Reviewer in Nuclear Medicine – Sayo, Ana Lychees A. 1 Reviewer in Nuclear Medicine – Sayo, Ana Lychees A.

NUCLEAR MEDICINE • in vitro - discovered the existence of neutrons • nucleus

- analysis of samples Frédéric Joliot-Curie and Irène Joliot-Curie - the nuclear portion of the atom
FUNCTIONAL DIAGNOSTIC - e.g. detecting gamma-emitting radionuclides in urine, - artificially produced radionuclides produced - positively charged central part of the atom
• the branch of medicine that deals with the use of radioactive feces 1934 radioactive phosphorus by bombarding - composes most of the mass of the atom
substances in research, diagnosis, and treatment • in vivo aluminum with alpha particles emitted from an - consists of nucleons, with varying numbers of protons
• a medical specialty that uses radioactive materials called - examination of the living body isotope of polonium and neutrons
radiopharmacueticals for diagnosis, therapy, and medical - commonly uses gamma camera to detect gamma- John Lawrence - protons
research emitting radionuclides, introduced to the body, most - first therapeutic use of 32P, used to treat > found within the nucleus of an atom and are
1936
• evaluates the body's function and processes instead of commonly by injection of a radiopharmaceutical leukemia symbolized by letter p or p+
structural appearance - first artificially produced radioisotope > provides positive charge to the nucleus
NUCLEAR MEDICINE TEAM - first diagnostic use of 131I > total number of protons equals atomic number (Z) of
1937
Procedure • nuclear medicine physician – a specialist with extensive - used in studies of thyroid physiology an element
1. administration – the tracer, or a pharmaceutical labelled education in the basic and clinical science of medicine who is Robley Evans > positively charged subatomic particle
with a radioactive substance, is administered to the patient licensed to use radioactive materials 1938 - investigated thyroid uptake using 138I > mass = 1.673 × 10-27 kg
• nuclear medicine technologist – perform the tests and is administered in the thyroid of rabbits > amu = 1
• injection
educated in the theory and practice of nuclear medicine - first successful radioisotopic treatment using 32P > discovered by Eugene Goldstein 1886
• swallowing 1939
procedures - 32P was used to treat polycthemia - neutrons
• inhalation - invention of atomic pile
• physicist – experienced in the technology of nuclear 1942 > neutral particles within the nucleus of the atom
2. localization – the tracer will localize to specific organs or - first controlled, self-sustaining nuclear chain
medicine and the care of the equipment, including computers > symbolized by the letter n
tissues reaction
• pharmacist or specially prepared technologist – qualified > slightly heavier than protons
3. emission – the tracer will emit gamma ray emissions from Enrico Fermi
to prepare the necessary radioactive pharmaceuticals > no electric charge (neutral)
the organ being studied - invented the nuclear rector that produces > proton # + neutron # = atomic mass (A)
4. detection – a gamma camera or a scintillation camera
History radioactive elements > mass = 1.675 × 10-27 kg
transforms these emissions into images, providing 1946 - the nuclear reactor expanded the capability of
Date Innovation > amu = 1
physiologic or pathophysiologic information the cyclotron to produce radioactive elements
John Dalton > discovered by James Chadwick in 1932
5. recording – the camera records this information in a - it was announced that by-products from nuclear
- father of the modern theory of atoms and • electron cloud
computer or film reactors can be shipped for medical purposes
1803 molecules - the extra nuclear region of the atom is the area outside
- invention of UNIVAC digital computer the nucleus and mostly empty space with electrons that
DIFFERENCES WITH X-RAY IMAGING - measured atomic weights of elements in
1951 - greatly enhanced the development of nuclear orbits the nucleus like planets revolving around the sun
• radionuclide imaging do not duplicate information obtainable reference to hydrogen, which he assigned as 1
medicine - system of electrons revolving around the nucleus in a
from x-ray imaging Wilhelm Conrad Röntgen
1895 Hal Anger discrete energy levels
- radionuclide images of an organ shows its function - discovered x-rays 1958
- invented the gamma camera or anger camera - electrons
- primarily shows physiology rather than anatomy - received the first Nobel Prize in Physics (1901)
David Edwards and Roy Kuhl > called negatrons and are given the symbol e or e-
• unlike x-rays that demonstrate areas of the body, RNI Henri Becquerel
1896 1960 - Single Photon Emission Computed Tomography > negatively charged subatomic particle
demonstrates specific organs or organ systems - discovered spontaneous radioactivity from
(SPECT) Camera > found in the extra nuclear portion of the atom
• nuclear medicine reveals early pathological changes, ahead naturally occuring elements
- nuclear medicine grew and there were > outside the nucleus
of other imaging methods that only demonstrate structural Marie Curie 1960s
1898 - discovered two new elements from uranium ore
significant advances in medicine technology > charge – 1.602 × 10-19 C (same as proton)
change 1980’s - SPECT imaging became standard practice > mass – 9.109 × 10-31 kg
• the body’s own physiology is used to indicate and/or treat pitchblende, radium and polonium
- coined the terms radioactive and radioactivity > amu – 0.00053
abnormalities which would not be possible using NUCLEAR PHYSICS – PHYSICAL PRINCIPLES > discovered by Joseph John Thomson in 1897
conventional radiology or radiotherapy Georg de Hevesy
- father of nuclear medicine
> Isotope Tracer Principle BASIC NUCLEAR PHYSICS Characteristics of Fundamental Particles
TWO BRANCHES Particle Relative Kilograms amu # Charge
- developed the tracer principle, coining the term • the total number of protons, neutrons, and electrons in an
1. therapeutic procedures 1923 Electron 1 9.109×10–31 0.000549 0 –1
radioinicator atom determines its characteristics, including its stability
• treatment of disease by means of radioactivity Proton 1836 1.673×10 –27
1.00728 1 +1
- expanded his studies from inorganic to organic
• radionuclide therapy is used in the treatment ATOM Neutron 1838 1.675×10–27 1.00867 1 0
chemistry
- benign disease • the smallest quantity of an element that retains all the
- first radioindicators used are naturally occurring,
> e.g. hyperthyroidism and arthritis chemical properties of that element NUCLEAR STRUCTURE
such as radium and radon
- malignant disease • the nuclear diameter is of the order of 10-15 m, and composed
Ernest Lawrence • the atom is made of two basic parts
> e.g. thyroid cancer and hepatocellular carcinoma of protons and neutrons
- invented the first cyclotron – device used to - the nucleus (nuclear portion)
• main radioisotope - the orbital electrons (extra nuclear portion) - -15 prefix – femto
131 produce (man-made) radioactive tracers
- I 1931 • nuclear mass
> only 4 inches in diameter • has three (3) principal types of subatomic particles that
2. diagnostic procedures - 1.673 x 10n–27 kg – proton
- made it possible for de Hevesy to expand his compose an atom
• using radioactive materials to test body functions work by enabling the use of artificially produced - protons, neutrons, and electrons - 1.675 x 10–27 kg – neutron
• main radioisotopes radionuclides • a proton can be converted to a neutron, and vice-versa
- 99mTc and 18F 1932 James Chadwick BASIC COMPONENTS OF AN ATOM
FORMS OF RADIONUCLIDE IMAGING PROCEDURES NUCLIDES
Reviewer in Nuclear Medicine – Sayo, Ana Lychees A. 3 Reviewer in Nuclear Medicine – Sayo, Ana Lychees A. 4

