Nuclear Medicine

The Department of Nuclear Medicine delivers comprehensive diagnostic and therapeutic applications of this unique specialty, which employs minute amounts of radioactive material called radiopharmaceuticals to study the function of body systems and organs. Handling and use of radiopharmaceuticals is governed by stringent international and national regulations and our team of highly qualified consultants ensures compliance with the standards set for the safe and appropriate use radiopharmaceuticals in medicine. Our physicians are backed by a team of physicists, radiochemists, radiopharmacists, cyclotron engineers, technologists and nurses to deliver this technology and labour intensive service. After more than two decades of persistent progress and investment in technology, equipment and human resource, the Department of Nuclear Medicine at SKMCH&RC remains one of the foremost departments for the specialty in Pakistan.

Facilities & Services

Unlike conventional radiology imaging like x-rays and CT where an individual is exposed to radiation from an external source, the radiopharmaceuticals in nuclear medicine are introduced in to the body through an injection, food or aerosols. A patient undergoing a nuclear scan is a source of radiation for a brief period during which images are acquired and judgment is made about the functional status of the organ or system utilizing a gamma camera or a PET/CT scanner. The amount of radiopharmaceuticals is carefully calculated and varies according to a patient’s age, size and type of investigation. Portable Molybdenum- Technetium generators are the primary source of radio-active material, which is sourced from internationally licensed vendors. Our department acquires these generators from three different sources to ensure constant availability. PET radiopharmaceuticals have to be produced on site and since 2009, SKMCH&RC Lahore  houses Pakistan’s first IBA Cyclotron for this purpose.

The Department of Nuclear Medicine is also equipped with two dual-head GE gamma cameras, one hybrid SPECT/CT camera, one hybrid Philips PET/CT scanner and one DXA scanner for bone density. The hot labs for preparation of radiopharmaceuticals are equipped with Lemer isolators and Synthera® synthesisers. Images are processed and analysed on dedicated work stations and archived on the Picture Archiving Communications System [PACS], accessible throughout the Hospital, making SKMCH&RC a filmless digital setup.

Diagnostic Nuclear Medicine

PET/CT:

  • Oncology (cancer staging and follow-up)
  • Neurology
  • Fever of unknown origin

Nuclear Oncology:

  • PET/CT
  • Radioactive iodine (thyroid cancer)
  • Gallium-67 (lymphoma, infection)
  • MIBG [neuroendocrine tumour]
  • Octreotide (somatostatin receptor studies)
  • Sentinel lymph node
  • Scintimammography

Nuclear Cardiology:

  • Myocardial perfusion studies
  • MUGA
  • FDG PET

Genitourinary System:

  • Dynamic renal imaging (DTPA, MAG3)
  • DMSA
  • Captopril studies
  • Nuclear cystography
  • Testicular imaging

Musculoskeletal imaging [SPECT/CT]:

  • Bone scan
  • Bone Marrow colloid scans

Gastrointestinal Imaging:

  • Gastric emptying
  • GI Bleed
  • Meckel’s Scan
  • Urea breath test

Hepatobiliary Imaging:

  • HIDA
  • Liver-Spleen colloid imaging

Pulmonary Imaging:

  • V/Q scans for PE/function assessment

Endocrine Imaging [SPECT/CT]:

  • Thyroid, parathyroid and adrenal imaging

Infection Imaging: [SPECT/CT]:

  • Gallium
  • FDG
  • Bone scan

Neurological Imaging:

  • Brain FDG PET/CT
  • Brain HMPAO SPECT/CT

Bone Densitometry:

  • DXA scan

Therapeutic Nuclear Medicine

  • Radioactive iodine (I131) therapy for benign and malignant thyroid disease
  • Palliative treatment for metastatic bone pain with Sr-89, Sm153
  • Thyroid cancer clinics/Thyroid multidisciplinary tumour board/clinics

Training Opportunity for Physicians

The Department of Nuclear Medicine has an unwavering commitment to education and research. We are affiliated with College of Physicians and Surgeons Pakistan for 4-year training in FCPS Nuclear Medicine. Currently the department has 5 positions for FCPS-II trainees. Additionally, we offer two positions for 1-year PET/CT fellowship for post-FCPS candidates. We also host visiting MSc. in Nuclear Medicine fellows from Pakistan Institute of Engineering and Applied Sciences [PIEAS] in Islamabad. Former trainees from our department have been awarded fellowships in UK and USA. Research work from our department has been presented and published at both the international and national level.

