THYROID SCAN (HOSPITAL KUALA LUMPUR)

MUHAMMAD SAFWAN BIN AHMAD FADZIL A127946 DIAGNOSTIC IMAGING AND RADIOTHERAPY FACULTY OF HELATH SCIENCE UNIVERSITI KEBANGSAAN MALAYSIA

Thyroid Gland
The thyroid is a gland that makes and stores

essential hormones that help regulate:

the heart rate blood pressure body temperature the rate of chemical reactions (metabolism) in the body.

It is located in the anterior neck just below the

Adams apple. The thyroid gland is the main part of the body that takes up iodine.

Anatomy of thyroid glands

Patient history
Female

Indian
MRN PN2011/2620 DOB 13/10/1970

Age 43 years old

Married Address Sungai Buloh

Clinical history (Sign and symptom)

Increased sensitivity to heat

Frequent sweating
Difficulty sleeping Tremor usually a fine trembling in the hands and

fingers Increase appetite Tachycardia

Previous medical investigation

Physical exam

Difficulty in swallowing. Trembling of the fingers.

Blood test

Low levels of TSH in blood which is 0.2 (normal range = 0.3 - 5.0 U/mL) High level of T3 (triiodothyronine) which is 1.2 (normal range = 0.2 - 0.5 ng/dL)

Ultrasound

Enlargement of the right lobe of thyroid.

Surgery

partial thyroidectomy of left lobe three years ago.

Impression
Indication: Hyperthyroidism

Enlargement of right lobe, homogeneous thyroid

gland with a pyramidal lobe. The area of the larger nodule is warm. Activity of right thyroid is more than normal (hot nodules).

Patient preparation
If the patient had any tests, such as an x-ray or CT

scan, surgeries or treatments using iodinated contrast material within the last two months, the procedure should be delayed 6 weeks later. Stop taking medications or ingesting other substances that contain iodine, including kelp, seaweed, cough syrups, multivitamins or heart medications. Tell the doctor if the patient has any allergies to iodine, medications and anesthetics. Nil orally a night before the procedure been done. Tell the doctor if you are pregnant or breastfeeding.

Procedure
Prepare the radiopharmaceutical which is 185 MBq (5

mCi) of Tc-99m pertechnetate. Ask the patient to change to hospital gown. Set an IV line on the patient. Measure the reading of the full syringe under the gamma camera. Ask the patient to lie down (supine) on the couch with pillow under neck to get extended neck.

Procedure
Inject the patient with the radiopharmaceutical. The

syringe is flushed twice to ensure that all the measured activity is injected. Setup the collimator. Delay 20 minutes. Scan the thyroid (AP/LAO/RAO/SPECT) for 200k count. Ask the patient to void and change the cloth. Measure the reading of empty syringe under the gamma camera.

Analysis
The study is analyzed by carefully outlining the thyroid

and defining a background area using irregular region of interest (thigh) .

x 100

Uptake (%) =

TR = thyroid region counts per second Bkgd = background counts per second SC = counts per second of dose measured in syringe pre

injection DC = decay correction factor

Images

Pinhole VS LEHR collimator

HKL PPUKM

Pinhole VS LEHR (parallel hole) collimator

Cone-shaped collimators Generates magnified Hexagonal, circular holes

images of a small organ Limited field-of-view (200 diameter)

typically Projects an image of the same size as the object onto the detector Wide field of view (540x400 mm)

Discussion
Thyroid imaging is conventionally obtained by planar

acquisition using a high-resolution large-field-of-view parallel-hole collimator, although a pinhole collimator has proven to increase the sensitivity of conventional scintigraphy. According to Ghanem et al. 2011 there were 40 nodules of different sizes detected by pinhole imaging and only 10 (25%) of these nodules were observed on parallel-hole images. Pinhole imaging must be used for thyroid imaging particularly in patients suspected of having nodular disease.

Tomas et al. 2008

Pinhole imaging was significantly more sensitive than

parallel-hole imaging (89% vs. 56%; P = 0.0003) for all 54 lesions. Specificity did not significantly differ between pinhole and parallel-hole imaging (93% vs. 96%, P = 0.29). Pinhole imaging was significantly more sensitive than parallel-hole imaging for single-gland disease (96% vs. 67%, P = 0.001). Because sensitivity is significantly higher, thyroid imaging of the neck should be performed with a pinhole collimator.

Fujii et al. 1999

Pinhole collimator showed better efficiency and

spatial resolution in the distance where the thyroid scan are actually performed. In the phantom study and clinical study of 30 patients, the nodular activities modeling parathyroid lesions were visualized better on the images obtained using the pinhole collimator. Pinhole collimator was thought to be more suitable for parathyroid scintigraphy than the parallel-hole collimator.

Conclusion
Pinhole collimator has proven to be a high-resolution

and sensitive method in both experimental and clinical studies for thyroid scan (Spanu et al. 2004).
Pinhole collimator is recognized as having very high

spatial resolution, superior to that achieved with conventional SPECT with a parallel-hole collimator due to the more favorable geometric properties of the cone beam collimator.

References
Fujii, H., R. Iwasaki, K. Ogawa, J. Hashimoto, K. Nakamura, E.

Kunieda, T. Sanmiya, A. Kubo & K. Inagaki 1999. [Evaluation of parathyroid imaging methods with 99mTc-MIBI--the comparison of planar images obtained using a pinhole collimator and a parallelhole collimator]. Kaku Igaku 36(5): 425-33. Ghanem, M. A., A. H. Elgazzar, M. M. Elsaid & F. Shehab 2011. Comparison of pinhole and high-resolution parallel-hole imaging for nodular thyroid disease. Clin Nucl Med 36(9): 770-1. Spanu, A., A. Falchi, A. Manca, P. Marongiu, A. Cossu, N. Pisu, F. Chessa, S. Nuvoli & G. Madeddu 2004. The usefulness of neck pinhole SPECT as a complementary tool to planar scintigraphy in primary and secondary hyperparathyroidism. J Nucl Med 45(1): 408. Tomas, M. B., P. V. Pugliese, G. G. Tronco, C. Love, C. J. Palestro & K. J. Nichols 2008. Pinhole versus parallel-hole collimators for parathyroid imaging: an intraindividual comparison. J Nucl Med Technol 36(4): 189-94.