The cardiovascular system, skeleton system, thyroid, parathyroid and other endocrine organs, genito-urinary system, gastrointestinal system, pulmonary system, central nervous system, infection and inflammation visualizations can be made by means of the gamma camera system with a double detector which is available at the Nuclear Medicine Department of Liv Hospital. While the functions of all systems can be visualized with planar images, tomographic data can be created where functional and anatomical details are obtained by SPECT-CT fusion technique.

The gamma camera device provides a superior and stable imaging quality by the state-of-the-art HD detector technology. Use of the patient’s bed with the ultra-thin visualization palette is simple and allows maximum comfort for the patient. This palette allows close positioning of the detector to the patient and reduces the attenuation.  Support for arm and head makes it easy to position the mechanisms for maximum patient comfort.

The automatic body contouring feature allows to minimize the space between the detector and the patient in order to provide the best resolution in whole body and SPECT imaging. To define the versatility of the device, the detector heads, including the internal and external angles, rotate to various directions easily and provide visualization positions in detail for oncology and neurology studies.

Intraoperative Gamma Probe
One of the important reflections of the advanced technology is to find and remove the initial lymph node (the sentinel lymph node) where tumor is drained during the operation following radioactive marking, which can help to detect the metastases that are impossible to detect them by examination and visualization in some tumors by monitoring the lymphatic current of the cancer tissue, sometimes in the basis of millimeter and sometimes in the basis of cell.
The intra-operative gamma probe is used also for finding the non-palpable breast lesions and for minimal invasive parathyroid surgery or the non-easy localized parathyroid adenomas during surgery, following radioactivity injection.

Urea-Breathe Test
The urea-breathe test is a simple and reliable test used for detecting the helicobacter pylori infection. Helicobacter pylori is a bacteria that is growing by localizing at the stomach or small intestine (duodenum) mucosa in humans and which is known associated with the gastric diseases in a wide range from gastritis, stomach-duodenum ulcer to gastric cancer and its lymphoma by the reactions created by the defense system of the infected people.  Thus, its diagnosis, treatment and response to the treatment are important.

Marked Leukocyte Scintigraphy
Marked leukocyte scintigraphy is a nuclear medicine imaging method with high diagnostic accuracy used for investigation of the infection focus. The most frequent indications are especially investigating the fever etiology with unknown reason, bone and soft tissue infections where other visualization are suspicious, determination of joint prosthesis and other implant infections and demonstrating the chronic inflammatory intestinal diseases’ activation.

• They are very sensitive and specific to purpose methods.
• It has no allergic and side effects.
• They provide functional information at physiological and metabolic level.
• They have the feature of being compared with each other when repeated, because the information is numerical at the same time.
• They will not give discomfort and harm the patient due to being non-invasive.
• The patient is receiving very low level of radiation in nuclear medicine practices.

