Nuclear Medicine

The Department of Nuclear Medicine of Dongguan Hospital Affiliated to Southern Medical University (Dongguan People's Hospital) was founded in 1994. After nearly 30 years of development it has become a comprehensive discipline integrating clinical care, scientific research and teaching. In terms of the nuclear medicine diagnostic and therapeutic equipment it possesses, the scale of its wards and its level of diagnosis and treatment, the department holds a leading position in the Dongguan area. The department is a Dongguan municipal key clinical specialty, a member unit of the Pearl River Thyroid Radionuclide Diagnosis and Treatment Specialty Medical Alliance, and the vice-chairperson unit of the Nuclear Medicine Physicians Branch of the Guangdong Medical Doctor Association.

The department has a high-calibre team of personnel. It currently has 18 medical and nursing staff, including 1 with a full senior professional title, 2 with an associate senior professional title, 6 with an intermediate professional title and 3 with a master's-level education in medicine; all of them have extensive experience in specialised nuclear medicine diagnosis and treatment.

The department is equipped with advanced medical equipment available in the country. It possesses one Siemens 64-slice PET/CT, two dual-head variable-angle SPECT/CT systems, a GE dual-energy X-ray bone densitometer, a thyroid function measuring instrument and a batch of other advanced equipment, providing an excellent diagnostic platform for clinical treatment. In 2022, after renovation and expansion was completed, the department set up more complete radionuclide treatment wards, with an isolation treatment area of four rooms and 6 beds and a general treatment area of 2 rooms and 6 beds, in order to meet the needs of the many patients who require radionuclide therapy. The department has already purchased a medical cyclotron and a new digital SPECT/CT, and will purchase a PET/MR and a second PET/CT, to meet the needs of clinical examination, research and teaching and to provide patients with more advanced and precise diagnostic and treatment services.

At present, the department offers more than 40 examination and treatment items, including a number of distinctive treatment techniques, such as PET/CT and SPECT/CT nuclear medicine imaging examinations, as well as treatment of hyperthyroidism, differentiated thyroid carcinoma, bone metastases, cutaneous haemangioma and scars.

The annual number of radionuclide diagnoses and treatments performed by the department and its diagnostic standards are in the leading ranks within the city and the advanced ranks within the province, and its treatment results are widely recognised by patients and peers. At the same time, the department has established several subspecialty teams and carries out MDT multidisciplinary diagnosis and treatment together with a number of disciplines including oncology, respiratory medicine and neurology.

The department attaches importance to teaching and to the transmission of its expertise. In recent years it has undertaken a number of teaching tasks, including undergraduate teaching and the supervision of interns and of physicians in standardised residency training. At the same time, taking the difficult and key problems arising in clinical practice as its basis, it has carried out a large amount of scientific research. In 2022 the department obtained approval for 3 research projects and published dozens of papers, including SCI papers, papers in domestic journals and papers presented at academic conferences.

Scope of diagnosis and treatment

1. Treatment of thyroid-related diseases such as differentiated thyroid carcinoma and hyperthyroidism: the diagnosis and treatment of thyroid-related diseases including hyperthyroidism (iodine-131 therapy), differentiated thyroid carcinoma (postoperative iodine-131 therapy), hyperfunctioning adenoma (iodine-131 therapy), hypothyroidism (including decreased thyroid function after treatment for hyperthyroidism and after surgery for thyroid cancer), thyroid nodules, thyroiditis (chronic thyroiditis, subacute thyroiditis, etc.) and abnormal thyroid function.

2. Radionuclide drug therapy for other related diseases: phosphorus-32 applicator therapy for cutaneous haemangioma, scars, refractory eczema and neurodermatitis; strontium-89 for a variety of bone metastases; “Yunke” for rheumatoid arthritis, hyperthyroid exophthalmos, osteoporosis, etc.

3. PET/CT examinations: the current main applications of whole-body PET/CT include the early diagnosis of tumours, benign versus malignant diagnosis, pre- and postoperative staging, searching for the primary focus, assessment of tumour treatment response and of recurrence, guidance of radiotherapy planning — delineation of the biological target volume before tumour radiotherapy — and health check-ups. In the near future, the development of a variety of new imaging agents, such as PSMA, FABI and DOTATATE, can further extend the scope of PET/CT applications.

