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Nuclear Imaging
CONTENTS:
■ Int roduct ion
■ Radiopharmaceut icals
■ Planar imaging
■ SPECT
■ PET
■ PET vs SPECT
■ Applicat ions of nuclear imaging
■ Conclusion
 Introduction

■ Nuclear imaging-Misnomer

■ Bone-seeking radiopharmaceut ical used- visualization of physiologic alterations in

bone metabolism and blood flow rate

+ Areas of increased upt ake ("h ot spot s ")-combined ef f ect of increased blood flow
through tissues and increased metabolic activity in the bone tissue

■ t he advant age of great er sensit iv it y of nuclear im aging was ext rem ely usef ul
advantage was accompanied by poor specificity
 Radiopharmaceuticals
• pharmaceuticals used for clinical imaging-prepared by tagging the
chosen carrier component with an appropriate radioactive isotope
• carrier component - biologically active molecule used to specific
organ or group of organs to provide diagnostic in those tissues.
• pyrophosphate and methylenediphosphonate(MDP) -localization in
the skeleton
• sodium iodine- the thyroid gland
• xenon or krypton gas-pulmonary studies
• sulfur colloid - liver, spleen, and bone marrow
 Radiopharmaceuticals
Various isotopes have been used for nuclear imaging.
Selection of the appropriate isotope depends upon:
• the practical availability of the element used
• matching the radioactive characteristics of the radioisotope
with the objective of a specific diagnostic examination
• amenable to commercial distribution to hospitals
• Reasonably longer half life
 Technetium 99m
■ 70% of clinical nuclear imaging examinat ions because it is commercially available
in a molybdenum/ technetium generator

Molybdenum-99- half- life of 67 hours- shipped to user facilities- its decay to

technetium-99m occurs- making the latter available for imaging studies in most
research and hospital settings

+ originally identif i ed by Subramaniam (1972), is an ideal agent for nuclear imaging,

