Nuclear Medicine is technically a distinct specialty with its own residency training programs and its own certification examination (administered by the American Board of Nuclear Medicine), however, Nuclear Medicine is also a part of Radiology resident training and practice (the details of which are not pertinent at this point). Whereas radiography, computed tomography, magnetic resonance imaging, and ultrasound obtain primarily anatomic information, nuclear medicine exams obtain primarily functional (physiologic or pathophysiologic) information. The fundamental principle on which almost all Nuclear Medicine tests are based is that of 1) having an understanding of a physiologic process, 2) isolating a participant in that process or an analogous substitute molecule, 3) applying a radioactive label to the process participant, and 4) imaging (via gamma or a positron cameras) the radioactive label’s kinetics and pharmacodynamics and by extension imaging the physiologic process. Common Nuclear Medicine tests and their most common applications include the HIDA scan (detects gallbladder disease), the V/Q scan (detects pulmonary embolism), radiolabeled white cell and red cell scans (detect infection and hemorrhage, respectively), bone scans (sensitive but nonspecific indicator of osseous abnormality), and radioactive iodine scans (evaluate for and characterize thyroid abnormalities). In addition to providing diagnostic functional information about the thyroid, radioactive iodine is also used to therapeutically ablate abnormal thyroid tissue. A number of cardiac Nuclear Medicine exams (both gamma and positron based) also exist and are performed and interpreted by nuclear cardiologists in the Division of Nuclear Medicine at the Brigham. It is worth saying a few words about positron emission tomography (PET), which uses a radioactive glucose analog called fluorodeoxyglucose (F18-FDG) amongst other probes, to localize hypermetabolic (glucose avid) areas within the patient. This serves as a sensitive but not specific test for malignancy, as a number of other processes that occur within the body are also often hypermetabolic (primarily infection, inflammation, and benign neoplasms). PET/CT and at some centers PET/MR, are hybrid imaging modalities -that provide functional information (PET images) fused with anatomic information (CT images most commonly) in order to arrive to the anatomo-metabolic basis of the disease process in question, maximizing the relative strengths and minimizing the relative weaknesses of each modality.
The nuclear medicine reading rooms are located on L2 at DFCI and in L1 at BWH as well as L2 Shapiro.