Rtle Nuclear Medicine

NUCLEAR
MEDICINE
RICHMOND K. QUILATAN, MHA,RRT

TOPIC
• INTRODUCTION
• NUCLEAR SPECIES
RICHMOND K. QUILATAN, MHA, RRT
• RADIOACTIVE DECAY PROCESS

• RADIATION DETECTORS
• GAMMA CAMERA
• SINGLE-PHOTON EMISSION TOMOGRAPHY (SPECT)
• POSITRON EMISSION TOMOGRAPHY (PET)
• RADIONUCLIDE PRODUCTION
• RADIOPHARMACEUTICALS
• RADIOPHARMACEUTICAL MECHANISM OF LOCALIZATION
• TERMINOLOGIES IN NUCLEAR MEDICINE
• CLINICAL NUCLEAR MEDICINE
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INTRODUCTION TO
NUCLEAR MEDICINE

INTRODUCTION
NUCLEAR MEDICINE
• Subspecialty of radiology aimed at the diagnosis and therapy of diseases.
• Diagnostic Nuclear Medicine

• It involves administration of radiotracers, whose distribution provides images
related to biochemical and physiological properties of tissues and organs.
• Uses gamma rays to look at the function of the body
• Gamma rays are emitted by radiopharmaceuticals injected into the bloodstream
rather than being produced by machine outside the body.
• Therapeutic Nuclear Medicine
• As a therapeutic modality, nuclear medicine similarly involves administration of
internal radioactive sources, which target pathologic tissues or organ based on
biochemical and physiological mechanism of localization.
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INTRODUCTION
END OF TOPIC
PHYSICS OF NUCLEAR
MEDICINE

PHYSICS OF NUCLEAR MEDICINE
NUCLEAR FAMILY OR SPECIES
• ISOTOPE
• ISOBAR
• ISOTONE
• ISOMER
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ISOTOPE
• Atoms that have the same atomic number but different atomic
mass number.
• Contains the same number of protons but with varying number
of neutron.
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ISOBARS
• Atomic nuclei that have the same atomic mass number but
different atomic number
• Different number of protons and different number of neutron
but the same number of nucleons (atomic mass number)
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ISOTONES
• Atom with different atomic number and different mass number

but the same number of neutrons
• 134
55Cs , 133
54Xe , 132
53I
ATOMIC ATOMIC MASS NUMBER OF

ATOM
NUMBER NUMBER NEUTRON
Cesium-134 55 134 79
Xenon-133 54 133 79
I-132 53 132 79
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ISOMERS
• Have the same atomic number and the same atomic mass
number in fact, isomers are identical atoms except that they
exists at different energy state because of differences in nucleon
arrangement
• 99m
43 Tc is isomer of 99
43Tc
• 81m36 Kr is isomer of 81
36Kr
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Characteristics of Various Nuclear Arrangements

Atomic Atomic Mass

Arrangement Neutron #
Number (Z) Number (A)
IsotoPe Same Different Different
IsobAr Different Same Different
IsotoNe Different Different Same
Isomer Same Same Same
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RADIOACTIVE DECAY
• Process in which an unstable nucleus transforms into a more

stable one by releasing particles or photons
• A material containing unstable nuclei is considered radioactive
RADIOACTIVE DECAY PROCESS
• Alpha Decay
• Beta Minus Decay (Negatron Decay)
• Beta Plus Decay (Positron Decay)
• Electron Capture Decay
• Isomeric Transition
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ALPHA DECAY (α)
• Spontaneous emission of an alpha particle from the nucleus.

• Typically occurs with heavy nuclides with atomic number(z) greater than
82
• The atomic number decreases by 2 and atomic mass number by 4
• Alpha particles have an energy between 4 to 7 MeV
• 220Rn86 → 216Po84 + 4 α 2 +6.4 MeV (transition energy)
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ALPHA DECAY (α)
• Spontaneous emission of an alpha

particle from the nucleus.
• Typically occurs with heavy nuclides
with atomic number(z) greater than 82
• The atomic number decreases by 2 and
atomic mass number by 4
• Alpha particles have an energy between
4 to 7 MeV
• 220Rn86 → 216Po84 + 4 α 2 +6.4 MeV
(transition energy)
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BETA MINUS DECAY OR NEGATRON
DECAY (β-)
• A neutron inside the nucleus is converted

into a proton, and the excess energy is
released as an energetic electron, called a
beta particle or negatron and an anti-
neutrino.
• It increases the number of protons by 1 and
thus transforms the atom into different
element with atomic number z + 1.
• Occurs in nuclei with too many neutrons
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BETA PLUS DECAY OR POSITRON
DECAY (β+)
• A proton inside the nucleus is

converted into a neutron, and the
excess energy is emitted as a positively
charged electron, called a positron, and a
neutrino.
• Occurs in nuclei with too many
protons
• The atomic number decreases by 1 and
the mass number stays the same.
• Example: 18F9→β+ 18O8
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ANNIHILATION INTERACTION
• Happens when positron, produced
in beta plus decay, and an orbital

electron from an atom are attracted
due to their opposite charges.
• The masses of positron and
electron are converted into two
0.511 MeV gamma ray that travels
180 degrees from one another.
• β+ + e- = γ (0.511 MeV) + γ(0.511
MeV)
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ISOMERIC TRANSITION
• Gamma rays are emitted as the

excited nucleus undergoes an
internal rearrangement and
transition from the excited state to a
lower energy state.
• These excited states are called
metastable or isomeric state and are
denoted by the letter m after the
atomic mass number.
• Example:99mTc → 99Tc + Energy
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RICHMOND K. QUILATAN, MHA, RRT 26
• Radioactivity is the random and spontaneous breakdown of
unstable atomic nuclei involving the emission of alpha, beta or
gamma radiation.
• The activity of a radioactive sample is defined as the rate at
which radioactive particles are emitted.
• Activity is usually represented by the symbol A
27
• The original unit for measuring the amount of radioactivity was
the Curie (Ci)