Diagnostic Nuclear Medicine Services

• PET / CT imaging
• PEM imaging
• Lung perfusion and ventilation scintigraphy
• Quantitative lung perfusion scintigraphy
• Right to left shunt investigation
• Radionuclide venography
• Myocardial perfusion scintigraphy
• Gated myocardial perfusion SPECT analysis
• Radionuclide ventriculography (MUGA)
• Radionuclide angiocardiography and shunt analysis
• Brain perfusion scintigraphy
• Radionuclide cisternography
• Ventricular fluid leakage and shunt investigation
• Thyroid scintigraphy
• Thyroid uptake test
• Perchlorate washout test
• Whole body iodine scintigraphy
• Parathyroid scintigraphy
• Parathyroid SPECT
• Iodine-131 MIBG scintigraphy
• Iodine-123 MIBG scintigraphy
• Salivary gland scintigraphy,
• Esophageal scintigraphy
• Gastro-oesophageal reflux scintigraphy
• Gastric emptying scintigraphy
• Biliary ducts scintigraphy
• Liver-spleen scintigraphy
• Labeled spleen scintigraphy
• Gastrointestinal bleeding scintigraphy
• Meckel’s scan
• Liver blood pool study (hemangioma investigation)
• Whole-body bone scintigraphy
• Three-phase bone scintigraphy
• Bone SPECT
• Labeled leukocyte scintigraphy
• Bone marrow scintigraphy
• Dynamic renal scintigraphy (with and without diuretic)
• Static renal scintigraphy
• Captopril renal scintigraphy
• Direct and indirect voiding radionuclide cystography
• Testicular scintigraphy
• Indium-111 octreotide scintigraphy
• Penta DMSA scintigraphy
• MIBI whole body scintigraphy
• Whole-body Tetrofosmin scintigraphy
• Lacrimal scintigraphy
• Peritoneal scintigraphy
• Lymphoscintigraphy
• Sentinel lymph node scintigraphy
• Intraoperative gamma probe applications,
• Carbon-14 urea breath test
• Nuclear Medicine Services Associated with Treatment
• Radionuclide therapy
• Radionuclide therapy follow-up
• Hyperthyroidism treatment with radioactive iodine
• Thyroid cancer treatment with radioactive iodine
• Radionuclide synovectomy in hemophilic synovitis and rheumatoid arthritis
• Radionuclide therapy of metastatic bone pain
• Radioimmunotherapy in Lymphomas
• Intra-arterial radiomicrosphere treatment of liver metastases

• Is preparation needed before the examination?

Preparation is required for some examinations in Nuclear Medicine Department. Information about how to do the preparation for these examinations while coming on the day of the appointment will be given to you orally as well as with a written form.

• How are the radioactive substances administered for diagnosis?

Examinations in Nuclear Medicine Department are carried out by administering the radioactive materials to the patient at a low-dose intravenously or orally.

• What is the estimated waiting time before imaging?

A certain time for the substance given to spread enough in the body after making the injection should be waited. Waiting time varies depending on the examination to be performed.

• How is imaging performed in nuclear medicine?

Imaging is performed with devices called gamma camera or PET-CT. Four sides of the devices are open and imaging duration varies according to the examination.

• How often can nuclear medicine examinations be performed?

Scintigraphy can be performed with 2-3 day breaks in cases that the desired result cannot be achieved, the repeat of the same examination is necessary again, or several nuclear medicine examinations are needed to be performed consecutively.

• Is there any damage of used radioactive substances? 

The patients are exposed to very low levels of radiation in nuclear medicine. The administered radiopharmaceuticals are short-lived radioactive substances with low radiation that does not accumulate in the body, they can be reduced automatically by their half-life physically as well as excreted from the body through urine, sweat and the intestines. These substances can be used safely at varying doses according to age and weight in patients and children all ages.

• Is staying away from people needed after the examinations?

Generally you do not need to stay away from people because the amount of radioactive substances used in the examinations are at very low levels, but it is recommended to stay away from children and pregnant women for 24 hours after injection with the purpose of the measures.

Treatment Procedures in Nuclear Medicine and Molecular Imaging Department;

Radioactive Iodine Treatment

The treatment of thyroid diseases with radioactive iodine I¹³¹ are carried out for more than about 50 years. I¹³¹ treatment, which is the oldest targeted treatment method, has been performed to thousands of people all over the world. No significant finding of this treatment method, which is needed followed up for a long time, is detected among the treatment dose related adverse effects due to radiation.

Radioactive iodine I¹³¹ treatment (with the definition “Atomic treatment” often used in the public) is performed to the patients in order to eliminate the remaining thyroid and / or the destruction of metastases after thyroidectomy operation.

A professional team with a treatment experience of over ten years is working in Liv Hospital Treatment Clinic. Also, the treatment of hyperthyroidism is performed in the service, which is structured by targeting to provide the highest level of medical services and patient comfort in isolation ensured rooms. The treatment of differentiated thyroid cancer and / or metastases, and the destruction of residual thyroid tissue after surgery is performed risk-free and successful in Liv Hospital Nuclear Medicine Clinic, where all radioactive treatments can be performed, with the application of “ablation”.

