Radionuclide scan

Why do you have a radionuclide scan?

A radionuclide scan may be done for all sorts of reasons. For example:

• A bone scan is a common type. A radionuclide is used which collects in areas where there is a lot of bone activity (where bone cells are breaking down or repairing parts of the bone). So a bone scan is used to detect areas of bone where there is cancer, infection, or damage. These areas of activity are seen as 'hot spots' on the scan picture. See the separate leaflet called Bone Scan for more details.

• A kidney scan can assess how well a kidney is working (as the radionuclide chosen is taken up by kidney cells and passes into the urine). So, the scan can detect scars on the kidney and how well urine drains from the kidney to the bladder. See the separate leaflet called DMSA Scan for more details.

• Lung perfusion scan (also called a 'VQ scan') can detect blood clots in the lungs (pulmonary embolism).

• A heart scan can assess blood flow to the heart muscle. Areas of poor blood flow to the heart muscle do not 'take up' the radionuclide very well and this will be shown in the picture.

• A thyroid scan may be done to assess cases of overactive thyroid (hyperthyroidism). For example, some nodules (small 'lumps') are sometimes a focus of overactivity and will show as 'hot spots' on the picture. See the separate leaflet called Thyroid Scans and Uptake Tests for more details.

• Lacrimal scintigraphy is done to test the function of tear ducts (lacrimal ducts.) The radionuclide is given as eye drops.

• Lymphoscintigraphy is done to check the drainage of the lymph nodes in people with a type of swelling of the legs, called lymphoedema.

There are various other types of radionuclide tests.

What preparation do I need?

The preparation needed is usually very little. It will depend on which type of scan you are having. Your local hospital should give you specific information to help you prepare for these tests.

• For some types of scan, you may be asked to have lots to drink to help to flush the radionuclide through your body.

• For some types of scan you may also be asked to empty your bladder of urine before the scanning begins.

• For some scans, such as thyroid scans, you may be instructed to stop certain medications for some time before the scan.

As these tests involve a small amount of radiation, pregnant women should not have them.

What happens during a radionuclide scan?

The procedures for the different types of radionuclide scans are different. Information about your scan should be sent to you with the appointment.

Depending on the type of scan you have, you usually either swallow a small quantity of radionuclide, or it is injected into a vein in your arm.

It then takes some time - sometimes several hours (depending on what is being scanned) - for the radionuclide to travel to the target organ or tissue, and to be 'taken' into the active cells.

So, after receiving the radionuclide you may have a wait of a few hours. You may be able to go out and come back to the scanning room later in the day.

When it is time to do the scanning, you usually lie on a couch while the gamma camera detects the gamma rays coming from your body.

Gamma camera

By Arturo 1299 (Own work) via Wikimedia Commons

The computer turns the information into a picture. You need to lie as still as possible whilst each picture is taken (so it is not blurred). Some pictures can take 20 minutes or more to expose.

The number of pictures taken and the time interval between each picture vary depending on what is being scanned. Sometimes only one picture is needed. However, for some scans (such as bone scans or heart scans), two or more pictures are needed. Each picture may be taken several hours apart. So, the whole process can take several hours.

What happens after a radionuclide scan?

Radionuclide scans do not generally cause any side-effects.

Uncommon side-effects from radionuclides may include flushing, racing heart and nausea but these are short-lived because they are flushed out of your system quickly.

Through the natural process of radioactive decay, the small amount of radioactive chemical in your body will lose its radioactivity over time. It may also pass out of your body through your urine or poo during the first few hours or days following the test.

You may be instructed to take special precautions after urinating, to flush the toilet twice and to wash your hands thoroughly. You may be advised to drink plenty of water to help flush the chemicals out of your system.

If you have contact with children or pregnant women you should let your doctor know. Although the levels of radiation used in the scan are small, they may advise special precautions. Your hospital should give you more advice on this.

Are there risks with radionuclide scans?

The term 'radioactivity' may sound alarming. But, the radioactive chemicals used in radionuclide scans are considered to be safe, and they leave the body quickly in the urine. The dose of radiation that your body receives is very small.

In many cases, the level of radiation involved is not much different to a series of a few normal X-rays. However:

• As with any other types of radiation (such as X-ray), there is a small risk that the gamma rays may affect an unborn child. So, tell your doctor if you are pregnant or if you may be pregnant.

• Rarely, some people have an allergic reaction to the injected chemical. Tell your doctor if you are allergic to iodine.

• Theoretically, it is possible to receive an overdose when the chemical is injected. This is very rare.

How does a radionuclide scan work?

A radionuclide (sometimes called a radioisotope or isotope) is a chemical which emits a type of radioactivity called gamma rays. A tiny amount of radionuclide is put into the body, usually by an injection into a vein. Sometimes it is breathed in, or swallowed, or given as eye drops, depending on the test.

There are different types of radionuclides. Different ones tend to collect or concentrate in different organs or tissues. So, the radionuclide used depends on which part of the body is to be scanned.

For example, if radioactive iodine is injected into a vein it is quickly taken up into the tissues of the thyroid gland. So, it is used to scan the thyroid gland.

Cells which are most 'active' in the target tissue or organ will take up more of the radionuclide. So, active parts of the tissue will emit more gamma rays than less active or inactive parts.

Gamma rays are similar to X-rays and are detected by a device called a gamma camera. The gamma rays which are emitted from inside the body are detected by the gamma camera, are converted into an electrical signal and sent to a computer.

The computer builds a picture by converting the differing intensities of radioactivity emitted into different colours or shades of grey. This is seen below in a lung perfusion scan.

Lung perfusion scan

By Myohan (Own work) via Wikimedia Commons

Alternatively areas of the target organ or tissue which emit lots of gamma rays may be shown as red spots ('hot spots') on the picture on the computer monitor.

Areas which emit low levels of gamma rays may be shown as blue ('cold spots'). Various other colours may be used for 'in between' levels of gamma rays emitted.