SIR SYED UNIVERSITY OF

ENGINEERING AND TECHNOLOGY

BIOMEDICAL ENGINEERING

Bio-physics

Assignment no 1

Name: Ali Inam

Roll No 2010-BM-056
Section “A”
Teacher: Sir Haleem
Nuclear Medicine
INTRODUCTION:
Nuclear medicine is a specialized area of radiology that uses very small amounts of radioactive
materials, or radiopharmaceuticals, to examine organ function and structure. Nuclear medicine
imaging is a combination of many different disciplines, including chemistry, physics,
mathematics, computer technology, and medicine. This branch of radiology is often used to help
diagnose and treat abnormalities very early in the progression of a disease, such as thyroid
cancer.

Since x-rays pass through soft tissue, such as intestines, muscles, and blood vessels, contrast
agents are used in nuclear imaging. Nuclear imaging examines organ function and structure,
whereas diagnostic radiology is based on anatomy.

Scans are used to diagnose many medical conditions and diseases. Some of the more common
tests include the following:

• Renal Scans - used to examine the kidneys and to detect any abnormalities, such as
tumors or obstruction of the renal blood flow.

• Thyroid Scans - used to evaluate thyroid function.

• Bone Scans - used to evaluate any degenerative and/or arthritic changes in the joints, to
detect bone diseases and tumors, and/or to determine the cause of bone pain or inflammation.

• Gallium Scans - used to diagnose active infectious and/or inflammatory diseases,

tumors, and abscesses.

• Heart Scans - used to identify abnormal blood flow to the heart, to determine the extent
of the damage of the heart muscle after a heart attack, and/or to measure heart function.
 • Brain Scans - used to investigate problems within the brain and/or in the blood
circulation to the brain.

• Breast Scans - often used with mammograms to locate cancerous tissue in the breast.

How it all started ? !

The concepts of Nuclear Medicine started from all the way back to the times when
RADIOACTIVITY was discovered and when some of the mysterious rays were found out
emitting mainly from Uranium. Then during 1897–1903, Marie and Pierre Curie discovered the
radioactive elements polonium and radium, and coined the term "radioactivity."

In 1936, John H. Lawrence used phosphorus-32 to treat leukemia, the first time an artificial
radionucleotide was used in clinical therapy.

Then in 1946, Samuel M. Seidlin, Leo D. Marinelli, and Eleanor Oshry cured thyroid cancer
using an "atomic cocktail" containing iodine-131. Their success helped to usher in the
widespread clinical use of nuclear medicine in the early 1950s.

In 1958, Hal Anger invented the scintillation camera (also known as the gamma camera, Anger
camera, or radioisotope camera). The scintillation camera allowed dynamic function studies to be
carried out on entire organs for the first time.

In 1959, Solomon Berson and Rosalyn Yalow invented the technique of radioimmunoassay
(RIA) to detect insulin antibodies in human serum. RIA allowed minute quantities of hormones
and other substances to be measured precisely for the first time.

In 1962, David Kuhl introduced emission reconstruction tomography, later known as SPECT and
PET. In radiology, this method gave rise to CT scans.

Then in 1971, The American Medical Association officially recognized nuclear medicine as a
medical specialty.

By the end of the 20th century, treatments and diagnosis using nuclear technologies gained very
much popularity and they were a key source of treatment for much of the deadly diseases such as
Cancer and Brain Tumers. In 2006, An estimated 17.7 million nuclear medicine procedures were
performed in the United States. The majority of procedures were cardiac exams or cancer-
related.
What really is Nuclear Medicine ?
In nuclear medicine imaging, radiopharmaceuticals are taken internally, for example
intravenously or orally. Then, external detectors (gamma cameras) capture and form images from
the radiation emitted by the radiopharmaceuticals. This process is unlike a diagnostic X-ray
where external radiation is passed through the body to form an image.

There are several techniques of diagnostic nuclear medicine. Scintigraphy ("scint") is the use of
internal radionuclides to create two-dimensional[1] images. SPECT is a 3D tomographic
technique that uses gamma camera data from many projections and can be reconstructed in
different planes. Positron emission tomography (PET) uses coincidence detection to image
functional processes.

