The NM ambulance is located in communication node B, -2. floor. It provides outpatient examinations for the University Hospital in Motol and the catchment area, offers a wide range of scintigraphic examinations (skeletal scintigraphy, nuclear nephrology, cardiology, tumor diagnostics, pneumology, CNS examinations, thyroid diagnostics) in patients of all ages, as well as palliative treatment of bone metastases and radionuclide synovectomy. The NM ambulance cooperates with surgical workplaces during radiation-guided procedures.

All examinations are performed on the recommendation of the attending physician after prior order.

Operation is provided by doctors (certified from NM), nurses for NM, radiology assistants. Radiopharmaceuticals are prepared in the radiopharmaceutical laboratory, which is part of the NM outpatient clinic. The Department of Radiological Physics KNME cooperates in providing diagnostic and treatment procedures using ionizing radiation sources.

KNME primary care physician and KNME nuclear medicine outpatient physician:

Doctors:

Office hours

Ordering scintigraphic examinations based on the recommendation of the attending physician by telephone Mon-Thu: 8:00 - 16:00, Fri 8:00-14:00 on telephone number (224) 434 626.

Instrumentation

Scintigraphic examinations are performed on the following devices:

Symbia Intevo Excel hybrid SPECT / CT camera	SYMBIA S double head gamma camera	SYMBIA T hybrid SPECT / CT camera

What is scintigraphy, SPECT?

These are tests that usually give you a small amount of a radioactive substance to show an organ in your body. Images are created by detecting radiation coming from your body. The acquired images will help to more accurately diagnose your disease or to choose the right treatment. We perform about 40 types of examinations with different procedures. SPECT stands for single photon emission tomography. These tomographic examinations allow spatial imaging of the functional properties of individual tissues and organs using computers. 

What is SPECT / CT?

This is a SPECT examination - as described in the previous paragraph - combined with a simultaneous CT examination. During the CT examination, your body is exposed to X-rays, which draw detailed details of the shapes and structure of your organs. Combined SPECT / CT examination allows accurate localization of scintigraphically displayed changes.

Who is the test performed for?

The examination is performed on patients only on the recommendation of a doctor with a duly completed guide.

What is the preparation for the examination?

Mostly none. You can eat and drink, take medication. It is advisable to increase fluid intake.
Some examinations have special preparations (for examinations of the gastrointestinal tract and heart, it is necessary to come on an empty stomach, in some examinations thyroid protection tablets are given, in other examinations it is recommended to discontinue some drugs). The sending doctor will acquaint you with these special preparations.

What is the procedure for arriving at the ward?

Upon each arrival at the ward, it is necessary to report to the reception, present an examination card and the insured's ID card. Here you will receive a written Instruction for a patient examined at KNME using a radionuclide, which you will confirm by reading. You will be acquainted with the examination procedure itself. If you have any questions, please contact our staff before the radiopharmaceutical injection. After the injection, contact the staff only when absolutely necessary.

What is the examination procedure?

The radioactive substance is usually given into a vein in the upper limb, less often into a vein in the back or skin. Before some examinations, it is necessary to drink, eat or inhale the radioactive substance. Imaging takes several minutes to 1,5 hours, depending on the type of examination; sometimes it is done immediately, other times after the injection. In some cases, the scan is even performed several times at intervals (even the second and third day). During the scan, you will lie motionless on the bed and scintigraphic detectors will move around you in close proximity. If you suffer from claustrophobia, please let us know in advance. All metal objects must be discarded before the examination.

How long should I wait?

The waiting time depends on the type of examination. For some examinations, it is necessary to wait for a few minutes or hours to take pictures after the injection, less often 24, possibly 36 hours. For most examinations, you can leave the ward while waiting, but you must return at the specified time. Patients who do not leave after the injection remain in the waiting room. Under no circumstances can you wait in the hallway. Every day we perform several types of examinations on different devices, which last different times. It is therefore possible that patients who have come for you are checked in earlier. In patients whose health is seriously endangered and there is a risk of delay, the examination is preferred.

What should be done after the examination?

In most examinations, the radioactivity decays by the next day, some in some cases urinating. Therefore, it is better to drink more by evening. It is advisable to keep a greater distance (more than 2 m) from children and pregnant women until the next day. The administered substance will have no effect on you, you can drive it. You can return to your work without any worries. However, if you work in nuclear facilities, plan a trip by plane or abroad, radiation from your body can be detected by very sensitive detectors, for example at the airport, even a few days after the examination. In this case, we will issue a confirmation of the completed examination with the administration of the radioactive substance at the reception.

What happens to the test result?

The doctors of our department will create a report based on your pictures and send it to the doctor who recommended your examination.

Is the test painful?

No, it is a small injection when injecting, smaller than when taking blood. It can be difficult for someone to lie motionless on a hard, narrow bed.

Are there any complications?

Complications associated with the administration of a radioactive substance are practically out of the question. In the case of polyvalent allergy sufferers, greater care must be taken; individual cases must be dealt with individually.

Is the radiation associated with the examination dangerous?

No more than driving. The dose of ionizing radiation you receive is small and similar to an X-ray. The substances we administer are non-toxic, are prepared under strictly sterile conditions and all meet the demanding criteria of the State Institute for Drug Control.

And what about pregnancy?

If you think you are pregnant, please inform us before the injection. The next steps need to be discussed in advance. If you happen to find out about your pregnancy after the examination, contact the doctors of our department immediately, who will help you clarify the situation and recommend further action. The performed examination is not a reason for postponing the pregnancy.

Is it necessary to stop breastfeeding?

Some radioactive substances are excreted in breast milk. The doctor of our department will tell you if it is necessary or not. for how long, stop breastfeeding.

Can children be examined?

Yes. We give children a smaller amount of radioactive substance according to their weight.

Can I bring an escort?

Of course, yes, but not children and pregnant women. Your escort will have to follow the instructions of the staff regarding radiation protection.

I need more information about my health…

We will be happy to inform you, but do not expect us to tell you your diagnosis and the necessary treatment on the basis of a single specialized examination. This belongs only to your attending physician, who has ordered you for the examination, has the results of other examinations at his disposal and can assess your illness comprehensively.

I need more information about radiation protection ...

 In case of further questions regarding radiation protection, the radiological physicist will advise you, ask his reception to call him.

1. Skeletal scintigraphy    

Your doctor has ordered a scintigraphic examination to examine your metabolic bone activity, which may identify possible bone problems related to your condition.

The examination is associated with radiation exposure, which is comparable to other X-ray examinations and which you will receive in two years of your life from cosmic radiation and radiation from natural radioactive sources.

Preparation: Not necessary, you can eat and drink before the examination. After administration of the radioactive substance, drink more (at least 0,5 l of fluid) and urinate frequently, observe this precaution during the day after the examination.

Design: You will receive a small amount of radioactive substance in an intravenous injection. The test itself is performed 3-5 hours after the injection and lasts approximately 30-90 minutes.

2. Targeted three-phase scintigraphy of the skeleton

Your doctor has ordered a scintigraphic examination to examine your metabolic bone activity and to identify your possible bone problems.

The examination is associated with radiation exposure, which is comparable to other X-ray examinations and which you will receive in two years of your life from cosmic radiation and radiation from natural radioactive sources.

Preparation: Not necessary, you can eat and drink before the examination. After administration of the radioactive substance, drink more (at least 0,5 l of fluid) and urinate frequently, observe this precaution during the day after the examination.

Design: You will receive a small amount of radioactive substance in an intravenous injection directly under the camera. In this first phase, the blood supply to the examined area is monitored. The next part of the examination is performed 3-5 hours after the injection and lasts 30-90 minutes. 

3. Bone marrow scintigraphy

Your doctor has ordered a scintigraphic examination to show your bone marrow.

The examination is associated with radiation exposure, which is comparable to other X-ray examinations and which you will receive in two years of your life from cosmic radiation and radiation from natural radioactive sources.

Preparation: Not necessary

Design: You will receive a small amount of radioactive substance in an intravenous injection. The examination itself is performed 1-2 hours after the injection and lasts 30-90 minutes.

1. Perfusion scintigraphy of the lungs

Your doctor has ordered a scintigraphic examination to monitor your blood flow to your lungs.

The examination is associated with radiation exposure, which is comparable to other X-ray examinations and which you will receive in two years of your life from cosmic radiation and radiation from natural radioactive sources.

Preparation: Not necessary

Design: You will receive a small amount of radioactive substance in an intravenous injection. The test itself is performed immediately after the injection and lasts approximately 15-30 minutes.

2. Ventilation scintigraphy of the lungs

Your doctor has ordered a scintigraphic examination to monitor your airflow to your lungs.

The examination is associated with radiation exposure, which is comparable to other X-ray examinations and which you will receive in two years of your life from cosmic radiation and radiation from natural radioactive sources.

Preparation: Not necessary. In patients with chronic obstructive pulmonary disease, administration of bronchodilators half an hour before the examination is appropriate.

Design: You will inhale a small amount of radioactive material for 10 minutes. Inhalations and examinations take place either simultaneously or follow each other. The examination itself then takes about half an hour.

1. Dynamic scintigraphy of the kidneys

Your doctor has ordered a scintigraphic examination to monitor your kidney function and urine outflow through the hollow kidneys.

The examination is associated with minimal radiation exposure. In well-functioning kidneys, 95% of the administered amount is excreted within 4 hours after administration.

Preparation: You can eat and drink, on the contrary, it is recommended to be well watered when you arrive for the examination. In the morning on the day of the examination, drink enough (at least two large glasses of water, juice) and after arriving at the ward you will drink another 0,5 liters of fluid.
In young children, fluid intake is proportional to their age and weight (100 ml fluids / 10 kg body weight), children are breastfed in the usual way and it is advisable to breastfeed the child upon arrival at the examination.

Design: You will receive a small amount of radioactive substance in an intravenous injection directly on the examination table. The examination itself lasts 20 minutes, after which a picture is taken after urination. If a blockage of urine is suspected, you may be given a substance that accelerates the outflow of urine (diuretic) and the injection is followed by additional pictures lasting 20 minutes.

2. Static scintigraphy of the kidneys

Your doctor has ordered a scintigraphic examination to monitor your kidney function.

The examination is associated with radiation exposure, which is comparable to other X-ray examinations and which you will receive in two years of your life from cosmic radiation and radiation from natural radioactive sources.

Preparation: Not necessary. You can eat and drink. After administration of the radioactive substance, drink more (at least 0,5 l of fluids) and urinate frequently, follow this precaution during the day after the examination.

Design: You will receive a small amount of radioactive substance in an intravenous injection. The test itself is performed 2,5-4 hours after the injection and lasts approximately 30-90 minutes. 

3. Glomerular filtration of 99mTc DTPA

Your doctor has ordered a scintigraphic examination to determine your kidney function by taking two blood samples.

