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Nuclear Medicine
We invite you to read over the following Patient Booklet, What Is Nuclear Medicine? It addresses many of the Frequently Asked Questions about Nuclear Medicine as a diagnostic tool, its safety and the concerns about radiation involved with many tests. Since the procedures practiced in our own department may be slightly different from the internet-based booklet (provided by the Society of Nuclear Medicine), we recommend that you check the quick links below to clarify important specific test information about the investigations we do offer in Nuclear Medicine at Markham Stouffville Hospital.
CLick here to download the Nuclear Medicine brochure
What you should know
Is there a chance that you are pregnant or are you breast feeding?
Please discuss this with your doctor before arriving for your appointment, or contact our department. If you are breast feeding, there may be some special precautions to consider before starting your nuclear medicine exam.
Have you had any other imaging exams recently?
Please let us know. In some cases, barium and contrast can "mask" or "block" our ability to take diagnostic nuclear medicine images so we may have to delay your appointment accordingly. If you have had any recent x-rays or other imaging exams of the same area that we are investigating please bring them with you on the day of your nuclear medicine appointment.
Do you take medications?
For some procedures it is important that some medicines be stopped prior to arriving for your appointment. Please share this with us when you call to book your appointment, so that we can advise you of any special instructions specific to your test. We also list any important instructions on the backside of the Markham Stouffville Hospital Diagnostic Imaging requisition. Please bring the requisition with you to the appointment.
After your nuclear medicine exam:
You may resume normal activities immediately, unless the physician or technologist tells you otherwise. We also suggest that you increase your fluids over the next day to help eliminate any residual tracer used in your procedure. A Radiologist or other specially-trained physician will interpret your images. For some procedures, the Radiologists find it useful to have other pictures or x-rays taken after your nuclear medicine scan, to help enhance the diagnostic report that will be sent back to your doctor. If additional images are required, we will do our best to fit this imaging in before you depart (after your nuclear scan is finished).
Will you be travelling after your nuclear medicine procedure?
Please discuss this with the technologist before the completion of your test. In recent years, international security measures have increased and radiation detectors have commonly been installed at airports, international border crossings, and some major tourist attractions and landmarks. Travelling with supportive documentation declaring your recent nuclear medicine test is advised and may help to avoid potentially lengthy delays. Visit the Society of Nuclear Medicine's Article on Nuclear Medicine Patients and Homeland Security Detectors, for more information.
Further questions
If you still have some questions which we have not been able to answer on our website please do not hesitate to contact us by calling (905) 472-7000, extension 6510. Staff Technologists or the Team Leader in our Nuclear Medicine Department would be pleased to help address your concerns directly.
Our Latest Gamma Camera
Installed September 2007
Thank you for your generous and continued support for improving our community Hospital.
Quick Links to specific test information:
Bone Mineral Densit (BMD, Fracture Risk Assessment)
Gastric Emptying Time (GET) Scan
Gastrointestinal (GI) Bleeding Scan
Myocardial Perfusion Imaging (MPI or Cardiolite) Scan
Thyroid Scan with Iodine (I-123)
Bone Mineral Density (BMD, Fracture Risk Assessment)
Natural aging and other factors contribute to a decrease in bone strength. As bones weaken the likelihood of a fracture increases. A BMD test helps your doctor assess this risk, and/or diagnose or follow the progression of osteoporosis. A BMD Scan is not the same as a nuclear medicine Bone Scan. To establish your bone density we use a specialized x-ray beam to measure specific weight-bearing bones in your skeleton, and not necessarily the areas that are causing you discomfort. We compare these measurements to a normal expected value for your age and provide your doctor with a report expressing a risk factor for osteoporosis. It is important that you have not undergone any other Nuclear Medicine or x-ray tests using a contrast solution within two weeks of your scheduled BMD Scan. There are no restrictions to food or medications prior to the exam, however we do ask that you not wear clothing with zippers, metal buttons or snaps, if possible and that you remove any waist-level body jewelry because the metal may interfere with these x-ray images.
