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Nuclear Medicine History

 Nuclear medicine is a branch of medicine that deals with the use of  radiation to diagnose and

treat a disease. It is safe, non-invasive and less expensive and often used to detect disease before

symptoms appear. It is performed by a medical specialist called radiologist. Nuclear medicineuses radiation to provide diagnostic information.

Nuclear Medicine Therapy

 Nuclear medicine is a new treatment modality and imaging technique used to diagnose and treat

diseases and track disease progression. This radiological subspecialty includes various studies inwhich radioactive materials are given to patients, to scatter through the body, and after that

image spectrum will be obtained. arious techniques used in this involve !-ray radiography,

ultrasound, computed tomography "#T$, nuclear medicine, positron emission tomography "%&T$and magnetic resonance imaging "'(I$ etc.

Nuclear Medicine Applications

 Nuclear medicine has applications across a broad spectrum of disease, focussing particularly on

oncology, cardiology, nephro-urology, orthopaedics, rheumatology and neuropsychiatry. Nuclearmedicine therapies for lymphoma, bone, liver and neuro-endocrine malignancies are advancing

rapidly. Nuclear medicine techniques in oncology can localise primary tumours, delineate extent

of disease, and monitor response to treatment. (adionuclide treatment is used in

hyperthyroidism, thyroid cancer , palliation of bone pain, and neural crest tumours.

Nuclear Magnetic Resonance

The absorption of electromagnetic radiation by a nucleus having a magnetic moment when in anexternal magnetic field, used mainly as an analytical technique and in diagnostic body imaging.

Nuclear Medicine Imaging

 Nuclear medicine imaging non-invasively provides functional information at the molecular andcellular level that contributes to the determination of health status by measuring the uptake and

turnover of target-specific radiotracers in tissue. Nuclear medicine imaging is also called

radionuclide scanning.

Nuclear Medicine Scans

 Nuclear medicine scans use a special camera "gamma$ to take pictures of tissues and organs inthe body after a radioactive tracer "radionuclide or  radioisotope$ is put in a vein in the arm and is

absorbed by the tissues and organs. The radioactive tracer shows the activity and function of thetissues or organs.

Radioisotopes for Medicine

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(adioisotopes are extensively used in nuclear medicine to explore body structures and functions

in vivo "in the living body$ with a minimum of invasion to the organ or treatment site.

(adioisotopes, containing unstable combinations of protons and neutrons. (adioisotopes are alsoused in radiotherapy "radiation therapy$ to treat some cancers and other medical conditions that

require destruction of harmful cells.

Radiotherapy

(adiation therapy also called as radiotherapy is an effective technique used to treat cancer byultimate destruction of cancer cells. Intense radiations are used to kill cancer cells in this method.

This treatment modality is being used along with others such as surgery, chemotherapy, or

immunotherapy. (adiation therapy is having range of applications in treating variety of  cancers with different treatment procedures.

Image Guided Radiation Therapy

Image-guided radiation therapy "I)(T$ is utili*ation of imaging, while the patient undergoes

radiation. This enables us to directly view the process of radiation and accurate and precisetreatment can be expected.

Positron Emission Tomography

%ositron emission tomography "%&T$ is a nuclear medicine imaging technique that produces a

three-dimensional image of functional processes in the body. The tracer may be in+ected,

swallowed or inhaled, depending on which organ or tissue is being studied by the %&T scan. Thetracer collects in areas of body that have higher levels of chemical activity, which often

correspond to areas of disease. n a %&T scan, these areas show up as bright spots.

Radionuclide Imaging

 radionuclide scan is a way of imaging bones, organs and other parts of the body by using asmall dose of a radioactive chemical. There are different types of radionuclide chemical.

(adionuclide imaging exposes to less radiation than do comparable x-ray studies.

Radioactive Material

(adioactive materials are given to patients, to scatter through the body to obtain image spectrum of the specified organ. (adioactive products which are used in medicine are referred to as

radiopharmaceuticals.

Radiopharmaceuticals

 radiopharmaceutical is a radioactive drug used for diagnosis or therapy in a tracer quantitywith no pharmacological effect. It is composed of two parts a radionuclide and a

 pharmaceutical. %harmaceutical drugs which have radioactivity can be used as /iagnostic and

therapeutic agents.

Radionuclide Therapy in Solid Tumors

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(adionuclide Therapy in 0olid Tumours is done by introducing radial dose of beta-particle-

emitting and alpha-particle-emitting molecules locali*ed either solely within endothelial cells of

tumour  vasculature or diffusing from the vasculature throughout the ad+acent viable tumour cells.

Radiation Therapy Accidents

(adiation therapy is a treatment modality which is commonly used in the treatment of metastatic 

diseases. There are some common accidents that occur during this curative therapy. They are

radiation overexposure, massive overdoses, failures in equipment design and design testing etc.The fatal radiation overdoses are one of the prominent among these and it causes nausea, vision

 problems, inability to hear, severe pain etc. part from the potential benefits this treatment

method is also associated with life threatening ha*ards.

Radiation ose

(adiation /ose is the amount of radiation energy absorbed by the body or exposure level of rays

during the treatment. This doses are usually measured in m)y1m0v. There are four different but

interrelated units for measuring radioactivity, exposure, absorbed dose, and dose equivalent.(adiation /ose is measured by dosimeter device.

Radioimmunotherapy

(adioimmunotherapy "(IT$ is a combination of radiation therapy and immunotherapy where a

laboratory-produced molecule called a monoclonal antibody is introduced on to surface of cell to

recogni*e and bind to cell. 'onoclonal antibodies mimic the antibodies naturally produced bythe body2s immune system that attack invading foreign substances. The two agents mostly used

are 3ttrium-45 Ibritumomab Tiuxetan "6evalin7$ and Iodine-898 Tositumomab ":exxar7$ in

radioimmunotherapy treatment.

Radioactive Iodine Therapy

(adioactive iodine treatment is used to treat certain thyroid diseases and thyroid cancer . The

 procedure is done with a radioactive form of the element iodine. (adioactive iodine therapy 

improves the survival rate of patients with  papillary or follicular thyroid cancer. (adioactiveiodine is given either in a capsule or in a tasteless solution in water.

Nuclear Medicine and Radiology

 Nuclear medicine is a branch of medical imaging that uses small amounts of  radioactive material

to diagnose and determine the severity of or treat a variety of diseases. Nuclear medicine scansare usually conducted by (adiographers. (adiology uses imaging technologies, such as !-ray

radiography, magnetic resonance imaging "'(I$, nuclear medicine, ultrasound, computed

tomography "#T$, and positron emission tomography "%&T$.

Nuclear Scanner

 Nuclear scans use radioactive substances to see structures and functions inside your body byusing special camera that detects radioactivity. ll type of tissue that may be scanned like bones,

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organs, glands, blood vessels etc. by using different radioactive compound as a tracer. The tracer

remains in the body temporarily before it is passed in the urine or stool "feces$.

