Crash course in nuclear medicine for radiology exam preparation

A quick fire review of nuclear medicine for radiology part II exam candidates.
What a whirlwind lecture that was! Apologies it went quite quickly and was quite dense - but there was a lot to get through. This was the first time I have run a lecture on nuclear medicine in such a way and was a good learning experience. I might look at teasing out and expanding some of the higher yield sections in future.
To review a few points that did not come across so clearly…
- Parathyroid adenomas will retain 99mTc-sestamibi while the remainder of the thyroid washes out. Hyperfunctioning nodules mimic adenomas, however will be very hot on the subsequent pertecnetate thyroid scan. On SPECT/CT they will be within the thyroid gland anatomically.
- Prior to radioiodine treatment or imaging, intravenous contrast should be avoided for 4 weeks. IV contrast floods the residual thyroid tissue or metastases with iodine and will reduce the uptake of radioiodine for treatment purposes.
- Rights and lefts can be trick as they are sometimes flipped. Anything acquired from the posterior detector, will be flipped to normal radiological anatomy. This includes native renal studies, posterior acquisitions in bone scans, and palmar or plantar views of the hands and feet. Ideally, if there is ambiguity it will be labelled. A pitfall is that renal transplants are imaged from the anterior detector as they are situated anteriorly in the abdomen.
- Renal tracers - we spend through this, but it is important.
o Dynamic renal scintigraphy is performed with DTPA or MAG3 to allow assessment of perfusion, renal cortical extraction and excretion.
o DTPA is a glomerular agent and MAG3 is a tubular agent. For ATN or transplant rejection, MAG3 is the tracer of choice. If you would like to concurrently measure GFR, DTPA is the tracer of choice.
- Babies scanned with HIDA/DISIDA for biliary atresia will have no demonstrated excretion of tracer into the small bowel. In a normal study, including in cases of neonatal hepatitis, there will be movement of biliary excreted tracer into the small bowel - however this may be delayed due to decreased hepatocyte function.

[@drsallyayesa]

Thank you everyone for the comments - this started as a recording for my local exam candidates which I posted here to help those who were unable to attend. Certainly didn’t expect 10,000 views as it was a fairly informal session! I would love to post more and will try to find time in future. And check the comments more often!

[@AryanSharma-qn4zf]

Please send me this ppt

[@EmranAskari]

For those who do not have enough time to watch all of the video, I recommend: - How to approach a nuclear medicine case: 4:45-6:10 - Use scan terminology wisely: 7:32-8:58 (e.g. do not use metabolic activity for PSMA or DOTATATE) - Some useful vocabularies: 10:25-11:59 (how to describe and conclude three-phase bone scan) - DDx for abnormal vascularity in bone scan: 13:48-14:41 - How to present a bone scan: 24:00-25:04 Interesting cases: 1. RSDS/CRPS: 15:50-17:10 2. Spondylodiscitis, typical: 18:37-21:15 3. Sacral insufficiency Fx, typical: 25:10-27:02 4. Non-accidental injury: 27:05-29:14 5. Device-related infection: 41:31-42:42 6. Metastatic paraganglioma with MIBI uptake: 59:37-1:00:44 (interesting case) 7. Rim sign in hepatobiliary scintigraphy: 1:17:37-1:18:14 8. FNH in SC scan: 1:20:37-1:21:35 (interesting case) 9. Intrapancreatic splenule and damaged RBC: 1:21:55-1:22:10 10. Intrathoracic splenosis due to trauma: 1:22:18-1:23:02 (interesting case) 11. Drainage to the contralateral breast in SLN imaging: 1:25:42-1:26:30 (interesting case) 12. Sarcoidosis with bone involvement and widespread focal FDG uptake: 1:32:40-1:33:23 (interesting case)

[@eliochavez1482]

love the way you put this together! Please keep making more videos.

[@rei9038]

I'm a fifteen year old getting into Nuclear Medicine, this is a great help, thank you!

[@user-lt5no1xt1z]

Just 15??!!

[@queenpower9514]

🙄

[@nloudon]

Awesome lecture! About to start my nucs rotation and had no clue where to start. Thank you for posting this!

[@artemis4227]

Dr. Sally Ayesa, I really love your style and I hope you will keep uploading your radiology lectures soon. Also several problems you faced mentioned in your blog, like the imposter syndrome, really spoke to me. Thanks a lot ! I'm really looking foreward to see more lectures.

[@bilalidrees7740]

Very informative Very comprehensive Blessing for rad residents esp for exams Much appreciated Obliged

[@chikechinwike6576]

Thank you very much for this video! It was really helpful for my exams.

[@openyourmindtomedicine]

Watching this in France! Brilliant explanations, thank you

[@hersassyness07]

Excellent session. Gentle suggestion of adding timestamps for each different test would be really helpful when listening in the car on the way to work! :)

[@ventrikill653]

Very helpful lecture. Thank you!!

[@portiapanda]

Really great Lecture! Thank you so much. Doing my Nucs term now as a 3rd year rad reg, and found this incredibly helpful. Love your lecture style. Thanks!

[@AryanSharma-qn4zf]

Hii are you nuclear medicine technologist??

[@AryanSharma-qn4zf]

Plz drop your email

[@Markymark__]

Thank you so much I’m using this to listen to as I study for my board exam coming up.

[@ayyazmahmood4010]

excellent lecture , looking forward to see you similer tutorials for our traing and exam preperation.

[@miavs12345diva]

Thank you! Great crash course 👍

[@AryanSharma-qn4zf]

Hii Divya are you doing msc nmt??

[@EmmaWiththeMaremma]

Sally I love your videos.

[@shashwatpriyadarshi972]

Thank you Dr.Sally

[@sistergrimace1567]

Appreciate it

[@aravindmaddini6348]

very nice session great video

[@MK-yf1vk]

Thnk u so much for the video.can u plz upload some scans?

[@nadiah9104]

Thanks dr 🌸

[@AryanSharma-qn4zf]

Are you nuclear medicine technologist student

[@nadiah9104]

@@AryanSharma-qn4zf no im a Doctor 👩🏻‍⚕️

[@AryanSharma-qn4zf]

Have you this slide??

[@AryanSharma-qn4zf]

Plzz make a Vedio nuclear medicine haematology like rbc labelling.

[@Pandya_715]

Mam one doubt now I am currently studying medicine 3 Rd year in jipmer pondicherry from India ,I want to do pg in nuclear medicine in usa..how many mark scored in USMLE to get a seat .is it worth doing nuclear medicine in usa or india.how many years it take to complete

[@unlikelysuspect5491]

Combat medic preparing for possible nuclear trikes on homeland soil

[@AryanSharma-qn4zf]

Plzz share this slide on my email

[@starstruck877]

Was excellent information. Please refrain from saying Umm so much

[@adams7839]

bro shut up