Radioisotope diagnostics of blood vessels: when is it necessary and how is the procedure performed. How is a radioisotope study of the kidneys performed Indirect radioisotope renoangiography

Radioisotope examination of the kidneys (scintigraphy) is nowadays a fairly simple and affordable method of diagnosing. It is performed not only in a hospital, but also on an outpatient basis with a device called a renograph.

Such an examination is superior in information content even to traditional ultrasound, and the harm from it is less on the body than from x-rays. However, there is contraindication to its use- and breastfeeding. Why, we will find out later in the article.

Indications for examination

Recommended for patients with various kidney diseases get regular x-rays. Often it is repeated without harm to a person in order to identify the effectiveness of the prescribed. It can also be done in combination with x-rays.

However, it must be remembered that x-rays are taken no more than once a year.

Scanning the kidneys with a radioisotope method is indicated in the presence of the following pathologies:

• Vascular diseases of the parenchyma: glomerulonephritis, nephritic syndrome, amyloidosis.
• Hydronephrosis.
• Malignant hypertension.

What is being researched?

The majority of patients examined with a renograph are with pathologies of the urinary system.

Radioisotope renography will help the doctor to carry out the following manipulations:

1. fix the excretory functions of the proximal tubules;
2. check the blood flow of the kidneys;
3. detect the presence of vesicoureteral reflux;
4. determine the state of kidney tissues in the largest and smallest segments of the kidneys;
5. consider the ability of the kidneys to function after transplantation.

How to prepare?

In order for the survey to qualitative results, you must follow certain rules before going through this procedure:

• Renography should not be performed on a full stomach.
• Refrain from taking medication for several hours before the procedure.
• Drink plenty of fluids.
• Do not have metal objects on the body.

In no case during the examination should not be under the influence of alcohol, narcotic, psychotropic drugs.

Renography in children

At up to one year, a radioisotope study of the kidneys is not used, similarly in pregnant women, because even small doses of radiation can negatively affect the fetus and fragile body of the baby.

Instead of renography, the doctor will prescribe screening ultrasound for children of this age to examine the kidneys.

However, if the child has a pathology, then in this situation the attending physician assesses the need for this research method.

Babies up to 3 years before the procedure are given sedative drug so that the child is calm, and the result of the scintigraphy is objective and of high quality.

For small patients, in the form of the necessary preparation, a preliminary intake of iodine in small quantities is carried out. For three days before renography, adults should give the child 3 drops of Lugol's solution orally or 3-5 drops 3 times a day 5% tincture of iodine to block the reactive functions of the thyroid gland.

Carrying out the procedure

With isotopes, it demonstrates the appearance of the kidneys, evaluates their functional abilities, and helps to detect pathologies that appear in them at an early stage. This is especially important in oncology.

In renography, a new generation radioisotope study, they use drug Hippuran. It helps to get a view of the affected areas of the kidneys, while ultrasound is useless in this case. It is administered in doses calculated in relation to body weight.

The kidneys have the ability to capture the radiopharmaceutical in the required quantities and remove it from the body. Gippuran is able to quickly disintegrate, so the exposure of the body is minimal.

renogram- This is a record of isotopic radiation that appears above the organs under study at the moment the Gippuran passes through them. The renogram displays all the ongoing changes in the internal organs.

The patient is examined in a static state, sitting. Seriously ill patients are examined lying down. The drug is injected into the vein of the subject, and special renograph sensors, which are installed on the patient's body, record its accumulation, passage and excretion from the kidneys.

Thus, the renogram is divided into 3 parts for each kidney:

1. Vascular, which shows the placement of the radioisotope in the vessels of the kidneys.
2. Secretory, shows the accumulation of Hippurine in the kidney.
3. Evacuation room, where the outcome of the drug from the kidneys is recorded.

Radiologists analyze the resulting result by mathematical analysis and use it to identify the effectiveness of the cleansing functions of the kidneys, the rate of filling of its vascular system, the period of excretion of the drug from the kidney, the features of its accumulation in the urinary system.

All about scintigraphy in children will be told by a radiologist in a video clip:

Radioisotope studies are one of the areas of nuclear medicine and are used to diagnose various pathologies using radioactive isotopes. In Israeli clinics, there are only modern devices for radioisotope scanning, and the radioactive isotopes themselves meet all safety requirements.

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foreign patients are annually treated at the Top Ichilov clinic

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Nuclear diagnostics helps our doctors detect diseases at early stages, carefully monitor the course of their treatment, and in some cases is a diagnostic method that cannot be replaced by any of the existing types of research.

