Dr Alfred O Ankrah FCNP

Transcription

1 Dr Alfred O Ankrah FCNP

2 Outline Introduction Brief history of Nuclear Medicine in Ghana Current situation of Nuclear Medicine in Ghana Use of Nuclear medicine in various disciplines Future of Nuclear Medicine in Ghana

3 Objectives To increase awareness of nuclear medicine among clinicians To show some common indications for nuclear medicine Increase in referral of patients for nuclear medicine services

4 Introduction Uses unsealed radioactive source for diagnosis and therapy Role has evolved over the years- functional imaging rather than morphological imaging An analogue labelled with a radioactive material traces physiological or pathological process Trace quantities of radiopharmaceutical used so has no pharmacologic effect for imaging The process is either imaged or treated by this tracer

5 History in Ghana Introduced in Ghana mid 70 s under Dr Kwame Nkrumah His vision was to use radioisotopes for medical and nonmedical purposes Ghana Atomic Energy Commission was formed Technical cooperation between IAEA and GAEC Nuclear Medicine Unit established at KBTH Collaborative effort of GAEC, UGMS and MOH Unit of Department of Medicine and therapeutics

6 Nuclear Medicine in Ghana Rectilinear scanner was the first camera acquired A refurbished gamma camera was later provided by the IAEA In 2005 a brand new SPECT was again provided by the IAEA In vitro radioimmunoassay were also being carried out in the department

7 Current situation One functional single head camera All radioisotopes and radiopharmaceuticals imported Bone scan, thyroid scans renal scan are the main studies conducted Therapy with radioiodine is also undertaken Not covered under health insurance severely limiting patients access to care

8 Uses of Nuclear medicine Oncology Musculoskeletal Endocrinology Genitourinary Cardiac

9 Uses of Nuclear medicine Respiratory Hepatobiliary Gastroenterology Haematology Central nervous system

10 22 year female with breast cancer

11 Images of old gamma camera

12 Indications for bone scan Metastatic bone malignancy Primary bone malignancy and benign tumours Stress fractures and shin splints Non accidental trauma Reflex sympathetic atrophy Metabolic bone diseae Spondylolysis Avascular necrosis Osteomyelitis in non-violated bone Soft tissue calcification

13 Stress fractures

14 Shin Splint

15 Paget s disease

16 Soft tissue calcification

17 Superscan

18 Musculoskeletal disorders Infected prosthesis Ga-67 T-99m labeled white blood cells F-18FDG

19 Hyperthyroidism

20 Multi nodular goitre

21 Neonatal hypothyroidism

22 Renal scintigraphy Diuretic scintigraphy- functional significance of hydronephrosis and renal function ACE inhibitor scintigraphy Relative split function GFR determination Assessment of renal transplant- Urinary leaks Renal scars

23 Renogram

24 DMSA study

25 GIT studies Milk scan Esophageal motility studies Gastric emptying studies Colonic transit GIT bleed Merkel s diverticulum

26 Merkel s Diverticum

27 GIT bleeds

28 Hepatobiliary scintigraphy Acute cholecystitis Chronic cholecystitis Biliary leaks Choledochal cyst Biliary atresia Sphincter of Oddi dysfunction Duodonogastric reflus

29 Biliary atresia

30 Hepatobiliary scintigraphy following trauma

31 Cardiology Myocardial perfusion imaging Diagnosis of coronary artery disease Assess severity and extent Preoperative assessment Viability assessment Acute chest pain in the emergency situation Radionuclide ventriculography

32 Ischemia in the RCA

33 Ischaemia in the circumflex

34 Ischemia in the LAD

35 Bulls eye plot normal MPI

36 Bulls eye plot MPI with fixed defects

37 Pulmonary scintigraphy Acute pulmonary embolism Chronic pulmonary embolism Lung sequestration in children Pulmonary fibrosis and disease activity Differential diagnosis in HIV

38 Ventilation Perfusion Study (A) A normal ventilation and perfusion lung scan showing uniform uptake of both Technegas and [99mTc]-MAA (macro aggregated albumin) in the lung fields in both studies. (B) Multiple mismatched ventilation and perfusion regions consistent with multiple PE.

39 In-111Octreoscan

40 Metastatic pheochromocytoma

41 PET/CT in head and neck cancers

42 PET/CT in NHL

43 CNS Dementia Epileptic focus localization Cerebral reserve Brain death Herpes encephalitis Post traumatic injury Parkisonian disorders CNS shunt patency CSF leak Normal pressure hydrocephalus

44 Therapy 98 patients received radioiodine therapy for hyperthyroidism 10 patient lost to follow up More than 80% had good response in 6 months 2 had repeat and responded Therapy also used for malignancy of the thyroid

45 Therapy in nuclear medicine Thyroid disorders Bone palliation Radiosynorvectomy Neuroendocrine tumors Hematological malignancy Pheochromocytoma and neurobastoma Malignancy in liver and other rare therapies

46 Conclusion An exciting field medicine with novel diagnostic and therapeutic developments Great potential for both clinical and research work Plans to get this therapy both old and new to help in the management of patients Education for clinician and general public To afford patience new diagnostic and therapeutic options

47 References Clinical Nuclear Medicine Springer 2007 Hans Biersach H and Freeman LM Patho-physiologic basis of Nuclear Medicine Springer 2 nd Edition Elgazzar AH

48 Thank you