Nuclear Medicine

The department of Nuclear Medicine, part of Cleveland Clinic’s Imaging Institute, is among the country’s largest in terms of volume and equipment.

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A brief overview of Cleveland Clinic's Department of Nuclear Medicine, virtual tour and Nuclear Medicine's reading room.

Cleveland Clinic’s Department of Nuclear Medicine has expanded with a move into the Sydell and Arnold Miller Family Pavilion. This move triples the department’s size and enhances its capabilities to deliver the best patient care possible.

The department has 12 cameras - three PET/CT scanners, three SPECT/CT scanners and six traditional gamma cameras. In addition to these capabilities, our mobile PET/CT system brings main campus capabilities to Cleveland Clinic community hospitals. Our unique expertise and unsurpassed technology are available to help care for patients, from offering the earliest possible diagnosis to helping assess and manage treatment plans.

Our subspecialty expertise coupled with leading-edge technology bring our Department of Nuclear Medicine to a new level.

Services

The Department of Nuclear Medicine utilizes radioactive materials to diagnose the presence of disease in the body and to treat multiple types of cancer as well as conditions such as Graves’ disease.

Nuclear Medicine’s advanced imaging capabilities can identify changes in organ function. SPECT and PET are performed at the main campus and at selected Cleveland Clinic-affiliated hospitals. Hybrid SPECT/CT and PET/CT fusion imaging also is performed on specialized scanners that directly map the abnormal tissue physiology depicted on the nuclear images to the affected anatomic area displayed on the high-resolution CT images.

The department possesses an unusual depth of expertise, with Nuclear Medicine physicians, radiochemists and a physicist. Physicians are board-certified and clinically experienced in a broad array of specialties, including cardiology, neurology and radiology.

Nuclear Medicine’s Center for PET and Molecular Imaging (CPMI) recognizes that many cancer patients undergoing a PET scan have already had a CT scan; in the past, these scans were presented to the referring physician as separate reports. Through CPMI, however, these studies are performed and interpreted together by a team of cross-trained specialists, resulting in one integrated report for the referring physician that contains a cohesive assessment of the patient’s overall condition.

Patient therapy is a significant component of Nuclear Medicine. Treatments, and sometimes pain relief, are offered for conditions such as Graves’ disease, thyroid cancer, liver cancer, cancer that has spread to the bone and refractory lymphomas. PET/CT scans also assist radiation oncologists in planning treatment with external sources of radiation.

Diagnostic Tests
  • Bone: Bone cancer spread or identifying causes of pain
  • Brain: Epilepsy, Tumors, Stroke/blood vessel narrowing
  • Breast Cancer
  • Cancer: All Organs
  • Heart: Ischemia, Heart Muscle Viability, Ejection Fraction
  • Infection and Inflammation: Osteomyelitis, Abscess
  • Kidneys: Obstruction from stones or congenital, Renal Failure
  • Liver/Gall Bladder: Abdominal Pain, Function of liver, gallbladder
  • Lungs: Blood flow obstruction and/or airway obstruction
  • Parathyroid: High Calcium Production
  • Pediatric Imaging: Ureter Obstruction, Gastric Emptying and Reflux, Oncology
  • Stomach: Gastric Motility, Reflux
  • Thyroid: Hyperthyroidism, Goiter or Cancer
Therapy Treatments
  • Thyroid: Hyperthyroidism and Cancer
  • Bone: Pain Palliation in Cancer Patients
  • Lymphoma

Education

Nuclear Medicine staff shares a strong commitment to education, expressed through training of radiology residents and cardiology fellows.

Leadership

The Nuclear Medicine staff is active in the Society of Nuclear Medicine, the American Society of Nuclear Cardiology, the American College of Cardiology and the American College of Radiology.

The Department of Nuclear Medicine participates in a number of national multi-center research studies and is part of National Oncologic PET Registry (NOPR) data collection.

Research focuses on the development of advanced instrumentation, cancer detection and non-invasive measurement of regional organ blood flow. At the cyclotron facilities, work continues on the development of novel radiotracers. The CPMI is participating in industry-sponsored clinical trials to evaluate new radiotracers.

The department is also involved in American College of Radiology Imaging Network (ACRIN) trials in conjunction with radiation oncology. Below are current department research activities:

  • Clinical quantitative myocardial perfusion imaging using PET tracers such as Rb-82 and [N-13] ammonia.

    This is a series of myocardial perfusion experiments quantifying coronary artery perfusion with Rb-82 chloride, a PET perfusion tracer (Richard Brunken, MD & Frank Difilippo, PhD).

  • Ongoing multicenter trial to evaluate the novel imaging agent I-124 G250 antibody.

    This is a positron emitting antibody for imaging patients with renal cell carcinoma (Shyam Srinivas, MD).

