The Role of Nuclear Medicine
Nuclear medicine is an important branch of cancer detection and treatment that combines doctors’ experience, cutting-edge technologies and radiopharmaceutical efficacy. The radiopharmaceuticals are injected into the body, they can reveal tumors, metastases, can be useful in evaluating the success of therapy, and can help establish a treatment plan. Body action of radiopharmaceuticals is assessed using PET-CT or SPECT-CT type machines that are successfully used in the ACIBADEM group, recognized for its cancer treatment performance. One of the top experts in nuclear medicine is Professor Dr. Erkan Vardareli of the ACIBADEM Altunizade Hospital, which explains the current performance of nuclear medicine.
What are the technologies you currently use in ACIBADEM, the newest and most performing?
Prof. Dr. Erkan Vardareli: Especially in patients with cancer, we use PET-CT and SPECT-CT. The laboratory also helps us with the preparation of radiopharmaceuticals used in diagnosis and treatment. In addition, one of the investigations used is bone densitometry. The most important technology in nuclear medicine, which we use in the diagnostic protocol of oncological pathogens, is PET-CT. The ACIBADEM nuclear medicine departments are highly advanced and experienced in the application of state-of-the-art nuclear medicine techniques, and here is the newest hospital in ACIBADEM, Altunizade. Within ACIBADEM, cancers are treated by multidisciplinary teams with a special experience, including surgeons, oncologists, radiotherapists, radiology experts, nuclear medicine, and each case is discussed and thororughly tackled by these teams. We want our patients to receive the best care in the world at ACIBADEM, and experience and technologies help us to offer them this. ACIBADEM Group provides top medical care to patients in Turkiye, but also in other countries in Europe and Asia.
What are the differences between PET-CT and SPECT-CT?
Prof. Dr. Erkan Vardareli: In PET-CT and SPECT-CT, CT means the same computed tomography. The difference between the two techniques lies in the type of radiopharmaceutical used. SPECT means single photon emission tomography, while PET means positron emission tomography. Thus, in PET-CT we use positron-radiopharmaceuticals, radioactive materials, and in SPECT-CT we use gamma-ray radiopharmaceuticals, we use 131 iodine and other radiopharmaceuticals.
In which situations do you use PET-CT and in which of the SPECT-CT situations?
Prof. Dr. Erkan Vardareli: In the evaluation of tumors, we use PET-CT. In the beginning, we also use SPECT-CT to detect malignant processes in the body, but now we are mainly focusing on PET-CT, because positron emission tomography is far better for malignant tissue detection. With PET-CT, we can show all metastases in the body as a result of body scanning. And this is done with the use of fluorine-labeled glucose, fluorodeoxyglucose or FDG. But not all metastases can be highlighted by FDG, so we use other agents like disfosfonates to detect, for example, bone metastases, through a bone scan investigation called bone scintigraphy. We are doing this investigation to detect osteoblastic metastatic lesions that are not responsive to the FDG.
What are the diseases that you can diagnose and treat with nuclear medicine?
Prof. Dr. Erkan Vardareli: Currently, most of the patients we diagnose and treat with nuclear medicine are the oncological ones. The oldest treatment – used since the ‘50s – is radioactive iodine for patients with thyroid carcinoma, especially in patients with differentiated thyroid carcinoma, such as papillary or follicular. However, at present, we also use other radiopharmaceuticals such as gallium-68 PSMA, lutetium-177 PSMA or gallium-68 DOTA-TATE.
What are the uses of these radiopharmaceuticals for the treatment of malignant tumors?
Prof. Dr. Erkan Vardareli: In the treatment protocol for oncological diseases, we need to target the diseased cells and protect the healthy ones. Thus, if malignant cells express certain proteins or certain receptors, we can use these substances that we label with radiopharmaceuticals, and thus treat targeted malignant tumors by radiation emission from radiation therapy. We start from the injection of radiopharmaceuticals into the body, which binds to the substances secreted by malignant tumors, and by scanning we can highlight the tumors and then we can destroy them by targeting healthy tissues. Radiopharmaceuticals are just part of the therapy protocol. Another part is biochemical molecules, receptors and other substrates. It is known that tumors differ from one patient to another: for example, in breast carcinoma, in some patients, the tumor exhibits the HER2 protein, the epidermal growth factor. In excess, it stimulates the development of breast cancer, and some patients have this particularity. The same is true for BRAF mutations present in some patients. And the personalization of cancer therapies and the choice of radiopharmaceuticals also take these aspects into account, in order to obtain maximum efficiency in the treatment of malignancies.
What can you tell us about the developments in nuclear medicine over the beginnings of this specialty?
Prof. Dr. Erkan Vardareli: In recent years, this field has evolved a lot and I would like to mention the emergence of high-performance diagnostic methods, such as hepatic scintigraphy, magnetic resonance scintigraphy and bone scintigraphy. In addition, today, due to the development of technology and imaging, we can detect, treat and monitor malignant maladies, we can learn a lot about how healthy and malignant tissues work, and so we can treat cases which we could not approach many years ago. In addition, I believe that the accelerated development of radiopharmaceuticals will make it possible to apply them to increasingly effective therapy protocols.
What are the most important benefits of top nuclear medicine for patients?
Prof. Dr. Erkan Vardareli: Nuclear medicine helps patients within the precision diagnostic protocol, which helps us apply the best and appropriate therapies to patients, in each case. If the diagnosis is accurate, then the treatment will be a well-chosen one. And, within ACIBADEM, the imaging and nuclear medicine departments are well equipped and have experienced physicians providing a precision diagnosis. Thus, treatments are successfully applied, making ACIBADEM one of the world’s most important cancer diagnostic and treatment centers.
Where do radiopharmaceuticals come from?
Prof. Dr. Erkan Vardareli: Certain radiopharmaceuticals are prepared in our laboratory department, such as gallium 68-PSMA, gallium 68-dotted and lutetium 177 PSMA. They have a very short halving life, eg 2 hours in the case of FDG or 1 hour in the case of gallium 68. Thus, if we do not prepare them in our laboratory, we can not use them in patients because they become rapidly ineffective.
What are the most common questions you get from patients about irradiation, side effects?
Prof. Dr. Erkan Vardareli: All radiopharmaceutical procedures are regulated by the International Atomic Energy Agency and by the National Atomic Energy Agency of Turkiye. Thus, we have clear rules regarding the radiation level, the time of exposure to them, the type of radiopharmaceuticals we can obtain, and we can safely use the radiopharmaceuticals that we inject into the patients. Radiopharmaceuticals are licensed by the European Council and comply with international regulations. Thus, there is no risk of adverse effects because procedures and radiopharmaceuticals are strictly regulated, both in diagnosis and during the treatment.
