A Compilation of Procedural Manual - Reflective Journal and Learning Journal Presented To The Faculty

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NAME: JAMBOY, MARIA CHRISTELLE KEITH C. DATE: January 14, 2022

TOPIC: SUMMARY
SUMMARY
Nuclear medicine is a branch of medicine that focuses on the diagnostic,
therapeutic, and research applications of radioactive compounds known as
radiopharmaceuticals. Nuclear medicine studies, unlike radiologic tests, which assess
the existence of disease based on structural appearance, discover the cause of a
medical condition based on organ or tissue function. The radioactive material or traces
are often injected, swallowed, or inhaled into the body. A professionally trained
professional performs nuclear medicine. A nuclear medicine physician, a nuclear
medicine technologist, a physicist, a pharmacist, or a particularly trained technologist
make up this group.
The history of nuclear medicine started with George de Hevesy (1923) the “father
of nuclear medicine”. He is a radiochemist that helps in the development of radioactive
tracers. Follower by Ernest Lawrence (1931), it made de Hevesy expand his studies to
a broader spectrum of biologic processes by using phosphorus-32, sodium-22, and
other cyclotron-produced radioactive tracers. In 1946 Enrico Fermi developed the
nuclear reactor, radioactive elements began to be produced in nuclear reactors. This
nuclear reactor greatly extended the ability of the cyclotron to produce radioactive
tracers. With the addition of Benidict Cassen (1950) and Hal anger (1958), they
developed the first rectilinear scanner and gamma camera respectively.
Roy Edwards and David Kuhl in 1960 achieve the greatest advancement in the
field of nuclear medicine when they made a nuclear medicine imaging with the
development of a crude single-photon emission computed tomography (SPECT)
camera known as the MARK IV with this, it was now possible to create a three-
dimensional of organ function instead of two-dimensional images. More so, basic
nuclear physics includes the atom which is composed of varying numbers of protons
and neutrons, and the orbiting electrons. Which revolve around the nucleus in discrete
energy levels. Protons have a positive electric charge, electrons have a negative
charge, and neutrons are electrically neutral. Radionuclides are atoms that emit
radiation during radioactive decay in the form of alpha particles (α), beta particles (β)),
or gamma rays (γ). Most radionuclides reach the ground state by a variety of decay
processes, including alpha, beta, or positron emission and electron capture, among
others. The sort of particles or gamma rays emitted in the decay is determined by these
approaches.
Hence, SPECT or Single-photon emission computed tomography produces
images similar to those obtained by CT or MRI in that a computer creates thin slices
through a particular organ. Tomographic images can be created using one to three
gamma detectors. Tomographic systems are designed to allow detector heads to rotate
up to 360 degrees around a patient's body to collect "projection" image data, which is
then reconstructed by a computer in a variety of formats, including transaxial, sagittal,
coronal, planar, and three-dimensional representations. In addition, PET or Positron
emission tomography imaging uses positron emissions from particular radionuclides to
produce detailed functional images within the body. Positron radiopharmaceuticals have
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short half-lives ranging from a few seconds to a few hours and must be manufactured in
a cyclotron near the imaging facility.
On the other hand, imaging methods in nuclear medicine include static imaging,
Static imaging is the acquisition of a single image of a particular structure. This image
can be thought of as a "snapshot “of the radiopharmaceutical distribution within a part of
the body. Static images are usually obtained in various orientations around a particular
structure to demonstrate all aspects of that structure such as Anterior, posterior, and
oblique images. Whole-body imaging creates an image of the full body or a major body
part using a specially developed moving detector system. The gamma camera takes
data as it passes across the body in this sort of imaging. These systems may also
incorporate dual heads for anterior and posterior imaging at the same time. Dynamic
imaging, A dynamic or "flow" analysis of a given structure is often used to measure
blood perfusion to the tissue and can be viewed as a sequential or time-lapse image.
A radiopharmaceutical is a group of pharmaceutical drugs which have
radioactivity. Radiopharmaceuticals can be used as diagnostic and therapeutic agents.
Radiopharmaceuticals generally have two components, a radionuclide, and a
pharmaceutical. The pharmaceutical is chosen based on its preferential localization or
participation in the physiologic function of a given organ. A radionuclide is tagged to a
pharmaceutical. After the radiopharmaceutical is administered, the target organ is
localized and the radiation emitted from it can be detected by imaging instruments,
gamma cameras.
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TOPIC: SUMMARY
SUMMARY
Nuclear Medicine involves the safe use of unsealed radioactive nuclides for the
diagnosis and treatment of diseases. There are two areas in nuclear medicine and
these are the supervised and controlled areas. A supervised area is a place where there
is no radiation. This includes the offices like the reception area, where patients are
interviewed by the clerk; Consultation area, where the doctor consults their patients
after the procedure; and the pantry where most of the staff eat or spend their breaks.
Furthermore, the other area of nuclear medicine is the controlled area; this is the area
where PPE and TLD are used. It includes the radioimmunoassay room, this is where
blood tests are done, usually used to measure the concentrations of substances for
example TSH and NT4 by the use of antibodies; Hot labs is where the radioactive
materials are kept; Thyroid Uptake Room is an area where the thyroid of the patient is
measured to know if they have hyperthyroidism or hypothyroidism. The Treadmill area
is also included in the controlled area. Bone Densitometer Room is an area where they
are used to measure the bone mineral densitometer of the patient. This area is for the
patients who are prone to osteoporosis which are the old aged persons. On the other
hand, the nuclear medicine team consists of nuclear medicine physicians, medical
technologists, radiologic technologists, medical physicists, radiochemists, and a clerk.
During the Focused Group Discussion, our clinical instructor did a review of the
recorded video. She also discussed the HIDA scan or the hepatobiliary scan for
advance knowledge. It captures images of the liver, gallbladder, bile ducts, and small
intestine to aid in the diagnosis of medical disorders affecting those organs. A bone
scan is a nuclear imaging test that can be used to detect and follow a variety of bone
illnesses, including fractures, arthritis, and Paget's disease. A renal glomerular filtration
rate (GFR) scan uses a radioactive tracer to show the function and blood flow of your
kidneys
NAME: JAMBOY, MARIA CHRISTELLE KEITH

DATE: JANUARY 18, 2022
C.
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TOPIC: SUMMARY
Nuclear medicine is a branch of medicine that focuses on the diagnostic,

therapeutic, and research applications of radioactive compounds known as
radiopharmaceuticals. Nuclear medicine studies, unlike radiologic tests, which assess
the existence of disease based on structural appearance, discover the cause of a
medical condition based on organ or tissue function. The radioactive material or traces
are often injected, swallowed, or inhaled into the body. A professionally trained
professional performs nuclear medicine. A nuclear medicine physician, a nuclear
medicine technologist, a physicist, a pharmacist, or a particularly trained technologist
make up this group.
Bone scans look at the skeletal system to detect abnormalities such as

metastasis, stress fracture, or a loose prosthesis. A bone scan can detect a fracture two
years after an injury. Technologists may have to perform closely collimated radiographs
of skeletal “hot spots” as determined by bone scans.
For the cardiac studies, cardiac perfusion imaging, also called stress/rest cardiac
imaging is performed. The patient is given a cardiac radiopharmaceutical by injection
into an arm vein. The radiopharmaceutical is extracted from the blood pool into the
heart muscle within 2 minutes; SPECT images are then acquired. The patient is given a
second injection of the radiopharmaceutical during the stress portion of the test.
Stressing the heart is accomplished by having the patient run on a treadmill or by one of
a variety of different pharmacologic stressing agents and being given the
radiopharmaceutical injection a second time through an intravenous line. The
radiopharmaceutical injection is given at maximum cardiac stress as evaluated by
electrocardiogram (ECG) under the direction of a physician, nurse practitioner, or
physician’s assistant trained in these examinations. SPECT images are acquired after
each portion of the test, stress and rest, and compared with each other during reading
to determine infarction from ischemia.
Lung scans look at both the ventilation, or air flow, and perfusion, or blood flow,
of the lungs most commonly to identify a pulmonary embolism. The ventilation scan is
usually performed first followed by the perfusion scan. Both sets of images use
radiopharmaceuticals tagged to Tc 99m, so the number of counts from the perfusion
images must be tripled to overshadow the counts from the ventilation images. Thyroid
therapy with I-131 can be given to reduce the function of the thyroid. Hyperthyroidism
(overactive thyroid) results in a higher uptake reading, which may indicate Graves’
disease (toxic multiple nodular goiter, also known as Plummer’s disease) while a lower
thyroid reading indicates hypothyroidism (thyroid with reduced activity); the uptake can
be so low the thyroid cannot be visualized during imaging.
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Nuclear medicine team consists of nuclear medicine technologist, responsible for
patient safety and accurate documentation, nuclear medicine physician, licensed to
acquire and use radioactive materials, radiation safety officer, reviews the imaging
protocols used in the nuclear medicine department and reviewing all dosimetry records
for the facility, and health physician, calibrates and maintains imaging equipment and
run audits on the record keeping of the nuclear medicine department.
PET is a unique, three-dimensional, tomographic imaging technique that is

capable of demonstrating the biochemical function of the body’s organs and tissue and
it is important because the biochemical metabolism and function of organs and tissues
can reveal whether they are diseased or healthy. The PET scanner is composed of
many individual detectors arranged in a series of circular arrays designed to detect
simultaneously the 511-keV (0.511-MeV) photons to create an image. This detection
process is also called coincidence imaging.
PET requires a specialized device called a cyclotron to produce the positron-

emitting elements. The cyclotron accelerates subatomic particles such as protons in a
circular orbit to very high energies and then directs them into a nonradioactive target
material then the end result is the production of a radioactive material. The radioactive
material is dependent on three things: (1) the type of target material used, (2) the
particle being accelerated, and (3) the energy to which particles are accelerated.
PET is a valuable tool for assessing the metabolism of tumors. PET scans for
this application generally are done to determine the initial sites of cancers and to see
whether cancer has spread to other areas of the body. PET may be used for the initial
diagnosis, for staging of a malignancy, and as a follow-up technique for determining
response to treatment. An increase in glycolysis (increased use of sugar by the cells) in
a specific organ or region of the body is an indicator of malignancy.
PET can be used to assess how coronary artery disease affects the normal
functioning of the heart. A PET perfusion tracer such as 13N-ammonia or rubidium
chloride Rb 82 is used to investigate whether certain areas of the heart are receiving
insufficient blood flow. Many newer PET/CT scanners are equipped with 64 slices,
which can permit CT angiography or calcium scoring to be done at the same time as
PET perfusion scanning.
PET can be used to investigate the location of seizure sites in epileptic patients
who are unresponsive to drug therapy; this is accomplished by measuring changes in
how the brain uses the sugar tracer (FDG) in the affected areas. PET can detect seizure
sites within the brain, regardless of whether or not a patient is experiencing a seizure at
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the time of scanning. Electroencephalography often is performed immediately after FDG
is injected to determine whether any epileptic activity is present.
PET brain mapping techniques are able to minimize the risk of injury to a key
motor or sensory region of the brain by allowing evaluation of patients before surgery so
that the locations of these vital areas can be characterized. PET can be used to
characterize central nervous system tumors in the same way that it is used for imaging
tumors elsewhere in the body. Actively growing brain tumors concentrate FDG. In
addition to FDG, another tracer, 11C-methionine, can be used to assess amino acid
metabolism. This agent is much more sensitive to the presence of even low-grade
tumors. By combining 11C-methionine scanning with FDG, it is possible to detect the
presence of a tumor and to determine how aggressive it is. PET scanning is capable of
evaluating and characterizing various types of dementias such as Alzheimer’s disease.
Using FDG, PET can measure glucose metabolism in the brain. PET can help to
confirm the diagnosis of Alzheimer’s disease and to monitor the effects of treatment.
GLOSSARY
Alpha particle: Helium nucleus that consists of two protons and two neutrons.
Attenuation: Process by which radiation is reduced in intensity when it passes through

