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Gamma Probe
A gamma probe is a handheld device containing a scintillation counter, for intraoperative use following injection of a radionuclide, to locate sentinel lymph nodes by their radioactivity. It is used primarily for sentinel lymph node mapping and parathyroid surgery. Gamma probes are also used for RSL (radioactive seed localization), to locate small and non-palpable breast lesions. History The sentinel node market experienced high growth in the early and mid 1990s starting with melanoma sentinel node surgical search and breast cancer sentinel node staging; both are currently considered standards of care. The use of a radioactive tracer, rather than a coloured dye, was proposed in 1984. Clinical use To locate the draining lymph nodes or sentinel lymph node from a breast cancer tumour a Technetium-99m based radiopharmaceutical is common. This may be a nanocolloid or sestamibi. Although imaging with a gamma camera may also take place, the idea of a small gamma probe is that it can be u ...
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Scintillation Counter
A scintillation counter is an instrument for detecting and measuring ionizing radiation by using the excitation effect of incident radiation on a scintillating material, and detecting the resultant light pulses. It consists of a scintillator which generates photons in response to incident radiation, a sensitive photodetector (usually a photomultiplier tube (PMT), a charge-coupled device (CCD) camera, or a photodiode), which converts the light to an electrical signal and electronics to process this signal. Scintillation counters are widely used in radiation protection, assay of radioactive materials and physics research because they can be made inexpensively yet with good quantum efficiency, and can measure both the intensity and the energy of incident radiation. History The first electronic scintillation counter was invented in 1944 by Sir Samuel Curran whilst he was working on the Manhattan Project at the University of California at Berkeley. There was a requirement to measur ...
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Intraoperative
The perioperative period is the time period of a patient's surgical procedure. It commonly includes ward admission, anesthesia, surgery, and recovery. Perioperative may refer to the three phases of surgery: preoperative, intraoperative, and postoperative, though it is a term most often used for the first and third of these only - a term which is often specifically utilized to imply 'around' the time of the surgery. The primary concern of perioperative care is to provide better conditions for patients before operation (sometimes construed as during operation) and after operation. Perioperative care Perioperative care is the care that is given before and after surgery. It takes place in hospitals, in surgical centers attached to hospitals, in freestanding surgical centers, or health care providers' offices. This period is used to prepare the patient both physically and psychologically for the surgical procedure and after surgery. For emergency surgeries this period can be short an ...
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Injection (medicine)
An injection (often and usually referred to as a "shot" in US English, a "jab" in UK English, or a "jag" in Scottish English and Scots) is the act of administering a liquid, especially a drug, into a person's body using a needle (usually a hypodermic needle) and a syringe. An injection is considered a form of parenteral drug administration; it does not involve absorption in the digestive tract. This allows the medication to be absorbed more rapidly and avoid the first pass effect. There are many types of injection, which are generally named after the body tissue the injection is administered into. This includes common injections such as subcutaneous, intramuscular, and intravenous injections, as well as less common injections such as intraperitoneal, intraosseous, intracardiac, intraarticular, and intracavernous injections. Injections are among the most common health care procedures, with at least 16 billion administered in developing and transitional countries each yea ...
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Radionuclide
A radionuclide (radioactive nuclide, radioisotope or radioactive isotope) is a nuclide that has excess nuclear energy, making it unstable. This excess energy can be used in one of three ways: emitted from the nucleus as gamma radiation; transferred to one of its electrons to release it as a conversion electron; or used to create and emit a new particle (alpha particle or beta particle) from the nucleus. During those processes, the radionuclide is said to undergo radioactive decay. These emissions are considered ionizing radiation because they are energetic enough to liberate an electron from another atom. The radioactive decay can produce a stable nuclide or will sometimes produce a new unstable radionuclide which may undergo further decay. Radioactive decay is a random process at the level of single atoms: it is impossible to predict when one particular atom will decay. However, for a collection of atoms of a single nuclide the decay rate, and thus the half-life (''t''1/2) for ...
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Sentinel Lymph Node
The sentinel lymph node is the hypothetical first lymph node or group of nodes draining a cancer. In case of established cancerous dissemination it is postulated that the sentinel lymph nodes are the target organs primarily reached by metastasizing cancer cells from the tumor. The sentinel node procedure (also termed sentinel lymph node biopsy or SLNB) is the identification, removal and analysis of the sentinel lymph nodes of a particular tumour. Physiology The spread of some forms of cancer usually follows an orderly progression, spreading first to regional lymph nodes, then the next echelon of lymph nodes, and so on, since the flow of lymph is directional, meaning that some cancers spread in a predictable fashion from where the cancer started. In these cases, if the cancer spreads it will spread first to lymph nodes (lymph glands) close to the tumor before it spreads to other parts of the body. The concept of sentinel lymph node surgery is to determine if the cancer has sprea ...
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Parathyroid
Parathyroid glands are small endocrine glands in the neck of humans and other tetrapods. Humans usually have four parathyroid glands, located on the back of the thyroid gland in variable locations. The parathyroid gland produces and secretes parathyroid hormone in response to a low blood calcium, which plays a key role in regulating the amount of calcium in the blood and within the bones. Parathyroid glands share a similar blood supply, venous drainage, and lymphatic drainage to the thyroid glands. Parathyroid glands are derived from the epithelial lining of the third and fourth pharyngeal pouches, with the superior glands arising from the fourth pouch and the inferior glands arising from the higher third pouch. The relative position of the inferior and superior glands, which are named according to their final location, changes because of the migration of embryological tissues. Hyperparathyroidism and hypoparathyroidism, characterized by alterations in the blood calcium levels ...
