NUCLEAR MEDICINE

(RT 327)
Prepared by:
KRISTINE CAMILLE J. SUSAYA, RRT, MSRT
BSRT Program Chair
UNIVERSITY OF EASTERN PHILIPPINES
 COURSE DESCRIPTION

Study of the principles and instrumentation in

Nuclear Medicine and its diagnostic and therapeutic
applications.
 LEARNING OBJECTIVES

At the end of the course, students will understand the principles involved in Nuclear
Medicine relative to its diagnostic and therapeutic applications. Students will:
1. Describe the basic structure of the atom, its nuclear components and
properties. Illustrate the physical principles involved in radioactivity;
2. Explain the principles and purpose of radiation detectors, image formation and
tomography;
3. Describe the methods of production of radionuclide and radiopharmaceutical
biodistribution in the body;
4. Describe the different clinical procedures for diagnosis and therapy; and
5. Explain the radiation hazards, measurement concepts, operational radiation
safety measurements, and quality control.
 COURSE OUTLINE

1. Introduction to Nuclear Medicine

2. Instrumentation
3. Radiochemistry and Radiopharmacology
4. Clinical Nuclear Medicine
5. Radiation Protection
 LESSON 1:

INTRODUCTION TO
NUCLEAR
MEDICINE
DEFINITION:
NUCLEAR MEDICINE is a medical specialty that focuses on
the use of radioactive materials called radiopharmaceuticals
for diagnosis, therapy, and medical research. In contrast to
radiographic procedures that determine the presence of
disease based on appearance, nuclear medicine determines
the cause of a medical problem based on the physiologic
function of organs or tissues.
DEFINITION:
Unlike conventional radiographic procedures (such as X-
rays or CT scans), nuclear medicine focuses on functional
imaging rather than just anatomical imaging.
PRINCIPLES OF
NUCLEAR MEDICINE:
For a nuclear medicine procedure, the
radioactive material, commonly referred to as a
radiopharmaceutical or a radiotracer (such as
technetium-99m, iodine-131, or fluorine-18), is
primarily introduced into the body by injection,
ingestion, or inhalation.
PRINCIPLES OF
NUCLEAR MEDICINE:
Radiopharmaceuticals are introduced into the body through three main
routes:
Injection: The most common method. The radiopharmaceutical is
injected directly into the bloodstream (intravenously or intramuscularly).
Ingestion: Some radiopharmaceuticals are taken orally (usually in the
form of a capsule or liquid). For example, iodine-131 is used for thyroid
imaging.
Inhalation: Rarely used, but certain radiopharmaceuticals can be
inhaled (e.g., xenon-133 for lung imaging).
PRINCIPLES OF
NUCLEAR MEDICINE:
• Different radiotracers are used to study different parts
of the body. Specific tracers are selected based on
their ability to localize in specific organs or tissues.
Radiotracers undergo radioactive decay to produce
gamma ray emissions that allow for the detection of
the tracer’s presence.
PRINCIPLES OF
NUCLEAR MEDICINE:
• Radiotracers are carefully chosen based on their affinity for specific sites in the body.
• Different radiotracers are used to study various aspects:
• Organ Function: Some radiotracers target specific organs (e.g., heart, liver, kidneys)
to assess their function.
• Tumor Imaging: Radiotracers can accumulate in tumors due to altered metabolism
or receptor expression.
• Blood Flow and Perfusion: Others help visualize blood flow patterns.
• Neurological Studies: Radiotracers allow us to study brain function, neurotransmitter
receptors, and blood flow in the brain.
PRINCIPLES OF
NUCLEAR MEDICINE:
• Once administered, radiotracers circulate through the
bloodstream.
• As they decay, they emit gamma rays (high-energy
photons).
• External detectors (such as gamma cameras) capture
these emitted gamma rays.
PRINCIPLES OF
NUCLEAR MEDICINE:
A special piece of equipment, known
as gamma camera or scintillation
camera is used to transform these
emissions into images that provide
information about the function
(primarily) and anatomy of the organ
being studied.
PRINCIPLES OF
NUCLEAR MEDICINE:
The lowest amount of radiotracer that can be used to
ensure a satisfactory examination or therapeutic goal is
administered to reduce the radiation exposure to the
patient.
NUCLEAR MEDICINE TEAM:
Nuclear medicine procedures are
performed by a team of specially
educated professionals: a nuclear
medicine physician – a specialist with
extensive education in the basic and
clinical science of medicine who is
licensed to use radioactive materials.
NUCLEAR MEDICINE TEAM:
A nuclear medicine
technologist – who performs the
tests and is educated in the
theory and practice of nuclear
medicine procedures.
NUCLEAR MEDICINE TEAM:

