Radionuclide Imaging / dental courses

Radionuclide Imaging – An overview
INDIAN DENTAL ACADEMY
Leader in continuing Dental Education
www.indiandentalacademy.com

RADIONUCLIDE IMAGING
Radionuclide Imaging is a Diagnostic
modality in which
RADIOPHARMACEUTICALS are used to
get the image. Radiopharmaceuticals are
administered intravenously in the body and
they reach the affected bone and bind with
pathological lesion by tagging with the
tissue resulting in the release of gamma
rays by the disintegration of radioactive
substances. The gamma rays are detected
by gamma camera as
RADIONUCLIDE IMAGE.
This image is recorded as SCINTIGRAPHY

Factors to be studied
• Tracer techniques
• Radiopharmaceutical
• Disintegration of the radiopharmaceutical
• Release of Gamma rays
• Gamma camera and detection of Gamma
rays
• Conversion of Gamma rays into image
• Recording the image as scintigraph

Radionuclide imaging is one of the
investigation with Tracer concept
• A tracer is a substance which when introduced into the
body, it tracks the course of labeled molecules or cells
in Diseased tissue and binds with tissue.
• Radioactive tracer has got radioactive isotopes
• Radioactive tracer is a tracer which releases radiation
on binding with the diseased tissue.
• Radiopharmaceutical is a pharmacological preparation
in which radioactive substance and other tagging
material is present.
• Radiopharmaceutical when injected into the body it
reaches the diseased cell. And the tagging material
binds in the tissue and the radioactive substance
disintegrates and releases radiation that is Gamma
rays.

Radiopharmaceuticals
Different radiopharmaceuticals
Gallium 67 Ga – Tumour
inflammation
Iodine – Thyroid
Krypton – lung
18 F Fluorodeoxy glucose(FDG) – PET scan
Technetium 99 M Pertecnetate – Saliva & Brain
Indium – CSF
Thallium – Heart
Technetium- 99 M colloid – Liver
Technetium 99 M Heat
denatured red cells - Spleen
Technetium 99 M
methyl di phosphonate MDP – Bone and Jaw bone

Radioactive Tracer in Bone
• In Bone diseases bone destruction – Osteolysis occurs
releasing calcium and to compensate the destruction,
Osteogenesis occurs to form the bone. Calcium and
Phosphate combine to form calcium phosphate apatite
crystals to form bone.
IF RADIOPHARMACEUTICAL IS INJECTED
1. Increased tracer uptake – disease with Osteogenesis –
hot spot
2. Decreased tracer uptake – disease with inactive bone ,
lack of vascularity ,
lack of Osteogenesis
– cold spotwww.indiandentalacademy.com

Technetium methyl
di-phosphonate(TcMDP)
Tc MDP
1.This Radiopharmaceuticals is used mainly
for jaw bone disease
2.It has short half life. 6.5 hours
3.It minimizes the patients radiation
exposure.
4.The release of gamma rays by TcMDP is
suitable for detection by Gamma camera

RELEASE OF GAMMA RAYS
Technetium 99 MDP
Technetium Methyl di –Phosphonate
(Radioactive) (Tagging)
Tc MDP
Injected intravenously in the body
Reaches the diseased bone
Calcium and phosphate in the diseased bone combine and form
calcium di - phosphonate apatite crystals
During this process the Radioactive substance disintegrates
& release Gamma Rays

Detection of gamma rays by
Gamma camera
Gamma rays
Picked up by the Sodium Iodide crystal Detectors
Fluorescence
Photo multiplier tube of Gamma Camera
Fluorescence light change into electrical signal
This signal is converted into radionuclide image in the
computer monitor
Recorded as scintigraphywww.indiandentalacademy.com

GAMMA CAMERA

ARMAMENTARIUM FOR
RADIONUCLIDE INJECTION

IV INJECTION OF RADIOPHARMACEUTICAL

PATIENT IN IMAGING POSITION

COMPUTER SOFTWARE
IMAGER

RADIONUCLIDE IMAGE

Three Phase Radionuclide Image
• Technetium 99 MDP is injected intravenously to
the body
I phase : - Flow Phase
Image is obtained 2 – 5 seconds for the first
30 seconds to see vascularity.
II Phase :- Blood Pool and Tissue Phase
Immediate static image for time 5 minutes.
To see blood flow and vascularity
III phase :- Skeletal Phase
Image is taken at 2 – 4 hours. To see
metabolic activity of bonewww.indiandentalacademy.com

SPECT IMAGE
SPECT : Single photon emission Computed Tomography
This type of Radionuclide Imaging are taken to
evaluate trauma, inflammatory disease and primary
bone Tumour.
In this study the images are obtained in 3 planes.
Axial-coronal-Sagittal
It allows more accurate interpretation and better
localization of bone pathology.
Different images from different axis are taken and
reconstructed in the computer &
SPECT images are developed.