• First defined to correspond to one gram of radium-226 and
more recently defined as:
• 1 Curie = 3.7x1010 radioactive decays per second (dps)
• In the International System of Units (SI) the CURIE has been
replaced by the BECQUEREL (Bq),
• Where
• 1 Bq = 1 dps = 2.703x10-11 Ci
• 1 Ci = 3.7x1010 Bq = 3.7x1010 dps
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ACTIVITY
The quantity of radioactive material, expressed as the number of

radioactive atoms undergoing nuclear transformation per unit
time.
A = -dN / dt
Where:
dN = the change in the total number of radioactive atoms
dt = given period of time
29
𝐨 −𝛌𝐭 .
𝐍=𝐍 𝐞
Where:
No = number of nuclei present initially
N = number of nuclei present at time ( t ) and ( λ )
λ = radioactive decay constant
e = base of natural logarithm ( equal to 2.718….)
t = elapsed time
30
A= Ao 𝐞−𝛌𝐭
Where:
Ao = number of nuclei present initially
A = number of nuclei present at time ( t ) and ( λ )
λ = radioactive decay constant
e = base of natural logarithm ( equal to 2.718….)
t = elapsed time
31
• The activity of a certain radionuclide last February 14, 2017 was 100Ci.
What will be its activity on June 7, 2017 if its half life is 20 days? Consider
1month = 30days.
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END OF TOPIC
RADIATION DETECTORS

RADIATION DETECTORS
RADIATION DETECTOR
• Instrument used to detect or identify high-energy particles,

such as those produced by nuclear decay, cosmic radiation, or
reactions in a particle accelerator
• Types of Detectors
• Gas-filled detector
• Scintillation detector
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RADIATION DETECTORS
GAS-FILLED DETECTORS
• Function by measuring the ionization that radiation produces

within the gas
• The operation of a gas-filled detector is based on the ionization
of gas molecule by radiation, followed by collection of the ion
pairs as charge or current with the application of a voltage
between two electrodes. The measured charge or current is
proportional to the applied voltage and the amount and energy
of radiation, and depends on the type and pressure of the gas.
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RADIATION DETECTORS
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RADIATION DETECTORS
RADIATION DETECTORS
Dose Calibrator
• Most frequently used in the

nuclear medicine department
as a table-top ionization
chamber to confirm that the
correct amount of activity has
been dispensed before a dose
of radiopharmaceutical is
administered
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RADIATION DETECTORS
RADIATION DETECTORS
Pocket Dosimeters
• A small ionization chamber is the
heart of the classic pocket

dosimeter.
• Are very sensitive type of personnel
monitoring device
• Provides an instantaneous reading,
but must be recalibrated daily
• Capable of only a predetermined
range
• Resembles a fountain pen
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RADIATION DETECTORS
RADIATION DETECTORS
Geiger Counter (GM-counter)
• The most widely used of the gas-
filled detectors.
• Its principal uses are the
monitoring of areas such as
nuclear medicine laboratories for
radiation and the detection of
contamination.
• Can detect all four major types
(alpha, beta, gamma and X-ray)
of radiation
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RADIATION DETECTORS
SCINTILLATION DETECTORS
• This type of detector is based on

the property of certain crystals to
emit light photon after deposition
of energy in the crystal by ionizing
radiation.
• The light produced from the
scintillation process is reflected
through a clear window where it
interacts with device called a
photomultiplier tube
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RADIATION DETECTORS
RADIATION DETECTORS
Photomultiplier
• An electronic tube that convert light

photons into electric pulses.
• A vacuum tube with a large potential
voltage distributed across a series of
intermediate electrodes called
dynodes.
Photocathode
• Is an extremely thin layer of an alloy
such cesium and antimony. 3-5 light
photon is converted to 1 electron
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RADIATION DETECTORS
Pulse Height Analyzer (PHA)
• An instrument used to analyze the frequency distribution of the

spectrum of photon energies that are captured by a Gamma
camera.
• Energy windows are selected to only allow certain photon
energies that fall within a preset range to contribute to the
output pulse.
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RADIATION DETECTORS
2 Fundamental Ways Of How A Detector System Process A Signal
• PULSE MODE
• The signal from each interaction is processed individually.
• GM counter
• These types of measurements are known as radiation
spectroscopy and usually work very well when the
radiation event rate is low
• CURRENT MODE
• The electrical signals from individual interactions are
averaged together forming a net current signal.
• Ionization Chamber & Dose Calibrators 50
RADIATION DETECTORS
DETECTION EFFICIENCY (SENSITIVITY)
• Measure of its ability to detect radiation

• Measured by placing a source of radiation in the vicinity of the
detector and dividing the number of particles of photon
detected by the number emitted
𝑛𝑢𝑚𝑏𝑒𝑟 𝑑𝑒𝑡𝑒𝑐𝑡𝑒𝑑
EFFICIENCY =
𝑛𝑢𝑚𝑏𝑒𝑟 𝑒𝑚𝑖𝑡𝑡𝑒𝑑
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RADIATION DETECTORS
Detection Efficiency = Geometric Efficiency x Intrinsic Efficiency
(number reaching the detector ) x (number detected)

DETECTION EFFICIENCY =
(number emitted) x (number reaching the detector)
• Geometric Efficiency
• Defined as the fraction of emitted particles or photon that
reaches the detector.
• Intrinsic Efficiency
• Defined as the fraction of those reaching the detector that are
detected
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RADIATION DETECTORS
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RADIATION DETECTORS
END OF TOPIC
GAMMA CAMERA

