Nuclear Medicine

St. Mary’s General Hospital operates the Kitchener-Waterloo Regional Nuclear Medicine Program, where service is offered out of two locations:

  • St. Mary’s General Hospital (1st floor)
  • Grand River Hospital (2nd floor)

Nuclear Medicine plays an important role in the diagnosis and treatment of disease. Nuclear medicine procedures are helpful to a broad range of medical specialties, from pediatrics to cardiology to oncology.

What Is Nuclear Medicine?

Nuclear medicine is a diagnostic service that uses very small amounts of radiopharmaceuticals to diagnose and treat disease.

Radiopharmaceuticals are substances that travel to specific organs, bones, or tissues. The radiopharmaceuticals used in nuclear medicine emit gamma rays that can be detected externally by special types of cameras (gamma cameras).

The amount of radiation from a nuclear medicine procedure is very low.

Is Nuclear Medicine Safe?

Nuclear medicine uses radioactive materials which are typically injected into the bloodstream, inhaled or swallowed. The materials give off gamma rays, which can be detected by a special gamma camera to create images of your body.

Safety

While these procedures use radioactive materials, they are safe. The amount of radioactivity is similar to that given during a CT scan. Other than the discomfort of an injection, the scans involved are painless.

Despite the small amount, you will be considered radioactive after your procedure. This radioactivity decays naturally. Depending on which radiotracer you’re given, it can also be excreted from the body.

If you plan on going to an airport or crossing a border, you should let your nuclear technologist know.

Scheduling Procedures

Appointments are scheduled through physician referral only. Your physician will:

  • Complete and fax the necessary requisition to order the test (similar to writing a prescription for medication)

To access the physician referral form, click here.

If you are unable to attend your appointment, or you need to re-schedule, please call the department of nuclear medicine at 519-749-6495.

Request for Images

Perhaps your physician has asked you for a copy of your nuclear medicine images. What do you do next?

Nuclear Medicine can be reached at 519-749-6495. After you call, we will have a copy of your images available for you to pick up. If possible, we ask that you give us 24 hours notice.

The images can be picked up between 7:30 a.m. and 5:30 p.m. on weekdays. We will ask you to complete a release form. This form is necessary for your security as well as our records.

Hours and Contact Information

The hours of operation for this program is as follows:

  • St. Mary’s General Hospital Site, 7:00 a.m. to 5:30 p.m.
  • Grand River Hospital Site, 8:00 a.m. to 4:00 p.m.

For more information contact:

Nuclear Medicine
519-749-6495

*Please note: Urgent matters should not be communicated over email. Please call the Nuclear Medicine line.

Information for physician referral can be found here.

Learn More About Your Procedure

Your doctor has referred you or a family member for a test in the nuclear medicine department because the information obtained from the test will be important in determining the diagnosis and treatment of the medical problem you may have.

Here are some answers to common questions.

What should I expect during the test?

Once you arrive into the department, a Technologist will explain the test to you and administer the radiopharmaceutical. Nuclear medicine scans can vary from 15 minutes to 1 hour depending on the organ of interest and the type of scan you are having. It is very important, just like any other imaging procedure, to stay still and not move during the imaging procedure.

Appropriate breaks will be give in between scans to ensure comfort. If you are claustrophobic please inform the Technologist prior to starting the test and they will be more than happy to make some adjustments.

How will I get my results?

The results are automatically fixed or emailed to the requesting doctor’s office. If you would like the reports to be sent to your family physician or any other doctors, please state your doctor’s name at the reception desk when you check in.

The following section provides information on some of the more commonly performed diagnostic and therapeutic nuclear medicine procedures.

Procedures at St. Mary’s General Hospital

The material presented here is for informational purposes only and is not intended as a substitute for discussion between you and your physician. If you require more information about a nuclear medicine procedure, please consult your physician or the nuclear medicine department.

If you think you might be pregnant or are nursing a baby, please contact the department prior to having your procedure.

Continue scrolling for a list of procedures and to learn what to expect from each of them.

Abdomen:

Gastric Emptying Scan

This procedure will evaluate how well food travels from your stomach to your intestines. The procedure will take up to four hours.

