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Department Of Radiology

Nuclear Medicine

Description


The Nuclear Medicine facility at the New York Presbyterian Hospital/Columbia University campus is an up to date, comprehensive diagnostic nuclear imaging and therapeutic treatment facility. Diagnostic nuclear medicine examinations are provided at the New York-Presbyterian Hospital. The division of nuclear medicine has seven gamma camera imaging systems including four SPECT cameras, one thyroid probe, and a multichannel well counter. An additional three SPECT cameras and a SPECT /CT scanner are located in Nuclear Cardiology. The imaging systems are all connected to the NYPH Picture Archiving and Communication System (PACS). In addition, a full range of oncologic, neurologic and cardiologic clinical PET and PET/CT exams are performed in the David A. Gardner PET Research/Kreitchman PET Center located on the CUMC campus. The PET Center is equipped with two clinical 40-slice PET/CT scanners as well as an additional 64-slice PET/CT scanner and a dedicated head PET scanner that are devoted to PET and PET/CT research studies.  For more information about the PET Center, please follow the link below.

  

A wide variety of pediatric and adult nuclear medicine examinations are provided including Brain perfusion SPECT scans; Thyroid/Parathyroid scans; Ventilation /perfusion lung scans; Gastrointestinal scans (bleeding scans, gastric emptying studies); Renal scans; MIBG, ProstaScint, and Octreotide scans for endocrinology and oncology, Gallium scans; Sentinel node lymphoscintigraphy and Bone scans. Additional studies including GFR measurement and red cell mass determination are also provided. In addition, this division is actively involved in the treatment of thyroid cancer and benign thyroid conditions with radioiodine as well as radioactive and radio-immunotherapy for treatment of a variety of oncologic diseases. All faculty members, in this division, are actively involved in clinical care, teaching and research in nuclear medicine and in the David A. Gardner/Kreitchman PET Center. In addition, a number of the faculty have been listed in the “Best Doctors in New York” and “The Best Doctors in America”.

 

Educational Opportunities


The Division of Nuclear Medicine offers two types of graduate training programs. One is a three-year residency fully- accredited ACGME program in Nuclear Medicine. The other is a one-year fully accredited ACGME fellowship program in Nuclear Radiology. The program typically has two - three nuclear medicine residents and one nuclear radiology fellow enrolled in the program. In addition, residents enrolled in the radiology program rotate in nuclear medicine as part of their radiology-training program. In addition, the faculty offers regular ongoing training courses and seminars in the basic sciences of nuclear medicine as well as in clinical SPECT and PET imaging.

 

Research


All faculty members are actively involved in research pertaining to the basic sciences of nuclear medicine as well as the development and clinical assessment of new SPECT and PET diagnostic probes for the evaluation of probe efficacy to detect disease and assess response to treatment. Faculty members are also actively in a wide array of multi-center clinical trials to evaluate new diagnostic/therapeutic radiotracers. Research from the division has appeared in a many professional journals, books, and book chapters. Members of the division staff are often also sought out to write review papers and chapters for books in the field. In addition, members of the division often present their research at national and international nuclear medicine meetings.

Neuroimaging


The nuclear medicine division offers brain perfusion SPECT scans for evaluation of a variety of medical conditions.  These include ictal and interictal seizure focus localization, dementias, evaluation of brain vascular reserve (Diamox challenge study) or vascular collaterals (balloon occlusion study), and assessment of infection and inflammatory diseases.

Brain SPECT

The division performs radionuclide cisternograms for evaluation for communicating hydrocephalus (including normal pressure hydrocephalus) and suspected CSF leakage, as well as radionuclide CSF shunt study for investigation of ventricular shunt patency.

 

Cisternogram

Lung

The division provides radionuclide ventilation and perfusion studies for evaluation of pulmonary embolism and other diseases.  Ventilation studies can be performed using a radioactive gas (xenon-133) or using Technetium-99m-labeled aerosolized particles.

Ventilation-Perfusion

Quantitative measurement of ventilation and/or perfusion is available for patient undergoing preoperative assessment for lung transplant, lung volume reduction, and other surgeries.

Quantification

Gastrointestinal / abdominal Imaging

The division provides diagnostic studies of the gastrointestinal system, including hepatobiliary imaging for acute and chronic cholecystitis, biliary obstruction, biliary leakage, and quantitative gallbladder contractility evaluation. 

