Aplikasi

Ilmu Kedokteran Nuklir

dr. Gani Gunawan Sp.KN., Mkes

Unit Kedokteran Nuklir
Instalasi Radiologi
Pemanfaatan Teknologi Nuklir
Peternakan : Pakan dan vaksin ternak
jateng-jabar-NTT
Pertanian : Pembibitan padi, kedelai,
kacang hijau
Pangan : Pengawetan makanan
Biologis : Mekanisme Rx fotosintesis
: Identifikasi unsur hara di tanah
Energi : Listrik
Arkeologi : Menentukan umur fosil
Hidrologi : Kecepatan aliran
: kebocoran pipa bawah tanah
 Pemanfaatan Teknologi Nuklir
Tambang : Menentuka sumber minyak
bumi.
Industri : Ukur ketebalan besi
Pangan : Mutu tektil
Biologis : Pengaruh olie dan adiktif pada
: mesin

 Diagnostik organ
(Pencitraan dan Laboratorium)
 Terapi interna
Apakah Ilmu Kedokteran Nuklir : √

Cabang ilmu kedokteran yang menggunakan

sumber radiasi terbuka berasal dari disintegrasi
inti radionuklida buatan, untuk mempelajari
perubahan fisiologi dan biokimia pada tingkat
Intra sel dan molekul, yang digunakan untuk
tujuan diagnostik, terapi dan penelitian.

WHO/IAEA 1988
STAF KN
SpKN

FISMED ADM

CITRA

RADIO
RADIO
FARMASI
GRAFER
S

PERAWA
T
PENDIDIKAN SpKN

 RSUP Dr HASAN SADIKIN, Bandung

 Dimulai 1971
 34 SpKN
 19 Residen
 PERKEMBANGAN KEDOKTERAN NUKLIR
DI INDONESIA SANGAT LAMBAT

1980-an : 13 Center Kedokteran nuklir

2014
Active : RSHS, RSCM, RSP Pertamina, RSPAD Gatot Subroto,
RS Kanker Dharmais, RS MRCCC,
RS Gading Pluit, RS Kariadi
Semi-active : RS Dr. Djamil, RS Adam Malik,
RSUD Dr.Soetomo, RS Jantung Harapan Kita
Non-active : RS Dr. Wahidin,
Plan :RS Husni Thamrin, RS Moewardi, RS Sardjito
 1. Cipto Mangunkusumo GH(SPECT/CT)
Adam Malik GH
2. Pertamina GH(SPECT/CT)
(SPECT/CT) 3. Gatot Subroto GH(SPECT)
4. Kanker Dharmais GH(SPECT/CT, PET/CT)
5. Jantung Harapan Kita GH(SPECT/CT)
6. Gading Pluit GH(PET/CT)
7. MRC Cancer Center (SPECT, PET/CT)

Wahidin GH

Kariadi GH
SPECT-CT

Sardjito GH

Hasan Sadikin GH
Seotomo GH
SPECT
SPECT/CT (2) Luas 1.990.000 km2
PET/CT Nuclear medicine centers in Indonesia
240 juta jiwa
KOMPETENSI
 ADMINISTRASI
 RADIOFARMASIS
 PERAWAT
 RADIOGRAFER
 FISIKAWAN MEDIS

Diberikan pelatihan sertifikat

KOMPETENSI KN
 The evolution of diagnostic imaging

PAST PRESENT “FUTURE”

Anatomic Functional Hybrid Molecular

NM, PET, SPECT,
plain films, CT, angiography, PET/CT, MRS, optical,
MRI, US doppler US, NM, SPECT/CT, PET/MR PET/MRI
MRI, PET contrast-enhanced
MRI/US/CT
 Role of Imaging Modalities
Anatomy Physiology Metabolism Molecular

X-Ray/CT

NM
US
ANATOMI
MRI

Nuclear LABORATORIUM

Optical
Role of Nuclear Medicine Techniques in Imaging

millimolar

X-ray
CT
MRI
Ultrasound
SPECT
PET
MRS
picomolar
PET
(MRS)
CT – computed tomography
MRI – magnetic resonance imaging
PET
MRS – magnetic resonance spectroscopy
PET – positron emission tomography
SPECT – single photon emission tomography
PET
PET
SPECT
Price P. Trends in Mol. Med.
2001, 7(10), 442-446.

ISNM, ISNMB Annual Meeting 03-05 Nov 2011 Dr Maung

 RADIOFARMAKA
Radiofarmaka gabungan antara
Radionuklida dan Farmaka (senyawa aktif)
yang diberikan ke pasien peroral maupun
parental untuk tujuan diagnostik maupun
terapi, merupakan sumber terbuka dan ikut
metabolisme dalam tubuh.

