Group number: 3 Section: 1J-MT Score

Seat number: 14 Name: de Mesa, Wensel R. Date: 08/24/19

A. USES OF RADIOACTIVE ISOTOPES IN MEDICINE

Search for the different radioactive tracers that are used to determine damage or
abnormalities in the following internal parts of the body:

1. Oral Cavity
Interstitial radiotherapy, either alone or in combination with external-beam
radiotherapy, is used for selected cases in the treatment of carcinoma of the oral
tongue, floor of the mouth, and buccal mucosa. Radioactive isotopes that have been
used in the past in interstitial radiotherapy of oral carcinomas include radium-226,
cesium-137, gold-198, and tantalum-182. Iridium-192 used in the form of pins
(epingles), wires, or seeds preloaded in a plastic ribbon have the advantage of being
suitable for afterloading techniques, and thus is used commonly for temporary
implants. Iodine-125 may be substituted and is the isotope of choice for permanent
implants.

Reference:
Hoppe, R., Phillips, T., & Mack, R. (2010). Leibel and Philipps textbook of radiation
oncology (3rd ed.). Philadelphia: Saunders

2. Brain
A brain positron emission tomography (PET) scan is an imaging test that allows
doctors to see how your brain is functioning. The scan captures images of the activity
of the brain after radioactive tracers have been absorbed into the bloodstream. These
tracers are attached to compounds like glucose (sugar). Glucose is the principal fuel
of the brain.

In PET a radioactive tracer is injected into a subject intravenously and is chemically

incorporated into a biologically active molecule of interest. The PET cameras capture
the gamma rays that are produced when the tracer decays and undergoes an
annihilation reaction. The common radioactive tracers use 11C, 15O and 18 F
isotopes.The three main PET methods that are used for imaging dementias are:
amyloid imaging (11C- or 18 F-based), fluorodeoxyglucose (18 F-FDG) imaging, and
tau (18 F-based) imaging.

Reference:
Krans, B. (2018, November 2). What Is a Brain PET Scan? Retrieved from
https://www.healthline.com/health/brain-pet-scan

Rosenberg, R., & Pascual, J. (2014). Rosenberg's molecular and genetic basis of
neurological and psychiatric disease (5th ed.). Cambridge, Massachusetts:
Academic Press
3. Eye
A non-invasive, functional and morphological documentation of tear flow through
lacrimal passages was introduced by Rossomondo et al. using radionuclide
technetium-99m pertechnetate (99mTc) and gamma camera by observing the tear
flow through lacrimal drainage system and taking series of image.

References:
Rossomondo, R.M., Carlton, W.H., Trueblood, J.H., & Thomas, R.P. (1972). A new
method of evaluating lacrimal drainage. Arch Ophthalmol, 88(5), 523-525.
Reddy,S.C., Zakaria, A., & Bhavaraju, V.M. (2016). Evaluation of lacrimal drainage
system by radionuclide dacryoscintigraphy in patients with epiphora. Iran J Nucl
Med, 24(2), 99-106.

4. Kidney
The 203Hg- and 197Hg-chlormerodrin were the early agents used, but it was
replaced by 99mTc-DMSA replaced because of its favorable imaging and dosimetry
properties. Also, the tubular function was originally studied with 131I-labeled
hippuran but it was replaced by 99mTc-MAG3 which is a better imaging agent that
also imparts a lower absorbed patient dose. The kidney imaging with radioactive
tracers is used to look for abnormalities in the renal location, intra- and perirenal
masses, and functional indicators of glomerular and tubular function. These tracers
localize in the kidney and stay there.

Reference:
Brill, A., Brill, N., & Beck, R. (2004). Evolution of Clinical Emission Technology.
http://dx.doi.org/10.1016/B978-012744482-6/50006-5

5. Pancreas
Selenium 75 has no beta radiation and a primary scanning gamma energy of 279 kev.
With a physical half-life of one hundred and twenty-eight days, the effective whole-
body half-life of selenomethionine-Se75 is twenty-seven days; the effective half-life in
the pancreas is approximately twenty-four hours. The whole-body radiation dose with
250 microcuries of selenomethionine-Se75 is approximately 0.9 rad; radiation dose to
the pancreas is 0.2 rad.