The Ministry of Health (MOHLTC) does not insure the performance of this test any sooner than at a strict, thirty-six month interval for "low risk" assessments, and twelve month interval for "high risk" assessments. Click here to view the MOHLTC Fact Sheet
Bone Scan
We perform a Bone Scan to detect areas of abnormalities caused by bone growth or degeneration, stress fractures, tumors, infections (Osteomyelitis) or other disorders. If you have had recent x-rays taken of the area we are assessing with the bone scan we ask that you bring these with you to the appointment and pass them on to your technologist. It takes several hours from the time of injection for the radioactive tracer to travel to the bones for imaging. Your technologist will assign you a return time, which is likely to be between 2 to 4 hours later, after the injection. You can carry on regular activities, take medicines, and eat lunch during this delay period. We ask that you increase your fluids to help distribute the injection throughout the body and improve the quality of your bone scan images. The technologist will ask you to empty your bladder again right before you are brought back into the room for imaging. Imaging may take 30-75 minutes and the technologist can define this for you before you go away for the break time. Click here for more information.
Biliary (Gallbladder) Scan
We perform a Biliary Scan to diagnose liver and gallbladder abnormalities caused by infections, gallstones, tumors, cysts or other disorders. A biliary scan may also be ordered before or after you have had your gallbladder removed in order to assess the duct pathways called the "biliary tree." You must be fasting (no food) 4 to 6 hours before the appointment time, while it must not be longer than 6 hours since your last meal. Too long of a fasting period could alter the expected outcome during imaging. Please inform the technologist if you have recently taken morphine. Imaging typically takes 60 minutes, and sometimes additional delayed pictures can be necessary to complete your study.
Gallium Scan
A Gallium Scan detects areas of abnormality caused by bone growth, fractures, tumors, infections, abscesses or other disorders. It may also be used in cancer treatment plans to show the staging of a disease. This test requires 2 visits to our department, on different days. On day one you will be injected with the gallium tracer, and this should only involve about 30 minutes of your time (including registration). You will be given a specific time to return for delayed imaging two days later and there are no special instructions to follow before your return. The delayed imaging typically takes between 45 to 90 minutes to complete, depending on the numbers of areas we need to take pictures of. You may choose to increase the fluids and fiber in your regular diet for the next few days to help flush the excess tracer from your system. If you suffer from any bowel disorders please check with your own doctor before altering your diet in any way.
Gastric Emptying Scan
A Gastric Emptying Scan measures the rate at which the stomach contents empty and pass into the small intestine. Slow or delayed emptying may be found in patients with peptic ulcers, diabetes, anorexia nervosa, tumors, or as a side effect of various medications. (Please bring a list of all your medicines with you to the test). The test may also be required to see if an existing condition has changed following medical or surgical treatment. We will ask you to swallow some food (usually a chopped egg sandwich), which we provide. The sandwich has a very small amount of radioactive tracer in it to help track the food contents as it travels through your stomach. We will be taking continual pictures as this is happening, so we may ask you to empty your bladder before you start eating the sandwich. It usually takes 90 to 120 minutes to complete the imaging. Please let us know in advance if you are allergic to eggs. We ask you to be fasting for at least 6 hours before the scan. You should inform the technologist of any medications you are taking to treat your stomach or overall digestion.
Gastrointestinal (GI) Bleeding Scan
This test is used to help identify areas of persistent bleeding in the bowels or abdomen. It is important for us to know ahead of time if you have had any other tests involving the use of barium in the last 2 weeks (because barium can interfere with the quality of the nuclear medicine pictures). You must be fasting (including beverages) for 4 to 6 hours prior to your appointment time. To complete all imaging it may take 60 to 90 minutes.
Kidney (Renal Function) Scan
A Kidney Scan assesses how well the kidneys are functioning. This test may also be done in conjunction with "Lasix" to assess any obstruction in the urinary system, or with "Captopril" to rule out high blood pressure caused by renal artery stenosis. When booking your test, please have your requisition available so that it can be referenced when trying to assure the proper type of kidney scan is booked for you. Each type of kidney scan varies in the length of time it takes for all the imaging to be completed. (Kidney function with or without Lasix takes about 1 hour, while a Captopril kidney scan takes 2 hours). Please be sure to bring any abdomen and/or pelvis ultrasound reports with you to the appointment. If you are on medications for blood pressure or water retention, it is possible that your physician may ask you to stop taking your pills for a few days prior to the test. Whether or not this is the case, some medications can alter test results so it's important that we know what you are taking. Bring a list of your medicines to the appointment. You also need to drink several glasses of water before arriving for the test to assure that you are well hydrated. You do not have to hold this in (unlike an ultrasound), so please void as necessary. Before you arrive, please check with us to make sure you know what kind of Kidney Scan your doctor wants you to have.
