Insight about Nuclear medicine

1. BY
M.Vharshini
4th year Biomedical Sciences

2. Introduction
 Nuclear medicine is the medical specialty in which
unsealed radionucleotides, chemically manipulated to
form radiopharmaceuticals, are used for diagnosis and
therapy.
 Radiopharmaceuticals localize in various target tissues
and organs and provide better display of physiology
and metabolism.

3. Principles Of Nuclear Medicine
 A wide range of radionucleotides are used in the diagnostic nuclear
medicine that meets the necessary requirements for effective and
efficient imaging.
 All radionucleotides are produced artificially, using four principle
routes of manufacture.
1. CYCLOTRON BOMBARDMENT: gallium-67, indium-111, thallium-201,
cobalt-57, carbon-11, oxygen-15, nitrogen-13 and fluorine-18
2. REACTOR IRRADIATION: chromium-51, selenium-75, iodine-125 and
iodine-131.
3. FISSION PRODUCTS: iodine-131, xenon-133 and strontium-90
4. GENERATORS THAT PROVIDE SECONDARY DECAY PRODUCTS FROM
LONGER LIVED PARENT RADIONUCLIDES: Column generators
incorporating molybdenum-99 for the provision of technetium-99m.

4.  The use of radiopharmaceuticals for diagnosis or therapy is based on the
accumulation or concentration of the isotope in the organ of interest
referred as Target organ.
 A radiopharmaceutical may have an affinity for a certain organ that is not
necessarily the target organ, in which case this organ is termed as Critical
organ.
 The risk to which the patient is subjected is clearly a function of the doses
received in all organs and is expressed in terms of the effective dose.
 The risk must be balanced against the expected advantages and benefits
rendered by the procedure.
Principles Of Nuclear Medicine

5. Nuclear Medicine In Diagnosis
 Nuclear Medicine imaging procedures are generally non-
invasive.
 The Nuclear Medicine imaging scans use radioactive
materials called radiopharmaceuticals or radiotracers.
 Depending on the type of nuclear medicine exam, the
radiotracer is either injected into the body, swallowed or
inhaled as a gas and eventually accumulates in the organ or
area of the body to be examined.

6. Single Photon Emission Computed Tomography
(SPECT)
 SPECT imaging instrument provide 3D
images of the distribution of radioactive
tracer molecules that have been
introduced into the patient’s body.
 SPECT imagers have the gamma
camera detectors that can detect the γ
ray emissions from the radiotracers that
have been injected into the patients.

7. Positron Emission Tomography (PET)
 PET scans also use
radiopharmaceuticals to create
three dimensional images.
 The main difference between
SPECT and PET scans is the
type of radiotracers used.
 The radiotracers used in PET
scans decay to produce small
particles called Positrons.

8.  Positrons have equal mass
of that of electron but
opposite charge.
 When a positron collides
with an electron,
annihilation occurs.
 It results in the production
of two or more gamma ray
photons that shoot off in
opposite directions.
Positron Emission Tomography (PET)

9.  The detectors in
the PET scanner
measure these
photons and use
the information to
create images of
internal organs.
Positron Emission Tomography (PET)

10. LIST OF
RADIOPHARMACEUTICALS
USED IN DIAGNOSIS AND
THERAPY

11. Carbon-11
 Chemical Symbol: 11C
 Chemical Form: Carbon-11 Choline
 Half-life: 20.334 minutes.
 Diagnostic use:
 Indicated for PET imaging of patients with suspected
prostate cancer recurrence based upon elevated
blood prostate specific antigen (PSA).

12. Carbon-14
 Chemical Symbol: 14C
 Chemical Form: Carbon-14 urea
 Half-life: 5,730 years
 Trade name(s): PYtest
 Diagnostic use: Detection of gastric urease as an
aid in the diagnosis of H.pylori infection in the
stomach

13. Fluorine-18
 Chemical Symbol: 18F
 Chemical Form: Fluorine-18 sodium fluoride
 Half-life: 109.771 minutes
 Manufacturer: Various
 Diagnostic use: PET bone imaging agent to
delineate areas of altered osteogenesis

14. Fluorine-18
 Chemical Symbol: 18F
 Chemical Form: Fluorine-18 fludeoxyglucose
 Half-life: 109.771 minutes
 Diagnostic use:
As a PET imaging agent to:
> Assess abnormal glucose metabolism in oncology
> Assess myocardial hibernation
> Identify regions of abnormal glucose metabolism
associated with foci of epileptic seizures

15. Gallium-67
 Chemical Symbol: 67Ga
 Chemical Form: Gallium-67 Gallium Citrate
 Half-life: 3.26 days
 Trade name(s): Neoscan (GE), DuPont Ga-67, Mallinckrodt Ga-67
 Diagnostic use:
Useful to demonstrate the presence/extent of:
>Hodgkin’s disease
>Lymphoma
>Bronchogenic carcinoma
>Aid in detecting some acute inflammatory lesions

16. Indium-111
 Chemical Symbol: 111In
 Chemical Form: Indium-111 Capromab Pendetide
 Half-life: 3.20 days
 Trade name(s): ProstaScint®
 Diagnostic use:
 A diagnostic imaging agent in newly-diagnosed patients with
biopsy-proven prostate cancer, who are at high-risk for
pelvic lymph node metastases.
 A diagnostic imaging agent in post-prostatectomy patients
with a rising PSA.