• any atomic species characterized by the atomic mass number - involves nuclear transformation • Positive Beta Decay - involves the rearrangement of protons and neutrons to
(A), proton (Z), and number of neutron (N) > negative beta decay (β– decay) - beta plus the lowest energy state and the emission of excess
• a species of atom, characterized the by the nucleus > positive beta decay (β+ decay) -Z=Z–1 energy in the form of a gamma photon
• atoms are specified by: > electron capture - A = constant
- atomic number > alpha decay - proton rich – occurs in neutron poor atoms RADIOACTIVE DECAY LAW
- atomic mass number - does not involve nuclear transformation - positron emission – emits positive beta particles (e+) • radioactivity reduces according to the natural physical law of
- energy content > gamma decay - proton to neutron – converts a proton to neutron exponential decay – a fixed percentage reduction occurs over
- other modes of decay • Electron or K Capture a given period of time
PARENT NUCLIDE > internal conversion -Z=Z–1 • describes the rate of radioactive decay and the quantity of the
• the original nuclide that undergoes radioactive decay > spontaneous fission - A = constant material present at any given time
> proton decay - occurs in unstable atoms with too many protons • the radioactive decay law is exponential in nature
DAUGHTER NUCLIDE - the nucleus has a very ↑ positive charge • expressed mathematically as
• the more stable nuclide in which results from radioactive PROPERTIES OF RADIOACTIVE MATERIALS - an electron in a low orbit is captured by the nucleus, - activity remaining = initial activity × .5n
decay • may emit x-rays, gamma-rays, electrons or alpha particles, whose negative charge converts a proton to a neutron, > where: n = number of half lives
and there may be one or more of these emitted reducing the overall positive charge of the nucleus
RADIONUCLIDES • daughter products may also be radioactive • Alpha Decay UNITS OF RADIOACTIVITY
• unstable nuclides • gamma rays will have “characteristic” energies -Z→Z-4 • curie (Ci) – old unit for the intensity of radioactivity
• in the course of becoming stable, they adjust their nuclear • decay exponentially -A=A-2 • becquerel (Bq) – SI unit for the intensity of radioactivity
components by conversion or emission of particles and - emission of an alpha particle comprised of two protons - where
radiant energy BASIC TYPES OF EMISSION and two neutrons > 1 Ci = 3 × 1010 Bq
• this process is called radioactive decay • alpha emission - equivalent to a helium nucleus > 1 Bq = 1 disintegration per second (dps)
• all radionuclides are radioactive - charge: +2 - being relatively large and highly positive in charge, it
- emission ↓ Z by 2 does not travel far in tissue, so they deliver a high local DECAY CONSTANT FORMULA
• theoretically, radioactivity of a material never disappears
- emission ↓ A by 4 radiation dose to the body tissues • determines how quickly the radionuclide decays
• a state of equilibrium between the parent and daughter
- emission of (+) alpha particles - this short distance prevents alpha particles to be detected • a large decay constant corresponds to fast decay
radionuclide is acheived after four (4) consecutive half-lives
> equivalent to ionized helium atoms by an imaging device outside the body • expressed mathematically as
> deliver high local dose, do not travel far in tissue • Annihilation - decay constant = 0.693 ÷ T½
NUCLEAR FAMILIES
> contributes to dose but not the formation of image - total transformation of matter into energy; occurs after
• Isotopes – same Z
> cannot penetrate paper the antimatter positron collides with an electron HALF-LIVES
• Isobars – same A
• beta emission - two photons are created; each equals the energy • Half-Life
• Isotones – same N equivalent of the mass of the individual particles
- charge: –1 - property that is unique to each radionuclide
• Isomers –same Z, same A, same N - conversion of mass into energy
- emission ↑ Z by 1 - the time required so that activity of a radionuclide is
- emission does not change A - involves collision of matter and antimatter reduced to 50%
RADIOACTIVITY • Internal Conversion
- emission of (–) beta particles • Biological Half-Life
• the emission of particles or energy to attain stability - equivalent to an electron - involves the emission of gamma ray from an unstable
• decays by spitting out: - time required for the body to eliminate half of an
> also easily absorbed by tissue atom administered dosage of any substance by regular process
- mass (alpha particle) > contributes to dose but not the formation of image > the gamma ray, upon exiting the atom, interacts with
- charge (beta particle) of deliberation
> cannot penetrate aluminum an electron in an orbital shell
- energy (gamma rays) • Effective Half-Life
• gamma emission - the electron absorbs the energy, ejects from the atom,
• three reasons/conditions why substance might be radioactive; - time required for a radioactive elimination in the body to
- charge: 0 carrying the energy of the gamma ray be diminished by 50% as a result of the combined action
its nucleus may be unstable - form of electromagnetic radiation • Auger Effect
- too many neutrons of the radioactive decay and biological elimination
- emission of high energy, short wavelength gamma - a vacancy of an electron in an inner orbital shell causes
- too few neutrons photons an electron from an outer shell to fill its vacancy,
- too many neutrons and protons Half-Lives of Common Radionuclides
> can pass easily through tissues releasing a characteristic x-ray in the process Common Radionuclide Approximate Half-Life
> can be detected by equipment outside the > upon leaving the atom, the characteristic x-ray
RADIOACTIVE DECAY PROCESS Krypton-81m 13 seconds
> cannot penetrate lead interacts with an electron in an orbital shell
Rubidium-82 1½ minutes
- the electron absorbs the energy, ejects from the atom,
Nitrogen-13 10 minutes
DECAY MODES OF RADIOACTIVE DECAY carrying the energy of the characteristic x-ray
Fluorine-18 110 minutes
• emission of high energy particles or rays from the nucleus of • Negative Beta Decay - the ejected electron is then called an auger electron
Technetium-99m 6 hours
unstable atoms to become stable - beta minus Iodine-123 13.3 hours
• decay always involve nuclear transformation or -Z→Z+1 TYPES OF TRANSITIONS
Yttrium-90 2.6 days
transmutation - A = constant 1. Isobaric Transition
Indium-111 2.8 days
• radioactivity – spontaneous emission of energy from nucleus - n → p + β + v ~ + energy - involves nuclear transformation
Gallium-67 3 days
of unstable atoms - neutron rich – occurs in neutron rich atoms 2. Isometric Transition
Thallium-201 3 days
• the process by which they emit high energy particles or rays - negatron emission – emits negative beta particles (e–) Xenon-133 5¼ days
from their nucleus - neutron to proton – converts a neutron to proton Iodine-131 8 days
Reviewer in Nuclear Medicine – Sayo, Ana Lychees A. 5 Reviewer in Nuclear Medicine – Sayo, Ana Lychees A. 6

