This document discusses various methods of radiology and radionuclide imaging. It describes how radiology methods are divided into diagnostic and therapeutic categories, and either non-invasive or invasive. Radionuclide imaging involves introducing radiopharmaceuticals into the body and using detection methods like radiometry, radiography, and scintigraphy to image their accumulation and distribution in organs. Key radionuclides discussed include Tc-99m, I-131, Cr-51, Au-198, and In-111. Safety considerations for radiopharmaceuticals and laboratory facilities are also outlined.

1. RadionuclideRadionuclide
ImagingImaging
PhD Lenchuk TatyanaPhD Lenchuk Tatyana

2. MMethods in radiology are divided :ethods in radiology are divided :
DiagnosticsDiagnostics TherapyTherapy
Non-invasiveNon-invasive ((not use ionizing radiationnot use ionizing radiation))
-Ultrasonography-Ultrasonography
- Magnetic resonance- Magnetic resonance
tomographytomography
- Thermography- Thermography
InvasiveInvasive
- X-ray examination- X-ray examination
- Radionuclide imaging- Radionuclide imaging
- Computed Tomography (CT)- Computed Tomography (CT)
- Positron emission tomography (PET- Positron emission tomography (PET))

3. Radionuclide diagnosis - a method of diagnosing a
patient based on the introduction of
radiopharmaceutical (RPh) in organіzm. Using the
radionuclide diagnostic can investigate virtually any
organ or tissue in the body, as some of them in several
ways. With clearly defined goals and a continuously
feedback between a radiologist and doctors clinical
departments, the possibilities of radionuclide
diagnostics are almost limitless, especially in case of
formulation particularly difficult diagnoses
RPh consists :
1. molecule, isotropic (native) to the target organ or
tissue
2. presence radiolabeling, allowing to determine the
dynamics and the amount of accumulated RPh via an
external encoder ( 99m
Tc, 18
F, 123
I )

4. 3.3. must emit detectable rays or photons. Most frequently usemust emit detectable rays or photons. Most frequently use
ƔƔ-radiated RPh.-radiated RPh.
4.4. RPh must be radiochemically pure. The purity isRPh must be radiochemically pure. The purity is
determined by concentration of main radionuclide.determined by concentration of main radionuclide.
5.5. RPh must be apyrogenic. Apyrogenity is determined byRPh must be apyrogenic. Apyrogenity is determined by
the use of reagents, solutionsthe use of reagents, solutions..
RPH Safety Regulations
1. RPh must be physiologically determined, i.e. it must
selectively be absorbed by specific organ, inserted into
it’s metabolism and show the function of organ or
organism.
2. RPh must be low-radiotoxic, i.e. to give minimal radiation to
organism and critical organ.
The radiotoxicity of RPh is determined by T 1/2 /Тphys/.Time
of the half amount of radionuclide decay.

5. The widely used radionuclides are followingThe widely used radionuclides are following::
99мТС99мТС - Т1/2- 6- Т1/2- 6 hours, for brain tumors, thyriodhours, for brain tumors, thyriod
gland, skeletal system, respiratory systemgland, skeletal system, respiratory system
diagnosticsdiagnostics..
I131I131 – Т1/2 – 8,04– Т1/2 – 8,04 days, for iodine metabolism,days, for iodine metabolism,
liver, kidneys functionliver, kidneys function..
51С51Сrr //27.7 days27.7 days/ -/ - in hematologyin hematology..
198Au198Au //2.697 days2.697 days// andand In111 –In111 – for liver, brainfor liver, brain
diagnosticsdiagnostics..

