Nuclear Medicine Therapy for Thyroid Cancer: Our Difference

Our Staff’s Experience

Our team of nuclear medicine physicians, technologists, and support staff at Washington Cancer Institute images and treats one of the largest, if not the largest volume, of patients with differentiated thyroid cancer in the United States every year. In addition, many of our staff members have been actively involved in the management and treatment of patients with differentiated thyroid cancer for 20, 30 and even 40 years. In one week, our Division typically evaluates, scans, and/or treats more patients with differentiated thyroid cancer than many hospitals treat in one year.   This is our area of very special expertise and experience.    

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Support Staff Dedicated Just to Thyroid Cancer Patient Scheduling, Imaging, and Therapies

For the convenience, comfort, and education of our patients with thyroid cancer, we have a dedicated scheduler, a physician assistant, and navigator to help the patient navigate through the system during his/her cancer evaluation and treatment.

On the patient’s initial telephone call with our scheduler, Tasha Peterson, or our physician assistant Shari Moreau, will work with the patient regarding the schedule in order to minimize the inconvenience to the patient as much as possible while maximizing the schedule to maximize the quality of the patient’s images and possible subsequent therapy.

On arrival in our Division, our navigator will literally help “navigate” the patient through the process such as your imaging and blood tests.

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Our Patient Education

We believe in the philosophy that the more the patient knows, the better the patient’s outcome, and with this objective in mind, education of our patient is very important.   The following are many but not all of our steps to help educate the patient as well as the patient’s family and friends.  

  • Printed Copy of the Schedule - After the patient is scheduled, the patient will receive a printed copy of his/her schedule.
  • Binder of the “Six-Steps” - The patient will also receive a binder that “breaks” the process down into six easier steps, which the patient can refer to when they are preparing for or during each particular step.  
  • Pre-Therapy Visits - Before the patient has his/her first radioiodine scan, the patient will come into the nuclear medicine clinic for full clinical evaluation and viewing of a ~20 minute information video regarding the radioiodine imaging, therapy, and side effects. The patient and at the patient’s choice, family and friends will meet with the physician to discuss and answer any remaining questions regarding imaging and possible radioiodine therapy.    
  • Low Iodine Diet Cookbook - Each patient will also receive a complimentary copy of a low iodine cookbook, which was developed by the Thyroid Cancer Survivors Group, Inc. (ThyCa) and contains extensive instruction about the low iodine diet and includes low iodine recipes. 
  • Thyroid Cancer Book - All our patients will receive the 2nd edition of the book entitled “Thyroid Cancer: A Guide for Patients,” published by Keystone Press and edited by D Van Nostrand, L Wartofsky, G Bloom, and K Kulkarni.  The book is over 300 pages long and is also available in Spanish and Chinese. Although we ask for a small donation to help under write the cost of this book, this is not required. This book was developed as a source of information for our patients about many aspects of thyroid cancer.  This book is also available through the Thyroid Cancer Survivors Group, Inc. (ThyCa) online at www.thyca.org or from Amazon.com.

Our education program is second to none.  

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Our Technique: Not all imaging is created equal

Our Nuclear Medicine team has designed these scanning procedures in order to obtain the best possible images, which in turn helps design the best treatment plan for the patients.  Multiple factors help distinguish our images from many other facilities, and all of these factors result in much better pictures. Examples are noted below. 

Longer imaging times: In obtaining radioiodine images, a special camera has to collect the energy coming out of the patient, but this is a slow process and takes significant time. In order to improve the quality and resolution of the images, longer imaging times are needed. We image our patients for a long period of time. Some patients have stated that our cameras must be older because their previous images were performed on cameras at another facility, and those images were completed much faster. Our cameras are the faster cameras sold by commercial companies, but we image longer in order to obtain images of better quality and resolution.

Multiple views: We perform multiple views. This allows us to use different settings and to use different collimators (discussed below), which in turn allows us to achieve different objectives when obtaining our images. This again improves the quality of our images in finding areas of normal or abnormal thyroid tissue, which we may not have found if we did not take these extra views.

Collimators: Collimators are specially designed equipment that goes on the face of a nuclear medicine camera, and depending on how that collimator is designed it maximizes specific aspects that one is trying to image. Although it is not a lens, it is similar to a lens in that a photographer will pick different lens in order to enhance selected aspects of his photograph. We use different collimators in order to enhance selected aspects of our radioiodine images.   One of the most important collimators is called a pin-hole collimator.   A pinhole collimator offers the best spatial resolution for small areas such as your thyroid bed while other collimators such as parallel- hole collimators are used for imaging large areas to obtain panoramic views of the rest of the body.