Cobalt-60 5.3 years - both functions may be performed by the radioactive - suitable for incorporation into a pharmaceutical Technitium-99m
Carbon-14 5730 years isotope • the most commonly used radionuclide
> e.g. I-123 in thyroid imaging DESIGN CHARACTERISTICS a. readily available
METASTABILITY - or the isotope may need to be chemically bound to a • decay in gamma emissions b. favorable energy
• most gamma rays are emitted almost immediately (<10-12 pharmaceutical - suitable energy - monoenergetic gamma photon (140keV)
second) after the primary decay process, whether it be alpha > e.g. Tc-99m HDP for bone scans > 100-300 keV is ideal for gamma cameras c. favorable dosimetry with lack of primary particulate
decay, negatron decay, positron decay, or electron capture - sufficient abundance of emission for detection radiations
• when the intermediate excited state last longer than 10-9 SOURCES OF RADIONUCLIDES • have no particulate emissions d. ideal half-life (6 hours) for many clinical imaging studies
second, the term “metastable” is used • Reactors - particulate radiation
99m
- uses neutron activation – the reactor adds neutrons to > increases patient's radiation dose Tc vs. 99Tc
RADIOPHARMACEUTICALS stable atoms > does not add diagnostic information • 99mTc
- radionuclides produced will generally decay by a beta - beta emissions – suitable only for therapeutic - half life is 6 hours
Radiopharmaceutical minus process radiopharmaceuticals - only emits gamma electromagnetic radiation
• a radioactive compound used for diagnostic or therapeutic > e.g. fission of nuclear fuel • optimal effective half-life - decay product of Mo-99 through isobaric transition
purposes > I-131, Mo-99, Y-97, (Cs-137, Co-60) - long enough for the intended application through a generator
99
• substance containing radionuclides suitable for • Accelerators - usually a few hours • Tc
administration to humans for diagnosis or treatment of - adds charged particles (protons, deuterons) to stable • high specific activity (99mTc) - half life is 211,000 years
nuclides - to avoid any toxic effect to the patient - emits beta particulate radiation
disease
- cyclotron - accelerated particle enters into nucleus • compatible pharmaceutical component - higher energy state thus must emit the excess energy in
• formulated in various chemical and physical forms to deliver
- radionuclides produced will generally decay by a beta - free of any toxicity order to go to a lower energy state
their radioactivity to particular parts of the body
minus process - free of secondary/side effects - 99Tc is the decay product of 335U through fission
• gamma radiation emitted from these drug molecules readily
> gamma emmiters – Ga-67, I-123, In-111, Co-57 • readily available
penetrates the tissues and escapes from the body, thus
> positron emmiters: 18F - easily compounded Forms of Technitium-99m
allowing external detection and measurement
• Generators - reasonable cost 1. Technitium-99m Pertechnetate (99mTcO-4)
• chosen to provide useful clinical information while
- produces radionuclides that are short lived • fast and precise localization - behaves similarly to iodine
minimizing the radiation exposure to the patient
- the useful radionuclides (daughter) is continuously - the agent should rapidly and specifically localize - to diagnose Meckel's diverticulum
• for image formation, radionuclides must be gamma emitters produced by the radioactive decay of a longer lived - used for thyroid, salivary gland and stomach imaging
while for patient safety, they must not emit alpha or beta - accords to the intended application
(parent) radionuclides. • radionuclides – most commonly used clinically are 2. Technitium-99m Macroaggregated Albumin (Tc-99m
particles - Radionuclides are transformed into daughter radioactive MAA)
• a.k.a. radiotracers artificially produced
elements - bombardment of medium atomic-weight nuclides with - used for lung imaging
• radionuclides have met Iegal requirements for administration - 99mTc, 81mKr - trapped in the capillary of the lung
low-energy neutrons in nuclear reactor
• portray a body system without disturbing its function - the albumin macroaggregates - 15-75um in size
> resulting neutron-rich radionuclides which
- physiology PREPARATION OF RADIOPHARMACEUTICALS - The biological half life of Tc-99m MAA in the lung is 8-
undergoes beta-minus decay
- biochemistry • Radiopharmaceuticals are provided prepared 12 hours.
- proton bombardment of a wide variety of target nuclides
- pathology • eventually necessary to be diluted 3. Technitium-99m Human Serum Albumin
in cyclotrons or other special accelerators
• radiolabeling/tagging – process of making • Radiopharmaceuticals are prepared at department of NM by • blood pool imaging such as heart or placenta
> produces proton-rich radionuclides that undergo
radiopharmaceuticals radiopharmacist • retained in the plasma for a long period of time
positron decay or electron capture
• radioparmaceutical is combination of: • provided non radioactive kits AGENT APPLICATION
- radioactive molecule • adjunction of radionuclide (at room temperature, by heating RADIONUCLIDE GENERATORS
99m
Tc Sodium Meckel’s diverticulum detection,
- biologically active molecule in waterbath) (all 99mTc preparations) Pertechnatate salivary and thyroid gland
• solution to the problem of supply of shortlived radionuclides
• main medical isotopes used for diagnosis - Tc99m, F18 (e.g. 99mTc, 82Rb) scintigraphy
• main medical isotope used for therapy - I131 99m
IDEAL RADIOPHARMACEUTICAL • principle Tc Sulfur Colloid lymphoscintigraphy
• ideal pharmaceutical - parent nuclides with relatively long half-life, upon (filtered)
MAIN COMPONENTS 99m
- short biological half-life decay, produces daughter nuclei with shorter half-life Tc Sulfur Colloid liver/spleen scintigraphy,
• radioactive molecule - minimal/No side effects bone marrow scintigraphy
99m
- allows the monitoring of distribution - easy to prepare ELUTION Tc Pyrophosphate acute myocardial infraction
- permits external detection from the body by a - labelling stability • process of removing ‘daughter’ radionuclide detection
99m
radionuclide imaging device (gamma camera, SPECT, - localization is fast and precise - no removal of ‘parent’ radionuclide Tc Diphosphate skeletal scintigraphy
99m
PET) or from a body fluid (blood plasma, urine) - should not alter physiological system under examination - elution is a sterile procedure Tc Macroaggreagated pulmonary perfusion scintigraphy,
• biologically active molecule • ideal radionuclide • techniques Albumin (MAA) liver intra-arterial perfusion
- acts as the tracer - short physical half-life - precipitation scintigraphy
99m
- drug that acts as a carrier and determines localization - pure gamma emitter - distillation Tc Red Blood Cells radionuclide ventriculography,
and biodistribution - easy to prepare - ion exchange gastrointestinal bleeding,
- determines the behavior of the radiopharmaceutical in - labelling stability - + others hepatic hemangioma
99m
the body - energy 100-200keV Tc Diethylenetriamine- renal scintigraphy, lung ventilation
- readily available Pentaacetic Acid (DTPA) (aerosol), glomerular filtration rate
Reviewer in Nuclear Medicine – Sayo, Ana Lychees A. 7 Reviewer in Nuclear Medicine – Sayo, Ana Lychees A. 8
99m 1
Tc renal dynamic scintigraphy Isotope Sym. Z T /2 Decay TECHNETIUM-99m > nodular or diffuse enlargement
Mercaptoacetyltriglycine Therapy • the most commonly used radionuclide - determine function of a palpable nodule
(MAG3) Yttrium-90 90
y 39 2.67 d β− • readily available > post therapy evaluation for adenoma
99m
Tc Dimercaptosuccinic renal cortical scintigraphy Iodine-131 131
I 53 8.02 d β− • favorable energy of its principal gamma photon - locate ectopic thyroid tissue
Acid (DMSA) • favorable dosimetry with lack of particulate radiations > lingual thyroid
99m
Tc Iminodiacetic Acid hepatobiliary scintigraphy SOURCES OF RADIONUCLIDES • ideal half-life - evaluation of a neck or substernal mass
(HIDA) Derivatives • Nuclear Reactor > thyroglossal duct cyst
99m
Tc Sestamibi myocardial perfusion scintigraphy, > fission of nuclear fuel RADIOIODINE-131 - assist in evaluation of hyperthyroidism
(Cardiolite, Miraluma) breast imaging > 131I, 99Mo, 97Y, (137Cs, 60Co) • first radiopharmaeutical of importance in clinical nuclear
99m
Tc Tetrafosmin myocardial perfusion scintigraphy medicine IODINE-131 Whole Body Scan
• Accelerator
(myoview) or 99mTc • used for routine studies of the thyroid gland for several years • post-surgical or post-therapy procedure in thyroid cancer
> Cyclotron – accelerated particle enters into nucleus
Teboroxime (CardioTec) > Gamma emmiters: 67Ga, 123I, 111In, 57Co in the late 1940’s patients
99m
Tc Exametazime cerebral perfusion scintigraphy, > Positron emmiters: 18F • evaluate residual functioning thyroid tissue in the neck
• remains an important radiopharmaceutical for the treatment
(HMPAO) WBC labeling • detection of thyroid cancer metastasis
99m • Radionuclide Generators of hyperthyroidism and differentiated thyroid cancer
Tc Bicisate (ECD) cerebral perfusion scintigraphy • detection of thyroid cancer recurrence
99m > radionuclides – transformed into daughter radioactive • relatively high principal photon energy
Tc Arcitumomab monoclonal antibody
elements • long half-life
(CEA) (colorectal cancer evaluation) BONE SCINTIGRAPHY
99m > 99mTc, 81mKr
Tc Apcitide (Acutest) acute venous thrombosis imaging • whole body picture of skeletal metabolism in one procedure
99m RADIOIODINE-123
Tc Depreotide tumor imaging • indication
CYCLOTRON AND PET ISOTOPES • substituted for I-131 for diagnostic purposes
(NeoTest) - neoplastic disease
99m • most PET isotopes are produced in cyclotrons • shorter half-life
Tc Fanolesomab infection imaging
- 18F, 11C, 15O • principal photon energy of 159 keV is better suited to
- occult fracture
(NeutroSpec) - osteomyelitis
• positron emitters have “too many” protons for stability imaging with the gamma scintillation camera
• normally produced by smashing protons into stable targets - avascular necrosis
Radiolabeling with 99mTc • dosimetry is favorable compared with that of I-131
• to make 18F, fire protons into 18O enriched water • is now increasingly replacing I-131 for whole body thyroid
- bone graft viability
• Cold Kits - unexplained bone pain
- pre-packed set of sterile ingredients designed for the cancer scans
Source of Radiation (patient) → Annihilation Radiation →
preparation of a specific radiopharmaceutical Detectors → Coincidence Processing → Central Processing Unit RADIONUCLIDE RENAL STUDIES
INDIUM-111
→ Cathode Ray Tube (image display) • Glomerular Filtration Rate (GFR)
Allowable Radionuclide Impurities in 99mTc Pertechnetate • its principal photon energies of 172 keV and 245 keV are
• Effective Renal Plasma Flow (ERPF)
Radionuclide Impurities favorable compared with I-131
SPECT • Renovascular Hypertension
99m
Mo < 0.15 µCi/mCi 99mTc • 2.8 days half-life permits multiple-day sequential imaging.
131 • uses radiotracer but unlike PET, the tracer use in SPECT • Urinary Tract Obstruction
I < 0.05 µCi/mCi 99mTc directly emits gamma radiation
• proven clinically useful
103 • Transplant Evaluation
Ru < 0.05 µCi/mCi 99mTc PET SPECT
• neuroendocrine tumors
89 • Renal Cortical Evaluation
Sr < 0.0006 µCi/mCi 99mTc • In-111 capromab pendetide (Prostascint) – used for
90 emits positrons emits gamma radiations
Sr < 0.00006 µCi/mCi 99mTc detection of recurrent prostate cancer
higher resolution lower resolution GI BLEEDING DETECTION
costlier scanner less capital intensive scanner • 99mTc – labeled RBC are intravenously injected
TYPICAL INGREDIENTS limited half-life of long lived radioisotopes GALLIUM-67 CITRATE
compound to be complex to the 99mTc • intraluminal extravasation of RBC indicates site of bleeding
radiopharmaceuticals • 78.3 hour half-life
- methylene diphosphonate (MDP) • minimal detectable bleeding rate of 0.1 ml/min
• does not have favorable properties for scintigraphy
- stannous Ions (Sn+) • low energy
Source of Radiation (patient) → Gamma Ray (gamma camera) → HEPATOBILIARY SCAN
- stabilizers, buffers, antioxidants, bactericides
Collimator → Scintillation Crystal → NaI (Tl) → Light → PMT • evaluates hepatocellular function and patency of the biliary
(photocathode) → Electrical Signal (current) → Pulse Height THALLIUM-201
Half-Life and Decay of Radioisotopes system
Analyzer (for selection of CM → Central Processing Unit → • 73.1 hours half-life
Isotope Sym. Z T 1/ 2 Decay - indication
Cathode Ray Tube (monitor/image display) • myocardial scintigraphy
> suspected acute cholecystitis
Imaging • excellent marker of regional blood flow to myocardium > evaluation of chronic biliary tract disorders
81m
Krypton-81m Kr 36 13.1 s IT RADIONUCLIDE CALIBRATOR • major disadvantage is the absence of an ideal photo peak for > detection of bile leak
82
Rubidium-82 Rb 37 1.27 m β+ • Ionisation Chamber imaging > detection of bile reflux
13
Nitrogen-13 N 7 9.97 m β+ • Acceptance Testing • alternative Tc-99m have been sought and are now available > congenital abnormalities of biliary tree
18
Fluorine-18 F 9 109.77 m β− - check against national or secondary standards
99m
Technitium-99m Tc 43 6.01 h IT • Daily QA THYROID SCINTIGRAPHY MYOCARDIAL PERFUSION STUDY
67
Gallium-67 Ga 31 3.26 d ec - long Lived Source • evaluation of morphology and function of the thyroid gland
123 • Thallium-201
Iodine-123 I 53 13.3 h ec - source assayed using several radionuclide settings • agents used
111 • Tc99m-Sestamibi
Indium-123 In 49 2.80 d ec • Geometrical Dependence - Tc-99m Pertechnetate
201 - ischemic cascade
Thallium-201 Tl 81 3.04 d ec - Iodine 131
133 - occlusive disease
Xenon-133 Xe 54 5.24 d β− RADIOPHARMACEUTICALS AND THEIR USE • indication - wall motion abnormality
- relate structure to function - LV dysfunction
Reviewer in Nuclear Medicine – Sayo, Ana Lychees A. 9 Reviewer in Nuclear Medicine – Sayo, Ana Lychees A. 10