GAMMA CAMERA
GAMMA CAMERA
• A device used to image gamma
radiation emitting
radioisotopes, a technique known
as scintigraphy.
• Developed by Hal O. Anger at
Donner Laboratory in Berkley,
California in the 1950s.
• Anger Gamma Scintillation
Camera
• Most common nuclear imaging
device
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GAMMA CAMERA
MAJOR PARTS
• GANTRY
• DETECTOR SYSTEM
• COLLIMATORS
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GAMMA CAMERA
GAMMA CAMERA GANTRY
• The gantry used to support and moves the detector.
• The Cantilever design of the gantry is flexible option for small

single detector system since it allows manual positioning by
virtue of a counter balance mechanism, which offset the weight
of the detector.
• Dual head and triple head system requires a more sturdy ring
gantry with robotic movement of the detector.
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GAMMA CAMERA
CANTILEVER DESIGN RING GANTRY

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GAMMA CAMERA
COLLIMATORS
• A collimator restricts the rays from the source so that each point in the
image corresponds to a unique point in the source.

• Attached to the face of the detector to limit the field of view so that g-
radiations from outside the field of view are prevented from reaching the
detector.
• Normally made of material with high atomic number and stopping power
(lead)
• They are designed in different sizes and shapes and contain one or many
holes to view the area of interest.
• Typically a 0.5 – 2 inch thick slab of lead, the same dimension as the
scintillation crystal with a geometric array of holes in it.
• The lead in between each hole is called a septum) 61
GAMMA CAMERA
Without a collimator, angled
photons introduce improperly

located scintillations.
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GAMMA CAMERA
TYPES OF COLLIMATOR
• PARALLEL HOLE
• CONVERGING
• DIVERGING
• PIN HOLE
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GAMMA CAMERA
PARALLEL HOLE COLLIMATOR
• Consists of an array of parallel holes,

essentially perpendicular to the crystal
face, and thus presents a real size
image to the crystal face.
• Low-energy all-purpose collimators
(LEAP)
• High-resolution collimators
• High- and medium-energy collimators
• Slant-hole collimators
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GAMMA CAMERA
GAMMA CAMERA
CONVERGING COLLIMATORS
• Consist of an array of tapered

holes (are not parallel but are
angled inward, toward the
organ) that aim at a point at
some distance in front of the
collimators.
• The image that is presented to
the crystal is magnified version
of the real image.
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GAMMA CAMERA
DIVERGING COLLIMATORS
• Achieve a wider field of view by angling the holes the

opposite way, outward toward the organ.
• This is used most often on a camera with a small crystal,
such as a portable camera.
• Using a diverging collimator a large organ such as the
lung can be captured on the face of a smaller crystal
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GAMMA CAMERA
GAMMA CAMERA
PINHOLE COLLIMATOR
• Are thick conical collimators with

a single 2 – 5 mm hole in the
bottom center.
• Magnifies or minifies depending
on the distance of the object from
the collimator
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GAMMA CAMERA
SENSITIVITY
• Refers to the ability of the imaging camera to detect the photons

generated by the nuclides.
• Low-sensitivity System
• Detects a smaller number of the generated photons
• High-sensitivity System
• Detects a greater number.
• Larger holes and thinner septa.
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GAMMA CAMERA
HIGH SENSITIVITY HIGH RESOLUTION HIGH RESOLUTION

COLLIMATOR COLLIMATOR: COLLIMATOR:
Narrower Holes Longer Holes
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GAMMA CAMERA
For the same hole diameter, the longer the

bore the higher the resolution
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GAMMA CAMERA
LOW-ENERGY ALL-PURPOSE
COLLIMATORS (LEAP)
• These collimators have relatively large

holes which allow the passage of many
of the photons emanating from the
patient.
• As such they have relatively high
sensitivity at the expense of resolution.
• Because the holes are larger, photons
arising from a larger region of the
source are accepted.
• As a result, image resolution is
decreased
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GAMMA CAMERA
HIGH-RESOLUTION COLLIMATORS
• These collimators have higher resolution images than the LEAP
collimators.
• They have more holes that are both smaller in diameter and longer in
length
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GAMMA CAMERA
HIGH- AND MEDIUM-ENERGY COLLIMATORS
• Low-energy collimators are not adequate for the higher energy

photons of nuclides such as
• Gallium-67 (it emits 394-keV, 300-keV, and 185-keV photons,
in addition to its low-energy 93-keV photon),
• Iodine-131 (376 keV)
• Indium-111(245 keV and 173 keV
• Fluorine-18 (511-keV annihilation)
• The photons of these nuclides can penetrate the thinner septa
of both the LEAP and the high-resolution collimators, resulting
in poorer resolution
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GAMMA CAMERA
Thicker septa are used to block high- and medium-energy photons.

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GAMMA CAMERA
Effect of matrix
configuration on image
resolution
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GAMMA CAMERA
CAMERA HEAD
• Contains the crystal, photomultiplier

tubes, and associated electronics
DETECTOR
• The detector is the device that records
the spatial distribution and
radioactivity and its change overtime.
• It contains components, which
converts the energy of the incident
photons first into light and then into
electrical signal
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GAMMA CAMERA
CRYSTAL
• The crystal is a device for converting electromagnetic radiation in
the form of gamma rays into visible light.