MIBG treatment

I¹³¹ MIBG is a radioactive substance used in treatment of malignant neuroectodermal tumors (pheochromocytoma, paraganglioma, carcinoid tumors, medullary thyroid cancer, neuroblastoma). I¹³¹ treatment is administered by infusion intravenously.

Radioimmunotherapy (Yttrium-90 (Y⁹⁰)

Radioimmunotherapy is defined as a treatment that can find and destroy cancer cells by givıng the medication after labeling with the radioactive substance through injection. The method, which is targeted only the cancer cell and carry contained radiation to the tumor cells, is also effective on cancer cells in places that current treatments have difficulty to reach through the blood. Crossfire against the tumors. The method that the active ingredient used in the treatment is administered to patients by injection after combining with a radioactive substance in nuclear medicine laboratory.

Radioembolization (Y⁹⁰ microsphere therapy)

The first treatment of liver cancers is surgery. Chemotherapy and radiotherapy can be administered to patients who cannot be performed surgical treatment. The patients that these treatments are not effective can be treated with radionuclide labeled microspheres, which can be introduced into the cancerous tissue. Radioactive microsphere therapy is a treatment method based on the administration of radioactive substances to the tumor in the liver via the selective angiography. Microspheres are labeled with a radioactive substance called Y⁹⁰. Radioactive substances (radionuclides) radiate in approximately 0.5-1 cm from the tissue. In this way, normal tissues are not exposed to radiation and the adverse effects of radiation.

Radionuclide Synovectomy

Performing synovectomy with local radionuclide application in patients with hemophilia and rheumatoid arthritis.

Radionuclide Treatment of Metastatic Bone Pain

– Samarium¹⁵³ Treatment

Palliative systemic therapy with Samarium-153 can be performed for the relief or alleviation of pain in patients with widespread bone metastases. Multiple painful bone metastases in analgesics and morphine-resistant osteoblastic (sclerotic) and mixed type are observed in prostate, breast and lung cancers (80%) most frequently and in thyroid, urinary bladder, melanoma and renal cancers less frequently. The control of pain can be obtained with Samarium-153 in these patients.

– Ra²²³ Treatment

Ra²²³ dichloride (Xofigo®), which is new pharmaceutical approved by U.S. Food and Drug Administration (FDA), is a method that can be used in metastatic hormone resistant prostate cancer patients spread to bone in patients with prostate cancer. This radiopharmaceutical agent, which is administered intravenously, emits radiation by combining with minerals in the region with metastasis by reaching directly to bone metastases. Thus, it reduces the pain associated with bone metastasis in patients with bone metastases, also causes a regression in the disease at the same time. Its damage to normal tissues is at minimal level.

Breast cancer is the most common cancer type in females in the world. Early diagnosis and correct staging of breast cancer are the very important factors in determining the course of the disease and survival. The anatomical imaging methods such as US (ultrasonography), mammography and MR used in assessment of the suspicious lesions detected in the breast and in accurate staging of the malign disease detected, may be inadequate in various situations. Positron Emission Mammography (PEM/BREAST PET) can visualize the minimal lesions of the breast before they become visualized in anatomical level by means of the current technology.

This device is available only in a few medical centers worldwide in only two countries in Europe, and only at the Department of Nuclear Medicine of Liv Hospital in Turkey.

Sensitivity of PEM in visualizing the breast lesions has been reported above 90%, and it allows preventing unnecessary biopsies and re-excisions and performing breast-protective surgery by doing the staging and surgical planning more accurately. In addition, it has a high sensitivity and specifity in assessment of the response to the medical treatments and in detecting the local recurrences, compared to the anatomical imaging techniques.

Through PEM imaging, uptakes of the abnormal tissue in the breast are revealed precise and detailed with a sensitivity of up to 1.6 mm. Moreover, as it is aimed only to make the breast inactive rather than compression, it provides much more patient comfort during imaging compared to mammography.

