This document discusses the use of radioisotopes, particularly iodine isotopes, in medical applications like diagnosis and treatment of thyroid disorders and cancers. It describes techniques like radioimmunoassay (RIA), radioimmunolocalization (RIL), radioimmunotherapy, and thyroid scanning that use radioisotopes. RIA uses radioisotope-labeled antigens or antibodies to detect substances in the body, while RIL and radioimmunotherapy use labeled antibodies to detect and treat tumors. Thyroid scanning uses various iodine isotopes to evaluate thyroid function and detect abnormalities.
Direct Sanger CE Sequencing of Individual Ampliseq Cancer Panel Targets from ...Thermo Fisher Scientific
The introduction of defined Ion AmpliSeq™ panels for detection and characterization of actionable mutations occurring in tumor tissue has the potential to revolutionize translational oncology research. The Ion Ampliseq™ cancer hot spot panel version 2 (CHP v2) by Ion Torrent includes 207 actionable sequences from a single target and mutation targets present in 50 genes and the more comprehensive Ion Oncomine™ cancer panel (OCP) developed by Life Technologies Compendia Bioscience™ contains over 2000 mutations. A hallmark of these Ion Torrent Ampliseq cancer panels is the low amount of input DNA needed which is critical when the clinical specimen material is limited such as with fine needle biopsy or FFPE samples. Typically, 10 ng of DNA obtained from these sources is sufficient to produce informative sequencing data. Often, cancer-causing or promoting mutations are detected at relatively low allele frequencies like 10-20 % compared to the major normal allele. Many researchers wish to verify these findings of low frequency mutations by an orthologous method such as traditional dye-fluorescent Sanger sequencing on a capillary electrophoresis (CE) instrument such as the Applied Biosystems 3500 genetic analyzer. To that end, we have developed a workflow that enables the amplification and traditional Sanger sequencing of individual Ion AmpliSeq targets directly from the AmpliSeq library starting material.
The method requires a retainer of 1 μl (~ 5%) of the original AmpliSeq preamplification material. A dilution of this aliquot is used as template source for individualized PCR/sequencing reactions. We show that a random selection of 48 targets from the CHPv2 panel could be successfully amplified and Sanger-sequenced from an Ion Torrent Ampliseq library originally prepared from 10 ng of FFPE
DNA. Furthermore, we show the successful Sanger-re-sequencing of all individual 24 targets covering the TP53 exons from the same sample processed and pre-amplified with the OncoMine AmpliSeq panel.
Taken together, this method will enable researchers to reflex-test potential mutations of interest from very material-limited specimen using Sanger CE sequencing
Actualización en el abordaje terapéutico ante un cáncer colorrectal metastásicoMauricio Lema
Ponencia en el VII Congreso internacional de coloproctología, Bogotá, 18.08.2016. Con énfasis en los estudios recientes en terapia antiangiogénica, y el impacto del lado del primario en el pronóstico (y aspectos predictivos) de la enfermedad metastásica.
Direct Sanger CE Sequencing of Individual Ampliseq Cancer Panel Targets from ...Thermo Fisher Scientific
The introduction of defined Ion AmpliSeq™ panels for detection and characterization of actionable mutations occurring in tumor tissue has the potential to revolutionize translational oncology research. The Ion Ampliseq™ cancer hot spot panel version 2 (CHP v2) by Ion Torrent includes 207 actionable sequences from a single target and mutation targets present in 50 genes and the more comprehensive Ion Oncomine™ cancer panel (OCP) developed by Life Technologies Compendia Bioscience™ contains over 2000 mutations. A hallmark of these Ion Torrent Ampliseq cancer panels is the low amount of input DNA needed which is critical when the clinical specimen material is limited such as with fine needle biopsy or FFPE samples. Typically, 10 ng of DNA obtained from these sources is sufficient to produce informative sequencing data. Often, cancer-causing or promoting mutations are detected at relatively low allele frequencies like 10-20 % compared to the major normal allele. Many researchers wish to verify these findings of low frequency mutations by an orthologous method such as traditional dye-fluorescent Sanger sequencing on a capillary electrophoresis (CE) instrument such as the Applied Biosystems 3500 genetic analyzer. To that end, we have developed a workflow that enables the amplification and traditional Sanger sequencing of individual Ion AmpliSeq targets directly from the AmpliSeq library starting material.
The method requires a retainer of 1 μl (~ 5%) of the original AmpliSeq preamplification material. A dilution of this aliquot is used as template source for individualized PCR/sequencing reactions. We show that a random selection of 48 targets from the CHPv2 panel could be successfully amplified and Sanger-sequenced from an Ion Torrent Ampliseq library originally prepared from 10 ng of FFPE
DNA. Furthermore, we show the successful Sanger-re-sequencing of all individual 24 targets covering the TP53 exons from the same sample processed and pre-amplified with the OncoMine AmpliSeq panel.
Taken together, this method will enable researchers to reflex-test potential mutations of interest from very material-limited specimen using Sanger CE sequencing
Actualización en el abordaje terapéutico ante un cáncer colorrectal metastásicoMauricio Lema
Ponencia en el VII Congreso internacional de coloproctología, Bogotá, 18.08.2016. Con énfasis en los estudios recientes en terapia antiangiogénica, y el impacto del lado del primario en el pronóstico (y aspectos predictivos) de la enfermedad metastásica.
Characterization of Novel ctDNA Reference Materials Developed using the Genom...Thermo Fisher Scientific
Liquid biopsy diagnostic technologies have revolutionized cancer testing and therapeutic monitoring. Non-invasive sample collection removes the need for invasive and dangerous biopsies to diagnose cancer and monitor therapeutic efficacy. As liquid biopsy technologies become more sensitive, screening for early detection of cancer DNA using a blood test could become routine clinical practice. However, such technologies cannot be developed without high quality reference materials. In this study, ctDNA reference materials using the NIST Genome in a Bottle GM24385 cell line DNA were developed in a human plasma-EDTA matrix. The allelic frequency (AF), size and stability of the materials were analyzed.
Treating cancer effectively requires an understanding of the molecular alterations driving each patient’s tumor. Targeted sequencing efforts that characterize prevalent somatic alterations and require limited sample input may provide an effective diagnostic approach. Herein, we describe the design and characterization of the Oncomine™ Cancer Research Panel (OCP) that includes recurrent somatic alterations in solid tumors derived from the Oncomine™ cancer database. Using Ion AmpliSeq™ technology, we designed a DNA panel that includes assays for 73 oncogenes with 1,826 recurrent hotspot mutations, 26 tumor suppressor genes enriched for deleterious mutations, as well as 75 genes subject to recurrent focal copy gain or loss. A complementary RNA panel includes 183 assays for relevant gene fusions involving 22 fusion driver genes. Recommended sample inputs were 10 ng of nucleic acid per pool. Sequencing libraries were analyzed on an Ion Torrent™ Personal Genome Machine™. Initial testing revealed an average read depth of > 1,500X with > 95% uniformity and on target frequency. The panel was shown to reliably detect known hotspots, insertions/deletions, gene copy changes, and gene fusions in molecular standards, cell lines and formalin-fixed paraffin embedded samples. Retrospective analysis of large sample cohorts has been completed and the results of analysis of 100 lung cancer and 100 prostate cancer cases will be summarized. In addition, a prospective cohort of 100 samples from the University of Michigan Molecular Diagnostics laboratory was profiled with OCP. Overall, we achieved >95% sensitivity and specificity for detection of KRAS, EGFR and BRAF mutations and ALK gene fusions.
Circulating cell free DNA is a potential tumor marker in a non-invasive blood test for the treatment and evaluation of cancer and recurrence monitoring. As circulating tumor DNA is often present at low frequencies within circulating cell free DNA, targeted sequencing on the Ion Torrent™ platform is an optimal tool or mutation detection with very little sample input required. Here, we demonstrate a complete workflow from isolation through molecular characterization of circulating tumor DNA. We have optimized a protocol using magnetic beads to isolate circulating cell free DNA. This protocol is easily automated to process up to 192 samples a day. It is also easily scalable for any input volume and can elute in volumes down to 15 μL resulting in no loss of low frequency alleles. We demonstrate comparable performance between this bead based isolation and column based isolation. We have completed molecular characterization of circulating cell free DNA using the multiplexing capabilities of AmpliSeq™ and the Ion PGM™. With the Ion AmpliSeq™ Cancer Hotspot Panel v2, we performed targeted sequencing of 50 genes of interest, covering 2800 COSMIC mutations. We demonstrate good reproducibility of amplicon representation as well as allelic frequencies. Through saturation studies and subsampling, we have determined the limit of detection of hotspots circulating cell free DNA on the Ion PGM™ to be below 1%. We further demonstrate proof of principle of this workflow on circulating cell free DNA and matched FFPE samples. Our results verify the accuracy and ease of our workflow. This protocol, from isolation through targeted sequencing, will not only result in a simple sample preparation for circulating cell free DNA but also facilitate rapid mutation detection to advance cancer research.
The Molecular Analysis on Circulating Tumor Cells to Determine Prognostic and...QIAGEN
Circulating tumor cells (CTCs) is an emerging source used molecular cancer diagnostics. Through expression profiling of CTCs, it allows a deeper understanding about which metabolic pathways enable tumor cells to survive in the circulation, how they become resistant to a drug regimen, how they transform and adapt and, finally, which cellular markers should targeted for future therapies.
This webinar will introduce the AdnaTest CTC detection platform which has been proven in several clinical trials to provide prognostic and predictive information in breast, ovarian and prostate cancer. The platform by itself is still open for research and allows access to any potential target of interest. Join us to learn more about this novel platform, its technology and applications in liquid biopsy.