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Palpable
Palpation is the process of using one's hands to check the body, especially while perceiving/diagnosing a disease or illness. Usually performed by a health care practitioner, it is the process of feeling an object in or on the body to determine its size, shape, firmness, or location (for example, a veterinarian can feel the stomach of a pregnant animal to ensure good health and successful delivery). Palpation is an important part of the physical examination; the sense of touch is just as important in this examination as the sense of sight is. Physicians develop great skill in palpating problems below the surface of the body, becoming able to detect things that untrained persons would not. Mastery of anatomy and much practice are required to achieve a high level of skill. The concept of being able to detect or notice subtle tactile signs and to recognize their significance or implications is called appreciating them (just as in general vocabulary one can speak of appreciating ...
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Lesion
A lesion is any damage or abnormal change in the tissue of an organism, usually caused by disease or trauma. ''Lesion'' is derived from the Latin "injury". Lesions may occur in plants as well as animals. Types There is no designated classification or naming convention for lesions. Since lesions can occur anywhere in the body and the definition of a lesion is so broad, the varieties of lesions are virtually endless. Generally, lesions may be classified by their patterns, their sizes, their locations, or their causes. They can also be named after the person who discovered them. For example, Ghon lesions, which are found in the lungs of those with tuberculosis, are named after the lesion's discoverer, Anton Ghon. The characteristic skin lesions of a varicella zoster virus infection are called '' chickenpox''. Lesions of the teeth are usually called dental caries. Location Lesions are often classified by their tissue types or locations. For example, a "skin lesion" or a " bra ...
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Technetium-99m
Technetium-99m (99mTc) is a metastable nuclear isomer of technetium-99 (itself an isotope of technetium), symbolized as 99mTc, that is used in tens of millions of medical diagnostic procedures annually, making it the most commonly used medical radioisotope in the world. Technetium-99m is used as a radioactive tracer and can be detected in the body by medical equipment (gamma cameras). It is well suited to the role, because it emits readily detectable gamma rays with a photon energy of 140 keV (these 8.8 pm photons are about the same wavelength as emitted by conventional X-ray diagnostic equipment) and its half-life for gamma emission is 6.0058 hours (meaning 93.7% of it decays to 99Tc in 24 hours). The relatively "short" physical half-life of the isotope and its biological half-life of 1 day (in terms of human activity and metabolism) allows for scanning procedures which collect data rapidly but keep total patient radiation exposure low. The same characteristics make the ...
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Radiopharmaceutical
Radiopharmaceuticals, or medicinal radiocompounds, are a group of pharmaceutical drugs containing radioactive isotopes. Radiopharmaceuticals can be used as diagnostic and therapeutic agents. Radiopharmaceuticals emit radiation themselves, which is different from contrast media which absorb or alter external electromagnetism or ultrasound. Radiopharmacology is the branch of pharmacology that specializes in these agents. The main group of these compounds are the radiotracers used to diagnose dysfunction in body tissues. While not all medical isotopes are radioactive, radiopharmaceuticals are the oldest and still most common such drugs. Drug nomenclature As with other pharmaceutical drugs, there is standardization of the drug nomenclature for radiopharmaceuticals, although various standards coexist. The International Nonproprietary Names (INNs), United States Pharmacopeia (USP) names, and IUPAC names for these agents are usually similar other than trivial style differences. The d ...
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Technetium (99mTc) Sestamibi
Technetium (99mTc) sestamibi (INN) (commonly sestamibi; USP: technetium Tc 99m sestamibi; trade name Cardiolite) is a pharmaceutical agent used in nuclear medicine imaging. The drug is a coordination complex consisting of the radioisotope technetium-99m bound to six (sesta=6) methoxyisobutylisonitrile (MIBI) ligands. The anion is not defined. The generic drug became available late September 2008. A scan of a patient using MIBI is commonly known as a "MIBI scan". Sestamibi is taken up by tissues with large numbers of mitochondria and negative plasma membrane potentials. Sestamibi is mainly used to image the myocardium (heart muscle). It is also used in the work-up of primary hyperparathyroidism to identify parathyroid adenomas, for radioguided surgery of the parathyroid and in the work-up of possible breast cancer. Cardiac imaging (MIBI scan) A ''MIBI scan'' or ''sestamibi scan'' is now a common method of cardiac imaging. Technetium (99mTc) sestamibi is a lipophilic cation w ...
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Gamma Camera
A gamma camera (γ-camera), also called a scintillation camera or Anger camera, is a device used to image gamma radiation emitting radioisotopes, a technique known as scintigraphy. The applications of scintigraphy include early drug development and nuclear medical imaging to view and analyse images of the human body or the distribution of medically injected, inhaled, or ingested radionuclides emitting gamma rays. Imaging techniques Scintigraphy ("scint") is the use of gamma cameras to capture emitted radiation from internal radioisotopes to create two-dimensional images. SPECT (single photon emission computed tomography) imaging, as used in nuclear cardiac stress testing, is performed using gamma cameras. Usually one, two or three detectors or heads, are slowly rotated around the patient's torso. Multi-headed gamma cameras can also be used for positron emission tomography (PET) scanning, provided that their hardware and software can be configured to detect "coincidences" (nea ...
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