Usage Areas

• For diagnostic purpose in patients with suspicious lesion detected in breast via MR or mammography,
• For planning and staging prior to surgical operation in breast cancer,
• For contralateral malignity investigation of multi-centric/multi-focal tumors,
• For investigation of axillary lymph node metastasis,
• For restaging of leuko-regional recurrence,
• For assessment of response to the treatment.

Recommended for

• Diagnostic in earlier stage,
• Menstruation proliferative phase where the diagnostic sensitivity of MR is low,
• Obese, kyphotic, metal-implanted, claustrophobic patients,
• Patients with chronic renal failure.

It is an excellent system that evaluates the functional-level images created with combination of PET-CT, PET (Positron Emission Tomography ) and CT (Computerized Tomography) with sequential anatomical data.  While PET provides information about the function and metabolism of the cells, CT provides anatomical information such as size, localization and density.
PET-CT has a centralized importance in determining the prevalence of cancer patients, in selection of the treatment to be applied and in investigation of the suspicious cases like recurrence. It plays in important role in determining the treatment method to be applied in staging (surgery, surgery + chemotherapy, chemotherapy/radiotherapy, etc.). Also, it is possible to perform a more accurate staging by determining if there is any relationship between the findings such as bone, liver lesions, lymph nodes or pulmonary nodules imaged by other diagnosis methods and the present tumor of the patient. In oncology patients, it is used for differentiating the benign-malign lesions, in staging of cancer, in determining the degree of malignity of tumor and its prevalence in the organ, in determining the whole body metastases, in detecting the recurrence, in selection of the treatment method, in evaluating the response to the treatment, in planning the radiotherapy by determining and aiming the real tumor volume and irradiating the correct spot in correct dose. All evaluations are supported also with digital data. Visualization of whole body using the PET-CT in the oncologic patient group is an excellent method which provides more information than total of all other imaging methods.

Usage Areas 

• The Nuclear Medicine applications are rather used to scan whole body in the oncologic aspect. For differentiation of nodule or masses identified before in patients as benign and malign, for identification of the main focus in patients with diagnosis of cancer, for staging to decide the treatment (identification of spread in other body regions), for assessment of the response of the patient to the treatment applied, for suspicious recurrence (renewal) or metastasis (spread elsewhere), and for planning of radiotherapy and for more precisely identification of the live cancer tissue to be irradiated and for protection of the healthy tissues recently,

• For differentiation diagnosis of pulmonary solid nodules in the lung, brain tumors, pancreatic masses and adrenal masses,

• In evaluation of the response to the treatment, decisions can be made in earlier periods for continuing to chemotherapy, or, if necessary, for changing the chemotherapy drugs (for example, if the cancerous tissue is resistive to the treatment applied) in case of a successful response.

• In addition, for investigation of the existence of living muscle tissue in heart patients before the interventions such as by-pass, stent, and therefore, for identification if benefit will be obtained or not from these interventions,

• For displaying the oxygen consumption and blood flow using different agents for cerebral glucose metabolism in psychiatry and neurological sciences, in detecting the epilepsy foci, and in visualization of receptors and molecule regarding the nervous system.  It can be used actually in Parkinson patients to evaluate the status of the dopamine receptors and to follow up the response to the treatment. It can be used in differential diagnosis of other movement disorders.

What are the preliminary preparations prior to imaging for the PET-CT patients? 

The patients must be hungry for a duration of 6 hours before imaging for PET-CT. Patients may take their oral antibiotic or medications other than insulin. In diabetic patients, the quality of image can be poor because of the competition of blood glucose with FDG. Therefore, the blood glucose level is determined before FDG injection, and imaging does not recommended usually at the blood glucose levels above 180 mg/dL.

How imaging is performed in PET-CT? 

On PET-CT imaging, a special radiopharmaceutic called FDG (fluorodeoxyglucose) is injected intravenously to the patient who is in state of resting in the room. After waiting for about 60 minutes for accumulation of FDG in the cancerous tissues, an imaging is performed for about 20 to 25 minutes proportional to the patient’s height. A second imaging may be performed 2 hours later if necessary.