The examination is associated with minimal radiation exposure. In well-functioning kidneys, 95% of the administered amount is excreted within 4 hours after administration.

Preparation: Not necessary. You can eat and drink.

Design: You will receive a small amount of radioactive substance in an intravenous injection. Blood samples are taken 120 and 180 minutes after administration.

4. Functional scintigraphy of the transplanted kidney 

Your doctor has ordered a scintigraphic examination to monitor the blood supply and function of the transplanted kidney.

The examination is associated with radiation exposure, which is comparable to other X-ray examinations and which you will receive in two years of your life from cosmic radiation and radiation from natural radioactive sources.

Preparation: You can eat and drink, on the contrary, it is recommended to be well watered when you arrive for the examination. In the morning on the day of the examination, drink enough (at least two large glasses of water, juice) and after arriving at the ward you will drink another 0,5 liters of fluid. Applies to adult patients unless the treating physician has restricted fluid intake.
In young children, fluid intake is proportional to their age and weight (100 ml fluids / 10 kg body weight).

Design: You will receive a small amount of radioactive substance in an intravenous injection directly on the examination table. The examination itself lasts 20 minutes, after which a picture is taken after urination. 

5. Direct radionuclide cystography

Your doctor has ordered a scintigraphic examination to monitor your urinary tract (bladder and ureters).

The examination is associated with a minimum radiation exposure, which is lower compared to X-ray examination.

Preparation: Insertion of a urinary catheter in the department that orders the examination.

Design: While lying on the examination table, you will receive a small amount of radioactive substance through a catheter inserted into the bladder. After the bladder is sufficiently full, urination is recorded sitting or standing.

1. Perfusion myocardial SPECT after exercise

Your doctor has ordered a scintigraphic examination, which examines the blood supply to the heart muscle during exercise (ergometric = pedaling) and can also provide information about heart function.

The examination is associated with radiation exposure, which is comparable to other X-ray examinations and which you will receive in two years of your life from cosmic radiation and radiation from natural radioactive sources.

Preparation: Do not eat, drink (drink only mineral water), do not smoke for 2 hours before the examination.
! Not valid for diabetics who follow their regimen!
Discontinue:

• nitrates 24 hours
• beta-blockers at least 2 days in advance, in hypertensive patients replace the beta-blocker with another antihypertensive agent 

If your doctor wants to check your blood flow to the myocardium during medication, do not stop taking beta-blockers and nitrates.

Do not miss other medicines - take them on the day of the examination!                                        
Bring comfortable sports shoes, snacks, including drinks, medication

Design: You will receive a small amount of radioactive substance in an intravenous injection during an ergometric load. The examination itself is performed 15-60 minutes after the end of physical activity and lasts approximately 30 minutes. Total examination time 3-5 hours. In some cases, it is necessary to supplement the rest examination, which is performed on another day, with a minimum interval of two days from the load. 

2. Perfusion myocardial SPECT after dipyridamole exposure

Your doctor has ordered a scintigraphic examination to check the blood supply to the heart muscle during exercise (pharmacological = administration of a substance that causes increased blood flow to the heart muscle) and may also provide information on heart function.
The examination is associated with radiation exposure, which is comparable to other X-ray examinations and which you will receive in two years of your life from cosmic radiation and radiation from natural radioactive sources.

Preparation: It is necessary to omit some drugs and foods that may affect the examination!

1 day must omit coffee, tea, chocolate, cocoa, caffeinated beverages (coca-cola, energy drinks), bananas. Medication is prescribed by your doctor.

• drugs containing methylxanthines for at least 2 days (eg Afonilum, Euphyllin, Spophyllin, Teotard, Theoplus, Aminophyllin, Syntophyllin…), dipyridamole in oral form for 24 hours
• caffeine drugs (analgesics eg Acifein, Alnagon, Ataralgin, Coldrex, Ibufein, Panadol extra ..., Kinedryl)
• medicines with pseudoephedrine (eg Clarinase, Disophrol, Modafen, Nurofen stopgrip, Panadol plus grip, Paralen plus ...)
• no need to discontinue pentoxifylline (eg Agapurin, Trental, Pentomer) and clopidogrel (Plavix)
• adjustment of cardiac medication - nitrates discontinued 24 hours. Beta-blockers do not need to be discontinued.
• fasting at least 2 hours before exercise, drink only mineral water
• children last meal 2 hours before the examination, they have to drink

Bring a snack, including a drink.

Design: The test is started by intravenous administration of dipyridamole for 4 minutes. In another 3-4 minutes you will receive a small amount of radioactive substance in an intravenous injection. The examination itself is performed 30-60 minutes after the end of the pharmacological load and lasts approximately 30 minutes. Total examination time 3-5 hours. In some cases, it is necessary to supplement the rest examination, which is performed on another day, with a minimum interval of two days from the load.

3. Perfusion myocardial SPECT after dobutamine exposure

Your doctor has ordered a scintigraphic examination to check the blood supply to the heart muscle during exercise (pharmacological = administration of a substance that causes increased cardiac work) and may also provide information on heart function.

The examination is associated with radiation exposure, which is comparable to other X-ray examinations and which you will receive in two years of your life from cosmic radiation and radiation from natural radioactive sources.

Preparation: Do not eat, drink (drink only mineral water), do not smoke for 2 hours before the examination.
! Not valid for diabetics who follow their regimen!
It is necessary to omit some drugs that may affect the examination. Medications are stopped by your doctor.

• nitrates 24 hours
• beta-blockers at least 2 days in advance, in hypertensive patients replace the beta-blocker with another antihypertensive agent

Bring a snack, including drinks and medication.

Design: The examination is started by intravenous administration of dobutamine for 6-12 minutes. You will receive a small amount of radioactive substance intravenously before the end of the infusion. The examination itself is performed 30-60 minutes after the end of the pharmacological load and lasts approximately 30 minutes. Total examination time 3-5 hours. In some cases, it is necessary to supplement the rest examination, which is performed on another day, with a minimum interval of two days from the load. 

4. Perfusion myocardial SPECT at rest

Your doctor has ordered a scintigraphic examination, which examines the blood supply to the heart muscle at rest and can also provide information about heart function.

The examination is associated with radiation exposure, which is comparable to other X-ray examinations and which you will receive in two years of your life from cosmic radiation and radiation from natural radioactive sources.

Preparation: Do not eat, drink (drink only mineral water), do not smoke for 2 hours before the examination!
! Not valid for diabetics who follow their regimen!
The drugs are not discontinued. Bring a small snack, yogurt or milk.

Design: You will receive a small amount of radioactive substance in an intravenous injection. The examination itself is performed in 60-90 minutes and lasts approximately 30 minutes.

 5. First pass angiocardiography (first pass)

Your doctor has ordered a scintigraphic examination to monitor the first flow of radioactive material through the heart and lungs, to assess the function of the left and right ventricles and to assess the presence of short-circuit defects.

The examination is associated with radiation exposure, which is comparable to other X-ray examinations and which you will receive in two years of your life from cosmic radiation and radiation from natural radioactive sources.

Preparation: Thyroid blockade by administration of Chlorigen (performed after arrival for examination).

Design: You will receive a small amount of radioactive substance in an intravenous injection. The test itself is performed immediately after the injection and lasts 1 minute.

6. Radionuclide equilibrium ventriculography

Your doctor has ordered an examination to assess the function of your heart chambers.

The examination is associated with radiation exposure, which is comparable to other X-ray examinations and which you will receive in two years of your life from cosmic radiation and radiation from natural radioactive sources.

Preparation: Thyroid blockade by administration of Chlorigen (performed after arrival for examination).

Design: We will mark your red blood cells directly in your bloodstream by giving two intravenous injections 30 minutes apart. The examination itself takes approximately 30 minutes.

1. Lymphoscintigraphy of the sentinel node

Your doctor has ordered a scintigraphic examination to show a sentinel node that has a direct inflow of lymph from the tumor.
The examination is associated with radiation exposure, which is significantly lower compared to other X-ray examinations.

Preparation: Not necessary.

Design: The day before or on the day of the operation, you will be given a small amount of radioactive substance in the vicinity of the tumor, which spreads from the injection site through the lymphatic vessels to the guard node. Depending on the type of tumor, the scan begins immediately or up to 2 hours after administration, a scan is taken lasting 3 minutes and the doctor marks the node on the skin, sometimes it is necessary to repeat the images until the node is imaged. The operating doctor uses a special hand probe to find the node during the operation. Based on the histological examination, the further procedure of the operation and treatment can be determined. 

2. Tumor scintigraphy - 99mTc MIBI

Your doctorI ordered a scintigraphic examination, in which a substance called MIBI is administered, which has the ability to accumulate in some tumor tissues.
The examination is associated with radiation exposure, which is comparable to other X-ray examinations and which you will receive in two years of your life from cosmic radiation and radiation from natural radioactive sources.

Preparation: Not required.

Execution: You will receive a small amount of radioactive substance in an intravenous injection, which is usually given into a vein in the back of the foot. The test itself is performed 10 minutes after the injection and lasts 30-90 minutes.

3. Tumor scintigraphy - 123I MIBG

Your doctor has ordered a scintigraphic test to give you a substance called MIBG, which has the ability to accumulate in neuroendocrine tumors.

The examination is associated with radiation exposure, which is comparable to other X-ray examinations and which you receive in a year of your life from cosmic radiation and radiation comes from natural radioactive sources.

Preparation: You can eat and drink before you arrive. Thyroid blockade: starts the day before application and lasts for 3 days. If the patient is after a total thyroidectomy, the blockade is not performed. Chlorigen or pharmacy-prepared perchlorate can be obtained from a nuclear medicine clinic.

Chlorogen:   

Lugol's solution: 1 drop / 3 kg body weight

Discontinuation of drugs affecting MIBG uptake (performed by the attending physician):
If you are taking medication, check it with your doctor at least 4 weeks before the examination and stop it according to his recommendation! Discontinued antihypertensives can be replaced by alpha-blockers (Cardura, Zoxon), diuretics.

• Combined alpha / beta blockers: labetalol 72 hours, others 24 hours
• Calcium channel blockers: 24-48 hours
• sympathomimetics: phenylpropanolamine, pseudoephedrine, phenyllephrine, amphetamine, dopamine, Fenoterol (Berotec®), Salbutamol (Ventolin®), Terbutaline (Bricanyl®) nasal drops and sprays with Xylometazoline (Otrivine drops®). 24 hours, for the treatment of glaucoma Brimonidine 48 hours
• antipsychotics (neuroleptics): Levomepromazine, Amisulpride 72 hours, Clozapine 7 days, Olanzapine 7-10 days, risperidone 5 days, depot form 1 month, sertindole 15 days, zotepine 5 days, Haloperidol, Flupentixol, Fluphenazine 2 days, depot form 1 month , Chlorpromazine, prochlorperazine 24 hours
• tricyclic and other antidepressants: amitriptyline and derivatives, imipramine and derivatives 24-48 hours, mirtazapine 8 days, maprotiline, mianserin, trazolone, venlaflaxine 48 hours
• opioids: tramadol 24 hours, CNS stimulants: Atomexetine 5 days, Modafinil 72 hours, methylphenidine 48 hours

Increased fluid intake is recommended after application. If you do not suffer from diarrhea, take the medicine to empty your bowels (glycerin suppository, Guttalax) in the evening after application.