  • Novel sensitive and specific method of parathyroid imaging using CT, I-123 and Tc99m sestamibi.

    Findings were published in the 12/08 issue of Journal of Nuclear Medicine (Donald Neumann, MD, PhD).

  • Collaborating with the pulmonary department to develop methods to image hypoxia in adults with asthma (Donald Neumann, MD, PhD & Frank Difilippo, PhD).
  • Collaborating with the pulmonary department in a multi-institutional trial to create images of primary pulmonary hypertension using FDG-PET (Donald Neumann, MD, PhD & Frank Difilippo, PhD).
  • Nuclear imaging of the brain.

    This primarily focuses on localizing epileptic foci for patients with seizure using FDG-PET and SPECT imaging. Developing novel PET imaging protocols to differentiate radiation necrosis and tumor recurrence in patients that underwent radiation treatment for brain tumor (Guiyun Wu, MD).

  • Clinical SPECT/CT and PET/CT imaging for assessment of treatment response for patients with cancer.

    Presentations of these findings have been made at the national meetings of the Society of Nuclear Medicine, American College of Nuclear Physician and Radiological Society of North America (Sankaran Shrikanthan, MD).

  • Multiple collaborative research efforts within, and outside of the department, to develop a unique high resolution animal imaging SPECT/CT system that can achieve 1mm resolution when imaging Tc99m tracer activity in mice (Frank Difilippo, PhD).
  • Engineering a peptide based molecular platform coupled to a high throughput screening system that will enable efficient search for lead polypeptide compounds against tumor targets.

    Screening for compounds binding to vascular endothelial growth factor receptor type 2 (VEGFR2) which is a major factor in tumor angiogenesis (Steve Shih Lin Huang, MD, PhD).

What is Nuclear Medicine?»

Nuclear Medicine is a medical specialty in which the diagnosis and treatment of human diseases are made by the use of a small amount of radioactive tracers. After administration of the tracer, images of the organ of interest in the patient’s body are obtained with a gamma camera that show the localization of the tracer in the organ, and physicians interpret them for the diagnosis of disease. Certain diseases are treated with high energy radiotracers in nuclear medicine based on the concept that high does radiation kills cells.

How is a Nuclear Medicine Study Performed?»

The patient is given intravenously, for some studies orally or by inhalation, a small dosage of a radiotracer specific for an organ under study. Some studies require that the patient exercise or receive a drug that dilates the arteries in the heart. The tracer localizes in the organ and emits gamma radiations that are detected by a special camera to form an image of the organ. Imaging of the organ is performed immediately, hours or days after administration of the tracer, depending on the type of study. The duration of imaging itself ranges from 15 to 120 minutes for different studies. Most tests require the patient to lie down on a bed, while others require the patient to sit. Some tests require taking many short pictures of the organ serially followed by one long picture at the end. Nuclear physicians interpret the images and can see any abnormality in the image either as a ‘hot’ area with increased localization of the tracer or a cold spot with decreased localization of the tracer, depending on the property of the tracer.

How is the Tracer Administered?»

The tracer is administered most commonly by injection through the vein, and for some tests orally or by inhalation.

How Long Does a Nuclear Medicine Test Take? »

It depends on the type of test. Since the localization of the radiotracer varies with the physiological behavior of the organ and the characteristics of the tracer, the time for optimal localization varies from organ to organ. Sometimes two tests are needed for some disease entities such as with cardiac studies. For example, a lung scan needs only half an hour, a heart study may take two to three hours, and yet other tests may takes 24-48 hours to complete.

Are There Specific Preparations for a Study?»

Some tests require minimal or no preparation, (e.g. bone, brain, kidneys and lungs), whereas others require specific preparations such as fasting for 4-12 hours and no caffeine consumption for 24 hours (cardiac studies). During scheduling of the test, the patient will be instructed for the specific preparation.

Are There Any Side Effects from the Studies? »

Because the administered radioactive dosages contain only a minimal amount of the carrier drug, no significant adverse or allergic reactions from the drug are commonly encountered. A patient receives a certain amount of radiation dose from nuclear medicine studies which is comparable to a diagnostic CT scan. The dose received from these diagnostic tests is not significantly harmful to the patient and the benefits of performing these exams typically outweighs the risks associated with the exposure.

What are the Benefits of Nuclear Medicine?»

Nuclear medicine tests are very sensitive and can detect some diseases at early stages. Unlike MRI and CT studies that give only structural information, nuclear medicine tests provide information about the physiological or functional status and viability of different organs and tissues.

How Does a Patient Make an Appointment? »

A primary physician or specialist can make a patient referral to the department or a patient make the appointment directly by calling 216.444.2772 or toll-free at 800.223.2273 ext. 42772.

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