Test preparation:

  • Nothing to eat or drink from midnight before the test
  • Please call the nuclear medicine department if you have an allergy to eggs

Exam Procedure:

You will be asked to eat a sandwich that contains a radioactive tracer. Images will be taken immediately after you have eaten the sandwich for up to four hours.

Gastrointestinal Bleed Scan (GI Bleed)

This scan looks for sites of bleeding within your abdomen. The procedure will take between one-and-a-half and four hours.

Test preparation:

  • None

Exam Procedure:

A tube of blood will be taken from a vein in your arm. The blood will then be labeled with a radioactive tracer and re-injected back into a vein.

Images of your abdomen will be taken for a minimum of one-and-a-half hours, but can last up to four hours.

Hepatobiliary Imaging (HIDA)

Gall bladder scans are used to evaluate upper abdominal pain, determine causes of jaundice and identify any obstructions in the gall bladder.

Test preparation:

  • Do not eat or drink for four hours before the test because contents in the stomach will alter the test results.

Exam procedure:

After the radioactive tracer injection (in the arm), you will lie on your back on the imaging table and multiple images of the abdominal area will be taken. For this test, the images are taken immediately after the tracer injection.

Imaging takes one to two hours or longer because it is not possible to determine how long it will take your liver to excrete the tracer, or when your gall bladder will be visible to the camera.

Depending on what your doctor is looking for, the test may involve the injection of a drug that will stimulate or contract your gall bladder or duct.

This will provide the nuclear physician with more information about how well your gall bladder is working. This test can also be performed on patients who have had their gall bladders removed; in this case, an assessment of the duct system will take place.

LeVeen Shunt Scan

This test evaluates the patency of perito-venous shunts (is the shunt working?). The procedure takes between one and four hours.

Test Preparation:

  • None

Exam Procedure:

A radioactive tracer will be injected by a physician directly into the abdomen. Images will be taken immediately following the injection for up to four hours.

Liver & Spleen Scan

Liver scans help diagnose disorders such as cirrhosis, hepatitis, tumours and other problems in the digestive tract.

Test preparation:

  • You should not have any gastrointestinal tests with barium at least 24 hours before the liver test.

Exam Procedure:

A radioactive tracer is injected in your arm. Ten to 15 minutes after the injection, you will lie on your back and images from different positions will be taken of your liver and spleen.

This procedure will take 45-60 minutes.

Liver Hemangioma Scan

This procedure looks for hemangioma(s), which are benign tumours with the liver. The procedure will take four-and-a-half hours.

Test preparation:

  • None

Exam Procedure:

A tube of blood will be taken from a vein in your arm, and the blood will then be labelled with a radioactive tracer and re-injected back into a vein. Images of your abdomen will be taken immediately following the injection and again four hours after the injection.

You are free to leave between the first and second set of images.

Meckel's Scan

This procedure will look for the presence of Meckel’s Diverticulum (an out-pouching of the stomach lining). The procedure will take between one and one-and-a-half hours.

Test Preparation:

  • Nothing to eat or drink four hours before the test.

Exam Procedure:

A radioactive will be injected into a vein in your arm. Images will be taken immediately following the injection.

Blood System Imaging:

Blood Volume (Red Blood Cell or Plasma Volume)

This procedure measures blood volume. The procedure will take one-and-a-half hours.

Test Preparation:

  • You must not have had a blood transfusion in the past four weeks. Please call the department of nuclear medicine to reschedule your appointment.

Exam Procedure:

An intravenous (IV) butterfly line will be set up in your arm. A radioactive tracer will be injected through the IV. Small tubes of blood will be taken so a volume of blood can be calculated.

Bone

Bone Scan

Bone scans are studies that detect local changes in bone metabolism. Because these changes can often be seen before any changes are detected on X-ray, the bone scan is considered more sensitive than X-rays for the detection of certain fractures, infections and tumours in the bone.

You will receive an injection of a radioactive substance, usually in your arms. This material travels through the bloodstream, into the soft tissue, and then concentrates in the bones.

