Nuclear Medicine

I. Basic overview of the discipline and qualifications and honors

The Department of Nuclear Medicine of Zhongshan Hospital Affiliated to Xiamen University was founded in 1996 and is one of the earlier units in Fujian Province to carry out clinical radionuclide SPECT imaging and treatment. After years of construction, the department has developed into a modern nuclear medicine specialty integrating medical care, teaching, research and talent cultivation. The department is the Medical Imaging Research Institute of the Medical College of Xiamen University, the Xiamen Nuclear Medicine Quality Control Center, the chair unit of Nuclear Medicine of the Fujian Provincial Association of Integrative Chinese and Western Medicine, and the affiliated unit of the Xiamen Key Laboratory of Clinical Translation of Nuclear Medicine Molecular Imaging. Among them, the key laboratory was approved for construction in December 2018. The department holds a Radiopharmaceutical Use License (Class II) and has the qualifications of a standardized residency training base and a national clinical drug trial base (GCP), providing platform support for clinical diagnosis and treatment, talent cultivation and drug clinical trials.

II. Core scope of diagnosis and treatment

The department has a PET-CT imaging room, a SPECT-CT imaging room, a functional examination room, and a radionuclide therapy clinic and ward, providing imaging diagnosis, functional assessment and radionuclide therapy services. 1. PET-CT imaging room: equipped with 1 Siemens Biograph 64-slice 52-ring high-definition (HD) PET-CT, providing support for molecular imaging diagnosis of tumors and cardiovascular and cerebrovascular diseases. 2. SPECT-CT imaging room: equipped with one GE NM/CT 860, one GE Discovery NM/CT 670 and one GE Infinia SPECT, meeting the functional imaging needs of multi-system diseases. 3. Functional examination room: carries out nuclear medicine examinations such as organ function assessment. 4. Radionuclide therapy clinic and ward: provides patients with radionuclide therapy assessment, treatment and inpatient services. The department routinely carries out more than 60 diagnostic and therapeutic items, completing more than 10,000 nuclear medicine examinations and more than 1,000 radionuclide therapy services annually. The SPECT/CT and related diagnostic and treatment area is located on the 4th floor of Building 1 and can be reached by elevator No. 5 or No. 6, mainly carrying out whole-body bone imaging, dynamic renal function imaging, thyroid imaging, myocardial perfusion imaging and the ¹³C urea breath test. The PET-CT diagnostic and treatment area is located on the 1st floor of Building 6, with a dedicated waiting hall, mainly carrying out whole-body tumor imaging and staging, myocardial metabolic imaging and brain metabolic imaging. The department offers a specialized radionuclide therapy clinic, providing pre-consultation assessment, treatment plan formulation and post-treatment follow-up for patients with hyperthyroidism, differentiated thyroid cancer, bone metastatic tumors and other patients with radionuclide therapy needs. On each working day, two senior nuclear medicine experts hold consultations on the 4th floor of Building 1 and the 1st floor of Building 6 respectively; for difficult and complex cases, they may conduct joint assessment. Outpatient services also include interpretation of nuclear medicine examination reports and clinical consultation. Visit tips: examinations such as PET-CT and SPECT/CT involve the preparation of radiopharmaceuticals; please make an appointment in advance through the hospital's official channels and report 15 minutes before the appointed time slot. When visiting the specialized radionuclide therapy clinic, please bring recent medical records, relevant laboratory reports, ultrasound and pathology reports. Requirements for examination preparation such as fasting and discontinuation of medication shall be subject to the appointment notice or the guidance of the hospital's official consultation channels.

III. Characteristic sub-specialties and core technical advantages

The department takes molecular imaging diagnosis and radionuclide targeted therapy as its main directions, promoting the coordinated development of diagnosis, treatment and follow-up.

(I) Molecular imaging diagnosis sub-specialty The department has accumulated clinical experience in radionuclide imaging diagnosis of tumors, thyroid, cardiovascular and cerebrovascular diseases, kidney diseases and pulmonary embolism, and carries out the Helicobacter pylori ¹³C urea breath test. Relying on PET-CT and SPECT/CT equipment, functional or metabolic information can be combined with anatomical imaging to provide a basis for disease diagnosis, staging, efficacy evaluation and follow-up.

(II) Radionuclide targeted therapy sub-specialty The department has established a management pathway covering pre-treatment assessment, standardized implementation and post-treatment follow-up, and mainly carries out the following items: 1. Iodine-131 (¹³¹I) therapy: for the standardized treatment and follow-up of hyperthyroidism and differentiated thyroid cancer. 2. Strontium-89 chloride (⁸⁹SrCl₂) therapy: for palliative analgesia in patients with bone metastatic cancer, helping to relieve bone pain. 3. Strontium-90/Yttrium-90 (⁹⁰Sr/⁹⁰Y) patch therapy: providing a local treatment option for patients with skin scars, cutaneous hemangiomas and the like. 4. Iodine-125 (¹²⁵I) seed implantation therapy: brachytherapy for local lesions of some solid tumors. 5. Yunke (⁹⁹Tc-MDP) therapy: for the treatment of diseases such as rheumatoid arthritis and thyroid-associated ophthalmopathy. 6. Yttrium-90 (⁹⁰Y) microsphere therapy: the related project for liver metastases is currently under application and has not yet been carried out as a routine item.

