Dubai Hospital – Clinical Support Services (CSS) - Nuclear Medicine Section

Introduction:


Our Nuclear Medicine Section at Dubai Hospital was established in 1982. It is a section within the Department of Clinical Support Services (CSS) of Dubai Hospital. We started our scintigraphy procedures using Siemens Planar Gamma camera. In 1992 we expanded our department to accommodate two General Electric (GE) single head SPECT system. The second development in the Nuclear Medicine services at Dubai Hospital was carried out recently, in 2003. Three new SPECT Gamma cameras were introduced within the new location of the department in Level 12 at Dubai Hospital.  The new cameras include two SPECT Siemens Ecam and Duet gamma imaging systems and SPECT Philips Forte system. These three new systems are introduced to replace the old GE systems.  The Siemens and the Philips imaging systems are connected through a computer network. 

The professional team of the Nuclear Medicine section at Dubai Hospital includes Physicians, Nurses, Medical Physicists, Nuclear Medicine Technologists and Administrative staff.

We receive Molybdeum-99/ Technetium-99m (99Mo/ 99mTc) generator (Activity = 21.5 GBq @ A.R.T) from Holland, Petten - Mallinckrodt Medical. We use the 99Mo/ 99mTc for about a week to elute the radioactive nuclide 99m Tc for diagnosis purposes. For therapy applications, we on request receive the desired radioactive nuclides from Mallinckrodt (such as 131I ) and from Amersham (such as 90Y and 32P) (Dispensing Laboratory) (Radiopharmaceutical Statistics).

The number of clinical examinations at our department is in a continuos increase (Patient Monthly Statistics), (Annual Scintigraphy Statistics) and (Studies Statisitics-2000) (Studies Statistics-2003).

The clinical developments we have over the years are summarized as:

1.  Renal Scintigraphy:

o   From day one we started using 99mTc-DTPA as a routine radiopharmecutical reagent for dynamic renal scans.

o   We introduced MAG 3 (Mallinckrodt) to our routine work in 1988. We started seeing gallbladder on delay renal images and since this might disturb our interpretations we switched to a new renal reagent named EC from Hungary which has almost no gallbladder visualization and has higher extraction rate (Abstract). Currently, we use EC for our routine dynamic renal scintigraphy.

2.  Bone Scintigraphy:

o   We perform routine 99mTc-HDP skeleton scintigraphy to detect various bone abnormalities.

o   We developed interest in using pinhole for localized bone lesions.

o   SPECT bone scintigraphy also became a common procedure at our department whenever it is needed (mainly for spine abnormalities).

3.  Nuclear Cardiology:

    • In 1986, we started to employ 201Tl as a routine myocardial scintigraphy. For stress studies, we used oral Persantin (400 mg).
       

    • In 1994 - 95, we switched to IV Persantin and dual isotope myocardial scintigraphies (first day 201Tl resting and second day 99mTc-Sestamibi).
       

    • In 1995, we introduced subspecialty to our hospital. One of the cardiologists at our hospital was trained, at the USA, as a nuclear medicine cardiologist. He is acting as alliance between the Nuclear Medicine and the Cardiology departments. This made a sharp increase in the cases of myocardial perfusion studies we investigate at our department.

4.  Oncology:

    • Bone (99mTc-HDP) whole body and liver (99mTc-NNC) SPECT scintigraphies are carried out at our department as a routine for breast and prostate cancer patients to detect any metastasis.
       

    • We use 201Tl and 99mTc-MIBI as tumour markers for different applications mainly for soft tissue tumours such as Sarcoma ( Tl-201 Images ), Brain, Breast ( Breast Images ), Lung and Thyroid (cold nodule cases in view to exclude malignancy).
       

    • Recently in early 1998, we started to use 111In-DTPA-MXT to, in vivo, image tumour folate receptors (Abstract).

5.   Paediatric Scintigraphy:

    • In 1984 we started our service for paediatric cases. The youngest paediatric case we had was 20 hours old.
       

    • Routine paediatric scintigraphies we carry out at our department are: Renal, Bone, Hepatobillary, CSF, Shunt, Lung (to detect foreign body inhalation)and Gastrointestinal Reflux.
       

    • We perform lung V/Q scintigraphy for children using aerosol technique as routine and urgent procedures. We built our experience in this area of scintigraphy which led us to publish our work in SNM meeting in 1994 (Abstract).

6.   Thyroid Scintigraphy:

    • Pertechnetate Tc-99m and Tl-201 are common examinations carried out to evaluate thyroid disorders.
       

    • The practice of Radioiodine (I-131) for diagnosis and therapy is considered as routine examinations at our section, Radio-Iodine Cases (Statistics).
       

    • Tc-99m MIBI for Parathyroid examinations and dual radionuclide studies are in practice within our section.

7.   Blood Components Labelling:

    • In 1991 we started in vitro 99mTc labelling procedures such as RBC mass, Plasma volume and GFR using CAPTUS2000 well counter.
       

    • We have employed a comprehensive but easy calculation techniques by using Microsoft Excel software.

8.   Brain Scintigraphy:

    • We started to use 99mTc-DTPA for brain scintigraphy as early as 1984, mainly for "Brain Death" cases.
       

    • We switched to 99mTc-HMPAO at early 1990. It has proven to be better for brain perfusion studies compared to the 99mTc-DTPA technique; it enabling better visualization with SPECT images.
       

    • We published a paper on semi-quantitative parameters of brain death scintigraphy (Abstract).
       

    • At present, we use 99mTc-99mTc-DTPA for Blood Brain Barrier (BBB), mainly for brain tumour diagnosis. Occasionally, we use Tl-201 for brain malignancy diagnosis.
       

    • Brain Scintigraphy became as a confirmatory test for Brain Death at Dubai Hospital.

 


"Science without Religion is blind, Religion without Science is lame",
Albert Einstein.

 

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