• Scintillates (give off light) when high energy photon interacts with it
• Amount of light produce is proportional to the number of
interactions
• The crystal for an imaging camera is a large slab of thallium-“doped”
NaI crystal
• The thickness of a crystal affects its resolution as well as its sensitivity
• Thicker crystals have higher sensitivity, the resolution is lower
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GAMMA CAMERA
CRYSTALS USED IN SCINTILLATION CAMERA:
• Sodium Iodide (NaI) Thallium activated

• Cesium Fluoride (CsF)
• Bismuth Germinate (BGO)
• The bismuth germinate (Bi4Ge3O12 or BGO) detector has a
higher density and effective atomic number and so higher
attenuation coefficient (hence, higher stopping power) for
511keV photons than NaI(Tl).
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GAMMA CAMERA
NaI(Tl) CHARACTERISTIC
• Pure sodium iodide does not produce any scintillation after

interaction with gamma radiations at room temperature.
However, if it is doped with a trace amount (0.1–0.4%) of
thallium as an activator, NaI(Tl) becomes quite efficient in
producing light photons after gamma radiation interact with it
• NaI (Tl) is a hygroscopic material
• The crystal is hermitically sealed against moisture to prevent
yellowing
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GAMMA CAMERA
Photomultiplier Tube
• Converts the light produced

in the scintillation detector
into an electrical signal
• Consists of a photocathode
that converts light photon
into electron
• Accelerating dynodes used to
amplify electrical signal from
photocathode
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GAMMA CAMERA
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GAMMA CAMERA
END OF TOPIC
SINGLE-PHOTON
COMPUTED TOMOGRAPHY
(SPECT)

SINGLE-PHOTON COMPUTED TOMOGRAPHY
SINGLE-PHOTON EMISSION COMPUTED TOMOGRAPHY
• SPECT cameras acquire multiple planar views of the radioactivity in an
organ.
• The data are then processed mathematically to create cross-sectional views
of the organ.
• SPECT utilizes the single photons emitted by gamma-emitting
radionuclides such as Tc-99m, Ga-67, In-111, I-123
• Similar to that of a planar camera but with two additional features
• SPECT camera is constructed so that the head can rotate either
stepwise or continuously about the patient to acquire multiple views
• It is equipped with a computer that integrates the multiple images to
produce the cross-sectional views of the organ.
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SINGLE-PHOTON COMPUTED TOMOGRAPHY
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POSITRON EMISSION
TOMOGRAPHY (PET)

POSITRON EMISSION TOMOGRAPHY
(PET)
• Are designed to detect the paired 511-kev

photons generated from the annihilation
event of a positron and electron
• A collimator is not required for PET since
PET cameras use the detection of the
simultaneous and oppositely directed 511-
kev photons of positron annihilation to
locate the direction from which the
photons originated. This is referred to as
“annihilation coincidence detection.”
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TRUE COINCIDENCE
(TRUE EVENT)
• Is the simultaneous
emissions resulting
from a single nuclear
transformation
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SINGLE EVENT
• Detection of a single gamma photon by an individual detector

(high noise)
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A coincident event is accepted after processing by the pulse height

analyzers, timing discriminators, and coincidence circuits.
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One of a pair of annihilation photons is scattered and their

data is rejected
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Random Events
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END OF TOPIC
PRODUCTION OF
RADIONUCLIDE

PRODUCTION OF RADIONUCLIDE
• CYCLOTRON-PRODUCED RADIONUCLIDES
• REACTOR PRODUCED RADIONUCLIDE

• GENERATOR PRODUCED RADIONUCLIDE
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CYCLOTRON-PRODUCED RADIONUCLIDES
• Accelerator are devices that increases the energy of the charged

particles like protons, deuterons (H2), tritons (H3) and alpha
particles to enable the nuclear reaction upon impact with a
target: either a cyclotron or linear accelerator can be used to
produced radionuclide
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CYCLOTRON
• Device for accelerating charged
particles to high energy using

magnetic and oscillating
electrostatic fields causing the
particle to move in a spiral path
with increasing energy.
• Developed by ERNEST O.
LAWRENCE in the 1930’s.
• Consists of a hollow metal
electrodes called “dees” between
the poles of a large
electromagnet.
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REACTOR PRODUCED RADIONUCLIDE
• Two Methods of production of Radionuclide in a nuclear reactor
• Neutron Activation or Thermal Neutron Reactor

• The core of a nuclear reactor has a very high flux of neutrons that are
produced in a self-sustaining nuclear chain reaction. When neutron
strike a target, some of the neutrons are captured by the nuclei of the
target atom and become radioactive.
• Fission Product Separation
• The fission process itself results in the production of lighter
radionuclides of unequal mass some of which are used in nuclear
medicine
• Example: Neutron bombardment of 235U92
• n + 235U92 236U92 = 92Kr36 + 141Ba56 + 3n
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GENERATOR PRODUCED
RADIONUCLIDE
• A generator is a system that provides

a radionuclide by radioactive decay.
This system locally produced a
relatively short half-life product
(daughter).
• A radionuclide generator is a
radioactive series in which a short-
lived (daughter) isotope is produced
for a decay of a longer lived (parent)
isotope.
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• Mo-99/Tc-99m GENERATOR
• The basic component of Mo-99/Tc99m generator is consist of a glass

containing an inner aluminum column impregnated with Mo-99.
• The entire apparatus is shielded in lead to minimize radiation exposure
to workers nearby. the Mo-99 undergoes beta decay with half-life of 66hrs.
To form Tc-99m, it is this daughter radionuclide is used in nuclear
medicine images studies. It decays by isomeric transition to Tc-99 with a
half-life of 6 hrs.
• The Mo-99 is insoluble and remains on the aluminum column but the
Tc-99m is in the solution increasing its activity.
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111
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END OF TOPIC
RADIOPHARMACEUTICALS

• Radioactive drugs used for

therapy and diagnostic purposes
RADIOPHARMACOLOGY
• Study of radioactive drugs and
their therapeutic and diagnostic
uses
115
TYPICAL STRUCTURE OF A RADIOPHARCEUTICAL
• Carrier (chemical) + Radionuclide = Radiopharmaceutical