The injection feels similar to a blood test. There are no side effects from the injection.

We may take some images at the time of the injection. We may take some images at the time to the injection or we may wait for three hours before we begin taking pictures.

You can leave between the first and second sets of images.

Test Preparation:

  • No special preparations are required before the bone scan
  • You will be asked to drink fluids in the three hours between injection and scan, and to empty your bladder frequently. This helps to clear the injected material from your soft tissue and improves the quality of the bone scan.

Exam Procedure:

Most of the bone scan images will be done approximately three hours after the injection. The pictures usually take a total of 30-60 minutes. There are a number of ways we can take images, but often the imaging uses a gamma camera positioned above and below you.

The camera will scan the entire length of your body. A SPECT (3-dimensional) study may be done to look at a particular area of your body in detail. This involves an additional 30 minutes of imaging while the camera rotates 360 degrees around you.

Bone Mineral Densitometry

Bone Mineral Densitometry (BMD) is the method used to quantify the mass of bone in the body. The machine uses a very low dose X-ray to perform measurement of bone density.

Patients who have been referred by their doctors for a BMD scan are usually being assessed by osteoporosis, a common bone disease which makes bone fragile and easy to fracture. Future risk of fracture can be predicted through a BMD measurement and steps can then be taken to prevent them from happening.

Test Preparation:

  • Do not wear metal around your waist
  • No barium X-rays of the abdomen within one week of the test

Exam Procedure:

You will be asked to fill in a detailed questionnaire. This tells the physicians who interpret the scans a bit about your history, e.g. if you have a relative who had osteoporosis, or if you are on medications that may reduce the bone density.

You will be asked to remove any metal items from around your waist (belts, keys, coins, etc.)

For the typical patient, you will lie on a bed and two images will be taken: one of your hip and one of your spine. Some patients will have a bone density scan of their wrist performed instead.

The procedure will take approximately 15 minutes.

Brain

Brain Scan

The brain scan assesses the blood flow to your brain.

Test preparation:

  • None

Exam Procedure:

The test will involve an injection into a vein in your arm.

Immediately following the injection, pictures will be taken watching the blood flow into your brain. Two sets of pictures will be taken altogether. Between the first and second sets of pictures, there’ will be a waiting period of approximately one-and-a-half to two hours..

Cisternogram (CSF Study)

The cisternogram looks for hydrocephalus, which is an abnormal accumulation of cerebrospinal fluid (CSF) within cavities called ventricles inside the brain. CSF is produced in the ventricles, circulates through the ventricular system, and is absorbed into the bloodstream.

CSF is in constant circulation and has many important functions. It surrounds the brain and spinal cord and acts as a protective cushion against injury. It contains nutrients and proteins necessary for the nourishment and normal function of the brain, and it carries waste products away from surrounding tissues.

Hydrocephalus occurs when there is an imbalance between the amount of CSF that is produced and the rate at which it is absorbed. As the CFS builds up, it causes the ventricles to enlarge and the pressure inside the head to increase.

Test Preparation:

  • None

Exam Procedure:

This test will involve an injection of a radioactive tracer into the spaces between your bones and your spine. You will be given a little medicine to numb the area before injection.

Imaging of your head will take place over a number of days.

Heart

Cardiac Amyloid Study

Myocardial Perfusion Scan (MIBI or Thallium)

A myocardial perfusion scan is a test that helps your doctor see if you have coronary artery disease. Coronary artery disease is a narrowing of the blood vessels that supply oxygen to the heart muscle.

If the heart muscle does not get enough oxygen, it can cause chest pain, also known as “angina.”

Test Preparation:

  • Nothing to eat or drink for four hours prior to the test.
  • Do not eat or drink anything containing caffeine for 24 hours before both stress and rest studies.  This includes coffee, tea, colas, chocolate, or pain medications with caffeine (check the labels). Decaffeinated are not permitted, either.
  • Wear shoes and clothing that are suitable for exercise (e.g. flat shoes with non-slip soles). If you are diabetic and are unable to fast for the full four hours, you may eat a light meal up to two hours prior to the test.
  • Please ask the doctor who ordered this test for instructions about stopping any medications that you are taking.

