Basic principles

K - rays

 Imagi

g rooms harmacy

Gamma ameras Hot Lab Dose calibrators Generators

Radio

Waste

storage areas Reading room

 Emitted

energy from the nucleus of an atom Nucleus Unstable, Decays by Emitting Betas, Al has, and Gammas

 rate

of decay. Radioactivity measured in Curies (Ci)

1 Ci = 3.7 x 1010 disintegrations er second

Also

measured in Becquerels (Bq)

1 Bq = 1 disintegration er second

half life (T ): the time necessary for a radionuclide to be reduced to half of it existing activity. Charachterstic value for each radionuclide . Biological half life (Tb): time is taken to
Physical

eliminate half of administrated chemical by biological trans ort or elimination from s ecific site (elimination from body with urine).

effective half life (Te) : inco erates both hysical and biological

T 1/2 T 1

e= XT b/T +T b

Saline Charge

Evacuated Vial Sodium pertecnetate (Na TcO4)

Alumina Column 99Mo (1-16Ci) (67 hrs half life)

Direction of Saline Flow

 Technetium

-99m Non articulate emission 6 hrs hysical half life Predominate (98%) 140 KeV hoton energy Small amount of internal conversion (10%) Low toxicity

 After

IV injection : Tc 99m concentrate in salivary gland , choroid lexus ,thyroid gland and gastric mucosa . Excretion by GI and renal routes .

Dual head

Parallel hole
Low Energy Medium Energy High Energy

Diverging hole
Low Energy

Converging hole
Low Energy

Pinhole
Low Energy Multi-Energy

Light

NaI crystal Thalium activated sodium iodine

Gamma Ray

Light into Electricity

 Indications

Detection/Staging of Metastatic bone disease Benign bone disease Primary neo lasm Infectious rocesses Joint diseases Avascular bone disease Osteo orosis Trauma; Stress fractures, scaphoid fracture Metabolic disorders
Pain

with normal x ray

 No

special preparation Hydrate patient as much as possible and void frequently to reduce dose and background. Ask pt to empty bladder before the scan immediately . Remove any metallic object from all over the body.

Tc-99m MDP or HDP Adult dosage: 20-25mCi Route of administration IV Delay time post injection 2-3 hrs Camera any, dual heads are recommended for WB Collimators LEAP LEHR Peak 140 kv Window 15% Views : Anterior and posterior for whole bone .

 Mainly

to determine osteomylities versus cellulities . Also primary bone tumor and stresss fracture Specifec area of skeleton imaged : 1- blood flow (vascularity)for 1-2 min. 2- blood pool immediate post perfusion to 5 min 3- delayed image phase .after 2 hrs

at Tc 99m , 15% window LEAP collimators Immediate after IV injection Frame time : frame per 10 sec for 5 min. Delayed imaged 2-3 hrs post injection whole or limited bone scan .
Peak

Blood pool

Delay image

 Indications

: Demonstrate kidney size ,shape and position Demonstrate renal tissue function Demonstrate unvisualized kidney in US Demonstrate ectopic kidney Demonstrate space occupying lesion (SOL) Demonstrate renal scarring

99mTc-labeled DMSA (2,3-dimercaptosuccinic acid) is taken up by cells of the proximal tubule with about 35% of the injected activity being localized (bound) in the renal cortex by one hour and 50 % by 6hrs. Adult dose : 2-5 mCi I.V Post injection time 2 hrs Views: ( 5 min per view ) Ant ,post, LPO ,RPO Peak 140 kv. window :20% Collimator : LEHR

 Analysis

: Calculate divided renal function .

 Indications

: Evaluation of renal perfusion and function . Detection of renal collecting system obstruction Renal evaluation for pt with allergy to contrast media Evaluation for renal transplant pt. R/O of reflux

 99mTc-DTPA Diethylenetriaminepenta-acetic

acid (DTPA) Its molecular characteristics are such that it is cleared from the plasma purely by glomerular filtration 99mTc-MAG3 is preferred for routine renography but DTPA is used when estimating individual kidney GFR (in ml/min) from the renogram .

 99mTc-MAG3 (mercaptoacetyltriglycine) Mainly

tubular function agent Technetium-99m-MAG3 is now the agent of choice for all renographic procedures.

 Adult

dose : Tc DTPA :15-20 mCi I.V Tc-MAG3 : 8-10 mCi I.V Scanning time : immediate for 30 min. Lasix : After 15 min

Provides valuable diagnostic information in the distinction between renal pelvis dilatation and an actual renal pelvis obstruction.

Normal renogram, showing first, second, and third phases.

timeactivity curve (TAC)

perfusion first 2 min . 2 uptake from 2- 6 min 3 excerction after 6 min

140 kv Window 20% Collimators : LEAP Frames : 1F/2 sec for 2 min 1F/20 sec for 28 min o views : posterior ( ant . In case of transplant kidney )
Peak

 Indications

: Determine of thyroid size ,function and position Evaluation of thyroid nodules Quantitative thyroid uptake Detection of ectopic thyroid tissue Base line for treatment for hyperthyroidism Detection of remnant thyroid tissue post surgery.

Common radionuclides used in thyroid diagnosis and imaging Nuclide HalfHalf-life

Decay Process

I-131

(NaI) NaI)

I-123

(NaI) NaI)

TcTc-99m
(TcO4(TcO4-)

8 days Beta 364 keV 81%

13 hours EC 159 keV 85%

6 hours IT 140 keV 89%

Principle K Abundance

 No

fasting for Tc scanning Fasting at least 3 hrs before uptake study. Off iodine containing drugs including contrast media . The minimum interval between iodine administration and scanning from 1 to 2 weeks , and between IVU or CT should be 4-6 weeks.

 Iodine

containing medications Iodine containing foods Thyroid hormones Anti thyroid drugs Recent radiopharmaceuticals Recent iodinated contrast media

 1-

for sodium pertechnetate NaTcO4 3- 5 mCi I.V 2- for iodine uptake ( 50-100 Ci ) of I-131 orally ( scan + uptake ) I-123 sodium iodine(500 Ci) 4-6 hr post Oral or intravenous I-123 is cyclotron-produced and has a relatively short half-life of 13.6 hours, it is more expensive.

 Scanning

time : 99m TcO4 : 20 min post injection I- 131 : 24 hrs Peak 140 kv Tc and 364 kv for I-131 Window 20 % Collimator : pin hole for magnification Imaging time : 10 min per view Views : Ant , LAO , RAO

STANDARD

PATIENT

1 Capsule Method (Thyroid count thigh count ) * DCF Standard count room background * 100 = % uptake

Diagnostically, I-131 is generally reserved for whole body imaging in patients with known Hx of thyroid carcinoma

After initial therapy of differentiated thyroid carcinomas (thyroidectomy and iodine-131 ablation of residual thyroid tissue) follow-up is currently based on periodic whole-body scintigraphy.

Metastatic surveys 5-10 mCi for whole body imaging Imaging 3-7 days post