• Carrier (Ligand)
• Provides for the affinity to special body tissues
• Affinity - ability of a substance to bind to a receptor; it is
a measurement of the strength of the binding
• Radionuclide
• Unstable nucleus that transmutes by way of nuclear decay,
intended to the purpose of detection only (diagnostic) or
interaction with the tissues (therapeutic)
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CATEGORIES OF RADIOPHARMACEUTICALS
• Nuclear Properties
• Half-life
• Decay Mode
• Photon Energy
• Biological Properties
• Route of administration
• Target Uptake
• Tracer Excretion
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NUCLEAR PROPERTIES OF DIAGNOSTIC REDIOPHARMACEUTICALS
• HALF-LIFE
• A radionuclides half-life must be long enough to allow synthesis, administration, and

biological localization. If the radionuclide is to long lived, unnecessary body
irradiation occurs.
• DECAY MODE
• Imaging procedures require an electromagnetic photon (gamma or x-rays) to produce
an image. It is desirable that the photon be emitted in high abundance and be
monoenergetic. Particulate radiations such as Beta and Alpha particles are not
detected. For diagnostic use, a pure gamma emitting decay mode would be desirable.
Radionuclides that decay by Isomeric Transition (IT) or Electron Capture (EC) are
the most useful and diagnostic.
• Examples:Tc-99m, Kr-81m decays by Isomeric Transition
• Tl-201, Ga-67, In-111 and I-123 decays by Electron Capture
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• PHOTON ENERGY
• It is one of the big trade off in Nuclear Medicine that involves the balance
between resolution and sensitivity

• This is a major concern when designing gamma camera system, crystals,
collimators and electronics because the design is strongly dependent on photon
energy.
• The energy must be high enough that it escapes the body without being
attenuated too much, but must also be low enough to undergo a photoelectric
interaction in the camera crystal.
• The gamma camera electronics are conventionally set-up to detect radiation in
the 60 – 400 keV range.
• For the Anger Camera, the energy of the Radiopharmaceutical emission should
be in the range of 100 to 200 keV.
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BIOLOGICAL PROPERTIES OF DIAGNOSTIC
• The nuclear properties of the radionuclides determine the

usefulness of a radiopharmaceutical for detection by imaging,
but the biological properties of the radiopharmaceuticals
determine its localization and fate after administration.
• Some radiopharmaceuticals localize because of the
radionuclide’s own elemental state (inert gases of ventilation
scanning – Xe-133) or ionic state (thyroid uptake of I-123 as
iodide).
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IDEAL RADIOPHARMACEUTICALS SHOULD DO THE
FOLLOWING:
• Localize rapidly and exclusively in the organ of interest

• Localize more in pathologic tissues rather than in the normal
tissues
• Be metabolically inert unless metabolism determines targeting
• Clear rapidly from background tissues
• Be rapidly excreted after the study is completed
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• ROUTE OF ADMINISTRATION
• The absorption and route of administration often determines the
localization characteristics of radiopharmaceuticals.

• Lung ventilation can be studied by inhalation of an aerosol or gas,
whereas pulmonary perfusion is studied by the intravenous injection of
labeled particles.
• Vast majority of radiopharmaceuticals are administered intravenously. By
selecting the route of administration, different biodistribution can be
obtained.
• Ex. Tc-99m Sulfur Colloid injected intravenously concentrates in the
reticuloendothelial system, injected subcutaneously is cleared by the
lymphatics and administered orally is confined in the GI tract.
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• TARGET UPTAKE
• An agent with better target uptake is a superior imaging agent.
• The rate of uptake is also important and the time of imaging depends on
it.
• Ex. I-123 Sodium Iodide Vs. Tc-99m Pertechnetate (TcO4)
• The thyroid can be imaged at 20 minutes with TcO4 but until 4 to 6
hours with I-123 NaI
• TRACER EXCRETION
• Organ visualization is better when the background tissue have fewer
uptakes than the target uptake.
• Radiopharmaceuticals must be cleared from blood and background
tissue to achieve high contrast
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THERAPEUTIC RADIOPHARMACEUTCALS
The use of therapeutic radiopharmaceutical dates back in 1911,
when radium 226 was use ineffectively to treat lupus. In 1939, P-32
Phosphate was used to treat leukemia in the first medical use of an
artificially produced radionuclide.
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Advantages of therapeutic radiopharmaceuticals over chemotherapy and
external beam radiation:
• The carrier-free nature of radiopharmaceuticals allows therapeutic effect

to be accomplished without pharmacological effect.
• Radiopharmaceutical therapy exposes neighboring malignant cells to
lethal irradiation even if the nuclide is not bound to them, whereas, with
chemotherapy, the drug molecule must be taken up by the cell to be
lethal.
• Radiopharmaceutical therapy is selective: that is, high target-to-non-target
ratio can be achieved. External beam irradiate all the tissues in its path,
and chemotherapy targets all fast growing cell populations.
• One can select the range in tissues by using radionuclides with different
energy emissions.
125
NUCLEAR PROPERTIES OF THERAPEUTIC
• Because the desired effect is lethality to the target tissue rather than
imaging, criteria for therapeutic radiopharmaceutical differ from those
for diagnostic use, especially in terms of nuclear properties.
• HALF-LIFE
• A shorter half life means there is a higher dose rate and therefore a
greater biological effect
• This is defined as the interval taken for a given quantity to decrease to
half of its initial value.
126
• DECAY MODE
• Particulate radiation with high Linear Energy Transfer (LET) is

desirable for maximum exposure and damage to tissues.
• All approved therapeutic radiopharmaceuticals are Beta
emitters. Alpha and Auger electron emitters (Electron Capture
decay mode) are also investigated today.
• The optimal decay mode depends on the range in tissue desired
for a particular application.
127
• ENERGY AND RANGE
• The optimal range and energy depends on the size of the tumor,
with large tumors requiring more range.