- area of decrease or no presence of radioactive - for I-131, incidents involving activities up to 1 mCi are 2. Prevent the spread of contamination by isolating the area and
LUNG VENTILATION material that would show as dark image considered minor; spills above that level are considered covering the spill (absorbent paper).
• Perfusion (V/Q) Scintigraphy - the administered tagged compounds localize in major 3. If clothing is contaminated, rinse contaminated region with
• indication normal tissues of an organ with abnormal areas - for Tc-99m, Tl-201 and Ga-67 the threshold for lukewarm water and wash with soap.
- determine likelihood of pulmonary embolism showing areas of absent activit /cold areas considering a spill to be major is 100 mCi 4. Notify the radiation safety officer.
- pre-operative evaluation > e.g. thyroid scanning and liver scanning • the basic principles of responding to both kinds of spills are 5. War gloves, disposable lab coats and booties to clean up spill
- evaluation of lung transplantation the same with absorbent paper.
PROPER STORAGE OF RADIOPHARMACEUTICALS - for minor skills, people in the area are warned that the 6. Put all contaminated absorbent paper in labeled radioactive
FACTORS AFFECTING THE DOSE spill has occurred waste container.
a. Administered Activity DISPENSING RADIOPHARMACEUTICALS > attempt are made to prevent the spread of the spilled 7. Check the area or contaminated individual with appropriate
b. Diagnostic Reference Levels (ARSAC) • dispensing of radiopharmaceuticals is under a series of rules material radiation survey meter.
c. Effective Half-Life and regulations promulgated by the Food and Drugs > minor spills can be cleaned up directly with
d. Bio-Distribution Administration and Nuclear Regulatory Commission appropriate technique, including use of soap and OCCUPATIONAL EXPOSURE
e. Radiochemical purity - as state pharmacy boards and hospital radiation safety water, disposable gloves and remote handling
f. Pathology committees devices RESPONSIBILITIES AND CONDITIONS OF SERVICE
g. Drugs • radiopharmaceuticals – prescription drugs that cannot be > the area should be continually surveyed until the • optimization of staff protection requires commitment by the
h. Type of radioactive decay legally administered without being ordered by an authorized reading from a Geiger-Muller survey meter is at management of the nuclear medicine facility
i. Energy of emissions individual background levels - the protection of occupationally exposed individuals
- the nuclear medicine physician and radiopharmacy are > all personnel involved should also be monitored, working in hospitals requires a rigorous organizational
METASTABLE RADIONUCLIDES responsible for confirming the appropriateness of the including their hands, shoes and clothing framework and a structured approach
• electrons of excited atoms are in higher energy state thus request > the spill should be reported to the institution’s - this should be reflected in the Local Rules for each
must emit the excess energy in order to go to a lower energy - ensuring that the correct radiopharmaceutical in the radiation safety officer workplace, which must define safe systems of work
state requested or designated amount is administered to the - for major spills, the area is cleared immediately • responsibility in radiation protection affects all members of
• the time it takes for that to happen is 10-8 sec. patient > attempts are made to prevent further spread with the administrative system from the employing authority to
• if the time it takes is much longer 10-3 sec, the atom is said to - keeping records of both the request and the absorbent pads, and if possible the radioactivity is the individual carrying out a nuclear medicine procedure
be metastable documentation of the dosage administration shielded
• before any material is dispensed, all appropriate quality > the room is sealed off and the radiation safety ACCORDING TO THE STANDARDS
METHODS OF LOCALIZATION asurance measures should be carried out officer is notified immediately • The occupational exposure of any worker shall be so
1. active transport • a good standard of practice, quality control should always be controlled that the following limits are not exceeded:
• as in thyroid scanning performed, even when not legally required RADIATION SAFETY PROCEDURES a. an effective dose of 20 mSv per year averaged over five
• potassium analogues in myocardial imaging - every dose should be physically inspected before 1. Wear laboratory coats in area where radioactive materials are consecutive years;
2. phagocytosis administration for any particulate or foreign material present. b. an effective dose of 50 mSv in any single year;
> bits of rubber from the tops of multidose injection 2. Wear disposable gloves when handling radioactive materials. c. an effective dose to the lens of the eye of 150 mSv in a
• liver scanning with labeled colloidal particles
vials 3. Monitor hands and body for radioactive contamination before year; and
3. cell sequestration
leaving the area. d. an equivalent dose to the extremities (hands and feet) or
• spleen scanning with 'damage' labeled RBC. • each dose administered to a patient must be assayed in a dose
4. Use syringe and vial shielding as necessary. the skin of 500 mSv in a year
4. capillary blockage calibrator
5. Do not eat, drink, smoke apply cosmetics, or store food in • According to the Basic Safety Standards:
• lung scanning with labeled albumin
any area where radioactive material is stored or used. - “A female worker should, on becoming aware that she is
• Tc99m-MAA for lung perfusion SPECIAL CONSIDERATIONS
6. Wear personnel monitoring devices in areas with radioactive pregnant, notify the employer in order that her working
5. single or exchange diffusion • the possibility of pregnancy should be considered for every
materials. conditions may be modified if necessary. The
• bone scanning with Strontium 85 woman of child bearing age referred to the nuclear medicine
7. Never pipette by mouth. notification of pregnancy shall not be considered a
• Kr-81m in lung ventilation service for a diagnostic or therapeutic procedure
8. Dispose of radioactive waste in designated, labeled and reason to exclude a female worker from work; however,
6. compartmental localization • the management of women who are lactating and properly shielded receptacles located in a secured area.
• cardiac scanning with labeled human serum albumin breastfeeding an infant is another special problem the employer of a female worker who has been notified
9. Label containers, vials, syringes containing radioactive of the pregnancy shall adapt the working conditions in
7. physiochemical adsorption materials. When not in use. place in shielded containers or
ADVERSE REACTION TO DIAGNOSTIC respect of occupational exposure so as to ensure that the
• phosphates localizing in mineral phase of bone behind lead shielding in a secure area.
RADIOPHARMACEUTICALS embryo or fetus is afforded the same broad level of
• labelled antibodies for tumor imaging 10. Store all sealed sources (floods, dose calibrator sources) in
• adverse reactions to radiopharmaceuticals are much less protection as required for members of the public.”
shielded containers in a secured area. - this means that the dose to the embryo or fetus should
ORGAN VISUALIZATION common than adverse reaction to iodinated contrast media 11. Before administering doses to patients, determine and record
• reaction are usually mild and for the radiopharmaceuticals in not normally exceed 1mSv
1. hotspot activity.
used today, rarely fatal - the possibility of a dose approaching 1 mSv to the
- area of increased accumulation of radioactive 12. Know what steps to take and who to contact (radiation safety embryo or fetus should be assessed once pregnancy has
material which will show a bright image officer) in the event of radiation accident, improper operation
RADIATION ACCIDENTS been declared
- the administered tagged compounds localize in of radiation safety equipment, or theft/loss of licensed
• in a busy nuclear medicine practice handling several patient > the departmental manager, in conjunction with the
abnormal areas showing areas of increased material.
doses a day, with most materials in liquid form, accidental radiation protection officer, should also decide
uptake/hot areas
spills of radioactive material occur from time to time whether it is appropriate to reallocate staff duties, or
> e.g. bone scanning and brain scanning PROCEDURE FOR RADIOACTIVE SPILL to apply extra protective measures
2. coldspot 1. Notify all persons in the area that a spill has occurred.
Reviewer in Nuclear Medicine – Sayo, Ana Lychees A. 11 Reviewer in Nuclear Medicine – Sayo, Ana Lychees A. 12