The Presence and Persistence of Resistant and Stem Cell-Like Tumor Cells as a...QIAGEN
Epithelial ovarian cancer is the fifth leading cause of cancer-related deaths of women in the United States and Europe and ranks as the second most common type of gynecological malignancy. Most cases are diagnosed in advanced stages and although the response rates to platinum-based chemotherapy are high, the majority of patients nevertheless have poor survival rates. Although the reasons for these poor outcomes are likely to be multifactorial, one particular area of interest has recently focused on hematogenous tumor cell dissemination that has been shown to originate from disseminated tumor cells (DTCs) in the bone marrow (BM) and circulating tumor cells (CTCs) in the blood. Here, we demonstrate that the negative prognostic impact of CTCs and DTCs arise from specific cellular phenotypes and are associated with platinum-resistance and stem cell-associated proteins.
POTENTIAL OFCIRCULATING CHEMOKINES AS SERUM TUMOUR MARKERS IN BREAST CANCERMarion Hartmann
CCL5 plays a potential role in breast cancer metastasis. A significant positive correlation between CCL5 and TGF-β1 across all samples examined suggests potential synergistic effect between the two factors that warrants further investigation.
Nanodroplet processing platform for deep and quantitative proteome profiling ...Gul Muneer
Nanoscale or single-cell technologies are critical for biomedical applications. However, current mass spectrometry (MS)-based proteomic approaches require samples comprising a minimum of thousands of cells to provide in-depth profiling. Here, we report the development of a nanoPOTS (nanodroplet processing in one pot for trace samples) platform for small cell population proteomics analysis. NanoPOTS enhances the efficiency and recovery of sample processing by downscaling processing volumes to <200 nL to minimize surface losses. When combined with ultrasensitive liquid chromatography-MS, nanoPOTS allows identification of ~1500 to ~3000 proteins from ~10 to ~140 cells, respectively. By incorporating the Match Between Runs algorithm of MaxQuant, >3000 proteins are consistently identified from as few as 10 cells. Furthermore, we demonstrate quantification of ~2400 proteins from single human pancreatic islet thin sections from type 1 diabetic and control donors, illustrating the application of nanoPOTS for spatially resolved proteome measurements from clinical tissues.
Proteogenomic analysis of human colon cancer reveals new therapeutic opportun...Gul Muneer
We performed the first proteogenomic study on a prospectively collected colon cancer cohort. Comparative proteomic and phosphoproteomic analysis of paired tumor and normal adjacent tissues produced a catalog of colon cancer-associated proteins and phosphosites, including known and putative new biomarkers, drug targets, and cancer/testis antigens. Proteogenomic integration not only prioritized genomically inferred targets, such as copy-number drivers and mutation-derived neoantigens, but also yielded novel findings. Phosphoproteomics data associated Rb phosphorylation with increased proliferation and decreased apoptosis in colon cancer, which explains why this classical tumor suppressor is amplified in colon tumors and suggests a rationale for targeting Rb phosphorylation in colon cancer. Proteomics identified an association between decreased CD8 T cell infiltration and increased glycolysis in microsatellite instability-high (MSI-H) tumors, suggesting glycolysis as a potential target to overcome the resistance of MSI-H tumors to immune checkpoint blockade. Proteogenomics presents new avenues for biological discoveries and therapeutic development.
Characterization of Novel ctDNA Reference Materials Developed using the Genom...Thermo Fisher Scientific
Liquid biopsy diagnostic technologies have revolutionized cancer testing and therapeutic monitoring. Non-invasive sample collection removes the need for invasive and dangerous biopsies to diagnose cancer and monitor therapeutic efficacy. As liquid biopsy technologies become more sensitive, screening for early detection of cancer DNA using a blood test could become routine clinical practice. However, such technologies cannot be developed without high quality reference materials. In this study, ctDNA reference materials using the NIST Genome in a Bottle GM24385 cell line DNA were developed in a human plasma-EDTA matrix. The allelic frequency (AF), size and stability of the materials were analyzed.
Treating cancer effectively requires an understanding of the molecular alterations driving each patient’s tumor. Targeted sequencing efforts that characterize prevalent somatic alterations and require limited sample input may provide an effective diagnostic approach. Herein, we describe the design and characterization of the Oncomine™ Cancer Research Panel (OCP) that includes recurrent somatic alterations in solid tumors derived from the Oncomine™ cancer database. Using Ion AmpliSeq™ technology, we designed a DNA panel that includes assays for 73 oncogenes with 1,826 recurrent hotspot mutations, 26 tumor suppressor genes enriched for deleterious mutations, as well as 75 genes subject to recurrent focal copy gain or loss. A complementary RNA panel includes 183 assays for relevant gene fusions involving 22 fusion driver genes. Recommended sample inputs were 10 ng of nucleic acid per pool. Sequencing libraries were analyzed on an Ion Torrent™ Personal Genome Machine™. Initial testing revealed an average read depth of > 1,500X with > 95% uniformity and on target frequency. The panel was shown to reliably detect known hotspots, insertions/deletions, gene copy changes, and gene fusions in molecular standards, cell lines and formalin-fixed paraffin embedded samples. Retrospective analysis of large sample cohorts has been completed and the results of analysis of 100 lung cancer and 100 prostate cancer cases will be summarized. In addition, a prospective cohort of 100 samples from the University of Michigan Molecular Diagnostics laboratory was profiled with OCP. Overall, we achieved >95% sensitivity and specificity for detection of KRAS, EGFR and BRAF mutations and ALK gene fusions.
Circulating cell free DNA is a potential tumor marker in a non-invasive blood test for the treatment and evaluation of cancer and recurrence monitoring. As circulating tumor DNA is often present at low frequencies within circulating cell free DNA, targeted sequencing on the Ion Torrent™ platform is an optimal tool or mutation detection with very little sample input required. Here, we demonstrate a complete workflow from isolation through molecular characterization of circulating tumor DNA. We have optimized a protocol using magnetic beads to isolate circulating cell free DNA. This protocol is easily automated to process up to 192 samples a day. It is also easily scalable for any input volume and can elute in volumes down to 15 μL resulting in no loss of low frequency alleles. We demonstrate comparable performance between this bead based isolation and column based isolation. We have completed molecular characterization of circulating cell free DNA using the multiplexing capabilities of AmpliSeq™ and the Ion PGM™. With the Ion AmpliSeq™ Cancer Hotspot Panel v2, we performed targeted sequencing of 50 genes of interest, covering 2800 COSMIC mutations. We demonstrate good reproducibility of amplicon representation as well as allelic frequencies. Through saturation studies and subsampling, we have determined the limit of detection of hotspots circulating cell free DNA on the Ion PGM™ to be below 1%. We further demonstrate proof of principle of this workflow on circulating cell free DNA and matched FFPE samples. Our results verify the accuracy and ease of our workflow. This protocol, from isolation through targeted sequencing, will not only result in a simple sample preparation for circulating cell free DNA but also facilitate rapid mutation detection to advance cancer research.
The Molecular Analysis on Circulating Tumor Cells to Determine Prognostic and...QIAGEN
Circulating tumor cells (CTCs) is an emerging source used molecular cancer diagnostics. Through expression profiling of CTCs, it allows a deeper understanding about which metabolic pathways enable tumor cells to survive in the circulation, how they become resistant to a drug regimen, how they transform and adapt and, finally, which cellular markers should targeted for future therapies.
This webinar will introduce the AdnaTest CTC detection platform which has been proven in several clinical trials to provide prognostic and predictive information in breast, ovarian and prostate cancer. The platform by itself is still open for research and allows access to any potential target of interest. Join us to learn more about this novel platform, its technology and applications in liquid biopsy.
The Presence and Persistence of Resistant and Stem Cell-Like Tumor Cells as a...QIAGEN
Epithelial ovarian cancer is the fifth leading cause of cancer-related deaths of women in the United States and Europe and ranks as the second most common type of gynecological malignancy. Most cases are diagnosed in advanced stages and although the response rates to platinum-based chemotherapy are high, the majority of patients nevertheless have poor survival rates. Although the reasons for these poor outcomes are likely to be multifactorial, one particular area of interest has recently focused on hematogenous tumor cell dissemination that has been shown to originate from disseminated tumor cells (DTCs) in the bone marrow (BM) and circulating tumor cells (CTCs) in the blood. Here, we demonstrate that the negative prognostic impact of CTCs and DTCs arise from specific cellular phenotypes and are associated with platinum-resistance and stem cell-associated proteins.
POTENTIAL OFCIRCULATING CHEMOKINES AS SERUM TUMOUR MARKERS IN BREAST CANCERMarion Hartmann
CCL5 plays a potential role in breast cancer metastasis. A significant positive correlation between CCL5 and TGF-β1 across all samples examined suggests potential synergistic effect between the two factors that warrants further investigation.
Nanodroplet processing platform for deep and quantitative proteome profiling ...Gul Muneer
Nanoscale or single-cell technologies are critical for biomedical applications. However, current mass spectrometry (MS)-based proteomic approaches require samples comprising a minimum of thousands of cells to provide in-depth profiling. Here, we report the development of a nanoPOTS (nanodroplet processing in one pot for trace samples) platform for small cell population proteomics analysis. NanoPOTS enhances the efficiency and recovery of sample processing by downscaling processing volumes to <200 nL to minimize surface losses. When combined with ultrasensitive liquid chromatography-MS, nanoPOTS allows identification of ~1500 to ~3000 proteins from ~10 to ~140 cells, respectively. By incorporating the Match Between Runs algorithm of MaxQuant, >3000 proteins are consistently identified from as few as 10 cells. Furthermore, we demonstrate quantification of ~2400 proteins from single human pancreatic islet thin sections from type 1 diabetic and control donors, illustrating the application of nanoPOTS for spatially resolved proteome measurements from clinical tissues.
Proteogenomic analysis of human colon cancer reveals new therapeutic opportun...Gul Muneer
We performed the first proteogenomic study on a prospectively collected colon cancer cohort. Comparative proteomic and phosphoproteomic analysis of paired tumor and normal adjacent tissues produced a catalog of colon cancer-associated proteins and phosphosites, including known and putative new biomarkers, drug targets, and cancer/testis antigens. Proteogenomic integration not only prioritized genomically inferred targets, such as copy-number drivers and mutation-derived neoantigens, but also yielded novel findings. Phosphoproteomics data associated Rb phosphorylation with increased proliferation and decreased apoptosis in colon cancer, which explains why this classical tumor suppressor is amplified in colon tumors and suggests a rationale for targeting Rb phosphorylation in colon cancer. Proteomics identified an association between decreased CD8 T cell infiltration and increased glycolysis in microsatellite instability-high (MSI-H) tumors, suggesting glycolysis as a potential target to overcome the resistance of MSI-H tumors to immune checkpoint blockade. Proteogenomics presents new avenues for biological discoveries and therapeutic development.