PET SCAN
POSITRON EMISSION TOMOGRAPHY
1. Type of Radionuclide Imaging
2. Functional Imaging
3. It helps to detect
a) Squamous cell carcinoma (known and unknown primaries).
b) Metastatic carcinoma.
c) Nodal involvement of malignancy.
d) Nodal involvement before the node enlarges.
e) Neural spread.
f) Recurrent carcinoma.
g) Metastasis of carcinoma in different parts of the body.
h) Prognosis of treatment – Surgical and Radiation
i) Detection of Primary Carcinoma
Note:
In PET scan FDG may accumulate in benign neoplastic growth and non-
neoplastic growth such as granulation ,inflammation, early scarring, in
Tuberculosis and in Sarcoidosis ,and hence it may give false positive and
false negative images.
History and clinical findings are to be correlated for correct imaging
and diagnosis.

PET SCAN RELEASE OF GAMMA RAYS
18 F – Flouoro deoxy glucose (FDG) is the radio pharmaceutical used in
imaging of PET Scan
18 –F- Fluoro deoxy Glucose (FDG)
Fluorine deoxy Glucose
(Radioactive material) (tagging material)
FDG
Injected intravenously in the body
Reaches the carcinoma
Deoxy Glucose enter the malignant cell and joins with
glucose of malignant cells
Cont next..

Fluorine radioactive substance disintegrates and
release Positrons
Travel short distance in tissue
Positron + electron
Release Gamma rays
During this process
Fluorine radioactive substance disintegrates
and release Positrons

LYMPHO SCINTIGRAPHY
It helps in the treatment of Oral Squamous carcinoma to evaluate
the spread in the lymph node. The radio-pharmaceutical Technetium
99-M sulphur colloid is employed in the imaging.
Technetium 99-M Sulphur colloid
Injected in 4-6 areas in the subcutaneous tissue around the carcinoma
The radioactive colloid is carried by the lymphatic channel
It reaches the first echelon lymph node draining that area
This node is called as Sentinel node
Cont next

This node can be imaged by gamma camera
The sentinel node is evaluated for metastasis
if this node is free ,then the other nodes are not involved
If this node is positive for metastasis then other nodes are
also involved
This helps to remove all Metastatic nodes in surgical
treatment

CLINICAL CASES
Our observations

CASE 1

RADIOGRAPH –
1. EXOSTOSIS, ENOSTOSIS
2. HYPERCEMENTOSIS
3. CEMENTAL DYSPLASIA
4. CEMENTOMA
5. OSTEOMA
RADIONUCLIDE IMAGE -
1. OSTEOMA

RADIOGRAPHS
1. Two dimensional appearance of
lesions
2. Showed periphery of bone tumor
3. Do not show initial genesis of
the lesion
4. Do not show posterior extension
of soft tissue tumor
5. Do not show whether cyst or
tumor in radiolucency
6. Lesions could be detected only
locally
RADIONUCLIDE IMAGING
1. Total deformity caused by the
lesion
2. Showed peripheral extension of
bone tumor
3. Showed initial lesion of bone with
higher tracer uptake
4. Showed posterior extension of
soft tissue tumor as there is
tracer uptake
5. Showed correctly cyst / tumor
tumor – tracer uptake
cyst – no tracer uptake
6. Multiple lesions can be detected.
COMPARISON BETWEEN RADIOGRAPHS
AND RADIONUCLIDE IMAGING

Scope of
Radionuclide image
in Jaw Disease

Fibro osseous lesions
• Paget’s disease
• Mono-ostotic Fibrous Dysplasia
• Polyostotic Fibrous Dysplasia
• Periapical Cemental Dysplasia
• Ossifying Fibroma

Inflammatory diseases of Jaw
• Osteomyelitis
• Osteoradionecrosis
• Condensing Osteitis
• Garre’s osteomyelitis

Multiple Lesions
• Hyper parathyroidism
• Multiple Myeloma
• Gardner’s Syndrome
• Multiple Metastasis
• Skeletal Reticulosis

Malignant Tumours
• Squamous cell carcinoma
• Metastatic carcinoma
• Adenoid cystic carcinoma
• Nodal involvement of malignancy without
enlargement of node and with enlargement
of node

TM Joint
• Condylar hyperplasia
• Degenerative diseases of TM Joint

Impression
• Radionuclide imaging is very much useful in
oral and Maxillofacial diseases
• Fundamentals of Radionuclide imaging,
different techniques and correct interpretation
of the imaging are very important to the Oral
Medicine and Radiology expert for better
diagnosis and better treatment.
• The science of Radiology has to be studied
broadly under the heading of Oral and
Maxillofacial Imageology with lot of research
activities. www.indiandentalacademy.com

THANK YOU

Radionuclide Imaging / dental courses

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