> pregnant women should be removed from the team • every type of work performed in a nuclear medicine • because evaluation of dosage is an essential part of the - TLDs can be worn for intervals up to 1 year
responsible for patients who have been treated with department will make a contribution to the external exposure radiation protection programme, it is important that workers • when exposed to radiation, the TLD absorbs energy and
radionuclides and from the laboratories where large of the worker: return dosimeters on time for processing stores it in the form of excited electrons
quantities of nuclides are prepared and administered - unpacking radioactive material • delays in the evaluation of a dosimeter can result in the loss • when heated, these excited electrons fall back to their normal
• According to the Basic Safety Standards: - activity measurements of the stored information state with the emission of visible light
- “No person under the age of 16 years shall be subjected - storage of sources - licensees should make every effort to recover any - the intensity of visible light is measured with a
to occupational exposure”, and “No person under the age - preparation of radiopharmaceuticals missing dosimeters photomultiplier tube and is proportional to the radiation
of 18 years shall be allowed to work in a controlled area - administration of radiopharmaceuticals • if an individual’s dosimeter is lost, the RPO should perform dose received by the crystal
unless supervised and then only for the purposes of - patient examination and document an evaluation of the dose the individual • it is more sensitive and more accurate than film badge
training”. - care of the radioactive patient and handling of received and add it to the worker’s dose record monitors
• Furthermore according to the Standards: radioactive waste - this can be done using the workers recent dose-history, • can measure exposure as low as 5 mR
- “For apprentices of 16 to 18 years of age who are doses of co-worker or the results of workplace • they can be worn for intervals up to 3 months at a time
training for employment involving exposure to radiation PERSONAL PROTECTIVE EQUIPMENT AND SAFE monitoring
and for students of age 16 to 18 who are required to use HANDLING OF SOURCES • a female worker should notify the licensee if she is pregnant POCKET DOSIMETER
sources in the course of their studies, the occupational • protective clothing should always be used in working areas as soon as she knows of her condition, and also if she is • measure approximately 2 cm in diameter by 10 cm long and
exposure shall be controlled so that the following limits where there is a likelihood of contamination breast feeding a baby, so that radiation protection are designed to be clipped onto wearing apparel like a writing
are not exceeded: - it may include laboratory coats or protective gowns; requirements for the fetus and baby can be met pen
a. an effective dose of 6 mSv in a year; waterproof gloves of high quality and shoes • periodic monitoring shall be conducted for controlled and • has a range of 0 20 200 mR.
b. an equivalent dose to the lens of the eye of 50 mSv • laboratories used for work should be provided with supervised areas • time consuming
in a year; and equipment to minimize the external exposure of the worker • investigation levels shall be used and a formal investigation • not employed frequently in diagnostic radiology
c. an equivalent dose to the extremities or the skin of and to deal with radioactive spill shall be conducted whenever a worker receives an effective • many radiologic technologists wear their personnel monitor
150 mSv in a year” - this equipment may need to include: dose that exceeds any of the levels in front at the waist or chest level because it is convenient to
Note: working in a nuclear medicine facility students and > tools for remote handling of sources (forceps, tongs) • a report shall be submitted to the Regulatory Authority and clip the badge over a belt or a shirt pocket
trainees should always be accompanied by an authorized > shielded containers for the radionuclides in use other concerned bodies as required, as soon as possible after
teacher > lead barrier with lead glass window the investigation DETECTION SYSTEM
> area monitor with alarm
CLASSIFICATION OF AREAS > contamination monitor PERSONNEL MONITORING
• areas in a nuclear medicine department are generally > carrying containers for moving radionuclides PRINCIPLES
• the personnel monitor offers no protection against radiation • a detection system can be considered to consist of two parts,
classified as controlled or supervised > equipment and materials to deal with spills exposure
- the rooms for preparation, storage and injection of the (emergency kit) a detector and a measuring apparatus.
• it simply measures the quantity of radiation to which it was
radiopharmaceuticals shall be controlled areas • working procedures should be designed to prevent exposed, and therefore is used as an indicator of the exposure
- due to the potential risk of contamination, the imaging contamination and spread of contamination from the working TYPES OF DETECTORS
of the wearer • Gas-Filled Detectors
rooms and waiting areas should also be controlled areas areas
• the area housing a patient to whom therapeutic amounts of - this will normally be achieved by a proper use of the - those that depend on ionization in which ionization is
FILM BADGES translated into electric current or impulses
activity have been given shall also be a controlled area personal protective equipment, by adopting clean • film badges came into general use during mid-1940’s and
• the room for temporary storage of radioactive waste shall be operating conditions and good laboratory practice • Scintillation Detectors
have been widely employed in diagnostic radiology ever - those that depend on excitation
a controlled area • the worker should be trained to deal with radioactive spills since
• it might be convenient to classify the whole nuclear and decontamination procedures (surfaces, equipment, • film badges are especially designed devices in which a small
department as a supervised area mainly due to the risk of persons) GAS-FILLED DETECTORS
piece of film is sandwiched between metal filters inside a • radiation is sensed by detecting the ionization of gas
contamination plastic holder
• each room of the facility should only be used for its specified MONITORING molecules produced by deposition of energy during
• the film incorporated into a film badge is special radiation radiation’s passage through the gas-filled detectors
work • individual dose monitoring shall be undertaken for workers dosimetry film that is particularly sensitive to ionizing
who are normally exposed to radiation in controlled areas • one important approach to radiation detection is the use of an
radiation ionization chamber
SOURCES OF EXPOSURE • these workers include nuclear medicine physicians, nuclear • the density on the exposed and processed film is proportional
• exposure of the worker may arise from unsealed sources medicine physicists, nuclear medicine technologists, nuclear - the generic design concept is a gas-filled chamber with
to the exposure received by the film badge positive and negative electrodes, placed either at
either through external irradiation of the body or through medicine nurses and radiopharmacists
entry of radioactive substances into the body • individual external doses shall be determined by using opposite sides of the chamber
ADVANTAGES OF FILM BADGE - a potential difference is created between two electrodes,
• the main precautions required in dealing with external individual monitoring devices approved by the Regulatory • inexpensive
irradiation depend on the physical characteristics of the Authority but no current flows in the absence of exposure of the
• easy to handle chamber to radiation
emitted radiation, the activity and the half-life of the - such as thermoluminescent dosimeters, film badges or
• not difficult to process • the interaction of ionizing radiation with the gas in the
radionuclide other devices
• reasonably accurate chamber creates positive and negative ions, which move to
• when a radionuclide enters the body, the internal exposure • the individual monitoring device should be typically worn on
will depend on factors such as the physical and chemical the front of the upper torso because, in nuclear medicine, the the electrodes and produced electrical current
THERMOLUMINESCENCE DOSIMETERS • principle:
properties of the radionuclide and the activity whole body is assumed to be fairly uniformly exposed
• the sensing material of the TLD monitor is lithium fluoride - when ionizing radiation produces ion pairs in the gas, the
(LiF) in crystalline form, either as a powder or more often as resulting free electrons are attracted to the anode and the
a small chip approximately 3 mm square and 1 mm thick positively charged gas molecule ions are attracted to the
Reviewer in Nuclear Medicine – Sayo, Ana Lychees A. 13 Reviewer in Nuclear Medicine – Sayo, Ana Lychees A. 14