Liver and Spleen Scan
A Liver and Spleen Scan detects areas of abnormalities caused by tumors, infections, cirrhosis, hepatitis, cysts or other disorders. There is no special preparation for a liver and/or spleen scan. There are two different types of liver scans, which differ in time. A routine liver/spleen takes about 1 hour to complete, while a red-blood-cell (RBC) liver scan requires about 2 hours to complete. Please be sure to bring any abdomen ultrasound reports with you to the appointment, as these are very helpful for us to understand if there are any specific parts of the organs your doctor would like us to focus on when the Radiologist interprets your study and creates the diagnostic report.
Meckel’s Scan
A Meckel’s Scan detects an abnormality in the abdomen caused by the persistence of an embryonic structure known as Meckel’s diverticulum. Abdominal pain and bleeding may result from the presence of this structure when it also contains some stomach tissue. We usually perform this test on children and adolescents, but also on adults in some cases. You must be fasting (no food or beverages) for at least 4 hours before the scan. You may be asked to empty your bladder just before the injection, (and possibly during the scanning process as well). The imaging will take about one hour to complete.
MUGA (Ejection Fraction, EF) Scan
This heart test, commonly called a "MUGA" Scan, provides information about how effectively the heart chambers are pumping. It provides a calculated value called an "ejection fraction" to quantify this function and also shows images of how effectively the different walls of the left main heart chamber are contracting. Some medications, illnesses or treatments (such as in cancer care) can affect how the heart functions and a MUGA Scan can be used to track and monitor any changes in the condition of the heart over the course of time. Try not to have any caffeine on the day of your appointment. There are no medication restrictions for this exam and the imaging will take approximately 60 minutes to complete. All pictures will be taken while you are laying still; there is no exercise involved with this test.
Myocardial Perfusion Imaging (MPI or Cardiolite) Scan
This type of heart examination is a non-invasive diagnostic tool with many uses:
- Diagnosing the presence or extent of coronary artery disease (CAD), especially for patients with diabetes;
- Completing a heart "risk assessment" before surgery;
- Diagnosing chest pain or angina;
- Assessing the blood flow through the coronary blood vessels (arteries of the heart) before and/or after bypass, grafts or angioplasty;
- Assessing the heart condition in patients with risk factors for heart disease, such as family history, smoking, obesity, diabetes, undiagnosed chest pain, and/or positive stress test.
The exam involves two distinct set of images taken at rest and then again after "stress." "Stress" is applied to our hearts when we exercise, so for this test you will be required to walk on a treadmill, and for those patients for whom walking is not a suitable option, there is a medication which mimics the effects of exercise on our hearts called Persantine. Plan to be at the hospital for about 4 to 5 consecutive hours in order to complete all parts of the test and the imaging. It is important that certain medications (typically "beta blockers") be discontinued for a necessary period of time before arriving for the test. Since every patient may be having this heart test for a slightly different reason, you must confirm with your doctor which medicine is appropriate and safe for you to stop before arriving for your heart test, as well as how long the medicine should be stopped. We do not expect any latent side effects to occur from the injections given during this test so please treat any possible heart related symptoms appropriately.
Remember that it is important not to dismiss symptoms that may be suspicious of heart attack or stroke. Be Heart Smart! See Heart Disease Warning Signs for more information.
Parathyroid Scan
A Parathyroid Scan detects areas of abnormality caused by tumors or cysts. We may perform a Parathyroid Scan simply to find the location or position of the parathyroid glands in the neck. There are no restrictions prior to this test. Inform the technologist if you are taking any medications for thyroid disorders, calcium related disorders, osteoporosis, kidney disease or stones. Also, please inform the physician or technologist if you have had any x-ray studies (particularly if any involved iodine contrast, like CT). We will ask you to lie very still on a stretcher for about 30 minutes while we take the initial set of pictures. Your technologist will instruct you of the necessary return time for some delayed imaging (usually a few hours later). The second set of images may also take about 30 minutes.
