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 CONTRIBUTORS vii

Helen Timberlake, MS Mathematics Kristen M. Waterstram-Rich, MS, CNMT, FSNMMI-TS

Senior Lecturer Professor
School of Mathematical Sciences Interim Associate Dean
Rochester Institute of Technology College of Health Sciences and Technology
Rochester, New York Rochester Institute of Technology
Rochester, New York
LisaAnn Trembath, CNMT, MSM, CRA, FSNMTS
Associate Director of Clinical Imaging Operations Shanon M. Younglove, BS, MHA, CNMT
Avid Radiopharmaceuticals, Inc. Clinical Instructor Nuclear Medicine
Philadelphia, Pennsylvania Barnes Jewish Hospital
St. Louis, Missouri
Austin Turner, MS, CNMT, PET, RT(MR)
Clinical Coordinator, Magnetic Resonance Imaging Program Katherine A. Zukotynski, MD
Department of Medical Imaging and Radiation Therapeutics Associate Professor
Edward and Margaret Doisy College of Health Sciences Departments of Radiology & Medicine
Saint Louis University McMaster University
St. Louis, Missouri Hamilton, Ontario, Canada

David Wang, BHSc

Faculty of Medicine
University of Toronto
Toronto, Ontario, Canada
REVIEWERS

Jonathan Baldwin, BSRT CNMT Kristi Klein, MS Ed(R)(M)(CT)

Clinical Assistant Professor and Clinical Coordinator Program Director
OUHSC MIRS Nuclear Medicine School of Health Education
Oklahoma City, Oklahoma Madison Area Technical College
Madison, Wisconsin
Jeff L. Berry, MS, RT(R)(CT)
Associate Professor, Radiography Program Director Diana E. Mishler, MBA-HM, RT(R)(S), RDMS
University of Oklahoma Health Sciences Center Clinical Assistant Professor and Coordinator
College of Allied Health Medical Imaging Technology Program
Department of Medical Imaging and Radiation Sciences Indiana University
Oklahoma City, Oklahoma Kokomo, Indiana

Nicole Dhanraj, PhD Robin Rayman, AAS in Nuclear Medicine, CNMT,

Independent Researcher/Contractor NMTCB-CT, PET, RT(N), EMT
Mangilao, Guam Nuclear Medicine Technologist
Salem, South Dakota
Kerry Greene-Donnelly, MBA, RT (R)(M)(CT)(QM)
Assistant Professor
Upstate Medical University
Syracuse, New York

viii

CONTENT
Writing a book is definitely a labor of love and testament to
patience, and the production of this book was no exception.
The process takes over 2 years and the work waxes and wanes
throughout the time period, but it is not until the very end
that one gets a glimpse of how the book will look in print.
This book, now in its eighth edition, has stood the test of
time and shows a noteworthy level of enthusiasm among its
authors. In the creation of each edition, information regarding
the current practice of nuclear medicine and the responsibil-
ities of nuclear medicine technologists is obtained from pro-
fessional organizations worldwide. As a result the textbook
continues to keep pace with the changes in the field of nuclear
medicine and health care, as it expands and evolves to meet
the needs of the professionals facing the challenges of chang-
ing technology and medical practice. Hippocrates once said,
“Declare the past, diagnose the present, foretell the future.”
This textbook follows that instruction. It is current and blends
the old and new while also addressing future developments.
Through all of the revisions it has stayed true to its focus of
providing information that covers all aspects of nuclear med-
icine, thereby serving as a comprehensive introductory text
for nuclear medicine professionals to enter practice in this
field. This book is intended for use by technologists and stu-
dent technologists and as a reference guide for physicians
and scientists entering nuclear medicine. It is used by many
nuclear medicine technologist educational programs and as a
resource in many nuclear medicine departments worldwide.
The eighth edition is divided into five sections: Foundations
(the basic science chapters); Patient Care, Management, and
Research; Physics and Instrumentation; Imaging Procedures and
Protocols; and Special Considerations. A fundamental knowl-
edge base is formed from the chapters that precede the clinical
chapters. In the clinical chapters, one can see the complexity
of the field of nuclear medicine and how the interconnected-
ness of physics, chemistry, anatomy, and physiology results
in diagnostic images or is used in clinical and therapeutic
applications. The clinical chapters essentially start at the head
and work their way down the body. The last two chapters are
special considerations. The chapter on Inflammatory/Tumor/
Oncology Imaging and Therapy includes topics that span all
body systems, while the chapter on the hematopoietic system
includes procedures rarely performed at the time of the pub-
lication but that exist in different locations around the world.
This coherent framework for the knowledge base of the book
provides an efficient and logical approach to study the field
of nuclear medicine for it allows students to see a unifying
theme or connectedness of the information. An appendix of
radiopharmaceuticals, which summarizes many of the radio-
nuclide properties, radiopharmaceutical names, and clinical
applications, is also included as an easy reference.
P R E FAC E
NEW TO THIS EDITION
Each revised edition captures the changes that have occurred
since the previous edition and gives a glimpse into changes and
advancements that are under investigation. The many expert
contributors of the chapters have reviewed and updated the
information in this edition to bring the materials and figures
to the current level of clinical practice. They have also added
PET applications to the clinical chapters when appropriate.
In addition to these changes, three new chapters have been
added. In recognition in the growth of individualized ther-
apies and consistent with the basics of molecular imaging, a
chapter on cellular and molecular biology is now included.
With an increase in the need for management skills, a chapter
was created to expand the topics associated with department
administration. The third new chapter provides an introduc-
tion to the requirements and terms associated with research
and clinical trials. Three chapters have been expanded. The
chemistry chapter now includes concepts of biochemistry, the
informatics chapter has been expanded to include additional
computer applications in imaging, and the MRI chapter has
been expanded to include an introduction to PET/MR. In
addition to new content, there are many new contributing
authors bringing their expertise to the edition.
LEARNING ENHANCEMENTS
Each chapter begins with an outline, learning objectives, and
key terms. The key terms appear in the front of each chapter
to aid student readers in identifying terms with which they
should become familiar. Each term will appear in boldface the
first time that it is used in the chapter. The key terms are also
defined in the glossary at the end of the book. There are also
summaries at the end of most chapters to highlight a few of
the important concepts in each chapter.
Chapter 1, Mathematics and Statistics, gives readers the
opportunity to practice the basic math skills necessary to
function as a nuclear medicine technologist. The answers for
these questions are provided at the end of the book so that
readers can assess their knowledge before proceeding to the
next chapter.
Boxes and tables are used throughout the book to call
attention to important information. The information and
writing style are targeted toward readers new to nuclear
medicine. The fundamentals are addressed first, with topics
becoming increasingly more complex.
INSTRUCTOR ANCILLARIES
Evolve is a secure and interactive learning environment
designed to work in coordination with Nuclear Medicine
and PET/CT: Technology and Techniques, eighth edition.
ix
x PREFACE
The instructor materials available on Evolve will assist
the educator in preparing exams and presenting material.
Included on Evolve is a test bank with multiple choice ques-
tions in ExamView, including rationales for correct answers
and references to the coordinating page number in the text-
book, as well as an electronic image collection with all the
images from the textbook in jpeg and PowerPoint formats.
Instructors may use Evolve to provide an Internet-based
course component that reinforces and expands the concepts
presented in class. Evolve may be used to publish the class
syllabus, outlines, and lecture notes; set up “virtual office
hours” and e-mail communication; share important dates and
information through the online class calendar; and encour-
age student participation through chat rooms and discus-
sion boards. Evolve also allows instructors to post exams and
manage their grade books online. For more information, visit
http://evolve.elsevier.com/Waterstram-Rich/nuclear or con-
tact an Elsevier sales representative.
 AC K N OW L E D G M E N T S
We would like to thank the hard work and extraordinary
efforts of the contributing authors of this text. Without their
dedication and commitment to the project, it would not have
been possible. It is also their talent in presenting informa-
tion that allows the reader to transfer theory, facts, and data
into comprehension through which they can practice nuclear
medicine.
We would also like to thank and recognize the adminis-
trators, co-workers, families, and loved ones of all of those
involved in the book whose names do not appear in writing
but who endured the time commitment made by the authors
and editors to ensure the delivery of quality material.
We cannot forget to thank our dedicated editors at Elsevier,
as well as the production and design team, whose patience,
support, guidance, and diligent work have made this project
a success.
Lastly, we want to give a special acknowledgment to the
man who has been involved in this book from the very first
edition—Paul Christian! We thank you and salute you for
really making this a reality for all of us in Nuclear Medicine.
From the first edition of this textbook, Paul Christian has
been integral to its success. Paul’s first involvement with the
book was as a co-author with the late Ed Coleman on the
Skeletal chapter. When the second edition was started, he was
invited by Don Bernier and Jim Langan to be a co-editor and
by the fourth edition was the primary editor. A journey of
several decades.
There are few in the field of nuclear medicine who do not
know or are not familiar with the name Paul Christian. This is
no surprise. He has given over 80 invited lectures, has provided
PET Board Exam Review Courses, and has more than 100
publications to his name. He has served as a journal reviewer
of four premier journals in the field, one of them continu-
ously since 1976 and another since 1983. He has served on
advisory boards for major companies in the field of nuclear
medicine (e.g., GE Medical Systems, Picker). He has served
on the Board of Directors for the Joint Review Committee
in Nuclear Medicine Technology (JRCNMT), the Nuclear
Medicine Technologist Certification Board (NMTCB), and
the Intersocietal Commission of the Accreditation of Nuclear
Medicine Laboratories. He has been an active member of
several professional organizations, most notably the Society
of Nuclear Medicine (now the Society of Nuclear Medicine
and Molecular Imaging) and the Technologist Section of this
organization. His participation has included membership on
numerous committees and task forces, and he has served as
chair on several committees. His recognitions also include
scientific exhibits at professional meetings through the years,
several awards, and a patent to his name.
Paul’s professional career spanned decades at University
of Utah, Salt Lake City, where he held a variety of positions
and served on several committees. Paul’s appointments
included but were not limited to Education Director and
later Program Director of the Nuclear Medicine Technology
School; Clinical Instructor of Nuclear Pharmacy; Assistant
Research Instructor of Radiology in the College of Medicine;
Director, Cyclotron Radiochemistry Laboratory and PET/
CT Imaging; and Associate Director-Operations, Molecular
Imaging Program.
Under his direction this textbook has served as a required
textbook of many nuclear medicine technology programs and
a valued resource throughout the educational and clinical
nuclear medicine community worldwide. Thank you, Paul,
for all of your work in the field of nuclear medicine and your
dedication to this textbook.
Kristen M. Waterstram-Rich
David Gilmore
xi
CONTENTS
SECTION 1 Foundations Patient-Centered Care, 142
Age-Specific Care, 143
1 Mathematics and Statistics, 1 Pediatric Considerations, 145
Maria Mackin and Helen Timberlake Body Mechanics, 147
Fundamentals, 2 Medication Administration, 149
Practical Applications, 10 Contrast Media, 164
Statistics, 22 Infection Control, 168
2 Cell and Molecular Biology, 40 Vital Signs and Patient Assessment, 171
Maureen Ferran Emergency Care, 173
Eukaryotic Cell Structure, 41 Ancillary Equipment, 175
Control of Gene Expression, 44 7 Department Administration, 181
The Cell Cycle, 47 Erin Beloin, Denise A. Merlino, and Mary Beth Farrell
Molecular Basis of Cancer, 50 Health Care Leadership, 182
3 General Chemistry and Biochemistry, 56 Health Care Management, 182
Leslie A. Bishop Coding and Reimbursement, 183
Elements, Compounds, and Mixtures, 57 Quality Measures and Improvement, 185
Laws of Constant Composition and Multiple Credentials and Accreditation, 197
­Proportion, 63 8 Clinical Research, 201
Atomic Weights, Molecular Weights, LisaAnn Trembath
and the Mole Concept, 64 Defining Clinical Research, 201
Solutions and Colloids, 64 Clinical Trials and Studies, 202
Chemical Reactions and Equations, 66 Conclusion, 206
Acids and Bases, 68 9 Health Informatics in Imaging, 207
Equilibriums and Equilibrium Constant, 70 Frances Keech
The pH Concept, 70 Background, 208
Buffer Solutions, 71 Computers in Health Care, 208
Organic Compounds, 71 Computer Hardware, 209
4 Radiochemistry and Radiopharmacology, 77 Computer Software, 209
Sally W. Schwarz, Reiko Oyama, and Michele M. Beauvais Image Acquisition, 209
Production of Radionuclides, 78 Image Display and Processing, 212
Technetium Radiopharmaceuticals, 84 Region of Interest, 215
Gallium and Indium Radiopharmaceuticals, 90 Clinical Applications, 217
Thallium Chloride, 92 Health Information Systems, 217
Iodinated Radiopharmaceuticals, 92 Electronic Health Records, 218
PET Radiopharmaceuticals, 93 Radiology Information System, 219
Therapeutic Radiopharmaceuticals, 97 Standard Operating Procedures, 220
Regulatory Issues: Radiopharmaceutical Quality Future Advances, 220
Assurance, 98
Radiopharmaceutical Quality Control, 99 SECTION 3 Physics and Instrumentation
5 Radiation Safety in Nuclear Medicine, 108
Norman E. Bolus and Krystle Worthington Glasgow 10 Physics of Nuclear Medicine, 223
Radiation Safety Program, 111 Patrick Byrne and Cybil Nielsen
Sources of Radiation Exposure, 129 Matter, 224
Radiation Regulations, 130 Nucleus of an Atom, 224
Radiation Dose, 131 Nature of Electromagnetic Radiation, 226
Biological Effects of Ionizing Radiation, 135 Mass Energy Equivalence, 228
Units, 228
SECTION 2 Patient Care, Management, Modes of Radioactive Decay, 229
and Research Mathematics of Decay, 234
Units of Radioactivity, 235
6 Patient Care, 140 Decay Factor and Precalibration Factor, 236
Kathy Thompson Hunt and Donna C. Mars Effective Half-Life, 237
Patient Care, 142 Parent-Daughter Radionuclide
Patient Preparation, 142 Relationships, 237
xii
 CONTENTS xiii

