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Nuclear Medicine

Department of Nuclear Medicine

Nuclear Medicine is defined as the science of imaging and therapy at the molecular level using radioactive sources in liquid, solid or gas form. Thanks to the applications carried out in the Nuclear Medicine Department, advanced diagnosis and treatment of diseases is possible. A multidisciplinary approach is used in the treatment of many diseases from heart diseases, kidney diseases, orthopedic problems to thyroid and hormonal diseases.

One of the points that differentiates the Yeditepe University Hospitals Nuclear Medicine department is its specially designed architecture. In architectural details such as large patient rooms, corridors and lighting system, the comfort and health of the patients to be treated are prioritized. The space planning within the department is arranged depending on the radiation intensity areas. Thus, radiation exposure of both patients and employees is kept at minimum levels. The special lighting system in the form of daylight created in the treatment rooms is also aimed to increase the comfort of the patients during treatment.

How are Imaging Procedures Performed in Nuclear Medicine?

A very low rate of radioactive material is given to the patients as food / drink, intravenously or by inhalation, by injecting into or under the skin.       This radioactive material, which is given, goes to the targeted organ or tissue and shows uptake there. Later, these areas are viewed with special cameras. The radiation received by the patient during this procedure is at a very low level considering the benefit / loss balance. All these examinations are evaluated by Nuclear Medicine experts.

 

Theranostic Approach in Cancer Treatment

Nuclear Medicine methods, in addition to imaging, are increasingly used in the treatment of cancer disease. Targeted atomic therapies have been developing at a significant rate since 2010.

Theranostic is a field of medicine that combines patient-specific and disease-targeted diagnosis with treatment. The most important feature of atomic therapies with radionuclides is that the diagnosis can be made with the same drugs and this situation provides an extraordinary advantage in cancer treatment. This feature ensures that the area of the drug administered for treatment, the area it will go in the body and its power to affect the diseased tissue, is known precisely before the treatment. This approach is called the “theranostic” approach.

Unlike conventional chemotherapeutics, theranostic drugs go directly to the cancer cell with little or no effect on normal cells. Thus, while healthy cells suffer the least damage, targeted treatment is performed by giving maximum damage to diseased cells such as cancer cells.

 

Practices in Nuclear Medicine

Applications for Neurological Diseases

  • In the diagnosis of some strokes
  • In the diagnosis of dementia
  • Detection of epileptic focus in epilepsy patients scheduled for surgery
  • In the diagnosis of hydrocephalus

 Applications for Lung Diseases

  • In the diagnosis of pulmonary embolism, that is, clot in the lung
  • In determining postoperative lung reserve in patients scheduled for lung surgery

Applications for Orthopedic Diseases

  • In visualizing hidden fractures
  • In Bone infections
  • In imaging bone metastases

In the diagnosis of coronary artery diseases

  • In By-pass surgery / post-stent evaluation
  • In the diagnosis of coronary artery diseases

Applications for Kidney Diseases

  • Applications for Kidney Diseases
  • To investigate whether there is urine leakage to the kidneys
  • In the investigation of kidney infections
  • In kidney transplantations

Applications for Oncological Diseases

  • In benign-malignant distinction
  • In the staging of tumors
  • In showing the biopsy site
  • In detecting tumor recurrence
  • In evaluating the response to chemotherapy
  • In the planning of radiotherapy

Other Applications

  • In goiter patients
  • In various esophagus and stomach diseases
  • In gall bladder diseases
  • In acute intestinal bleeding
  • In suspicion of latent infection
  • In the examination of lymph tracts
  • In the examination of tear pathways
  • In the examination of salivary gland functions

Treatments Applied in Nuclear Medicine

  • “Iodine I-131” for the treatment of thyroid cancers
  • “Lutetium Therapy” in neuroendocrine tumors
  • “Lu-117 PSMA” for the treatment of advanced stage hormone resistant prostate cancer
  • “Ra-223” in patients with prostate cancer with advanced stage hormone-resistant bone metastases
  • In prostate cancer
  • Radioembolization with “Y-90” microspheres in primary or metastatic liver tumors
  • Palliative pain in patients with bone metastases
  • Radionuclide for intra-articular fluid accumulation and pain
  • “Iodine-131” for the treatment of hyperthyroidism (toxic goiter)
  • Intraoperative sentinel lymph node removal with gamma probe in diseases such as breast, malignant melanoma, parathyroid adenoma.

Personalized Nuclear Medicine Treatments

Dosimetric calculations can be applied in a limited number of centers in our country. However, these calculations are necessary for the correct determination of the amount of radioactive material needed by the patient in the treatment of thyroid cancer. In addition, it is used in treatments such as prostate cancer to determine the most appropriate amount of radioactive material to prevent damage to healthy organs, such as the kidneys. In addition, the amount of radioactive material required for ablation should be determined with dosimetric studies applied in the ablation treatment of thyroid cancer.