Methods of radioisotope research

In certain respects, nuclear medicine can be contrasted with radiology. If in radiographic studies the visualization of pathology occurs due to the penetration of radioactive radiation from the external environment into the patient's body, then in radioisotope studies, the radiation emitted by isotopes introduced into the body is directed from the organs and structures of the patient's body to the external environment.

When conducting radioisotope studies, radioactive isotopes are administered to the patient intravenously or orally (through the mouth). Then their distribution in the body is recorded using external detectors - gamma cameras. Nuclear diagnostic methods are widely used in the detection of bone diseases, the diagnosis of narrowing of the coronary arteries, diseases of the gallbladder and parathyroid glands, oncological diseases, pulmonary embolism, etc. Radioisotope research in Israel receives good reviews both from foreign patients and from leading world experts in nuclear diagnostics.

In Israeli clinics, three methods of radioisotope diagnostics are most widely used.

• Scintigraphy.
• Single photon emission computed tomography (SPECT).
• Positron emission computed tomography (PET-CT).

Scintigraphy

During scintigraphy, radioisotopes that are part of special preparations are introduced into the body and concentrated in specific tissues or organs. The gamma radiation emitted by the isotopes is recorded on the detector screen and produces a two-dimensional image resembling an x-ray.

There are many types of scintigraphic studies - radioisotopes help diagnose diseases of the bile ducts, respiratory system, bones, heart, endocrine and external secretion glands, kidneys and excretory system. Bile duct scintigraphy (cholescintigraphy) is used to detect blockage by gallstones. Lung scintigraphy is used to diagnose embolism and lung transplantation. Bone scintigraphy makes it possible to detect cracks and fractures, and heart scintigraphy makes it possible to assess its blood supply and visualize the consequences of myocardial infarction. A scintigraphic examination of the parathyroid glands can detect an adenoma, and a thyroid scintigraphy can detect metastases.

Xenon, technetium, thallium and iodine isotopes are used as radio preparations during scintigraphy.

SPECT

Single photon emission computed tomography (SPECT) is a tomographic method of nuclear diagnostics, very similar to scintigraphy, but differs from the latter in the ability to give a three-dimensional, rather than two-dimensional, image of the internal structures of the body.

Before the start of the study, the patient is injected with a radiopharmaceutical (for example, an isotope of thallium), which can accumulate in certain tissues. Using different types of radiopharmaceuticals, it is possible to achieve their selective accumulation in the body structures of interest to the doctor.

The gamma radiation emitted by the radiopharmaceutical is recorded by a gamma camera, which can be used to take a series of pictures at different angles and, on their basis, recreate a three-dimensional picture of the state of internal organs in a computer. A full reconstruction requires a 360-degree rotation of the gamma camera around the table on which the patient is sitting with a projection resolution of 3-6 degrees (typical time to create an image in each projection is 15-20 seconds, and the entire procedure for a full scan takes about 20 minutes).

SPECT is used to clarify the results of scintigraphy or radiography, as well as in cases where visualization of a three-dimensional image is required - for example, in the diagnosis of tumors, infectious lesions, examination of the thyroid gland, in functional studies of the brain and heart (functional radioisotope examination of the heart is used in the diagnosis of coronary disease, and a radioisotope study of the brain helps to assess cerebral blood flow and metabolism).

The radiopharmaceuticals used in SPECT are mostly the same as in the case of scintigraphy (isotopes of technetium, iodine and other elements).

PET-CT

Positron emission computed tomography (PET-CT) is in many ways similar to SPECT with one cardinal difference - if during SPECT the gamma camera captures gamma radiation emanating directly from the radioisotope, then PET-CT uses isotopes capable of releasing positrons, and already emerging during their annihilation, gamma quanta are fixed by a scanner.

Schematically, the principle of SPECT can be expressed as follows: radioisotope - gamma radiation - fixation of gamma radiation by a scanner.

And the principle of PET-CT is schematically expressed as follows: a radioisotope - the release of positrons by it - the collision of positrons with electrons of the patient's body tissues - the annihilation of positrons with the release of gamma quanta - the fixation of gamma quanta by a scanner.

PET-CT is an actively developing type of diagnostics, which is widely used not only in clinical practice, but also in scientific research. Positron emission tomography allows mapping the brain, studying metabolic processes in the body, diagnosing atherosclerosis, bacterial infections, studying the pharmacokinetics of new drugs, etc.

PET-CT has found wide application in oncology. Fast-growing malignant tumors actively consume glucose, so the administration of a drug that is a compound of glucose and a radioisotope to a patient leads to the accumulation of the isotope in the tumor due to the phosphorylation reaction. This makes it possible to visualize the tumor using a PET scanner (PET-CT has become especially widespread in the diagnosis of brain tumors).