IV. Multidisciplinary MDT comprehensive diagnosis and treatment and whole-course management

Relying on PET/CT, SPECT/CT and radionuclide therapy technologies, the department collaborates with the Departments of Medical Oncology, Thyroid Surgery, Cardiovascular Medicine, Neurology, Nephrology, Respiratory and Critical Care Medicine, and Dermatology, etc., to provide patients with services linking imaging diagnosis, treatment decision-making, efficacy evaluation and long-term follow-up.

(I) Routine MDT collaboration mechanism 1. “One-stop” joint clinic and regular consultation The department jointly carries out MDT clinics and regular discussions of difficult cases with relevant clinical departments. For complex cases, nuclear medicine physicians and clinical experts review images and discuss together, and formulate diagnosis and treatment plans by combining pathology, clinical indicators and imaging information. 2. Integrated diagnosis and treatment with whole-course management Before treatment, molecular imaging assists in staging, lesion assessment and treatment selection; during treatment, radionuclide therapy is incorporated into the overall diagnosis and treatment pathway and treatment response is monitored; after treatment, long-term follow-up is carried out in combination with re-examination results, so as to promptly identify the risk of recurrence or metastasis. 3. Green channel and information interconnection Relying on the hospital's smart healthcare platform, the department provides eligible MDT patients with priority examinations, priority issuance of reports and priority arrangement of radionuclide ward beds, and promotes the sharing of imaging and clinical information.

(II) Typical MDT diagnosis and treatment practices 1. Closed-loop “diagnosis—treatment—follow-up” management of differentiated thyroid cancer A 45-year-old patient with locally advanced papillary thyroid carcinoma and multiple cervical lymph node metastases, after thyroid surgery, was assessed by the Department of Nuclear Medicine and underwent iodine-131 ablation of residual thyroid tissue and ablation of lesions, with the Department of Medical Oncology participating in adjuvant therapy and adverse reaction management. After two courses, whole-body imaging and thyroglobulin testing indicated complete remission of the lesions; the patient was enrolled in long-term follow-up and has currently survived without disease for more than 5 years. 2. Non-invasive diagnosis of difficult cardiac amyloidosis An elderly male patient with refractory heart failure, renal function decline and myocardial hypertrophy underwent MDT assessment and could not tolerate myocardial biopsy. The Department of Nuclear Medicine recommended ⁹⁹ᵐTc-PYP myocardial imaging, and the results showed grade 3 uptake in the cardiac region. Combined with the negative results of blood and urine light chain-related tests, the MDT team diagnosed transthyretin amyloid cardiomyopathy (ATTR-CM) and accordingly carried out targeted treatment and renal protective intervention.

V. Talent team and expert strength

The department currently has 19 staff members, including 1 professor and master's supervisor, 3 chief physicians, 3 associate chief physicians and 4 personnel with intermediate titles; it has 1 doctoral degree holder, 5 master's degree holders, 1 scholar returned from the United States, 1 Fujian Provincial high-level talent and 2 Xiamen City high-level talents. Under the leadership of the discipline leader Su Fu, the team continues to advance precision nuclear medicine diagnosis and treatment. The department implements a two-expert clinic mechanism on working days, receiving patients in the two diagnostic and treatment areas respectively, and providing services such as condition assessment, plan discussion and report interpretation.

VI. Coordinated development of medical care, teaching and research

The department builds clinical services, teaching and training, and research innovation in a coordinated manner, promoting the common improvement of diagnostic and treatment capabilities and talent cultivation.