4. SPECT/CT examinations: the examination items currently performed include dynamic renal imaging, whole-body bone imaging, tomographic bone imaging, thyroid imaging, pulmonary perfusion–ventilation imaging, myocardial perfusion imaging, salivary gland imaging, parathyroid imaging, adrenal medullary imaging, lymphatic imaging, cerebral perfusion imaging, gastrointestinal bleeding imaging, paediatric hepatobiliary imaging, ectopic gastric mucosa imaging and other examinations, providing great help in the diagnosis and treatment of clinical diseases.

5. Bone mineral density measurement: it can determine at a relatively early stage whether the person examined has reduced bone mass or has osteoporosis, perform fracture risk assessment, dynamically observe the percentage change in bone mineral density in the near and long term, and evaluate the effect after treatment. Bone mineral density measurement is applicable to the entire population, and in particular to middle-aged and elderly people, women, children, people who are bedridden for long periods, and people with endocrine system diseases, chronic diseases and chronic lumbar and leg pain, as well as for the assessment of bone mass before orthopaedic surgery.

6. Thyroid function measurement: this item helps to understand the functional state of the thyroid, is used to differentiate hyperthyroidism from subacute thyroiditis, and has a certain guiding significance for the treatment of hyperthyroidism.

Featured techniques

1. Postoperative iodine-131 remnant ablation and lesion ablation for differentiated thyroid carcinoma

The department has well-equipped radionuclide treatment wards. For differentiated thyroid carcinoma after total surgical resection, iodine-131 internal radiation is applied to remove residual thyroid tissue (the small amount of thyroid tissue that cannot be completely removed by surgery), which is beneficial to patient follow-up and treatment. For unresectable metastatic lesions of thyroid carcinoma, high-dose iodine-131 internal radiation therapy is given; the efficacy is definite, it can clearly prolong the survival of patients with thyroid carcinoma, and it is currently the most effective method recommended by diagnostic and treatment guidelines for treating differentiated thyroid carcinoma. At present the department has established scientific and efficient clinical pathways, promotes standardised and individualised radionuclide diagnosis and treatment, and its standards of diagnosis and treatment are advanced within the province.

2. Iodine-131 therapy for hyperthyroidism

For patients who develop impaired liver function or reduced granulocytes during treatment for hyperthyroidism, or for patients whose condition relapses after long-term medical treatment and who are unwilling or unable to accept surgery, iodine-131 therapy is a very good choice. It has the advantages of being simple and safe, with good efficacy, a low relapse rate, few complications and relatively low cost.

3. PET/CT imaging applications

PET/CT is a safe and efficient examination item. This technology perfectly integrates PET and CT into one: PET provides detailed functional, metabolic and other molecular information on the lesion, while CT provides precise anatomical localisation of the lesion, achieving a “1+1>2” effect. The patient needs only one whole-body imaging session lasting about 20 minutes to obtain, at a glance, a clear understanding of the overall condition of the whole body.

The large functional molecular imaging equipment introduced by Dongguan People's Hospital, the Siemens Biograph TruePoint 64 (52-ring) PET/CT, is an ultra-high-end, multifunctional all-in-one machine with advanced equipment and powerful functions. Using this advanced equipment, the department is able to detect tumours and diseases of the heart and brain systems early and to make an early diagnosis; whole-body scanning can discover tiny lesions in the body, and early diagnosis enables the person examined to receive early treatment.

These technical applications include:

Tumour imaging: PET/CT enables the diagnosis and differential diagnosis of benign and malignant tumours or other lesions; it is applied in the staging and grading of the great majority of tumours and in the localisation of tumour metastases, and provides assessment of efficacy after tumour chemotherapy and radiotherapy. For the differential diagnosis of local necrosis and fibrosis versus residual or recurrent tumour tissue after tumour treatment, for searching for the primary tumour focus, and for tumour gene imaging and localisation of the biological target volume for tumour radiotherapy, it provides dual functional and morphological biological information on the tumour.

