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Diagnostic Imaging

Central Scheduling Phone: 603-663-2180


Welcome to Nuclear Medicine


Nuclear medicine is a branch of medical imaging that uses small amounts of radioactive material to diagnose and determine the severity of or treat a variety of diseases including cancer, heart disease, gastrointestinal, endocrine, neurological disorders and other abnormalities within the body. Nuclear medicine imaging uses small amounts of radioactive materials called radiotracers that are typically injected into the bloodstream, inhaled or swallowed. The radiotracer travels through the area being examined and gives off energy in the form of gamma rays which are detected by a special camera and a computer to create images of the inside of your body.


Is it safe?

Yes. Most commonly, the amount of radiation to the patient during a nuclear medicine procedure is similar to the results from standard X-rays. Most of the radioactivity passes out of your body through urine or stool. Any remaining radioactivity will disappear over time naturally. The staff will talk to you in detail about what you can expect before, during and after your nuclear medicine procedure and answer any questions you may have.


How should I prepare?

You should tell your doctor if there's a possibility you are pregnant or if you are breastfeeding.

Depending on the type of exam, your doctor will instruct you on what you may eat or drink beforehand.

Leave jewelry at home and wear loose, comfortable clothing. You may be asked to wear a gown.

You will receive specific instructions based on the type of scan you are undergoing.


What are some common procedures?

  • Bone Scan
  • Cardiac Imaging MIBI
  • Thyroid Scan and Uptake
  • Gastric Emptying
  • HIDA Scan-Hepatobiliary/ Gallbladder/Liver Function imaging

The length of time for nuclear medicine procedures varies greatly, depending on the type of exam. Actual scanning time for nuclear imaging exams can take from 20 minutes to several hours and may be conducted over several days.


After the procedure

Unless your physician tells you otherwise, you may resume your normal activities after your nuclear medicine scan. If any special instructions are necessary you will be informed before you leave the nuclear medicine department by a technologist, nurse or physician.

Through the natural process of radioactive decay, the small amount of radiotracer in your body will lose its radioactivity over time. It may also pass out of your body through your urine or stool during the first few hours or days following the test. You should also drink plenty of water to help flush the radioactive material out of your body as instructed by the nuclear medicine personnel.

A radiologist who has specialized training in nuclear medicine will interpret the images and send a report to your referring physician usually within 24-48hrs.





Bone Scan

  • A bone scan is a nuclear imaging test that helps diagnose and track several types of bone disease. Your doctor may order a bone scan if you have unexplained skeletal pain, a bone infection or a bone injury that can't be seen on a standard X-ray.
  • A bone scan can also be an important tool for detecting cancer that has spread (metastasized) to the bone from the tumor's original location, such as the breast or prostate.

Reasons for having a Bone Scan
If you have unexplained bone pain, a bone scan might help determine the cause. The test is very sensitive to any difference in bone metabolism. The ability to scan the entire skeleton makes a bone scan very helpful in diagnosing a wide range of bone disorders, including:

  • Fractures
  • Arthritis
  • Paget's disease of bone
  • Cancer originating in bone
  • Cancer that has metastasized to bone from a different site
  • Infection of the joints, joint replacements or bones (osteomyelitis)
  • Impaired blood supply to bones or death of bone tissue (avascular necrosis)

How a Bone Scan is performed
A bone scan is a nuclear imaging procedure. In nuclear imaging, tiny amounts of radioactive materials (tracers) are injected into a vein and taken up in varying amounts at different sites in the body. Areas of the body where cells and tissues are repairing themselves most actively take up the largest amounts of tracer. Nuclear images highlight these areas, suggesting the presence of abnormalities associated with disease or injury. A bone scan procedure includes both an injection and the actual scan.

The injection
Tracers will be injected into a vein in your arm. The amount of time between the injection and scan varies, depending on the reason your doctor has ordered the scan. Some images may be taken immediately after the injection. But the main images are taken three to four hours later to allow the tracer to circulate and be absorbed by your bones. Your doctor may recommend that you drink several glasses of water while you wait.