Research

All our trainees undertake research projects as a part of their FCPS II requirement. In addition, the Faculty of the Nuclear Medicine Department regularly presents research work at national and international meetings.

  1. Tc99m MDP SPECT-CT based Modified Mirel’s classification for Evaluation of Risk of Fracture in Skeletal Metastasis. A pilot study. S Riaz, H Bashir, IK Niazi, F Qamar, S Butt. Accepted by ‘Clin Nucl Med’ (Clin Nucl Med. 2018 Mar 20. doi: Epub
  2. Triage of Limited Versus Extensive Disease on 18F-FDG PET/CT Scan in Small Cell lung Cancer. S Riaz et al. Asia Ocean J Nucl Med Biol. 2017; 5(2): 109–113.
  3. Spectrum Of Brain Abnormalities Detected On Whole Body F-18 FDG PET/CT Scan. Hassan A, Majeed Y, Aftab K. J Ayub Med Coll Abbottabad. 2017 Jan-Mar;29(1):177-182.
  4. 18F-FDG PET-CT imaging vs. bone marrow biopsy in pediatric Hodgkin’s lymphoma: a quantitative assessment of marrow uptake and novel insights into clinical implications of marrow involvement. A Hassan, M Siddiq, H Bashir, S Riaz et al. Eur J Nucl Med Mol Imaging (2017) 44:1198–1206.
  5. Impact and prognostic value of 18F-FDG PET/CT scan in the evaluation of residual head and neck cancer: Single-center experience from Pakistan. Riaz S, Bashir H, et al. South Asian J Cancer.
  6. “Bottle Brush Sign”-Spinal Meningeal Disease on 18F-FDG PET-CT Scan. Riaz S, Naz F, Bashir H, Niazi IK. Clin Nucl Med. 2016 Sep;41(9):726-7.
  7. A rare case of medullary carcinoma thyroid metastasizing to bilateral breast parenchyma. Hassan A, Siddiqui M, Jahangir S. Nucl Med Rev Cent East Eur. 2016;19(B):17-19.
  8. Sinister cause of high bone mineral density on dual energy x-ray absorptiometry. Razi M, Hassan A. J Ayub Med Coll Abbottabad. 2016 Jan-Mar;28(1):194-6.
  9. Detection of melorheostosis in a young lady with upper limb pain on Three Phase Bone Scintigram/SPECT-CT. Hassan A, Khalid M, Khawar S. Clin Cases Miner Bone Metab. 2016 Jan-Apr;13(1):48-50
  10. Can the American Thyroid Association Risk of Recurrence Predict Radioiodine Refractory Disease in Differentiated Thyroid Cancer. Hassan A, Riaz S, Bashir H, Nawaz MK, Hussain R. Eur Thyroid J. 2016;5(4).
  11. F-18 FDG avid thyroid incidentalomas on PET/CT scan in cancer patients: how sinister are they? Hassan A, Riaz S, Zafar W. Nucl Med Commun. 2016 Oct;37(10):1069-73.
  12. Aggressive disease course of papillary thyroid carcinoma with focal undifferentiated component. S Riaz, H Bashir et al. MolImaging Radionucl Ther. 2016 Oct 5;25(3):134-139.
  13. Interim 18F-FDG PET/CT in Diffuse Large B Cell Lymphoma-as a prognostic tool. A Basit, N Siddique, Abdul Hameed, H Bashir et al., J Pak Med Assoc Vol 66(4), 2016
  14. Diagnostic accuracy of 18F-FDG PET-CT in the evaluation of Carcinoma of Unknown Primary. S Riaz, MK Nawaz, ZS Faruqui, SAS Kazmi, A Loya, H Bashir. MolImaging Radionucl Ther. 2016 Feb; 25(1): 11–18.