Reference:
Bruce Sodee, D. (1964). Radioisotope scanning of the pancreas with
selenomethionine Radiology, 83(5). https://doi.org/10.1148/83.5.910

6. Spinal Cord
A study of the Cerebrospinal fluid circulation by intrathecal injection of radioactive
tracers has become a common technic of neurological exploration. Among the
molecules used at present, Indium111 DTPA has numerous advantages for this
type of study. Indium111 is a product of the cyclotron and the physical period (2.8
 days) is compatible with the duration of the examination. The patient's spinal fluid
is injected with a radiopharmaceutical tracer, such as DTPA tagged with indium
111, through a lumbar puncture (spinal tap).

References:
Battal, B., Kocaoglu, M., Bulakbasi, N., Husmen, G., Tuba Sana, H., & Tayfun, C.
(2011). Cerebrospinal fluid flow imaging by using phase-contrast MR
technique. The British Journal of Radiology, 84, 758–765.
doi:10.1259/bjr/66206791.

Moreau, R., Mathieu, E., Moretti, J.L., & Askienazy, S. (1976). Study of circulation
of cerebro-spinal fluid using indium 111 DTPA. Apropos of 300 cases. Sem
Hop, 20(52), 25-28.

7. Spleen
Technetium-99m with a half life of 6 hours is used to image spleen.
Also, Iron-59 with a half life of 46 days is used in the studies of iron metabolism in
the spleen.

Reference:
Radio Chemistry. (n.d.) Isotopes Used in Medicine. Retrieve from
https://www.radiochemistry.org/

B. USES OF RADIATION IN THERAPEUTICS

Discuss the advantages and disadvantages of using radiation in the treatment of cancer.

Radiation therapy, also called radiotherapy, is the branch of medicine that deals
with the treatment of cancer by delivering high-energy beams directly to a tumor, or
intended target (TROG Cancer Research, n.d., para. 1) For more than 100 years, the
field of medicine has used radiation therapy as a treatment for cancer. It’s earliest roots
can be traced way back in the year 1895, when Wilhelm Roentgen discovered the x-ray
(University of Alabama at Birmingham, 2008).

With the aforementioned humble beginning, the field of radiation therapy has
started to grow in the early 1900s due to the groundbreaking work of Marie Curie who
discovered the radioactive elements polonium and radium in 1898. This discovery began
a new era in medical treatment and research (University of Alabama at Birmingham,
2008).

Radiation therapy is a common form of treatment for cancer today. According to

the American Society of Radiation Oncology (ASTRO), more than 60% of cancer patients
receive radiation therapy - either alone or in combination with other treatment approaches,
such as surgery and chemotherapy (TROG Cancer Research, n.d., para. 2). With this
figure, 40% of all cancer cures worldwide as well as relieving symptoms, such as pain,
and improving the quality of life are said to be contributed by radiation therapy (Radiation
Oncology Targeting Cancer, n.d.).
 So how does radiation therapy works? Radiation therapy uses high-energy
particles or high-energy waves to kill cancer cells. Cancer cells reproduce faster than
normal cells and lack the controls found in normal cells. The high energy particles kill
cancer cells by causing damage to their genetic information (American Cancer Society,
n.d.).

