RT 314(FINALS)

Purpose of Radionuclide imaging

 To obtain the picture of the distribution of a relatively labeled substance within the
body after it has been administered to a patient

Single Photon Emission Computerized Tomography (SPECT)

 SPECT system comprises a conventional scintillation camera mounted on a
special gantry & connected to appropriate computer system
 Basic principle used by SPECT system – series of planar images are collected
while camera is rotated through either 180 or 360 around the patient
 Planar images are called projection images & used to create transaxial slice
images by filtered back projection of the data into the transaxial plane
 Two principal components of SPECT system
 Conventional scintillation camera system
 Computer
 Secondary components are
 Patient couch – tomographic beds are normally specially designed, & differ
considerably from conventional camera beds.
 Gantry – tomographic gantries are designed to rotate the camera head(s) about
the patient. In many cases, move under the control of microprocessor
 Rotation controller – this device controls the rotation of the camera around the
axis of rotation.
 Emergency stop and other patient safety devices – emergency stop button is
used to prevent motion, which might injure a patient.
 Position read-out devices – are devices whereby the angular position, radius of
rotation etc., are displayed

Five Basic Collimators

There are 5 basic collimator designs to channel photons of different energies,

to magnify or minify images, and to select between imaging quality and
imaging speed.

1. Parallel hole collimator

All holes are parallel to each other. Most common designs are Low
Energy All-Purpose (LEAP), Low Energy High-Resolution (LEHR)
and Medium- and High Energy Collimators.

LEAP collimators have holes with a large diameter. The sensitivity is

relatively high as where the resolution is moderate (larger diameter
holes allow more scattered photons). The average sensitivity of a
LEAP is approx. 500,000 cpm for a 1-uCi source, and the resolution
is 1.0cm at 10cm from the patent side of the collimator.
LEHR collimators have higher resolution images than the LEAP.
They have more holes that are both smaller and deeper. The
sensitivity is approx. 185,000 cpm for 1-uCi source, and the
resolution is higher with 0.65cm at 10cm from the patient side of the
collimator.

Medium Energy Collimators are used for medium energy photons of

nuclides such as Krypton81, Gallium67, Indium111. High Energy
Collimators are used for Iodine131 and F-18FDG. These collimators
have thicker septa than LEAP and LEHR collimators (mainly used
with Technetium 99m) in order to reduce septal penetration by the
higher energy photons.

2. Slanthole collimators

A variation of the Parallel hole is the Slanthole collimator, which has

all tunnels slanted at a specific angle. It generates an oblique view
for better visualization of an organ, which view is (partly) blocked by
other parts of the body. As an advantage, this collimator can be
positioned close to the body for the maximum gain in resolution.
3. Converging and Diverging Collimators
In a Converging collimator the holes are not parallel but focused
toward the organ. The focal point is normally located in the center of
the field of view (FOV). Some Converging collimators have the focal
point off-center near the edge of the FOV, (the so-called Half
Converging). The organ appears larger at the face of the crystal with
a Converging collimator. When the Converging collimator is flipped
over you get a Diverging collimator, generally used to enlarge the
FOV, for example used with portable cameras with a small crystal.
4. Fanbeam collimators
They are designed for a rectangular camera head to image smaller
organs like the brain and heart. When viewed from one direction, the
holes are parallel. When viewed from the other direction, the holes
converge. This arrangement allows the data from the patient to use
the maximum surface of the crystal. When the Fanbeam is flipped
over it is called a Single Pass Diverging Collimator used for whole
body sweeps.
5. Pinhole collimators
These cone-shaped collimators have a single hole with
interchangeable inserts that come with a 3, 4 or 6 mm aperture. A
pinhole generates magnified images of a small organ like the thyroid
or a joint. Most Pinhole collimators are designed for low energy
isotopes.
Quality Assurance (QA) of Imaging Instruments
 Embraces all efforts made to attain an ideal, efficient and reliable procedures, free
from all errors and artifacts
 It includes all testing procedures used to ensure that nuclear medicine instruments
are providing images of optimal image quality
 Determination of image uniformity – one troublesome problems with scintillation
camera
 Uniformity is usually tested on a daily basis by recording a flood-field image obtain
by exposing the detector to a uniform radiation field
 Bar phantoms – other test for evaluating spatial resolution and linearity
conducted less frequently

