28/11/2024

Nuclear Medicine (Also known as Radio-Nuclide) Imaging

(RGY428)

Visiting Lecturer : Njoagwuani RN

Department of Radiography
University of Benin

Introduction to Nuclear Medicine imaging

The principle of Nuclear Medicine (Radio-Nuclide )Imaging
Molecular Imaging is a type of medical procedure that provides the visualization, characterization, and
measurement of biological processes at the molecular and cellular levels in living systems.
Nuclear Medicine is a type of molecular imaging, it is based on the imaging of the bio-distribution of a
radioactive compound.
 It provides physiological/functional information depicting blood flow.
 It measures functional, metabolic, chemical, and biological processes within the body and/or to
treat malignant tumours, cancer, and other diseases.
 It is based on the selective uptake of radioisotope, depending on the type of pharmaceutical used.
Conventional X-rays imaging vs Nuclear medicine imaging
X-ray imaging- The x-ray photons from the x-ray tube incident on a patient passes through the patient
and the details of inherent structure within the patient is registered on a receptor behind the patient
Nuclear medicine imaging – a gamma camera is used to form the image of the inherent structures
within the patient from the distribution of radioactivity after a radioisotope is administered to the
patient.

Nuclear medicine

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Conventional X-ray

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Administered Compound

Radioisotope + Pharmaceutical (Carrier/Tracer) = Radiopharmaceutical

Radiopharmaceutical are administered to the patients and the patient continually emits
radioactivity which is detected by a receptor (Gamma camera) and converts the energy to
discernible images (monitor).

Schematic representation of linkage of the carrier and the radioactive atom to form the radiopharmaceutical that
interacts with a specific biological target. (Boschi, A et al, 2019).

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Radioisotopes used in Nuclear medicine imaging

What are Radioisotopes/ Radionuclides or Radioactive isotopes?
Isotopes
Atoms of same element with same number of protons and electrons, but different neutrons.
OR Atoms of same element with same atomic number but different atomic mass.
e.g., Isotopes of Hydrogen: 1H1 - Protium 2H1 -Deuterium 3H1-Tritium

Radioactive isotopes/Radioactivity
Within the nucleus of some atoms, the nuclear force and the electric repulsion force, (two very
potent forces in nature) compete within the nucleus and this make the nucleus unstable.
Isotopes with unstable nuclei undergo spontaneous disintegration or decay over time to form
other isotopes (stable), with the release of energy in form of Radiation such as Alpha, Beta or
gamma rays of different energy levels. This process of decay with time is known as
Radioactivity. Radioactivity is measured in the unit Becquerel.
Becquerel is defined as the amount of decay/disintegration per second.

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Radioactive Decay Chains of a Radioisotope

Radioactive decay is the process by which an unstable atomic nucleus loses energy through
the emission of different types of radiations/particles (such as Alpha, Beta and Gamma rays)
to produce a stable atomic nucleus. When they release these energies, they produce
different radioactive daughter atoms, until a stable daughter atom is formed in the process.
The energies such as Alpha, Beta and Gamma rays emitted as part of the decay is useful
medically either for diagnosis or therapeutically.
The radioactive decay chain depicts the sequence of radioactive decays experienced by a
radioactive atom. It shows the different daughter atoms, and types of radiation emitted in
the process until a stable atom is formed. Each daughter isotope produced also have
different half-lives.

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Half-Life of a radioisotope
It is defined as the length of time it takes for given activity of the radioisotope to decay
to half of its initial activity.

Half-life of a Radioisotope is a unique property of the radioisotope. Some radioisotope

have half-lives of up to1024 years, while others are just few seconds.

This is a very useful property of radioisotopes used in imaging as it determine how long
a patient remains radioactive after the injection.

A Radioactive decay curve depicts the relationship between the Activity and the Half-
life of a radioisotope

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Generator systems for medical application of short half-lived

radionuclides
A Generator system is a convenient way for transporting and supplying short half-life
radionuclides for use in a medical setting. In principle the longer half-life Parent radionuclide
(Generator) decay to generate the short half-life daughter radionuclide that are the source of
radioactivity used for imaging purposes in a Nuclear medicine practice. Below are examples of
generators with their unique properties

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Production of Technetium (99mTc) - Cyclotron design and performance

Technetium (99mTc) is the most widely used radioisotope for nuclear medicine imaging. It is
a daughter isotope of the Molybdenum (99Mo) generator. 99Mo may be produced either in a
Reactor or from an Accelerator. 99Mo is primarily produced from the fission of Uranium
(235U). Though it can be produced from other sources such as another isotope of
Molybdenum (98Mo & 100Mo).