cathode, (an ion pair is positively charged gas molecule • the detector may not be capable of responding to a second • shielding device used to limit the angle of entry of radiation • whenever possible, cover the crystal with a collimator or
ion and the free electron that came from it) event if the filling gas has not been restored to its initial • determine to a large extent the final image quality obtained other protective cover to avoid something dropping on or
- this bulk movement of charge produces an electrical condition from the gamma camera and are therefore one of the most biting the crystal
signal from the detector - therefore, a quenching agent is added to the filling gas of important part of the gamma camera - even a quite small impact can break the crystal
> commonly used gases: helium, neon, argon, and the Geiger counter to enable the chamber to return to its • shape of collimator holes to permit higher resolution • crystal protection
hydrogen in an ionization chamber original condition - square - avoid large temperature fluctuations in the gamma
- the voltage difference between the electrodes are > subsequent ionizing events can then be detected - hexagonal camera room and ensure the collimator is attached to the
calibrated to be just high enough to “harvest” all of the • the minimum time between ionizations that can be detected is - triangular camera detector head whenever possible to insulate the
ions from the sensitive volume of the chamber, but not known as the resolving time or dead time crystal from temperature fluctuations
high enough that the ions in the chamber are accelerated • Geiger counter is used for contamination control in nuclear TYPES OF COLLIMATOR - avoid the sun shining directly on the detector and crystal
to the point of creating additional secondary ionizations medicine laboratories • Parallel Hole Collimator - avoid contamination of the crystal
- as a result of this voltage calibration strategy, the current - not particularly useful as dosimeters because they are - the most common used collimator
produced in any single event is very small and not difficult to calibrate for varying condition of radiation - consists of a large number of small hole, separated by PHOTOMULTIPLIER TUBE (PMT)
measurable with any accuracy • survey meter – one of the example of GM counter the lead sepia, which are parallel to each other, and • the light pipe and reflector – a large fraction of light is
> the ionization chamber is used to measure the total away the nucleus → ↑ energy contained-electron usually perpendicular to the crystal transmitted to the photocathode of the PMT, wherein it
current resulting from multiple events over a certain near the nucleus → ↑ binding energy - geometric efficiency is affected by converts the light from the crystal into an electrical pulse
integration time in a given radiation detection > shape of the collimator holes which contain series of dynodes
setting SCINTILLATION DETECTORS > length of the collimator holes • optically coupled to the crystal through a light guide or a
• radiation survey meters such as the cutie-pie, some pocket • when ionizing particles pass through certain crystals, flashes > diameter of the collimator holes simple glass window
dosimeters and radionuclide dose calibrator are all examples of light or scintillation is emitted • Converging Collimator - light pipe – usually used to ensure that the light produced
of specialized basic ionization chambers • the amount of light emitted is proportional to absorbed by the - holes are not parallel but are angled to converge to a in the crystal reaches the photocathode in PMT
• the amount of energy converted to electrical current per unit material focal point, providing some magnification - for every 7-10 light photons, which reach the cathode,
of radioactivity is unique for each radionuclide, and • this type of detector is the most commonly used type in • Diverging Collimator one electron is ejected by photoelectric effect
radionuclide dose calibrators must be calibrated for the nuclear medicine - opposete of converging collimator, holes are angled - the electron produced are accelerated towards the first
radionuclide to be measured • this detector can be used to measure the energy distribution opposite to the direction in converging collimator which dynode, 3-4 electrons are released, which in turn
of particles in addition to counting them. make the image smaller accelerated towards D2, where again 3-4 further
PROPORTIONAL COUNTERS • Pinhole Collimator electrons are released and so on for all the dynodes
• has a very high sensitivity to gamma rays and to small
• the main difference between a proportional counter and basic amounts of activity - thick conical collimators with a single 2-5 mm hole in > therefore, for each dynode, the number of electrons
ionization chamber is greater applied voltage between - due to its high sensitivity, it is particularly used for the bottom center is multiplied by a factor of 3-4
electrodes in the former detecting low levels of activity - as a source is moved away from the surface of a pinhole • the electrons are finally collected by the anode to form the
• considered to be the most useful type of nuclear-indicator collimator, the camera image gets smaller final electrical signal from the PMT and are directed into a
GAS AMPLIFICATION • Fan Beam Collimator preamplifier circuit, which forms and shapes the pulse that is
detector
• phenomenon where a higher voltage results in secondary - combination of parallel hole collimator (along one axis) further amplified by a linear amplifier from a few millivolts
• they should be calibrated with the nuclide of interest
ionization in the sensitive volume of the chamber and a converging collimator (along other axis) to a few volts
• increases ionization by a factor of 1,000 - 1,000,000 ANGER SCINTILLATION CAMERA/GAMMA CAMERA • the size of the electrical signal from the PMT depends on:
- the resulting current pulse is large enough to be SPATIAL RESOLUTION - the total number of light photons which reach the
• invented by Hal Anger in 1898
measured in individually and is proportional to the • R = [d (L + D)] ÷ L cathode depending on the gamma ray energy
• most commonly used instrument in nuclear medicine
energy originally deposited in the gas chamber. • where: - the light voltage applied to PMT
• complete camera system consists
- the device is based on the proportionality of total - R - geometrical resolution
- collimator
ionization to the total energy of the ionizing radiation. - d - diameter PULSE HEIGHT ANALYZER (PHA)
- crystal sodium iodide
- proportional chambers do not have wide application in - L - length of collimator • an electronic device used to determine which portion of the
- photomultiplier tube
clinical nuclear medicine - D - distance from collimator detected spectrum is used to create images
- pulse/height analyzer
> they are used in research to detect alpha and beta > d., R. = resolution • the PHA can be set to allow only selected energies to be
- scaler/timer
particles > L., R. = resolution counted, and reduce the number of Compton scatter photons
- cathode ray tube (CRT)
> D., R. = resolution in the image
GEIGER-MÜLLER COUNTER • the basic function of the gamma camera is to provide an
image of the radionuclide injected to the patient - sensitivity – efficiency of the collimator greater/larger • the PHA allows the operator either to set the upper and lower
• a device for measuring radioactivity by detecting and holes = higher/greater sensitivity energy limits or to set a peak energy level and associated
- the radionuclide emits gamma rays, which can escape
counting ionizing particles window
from the body and thus can be detected by gamma
• the voltage is increased even higher than in the proportional CRYSTALS • window – measured by percent, determines the acceptable
camera
chamber application • NaI (Tl) crystals are hydroscopic, thus they absorbed range of energies around the peak for subsequent counting
• the detector detects the gamma ray and determines its
• the effect is that nearly all the molecules of the gas are moisture from air, so they have to be sealed with aluminum • wide windows accept more photons and produce images in a
location and its energy in which is further processed by
ionized, liberating a large number of electrons can with a window shorter time but include more photons that degrade image
electronic in the console before being displayed on CRT
- this results in a large electron pulse and detection of • its purpose is to convert gamma rays to light photons as the quality
screen for exposing film and collected in a computer memory
single event but not their energy gamma rays interact with the crystal and loose energy
for later display and filming
• the numbers of light photons produced in the crystals are SCALER AND TIMER
COLLIMATOR proportional to the energy of the gamma ray
Reviewer in Nuclear Medicine – Sayo, Ana Lychees A. 15 Reviewer in Nuclear Medicine – Sayo, Ana Lychees A. 16