Equipements, paysage audiovisuel, écrans, usages, audiences, social TV, investissements publicitaires, efficacité, réglementation… le SNPTV a sélectionné et intégré dans ce guide des « + de la TV » des études françaises et internationales réalisées par des instituts d’études, des cabinets de conseil, des agences média, des agences de communication, des annonceurs… Leur expertise, réunie dans cet outil, offre une vision optimale de ce qu’est et sera le marché de la TV & de la Pub TV.
Development and Validation of a Two-Site Immunoradiometric assay for Glypican...Premier Publishers
This work aimed to set-up and evaluate a lab-made immunoradiometric assay for the detection of plasma glypican-3 (GPC3) in comparison with a commercial ELISA kit and to use them to evaluate the diagnostic potential of GPC3 in HCC patients. Anti-GPC3 monoclonal antibodies were radio-iodinated and used with a second antibody in the IRMA assay. The study included 450 subjects in 3 groups, 150 HCC patients, 150 hepatitis-C-virus (HCV) patients and 150 normal healthy subjects. Plasma GPC3 was assayed by our lab-made IRMA and by a commercial ELISA kit, along with alpha-fetoprotein (AFP). We were able to set-up an IRMA assay to measure plasma GPC3 and applied it to diagnose HCC patients. When compared to a ELISA kit, our IRMA assay showed much better performance characteristics on ROC curves with much higher area under the curves, sensitivities and specificities when diagnosing HCC patients from normal controls or HCV patients. Using our IRMA assay, showed that GPC3 is a good diagnostic indicator for HCC with 1.4 ng/ml cutoff for controls and at a cutoff value of 1.55 ng/ml it was able to discriminate HCC and HCV patients. GPC3 measurement was much better than AFP for the diagnosis of HCC.
Eligibility for ACOSOG Z0011 Trial and Results on a Cohort of 3546 Breast Can...NainaAnon
Since results of ACOSOG-Z0011 and IBCSG-23-01 trials, complementary Axillary Lymph Node Dissection (cALND) was questioned for Breast Cancer (BC) with involved Sentinel Node (SN). We examine eligibility rate to Z0011-trial criteria and results among patients with SN micro or macro-metastases....
Robert P. Edwards, MD, Chair of OB/GYN/RS, Co-Director of Women's Cancer Program at University of Pittsburgh, offers information about the current state of immunotherapy for recurrent ovarian cancer patients.
Since results of ACOSOG-Z0011 and IBCSG-23-01 trials, complementary Axillary
Lymph Node Dissection (cALND) was questioned for Breast Cancer (BC) with involved Sentinel
Node (SN). We examine eligibility rate to Z0011-trial criteria and results among patients with SN
micro or macro-metastases.
Eligibility for ACOSOG Z0011 Trial and Results on a Cohort of 3546 Breast Can...semualkaira
Since results of ACOSOG-Z0011 and IBCSG-23-01 trials, complementary Axillary
Lymph Node Dissection (cALND) was questioned for Breast Cancer (BC) with involved Sentinel
Node (SN). We examine eligibility rate to Z0011-trial criteria and results among patients with SN
micro or macro-metastases.
Eligibility for ACOSOG Z0011 Trial and Results on a Cohort of 3546 Breast Can...semualkaira
Since results of ACOSOG-Z0011 and IBCSG-23-01 trials, complementary Axillary
Lymph Node Dissection (cALND) was questioned for Breast Cancer (BC) with involved Sentinel
Node (SN). We examine eligibility rate to Z0011-trial criteria and results among patients with SN
micro or macro-metastases.
Eligibility for ACOSOG Z0011 Trial and Results on a Cohort of 3546 Breast Can...semualkaira
Since results of ACOSOG-Z0011 and IBCSG-23-01 trials, complementary Axillary
Lymph Node Dissection (cALND) was questioned for Breast Cancer (BC) with involved Sentinel
Node (SN). We examine eligibility rate to Z0011-trial criteria and results among patients with SN
micro or macro-metastases.
Description (with pictures) of successful (and failed) lunar landings - supplemented with numerous pictures of Lunar Surfaces, with Craters and all.
Disclaimer and Credits
All material (Text, Images, Graphics etc.) in these slides have been procured from publicly available sources of ISRO and other agencies, which includes ISRO partners. There are selected images from NASA and Wikipedia also, where relevant, also procured from freely available public resources, with attribution. Some images and text have been individually acknowledged. Others have been collectively credited through this Disclaimer page. The author makes no copyright claims on any material.
They have been sorted, edited as relevant, collated, compiled and inserted to align them with the sequence of the slides, as deemed fit by the author. They have been posted with academic altruism in mind, for those interested in Astrophysics and Astronomy and related technology, like the author. There is no commercial or promotional motivation involved anywhere.
The author is not an Astrophysicist or an Astronomer. The author does not work for ISRO, NASA or any tech company. The author is a nerd who loves technology, Astrophysics and Astronomy and who dabbles in related developments of ISRO, NASA etc. during his spare time, as an intellectual hobby. Thus, he satiates his academic appetite, learns in the process and wishes to share them with like-minded people.
At the time of publication, all material has been updated and is deemed to be accurate. If any errors are detected by the reader(s) the author will be happy to be corrected. The responsibility for any errors are solely the author’s and not that of the parent organization(s).
Here’s is wishing everyone a happy armchair space exploration on this occasion of New Year 2024!
Updated as on 31 January 2024
JAXA being an ethical Space Agency disclosed the real reason why SLIM Lander could not communicate for 1st week after soft-landing on Moon.
Picture released by JAXA
A. SLIM lost one of its Engines during descent
B. Because of the resultant asymmetric Thrust, SLIM landed on Lunar Surface upside down
C. Resulting in its Solar Panels facing away from Sun (See the direction of shadows to determine relative position of Sun and Solar Panels)
MARS Images ISRO-NASA-Compiled by Sanjoy SanyalSanjoy Sanyal
MCC Imaging Timeline
28 September 2014 – MOM (Mars Orbiter Mission) controllers published the spacecraft's first global view of Mars. The image was captured by the Mars Color Camera (MCC)
4 March 2015 – MCC was returning new images of Martian surface
24 September 2015 – ISRO released ‘Mars Atlas’, a 120-page scientific atlas containing images and data from MOM’s 1st year in orbit
19 May 2017 – MOM reached 1,000 days (973 sols (Martian Days)) in orbit around Mars. In that time, the spacecraft completed 388 orbits of the planet and relayed > 715 images back to Earth
24 September 2018 – MOM completed 4 years in its orbit around Mars, although the designed mission life was only 6 months. Over these years, MOM’s MCC captured > 980 images that were released to the public
24 September 2019 – MOM completed 5 years in orbit around Mars, sending 2 TB of imaging data
1 July 2020 – MOM captured a photo of Mars satellite Phobos from 4,200 km away
18 July 2021 – MCC captured full disc image of Mars from an altitude of 75,000 km with spatial resolution about 3.7 km
October 2022 – MCC produced 1,100+ images before retirement
DISCLAIMER
All material (Text, Images, Graphics etc.) in these slides have been procured from publicly available sources of ISRO and other agencies, which includes ISRO partners. There are selected images from NASA also, where relevant, also procured from freely available public resources. Instead of individually acknowledging each image they have been collectively credited through this Disclaimer page. The author makes no copyright claims on any material.
They have been sorted, edited as relevant, collated and inserted to align them with the sequence of the slides, as deemed fit by the author. They have been posted with academic altruism in mind, for those interested in Astrophysics and Astronomy and related technology, like the author. There is no commercial or promotional motivation involved anywhere.
The author is not an Astrophysicist or an Astronomer. The author does not work for ISRO, NASA or any tech company. The author is a nerd who loves technology, Astrophysics and Astronomy and who dabbles in related developments of ISRO, NASA etc. during his spare time as an intellectual hobby. Thus, he satiates his academic appetite, learns in the process and wishes to share them with like-minded people.
At the time of publication, all material has been updated and is deemed to be accurate. If any errors are detected by the reader(s), I shall be happy to be corrected. The responsibility for any errors are solely mine and not that of the parent organizations.
Here’s is wishing everyone a happy armchair space exploration on this occasion of New Year 2024!
Aditya-L1 Suit Images ISRO - Compiled by Sanjoy Sanyal.pptxSanjoy Sanyal
Solar Ultraviolet Imaging Telescope (SUIT):
Instrument on board Aditya-L1 Spacecraft has successfully captured the first full-disk images of the Sun in 200-400 nm Wavelength range
SUIT captures images of the Sun's Photosphere and Chromosphere in this wavelength range using various Filters
20 November 2023: SUIT payload was powered ON
Successful pre-commissioning phase
6 December 2023: SUIT captured its first light science images
Images: Taken using 11 different Filters (Slide 4), include the first-ever full-disk representations of the Sun in Wavelengths ranging from 200 to 400 nm, excluding Ca II h
Notable Features: Sunspots, Plage (Chromosphere variant of Faculae), Limb Darkening, and Quiet Regions of Sun, as marked in Mg II h image (Slide 7), provide scientists with insights into the intricate details of Sun's Photosphere and Chromosphere
SUIT observations will help scientists study the dynamic coupling of magnetized solar atmosphere and assist them in determining the effects of solar radiation on Earth's climate
DISCLAIMER
All material (Text, Images, Graphics etc.) in these slides have been procured from publicly available sources of ISRO and other agencies, which includes ISRO partners. There are selected images from NASA also, where relevant, also procured from freely available public resources. Instead of individually acknowledging each image they have been collectively credited through this Disclaimer page. The author makes no copyright claims on any material.