Fluorine, oxygen, carbon, and nitrogen isotopes are used as radiopharmaceuticals for PET scanning. Fluorine-18 is the most commonly used.

Doses of radiation during radioisotope studies

Patients who undergo radioisotope examinations receive a certain dose of ionizing radiation. The Top Ichilov clinic uses only modern and safe radiopharmaceuticals and equipment from the world's leading manufacturers. Therefore, diagnostics using scintigraphy or computed tomography in our clinic is completely safe for patients.

The risk of negative consequences after undergoing a radioisotope study is as scanty as with conventional x-ray diagnostics (although the dose of radiation received by the patient is somewhat higher than with x-rays). For comparison: the amount of radiation that a patient receives during a PET scan session using the fluorine-18 isotope corresponds to the annual dose of natural radiation that each resident of the high-mountain American city of Denver, Colorado receives (12-14 millisieverts), and is several times lower than the maximum allowable annual radiation exposure for workers at US nuclear power plants (50 millisieverts).

Radioisotope research in Israel - cost

Radioisotope research in Israel at prices is quite different from similar diagnostics in the EU and the USA. As a rule, savings in Israeli clinics reach 25-45% or more. This is due to the active participation of the government of our country in the development of domestic medicine - thanks to the action of government programs, Israeli clinics have the opportunity to purchase the most modern diagnostic equipment, including devices for radioisotope research.

Patients who underwent radioisotope testing in Israel, judging by their feedback, were able to save significant funds and send them to treatment.

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Advantages of radioisotope diagnostics at the Top Ichilov clinic

• State of the art equipment for accurate diagnosis. Our clinic uses tomographs from the world's leading manufacturers that meet all international quality and safety standards.
• The radiopharmaceuticals used have no side effects and are safe. The radiation exposure that a patient receives from the administration of such drugs is comparable to the dose of radiation received from a simple x-ray diagnosis.
• The scan results are studied by experienced specialists with extensive experience in radiodiagnostics. Their skills and knowledge are a guarantee that you will be given an accurate and correct diagnosis, and an effective treatment program will be prescribed.
• Affordable prices are a third lower than European and half lower than American ones.
• The comfort of our patients is one of the important tasks facing the clinic team. Well-appointed wards, polite and helpful medical staff, personal curator-translator will create an atmosphere of comfort and set you in a positive mood.

Long-term experiments with uranium allowed the French physicist Antoine Henri Becquerel to discover that he was able to emit certain rays that penetrate opaque objects. So about a hundred years ago, the study of radioactivity began.

Substances that emit radioactive rays are called isotopes. And as soon as they learned to register the radiation of isotopes with the help of special sensors, they began to be widely used in medicine.

During the study, the isotope is injected into the patient's body (usually through a vein), then its radiation is recorded using sensors. It signals violations in the work of organs or tissues. If the isotope is chosen correctly, it accumulates only in those organs and tissues that are being studied.

Currently, more than 1000 different radioisotope preparations are used in medicine, but the list is constantly growing. Get medical isotopes in nuclear reactors. The main requirement for these drugs is a short decay period.

A radioisotope study reveals abnormalities in the functioning of the lungs, informing the doctor about the obstacles that arise in the path of pulmonary blood flow in tuberculosis, pneumonia, and emphysema. Based on the radiation of isotopes accumulated by the patient's kidneys, the doctor may decide on an urgent operation. Informative radioisotope study and damage to the liver, especially the biliary tract. Isotopes, on the other hand, make it possible to predict with certainty the degeneration of hepatitis into cirrhosis.

The study of the stomach after eating a meal with a small admixture of isotopes provides extremely valuable information about the functioning of the digestive system.

The most modern method of radioisotope diagnostics is scintigraphy - computer radioisotope diagnostics. The radiation of intravenously injected isotopes is recorded by special detectors located at a certain angle, then the information is processed using a computer. The result is not a flat image of a separate organ, as in an x-ray, but a three-dimensional picture. If other imaging methods (radiography, ultrasound) allow us to examine our organs in statics, scintigraphy makes it possible to observe their work. When diagnosing neoplasms of the brain, intracranial inflammatory processes and vascular diseases, physicians in Europe and America resort exclusively to scintigraphy. In our country, as usual, the cost of the equipment hinders the spread of the method.

Patients often ask doctors how safe radioisotope diagnostics are. And this is natural: any medical procedure associated with radioactivity causes, if not fear, then anxiety. Many are also alarmed by the fact that, after injecting a radioactive drug into a vein, the doctor and nurse leave the room. Anxieties are in vain: with a radioisotope study, the patient's radiation dose is 100 times (!) Less than with conventional x-ray diagnostics. Even newborns can carry out such a procedure. Doctors do several such studies per day.