• responsible for counting the number of defected gamma ray - aid in detecting some acute inflammatory - cardiac and pulmonary blood volumes and DU: evaluation of pulmonary perfusion*
which falls inside the PHA window lesions circulation times evaluation of peritoneo-venous (LaVeen) shunt
Indium-111 capromab pendetide - protein turnover studies patency
POSITRON EMISSION TOMOGRAPHY DU: agent in newly-diagnosed patients with biopsy- - heart and great vessel delineation
• a form of tomography made possible by the unique fate of proven prostate cancer - localization of the placenta Technetium-99m mebrofenin
positrons - localization of cerebral neoplasm DU: hepatobiliary imaging agent
- when positrons undergo annihilation by combining the Indium-111 chloride
negatively charged electron, two 511 keV gamma rays DU: labeling monoclonal antibodies and peptides Iodine-131 iodohippurate Technetium-99m medronate
are given off in opposite directions 180° apart sodium/hippurate DU: delineate areas of altered osteogenesis
• the density and effective atomic number of NaI (TI) crystals Indium-111 diethylenetriamine pentaacetic acid DU: determine renal function, effective renal
are not ideal for detecting the 511 keV gamma rays used in (DTPA) plasma flow, and urinary tract obstruction Technetium-99m mertiatide
PET imaging DU: for use in radionuclide cisternography DU: patient >30 days of age as a renal imaging
• Bismuth Germanate Oxide (BGO) cerebrospinal fluid imaging Iodine-131 sodium iodide agent:
- approximately twice as dense with an effective Z of 74, DU: evaluate thyroid function - congenital and acquired abnormalities
compared with an effective Z of 50 for NaI 111 Indium-111 oxyquinoline - Localizing metastases associated with - renal failure
In
(TI)/thallium-activated sodium iodide BGO detectors DU: indicated for radiolabeling autologous thyroid malignancies - urinary tract obstruction and calculi
2.80 days
have been used extensively in PET imaging applications detection of inflammatory processes to which TU: treatment of - renal function
for this reason leukocytes migrate (associated with abscesses or hyperthyroidism and - renal angiograms
• used for treatment planning as the CT scan machine is used other infection) carcinoma of the thyroid renogram curves for whole kidney and renal cortex
in localizing pathology
• other materials Indium-111 pentetreotide Iodine-131 tositumomab Technetium-99m oxidronate
- gadolinium orthosilicate (GSO) DU: localization of primary and metastatic TU: treatment of Rituximabrefractory non- DU: osteogenesis*
- lutetium orthosilicate (LSO) neuroendocrine tumors Hodgkin’s lymphoma
- yttrium orthosilicate (YSO) imaging of neuroendocrine tumors 99 Mo-99 generator Technetium-99m pentetate
Mo
• CT scan – used as the localization of pathology DU: generation of Tc-99m sodium pertechnetate DU: brain imaging
2.7489
Indium-111 satumomab pendetide for administration or radiopharmaceutical assess renal perfusion and to estimate glomerular
• PET – used for treatment planning days
DU: imaging of metastatic disease preparation filtration rate
- uses radionuclides with short half-life time span 13
associated to colorectal and ovarian N Nitrogen-13 ammonia
cancer 9.97 DU: imaging of suspected or existing coronary Technetium-99m pyrophosphate
Radioisotopes
Iodine-123 iobenguane/ metaiodobenzylguanidine minutes artery disease (CAD) DU: osteogenesis
Half-Life Chemical Form and Use
11 (MIBG) 223 Radium-223 dichloride acute myocardial infarction
C Carbon-11 choline Ra
DU: metastatic pheochromocytoma or TU: treatment of castrationresistant prostate blood pool imaging agent
20.334 DU: indicated for PET imaging of patients with 11.4 days
neuroblastoma cancer, symptomatic bone metastases, and no gastrointestinal bleeding
minutes suspected prostate cancer recurrence
14 neuroendocrine tumor imaging known visceral metastatic disease
C Carbon-14 urea 82
Rb Rubidium-82 chloride Technetium-99m red blood cells
5,730 DU: detection of gastric urease as an aid in the 123
I Iodine-123 ioflupane 1.27 DU: PET myocardial perfusion agent DU: Blood pool imaging including cardiac first pass
years diagnosis of H.pylori infection in the stomach
13.22 DU: SPECT brain imaging to minutes distinguishing normal from abnormal and gated equilibrium imaging
Fluorine-18 florbetapir
hours assist in the evaluation of 153 Samarium-153 ethylene diamine tetra methylene Detection of sites of gastrointestinal bleeding
DU: indicated for PET imaging of patients with Sa
adult patients with suspected phosphonate EDTMP
suspected prostate cancer recurrence 46.3 hours
Parkinsonian syndromes (PS) DU: osteoblastic metastatic bone lesions Technetium-99m sestamibi
Strontium-89 chloride DU: detecting coronary artery disease by localizing
Fluorine-18 sodium fluoride 89
Iodine-123 sodium iodide Sr DU/TU: relief of bone pain in patients with painful myocardial ischemia (reversible defects) and
DU: PET bone imaging agent to delineate areas of
18 DU: evaluation of thyroid, function 50 days skeletal metastases that have been confirmed prior infarction (non-reversible defects)
F altered osteogenesis
and morphology to therapy evaluating myocardial function
109.771
Iodine-125 human serum albumin Technetium-99m bicisate planar breast imaging (abnormal palpable breast
minutes Fluorine-18 fludeoxyglucose
DU: indicated for use in the DU: localization of stroke mass)
DU: PET imaging agent to:
125 determination of the total blood
- assess abnormal glucose metabolism in I
plasma volume Technetium-99m disofenin Technetium-99m sodium pertechnetate
oncology 59.4 days
99m DU: acute cholecystitis DU: brain imaging*
- assess myocardial hibernation Tc
Iodine-125 iothalamate thyroid imaging*
- regions of abnormal glucose metabolism 6.0058
DU: indicated for evaluation of glomerular filtration Technetium-99m exametazine salivary gland imaging
associated with foci of epileptic seizures hours
DU: altered regional cerebral perfusion in stroke, placenta localization
Gallium-67 gallium citrate 131
I Iodine-131 human serum albumin localization of intra abdominal infection and blood pool imaging*
67 DU: use to demonstrate the presence/extent of:
Ga 8.0197 8.0197 days inflammatory bowel disease urinary bladder imaging*
- Hodgkin’s disease
3.26 days days DU: indicated for use in determinations of: nasolacrimal drainage system imaging
- lymphoma
- total blood and plasma volumes Technetium-99m macroaggregated albumin
- bronchogenic carcinoma
- cardiac output (MAA) Technetium-99m succimer
Reviewer in Nuclear Medicine – Sayo, Ana Lychees A. 17