They have been sorted, edited as relevant, collated and inserted to align them with the sequence of the slides, as deemed fit by the author. They have been posted with academic altruism in mind, for those interested in Astrophysics and Astronomy and related technology, like the author. There is no commercial or promotional motivation involved anywhere.
The author is not an Astrophysicist or an Astronomer. The author does not work for ISRO, NASA or any tech company. The author is a nerd who loves technology, Astrophysics and Astronomy and who dabbles in related developments of ISRO, NASA etc. during his spare time as an intellectual hobby. Thus, he satiates his academic appetite, learns in the process and wishes to share them with like-minded people.
At the time of publication, all material has been updated and is deemed to be accurate. If any errors are detected by the reader(s), I shall be happy to be corrected. The responsibility for any errors are solely mine and not that of the parent organizations.
Here’s is wishing everyone a happy armchair space exploration on this occasion of New Year 2024!
Charting Neural Pathways in Schizophrenia and BPD-Chicago Conference 2016 - S...Sanjoy Sanyal
This was presented by Dr. Sanjoy Sanyal, Professor, Surgeon, Neuroscientist, Informatician, at 2nd International Conference on Brain Disorders and Therapeutics, Chicago, USA, October 26-28, 2016
Types of Schizophrenia
Types of Bipolar Disorder (BPD)
DTI Findings in Schizophrenia / BPD
Videos of White Matter Affected in Psychosis
Brain Network Concepts
Basal Forebrain Components and VTA
Videos of Meso-limbic / Meso-cortical Tracts
Receptors in Psychotic Disorders
Videos of Pathophysiology in Schizophrenia 1 and 2 – Rx Principles
Future Research Possibilities
Summary and Conclusion
Thank you for watching.
Aorta–IVC–Kidney Dissection and Surgical Correlations - Dr Sanjoy SanyalSanjoy Sanyal
Educational PPTX created by Dr. Sanjoy Sanyal; Professor, Department Chair, Surgeon, Neuroscientist and Medical Informatician
It shows the surgical anatomy of the posterior abdominal contents, with special emphasis on the aorta, IVC and Kidney-Ureters. The specimen was harvested from a cadaver.
With real-time narration and relevant captions, it enhances the learning experience by means of a trimodal learning style approach - Visual, Auditory, Textual.
Thank you for watching. If you have any questions or comments, please put them in the comments section below. Have a nice day!
Educational Video created by Dr Sanjoy Sanyal; Professor, Surgeon, Medical Informatician and Department Chair in the Western Hemisphere.
A section of the anterior chest wall from a cadaver is described - the Bones, Muscles, Vessels, and some Clinical Correlations
Camera person is Ms. Selvie Krishna, an enthusiastic student with her Blackberry.
Errata Corrigendum: There is an inadvertent error in my narration, where I mentioned Sternum instead of Vertebral Column. The same was corrected immediately thereafter in my narration, and the error and correction have also been captioned in the body of the video.
Thank you for watching. If there are questions or comments, put them in the comments section below.
Dissections of the calf and its functional and surgical aspects have been discussed in real time by Dr. Sanjoy Sanyal, Professor, Surgeon, Neuroscientist and Medical Informatician.
Important points discussed are: Triceps surae, Gastrocnemius, Soleus, Plantaris, Tendo calcaneus, Love and Whelan classification, Plantar reflex, calcaneal bursitis, calcaneal tendinitis, calcaneal tendon rupture, Gastrocnemius strain, tennis leg, PAES, accessory soleus
Educational importance lies in the following aspects: Combination of audio, video, graphics and textual description in real time
Surgical Aspects of Popliteal Fossa - Dr. Sanjoy SanyalSanjoy Sanyal
Dissection of the popliteal fossa and its surgical aspects has been discussed in real time by Dr. Sanjoy Sanyal, Professor, Surgeon and Neuroscientist.
Important points discussed are: Popliteal fossa, Palpation, Popliteal artery entrapment, PAES, Popliteal aneurysm, Popliteal AV fistula, Popliteal hemorrhage, Genicular anastomosis, Popliteal cyst, Baker cyst, Morrant baker cyst, Heidelberg classification, Love and Whelan classification
Educational importance lies in the following aspects: Combination of audio, video, graphics and textual description in real time
Surgical Anatomy of Cadaveric Abdominal Viscera - Dr Sanjoy SanyalSanjoy Sanyal
Educational Video created by Dr Sanjoy Sanyal; Professor, Surgeon, Neuroscientist and Medical Informatician
A section of abdominal viscera from a cadaver has been described - Stomach, Spleen, Colon, Greater Omenutm, with some clinical and surgical correlations
Corrigendum: Please disregard the inadvertent error when the Gastrosplenic ligament is being described - GS ligament contains Gastro-epiploic vessels; Spleno-renal ligament contains the Splenic vessels
This was presented by Dr Sanjoy Sanyal at the 2016 International Education Conference in Orlando, FL on 4 January 2016 in Disney's Boardwalk Inn.
It was voted the best paper presentation of the session by the attendees.
Educational Video created by Dr Sanjoy Sanyal; Professor, Surgeon and Medical Informatician
Deals with Blended / Hybrid Learning, Rotation Model, Flipped Classroom, Student responses, Audience Response System Clicker,
Abnormal Right Vertebral Artery MRA Sequence - Sanjoy SanyalSanjoy Sanyal
This is an MR Angiography sequence of a 46-year old male patient who was being investigated for TIA. The image sequence shows 3-D Time of Flight (TOF) Spoiled Gradient Recall (SPGR) Echo Acquisition images. It shows the Vertebrobasilar and Carotid systems of Cerebral circulation. An incidental finding was abnormal Right Vertebral artery - Narrow, Double, Accessory, Communication with Right Internal Carotid. The best way to visualize the image is by slideshow - imagine the head is rotating clockwise. There are plenty of labels in the images to guide the viewer.
Ionizing Radiation in Surgery - Sanjoy SanyalSanjoy Sanyal
Ionizing radiations exert their biological effects by excitation and ionization of molecules within cells. In terms of energy deposited within cells, ionizing radiations are the most potent of all physical and chemical agents
Lasers in Surgery Systemic Applications Part-III - Sanjoy SanyalSanjoy Sanyal
Applications of lasers in organ-systems of the body are at the cross-roads today, with limitless horizon ahead of it. The authors dwell upon the applications in important oragns of the human body.
Illustrated Surgical GI Endoscopy - Sanjoy SanyalSanjoy Sanyal
Therapeutic endoscopy has made considerable inroads in the treatment of surgical disorders of the GI tract. This has been brought about by technological innovations in the hardware and the ingenuity of the clinician in accessing the lesion.
Lasers in Surgery Specific Applications Part-II - Sanjoy SanyalSanjoy Sanyal
Experiments with lasers are going on a hectic pace in order to improve upon the existing applications of lasers in surgery. However it behoves the surgeon to be cognizant of its potential hazards and to take appropriate precautions.
Automatic Physiological Assessment in Surgery Computer Program - Sanjoy SanyalSanjoy Sanyal
Computer programs for automatic interpretation of physiological variables in critically ill surgical patients are quick and efficient decision-making aids to the clinician.
Surgical Aspects of Colorectal Endoscopy Part-IV - Sanjoy SanyalSanjoy Sanyal
Colorectal endoscopy differs significantly from UGI endoscopy. The authors describe some differential aspects, some common and some exotic coloscopic findings.
Surgical Wounds Biological and Management Principles - Sanjoy SanyalSanjoy Sanyal
Wound healing is a natural process in the human body. The surgeon's role is to ensure there is no impediment to the process and to guide its course so that there is minimum functional disability.
Basavarajeeyam is an important text for ayurvedic physician belonging to andhra pradehs. It is a popular compendium in various parts of our country as well as in andhra pradesh. The content of the text was presented in sanskrit and telugu language (Bilingual). One of the most famous book in ayurvedic pharmaceutics and therapeutics. This book contains 25 chapters called as prakaranas. Many rasaoushadis were explained, pioneer of dhatu druti, nadi pareeksha, mutra pareeksha etc. Belongs to the period of 15-16 century. New diseases like upadamsha, phiranga rogas are explained.
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
Rasamanikya is a excellent preparation in the field of Rasashastra, it is used in various Kushtha Roga, Shwasa, Vicharchika, Bhagandara, Vatarakta, and Phiranga Roga. In this article Preparation& Comparative analytical profile for both Formulationon i.e Rasamanikya prepared by Kushmanda swarasa & Churnodhaka Shodita Haratala. The study aims to provide insights into the comparative efficacy and analytical aspects of these formulations for enhanced therapeutic outcomes.
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
Here is the updated list of Top Best Ayurvedic medicine for Gas and Indigestion and those are Gas-O-Go Syp for Dyspepsia | Lavizyme Syrup for Acidity | Yumzyme Hepatoprotective Capsules etc
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
Muktapishti is a traditional Ayurvedic preparation made from Shoditha Mukta (Purified Pearl), is believed to help regulate thyroid function and reduce symptoms of hyperthyroidism due to its cooling and balancing properties. Clinical evidence on its efficacy remains limited, necessitating further research to validate its therapeutic benefits.
Role of Mukta Pishti in the Management of Hyperthyroidism
[3]Radionuclides_Surgery
1. Radio-nuclides in surgery: Part 3
Sanjoy Sanyal MS (sanyal.sanjoy8@gmail.com)
Sr. Lecturer, National University of Rwanda
I. Nyaruhirira
Director,
Centre Hospitalier de Kigali, "C.H.K.",
Kigali, Rwanda.
Using radio-labelled antibodies appears to be an innovative method of localising and treating
tumours. Theoretically sound though the technique may be, there are many technical problems
which need to be overcome before it becomes universally acceptable.
Published in May 2000 issue of SURGERY journal (Passi Publications), New Delhi, India
This 1999 issue of SURGERY journal will lay emphasis on isotopes of iodine and their applications in
the radio-immunology, thyroid gland etc. This member of the halogen family, besides being an
essential element in the human body, also has many radioisotopes which can be easily attached to
various substances as a radioactive label (tables1a,b).
