 What is up YouTube? Welcome back to my channel. For those of you who saw my last Instagram post, I posted a picture of all the pet scans I read last week and a lot of you guys were asking me why I'm reading pet scans, why I'm doing a nuclear medicine rotation, what is a pet scan, why am I reading scans on animals and all that stuff. So I figured I would clear some things up for this video and talk a little bit about nuclear medicine in the process. Let's go. It requires us to do four one-month rotations in nuclear medicine. So the ACGME is the accreditation council of graduate medical education and they are the hierarchy of all of residency programs in the U.S. I have already done three of my one-month rotations, which is why I'm doing my final one-month rotation in my fourth year of residency. And yes, even though I'm doing IR as my specialty of choice, I still have to meet all of my requirements in order to be dual board certified in diagnostic radiology and interventional radiology. So now let's talk a little bit about nuclear medicine and find out what exactly it is. So nuclear medicine is a very specialized field within radiology that uses radioactive materials or radioactive pharmaceuticals to examine ordnance function and structure. Now nuclear medicine is a very complex field which involves many different disciplines like math, chemistry, information technology, and medicine of course. Nuclear medicine is important for treating and diagnosing multiple disease processes including cancer. So at my institution nuclear medicine is broken up into PET and general nuclear medicine which is basically everything nuclear medicine that isn't PET. So let's talk about all the stuff that isn't PET first. So I'm not going to get into everything about general nuclear medicine because the field is so complicated and very vast but I wanted to talk about a few of the scans that we do in nuclear medicine. We do thyroid scans to evaluate thyroid function and or to evaluate a thyroid nodule or mass, renal scans to examine structure and function, bone scans to evaluate for bone tumors and disease as well as infection, heart scans to look for abnormal blood flow or damage to the heart muscle itself, breast scans and or lymphocentigraphy to locate cancerous lesions or metastatic lymph nodes, and brain scans to evaluate for abnormal blood flow within the brain. So PET stands for positron and mission tomography in which we inject a small radio tracer into the body via the bloodstream. Now I'm not going to get into the inner workings of how a PET scan actually works because it is also extremely complicated and I don't even think I can do any justice explaining it to you guys. So the radio tracer we inject is something called fluorideoxyglucose or FDG for short. It's basically a glucose analog or a substance that mimics sugar and it gets taken up by all cells in the body. So as you can probably imagine these cancer cells are not normal cells and they tend to divide a lot more than normal cells and in order to divide they need glucose. So you can see how something that mimics glucose would be taken up a lot more by these cancerous cells when compared to normal cells. So that's how we find cancer in the body with a PET scan. Any cancerous lesions in the body tend to be very hot or very bright on PET scan when compared to normal cells. And as you can probably tell PET scans are really good for detecting spread of disease which is also called metastasis. And we overlay every PET scan with a CT scan so we know exactly where the disease is. A lot of PET scans are done every day to diagnose cancer, stage cancer and even to assess the response to chemotherapy on cancer. Say for instance we had someone diagnosed with lymphoma such as this patient. You see all the hot spots in the mediastinum and surrounding the heart all this dark stuff and then you look at the scan of the same patient two months after a full treatment of chemotherapy. You don't have to be a radiologist to tell that all of this dark hot spots in the mediastinum have dissipated and this is essentially a complete response to the chemotherapy regimen. It's that easy. At my institution on the PET side there are about 20 PET CTs performed each day which takes an entire day to read them all. As a first year I was pretty overwhelmed as this seemed like a ton of work because with every PET scan comes an entire CT chest abdomen pelvis and sometimes a head and neck so it's a lot of imaging to read for one PET scan. But as I progressed in my training I can get through PET scan pretty quickly and reading 20 PET scans in a day isn't that big of a deal anymore. Also what you guys may not know is that we utilize nuclear medicine a lot in interventional radiology. Many of you all may have heard of a procedure called transarterial radioembolization which is also known as tear for short and also sometimes known as just a Y90 procedure for short. Tear is a procedure specifically designed to treat liver cancer or hepaticellular carcinoma. We perform this procedure by first gaining access into the arterial system either through the radial artery in the wrist or the femoral artery in the groin. Once we have access we can advance a small catheter under x-ray guidance all the way up into the small vessels supplying the liver tumor. Once we have our catheter parked in a good spot next to the liver tumor we can inject tiny beads that are coated with a very potent radioactive material called yitrium-90 or Y90 which is why they call it Y90 procedure for short. This allows for safe and direct administration of high doses of radiation directly to the tumor. Now when administering Y90 you have to be extremely careful with everything you do. In fact during the procedure there are multiple safety checkpoints before you can inject Y90 because if a spill happens it's kind of a big deal. In fact a few years ago or so we actually had this issue where one of our catheters was dislodged and happened to send a few droplets of Y90 onto our monitor and the room had to be closed for about three days or so and also the physician who was performing the procedure their lead had a little Y90 on it so they had to put their lead in contaminated storage for about 30 plus days so they couldn't even wear their lead for that long. In fact when you finish the procedure you take off your sterile down and you have to get scanned with a guide or counter before you leave the room to make sure there's no contamination walking around the hospital. So how do you become a nuclear medicine physician? Well there are a few pathways but the traditional pathway that most people do is they do four years of undergrad followed by four years of medical school followed by a year internship followed by a four-year residency in radiology followed by a subspecialty fellowship in nuclear medicine which is pretty much the same pathway for interventional radiology and the other radiology subspecialties as well. And I know you guys may be asking yourself why should an interventional radiologist be trained in nuclear medicine? Why does the ACGME require us to do four months of nuclear medicine? Well the short answer is once you get out in private practice you pretty much have no idea what you're going to be reading so I actually may be reading PET scans as an interventional radiologist depending on what private practice I go to. So hopefully that clears up a little bit about this unclear medicine which is a radiology joke for nuclear medicine because a lot of the images are like pixelated and grainy so we call it nuclear medicine, unclear medicine. Anybody? Anyways make sure you smash that like and subscribe button turn on post notifications so you see when I post a new video which is usually around every Saturday or so make sure you follow me on Instagram if you don't already leave a comment below if I like it I'll respond to it share my videos with your friends otherwise see you guys on the next video