Hepatobiliary scan

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Gallbladder contractility

GI bleeding may be evaluated using either tagged RBC or sulfur colloid.

 

GI bleeding scan

Meckels scan is available for evaluation of ectopic gastric mucosa frequently seen in Meckels diverticulum.

 

Ectopic gastric mucosa (Meckels) scan

Salivary gland imaging is available for patients with sialadenitis and other salivary gland disorders.

Salivary gland

The nuclear medicine division offers planar and tomographic (SPECT) liver-spleen imaging for evaluation of portal hypertension, splenic activity, and hepatic and splenic lesions.

Liver-spleen scan

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Liver SPECT

Gastric emptying studies are available for patients with abdominal pain, gastroparesis, gastroesophageal reflux, and aspiration.  

Gastric emptying scan

GI reflux scan

Renal Imaging

The division offers radionuclide imaging for renal function, including evaluation of urinary obstruction, Lasix washout analysis, functional assessment (split function), and renal transplant. 

MAG-3

The division also performs high-resolution renal parenchymal imaging for suspected renal lesions, scarring, and split function.

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DMSA

The division also offers assessment of glomerular filtration clearance, most frequently requested for renal donors and monitoring renal function during chemotherapy.

GFR

Bone Scintigraphy

The division offers radionuclide imaging for both benign and malignant diseases involving the skeletal system.  The most common studies include whole body bone scans for evaluation of bony metastases in many cancers, benign bone lesions, metabolic bone diseases, infection, and reflex sympathetic dystrophy (also known as complex regional pain syndrome).

WB bone scan

Three-phase bone scans, which include dynamic blood flow, soft tissue blood pool, and delayed osseous localization of the radiotracer to the clinically suspected region of abnormalities, are frequently requested for evaluation of suspected osteomyelitis, fractures, and prosthetic loosening.

Three-phase

 

Infection/inflammation

Indium-111 labeled white cell studies are available for patients with suspected infection or fever of unknown origin.  In the setting where findings in bone scan are suspicious for osteomyelitis, further evaluation with sulfur colloid and white cell studies (can be performed on the same day) may offer additional information.

Tagged WBC

Gallum scans are particularly helpful in evaluation of subacute to chronic infection focus and assessment of active sacroidosis.  Gallium scans may also be used in the evaluation of some tumors.

Gallium

Endocrine

The division offers imaging and quantitative assessment of thyroid glands for both benign diseases and malignancy of the thyroid gland.  Common benign conditions that cause thyroid dysfunction include Graves’ disease, thyroid nodules, multinodular goiter, thyroiditis of infectious or autoimmune etiologies.   Iodide uptake is performed for diagnostic considerations and possible treatment planning.

 Thyroid

In addition to diagnostic whole body I-131 scans for sensitive detection of recurrent or metastatic thyroid cancers, the division offers therapeutic I-131 doses for treatment of hyperthyroidism and thyroid malignancy.

Thyroid cancer WB scan

I-131 treatment for thyroid cancer and hyperthyroidism

The division offers dual-isotope radionuclide diagnostic imaging for suspected hyperfunctioning parathyroid gland adenomas or hyperplasia using Tc-99m MIBI in conjunction with I-123, and employed a standardized subtraction technique.

Parathyroid

The division offers adrenal (MIBG) imaging for neoplasms with high adrenergic  avidity such as pheochromocytoma and neuroblastoma.  Also available is somatostatin (Octreotide) scan for neuroendocrine tumors and Prostascint scan for prostate cancer.  The division also performs lymphoscintigraphy for sentinel node localization.         

 

Adrenal (MIBG)

  

Octreoscan and SPECT

 

Lymphoscintigraphy

Treatment
In addition to I-131 therapy for hyperthyroidism and thyroid cancer, the division offers Y90-SIR sphere for hepatocellcular carcinoma chemoembolization, Y90 ibritumomab tiuxetan (Zevalin) treatment for non-Hodgkin’s lymphoma, and Sm-153 (Quadrimet) palliative alleviation of bone pain.

Brain PET-CT and PET

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Whole body PET-CT

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Contrast enhanced PET-CT