17. Iodine - 123
 Chemical Symbol: 123I
 Chemical Form: Iodine – 123 Ioflupane
 Half-life: 13.22 hours
 Trade name(s): DaTscan™
 Diagnostic use:
 Indicated for striatal dopamine transporter visualization using SPECT
brain imaging to assist in the evaluation of adult patients with
suspected Parkinsonian syndromes (PS).
 It may help differentiate essential tremor due to PS.

18. Iodine - 123
 Chemical Symbol: 123I
 Chemical Form: Iodine – 123 Sodium iodide
 Half-life: 13.22 hours
 Trade name(s): Mallinckrodt, Amersham
 Diagnostic use: Indicated for use in the evaluation of thyroid:
• Function
• Morphology

19. Iodine - 131
 Chemical Symbol: 131I
 Chemical Form: Iodine – 131 human serum albumin
 Half-life: 8.0197 days
 Trade name(s): Megatope
 Diagnostic use: Indicated for use in determinations of:
• Total blood and plasma volumes
• Cardiac output
• Cardiac and pulmonary blood volumes and circulation times
• Protein turnover studies
• Heart and great vessel delineation
• Localization of the placenta
• Localization of cerebral neoplasm

20. Iodine - 131
 Chemical Symbol: 131I
 Chemical Form: Iodine – 131 sodium iodide
 Half-life: 8.0197 days
 Trade name(s): HICON™
 Diagnostic use:
• Performance of the radioactive iodide (RAI) uptake test to evaluate
thyroid function.
• Localizing metastases associated with thyroid malignancies
 Therapeutic uses:
• Treatment of hyperthyroidism
• Treatment of carcinoma of the thyroid

21. Iodine – 131 (Radioimmunotherapy)
 Chemical Symbol: 131I
 Chemical Form: Iodine – 131 tositumomab
 Half-life: 8.0197 days
 Trade name(s): BEXXAR®
 Diagnostic use: Indicated for:
 Treatment of patients with CD20 antigen-expressing relapsed
or refractory, low grade, follicular, or transformed non-
Hodgkin’s lymphoma.

22. Nitrogen-13
 Chemical Symbol: 13N
 Chemical Form: Nitrogen-13 Ammonia
 Half-life: 9.97 min
 Diagnostic use: Indicated for diagnostic Positron Emission
Tomography (PET) imaging of the myocardium under rest or
pharmacologic stress conditions to evaluate myocardial
perfusion in patients with suspected or existing coronary artery
disease.

23. Radium-223
 Chemical Symbol: 223Ra
 Chemical Form: Radium-223 dichloride
 Half-life: 11.4 day
 Trade name(s): Xofigo®
 Diagnostic use: Indicated for the treatment of patients with
 Castration - resistant prostate cancer,
 Symptomatic bone metastases and
 Unknown visceral metastatic disease.

24. Rubidium-82
 Chemical Symbol: 223Ra
 Chemical Form: Rubidium-82 chloride
 Half-life: 1.27 minutes
 Trade name(s): Cardiogen-82®
 Diagnostic use: PET myocardial perfusion agent that is useful
in distinguishing normal from abnormal myocardium in patients
with suspected myocardial infarction.

25. Strontium-89
 Chemical Symbol: 89Sr
 Chemical Form: Strontium-89 chloride
 Half-life: 50 days
 Trade name(s): Metastron
 Diagnostic use: Indicated for the relief of bone pain in patients
with painful skeletal metastases that have been confirmed prior
to therapy.

26. Technetium-99m
 Chemical Symbol: 99mTc
 Chemical Form: Technetium-99m bicisate
 Half-life: 6.0058 hours
 Trade name(s): Neurolite®
 Diagnostic use: SPECT imaging in the localization of stroke
in patients already diagnosed with stroke.

27. Technetium-99m
 Chemical Symbol: 99mTc
 Chemical Form: Technetium-99m sestamibi
 Half-life: 6.0058 hours
 Trade name(s): Cardiolite®
 Diagnostic use:
Myocardial perfusion agent that is indicated for:
 Detecting coronary artery disease by localizing myocardial ischemia
(reversible defects) and infarction (non-reversible defects)
 Evaluating myocardial function
 Planar breast imaging as a second line diagnostic drug after
mammography to assist in the evaluation of breast lesions in
patients with an abnormal mammogram or a palpable breast mass

28. Thallium-201
 Chemical Symbol: 201Tl
 Chemical Form: Thallium-201 chloride
 Half-life: 72.912 hrs
 Trade name(s): DuPont, Mallinckrodt, Amersham
 Diagnostic use:
 Useful in myocardial perfusion imaging for the diagnosis and localization
of myocardial infarction
 As an adjunct in the diagnosis of ischemic heart disease (atherosclerotic
coronary artery disease)
 Localization of sites of parathyroid hyperactivity in patients with elevated
serum calcium and parathyroid hormone levels.

29. Yttrium-90 (radioimmnunotherapy)
 Chemical Symbol: 90Y
 Chemical Form: Yttrium-90 ibritumomab tiuxetan
 Half-life: 64 hrs
 Trade name(s): Zevalin
 Therapeutic use: Indicated for the:
• Treatment of relapsed or refractory, low-grade or follicular B-cell
non-Hodgkin’s lymphoma (NHL)
• Treatment of previously untreated follicular NHL in patients who
achieve a partial or complete response to first-line chemotherapy

30. Bibliography
 Radiobiology for the radiologist by Eric Hall.
 National institute of biomedical imaging and
bioengineering. (2017). Nuclear Medicine.
 http://nuclearpharmacy.uams.edu/RPLIST.html
 http://www.radiologyinfo.org/en/info