Nuclear medicine and Thyroid Scan

Thyroid scan "thyroid scintigraphy$ is a nuclear medicine examination used to evaluate thyroidtissue. Thyroid 0can is a nuclear medicine test that provides information about the function and

structure of the thyroid gland. The scan involves in+ection of a radiopharmaceutical into a vein in

your arm and imaging with a gamma camera.

Nuclear Medicine and !one Scan

  bone scan is a nuclear imaging test that helps diagnose and track several types of bone disease.

 Nuclear medicine bone scan shows the effects of in+ury or disease such as cancer  or infection on

the bones. radioactive material "radiopharmaceutical$ is in+ected into a vein, attaches to the bones and is detected by a special camera "gamma camera$ that takes images or pictures that

show how the bones are working.

"ancer Radiation Therapy

(adiation therapy uses high-energy radiation to shrink tumors and kill cancer cells. !-rays,gamma rays, and charged particles are types of radiation used for cancer treatment by killing

cancer cells by damaging their /N "the molecules inside cells that carry genetic information

and pass it from one generation to the next$. (adiation therapy can either damage /N directly

or create charged particles "free radicals$ within the cells that can in turn damage the /N.

Nuclear Medicine Radioisotopes

(adioisotopes are radioactive isotopes of an element. /ifferent isotopes of the same elementhave the same number of protons in their atomic nuclei but differing numbers of neutrons.

(adioisotopes are an essential part of radiopharmaceuticals. (adioisotopes are commonly used inindustrial radiography. (adioisotopes used in nuclear medicine have very short half-lives, which

makes them suitable for therapeutic purposes.

Anticancer Therapy

nticancer , or antineoplastic, drugs are used to treat malignancies, or cancerous growths. /rugtherapy may be used alone, or in combination with other treatments such as surgery or radiation

therapy. nticancer  drugs are used to control the growth of cancerous cells.

;ournal of Nuclear 'edicine < (adiation Therapy is supporting =International #onference on

 Nuclear 'edicine < (adiation Therapy> during ;une 54-85, ?58@ at #ologne, )ermany with therespective theme =Ausion of &merging TechnologiesB Nuclear 'edicine < (adiation Therapy>.

Nuclear medicine is a branch or specialty of medicine and medical imaging that

uses radioactive isotopes (radionuclides) and relies on the process of radioactive

decay in the diagnosis and treatment of disease. In nuclear medicine procedures,

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radionuclides are combined with other chemical compounds or pharmaceuticals to

form radiopharmaceuticals.

#ancer therapy can be much more effective using a new way to customi*e nuclear medicine

treatment, researchers say in the /ecember ?58C issue of The Journal of Nuclear Medicine. The

 process could also be useful for other diseases that could benefit from targeted radiation.

Targeted therapy with radiopharmaceuticals--radioactive compounds used in nuclear medicine

for diagnosis or treatment--has great potential for the treatment of cancer, especially for cancer

cells that have migrated from primary tumors to lymph nodes and secondary organs such as bone

marrow. These disseminated tumor cells can be difficult to treat with a single targeting agent

 because there are dramatic differences in the number of targetable receptors on each cell.

In the study, breast cancer cells were treated with different concentrations of a cocktail of four

fluorochrome-con+ugated monoclonal antibodies. The amount of each antibody bound to each

cell was determined using flow cytometry. Aormulas were developed to >arm> the antibodieswith the desired radionuclide and activity, calculate the absorbed dose to each cell, and perform a

simulation of the surviving fraction of cells after exposure to cocktails of different antibody

combinations. 0imulations were performed for three alpha-particle emitters.

>ur approach moves radiation treatment planning for cancer therapy from the tumor level to the

molecular and cellular level, with nuclear medicine serving as the treatment engine,> stated

(oger Dowell, %h./., lead researcher. >The concepts are not restricted to cancer therapy but can

 be applied more widely to other diseases that may benefit from a targeted approach with

cocktails of radiopharmaceuticals. The approach can also be extended to cocktails consisting of

radiopharmaceuticals and non-radioactive agents.>

The effect of the radiopharmaceutical cocktails was compared to that of single antibodies. In

certain activities, cocktails outperformed single antibodies by a factor of up to ?CC. These

findings suggest that targeted alpha therapy can be improved with customi*ed radiolabeled

antibody cocktails. /epending on the antibody combination and specific activity of the

radiolabeled antibodies, cocktails can provide a substantial advantage in tumor cell killing. The

methodology used in this analysis provides a foundation for pretreatment prediction of tumor cell

survival in the context of personali*ed cancer therapy.

>This method is preferable, as it accounts for behavior of the drugs in the patientEs body,> Dowell

continues. >The beauty of either approach for planning a treatment is that the patient is not

sub+ected to any radiopharmaceutical in+ections during the planning phase, which uses only

fluorescent-labeled drugs. The patient is not in+ected with radiopharmaceuticals until the

treatment phase, whereupon only a cocktail specifically optimi*ed for that individual is

administered. This spares the patient from receiving ineffective cocktails that may damage

normal tissues and prevent further treatment.>

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Dospitals are now able to ensure that the correct dose is administered to the @F5,555 patients that

undergo nuclear medicine procedures every year due to a new device developed by scientists at

the National %hysical Gaboratory "N%G$.

The number of nuclear medicine procedures has increased by 9@H over the last 85 years. ?C5

 ND0 sites around the country now use nuclear medicine, mostly for diagnostic scans on areas

such as bone, lung perfusion, myocardium and the kidneys. Nuclear medicine is also used in

cancer and thyroid therapy.

Aor most diagnostic procedures, radioactive compounds are in+ected into the body so that

 physiological images can be made with gamma cameras. f course, the exact radioactivity of the

dose is crucial, not only to the ultimate safety of the patient but also to the quality of the

 procedure. low dose can result in inconclusive images whereas a high dose could cause harm

to the patient.

new instrument, called EAidelisE, allows medical physicists to check their in-house instruments

against the J national standards for radioactivity. nce confident that their own instruments are

measuring activity correctly, the right dose should always be given to the patient.

The instrument is comprised of an ionisation chamber designed by the National %hysical

Gaboratory "N%G$, the JEs national measurement institute and a brand new computer-controlled

electrometer module from 0outhern 0cientific Gtd "which manufactures and sells the instrument$.

n ionisation chamber is a gas filled enclosure between two conducting electrodes. Khen a

radioactive source is placed near to the enclosure, gamma-rays emitted by the source ionise the

gas -- thus creating a current that can be measured by the electrometer.

%reviously hospitals have used off-the-shelf (adionuclide #alibrators which needed re-

calibrating every time new applications for nuclear medicine or a new design of vial came on

stream. Kith Aidelis, this problem is solved.

EThe ionisation chamber is an identical version of the master chamber here,E says %iers de

Gavison, the Dead of (adionuclide 'etrology at N%G. EItEs like having N%G in a box -- it is a

great example of how our work contributes to quality assurance in healthcare, something that

touches all our lives.E

Nuclear medicine-induced allergic reactionsNyakale, Nozipho E. !ockhat, "arina I. #athekge, $ike $achaba

%&I' http'hdl.handle.net*+--/ 

0ate' 12-31+

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Abstract:

Immunologic reactions to radiopharmaceuticals are usually mild and transient and

re4uire little or no medical treatment. 5s the usage of radiopharmaceuticals has

increased, the reported adverse reactions remain comparatively few in number.