Design: The examination is performed in two days. The first day you will receive a small amount of radioactive substance by intravenous injection. The examination itself is performed 24 hours apart and lasts 30 minutes to 2 hours, depending on the number of images. 

4. -111In OctreoScan tumor scintigraphy

Your doctor has ordered a scintigraphic test to give you a substance called Octreoscan, which has the ability to accumulate in neuroendocrine tumors.

The test is associated with a radiation exposure that is higher than other X-ray tests and is approximately seven times the dose you receive in a year of your life from cosmic radiation and radiation from natural radioactive sources.

Preparation: Omission of somatostatin preparations (Sandostatin 3 days, Somatulin 6 weeks) will be ensured by the sending doctor. You can eat and drink before the test. After administration of the radioactive substance, drink more (at least 0,5 l of fluid) and urinate frequently, observe this precaution during the day after the examination.

Design: You will receive a small amount of radioactive substance in an intravenous injection. The examination itself is performed in 2-3 days, the first images are performed 4-6 hours after application, the next in 24, sometimes 48 hours, and each scan lasts 1-2 hours. 

1. Perfusion SPECT brain

Your doctor has ordered a scintigraphic examination of your brain, which assesses the blood supply and functional condition of the cerebral cortex.

The examination is associated with radiation exposure, which is comparable to other X-ray examinations and which you will receive in two years of your life from cosmic radiation and radiation from natural radioactive sources.

Preparation: Before coming for the examination
Skip alcohol and caffeine preparations (coffee, coca-cola, energy drinks) 24 hours before the examination.

Procedure: You will receive a small amount of radioactive substance in an intravenous injection. The injection is given at rest, so we will insert a cannula, place you in a darkened room where you will rest, and you will not talk for about 10-15 minutes before and after the injection. The examination itself starts 45-60 minutes after application and lasts approximately 45 minutes, after which you will lie on the bed, the camera will move around your head. It is important that you stay still during the examination.

2. Perfusion SPECT of the brain after Diamox load

Your doctor has ordered a scintigraphic examination of your brain after administration of Diamox. This substance increases the blood supply to your brain, there is no increase in the areas behind the narrowing of the arteries.

The examination is associated with radiation exposure, which is comparable to other X-ray examinations and which you will receive in two years of your life from cosmic rays.

Preparation:  Before arriving for the examination, omit alcohol and caffeine preparations (coffee, coca-cola, energy drinks) 24 hours before the examination.

Design: The examination is performed in 2 days, the first resting examination, when you receive a small amount of radioactive substance in an intravenous injection. The injection is given at rest, so we will insert a cannula, place you in a darkened room where you will rest and will not talk for about 10-15 minutes before and after the injection. The examination itself starts 45-60 minutes after application and lasts 45 minutes, during which you will lie on the bed, the camera will move around your head. It is important that you stay still during the examination. The next day we will perform a stress test, when you will first receive Diamox intravenously, we will check your blood pressure regularly during the administration and you will receive an injection with a radioactive substance in 20 minutes as described above. 

3. 123I - DaTSCAN

Your doctor has ordered a scintigraphic examination to assess the biochemical and structural integrity of the presynaptic dopaminergic system.

The examination is associated with radiation exposure, which is comparable to other X-ray examinations and which you receive in two years of your life from cosmic radiation and radiation comes from natural radioactive sources.

Preparation: omit drugs that affect the binding of dopamine transporters before the examination (performed by the attending physician):

• amphetamine, cocaine
• benzotropine (Apo-benzotropine)
• bupropion (Wellbutrin, Zyban)
• Mazindol
• methylphenidine (Ritalin)
• sertraline (Adjuvin, Apo-Sertral, Asentra, Sertraline, Serlift, Zoloft)

Before and after RF application:

• thyroid blockade: Chlorigen (Perchlorate) 30 minutes before (400mg) and 12-24 hours after radiopharmaceutical application (400mg) - performed after arrival for examination

After administration drink more radioactive substances (at least 0,5 l of fluid) and urinate frequently, observe this precaution during the day after the examination.

Design: You will receive a small amount of radioactive substance in an intravenous injection. The examination itself is performed 3 to 6 hours after application and lasts 45 minutes.

Scintigraphy of inflammation with labeled leukocytes

Your doctor has ordered a scintigraphic examination to check that you do not have a site of inflammation in your body in which white blood cells (leukocytes) accumulate.

The examination is associated with radiation exposure, which is comparable to other X-ray examinations and which you receive in two years of your life from cosmic radiation and radiation comes from natural radioactive sources.

Preparation: Do not eat 4-6 hours before taking blood, you can drink. The sending doctor will arrange the KO + diff. Examination, bring the results (not older than 10 days) with you.

Design: According to the method of marking white blood cells, you will either receive a small amount of radioactive substance in an intravenous injection and the blood cells will be marked directly in your body or we will take 45-60 ml of blood, from which the white blood cells will separate, label with a radioactive substance. We will return the marked blood cells to you by intravenous injection.

The examination itself is performed every two days, scanning is performed repeatedly 1, 5-8 and 24 hours after the injection. Individual images can take from 10 minutes to 2 hours. In some cases, a bone marrow scintigraphic examination is completed at least two days later if an endoprosthesis infection is suspected.

1. Thyroid scintigraphy 99mTc pertechnetate

Your doctor has ordered a thyroid scintigraphy.

The examination is associated with radiation exposure, which is comparable to other X-ray examinations and which you receive in four years of your life from cosmic radiation and radiation from natural radioactive sources.

Preparation: It is necessary to discontinue thyroid medication before the examination (provided by the indicating doctor):

• Levotyroxine (Euthyrox, Letrox, Thyroid) for at least 10 days
• Triiodothyronine at least 3 days

Avoid administration of iodine in food, drugs for internal or external use at least 4 weeks before the examination (therapy with amiodarone, betadine, administration of X-ray contrast agent, application of iodine disinfectants on the skin may affect the accumulation of RF for up to 3 months).
You can eat, you can drink.

Design: You will receive a small amount of radioactive substance in an intravenous injection. The test itself is performed 10 minutes after the injection and lasts 20 minutes.

2. Thyroid scintigraphy 123 I

Your doctor has ordered a thyroid scintigraphy.

The examination is associated with radiation exposure, which is comparable to other X-ray examinations and which you receive in four years of your life from cosmic radiation and radiation from natural radioactive sources.

Preparation: It is necessary to stop thyroid medication before the examination (provided by the indicating doctor):

• Thyroxine (Euthyrox, Letrox, Thyroid) for at least 4 weeks
• Triiodothyronine for at least 17 days
• Propylthiouracil (Propycil), methimazole (Thyrozole, Favistan), Carbimazole at least 3 days - (examination in 72h rebound thyrostatics).

Exclude iodine administration in any application form at least 4 weeks before the examination.

With a higher amount of iodine (therapy with amiodarone, betadine, KI, Solutan, administration of X-ray and CT iodine contrast agent, chronic application of iodine disinfectants on the skin, Jox spray, etc.) delay at least 3 months!

Fast for 4 hours before administration and 1 hour after application

Design: Swallow a small amount of radioactive material. The examination itself is performed in 6 hours and lasts 30-90 minutes.

2. Scintigraphy of the parathyroid glands

Your doctor has ordered a scintigraphic examination to check for the presence of an enlarged parathyroid gland.
The examination is associated with radiation exposure, which is comparable to other X-ray examinations and which you receive in two years of your life from cosmic radiation and radiation comes from natural radioactive sources.

Preparation: Not necessary.

Design: You will receive a small amount of radioactive substance in an intravenous injection. The examination itself is performed in two steps, the first images 10 minutes after the injection, the next 1,5-2 hours. In the meantime, it will perform SPECT / CT.

1. Scintigraphic examination of the presence of Meckel's diverticulum 

Principle:

Your doctor has ordered a scintigraphic examination to check that a certain area of ​​your gut does not contain the gastric mucosa.

The examination is associated with radiation exposure, which is comparable to other X-ray examinations and which you receive in two years of your life from cosmic radiation and radiation comes from natural radioactive sources.

Preparation: Fasting 4-6 hours before the examination. Ranisan 150 mg after (in children weighing 2-4 mg / kg) in the evening and in the morning before the test. Appropriate scintigraphy interval from X-ray contrast administration for at least 48 hours.

Design: You will receive a small amount of radioactive substance in an intravenous injection. The examination itself is performed immediately after the injection and lasts 45-60 minutes, after the end you can add additional pictures lasting 3 minutes.

2. Dynamic scintigraphy of esophageal motility  

Your doctor has ordered a scintigraphic examination to monitor the passage of the liquid bite through the esophagus.

The examination is associated with radiation exposure, which is comparable to other X-ray examinations and which you receive in four years of your life from cosmic radiation and radiation from natural radioactive sources.

Preparation: At least 4-6 hours of fasting, do not smoke before examination.

Design: Swallow a small amount of radioactive material. The examination itself begins with the ingestion of the substance and lasts approximately 15 minutes.

3. Scintigraphic determination of gastroesophageal reflux¬   

Your doctor has ordered a scintigraphic examination to monitor for possible fluid penetration from the stomach into the esophagus.

The examination is associated with radiation exposure, which is comparable to other X-ray examinations and which you receive in four years of your life from cosmic radiation and radiation from natural radioactive sources.

Preparation: At least 4-6 hours of fasting, do not smoke before the examination. Older children and adults will bring juice or tea (0,5 liters) and the usual breakfast. Infant mothers bring one empty bottle for examination, the other with prepared milk. If breastfeeding, only one empty bottle.

Design: Swallow a small amount of radioactive material. In infants, the radioactive substance is given a small amount of milk, which the child drinks enough with milk or tea. Older children and adults receive a radiopharmaceutical in a small amount of juice or tea, they can get them on a solid diet. The examination itself begins after drinking and eating, lasting 30-60 minutes. Another image can be added in 4 hours. 

4. Stomach evacuation scintigraphy 

Your doctor has ordered a scintigraphic examination to monitor the progress and rate of gastric emptying after eating a semi-solid meal. The examination is associated with radiation exposure, which is comparable to other X-ray examinations and which you receive in four years of your life from cosmic radiation and radiation from natural radioactive sources.