The scan
You'll be asked to lie still on a table while an arm-like device supporting a tracer-sensitive camera passes back and forth over your body. The scan itself can take up to an hour. The procedure is painless. Your doctor might order a three-phase bone scan, which includes a series of images taken at different times. A number of images are taken as the tracer is injected, then shortly after the injection, and again three to five hours after the injection. To better see some bones in your body, your doctor might order additional imaging called single-photon emission computerized tomography (SPECT). This imaging can help with conditions that are especially deep in your bone or in places that are difficult to see. During a SPECT scan, the camera rotates around your body, taking images as it rotates.

After the test
A bone scan generally has no side effects, and no follow-up care is needed. The radioactivity from the tracers is usually completely eliminated within two days after the scan.

Images of Bone scans and a patient having a bone scan:





MIBI/Cardiac Imaging

A nuclear stress test uses radioactive tracer and an imaging machine to create pictures showing the blood flow to your heart. The test measures blood flow while you are at rest and are exerting yourself, showing areas with poor blood flow or damage in your heart. The test usually involves injecting radioactive tracer, then taking two sets of images of your heart — one while you're at rest and another after exertion. A nuclear stress test is one of several types of stress tests that may be performed alone or in combination. Compared with an exercise stress test, a nuclear stress test can help better determine your risk of a heart attack or other cardiac event if your doctor knows or suspects that you have coronary artery disease.

Reasons for Having a MIBI Cardiac Imaging
You may need a nuclear stress test if a routine stress test didn't pinpoint the cause of symptoms such as chest pain or shortness of breath. A nuclear stress test may also be used to guide your treatment if you've been diagnosed with a heart condition. Your doctor may recommend a nuclear stress test to:

  • Diagnose coronary artery disease. Your coronary arteries are the major blood vessels that supply your heart with blood, oxygen and nutrients. Coronary artery disease develops when these arteries become damaged or diseased — usually due to a buildup of deposits containing cholesterol and other substances (plaques). If you have symptoms such as chest pain or shortness of breath, a nuclear stress test can help determine if you have coronary artery disease and how severe the condition is.
  • Guide treatment of heart disorders. If you've been diagnosed with coronary artery disease, a nuclear stress test can help your doctor find out how well treatment is working. It may also be used to help establish the right treatment plan for you by determining how much exercise your heart can handle.

How a Cardiac MIBI Imaging is performed
A nuclear stress test may be performed in combination with an exercise stress test, in which you walk on a treadmill. If you aren't able to exercise, you'll receive a drug through an IV that mimics exercise by increasing blood flow to your heart. A nuclear stress test can take two or more hours, depending on the radioactive material and imaging tests used.

Before a nuclear stress test
First, your doctor will ask you some questions about your medical history and how often and strenuously you exercise. This helps determine the amount of exercise that's appropriate for you during the test. Your doctor will also listen to your heart and lungs for any abnormalities that might affect your test results.

During a nuclear stress test

Exercise or Pharmacological stress test
Before you start the test, a technician inserts an intravenous (IV) line into your arm and injects a radioactive dye (radiopharmaceutical or radiotracer). The radiotracer may feel cold when it's first injected into your arm. It takes about 20 to 40 minutes for your heart cells to absorb the radiotracer. Then, you'll lie still on a table and have your first set of images taken while your heart is at rest A nurse or technician will place sticky patches (electrodes) on your chest, legs and arms. Some areas may need to be shaved to help them stick. The electrodes have wires connected to an electrocardiogram machine, which records the electrical signals that trigger your heartbeats. A cuff on your arm checks your blood pressure during the test. You may be asked to breathe into a tube during the test to show how well you're able to breathe during exercise. If you can't exercise, your doctor will inject the drug into your IV line that mimics exercise by increasing blood flow to your heart. Possible side effects may be similar to those caused by exercise, such as flushing or shortness of breath. You might get a headache. For an exercise stress test, you'll probably walk on a treadmill or ride a stationary bike. You'll start slowly, and the exercise gets more difficult as the test progresses. You can use the railing on the treadmill for balance. Don't hang on tightly, as this may skew the results. You'll continue exercising until either your heart rate has reached a set target, you develop symptoms that don't allow you to continue or you develop:

  • Moderate to severe chest pain
  • Severe shortness of breath
  • Abnormally high or low blood pressure
  • An abnormal heart rhythm
  • Dizziness
  • Certain changes in your electrocardiogram

You and your doctor will discuss your safe limits for exercise. You can stop the test anytime you're too uncomfortable to continue. You'll have another injection of radiotracer when your heart rate peaks. About 20 to 40 minutes later, you'll lie still on a table and have a second set of images made of your heart muscle. The dye shows any areas of your heart receiving inadequate blood flow. Your doctor will use the two sets of images to compare the blood flow through your heart while you're at rest and under stress.

After a nuclear stress test: After you stop exercising, you might be asked to stand still for several seconds and then lie down for a period of time with the monitors in place. Your doctor can watch for any abnormalities as your heart rate and breathing return to normal. When the test is complete, you may return to normal activities unless your doctor tells you otherwise. The radioactive material will naturally leave your body in your urine or stool. Drink plenty of water to help flush the dye out of your system.

Images of patient having Cardiac MIBI Imaging and MIBI Images





Thyroid Scan and Uptake

The thyroid scan and uptake provide information about the structure and function of the thyroid. The thyroid is a gland in the neck that controls metabolism, a chemical process that regulates the rate at which the body converts food to energy.

Thyroid scan and uptake uses small amounts of radioactive material called a radiotracer, a special camera and a computer to provide information about your thyroid's size, shape, position and function that is often unattainable using other imaging procedures.

Reasons for Having a Thyroid Scan and Uptake

  • determine if the gland is working properly
  • help diagnose problems with the thyroid gland, such as an overactive thyroid gland, a condition called hyperthyroidism, cancer or other growths
  • assess the nature of a nodule discovered in the gland
  • detect areas of abnormality, such as lumps (nodules) or inflammation

With ordinary x-ray examinations, an image is made by passing x-rays through the patient's body. In contrast, nuclear medicine procedures use a radioactive material, called a radiopharmaceutical or radiotracer, which is injected into the bloodstream, swallowed or inhaled as a gas. This radioactive material accumulates in the organ or area of your body being examined, where it gives off a small amount of energy in the form of gamma rays. Special cameras detect this energy, and with the help of a computer, create pictures offering details on both the structure and function of organs and tissues in your body.

Prep for the procedure
Women should always inform their physician or technologist if there is any possibility that they are pregnant or if they are breastfeeding. You should inform the technologist performing your exam of any medications you are taking, including vitamins and herbal supplements. You should also inform them if you have any allergies and about recent illnesses or other medical conditions.


You should tell your technologist if you:

  • Have had any tests, such as an x-ray or CT scan, surgeries or treatments using iodinated contrast material within the last two months.
  • Are taking medications or ingesting other substances that contain iodine, including kelp, seaweed, cough syrups, multivitamins or heart medications.
  • Have any allergies to iodine, medications and anesthetics.
  • Are breastfeeding.

In the days prior to your examination, blood tests may be performed to measure the level of thyroid hormones in your blood. You may be told not to eat for several hours before your exam because eating can affect the accuracy of the uptake measurement. Jewelry and other metallic accessories should be left at home if possible, or removed prior to the exam because they may interfere with the procedure. Please do not eat anything after midnight before your exam.


How the procedure is performed

This is a 3 part procedure over 2 days. You will be given radioactive iodine (I-123) in a capsule form to swallow. You will be instructed to return approx 6hrs later for the 2nd part of the procedure for images and measurements which will take about 30mins. You will be sitting in front of a probe for measurements of the uptake o radioactive iodine in your thyroid gland first, then laying on a table for images of your thyroid gland by a special camera. You will be given a time to return the following morning for the 3rd part of the procedure another uptake measurement, which will only take a few minutes.