5lthough the low reported numbers demonstrate that radiopharmaceuticals are safe

and the pharmaceutical amount used in the formulation is small, it is worrisome thatthere is no single system for reporting adverse events associated with

radiopharmaceuticals. 6he most commonly described allergic reactions still remain

77m6c3labelled diphosphonates, colloids and albumin. 6he likelihood of a reaction to

8E6 radiopharmaceutical administration is low due to the chemical used being too

small to induce a physiologic e9ect. &eports on allergic reactions to therapeutic

radiopharmaceuticals are rare. 5lthough the advent of adverse events from the

administration of this therapy may occur due to the deterministic e9ects of these

radiopharmaceuticals, this is usually related to the amount of radiation

administered rather than the pharmaceutical e9ects. 6he advancement in

technology has catapulted imaging into a new era allowing for hybrid imaging with

#8E:6 :6 or $&I and 8E6:6 or $&I. 6his brings with it further risks for adverse

events which have been associated with these radiological modalities and

necessitates a discussion of allergic reactions from iodinated contrast media as well

as gadolinium contrast. 5s there is no alternative to the use of radiopharmaceuticals

for nuclear medicine and the added bene;t of a diagnostic radiology in one3sitting

for certain cases, it is important to document and report on these few adverse

reactions in order to improve the imaging methodology and possi ble prophylactic

measures.

Nuclear medicine is a medical specialty involving the application of radioactive substances in

the diagnosis and treatment of  disease. Nuclear medicine scans are usually conducted by(adiographers. Nuclear medicine, in a sense, is >radiology done inside out> or >endoradiology>

 because it records radiation emitting from within the body rather than radiation that is generated

 by external sources like !-rays.L8M

0iagnostic medical imaging

Diagnostic

In nuclear medicine imaging, radiopharmaceuticals are taken internally, for example,

intravenously or orally. Then, external detectors "gamma cameras$ capture and form images from

the radiation emitted by the radiopharmaceuticals. This process is unlike a diagnostic !-ray,where external radiation is passed through the body to form an image.

There are several techniques of diagnostic nuclear medicine.

• 0' Scintigraphy  (<scint<) is the use of internal radionuclides to create two3dimensional images.=>

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•

nuclear medicine whole body bone scan. The nuclear medicine whole body bone scan

is generally used in evaluations of various bone-related pathology, such as for bone pain,

stress fracture, nonmalignant bone lesions, bone infections, or the spread of cancer to the

 bone.

•

 Nuclear medicine myocardial perfusion scan with thallium-?58 for the rest images

"bottom rows$ and Tc-0estamibi for the stress images "top rows$. The nuclear medicine

myocardial perfusion scan plays a pivotal role in the noninvasive evaluation of coronary

artery disease. The study not only identifies patients with coronary artery disease it also

 provides overall prognostic information or overall risk of adverse cardiac events for the

 patient.

•

nuclear medicine parathyroid scan demonstrates a parathyroid adenoma ad+acent to the

left inferior pole of the thyroid gland. The above study was performed with Technetium-

0estamibi "8st column$ and iodine-8?9 "?nd column$ simultaneous imaging and thesubtraction technique "9rd column$.

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•

 Normal hepatobiliary scan "DI/ scan$. The nuclear medicine hepatobiliary scan is

clinically useful in the detection of the gallbladder disease.

•

 Normal pulmonary ventilation and perfusion "1$ scan. The nuclear medicine 1 scan

is useful in the evaluation of pulmonary embolism.

•

Thyroid scan with iodine-8?9 for evaluation of hyperthyroidism.

• +0' SPECT  is a +0 tomographic techni4ue that uses gamma camera datafrom many pro?ections and can be reconstructed in di9erent planes. Positronemission tomography  (8E6) uses coincidence detection to image functionalprocesses.

•

nuclear medicine 0%&#T liver scan with technetium-44m labeled autologous red blood

cells. focus of high uptake "arrow$ in the liver is consistent with a hemangioma.

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•

'aximum intensity pro+ection "'I%$ of a whole-body positron emission tomography

"%&T$ acquisition of a F4 kg female after intravenous in+ection of 9F8 ':q of 8OA-A/)

"one hour prior measurement$.

 Nuclear medicine tests differ from most other imaging modalities in that diagnostic tests

 primarily show the physiological function of the system being investigated as opposed to

traditional anatomical imaging such as #T or '(I. Nuclear medicine imaging studies are

generally more organ- or tissue-specific "e.g.B lungs scan, heart scan, bone scan, brain scan, etc.$

than those in conventional radiology imaging, which focus on a particular section of the body

"e.g.B chest !-ray, abdomen1pelvis #T scan, head #T scan, etc.$. In addition, there are nuclear

medicine studies that allow imaging of the whole body based on certain cellular receptors or

functions. &xamples are whole body %&T scans or %&T1#T scans, gallium scans, indium white

 blood cell scans, 'I:) and octreotide scans.

Iodine32+ whole body scan for thyroid cancer evaluation. 6he study above was

performed after the total thyroidectomy and 6#@ stimulation with thyroid hormone

medication withdrawal. 6he study shows a small residual thyroid tissue in the neckand a mediastinum lesion, consistent with the thyroid cancer metastatic disease.

 6he observable uptakes in the stomach and bladder are normal physiologic ;ndings.

Khile the ability of nuclear metabolism to image disease processes from differences in

metabolism is unsurpassed, it is not unique. #ertain techniques such as f'(I image tissues

"particularly cerebral tissues$ by blood flow and thus show metabolism. lso, contrast-

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enhancement techniques in both #T and '(I show regions of tissue that are handling

 pharmaceuticals differently, due to an inflammatory process.

/iagnostic tests in nuclear medicine exploit the way that the body handles substances differently

when there is disease or pathology present. The radionuclide introduced into the body is often

chemically bound to a complex that acts characteristically within the body this is commonly

known as a tracer . In the presence of disease, a tracer will often be distributed around the body

and1or processed differently. Aor example, the ligand methylene-diphosphonate "'/%$ can be

 preferentially taken up by bone. :y chemically attaching technetium-44m to '/%, radioactivity

can be transported and attached to bone via the hydroxyapatite for imaging. ny increased

 physiological function, such as due to a fracture in the bone, will usually mean increased

concentration of the tracer. This often results in the appearance of a >hot spot>, which is a focal

increase in radio accumulation or a general increase in radio accumulation throughout the

 physiological system. 0ome disease processes result in the exclusion of a tracer, resulting in the

appearance of a >cold spot>. 'any tracer complexes have been developed to image or treat manydifferent organs, glands, and physiological processes.

Hybrid scanning techniques

In some centers, the nuclear medicine scans can be superimposed, using software or hybrid

cameras, on images from modalities such as #T or '(I to highlight the part of the body in

which the radiopharmaceutical is concentrated. This practice is often referred to as image fusion

or co-registration, for example 0%&#T1#T and %&T1#T. The fusion imaging technique in nuclear 

medicine provides information about the anatomy and function, which would otherwise be

unavailable or would require a more invasive procedure or surgery.

