Basic principles

K - rays

€ Imagi
ƒ

g rooms harmacy

Gamma ameras Hot Lab Dose calibrators Generators

€ Radio
ƒ ƒ ƒ

€ Waste

storage areas € Reading room

€ Emitted

energy from the nucleus of an atom € ´Nµucleus € ´Uµnstable, € ´Dµecays by € ´Eµmitting € ´Bµetas, € ´Aµl has, and € ´Gµammas

€ rate

of decay. € Radioactivity measured in Curies (Ci)
ƒ

1 Ci = 3.7 x 1010 disintegrations er second

€ Also
ƒ

measured in Becquerels (Bq)

1 Bq = 1 disintegration er second

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

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

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

€ T 1/2 €T 1

e= XT b/T +T b

Saline Charge

Evacuated Vial Sodium pertecnetate (Na TcO4)

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

Direction of Saline Flow

€ Technetium

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

€ After

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

Dual head

Parallel hole
Low Energy Medium Energy High Energy

Diverging hole
Low Energy

Converging hole
Low Energy

Pinhole
Low Energy Multi-Energy

Light

NaI crystal Thalium activated sodium iodine

Gamma Ray

Light into Electricity

€ Indications
€

:

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

with normal x ray

€ No

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

€ € € € €

€

€ € €

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

€ Mainly

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

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

Blood pool

Delay image

€ Indications

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

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

€ Analysis

: € Calculate divided renal function .

€ Indications

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

€ 99mTc-DTPA € Diethylenetriaminepenta-acetic

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

€ 99mTc-MAG3 € (mercaptoacetyltriglycine) € Mainly

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

€ Adult

dose : € Tc ²DTPA :15-20 mCi I.V € Tc-MAG3 : 8-10 mCi I.V € Scanning time : immediate for 30 min. € Lasix : € After 15 min
€

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

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

´time²activity curveµ (TAC)

€1

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

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

€ Indications

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

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

I-131

(NaI) NaI)

I-123

(NaI) NaI)

TcTc-99m
(TcO4(TcO4-)

8 days Beta 364 keV 81%

13 hours EC 159 keV 85%

6 hours IT 140 keV 89%

Principle K Abundance

€ No

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

€ Iodine

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

€ 1-

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

€ Scanning

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

STANDARD

PATIENT

1 Capsule Method (Thyroid count ² thigh count ) * DCF Standard count ² room background * 100 = % uptake

ƒ

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

€

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

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

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