Crystals: To capture the radioiodine to form a picture for the patient, a nuclear medicine camera must has what is called a crystal, and a crystal is exactly that—a crystal like a crystal of ice. However, these crystals can be made from different material and in many different ways. One difference is the thickness of the crystal. To maximize imaging, we pick specific thickness of crystal depending on which radioisotope we are trying to image.  When we are imaging I-131 we use a thicker crystal, and when we are imaging I-123 we use a thinner crystal. This is just one more factor that helps increase the quality and resolution of our images.

Cross sectional Imaging:    In addition to taking standard images from the front and back aspect of the patient, with a special camera so we can obtain cross sectional images. This is like instead of a picture of the front and back of a loaf of bread, we can obtain cross-sectional imaging, which is obtaining an image of one slice from the loaf of bread. To do this in Nuclear Medicine, one uses a camera called a SPECT camera (Single Photon Emission Computer Tomography). After review of the patients initial set of images, a SPECT image may be performed in order to further evaluate a specific area such as the patient’s thyroid bed area.   This not only allows cross-sectional imaging of that area, but it also allows that cross-sectional image to be compare with the similar cross-sectional image obtain from a CT scan and/or MR scan.

Radioiodine Uptake:  We perform what is called a radioiodine uptake test on all our patients. For example, a radioiodine uptake is a quantitative measure of the actual percent of the dose of radioiodine that we administered to the patient that has localized to a particular area in the patient such as the patient’s thyroid bed. This can be useful to your nuclear medicine physicians.

Dosimetry:   Dosimetry is a very special technique that is performed in selected patients, and dosimetry and simplified dosimetry are discussed in more detail elsewhere. 

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Our Customized Approach

Our physicians use a personalized approach for not only deciding therapeutic doses for each patient, but also types of scans, schedule for scans and selected additional imaging studies. Specifically, our nuclear medicine physician will work with the other members of the patient’s multidisciplinary team including endocrinologists, surgeons, and radiologists to develop an individualized scanning and treatment plan that offers the patient the best opportunity for treatment success.

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Our Aggressive Preventive Management of Side Effects

I-131 can have side effects and we are very aggressive with multiple preventive measures to minimize side effects of radioiodine therapies, and this is regardless of whether one is only going to receive one treatment or may received several treatments.

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Nuclear Medicine Physicist Support

Our imaging and dosimetry thyroid cancer program is overseen by a board certified Nuclear Medicine physicist.   This is important for quality control of images and our dosimetry program.

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Full time Radiation Safety Team

MedStar Washington Hospital Center has a Department of Radiation Safety, and this team helps coordinate all aspects of inpatient and outpatient I-131 therapies.

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Inpatient and outpatient services for radioiodine therapy

I-131 therapies may be performed with the patient either as an outpatient or as an inpatient, and this depends upon the amount of I-131 that is to be administered and the patient’s living conditions at home. Our staff will work with the patient and the patient’s family to try to perform the I-131 in setting that is best suited for their family situation.

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Potential for Discount Hotels or Free Hotel Rooms for Guests that Come From Afar and Qualify

Through various mechanisms, we have obtained discounted rates for a selected hotel in the Washington, D.C. area that is near the hospital, near metro and near all the sites in Washington D.C. We also have access to several hotels and motels in the area from which we potentially able to obtain rooms for either no charge or a significantly discounted charge.   Our physician assistant, Shari Moreau, will work with you regarding these possibilities.

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Flexible Thyrogen Schedule 

Thyrogen® is a medication used to prepare patients for diagnostic imaging and therapy with radioiodine (I-131).   The Division of Nuclear Medicine at MedStar Washington Hospital Center administers more Thyrogen® than any other facility in the United States. Of the many reasons for this, several important reasons are the flexibility in our schedule, guaranteed availability of the drug, and superior service. We perform injections throughout each regular work day throughout the year, and we can almost always administer Thyrogen® during the standard hours at a time that is convenient to the patient’s schedule.

Because we stock Thyrogen® in our own pharmacy, Thyrogen is always available, and once the patient is scheduled, a kit is assigned to that patient—guaranteed.  

Finally, our staff is well known for delivering superior service, and our staff work hard with the patient’s insurance companies to help minimize any additional out of pocket expenses for the patient. The patients also receive parking vouchers.

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Our Research Studies and Publications

Our physicians are committed to research and advancing treatment options for patients with thyroid cancer and thyroid disease. At any one time ten to twenty research studies are underway.

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Thyroid Cancer Textbook

The third edition of one of the premier, if not the premier, textbook on differentiated thyroid cancer is entitled “Thyroid Cancer: A Comprehensive Guide to Clinical Management” and this has been edited by Drs. Wartofsky and Van Nostrand at MedStar Washington Hospital Center. In additionmany of the chapters of this textbook have been written by the Nuclear Medicine staff.

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