Interaction with Matter, 238 Radiation Safety in PET, 354

Attenuation and Transmission of Photons, 241 Requirements for Gating and Radiation Therapy
11 Instrumentation, 244 Treatment Planning, 354
Cybil Nielsen and Patrick Byrne 14 Principles of Magnetic Resonance Imaging, 357
Radiation Detection, 246 Martha Kennedy and Austin Turner
Gas-Filled Detectors, 250 History, 358
Gas Ionization Curve, 251 Introduction to Atomic Structure and Basic
Survey Meters, 252 Principles, 358
Dose Calibrator, 254 Hydrogen Nucleus, 358
Dose Calibrator Quality Control, 255 Precession, 359
Scintillation Detectors, 257 Resonance and Excitation, 360
Gamma Cameras, 258 Free Induction Decay, 360
Gamma Camera Detector Components, 260 T1 and T2, 360
Spectroscopy, 265 Instrumentation, 362
Gamma Camera Corrections, 267 Pulse Sequences and Scan Parameters, 362
Image Acquisition, 268 Contrast Media, 364
Single Photon Emission Computed Tomography, 269 Safety, 365
Image Quality, 285 Hybrid Imaging: PET/MRI, 367
Gamma Camera Quality Control, 288 15 Clinical PET/CT in Oncology, 371
Scintillation Counting Systems, 295 Nancy M. Swanston
12 CT Physics and Instrumentation, 299 Intracellular 18F-FDG Metabolism, 372
Lance D. Burrell and Paul E. Christian Patient Preparation and Injection, 374
Physics of X-Rays, 300 PET Scan Acquisition, 376
X-Ray Tube and the Production of X-Rays, 301 Normal Whole-Body FDG Distribution, 378
Principles of Computed Tomography, 304 Normal Variations in FDG Localization, 379
CT Scanner Design, 305 PET Oncology Applications, 381
Multislice Helical CT Systems, 310 Solitary Pulmonary Nodule, 384
Image Data Acquisition, 311 Non–Small-Cell Lung Carcinoma, 384
CT Image Reconstruction, 312 Other Chest Malignancies, 385
CT Display, 314 Melanoma, 386
Display of Volumetric Image Data, 314 Lymphoma, 387
Image Quality, 315 Myeloma, 388
CT Protocols, 316 Colorectal Cancer, 388
CT Artifacts, 319 Head and Neck Cancer, 389
CT Radiation Safety, 319 Esophageal Cancer, 389
CT Quality Control, 321 Breast Cancer, 390
13 PET Instrumentation, 325 Brain Cancer, 391
Paul E. Christian Prostate Cancer, 391
Physics of Positrons, 326 Cervical Cancer, 392
Production of PET Radiotracers, 327 Ovarian Cancer, 393
PET Radiation Detectors, 327 Testicular Cancer, 394
PET Scanner Design, 328 Thyroid Cancer, 394
Coincidence Detection: True, Scatter, and Random Pancreatic Cancer, 395
Events, 331 Gastric Cancer, 396
Data Acquisition, 332 Hepatocellular Carcinoma, 396
Two- and Three-Dimensional Scanner Endometrial Cancer, 396
­Configuration, 335 Sarcomas, 397
PET/CT Scanners, 337 Leukemia, 399
Reconstruction Algorithms, 338 Unknown Primary, 399
Attenuation Correction by Transmission Imaging, 342 Future Trends, 402
Time of Flight PET, 346
Scanner Calibration and Quality Control, 347 SECTION 4 Imaging Procedures and Protocols
Partial Volume Effect, 350
Quantitative Image Information, 351 16 Central Nervous System, 407
Displaying PET Data, 352 David Wang, David Gilmore, and Katherine A. Zukotynski
Image Fusion, 352 Chemistry of the Brain, 408
PET/MRI Scanners, 353 Anatomy and Physiology, 408
xiv CONTENTS