Preparation: At least 8 hours of fasting. Diabetics bring insulin. Older children and adults will bring juice or tea (0,5 liters), a cup of milk rice (200-250 g) and two rolls or slices of bread for examination. Infant mothers bring one empty bottle for examination, the other with prepared milk. If breastfeeding, only one empty bottle.

Design: Swallow a small amount of radioactive material. In infants, the radioactive substance is given a small amount of milk, which the child drinks enough with milk or tea. Older children and adults receive radiopharmaceuticals mixed in a cup of milk rice, they can eat them with a solid diet. The examination itself starts after drinking and eating, it lasts 90 minutes. Another image can be completed in 1-4 hours. 

5. Scintigraphic diagnosis of bleeding into the GIT                                         

Your doctor has ordered a scintigraphic examination to detect bleeding into the digestive tract using marked red blood cells. The examination is associated with radiation exposure, which is comparable to other X-ray examinations and which you receive in two years of your life from cosmic radiation and radiation comes from natural radioactive sources.

Preparation: Thyroid blockade by administration of Chlorigen (performed after arrival for examination).

Design: According to the method of marking red blood cells, you will either receive a small amount of radioactive substance in an intravenous injection and the blood cells will be marked directly in your body or we will take 10 ml of blood, from which the red blood cells will separate, label with a radioactive substance. We will return the marked blood cells to you by intravenous injection. The examination itself begins with the administration of the radioactive substance, lasts 90 minutes, further images can be taken within another 24 hours.

6. Dynamic scintigraphy of the liver and bile ducts

Your doctor has ordered a scintigraphic examination to assess liver function and bile duct outflow.

The examination is associated with radiation exposure, which is comparable to other X-ray examinations and which you receive in two years of your life from cosmic radiation and radiation comes from natural radioactive sources.

Preparation: Fasting 4-6 hours before the examination. Bring dark chocolate for the test. Starvation is not necessary in infants with suspected bile duct atresia.

Design: You will receive a small amount of radioactive substance in an intravenous injection. The examination itself is performed immediately after the injection and lasts 60 minutes, after the end you can add more pictures with an interval of 30 minutes, if necessary, even longer (1-4 hours).

7. Scintigraphy of the liver and spleen

Your doctor has ordered a scintigraphic examination to show your liver and spleen.

The examination is associated with radiation exposure, which is comparable to other X-ray examinations and which you receive in two years of your life from cosmic radiation and radiation comes from natural radioactive sources.

Preparation: No need to eat, you can drink.

Design: You will receive a small amount of radioactive substance in an intravenous injection. The examination itself begins 15-30 minutes after the injection and lasts 1-2 hours.

8. Scintigraphy of the liver to detect hemangioma

Your doctor has ordered a scintigraphic examination to check for the presence of hemangiomas in the liver (a benign body made of blood vessels).

The examination is associated with radiation exposure, which is comparable to other X-ray examinations and which you will receive in two years of your life from cosmic radiation and radiation from natural radioactive sources.
Preparation: You can eat, you can drink. Thyroid blockade by administration of Chlorigen (performed after arrival for examination).

Design: We will mark your red blood cells directly in your bloodstream by giving two intravenous injections 30 minutes apart. The self-examination begins with the second injection. The first shots last approximately 30 minutes. Others are replenished in 2 hours and shooting takes 45 minutes.

Design: We will mark your red blood cells directly in your bloodstream by giving two intravenous injections 30 minutes apart. The examination itself takes approximately 30 minutes.

Palliative therapy of painful bone metastases 153Sm 

What is Samarium?

Samarium is an injectable substance designed to relieve bone pain in your illness.
Samarium is chemically similar to calcium. It settles wherever the bones receive new calcium, even in painful places. Here Samarium lasts for many weeks and reduces pain. For many years, doctors have used certain types of radiation to reduce the pain to which people like you are exposed. Samarium is the result of new developments in this treatment. The injection contains a small amount of a specially selected form of radioactive Samarium, chosen so that almost all the radiation is released in the places where the Samarium binds. This allows treatment to be delivered exactly where it is needed.

Why was Samarium prescribed for me?

The substance treats bone findings and relieves pain. For many people, Samaria is much more acceptable than other treatments. It has been prescribed to you because the doctors believe that it will be the most advantageous treatment for you.

What is the procedure after injecting Samaria?

If you are an outpatient, you will be released for home care after administration. If you are hospitalized, you will return to the appropriate ward some time after application.

What effect will Samarium have?

You may temporarily increase your pain within one to three days of taking it. This is normal and the doses of sedatives can be increased in consultation with your doctor. Within about a week of application, you will experience pain relief that lasts for up to several months. Samaria may be repeated as needed.

Are there any side effects?

After serving Samaria, you can eat and drink normally. In some patients, the number of white blood cells and platelets may decrease. A decrease in white blood cells can cause infection, a decrease in platelet bleeding. Your doctor will therefore invite you for a blood test for 6 weeks after administration, the first 1-2 weeks apart.

Should I stop taking painkillers?

Your doctor may advise you to continue taking painkillers until they begin to subside. He may then recommend that you gradually reduce your dose. You can continue to reduce your doses and may not need sedatives at all. If you have any doubts, talk to your doctor.

What is the next treatment?

Your doctor will advise you on further treatment if you need it. You may have already received hormonal injections or tablets and your doctor may continue this treatment.

What activities can I run?

The injections do not stop you from doing anything you have been running. Once the effect of Samaria begins to subside by relieving your pain, you will find that you can engage in activities that were previously difficult or strenuous. There are usually no problems with this, but be careful not to overestimate your strength. If you have any further questions, ask your doctor for advice. Samarium has no influence on your ability to drive or use machines.

Who should I tell?

You should tell everyone who prescribes any treatment that you have been injected with Samaria.

What measures should I take?

The effect of Samaria within the body is limited to the painful areas in which it is concentrated. Samarium, which is not deposited in painful places, enters your blood and urine. Therefore, the following precautions should be strictly observed within 24 hours after application:

• Where a normal toilet bowl is available, use it in preference to a shell. Urinate sitting. Always rinse the toilet twice. Dry any urine-stained areas and rinse. Wear rubber gloves. Always wash your hands thoroughly after each use of the toilet.
• If your laundry is splashed with urine, wash it immediately. Work in rubber gloves. Wash the laundry separately and rinse it well.
• Store used rubber gloves in a plastic bag for 23 days in a place where your household members are not normally present, before disposing of them.
• In case of injury, rinse all blood well.
• Do not stay unnecessarily close to other people, especially children and pregnant women, for one week after administration. In case of hospitalization, the nursing staff will be instructed.

What happens when the pain returns?

If the pain returns, you should contact your doctor, who may prescribe another injection of Samaria.

Patients are hospitalized for treatment with open emitters (¹³¹I - radioiodine; ¹³¹I-mIBG) on the basis of recommendations caregiver specialists (catchment endocrinologist), sending complete documentation (operational protocol, histology, discharge report, ...) and an indicative interdisciplinary consultation at the Department of Nuclear Medicine and Endocrinology, Motol University Hospital.

The KNME inpatient department has a total of 34 beds. It is divided into a diagnostic-therapeutic part (1st bed station, located in communication node B, 1st floor), where patients with mostly lower whole-body activity are hospitalized, and a therapeutic part (2nd bed station, located in communication node B, 2st floor). , -1nd floor), where patients with higher whole-body activity are hospitalized. In the diagnostic-therapeutic part there is 8 single room, 1 double rooms, in the therapeutic station there is also 8 single room and XNUMX double rooms. The two adjoining rooms usually have shared bathroom facilities.

One single room and two double rooms at the 2nd bed station have their own bathroom and are equipped with an audiovisual monitoring system that allows staff to intensively monitor the patient and his life functions without being at the bedside. If a pediatric patient is hospitalized in the room, he or she can use the audiovisual system to communicate with the parent present in the adjoining room.  

All rooms have one-way telephones, TVs and radios. There is a common room and a dining room with a TV at the diagnostic-therapeutic station. A small library located at the ward is available to patients. The way the ward works, where patients move between inpatient stations depending on the whole-body activity, does not make it possible to set up rooms with above-standard care. Paid internet access is available in the departments.

The application of radioiodine tablets (in very small situations of radioiodine solution) takes place in a radioiodine laboratory equipped with a special shielded fume hood for working with open emitters. Intravenous use (¹³¹I-mIBG) take place in a single room.

Iodine application	Iodine hood

The operation is provided by nurses and physicians with certifications in endocrinology, internal medicine and nuclear medicine under the leadership of the head of the clinic. The Department of Radiological Physics KNME cooperates in providing diagnostic and treatment procedures using ionizing radiation sources.

Chief physician of the inpatient department of KNME:

We provide information about the patient's health status to relatives (authorized) persons only with the patient's consent and only during a personal visit, not by telephone.

Diagnostic and posterior scintigraphic examinations are performed on SPECT Siemens Symbia S at the 2nd bed station. If SPECT / CT needs to be supplemented, the patient is sent to an NM clinic on the same floor. We use dose rate meters, specifically a scintillation probe, to determine whole-body activity after diagnostic application. We use dose rate meters, specifically the ionization chamber (SVLD probe), to determine whole-body activity after therapeutic application.

Symbia S	Symbia S

Information for patients and attending endocrinologists

Due to the increase in the number of new patients with differentiated thyroid cancer, the procedure for ordering and examining new patients was unified:

The attending endocrinologist indicates the patient's thyroid surgery, who also checks the patient after the operation, resulting in histology. If the patient has histological confirmation of thyroid cancer, the attending endocrinologist sends documentation (anamnesis, surgical protocol, histology, discharge report from surgery) to KNME FN Motol or to another workplace where treatment with radioiodine (¹³¹I) and dispensarization of patients.
Based on an indicative interdisciplinary consultation, this workplace indicates radioiodine treatment or another procedure.  

I'm coming to the Department of Nuclear Medicine and Endocrinology

Your attending physician has recommended that you be admitted to our clinic. Here we will examine you in detail and decide on the most suitable and effective treatment for your thyroid disease. 

We will send you the exact date of hospitalization by letter 6-8 weeks before the scheduled start. We will notify you of any change by phone.
We have compiled brief information and instructions regarding your stay at our clinic. Compared to ordinary hospital wards, the nature of our stay in our country - due to the use of radioactive preparations - is quite different.

Length of hospitalization

The length of stay in our department is individual. The usual length of stay is from about 1 week to 2 weeks (treatment program), the length of stay depends on the health condition and the excretion of radioiodine from the body. In exceptional cases, after administration of radioiodine treatment activity, hospitalization needs to be extended for radiation protection reasons.

You will be informed of the estimated time of release in the invitation letter.

What to arrange before admission?

Before admission to KNME, it is advisable to visit a dentist and arrange dental treatment to avoid acute problems. During the stay, access to any examinations and treatments outside the clinic is limited to the most serious conditions. If you are being treated at a professional medical institution, ask for the medical findings to be borrowed so that we can take them into account and continue the appropriate treatment during your stay with us. Tell your doctor that you are waiting for admission to our ward and warn him that you must not take any iodine-containing medicines before staying with us.