due to
• its 6-hour half-life,
• t he emission of large amount s of gamma radiat ion per unit t ime,
the absence of alpha or beta emissions,
• an energy level of 4o kev gamma radiation.
 RADIOPHARMACEUTICALS DENTOMAXILLO FACIAL REGION
• Several agents are especially useful for imaging in the dento-
maxillofacial region.
• Chief among them: Tc-99m-monodiphosphonate(99Tc-MDP) and
Technetium-99m pertechnetate.
• 99mTc-MDP: prepared for bone scanning because the phosphate
compound has a specific affinity for hydroxyapatite
• 99mTc-MDP uptake indicates osteogenic activity and skeletal
perfusion. It is therefore useful in the examination of the skull
and facial skeleton
• Technetium-99m pertechnetate: used for salivary gland imaging
and is also useful in thyroid examinations. Both Tc-MDP and Tc-
99m pertechnetate-gets eliminated within a few days
 Galium-67 citrate
• Gallium (Ga 67) Citrate Injection is supplied in a 1o milliliter
vial as an sterile, non-pyrogenic isotonic, solution.
• Each milliliter of the isotonic solution contains 74 mega
Baqruels
• Gallium Ga 67, with a half-life of 78.26 hours Decays by
electron capture to stable Zinc -Zn 67.
• Gallium Citrate Ga 67, with no carrier added, concentrates
in certain viable primary and metastatic tumors as well as
focal sites of infection
 lodine-131
• Sodium lodide l -131 Capsules used for diagnostic
purpose is a radiopharmaceutical containing Sodium
lodide I-131
• Oral administration in a gelatin capsule.
• Each capsule contains no-carrier-added Sodium lodide I-
131
• Imaging starts after 16 Hrs
• Half-life-8days
 Precautions to be taken for patients
undergone nuclear imaging
• Seperation-1day- 10 feet distance, stay 3 feet away -1 week
• Patients may also be advised to wear slippers or socks at all
times, and keep themselves physically isolated from others
• Minimize accidental exposure by family members, especially
children.
• Smaller amounts will continue to be released over the next
several weeks, as the body processes thyroid hormones created
with the 1-131.
• For this reason, it is advised to regularly clean toilets, sinks, bed
sheets and clothing used by the person who received the
treatment.
• The use of chlorine bleach solutions, or cleaners that contain
chlorine bleach for cleanup, are not advised, since radioactive
elemental iodine gas may be released.
• Any activity which involves sharing should be avoided.
• women are told not to conceive for six months afterwards
• Patients should be warned that if they travel by air, they may
trigger radiation detectors at airports up to 95 days after their
treatment with I-131
 Gamma Scintillation camera
• A gamma camera (γ-camera), also
called a scintillation camera or Anger
camera, is a device used to image
gamma radiation emitting
radioisotopes, a technique known
as scintigraphy. The applications of
scintigraphy include early drug
development and nuclear medical
imaging to view and analyze images of
the human body or the distribution of
medically injected, inhaled, or
ingested radionuclides emitting gamma
rays.
• Patients are injected intravenously (IV) with the
radiopharmaceutical of choice, and following a 30-
minute to three-hour delay, they are imaged with the
detection camera. In selected cases, 24-hour scanning
is accomplished.
• The interval between IV injection and imaging is
determined by the type of examination and
radiopharmaceutical used. For bone scanning, a two-
to three-hour interval is required for localization of the
radioactive phosphate compound in bone cells
• 30 minutes or less is used for drug localization in most
soft tissue examinations
• Applications:
• Planar nuclear imaging is commonly used to examine patients
with primary and secondary malignant tumors metabolic
disease, trauma, pulmonary abnormalities, and cardiac disease
• Merits:
• Large anatomical areas can be imaged efficiently from a wide
variety of directions
• Examinations of total body skeleton can be done, as can
examinations of selected organs such as liver/spleen, thyroid, and
salivary gland .
• Another capability of planar imaging is that it can display blood
flow. For this application, patients are imaged within the first few
minutes after injection of the radiopharmaceutical
 Disadvantages :
• Limited resolution and lack of diagnostic
specificity.
• accuracy of quantitative assessments is also limited
- recorded activity from any perspective results
from radioactivity of the full thickness of anatomic
tissues rather than a selected layer or volume of
tissue comprising a specific organ.
 Single photon emission computed
tomo ra h SPECT
■ Developed as an enhancement of planar imaging

■ In SPECT, t he image detector move about the patient in a fashion similar to that of
standard tomography

■ Comput er manipulat ion - not only provides images wit h improved resolut ion•
reconstructed transverse or surface-rendered images can be displayed

■ a SPECT scan monit or level of biological act ivit y at each place in t he 3-D region analyzed.
• Performed by using a gamma camera to acquire
multiple 2-D images (also called projections),
from multiple angles.
• A computer is then used to apply a tomographic
reconstruction algorithm to the multiple
projections, yielding a 3-D data set
• To acquire SPECT images, the gamma camera is
rotated around the patient. Projections are
acquired at defined points during the rotation,
typically every 3-6 degrees.
• In most cases, a full 360-degree rotation . The
time taken to obtain each projection is also
variable, but 15-20 seconds is typical- a total
scan time of 15-20 minutes.
• Multi-headed gamma cameras can provide
accelerated acquisition.
• For example, a dual-headed camera can be used
with heads spaced 18o degrees apart, Triple-
head cameras with 120-degree spacing are also
used.
 Limitations:
■ Scanning is time consuming- no patient movement during the scan time. Movement
can cause significant degradation of the reconstructed images.

■ A highly uneven dist ribut ion of radiopharmaceut ical also has t he pot ent ial t o cause
artifacts.
• A very intense area of activity can cause extensive streaking of the images and obscure
neighboring areas of activity.

■ Att enuat ion of t he gamma rays wit hin t he pat ient can lead t o significant underest imat ion
of activity in deep tissues, compared to superficial tissues.