Radiopharmaceuticals, 414 22 Skeletal System, 576

Imaging Techniques and Protocols, 416 Kristen M. Waterstram-Rich and Gary Dillehay
Clinical PET and SPECT Studies, 421 Composition of Bone, 579
17 Endocrine System, 431 Gross Structure of Bone, 579
Lauren Shanbrun and Daniel Tempesta Joints, 580
Thyroid Gland, 433 Radionuclide Imaging, 582
Parathyroid Glands, 453 Instrumentation, 584
Neuroendocrine System, 456 Spot Views, 584
Adrenal Glands, 463 Whole-Body Imaging, 585
18 Respiratory System, 469 SPECT Imaging, 585
William L. Hubble and Crystal Botkin Clinical Aspects, 586
Normal Anatomy and Physiology, 470 Other Uses for Bone Imaging, 592
Pathophysiology, 473
Perfusion Imaging, 475 SECTION 5 Special Considerations
Ventilation-Perfusion Studies, 483
19 Cardiovascular System, 490 23 Inflammatory/Tumor/Oncology Imaging
Nancy McDonald DeLoatch and Diwaker Jain and Therapy, 599
Anatomy, Physiology, Pathology, 491 Kathy S. Thomas
Myocardial Perfusion Imaging, 494 Inflammatory Imaging, 600
Positron Emission Tomography of the Heart, 509 Tumor Imaging, 603
Radionuclide Evaluation of Ventricular Lymphoscintigraphy, 609
Function, 511 Therapy, 611
Imaging Cardiac Neurotransmission, 516 24 Hematopoietic System, 618
20 Gastrointestinal System, 518 Kristen M. Waterstram-Rich
Bennett S. Greenspan, Mary Anne Owen, and Deborah M. Gibbs Blood, 619
Salivary Glands, 520 Blood Components, 619
Oropharynx, 521 Isotopic Labeling of Cellular Elements, 622
Esophagus, 524 Platelet Kinetics, 622
Stomach, 532 Erythrokinetics, 622
Small Bowel and Colon, 537 Measurement of Absorption and Serum Levels of
Intestinal Tract, 538 Essential Nutrients, 628
Liver and Spleen, 541
Gallbladder, 545 APPENDIX A Percentage Points and Chi-Square
Breath Testing with 14C-Labeled Distribution, 632
Compounds, 551
21 Genitourinary System, 556 APPENDIX B Laboratory Glassware and
Akash Sharma and Shanon M. Younglove Instrumentation, 633
Anatomy, 556 APPENDIX C Radionuclides and Radiopharmaceutical
Physiology, 559 Form Used in Clinical Nuclear Medicine (Includes Research
Radiopharmaceuticals, 561 Radiopharmaceuticals), 636
Radionuclide Procedures, 563 APPENDIX D Glossary, 640
Testicular Imaging, 571
Measurement of Effective Renal Plasma Flow and APPENDIX E Answers to Chapter 1 Mathematics and
the Glomerular Filtration Rate, 572 Statistics Review, 659
Illustration Credits, 660
SECTION 1 Foundations
Mathematics and Statistics
OUTLINE
Fundamentals, 2
Scientific Notation, 2
Fractions and Percentages, 3
Algebraic Equations and Ratios, 3
Inverse Square Law, 4
Units, 5
Exponent Laws and Logarithms, 6
Numeric Accuracy: Significance and Rounding, 9
Calculators and Computer Programs, 10
Practical Applications, 10
Radioactive Decay, 10
Decay Factor Tables for Radioactive Decay, 12
Concentration-Volume Calculations, 13
99Mo-99mTc Radionuclide Generators, 14
OBJECTIVES
After completing this chapter, the reader will be able to:
• Use scientific notation in performing algebraic
operations.
• Use the inverse square law to calculate the intensity of a
radiation field at various distances.
• Perform radioactive dilution calculations.
• Define the units of radioactivity, radiation exposure,
radiation absorbed dose, and radiation dose equivalent.
• Perform calculations with logarithms and exponents
using a calculator.
• Discuss numeric accuracy, significant digits, and
rounding.
• Calculate quantities of radioactivity using the general
form of the decay equation and decay factors.
• Use tables of decay factors to calculate remaining
radioactivity.
• Calculate concentration and volume and radioactivity for
patient doses.
aThe authors wish to acknowledge Paul H. Brown for his previous
contributions to this chapter.
1
Maria Mackin and Helen Timberlakea
Half-Life: Biological, Physical, and Effective, 15
Attenuation of Radiation, 15
Graphs, 17
Measurement of Effective Half-Life, 19
Least Squares Curve Fitting, 20
Other Graphs, 22
Statistics, 22
Mean and Standard Deviation, 22
Gaussian Distributions, 24
Poisson Distributions and Counting Statistics, 24
Chi-Square Tests, 26
t-Tests, 28
Medical Decision Making, 30
• Compute the concentration of 99Mo in 99mTc.
• Compute effective half-life and biological half-life.
• Calculate intensity with half-value layers.
• Diagram various types of graphs and graphing
techniques.
• Discuss curve-fitting techniques.
• Define mean, standard deviation, and coefficient of
variation.
• Discuss Gaussian and Poisson distributions.
• State the formula for standard deviation, and perform
calculations in the presence of background.
• Explain the function of the chi-square test and
interpretation of results.
• Interpret the results of a chi-square test using a
probability table.
• Discuss the use and interpretation of t-tests.
• Describe the interpretation of sensitivity, specificity,
prevalence, and accuracy.
1
2 SECTION 1 Foundations

KEY TERMS
accuracy linear attenuation coefficient
biological half-life logarithm
chi-square test mean
coefficient of variation (CV) natural logarithm
decay constant physical half-life
decay factor Poisson distribution
effective half-life proportional
Euler’s number scientific notation
exponent sensitivity
half-value layer (HVL) significant figures
inverse square law specificity
least squares curve fit standard deviation (SD)