The advantages of using radiation therapy to treat cancer are the following: first is
the death of a large proportion of cancer cells within the entire tumor and the ability to kill
more cells together than either therapy could do alone. Next is the death of microscopic
disease at the periphery of the tumor that would not be visible to the naked eye. Also, the
ability to shrink tumors which may help to relieve mass effect. Also, the possible
stimulation of an immune response against the tumor is another advantage. Radiation
therapy is also relative safe for the patient because radiation can be delivered from
outside of the body and is only focused on the tumor. Therefore, it is painless, and
generally does not require anesthesia. Another advantage is the organ preservation
because the removal of organs such as breast and larynx could have a negative impact
on a patient’s quality of life (Cancer Quest, n.d.). Furthermore, many patients find that
their radiation therapy sessions have a minimal effect on their daily schedules. Also, the
treatment sessions are typically given on an outpatient basis, meaning no hospital stay is
required. The sessions typically takes less than an hour, and sometimes as little as 15
minutes (TROG Cancer Research, n.d.).

Despite the aforementioned advantages, like other treatments there are also
disadvantages. The disadvantages of using radiation therapy are the following: The
disadvantages of radiation therapy include: damage to surrounding tissue such as the
lungs and heart, depending on how close the area of interest is located to the tumor.
Another disadvantage is the inability of radiation therapy to kill tumor cells that can’t be
seen on imaging scans. Also, its inability to kill the all cancer cells in large tumors. Next
is the inability to completely relieve mass effect such as the pushing of tumor on
surrounding normal structures in certain parts of the body, thus requiring surgery.
Radiation therapy is also poor at killing cancer cells in areas that do not have a good
supply of oxygen. Also, radiation therapy can increase the possibility of wound
complication and poor healing. This is if the surgery is used after radiation. Lastly, the
contraindications to radiation therapy (Cancer Quest, n.d.).

Aside from the mentioned disadvantages, there are possible side effects of
radiation therapy because the radiation can affect cells other than cancer cells. The side
effects depends on the type and amount of radiation used and the area being treated.
However, in general the side effects are the following: first is fatigue which is the most
common side effect because of the energy expended in replacing normal cells killed in
the process. Next, the skin over the site of radiation may get red and/or sore. The
development of a second cancer, caused by the radiation therapy, is relatively uncommon,
but can occur. The possibility of this to happen depends on a several things, such as the
site being treated, and the age of the patient (Cancer Quest, n.d.).
 There are other side effects which are site-specific. Radiation therapy aimed at a
person’s head or neck may cause these side effects: dry mouth, mouth and gum sores,
difficulty swallowing, stiffness in the jaw, nausea, hair loss, a type of swelling called
lymphedema, and tooth decay. Radiation therapy aimed at the chest may cause these
side effects: difficulty swallowing, shortness of breath, breast or nipple soreness, shoulder
stiffness, cough, fever, and fullness of the chest, known as radiation pneumonitis. Also,
radiation fibrosis, which causes permanent lung scars from untreated radiation
pneumonitis. Radiation therapy aimed at the stomach or abdomen may cause these side
effects: nausea, vomiting, and diarrhea. Radiation therapy aimed at the pelvis may cause
these side effects: diarrhea, rectal bleeding, incontinence, and bladder irritation. In
addition, men and woman may have different symptoms. The potential side effects for
men include: sexual problems, such as erectile dysfunction. Also, lowered sperm counts
and reduced sperm activity, this may affect a man's ability to father a child. The potential
side effects for women include: changes in menstruation, such as having menstruation
stop, and infertility which may occur if both ovaries receive radiation therapy (Cancer.Net,
2019.).

References:
American Cancer Society. (n.d.). Radiation Therapy Basics. Retrieved from
https://www.cancer.org/

Cancer.Net. (2019, January 8). Side Effects of Radiation Therapy. Retrieved from
https://www.cancer.net/

Cancer Quest. (n.d.). Radiation Therapy. Retrieved from https://www.cancerquest.org/

Radiation Oncology Targeting Cancer. (n.d.). Radiation Therapy Benefits & Effectiveness.
Retrieved from https://www.targetingcancer.com.au/

TROG Cancer Research. (n.d.). What is Radiotherapy? Retrieved from

http://www.trog.com.au/

University of Alabama at Birmingham. (2008, January 05). History of Radiation Oncology.

Retrieved from https://web.archive.org/