 

Benefits of Dosimetric Calculations

  • In many patients, the sufficient amount determined by dosimetry is at or below the limit of outpatient treatment. Thus, patients can be discharged within a few hours without hospitalization.
  • If a sufficient amount is determined by dosimetry, patients are protected from the side effects of the radioactive material that can be given unnecessarily.
  • In some cases the conventional amount of therapeutic activity is below the doses that should be given. In such cases, calculating and administering the correct dose with dosimetric studies saves patients from the trouble of receiving treatment again.

 

Lutetium Therapy in Neuroendocrine Tumors

Neuroendocrine tumors (NETs) are rare tumors that mostly originate from the stomach, intestine, pancreas and lung. These tumors usually have a slow course and patients continue to live with water disease for a long time without any complaints. Since the symptoms can be confused with different diseases, it constitutes a very difficult disease group to diagnose.

 

What are the Symptoms of Neuroendocrine Tumors?

It is also very difficult to diagnose in insidious neuroendocrine tumors. For this reason, accurate diagnosis is extremely important for timely treatment. When the disease begins to manifest symptoms, symptoms such as abdominal pain, diarrhea, digestive problems and nausea usually occur.

How Are Neuroendocrine Tumors Diagnosed?

Many different imaging methods, including CT, MRI, PET/CT and ultrasound, can be used in the diagnosis of neuroendocrine tumors. PET/CT imaging with FDG, a type of sugar used in the diagnosis of many cancers and in the detection of disease spread, is insufficient in detecting neuroendocrine cancers. For this reason, special PET/CT scans using smart molecules are used for neuroendocrine cancers. Gallium-68 DOTATATE PET/CT imaging is used to find and view tumor cells in the body at the molecular level. Gallium-68 DOTATATE is accepted as the current imaging method used for neuroendocrine tumors.

 

What is Lutetium Therapy in Neuroendocrine Tumors?

As with other cancers, the main treatment of neuroendocrine tumors is surgery. However, since it is a disease that is detected in late stages, very few of the patients have the chance to be operated on. In patients who cannot be treated surgically, the most effective treatment that can be used is Lu-177-DOTATATE treatment (Peptide Receptor Radionuclide Therapy). Known as lutetium treatment, Lu-177 treatment, this treatment is used as the treatment method that prolongs the life of the patient in advanced stage neuroendocrine tumors.

 

How is Lutetium Treatment Applied?

Lutetium 177-DOTATATE is prepared in the laboratories in the hospital and given to the patient in serum via the vein. The smart drug enters the cell by finding the cancerous tissue through the receptors on it. Thus, cancerous tissue is irradiated from inside the cell. Therefore, while cancerous tissue is irradiated, normal tissues are less damaged.  As the patient did not feel any side effects during the treatment. After treatment, no significant side effects are expected, except for a temporary and mild decrease in blood values.

 

How Long Does Lutetium Treatment Take in Neuroendocrine Tumors?

Lutetium 177 DOTATATE treatment is usually applied as 3 or 4 cycles at 6-8 weeks intervals. It can be applied up to 8-10 cycles according to the course of the disease, kidney functions, blood values and special calculations.

Patients suitable for treatment are determined by examination by experienced nuclear medicine specialists. After the planning of the patients for whom the treatment decision is made, smart medication is administered via a vein in a protected private room under the supervision of experienced health personnel, nurses and doctors.

 

Myths About Neuroendocrine Tumors

“The disease that has spread to organs such as bones and lungs is an end-stage disease, there is nothing left to do”.

Actually: Being an advanced stage disease does not always mean an end stage disease. Since most of the neuroendocrine tumors are relatively slow-growing tumors, patients can survive for years with the right treatments.

  • “Neuroendocrine tumors are not cancer”

Actually: Although many neuroendocrine tumors progress much more slowly than other types of cancer, it should not be forgotten that it is a type of cancer. Therefore, it is extremely important to consider all the warnings of the healthcare team in all treatments related to the disease during the treatment process.

  • “Neuroendocrine tumors always grow slowly”

Actually: Many neuroendocrine tumors grow slowly, but some types (high grade NETs) may progress very rapidly from time to time. For this reason, it is extremely important to make the correct diagnosis and to perform the correct imaging methods. After the evaluation, the physician will make the necessary information about how the disease can progress. However, it should be kept in mind that the behavior of slowly growing neuroendocrine tumors is not always predictable.

  • “Neuroendocrine tumors respond similarly to treatment in every patient”

Actually: As in many other types of cancer, the principle of “there is no patient, there is the disease” applies to neuroendocrine tumors. In other words, although patients will have similar experiences, it should be kept in mind that each neuroendocrine tumor patient will show a different course and respond differently to treatments.

Treatments Applied in Nuclear Medicine

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