Radioisotope research methods are an important section in the diagnosis of diseases of the liver, biliary system, pancreas, and some other organs. Their diagnostic capabilities are based on the ability of certain radioactive preparations introduced into the human body before the study, to concentrate in the organ under study in amounts proportional to the morphological and functional viability of the tissues of this organ, and also to be removed from it at a rate characterizing the degree of functional disorders of this organ. Accurate registration of the amount of accumulated radioactive material, its distribution in the anatomical parts of the organ under study during one of the considered diagnostic methods - scanning - allows you to determine the displacement, increase or decrease in the size of the organ, as well as a decrease in its density. Scanning is used to examine the liver in the diagnosis of hepatitis, cirrhosis, neoplasms, in the study of other organs (thyroid gland, kidneys) involved in the development of the pathology of the digestive system.

Radioactive isotopes are also used to study absorption in the small intestine, determine the nature of disorders and localize damage to the biliary system, identify features of the pathological process in the pancreas, and circulatory disorders in the liver.

Patients should be aware that radioisotope diagnostic methods are completely harmless.

At the same time, people who have frequent professional contact with radionuclides, as well as those who live in areas with an increased radioactive background and, for this reason, belong to areas of ecological trouble, radioisotope research methods should not be carried out.

Also, radioisotope studies are contraindicated in children.

Special preparation for the considered diagnostic methods is not required.

Electrometric and electrographic research methods

In hospitals and clinics, a number of methods are used to investigate certain parameters of the functional activity of various digestive organs. Conventionally, these methods can be summarized in four groups. The first includes methods based on the registration of electrical biopotentials that arise during the functioning of organs: the stomach - electrogastrography, the intestines - electrointestinography, etc. The motor activity of the stomach and intestines is accompanied by the appearance of electrical potentials, the registration of which provides information about the nature of the rhythm of the peristalsis of the organs under study. Methods of electrogastrography and electrointestinography help clinicians to establish not only the hypermotility of the gastrointestinal tract, but also to fix the quantitative parameters of these disorders, to objectify the appointment of a particular therapy, to monitor the effectiveness of treatment.

Special preparation for electrogastrography and electrointestinography is not required. The study is carried out on an empty stomach (in the interdigestive period) and in the process of digestion. It should only be canceled at least 2 days before it, in agreement with the doctor, drugs that increase or decrease the motor-evacuation activity of the gastrointestinal tract.

The second group includes methods for recording the resistance of organ tissue or mucous membranes to an electric current passing through it (rheography).

Fluctuations in electrical resistance, due to changes in the blood supply to the tissue, are recorded using a special apparatus - a rheograph. The rheography of the liver, pancreas, stomach, duodenum, intestinal tract allows obtaining important information about the state of blood circulation in the studied organs, identifying local blood supply disorders and establishing causal relationships of diseases of the digestive system with detected disorders, determining targeted therapy and monitoring the effectiveness of its results.

Rheographic studies are carried out, as a rule, in the morning hours; special preparation of patients is not required. Before the study, the doctor temporarily excludes from the complex of treatment drugs that affect the vascular system (lowering or increasing blood pressure, increasing local blood flow, etc.).

The third group of methods consists of devices, devices and methods for examining patients, which, thanks to a radio telemetry system, allow studying the physiological processes in the human gastrointestinal tract in natural conditions of life (on an empty stomach, during and after a meal, throughout the entire period of digestion). The installation for radiotelemetric study of the human digestive tract consists of a radio transmitter (radiopill, radio capsule, endoradiosonde), swallowed by patients before the study, a receiving antenna, a radio receiver and a recording device - a recorder. The radio capsule, passing through the gastrointestinal tract, emits radio signals in accordance with the parameters of acidity, pressure, and temperature registered by it. These radio signals, received from the radio capsule by a special antenna, are transmitted to a special device (radio telemetry unit), which records them on a moving paper tape or in computer memory. The deciphered signals about the activity of various parts of the gastrointestinal tract are important for the diagnosis of the disease and the information necessary for the doctor about the features of the occurrence and course of pathological processes.

The fourth group includes methods for recording sound phenomena that occur in the process of motor-evacuation activity of the organs of the gastrointestinal tract; phonogastrography and phonointestinography (recording sounds in the stomach and intestines). The implementation of these research methods is aimed at identifying disorders of the motor function of the digestive tract, is used to control the quality of treatment and individualization of therapy. Special preparation of patients for the study is not required.