Radio-nuclide immunology
Radio-immunoassay
Berson and Yalow were the first to develop the technique of radio-immunoassay (RIA) in 1958 using
these isotopes. RIA can be used to quantify any substance in the body fluids against which an antibody
can be raised, viz. all peptide hormones and many antigens (HbSag, oncofoetal antigen etc). It is a rapid
(within a few hours) and sensitive method as compared to bioassay (which is time-consuming,
expensive and less specific). RIA depends on quantitative interaction between an antigen (ag) and its
specific antibody (ab). A known amount of 125I-labelled ag competes with an unknown amount of
unlabelled ag in the test sample, for a specific ab. Free and bound ag are separated by washing and a
gamma counter analyses the radioactivity of the ag-ab complex.1
Tumour diagnosis: RIA is used for circulating oncofoetal ag (OFA) viz. (a) alphafoetoprotein (AFP) in
hepatoma and germ cell tumours of testis (teratoma) and ovary; (b) pancreatic OFA (POA) in
pancreatic cancer; and (c) carcinoembryonic ag (CEA) in colorectal and pancreatic cancer. RIA is not
2. helpful in the early diagnosis of these tumours because circulating levels of these ag depend on tumour
mass and they may not be raised in small tumours. However, RIA is useful in detecting early tumour
recurrence during post-operative follow-up, when the circulating levels of OFA rise again, often pre-
dating clinical evidence of recurrence by several months. The ab used in RIA are the conventional
polyclonal antiserum (PAS) or the newer, more specific monoclonal ab (MAB).
PAS: The anti-sera produced by immunising rabbits, sheep, goats or horses with tumour ag
preparations contain ab reacting to an array of tissue and tumour ag (hence the term polyclonal). Thus
they are not specifically directed against any particular tumour. Purification procedures are required,
and attempts to improve tumour specificity of these ab by absorption with normal tissues often results
in loss of ab activity.
MAB: These specific (monoclonal) ab are produced from a single ab-producing cell line, by the mouse
hybridoma technique (fusion of murine splenic β-lymphocytes and myeloma cells). Such a cell line can
be maintained indefinitely in culture to produce large quantities of MAB (table 2). As is obvious from
the table, hybridomas produce ab showing restricted but not necessarily 100% tumour-specific
reactivity.
Radioimmunolocalisation
Ab may be labelled with radioisotopes without altering their ag-binding characteristics. Once these
tagged ab attach on the tumour the same may be imaged with a gamma camera. Thus
radioimmunolocalisation (RIL), a.k.a. tumour imaging (TI) or immunoscintigraphy (ISG), allows early
detection and localisation of primary, secondary and recurrent tumours. (In RIA, labelled ag is used to
detect circulating tumour ag; in RIL, labelled ab is used to detect the tumour itself).
The radioisotopes used are 131I (most common), 123I (table 1A), 111Indium(In), 67Gallium(Ga) and 99mTc-
RBC (for image enhancement; described below). The false-negative results of RIL often result from
limitations in resolution of the image, which in turn is dependent on the energy of gamma emission and
other characteristics of the isotopes. 111In appears to be the most suitable for RIL and also gives better
tomoscintigraphic images (infra), though each isotope has its own disadvantages and uses (table 3).
The ab used in RIL may be PAS or MAB. The latter has the following advantages; (a) the amount of
injected immunoglobulin is less; (b) the number of cross-reactions are few; and (c) there is increased
tumour specificity. Table 4 gives a few examples of RIL/TI using 131I-labelled PAS. The technique of
imaging colorectal cancers (CRC) using 131I-labelled MAB is described.
Technique: Human CRC was first imaged with 131I-anti-CEA MAB Mach et al in 1981. Subsequently
many other MAB have been developed which can recognise several ag (other than CEA) on colorectal
tumours. The MAB designated as 791 T/36 (table 2) has been used to image both primary and
metastatic CRC. After a prior intra-dermal skin test (1 µg) to rule out Type-1 hypersensitivity reaction,
131
I-labelled MAB is administered IV and images are obtained using a gamma camera linked to a
computer.
The positivity rate is 70-75 % for localising primary tumours, and 85% for detecting liver metastases
(table 5). The uptake per gram of tumour is 2.6 times that of normal colonic tissue, and the ratio of
tumour : normal tissue levels of 131I-labelled MAB is > 3 times the ratio of tumour : normal tissue
3. levels 125I-labelled normal IgG; indicating that the binding of MAB (791 T/36) is antigenically related
rather than a non-specific binding like a normal Ig.
False-negative: The reasons for failure to localise tumours at times are due to; (a) variations in ag
expression of the tumour; (b) problems in scanning (small rectal tumour masked by isotope in urinary
bladder); (c) isotope emission variations giving limited image resolution (supra); and (d) poor image
enhancement. This results from overlapping of images from the blood and tissue pool. This can be
obviated by the following means: (1) Rapid blood clearance; Fragments of MAB which are rapidly
cleared from the circulation may be used. F(ab1)2 fragments have been used to image CRC and
malignant melanoma. Alternatively, the initial injection of 131I-labelled MAB is followed by
administration of LESA (liposome-entrapped second antibody) directed against the first antibody
(MAB). The LESA-MAB complex is quickly engulfed by the reticuloendothelial cells. (2) Separate
labelling; This is done by using normal Ig of a similar type to the MAB but labelled with a different
radio-nuclide. The distribution of the normal Ig should correspond exactly with that of the active ab
apart from the specific uptake of the latter in tumour deposits. 111In and 67Ga have similar
characteristics, making paired labelling technique possible. Alternatively, the blood pool is labelled
with 99mTc-RBC. This latter image is then digitally subtracted from the 131I-labelled MAB image, to
give only the enhanced tumour image.2
Tomoscintigraphy
Tomoscintigraphy (TSG), a.k.a. emission tomography, gives a three-dimensional image of the
distribution of the isotope. It therefore detects smaller tumour sites (10 cm3 vs. 50 cm3) and has a higher
detection rate (94% vs. 43%), compared to conventional rectilinear ISG (the latter figures), when
imaging CRC and medullary thyroid cancers with 131I-labelled anti-CEA ab.2
Radioimmunotherapy
This employs the same principle as RIL, to deliver a tumoricidal dose of radiation to the tumour site.
Systemic administration of labelled MAB for treating melanoma or hepatoma has not met with much
success because the fraction of the total administered dose reaching the tumour is low. However it has
been possible to instil 131I-labelled MAB against human milk fat globule membrane (131I-labelled anti-
HMFG 2 MAB) directly into the pleural and pericardial cavities to treat these malignant effusions from
ovarian cancer with 5000-7000 cGy (centi Gray) (1 cGy = 1rad) of radiation.2
Miscellaneous tests
Tests to detect IgE in serum of atopic allergic patients use radio-labelled IgE, and use; (a)
radioimmunodiffusion test (RID) (sensitivity <1000 ng ml–1); (b) competitive radioimmunosorbent test
(RIST) (sensitivity=50ng ml-1); (c) non-competitive RIST (more sensitive); and (d) double ab RID.
Even more useful is the radioallergosorbent test (RAST), which measures specific anti-IgE in serum by
using radio-labelled anti-IgE.
4. Thyroid scan
Radioisotopes (table 6) are used in thyroid disorders for; (a) evaluating the thyroid function; (b)
scintiscanning; and (c) therapy. The first has been enumerated in table 1B and shall not be elaborated
any further.
Scintiscanning
It defines areas of physiologically active, inactive or hyperactive tissue within the gland, its degree and
uniformity.
It is highly valuable in the diagnosis of an autonomous toxic nodule (either solitary or the dominant
nodule of a toxic nodular goitre).
It is often (but not always) helpful in evaluating the 'clinically solitary nodule' (infra) and occasionally
helpful in thyroid carcinoma.
It helps to determine the location of the thyroid gland (normal, ectopic or aberrant location) and the
presence or absence of any continuity between them. This helps to determine the treatment modality.
It locates stuma ovarii (ovarian teratoma with functioning thyroid tissue) or functioning metastases
from carcinoma.
Isotopes
131
I: This isotope (T1/2=8 days) and the others are taken up by the thyroid just like the stable isotope
(127I) and made to go through the same sequence of events (trapping, oxidation, iodination, coupling) in
the biosynthesis of thyroid hormones. Therefore it forms the basis of all the thyroid function tests listed
in table 1B. In this capacity it represents one of the earliest applications of radioisotopes in medicine.
Its radioactive emission is used to scan the gland and treat thyrotoxicosis and cancer. 131I has a high
energy of γ emission which a lower efficiency of detection by the gamma camera, as compared to 123I.
For 131I uptake (RAIU) test 5 µ Ci is given orally and activity is counted at 4, 12, 24, 48 hours. For
thyrotoxic ablation the dose is 140-160 µ Ci per gram of estimated gland weight, given orally. More is
described under 'Therapy'.
123
I: This is ideal but costly and not easily available. Its low T1/2 (13 hours) and lower energy of
γ emission makes it more suitable for gamma camera performance, safer for children and pregnant
women, and for performing serial measurements of thyroid function.
132
I: Its short T1/2 (2.3 hours) precludes its use in scanning but has been used in Werner's T3 suppression
test to predict whether a thyrotoxic patient will have a relapse after 6 months of antithyroid drugs. 132I is
administered IV and activity counted at 20 minutes. Failure to suppress 132I uptake by T3 administration
indicates persistent thyroid-stimulating-immunoglobin (TSI) control (TSH-independent), with
likelihood of relapse.
99m
Tc: This has been described in the previous issue. Since it is trapped by the thyroid but not
organified, it cannot be used for thyroid function tests, and the scan information may not be the same as
that with 131I. But because of its numerous advantages (q.v.) it is ideal when thyroid morphology (but
not function) is to be assessed.