•

 Normal whole body %&T1#T scan with A/)-8O. The whole body %&T1#T scan is

commonly used in the detection, staging and follow-up of various cancers.

•

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bnormal whole body %&T1#T scan with multiple metastases from a cancer. The whole

 body %&T1#T scan has become an important tool in the evaluation of cancer.

Practical concerns in nuclear imaging

lthough the risks of low-level radiation exposures are not well understood, a cautious approach

has been universally adopted that all human radiation exposures should be kept s Gow s

(easonably %racticable, >G(%>. "riginally, this was known as >s Gow s (easonably

chievable> "G($, but this has changed in modern draftings of the legislation to add more

emphasis on the >(easonably> and less on the >chievable>.$

Korking with the G(% principle, before a patient is exposed for a nuclear medicine

examination, the benefit of the examination must be identified. This needs to take into account

the particular circumstances of the patient in question, where appropriate. Aor instance, if a

 patient is unlikely to be able to tolerate a sufficient amount of the procedure to achieve a

diagnosis, then it would be inappropriate to proceed with in+ecting the patient with the

radioactive tracer.

Khen the benefit does +ustify the procedure, then the radiation exposure "the amount of radiation

given to the patient$ should also be kept as low as reasonably practicable. This means that the

images produced in nuclear medicine should never be better than required for confident

diagnosis. )iving larger radiation exposures can reduce the noise in an image and make it more

 photographically appealing, but if the clinical question can be answered without this level of

detail, then this is inappropriate.

s a result, the radiation dose from nuclear medicine imaging varies greatly depending on the

type of study. The effective radiation dose can be lower than or comparable to or can far exceed

the general day-to-day environmental annual background radiation dose. Gikewise, it can also be

less than, in the range of, or higher than the radiation dose from an abdomen1pelvis #T scan.

0ome nuclear medicine procedures require special patient preparation before the study to obtain

the most accurate result. %re-imaging preparations may include dietary preparation or the

withholding of certain medications. %atients are encouraged to consult with the nuclear medicine

department prior to a scan.

AnalysisThe end result of the nuclear medicine imaging process is a >dataset> comprising one or more

images. In multi-image datasets the array of images may represent a time sequence "i.e. cine or

movie$ often called a >dynamic> dataset, a cardiac gated time sequence, or a spatial sequence

where the gamma-camera is moved relative to the patient. 0%&#T "single photon emission

computed tomography$ is the process by which images acquired from a rotating gamma-camera

are reconstructed to produce an image of a >slice> through the patient at a particular position.

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collection of parallel slices form a slice-stack, a three-dimensional representation of the

distribution of radionuclide in the patient.

The nuclear medicine computer may require millions of lines of source code to provide

quantitative analysis packages for each of the specific imaging techniques available in nuclear

medicine.Lcitation needed M

Time sequences can be further analysed using kinetic models such as multi-compartment models 

or a %atlak plot.

Interventional nuclear medicine

$ain articles' %nsealed source radiotherapy and Arachytherapy

(adionuclide therapy can be used to treat conditions such as hyperthyroidism, thyroid cancer ,

and blood disorders.

In nuclear medicine therapy, the radiation treatment dose is administered internally "e.g.

intravenous or oral routes$ rather from an external radiation source.

The radiopharmaceuticals used in nuclear medicine therapy emit ioni*ing radiation that travels

only a short distance, thereby minimi*ing unwanted side effects and damage to noninvolved

organs or nearby structures. 'ost nuclear medicine therapies can be performed as outpatient

 procedures since there are few side effects from the treatment and the radiation exposure to the

general public can be kept within a safe limit.

"ommon nuclear medicine #unsealed source$ therapies

Substance Condition

Iodine32+23sodium iodidehyperthyroidism and

thyroid cancer

 Bttrium3713ibritumomab tiuCetan ("evalin) and Iodine3

2+23tositumomab (AeCCar)refractory lymphoma

2+2I3$IAD (metaiodobenzylguanidine) neuroendocrine tumors

#amarium32-+ or #trontium37palliative bone pain 

treatment

In some centers the nuclear medicine department may also use implanted capsules of isotopes

" brachytherapy$ to treat cancer.

"ommonly used radiation sources #radionuclides$ for %rachytherapy L9M

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Radionuclide Type Hal-lie !nergy

:aesium32+/ (2+/:s) 3ray +1.2/ years 1.** $eF

:obalt3*1 (*1:o) 3ray -.* years 2.2/, 2.++ $eF

Iridium327 (27Ir) GH3particles /+. days 1.+ $eF (mean)

Iodine32- (2-I) 3rays -7.* days /., +2. and +-.- keF

8alladium321+ (21+8d) 3ray 2/.1 days 2 keF (mean)

&uthenium321* (21*&u) GH3particles 2.1 years +.- $eF

@istory

The history of nuclear medicine is rich with contributions from gifted scientists across different

disciplines in physics, chemistry, engineering, and medicine. The multidisciplinary nature of

nuclear medicine makes it difficult for medical historians to determine the birthdate of nuclearmedicine. This can probably be best placed between the discovery of artificial radioactivity in

849C and the production of radionuclides by ak (idge National Gaboratory for medicine related

use, in 84C@.LCM

The origins of this medical idea date back as far as the mid-84?5s in  Areiburg, )ermany, when

)eorge de Devesy made experiments with radionuclides administered to rats, thus displaying

metabolic pathways of these substances and establishing the tracer   principle. %ossibly, the

genesis of this medical field took place in 849@, when ;ohn Gawrence, known as >the father of

nuclear medicine>, took a leave of absence from his faculty position at 3ale 'edical 0chool, to

visit his brother &rnest Gawrence at his new radiation laboratory "now known as the Gawrence

:erkeley National Gaboratory$ in :erkeley, #alifornia. Gater on, ;ohn Gawrence made the first

application in patients of an artificial radionuclide when he used phosphorus-9? to treat

leukemia.LPML@M

'any historians consider the discovery of artificially produced radionuclides by ArQdQric ;oliot-

#urie and IrRne ;oliot-#urie in 849C as the most significant milestone in nuclear medicine.LCM In

Aebruary 849C, they reported the first artificial production of radioactive material in the +ournal

 Nature, after discovering radioactivity in aluminum foil that was irradiated with a polonium

 preparation. Their work built upon earlier discoveries by Kilhelm Jonrad (oentgen for !-ray,

Denri :ecquerel for radioactive uranium salts, and 'arie #urie "mother of IrRne #urie$ for

radioactive thorium, polonium and coining the term >radioactivity.> Taro Takemi studied the

application of nuclear physics to medicine in the 8495s. The history of nuclear medicine will not

 be complete without mentioning these early pioneers.