Recognition of pathological changes in the human body using radioactive compounds. It is built on the registration and measurement of radiation from drugs introduced into the body. With their help, they study the work of organs and systems, metabolism, the speed of blood flow and other processes. In radioisotope diagnostics, two methods are used:

• 1) The patient is given a radiopharmaceutical, followed by a study of its movement or unequal concentration in organs and tissues.
• 2) Labeled substances are added to the test tube with the test blood, evaluating their interaction. This is etc. screening test for early detection of various diseases in an unlimited number of people.

Indications for radioisotope research are diseases of the endocrine glands, digestive organs, as well as bone, cardiovascular, hematopoietic systems, brain and spinal cord, lungs, excretory organs, and lymphatic apparatus. It is carried out not only with suspicion of some kind of pathology or with a known disease to clarify the degree of damage and evaluate the effectiveness of treatment. There are no contraindications to radioisotope research, there are only some limitations. Of great importance is the comparison of radioisotope data, x-ray and ultrasound. There are six main methods of radioisotope diagnostics: clinical radiometry, radiography, whole body radiometry, scanning and scintigraphy, determination of the radioactivity of biological samples, radioisotope examination of biological samples in vitro. Clinical radiometry determines the concentration of radiopharmaceuticals in organs and tissues of the body by measuring radioactivity over time. Designed for the diagnosis of tumors located on the surface of the skin, eyes, mucous membrane of the larynx, esophagus, stomach, uterus and other organs. Radiography - registration of the dynamics of accumulation and redistribution of the introduced radioactive drug by the body. It is used to study fast processes, such as blood circulation, ventilation of the lungs, etc.

Whole body radiometry - carried out using a special counter. The method is designed to study the metabolism of proteins, vitamins, the function of the gastrointestinal tract, as well as to study the natural radioactivity of the body and its contamination with radioactive decay products. Scanning and scintigraphy are designed to obtain images of organs that selectively concentrate the drug. The resulting picture of the distribution and accumulation of the radionuclide gives an idea of ​​the topography, shape and size of the organ, as well as the presence of pathological foci in it. Determination of the radioactivity of biological samples - designed to study the function of the body. The absolute or relative radioactivity of urine, blood serum, saliva, etc. is considered.

Radioisotope study in vitro - determination of the concentration of hormones and other biologically active substances in the blood. At the same time, radionuclides and labeled compounds are not introduced into the body; all analysis is based on in vitro data. Each diagnostic test is based on the participation of radionuclides in the physiological processes of the body. Circulating along with the blood and lymph, drugs are temporarily retained in certain organs, their speed and direction are fixed, on the basis of which a clinical opinion is made. In gastroenterology, this allows you to explore the function, position and size of the salivary glands, spleen, and the state of the gastrointestinal tract. Various aspects of liver activity and the state of its blood circulation are determined: scanning and scintigraphy give an idea of ​​focal and diffuse changes in chronic hepatitis, cirrhosis, echinococcosis and malignant neoplasms. When scintigraphy of the pancreas, receiving its image, analyze inflammatory and volumetric changes. With the help of labeled food, the functions of the stomach and duodenum are studied in chronic gastroenteritis, peptic ulcer disease.

In hematology, radioisotope diagnostics helps to establish the lifespan of red blood cells, to determine anemia. In cardiology, the movement of blood through the vessels and cavities of the heart is traced: by the nature of the distribution of the drug in its healthy and affected areas, a reasonable conclusion is made about the state of the myocardium. Important data for the diagnosis of myocardial infarction is given by sciptigraphy - an image of the heart with areas of necrosis. The role of radiocardiography in the recognition of congenital and acquired heart defects is great. With the help of a special device - a gamma camera, it helps to see the heart and large vessels at work. In neurology, a radioisotope technique is used to detect brain tumors, their nature, localization and prevalence. Renography is the most physiological test for kidney diseases: image of the organ, its location, function. The advent of radioisotope technology has opened up new possibilities for oncology. Radionuclides that selectively accumulate in tumors have made it possible to diagnose primary cancers of the lungs, intestines, pancreas, lymphatic and central nervous systems, since even small neoplasms are detected. This allows you to evaluate the effectiveness of treatment and identify relapses. Moreover, scintigraphic signs of bone metastases are caught 3-12 months earlier than x-rays. In pulmonology, these methods “hear” external respiration and pulmonary blood flow; in endocrinology they “see” the consequences of iodine and other metabolic disorders, calculating the concentration of hormones - the result of the activity of the endocrine glands. All studies are conducted only in radioisotope diagnostic laboratories by specially trained personnel. Radiation safety is ensured by the calculation of the optimal activity of the injected radionuclide. The radiation doses of the patient are clearly regulated.