Hina Aslam

Govt College University

Pakistan.

Nuclear Medicine and Imaging

Introduction:
Nuclear medicine is a medical
specialty involving the application of
radioactive
substances
in
the
diagnosis and treatment of disease.
It uses small amounts of
radioactive material to diagnose and
determine the severity of or treat a
variety of diseases.

Fast facts about Nuclear Medicine:

Cost effective.
Nearly 100 different NMI procedures.
Pinpoint molecular activity within the body.

Safest diagnostic imaging tests available.

Less amount of radiation received.
Painless and do not require anesthesia.
Approximately 4,000 board certified nuclear medicine

physicians and 15,700

technologists worldwide.

certified

nuclear

medicine

History of nuclear medicine & imaging:

1896
1936
1946
1950s
1954
1970s
1971
2011

Henri Becquerel discovered "rays from uranium.

John Lawrence made first clinical therapeutic
application of an artificial radionuclide phosphorus
-32 to treat leukemia.
Nuclear medicine gained public recognition as a
potential specialty.
Widespread clinical use of nuclear medicine.
The Society of Nuclear Medicine was formed in
Spokane, Washington, USA.
Most organs of the body could be visualized using
nuclear medicine procedures.
American Medical Association officially recognized
nuclear medicine as a medical specialty.
A fully integrated MRI/PET scanner is on market.

The scope of practice:

The scope of practice in nuclear medicine technology includes
the following areas and responsibilities:
Patient care
Quality control
Diagnostic procedures
Radiopharmaceuticals
Adjunctive medications
In vitro diagnostic testing
Operation of instrumentation
Imaging instrumentation
Non-imaging instrumentation
Radionuclide therapy
Radiation safety

Diagnosis using nuclear medicine:

A distinctive feature of
NMI is that the radiation source
is internal, administered directly
to the patient.
The gamma rays emitted
from the internal radiation
source are usually detected by
the gamma camera.
In the gamma camera,
gamma
ray
radiation
is
converted to light photons by a
collimator and a crystal, then to
an
electric
signal
by
a
photomultiplier, and finally to an
image by a computer.

Construction of Gamma ray camera

Techniques of diagnostic nuclear imaging:

There are several techniques of diagnostic nuclear medicine.

Two dimensional techniques

Scintigraphy

Three dimensional techniques

Single Photon Emission Computed Tomography

Two dimensional techniques:

Scintigraphy:
Scintigraphy is a form of
diagnostic
test
wherein
radioisotopes
are
taken
internally.
Then,
gamma
cameras capture and form
two-dimensional images from
the radiation emitted by the
radiopharmaceuticals.

Three dimensional techniques:

Single Photon Emission Computed Tomography:
SPECT is a 3D tomographic
technique that uses gamma
camera
data
from
many
projections
and
can
be
reconstructed
in
different
planes.

Maximum Intensity Projection

(MIP) of a wholebody positron
emission tomography (PET)

Positron Emission Tomography:

Short-lived
positron
emitting isotope (18F), is
incorporated
with
an
organic substance such as
glucose,
creating
F18fluorodeoxyglucose,
which
can be used as a marker of
metabolic utilization.
Images
of
activity
distribution throughout the
body can show rapidly
growing tissue, like tumor,
metastasis, or infection.

Practical concern in Nuclear Imaging:

The amount of radiation from diagnostic nuclear

medicine procedures is kept within a safe limit relative to
the established "ALARA" (As Low As Reasonably
Achievable) principle.
The radiation dose from nuclear medicine imaging
varies greatly depending on the type of study.

Common nuclear medicine

(unsealed source) therapies:
Substance

Condition

Iodine-131-sodium iodide

hyperthyroidism
and thyroid cancer

Yttrium-90-ibritumomab tiuxetan
(Zevalin) and Iodine-131tositumomab (Bexxar)

refractory lymphoma

131I-MIBG
(metaiodobenzylguanidine)

Adrenal gland tumor and nerve

tissue tumor

Radioactive Phosphorous P-32

certain blood disorders

Samarium-153 or Strontium-89

palliative bone pain treatment

Commonly used radiation sources

(radionuclides) for brachytherapy:
Radionuclide

Type

Half life

Energy

Caesium-137

-ray

30.17 years

0.662 MeV

Cobalt-60

-ray

5.26 years

1.17, 1.33 MeV

Iridium-192

-particles

73.8 years

0.38 MeV

Iodine-125

-ray

59.6 days

Palladium-103

-ray

17.0 days

27.4, 31.4, and

35.5 KeV
21 KeV

Ruthenium-106

-particles

1.02 years

3.54 MeV

Benefits vs risks of nuclear medicine:

Benefits:
It is unique including details on both function and structure.
It yield the most useful information needed to make a

diagnosis.
Nuclear medicine is less expensive.
It may yield more precise information than exploratory
surgery.
It offers the potential to identify disease in its earliest
stage.
Can detect whether lesions are likely benign or malignant.

Risks:
The radiation risk is very low compared with the potential

benefits. Because the doses of radiotracer administered

are small.

Allergic reactions to radiopharmaceuticals may occur but

are extremely rare and are usually mild.

Injection of the radiotracer may cause slight pain and

redness which should rapidly resolve.

Applications of Nuclear Medicine:

An Integral Part of Patient
studies can help diagnosis and treat
Physicians use radionuclide
visualize the structure and function
or system within the body.