In the period 3 months before administration radioiodine, you must not have an X-ray or CT scan with iodine contrast agent.

In the period 4 weeks before administration radioiodine do not take any medication or supplements containing iodine, vitamin E; do not use iodine tincture or other disinfectants containing iodine; Avoid eating foods and beverages that contain large amounts of iodine (eg seafood, seafood and algae, Vincentka).

Consult your general practitioner and endocrinologist according to your job classification about the suitability of the onset of incapacity for work according to the development of hypothyroidism.

Important notice for patients:

If you are breast-feeding or have stopped breastfeeding less than one month, or if you are pregnant, call 224434660 for more information. Lactation or pregnancy is a contraindication to the administration of radioiodine and the possible administration of radioiodine must be decided by counseling.

What to take to the hospital?

• Identity card - ID card or passport
• Proof of health insurance (ie the insured's card)
• Proof of incapacity for work (if you are issued)
• Addresses of your general practitioner and attending endocrinologist (for sending a discharge report)
• Identification of diabetics, allergy sufferers, etc.
• Personal items:

  • pajamas, bathrobe, towel (the possibility of their use depends on the type of treatment program; for a certain period of your stay it will be necessary to use hospital linen; the staff of the department will inform you in detail)  
  • home shoes (preferably rubber washable or disposable)
  • handkerchiefs - paper only (wet wipes are also suitable)
  • toiletries (non-electric toothbrushes, disposable razors, etc.)

• Permanently used drugs (common basic drugs are available at the clinic, special drugs of other specialties must be ordered and possibly replaced by appropriate preparations, which may lead to a temporary interruption of treatment for the time necessary to obtain them)
• Candies (preferably acidic) to support salivation and thus reduce the radiation exposure of the salivary glands
• Mobile phone, laptop, etc. - when using electronic devices brought by you, it is necessary to carefully observe special measures to prevent possible contamination of the device with radioiodine (for example, the use of a plastic bag, foil keyboard cover, use of rubber gloves, etc. informed of the measures at the department)

What not to take to the hospital?

• Valuables (jewelry, etc.)
• Larger amounts of perishable food (after a medical examination you will be prescribed a diet that will be fully adequate)

It is generally not advisable to bring non-washable items (eg "hairy" home shoes, your own pillow, blanket, plush toys for children, etc.) that you can easily contaminate with radioiodine contained in your body (saliva, sweat, urine). In the event of contamination, the item may need to be disposed of or stored in a clinic until the contamination falls below the allowable level, which can be several weeks.

What is the procedure for joining the department?

Each patient booked for hospitalization at the inpatient department of KNME will receive an invitation letter in advance with the date of admission and detailed information on when and where to arrive. 

Upon arrival, you will first be accepted administratively, followed by an admission examination by a doctor. The doctor will acquaint you in detail with the course of your stay and the next steps.

What is the daily routine of the department?

Due to the administration of radioactive iodine, the KNME inpatient department is a closed workplace where measures must be taken to ensure radiation protection for both patients and staff and the surrounding area. The operation in our department is therefore very different from other regular departments. For example:

• patients should only remain in their rooms during therapeutic hospitalization. Patients who meet the radio hygiene limit are allowed to stay in the living room at the 1st bed station.
• patients are not allowed to walk on or off the hospital premises (staff is able to arrange daily newspapers and small purchases upon agreement with the department);
• the possibility of visits is limited (see below).

Please do not understand these measures as an unpleasant restriction of your personal freedom. These are necessary measures that you need to take to protect yourself, your loved ones and your surroundings.
You will be acquainted in detail with the daily schedule in the inpatient department after admission to the clinic.

How is radioiodine applied?

Radioiodine is administered orally. Application ¹³¹I-mIBG is given by intravenous infusion.

Why do I have to spend most of my time in the room after application?

After the application of radioiodine, your body and all excrement (urine, feces, sweat, saliva, tears) become radioactive and emit invisible ionizing radiation. This radiation, part of which helps to treat you, poses a certain health risk to others around you. To reduce this risk, it is advisable to limit your contact with the environment for a certain period of time.

Why can't hospitalization be shortened?

One condition for discharge from hospitalization is a drop in the radioactivity in your body below the value recommended by the State Office for Nuclear Safety (SÚJB), which will prevent excessive exposure of people in your area. This is a necessary but not sufficient condition. There are also other health reasons related to, for example, the development of hypothyroidism, due to which it is not appropriate to terminate hospitalization prematurely. At the same time, the longer you stay in the hospital, the more the radioactivity in your body will decrease and the less risk you will expose your loved ones when you return home.

What is the possibility of contact with home?

All rooms have telephones that allow you to receive calls. Please use your own mobile phones to make calls from the hospital.

Due to the administration of radioactive substances, the KNME inpatient department is a closed workplace with the need to monitor entrances to the workplace. The visit regime is therefore different from the hospital-wide visit and is governed by the KNME Visitor Regulations.

Usually, a visit is possible before the application of radioiodine and after the diagnostic application. After the therapeutic application of radioiodine, the head of the clinic decides on the possibility and conditions of the visit on the basis of measurements performed on the 4th day after the therapeutic application of radioiodine (during mIBG therapy on the 6th day).
We ask you to limit your visits to the bare minimum, both because of the radiation protection of your loved ones and friends and because of the capacity of the areas designated for visits. The length of the visit is set at a maximum of 15 minutes between 14-20 hours.

Visits are forbidden to persons under 18 years of age and pregnant and breastfeeding women!

Can the family find out about my health?

We provide information about the patient's health status to relatives (authorized) persons only with the patient's consent and only during a personal visit, not by telephone.

How to behave after discharge from the hospital?

Patients are released from hospitalization only if they meet the radiation protection criteria of SÚJB. Depending on the current amount of radioiodine in the body, the authorized person (radiological physicist, radiological technician or discharging doctor) gives patients a written recommendation against the signature regarding the behavior after returning home. However, in some patients, radioiodine from the body is already so excluded on discharge that no significant follow-up is required. If you have any questions in this regard, please contact the staff of the Department of Radiological Physics.

See the FAQ for more answers to your questions.

The entire staff of the Department of Nuclear Medicine and Endocrinology will do their best to ensure that your stay with us runs smoothly and benefits your health.

When is outpatient treatment possible and when is hospitalization necessary?

Pursuant to Section 78 of Decree No. 422/2016, the therapeutic application of a radionuclide must be carried out in the inpatient part of the medical facility of the health service provider, which is specially adapted and equipped for this purpose.

Is surgery or radioiodine better?

The standard procedure in the case of a thyroid malignancy is to include both treatment techniques, ie if the extent of the disease requires it. In the case of oncological diseases, the treatment procedure is determined by the attending physician.

What is the difference between Letrox and Euthyrox?

There is no fundamental difference between drugs. Both drugs contain the hormone thyroxine. Euthyrox, in addition to Letrox, contains lactose, so it is not suitable for patients with allergies to this substance.

Papillary carcinoma that does not take up radioiodine, an alternative treatment?

Such cases are handled by the attending physician and oncologist, who then suggest alternative treatments.

Before hospitalization

What is the K program?

Diagnostic hospitalization: This is a patient admission program that includes a diagnostic test application and, if indicated, a possible therapeutic application.

What is an O program?

Therapeutic hospitalization: It is a program of admission of patients for therapeutic application. If indicated, it may include control diagnostic scintigraphy. 

Is there a list of iodine-containing medications that the patient should replace with other medications before treatment?

Diagnostic and therapeutic hospitalization: If you are taking any of the following medicines, ask your doctor or pharmacist about which medicine can be used temporarily:

Amiodaron, Amiohexal, Amiokordin, Cordarone, Rivodaron, Sedacoron, Jox, Vincentka in various forms and iodine disinfection

X-ray contrast must not be applied 6 months before hospitalization.

Is An Iodine Diet Really Necessary?

Diagnostic and therapeutic hospitalization: The elimination of iodine-containing foods and preparations leads to more effective patient treatment. Therefore, the patient should avoid eating foods that contain increased amounts of iodine (eg seafood, fruits and algae, Vincentka, etc.) immediately before therapy. It is also important to limit "too" salty bread, potato chips, salted peanuts, etc. In general, it is advisable to limit salting. No need to bake your own pastries.

If necessary, contact your doctor.

How long in advance is it necessary to discontinue HR hormones?

Diagnostic and therapeutic hospitalization: The patient should follow the hospitalization instructions sent to him before hospitalization when discontinuing thyroid hormones. They always state the date of withdrawal.

Is normal weight gain after hormone withdrawal?

Diagnostic and therapeutic hospitalization: Weight gain in patients with discontinued hormones is common as it slows metabolism. This causes increased fatigue, in which the patient has a lower energy expenditure and increased water retention in the body. Therefore, if the patient does not reduce the normal energy expenditure, his body weight will increase as a result. After the hormones are used again, the excess water is naturally eliminated from the body.

What does hormone withdrawal versus Thyrogen application depend on?

Diagnostic and therapeutic hospitalization: Thyrogen administration is indicated by a KNME physician and is determined individually based on current results.

Is a gynecologist (pregnancy) required?

Diagnostic and therapeutic hospitalization: In all women of childbearing potential, this confirmation must be provided at admission, as pregnancy is a contraindication to treatment.

Does radioiodine affect contraceptive function during therapy?

Diagnostic and therapeutic hospitalization: The effect of radioiodine on hormonal contraceptive function is excluded from the package leaflet of this medicine.

Is there a smoking room in the inpatient department?

Diagnostic and therapeutic hospitalization: There is a special regime at KNME where patients are not allowed to leave the clinic during hospitalization for radio-hygienic reasons. Therefore, they cannot use the designated smoking areas on the hospital premises. Therefore, we recommend that patients be equipped with nicotine-containing preparations: chewing gum, patches, electronic cigarettes, etc.

Does it matter to taking a vacation by the sea before hospitalization?

Diagnostic and therapeutic hospitalization: Staying at a seaside destination is not recommended for patients who are instructed to discontinue thyroid hormones in the invitation letter (but rather 2 months before therapeutic or diagnostic application), as iodine is present throughout the food chain and is therefore not present. it is possible to completely follow the iodine-free diet when consuming local foods.

Using cosmetics (nail polish, lipstick, ...) before and during therapy?

Diagnostic and therapeutic hospitalization: The invitation letter that each patient receives before starting treatment states that the patient should avoid using products that contain more iodine before therapy.

During hospitalization

Is insulation necessary?

Diagnostic and therapeutic hospitalization: In both diagnostic and therapeutic applications, isolation is necessary due to the nature of medical exposure to prevent the spread of possible contamination and exposure of others.

What about using your phone and other electronic devices in your room?

