"Role of nuclear medicine in Paediatric Surgery" by Dr G Botha, Department of Paediatric Surgery, East London + advice by Dr Anita Brink, Nuclear Medicine Specialist, South Africa. This is the recording of a talk as a part of the Zoom academic meetings of the Department of Paediatric Surgery in East London, South Africa.
"Role of nuclear medicine in Paediatric Surgery" by Dr G Botha, Department of Paediatric Surgery, East London + advice by Dr Anita Brink, Nuclear Medicine Specialist, South Africa
Summary
Join this essential, on-demand teaching session focusing on the role of Nuclear Medicine in Pediatric Surgery. Learn about functional imaging where a radioactive tracer is injected into the patient. We will dive deeper into DMSA, the current gold-standard to assess renal morphology, structure and function, and its essential use in pediatric nephrourology. MAG3 scans, another significant highlight, are used to evaluate a variety of conditions such as vesicoureteric reflux and suspected obstructions. Learn about MIBG's role in managing neuroblastic tumors and the utility of HIDA scans in identifying issues with the liver, gallbladder, and bile ducts. The session also offers insights into Meckel’s scan, its specificity, sensitivity and utility. Equip yourself with the knowledge of these imaging techniques to better your patient outcomes and treatment decisions. Don't miss out on this essential learning opportunity!
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Description
Learning objectives
- Understand the role and importance of nuclear medicine in pediatric surgery including the use of tracers for functional imaging.
- Learn the process of how radioactive tracers are injected and captured in imaging for surgical purposes.
- Gain knowledge about the different types of scans such as DMSA, MAG3, MIBG, and HIDA, their purpose, procedure and implications in specific medical conditions.
- Identify the applications of nuclear medicine in diagnosis, staging and evaluation of diseases like neuroblastic tumours, renal functioning, biliary atresia, and Meckel's diverticulum.
- Develop the ability to interpret and utilize the results of nuclear medicine procedures for optimized patient care and treatment planning.
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TheRoleofNuclarMe diineineditricSrgey GJBBoha BothDx&Rx Functional imaging Radioactivetracer injected Mayneedsedation/GANM scans are Functional imaging Patientisinjectedwitharadiopharmaceutical-the radioactivetracer emittedotracergetstaken up andGamma rays are cameraamma raysarethen captured byaGamma An imageisproducedwhichistheninterpretedbya specialist DMSA Dimercaptosuccinicacid Thecurrentgoldstandard Renalmorphology,structure& functionDMSAscan:currentgold standardtoassess •Integrity of therenalparenchyma •Contribution ofeach kidneyto the total renal parenchymalfunction •Highly sensitivein theidentificationof corticalrenal scarsUses in paediatric nephrourology •Antenatallydiagnosed hydronephrosis Following anUTI to lookfor pyelonephritisin the acute setting 4-6 monthsafterUTI if renal scarring is suspectedDMSAMAG3Scan Tc-99m-mercaptoacetyltriglycinerenography Renalperfusion,parenchymalfx &collectingsystem drainage Image20-30 minsafterinjecting Dynamicimage EDE0.3–0.7mSvMAG3 scans isused to: • Evaluate forthe presence of vesicouretericreflux • Suspected PUJ orVUJ obstruction • Six to nine months following surgery(Pyeloplasty) to helpassess outcome • To confirm thediagnosis of aduplexrenal collectingsystemL RDMSA vs MAG3Inadequacy ofMAG3 renograms Grossly enlargedkidney Poorparenchymal extractionof the radiopharmaceutical Conditions with high backgroundactivity immature kidneys severechronic kidney diseaseMIBG Meta-iodo-benzyl-guanidineI-123 Cornerstone of Mxof Neuroblastic tumours SedationorGAmaybeneededMIBG in neuroblastic tumours •Arethereany metastases?-local or distant •Staging of the disease •Whereshould a biopsy bedone? •Responseto treatment •Anyresidualdisease •Diseaserecurrence following treatmentMIBGHIDA Tc-99m-mebrofenin Looksfor problems of the: Liver Gallbladder Bileducts CanexcludebiliaryatresiaUtility of HIDAscan Gallbladder inflammation- cholecystitis Congenital abnormalitiesin thebileducts- biliary atresia- to distinguishfrom hepatitis Postoperative complications-bileleaksand fistulas Assessmentfor liver transplantHIDA scan in biliary atresia: Good tracer uptake, but no excretion into the bowel- biliary atresia Poor tracer uptake - hepatocellular damage Simple, safe and cost-effectiveinvestigation forbiliary atresia in the first six-eight weeks of lifebeforebiliarycirrhosis sets in Definite diagnosis of biliary atresia still requires intraoperative cholangiographyHIDAMeckel’s scan Technetium-99mpertechnetate Specificity+/-95% Sensitivity +/-60%Why usea Meckel’sscan? Ba meal andfollow through-rarelyrevealreflux of contrastinto thediverticulum Laparoscopy orexplorativelaparotomy- invasive Capsule endoscopy-not availablefor usReferences: “Paediatricnuclear medicineimaging”;L.Biassoni,M.Easty;BritishMedical Bulletin,2017, 123:127–148 www.cyberphysics.co.uk;GammaCamera “Ashcraft'sPediatricSurgery2010”:Chapter41;Meckel'sDiverticulum;P .K. Schropp,C.L.Garey ; p526-531 “NuclearImaging inMeckel'sDiverticulum”;S.S.Anand,R. Handa,M.S. Chauhan; MedicalJournal,ArmedForcesIndia2004Apr,198-199 “Hepato-biliaryScintigraphy in diagnosisofBiliaryAtresia”;S.S.Anand,R.K. Handa,J.Singh, ISinha; MedicalJournal,ArmedForces India2006Jan, 20-21 SvjetlanaGrbac-Ivanković,NevaGirotto,MirnaSubatDezulović,Giordano Saina, Marina MiletićBarković