Brain function imaging: PET/CT has been widely applied in brain function imaging. Taking the treatment of epilepsy as an example, many patients with epilepsy have no organic or structural changes; conventional imaging methods (CT, MRI) can only show lesions of anatomical structure, whereas PET/CT can carry out analysis from a metabolic perspective and thereby accurately localise the lesion, providing assessment of surgical efficacy. This examination is also maturely applied in the early diagnosis of presenile dementia (Alzheimer's disease) and Parkinson's disease, and provides a diagnostic basis for early localisation, efficacy assessment and prognosis judgement in cerebral ischaemia and cerebral infarction.

Myocardial metabolic imaging: for patients with myocardial ischaemia caused by severe coronary artery stenosis, is revascularisation (stenting or bypass surgery) appropriate, or is drug therapy alone sufficient? Effective identification of viable myocardium plays a key role in treatment decisions and prognosis assessment for patients with coronary heart disease. PET/CT is the gold standard for judging whether the myocardium at the site of myocardial infarction is viable; it can be applied in a variety of assessments, including non-invasive coronary angiography to show the degree of coronary artery stenosis, assessment after coronary artery bypass grafting or interventional treatment, classification diagnosis of coronary atherosclerotic plaques, and diagnosis of coronary artery malformations and variants.

4. SPECT organ function imaging

SPECT is one of the core technologies of nuclear medicine imaging. By introducing a safe dose of radionuclide into the human body as an imaging agent and using nuclear medicine equipment to detect the metabolism of the drug in the body, it reveals organ function and assists in disease diagnosis and treatment.

Unlike conventional morphological examinations such as ultrasound, CT and magnetic resonance imaging, SPECT imaging can reflect the functional state of different organs, and can achieve organ visualisation, quantitative analysis and comparative study through the computer.

At present, SPECT in our hospital has been maturely applied in a number of fields:

Whole-body bone imaging: it can be used for disease staging, bone pain evaluation, prognosis judgement and efficacy monitoring; it can detect bone metastases 3–6 months or even earlier than conventional X-ray films, and is an important tool for the early diagnosis of bone metastases from malignant tumours.

Bone–joint tomographic imaging and dynamic imaging: SPECT reduces the problems of whole-body planar bone imaging caused by overlapping anatomical structures, deep lesions or radioactive interference from adjacent tissues and organs, in order to observe the blood supply of the femoral head and the blood supply and survival status of transplanted bone; it is applied in the diagnosis of local bone and bone–joint functional disorders.

Thyroid imaging: diagnosis and localisation of ectopic thyroid, judgement of thyroid nodule function and differentiation of benign from malignant, auxiliary localisation and diagnosis of metastases of differentiated thyroid carcinoma, and estimation of thyroid size and weight.

Dynamic renal imaging: SPECT dynamic renal imaging is a mature examination method for detecting diseases of the urinary system. In evaluating renal parenchymal function it has the advantages of high sensitivity, simplicity, convenience and non-invasiveness; it can more accurately reveal the size, shape and function of both kidneys and the patency of the urinary tract, assess renal artery disease and the blood supply of both kidneys, and diagnose renal artery embolism and observe the efficacy of thrombolysis, and it has clear clinical value.

Pulmonary perfusion–ventilation imaging: applied in the diagnosis of pulmonary embolism and judgement of treatment efficacy, assessment of the infiltration range of intrapulmonary lesions and the degree of pulmonary vascular involvement, prediction of residual pulmonary function after surgery, and judgement of severity and assessment of treatment efficacy in chronic obstructive pulmonary disease.

Myocardial perfusion imaging: SPECT myocardial perfusion imaging (MPI) is the core content of nuclear cardiology; it has important clinical value for assessing the site, extent and prognosis of myocardial ischaemia or infarction in coronary heart disease, and effectively provides auxiliary diagnosis for cardiomyopathy and myocarditis.

5. CT-guided auxiliary localisation techniques

The department carries out various CT-guided auxiliary localisation techniques, assisting the interventional, general surgical, respiratory and orthopaedic departments and other clinical departments in routinely performing percutaneous tumour needle biopsy, ablation of liver and lung tumours, vertebroplasty, and intervertebral discography and disc softening treatment.