Image Quality in Nuclear Medicine

 There are many factors which influence whether a “good or bad” final picture is
obtained
 Some are outside the control of the technologist, such as the quality of
radiopharmaceutical
 Other are due to inherent limitations in the equipment or in the procedure itself
 Patient positioning and management are of great importance
 Main technical considerations are
 Collimators – energy, depth of focus, resolution, sensitivity
 Setting of pulse height analyzer
 Information density – scanning speed, total counts
 Display
 A “good” scan is one which most clearly provides the required diagnostic
information
 Three factors used to characterized Nuclear Medicine image quality
 Spatial resolution – sharpness or detail of the image or ability of the imaging
instrument to provide such sharpness or detail
 It includes collimator resolution, intrinsic resolution and image sharpness
 Two methods of evaluating spatial resolution are
 Subjective – visual inspection of images of organ phantoms/bar
phantoms
 Objective – quantitative, line spread functions, modulation transfer
functions
 Image contrast – refers to difference in density (or intensity)in parts of the
image corresponding to different concentrations of activity in the patient
 Noise (mottle or blur) – motion of the patient during the imaging procedure is
an obvious source of blur
 Gamma camera noise/blur may be in a form of
 Random noise – cause by statistical fluctuations in radioactive decay
 Structured noise – due to imaging system or instrument artifacts

Radioactive Iodine-131 Radiotherapy

 Radioactive I-131 in liquid form is used as an internal gamma ray emitter for the
treatment of thyroid disease
 Thyroid gland – synthesize, store and secrete the thyroid hormones thyroxine (T3)
& tri-iodothyronine (T4) and this is controlled by pituitary thyroid stimulating
hormone thyrotropin
 Iodine is an essential part of thyroid hormones
 Gland contains about 90% of total body iodine
 A therapeutic administration of I-131 might be 100-150 mCi
 Less than 30 mCi are used to the treatment of non-malignant condition of
hyperthyroidism (thyrotoxicosis)
 I-131 has also a biological half-life to be considered in addition to physical half-
life of 8 days
 Iodine is administered as an unsealed source, a proportion is accumulated in the
thyroid and the remainder is excreted in the urine
 In the normal person, over half of the iodine is excreted in the urine the first 24
hours after administration
 In 48 hours, three quarters has been excreted
 Effective half-life of radioactive I-131 takes into account both the physical and the
biological half-lives
 Two main hazards when nursing radioactive I-131 therapy
 Exposure from external radiation from the patient
 Exposure from radioactive contamination
 Contamination problem presents the major hazard
 Contamination occurs when the radionuclide spreads beyond its normal place of
confinement and this spread may occur through the air, by water, over floors etc.,
 Decontamination is the way to solve contamination problem
 Steps to be followed in dealing with radioactive spill
 Inform
 Contain/confine
 decontaminate

PROTECTING THE NUCLEAR MEDICINE TECHNOLOGIST

 NRC – Nuclear Medicine Regulatory Commission
 ALARA – As Low As Reasonably Achievable
 ALARA concept requires that nuclear medicine technologist use any reasonable
means to lower their exposure
 Monitoring personnel radiation exposure – is one way to assess that radiation
safety practices and ALARA concept are being observed
 It is important that personnel monitors be used consistently and handled properly
to ensure that the readings are an accurate reflection of the technologist’s radiation
exposure
 The body badge, which records exposure to the whole body, should be worn
between the shoulder and the waist in the area most likely to receive the greatest
radiation exposure
 Radiation exposure to the hands is best assess with the thermoluminescent
dosimeter designed to be worn as a ring
 The ring should be worn on the dominant hand with the thermoluminescent
crystal facing the palm, since the palm will be receiving the greatest radiation
exposure when manipulating radioactive materials or positioning patients
 When not in use, the ring and body badges should be stored in an area away from
radiation sources
 Consistent with ALARA, reasonable and cost effective means of decreasing
radiation exposure and protecting the technologist include the use of time, distance
and shielding

SHIELDING
 One of the most effective means of decreasing radiation – is to absorb most of
the radiation through the use of shielding around the radioactive source
 NRC requires that syringes be shielded during radiopharmaceutical kit
preparation and administration to the patient, unless the use of shield is
contraindicated for a particular patient
 It is estimated that dose equivalent to the index finger tip from an unshielded syringe
containing 20 mCi (740 MBq) of Tc-99m – is about 22 rem/hr (220mSv/hr)
 According to the NRC all vials containing radiopharmaceutical must be shielded
 Specially designed lead shields that fit around radionuclide generators are
necessary because a generators internal shielding is intended only to meet
Department of Transportation regulation for shipment of radioactive materials
 Additional shielding is required once the generator is set up for operation in the
nuclear medicine department
 Lead bricks can also be used to provide extra shielding around generators and
other areas where radioactive materials are stored
 An L-block shield should be used during the preparation of radiopharmaceutical
kits and unit doses
 The leaded glass windows permit the technologist to see the manipulation of the
equipment while affording some protection to the eyes and torso
 Placing a beta source in a lead shield causes the production of bremsstrahlung
radiation which results from deceleration of beta particles as they approach the
nuclei of the lead atoms in the shielding
 Placing a beta-emitting source in a lead shield can actually increase the amount of
radiation emitted
 Low density materials such as plastic or Lucite are recommended to absorb beta
radiation and to prevent the production of bremsstrahlung radiation