6. Target (critical) OrganTarget (critical) Organ
So, what is target organSo, what is target organ??
Target organ – is organ in which the RPh is maximallyTarget organ – is organ in which the RPh is maximally
accumulated and which is exposed by excessiveaccumulated and which is exposed by excessive
radiationradiation.. Mostly, it is the organ we want to examineMostly, it is the organ we want to examine..
By safety regulationsBy safety regulations there are 3 groups of targetthere are 3 groups of target
organs due to decreasing or radiosencitivityorgans due to decreasing or radiosencitivity::
1.1. groupgroup –– whole body, genitals, bone marrow, smallwhole body, genitals, bone marrow, small
intestine mucosaintestine mucosa..
2.2. groupgroup –– muscles, thyroid, fat, liver, kidneys,muscles, thyroid, fat, liver, kidneys,
spleen GI tract, lungs, lensspleen GI tract, lungs, lens..
3.3. groupgroup –– skin,bonesskin,bones..

7. Radionuclide LaboratoryRadionuclide Laboratory
All the activity with RPH must undergo in specific offices. AllAll the activity with RPH must undergo in specific offices. All
equipment must be shielded and RPH should not waste theequipment must be shielded and RPH should not waste the
environmentenvironment.. The laboratory must include following roomsThe laboratory must include following rooms::

Storage facilityStorage facility – 8-10м2– 8-10м2 ventilationventilation 5-105-10 times per hourtimes per hour..

Preparation roomPreparation room - 8-20м2.- 8-20м2.

Washing roomWashing room – 10м2.– 10м2.

Procedural roomProcedural room - 16-20м2 .- 16-20м2 .

Radiometry facilityRadiometry facility – 20-25м2.– 20-25м2.

Radiography facilityRadiography facility – 15-18м2.– 15-18м2.

Gamma – topography facilityGamma – topography facility – 12-18м2.– 12-18м2.

Room for detection of activity of biological substancesRoom for detection of activity of biological substances – 12м2– 12м2

Observation room (for outpatients)Observation room (for outpatients)..

Sanitary roomsSanitary rooms..

8. Methods of radionuclideMethods of radionuclide
diagnosticsdiagnostics
1.1. ііnn vivovivo i/venously or per osi/venously or per os..
2.2. In vitroIn vitro (blood, urina, other biological(blood, urina, other biological
fluids)fluids).. Radioimmunoassay in comparison withRadioimmunoassay in comparison with
biological and biochemical research methodsbiological and biochemical research methods
has several advantages: high sensitivity, whichhas several advantages: high sensitivity, which
allows to determine small amounts of theallows to determine small amounts of the
substance, specificity, due to the principle ofsubstance, specificity, due to the principle of
immunological reactions, high accuracy andimmunological reactions, high accuracy and
reproducibility of the method. The disadvantagesreproducibility of the method. The disadvantages
include a relatively high cost of a standard set ofinclude a relatively high cost of a standard set of
reagents for each blood component.reagents for each blood component.

9. Methods of radionuclide diagnostics (in vivo)Methods of radionuclide diagnostics (in vivo)
1.1. RadiometryRadiometry –– is method, which determinesis method, which determines
radioactivity of the body, organ. This method allows toradioactivity of the body, organ. This method allows to
detect amount of radionuclide in organ or organism.detect amount of radionuclide in organ or organism.
2.2. RadiographyRadiography..
This method allows to detect distribution,This method allows to detect distribution,
accumulation and elimination of RPHaccumulation and elimination of RPH.. The result is aThe result is a
curve of the intensity of RPH in target organ duringcurve of the intensity of RPH in target organ during
period of time (blood circulation, liver, kidneys function).period of time (blood circulation, liver, kidneys function).
This method allows to estimate clearance of blood.This method allows to estimate clearance of blood.