Nuclear medicine tests differ from most other imaging modalities in that diagnostic tests
primarily show the physiological function of the system being investigated as opposed to
traditional anatomical imaging such as CT or MRI. Nuclear medicine imaging studies are
generally more organ or tissue specific (e.g.: lungs scan, heart scan, bone scan, brain scan, etc.)
than those in conventional radiology imaging, which focus on a particular section of the body
(e.g.: chest X-ray, abdomen/pelvis CT scan, head CT scan, etc.). In addition, there are nuclear
medicine studies that allow imaging of the whole body based on certain cellular receptors or
functions. Examples are whole body PET scan or PET/CT scans, gallium scans, indium white
blood cell scans, MIBG and octreotide scans.

While the ability of nuclear metabolism to image disease processes from differences in
metabolism is unsurpassed, it is not unique. Certain techniques such as fMRI image tissues
(particularly cerebral tissues) by blood flow, and thus show metabolism. Also, contrast-
enhancement techniques in both CT and MRI show regions of tissue which are handling
pharmaceuticals differently, due to an inflammatory process.

Diagnostic tests in nuclear medicine exploit the way that the body handles substances differently
when there is disease or pathology present. The radionuclide introduced into the body is often
chemically bound to a complex that acts characteristically within the body; this is commonly
known as a tracer. In the presence of disease, a tracer will often be distributed around the body
and/or processed differently. For example, the ligand methylene-diphosphonate (MDP) can be
preferentially taken up by bone. By chemically attaching technetium-99m to MDP, radioactivity
can be transported and attached to bone via the hydroxyapatite for imaging. Any increased
physiological function, such as due to a fracture in the bone, will usually mean increased
concentration of the tracer. This often results in the appearance of a 'hot-spot' which is a focal
increase in radio-accumulation, or a general increase in radio-accumulation throughout the
physiological system. Some disease processes result in the exclusion of a tracer, resulting in the
appearance of a 'cold-spot'. Many tracer complexes have been developed to image or treat many
different organs, glands, and physiological processes.

How do we use Nuclear Medicine in the

Medical Fields ? !

It has generally been seen that there are various different techniques introduced today involving
Nuclear and Radioactive methods for diagnosis and different complex treatments, one of the
most common example which is widely uses today is PET ( Positron Emission Tomography):

POSITRON EMISSION TOMOGRAPHY PET:

Positron Emission Tomography (PET) is a type of nuclear medicine that provides physicians
with information about how tissues and organs are functioning. PET, often used in combination
with CT imaging, uses a scanner and a small amount of radiopharmaceuticals which is injected
into a patient’s vein to assist in making detailed, computerized pictures of areas inside the body.

Depending on the type of nuclear medicine exam you are undergoing, the radiotracer is either
injected into a vein, swallowed or inhaled as a gas and eventually accumulates in the organ or
area of your body being examined, where it gives off energy in the form of gamma rays. This
energy is detected by a device called a gamma camera, a (positron emission tomography) PET
scanner and/or probe. These devices work together with a computer to measure the amount of
radiotracer absorbed by your body and to produce special pictures offering details on both the
structure and function of organs and tissues.

In some centers, nuclear medicine images can be superimposed with computed tomography (CT)
or magnetic resonance imaging (MRI) to produce special views, a practice known as image
fusion or co-registration. These views allow the information from two different studies to be
correlated and interpreted on one image, leading to more precise information and accurate
diagnoses. In addition, manufacturers are now making single photon emission computed
tomography/computed tomography (SPECT/CT) and positron emission tomography/computed
tomography (PET/CT) units that are able to perform both imaging studies at the same time.
There are many different uses of the PET, which are mainly to detect cancer and also do
determine the situation of Cancer in the body, it is also used to determine various stages
of cancer. PET is also widely used to determine the blood flow and the effects on the
body after suffering from heart attack.

