Notes on Nuclear Medicine

Radiopharmaceutical - “a radioactive drug”

- Do not elicit any pharmacologic response and are used primarily for diagnosis
- Composed of a radioactive material and a non-radioactive compound
Scintiphotos are images depicting radiopharmaceutical localization (“ biodistribution”)

Radioactivity

Stable vs. Unstable

Radioanuclide
Radioactive Decay
Types of Emissions
Types of Decay
Alpha, beta minus, beta plus, gamma emission, internal conversion, electron capture
Units
Half-life
Physical, biological, effective, calculations
Teff = TpTb/(Tp+Tb)
Activity concentration – is the amount of radioactivity per unit volume

Volume = act. needed / act. concentration

Production of Radionuclides
Proton bombardment, neutron bombardment, fission production
Barn = 10 exp -24 sqcm (the higher value would mean ready activation)
Radionuclide generators
Properties: 1. Easy to operate
2. Daughter must have high purity and different than parent
3. Sterile and pyrogen free
4. Daughter in form suitable for preparation elution process
Eluant is usually saline
Secular equilibrium – when the parent’s half-life is much longer than the daughter’s;
usually after 5 to 6 half-lives
transient equilibrium – when the half-life of the parent is greater than the daughter by
only a factor of 10 or less

The Mo -99-Tc-99m generator

- first developed by Powell Richards in 1966 at the Brookhaven Nat’l. Lab

Elution – process of daughter removal
Eluant – solvent used to collect the daughter
Eluate – collected solution containing the daughter
Types: a. wet – contains a reservoir of saline
b. dry – require eluants to be placed on the generator
“moly breakthrough” (.0015 uCi of Mo-99 / mCi of Tc-99m)

“complexing” – another term for radiolabelling

 Type Examples Clinical Indication
1. Simple salts Tc-99m pertechnetate Thyroid, brain, salivary gland
2. Radioactive gases Xe-133, Kr-81m Pulmonary ventilation
Cerebral blood flow
3. Particulates (colloids Tc-99m sulphur colloid, Liver imaging, lung
& aggregates) MAA perfusion
4. Chelates of Tc-99m MDP Skeletal imaging
radiometals Tc-99m DTPA Renal imaging
Tc-99m disofenin Hepatobiliary studies
5. Radiolabeled blood Cr-51 RBC Blood vol. meas.
products Tc-99m RBC Blood pool imaging
In-111 WBC Abscess imaging
6. Radiolabeled analogs Se-75selenomethionine Pancreas imaging
C-11 valine -do-
I-131 cholesterol Adrenal imaging
I-131 mIBG -do-
7. Radiolabeled I-131 CEA Tumor detection
antibodies

Mechanism of localization:
1. Active transport – involves cellular metabolic processes that result in organ or tissue
concentrations above plasma levels. Ex.: I-131
2. Simple diffusion – involves the movement of a substance from regions of higher concentration
to lower concentrations. Ex.: BBB
3. Capillary blockade – particles larger than RBCs will be lodged at the first capillary bed they
encounter
4. Phagocytosis – involves RE system; involves recognition and removal of small foreign
particles in the blood. Ex.: sulphur colloid
5. Cell sequestration – is the process by which the spleen recognizes and removes damaged RBCs
and cells nearin =g the end of their life expectancy
6. Compartmental localization – this occurs when radiopharms are introduced directly into well-
defined body compartments and remain there for a time necessary for imaging. Ex.: lung vent,
orally insoluble in GI tract CSF (cerebral spinal fluid)
7. Antigen-antibody complexation – tumor localization “p97”
 Bone: Tc-99m
phosphate
 Renal: Tc-99m
DTPA, DMSA, MAG3
 Thyroid: I-131, Tc-99m
pertechnetate
 Liver: Tc-99m
Colloid, HIDA
 Brain: Tc-99m,
Pertechnetate, HMPAO, glucoheptonate
 Lungs: Tc-99m, aerosol, MAA
 Heart: T1-201, Tc-99m RBC

Detection of Radiation
Ionization
Gas-filled detectors
Ionization chambers, proportional counters, GM
Scintillation crystals
Solids used are called “fluors” since they give off light when they absorb radiation
“Activators “ impurity atoms that help produce scintillations
Resolving time
Gamma cameras
.5 in. thick 20 in. in diameter
Sensitivity and resolution dependent on collimators
Parallel holes O = O patient
Diverging o < O
Converging O > o
Pinhole O > o

Clinical selection of radiopharms

Nuclear properties:
1. Principal photon energy 150 keV is ideal
2. Decay mode
3. Physical half-life
4. Physical and chemical properties

Notes on Physics Review

Wave concepts:

V = λv where λ is wavelength
v is frequency 1°A (angstrom) = 10-10 m
Particle concepts:

E = hv where h = 6.62 x 10-34 J-s E = 12.4 / λ E in keV, λ in angstroms

Wilhelm Conrad Roentgen discovered x-rays on Nov. 8, 1895.

Production of X-rays
Glass Enclosure
The purpose of the vacuum is to allow the number and speed of the accelerated electrons to be
controlled independently.

Cathode
Cathode or filament is the source of electrons.
x-ray tube current – no. of e flowing per sec from filament to target (mA)
thermionic emission – emission of e resulting from the absorption of thermal energy
Edison effect – e cloud surrounding the filament due to thermionic emission
Space charge – collection of negative charge or electron cloud
Space charge effect – tendency to limit emission of e from filament
Line Focus Principle
Focal spot – area of the target that is bombarded by electrons
As the anode angle decreases the apparent focal spot decreases
Anode
Stationary or rotating; the purpose of rotating anodes is to spread the heat produced during an
exposure over a large area of the anode.
Total target area for rotating anode is = 2πr x height of e stream
90% tungsten and 10% rhenium – anode composition

Heel effect
The intensity of the x-ray beam that leaves the tube is not uniform throughout all portions of the
beam. 3 clinically important aspects are worth mentioning:
a. The intensity of the film exposure on the anode side is significantly less than on the cathode
side
b. The heel effect is less noticeable whenlarger focus-film distances are used
c. The heel effect is less for smaller films (equal target film distances)

Tube rating charts

Heat unit (HU) = kVp x mA x s for single phase
kVp x mA x s x 1.4 for constant potential (3φ)

Physics
Atomic and Nuclear structure
Electron orbits and shells
Processes of x-ray generation
 Bremsstrahlung
Λmin = 12.4 / kVp (angstrom)
Characteristic radn

X-ray Generators

- Device that supplies electric power to the x-ray tube

Transformers

- A device that either increases or decreases the voltage in a circuit

Rectifiers – changes AC to DC
NpVs = NsVp VpIp = VsIs