 Nuclear medicine gained public recognition as a potential specialty on /ecember F, 84C@ when

an article was published in the ;ournal of the merican 'edical ssociation by 0am 0eidlin. The

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article described a successful treatment of a patient with thyroid cancer metastases using

radioiodine "I-898$. This is considered by many historians as the most important article ever

 published in nuclear medicine.LFM lthough the earliest use of I-898 was devoted to therapy of

thyroid cancer, its use was later expanded to include imaging of the thyroid gland, quantification

of the thyroid function, and therapy for hyperthyroidism.

Kidespread clinical use of nuclear medicine began in the early 84P5s, as knowledge expanded

about radionuclides, detection of radioactivity, and using certain radionuclides to trace

 biochemical processes. %ioneering works by :enedict #assen in developing the first rectilinear

scanner  and Dal . nger Es scintillation camera "nger camera$ broadened the young discipline

of nuclear medicine into a full-fledged medical imaging specialty.

In these years of nuclear medicine, the growth was phenomenal. The 0ociety of Nuclear

'edicine was formed in 84PC in 0pokane, Kashington, 0. In 84@5, the 0ociety began

 publication of the ;ournal of Nuclear 'edicine, the premier scientific +ournal for the discipline in

merica. There was a flurry of research and development of new radionuclides and

radiopharmaceuticals for use with the imaging devices and for in-vitro studiesP.

mong many radionuclides that were discovered for medical-use, none were as important as the

discovery and development of Technetium-44m. It was first discovered in 849F by #. %errier and

&. 0egre as an artificial element to fill space number C9 in the %eriodic Table. The development

of a generator system to produce Technetium-44m in the 84@5s became a practical method for

medical use. Today, Technetium-44m is the most utili*ed element in nuclear medicine and is

employed in a wide variety of nuclear medicine imaging studies.

:y the 84F5s most organs of the body could be visuali*ed using nuclear medicine procedures. In

84F8, merican 'edical ssociation officially recogni*ed nuclear medicine as a medical

specialty.LOM In 84F?, the merican :oard of Nuclear 'edicine was established, and in 84FC, the

merican steopathic :oard of Nuclear 'edicine was established, cementing nuclear medicine

as a stand-alone medical specialty.

In the 84O5s, radiopharmaceuticals were designed for use in diagnosis of heart disease. The

development of single photon emission computed tomography "0%&#T$, around the same time,

led to three-dimensional reconstruction of the heart and establishment of the field of nuclear

cardiology.

'ore recent developments in nuclear medicine include the invention of the first positron

emission tomography scanner "%&T$. The concept of emission and transmission tomography,

later developed into single photon emission computed tomography "0%&#T$, was introduced by

/avid &. Juhl and (oy &dwards in the late 84P5s .Lcitation needed M Their work led to the design and

construction of several tomographic instruments at the niversity of %ennsylvania. Tomographic

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imaging techniques were further developed at the Kashington niversity 0chool of 'edicine.

These innovations led to fusion imaging with 0%&#T and #T by :ruce Dasegawa from

niversity of #alifornia 0an Arancisco "#0A$, and the first %&T1#T prototype by /. K.

Townsend from niversity of %ittsburgh in 844O .Lcitation needed M

%&T and %&T1#T imaging experienced slower growth in its early years owing to the cost of the

modality and the requirement for an on-site or nearby cyclotron. Dowever, an administrative

decision to approve medical reimbursement of limited %&T and %&T1#T applications in

oncology has led to phenomenal growth and widespread acceptance over the last few years,

which also was facilitated by establishing 8OA-labelled tracers for standard procedures, allowing

work at non-cyclotron-equipped sites. %&T1#T imaging is now an integral part of oncology for

diagnosis, staging and treatment monitoring. fully integrated '(I1%&T scanner is on the

market from early ?588.Lcitation needed M

#ource of radionuclides, with notes on a few radiopharmaceuticals

$ain article' &adiopharmacology

bout a third of the worldEs supply, and most of &uropeEs supply, of medical isotopes is produced

at the %etten nuclear reactor  in the Netherlands. nother third of the worldEs supply, and most of

 North mericaEs supply, is produced at the #halk (iver Gaboratories in #halk (iver , ntario,

#anada. The N( started operating in 84PF. The #anadian Nuclear 0afety #ommission ordered

the National (esearch niversal reactor  reactor to be shut down on November 8O, ?55F for

regularly scheduled maintenance and an upgrade of the safety systems to modern standards. The

upgrade took longer than expected, and in /ecember ?55F a critical shortage of medical isotopes

occurred. The #anadian government passed emergency legislation allowing the reactor to restarton 8@ /ecember ?55F, and production of medical isotopes to continue. pdateB In 'id-Aebruary,

?554, the reactor was shut down once again due to a mechanism problem that extracts the

isotope containing rods from the reactor. The reactor was again shut down in 'id 'ay of the

same year because of a heavy water leak. The reactor was started again during the first quarter of 

?585. The N( will cease routine production in the fall of ?58@, however the reactor will be

available for backup production until 'arch ?58O, at which point it will be shut down.L4M

The #halk (iver reactor is used to irradiate materials with neutrons which are produced in great

quantity during the fission of -?9P. These neutrons change the nucleus of the irradiated material

 by adding a neutron, or by splitting it in the process of  nuclear fission. In a reactor, one of the

fission products of uranium is molybdenum-44 which is extracted and shipped to

radiopharmaceutical houses all over North merica. The 'o-44 radioactively beta decays with a

half-life of ?.F days "or @@ hours$, turning initially into Tc-44m, which is then extracted "milked$

from a >moly cow> "see technetium-44m generator $. The Tc-44m then further decays, while

inside a patient, releasing a gamma photon which is detected by the gamma camera. It decays to

its ground state of Tc-44, which is relatively non-radioactive compared to Tc-44m.

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The most commonly used radioisotope in %&T A-8O, is not produced in any nuclear reactor, but

rather in a circular accelerator called a cyclotron. The cyclotron is used to accelerate protons to

 bombard the stable heavy isotope of oxygen -8O. The -8O constitutes about 5.?5H of ordinary

oxygen "mostly -8@$, from which it is extracted. The A-8O is then typically used to make A/) 

"see this link for more information on this process$.

:ommon isotopes used in nuclear medicine =21>=22>

isotope symbol " T#$% decay gamma &'e() positron &'e()

Imaging'

uorine32 2J 7 217.// m GK -22 (27+L) 7. (7/L)=2>

gallium3*/ */Da +2 +.* d ec

7+ (+7L),

2- (2L),

+11 (2/L)

3

krypton32m 2mMr +* 2+.2 s I6 271 (*L) 3

rubidium3 &b +/ 2./ m GK -22 (272L) +.+/7 (7-L)

nitrogen32+ 2+N / 7.7/ m GK -22 (11L) 2271 (211L)=2+>

technetium377m 77m 6c + *.12 h I6 21 (7L) 3

indium3222 222In 7 .1 d ec2/2 (71L),

- (7L)3

iodine32+ 2+I -+ 2+.+ h ec 2-7 (+L) 3

Cenon32++ 2++e - -. d GH 2 (+2L) 1.+* (77L)

thallium312 12 6l 2 +.1 d ec*7O+P (7L),

2*/ (21L)3

 6herapy'

yttrium371 71 B +7 .*/ d GH 3 .1 (211L)

iodine32+2 2+2I -+ .1 d GH +* (2L) 1.1/ (211L)

6 S atomic number, the number of protons T81? S half-life decay S mode of decay

 photons S principle photon energies in kilo-electron volts, ke, "abundance1decay$

S beta maximum energy in mega-electron volts, 'e, "abundance1decay$

U S U  decay V S V  decay IT S isomeric transition ec S electron capture

W !-rays from progeny, mercury, Dg

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typical nuclear medicine study involves administration of a radionuclide into the body by

intravenous in+ection in liquid or aggregate form, ingestion while combined with food, inhalation

as a gas or aerosol, or rarely, in+ection of a radionuclide that has undergone micro-encapsulation.

