Spec acquisition can be performed (20-30 minutes).
Thyroid scintigraphy
No specific preparation is required to undergo thyroid scintigraphy, so you can have breakfast. If the hormonal dosages must also be performed at the same time as the scintigraphy, fasting is scheduled from midnight.
The sampling must be carried out before the scintigraphy.
For this examination, there are no known contraindications or significant side effects. In any case, it is good practice, before any intravenous injection, to report any allergic reactions suffered in the past.
Carrying out the examination: it is very important to bring with you the reports of previous instrumental and laboratory investigations (CT scans, urographies, ultrasounds, scintigraphies, blood chemistry dosages) relating to the pathology being studied.
The time required for the investigation is about 30 minutes. After the injection of the radioactive tracer, it is necessary to wait about 15-20 minutes, after which the acquisition of the images takes between 5 and 10 minutes.
The survey is performed in a supine position, with a single-headed gamma camera. Only one image is usually acquired; if deemed necessary, targeted scintigrams are acquired in the appropriate position.
Salivary gland scintigraphy
No specific preparation is required to undergo salivary gland scintigraphy, but you must remain fasting. The examination involves a phase of stimulation of saliva with citric acid: it is therefore necessary to bring home 2 lemons, the juice of which will be administered to the patient during the investigation.
For this examination, there are no known contraindications or significant side effects. In any case, it is good practice, before any intravenous injection, to report any allergic reactions suffered in the past. It is very important to bring with you the reports of previous instrumental and laboratory investigations (CT scans, urographies, ultrasounds, scintigraphies, blood chemistry dosages) concerning the pathology being studied.
Performance of the examination: The total time for the investigation is about 60 minutes. The examination takes place in three phases: the first involves an intramuscular injection of atropine, a drug that causes the pharmacological blockade of salivation; after about 20 minutes the 40-minute scintigraphic examination begins, in which you will have to drink the previously prepared lemon juice.
The examination is performed in a supine position, as a single-headed gamma camera and requires a certain amount of patience and cooperation.
Perfusion lung scintigraphy
No specific preparation is required to undergo perfusion lung scintigraphy, but since these examinations are usually carried out in the early afternoon at our centre, it is preferable to have a light meal around 12:00 – 12:30, to allow sufficient emptying of the stomach.
No contraindications or significant side effects are known for this examination, but since substances derived from human plasma are used, it is good practice to report to the doctor any allergic reactions suffered in the past after intravenous injections or after transfusions.
This suggestion is particularly important for patients who are opposed to transfusions due to their religious beliefs.
It is very important to bring the reports of previous investigations with you. In particular, you should always have a very recent chest X-ray.
Conduct of the examination: the time required for the investigation is approximately 15 minutes. The examination is usually carried out in a supine position and begins immediately after the injection of the radiopharmaceutical. 4 or more images are acquired according to the situation encountered.
Perfusion Myocardial Scintigraphy
The examination of perfusion myocardial scintigraphy is divided into two parts that take place on two separate days at our centre. That said, extreme attention must be paid to the fact that in order to access this service, the following prerequisites must be met, in the absence of which the examination cannot take place:
- the prescription must be made by the cardiologist specialist who will provide a basic assessment showing the appropriateness of the request;
- on the basis of the diagnostic question, the specialist must specify whether the ergometric test associated with scintigraphy must be carried out in therapy or in pharmacological wash-out;
- the patient must submit all the documentation relating to their clinical and cardiological history (discharge letters for recent hospitalizations, reports of specific examinations such as coronary angiograms, hemodynamic studies, reports of bpaoc revascularization interventions, ptca, etc.);
- finally, you will have to provide a precise list of the drugs included in any ongoing therapy.
It is reiterated that since the investigation is based on a provocative test, patients without adequate documentation certifying the functional compensation status of the disease will not be admitted to take the exam.
Performance of the examination: the investigation is carried out in two sessions in a single day (at rest and under stress); usually the stress is physical (at the cycle ergometer); in patients unable to take the ergometric test, a provocative pharmacological test is performed, as decided by the cardiologist who performs the stress test.
The specific preparation for this session is always checked in advance by the cardiologist. No special preparation is foreseen for the examination at baseline.
The scintigraphic investigation begins 30 minutes after the intravenous administration of the radiopharmaceutical and lasts for about 30 minutes: the patient must remain lying down and immobile for the entire duration of the scan; in particular cases it is necessary to return to Nuclear Medicine after a few hours to complete the examination.
After the stress test, the patient must resume taking any discontinued drugs.
Opening Hours
The service is open from Monday to Saturday, from 7.00 am to 2.00 pm.
For confidentiality reasons, no information or anticipation of the results will be provided by telephone.