Nuclear medicine molecular imaging occupies a unique posi- 3 enter the value of the exponent
tion in the allied health sciences because of its strong depen- ÷ divide key
dence on quantitative, or mathematical, results. This chapter 2.3 enter the value for denominator
attempts to provide a sound basis for performing calculations EE enter exponent key or the ^ key
that are typically required of nuclear medicine technologists. 4 enter the value of the exponent
The emphasis here is on practical use, not on theoretical prin- = (see result of 6.5217391E−8 in display) or 6.5 x 10−8
ciples. Practical examples are provided, and each type of cal- This is precisely the same result as would be obtained by
culation includes a brief discussion on the use of scientific dividing 0.0015 by 23,000 on the calculator.
calculators and general instructions for the use of Microsoft It is often desirable to use numeric prefixes to represent
Excel. A basic scientific calculator is needed for this chapter as very small or large numbers (Table 1-1). The value 6.52 ×
well as access to Microsoft Excel. Reference to the instruction 10−8 grams (g), or 6.52E−8 g, can be more conveniently rep-
booklet provided with your scientific calculator is highly rec- resented by converting the exponent to one of the exponent
ommended. This chapter reviews elementary algebra, graphing values shown in Table 1-1, which are usually exponents divisi-
techniques, and statistical principles, always with an emphasis ble by 3 (e.g., 3, 6, 9, and so on). Thus 6.52 × 10−8 g can be rep-
on practical applications. It is presumed that readers are knowl- resented as 65.2 × 10−9 g, or in convenient shorthand form as
edgeable of high school–level mathematics. The more advanced 65.2 nanograms (ng), where nano stands for 10−9. Notice that
reader may wish to skip to the Practical Applications section of the decimal point in the number 6.52 × 10−8 can be shifted to
this chapter. The reader who requires a more basic review of the right by making the exponent smaller by 1 for each right
algebra may wish to consult another mathematics text.1 shift of the decimal (e.g., 6.52 × 10−8 = 65.2 × 10−9), the object
being to have an exponent that is divisible by 3 so that the
FUNDAMENTALS numeric prefixes in Table 1-1 can be used. Similarly, a number
like 2.3 × 104 counts (ct) can be expressed as 23.0 × 103 ct, or
Scientific Notation 23 kct, with the k denoting kilo, or thousand.
Numbers in scientific calculations are typically either very
small, such as 0.0015, or very large, such as 23,000. Scientific TABLE 1-1 Numeric Prefixes
notation allows these numbers to be presented in a more con-
Abbreviation Prefix Numeric Value
venient notation, such as 1.5 × 10−3 and 2.3 × 104. The expo-
A atto- 10−18, one quintillionth
nent on the 10 specifies how many places the decimal point in
F femto- 10−15, one quadrillionth
the number is to be shifted to the left (for negative exponents) P pico- 10−12, one trillionth
or shifted to the right (for positive exponents). Scientific N nano- 10−9, one billionth
calculators typically have a “^” or “EE” key (for “enter expo- μ micro- 10−6, one millionth
nent”), which allows easy entry of data in scientific notation. M milli- 10−3, one thousandth
For example, if it is desired to calculate: C centi- 10−2, one hundredth
D deci- 10−1, one tenth
( ) ( )
1 . 5 × 10 – 3 ÷ 2 . 3 × 104 Da deka- 101, ten
K kilo- 103, thousand
The procedure on the scientific calculator might be as follows: M mega- 106, million
1.5 enter value for numerator G giga- 109, billion
T tera- 1012, trillion
EE enter exponent key or the ^ key
P peta- 1015, quadrillion
+/− change sign key to make the exponent negative
 CHAPTER 1 Mathematics and Statistics 3

This type of notation is often used for units of radioactiv- clearance rate of 42 milliliters per minute (ml/min). The
ity, which is measured in becquerels (Bq). A patient might patient returns today and has a kidney clearance rate of 58
be injected with 7.4 × 108 Bq of radioactivity, which can be ml/min. The patient’s kidney function has improved by 38%
written 0.74 × 109 Bq (the decimal point can be shifted left if based on the following:
the exponent is increased by 1 for each left shift); therefore,
New value = 58 ml/min
the injected radioactivity is 0.74 GBq. Alternately, the value
Old value = 42 ml/min
7.4 × 108 Bq can be written 740.0 × 106 Bq = 740 MBq (the
decimal was shifted two places to the right, so the exponent is Therefore:
decreased by 2). Choosing between the two forms is simply a % change = [(new value − old value)/old value] × 100
matter of preference. Note that scientific calculators often have = [(58 − 42)/42] × 100
an engineering notation key, which controls the scientific nota- = (16/42) × 100
tion exponents in the calculator display to always be a power of = 0.38 × 100 = 38%
3. For example, 7.4 × 108 Bq is displayed as 740E6 on the calcu-
lator, which the user understands to be the same as 740 MBq.
Algebraic Equations and Ratios
Fractions and Percentages Calculations in nuclear medicine often involve expressing a
Fractions, such as ¾, consist of a numerator (3) that is to be mathematical concept as a ratio. For example, a point source
divided by a denominator (4). The value of a fraction may containing 240μCi of Tc99m will produce a suitable image for
also be expressed decimally, such as ¾ = 0.750 (a fraction that a bar phantom with 500,000 ct in the acquisition (500 kct).
terminates in a zero digit), or 4/3 = 1.3333… (a fraction that What point source activity of Tc99m should be used to obtain
never terminates in a zero digit). The mathematical manipu- a suitable 300,000 ct (300 kct) image using the same bar phan-
lation of fractions requires care as to the number of digits and tom? This translates mathematically into the following:
placement of the decimal point. The safest way to handle the x 240 µCi
mathematical manipulation of fractions is to use the power of =
300 kct 500 kct
the scientific calculator to perform calculations such as 1⁄3 + 9⁄4
by first converting the fractions to decimals and then com- First, it is necessary to translate a mathematical concept,
pleting the arithmetic: expressed in words, into an algebraic equation. The equation
generally contains several numbers and one unknown value;
1/ = 0.333 here the new point source activity is the unknown value x.
3
The object is to solve for the unknown value by rearranging
9/ = 2.250
4 the terms in the equation. In this example, the unknown point
Sum = 2.583 source activity x can be isolated on one side of the equation by
multiplying both sides of the equation by 300 kct. Remember,
As a general rule, the arithmetic should maintain at least one any mathematic operation can be done to both sides of an
more digit in each fraction than is necessary in the final result. equation without changing the equality. This technique is
For example, if it is desired to describe the area of a rectangle referred to as cross-multiplication.
(Area = Length x Width) to the nearest centimeter, then mea-
 x   240 µCi 
surements of the length and width of the rectangle should be 300 kct ×   = 300 kct ×  500 kct 
made to the nearest tenth of a centimeter. Use of the scientific 300 kct   
calculator generally produces at least eight digits of accuracy, The 300 kct cancels in the left numerator and denominator, so
which is more than enough for nuclear medicine calculations.
240 µCi
Percentages are values expressed as a fraction of some x = 300 kct × = 144 µCi
whole, entire value: For example, 75% of some number is the 500 kct
same as 0.75 multiplied by that number. This is exemplified in Another frequently encountered calculation found in
the following: nuclear medicine and molecular imaging relates to radio-
75% of 5 ml = 0.75 × 5 ml = 3.75 ml activity concentrations in patient doses. For example, the
morning elution of the 99Mo-99mTc generator yields 943 mil-
Many scientific calculators have a % key, which makes it licuries (mCi) of 99mTc radioactivity in 20 ml of saline eluate.
unnecessary to first convert the percentage to a decimal: What volume should be withdrawn from the eluate vial into
75 enter percent value a patient syringe to perform a 20-mCi patient scan? (Assume
% percent key that no decay correction is needed.)
× multiply key
5 enter 5 x 20 ml
=
= (see result of 3.75 in display) 20 mCi 943 mCi
Percentages are often used to express percentage change
between two values. For example, a patient may have had 20 ml
x = 20 mCi × = 0.42 ml
a kidney function test last month that showed a kidney 943 mCi
4 SECTION 1 Foundations

Inverse Square Law or

The radiation exposure from a radioactive point source is ( 2.5 mR ) × (2 m)2
governed by a mathematical relationship called the inverse I1 = hr
square law. This law states that the radiation exposure or (3 m)2
intensity (I) at a distance (d) from a radioactive source is pro- ( 2.5 mR ) × 4 m2
portional to the inverse square of the distance. I1 = hr
The radiation dose emitted from a source is symmetrical 9 m2
with the photons traveling in all directions. As the distance The technologist’s radiation exposure is more than halved by
from the source increases, the emissions diverge from one moving 1 m farther from the source. Note that scientific calcu-
another; therefore, as you move further from the source, you lators generally have an x2 key, which facilitates the calculation:
have fewer interactions with emissions. Conversely, as you 2.5 enter intensity value
move closer to the source, you have increased interactions × multiply key
with emissions. 2 enter old distance value
This law holds for a point source (a source that is very small x2 squaring key
compared with the distance from the source) that emits radia- ÷ divide key
tion not absorbed while traveling over the distances involved. 3 enter new distance value
Syringe source γ-rays at a distance of 1 meter (m) or more in x2 squaring key
air would qualify as a point source. Air is a weak absorber of = (see result of 1.1 in display)
x-rays or γ-rays in the energy ranges typically encountered in In another example, a technologist is working 4 feet (ft)
nuclear medicine. Note that a syringe source for exposure to from a point source that results in an exposure of 0.62 mR/
the hands does not obey the inverse square law, because the hr. Radiation safety is concerned about the exposure rate and
distance from the syringe to the hands is not large compared suggests that the intensity should be maintained at no more
with the syringe dimensions. Similarly, the exposure from than 0.25 mR/hr for a safe working environment. To what
standing near patients does not follow the simple inverse distance from the source should the technologist move to
square law. achieve an exposure level of 0.25 mR/hr?
Mathematically, the inverse square law states:
0.25 mR/hr × (d1)2 = 0.62 mR/hr × (4 ft)2
k
Iα 2 (0.62 mR/hr) × (4 ft)2
d (d1)2 =
0.25 mR/hr
where k is a proportionality constant that depends on the type
of radioactive source and its activity. The symbol ∝ means “is (0.62 mR/hr) × 16 ft2
(d1)2 =
proportional to.” The inverse square law results in the radi- 0.25 mR/hr
ation intensity quadrupling if the distance from the source is 2
(d1) = 39.7 ft
2