Salivary Scan
A Salivary Scan detects areas of abnormality caused by infections, tumors, cysts or other disorders. Imaging of the salivary glands is performed before and after you consume some lemon slices to help identify whether the glands are secreting properly. Please advise us before the procedure if you have any known allergies to lemons. All imaging is completed in approximately 1 hour.
Thyroid Scan
A Thyroid Scan detects areas of abnormality caused by infection, tumors, cysts, goiters or other disorders related to an over- or under-active thyroid gland. We may perform it simply to find the location or position of the thyroid gland in the neck. It may be required to see if an existing condition has changed following surgery, radiotherapy or chemotherapy. Inform the technologist if you are currently taking any medications related to a thyroid condition. Some medications must be discontinued prior to performing the test, or the results can be affected. Your physician should advise you of any restrictions required prior to booking the test. A radioactive "technetium" tracer will be injected into a vein in your arm, and we must wait about 10 to 20 minutes for the tracer to concentrate in your thyroid gland before images can be taken. The test takes approximately 1 hour.
Thyroid Scan with Iodine (I-123)
An Iodine Thyroid Scan detects or rules out areas of abnormalities within the thyroid gland that may have been suspect on alternate thyroid imaging. It is important that we know in advance if you have a known allergy to Iodine, as we will ask you to swallow a small amount of radioactive iodine either by capsule or liquid form. We require that you return approximately 4 hours later for some pictures to be taken of your thyroid gland. It takes that long for your body to properly absorb this material for the test. The radioactive "Iodine-123 Thyroid Scan" shows slightly different functionality of the thyroid gland than what is seen on a "Technetium Thyroid Scan." Check with your doctor on which thyroid medicines (if any) should be stopped for days or weeks prior to your nuclear medicine procedure. Bring a list of all your medications.
Thyroid Therapy Procedure
In some specific thyroid conditions (some hyperthyroidisms and non-toxic multinodular goiters) it is necessary to apply a therapeutic treatment to the gland which "stuns" it, allowing for a more likely control of thyroid function. The prescribing doctor (specialist) will determine the amount of radioactive iodine necessary to treat the disorder or condition and forward this request to our nuclear medicine department. The prescribing doctor must tell you which thyroid medications need to be discontinued and for how long before the treatment date. It is necessary that female patients of child-bearing age have pregnancy ruled out before being given any radioactive iodine treatments. There are some precautionary instructions which your doctor will discuss with you in advance as well as discussing how this therapy treatment will help your specific health condition. Please see the Guidelines for Caregivers & Patients Receiving Radioactive Iodine Treatments.
A Radiologist/Physician will administer the radioactive iodine capsule to you. The appointment is typically not longer than 30 minutes. All of our therapy treatments are administered on an outpatient basis only - you will not be admitted to the hospital for this procedure. Each therapy capsule is ordered from an external pharmacy and is prescribed for use on a specific date. If you need to reschedule your test for any reason, it is important that you contact the Nuclear Medicine Department at least 72 hours in advance.
Thyroid Uptake Scan
A Thyroid Uptake Scan determines the level of metabolic activity within your thyroid gland. The result may then be used to help in the diagnosis of infection, tumors, cysts, goiters or other disorders relating to an over- or under-active thyroid gland. In order to undergo this test you cannot be allergic to Iodine. The test is performed over 2 days. On day one we will ask you to swallow a pill (or two), containing a tiny amount of radioactive Iodine, and this may take about 30 minutes. The thyroid gland picks up the material as it is digested. The amount that collects in the gland is related to how active the gland is. You must wait about 24 hours for the material to be optimally absorbed by the thyroid, and you will be given a specific return time for the thyroid function measurements to be taken on day two. Some images will be taken on day two. This portion of the test will take approximately 1 hour. Certain supplements (such as kelp or seaweed) and some thyroid medications can interfere with a true impression of the thyroid function determined through this test. For this reason, certain supplements and medications must be stopped for a period of time prior to the appointment. Please check with your doctor in regards to which medicines are safe for you to stop for the required period of time. Bring a list of any supplements and medicines with you to the test. Also, if you have undergone an ultrasound exam on your neck or thyroid, please bring a copy of this report with you to the appointment or have your doctor fax it to us with the requisition.
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