TIME AND DISTANCE

 Minimizing the time spent and maximizing the distance from the radiation source
– are other practical methods of reducing radiation exposure
 The greatest radiation exposures were obtained during the flood phantom imaging
and during gated cardiac studies
 Other procedures yielded exposures 4-6 times less than the two procedures
mentioned
 Difficult patients could as much as double the radiation exposure to the
technologist for a given imaging procedure
 Condition of the patient will dictate the proximity of the technologist and the
amount of time it will take to complete an imaging study
 Size of imaging rooms should be taken into consideration when planning a nuclear
medicine department
 Technologist also should become adept in using appropriate restraint devices to
hold patients in correct position for imaging
 Using long-handled tongs to move unshielded radioactive material is another way
to use distance for radiation protection
 Working efficiently with radioactive materials, practicing new procedures with
non radioactive materials and remaining in the “hot-lab” only for time necessary –
decrease radiation exposure by minimizing the time to technologist is exposed to
radiation

Procedure Radiopharmaceutical Administered Mean Time Mean

Activity (mCi) (minutes) Exposure
(mR)
Bone (whole- Tc-99m medronate 20 51 0.15
body imaging)
Gated geart Tc-99m pertechnetate 20 43 0.45
(rest only)
Flood phantom Tc-99m pertechnetate 5-8 26 0.58
quality control
Gallium Ga-67 citrate 4 61 0.06
imaging
Liver Tc-99m sulfur colloid 5 32 0.09
tomography
Lung perfusion Tc-99m MAA 3 13 0.11
Lung ventilation Xe-133 gas 10-20 16 0.13
Myocardial Tl-201 thallous 2.2 32 0.04
perfusion chloride
Thyroid I-131 sodium iodide 0.05 13 0.01*
imaging liquid
Thyroid uptake I-131 sodium iodide 0.05 6 0.01
liquid

INTERNAL EXPOSURE
 Technologist can receive internal radiation exposure by inhaling or ingesting
radioactivity or by absorbing it through the skin or wounds
 Internal exposure is controlled primarily by eliminating potential causes of internal
contamination
 This type of contamination may be avoided by abstaining from eating, drinking,
smoking or applying cosmetics in areas where radioactive materials are used
 Pipetting of radioactive solutions by mouth must be prohibited
 Protective clothing, especially gloves can minimize absorption through the skin
and simplify decontamination of spills occur
 Two radionuclide that are potential source of internal radiation exposure are I-131
and Xe-133
 1Ci (37 kBq) of I-131 delivers a radiation dose of 1.3 rad (0.013 Gy) to the thyroid
based on 25% thyroid uptake
 Wipe testing the outside of shipping containers will indicate where contamination is
present and will help ascertain the extent of iodine volatility
 Using the uptake probe, external counts of the thyroid are obtained
 Radioiodine capsules lessen the potential for iodine vaporization and thereby
decrease the radiation hazard associated with radioiodine solutions
 Xe-133 are another potential source of internal radiation exposure through
inhalation
 Familiarizing the patient with the equipment and the breathing technique required to
complete the study may increase patient cooperation

THE PREGNANT TECHNOLOGIST

 Fetus is limited to receiving not more than 500 mrem (5 mSv) during the gestation
period
 Individuals who receive more than 100 mrem (1mSv) to the whole body per month
should monitor their gonadal radiation exposure and use all appropriate
precautions to minimized this exposure
 Exposure that may exceed the 500 mrem (5 mSv) limit can be reduced before
pregnancy occurs
 Thermoluminescent badges rather than film badges are recommended to
monitoring radiation exposure
 Thermoluminescent Dosimeter (TLD’s) provide more accurate reading
 Badges do not give reliable readings below 50 mrem (0.5 mSv)
 Double badging – placing one TLD at the waist underneath the lead apron and the
other at the collar on the outside of the apron is one way to record the dose of
the fetus
 Exposure to the surface of the mothers abdomen overestimates the true radiation
exposure to the fetus
 The pregnant employee should be aware that up to 3% of all births involves serious
defects and that the adverse effects of radiation exposure at low dose levels

