Short notes of isotope scan

1) nuclear force with which proton and neutron, attract one another in the nucleus
is called
2) Gamma rays is electromagnetic radiation similar to x-ray can pass right
through the human body
3) Scintillation Crystal made of Na Iodide thallium activated crystal with thickness
of 0.25- 0.5 inch.
4) Types of collimators are parallel for large organ, pin hole for thyroid scan,
convergent.
5) Cyclotron use to produce radioactive isotopes.
6)
7) In TC generator, the mother nuclide Mo-99 decays into Tc-99m with a half-
life of 2.7 days, which itself has a half-life of 6 hours
8) Half-Life defined as the amount of time required for one-half of the radioactive
atoms to decay.
9) Radionuclides used in PET scanning are typically isotopes with half-life of 6
minute
10) Gallium -citrate has a physical half-life of 68 minutes. used on thyroid and
prostate isotope scan.
11) The potential health risks from radiation exposure are lower compared with
the potential benefits
12) Isotope scan can detect the biological activity and neoplastic changes
13) ventilation perfusion scan is a physiologic map that evaluates the segmental
bronchi-alveolar tree ventilation and lung vascular perfusion.
14) Radiation particle are proton, neutrons and high speed electrons.
15) Alpha & beta and fast neutron are radiation particle while gamma not.
16) Pregnant nurses should not allowed to work in a therapy ward.

17) Indication of renal scentiraphy are Renal perfusion, obstruction (Lasix renal
scan) and renal transplant.
18) HIDA is used to test Hepatobilliary system.
19) Splenic scintigraphy studied by sulfur colloid
20) SPECT examination : emits gamma ray, it cross section study and can add
 3 D images, cheap and give high resolution images.
21) The typical time to obtain each SPECT projection is 15–20 second(s).
22) Each isotope of a given elemete has a different mass number as carbon-12 &
32 33 45
carbon 14 are isotope for carbon. Others examples as 15P , 16S and 19K ,
45
20Ca

a. ‫بمعني لما احب اعل عنصر ذرى مشع مه عنصر غير مشع اذود جنبه رقم اللي هو وزن العنصر‬
23) The steps to follow in dealing with a radioactive spill are decontaminate,
contain and reporting
24) External sources for exposure include syringes External sources for exposure
include the following except syringes , waste disposal areas and patient excreta
25) In ventilation scan technique the patient inhales the aerosol for 3-5 min in
prone position through a tight face mask.
26) Tc-99m DTPA in ventilation scan with its half-life is 20 min.
27) 18 F is radionuclides used in PET scanning with half-life of 109 minute &
11C is 20 minute and 68 Ga is one hour
28) Thallium is radio-isotop scan for myocardial perfusion image with short
half-life of 7.4 hours injected intravenously 2.0 to 4.0 millicuries (74 to 148
MBq).
29) myocardial perfusion scan done either at rest or stress study to assess the
presence, location and extend of coronary artery disease
30) Xenon133 used for ventilation scan of the lung
31) Morphology of the kidney, studied by DMSA.
32) Perfusion, obstruction and GFR studies with DTPA
33) When use albumin micro aggregate Shake the syringe prior to injection to
resuspend the particles
34) 99mTc-Sestamibi protocols done be SPECT technique
Indication of bone scan:
 1) screening of patients with tumors (metastatic workup)
2) detection of early osteomyelitis
3) detection of early avascular necrosis
4) detection of stress fractures and other occult skeletal trauma
5) detection and evaluation of Paget's disease, metabolic bone disease
6) detection and evaluation of arthritis
7) evaluation following an elevated alkaline phosphatase level
8) evaluation following questionably abnormal skeletal radiographs
9) serially following the course of bony response to therapeutic regimens
(radiation therapy, chemotherapy, antibiotic therapy)
Methods of nuclear medicine protection:
1- for nursing and patient
• Pregnant nurses :
• Should not be allowed to work in a therapy ward.
• Nursing care to the patient should always be given across a shoe barrier
such as medication, food etc.
• Spend minimum time in direct contact with the patient.
• During the period of isolation, in the first 48 hours after therapy the sampling
of blood and urine for pathological examination should be strictly avoided, to
prevent contamination of the laboratory.
• In case it is required, it has to be done/taken in consultation with RSO only.
In case of any medical and/or radiation related emergency, the nursing staff
should have list of names and addresses with telephone numbers of the
Nuclear Medicine Physician and RSO, so as to contact them immediately, if
required
2- To the visitors:
• The visitors must follow instructions of the nursing staff
• The duration of visit and restrictions on distance from the patient.
• Not entering the isolation room and
• Abstain from physical contact with the patient.
• Children and pregnant women should be prohibited to visit the patient

Technique of perfusion lung scan

o Shake the syringe prior to injection to resuspend the particles.
o The patient is asked to breath slowly and deeply in supine position.
o Examined in upright or supine position using a large field of view and a
high resolution gamma camera immediately post injection.
 o 8 Views are obtained: anterior, posterior, rt and lt lateral, rt and lt
anterior oblique, right and left posterior oblique.
Ventilation lung scan technique

• First, patient inhales the aerosol for 3-5 min in supine position through a
tight facemask. To avoid the normal apex-to-base gravity gradient.
• 5-10 mCi,
• After 5 min of re-breathing, a posterior equilibrium image is obtained that
represent the aerated lung volume.
• Same views as perfusion study are taken.

Technique of cardiac scintigraphy

• Thallium is injected intravenously 2.0 to 4.0 millicuries (74 to 148 MBq).
• When stress is used, injection should precede cessation of stress by 1
minute.
• Imaging is routinely started within 5 minutes after injection.
• Redistribution images are obtained 3 to 4 hours after injection
• Sestamibi is taken up by the myocardium according to regional myocardial
perfusion.
• Unlike thallium, very little redistribution occurs. Measurement of regional
myocardial perfusion during stress and rest requires 2 separate intravenous
injections.
99mTc-Sestamibi protocols
• Needs 2 separate injections one at rest and the other at stress.
2 days protocol:
• injections are separated by 24-48h
• Dose 20-30mCi
1 day protocol:
• Injections are separated by 2h
• Rest/stress is better than stress/rest.
• Dose: first study 8-10mCi second study 25-30mCi (1:3 ratio)
Scintigraphy of Inflammation and Infection

Indications
 • Fever of unknown etiology
• Localization of an unknown source of sepsis (occult infection).
• Cardiovascular infections (e.g., prosthetic grafts, mycotic aneurysms).
• Differentiation of infection from tumor.
• Pulmonary inflammation Postoperative infections.
• Sarcoidosis. Tuberculosis
• Interstitial nephritis. inflammatory bowel diseases
Technique of bone scan:
• Patient should be well hydrated
• Tracer: 99mTc MDP (Methylene DiPhosphonate)
• Dose: 20 mCi iv
• Patient is asked to drink plenty of fluids and void urine frequently (to wash
out tracer from soft tissues ) and immediately before scan
Imaging
Static
• Images taken 3 hours post injection
• Parallel hole collimator
• Whole body anterior and posterior scans
• Normal: symmetrical osseous uptake, soft tissue uptake in breasts,
kidneys and urinary bladder
Whole Body Images
• Blood pool static images
Indication of thyroid scans:

1. To relate the general structure of the thyroid gland

2. Detection of metastases from thyroid carcinoma
3. Follow-up of radioiodine therapy for differentiated thyroid cancer
4. To locate ectopic thyroid tissue (i.e. lingual)
5. To assist in evaluation of congenital hypothyroidism.
6. To evaluate a neck or substernal mass