5. Special scans
These are aimed at; (a) detecting carcinoma; (b) improving the diagnostic accuracy of the same and; (c)
detecting metastases from thyroid cancer. The first and third aims are fulfilled by TSG/ISG and total
body scan / skeletal scan, respectively. The scans to improve the diagnostic accuracy of cancer are
based on the premises that; (1) a cancer shows lack of affinity for radio-iodine (with rare exceptions);
and (2) it has a high affinity for methionine because of its cellularity. 99mTc photoscanning and
241
Americium(Am) fluorescent scan are based on the first premise and 75Selenomethionine scan is based
on the second.
131
Tomoscintigraphy: TSG/ISG using I-labelled anti-CEA ab to image medullary thyroid carcinoma
has been described earlier.
99m
Tc photoscanning: Conventional rectilinear scanning may miss a lesion < 1 cm because of the
intimate relationship of the nodule to the surrounding normal parenchyma, and the scan may not
accurately reflect the iodide uptake within the nodule because of the overlying normal parenchyma.
99m
Tc photoscanning techniques permitting oblique views overcome these disadvantages of rectilinear
scanning. Thus a nodule which appears hypo-functioning in the A-P view (due to overlying tissues)
may be confirmed to be non-functioning in the oblique view . These techniques permit better appraisal
of the intrinsic radioactivity of a nodule and provide a more accurate index of the radio-nuclide content
of a nodule. The positive correlation between lack of iodide uptake within a nodule and thyroid cancer
is 10-20%. However, colloid nodules, cysts and follicular adenomas may also exhibit lack of iodide
uptake and cannot be differentiated from cancer by scan alone.
241
Am fluorescent scan: When parallel (collimated) γ photons from 241Am are focussed on the thyroid
gland, the I2 atoms get sufficiently agitated to release 28.5 keV of x-ray which can be detected by
fluorescence imaging. The quantum of x-ray emitted depends on the amount of I 2 atoms in the field. By
the fluorescent scan, comparison of the I2 content in a 'cold' solitary nodule (as seen in a conventional
scan) and the corresponding area on the opposite side may be used to distinguish between benign and
malignant lesions.
75
Se-methionine scan: This may be used to distinguish between a benign 'cold' nodule and a malignant
'cold' nodule (as demonstrated in a conventional scan). However, the theoretical premise that an
actively dividing highly cellular carcinoma will take up more 75Se-labelled-methionine and show as a
'hot' spot is often belied by many well-differentiated carcinomas which are not sufficiently mitotically
active to take up 75Se-methionine.
:131
I total body scan: It is performed in thyroid cancer as a screening procedure for metastases, to detect
their site(s) and to assess the functional status of such deposits. (1) Screening: TBS is performed after
total thyroidectomy. Pre-operative TBS is useless because secondary deposits do not take up 131I in the
presence of functioning thyroid tissue. Routine screening is not necessary for well-differentiated
tumours. (2) Site(s): If a solitary secondary is present local radiotherapy to the site (instead of systemic
131
I therapy) will be beneficial. All hepatic, pulmonary and skeletal metastases appear as 'hot' spots.
Post-operative neck scan is essential; (a) some functioning thyroid tissue commonly remains even after
total thyroidectomy; (b) determination of its size and location permits later differentiation from local
recurrence, (c) if significant amount is present, it should be ablated prior to systemic therapy with 131I.
(3) Status: Post-operatively, the metastases may demonstrate sufficient function to take up 131I. This is
further enhanced by TSH administration 5 days before. Very rarely, a large mass of secondary may
6. produce mild hyperthyroidism (functional autonomy). Scan is of predictive value; if the secondary
shows good 131I uptake, therapy with same is likely to be beneficial.
Procedure: It is performed several weeks after surgery. Ten units of TSH are administered 5 days
before the day of scanning. Three days later 2 mCi of 131I is given orally. This ablates any residual
thyroid tissue in the neck and demonstrates any functioning metastases. On the day of TBS urinary 131I
is also measured. When functioning metastases are demonstrated, they are treated with therapeutic
doses of 131I.
99m
Tc PYP skeletal scan: Invasive follicular cancer metastases to the bones (sternum, skull, humerus,
spine, ilium, knee bones etc) appear as 'hot' spots in 99mTc stannous pyrophosphate(PYP) scan. More
will be discussed under 'Bone scan' in the next issue.
131
I therapy
In cancer, 131I ablates the whole tissue; in hyperthyroidism it reduces the functioning mass below a
critical level.
Metastases: Anaplastic metastases do not respond to 131I ablation. Only follicular carcinoma or
follicular elements in papillary carcinoma accumulate sufficient quantities of 131I. Solitary metastases
may be locally irradiated but multiple deposits require 131I systemically. All normal thyroid tissue must
have been ablated by surgery and/or radio-ablation and the patient must be hypo-thyroid when the
treatment is given. Following therapeutic dose (50-200 m Ci) of 131I, T4 (0.2-0.3 mg day-1) is started (for
thyroxin replacement and for TSH suppression). One year later TSH is stimulated large doses of TRH
(so as to maximise the stimulation of any residual functional tissue) and the 131I scan is repeated. Re-
ossification of the sites of deposits is looked for, as well as uptake of 131I, if any. If present, a further
therapeutic dose of 131I is administered.
Thyrotoxicosis: (1) Radiation and 131I are avoided in; (a) children (interference with growth,
subsequent development of papillary carcinoma); (b) pregnancy (intra-uterine growth retardation,
chromosomal defects, mutations in the foetus); (c) < 45 years of age (delayed hypothyroidism)and; (d)
retrosternal goitre with obstructive symptoms (goitre may enlarge and worsen the thoracic inlet
obstruction). (2) Toxic nodular goitres do not respond well to 131I. (3) In elderly cardiac patients
(surgery contraindicated), 131I is given first and anti-thyroid drugs are started 48 hours later and
continued until 131I has had effect. (4) In case of failure hyperthyroidism to respond to 131I, radio-
ablation of thyroid gland with same (and T4 replacement) is required.
The dose is 140-160 µ Ci per gram of estimated gland weight. For toxic nodule (hyper-functioning
adenoma) this is usually 10 m Ci and for toxic multinodular goitre it works out to 20-30 m Ci. Due to a
large proportion of sub-lethal cell damage, there is progressive delayed hypothyroidism whose
incidence has been variously reported as 40 to 80% after 10 years. Some have advocated a dose of 80 µ
Ci of 131I per gram of thyroid, but this just delays the onset of hypothyroidism. Radiation thyroiditis is
an occasional complication which occurs within 7-10 days and is associated with excessive release of
hormone into the blood.
7. Solitary nodule
The problem of clinically solitary nodule (CSN) revolves around 3 questions. Is it truly solitary? Fifty
percent prove to be otherwise on exploration. What is its activity status? Is it benign or malignant (the
most important consideration)? See table 7.
'Hot' nodule: Isotope scan is useful if there is hyperthyroidism. Demonstration of a 'hot' nodule
(autonomous toxic nodule, hyper-functioning adenoma) determines the mode of treatment (surgery /
131
I therapy). The site of over-activity is a useful guide to the surgeon if excision is planned. On the
other hand, such a lesion is never malignant; therefore conservative treatment may be justified (if
anaesthetic risk is unusually high). Finally, 131I is the treatment of choice in patients > 45 years old. The
suppressed surrounding thyroid tissue does not take up 131I; so delayed hypothyroidism is unlikely. Due
to all these considerations, thyroid scan is essential in autonomous toxic nodule.
Malignancy: Scan cannot diagnose malignancy with certainty. Various methods to improve the
diagnostic accuracy of malignancy (TSG/ISG, 99mTc photo-scanning techniques, 241Am and 75Se-
methionine scans) have been described. Each has its own shortcomings.
Drawbacks: (1) Rectilinear scan misses lesions < 1 cm in size (due to intimate relation of nodule with
surrounding normal tissue) and also deep-seated lesions (due to masking effect of contiguous
overlapping normal tissue). Photo-scanning techniques partly overcome these problems. (2) A 'cold'
nodule is benign in 75-90% of cases (viz. cyst, adenoma, focal thyroiditis) and malignant in 10-25% of
cases. A large number of innocent swellings will thus be over-treated if operation is based purely on
scan findings. (3) Five percent of 'warm' nodules (same uptake as surrounding normal tissue) are
malignant (some well-differentiated carcinomas have normal or even increased uptake). If surgery is
routinely avoided in all 'warm' nodules, these carcinomas will be missed. Given these drawbacks of
scan coupled with the fact that scan findings do not influence the treatment of CSN (except
autonomous toxic nodule), some workers have proposed that its routine use in all cases should be
discontinued.3
Ectopic/aberrant thyroid
The role of scan is best understood if it is studied in conjunction with a working classification of
ectopic/aberrant thyroids (table 8). For ectopic thyroid, scan helps to; (a) establish the diagnosis
(differential diagnosis of midline neck swellings); and (b) often demonstrates this to be the only
functioning thyroid tissue. Thus treatment can be tailored accordingly. For mediastinal (aberrant)
thyroid, scan establishes both the above-mentioned points besides demonstrating continuity (or
otherwise) with the cervical gland. This helps in determining the operative approach. Not all aberrant
thyroid tissue metabolises iodine, and lack of function on scan does not exclude the possibility of
thyroid tissue within a mass.
Hepatic scan
Radioisotope scan of the liver (table 9) demonstrates; (a) the liver size and shape; (b) focal lesions
(tumours, cysts, abscesses etc); and (c) intra-hepatic lesions or extrinsic compression (viz. subphrenic
abscess). Lesions greater than 2-3 cm are readily detected. The normal liver presents an even
distribution of activity.
8. Colloid scan
Radioactive colloid particles (viz. 99mTc sulphur colloid) of 1 µ diameter are phagocytosed by the cells
of the reticuloendothelial system (RES) i.e. Kupffer cells lining the hepatic sinusoids, macrophages in
the splenic red pulp and mononuclear-phagocytic cells of the bone marrow. Normally the hepatic
uptake predominates because of its greater bulk and concentration of Kupffer cells. The splenic image
is smaller than the liver and the vertebral bodies are not seen in between the two. The uptake is uniform
in both organs.