Exam Procedure:

During the test, radioactive tracers are used to take pictures of the heart. These tracers are injected into your bloodstream and travel to the heart muscle through the coronary arteries. The pictures we then take of your heart will help your doctor decide if you have coronary artery disease.

Your procedure will have two parts:

  1. Pictures of your heart following the stress test
  2. Pictures of your heart during rest (rest pictures may take place before or after the stress portion)

Stress Test:

You will have an intravenous line inserted into your arm. You will be asked to walk on a treadmill for a period of time. Those patients who are not able to walk on a treadmill will be given a drug (Persantine or Dobutamine), which stresses your heart without exercise.

A radioactive tracer will be injected through the intravenous line. You will be monitored throughout the test (blood pressure and ECG tracings of the heart) and will have pictures of your heart taken shortly after.

Rest Test:

You will have a radioactive tracer injected into a vein in your arm. One hour after the injection, pictures will be taken of your heart.

Once both sets of images have been completed, the nuclear medicine physician will compare the images of your heart after stress with the images of your heart at rest.

Wall Motion (MUGA) Study

A wall motion study provides information about the heart’s ability to pump blood. A series of images is produced showing how blood travels through the heart. The amount of blood pumped by the heart during each beat is calculated so that the strength of the heart muscle can be assessed.

Test preparation:

  • No preparation is necessary. Plan on one to two hours in nuclear medicine.

Exam Procedure:

First, an intravenous line will be placed in your arm. A small amount of blood will be withdrawn. This blood will be combined with a radioactive substance that can be visualized by a special camera. This blood labelling procedure takes approximately 45 minutes.

Next, you will be connected to a heart monitor. As you lie your back on the table, your labelled blood will be injected back into you through the intravenous line. You will not feel anything from this injection.

A camera will be placed near your chest. Images of your heart will be taken from three different angles. The labelled blood highlights your heart and produces a picture of your heart’s structure and function. The imaging procedure takes approximately 45 minutes.

Infection or Tumour Imaging

Gallium Scan

Gallium scans often are used to diagnose and follow the progression of tumours or infections. Gallium scans can also be used to evaluate the heart, lungs, or any other organ that may be involved with inflammatory disease.

Test Preparation:

  • No special preparation is required before the study.

Exam Procedure:

A gallium scan usually requires two visits to the Nuclear Medicine Department. On the first day, you will receive an injection in a vein in your arm. Your visit should take about 15 minutes and the injection will cause no more discomfort than having blood drawn.

You will be scheduled to return for diagnosing between two and four days later, depending on your diagnosis. Your initial scan is the longest part of the procedure and may take up to two hours.

For most gallium scans, you will lie on a stretcher or imaging table with the camera positioned above or below you. Multiple images may be taken, or the camera may move slowly, scanning the entire length of your body. A SPECT (tomographic) study may be done to look at a particular area of your body in detail. This involves lying on a narrow imaging table while the camera rotates 360 degrees around you.

Because gallium is normally excreted through the bowel, it may obstruct our view of your abdomen and pelvis on the first day of imaging. Therefore, we may ask you to return on another day for more imaging.

Octreotide Scan

Currently, this scan is only available for patients living within the Waterloo-Wellington LHIN.

This octreotide procedure assists in locating neuroendocrine tumours. This test will assist with diagnosis or treatment of the tumour.

Test Preparation:

  • Drink lots of fluids the day before and the day of the test.
  • Take a mild laxative containing Bisocodyl (over the counter preparations contain this ingredient). If you have diarrhea, do not take a laxative.

Exam Procedure:

This procedure can take up to three days to complete. The path of the radioactive tracer will be watched over a period of time.

On day one, you will receive an injection of the radioactive tracer into a vein in your arm. Images will be taken four hours after the injection.

On days two and three, more images will be taken. Each set of images will take between one to two hours to complete.

MIBG Scan

The radiopharmaceutical I-131 MIBG is used to aid in the diagnosis and detection of adrenal tumours or pheochromocytoma.