Gunakan dosis RF minimal

hasil diagnostik/terapi maksimal
REAKTOR
Radionuclides Radiopharmaceuticals Camera Study

Tc-99m Tc-99m pertechnetate Photon Brain Perfusion, Thyroid Scan

Salivary Scan, Dacriocystography
Tc-99m DTPA Photon Renography, GFR
Pulmonary Ventilation Study
Tc-99m MAG3 Photon Renography, ERPF
Tc-99m EC
Tc-99m MDP Photon Bone Scan

Tc-99m MIBI Photon Myocardial Perfusion

Tc-99m Tetrofosmin Scintimammography
Malignancy
Tc-99m HMPAO Photon Brain Perfusion

Tc-99m Ciprofloxacin Photon Bacterial Infection

Tc-99m RBC Photon Lower GIT Bleeding

I-131 NaI-131 Photon Thyroid study

I-131 Hippuran Photon Renography

F-18 F-18 FDG Positron Malignancy

Myocardial Viability
Photon camera: SPECT / Planar; Positron camera: PET
RADIOFARMAKA
RUANG HOT LAB

ALAT MONITORING WB
ALAT PELINDUNG DIRI (APD)
RADIOFARMASIS
MONITOR RADIASI
PROSES LABELING
PROSES DIAGNOSTIK KN
 GAMMA KAMERA
SPECT
1 HEAD
DETEKTO
R

SPECT/SPECT-CT
2 HEAD DETEKTOR

PET-CT
In-Vivo Study
Two types of NM gamma camera :
1. Single photon emission computed tomography (SPECT) / Planar
imaging
2. Positron (double photon) emission tomography (PET)
 Fisiologi, molekular  Anatomi
 Nuklir properti  Radiologi
(gamma, beta, alpha) properti(x-rays)
 Sumber terbuka  Sumber tertutup
 Emissions  Transmission
 Therapy  internal  Therapy  external
radiation radiation
LABORATORIUM :
LABORATORIUM :

MONOCLONAL
ANTIBODY
LABELING
DIAGNOSTIK
KASUS Neuroblastoma Indikasi :
 Peny
Sebrovasculer
 Demenctia
alzheimer
cancer
 Epilepsi
Mati Otak
DAKRIOSISTOGRAFI

SUMBATAN DUCTUS LAKRIMALIS

 Clinical Images
Indications
Determine Thyrotoxicosi Toxic
thyrotoxicosis Graves’
s Factitia / Autonomous
causal Disease
Struma Ovarii Nodule
Subacute
Marine- Thyroiditis / Plummer’s
Lenhart Iod Basedow Disease
Syndrom Syndrome
e
Assesment of
struma and/or Simple Cold
nodule Goiter Nodule
Struma Thyroglossa
Duct Cyst
Asymmet Hot Nodule
ric Struma
Congenital
thyroid
disorders Dyshormogenesis

Agenesi Sublingual Hemiagenesis

s
Assesment of
Post-total Thyroidektomi Post-total Thyroidektomi
thyroid cancer with Thyroid Tissue
w/o Thyroid Tissue Remnant
Remnant
SPECT/CT : Differentiated Thyroid Carcinoma
(recurrence)
SIDIK ETAMBUTOL Indikasi :
 Ragu –ragu
foto thorak
hasil sputum
SST_MIBI Indikasi :
 Sreening cancer
 Identifikasi cancer
 Follow up pasca
terapi
 Staging
 Restaging
SIDIK JANTUNG

Indikasi :
 Sreening dan
stratifikasi
PJK
 EF
 Viabilitas miokard
Follow up steam cell
Indikasi GFR:
 jaringan fungsional
ginjal
 follow up tranplasi
Indikasi Reno:
 Restaging
Uji hipertensi Vaskuler GFR dan RENOGRAFI
Evaluasi Obstruksi
Evaluasi truma ginjal
SIDIK DIVERTIKULUM MECKEL’S
LIMFOSINTIGRAFI
KASUS Bone Scan
Indikasi :
 Membedakan
keganasan dgn
infeksi
 Identifikasi
cancer
 Follow up pasca
terapi
 Staging
 Restaging
SIDIK SISTIM HEPATOBILIARIS
TERAPI
HIPERTIROIDISM

CA TIROID

LEBIH BAIK MENGOBATI

HIPOTIROID
 ABLASI CA TIROID
1. TIAP KAMAR 1 PASIEN
2. TSHs > 30 Uiu/ml
3. PASIEN TIDAK DIINFUS
4. PUASA
5. PR > 1 mRad/meter  pulang
Struktur I-131 :
3 cc, bening, tidak berasa
Efek samping :
No Kulit kering,
No Rambut rontok
 HIPERTIROID
1. RAWAT JALAN
2. STOP OBAT2AN ANTI TIROID 3 HARI
3. PUASA

Struktur I-131 :
0.5 cc, bening, tidak berasa

Efek samping :
No Kulit kering,
No Rambut rontok
 Ablasi I-131 Ca Thyroid

October 2002 April 2003

123I Total Body Scan
 Fig.3 . Tumor recurrence 16.7 yr
(median) after thyroid surgery and
I-131 ablation of uptake in the
thyroid bed compared with those
treated with thyroid hormone alone
A. All recurrences
B. Distant metastases recurrences

Mazzaferi and Kloos.

J Clin Endocrinol Metab 2001;86(4):1447-1463
 A B

before (a) after before (b) after

 The image is actually two sets of before-and-after PET scans of two

patients. One patient was treated with (a) Iodine-131 tositumomab
(Bexxar®). The other received (b) Yttrium-90 ibritumomab tiuxetan
(Zevalin®). The PET images reveal that both patients showed no
metabolically active NHL as early as three months after treatment.

Courtesy of : A. Iagaru; E. Mittra, M. Goris; 2009

KESIMPULAN

1. Pelayanan KN Diagnostik dan Terapi

2. Diagnostik  Tidak invansive
3. DiagnostikMolekuler imaging
4. Efek samping diagnostik kecil
5. Efek samping terapi minimal (tidak
menyebabkan kulit kering dan rambut
rontok)
SEKIAN & TERIMA KASIH
SEMOGA BERMANFAAT
UNTUK BEKAL ANDA KELAK