Diagnostic hospitalization: It is possible to use common electronics (mobile phone, tablet, laptop) during the diagnostic application.

Therapeutic hospitalization: In therapeutic application, it is necessary / necessary to protect these devices with suitable packaging (food foil, sachet, etc.) from direct contact with the body surface to prevent their contamination.

What is the age group of patients in the room?

Diagnostic and therapeutic hospitalization: The age of the patients is always taken into account when placing patients in a common room. The aim is to assign patients of approximately the same age. However, this is not always possible for operational reasons.

Is it possible to have your own medical pillow?

Diagnostic and therapeutic hospitalization: Yes, it is possible, but during your stay, it may become contaminated. Therefore, if the so-called release level is not reached after its re-measurement, it will have to be stored in the department until the contamination falls below the permitted limit (even several weeks), or be disposed of as radioactive waste. It is generally not advisable to bring items that are not washable and may be contaminated.

What kind of patient will he get for a dress?

Diagnostic hospitalization: You can have your own clothes during this hospitalization. However, if you do not bring it, we can lend you pajamas or a nightgown and bathrobe. In case of forgetting the shoes, it is possible in exceptional cases to rent fishing shoes. It is generally not advisable to bring items that are not washable and may be contaminated.

Therapeutic hospitalization: Each patient will receive a pajama or nightgown and bathrobe. In case of forgetting the shoes, it is possible in exceptional cases to rent fishing shoes. It is generally not advisable to bring items that are not washable and may be contaminated.

How to accelerate the excretion of radioiodine from the body?

Diagnostic hospitalization: Not required for diagnostic application.

Therapeutic hospitalization: In general, patients are advised to drink more fluids and urinate more often a few days after therapeutic application to dilute the radioactive substance and reduce bladder exposure. Significant acceleration However, the excretion of radioiodine from the patient's body is not desirable, because with a significant increase in the drinking regime or. the use of laxatives may reduce the effectiveness of treatment by not adequately irradiating the diseases of the affected tissue.

Side effects of radioiodine therapy: dry mouth, fatigue,…?

Therapeutic hospitalization: As with all medicines, they may occur after application ¹³¹I experience side effects that may not affect every patient. Severe stomach may be observed in some patients. Several patients also reported "pseudonavals" or temporary reductions in salivation. Therefore, it is good to drink more and suck sour candies after therapeutic application.

In the package leaflet ¹³¹I:

After administration of therapeutic doses, some patients may experience itching, pressure and tension in the thyroid gland, reddening of the skin above the thyroid gland, indigestion, burning, pain or dry mouth, partly anorexia;

These effects usually subside spontaneously within a few days.

When will he be fired?

 Diagnostic and therapeutic hospitalization: For operational reasons, hospitalized patients are discharged after breakfast (between 8:00 and 9:00). Upon agreement with the attending physician, the patient may be discharged at another time of day.

What happens to contaminated things?

Diagnostic and therapeutic hospitalization: The things the patient used during his stay at the inpatient station will be measured before he leaves. In order to be able to take the object out of the department that belongs to the controlled area, it is necessary to reach the so-called release level. For this reason, it is important to clean (decontaminate) things by washing, wiping until the release level is reached.

 If it is not possible to carry out decontamination, the object is disposed of as radioactive waste (eg non-washable slippers, etc.), or stored at the clinic until the contamination falls below the permitted limit.

Which things will you definitely leave in the inpatient department:

Diagnostic hospitalization: Toothbrush.

Therapeutic hospitalization: Toothbrush, toothpaste, dental floss, solid soap, bath sponge, razor head.

Menstruation during and after therapy. What about tampons and pads after release?

Diagnostic and therapeutic hospitalization: The patient's menstruation is not an obstacle to the application of radioiodine. During hospitalization, patients throw their hygiene items in a basket in the bathroom, where all waste from patients' rooms is thrown. The patient is discharged from the hospital at a time when he no longer poses a significant risk of exposure to his surroundings in compliance with the radiation protection instructions, resp. Neither do the items he uses. Therefore, it is possible to dispose of these hygiene items as normal waste after leaving the ward.

Possibility to connect to WiFi during hospitalization?

Diagnostic and therapeutic hospitalization: A paid WiFi connection is provided in the entire Motol University Hospital complex (CZK 100 for 25 hours of connection). The signal strength is not the same in all places. WiFi routers are located at both KNME bed stations. However, the signal coverage may vary from room to room.

Transport from the hospital - car or is it possible to use public transport? Isn't it dangerous for fellow passengers?

Diagnostic and therapeutic hospitalization: The patient leaving the inpatient department meets the conditions set by the state for release to home care and is instructed on the principles of radiation protection. Among other things, he learns that he should limit travel by public transport. However, with sufficient distance from other passengers (especially small children and pregnant women), it is possible to use public transport. Irradiation of fellow passengers does not pose a significant risk of complications.

Traveling by car for a distance of less than a few hours also does not pose an immediate threat to fellow passengers. However, we recommend that children and pregnant women do not ride in the car with the patient. The patient does not contaminate the car with its transport, so subsequent transport of other people is possible.

After hospitalization

Is pregnancy possible after hospitalization at KNME?

Diagnostic hospitalization: It is possible to get pregnant after the use of hormones and after the onset of the effect of hormones in the body (approximately 14 days after the application of hormones). The diagnostic application of radioiodine does not affect the potential germ.

Therapeutic hospitalization: It is recommended not to become pregnant within 12 months after the therapeutic application, due to the possible repetition of this application. Pregnancy and breast-feeding are contraindications to the application ¹³¹I. In case of accidental pregnancy during this period, individual consultation with the attending physician and radiological physicist is necessary.

Follow-up of radioiodine therapy to surgery. What is the time lag between surgery and therapy ¹³¹I?

Therapeutic hospitalization: The time between surgery and therapy is individual. The patient's risk factors are taken into account and the histological findings are evaluated. Patients are usually admitted after the scar has healed 2-3 months after surgery, but no later than 6 months.

What are the gaps between other therapies?

Therapeutic hospitalization: By default, patients are ordered for repeated radioiodine therapy approximately one year after receiving the previous therapy. In some cases (depending on the patient's current medical condition), the interval between therapies may vary from 4 to 24 months.

Entitlement to an ambulance after therapy?

Diagnostic and therapeutic hospitalization: Persons with reduced mobility are entitled to ambulance transport. This entitlement is determined by the attending physician based on the patient's medical condition.

Can a patient endanger people in their immediate area after discharge from a hospital where he or she has undergone radioiodine application? E.g. children or a pregnant girlfriend?

Diagnostic and therapeutic hospitalization: Before leaving the workplace that performed the application, the patient undergoing application is instructed orally and in writing about possible risks and ways to reduce exposure of people in the patient's immediate vicinity (family, partner, friends, colleagues, etc.). If the instructions are followed, the patient does not pose a risk to his surroundings.

When can a patient resume sexual intercourse after discharge from the hospital?

Diagnostic and therapeutic hospitalization: Before leaving the inpatient department, the patient is instructed orally and in writing to adhere to radiation protection. He will receive this instruction in writing together with the stated date by which he should observe it. This date is also the deadline by which he should abstain from sexual intercourse.

• RRT - Patient indication sheet (17,722 KB)

The endocrinology outpatient clinic is located in communication node A, 3rd floor. It provides consulting services for individual departments of the Motol University Hospital in the entire scope of the field, but patients are also treated in a network of outpatient outpatient endocrinologists. The main task of the department is to ensure the treatment of patients from the Czech Republic with differentiated thyroid carcinoma and moderate and severe thyroid orbitopathy. The department works closely with the Department of Internal Medicine and the Department of Clinical Biochemistry in the treatment of patients with metabolic disorders and with the Department of Gynecology and Obstetrics, Charles University, 2nd Faculty of Medicine in the treatment of sterility. Provides sonographic thyroid diagnostics, including targeted thin needle aspiration biopsy (FNAB). After a conciliar examination (except in the most serious cases), the patients are transferred to the catchment endocrinological facilities.

Examinations are performed on the recommendation of a specialist from the Motol University Hospital or a certified endocrinologist by prior telephone order.

Head of KNME:

Chief physician of the KNME endocrinology outpatient clinic:

Doctors:

Office hours

Ordering examinations on the phone number: (224) 434 628

We change your appointment changes or other requirements by phone - for operational reasons - only on working days between 7.00 - 10.00. Thank you for your understanding.

Reorder dates and e-recipes: lenka.andelova@fnmotol.cz, martina.verner@fnmotol.cz

Warning:

We provide endocrinological conciliation examinations only within the Motol University Hospital or, upon agreement of the superconsiliary service, at the written request of a certified endocrinologist within the Czech Republic. We dispensary patients with differentiated and medullary thyroid carcinoma and severe forms of thyroid orbitopathy, we are not able to treat other endocrine diseases for capacity reasons and we refer these patients to standard field endocrinology departments for dispensary care.

Surgery hours only for booked patients (valid from January 2018):

Blood collection:

Monday to Wednesday 7:00 - 14:00
Thursday 8:45 - 14:00
Friday 7:00 - 14:00

The endocrinology outpatient clinic is equipped with Toshiba Nemio SSA-550A / E and Toshiba SSA-250A sonographers

Toshiba Nemio SSA-550A / E 

 Toshiba SSA-250A

Radiological physics and radiation protection

The issues of radiological physics and radiation protection are handled for the KNME by the employees of the Independent Department of Medical Physics - nuclear medicine section. This is a separate department, which is located in the premises of the clinic in the section "KNME - Clinic management" in communication node B, -2. floor. Clinical radiological physicists, radiological physicists and radiological technicians work in the department.

Department:

• ensures regular quality control of imaging systems and measuring technology
• ensures the application and optimization of radiation protection in the provision of health care, especially radiation protection of patients during medical exposure, radiation protection of workers, workplaces and their surroundings
• ensures continuous monitoring of compliance with radiation protection requirements
• determines the radiation exposure of the patient from examination or treatment with a radionuclide
• cooperates with physicians in the acquisition and evaluation of clinical data
• cooperates in the introduction of new diagnostic and therapeutic methods in accordance with the recommendations of the European Association of Nuclear Medicine (EANM)
• ensures compliance of documentation and records of the workplace with legislative regulations and recommendations of the State Office for Nuclear Safety concerning the management of ionizing radiation sources and radiation protection
• participates in the solution of scientific grants
• participates in teaching within KNME

Clinical radiological physicist

Radiological Physicist:

Radiology technician:

Terms, quantities, units

Radioactivity is the property of some atoms (or their nuclei) to disintegrate, transform or change the energy state spontaneously with the simultaneous formation of ionizing radiation. Radioactive elements are called radionuclides.

Radiation is the transmission of energy through space at a distance through physical fields or particles. We recognize several types of radiation - microwave radiation, infrared light, visible light, ultraviolet light, X-rays, which is a special part of ionizing radiation.