some material.
Becquerel (Bq): Unit of radioactivity in SI (International System of Units).
Beta emission: Release of high-energy beta particles through disintegration of certain

radioactive nuclides.
Beta particle: Ionizing radiation with characteristics of an electron emitted from the
nucleus of a radioactive atom.
Biologic half-life: Time required for an organism to eliminate half of an administered

dose of any substance through normal processes.
Collimator: Device used to confine the elements of a beam within an assigned solid
angle.
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Contamination (radioactive): Deposition of radioactive material in any place where its
presence is not desired.
Count: External indication of a device designed to enumerate ionizing events.
Curie (Ci): Traditional or standard unit of radioactivity.
Cyclotron: Device for accelerating charged particles in a spiral fashion to high energies
via an alternating electrical field.
Daughter: Synonym for a product of decay.
Decay: Spontaneous transmutation of a radionuclide that results in a decrease in the

number of radioactive events in a sample.
Disintegration (nuclear): Spontaneous nuclear transmutation characterized by

emission of energy or mass or both from the nucleus.
Dose: Amount of radiopharmaceutical given to a patient.
Electron capture: Method of radioactive decay that involves the capture of an orbital
electron by its nucleus.
Equilibrium: Stage in a reaction in which the concentration of the reactive species is no

longer changing.
Fusion imaging: Nuclear medicine scans can be superimposed, using software or

hybrid cameras, on images from modalities such as CT or MRI. Also referred to as
image fusion or coregistration
Gamma rays: High-energy, short-wavelength electromagnetic radiation emanating from

the nucleus of a nuclide.
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Half-life: Time required for disintegration of half of the original activity of a radioactive
nuclide.
In vitro: Outside of the patient; occurring or being in an artificial environment, such as a

test tube or a culture plate.
In vivo: Inside of the patient; describes a process or reaction that occurs within the
patient.
Infarction: Development and formation of a localized area of necrosis within a tissue.
Ion: Atom or chemical radical that bears an electrical charge that is either positive or
negative.
Isotope: Nuclides of the same element that have different atomic mass (neutrons) but
the same atomic number (protons).
Microcurie (µCi): Unit of radioactivity equal to one-millionth of a curie.
Millicurie (mCi): Unit of radioactivity equal to one-thousandth of a curie.
Parent: Radionuclide that yields another nuclide during disintegration.
Pharmaceutical: Any chemical substance intended for use in the medical diagnosis,
cure, treatment, or prevention of disease.
Radioactivity: Spontaneous disintegration of an unstable atomic nucleus, resulting in

the emission of ionizing radiation.
Radionuclide: Type of atom whose nucleus disintegrates spontaneously.
Radiopharmaceutical: Group of radioactive drugs used in the diagnosis and treatment

of disease.
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Scintillation: Emission of light flashes from certain materials as a result of interaction
with ionizing radiation.
SPECT (single photon emission computed tomography): Imaging system that uses
one to three gamma detectors to produce tomographic images of an organ or structure.
Technetium 99m: Common radionuclide of technetium used for 90% of nuclear

medicine procedures.
NAME: JAMBOY, MARIA CHRISTELLE KEITH C. DATE: JANUARY 21, 2022
TOPIC: SUMMARY
Overactive thyroid (hyperthyroidism) and certain kinds of thyroid cancer are

treated with radioactive iodine (RAI). The radioactive iodine has an 8-day half-life. It is
possible to use a modest dose or a high dose of radioactive iodine for treatment.
Grave's disease, which can induce hyperactive thyroid or hyperthyroidism, is treated
with a low dose therapy of 5 to 15 mCi. Thyroid cancer is classified as papillary or
follicular, and high dosage treatment ranges from 15 to 200 mCi.
Thyroid cancer is classified into two types: papillary cancer, which is the most
prevalent and appears as a solid mass, and follicular cancer, which is more aggressive.
The patient would only be admitted for one day for a low-dose diagnostic procedure and
then be allowed to return home after obtaining a specific amount of radiation safety
teaching. Thyroid scans using 99m Tc are used in SPECT CT screening techniques to
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identify the degree of hyperthyroidism, while TSH, FT4, and even Anti-TPO are used in
RIA screening processes, depending on the doctor's discretion.
In RAI therapy low dose treatment, after the patient is admitted for a day, the
next day the patient may be discharged provided with radiation safety instructions. The
screening procedures are the following: for SPECT/CT with t99m is thyroid scan, to
determine the severity of hyperthyroidism, for radioimmunoassay (RIA) is thyrotropin
(TSH), free thyroxine (FT4) but some doctors order anti-TPO. In RAI therapy high dose
treatment, 15 mCi to 200 mCi is used to treat thyroid cancer and metastatic thyroid
cancer. The patient is admitted for 3 days, for visiting relatives, the time is limited for
visiting hours and minors are not allowed. Pregnant are not allowed inside the isolation
room. The patient can be discharged when radiation levels are 25 uSv per hr at 1 meter,
which will be monitored by a radtech, and the patient will have a post RAI imaging after
discharge and after seven days. Radiation safety instructions will be given prior to
discharge and to be observed for one month.
The thyroid scan is used to evaluate the amount of the residual thyroid to be
ablated and to estimate the dose to be given after thyroidectomy. After radioactive
iodine treatment, a post-radioactive iodine therapy scan is performed to determine what
was treated and whether there is any sign of metastatic thyroid cancer. After 6 months
of RAI therapy, a total body scan is performed to see if the thyroid cancer has returned.
It's used to see if there are any leftover working thyroid tissues following a
thyroidectomy, as well as to find out if there are any functioning thyroid cancers,
metastases, or recurrences after radioactive I-131 ablation therapy.
Furthermore, the patient must stay in a separate room with a separate bathroom, the
patient must not be cuddled, kissed, and relatives must keep a one meter distance from
the patient, when using the toilet flush twice and if possible use disposable utensils, the
patient must not share utensils and must not cook or prepare food, and the patient can
visit the Nuclear Mecca.
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TOPIC: SUMMARY
The topic that was discussed was all about the Elution and Reconstitution of
Radiopharmaceuticals. This process is known as ‘eluting the generator’ and the
resultant eluate is used to compound the radiopharmaceuticals. In making technetium
using a generator, first, we need to wear proper PPE, TLD (Thermoluminescent
detector, thyroid shield, and lead gown- to protect from radiation exposure. Only
evacuated vials and salines are to be used for elution.
Furthermore, to avoid confusion with other radioactive elements, always
remember that Molybdenum 99m is the mother chemical of Technetium. After that, fill
the outlet with saline and place the protected vial on the other. Following that, the liquid
in the vial should be sucked by the machine, and the outcome is technetium (while
waiting for 5-10 mins). Finally, using a dosage calibrator, measure the technetium yield
to determine the precise yield.
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We were taught four different sorts of radioactive compounds for reconstitution.
First is the DTPA pharmaceutical; to see whether the kidneys are working properly.
Second is the MDP; a bone scan to see if there are any bone mets, bone inflammation,
or fractures. Third is the techida which is the most common patients are children. For
the diagnosis of congenital disorders of the liver, gall bladder, and bile ducts. Lastly, the
DMSA; Bone scan extract with tc99m 20mci using a syringe and placing it in a MDP vial
to mix is the first stage in the reconstitution process. The dosage calibrator is used to
measure the dose in the second phase.
Therefore, Radiopharmaceuticals are unique medicinal formulations containing
radioisotopes which are used in major clinical areas for diagnosis and or therapy.
TERMINOLOGIES
ELUTION- as the removal of the technetium by the passage of saline.
MDP- methyelene diphosphonate; was formulated as a complex of 99mTc for skeletal
imaging.
DTPA- Diethylenetriamine pentaacetate; is a medicine that can bind to
radioactive plutonium, americium, and curium to decrease the amount of time it takes to
get radioactive plutonium, americium, and curium out of the body.
DMSA- is a radionuclide scan that uses dimercaptosuccinic acid (DMSA) in assessing
renal morphology, structure and function.
TOPIC: SUMMARY
The topic that was discussed was all about the Radioactivity, Radionuclides and
Radiopharmaceuticals. It started with the basic isotope notation in which explains that
atom is the collection of protons, neutrons and electrons. The protons and neutrons are
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found in the nucleus, N is a common symbol for the number of neutrons in a system. Z
is concerned about the quantity of protons (also called the atomic number). The total
number of nuclear particles, or atomic mass, is just the sum of N and Z, and is
represented by A. The chemical symbol X is used to denote the atoms of an element
that have the symbol X in their name.
Furthermore, Isotopes attempting to reach stability by emitting radiation are
radionuclides. Stable nuclides, most have even numbers of neutrons and protons. While
nuclides with odd numbers of neutrons and protons are usually unstable. Nuclear
instability may result from either neutron or proton excess. Nuclear decay may involve a
simple release of energy from the nucleus or may actually cause a change in the
number of protons or neutrons within the nucleus. When decay involves a change in the
number of protons, there is a change of element. This is termed a transmutation.
On the other hand, Half-life usually refers to the physical half-life, which is the amount of
time necessary for a radionuclide to be reduced to half of its existing activity. The
physical half-life (Tp) is equal to 0.693/λ, where λ is the decay constant. Thus, λ and the
physical half-life have characteristic values for each radioactive nuclide. In evaluating
the choice of a radionuclide to be used in the nuclear medicine laboratory, the following
characteristics are desirable first is Minimum of particulate emission, Primary photon
energy between 50 and 500 keV, Physical half-life greater than the time required to
prepare material for injection, Effective half-life longer than the examination time,
Suitable chemical form and reactivity, Low toxicity and Stability or near-stability of the
product. Also, the different types of radiopharmaceuticals used in nuclear medicine was
discussed in which;
RADIONUCLIDE RADIOPHARMACEUTICAL USES
Carbon-11 Acetate
Prostate
Nitrogen-13 Ammonia
Cardiac perfusion
Oxygen-15 Gas Brain

perfusion
Fluorine-18 FDG (fluorodeoxyglucose) Tumor,

cardiac viability, brain metabolism,
infection
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Sodium Bone
Gallium-67 Citrate
Infection, tumor
Krypton-81m Gas
Pulmonary ventilation
Rubidium-82 Chloride
Myocardial perfusion
Technetium-99m Diphosphonate Bone
DISIDA (diisopropyl iminodiacetic acid) Biliary
DMSA (dimercaptosuccinic acid) Renal cortical
DTPA (diethylenetriamine pentaacetic acid) Renal dynamic, brain, lung
ventilation
ECD (ethyl cysteinate dimmer) Brain perfusion
Glucoheptonate Brain, renal dynamic
HMPAO (hexamethylpropyleneamine oxine) Brain perfusion
HMPAO labeled white cells Infection
Labeled red cells GI blood loss, cardiac function,
hepatic hemangioma
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MAA (macroaggregated albumin) Lung perfusion, leVeen
shunt
patency, intraarterial liver.
MAG3 (mercaptoacetyltriglycine) Renal
Mebrofenin Biliary
Pertechnetate Thyroid, salivary glands,

Meckel
diverticulum, testicular.
Sestamibi Myocardial perfusion, parathyroid, breast
Sulfur colloid Liver/spleen, red bone marrow,

esophageal
transit, gastric emptying
Sulfur colloid (filtered) Lymphoscintigraphy Teboroxime