0ome studies require the labeling of a patientEs own blood cells with a radionuclide "leukocyte

scintigraphy and red blood cell scintigraphy$. 'ost diagnostic radionuclides emit gamma rays, 

while the cell-damaging properties of beta particles are used in therapeutic applications. (efined

radionuclides for use in nuclear medicine are derived from fission or fusion processes in nuclear

reactors, which produce radionuclides with longer half-lives, or cyclotrons, which produce

radionuclides with shorter half-lives, or take advantage of natural decay processes in dedicated

generators, i.e. molybdenum1technetium or strontium1rubidium.

The most commonly used intravenous radionuclides areB

•  6echnetium377m (technetium377m)

• Iodine32+ and 2+2

•  6hallium312

• Dallium3*/

• Jluorine32 JluorodeoCyglucose

• Indium3222 !abeled !eukocytes

The most commonly used gaseous1aerosol radionuclides areB

• enon32++

• Mrypton32m

•  6echnetium377m 6echnegas=dead link > a radioaerosol invented in 5ustralia by 0rAill Aurch and 0r &ichard Jawdry

•  6echnetium377m 0685

&adiation dose

patient undergoing a nuclear medicine procedure will receive a radiation dose. nder present

international guidelines it is assumed that any radiation dose, however small, presents a risk. The

radiation doses delivered to a patient in a nuclear medicine investigation, though unproven, is

generally accepted to present a very small risk of inducing cancer. In this respect it is similar to

the risk from !-ray investigations except that the dose is delivered internally rather than from an

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external source such as an !-ray machine, and dosage amounts are typically significantly higher

than those of !-rays.

The radiation dose from a nuclear medicine investigation is expressed as an effective dose with

units of sieverts "usually given in millisieverts, m0v$. The effective dose resulting from an

investigation is influenced by the amount of radioactivity administered in mega becquerels 

"':q$, the physical properties of the radiopharmaceutical used, its distribution in the body and

its rate of clearance from the body.

&ffective doses can range from @ X0v "5.55@ m0v$ for a 9 ':q chromium-P8 &/T

measurement of glomerular filtration rate to 9F m0v "9F,555 X0v$ for a 8P5 ':q thallium-?58

non-specific tumour imaging procedure. The common bone scan with @55 ':q of technetium-

44m-'/% has an effective dose of approximately 9.P m0v "9,P55 X0v$ "8$.

Aormerly, units of measurement were the curie "#i$, being 9.F&85 :q, and also 8.5 grams of

(adium "(a-??@$ the rad "radiation absorbed dose$, now replaced by the gray and the rem

"(Yntgen equivalent man$, now replaced with the sievert. The rad and rem are essentially

equivalent for almost all nuclear medicine procedures, and only alpha radiation will produce a

higher (em or 0v value, due to its much higher (elative :iological &ffectiveness "(:&$. lpha

emitters are nowadays rarely used in nuclear medicine, but were used extensively before the

advent of nuclear reactor and accelerator produced radionuclides. The concepts involved in

radiation exposure to humans are covered by the field of Dealth %hysics the development and

 practice of safe and effective nuclear medicinal techniques is a key focus of 'edical %hysics.

#ee also

• 5merican Qsteopathic Aoard of Nuclear $edicine

• 5merican Aoard of Nuclear $edicine

• Nuclear medicine physician

• !ist of Nuclear $edicine #ocieties

• &adiopharmaceutical

• &adiation therapy

• &adiographer

• &adiologist

• &adiology

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• Aackground radiation

• @uman sub?ect research

Nuclear medicine imaging uses small amounts of low3level radioactive

compounds, which are given as an in?ection or by mouth (swallowed). 6hesecompounds are attracted to speci;c organs, bones or tissues, which absorb the

radioactive material.

Rhat is Deneral Nuclear $edicineS

 Nuclear medicine is a branch of medical imaging that uses small amounts of  radioactive material

to diagnose and determine the severity of or treat a variety of diseases, including many types of

cancers, heart disease, gastrointestinal, endocrine, neurological disorders and other abnormalities

within the body. :ecause nuclear medicine procedures are able to pinpoint molecular activity

within the body, they offer the potential to identify disease in its earliest stages as well as a

 patient2s immediate response to therapeutic interventions.

iagnosis

 Nuclear medicine imaging procedures are noninvasive and, with the exception of intravenous

in+ections, are usually painless medical tests that help physicians diagnose and evaluate medical

conditions. These imaging scans use radioactive materials called radiopharmaceuticals or

radiotracers.

/epending on the type of nuclear medicine exam, the radiotracer is either in+ected into the body,

swallowed or inhaled as a gas and eventually accumulates in the organ or area of the body beingexamined. (adioactive emissions from the radiotracer are detected by a special camera or

imaging device that produces pictures and provides molecular information.

In many centers, nuclear medicine images can be superimposed with computed tomography "#T$

or magnetic resonance imaging "'(I$ to produce special views, a practice known as image

fusion or co-registration. These views allow the information from two different exams to be

correlated and interpreted on one image, leading to more precise information and accurate

diagnoses. In addition, manufacturers are now making single photon emission computed

tomography1computed tomography "0%&#T1#T$ and positron emission tomography1computed

tomography "%&T1#T$ units that are able to perform both imaging exams at the same time. n

emerging imaging technology, but not readily available at this time is %&T1'(I.

Therapy

 Nuclear medicine also offers therapeutic procedures, such as radioactive iodine "I-898$ therapy 

that use small amounts of radioactive material to treat cancer  and other medical conditions

affecting the thyroid gland, as well as treatments for other cancers and medical conditions.

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 Non-DodgkinEs lymphoma patients who do not respond to chemotherapy may undergo

radioimmunotherapy "(IT$.

(adioimmunotherapy "(IT$ is a personali*ed cancer treatment that combines radiation therapy 

with the targeting ability of immunotherapy, a treatment that mimics cellular activity in the

 bodyEs immune system.

top of page

Rhat are some common uses of the procedureS

%hysicians use radionuclide imaging procedures to visuali*e the structure and function of an

organ, tissue, bone or system within the body.