A physicist – who is experienced in

the technology of nuclear medicine
and the care of equipment, including
computers.
NUCLEAR MEDICINE TEAM:
A pharmacist – or a specially
prepared technologist who is
qualified to prepare the necessary
radioactive pharmaceuticals.
HISTORICAL
DEVELOPMENT:
In 1923, George de Hevesy, often called
the “father of nuclear medicine,” developed
the tracer principle. He coined the term
radioindicator and extended his studies
from inorganic to organic chemistry. The
first radioindicators were naturally occurring
substances such as radium and radon.
HISTORICAL
DEVELOPMENT:
Tracer principle uses isotopes, atoms of the same
element with different numbers of neutrons, as labels.
These isotopes can be radioactive, emitting detectable
radiation, or stable, having normal nuclear properties. By
introducing small amounts of labeled isotopes into a
system, scientists can track their movement and behavior,
gaining valuable information about the system itself.
HISTORICAL
DEVELOPMENT:
George de Hevesy's tracer principle not only revolutionized
how scientists study different systems but also led to the
development of nuclear medicine. By using radioactive
tracers to diagnose and treat diseases, this field continues
to benefit countless patients globally. His innovation
demonstrates the power of creative thinking and ingenuity,
inspiring further advancements in understanding the world
around us.
HISTORICAL
DEVELOPMENT:
The invention of the cyclotron by Ernest
Orlando Lawrence in 1931 made it
possible for de Hevesy to expand his
studies to a broader spectrum of biologic
processes by using 32P (Phosphorus-32),
22
Na (Sodium-22), and other cyclotron-
produced (synthetic) radioactive tracers.
 HISTORICAL DEVELOPMENT:
While Hevesy's initial use of naturally occurring radioactive
isotopes like radium and radon was groundbreaking, it had
limitations:

Limited number of available isotopes: Only a few naturally

occurring radioisotopes were suitable for tracing studies.
High energy: Many had high radiation energies, making them
unsuitable for biological applications due to potential damage.
Short half-lives: Some had short half-lives, limiting their use in
longer-term studies.
HISTORICAL
DEVELOPMENT:
Radioactive elements began to be produced
in nuclear reactors developed by Enrico
Fermi and colleagues in 1946. The nuclear
reactor greatly extended the ability of the
cyclotron to produce a radioactive tracer. A
key development was the introduction of the
gamma camera by Hal Anger in 1958 .
HISTORICAL
DEVELOPMENT:
In the early 1960s, Edwards and Kuhl made the
next advance in nuclear medicine with the
development of a crude Single Photon Emission
Computed Tomography (SPECT) camera known as
MARK IV. With this technology, it was possible to
create two-dimensional images created previously.
It was not until the 1980s, when computers became
fast enough to acquire and process all of the
information and successfully, that SPECT imaging
could become standard practice.
HISTORICAL
DEVELOPMENT:
With the development of more suitable scintillators, such as
sodium iodide (NaI), and more sophisticated nuclear counting
electronics, positron coincidence localization became possible.
Wrenn demonstrated the use of positron-emitting radioisotopes
for the localization of brain tumors in 1951. Brownell further
developed instrumentation for similar studies.
HISTORICAL
DEVELOPMENT:
The next major advance came in 1967, when
Hounsefield demonstrated the clinical use of
Computed Tomography (CT). The
mathematics of Positron Emission
Tomography (PET) image reconstruction is
similar to that used for CT reconstruction
techniques.
HISTORICAL
DEVELOPMENT:
From 1967 to 1974, significant
developments occurred in computer
technology, scintillator materials, and
photomultiplier tube (PMT) design. In
1975, the first closed-ring transverse
positron tomograph was built by Ter-
Pogossian and Phelps.
HISTORICAL
DEVELOPMENT:
During the mid-1980s, PET was used
predominantly as a research tool; however, by the
early 1990s, clinical PET centers had been
established, and PET was routinely used for
diagnostic procedures on the brain, heart, and
tumors. In middle to late 1990s, three-dimensional
PET systems that eliminated the use of
interdetector septa were developed. This
development allowed the injected dose of
radiopharmaceutical to be reduced by
approximately 6-fold to 10-fold.
HISTORICAL
DEVELOPMENT:
One of the first organs to be examined by nuclear medicine studies using
external radiation detectors was the thyroid. In the 1940s, investigators
found that the rate of incorporation of radioactive iodine by the thyroid
gland was greatly increased in hyperthyroidism (overproduction of thyroid
hormones) and greatly decreased normal biochemical properties. The
most commonly used PET radionuclide, 18F (fluorine-18), can replace
hydrogen in many molecules, providing an even greater assortment of
biologic analogs that are useful PET radiopharmaceuticals.
HISTORICAL
DEVELOPMENT:
Beginning in 2000, major nuclear medicine
camera manufacturers developed combined
PET and CT systems that can simultaneously
acquire PET functional images and CT
anatomic images. Both modalities are co-
registered or exactly matched in size and
position. The success of these camera
systems led to the development of combined
SPECT and CT systems, as well. Significant
benefits are expected for diagnosing
metastatic disease because precise
localization of tumor site and function can now
be determined.
HISTORICAL
DEVELOPMENT:
In addition to the hybrid fusion of PET and CT,
the first PET/magnetic resonance imaging
(MRI) system was approved by the U.S Food
and Drug Administration (FDA) for customer
purchase in 2011. The integration of PET and
MRI is not straightforward and challenges the
technical design of both systems. PET/MRI
merges the metabolic activity of PET imaging
of MRI to generate diagnostic images for
oncologic, cardiologic, and neurologic
purposes.
COMPARISON WITH
OTHER MODALITIES:
Nuclear medicine is predominantly
used to measure human cellular,
organ, or system function. A
parameter that characterizes a
particular aspect of human physiology
is determined from the measurement
of the radioactivity emitted by a
radiopharmaceutical in a given
volume of tissue.
COMPARISON WITH
OTHER MODALITIES:
In contrast, conventional radiography measures the structure, size, and
position of organs or human anatomy by determining x-ray transmission
through a given volume of tissue. X-ray attenuation by structures
interposed between the x-ray source and the radiographic image receptor
provides the contrast necessary to visualize an organ. CT creates cross-
sectional images by computer reconstruction of multiple x-ray
transmissions.
COMPARISON WITH
OTHER MODALITIES:
Modality
PET SPECT MRI CT
Information
Measures Anatomy (Physiology Anatomy
Physiology Physiology
Resolution
3-5 mm 8 -10 mm 0.51 – 1.0 mm 1.0 – 1.5 mm
Technique Positron Gamma Nuclear Magnetic Absorption of x-
annihilation emission Resonance rays
Harmful Radiation Radiation None known Radiation effects
exposure exposure exposure
Use Research and Clinical Clinical (research) Clinical
Clinical
No. of exam
4 - 12 5 - 10 10 - 15 15 - 20
per day
ASSIGNMENT 1:
1. Biography of George de Hevesy.
2. History of “Artificial Radioactivity.”
3. History of “Tracer Principle”
4. Narrative report on how Cyclotron was
invented.