• GAMMA ENERGY AND ABUNDANCE
• It is desirable to have gamma ray of imageable energy to allow in
vivo verification of the localization of the radiopharmaceutical
and possible patient-specific dosimetry calculation with a
gamma camera.
128
Common Therapeutic Radiopharmaceuticals
HALF- ENERGY RANGE IN

DECAY
RADIONUCLIDE LIFE (keV) TISSUE (mm)
PROCESS
(Days) MaX./Mean Max./Mean
I-131 8 Beta Minus 606/190 2.4/0.95
Sr-89 50.50 Beta Minus 1,470/583 8/2.92
Sm-153 1.95 Beta Minus 804/233 3/1.16
Rh-186 3.77 Beta Minus 2,116/766 5/1.75
P-32 14.3 Beta Minus 1,709/694 8.7/3.47
129
Radiopharmaceutical Half-life Use
PET-bone imaging agent to delineate

F-18 Sodium Fluoride 110 min.
osteogenesis
Scintigraphic localization of primary and

In-111 pentetreotide 2.8 days
metastatic neuroendocrine tumors
For labelling monoclonal antibodies and

In-111 Chloride 2.8 days
peptides
In-111 Satumomab Imaging metastatic disease associated with

2.8 days
Pendetide colorectal and ovarian cencer
130
In – 111 Diethylenetriamine Radionuclide cisternography and cerebro

2.8 days
PentaaceticAcid (DTPA) spinal fluid imaging
Imaging agent in post-prostatectomy

In – 111 Capromab Pendetide 2.8 days
patient
Total Blood Plasma Volume, Cardiac
I-131 Human Serum Albumin 8 days
Output
For the evaluation of thyroid function and
I-123 Sodium Iodide 13 hrs.
morphology
131
I-123 Iobenguane 13 hrs Neuroendocrine tumor imaging

I-125 Human Serum Use in the determination of Total
59 days
Albumin Blood and Plasma Volume
Striatal dopamine transporter
I-123 Ioflupane 13 hrs visualization using SPECT brain
imaging
To demonstrate the presence of
Ga-67 Gallium Citrate 3.27 days Hodgkin’s disease, Lymphoma and
broncogenic carcinoma
132
For treatment of castration-resistant

Ra-223 Dichloride 11.4 days
prostate cancer
Relief of pain in patients with bone
Sa-153 EDTMP 46.3 hrs
metastasis
PET imaging of myocardium under
N-13 Ammonia 10 mins
rest
Tc-99m Bicisate 6 hrs For stroke
Relief of bone pain (bone
Sr-89 Chloride 50 days
metastasis)
133
Evaluation of pulmonary perfusion

Tc-99m macroaggregated
6 hrs and peritoneo-venous (LaVeen)
albumin
shunt patency
Leukocyte labeled scintigraphy as an
adjunt in the localization of intra
Tc-99m Exametazine 6 hrs
abdominal infection and
inflammatory bowel disease
Tc-99m Disofenin 6 hrs Diagnosis of acute cholecystitis
134
Renal Imaging agent for use in the

diagnosis of:
Tc-99m Mertiatide 6 hrs • congenital and acquired abnormalities
• Renal function
• Urinary tract obstruction
Bone imaging agent to delineate areas of
Tc-99m Medronate 6 hrs
altered osteogenesis
Bone imaging agent to delineate areas of

Tc-99m Oxidronate 6 hrs
altered osteogenesis (adult and pedia)
135
Brain imaging and

kidney imaging
Tc-99m Pentetate 6 hrs
• Asses renal perfusion
• Estimate glomerular filtration rate
Tc-99m labeled RBC for:
• Blood pool imaging
Tc-99m RBC 6 hrs
• Detection of site of
gastrointestinal bleeding
Tc-99m Sestamibi 6 hrs Myocardial Perfusion Agent
136
An aid in the scintigraphic evaluation of

Tc-99m Succimer 6 hrs
renal parenchymal disorder
Myocardial perfusion agent indicated for

Tc-99m Tetrofosmin 6 hrs
detecting coronary artery disease
Tc-99m Sodium Pertechnetate 6 hrs Thyroid Imaging
Imaging areas of functioning

Tc-99m Sulfur Colloid 6 hrs reticuloendothelial cells in liver, spleen
and bone marrow
137
Indicated for lymphatic mapping with

hand held gamma counter to asist the
Tc-99m Tilmanocept 6 hrs
localization of lymph nodes draining
a primary tumor site
Myocardial perfusion imaging for the

Thallium-201 Chlioride 73hrs diagnosis and localization of
myocardial infarction
138
For labelling Zavelin used for

Yttrium-90 Chloride 64 hrs
radioimmunotherapy
For the evaluation of pulmonary

Xe-133 gas 5.25 days
function and for imaging the lungs
Treatment of relapsed or refractory,

Yttrium-90 Ibritumumab
64 hrs low grade B-cell non-Hodgkin’d
Tiuxetan
Lymphoma (NHL)
139
Radiopharmaceutical used to identify

Tl-201 Thallous chloride 73 hrs. and semi-quantitative assessment of
myocardial ischemia and infarction
110 for the assessment and localization of

F-18 Fluorodeoxyglucose
minutes brain hypometabolism in PET Scan
used in the diagnosis of pernicious
Co-57 Cyanocobalamin 271 days anemia and intestinal absorption
deficiency
140
Prepared in-vitro with In-111

Oxyquinoline and isolated
In-111 White Blood Cells 2.8 days
plasma free suspension of
autologous WBCs
Tc-99m
6 hrs Used for skeletal imaging
Methylenediphosphonate
Assesstment of renal function like
I-131 Sodium Iodohippurate 8 hrs.
urinary tract obstruction
141
END OF TOPIC
RADIOPHARMACEUTICAL
MECHANISM OF
LOCALIZATION

Radiopharmaceutical Mechanism of Localization
• COMPARTMENTAL LOCALIZATION
• CELL SEQUESTRATION
• PHAGOCYTOSIS
• CAPILLARY BLOCKADE
• ANTIBODY-ANTIGEN COMPLEXATION
• FILTRATION
144
• COMPARTMENTAL LOCALIZATION
• Compartmental localization refers to the introduction of the
radiopharmaceuticals into well-defined anatomical compartment.

