DFCI – Chris Sakellis
617-632-3223
BWH - Victor Gerbaudo, PhD
617-732-6290
Nuclear medicine is technically a distinct specialty with its own residency training programs and its own certification examination (administered by the American Board of Nuclear Medicine), however, nuclear medicine is also a part of radiology resident training and practice.
Unlike other modalities (CT, MRI) which provide detailed anatomic information, nuclear medicine is used to study physiology (or pathophysiology). The fundamental principle on which almost all nuclear medicine tests are based is that of 1) having an understanding of a physiologic process, 2) isolating a participant in that process or an analogous substitute molecule, 3) applying a radioactive label to the process participant, and 4) imaging (via gamma camera) the radioactive label and by extension imaging the physiologic process. Common nuclear medicine tests and their most common applications include the HIDA scan (detects gallbladder disease), the V/Q (Ventilation/Perfusion) lung scan (detects pulmonary embolism), radiolabeled white cell and red cell scans (detect infection and hemorrhage, respectively), bone scans (sensitive but nonspecific indicator of osseous abnormality), and radioactive iodine scans (evaluate for and characterize thyroid abnormalities). In addition to providing diagnostic functional information about the thyroid, radioactive iodine is also used to therapeutically ablate abnormal thyroid tissue. A number of cardiac nuclear medicine exams also exist but are administered and interpreted by cardiology at the Brigham.
PET/CT is a special technique in nuclear medicine which is very frequently used at Brigham given our close association with the Dana Farber Cancer Institute. PET/CT has many applications but is most frequently used in oncologic imaging (“Onco-radiology”). In this technique, a radioactive glucose analog called fluorodeoxyglucose (F18-FDG) is administered intravenously to localize hypermetabolic (glucose avid) areas within the patient. This can identify tumor deposits (metastases) which often consume large amounts of glucose due to rapid cell replication. PET/CT can identify a number of other processes that occur within the body are also often hypermetabolic (primarily infection, inflammation, and benign neoplasms). PET-CT (and at some centers PET-MR) allows the fusion of data providing primarily functional information (PET images) with data providing primarily anatomic information (CT images most commonly) to provide a more complete evaluation by maximizing the relative strengths and minimizing the relative weaknesses of each modality.
The nuclear medicine reading rooms are located on L2 at DFCI and in L1 at BWH as well as L2 Shapiro.