Ionizing radiation is a collective term for radiation (electromagnetic or particle current) that has enough energy to ionize the atoms or molecules of the irradiated substance. Ionization is the process by which an electrically neutral atom or molecule becomes a positively or negatively charged ion.

Activity is a quantity indicating the "amount" of a radioactive substance. The activity is given by the number of radioactive transformations that occur in a certain substance over a certain time interval. The unit of activity is Bq (becquerel). The activity in the order of units Bq to thousands of Bq (ie kBq - kilobecquerel) is very low. The amount of radionuclides contained in nature varies in these relations. For use in diagnostic nuclear medicine, we use on the order of kBq to MBq (megabecquerel), in therapeutic applications GBq (gigabecquerel) of radioactive substances.

Dose is a quantity describing the "amount" of radiation absorbed in the tissue after administration of a radioactive substance. The unit of dose is Gy (gray) or Sv (sievert, or milisievert mSv) depending on the "type" of dose (detailed description of this issue exceeds the space on this site, details such as http://www.astronuklfyzika.cz/strana2.htm).
In diagnostic examinations, the aim is to keep the dose in the patient's body as low as possible; in therapeutic administration, the dose in the treated organ needs to be as large as possible while at the same time exposing the rest of the body as little as possible.

Natural radioactivity

Terms such as ionizing radiation, radiation or radioactivity are a cause for concern for most people. At the same time, they usually have no idea that radioactivity is an integral part of our environment and natural resources have the largest share in the exposure of the population.
A stream of high-energy particles from space - the so-called cosmic rays - is constantly falling on the Earth. The atmosphere partially protects against cosmic radiation, so at sea the radiation is the smallest and in the mountains or when flying by plane the radiation is stronger. Cosmic radiation interacts with the Earth's outer shell, creating carbon isotopes ¹⁴C, tritium ³H, beryllium ⁷Be. Other radioactive elements have been contained in the subsoil and soil since the very beginning of the Earth (especially uranium ²³⁸At a ²³⁵U, thorium ²³²Th, rubidium ⁸⁷Rb) and during their conversion other radioactive elements such as radium are formed ²²⁶Ra, polonium ²¹⁰After, radon ²²²Rn a ²²⁰rn.
Natural radioactive sources cause an average exposure of people living in the Czech Republic at the level of 3 mSv (Germany 4,8 mSv, Italy 5 mSv). The global average is 2,4 mSv per year, but there are also places where the concentration of radioactivity in the subsoil is increased, such as in the Iranian city of Ramsar, on the beaches of the Brazilian city of Guarapari or on the beaches of the South Indian state of Kerala. Specifically, in the Ramsar area, annual irradiation values ​​of up to 260 mSv per year were measured. However, these increased levels of natural exposure have not been shown to have a negative impact on local people.
A significant radionuclide in terms of internal irradiation is the natural isotope of potassium in almost all foods and even in the human body. ⁴⁰K. Its concentration is practically the same in all persons at a level of around 55 Bq / kg (which corresponds to an average annual effective dose of 0,17 mSv). Attention is also paid to a large extent to radon, which can penetrate from the subsoil into buildings and thus increase the exposure of people.
Natural radioactivity was discovered in 1896 by the French physicist Henri Becquerel.

Artificial radioactivity

In addition to natural radioactive sources, there are also artificial sources. These came with the discovery of artificial radioactivity in 1933, when Irène and Frédéric Joliot-Curie first observed it. At present, we can use various methods to produce over 1400 radioactive elements - radionuclides. The total number of known elements - natural and man-made - is higher than 2000, but only 255 of them are stable, ie non-radioactive.

Use of radioactivity

Radioactivity has found use in many fields - in science, research, medicine, industry; nuclear materials in energy.
Ionizing radiation is used to sterilize materials (disposable rubber gloves, blood, etc.), to search for hidden material defects (defectoscopy), to measure the thickness of materials (sheet rolling mills, plastics production), to determine the composition of unknown material, to examine the age of archaeological finds ( carbon-carbon dating). The use of radiation sources in medicine is better known - X-rays, CT, radiotherapeutic irradiators; a little less known are the methods of nuclear medicine.

Radiation exposure of the population

Radon (40%), radionuclides in the earth's crust (10%), radionuclides in the body and in food (20%), cosmic radiation (10%) have the largest share in the average exposure of people living in the Czech Republic. Medical artificial radiation is the most important. (20%). The feared nuclear power plants, on the other hand, are responsible for only about 0,01% of the total exposure of people.

Examples:

Medical exposure

If we use ionizing radiation for the diagnosis or treatment of diseases, we speak of so-called medical exposure. Medical exposure is not bound by insurmountable limits, but the principles of radiation protection - justification and optimization - are applied. The benefits and risks associated with ionizing radiation examination / treatment should be carefully considered before performing medical exposure. Intentional exposure of humans for medical purposes is used when no other "conventional" method can give a comparable result, and even then it is necessary to use the optimal amount of radiation, ie "little or no" and the benefits of examination or treatment with ionizing radiation must outweigh the risks to the individual patient.

Risk associated with ionizing radiation testing

If we want to assess the health risks associated with examinations using radioactive substances or X-rays, we need to be aware of the effect that failure to perform this examination would have on the patient's health (provided that there is no "non-radioactive" alternative method).
A major problem with this topic is that we can only talk about the likelihood of side effects and the risk of exposure, which are usually harder to understand.
We divide the biological effects of radiation into early and late. From the available information on human exposure, we know that when a certain threshold value is reached (which is approximately 1000 times greater than the values ​​from routine examinations), early (so-called deterministic) effects such as erythema, redness, hair loss, fertility damage, in pregnant fetal damage. These effects do not occur in any case in diagnostic nuclear medicine applications.
The second type are late, so-called stochastic effects on the body. These can manifest themselves months or even decades after exposure. These are cancers and genetic mutations. The most widespread theory is that these late effects are non-threshold, that the probability of the effect increasing linearly with the dose (a quantity describing the magnitude of the exposure) and that the severity of the exposure does not depend on the dose. The risk from exposure adds up for a lifetime. The lifetime fatal risk of cancer when irradiated with 1 mSv is 1: 20. This value applies regardless of gender and age, if we consider age, then young children are up to 000 times more sensitive to radiation than adults. However, we must emphasize that this is an additional risk to the risk of death from spontaneous cancers, which is 10: 1 (ie 4-20 thousand people die per year in cancer in the Czech Republic, which is 30-20% of all deaths ). It is not possible to distinguish radiation-induced tumors and genetic changes. They have the same symptoms as those that arise spontaneously in the population.

Example:

10 people receive a dose of 000 mSv (equivalent to NM dg examination), every fourth eventually dies of cancer (ie 10 = spontaneous occurrence) and 2 other people in this group can be expected to die of radiation-induced tumor (but we do not know in which five).

To compare life risks, we take the following table, which summarizes the fatal (fatal) risks of some human activities and diseases (Prof. Hušák):

At present, there is no direct evidence that low levels of radiation (up to 400 mSv) are immediately harmful to health. Nevertheless, the global effort is to irradiate the population as little as possible.

Risk associated with therapeutic administration of radionuclide

When assessing the risk of late effects associated with radioactive treatment, it is important to be aware of the impact that failure to perform this treatment would have on the patient's condition, provided that there is no "non-radioactive" alternative method.

Risk to the patient's environment after diagnostic application of radionuclide

After diagnostic application of the radionuclide, the patient is radioactive until the radionuclide is eliminated from his body based on physiological (eg urine) and physical (half-life) processes. During this time, the patient does not mean a significantly increased risk to his surroundings. However, with a very conservative approach, it is recommended to avoid close contact (less than 2 meters) with small children and pregnant women in order to protect these people who are most sensitive to radiation.

Risk to the patient's environment after therapeutic application of radionuclide

After administration of radionuclide therapeutic activities, patients are potentially dangerous to "healthy" people around them, as radiation from the patient may increase the risk of late effects in people around the patient. Therefore, patients are hospitalized in closed wards until the radioactivity contained in their bodies drops to a level that no longer significantly increases public exposure (a decrease in activity is necessary, but not a sufficient condition for discharge from hospitalization). Upon discharge, patients receive written instructions on how to behave when they return home. Transmission of written instructions after therapeutic application is required by law. The instructions are of a recommendatory nature and their task is to limit the exposure of persons in the immediate vicinity of the patient as much as possible.

Risk to the patient's surroundings after X-ray examination

After X-ray or CT examination, the patient does not pose any danger to his surroundings. His body does not become radioactive with the passage of X-rays!

Radioactive waste related to radionuclide application

After the application of the radionuclide, the patient's blood and excrement (especially urine, but also stool, sweat, tears - depending on the type of radionuclide applied) become radioactive. When disposing of material that has come into contact with them, it is necessary to follow the instructions given to patients. E.g. used diapers and other disposable hygiene products should not be disposed of immediately (due to the possibility of environmental contamination), but according to the submitted recommendation, they should be stored and disposed of for a certain period of time only after this period has elapsed.

For more information, we recommend:

1) https://rpop.iaea.org/RPOP/RPoP/Content/InformationFor/Patients/index.htm (English only)

2) https://www.sujb.cz/fileadmin/sujb/docs/radiacni-ochrana/dokumenty/Radiation-InsidePart-Czech-Feb_2017-1.pdf (Czech)

3) www.imagegently.org (English only)

4) www.sukupova.cz

5) http://astronuklfyzika.cz/RadOchrana.htm

• Projects
• Publications
• Grant agencies
• Teaching

2016-2019

Thyroid tumors in children and adolescents and their molecular genetic nature

2012-2015     

Study of genetic changes in thyroid tumors

2011-2014       

Chromogranin, metanephrines and thyroid factors in the differential diagnosis of neuroendocrine tumors with a focus on medullary thyroid cancerand pheochromocytoma

2010-2014     

Long-term comprehensive monitoring of patients with less advanced thyroid cancer, development of an algorithm for optimal treatment

2007-2009     

The main genetic causes and modifying factors in the pathogenesis of thyroid tumors

2007-2009     

Treatment of severe thyroid orbitopathy by hemorrhopheresis, significance of changes in selected pathogenetic factors

2006-2007     

Intelligent decision support in diagnostics and therapy in nuclear medicine by Bayesian processing of indeterminate data of probabilistic mixtures

2005-2007     

Proteomic analysis of pheochromocytoma cells

2005             

Quantitative lymphoscintigraphy for the diagnosis and treatment of upper limb lymedema

2001-2003     

Late consequences of oncological treatment of children and adolescents in long-term remission of Hodgkin's disease

2001-2003     

Detection of RET proto-oncogene mutations in families with medullary thyroid carcinoma, MEN 2 syndrome - predictive molecular diagnostics

1999-2001     

Thyroid oncology

1998-2000     

Quantitative evaluation of the influence of biophysical data of patients treated for thyroid cancer with radioiodine ¹³¹I

1994-1996     

Objective evaluation of data measured for diagnostic and therapeutic purposes in nuclear medicine

1994-1996     

Ensuring the quality of data measured for diagnostics and therapy in nuclear medicine

1993-1995     

Thyroid oncology

1986-1990     

Diagnosis of thyroid cancer

An overview of KNME publications is available on the website of the 2nd Faculty of Medicine, Charles University <a href="https://cdn.shopify.com/s/files/1/1932/8043/files/Odstoupeni_od_smlouvy_EN.pdf?v=1595420299" data-gt-href-en="https://en.notsofunnyany.com/">HERE</a>.