Focal liver lesions produce filling defects (negative scans; 'holes'; 'cold spots') and generalised diseases
produce diffuse reduction in liver uptake. Any parenchymal liver disease may decrease activity of the
hepatic RES cells and cause apparent defects in the liver image. Additionally, any disease causing
significant destruction of the Kupffer cells, e.g. extensive metastases, causes decreased liver
phagocytosis of the labelled colloid and increased phagocytosis by the spleen and marrow of the
vertebral bodies. Then there is decreased tracer density in the liver, more prominent visualisation of the
spleen (which is not necessarily enlarged) and visible vertebral bodies between the hepatic and splenic
images.
Rose Bengal scan
Unlike 99mTc sulphur colloid (or any other colloid), 131I-Rose Bengal (RB) is taken up by the
hepatocytes and excreted by them into the biliary system. Therefore the former is for hepato-splenic
scanning and the latter is for hepato-biliary scanning. Since the hepatocytes and Kupffer cells are
intimately related to each other in the hepatic lobular architecture and both are uniformly distributed in
the liver, destruction of one is bound to affect the other, giving scan findings which are substantially
similar in both the scans. Excretion of RB into the biliary system and its concentration in the
gallbladder causes problems with delineation of the liver edge. RB has been used to differentiate
between intra-hepatic cholestasis and complete extra-hepatic obstruction. In the latter condition there is
failure of the isotope to enter the duodenum while in the former situation some radioactivity is seen in
the small bowel lumen. However this differentiation not well defined and is of limited clinical utility.
Gallium scan
67
Gallium (Ga) citrate is concentrated more in neoplastic and inflammatory cells than in hepatocytes.
Thus a hepatoma or liver abscess appears as a 'cold spot' in the other scans and as a 'hot spot' in the
67
Ga scan. In liver abscess 67Ga is picked up by the rim of inflammatory tissue around the abscess (not
by the abscess contents), thus outlining the periphery of the lesion. This is also characteristic of a large
neoplasm with central necrosis. 67Ga is useful in diagnosing malignancy with cirrhosis because the
tumour shows increased uptake and the fibrous bands decreased uptake. By the other scans, decreased
uptake by both fibrous bands and neoplasm may cause a malignancy to be missed (false-negative).
Moreover, cirrhosis without malignancy may show irregular uptake and filling defect(s) in the other
scans, due to regenerating nodules and distortion of lobular architecture, thus giving a false-positive
diagnosis of neoplasm, which can be refuted by a 67Ga scan.
Accuracy: Isotope and CT scans are equally sensitive (95%; vs. 75% for USG). However lesions <2
cm are often falsely negative in isotope scan. The overall diagnostic accuracy is 74%, which can be
improved to 93% by supplementing with USG and CT scans.
9. Scanning in hepatic disorders
Cirrhosis: Isotope scan is more informative than CT scan or USG in this condition. The scan findings
with 99mTc sulphur colloid may be; (a) diffuse reduction in uptake; (b) irregular uptake; (c) 'cold spots'
(giving a false-positive diagnosis of malignancy). When there is portal hypertension and splenomegaly
the most characteristic features are patchy and decreased uptake in a shrunken liver and increased
uptake in a large spleen and in the bone marrow. Malignancy in cirrhosis may be missed by a colloid
scan, as described earlier.
Malignancy: Any malignancy, primary or secondary, appears as 'cold spot(s)' in 99mTc colloid or 131I-
RB scans and as 'hot spot(s)' in 67Ga scan. The last is the best for delineation of hepatoma in cirrhosis.
When there is extensive destruction of Kupffer cells by multiple metastases, there are multiple filling
defects in the liver and a proportionately greater uptake of labelled colloid (but not others) by the RES
cells of the spleen and vertebral bone marrow. This typical finding is seen with colloid scan in any
condition producing extensive destruction of RES cells of the liver.
For diagnosis of primary tumours CT scan is the most accurate, and the most reliable combination is
CT scan and scintigraphy. The false-positive results with 99mTc sulphur colloid (the agent of choice) is
26% (vs. 12% and 17% with CT scan and USG respectively.
Abscess (pyogenic, amoebic): 99mTc sulphur colloid gives the most reliable results. Abscesses appear as
'cold' areas in colloid or 131I-RB scan. More than one may be present. A proper scan includes anterior,
posterior, oblique and lateral views, to determine the exact location and extent of a 'cold' area within
the liver substance. Lesions < 2 cm rarely appear on a scan. These scans do not distinguish between
abscess, hepatoma or secondary deposit(s), but they are useful in confirming the diagnosis and
particularly in identifying left lobe abscess, which is difficult to diagnose by other means. 67Ga scan
shows 'hot' areas outlining the uptake by the inflammatory tissue itself. It is considered less useful than
the colloid image and is thus not widely employed. It has been suggested that addition of 67Ga study of
a liver abscess may provide additional information in assessing the size and resolution in response to
treatment. 111Indium-WBC(autologous) has been used to define their progression into areas of
inflammation or abscess. But normal liver also accumulates such a label. So it may not be of much use
in defining pyogenic abscess. Labelled metronidazole has been suggested as a possible agent for
imaging amoebic abscess, by virtue of selective accumulation of the same in the abscess contents. This
may provide a method of specifically identifying amoebic abscess and differentiate it from other intra-
hepatic space-occupying lesions.
Miscellaneous: Haemobilia demonstrates a filling defect (cavity containing necrotic tissue, clots and
bile) by 99mTc colloid scan. Such a scan may be of use in diagnosing liver wounds, though scintiscan
rarely yields information not provided by other modalities. 131I-RB (but not others) may be helpful in
differentiating intra-hepatic cholestasis from complete extra-hepatic obstruction, as described earlier.
Hepatic blood flow
In comparison to BSP or indocyanine green clearance studies, radioisotopes (table 9) provide a simpler
method of estimating hepatic blood flow (HBF), especially in cirrhosis with portal hypertension. 99mTc
injected IV is removed mainly by the liver. Its disappearance rate from the peripheral blood is
determined by; (a) external monitoring; and; (b) analysis of radioactivity in serial blood samples. This
is then used to calculate the HBF. There are inherent sources of error in the technique which become
10. magnified in the presence of liver disease. In marked hepatic damage uptake of 99mTc is decreased
irrespective of changes in HBF, and extra-hepatic removal (spleen etc) is increased, leading to
unreliable results. A portacaval shunt further complicates the picture.
Splenic scan
Colloid scan
99m
Tc sulphur colloid scan has been described in detail under hepatic scan, including the normal and
some abnormal splenic findings in liver disorders (portal hypertension, hypersplenism, liver metastases
etc). Colloid scan may show a sub-capsular haematoma in splenic trauma. Splenic cysts appear as
splenomegaly and filling defect, but show no evidence of hypersplenism, in the form of decreased
survival of RBC and increased splenic sequestration (infra).
Labelled-cell scan
Isotopes: They are; (a) autologous RBC labelled with sodium(51Cr)chromate (Na251CrO4) or
diisopropylfluoro (32P)phosphate (DIPFP); and (b) autologous platelets labelled with Na251CrO4 or
111
Indium (In) or 113mIn (table 10). These scans are used to determine; (a) the life span (or T 1/2) of the
blood cells; (b) the role of spleen in inappropriately sequestering and destroying the cells (i.e. to
diagnose if there is hypersplenism); (c) if splenectomy is likely to be beneficial; and (d) to assess if
there is compensatory increased haematopoiesis in the marrow in the face of excessive splenic
destruction.
Procedure: Patient's own RBC are heated to 50°C for 1 hour (to render them spheroid and more
vulnerable to splenic sequestration), mixed with radioactive solution (to label the RBC) and injected
back into the circulation. Serial counting of radioactivity indicates the rate of disappearance of the cells
from the circulation and simultaneous daily scan over liver, spleen and praecordium (for reference)
shows the concentration of the labelled cells in these organs and the rate of splenic sequestration. The
procedure is similar with platelets.
Life span / T1/2: Following injection of labelled RBC into the circulation the percentage decrease in
radioactivity is noted over successive days and is plotted in the Y-axis of a graph as a function of the
number of days in the X-axis. A linear fall of radioactivity to 50% in 30 days indicates the normal T 1/2
of RBC and disappearance of radioactivity in 120 days indicates the normal life span. A measured T1/2
< 20-25 days is considered as accelerated rate of destruction. Similarly the life span of platelets
(normal=8-10 days) has been found to be significantly reduced in patients with splenomegaly and
idiopathic thrombocytopaenic purpura (ITP). However attempts to demonstrate a decreased longevity
of circulating WBC (normal=6-12 days) have not been clinically helpful.
Splenic sequestration: That the spleen is the culprit can be assessed by splenic scan with a columnated
detector, after the labelled cells have been injected. A selective rise in spleen : praecordial ratio of
radioactivity suggests significant splenic sequestration. Normally the graphs of spleen : praecordial and
liver : praecordial ratios are evenly matched. Using 51Cr-RBC it has been shown that the spleen is the
major site of haemolysis in pyruvate-kinase deficiency. Similarly, in ITP, infusion of 51Cr-platelets
11. causes a rise of radioactivity predominantly in the spleen. (In hypersplenism up to 90% of the platelet
pool may be sequestered in the spleen, as against 20-40% in the normal spleen). However the
mechanism of leucopoenia in hypersplenism is not clear because there is no satisfactory method of
determining the relative importance of spleen in the destruction of circulating WBC. Hyposplenism
(splenic atrophy), as may occur in sickle-cell infarcts, celiac disease etc, is documented by splenic scan
and by decreased clearance of 51Cr-RBC.
Splenectomy: Using the above two techniques a satisfactory result from splenectomy may be predicted
when; (a) the T1/2 of 51Cr-RBC is < 50% of normal (i.e. < 15 days); and (b) when the spleen : liver ratio
of radioactivity is > 2 :1. This prediction approaches 80-90% accuracy in cases of haemolytic anaemia
while in other conditions (myeloid metaplasia, malignant lymphoma, leukaemia etc) the predictive
value is variable.