PROTECTING OTHER PERSONNEL IN THE WORK ENVIRONMENT

AREA POSTING
 Areas are classified as unrestricted or restricted
 Unrestricted areas – access by general public, anyone who occupies an area must
receive not more than 2 mrem (0.02 mSv) in any single hour not more than 100
mrem (1 mSv) in 7 consecutive days, and not more than 500 mrem (5 mSv) in a
year
 Restricted areas must be identified with one of the following signs
  Caution: Radioactive Materials – this phrase identifies any area which
radioactive materials are used to stored in amounts exceeding exempt
quantities
 Caution: Radiation Area – this words indicate an area in which a major part of
the body could receive greater than 5 mrem (0.05 mSv) in any one hour or
more than 100 mrem (1mSv) in 5 consecutive days
 Isolation rooms for radioiodine therapy and radiopharmacy hot labs are areas
that often require this sign
 Caution: High Radiation Area – this phrase indicates an area in which a major
part of the body could receive more than 100 mrem (1 mSv) in any one hour

AREA SURVEYS
 Surveys of areas in which radioactivity is used or stored are required by the NRC to
monitor external radiation exposure
 Daily monitoring with Geiger-Mueller (GM) counter or ionization chamber is
required in areas where radiopharmaceuticals are prepared and administered
 Weekly monitoring are required in areas where radioactive materials are stored
 Places where higher than background levels radiation should be wipe tested to
determine whether the contamination can be removed
 Decontamination of sites should be carried out if the wipe test indicate that
radioactivity is removable
 If contamination cannot be removed, taping a sheet of paper over the area will
remind others about the contamination
 NRC required that records of areas surveys and wipe test be maintained for 3
years

RADIOACTIVE SPILLS
Minor spills involving only a small area of low level of radioactivity, can be handled as
outlined
 Inform other people working in the area that spill occur
 Pour on protective clothing
 Confine the spill to a small area as possible
 If personnel are contaminated, they should be decontaminated as soon as possible
 Decontamination may involved simply the removal of contaminated clothing or
washing affected areas of the skin with mild soap or warm water
 Place all materials use to clean up the spill in plastic bags for monitoring and
disposal
 Monitor the area of the spill with the GM
 When decontamination is finished, removed all he protective wear and discard with
other contaminated materials
 Label all discarded materials as radioactive
 Notify radiation safety officer about the spill

Major radioactive spills involving high level of radiation exposure or widespread

contamination require special handling. Guidelines for major spills include
 Shut off ventilation, air conditioning and heating systems and fume hoods to contain
the spread of airborne contamination
 Remove contaminated clothing
 Evacuate personnel from affected area, close and lock all doors to area
 Post warning signs to inform others
 Begin personnel decontamination
 Notify the radiation safety officer

RADIOACTIVE WASTE DISPOSAL

 Decay in storage is an expensive method of disposal for short-lived, low-level
radioactive waste, such as generated in nuclear medicine department
 The waste is separated according to half-life and allowed to decay to background
levels
 Radiation waste that contains potentially biohazardous materials, is incinerated
after it has decayed to background radiation levels
 Disposal of certain soluble materials through the sewer system is allowed, providing
the amounts do not exceed calculated limits
 Long-lived (half-life greater than 65 days) radioactive waste is disposed of by
transfer to licensed commercial waste handlers

HANDLING RADIOACTIVE GASES AND AEROSOLS

 Radioactive Xenon gas and Tc-99m aerosol are both use for lung ventilation
imaging. Both require special handling to prevent the spread of radioactive
contamination
 Radioxenon is administered to the patient from closed system through a
mouthpiece, making a patient part of the system

PROTECTNG THE PATIENT

 For the purpose of radiation protection , the conservative assumption is that there is
no “risk free” level of radiation

PATIENT RECORDS
 The medical record of every patient for whom a nuclear medicine test is ordered
should be reviewed before any part of the test begins

PATIENT DOSES
 It is technologists responsibility to ensure that the correct patient receives the
prescribed radiopharmaceutical in the prescribe dosage and by appropriate route of
administration
 The technologist must verify or identify the patients first
 Next, technologist must ensure that the correct radiopharmaceutical is furnished
by carefully reading the label on the radiopharmaceutical vial or unit dose syringe