Images of patient having thyroid scan and uptake and thyroid scan images





Gastric Emptying

A Gastric Emptying Study is a test to determine the time is takes a meal to move through a person’s stomach. It is typically ordered by physicians for patients with frequent vomiting, gastroparesis, abdominal pain, early satiety and pre-operative evaluation

Preparation for the procedure

  • Do not eat or drink 6 hours prior to the exam.
  • You will not need a change of clothes.
  • You may take medications prior to this test if you are advised by your doctor, especially if you are diabetic.
  • This test takes over 4 hours and images will be made at specific times.
  • Let the technologist know if you are pregnant or nursing

What is done during the test?
The technologist will explain the Nuclear Medicine Gastric Emptying Study to you. Ask questions if you don't understand.

You will be given a special meal to eat. This meal includes scrambled eggs with a small amount of a radioactive tracer (mixed in) and a small cup(6oz) of water. If you have an allergy to eggs please inform the scheduler. You will not be allowed to eat anything else until this test is completed. Images will be performed at specific times over a 4 hour period.

A radiologist who has specialized training in nuclear medicine will interpret the images and send a report to your referring physician usually within 24-48hrs.





HIDA Scan-Hepatobiliary/ Gallbladder/Liver Function imaging

A nuclear medicine HIDA scan helps evaluate the parts of the biliary system, including the liver, gallbladder and bile ducts, using small amounts of radioactive materials called radiotracers that are typically injected into the bloodstream, inhaled or swallowed. The radiotracer travels through the area being examined and gives off energy in the form of gamma rays which are detected by a special camera and a computer to create images of the inside of your body. Nuclear medicine imaging provides unique information that often cannot be obtained using other imaging procedures.

Reasons for a HIDA scan
Physicians perform hepatobiliary imaging to evaluate disorders that affect liver cells, the ducts of the biliary system and the gallbladder. Hepatobiliary imaging is also used to help diagnose symptoms such as:

  • abdominal pain that may be caused by a sudden inflammation of the gallbladder called cholecystitis
  • pain or fever following surgery on the gallbladder or the upper gastrointestinal tract
  • biliary atresia in newborns, a blockage in the ducts that carry bile from the liver to the gallbladder

Preparation for a HIDA scan
Women should always inform their physician or technologist if there is any possibility that they are pregnant or if they are breastfeeding. See the Safety page for more information about pregnancy and breastfeeding related to nuclear medicine imaging.

You should inform your physician and the technologist performing your exam of any medications you are taking, including vitamins and herbal supplements. You should also inform them if you have any allergies and about recent illnesses or other medical conditions.

Jewelry and other metallic accessories should be left at home if possible, or removed prior to the exam because they may interfere with the procedure. You should not eat or drink for at least four hours before your exam. You should not have tests that use barium for 48 hours before hepatobiliary imaging.

How is the procedure performed?
You will be positioned on an examination table. If necessary, a nurse or technologist will insert an intravenous (IV) catheter into a vein in your hand or arm, the dose of radiotracer is then injected intravenously. When it is time for the imaging to begin, the camera or scanner will take a series of images. The camera may rotate around you or it may stay in one position and you may be asked to change positions in between images. While the camera is taking pictures, you will need to remain still for brief periods of time. In some cases, the camera may move very close to your body. This is necessary to obtain the best quality images. If you are claustrophobic, you should inform the technologist before your exam begins. It is important that you remain still while the images are being recorded. Though nuclear imaging itself causes no pain, there may be some discomfort from having to remain still or to stay in one particular position during imaging.

If you receive a medication that causes your gallbladder to empty, you may experience slight abdominal discomfort or nausea, but it should pass within a few minutes. Although imaging may be performed over a period of several hours, you may not be on the imaging table the entire time.

Additional images will be taken as your gallbladder empties.

Hepatobiliary imaging is usually completed within two to four hours. Occasionally, patients may need to return for additional imaging up to 24 hours later.

If you had an intravenous line inserted for the procedure, it will usually be removed unless you are scheduled for an additional procedure that same day that requires an intravenous line.

A radiologist who has specialized training in nuclear medicine will interpret the images and send a report to your referring physician usually within 24-48 hrs.


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