halved, or the radiation intensity decreasing to one fourth of

its value if the distance is doubled. Changing the distance by
a factor of 3 results in a factor of 9 change in intensity (nine
times more intensity for one third the distance, or one ninth
the intensity for three times the distance). This is usually
stated in a form relating the prior intensity (I2) at some prior
distance (d2) to a new intensity (I1) at some new distance (d1):
I1(d1)2 = I2(d2)2
The intensity of radiation is usually measured in units
of roentgens (R) or milliroentgens (mR) per hour (hr). For
example, suppose a technologist working 2 m from a small
vial of radioactivity results in an intensity or exposure level of
2.5 mR/hr at 2 m. If the technologist moves to a distance of 3
m from the source, what is the new radiation intensity?
I1 = X
d1 = 3 m
I2 = 2.5 mR/hr
d2 = 2 m
Therefore:
I1 × (3 m)2 = (2.5 mR/hr) × (2 m)2
(d1)2 = 39.7 ft2
d1 = 6.3 ft
Again, scientific calculators generally have a square root
key (√ ), which facilitates calculation:
0.62 enter old intensity value
× multiply key
4 enter old distance value
x2 squaring key
÷ divide key
0.25 enter new intensity value
= results of division
√ square root key (see result of 6.3 in display)
Notice that in solving this problem the left side of the equa-
tion contained (d1)2, but because the object was to solve for d1,
the square root of both sides of the equation was taken. The
squaring function and the square root function canceled on the
left side of the equation because x2 = x. Functions that have this
property are called inverse functions. The squaring function
(x)2 and the square root function (√ ) are inverse functions.
In nuclear medicine and molecular imaging, there are a
number of situations in which a solution of a known concentra-
tion is used to make another solution of a lower concentration.
 CHAPTER 1 Mathematics and Statistics
The standard stock is often described as having the given
percentage of the patient’s administered dose. For example, a
dilute standard solution is made by diluting a 1-ml volume of
some standard source of radioactivity up to a 500-ml volume.
A 2-ml volume of the diluted standard yields 15,346 ct. How
many counts were in the original 1 ml of the standard?
C1 V1 = C2 V2
C1 = Counts in the initial solution
V1 = Volume of the initial solution
C2 = Counts in the new solution
V2 = Volume of the new solution
 15,346 ct 
C1 × 1 ml =  × 500 ml
 2 ml 
C1 = 3, 836, 500 ct/ml
Notice how the units are carefully included with each number.
The dilution principle can also be used to measure an
unknown volume. For example, suppose a 2-ml sample of a stan-
dard solution produces 647,530 ct per minute (cpm) in a well
counter. This standard sample is then injected intravenously into
a patient, and a 2-ml sample of the patient’s blood yields 2600 ct
in 10 minutes (or 260 cpm). What is the patient’s blood volume?
C1 V1 = C2 V2
 260 cpm   647,530 cpm 
 2 ml  × V1 =  2 ml  × 2 ml
V1 = 4981 ml
In the previous example, the patient blood counts yielded
only 260 cpm/2 ml, which would be subject to a large statistical
uncertainty (as discussed in the following section). It would
therefore be necessary to obtain more blood counts. This
requires increasing the activity in the standard source, which
then becomes too concentrated to be accurately counted in
the well counter. The problem is either that the standard is too
strong or the patient sample is too weak because of the large
count dilution in the patient blood volume. The answer to the
problem is to dilute a portion of the standard and count this
diluted standard while the full-strength undiluted standard
can be injected into the patient. The standard can be diluted
by adding 1 ml of it to a flask, which is then filled to 500 ml.
The dilution factor is then 500. For example, a 2-ml sample
of the 1:500 diluted standard in a well counter might yield
26,835 cpm. Then 5 ml of the undiluted standard is injected
into the patient, producing blood plasma counts of 26,500
cpm in 2 ml of plasma. What is the plasma volume?
C1 V1 = C2 V2
 26,500 cpm   26,835 cpm 
 2 ml  × V1 =  500 × 2 ml  × 5 ml
V1 = 2530 ml
Note that the standard counts had to be multiplied
by the dilution factor of 500 to obtain the true standard
5
concentration, which was injected into the patient. It can also
be noted that dilution calculations are inverse proportions.
If one variable increases, the second variable decreases; for
example, if volume increases, concentration decreases.
Units
When manipulating numbers, it is critical to consider the
units of the numbers involved. Forgetting to specify whether
a patient was injected with 5 μCi or 5 mCi of iodine-131 (131I)
radioactivity can have disastrous consequences. It is best to
develop a habit of writing down the units for all the numbers
in any calculation.
Units are agreed-upon, standard quantities of measurement.
They are often composed of some combination of the three fun-
damental properties of mass, length, and time. These properties
can be measured in the physical or biological world. From these
fundamental units other units can be derived, such as speed in
meters per second (m/sec), centimeters per second (cm/sec), or
feet per second (ft/sec). These three units of speed are derived
from three different measurement systems that arose many
years ago: the meter-kilogram-second (mks) system of units;
the centimeter-gram-­second (cgs) system of units; and the foot-
pound-second system of units. Also commonly encountered are
energy units of 1 joule (1 kg × m2/sec2) in the mks system and
1 erg (1 kg × cm2/sec2) in the cgs system. Table 1-2 lists units
often encountered in nuclear medicine. In 1977, the three exist-
ing unit systems were modified when the “worldwide” Système
International d’Unités (SI) was developed. Although the intent of
SI units was simplification, both the old units and SI units con-
tinue to be in use in the United States. In SI, each unit is named
after a person, and numeric factors are not present in the defi-
nition of the SI unit. For example, the old temperature scale of
centigrade was renamed Celsius, and the old unit of radioactiv-
ity, the curie (3.7 × 1010 disintegrations per second [dps]), was
replaced in SI units by the becquerel (Bq; 1 dps), which has no
complicating numeric factor in the definition. The reader should
be familiar with both the old units and the SI units shown in
Table 1-2. It is often necessary to convert between various sys-
tems for consistency in applying mathematical equations. Most
common is the necessity to convert between the old units and
SI units for radioactivity, radiation exposure, absorbed dose, and
dose equivalent. For example, how many becquerels are equiva-
lent to 20 mCi of a radionuclide? This can be calculated from the
conversion factor in Table 1-2 as follows:
Ci   10 Bq
Activity in Bq = 20 mCi × 10−3 × 3.7 × 10
 mCi   Ci 
= 20 × 10−3 × 3.7 × 1010 Bq
= 7.4 × 108 Bq = 740 × 106 Bq
= 740 MBq (or 0.74 GBq)
So 20 mCi is the same activity as 740 MBq. Note how
all the units except Bq canceled between numerator and
denominator in the conversion. In radiation safety calcu-
lations, it is common to encounter measurements of radi-
ation expressed in either older historical units (commonly
used in the United States) or internationally standardized
6 SECTION 1 Foundations

TABLE 1-2 Units of Measure

Measured Property Old Unit SI Unit Conversion Factor
Radioactivity curie (Ci) = 3.7 × 1010 dps becquerel (Bq) = 1 dps 1 Ci = 3.7 × 1010 Bq
1 Bq = 2.7 × 10−11 Ci
Radiation exposure C/kg roentgen (R) = 2.58 × 10−4 C/kg coulomb/kg (C/kg) 1 R = 2.58 × 10−4 C/kg
1 C/kg = 3.88 × 103 R
Radiation absorbed dose rad = 100 erg/g gray (Gy) = 1 joule/kg 1 rad = 0.01 Gy
1 rad = 10 mGy
1 Gy = 100 rad
Radiation dose equivalent rem = QF × rad sievert (Sv) = QF × Gy 1 rem = 0.01 Sv
1 rem = 10 mSv
1 Sv = 100 rem
QF, Quality factor; SI, Système Internationale.