In adults, nuclear medicine is used toB

Heart

• visualize heart blood ow and function (such as a myocardial perfusion scan)

• detect coronary artery disease and the eCtent of coronary stenosis

• assess damage to the heart following a heart attack

• evaluate treatment options such as bypass heart surgery and angioplasty

•

evaluate the results of revascularization procedures

• detect heart transplant re?ection

• evaluate heart function before and after chemotherapy ($%D5)

&ungs

• scan lungs for respiratory and blood ow problems

• assess di9erential lung function for lung reduction or transplant surgery

• detect lung transplant re?ection

!ones

• evaluate bones for fractures, infection and arthritis

• evaluate for metastatic bone disease

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• evaluate painful prosthetic ?oints

• evaluate bone tumors

• identify sites for biopsy

!rain

• investigate abnormalities in the brain, such as seizures, memory loss andabnormalities in blood ow

• detect the early onset of neurological disorders such as Alzheimer disease

• plan surgery and localize seizure foci

• evaluate for abnormalities in a chemical in the brain involved in controllingmovement in patients with suspected 8arkinsonTs disease

• evaluation of brain tumor recurrence, surgical or radiation planning orlocalization for biopsy

'ther Systems

• identify inammation or abnormal function of the gallbladder

• identify bleeding into the bowel

• assess post3operative complications of gallbladder surgery

• evaluate lymphedema

• evaluate fever of unknown origin

• locate the presence of infection

• measure thyroid function to detect an overactive or underactive thyroid

• help diagnose hyperthyroidism and blood cell disorders

• evaluate for hyperparathyroidism

• evaluate stomach emptying

• evaluate spinal uid ow and potential spinal uid leaks

In adults and children( nuclear medicine is also used to)

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"ancer

• stage cancer by determining the presence or spread of cancer in variousparts of the body

•

localize sentinel lymph nodes before surgery in patients with breast cancer orskin and soft tissue tumors.

• plan treatment

• evaluate response to therapy

• detect the recurrence of cancer

• detect rare tumors of the pancreas and adrenal glands

Renal

• analyze native and transplant kidney function

• detect urinary tract obstruction

• evaluate for hypertension related to the kidney arteries

• evaluate kidneys for infection versus scar

• detect and follow3up urinary reuC

In children( nuclear medicine is also used to)

• investigate abnormalities in the esophagus, such as esophageal reuC ormotility disorders

• evaluate the openness of tear ducts

• evaluate the openness of ventricular shunts in the brain

• assess congenital heart disease for shunts and pulmonary blood ow

Nuclear medicine therapies include)

• &adioactive iodine (I32+2) therapy used to treat some causes ofhyperthyroidism (overactive thyroid gland, for eCample, DravesT disease) andthyroid cancer

• &adioactive antibodies used to treat certain forms of lymphoma (cancer ofthe lymphatic system)

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• &adioactive phosphorus (83+) used to treat certain blood disorders

• &adioactive materials used to treat painful tumor metastases to the bones

• I32+2 $IAD (radioactive iodine labeled with metaiodobenzylguanidine) usedto treat adrenal gland tumors in adults and adrenal glandnerve tissue tumorsin children

top of page

@ow should I prepareS

3ou may be asked to wear a gown during the exam or you may be allowed to wear your own

clothing.

Komen should always inform their physician or technologist if there is any possibility that they

are pregnant or if they are breastfeeding. See the Safety page for more information about pregnancy and breastfeeding related to nuclear medicine imaging.

3ou should inform your physician and the technologist performing your exam of any

medications you are taking, including vitamins and herbal supplements. 3ou should also inform

them if you have any allergies and about recent illnesses or other medical conditions.

;ewelry and other metallic accessories should be left at home if possible, or removed prior to the

exam because they may interfere with the procedure.

3ou will receive specific instructions based on the type of scan you are undergoing.

In some instances, certain medications or procedures may interfere with the examination ordered.

0ee the Radioactive Iodine (I-!" Therapy page for instructions on ho# to prepare for the

 procedure.

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Rhat does the e4uipment look likeS

0pecial camera or imaging devices used in nuclear medicine include the gamma camera and

single-photon emission-computed tomography "0%&#T$.

The gamma camera, , also called a scintillation camera, detects radioactive energy that is emitted

from the patientEs body and converts it into an image. The gamma camera does not emit any

radiation. The gamma camera is composed of radiation detectors, called gamma camera heads,

which are encased in metal and plastic and most often shaped like a box, attached to a round

circular donut shaped gantry. The patient lies on the examination table which slides in between

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the parallel gamma camera heads which are suspended over the examination table and located

 beneath the examination table. 0ometimes, the gamma camera heads are oriented at a 45 degree

angle and placed over the patientEs body.

0%&#T involves the rotation of the gamma camera heads around the patientEs body to produce

more detailed, three-dimensional images.

%&T scanner is a large machine with a round, doughnut shaped hole in the middle, similar to a

#T or '(I unit. Kithin this machine are multiple rings of detectors that record the emission of

energy from the radiotracer in your body.

computer aids in creating the images from the data obtained by the gamma camera.

probe is a small hand-held device resembling a microphone that can detect and measure the

amount of the radiotracer in a small area of your body.

There is no speciali*ed equipment used during radioactive iodine therapy, but the technologist or

other personnel administering the treatment may cover your clothing and use lead containers to

shield the radioactive material you will be receiving.

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@ow does the procedure workS

Kith ordinary x-ray examinations, an image is made by passing x-rays through the patientEs

 body. In contrast, nuclear medicine procedures use a radioactive material, called aradiopharmaceutical or radiotracer, which is in+ected into the bloodstream, swallowed or inhaled

as a gas. This radioactive material accumulates in the organ or area of your body being

examined, where it gives off a small amount of energy in the form of gamma rays. 0pecial

cameras detect this energy, and with the help of a computer, create pictures offering details on

 both the structure and function of organs and tissues in your body.

nlike other imaging techniques, nuclear medicine imaging exams focus on depicting

 physiologic processes within the body, such as rates of metabolism or levels of various other

chemical activity, instead of showing anatomy and structure. reas of greater intensity, called

>hot spots,> indicate where large amounts of the radiotracer have accumulated and where there isa high level of chemical or metabolic activity. Gess intense areas, or >cold spots,> indicate a

smaller concentration of radiotracer and less chemical activity.

In radioactive iodine "I-898$ therapy for thyroid disease, radioactive iodine "I-898$ is swallowed,

absorbed into the bloodstream in the gastrointestinal ")I$ tract and concentrated from the blood

 by the thyroid gland where it destroys cells within that organ.

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(adioimmunotherapy "(IT$ is a combination of radiation therapy and immunotherapy. In

immunotherapy, a laboratory-produced molecule called a monoclonal antibody is engineered to

recogni*e and bind to the surface of cancer cells. 'onoclonal antibodies mimic the antibodies

naturally produced by the bodyEs immune system that attack invading foreign substances, such as

 bacteria and viruses.

In (IT, a monoclonal antibody is paired with a radioactive material. Khen in+ected into the

 patientEs bloodstream, the antibody travels to and binds to the cancer cells, allowing a high dose

of radiation to be delivered directly to the tumor.