Marrow function: In ITP the bone marrow often shows compensatory increase in immature
megakaryocytes. This may be detected, at least on principle, by the use of surface scanning after
injection of 113mIn-platelets. This technique may be a helpful diagnostic aid in predicting the value of
splenectomy. (Extramedullary haematopoiesis at times leads to the formation of paravertebral masses
visible on chest x-ray).
The subsequent issues will contain applications of radioisotopes in the remaining organ-systems of
the body.
References
Sagor GR, Baron JH et al. The clinical relevance of regulatory peptides. In:
Russell RCG(Ed.). Recent Advances in Surgery, Vol 11. London, Churchill
Livingstone, 1982: 1-25.
Hardcastle JD, Baldwin RW. Monoclonal antibodies. . In: Russell RCG(Ed.). Recent Advances in
Surgery, Vol 12. London, Churchill Livingstone, 1986: 43-56.
Matheson NA. The diagnosis of thyroid swellings. In: Russell RCG (Ed.). Recent Advances in
Surgery, Vol 12. London, Churchill Livingstone, 1986: 179-197.
12. Table 1A
Table 1A
Radio-iodine preparations and their uses
Radio-iodine preparations and their uses
Radio-iodine labelled Clinical applications
preparations
125
I-labelled antigen (peptides, Radioimmunoassay (RIA) of hormones and serum levels of
glycoproteins, OFA, viral antigens etc) CEA, AFP, POA, PSA, HbsAg etc
123
I-, 131I-MAB (monoclonal ab against Radioimmunolocalisation and tomoscintigraphy of the
colorectal, medullary thyroid cancers corresponding tumours (see text)
(MTC), malignant melanoma etc)
131
I-PAS (polyclonal antiserum against Tumour localisation: Colorectal, MTC (anti-CEA); germ
CEA, AFP, insulin, HCG etc) cell tumours of testis, ovary, hepatoma (anti-AFP);
insulinoma (anti-insulin); choriocarcinoma (anti-HCG)
131
I-ant-HMFG2 (human milk fat Radioimmunotherapy of malignant pleural and pericardial
globule membrane) effusions from ovarian cancer
125
I-α bungarotoxin (snake venom) RIA of acetylcholine receptor ab; diagnosis of myasthenia
gravis
131
I-labelled snake venom Experimental: To show that absorption of snake venom is
reduced by 70% after tourniquet application
Note: Radio-iodine can be used to label a wide variety of substances.
Note: Radio-iodine can be used to label a wide variety of substances.
Table 1B
Table 1B
Radio-iodine preparations and their uses
Radio-iodine preparations and their uses
Radio-iodine Clinical applications
preparations
123
I RAIU test in children, pregnancy and serial assessments of thyroid function
(because of low radioactive dose)
13. 132
I T3 suppression test after 6 months of antithyroid drugs, to predict relapse
131
I 1)Radioactive T3 uptake, radio-iodine uptake (RAIU), T3 suppression, TSH
stimulation tests; PB131I, FT4, FT3 estimations; resin T3 uptake; 2) Thyroid,
whole body scan; 3) therapy of toxic nodule, toxic nodular goitre, thyroid
and skeletal metastases ablation
131
I-Rose Bengal Liver, biliary scan
Na(125,131I)diatrizoate Total renal function tests, radioisotope renogram
(labelled Hypaque)
125
I-fibrinogen Leg deep vein thrombosis
125,131
I-colloidal human Liver, splenic scan, liver blood flow studies
serum albumin
131
I-cholesterol Adrenal scan
derivatives
Table 2
Table 2
Types of monoclonal antibody (MAB)
Types of monoclonal antibody (MAB)
MAB raised against MAB active against
Anti-melanoma MAB (NU 4 B) Melanoma cells, astrocytoma (many cell types), foetal astrocytes
Anti-osteogenic sarcoma MAB Estrogenic sarcoma, colorectal cancer (primary, metastatic),
(791 T/36) ovarian, breast cancer
Anti-neural MAB Neuroblastoma
Anti-human milk fat globule Breast cancer metastases in marrow and in serous effusions,
membrane (HMFG 2) ovarian cancer metastases in serous effusions
Anti-breast cancer MAB Breast cancer cells (prognostic indicator)
Anti-haemoglobin MAB Occult bleeding per rectum in colorectal cancer (early detection)
Anti-CEA MAB Colorectal, medullary thyroid cancer
F(ab1)2 fragments of MAB Colorectal cancer, malignant melanoma
Note: Any of these MAB may be radio-labelled and used to image the corresponding tumour or to treat it.
Note: Any of these MAB may be radio-labelled and used to image the corresponding tumour or to treat it.
14. Table 3
Table 3 Table 3 Table 3
Comparison of 3 isotopes in ISG
Comparison of 3 isotopes in ISG Comparison of 3 isotopes in ISG Comparison of
3 isotopes in ISG
131 123 111
Iodine Iodine Indium
Gamma High energy Low energy Suitable range
emission
Camera Low efficiency of Efficient detection Efficient detection
performance gamma camera by gamma camera
detection
Image Masking by thyroid Masking by thyroid
interference uptake and urinary and bladder
excretion excretion
Half life 8 days 13 hours 2.8 days
Labelling Easily attached as Easily attached Difficult to attach to MAB;
radio-label chelating agent required
Image Positive image; radio- Positive image Negative image; taken up by
label attached to normal liver, metastases appear as
tumour filling defects
Suitability Not ideal Limited use in Ideal for ISG and TSG
clinical work
Table 4
Table 4
Immunoscintigraphy (ISG) with labelled polyclonal antiserum (PAS)
Immunoscintigraphy (ISG) with labelled polyclonal antiserum (PAS)
131
I-labelled antibody (in PAS) Tumour localisation
Anti-CEA (carcinoembryonic ag) Colorectal cancer-primary, secondary (84%), recurrent (77%);
15. medullary thyroid cancer
Anti-AFP (α-fetoprotein) Germ cell tumours of testis, ovary; hepatoma
Anti-insulin Insulinoma
Anti-HCG (human chorionic choriocarcinoma
gonadotrophin)
Table 5
Table 5 Table 5
Comparison of 131I ISG and 99mTc scan in liver metastases
Comparison of 131I ISG and 99mTc scan in liver metastases Comparison of 131I
ISG and 99mTc scan in liver metastases
131 99m
I-labelled MAB ISG Tc sulphur colloid
scan
Smallest metastasis 1 cm 2 cm
detected
Accuracy 85% 63%
Nature of image Positive image (tumour Negative image (filling
localised) defect)
Table 6
Table 6 Table 6
Isotopes used in thyroid studies and immunology
Isotopes used in thyroid studies and immunology
Isotopes used in thyroid studies and immunology
123
Thyroid I, 132I Function tests (certain
occasions)
131
I Function tests, scan
therapy
16. 99m
Tc-pertechnetate Scan, photoscan
techniques
241
Americium Fluorescent scan
75
Se-methionine Tumour scan
99m
Tc-PYP Skeletal scan
125
Radioimmunology I-antigen Radioimmunoassay
123
I-, 131I-, 111
In- Tumour imaging
labelled ab
99m
Tc-RBC Blood pool labelling
67
Ga citrate Paired labelling (with
111
In)
Table 7
Table 7
Scan findings in thyroid pathology
Scan findings in thyroid pathology
131
I or 99mTc scan
Thyroid pathology
Cyst Non-functioning ('cold') nodule
Adenoma Non-functioning ('cold') nodule
Carcinoma (follicular, Non-functioning ('cold') nodule
papillary,
undifferentiated)
Well differentiated Normal functioning ('warm') nodule
carcinoma (occasionally)
Toxic nodule (hyper- Hyper-functioning ('hot') nodule, complete non-uptake by surrounding
functioning adenoma) thyroid due to suppression; TRH stimulation – uptake by suppressed
17. tissue (confirms functional status)
Multinodular goitre Heterogeneous uptake, thyromegaly, hyperfunctioning areas (+),
contiguous retrosternal extension (+)
Adenomatous goitre Hypo-/ non-functioning
de Quervain's thyroiditis Hypo-/ non-functioning
Hashimoto's thyroiditis Heterogeneous (patchy) uptake, some areas devoid of 131I
Riedel's thyroiditis No uptake
Table 8
Table 8 Table 8
Thyroid in abnormal location
Thyroid in abnormal location Thyroid in abnormal location
Ectopic (in path of Aberrant
descent; along course of
thyroglossal tract) (not along path of descent)
Site -Lingual
Intra-thoracic:
-Cervical (midline thyroglossal)
-Anterior mediastinum}substernal or
-Superior mediastinum}plunging
-Posterior mediastinum (rare)
Origin Developmental Acquired (first 2); developmental (last)
Relation to May be only thyroid present First 2 continuous with neck thyroid (common
neck thyroid blood supply); last one separate from neck thyroid
Note: Struma is not ectopic thyroid. It is teratoma of ovary with thyroid tissue in it.
Note: Struma is not ectopic thyroid. It is teratoma of ovary with thyroid tissue in it. Note: Struma is not ectopic thyroid. It
is teratoma of ovary with thyroid tissue in it.
18. Table 9
Table 9
Radioisotopes in liver studies
Radioisotopes in liver studies
Study Isotope/ radio-
pharmaceutical
198
Colloidal scan Au colloidal gold
125, 131
I colloidal human serum
albumin
99m
Tc sulphur colloid (most
common)
131
Rose Bengal scan I Rose Bengal
67
Gallium liver scan Ga Gallium citrate
99
Miscellaneous Mo Ammonium molybdate
scan 111
Indium-WBC (pyogenic
abscess)
Labelled metronidazole
(amoebic)
Liver blood flow Same as for colloid liver scan
32
P chromic phosphate
19. Table 10
Table 10
Isotope preparations for splenic
scan
Isotope preparations for splenic
scan
99m
Colloid scan Tc sulphur colloid
(same as for liver scan)
Labelled cell
scan
-RBC Sodium(51Cr)chromate
Diisopropylfluoro(32P)phosp
hate
-Platelet Sodium(51Cr)chromate
111, 113m
Indium (In)