SI units. For example, radiation absorbed dose can be spec- To convert 720 mrem to rem, use the following proportional
ified in units of rad or in SI units of gray (Gy). The con- equation. Given that
version of radiation absorbed dose from rad to SI units is
1 rem = 1000 mrem
defined by 1 Gy = 100 rad. To convert a measurement of 5
rad SI units is as follows: so
x Gy/5 rad = 0.1 Gy/1 rad 1 rem/1000 mrem = x/720 mrem
x Gy/rad = 0.05 Gy/rad 720 mrem (rem) = (x rem/1000 mrem)
x Gy = 0.05 Gy 720 mrem (rem) /1000 mrem = x rem
1Gy 0.72 rem = x
Absorbed dose = 5 rad × = 0.05 Gy
100 rad Note again how the units cancel out.
= 5 centigrays (cGy) Use of the radioactive decay equations discussed in the
So 5 rad is the same absorbed dose as 0.05 Gy or 5 cGy. following section often requires converting between different
Similarly, in radiation safety it is common to encounter time units. Suppose it is necessary to convert the time differ-
measurement of dose equivalent, either in units of rem or in ence between 10:45 am and 1:20 pm to units of days. The time
SI units of sievert (Sv). The conversion factor is defined by 1 difference is 155 minutes, which can be converted to days:
Sv = 100 rem or 1 mSv = 100 mrem. The conversion of dose
equivalent from 1 mSv to rem is as follows: 1 hr 1 day
155 min × × = 0.108 days
60 min 24 hr
1 Sv/1000 mSv = 0.1 Sv/x mSv
1 Sv (x mSv) = (0.01 Sv) (1000 mSv) Exponent Laws and Logarithms
Divide both sides by 1 Sv, and the result is: This section expands the algebra of exponents and logarithms.
In general, exponent notation is:
x = 10 mSv
Sv 100 rem baseexponent = number
Dose equivalent = 1 mSv × 10−2 ×
mSv Sv For example:
= 1 rem
104 = 10, 000
So 1 mSv is the same dose equivalent as 1 rem. Again,
note that all the units except the final desired value cancel in The exponent notation of 104 means the same as 10 multi-
numerator and denominator. Note also the conversion of Sv plied four times:
to mSv must be completed first. 104 = 10 × 10 × 10 × 10 = 10, 000
Another example is to convert 7.2 mSv to mrem and then to
rem. In the last example, we calculated 1 mSv equal to 0.1 rem Generally, one is confronted with exponential calculations
or 100 mrem. involving raising a base of 10, 2, or e to some power.
7 . 2 mSv/x mrem = 1 mSv/100 mrem 28 = 2 × 2 × 2 × 2 × 2 × 2 × 2 × 2 = 256
x mrem (mSv) = (100 mrem) (7 . 2 mSv)
Scientific calculators generally have a YX key, meaning
Divide both sides by mSv: raise the base Y to the power x, which facilitates this type of
calculation. To find 28 using the calculator,
x mrem = 720 mrem 2 enter base value Y
x = 720 mrem YX exponentiation key or (^ key)
 CHAPTER 1 Mathematics and Statistics 7

8 enter exponent value x The difficulty lies in how to evaluate the units. First, elim-
= (see result of 256 in display) inate denominator units within each term of the equation—
A special case arises when the exponent is zero. By mathe- that is, write 1/cm as cm−1 and g/cm3 as g × cm−3, using the
matic definition, any number (except zero) raised to the zero rule discussed previously for moving from denominator to
power is equal to 1: numerator by changing the sign of the exponent. Then:
e0 = 1 0.12 cm−1
100 = 1 µm =
3.4 g/cm−3
20 = 1
Now follow the previous rule for division of exponents with
Negative exponents provide a convenient form for represent- centimeter dimensions:
ing small numbers:
1 0.12 cm−1−(−3) 0.12 cm2 cm2
−4
10 = 4 = 0.0001 µm = = = 0.035
10 3.4 g 3.4 g g

Note that this shows how a number in exponent notation Alternatively, the units of μm might be written as:
can be moved from numerator to denominator simply by
µ m = 0.035 cm2 × g−1
changing the sign of the exponent:
1 Another example is hertz (Hz), the measure of frequency
28 = = 256 expressed as the number of waves or cycles per second. For
2−8
example, if three waves pass by a certain point in space in 1
The algebra of exponents in equations follows certain second, then the frequency (v) is given by:
rules.
v = 3/sec, or 3 sec−1, or 3 Hz
Multiplication: add the exponents.
Taking the root of a number is the inverse of raising it to
Bx × By = Bx+y
a power. A special case is the square root (√ ) of a positive
10 × 103 = 105
2
number x, which is defined by:
104 × 10 – 5 = 10 – 1 √ √
x × x =x
To find the area of a rectangle, multiply width by height:
Area = 20 cm × 30 cm = 600 cm2 e.g., 9 × 9 = 3 × 3 = 9
Note how this follows the rule for multiplying exponents: Note that finding the square
√ root is the same as raising a
1
cm × cm = cm 1 2 number to the half power: x = x1/2. As mentioned previously,
the square root and squaring operation are inverses of each
Division: subtract the exponents. other because
Bx x−y (x2 ) = x
=B
By
( x)
2

2
and =x
10
= 102−3 = 10−1 Whether the squaring or the square root is performed first,
103
the inverse function always cancels the other operation and
104 simply returns the number x. Other roots can√be calculated as
= 104−(−5) = 109
10−5 the
√ nth root of a number, which is written as n x . For example,
64 = 4, because 4 × 4 × 4 = 64. Some scientific calculators
3

23 √
have a root key such as x y , or the calculator might have an
= 20 = 1
23 inverse (INV) key which is pressed before pressing another
A practical problem involves the calculation of the mass function √ to get the inverse of that function. For example, to
attenuation coefficient μm, which is defined by the quotient
3
calculate 64 on the calculator:
of the linear attenuation coefficient μ (in units of cm−1 or 64 enter value y to find cube root
√
1/cm) divided by the density r (in units of g/cm3) for some INV and Yx or root key x y , which is same as INV − Yx
substances such as human soft tissues. 3 enter root value x
= (see display of result, 4)
μm = μ/ρ
The base e (= 2.718…) is an irrational number called
For example: Euler’s number, named after Swiss mathematician and phys-
icist Leonhard Euler (1707-1783). Calculations involving e
if µ = 0.121/cm, and ρ = 3.4 g/cm3, then
pervade the mathematical, physical, and biological world:
0.121/cm radioactive decay, absorption of radiation, growth of bacteria,
µm =
3.4 g/cm3 and radiation damage to cells. Scientific calculators often have
8 SECTION 1 Foundations