Myocardial
perfusion Tetrofosmin Myocardial

perfusion
Indium-111 DTPA CSF flow,

gastric liquid emptying
Oxine labeled white cells Infection
Pentetreotide Somatostatin receptor tumors
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Iodine-123 Sodium Thyroid MIBI
(metaiodobenzylguanidine) Pheochromocytoma,
adrenal medullary, neural crest tumors
Iodine-131 Sodium Thyroid

cancer
Xenon-127 or 133 Gas Lung

ventilation
Thallium-201 Chloride Myocardial

perfusion
TERMINOLOGIES
Alpha-particle emission - an alpha (α) particle, consisting of two protons and two
neutrons, is released from the nucleus, with a resulting decrease in the atomic mass
number (A) by four and reduction of both Z and N by two.
Beta-particle emission - is a process for achieving stability and is found primarily in

nuclides with a neutron excess.
Electron capture - occurs in a neutron-deficient nuclide when one of the inner orbital
electrons is captured by a proton in the nucleus, forming a neutron and a neutrino.
Isomeric transition - Any process in which energy is given off as gamma rays and in
which the numbers of protons and neutrons are not change.
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TOPIC: BONE SCAN
The topic that was discussed in the two minutes video is all about how radiologic
technologists perform the bone scan procedure. A bone scan is an imaging technology
that creates three-dimensional images of the bones by using radioactive materials. A
bone skin uses a technique called single photon emission computed tomography, or
SPECT, which uses a radioactive substance and a special camera to produce 3d
images of the organs and other internal structures. Unlike an x-ray, which shows what
internal structures look like, spec shows how these structures work, for example.
Before the procedure begins, there is no specific patient preparations but only to
inform the physician during the appointment if you are pregnant or suspected to be as
well as a breastfeeding mom. There are two parts the nuclear medicine bone scans the
injection and the scan in the first part you will receive an injection of a small amount of
radioactive material into a vein, you will be asked to return to the imaging area in about
two hours. for the second part of your scan the radioactive materials need time to be
absorbed by the bones during the two-hour wait you may eat whatever your doctor has
allowed the radioactive material is eliminated from your body through urine it is
important that you drink lots of fluid to stay hydrated.
During the scan, the radiologic technologist first performs a Topogram or a scout
scan which serve as the baseline of the procedure. This is a two-dimensional X-ray
image acquired using a CT scanner. The topogram is routinely used in clinical CT
scanning only to define the scan range of the subsequent CT scan.
TERMINOLOGIES
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 Bone Scan - a bone skin is a type of nuclear medicine tool that uses trace amounts
of radioactive substances called radiotracers to evaluate physical and chemical bone
changes.
 Topogram - is routinely used in clinical CT scanning only to define the scan range of
the subsequent CT scan.
NAME: JAMBOY, MARIA CHRISTELLE KEITH C. DATE: FEBRUARY 2, 2022
TOPIC: BONE SCAN
The topic that was discussed in video was the continuation of the topic bone
scan. It also clarifies the process of doing a bone scan procedure. In which, before the
procedure begins, there is no specific patient preparations but only to inform the
physician during the appointment if you are pregnant or suspected to be as well as a
breastfeeding mom. There are two parts the nuclear medicine bone scans the injection
and the scan in the first part you will receive an injection of a small amount of
radioactive material into a vein, you will be asked to return to the imaging area in about
two hours. for the second part of your scan the radioactive materials need time to be
absorbed by the bones during the two-hour wait you may eat whatever your doctor has
allowed the radioactive material is eliminated from your body through urine it is
important that you drink lots of fluid to stay hydrated.
During the scan, the radiologic technologist first performs a Topogram or a scout
scan which serve as the baseline of the procedure. This is a two-dimensional X-ray
image acquired using a CT scanner. The topogram is routinely used in clinical CT
Furthermore, bone scan has also its advantages and disadvantages. The main
advantage of a bone scan is that it is a whole-body evaluation in one test in one
radiation exposure. It is also safer since it only uses low radiation exposure by having a
sensitive evaluation. While the disadvantages of this procedure are that it needs
radiopharmaceuticals and gamma camera that is not widely available in some areas, it
has also low specificity and it is more expensive compared to the other procedures.
On the other hand, it is also discussed in the video that the most widely used
radiopharmaceuticals is TC-99m labeled diphosphonates. Thus, although findings on
bone scan are non-specific, its monostotic or polyostotic status and anatomical
distribution can provide important clues to the differential diagnosis.
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TERMINOLOGIES
 RADIOTRACERS- radioactive materials called radiopharmaceuticals or radiotracers
to help diagnose and assess medical conditions. Radiotracers are molecules linked
to, or "labeled" with, a small amount of radioactive material. They accumulate in
tumors or regions of inflammation.
 BONE SCAN - a bone skin is a type of nuclear medicine tool that uses trace
amounts of radioactive substances called radiotracers to evaluate physical and
chemical bone changes.
 TOPOGRAM - is routinely used in clinical CT scanning only to define the scan range
of the subsequent CT scan.
NAME: JAMBOY, MARIA CHRISTELLE KEITH C. DATE: February 14, 2022
TOPIC: SUMMARY
For today’s lecture, the video discussion was explained by the Nuclear Medicine
Technologist. The said discussion was all about the various Nuclear Imaging
Procedures that were usually done within Nuclear Medicine facilities. The first
procedure discussed was about the Bone Scan. It’s indications include bone mets,
osteomyelitis, etc. It is used with the pharmaceutical MDP with a 25 mCi dose and a
waiting time of 2-3 hours. Images are acquired either through whole body or static
acquisition. The second procedure discussed was about the Renal Scan GFR. It’s
indications include eval. of renal perfusion and function, evaluation of renal trauma, etc.
It is used with the pharmaceutical DTPA with a 15 mCi dose. Images are acquired
through dynamic acquisition.
Thirdly, the Renal Scan Tubular Function. It’s indications include diagnosis of
acute/chronic pyelonephritis, evaluation of renal cortical scanning, etc. It is used with
the pharmaceutical DMSA with a 5 mCi dose and a waiting time of 2-3 hours. Images
are acquired through static acquisition. Patients are usually pediatric. The fourth
procedure discussed was about the Parathyroid Imaging. It’s indications include
detecting and localizing parathyroid adenomas. It is used with the pharmaceutical
Sestamibi with a 25 mCi dose and a static acquisition with timeframes of after 15 mins,
30 mins and 3 hrs.
On the other hand, the fifth procedure discussed was about the Thyroid Scan. It’s
indications include evaluation of palpable nodules, diagnosis of grave’s disease, etc. It
is used with the pharmaceutical Tc-99m with a 1-3 mCi pediatric and 3-10 mCi adult
dose. Images are acquired through static acquisition. The sixth procedure discussed
was about the GI bleeding study RBC tagging. It’s indications include localization of GI
bleeding sites and non-GI bleeding sites. It is used with the pharmaceutical PYP with a
25 mCi dose and a waiting time of 2-3 hours. Images are acquired through dynamic
acquisition.
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Next was about the Meckel’s Scan. It’s indications include detection and
localization of Meckel’s diverticulum. It is used with the pharmaceutical Tc-99m with a
15 mCi dose. Images are acquired through static acquisition with timeframes of 5 mins,
10 mins, 15 mins, 30 mins, 45 mins and 1 hr. The eighth procedure discussed was
about the Hepatobiliary Imaging. It’s indications include diagnosis of acute cholecystitis,
evaluation of biliary tract obstruction, etc. It is used with the pharmaceutical Techida
with a 6 mCi dose. Images are acquired through static acquisition with a timeframe of 5
min, 10 min, 15 min, 30 min, then 1 hr.
Futhermore, the ninth procedure discussed was about the Lung Perfusion. It’s
indications include diagnosis of pulmonary embolism. It is used with the pharmaceutical
MAA with a 6 mCi dose. Images are acquired through static acquisition. The tenth
procedure discussed was about the Lung Ventilation. It’s indications include diagnosis
of pulmonary embolism and evaluation of ventilation. It is used with the pharmaceutical
DTPA with a static acquisition. Lastly, Bone Densitometry was discussed. It measures
the density of bones and helps diagnose osteoporosis. It uses Dual Energy Xray
Absoptiometry.
Thus, this discussion was all about the different procedure in lined with nuclear
medicine. This won’t be possible without the nuclear medicine personnel and staff. Each
procedure offers different therapeutic and diagnostic benefits to patients.
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NAME: JAMBOY, MARIA CHRISTELLE KEITH C. DATE: February 14, 2022
TOPIC: SUMMARY
A video about the Radiation Therapeutic Unit was the second video we saw
today. We were first introduced to Maam Novi, the unit's leader, who then outlined the
steps for a patient's admission to the facility. To avoid nausea/vomiting during the
therapeutic procedure, fasting should be done within 2 hours. To assist the radiation
subside, patients should increase their water intake and bathe twice a day after
receiving the drug. Following that, we were shown a room with a red light indicating that
a process is in progress, as well as movable lead shields, monitoring devices, lead
robes, and a thyroid shield. The therapy room was also shown to us.
On the other hand, the next topic was the distinction between an ITU nurse and a
ward nurse. ITU nurses have a lower load than ward nurses, according to the unit's
leader, because wards often deal with a lot more cases. ITU nurses do not deal with the
same number of cases; instead, they are assigned to specific cases. The nuclear
medicine department was then shown to us. Maam Karen, a nuclear medicine
technologist, explained the difference between a nuclear medicine medical technologist
and a laboratory medical technologist. The primary difference was that in nuclear
medicine facilities everything they handle is radioactive as compared to a normal
laboratory which does a certain risk compared to that. We were also shown the other
areas such as the extraction area which is used to extract blood samples, the waiting
area for radioactive patients, the RIA room where the radiopharmaceuticals are stored
such as the MDP, DTPA, PYP, MIBI, DMSA and the TSH and FT4, the hot lab room
where the elution and reconstitution of radiotracers are done. Within the room is the
fumehood and lead block/pots/shields, with the dose calibrator used to determine the
radioactivity of the pharmaceutical.
Furthermore, we were also given a demonstration of how to utilize the dose

calibrator and generator. The technologist then proceeded to elute MDP while wearing a
lead gown, thyroid shield, and gloves. He started with the saline water (left) and the
vacuum chamber. The sterile water will now be eluted within the generator, and
technetium will be produced in the evacuated vial. Its process is dependent on the
mother element. The mother element of technetium-99m is molybdenum-99. Once that
is done, always make sure to wear gloves and then put it into the dose calibrator. Then
comes the reconstitution: first, remove the isotope with a syringe, then inject the
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pharmaceutical with the MDP vial, and last, acquire a new syringe and withdraw from
the newly reconstituted radiopharmaceutical before placing it in a lead dosage holder.