In I-898'I:) therapy for neuroblastoma, the radiotracer is administered by in+ection into the

 blood stream. The radiotracer binds to the cancer cells allowing a high dose of radiation to be

delivered to the tumor.

top of page

@ow is the procedure performedS

 Nuclear medicine imaging is usually performed on an outpatient basis, but is often performed on

hospitali*ed patients as well.

3ou will be positioned on an examination table. If necessary, a nurse or technologist will insert

an intravenous "I$ catheter into a vein in your hand or arm.

/epending on the type of nuclear medicine exam you are undergoing, the dose of radiotracer is

then in+ected intravenously, swallowed or inhaled as a gas.

It can take anywhere from several seconds to several days for the radiotracer to travel through

your body and accumulate in the organ or area being studied. s a result, imaging may be done

immediately, a few hours later, or even several days after you have received the radioactive

material.

Khen it is time for the imaging to begin, the camera or scanner will take a series of images. The

camera may rotate around you or it may stay in one position and you will be asked to change

 positions in between images. Khile the camera is taking pictures, you will need to remain still

for brief periods of time. In some cases, the camera may move very close to your body. This isnecessary to obtain the best quality images. If you are claustrophobic, you should inform the

technologist before your exam begins.

If a probe is used, this small hand-held device will be passed over the area of the body being

studied to measure levels of radioactivity. ther nuclear medicine tests measure radioactivity

levels in blood, urine or breath.

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The length of time for nuclear medicine procedures varies greatly, depending on the type of

exam. ctual scanning time for nuclear imaging exams can take from ?5 minutes to several

hours and may be conducted over several days.

3oung children may require gentle wrapping or sedation to help them hold still. If your doctor

feels sedation is needed for your child, you will receive specific instructions regarding when and

if you can feed your child on the day of the exam. physician or nurse speciali*ing in the

administration of sedation to children will be available during the exam to ensure your childEs

safety while under the effects of sedation. Khen scheduling the exam for a young child, ask if a

child life specialist is available. child life specialist is trained to make your child comfortable

and less anxious without sedation and will help your child to remain still during the examination.

Khen the examination is completed, you may be asked to wait until the technologist checks the

images in case additional images are needed. ccasionally, more images are obtained for

clarification or better visuali*ation of certain areas or structures. The need for additional images

does not necessarily mean there was a problem with the exam or that something abnormal was

found, and should not be a cause of concern for you.

If you had an intravenous line inserted for the procedure, it will usually be removed unless you

are scheduled for an additional procedure that same day that requires an intravenous line.

Aor patients with thyroid disease who undergo radioactive iodine "I-898$ therapy, which is most

often an outpatient procedure, the radioactive iodine is swallowed, either in capsule or liquid

form.

(adioimmunotherapy "(IT$, also typically an outpatient procedure, is delivered through

in+ection.

I-898'I:) therapy for neuroblastoma is administered by in+ection into the blood stream.

#hildren are admitted to the hospital for treatment as an inpatient.

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Rhat will I eCperience during and after the procedureS

&xcept for intravenous in+ections, most nuclear medicine procedures are painless and are rarelyassociated with significant discomfort or side effects.

Khen the radiotracer is given intravenously, you will feel a slight pin prick when the needle is

inserted into your vein for the intravenous line. Khen the radioactive material is in+ected into

your arm, you may feel a cold sensation moving up your arm, but there are generally no other

side effects.

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Khen swallowed, the radiotracer has little or no taste. Khen inhaled, you should feel no

differently than when breathing room air or holding your breath.

Kith some procedures, a catheter  may be placed into your bladder, which may cause temporary

discomfort.

It is important that you remain still while the images are being recorded. Though nuclear imaging

itself causes no pain, there may be some discomfort from having to remain still or to stay in one

 particular position during imaging.

nless your physician tells you otherwise, you may resume your normal activities after your

nuclear medicine scan. If any special instructions are necessary, you will be informed by a

technologist, nurse or physician before you leave the nuclear medicine department.

Through the natural process of radioactive decay, the small amount of radiotracer in your body

will lose its radioactivity over time. It may also pass out of your body through your urine or stool

during the first few hours or days following the test. 3ou should also drink plenty of water to

help flush the radioactive material out of your body as instructed by the nuclear medicine

 personnel.

See Safety in Nuclear Medicine $rocedures for more information.

3ou will be informed as to how often and when you will need to return to the nuclear medicine

department for further procedures.

See the Radioactive iodine (I-!" Therapy page for information regarding the side-effects of

this treatment .

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Rho interprets the results and how do I get themS

radiologist or other physician who has speciali*ed training in nuclear medicine will interpret

the images and forward a report to your referring physician.

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Rhat are the bene;ts vs. risksS

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*ene+ts

• Nuclear medicine eCaminations provide uni4ue informationUincluding detailson both function and anatomic structure of the body that is oftenunattainable using other imaging procedures.

• Jor many diseases, nuclear medicine scans yield the most useful informationneeded to make a diagnosis or to determine appropriate treatment, if any.

• Nuclear medicine is less eCpensive and may yield more precise informationthan eCploratory surgery.

• Nuclear medicine o9ers the potential to identify disease in its earliest stage,often before symptoms occur or abnormalities can be detected with otherdiagnostic tests.

• Ay detecting whether lesions are likely benign or malignant, 8E6 scans may

eliminate the need for surgical biopsy or identify the best biopsy location.

• 8E6 scans may provide additional information that is used for radiationtherapy planning.

Ris's

• Aecause the doses of radiotracer administered are small, diagnostic nuclearmedicine procedures result in relatively low radiation eCposure to the patient,acceptable for diagnostic eCams. 6hus, the radiation risk is very lowcompared with the potential bene;ts.

• Nuclear medicine diagnostic procedures have been used for more than ;vedecades, and there are no known long3term adverse e9ects from such low3dose eCposure.

•  6he risks of the treatment are always weighed against the potential bene;tsfor nuclear medicine therapeutic procedures. Bou will be informed of allsigni;cant risks prior to the treatment and have an opportunity to ask4uestions.

• 5llergic reactions to radiopharmaceuticals may occur but are eCtremely rareand are usually mild. Nevertheless, you should inform the nuclear medicine

personnel of any allergies you may have or other problems that may haveoccurred during a previous nuclear medicine eCam.

• In?ection of the radiotracer may cause slight pain and redness which shouldrapidly resolve.

• Romen should always inform their physician or radiology technologist if thereis any possibility that they are pregnant or if they are breastfeeding. See the

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Safety page for more information about pregnancy, breastfeeding andnuclear medicine exams.

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Rhat are the limitations of Deneral Nuclear $edicineS

 Nuclear medicine procedures can be time consuming. It can take several hours to days for the

radiotracer to accumulate in the body part of interest and imaging may take up to several hours to

 perform, though in some cases, newer equipment is available that can substantially shorten the

 procedure time.

The resolution of structures of the body with nuclear medicine may not be as high as with other

imaging techniques, such as #T or '(I. Dowever, nuclear medicine scans are more sensitive

than other techniques for a variety of indications, and the functional information gained from

nuclear medicine exams is often unobtainable by other imaging techniques.

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