10. Methods of radionuclideMethods of radionuclide
diagnosticsdiagnostics
Radiography

11. Blood clearanceBlood clearance – the velocity of blood purification– the velocity of blood purification
from RPH per time. The faster is clearance - the better isfrom RPH per time. The faster is clearance - the better is
the organ function. A typical example is the radiographicthe organ function. A typical example is the radiographic
study of the accumulation and excretion of thestudy of the accumulation and excretion of the
radiopharmaceutical from lungs, kidney, liver.radiopharmaceutical from lungs, kidney, liver.
Radiographic function in modern devices is combined inRadiographic function in modern devices is combined in
a gamma camera with visualization of organsa gamma camera with visualization of organs

12. 3.3. Radionuclide imagingRadionuclide imaging. The technique of painting. The technique of painting
the spatial distribution in the organs of thethe spatial distribution in the organs of the
radiopharmaceutical injected into the body.radiopharmaceutical injected into the body.
Radionuclide imaging currently includes theRadionuclide imaging currently includes the
following:following:
• a)• a) scanning​​scanning​​ ,,
• b)• b) scintigraphyscintigraphy with the use of gamma camera,with the use of gamma camera,
• c)• c) single-photon emission tomographysingle-photon emission tomography and two-and two-
photon positron emission tomography (PET).photon positron emission tomography (PET).

13. ScanningScanning - method visualization of organs and- method visualization of organs and
tissues by moving over the body of the scintillationtissues by moving over the body of the scintillation
detector. The device is conducting a study calleddetector. The device is conducting a study called
the scanner. The main drawback - the longthe scanner. The main drawback - the long
duration of the study.duration of the study.

14. Scintigraphy. Method of imaging the spatial
distribution in organ of RFh and photon detection
with a scintillation detector or detectors. The method
makes it possible to evaluate the morphological and
functional state of the body. Scintigraphy - is
currently the main method of radionuclide imaging in
the clinic.

15. Gamma radiation from the body
of the patient is recorded by the
detector gamma camera and
computer after processing the
obtained information is
converted into a functional
image of the investigated body.

16. There are several types of scintigraphy.There are several types of scintigraphy.
Static planar scintigraphyStatic planar scintigraphy. The simplest type of. The simplest type of
scintigraphy. After the introduction of RPh, registration itsscintigraphy. After the introduction of RPh, registration its
distribution in the target organ by fixed detector. Determinedistribution in the target organ by fixed detector. Determine
the shape, size and nature of the organ contours, andthe shape, size and nature of the organ contours, and
most importantly, areas of abnormal accumulation indicatormost importantly, areas of abnormal accumulation indicator
- high or low- high or low ("hot"("hot" oror "cold""cold" lesions). The method islesions). The method is
applicable for the detection of tumor lesions in parenchymalapplicable for the detection of tumor lesions in parenchymal
organs.organs.

17. Scintigraphy result of the
healthy liver thyrotoxic adenoma, hot node

18. Whole-body scintigraphyWhole-body scintigraphy. Variant static. Variant static
scintigraphy, however, here the table with thescintigraphy, however, here the table with the
patient or the detector are moved in a horizontalpatient or the detector are moved in a horizontal
plane, which allows to detect of photons from allplane, which allows to detect of photons from all
Rph tracers of organism or a part of it. Widely usedRph tracers of organism or a part of it. Widely used
in the study of skeletal -in the study of skeletal - bone scintigraphybone scintigraphy toto
identify multiple lesions pathological process, suchidentify multiple lesions pathological process, such
as searching for metastases.as searching for metastases.

19. metastases in bone

20. arthrosis

21. Dynamic scintigraphy. In contrast to the static, here, a
series of scintigrams with a certain time interval. This allows,
in addition to anatomical characteristics, to study organs
function ( eg. excretory function of the liver, the filtration and
excretory function of the kidneys, etc).

22. Immunoscintigraphy - imaging of tumors by
monoclonal antibodies with RPh are obtained by
immunization of animals extracts antigens from
remote malignant tumors. Sufficiently accurate
method for the diagnosis of malignancy.
Fused ProstaScint and MRI images (right) demonstrating 2
areas of focal activity (white arrows) that correspond to
step-sectioned pathologic presence of prostate cancer
(black arrows, left). Circled areas without arrows represent
inflammation.