DATE: February 16, 2022
C.
TOPIC: TOMOTHERAPY
For today’s video presentation, it mainly talks about the Tomotherapy Room.
Because the Tomotherapy Room is a limited space, only those who have been
authorized entry are permitted to utilize it. The room's labyrinth entry was created to
lower the amount of lead shielding used as well as the dose of scattered photons.
Tomotherapy is a cutting-edge method of administering radiation therapy that can be
used to treat almost any ailment. It has been used to treat both common cancers like as
breast cancer and prostate cancer, as well as unusual cancers.
On the other hand, tomotherapy has a variety of advantages in terms of effectively
regulating the radiation dose within the body, ensuring that it is only directed at the
cancer cells we want to spare and not at healthy tissue. We will take a CT scan on a
regular basis before starting the operation. This will allow us to see if the target we were
supposed to treat has moved or changed in any manner. As a result, you may rest
comfortable that if you come in for tomotherapy treatment, we will target you to the
millimeters where you were intended to be targeted. The therapy will not be more than
2, 3, or 4 millimeters off center, which may not seem like much.
Futhermore, the following are the different instrument used in tomotherapy

procedure. First is the Head Step, it is used in treating head cases especially in brain
cancer or brain metastasis cancer treatment, in order to immobilize the patient while
undergoing the treatment. Second, the Pillows which ensures the patient comfortability
in positioning, because the treatment lasts 13 days. Third is the Breast Step, which is
used in breast cancer patients; patients’ position is in supine. Fourth is the Belly Step,
which is used to treat rectal cancer patient; prone position. Lastly, the Van Lock which is
used for patients who has problems in spine.
Terminologies:
 Tomotherapy - is a radiation therapy modality, in which the patient is scanned
across a modulated strip-beam.
 Maze Entrance – a type of entrance is radiation therapy room that is capable to
minimize the use of lead shielding and in order to reduce the dose of the scattered
photons.
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C.
TOPIC: SUMMARY
For today’s recorded video presentation, it has two parts; the DRMC’s Radiation
Therapy virtual room tour and the CT scan Simulation and Planning. DRMC is the
cancer center for Mindanao, the center has a lot of areas. First is the triage area, where
the patient will be interviewed for Covid-19 restrictions and what are the things needed
in order to enter the center. Also, the patients’ vital signs will be collected here. Next is
the waiting area, the cashier/billing area, receiving area; where patients are received as
well as their requirements and also where patients are interviewed by their physicians.
Lastly, the insertion area is where the insertion of the IV line to the patient will be done.
On the other hand, the machines that will be used in the radiation therapy room
is also discussed. CT scan machine is used for the simulation and imaging purposes.
Next is the brachytherapy area, it is composed of recovery room where patients stay
here for recovery after the procedure and the preparation area, where apparatus, sterile
equipment and applicators for brachy can be found.
Furthermore, High-Dose Rate (HDR) Brachytherapy room is composed of Lead
Door, C-Arm (GE) which is used machine for the imaging, the Controlled Area and
Sterile where the Anesthesia Machine, OR (Operating Room) Light, and the HDR
Machine is found. Console for the HDR Machine (Left Side) and CCTV Monitor (Right
Side), the Palliative Performance Scale (PPS) for brachytherapy which is used by the
physicist if to do planning and lastly the Victoreen Survey Meter which serve as the
thermoluminescence dosimeter of the staffs.
LINAC console has four main monitors, the ARIA System V 15.5 Software where
patients’ information, patients scheduling, treatment records, and treatment plans done
by the physicist can be found. The Treatment Screen which has a software that shows
all the patients scheduled for that day and also the treatment plans by the physicist as
well as the parameters. The DRR Screen where the images obtained appears. The
CCTC monitor is used to monitor patient for the whole duration of the treatment. And
also, there is a Motion control where we can see and monitor the machine inside the
room.
Molding room, it is where we modify or made a custom block depending on what
part or area that is needed to treat. Electron blocks is use to shield normal tissues from
electron beam in therapeutic radiation treatment or the radiation therapy. In making the
custom block, the materials used are the Styrofoam block, electrically heated wire which
serve as the cutter, the heater, the pattern which serve as the outline of the treatment
field, the moulder, which comes in different sizes the 20x20, 14x14, 25x25 and 10x10.
These blocks are made from Cerrobend alloy containing Cadmium and Lead. The
electron applicator, it is used to hold the electron block which also comes in different
sizes, 6x6, 10x10, 14x14, and 20x20. In determining the size of the electron applicator
to use prior to the treatment, it depends on the plan of the radiation oncologist and the
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physicist. In radiation therapy, there are two types of energy used. The photon energy is
used for deep seated tumors while the electron energy which is used for superficial
tumors.
The next discussion is the CT Scan Simulation and Planning. CT Simulation is
where patients are imaged on a CT Scanner specially configured to acquire three
dimensional images used for treatment planning. The CT scanner allows the radiation
oncologist to localize the tumor and surrounding areas that will require radiation
treatments.
Immobilization devices is used to make sure the patients stay in the treatment
position during the course of the treatment. There are six immobilization devices
mentioned in the video, first is the headstep and thermoplastic mask which is used for
patients that undergo procedures in the head area. The wingstep for chest patient,
breast step for breast cancer patients, the bodyfix which is used in lower abdomen
cases and the bellystep which is used for rectal cancer cases and lastly, the feet fix for
the lower extremities’ cases.
Moreover, there are five techniques used in radiation therapy. The Single Beam
uses high energy single beam photon. The Two parallel opposed fields is the simplest
combination of two fields directing the same axis from opposite sides. The Isocentric
Setup which uses isocenter as the center of all fields. The Four field box for 3D CRT; to
deliver a conformal dose of radiation to the tumor while spearing the normal tissue
surrounding the tumor as much as possible. Lastly, the Coplanar & Non-Coplanar
beams. Coplanar uses many fields but pass one uniform axis while the Non-Coplanar
uses multiple axis points; in the case on the video, it uses tangential to avoid hitting the
heart or minimize the dose in the lungs.
TERMINOLOGIES:
 LINAC- is the device most commonly used for external beam radiation
treatments for patients with cancer. It delivers high-energy x-rays or electrons to
the region of the patient's tumor.
 SIMULATOR- additional device to assist with the preparation of external
radiation therapy.
 IMMOBILIZATION- to prevent, restrict, or reduce normal movement.

C.
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TOPIC: SUMMARY
For today’s recorded video presentation, it talks about the two special techniques
in radiation therapy. The Intensity Modulated Radiation Therapy (IMRT) and Image
Guided Radiation Therapy (IGRT). IMRT (Intensity Modulated RT) is a three-
dimensional conformal radiotherapy technique which optimize the dose distribution by
varying the radiation fluence across the beam. The delivery is fully dynamic using the
sliding window technique, where each pair of leaves form a small moving window. This
way, the dose is modulated by the size and speed of these windows.
On the other hand, the IGRT (Image Guided RT) is a technique of imaging the
patient anatomy on the treatment machine just prior to each daily dose. It can happen
that while patient is undergoing a treatment the technician can also take images. IGRT
or image-guided radiation therapy is used in conjunction with IMRT and RapidArc for
precise patient positioning. This innovative radiation treatment technology provides
high-resolution three-dimensional images to visualize tumor sites throughout the course
of treatment. In doing so, incremental adjustments to the patient's position can be made
thereby increasing the accuracy of each dose of radiation. IGRT typically allows patients
to breathe normally during their treatment and combines advanced imaging and
treatment capabilities into a single machine.
Thus, in most treatment delivery is verified using variants portal vision system
mounted on a robotic arm the IMRT field is delivered without the patient the predicted
dose from the Eclipse heylia's treatment planning system is compared with the
measured dose from portal vision different tools permit the analysis and comparison of
the two dosematrices treatments are performed by delivering a number of treatment
fields in the following prostate treatment. An example of 5mi RT fields will be delivered
the delivery is fully dynamic using the sliding window technique where each pair of
leaves form a small moving window this way the dose is modulated by the size and the
speed of these windows looking inside the patient shows us the dose contribution of this
first field the target volume and the organ at risk are clearly visible the second field is
delivered from a different direction. Again, the beam moves quickly over the
organ at risk in order to limit the dose delivered to it the treatment continues with the
third field the fourth field and the fifth field.
TERMINOLOGIES:
 IMRT (Intensity Modulated RT) - is a 3D conformal radiotherapy technique

which optimize the dose distribution by varying the radiation fluence across the
beam.
 IGRT (Image Guided RT) - a technique of imaging the patient anatomy on the
treatment machine just prior to each daily dose.
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C.
TOPIC: SUMMARY
For today’s recorded video presentation, it talks about Radiation Therapy

Treatment Planning in Davao Doctors Hospital. First is the CT planning procedure,
there are three steps; where patient will be assessed by the doctor about the anatomy
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to be examined and releasing of the doctor’s request, checking of the accessories to be
used because it depends on the case and the anatomy of interest, and lastly the patient
will be instructed on what to do before and after the procedure. Patient instructions
varies in its cases, for pelvic cases ensure that the bladder is in full condition. Also,
instruct the patient not to remove the tapes after the procedure because it serves as the
reference during the set-up.
Next is the CT simulation. It has three main components to consider, first is the
positioning. In positioning the patient, ensure that the shoulders, spine and pelvis are at
the same level it should be aligned and symmetrical. Patient should be in its most
comfort position since this position will be used in the entire treatment. Second is the
patient instruction, in pelvic cases, full bladder is required to distend the intestine to
avoid diarrhea. There should be no necessary movements during the treatment to avoid
poor quality image that is why the patient is immobilized. Third, CT marker is present in
the patients’ body for planning reference and also the patient will be using a heated
thermoplastic mask which is shaped on the patients’ head during the treatment.
During the procedure, the patient will be positioned and the technologist will start
scanning. Topogram scan will be performed first because it serves as the basis of the
procedure, ensure that the patient’s body is aligned. For gyne patients, the spine and
the pelvis should be aligned together. For chest patients, the shoulders should be
straight, and for head patients, the head should not be in tilt position. After scanning the
patient, the image obtained will be sent to the physicist for contouring and planning.
After contouring and planning which takes almost four hours, the image will be sent to
the console computer to make this as a basis in reproducing the positioning.
As well as that, radiotherapy workflow
should be strictly followed by the radiotherapy personnel. It starts with the patient
evaluation, where the patient is being evaluated by the doctor. Second, patient set-up
and immobilization this will happen during the CT simulation. Third, the target and
organs-at-risk delineation where patient contouring is done. Fourth, the radiotherapy
planning and dosimetry and validation, this is the time where the doctor prescribes the
total amount of dose to be given to the patient. Fifth, the treatment simulation, this is
where the radiologic technologist performs the position of the CT scan and must be
reproduced in the treatment room. Lastly, the treatment delivery.
Along with this, the dose to be provided to
the patient must not exceed the tolerance dose to avoid organ malfunction or even
organ failure. The following are the tolerance dose in each organ;
 Spinal Cord: 50-60Gy
 Heart: 43-50Gy
 Normal Lung: 20-30Gy
 Esophagus: 50-55Gy
 Bone Marrow: 25-35Gy
 Skin: 30-40Gy
 Liver: 35-40Gy
 Bone: 65-70Gy
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Moreover, for the treatment planning the electron densities can be seen in the
image serve as the basis for the computation. During the contouring, the basis would
be the GTV (Gross Target Volume); ITV (Internal Target Volume); PTV (Planning
Target Volume); and CTV (Clinical Target Volume).
TERMINOLOGIES:
 TOPOGRAM- The CT scout view (topogram) is a 2-dimensional X-ray image
acquired using a CT scanner. The topogram is routinely used in clinical CT
 WORKFLOW- is a sequence of tasks that processes a set of data.
 GROSS TARGET VOLUME- is defined as the gross palpable or
visible/demonstrable extent and location of malignant growth.
 INTERNAL TARGET VOLUME- is the volume encompassing the CTV, which
takes into account the fact that the CTV varies in position, shape and size.
 PLANNING TARGET VOLUME- is the CTV plus a margin to allow for
geometrical uncertainty in its shape and variations in its location relative to the
radiation beams due to organ mobility, organ deformation, and patient setup
variations.
 CLINICAL TARGET VOLUME- is defined as the tissue volume that contains the
gross tumor volume (GTV) and subclinical microscopic malignant lesions.
NAME: Jamboy, Maria Christelle Keith DATE: February 28, 2022
TOPIC: SUMMARY
For today’s activity, we watch a video about Brachytherapy. We were introduced
what is brachytherapy which is a therapy in a short distance that is from the Greek work
brachy means short. This is which the sources or radiation are placed at close proximity
to or distance at the target volume. It is a type of internal radiation therapy in which
seeds, ribbons, or capsules that contain a radiation source are placed in your body, in
or near the tumor. Brachytherapy is a local treatment and treats only a specific part of
your body. It places radioactive sources inside the patient to kill cancer cells and shrink
tumors. This allows your doctor to use a higher total dose of radiation to treat a smaller
area and avoid delivering radiation to some surrounding organs.
The dose is delivered continuously either over a short period of time or a