What kind of tests are there in Nuclear

Medicine ?
There are various different test involved in the Nuclear medicine, some of which are:

Bone Scan:
Nuclear medicine bone scans are used to detect bone damage, which may be due to disease (such
as arthritis, osteoporosis or tumors), infection or injury (such as fractures).

Brain Scan:
This scan looks at the blood supply to the brain and the distribution of the blood within the brain
and has a number of uses e.g. detection of stroke, the cause of recurrent headaches or to pinpoint
the origin of seizures (such as epileptic fits). This scan will help the doctor diagnose your
condition, and give appropriate treatment as necessary.

Gastro-Intestinal Systems Scan:

The purpose of this study is to detect the site of internal bleeding in your gut. This will help the
doctor make a diagnosis and give appropriate treatment as necessary.

Cardiac Scan:
The purpose of this study is to demonstrate the blood supply to your heart muscle (the
myocardium), under stress and resting conditions.

Infections Scan:
The purpose of this study is to show sites of infection or inflammation in the body. This will
enable your doctor to make a diagnosis and so give appropriate treatment as necessary.

Renal Scan:
The purpose of this study is to obtain pictures of your kidneys and investigate how they function,
in order to help the doctor diagnose your condition, and give appropriate treatment as required.
Liver and Spleen Scan:
The purpose of this study is to obtain pictures of your liver and gall bladder. This is to help the
doctor diagnose your condition and give appropriate treatment.

Lungs Scan:
The purpose of this study is to take pictures of the air and blood supply to your lungs. This is to
help the doctor diagnose your condition, and give appropriate treatment as required.

Thyroid Scan:
The purpose of this study is to take pictures of your parathyroid glands (small glands situated in
the region of the thyroid) that may be causing elevated calcium. This will help the doctor
diagnose your condition and give appropriate treatment as required.

Tumor Scan:
The purpose of this study is to take pictures of your body to help the doctor diagnose your
condition, and give appropriate treatment as required. It can show sites of uptake of gallium
citrate in your body. It is most commonly used for localisation of tumour (e.g lymphoma) or
infection/inflammation. This will help the doctor understand your condition, and give
appropriate treatment as required.

Some of the materials which are

commonly used in Nuclear Medicine:
• Fluorine
• Gallium
• Krypton
• Rubidium
• Technetium
• Indium
• Iodine
• Xenon
• Thallium
 THE SIDE-AFFECTS OF NUCLEAR
MEDICINE

A patient undergoing a nuclear medicine procedure will receive a radiation dose. Under present
international guidelines it is assumed that any radiation dose, however small, presents a risk. The
radiation doses delivered to a patient in a nuclear medicine investigation present a very small risk
of inducing cancer. In this respect it is similar to the risk from X-ray investigations except that
the dose is delivered internally rather than from an external source such as an X-ray machine.

The radiation dose from a nuclear medicine investigation is expressed as an effective dose with
units of sieverts (usually given in millisieverts, mSv). The effective dose resulting from an
investigation is influenced by the amount of radioactivity administered in
megabecquerels (MBq), the physical properties of the radiopharmaceutical used, its distribution
in the body and its rate of clearance from the body.

Effective doses can range from 6 μSv (0.006 mSv) for a 3 MBq chromium-51 EDTA
measurement of glomerular filtration rate to 37 mSv for a 150 MBq thallium-201 non-specific
tumour imaging procedure. The common bone scan with 600 MBq of technetium-99m-MDP has
an effective dose of approximately 3.5 mSv (1).

Formerly, units of measurement were the curie (Ci), being 3.7E10 Bq, and also
1.0 grams of Radium (Ra-226); the rad (radiation absorbed dose), now replaced by the gray; and
the rem (Röntgen equivalent man), now replaced with the sievert. The rad and rem are
essentially equivalent for almost all nuclear medicine procedures, and only alpha radiation will
produce a higher Rem or Sv value, due to its much higher Relative Biological
Effectiveness (RBE). Alpha emitters are nowadays rarely used in nuclear medicine, but were
used extensively before the advent of nuclear reactor and accelerator produced radionuclides.
The concepts involved in radiation exposure to humans is covered by the field of Health Physics.