23. RadioimmunoscintigraphyRadioimmunoscintigraphy is an imaging modality thatis an imaging modality that
uses radiolabeled MAbs to target specific tissueuses radiolabeled MAbs to target specific tissue
types. MAbstypes. MAbs ((monoclonal antibodiesmonoclonal antibodies)) that react withthat react with
specific cellular antigens are conjugated with aspecific cellular antigens are conjugated with a
radiolabeled isotope. The labeled antibody-isotoperadiolabeled isotope. The labeled antibody-isotope
conjugate is then injected into the patient andconjugate is then injected into the patient and
allowed to localize to the target over a 2- to 7-dayallowed to localize to the target over a 2- to 7-day
period. The patient then undergoes imaging with aperiod. The patient then undergoes imaging with a
nuclear medicine gamma camera, and radioisotopenuclear medicine gamma camera, and radioisotope
counts are analyzed. Imaging can be performed withcounts are analyzed. Imaging can be performed with
planar techniques or by using single-photon emissionplanar techniques or by using single-photon emission
computed tomography (SPECT).computed tomography (SPECT).

24. Physiologic, anatomic, and fused images, showing a suggestion of increased
activity on the ProstaScint (physiologic) scan (A) and very small periprostatic
(PPFLN) and perirectal (PRLN) lymph nodes that do not meet the size criteria for
malignancy on the computerized tomography (anatomic) scan (B). C. The fused
image demonstrates increased signal intensity in lymph node structures separate
from vascular structures and bone marrow. Note the signal in the blood pool of
the male genital system external to the body and in the spermatic cord (SC). FV,
femoral vein; R, rectum; P, prostate; AM, acetabular marrow; SM, symphysis
pubis; IM, iliac marrow.
Radioimmunoscintigraphy

25. Single photon emission computed tomography (SPECT
tomoscintigraphy) - registration of photons RPh of the
examined organ by using one, two or three detectors rotate
around the patient's body for some orbit (circular, elliptical, or
difficult-adaptive). The number of slices obtained from 32 to
128, slice thickness of 4 to 10 mm, reconstruction is possible
in different projections. This allows not only the anatomical
and topographical characteristics of the organ, but also
allows to study the biochemical, physiological, and transport
processes. Used for the diagnosis of volumetric formations
and vascular disorders of the brain, for the early detection of
pulmonary embolism, coronary artery disease.

26. Slice images
accumulation
Of RPh

27. Positron emission tomography (PET) - a method of nuclear medicine based
on the use of ultra-short-lived radiopharmaceuticals labeled with positron
emitters - 15O, 13N, 11C, 18F-FDG. T- aff. these drugs is 2, 10, 20.4 and
110 minutes. Sensitivity of the method is fantastic. PET allows us to
conclude the change rate of glucose labeled with C11 in the "eye center" of
the brain when you open the eyes, it is possible to detect changes at the
thinking process, and even to determine the so-called "Soul". PET enables
the study of functional changes and ability to live of tissue at the molecular
level, such as glucose metabolism, oxygen utilization, assessment of blood
flow and perfusion assessment . As well as functional changes precede
morphological, cellular metabolism study provides an opportunity to
diagnose a number of diseases earlier than with CT and MRI.

28. PET CT
lymphoma, multiple foci of
metastasis

29. Essentially this is the only method to evaluate the metabolic processes
in vivo. The method is used in cardiology for the study of perfusion and
blood flow in the myocardium with coronary artery disease, to determine
the viability of the myocardium after myocardial infarction; neurology for
the detection of epileptogenic foci in the diagnosis of various types of
dementia , in oncology for the diagnosis and staging of brain tumors,
lung, breast, colon, for evaluating chemotherapy for detecting tumor
recurrence. The disadvantage of this method is that its use is possible
only with the cyclotron, the radiochemical laboratory for short-lived
nuclides, positron tomography and computer information processing,
which is very expensive and cumbersome.
PET CT

30. Thank you for attantion!