Test Preparation:

  • Please contact your physician or the nuclear medicine department for specific instructions.

Exam Procedure:

The procedure involves an injection of a radioactive tracer into a vein in your arm. Imaging will take place for up to four days as the distribution of the tracer is followed over time. Imaging could take approximately two hours each day.

White Blood Cell Scan

This test is performed to determine the area of infection within the body or to find out if you have an ischemic bowel disease.

Test Preparation:

None

Exam Procedure:

This procedure will take up to one full day to perform. Some patients will need to come back for imaging the next day as well.

You will have blood taken. Your blood will be labelled with a radioactive tracer and returned to you four hours later. Images will be taken four hours after the tracer injection.

Kidney

Renal Scan

A renal scan is a nuclear medicine examination done to study the function and blood flow to the kidneys. The test will check how well the kidneys are working by watching the kidneys fill and empty into the bladder. Some patients will have medications injected prior to or during the procedure that help to assess the kidneys.

Test Preparation:

  • Drink plenty of fluids the day of the procedure.
  • You may need to be off certain medications prior to this procedure. Please check with your physician.

Exam Procedure:

You will have an intravenous line inserted into a vein in your arm. Radioactive tracers will be injected through the IV and images of your kidneys will be taken during the injection. The injection and imaging will take one hour to complete.

Blood will be drawn one and three hours after the initial injections. You may eat and drink between the blood sample times. The blood samples allow us to perform calculation of kidney function.

Lung

Lung Scan (V/Q)

The lung scan is also known as a V/Q scan. This procedure looks for blood clots to your lungs (pulmonary embolism).

Test Preparation:

  • None
  • You may be required to have a chest X-ray, or if you have had one, you may be asked to bring the films along. The doctors find a chest X-ray helpful in interpreting the lung scan pixtures.

Exam Procedure:

The lung scan has two parts to it: ventilation and perfusion.

The ventilation looks at the airflow to your lungs. You will be asked to breathe in a radioactive gas. Pictures will be taken at various angles around your chest.

The perfusion looks at the blood flow to your lungs. You will receive an injection of a radioactive tracer into a vein in your arm. Pictures will be taken at various angles around your chest.

Lymphatic

Sentinel Node Imaging

The procedure provides a “road map,” showing the direction of lymphatic drainage from around the site of a cancer.

The Sentinel Node Study demonstrates the path of lymphatic drainage. This allows the surgeon to take out the specific node (or nodes) that are the first to receive lymphatic drainage from the area around the tumour. If the “sentinel” node(s)do not show any microscopic evidence of tumour, it is very unlikely that any other nodes would contain tumour cells.

Test Preparation:

The procedure involves no preparation on the part of the patient, other than the usual pre-operative instructions provided by the surgeon.

Exam Procedure:

In nuclear medicine, staff will inject a small amount of radioactive tracer in the region of the tumour.

The rest of the exam consists of taking pictures. The technologist will take images of the lymph nodes draining the region around the tumour. If lymph nodes are seen, the nuclear medicine staff may use a pen to put a mark on the skin overlying the lymph node to help the surgeon find the nodes.

In the operating room, the surgeon has a probe that detects the radioactivity in the lymph nodes. The probe is used in conjunction with the pictures and skin marks from nuclear medicine to identify the sentinel node(s). Once the nodes are removed, they are sent to pathology for microscopic examination for evidence of spread of the tumour.

PyTest (Helicobacter-pylori)

PyTest (Helicobacter-pylori)

The PyTest uses Urea Carbon-14, which is a radioactive tracer. It is used to diagnose stomach ulcers caused by a certain kind of bacteria known as Helicobacter-pylori, or H. pylori.

This agent is taken by mouth (it is a capsule). If any H. pylori bacteria are present in the stomach, they will cause the Urea C-14 to be broken down into radioactive carbon dioxide gas. The amount of gas can be measured and the presence or absence of bacteria can be confirmed.