temporary implant, or over a lifetime of the source to a complete decay or permanent
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implants. This permanent implant is to deliver the dose to the tumor during a period of
several weeks or months and it is most common use for prostate cancers. Wear
suitable shielding such as a lead gown, thyroid shield, and lead goggles before entering
a Brachytherapy storage room. All of the radioactive materials are kept in the
brachytherapy storage room. To handle the radioactive sources, they are placed within
a storage box and handled with tongs. Cs-137 is the radioactive source used in DDH.
Radiation levels are measured using a survey meter. The radioactive source is
contained within a metallic cylinder and transported to the brachytherapy chamber via a
cart. Straws with radioactive sources and a Fletcher-suit applicator are required for
inserting a radioactive source in a low dosage brachytherapy technique.
Furthermore, the applicator is inserted into the vagina of the patient and since the
applicator has three tubes, two of the straws are inserted into the left and right tubes or
the outer tubes which is called ovoids, and the remaining one is inserted into the middle
tube which is called tandem, and then after inserting the straws you close them. In
inserting the radioactive source, the radiologic technologist must be fast in order to
avoid being exposed in radiation. Just follow the principle of Time, Distance, and
Shielding. Low Dose Rate (LDR) Brachytherapy involves permanently or temporarily
placing radioactive seeds inside or near the tumor to deliver radiation over an extended
period of time, while HDR involves inserting flexible needles into the tumor to deliver a
high dose of radiation over a period of a few minutes.

DATE: March 2, 2022
C.
TOPIC: SUMMARY
A video regarding cervical cancer was shown to us today. It's a cancer that
develops in the cells of the cervix, which connects the uterus to the vaginal canal. Most
cervical cancer is caused by different strains of the human papillomavirus (HPV), a
sexually transmitted infection. Brachytherapy is typically used in conjunction with EBRT
as part of a comprehensive cervical cancer treatment plan. Shown in the video first
were the accessories used for patients with cervical CA cases are pelvic board and
thermoplastic mask. Before any CT scan procedure, we must have the request form
with indicated patient position and accessories to be used. In the CT scan room, when
turning on the CT scanner, the green laser lights will light which is used for patient
centering and alignment.
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On the other hand, before starting the procedure, the patient couch should be
prepared and for the patient position, the patient is in supine with both arms up. They
also showed the patient preparation in cervical CA cases, in which the patient is
instructed to drink 1 liter of water and then wait for 20-25 minutes. The thermoplastic
mask on one patient depends on the plan on how long it will be used, in some cases it
will be 25 days.
In the CT scan control room is where you can see the current position of the
patient and will be monitored if the spine of the patient is aligned and also the superior
and inferior border of the spine. Before placing a thermoplastic mask to the patient,
make sure to obtain a topogram image to ensure alignment of the patient’s spine.
Topogram (a CT scout view) is a 2D x-ray image acquired using a CT scanner. In the
video, it showed the lateral view of the patient. After the topogram and some correction
on the patient position, the thermoplastic mask is heated then cools it off then placed on
the pelvic area of the patient. CT markers are placed on the pelvic mask for reference.
After the CT scanning, the image is sent to the physics room, where the treatment
planning is done and this is also where the image is edited, what technique to be used
on the patient, and where the contouring happens and treatment planning. After the
physics room, will then proceed to treatment and setting up the patient. The patient is
positioned inside the room and then scanning and setting up the FOV or field of view for
the treatment.
Furthermore, a yellow and other color outline, which is the OAR or organs at risk,
and a red outline, which is the PTV or planning target volume, were shown in the film.
After selecting the FOV, the machine begins scanning with a 150-second scanning time.
One image was from tomotherapy, while the other was from a CT scan. They must now
be matched. We can accept the image once it has been replicated with the exact patient
location, and then proceed to treatment. Proceed to the status console to begin after
some program finalization.
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DATE: March 3, 2022
C.
TOPIC: SUMMARY
For today’s discussion we tackle about brain cancer. It's a type of cancer in which
cells in the brain grow out of control and develop tumors. Depending on the type of
tumor, cancerous or malignant brain tumors can grow very quickly. They can cause
problems on the body's functioning and even put one's life in jeopardy. However, brain
cancer is a rare occurrence.
Secondary brain tumors are commonly treated with radiotherapy. Its goal is to
decrease the tumor, relieve pressure inside your skull, and alleviate your symptoms.
Patient evaluations, CT scan simulation, target and OAR delineation and planning,
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treatment simulation, and treatment delivery are all part of the radiation workflow for a
brain CA case. We'll need the equipment for the CT simulation, as well as patient
placement and immobilization, which will be provided by the thermoplastic mask.
Overlay, headmask, and pillow are the accessories.
Furthermore, there should be no tilting in the patient's position, which is supine
with arms at the side. The headmask is then applied to immobilize the patient, and the
scan is limited to the vertex of the skull to the base, with a 2cm margin on all sides. The
image is submitted to the physics room for contouring and planning after the simulation.
The patient's location in the treatment simulation is identical to that in the CT simulation.
There are parameters in the control console that you can store after you've correctly
positioned the patient for therapy delivery. To avoid headaches, make sure the patient
received dexamethasone or steroids.
With that, photon and megavoltage radiation are used in radiobiology and
fractionation. In some cases, such as when the tumor's histology is unknown, the total
dose can be adjusted (melanoma 5000 cgy, lymphomas 3000 cgy). The overall dose is
usually 4000 cgy in 20 fractions over 5 weeks. The complete brain is irradiated with a
form obstructed at the base of the skull to shield the eyes and include the cerebral
contents with a 2 cm margin all around and opposed laterally.
TERMINOLOGIES:
 TUMOR- is a solid mass of tissue that forms when abnormal cells group
together.
 PHOTON- is a tiny particle that comprises waves of electromagnetic radiation.
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 MEGAVOLTAGE- Megavoltage (MV) X-ray beams generated from a linear
accelerator are commonly used to deliver the prescribed radiation dose to the
tumor while minimizing the dose to the surrounding healthy tissues.
 FRACTIONATION- is a separation process in which a certain quantity of a
mixture (gas, solid, liquid, enzymes, suspension, or isotope) is divided during a
phase transition, into a number of smaller quantities (fractions) in which the
composition varies according to a gradient.
 RADIOBIOLOGY- is a field of clinical and basic medical sciences that involves
the study of the action of ionizing radiation on living things, especially health
effects of radiation.
NAME: JAMBOY, MARIA CHRISTELLE KEITH DATE: March 14, 2022
TOPIC: CT SCAN
Today, we watched videos about CT scan and had FGD to highlight the
important parts of the video. Sir Earl, the assigned instructor for today, narrated some of
his personal experience on CT scan in an actual clinical setting so we can have ideas
on the day-to-day events and the diversity of patients we might soon encounter.
A CT scan may be recommended by your doctor to check for blood clots, broken
bones, brain tumors (cancerous tumors), infection (sinus infection), internal injuries and
bleeding (ruptured spleen), and heart and vascular disease indications (heart disease).
CT scan is a painless diagnostic technique that creates cross-sectional images of bones
and tissues within your body using x-rays and computers. It helps clinicians determine
the optimal location for surgery, biopsy, or radiation therapy, as well as monitor cancer
or heart disease treatment and recovery. The patient will lie on a table that slowly
moves through the tunnel during a CT scan. A large ring called a gantry will rotate
around the patient’s body as you pass down the tunnel. A tube will discharge x-ray
beams from the gantry, and detectors will monitor the amount of radiation absorbed by
the body.
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The x-ray rays will hit the body from a variety of angles. While the gantry spins,
the detectors will send information to a computer. In other situations, the doctor may
use contrast dye to examine where a disorder is located inside the body, which will help
them decide how to treat it or see how well the treatment is progressing. Your
esophagus or stomach will be highlighted if you were given a contrast dye drink. The
blood vessels, gallbladder, liver, and urinary tract will all be highlighted if you had an
injection. The big intestine will be emphasized if you have had a barium enema. If
contrast dye was used during the surgery, the patient might return to normal activities.
Take a lot of water.
They scan the Uninterrupted Power Supply with Neusoft 128 slice CT scan in the
video given, the DRMC virtual tour (UPS). The control room houses the operating
console, a computer for PACS (picture archiving and communication system), and
access to the hospital's integrated system. In the T scan room, there is a gantry, table,
lead gown, patient's gown, preparation area, and high-pressure syringe. The operational
console has a keyboard, monitor, mouse, buttons to access the gantry from the inside,
and a button and monitor for the high-pressure syringe. We must undertake a warm-up
operation after turning on the machine because of the machine's quality control so that
the tube can be properly warmed up before doing any procedures.
NAME: JAMBOY, CHRISTELLE KEITH DATE: March 15, 2022

TOPIC: DRMC CT SCAN
Today we had a virtual tour in which Sir

Merchard James P. Alonzo, the technologist in charge, took us for a walk throughout
DRMC and their CT facilities. First, off was the demonstration of the LINAC machine
and peek at the Nuclear Medicine department. Second, they showed the MRI room,
which is a 1.5T PHILIPS MRI machine. With that, they also explained the basics before
condoning any procedure. For each procedure, we must identify the patient parameters,
double-check the procedure, check the patient’s creatinine result (and current swab
result as per covid-19 protocols). Secure the contrast media waiver, which must be
signed, and then proceed with the procedure.
In the last parts of the virtual tour, the

DRMC’s Toshiba 16-slice CT scan machine was introduced and used to show the
practice of an abdominal case in which the scan is from the head to the femoral. To
avoid extravasation, the DRMC employs a Bolus contrast injection. In a supine position,
with arms at the side and feet first. Then, align both hips and arms up for a relaxed
position or relaxed pose, and check the isocentric or collimator line. Explain the
breathing instructions to the patient and then execute the scan. When the line is
dislodged or the line is fine, use a saline solution of 10cc, then apply the bolus as the
artery is very fragile and easily extravasated). For the portal venous phase, add 30cc
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and patient instruction before injecting contrast media with contrast communication to
the patient.