DU: renal parenchymal disorders

90
Y
Technetium-99m methylene diphosphonate (MDP) Yttrium-90 ibritumomab tiuxetan
DU: detect skeletal metastases in cancer TU: treatment for Hodgkin’s
patients lymphoma (NHL); treatment for
previously achieve a partial or
Technetium-99m sulfur colloid complete response to first-line
DU: retriculoendothelial cells in the liver, spleen chemotherapy
and bone marrow* *adult and pediatric use
esophageal transit studies*
gastroesophageal reflux “Yourself is your own BOUNDARY. It’s either you lift
detection of pulmonary aspiration of gastric yourself to succeed or you push yourself down.”
contents*
peritoneo-venous (LeVeen) shunt patency – Sayo, Ana Lychees A.
localization of lymph nodes draining Soon to be RRT
06.25.18
Technetium-99m tetrofosmin
DU: Myocardial perfusion agent that is indicated Credits To:
for: Mr. Cedrick S. Modelo, RRT
- detecting coronary artery disease by localizing Ms. A. Oliva, RRT
myocardial ischemia (reversible defects) and Dean Abelardo L. Marva III
infarction (non-reversible defects)
assessment of left
ventricular function (left
ventricular ejection fraction
and wall motion)

Technetium-99m tilmanocept
DU: localization of lymph nodes draining

Technetium-99m diethylene triamine pentaacetic

acid (DTPA)
DU: renal function

Technetium-99m
hexamethylpropyleneamine
oxime (HMPAO)
DU: Alzheimer's disease

Technetium-99m hydroxyiminodiacetic acid

(HIDA)/
paraisopropyl iminodiacetic acid (PIPIDA)/
diisopropylacetanilido imjnodiacetic acid
(DISIDA)
DU: gall bladder imaging/cholescintigraphy
201 Thallium-201 chloride
Tl
DU: localization of myocardial infarction, ischemic
72.912
heart disease (atherosclerotic coronary artery
hours
disease), and localization of sites of parathyroid
hyperactivity
133 Xenon-133 gas
Xe
DU: Evaluation of pulmonary function and for
5.2475
imaging the lungs
days
lung ventilation imaging
90 Yttrium-90 chloride
Y
TU: radiolabeling, used for radioimmunotherapy
64 hours
procedures