  15. Musculoskeletal SPECT-CT: A pictorial review. S Riaz, H Bashir, A Hassan, M K Nawaz. J Ayub Med Coll Abbottabad 2016; 28(2).
  16. Survival Analysis of Papillary Thyroid Carcinoma in Relation to Stage and Recurrence Risk: A 20-Year Experience in Pakistan. Hassan A, Razi M, Riaz S, Khalid M, Nawaz MK, Syed AA, Bashir H. Clin Nucl Med. 2016 Aug;41(8):606-13.
  17. Ga68- DOTATATE uptake in pineal gland, a rare physiological variant: case series. S Riaz, R Syed, E Skoura et al. Ann Nucl Med 2015 Nov 29 (9) 838-837.
  18. Follicular Thyroid Carcinoma – Disease response evaluation by ATA risk assessment guidelines. A Hassan, M Khalid, S Riaz, MK Nawaz, H Bashir. Eur Thyroid J .2015 Dec; 4(4): 260–265.
  19. Metastatic Radioiodine Avid Struma Ovarii Associated with Pseudo-Meigs’ Syndrome. S Riaz, H Bashir et al. J Ayub Med Coll Abbottabad 2015;27(3).
  20. Hyalinizing trabecular neoplasm of thyroid: A case report. J Ayub Med Coll Abbottabad 2014; 26(3):410–2.
  21. The role of imaging specialists and authors of systemic reviews on diagnostic and interventional imaging and its impact on scientific quality: Report from the EuroAIM evidence-based Radiology working group. Sardanelli F, Bashir H et. al. Radiology (Vol 272) No. 2. August 2014
  22. FDG PET in Lymphoma Assessment and the Application of Deauville Criteria. U Awan, N Siddiqui, M Saadullah, H Bashir et al. J Pak Med Assoc 63, 725; 2013
  23. Clinical utility of 18F FDG-PET/CT in the detection of bone marrow disease in Hodgkin’s lymphoma. Muzahir S, Mian M, Munir I, Nawaz MK, Faruqui ZS, Mufti KA, Bashir H et.al. Br J Radiol. 2012 Aug(85) 1016
  24. The diagnostic value of FDG-PET cannot be judged by iliac bone marrow biopsy: Author response. Muzahir S, Bashir H, Mian M. Br J Radiol. 2012 Aug;85 (1016) :1206-7. PMID: 22815419.
  25. Judicious use of recombinant TSH in the management of differentiated thyroid carcinoma. M Umar Khan, M K Nawaz, MA Shah, AA Syed, AI Khan. Annals of Nucl Medicine Oct 2010
  26. Differentiated thyroid carcinoma in a juvenile patient. Clin Nucl Med 2008; 33:319-20.
  27. Pleomorphic Liposarcoma Metastatic to the Thyroid Gland. Clin Nucl Med 2002; 27:9-10.
  28. Pretherapy Gallium-67 scanning in paediatric patients with Hodgkin’s disease. Shah Syed GM, Younis MN, Usmani GN, Zafar N. Med Princ Pract. 2004 Mar-Apr;13(2):74-7.
  29. Role of iodine-131 MIBG scanning in the management of paediatric patients with neuroblastoma. Shah Syed GM, Naseer H, Usmani GN, Cheema MA. Med Princ Pract. 2004 Jul-Aug;13(4):196-200.
  30. Effective and economical option for pain palliation in prostate cancer with skeletal metastases: 32P therapy revisited. GM S Syed, Maken RN, Muzzafar N et al. Nucl Med Commun. 1999 Aug;20(8):697-702.

 

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