■ Scat t er of t he gamma rays as well as t he random nat ure of gamma rays can also lead t o t he
degradation of quality of SPECT images and cause loss of resolution.
 Integrated SPECT-CT scanners
■ The com binat io n of f unct io nal dat a from SPECT acquisit io n and anat om ic
characterization on CT images has been shown to improve sensitivity and
specificity

■ a SPECT gamma scanner may be built t o operat e w it h a convent io nal CT

scanner, with coregistration of images.

■ allow s locat ion of t um o rs or t issues which may be seen on SPECT

scint igraphy,- dif f icult t o locat e precisely w it h regard t o ot her anat om ical
st ruct ures.

■ Merit s:
■ Sho rt en acquisit io n t im e
■ Provide accurat e at t enuat ion correct ed im age
■ Im proved sensit ivit y
FtCoron
■ Conf ir mat ion of physiologic upt ake
 POSITRON EMISSIO TOMOGRAPHY
• Positron emitting isotopes such as such as
Flourine-18, are used in positron emission
tomography (PET)
• Fluorinelabeled deoxyglucose (FDG) is used
to study glucose metabolism with PET
scanning
• Positrons released from positron-emitting
isotopes interact with nearby electrons to
annihilate one another, There by generating
two gamma rays which travel in opposite
directions
• Rings of detectors are installed in PET
scanners to detect gamma emissions
• The scintillation detectors in PET scanners
are sensitive to the high-energy photons
(511 keV) emitted by these isotopes, and
the signals from the detectors are
processed, resulting in transverse images of
the radionuclide distribution in the patient.
PET SCAN
• There are four positron-emitting radionuclides-
oxygen-15(O-15); nitrogen-13 (N-13), carbon-11 (C-
11), and fluorine-18 (F-18)
• Reason of selection :these radionuclides can be
substituted into biologically-active molecules
• unlike the carbon, oxygen, and nitrogen, the natural
abundance of fluorine in endogenous biomolecules
is very limited.
• O,N shorter half lives
• Fluorinelabeled deoxyglucose (FOG) is used to study
glucose metabolism with PET scanning-110min.
• After receiving the radioactive sugar, the patient lies still for
about 60 minutes while the radioactively labeled sugar circulates
throughout the body.
• If a tumor is present, radioactive sugar will accumulate in the
tumor
• The patient then lies on a table, which gradually moves through
the PET scanner 6 to 7 times during a 45-60-minute period.
• The PET scanner is used to detect the distribution of the sugar in
the tumor and in the body.
• Positrons released from positron-emitting isotopes interact with
nearby electrons to annihilate one another, thereby generating
two gamma rays which travel in opposite directions
ADVANTAGES
• PET scans -accurate in detecting larger and more aggressive
tumors than they are in locating tumors that are smaller than 8
mm and/or less aggressive
• May also detect cancer when other imaging techniques show
normal results.
• PET scans may be helpful in evaluating and staging recurrent
disease
DISADVANTAGES
• Poor specificity
• Positive areas of radionuclide uptake could also represent Areas
of metabolically active tissues Inflammation, healing, and benign
tumors in addition to malignant disease.
 PET-CT scans
+ PET scans are increasingly read alongside CT, wit h the combinat ion (called "co•
registration") giving both anatomic and metabolic information

■ t w o scans can be perf ormed in im m ediat e sequence during t he sam e sessio n- pat ient
not changing position between the two types of scans the two sets of images are
more-precisely registered, so that areas of abnormality on the PET imaging can be
more perfectly correlated with anatomy on the CT images
PET vs SPECT
SPECT
Emit positrons Emits gamma radiations
High resolution Lower radiation
Costlier scanner Less capital intensive
Limited half-life of radiopharmaceuticals Longer half-life radioisotopes used
 Research Applications Of Nuclear
Ima in
■ Research applicat ions of nuclear imaging in oral biology include
■ the evaluat ion of the presence and extent of inflammat ion
■ the detection of primary and secondary malignant disease
■ detect ion of stress fract ures
■ evaluat ion of bone healing
■ an assessment of temperomandibular joint disease
■ determinat ion of blood flow through tissues