BASIC PRINCIPLES OF NUCLEAR MEDICINE

•Aims of nuclear medicine

•Nuclear medicine procedure
•Gamma cameras
•Advantages and disadvantages of NM
•Commonly used radioisotopes in NM
•Features of an ideal radioisotope
Aims
check the structure and function of tissues or organs,
such as the brain, thyroid, lungs, heart, liver, spleen,
kidney and bone
detect disease in organs or bones
find tumors, especially in the bones and thyroid
determine the stage (how far cancer has spread and if
it is present in other organs and tissues)
find out if cancer treatment is working
Procedure
No special preparation is required for most NM tests,
Radiopharmaceutical (RP) is given before the scan –
injected; oral; inhaled
RP collects in the organ or tissue
Pt sits or lies in the NM machine, immobilized and may
change positions if required
Gamma camera picks up the pattern of radioactivity given
off by the radiopharmaceutical
Sometimes a probe is used to detect the rays
A computer analyzes the patterns and creates 2 or 3
dimensional images that are interpreted by a Dr
After the scan the RP quickly loses its radioactivity and
passes out of the body through urine or stool
Gamma cameras
They image the radiation from a tracer introduced
into the patient’s body
As the tracer travels through the body and emits
radiation its progress is tracked by a crystal (sodium
iodide) that scintillates in response to gamma rays
Light is picked up by detectors (photomultiplier
tubes) located behind the crystal that convert the
resulting flash of light into an electrical signal.
Electrical signal from the detectors is fed to a
computer that translates it into an image on a screen
So the gamma camera maps the function and
processes of the body (functional images)
Advantages and disadvantages of NM
Advantages
Relatively Safe since it is used in small amounts
Sensitive
Quantitative information
Functional information
Minimally invasive
Low radiation
Screening, follow up
Disadvantages
Radiation exposure
Cost of gamma camera
Cost of radioisotopes, care is radioisotopes
Non specific images
Not widely available(none in Malawi)
Commonly used radioisotopes in medicine
Different radioactive isotopes are used depending on
the type of test and the tissue or organ being
studied, including:
technetium-99m (Tc-99m)
radioactive iodine
strontium
gallium
thallium
Features of an ideal radioisotope
The distribution of the radiopharmaceutical in the
body or organ can reveal the normal or altered
state of blood flow, capillary permeability, tissue
metabolism, or specific function of an organ
system. For example, if the physiology of an
organ system or area of an organ is changed for
reasons such as a tumor absence of blood flow,
duct blockage, or disease process, the way in which
the radiopharmaceutical is incorporated will
reflect any alteration.
Radiopharmaceuticals are also chosen for their particular radioactive
properties such as
half-life,
type of radiation emitted during decay, 
photon energy,
cost,
availability.
Today, 99mTechnetium (99mTc [half-life = 6.0 hours]), a daughter product
of 99Molybdenum (99Mo), is the most commonly used radionuclide for
nuclear medicine procedures and for making radiopharmaceuticals.
Technetium is considered ideal because
it gives a low radiation dose to the patient
has a low energy (140keV),
most of its decay emissions are gamma-rays,
it has a short half-life (six hours),
inexpensive and readily obtained
combines easily with many compounds.
 Mri scan

Whole body
PET/CT Scan

PET
SCAN
Radiation sources
Radiation and Radioactivity
The electromagnetic spectrum
Effects of radiation on humans
Ionizing radiation are high-frequency, high energy
rays because they contain sufficient energy to displace
an electron from its orbit around a nucleus.
Most important consequence of this displaced
electron on human tissue is the potential damage it
can inflict on DNA
Radiosensitivity is the probability of a cell, tissue or
organ suffering an effect per unit dose of radiation. It is
highest in cells which are highly mitotic or
undifferentiated.
Basal epidermis, bone marrow, thymus, gonads and
lens are highly radiosensitive
Deterministic (Non-stochastic) effects
Occur once a threshold of exposure has been exceeded
Severity increases as the dose of exposure increases.
Due to the identifiable threshold level appropriate
mechanisms and occupational dose limits can be put
in place to reduce the likelihood of these effects
Examples – skin erythema, cataract, sterility, radiation
sickness, IUGR
Stochastic effects
Occurrence follows a linear no-threshold hypothesis –
occur by chance
Risk of an effect increases linearly as the dose
increases
Probability is proportional to dose and severity is
independent of dose
Examples – cancer, hereditary defects (Down
syndrome)
Radiation detectors
There are different radiation detectors as follow;
Geiger-Muller counters
Thermoluminescent dosimeters (TLD)
Film badges
Ionization chambers
Gamma cameras