List of agencies:

• FRVŠ
• GACR
• GAUK
• IGA of the Ministry of Health of the Czech Republic

The Department of Nuclear Medicine and Endocrinology, Charles University, 2nd Medical Faculty and University Hospital in Motol provides:

• teaching nuclear medicine for students of the 4th year of master's study of the 2nd Faculty of Medicine, Charles University
• teaching internal medicine (endocrinology) for students 5th year of master's study of the 2nd Faculty of Medicine, Charles University
• teaching nuclear medicine for students of the 2nd and 3rd year of bachelor's study FBMI CTU
• teaching nuclear medicine for students of radiological technology and physics FNSPE CTU
• postgraduate specialization education doctors in the fields of endocrinology and nuclear medicine.

Teaching - nuclear medicine:

Teaching takes place for one week within the block teaching of the subject "Imaging Methods + Nuclear Medicine" always from Monday to Friday in the KNME library (building for adults, node B, 2nd floor).

The schedule and other information for teaching are available on the website of the 2nd Faculty of Medicine, Charles University (<a href="https://cdn.shopify.com/s/files/1/1932/8043/files/200721_ODSTOUPENI_BEZ_UDANI_DUVODU__EN.pdf?v=1595428404" data-gt-href-en="https://en.notsofunnyany.com/">here</a>).

Postgraduate education:

Date of study stay must be arranged by telephone at the KNME secretariat, telephones: 224 434 601, 224 434 602. Participants will receive more detailed instructions on the content and course of the study stay in writing. The condition for starting is a study stay contract signed by the statutory representative of the University Hospital in Motol and the participant before the date of the internship. It is therefore necessary to send completed documents (at least 4 weeks before the date of the internship, including proof of payment). Trainees are reminded that pregnancy and lactation do not allow access to the inpatient department and graduate course can't pass!

The following must be delivered to the KNME secretariat:

Doc. MUDr. Karel Šilink, DrSc., The disciple of the founder of Czech endocrinology, academic prof. Josef Charvát, DrSc. The workplace was established as a detached bed base of the Research Institute of Endocrinology (VÚE) founded by Šilinka and was ceremoniously opened on 1 July 7.

doc. MUDr. Karel Silink, DrSc.  

Until then, it was not possible to administer therapeutic doses systematically ¹³¹ Also to patients with thyrotoxicosis and thyroid cancer (the first experimental therapies in our country were given in 1956-9 at the VÚE and hospitalization took place internally at the hospital in the Old School in Dušní Street). The capacity of 20 beds was used for diagnostics and, since January 1960, also for therapy with open emitters, the focus of the work of the inpatient department was mainly in the therapy of thyrotoxicosis. After equipping the workplace with a Siemens scintigrapher (1962), it was possible to expand the services with a consultation examination for the Municipal Hospital in Prague 5 Motol and the workplace was partially integrated into the structures of the MěN in Motol as a cooperating internal department. They consisted of about 30 employees from VÚE and Motol Hospital, the department was headed by MUDr. Jan Kubal. Around 400 patients a year were examined in the outpatient clinics and beds. Before 1973, before the era of cytostatics, about 200 patients were treated by intracavitary application of radiogold colloid in cooperation with the gynecological department. ¹⁹⁸Au. Close cooperation with the head of the surgical department prof. MUDr. B. Niederlem, DrSc. an excellent thyroid surgeon, enabled the introduction of so-called "hot" operations on thyroid tumors after the application of radioiodine.

From 1965, the Radioisotope Department was headed by MUDr. Jan Nemec, CSc. and the main area of ​​interest has shifted to the treatment of differentiated follicular and papillary thyroid carcinoma, this line of work continues to this day.

prof. MUDr. Jan Nemec, DrSc. 

Further development of diagnostics and therapy took place in 1972-1974 with the installation of the Picker color scintigrapher and the extension of the second pavilion, where the diagnostic part of the radioisotope department was moved, which increased the bed stock capacity to 25 and after further reconstruction in 1980 to 29 beds.

 In 1970, a specialized clinic for the treatment of severe forms of endocrine orbitopathy was established, headed by MUDr. Stanislav Váňa, CSc., Who laid the foundations for the emergence of interdisciplinary cooperation between an endocrinologist and an ophthalmologist in one surgery.

In addition to the treatment and nationwide dispensary of patients with papillary and follicular thyroid cancer (there is a therapeutic gradient for most of Slovakia at that time), the workplace has been working since 1978, under the leadership of MUDr. Marta Neradilová, CSc., Also began to focus on nationwide care for patients with medullary thyroid cancer.

In 1985, the Department of Nuclear Medicine in Motol was established in connection with the change of the hospital's statute to the University Hospital in Motol. This department, together with the inpatient department of the VÚE, became the basis for the newly established Department of Nuclear Medicine (1992), a joint workplace of the 2nd Faculty of Medicine, Charles University and the University Hospital in Motol. MUDr. Jan Nemec, DrSc.

Major changes at the clinic occurred by moving to the new premises of the blue pavilion of the University Hospital in Motol in March 1998. The clinic acquired modern equipment and premises worthy of workplaces of national importance. This enabled the further development of nuclear diagnostics in particular, with a number of special radionuclide examinations and new treatments for non-thyroid diseases. From the same year, the KNM radioimmunoassay laboratory became a part of the Institute of Clinical Biochemistry, Charles University, 2nd Medical Faculty and Motol University Hospital.

In 1999, he replaced prof. German doc. MUDr. Petr Vlcek, CSc. Under his leadership, basic diagnostic and treatment programs are further developed, cooperation with other clinics is expanding, and rich scientific research and pedagogical activities continue.

The clinic currently has around 60 employees. The clinic's registry consists of 45 patients; at the end of 000, more than 2010 patients with differentiated thyroid cancer were treated (this is one of the largest groups in the world). Around 11300 patients (including 950% of cancers) are hospitalized in the inpatient department every year. Around 95 patients are examined in the clinic's endocrinology clinic and around 13 patients a year in the nuclear medicine clinic.

The research activities of the clinic are closely connected with clinical practice. In the 90s, scintigraphic diagnostics was introduced into the standard examination program ^99mTc-MIBI. The first therapies took place at the clinic ¹³¹I-mIBG in patients with medullary thyroid carcinoma (1994), in collaboration with the Department of Pediatric Oncology, Charles University, 2nd Faculty of Medicine in children with malignant neuroblastoma (1997), carcinoid (1999) and malignant pheochromocytoma (2001).

In 2001, by the director of the University Hospital in Motol, the Center for Thyroid Oncology and Thyroid Orbitopathy of the Charles University 2nd Medical Faculty and the University Hospital Motol was established at the clinic, under the leadership of doc. Vlčka, which provides professional counseling care for the entire Czech Republic. In 2002, by decision of the Minister of Health of the Czech Republic, the workplace was renamed, in accordance with the scope of medical-preventive activities and the focus of undergraduate and postgraduate teaching, at the Department of Nuclear Medicine and Endocrinology, Charles University, 2nd Medical Faculty and Motol University Hospital (KNME).

Since 2008, KNME has been an approved center for the treatment of oncological diseases using a radiopharmaceutical ¹³¹I-mIBG, diagnostics and therapy after preparation with human recombinant thyroid stimulating hormone (rhTSH) and for the treatment of severe thyroid autoimmune orbitopathy (TAO) somatostatin analogues.

Reception of patients - ambulance

Production of radiopharmaceuticals

Release from pharmacological laboratory

Application box

Preparation of a radiopharmaceutical for a given patient

Preparation of a radiopharmaceutical for a given patient

Application chair

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Application

Scintillation camera SPECT / CT Siemens Intevo ...

Scintillation camera SPECT / CT Siemens Intevo ...

SPECT Siemens Symbia S scintillation camera

SPECT / CT control room

SPECT / CT control room

Image evaluation

Inpatient department

Inpatient department

Inpatient department

Inpatient department

Scintillation camera SPECT Siemens Symbia S -...

Scintillation camera SPECT Siemens Symbia S -...

Contact

The head

prof. MUDr. Petr Vlcek, CSc., MHA
personal website
phone: 224 434 600
Email: petr.vlcek@fnmotol.cz

Secretariat of the Head

Petra Luptáková
phone: 224 434 601
Email: nuclear@fnmotol.cz

 Lenka Houserová
phone: 224 434 602
fax: +420 224 434 620
Email: nuclear@fnmotol.cz

Deputy Head for Medical-Preventive Care - Head of the Clinic

 MD Kateřina Táborská
phone: 224 434 626
Email: katerina.taborska@fnmotol.cz

Deputy head for pedagogical activities

 MD Lucie Lančová
phone: 224 434 667
Email: lucie.lancova@fnmotol.cz

Head nurse

Ladislava Novotná
phone: 224 434 605
Email: ladislava.novotna@fnmotol.cz

Endocrinology clinic

Endocrinology clinic reception
phone: 224 434 628

Chief physician of the endocrinology clinic
MD Kateřina Personová
phone: 224 434 628
Email: katerina.personova@fnmotol.cz

Nuclear medicine clinic

 Nuclear medicine clinic reception
phone: 224 434 626

Chief physician of the nuclear medicine clinic
MD Kateřina Táborská
phone: 224 434 626
Email: katerina.taborska@fnmotol.cz

Inpatient department

Chief physician of the inpatient department
MD Kateřina Táborská
phone: 224 434 626
Email: katerina.taborska@fnmotol.cz

Inpatient department
Nurse 1st station, tel .: 224 434 631
Nurse 2st station, tel .: 224 434 630
Laboratory of therapeutic radiopharmaceuticals, tel .: 224 434 627

Radiopharmaceutical laboratory

Head of the radiopharmaceutical laboratory
RNDr. Martin Vlk, Ph.D.
phone: 224 434 665
Email: martin.vlk@fnmotol.cz

Separate department of medical physics – nuclear medicine section

Head of SOLF-NM department
Ing. Dana Prchalová
phone: 224 434 611
Email: dana.prchalova@fnmotol.cz

Supervisor
MD Kateřina Táborská
phone: 224 434 626
Email: katerina.taborska@fnmotol.cz