DATE: March 10, 2022
C.
TOPIC: REFLECTION
The basic principles of CT scanning and data acquisition are the focus of our discussion
today. The information obtained from the passage of x-ray beams through an area of
anatomy is processed by a computer in computed tomography. The resulting images
are cross-sectional. The elimination of superimposed structures, the capacity to identify
minor changes in density of anatomic structures and anomalies, and the higher image
quality are the key advantages of CT over conventional radiography.
Each CT slice represents a specific plane in the patient’s body. The thickness of the
plane is referred to as the Z axis. The Z axis determines the thickness of the slices. The
data that form the CT slice are further sectioned into elements: width is indicated by X,
while height is indicated by Y.
The different parts of a CT scan machine and its functions was also discussed:
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1. Gantry - ring-shaped part of the CT scanner. It houses many of the components
necessary to produce and detect x-rays. The CT gantry can be tilted either
forward or backward as needed to accommodate a variety of patients and
examination protocols. In addition, the gantry houses the following parts:
a. Slip rings
b. Generator
c. Cooling systems
d. X-ray source
e. Filtration
f. Collimation
g. Detectors
1. Console - master control center of the CAT scanner. It is used to input all of the
factors related to taking a scan.
2. Patient table - The patient lies on the table (or couch, as it is referred to by some
manufacturers) and is moved within the gantry for scanning.
NAME: JAMBOY, MARIA CHRISTELLE KEITH C. DATE: March 21, 2022
TOPIC: SUMMARY
For today’s activity, we are given a topic to study. The chapter two which
discusses about Data Acquisition and chapter three which is about Image
Reconstruction. The computer in CT uses reconstruction algorithms to solve the many
mathematical equations required to convert information from the detector array to
information suitable for image display. Fortunately, understanding the specific
mathematics involved is not required to comprehend the image reconstruction process.
An algorithm is a precise set of steps that must be followed in a specific order in order to
solve a problem. The majority of computer programming is based on algorithms.
The equipment components used for image construction are hard drive, input
and output device, CPU, and memory. The hard disk (or hard drive) is an essential
component of all CT systems. The number of images that the hard disk can store varies
according to the make and model of the scanner. It is important to remember than an
enormous amount of information is collected for each image. When hard disk space
capacity is reached, existing data must be deleted before any new data can be
acquired. The CPU is the component that interprets computer program instructions and
sequences tasks. It contains the microprocessor, the control unit, and the primary
memory. In the past the CPU design frequently used for CT image reconstruction was
the array processor. Also called a vector processor, this design was able to run
mathematical operations on multiple data elements simultaneously. The central
processing unit, or CPU, interprets computer program instructions and sequences
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tasks. It has been referred to as the “brain” of the CT system. The three principal types
of solid-state memory are read-only memory (ROM), random access memory (RAM),
and write-once read-many times (WORM) memory. Both ROM and RAM are part of the
system’s primary memory. Primary storage refers to the computer’s internal memory. It
is accessible to the CPU without the use of the computer’s input/output channels.
Primary memory is used to store data that are likely to be in active use. Primary storage
is typically very fast. ROM is imprinted at the factory and is used to store frequently
used instructions such as those required for starting the system. RAM includes
instructions that are frequently changed, such as the data used to reconstruct images.
RAM is very fast, but is also volatile, losing the stored data in the case of a power loss.
The opposite of RAM is serial access memory (SAM), which stores data that can only
be accessed sequentially (like a cassette tape). WORM refers to computer storage
devices that can be written to once, but read from many times. These can be subdivided
into two types: those that can be physically written to only once, such as CD-R
(compact disk-recordable) and DVD-R (digital video disk-recordable), and those that
have rewriting capabilities but use devices that prevent data already written on a tape
from being rewritten, reformatted, or erased. The rationale for disabling rewrite
functionality is to comply with regulatory standards, such as the Health Insurance
Portability and Accountability Act (HIPAA).
Image reconstruction refers to the process whereby a computer manipulates data

collected from the detectors to create a CT image. A basic understanding of the
concepts common in computer science are helpful building blocks. These concepts
include the use of algorithms, Fourier transform, and methods of interpolation. Similarly,
the student should be aware of the function of the hardware and software used by CT
systems. Raw data include all attenuation measurements obtained from the detector
array. Some of these raw data are used in the creation of the image. After the raw data
are averaged and each pixel is assigned a Hounsfield number, an image can be
reconstructed. The data that form this image are then referred to as image data. SFOV
refers to a selected circle in the center of the gantry. Raw data are acquired and
calibrated for any object that lies within this circle. The entire scan circle or any portion
of the circle may be selected to display on the monitor. The size of the circle that is
displayed is called DFOV. Once the computer has manipulated the raw data throughout
the image reconstruction process, it is then ready to be displayed.
Image display includes all of the system components necessary to convert the
digital data created from the reconstruction process to electrical signals needed by the
CT display monitor. The display system also includes the ability to display patient
information and scan protocol data, and provides many graphic aids designed to assist
in image interpretation.
The device used to display CT images is generally a black-and-white or color

monitor. The display device is usually either a cathode-ray tube (CRT) or some form of
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fl at panel such as a TFT LCD (thin-film transistor, liquid crystal display). The monitor
consists of the display device, circuitry to generate an image from electronic signals
sent by the computer, and an enclosure. The CRT monitor included in many CT
systems is basically a standard television set with some modifications that improve
image resolution. CRT monitors are heavier, bulkier, hotter, and less durable than the
newer LCD monitors. In addition, LCD monitors produce higher luminance and higher
spatial resolutions. It is a common misconception that all computer monitors are digital.
Because the monitors used in CT work with analog signals, it is necessary to convert
the digital signal from the computer’s memory back to an analog format. Digital-to-
analog converters (DAC) accomplish this task. DAC change the digital signal from the
computer memory back to an analog format so that the image can be displayed on the
monitor.
In some instances the images are transferred to film. The camera is an output
device that transfers the image from the monitor to the film. The camera used may be a
multiformat camera, although most CT systems today include a laser camera.
Multiformat cameras transfer the image displayed on the monitor to film. Laser cameras
bypass the image on the display monitor and transfer data directly from the computer,
bypassing the video system entirely, thereby significantly improving image quality. The
film used in CT consists of a single emulsion that is sensitive to either the light-emission
spectrum of the video screen phosphor (for the multiformat camera) or to the laser
beam light.
The display functions are the final step in creating the CT image. Analog
monitors display the CT image. Therefore, the digital signal from the computer’s
memory must be converted back to an analog format. Changing the window width
broadens or narrows the range of visible CT numbers. Window width and window level
determine which aspects of an image are displayed as shades of gray. The shade of
gray that is assigned to a specific anatomic structure is related to the structure’s beam
attenuation. Higher Hounsfield values are represented by lighter shades of gray. The
window width selects the range of Hounsfield units for a particular image, and the
window level determines the center Hounsfield unit in this range. In general, the window
level is set at roughly the same level as the Hounsfield value of the tissue of interest.
Optimal window settings are highly subjective, and they vary dramatically within the
field. Published window widths and centers are intended to serve as guidelines only.
Patient conditions as well as personal preference make considerable adjustment
necessary. CT systems offer a variety of functions that allow images to be manipulated
to facilitate diagnosis. Defining an ROI is the first step in many measurement and
display functions. Hounsfield measurement, standard deviation, and distance
measurement may offer valuable diagnostic information. It is important to annotate
images with any information that may not be immediately apparent. Examples of such
annotation include “Images in this study have been flipped, top to bottom” and “Delayed
image: 15 minute post contrast injection.” The technologist must understand the
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difference between image magnification and decreasing the display field of view size
and use each function appropriately.

DATE: March 23, 2022
C.
TOPIC: Neurologic Imaging Procedures
The particular topic of today's lecture is Neurologic Imaging Procedures. Images

in a neurological CT (computed tomography) scan are created using ionizing radiation.
This noninvasive imaging examination examines the components of your brain and
spinal cord. A CT scan of the brain can detect tumors and other lesions, as well as
trauma, cerebral hemorrhage, and structural abnormalities. If other tests, such as x-rays
or a physical exam, are inconclusive and the patient has hydrocephalus, infections,
brain function, or other disorders, this method is used.
In addition to that, the patient's head is positioned in the head holder for most
head imaging protocols, according to the General Imaging Methods for the Head. The
head holder can sometimes be used for neck procedures, depending on the design.
When the head holder isn't needed, a molded sponge is placed directly on the scan
table and the patient's head is positioned within it. To avoid motion artifact on the
images, the patient should be made as comfortable as feasible and immobilized as well
as possible. Small wedge sponges on either side of the patient's head are commonly
used to achieve this. For CT scans of the head, it is usually unnecessary to instruct the
patient to hold their breath. The slice angle is determined by the patient's head position
and the gantry's angle. Although it was originally typical to design the brain's cross-
sectional slices to be parallel to the orbitomeatal line, more current practice prefers
using the supraorbital meatal line to decrease radiation exposure to the eye's lens.
Many multidetector CT systems have the drawback of not allowing the gantry to be tilted
when in helical mode. As a result, for routine brain imaging, axial or step-and-shoot
techniques are frequently used. The beam-hardening artifact is widespread in the
posterior fossa due to the dense bone of the skull.
Furthermore, it is not the job of the technologist to interpret images. However,
technologists must be able to detect certain potentially critical pathologic changes in
order to bring them to the attention of a radiologist when they occur. Unless
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contraindicated, an IV contrast medium is used to scan the neck. The goal of CT
scanning the neck is to give the mucosa, lymph nodes, and pathologic tissue enough
time to improve after contrast administration while keeping the vasculature opacified.
When CT is performed after intrathecal contrast delivery for fluoroscopic myelography, a
delay of 1 to 3 hours is recommended between the contrast injection and CT scanning.
This time lag allows the contrast substance to dilute sufficiently.
A non-contrast CT scan of the brain is used to distinguish ischemic stroke from
hemorrhagic stroke, examine the state of cerebral circulation and tissue, and,
secondarily, assess the underlying disease. The transport of iodinated contrast through
the cerebral arteries is monitored in perfusion studies. CT perfusion is most used to
diagnose acute stroke; however, it can also be used to diagnose vasospasm or tumor
grading. CT perfusion can also be utilized to measure cerebrovascular reserve during
temporary balloon occlusion techniques with few modifications.
As a result, CT perfusion is a useful tool for assessing patients who have
suffered an acute stroke, but it can also be used to diagnose other cerebrovascular
illnesses. A CT scan can be used to determine the cause of a neurologic problem or to
assess injuries to the head, sinuses, temporal bone, neck, and spine. With the
introduction of multi-slice CT, the benefits of a broader scanning range, shorter
scanning time, and finer z-axis resolution were realized, all of which are beneficial in
neuroradiologic diagnosis. CT is the most commonly used imaging modality for trauma
and acute neurologic changes such as ischemia and cerebral bleeding. CTA has
become a popular alternative to digital subtraction angiography for quick examination of
the cervical and cerebral arteries. A CT scan can also clearly show the anatomy and
pathology of the spine. The use of CT with intrathecal contrast medium injection is well
established, and it is common in spine evaluation to use CT as a follow-up study to
standard fluoroscopic myelography.
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NAME: MARIA CHRISTELLE KEITH C. JAMBOY DATE: March 28, 2022
TOPIC: SUMMARY
We began today's session with a virtual presentation of an actual scan, courtesy of
the DRMC hospital, and then moved on to our focus group discussion, which included
an in-depth discussion of the topic. Both of the patients engaged in the surgery agreed
to be filmed and gave their full consent, which we students appreciate because it
allowed us to observe an actual CT technique in action. First, the patients were
questioned and asked if they had any food allergies, such as to shellfish, eggs, or
eggplants. The tech also looked over the patient's physique for any leftover metallic
materials. Ensure that all metals, such as bra wire, belts, and even buttons, as well as
belly bands, are removed from the body. After being interviewed, the patient is then now
positioned in bed, feet first and supine in the user interface.
On the other hand, the patient’s procedure is a chest and whole abdomen CT
scan. The tech aims for correct planning by straightening the spine, no rolling below
pelvis or the hips part. Once the patient is settled down on the bed, you have to pre-
instruct the patient’s breathing exercise prior to the procedure. Upon entering the control
room, then the procedure can be started. The tech now is communicating with the
patient. Eventually the first procedure was a plain scan. The tech then made additional
reconstruction details for chest area, for lung reconstruction with slice thickness of
5.0/5mm. The tech constantly communicates to the patient. The next procedure is the
administration of saline flush, ask the patient for any discomfort sensation to check for
extravasation, after the flush is the administration of contrast media for chest and
arterial phase then continue the scanning. Consequently, review the images before
letting the patient leave.
Also, they showed about the tibe/heat load, it is the amount of energy deposited
during the exposure. The procedure also has post-procedural care, the reason why the
patient was being asked in the first place if this is their first time undergoing such a
procedure or they had experienced already to interconnect the post-procedural care. In
such cases, if the patient is a first timer, there is a possibility of having delayed onset of
allergic reaction to contrast. Thus the patient must stay for at least 1 hour before
removal of heplock, however if it's not their first time therefore the patient must stay at
least 30-45 minutes depending on the institution.
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On the other hand, the same goes to the second patient, they both performed chest and
whole abdomen. However, the patient said she’s allergic to seafood, that’s why the
techs held the procedure and went to confirm if the patient had pre-med, so as the
patient said she’s somehow allergic to seafoods. Consequently, double check the
patient’s information to avoid adverse reaction to contrast media, thus the tech will take
the responsibility once there’s an occurrence of any reactions.
TOPIC: SUMMARY
We are provided some references to read on abdominal and pelvic CT tests

