Seeing The Unseeable

Monday, October 22, 2018

Across all of Germany, only the University of Giessen and Evidensia’s Tier√§rztliche Klinik Norderstedt are approved to perform clinical procedures using radioactive pharmaceuticals.

Once you consider all the rules and regulations involved, that’s hardly surprising. Certification to store, handle and dispense these materials requires users to be specially trained, while the facilities themselves must be properly constructed, secured and shielded. Finally, staff must constantly wear personal dosage devices that monitor radiation.

To the general public, X-rays of broken bones are the only medical use of radiation, with maybe a few people also considering CT scanners or cancer-treating radiotherapy. Yet for Prof. Rafael Nickel and his colleagues at Norderstedt, nuclear medicine has a broad range of uses, from non-invasive imaging of organ function and measurement to long-lasting treatment of various ailments.

“Radioactive substances can be injected for diagnostic purposes,” Rafael explains. “By placing the slightly sedated animal on a glass table, a gamma camera can track the flowing or the incorporation of these substances in, for example, the joints or the kidneys or the liver, revealing physiological as well as pathological processes.” This can allow diagnosis of obscure lameness in animals by imaging bones, but also decreased liver or kidney function in soft tissue.

“By law, each animal must be considered a radioactive source until its levels drop.” Professor Rafael Nickel – Norderstedt Clinic


Nuclear medicine can also be used for treatment, with the clinic regularly treating cats with hyperthyoridism, more commonly known as a ‘hyperactive thyroid’. “It’s a surprisingly common condition in cats,” notes Rafael, “and while there are drugs to control the symptoms, the best results for long-term survival are achieved with radioiodine injections, which go straight to the thyroid and destroy only the diseased thyroid tissue.”

For the time of radioactive decay, each cat becomes the (possibly unwilling) guest of the nuclear medicine department. “By law, each animal must be considered a radioactive source until its levels drop, so it must stay in a specialised ward. Because of this, and because of the low rates of pet insurance in Germany,  if your cat has to stay with us for around ten days, the cost of the treatment can be as much as €1,800, which of course many owners are still willing to pay in order to help their cat.”


Providing another longer-lasting alternative to drug treatment, radiosynoviorthesis uses radiation to relieve joint pain through the targeted obliteration of inflamed tissue layers. Replacing frequent cortisone injections, a weak radioactive substance has a far more prolonged effect on the joint capsule, reducing fluid production and its associated pain.

“It’s not very well known that this procedure is helpful, so we actually published a paper about this treatment to increase awareness.”

Yet with its 18 years of experience in nuclear medicine, awareness of the Norderstedt Clinic and its nuclear medicine programme is already impressively high. Vets all around Germany, Holland and even Denmark regularly refer animals for treatment there.

“Despite our good reputation, we still regularly present at conferences to other veterinarians,” admits Rafael. “What we do is so specialised that, with the most usual search terms, most vets going online to research treatments for certain conditions will tend to find us quickly.”

Location: Hamburg, Germany

Staff: Around 30 vets, 40 nurses, eight receptionists and four administrators

Pets treated: Approx. 19,000 consultations per year

Surgeries: Typically 2,500 operations per year

Although located close to Hamburg, Norderstedt Clinic also treats referrals from all of northern Germany. As one of a handful of veterinary clinics practicing nuclear medicine, it also handles specialist cases from other European countries.