Test Preparation:

  • Do not eat or drink anything six hours before the test.
  • **Please check with your physician about stopping any medications that you are taking.
  • No antibiotics for four weeks prior to the test
  • No medicines containing Bismuth (e.g. Pepto-Bismol) for four weeks prior to the test.
  • No proton pump inhibitors for two weeks prior to the test. Please check with your physician before discontinuing medication.

Exam Procedure:

You will be asked to swallow a small capsule containing a radioactive tracer. Ten minutes later, you will be asked to blow into a balloon. The balloon is sent out for measurement. If the test shows the presence of the bacteria, your physician will begin treatment (usually involves antibiotics).

Salivary Gland

Salivary or Parotid Scan

A salivary gland scan is a nuclear medicine test that examines the uptake and secretion of a radioactive tracer in the salivary glands. The pattern of uptake and secretion shows if these glands are functioning normally.

Test Preparation:

  • None

Exam Procedure:

A radioactive tracer will be injected into a vein in your arm. Immediately after, images will be taken. The procedure will take just under one hour.

Tear Duct (Dacryoscintigaphy)

Lacrimal or Tear Duct Scan

This procedure can also be called Lacrimal duct scanning or Dacryoscintigaphy.

The purpose of performing the Lacrimal Scan is that a radioactive tracer, when placed in your eyes (like an eye drop) will follow the path of tears. Pictures will be taken of the tear ducts to make sure there are no blockages.

Test Preparation:

  • None

Exam Procedure:

A radioactive droplet will be dripped into the eyes. You will be placed (in the sitting position) in front of a gamma camera, which will take pictures of the tear ducts. The test will take approximately 30 minutes.

Testicular Scan

Testicular Scan

A testicular scan can help diagnose conditions that can affect the testicales. This test may be done in an emergency to evaluate the cause of sudden, painful swelling of a testicle, which can be caused by a twisted cord (spermatic cord) in the testicles. This condition is called torsion and needs to be treated immediately.

Test Preparation:

  • None

Exam Procedure:

You will have a radioactive tracer injected in your arm. Pictures will be taken immediately following the injection.

Thyroid

Parathyroid Scan

This study is performed for the evaluation of a possible parathyroid adenoma. The parathyroids are four glands in the neck which help to regulate calcium metabolism. A parathyroid adenoma is a benign tumour of the parathyroid gland.

This tumour is the most common cause of hyperparathyroidism, which causes elevated levels of calcium in the blood (hypercalcemia).

Test Preparation:

  • None

Exam Procedure:

You will be given an injection of a radioactive tracer into a vein in your arm. Ninety minutes-worth of images of your parathyroid glands will take place immediately following the injection, and then again three hours after the injection.

You may leave in between the first and second sets of images.

Thyroid Uptake and Scan

The thyroid gland can be studied a number of ways in the Nuclear Medicine Department. Because the thyroid normally needs iodine to make thyroid hormone, a radioactive isotope of iodine is used, which allows us to measure how well the thyroid is functioning (thyroid iodine uptake).

To obtain images of the thyroid gland (thyroid scan), a radioactive tracer will be injected into a vein in your arm.

Test Preparation:

  • If you are taking thyroid medications, a mineral supplement with iodine, or other medications or preparations that contain iodine, you may be asked to stop them for a time before this test.
  • Check with your physician regarding your medications.

Exam Procedure:

The uptake and scan procedures involve two visits to the Nuclear Medicine Department.

On the first day, you will be asked to swallow a small amount of radioactive iodine (in capsule form). The visit should take about 15 minutes.

The next day you will return for a measurement of the radioiodine uptake, as well as an injection of a radioactive tracer. The tracer allows a picture to be taken of your thyroid gland. This will take one hour or longer.

The uptake procedure measures the absorption of the radioactive iodine by your thyroid gland. As you sit comfortably in a chair, a detector will be positioned several inches from your neck, and the amount of the radioiodine in your thyroid gland will be recorded. This will take 10 or 15 minutes.

For the scan, you will lie on your back on an imaging table with the camera positioned above you. We will take several images of your thyroid. Each image takes five or 10 minutes. Then, a nuclear medicine physician will examine your gland.

We may then take additional images to look at a certain part of your gland in detail. The imaging procedure will take about 45 minutes.