for today's activities. The preparation of the patient for a CT examination of the
belly and pelvis is more important than the preparation of the patient for any other
body location. The better the intestinal opacification in an abdominopelvic CT scan,
the more oral contrast material is used. Despite the fact that a volume of at least
600 mL is recommended, patient compliance could be a stumbling barrier in
achieving this target. When the bladder is filled with urine or contrast agent, it can
be seen in the best light on CT.
For specific examinations of the pancreas, liver, and kidney, as well as in
many abdominal CTA procedures, multiphasic imaging is widely employed. In any
given slice, there is significantly more information than can be displayed by a single
window with its width and level settings set to their maximum. As a result, photos
are frequently evaluated in two or more window configurations.
On the other hand, patients are asked to hold their breath during
abdominopelvic scanning in order to reduce movement and motion artifacts, which
are undesired. Anatomic structures will be shifted, distorted, or concealed as the
patient moves throughout the scanning process. The liver's attenuation is lower
than normal when fatty infiltration occurs, and there is an abnormal attenuation
differential between the liver and the spleen, respectively. Non-contrast CT scans
are the most accurate way to determine this. Many operators incorporate a ROI of
the liver as well as a ROI of the spleen in their procedures. When the liver
measurement is at least 10 HU lower than the spleen level, fatty infiltration of the
liver is suspected and should be treated.
Furthermore, the majority of hepatic hemangiomas have a distinct
appearance on CT scans. On unenhanced computed tomography, hemangiomas
appear as a well-defined hypodense tumor (CT). The lesion demonstrates
increased "filling-in" enhancement from the periphery as time goes on after IV
contrast is introduced. After a while, the appearance of the lesion becomes more
even. CT scans of the kidneys and ureters without contrast agents are often used
to detect calcifications and calculi that would otherwise be obscured by the contrast
agent. Assessing the attenuation values of an adrenal mass and measuring the
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amount of iodinated contrast that is washed out of the bulk on delayed imaging are
two methods for determining whether an adrenal mass is benign or cancerous.
Using specialized adrenal imaging procedures, doctors can try to determine
the nature of lesions in the adrenal gland. With imaging, the goal is to reduce
unneeded biopsies, the number of follow-up investigations required for an
appropriate diagnosis, and the overall cost of health-care services and procedures.
Any homogenous adrenal mass that measures less than 10 HU on unenhanced
CT is considered benign, and there is no need to change the scan protocol in this
case. This is significant because the varying placement of the appendix leads to
the various clinical presentation of acute appendicitis.
Because of the variety in positioning, cross-sectional scans make it more
difficult to find the appendix. Appendicitis treatment procedures vary widely;
different combinations of oral, rectal, IV, and no contrast material may be used in
different circumstances. The anatomical area that will be scanned during the scan
varies depending on the protocol. According to the research, the accuracy of all
technique modifications for detecting appendicitis is high. When the appendix is
found to be normal, the rate at which these approaches yield an alternate
diagnosis is likely to be the most variable.
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LEARNING JOURNAL

TOPIC: MUSCULOSKELETAL IMAGING PROCEDURES
Today's lesson focused on musculoskeletal imaging procedures. CT of the

musculoskeletal system has several advantages, including the ability to display cross-
sectional anatomy and spatial relationships, the ability to image both sides of the body
to allow comparison (particularly useful in evaluating asymmetry of joints), the ability to
display bone and soft tissue components simultaneously, excellent contrast sensitivity,
and the ability to image both sides of the body to allow comparison (particularly useful in
evaluating asymmetry of joints), the ability to display bone and soft Scanning protocols
for the musculoskeletal system are customized for each patient. Although intravenous
contrast medium is not usually used in the treatment of musculoskeletal damage, it is
useful in other situations, such as the diagnosis of infection or a soft-tissue malignancy.
Multiplanar reformations are included in the majority of musculoskeletal treatments.
Musculoskeletal protocols follow the main scanning rules acquired in previous

chapters. However, a few specialized examinations, such as wrist, shoulder, knee, foot,
and ankle, are worth addressing because of their distinct placement issues. CT
examinations of the wrist are indicated for complex fractures involving the distal radius
and ulna, scaphoid fracture, or other carpal fracture that are unclear on conventional x-
ray images. CT may also be of value in the detection of subtle fractures. It is often
difficult to comfortably and stably position the patient for a CT examination of the wrist.
Different approaches are used. Sometimes the patient is positioned with his arm over
his head. Another approach is to have the patient sit or stand on the far side of the
scanner and extend his arm into the scanner. A third, less favorable, approach is to
scan the patient’s wrist as it rests on his abdomen.
Furthermore, CT remains the modality of choice in certain situations, such as

tibial plateau fractures. The primary indication of knee CT is to assess the degree and
alignment of fracture fragments, particularly at the articular surfaces. Knee CT is also
performed to assess the integrity of the bone around a prosthesis. CT data of the foot
and ankle can be displayed in a number of different imaging planes. Some of these
planes can be obtained directly by positioning the patient in a specific position, whereas
other planes are best displayed by reformatting the data. The choice of which plane(s)
to display depends on which joint is of primary concern.
Thus, in some cases, CT is the preferred

modality. When compared to MRI, MDCT with MPR is more effective at detecting and
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evaluating fractures. MDCT can also be used to identify fine calcification, which is
crucial in the diagnosis of cartilage- or bone-forming cancers, as well as other bone-
formation disorders. CT and MRI exams are complementary in various clinical
circumstances, and both are used to offer a complete diagnosis.
NAME: JAMBOY, MARIA CHRISTELLE KEITH C. DATE: APRIL 18, 2022

SECTION: B SUBJECT: CE2
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For today’s activity, we watch a video about the virtual tour of MRI at Davao
Doctors Hospital. To start, Magnetic Resonance Imaging, or MRI, is a technique that
allows doctors to detect and treat medical disorders. Strong magnets, radio waves, a
gradient, and a computer are used in MRI to create a picture of the inside of the body.
MRI images are more detailed than those obtained using conventional technologies.
The tech will ask you to remove all metallic objects such as your belt and jewelry before
undergoing the MRI process, as it is not safe to have an MRI with some medical
implants. Also, there were zones in every part of the MRI department first zone 1 is an
MRI access area it is a waiting area for the patients as well as the reception. Zone 2 is
for patient screening and preparation for their procedure. While zone 3 this zone is
restricted from general public access by a reliable restricting method that differentiates
between MR and non-MR personnel. When you enter this area there will be a fingerprint
accessed door before you enter it and also a metal detector so that if there is metal
inside the body or any metallic objects.

Also, MRI department has its things or materials like MR-compatible Fire
Extinguisher, MR-compatible Stretcher, and Wheelchair and inside the MRI room
oxygen tanks are not allowed since it is dealing with magnets so inside the MRI there
are wall-mounted oxygen, a vacuum for suction, and medical air. In MRI room before
you enter in zone 3 there is a note “please do not enter without the supervision of MRI
personnel” since it restricted area there are also warning signs since this area strong
magnetic field. Inside MR room there is comfort room, dressing room and locker for
patient’s belongings and there is a consent forms for each patient fill out before the
procedure and patients are provide with slippers. Zone 4 is where the MRI machine is
located this area has a strong magnet which can detect any metallic objects. MRI
machine has magnetic field strength with 1.5 T and there is coil mounted which is the
head coil where it acts as an antenna to received the radio frequency signal coming out
of the body and transmit that data to a computer which then generates images and also
there is a coil cabinet where the different types of coils are placed, and also there is a
MR compatible mechanical injector.

Inside the MRI room the allowed things are marked as a MR-safe or MR-
conditional. In MRI console area there is a mirror in between in MRI room. There is a
computer, different types of monitors and control buttons to press like stop button,
pause, start, moving/stop the table and microphone button used to communicate with
the patient inside the MRI room. For preparation, you will lie on a table just outside the
scanner. MRI scanner are very noisy the patient will probably wear earplugs or
headphones. For different equipment such as pillows and straps this will help to
maintain the correct position of the patient once the patients are ready the table will
slide into the scanner. Inside the scanner is very narrow. During the scan magnets in
the machine will ceate a strong magnetic field but it’s not harm as what people think
then the scanner will send radio waves through you body, when the radio waves are
turned off the scanner will pick up energy signals from the patient’s body those signals
are used to make the pictures during the scan the patient should stay still to have a
clear image and asked to hold breath for a short time. MRI’s takes 30-45 minutes or
longer to have a complete procedure in some cases patient’s will undergo with contrast
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dye with your with MRI, the dye with MRI helps to make clear pictures and then after the
procedure the patient can go back to his/her normal activities but if the patient received
contrast dye the tech may ask the patient to drink plenty of water to drink to removed
the from the body.

NAME: JAMBOY, MARIA CHRISTELLE KEITH DATE: April 20, 2022
TOPIC: MRI
We had a conversation regarding MRI today. This is not a new issue

for us, but there are many topics to discuss because we haven't had the
opportunity to examine and grasp it thoroughly previously. MRI is a non-
invasive imaging technique, which means it does not necessitate the removal
of some tissues like in surgery. It generates comprehensive anatomical
images in three dimensions. It's frequently used to detect diseases, diagnose
them, and track their progress.
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The ability of MRI to obtain direct transverse, sagittal, coronal, and
oblique plane pictures is known as multi-planar imaging. MRI does not use
ionizing radiation; instead, it uses RF electromagnetic radiation and magnetic
fields, which do not cause ionization and thus do not have the potentially
harmful effects associated with ionizing radiation. The basic idea of MR is that
if a specific atomic nucleus is placed in a magnetic field, it can change form
(absorb energy from) and then release the excess absorbed energy by
producing radio waves as a result of this stimulation. An antenna can pick up
the (MR) signal, which can then be investigated. The advantages of MRI
contrast resolution, multi-planar imaging, and radiation-free imaging are as
follows:
The MRI Gantry, Computer, and Operating Console are the three
essential components. A gantry is a large, typically cylindrical device that
accommodates the patient during imaging. An MRI gantry has no moving
parts and is entirely controlled electronically, with a patient aperture of 50- 60
cm in diameter. In this aperture, RF coils, also known as the RF probe,
surround the patient and produce RF waves. At the same time, it functions as
an RF transmitter and receiver. A computer that is similar to a CT scan but is
faster and larger. More data is acquired during an MRI examination, and the
computations necessary are lengthier and more difficult than in a CT scan,
and finally, MRI operating control. Hydrogen is abundant in the human body,
abundant with a big magnetic moment, and abundant with a large magnetic
moment.
The hydrogen nucleus "wobbles" or precesses due to the action of B,

which causes a shift in the orientation of the rotation axis of a rotating body
(like a spinning top as it comes to rest). The speed at which hydrogen
precesses depends on the strength of B0 and is known as the "precessional
frequency" The precessional paths of individual hydrogen nuclei are random,
or "out of phase" The Larmor Equation, Sir Joseph Larmor is an Irish-born
mathematical physicist, Professor of mathematical physics at
Cambridge. His famous 1897 equation was to explain the Zeeman splitting of
optical rays.
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Name: JAMBOY, MARIA CHRISTELLE KEITH C. Date: April 25, 2022
Section: 54A Subject: MRI
For today’s discussion it is all about Magnetic Resonance Imaging Hardware.