Care Nuclear medicine

many diseases.
imaging procedures to
of an organ, tissue, bone

Some areas in which nuclear medicine is used include:

Neurological applications:
Stroke
Demonstrate Changes in AIDS Dementia
Evaluate Patients for Carotid Surgery
Investigate abnormalities in the brain, such as
seizures, memory loss and abnormalities in blood flow
Detect the early onset of neurological disorders
such as Alzheimer disease
Plan surgery and localize seizure foci
Evaluate Post-Concussion Syndrome

Oncologic applications:

Tumor Localization
Tumor Staging
Identify Metastatic Sites
Judge Response to Therapy
Relieve Bone Pain Caused by Cancer
Evaluate response to therapy
Detect the recurrence of cancer
Detect rare tumors of the pancreas and adrenal glands

Orthopedic applications:

Identify Occult Bone Trauma (Sports Injuries)

Diagnose Osteomyelitis
Evaluate Arthritic Changes and Extent
Localize Sites for Tumor Biopsy
Measure Extent of Certain Tumors
Identify Bone Infarcts in Sickle Cell Disease
Evaluate Bones for fractures, infection and arthritis
Evaluate for metastatic bone disease
Evaluate painful prosthetic joints
Evaluate bone tumors

Renal Applications:

Detect Urinary Tract Obstruction

Diagnose Reno vascular Hypertension
Measure Differential Renal Function
Detect Renal Transplant Rejection
Detect Pyelonephritis
Detect Renal Scars
Analyze native and transplant kidney function
Evaluate and follow-up urinary reflux in pediatric patients

Cardiac Applications:

Detect Coronary Artery Disease

Measure Effectiveness of Bypass Surgery
Detect Heart Transplant Rejection
Select Patients for Bypass or Angioplasty
Identify Surgical Patients at High Risk for Heart Attack
Measure Chemotherapy Cardiac Toxicity
Visualize heart blood flow and function (such as a
myocardial perfusion scan)
Assess damage to the heart following a heart attack
Evaluate treatment options such as bypass heart surgery
and angioplasty
Evaluate the results of revascularization procedures
Evaluate heart function before & after chemotherapy

Pulmonary Applications:

Diagnose Pulmonary Emboli

Detect Pulmonary Complications of AIDS
Quantify Lung Ventilation and Perfusion
Detect Lung Transplant Rejection
Detect Inhalation Injury in Burn Patients
Scan lungs for respiratory and blood flow problems
Assess differential lung function for lung reduction or
transplant surgery

Other Applications:

Diagnose and Treat Hyperthyroidism.

Chronic Biliary Tract Disfunction
Detect Acute Gastrointestinal Bleeding
Diagnose and Treat Blood Cell Disorders
Identify inflammation of the gallbladder
Identify bleeding into the bowel
assess post-operative complication of gallbladder surgery
Evaluate fever of unknown origin
Locate the presence of infection
Measure thyroid function to detect an overactive or
underactive thyroid
Evaluate for hyper-parathyroidism
Evaluate stomach emptying
Evaluate spinal fluid flow and potential spinal fluid leaks

In children, nuclear medicine is also used to:

investigate abnormalities in the esophagus, kidneys and

intestines.

evaluate the openness of tear ducts and shunts in the brain

and heart.

Limitations of General Nuclear Medicine:

Nuclear medicine procedures can be time consuming. It can

take hours to days for the radiotracer to accumulate in the

part of the body under study and imaging may take up to
several hours to perform.

The resolution of structures of the body with nuclear

medicine may not be as high as with other imaging

techniques, such as CT or MRI.

Safety from Nuclear Medicine:

These are among the safest diagnostic imaging exams available.
The amount of radiation from a nuclear medicine procedure is

comparable to, or often times less than, that of a diagnostic xray.

With most nuclear medicine procedures, the patient receives

about the same amount of radiation as that acquired in a few

months of normal living.

The nuclear medicine physician is able to select the most

appropriate examination for the patient's particular medical

problem, thereby avoiding any unnecessary radiation exposure.

Nuclear medicine in Pakistan:

In 1956, Pakistan Atomic Energy Commission (PAEC) was
established under the executive order of the Prime Minister of
Pakistan, Hussain Shaheed Suhrawardy.
The PAEC, the scientific body who is responsible for
establishing the nuclear power plants in the country, has sat up
a Nuclear Medicines laboratory.
The PAEC also sat up the nuclear medicines lab and
facilities throughout the country to fight against Cancer. PAEC
also sponsored the research program in the field of
radiochemistry and biochemistry.

PAEC also sat up the research institutes all over the

country, some of them are below:

Atomic Energy Medical Centre (AEMC)

Multan Institute of Nuclear Medicine and Radiotherapy (MINAR)
Institute of Nuclear Medicine & Oncology (INMOL)
Punjab Institute of Nuclear Medicines (PINUM)
Institute of Radiotherapy & Nuclear Medicine (IRNUM)
Centre for Nuclear Medicines (CENUM)
Nuclear Institute of Medicine & Radiotherapy (NIMRA)
Centre for Nuclear Medicine & Radiotherapy (CENAR)
Bahawalpur Institute for Nuclear Oncology (BINO)
Larkana Institute of Nuclear Medicine and Radiotherapy (LINAR)
Nuclear Medicine Oncology & Radiotherapy Institute (NORI)
Institute Of Nuclear Medicine Oncology & Radiotherapy (INOR)
Institute of Nuclear Medicine, Oncology and Radiotherapy