Examples include Xe-133 gas inhalation into the lung and
intraperitoneal instillation of P-32 Chromic Phosphate.
• CELL SEQUESTRATION
• Red blood cells (RBC) are withdrawn from the patient, labeled
with Tc-99m, and slightly damaged by in vitro heating in boiling
water bath for approximately 30 minutes. Once reinjected, the
spleen’s ability to recognize and remove the damaged RBCs is
evaluated. This procedure allows for the evaluation of both
splenic morphology and function.
145
• PHAGOCYTOSIS
• The cells of reticuloendothelial system are distributed in the

liver (~85%), spleen (~10%), and bone marrow (~5%). These
cells recognize small foreign substance in the blood and remove
them by Phagocytosis. Sulfur Colloid particles are recognized,
being substantially smaller that circulating cellular elements and
are rapidly removed from circulation
146
• CAPILLARY BLOCKADE
• When particles slightly larger than the RBC are injected

intravenously, they become trapped in the narrow capillary beds.
A common example in Nuclear Medicine is the assessment of
pulmonary perfusion by the injection of Tc-99m-labeled
macroaggregated albumin (Tc-99m MAA). Tc-99m MAA is
trapped in the pulmonary capillary bed. Imaging the
distribution of Tc-99m MAA provides a representative
assessment of pulmonary perfusion.
147
• ANTIBODY-ANTIGEN COMPLEXATION
• An antigen is a biomolecule (typically a protein) that is capable

of inducting the production of and binding to an antibody in
the body. An antigen has strong and specific affinity for the
antibody. An in vitro test called radioimmunoassay (RIA) was
developed by Berson and Yalow in the late 1950s to measure
minute quantities of various enzymes, antigens, drugs, and
hormones
148
149
• Antibody
• A protein produced by the body’s immune system in response to

the presence of a foreign substance, called an antigen. The body
fights off infection by producing antibodies, which destroy or
neutralize bacteria, viruses, or other harmful toxins.
• Antigen
• Any foreign substance, such as a protein, toxin or other particle
that stimulates the body’s immune system to produce
antibodies. Antigens can be substances like bacteria, viruses, or
even pollen that invade the body.
150
• FILTRATION
• Filtration refers to a special case of diffusion involving transit of
molecules through pores, or channels, driven by a hydrostatic or osmotic

pressure gradient.
• This prime example of this is glomerular filtration by the kidney. There
are two primary factors involved in filtration. The first is molecular size
vs. pore size. For glomerular filtration, only small hydrophilic molecules
(i.e., molecular weight of <5000) are typically able to pass through the
glomerular pores.
• The second factor is availability. For glomerular filtration, only those
molecules that are free in plasma (i.e., not protein bound) are available to
be filtered
151
END OF TOPIC
TERMINOLOGIES IN
NUCLEAR MEDICINE

TERMINOLOGIES IN NUCLEAR MEDICINE
• HOT LAB
• Laboratory in which radiopharmaceuticals or radioactive tracers
are prepared
• HOT SPOTS
• The areas where the radionuclide collects in greater amounts
• COLD SPOTS
• The areas that do not absorb the radionuclide and appear less
bright on the scan image
154
• COLD KIT
• Non-radioactive precursor of a radiopharmaceutical containing all the
elements that enable this medication to be reconstituted almost

instantaneously, simply by adding a radionuclide solution
• RADIOCHEMIST
• A chemist specializing in the manufacture of radioactive substances;
therefore, in the field of nuclear medicine, a specialist in the
development of labeling, and in the field of nuclear physics, a specialist in
the chemistry of radionuclides.
• RADIOCHEMISTRY
• Chemistry of substances incorporating a radioactive element.
155
• CONTAMINATION
• Physical contact leaving a deposit of radioactive material on a
surface, matter, or person. The contaminated person is

irradiated as long as the active matter has not been eliminated
or the radioactivity has not fully decayed naturally. (10th Half-
life before considering it safe for disposal)
156
• SCINTIGRAPHY
• Method of imaging based on recording γ or β+ radiation emitted by a
substance injected into the patient which concentrates in a particular organ or

tissue (heart, thyroid, bones, etc.).
• SPECIFIC ACTIVITY
• Radioactive activity value comparing the activity of the radionuclide with the
total mass of the element present. When the radioisotope is present in its pure
form, even in an extremely dilute solution, we talk about a carrier-free
radioisotope solution. It is expressed in becquerels per mass unit.
• SPECIFIC CONCENTRATION
• Value that determines the degree of radioactive substance per volume unit. It
is expressed in Becquerels per volume unit.
157
• BIOLOGICAL HALF-LIFE
• Time period at the end of which a cell or tissue has eliminated
half the quantity of a molecule present by a biological

metabolic mechanism followed by excretion.
• EFFECTIVE HALF-LIFE
• Radioactive half-life corrected by the biological half-life. With
this information, the practitioner can estimate how long a
radioactive substance that has been ingested by or injected into
a patient will take before generating an effect on the organism
(or a certain type of cell or tissue).
158
END OF TOPIC
CLINICAL NUCLEAR
MEDICINE

CLINICAL NUCLEAR MEDICINE
• BONE SCAN (BONE SCINTIGRAPHY)
• Is a special type of nuclear medicine procedure that uses small amounts
of radioactive material to diagnose and assess the severity of a variety of

bone diseases and conditions, including fractures, infection, and
cancer.
• Indications:
• Primary and secondary cancer
• Benign bone tumors
• Stress fracture
• Child abuse
• Bone graft viability
161
• PATIENT PREPARATION
• Pediatric patients need an IV in place at time of arrival for injection. A urinary
catheter with collection bag should be in place at time of scan for sedated and non-
toilet trained children. Adult patients need no preparation.
• SCHEDULING
• Allow 45 min. on dual headed camera, 60 min on single headed camera at 3 hours
after injection.
• RADIOPHARMACEUTICAL AND DOSE
• 24 to 36 mCi technetium 99m methylene diphosphonate (Tc-99m MDP). After
injection, patient should drink four 8-ounce glasses of liquid before returning for the
scan
162
• IMAGING DEVICE:
• Gamma camera with low-energy, high-resolution (LEHR) collimation for
planar imaging. Multi-headed device with LEHR collimation for SPECT.