a special ex key that is used for calculations. Some calculators photographic film is measured by the optical density (OD) of
require the user to invoke the ex function by virtue of the fact the film, which is defined by shining a beam of light through
that the ex function and the natural logarithm function (ln x) the film:
are inverses of each other. This means that ln(ex) = x, and e(ln x) OD = log (100 % / % transmitted through film)
= x. For example, a radioactive decay problem might require
the following calculation: The human eye can generally distinguish optical densities
in the range of 0.25 to 2.25; less than 0.25 is too dim to be
At = A0 e − λt
seen, and greater than 2.25 is too black. The OD corresponds
where to the percentage of light transmitted through the film.
λ = 0.693/t1/2
% Light Transmitted
t = elapsed time through Film OD
t1/2 = the half-life of the isotope
100 log 100/100 = 0
A0 = the original activity
10 log 100/10 = 1
An example of a radioactive decay problem using the cal- 1 log 100/1 = 2
culation is below.
0.1 log 100/0.1 = 3
e−0.693 × 4.5/6.0 = e−0.51975 = 0.59
Logarithms have certain algebraic properties that can sim-
This can be performed on the scientific calculator as fol- plify mathematical calculations.
lows: Multiplication: log(xy) = logx + logy
0.693 enter value Division: log(x/y) = logx − logy
+/− change sign key Exponents: logxn = n × logx
× multiply key The other frequently encountered base for logarithms is
4.5 enter value the base e, or the natural logarithm, which is denoted by the
÷ divide key special symbol ln:
6 enter value
lnx = logex
= (see result of division)
INV and ln x or ex key (see result of 0.59 in display) Scientific calculators usually have an ln x key, which allows
Logarithms provide another convenient system of nota- easy calculation. The major use of natural logarithms in
tion that can make mathematical problems easier to solve. In nuclear medicine is to solve problems in radioactive decay
nuclear medicine, logarithms can be used to linearize certain and radiation absorption, such as the time of decay (t) in the
graphs (change a curved line into a straight line), solve prob- following equation:
lems in radioactive decay or radiation absorption, or provide
0.25 = e−0.693 × t/6 hr
a graphic axis scale capable of accommodating a wide range
of numeric values. The scientific calculator quickly computes The difficulty lies in solving for t by removing it from
logarithms, so that the reader only needs to become famil- within the exponent. To eliminate a function (e.g., ex),
iar with their algebraic properties. The logarithm (logb x) of a the natural logarithm of both sides of the equation can be
number (x) is the value to which the base (b) must be raised taken:
to equal the number:
ln(0.25) = ln (e−0.693 × t/6 hr )
logbx
x=b
Using the rule for log of exponents,
For example, for base 10 logarithms the log10 1000 = 3,
 −0.693 × t 
because 1000 = 103. Note that the expression log10 1000 is ln0.25 =   × lne
read as the base 10 log of 1000. Some examples follow:  6 hr
And now using ln e = 1:
log10 0.01 = −2
log10 0.1 = −1 −0.693 × t
ln0.25 =
log10 10 = 1 6 hr
log10 100 = 2 Note that the minus sign and units are carefully retained.
n Simply rearranging algebraically to solve for t then results in:
log10 10 = n
−6 hr × ln0.25
If a logb x is written without any value specified for the t=
0.693
base (as log x), then base 10 is understood.
Most nuclear medicine and molecular imaging labora- −6 hr × (−1.386)
= = +12 hr
tories use digital imaging; however, this is still a practical 0.693
example in some nuclear laboratories where film is still used. The minus from the original equation times the negative
The blackness of a nuclear medicine image on a piece of value of ln 0.25 results in a + sign.
 CHAPTER 1 Mathematics and Statistics
Numeric Accuracy: Significance and Rounding
The accuracy of mathematical calculations is governed by three
concepts: significant figures, rounding, and significant dec-
imal places. Significant figures refer to the number of digits
required to preserve the mathematical accuracy in a number.
Numeric Accuracy Rule 1. For a number with no leading or
trailing zeros, the number of significant figures is the number
of digits.
Number Number of Significant Figures
3 1
3.45 3
Numeric Accuracy Rule 2. For a number with leading
zeros, the leading zeros are not significant.
Number Number of Significant Figures
0.0015 2 figures). The rightmost digits are 4728, which is less than
0.0463 3 5000; therefore, the 0.049 is the correct, rounded, final
Notice that expressing a number like 0.0015 in scientific nota-
tion as 1.5 × 10−3 eliminates the leading zeros and therefore
eliminates the need for rule 2.
Numeric Accuracy Rule 3. Trailing zeros in a number
should be retained only if they are significant, which depends
on the context of the problem. Thus a problem may state
that a drug costs $37; the cost has two significant figures.
Or the problem may state that the drug costs $37.00, which
is interpreted as being accurate in both dollars and cents;
it has four significant figures. A length expressed as 4 cm
has one significant figure; the length was measured to the
nearest centimeter. But a length expressed as 4.0 cm has two
significant figures; the length was measured more accurately
to the nearest millimeter.
Numeric Accuracy Rule 4. The accuracy of the result in
multiplication or division is such that the product or quotient
has the number of significant figures equal to that of the term
with the smaller number of significant figures.
For example, 2 × 2.54 = 5; the correct answer has only one
significant figure because the 2 in the calculation has only one
significant figure. But 2.00 × 2.54 = 5.08; the result has three
significant figures because it is presumed that the trailing
zeros in the 2.00 are significant. In another example,
0.061
= 0.0049
12.34
or
6.1 × 10−2
= 4.9 × 10−3
12.34
The result has only two significant figures. Note that a cal-
culator display might show 0.0049433, but the proper answer
to record as a result is 0.0049 with only two significant figures.
9
It is necessary to properly round off the result from the
calculator before recording the result. For example:
0.061
= 0.0494728 = 0.049
1.233
whereas
0.061
= 0.0495130 = 0.050
1.232
Both answers have two significant figures, but the results
are different because of rounding. The mechanics of rounding
a number consist of carrying the mathematical calculations
to several more digits than are needed in the final answer. The
final result is rounded by the following rules.
Numeric Accuracy Rule 5. If the rightmost digits, beyond
the significant figures in the final result, are less than 5000,
then simply drop the rightmost digits. As an example,
consider 0.061 / 1.233 = 0.0494728, which must be rounded
to two significant figures (because 0.061 has two significant
answer.
Numeric Accuracy Rule 6. If the rightmost digits beyond
the significant figures are greater than 5000, then increase
the least significant figure by 1. As an example, consider
0.061 / 1.232 = 0.0495130, which again must be rounded to
two significant figures (because of the 0.061). The rightmost
digits are 5130, which is greater than 5000; therefore, the final
answer needs to be rounded up by one least significant digit
(0.049 + 0.001). The final answer is 0.050, rounded correctly
to two significant figures.
Numeric Accuracy Rule 7. It may sometimes be necessary
to round a number when the rightmost digit is exactly 5. The
rule in this case is to round down the number if the digit to
the left of the 5 is even, and round up the number if the digit
to the left of the 5 is odd. For example 2.45 is 2.4, rounded to
two significant figures; 1.5 is 2, rounded to one significant
figure. This rounding scheme for numbers that end in 5 is
arbitrary and results in averaging out rounding errors when a
large number of calculations is performed.
Numeric Accuracy Rule 8. For addition and subtraction,
the final result has the same number of significant decimal
places (rather than significant figures) as the number in the
problem with the least number of significant decimal places.
For example:
0.123 + 3.42 = 3.54 (two significant decimal places)
0.1 + 3.42 = 3.5 (one significant decimal place)
1 + 3.42 = 4 (zero significant decimal places)
Sometimes addition and rounding must be used simul-
taneously, as in 0.125 + 3.42 = 3.545, which should prop-
erly be rounded to 3.55, with only two significant decimal
places because the 3.42 has only two significant decimal
places.
10 SECTION 1 Foundations
Scientific calculators often have a key for fixing the num-
ber of decimal places to be used in a calculation. The calcu-
lator also does the rounding, simplifying such calculations.
Calculators and Computer Programs
Examples throughout this chapter have emphasized the use of
the scientific calculator. These scientific calculators are avail-
able from many manufacturers and should offer, at a mini-
mum, the ln x and ex functions. On some calculators, these
options may be presented through a combination of ln x and
inverse keys, as discussed in the previous examples. Generally,
a scientific calculator also offers other useful statistical func-
tions, such as mean, standard deviation, and linear regression
(or least squares curve fit). Mastering the scientific calculator