(I) Medical services The department, in accordance with the quality control requirements for nuclear medicine diagnosis and treatment and relying on zoned settings and equipment configuration, provides imaging diagnosis, functional examination and radionuclide therapy services. 1. Distribution of diagnostic and treatment areas SPECT/CT and related diagnostic and treatment area: located on the 4th floor of Building 1, accessible by elevator No. 5 or No. 6, carrying out routine nuclear medicine imaging and the ¹³C urea breath test. PET-CT diagnostic and treatment area: located on the 1st floor of Building 6, with a dedicated waiting hall, carrying out molecular imaging examinations of tumors, myocardium and brain metabolism, etc. 2. Specialized radionuclide therapy clinic For patients with hyperthyroidism, differentiated thyroid cancer, bone metastatic tumors, etc., providing pre-treatment assessment, individualized plan formulation and long-term follow-up. 3. Two-expert clinic mechanism On each working day, two senior nuclear medicine experts hold consultations on the 4th floor of Building 1 and the 1st floor of Building 6 respectively. The clinic covers iodine-131 therapy assessment and follow-up, radionuclide therapy assessment for bone metastases, as well as interpretation of nuclear medicine reports and clinical consultation; difficult cases can be discussed jointly by the experts. 4. Visit tips Make an appointment in advance: for examinations such as PET-CT and SPECT/CT, please make an appointment through the hospital's official channels and report 15 minutes early. Bring complete materials: patients of the radionuclide therapy clinic please bring recent medical records, relevant laboratory reports, ultrasound and pathology reports. Confirm preparation requirements: matters such as fasting and discontinuation of medication shall be subject to the appointment notice or the hospital's official guidance.

(II) Teaching and training The department has long undertaken the teaching tasks of the “Nuclear Medicine” course for the Medical College of Xiamen University and Xiamen Medical College, and has cumulatively trained more than 10 graduate students and standardized residency training trainees. The department has established a rotation system covering PET-CT and SPECT/CT imaging diagnosis, radionuclide therapy, in vitro analysis testing and radiation safety protection; implements “one-to-one” mentor teaching, attaching importance to the cultivation of image reading, report writing, MDT clinical thinking and doctor-patient communication skills; and ensures training quality through departmental induction education, daily assessment, exit assessment, as well as case discussions and teaching rounds.

(III) Research innovation The department, relying on the Xiamen Key Laboratory of Clinical Translation of Nuclear Medicine Molecular Imaging, continues to carry out molecular imaging-related research. It has undertaken 2 general projects of the National Natural Science Foundation of China, 1 project each from the Ministry of Human Resources and Social Security and the Ministry of Education for returned overseas scholars, and 12 provincial and municipal projects; has published more than 20 SCI papers and more than 30 papers in Chinese core journals; has won 1 third prize of the Fujian Provincial Science and Technology Progress Award and 1 second prize of the Xiamen Municipal Science and Technology Progress Award; has cumulatively applied for 4 invention patents and 4 utility model patents, and has participated in the compilation of 5 monographs.

VII. Summary of the department's core advantages 1. Deep development accumulation: established in 1996, it is one of the earlier units in Fujian Province to carry out clinical radionuclide SPECT imaging and treatment. 2. Complete platform qualifications: it has qualifications such as the Radiopharmaceutical Use License (Class II), a standardized residency training base and a national clinical drug trial base (GCP), and carries out its work on the basis of multiple discipline platforms. 3. Complete sub-specialty setup: it has units for PET-CT, SPECT-CT, functional examination and radionuclide therapy, forming a service system with coordinated diagnosis and treatment. 4. Rich diagnostic and treatment items: it routinely carries out more than 60 diagnostic and therapeutic items, with more than 10,000 nuclear medicine examinations and more than 1,000 radionuclide therapy services annually. 5. Complete equipment configuration: it is equipped with 1 PET-CT and a total of 3 SPECT and SPECT/CT devices, providing support for molecular imaging diagnosis and efficacy evaluation. 6. Rational talent echelon: it has a professional team of 19 people, as well as provincial and municipal high-level talents and backbones with overseas study backgrounds. 7. Complete service mechanism: through the two-expert clinic, the specialized radionuclide therapy clinic and MDT collaboration, it links pre-consultation assessment, treatment and follow-up. 8. Coordinated development of medical care, teaching and research: it undertakes the course teaching tasks of two medical colleges and continues to advance talent cultivation, research innovation and clinical translation.

VIII. Outlook of the department In the next 5–10 years, the department will rely on the discipline platform of Xiamen University and the Xiamen Key Laboratory of Clinical Translation of Nuclear Medicine Molecular Imaging, focus on patient needs, and continuously improve its capabilities in molecular imaging diagnosis, radionuclide therapy and whole-course management. The department plans to advance the construction of a characteristic radionuclide diagnosis and treatment center in stages, optimize the configuration of PET/CT, SPECT/CT, radionuclide therapy wards and research platforms, and promote the standardized admission and clinical translation of technologies such as novel molecular probe imaging, targeted radionuclide therapy, iodine-125 seed implantation and yttrium-90 microspheres. At the same time, it will strengthen talent introduction and cultivation and sub-specialty construction, deepen MDT collaboration, and improve the integrated service model of “precision imaging diagnosis — individualized treatment — efficacy evaluation — long-term follow-up”. The department will continue to improve medical service quality, research innovation capability and regional service capability, build a modern nuclear medicine specialty with distinctive diagnostic and treatment features and coordinated development of medical care, teaching and research, and provide high-quality nuclear medicine diagnosis and treatment services to the people of southwestern Fujian.