Cyclotron
A Cyclotron is type of Accelerator. It is an equipment that repeatedly propels a beam of
charged particles (protons) to very high speeds and energies, outwards from the centre of a
flat cylindrical vacuum chamber along a spiral path using electromagnetic fields. These
protons interacts with non-radioactive materials (stable isotopes), causing a nuclear
reaction, resulting in the production of radioactive isotopes such as Gallium and
Technetium.

The first cyclotron was invented by Ernest Lawrence in 1929–1930.

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Production of Molybdenum generators

Producing Mo-99 from a Reactor

Producing Mo-99 from an Accelerator(Cyclotron)

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Decay Schemes of Molybdenum with the generation of Technetium

99Mo is unstable and will further undergo decay by the emission of beta particles to produce

the unstable 99mTc. Technetium

Why is Technetium the most widely use radioisotope in imaging?

• It is readily available
• It has a half-life of 6 hours- by 4 half-lives patient is non-radioactive.
• It emits are mainly gamma photons of 140Kev which is the radiation used
for imaging in nuclear medicine imaging.
• It transition chemistry make it easy for labelling with wide range of
radiopharmaceuticals
• Easily sourced from Molybdenum with a half-life of 67Hrs which means it
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The Radio-pharmacy is the Hot Lab, where the radioisotope is labelled to the unique
Tracer required for a typical Nuclear medicine procedure. This process known as the
Reconstruction of the Radiopharmaceutical.

These processes occurs within the laminar air flow cabinet as shown below. The laminar
flow is sterile compartment, created by an enclosed air volume and filtration system
which helps to minimize contamination.

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Process of Eluting 99mTc from a 99Mo generator for daily use

The generator is supplied on a weekly basis to the hospital
in Lead shielded housing as shown in image “A”. Different
manufacturers have different housing designs. The lifetime
of the generator is determined by half-life and the calibrated
activity. It is stored in a shielded compartment in the
Laminar flow cabinet in the Radio-pharmacy.
• Throughout the life of the 99Mo generator there is
continuous decay of the 99Mo, producing loosely held
radioactive daughter (99mTc molecules).
A • Each morning an evacuated vacuum vial held in a
shielded holder is inserted on the needle on top of the
generator housing as shown in image “B”.
• The vacuum within the vial exerts a suction pressure
effect which makes normal saline from the Reservoir to
flow through the column (usually an Aluminium oxide
column on which the 99Mo Molybdate is bound to).
• The saline washes off the 99mTc molecules from the
Aluminium column and is collected in the vial as a
solution of 99mTc Sodium pertechnetate.
• This solution is used for the reconstitution of the
B Radiopharmaceuticals used for routine imaging in
Nuclear medicine imaging.
B: Schematic diagram of a Molybdenum Generator
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99mTc : Quality Assurance

After the 99mTc is Eluted from the Mo generator, a series of quality assurance tests
are done to check for impurities before it is administered to the patient.

Two key QA tests done include

1. Molybdenum breakthrough,, if Mo is present in the solution it may result in

additional/unnecessary burden for the radiation patient.
2. Test for aluminium impurities, same applies for aluminium impurities in the
solution for making the injected radiopharmaceuticals.

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Examples of radioisotopes and their diagnostic application

Some common Radioisotope used for medical diagnostic imaging

Radioisotopes Half life Tracer Study
Osteocis Bone studies
Renocis/Pentacis Kidney Studies
Technetium (99mTc) 6 Hrs
Cholediam Gall Bladder
Nanocis Lymphatic/Gastric Studies
Indium (111In) 2.8 days Octreoscan Neuroendocrine Tumour imaging

Iodine (123I &131I) 13.3mins & 60 days Thyroid imaging

Xenon (127Xe & 133Xe) gas 36 days & 5.3days LyoMMA Lung Function studies

Fluorine (18F) 110Min FDG PET Imaging

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Some case studies

Bone scan -Orthopaedics 3-Phase Bone scan
Fractures
Indication : Right foot pain , walks long distances ,
o/e tenderness along MTT bones ? stress fracture
Two x-rays of the Rt foot done @ 2weeks intervals
were reported as normal

Conclusion: Concerning for stressed injury

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1. Painful shin, No Hx of trauma. X-rays of the TIB/fib

normal

2. 2 and 3 Hx of fall on outstretched hands. Two X-rays

normal

The areas of high intensity is suggestive of

pathology (highly suspicious of fractures).

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Bone scan-Infection
Indication: Puncture wound to left index
finger 12/02/2015. Very tender proximal
phalanx with reduced ROM PIPJ ?
retained foreign body ?

Conclusion: Osteomyelitis

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Bone scan -Oncology

Whole-body bone scan for Staging in cancer Patients
Indication: 48yrs old male, Lower back pain. L/S x-ray normal, Incidental findings of raised
PSA

2010 2015

Conclusion: finding suggestive of

progressive metastatic deposit in the
vertebral bones

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2012

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