• IMAGING PROCEDURE:
• Patient should be ask to empty his bladder before the scan.
• Use whole body mode, keep collimator as close as possible to the patient
• If patient is unable to empty bladder completely, obtain 15 to 30 deg
oblique views to view the sacrum, or perform delayed views
163
• INTERPRETATION:
• In general, abnormalities on
bone scans are hot. This
represents reactive new bone
formation. Occasionally,
abnormalities are cold spots, such
as hemangiomas and tense pack
lesions with no blood flow to the
lesion
164
165
• THYROID SCAN
• Is a nuclear medicine examination used to evaluate thyroid tissue
• Indications:
• Identification of ectopic thyroid tissue (lingual and bilingual)
• Localization of residual thyroid tissue (post-operatively)
• Determination of whether a palpable thyroid nodule is functional
• Determination of if a suspected mediastinal mass is thyroid tissue
166
• IMAGING DEVICE:
• Gamma Camera with pinhole collimation
• IMAGING PROCEDURE:
• Timing of Scan:
• Tc-99m: 20 mins after dose
• I-123: 4-6 hours after dose, and occasionally 24 hours
• Positioning:
• With the patient supine, place a pillow under the patient’s shoulder
blades, extending the patient’s neck maximally.
167
• PATIENT PREPARATION
• Be off all thyroid medication, including the following:
• Propylthiouracil (PTU) or methimazole (Tapazole) for between 3 and 5 days

• Liothyronine (Cytomel) for at least 10 days
• L-thyroxine for at least 1 month
• No iodine contrast studies or ingested iodide (e.g. kelp) in the past week
• SCHEDULING:
• Technetium scans are obtained as a routine.30 mins imaging time.
• RADIOPHARMACEUTICAL AND DOSE
• 8-12 mCi of Tc-99m as pertechnetate IV. Dose will be adjusted for patient
weight if less than 45 kg or more than 90 kg.
168
• VIEWS:
• Use the pinhole collimator
initially at a distance that

includes the patient’s
suprasternal notch and
cricoid cartilage (mark
both side on film).
Acquire an anterior view
with decrease pinhole-to-
neck distance so that the
thyroid gland nearly fills
the entire FOV.
169
• INTERPRETATION:
• The scan basically seeks to identify cold nodules. Cold nodules or
regions occur with carcinoma, colloid nodules, adenomas, cyst and

regions of inflammation (Thyroiditis).
170
171
END OF TOPIC

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NUCLEAR

RICHMOND K. QUILATAN, MHA,RRT

• RADIOACTIVE DECAY PROCESS

RICHMOND K. QUILATAN, MHA,RRT

• Diagnostic Nuclear Medicine

RICHMOND K. QUILATAN, MHA,RRT

• Atom with different atomic number and different mass number

ATOMIC ATOMIC MASS NUMBER OF

Characteristics of Various Nuclear Arrangements

Atomic Atomic Mass

• Process in which an unstable nucleus transforms into a more

• Spontaneous emission of an alpha particle from the nucleus.

• Spontaneous emission of an alpha

• A neutron inside the nucleus is converted

• A proton inside the nucleus is

in beta plus decay, and an orbital

• Gamma rays are emitted as the

the Curie (Ci)

The quantity of radioactive material, expressed as the number of

RICHMOND K. QUILATAN, MHA,RRT

• Instrument used to detect or identify high-energy particles,

• Function by measuring the ionization that radiation produces

• Most frequently used in the

heart of the classic pocket

• This type of detector is based on

• An electronic tube that convert light

• An instrument used to analyze the frequency distribution of the

• Measure of its ability to detect radiation

(number reaching the detector ) x (number detected)

RICHMOND K. QUILATAN, MHA,RRT

• The Cantilever design of the gantry is flexible option for small

CANTILEVER DESIGN RING GANTRY

image corresponds to a unique point in the source.

photons introduce improperly

• Consists of an array of parallel holes,

• Consist of an array of tapered

• Achieve a wider field of view by angling the holes the

• Are thick conical collimators with

• Refers to the ability of the imaging camera to detect the photons

HIGH SENSITIVITY HIGH RESOLUTION HIGH RESOLUTION

For the same hole diameter, the longer the

• These collimators have relatively large

• Low-energy collimators are not adequate for the higher energy

Thicker septa are used to block high- and medium-energy photons.

• Contains the crystal, photomultiplier

the form of gamma rays into visible light.

• Sodium Iodide (NaI) Thallium activated

• Pure sodium iodide does not produce any scintillation after

• Converts the light produced

RICHMOND K. QUILATAN, MHA,RRT

RICHMOND K. QUILATAN, MHA,RRT

• Are designed to detect the paired 511-kev

• Detection of a single gamma photon by an individual detector

A coincident event is accepted after processing by the pulse height

One of a pair of annihilation photons is scattered and their

RICHMOND K. QUILATAN, MHA,RRT

• REACTOR PRODUCED RADIONUCLIDE

• Accelerator are devices that increases the energy of the charged

particles to high energy using

• Neutron Activation or Thermal Neutron Reactor

• A generator is a system that provides

• The basic component of Mo-99/Tc99m generator is consist of a glass

RICHMOND K. QUILATAN, MHA,RRT