This refers to both inside and outside the modality the system's pieces and components.
The system's magnets are explained in further detail, and an MRI system block diagram
helps me grasp the system and how it works. Coils for the neck, head, and extremities
were added, as well as coils for the neck, head, and extremities.
Furthermore, the Gantry, Operating Console, and Computer System are the
three main components. The gantry houses the main magnet and other electromagnetic
devices; however, unlike a CT scanner, the MRI gantry has no moving parts and just
the patient couch. After being placed on the couch and slid to the aperture, the gantry
can be daunting to the patient. The image acquisition and image processing controls
are operated by the special function keys on the operating console, but the majority are
controlled by the computer. The computer system is the third component; the most
common type of computer is the minicomputer, which comes in three sizes. The
computer must be large, fast, and capable of storing and manipulating data.
In addition to that, by the use of the MR magnet this would generate a strong,
stable and spatially uniform polarizing magnetic field that is primary requirement in
creating net nuclear spin magnetization due to the polarization specifies the geometrical
orientation of the oscillations. The polarization of electromagnetic waves refers to the
direction of the electric field; by convention, the polarization of electromagnetic waves
refers to the direction of the electric field. In addition, variables such as weight, stray
field dimension, overall bore length, start-up and operating costs all play a role in
determining which MRI magnet to use.
Thus, the ideal magnet design will be determined by the anticipated demands of
clinical applications as well as the MRI experiments to be done, as available magnet
technologies usually provide a balance between diverse requirements. Permanent,
resistive, and superconducting magnets are the three types of magnets. Shimming was
also discussed, which is used to improve the primary magnetic field uniformity and so
provide a high-quality image.
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NAME: JAMBOY, MARIA CHRISTELLE KEITH DATE: APRIL 27, 2022
C.
TOPIC: QAQC MRI

Today, we talked about the various phantoms and the daily Quality Assurance
and Quality Control test in Magnetic Resonance Imaging. The Radiofrequency coil
testing was the first topic of discussion. Its purpose is to ensure that the coils are in
good working order prior to the procedure.
There are four RF coils discussed. First is the knee coil, it uses phantom bottle.
The knee coil is wrapped around the bottle. The bottle is placed beneath the coil for the
whole-body coil to simulate a human spine. Two bottles are placed within the coil's two
holes to simulate hanging breasts of prone-positioned patients. A ridge is used for the
head coil and is aligned for the collimator light to simulate a patient's head. The
collimator should be aligned with the triple underscore mark on the phantom.
Furthermore, the weekly Quality Assurance and Quality Control follows, with the
technologist inserting a phantom and head coil into the machine. This QAQC is primarily
concerned with the calibration and testing of the machine's coils. The first step
demonstrated was the use of the System Performance Tool's Periodic Image Quality
Test (PIQT) (SPT). The PIQT will then proceed with the phantom scanning and
calibration, which should take about 15-20 minutes. After that timeframe, the
technologist will set the parameters for the RL (right to left), FH (feet to head), and AP.
Manual planning is possible.
Also, using a phantom is also very different from planning for a real patient
because a phantom is only focused with one side. A real patient will have to include its
sagittal, coronal and transverse view planning.
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Name: JAMBOY, MARIA CHRISTELLE KEITH Date: May 04, 2022
A video regarding a brain scan technique was shown to us. The initial
stage was to scan the patient with a metal detector that had previously stored the
patient's information. The patient is positioned supine with immobilization devices
in place to minimize movement, and MRI-compatible headphones are provided to
reduce MRI noise. The patient is subsequently fitted with a head coil that is
targeted on the IOML. We were also shown the procedure planning which
involved the various pulse sequences for the procedure. Next up is the patient
scanning. the technologist first configured the setup for the seizure MRI
procedure.
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For image planning, the sagittal coronal and transverse images were
displayed and established. The anterior and posterior horns of the corpus
callosum, as well as the odontoid process of c2, should be aligned if the neck is
included. The MRI sequence and numerous approaches for enhancing MRI
images were reviewed in the third segment. T1 is followed by T2 in the MRI
sequence. T1 highlights fat tissue while T2 highlights water content and
suppresses fat. The prime difference with the two is that T1 visualizes normal
anatomy while T2 evaluates pathology. The PD of Proton density image is used
to evaluate extremities. STIR, or short tau inversion recovery, is a fat-
suppression sequence used in image-enhancing software. The equivalent of
STIR, spectral pre-saturation with inversion recovery, is utilized in images
containing contrast. Lesions within a part are evaluated using DWI, or diffusion
weighted imaging.
Name: JAMBOY, MARIA CHRISTELLE KEITH C. Date: May 5, 2022

Learnings about the video presentation.
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DDH MRI Brain and Cervical Spine Procedure by Ma'am Shaira Jordan Catalan
BRAIN MRI SCAN- patient position

 Materials: foams, wedge foams, ear plugs, head coil.
 Patient is screened first, then patient changes into a patient gown
 Patient t is positioned (supine, head first)
 Ensure patient’s comfort
 Instruct patient what is the procedure about and what to expect during the
procedure
 Patient is provided with earplugs to protect hearing from MRI noise
 Scan time: 30mins
 Insert the foams at the sides of both ears to avoid them from being clipped
into the head coil and to support head position.
 Place the head coil and lock properly
 Check laser alignment, it should be aligned at the level of patient’s
glabella
 Send the patient inside the gantry and proceed with the scan.

CERVICAL SPINE (neck) SCAN- patient position
 Materials: Cervical coil/neck coil
 Procedure is all the same with brain scan except for the type of coil used
and the laser alignment
 Laser alignment (isocenter) is at the level below the mandible
AT OPERATING CONSOLE
 Obtain a 3D plane localizers
 Brain scan planning (sagittal, axial/transverse, coronal)
 Start with the 3D plane localizer to have basis for initial planning
 Click the same rx and click scan, then plan sagittal planning
 FOR SAGITTAL PLANNING: load the 3 plane localizer, click slices (23),
FOV (25), thickness (5), and interval (1)
 Uncheck show slices to view middle slice in the sagittal view center the
line following the inter hemispheric fissure, straight to brain in coronal
 Scan takes about 2mins 46 secs
 FOR AXIAL/TRANSVERSE PLANNING: same as sagittal
 Electromechanical injector monitor/automatic injector: turn on, warning

signs appear then press continue
 Reset button: change parameter/protocol
 Store button: save modifications made
 Recall button: see saved protocols
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 Each study has different approach in injecting CM
 Each hospital has diff standards and protocols
 A (white) syringe is for CM, B (Blue) syringe is for saline flush starts with
saline then pauses, resumes with injection of cm then followed by saline
 Stop watch: for timer
 KVO: to keep vein open
 To arm: to get Para injector ready
 Notification for confirmation appears: check for air when light blinks, cm
can be injected
 Preparing CM with electromechanical injector for administration connect
the IV line to EM injector tube
 Test inject if line is okay, whether pt complains or not.

 Press start button
 After test, inject contrast.
Image discussion with Ms. Ivy Krista Diel, RRT for BRAIN
 Plain: no enhancement
 Contrast: has white enhancement
 T1 sequence for brain
 for CERVICAL
 T1- fat saturation: sequence used for contrast
 CM used in MRI, to enhance and clarify internal body structures

 Commonly used are with the base gadolinium
 Gadoteric acid (brand name Dotarem): 10ml depends on procedure, used
in any mri studies. Has computations for dose, recommended dose
is .1milli mole per kg. compute depending on pt’s weight
 Gadovist (gen name Gadobutrol): prefilled syringe, more concentrated,
only 5ml
 Preferred for abd and liver studies is MULTIHANCE (gen name
gadobenate dimeglumine) in DDH, 10ml vial
 Primovist, the best cm for liver studies. Prefilled syringe, 10ml. good for
small lesion masses on liver
 CM mentioned above are around 4k-6k, primovist is 15k
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NAME: JAMBOY, MARIA CHRISTELLE KEITH C. DATE: January 14, 2022

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NAME: JAMBOY, MARIA CHRISTELLE KEITH C. DATE: January 17, 2022

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NAME: JAMBOY, MARIA CHRISTELLE KEITH

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Nuclear medicine is a branch of medicine that focuses on the diagnostic,

Bone scans look at the skeletal system to detect abnormalities such as

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PET is a unique, three-dimensional, tomographic imaging technique that is

PET requires a specialized device called a cyclotron to produce the positron-

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Attenuation: Process by which radiation is reduced in intensity when it passes through

Becquerel (Bq): Unit of radioactivity in SI (International System of Units).

Beta emission: Release of high-energy beta particles through disintegration of certain

Biologic half-life: Time required for an organism to eliminate half of an administered

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Count: External indication of a device designed to enumerate ionizing events.

Curie (Ci): Traditional or standard unit of radioactivity.

Daughter: Synonym for a product of decay.

Decay: Spontaneous transmutation of a radionuclide that results in a decrease in the

Disintegration (nuclear): Spontaneous nuclear transmutation characterized by

Dose: Amount of radiopharmaceutical given to a patient.

Equilibrium: Stage in a reaction in which the concentration of the reactive species is no

Fusion imaging: Nuclear medicine scans can be superimposed, using software or

Gamma rays: High-energy, short-wavelength electromagnetic radiation emanating from

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In vitro: Outside of the patient; occurring or being in an artificial environment, such as a

Infarction: Development and formation of a localized area of necrosis within a tissue.

Microcurie (µCi): Unit of radioactivity equal to one-millionth of a curie.

Millicurie (mCi): Unit of radioactivity equal to one-thousandth of a curie.

Parent: Radionuclide that yields another nuclide during disintegration.

Radioactivity: Spontaneous disintegration of an unstable atomic nucleus, resulting in

Radionuclide: Type of atom whose nucleus disintegrates spontaneously.

Radiopharmaceutical: Group of radioactive drugs used in the diagnosis and treatment

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Technetium 99m: Common radionuclide of technetium used for 90% of nuclear

NAME: JAMBOY, MARIA CHRISTELLE KEITH C. DATE: JANUARY 21, 2022

Overactive thyroid (hyperthyroidism) and certain kinds of thyroid cancer are

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NAME: JAMBOY, MARIA CHRISTELLE KEITH C. DATE: JANUARY 25, 2022

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RADIONUCLIDE RADIOPHARMACEUTICAL USES

Oxygen-15 Gas Brain

Fluorine-18 FDG (fluorodeoxyglucose) Tumor,

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Technetium-99m Diphosphonate Bone

DISIDA (diisopropyl iminodiacetic acid) Biliary

DMSA (dimercaptosuccinic acid) Renal cortical

DTPA (diethylenetriamine pentaacetic acid) Renal dynamic, brain, lung

ECD (ethyl cysteinate dimmer) Brain perfusion

Glucoheptonate Brain, renal dynamic

HMPAO (hexamethylpropyleneamine oxine) Brain perfusion

HMPAO labeled white cells Infection

Labeled red cells GI blood loss, cardiac function,

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patency, intraarterial liver.

MAG3 (mercaptoacetyltriglycine) Renal

Pertechnetate Thyroid, salivary glands,

Sestamibi Myocardial perfusion, parathyroid, breast