will greatly speed the results of many common nuclear med-
icine calculations. Calculation of the variability in a nuclear
counting system through a chi-square test, for example, can
be conveniently derived from the standard deviation function
on the scientific calculator or computer program.
PRACTICAL APPLICATIONS
Radioactive Decay
Nuclei that have an unstable balance of neutrons and pro-
tons spontaneously undergo radioactive decay to achieve a
more stable nuclear configuration. The number of radioac-
tive nuclei that decay per unit time defines the radioactivity,
which is measured in Ci or Bq (see Table 1-2). A radioactivity
level is computed as follows:
Ci   dps 
1 mCi = 1 × 10−3 ×  3.7 × 1010  A = A 0e−0.693 × (t/t1/2)
 mCi   Ci 
= 3.7 × 107 dps
This means that 3.7 × 107 dps occur in the sample of
radioactive material. The equation that defines the decay of
the activity (A) over time (t) arises from a differential equa-
tion, which states that the number of atoms decaying per
second is proportional to the number of atoms present. If
the number of atoms in a sample of radioactive material is
doubled, then the number of atoms decaying per second is
also doubled. Solving the differential equation yields the
radioactive decay law:
At = A0 e – λt
At = activity at time t
A0 = activity at starting time
λ = decay constant
t = time since starting time
The decay constant λ is the fraction of atoms that decay
per (small) time interval, and it has units of 1 over time (e.g.,
1/hr) or inverse time (hr−1). The decay constant for 99mTc,
for example, is 0.115 hr−1, which means that about 0.115 (or
11.5%) of the 99mTc atoms decay per hour.
Note carefully that the verbal interpretation of the decay
constant λ as the fraction that decays per some time interval
is an approximation that holds only when the period being
considered leads to a very small fractional decay. It is incor-
rect, for example, to conclude that λ = 0.115 hr−1 means that
in 6 hours a fraction of 6 × 0.115 or 69% of the atoms decay
(it is really 50%). Even saying 11.5% decay per hour is only
approximate (it is really 10.9%). It is advisable to simply use λ
for the exact mathematical calculations using the radioactive
decay equation and to avoid using the inaccurate verbal inter-
pretation as fractional decay.
The typical radioactive decay calculation required in
nuclear medicine specifies three of the four variables (At, , A0,
λ, t) in the decay equation, requiring that the fourth unknown
variable be solved for. For example, a radiopharmacy deliv-
ers a 20.0-mCi dose of 99mTc (λ = 0.115 hr−1) to the nuclear
medicine department at 8 am. What amount of radioactiv-
ity would remain to be injected into the patient for an 11 am
nuclear medicine scan? (To solve this problem on the scien-
tific calculator, it is best to consult the instruction booklet for
your scientific calculator.)
A0 = 20.0 mCi , λ = 0.115 hr – 1 , and t = 3.00 hr
At = A0 e – λt
At = 20.0 mCi × e – (0.115 hr − 1)(3.00 hr)
At = 20.0 mCi × e – (0.345)
At = 14.2
The radioactive decay law is often expressed in an alge-
braic form involving the half-life (t1/2), rather than the decay
constant 2. The t1/2, which depends on the radioactive mate-
rial involved, is the time at which the activity is decreased to
half its original value. The radioactive decay law may alterna-
tively be expressed as:
The factor 0.693 is actually ln 2, which is commonly writ-
ten with three significant figures. Each half-life of radioactive
decay causes the activity level to drop by 50%. The following
is a timeline for radioactivity remaining:
Activity remaining = 100 % → 50 % → 25 % → 12 . 5 % K
At time = 0 → t 1/2 → 2t 1/2 → 3t 1/2
(See Figure 1-2 for a graph of the radioactive decay law as
a function of time for 99mTc with t1/2 = 6 hours.)
Because both forms of the radioactive decay law are valid,
it can be written as:
At = A0 e – λt = A0 e – (0.693)(t/t1/2 ) = A0 e – (0.693/t1/2 ) × t
Because the expressions in the exponent e in these equa-
tions are equal, it can be seen that a relationship between λ
and t1/2 is given by:
0.693
λ=
t1 2
The λ and t1/2 are inversely proportional to each other: a
large λ means a small t1/2 and vice versa. Whether to use one
form of the radioactive decay law or the other is simply a mat-
ter of convenience. Given λ, t1/2 can be calculated easily (and
vice versa). For example, given that the decay constant λ for
99mTc is 0.1153 hr−1, what is the t ?
1/2
 CHAPTER 1 Mathematics and Statistics
0.693 0.693
t1 2 = = = 6.01 hr
λ 0.1153 hr−1
Careful attention to the units is necessary to avoid errors.
To make the units clearer, this might be restated as:
0.693
t1 2 =
1
0.1153
hr
To obtain the units of 1/hr out of the denominator, mul-
tiply both numerator and denominator by units of hours
(essentially multiply by 1):
0.693 hr
t1 2 =
1
0.1153 hr
hr
The 1/hr and the hr cancel in the denominator, leaving:
0.693
t1 2 = hr
0.1153
The common radioactivity problem is to solve for one of
the four variables (At, A0, t, t1/2) when the problem specifies
three of them.
For example, on Monday at 8 am, a sample of 131I (t1/2 =
8.04 days) is calibrated for an activity of 10 μCi. What amount
of radioactivity will be given to the patient if the dose is
administered on the following Friday at 2 pm?
Given: A0 = 10 µCi, t = Mon 8 am → Fri 2 pm,
t1 2 = 8.04 days
Solve for : At
A digression to discuss units is necessary. Remember the
good practice of always writing down the units associated
with every number. Any problem involving the ex function
must have a dimensionless number for the value of x, so it
is absolutely necessary that identical units be used for both t
and t1/2. Then the units cancel in the numerator and denom-
inator of t/t1/2, making the calculation independent of the
units chosen to measure time. In this problem, the time of
decay (Mon 8 am → Fri 2 pm) is 102 hours, but t1/2 has already
been given in days. It would be correct to express the time of
decay t as 4.25 days (rather than 102 hours) with the t1/2 also
in days, or it would be correct to express the t1/2 as 193 hours
(rather than 8.04 days) with the t also in hours.
A = 10 µCi × e−0.693 × (4.25 days/8.04 days)
or
A = 10 µCi × e−0.693 × (102 hr 193 hr)
A = 10 µCi × e−0.366 = 6.93µCi
A quick check of the results of the calculator’s answer is
also useful, based on the 100% → 50% → 25% → … timeline for
each half-life. In this example, the decay time of 4.25 days is
less than one t1/2 (8.04 days), so the answer should be between
100% and 50% of the initial 10μCi activity. The calculator
result of 6.93 μCi agrees with the mental check. Inadvertent
calculator usage errors can be prevented with these mental
checks.
11
A radionuclide is often calibrated for some activity level on
a Friday, but it might have been administered to the patient on
the previous Monday. This type of radioactivity problem can
be solved using negative time values for times that precede
the time of A0 calibration. For example, a radionuclide with
a 2-day half-life is calibrated for Friday at noon to be 3 mCi.
What activity level was present on the preceding Monday at
noon?
Given: A0 = 3 mCi
t = −96 hr (–4 days),t1 2 = 2 days
Find:A = A0e0.693 × (t t1 2)
A = 3 mCi × e−0.693 × (−4days 2days)
A = 3 mCi × e+1.386 (notice [−] times [−] is [+])
A = 12 mCi
This result is easy to check mentally because the time
difference is exactly 2 half-lives; the answer should be that
Monday noon has four times the activity of Friday noon, in
agreement with the calculated result.
Sometimes a problem concerns only the fraction of remain-
ing radioactivity (A/A0), rather than the actual remaining
activity in mCi. For example, what fraction of radioactivity
is left at a time equal to 3 half-lives? Here, t = 3t1/2 is given
and the object is to find A/A0. The radioactive decay law can
be algebraically rearranged (dividing both sides of the decay
equation by A0) as:
A A0 = e−0.693 × (t t1 2)
A A0 = e−0.693 × (3t1 2 t1 2)
A A0 = e−0.693 × 3
A A0 = e−2.079
A A0 = 0.125
A quick mental check confirms the result: in 3 half-lives
the radioactivity should decay 100% → 50% → 25% → 12.5%.
Remember that the radioactive decay equation always
refers to the remaining activity, which is the same as 100%
minus the decayed activity. It is important to determine
whether the problem is stating the amount of radioactivity
remaining, which the decay equation predicts, or the radio-
activity that has decayed away. For example, the previous
problem showed that only 12.5% of the original radioactivity
remains after 3 half-lives. This problem could also state that
87.5% of the radioactivity decayed away in 3 half-lives.
Radioactive decay problems can also require the solving
for the t or t1/2 value in the radioactive decay law. These values
are contained in the decay law as part of the exponent func-
tion, so the exponent must be removed. An example might be
to calculate the time necessary for 99.9% of a sample of 99mTc
to decay away. Remember that the decay law works with the
remaining radioactivity.
Given: A A0 = 0.1% = 0.001
t1 2 = 6.01 hr
Solve for t1 2in: A A0 = e−(0.693) × (t t1 2)
0.001 = e−0.693 × (t 6.01 hr)
12 SECTION 1 Foundations
Taking the natural logarithm of both sides and using
ln(ex) = x yields:
ln(0.001) = −0.693 × t 6.01 hr
Now the t value is out of the exponent and the equation
can be simply rearranged algebraically:
t = −6.01 hr × ln(0.001) 0.693
Notice how the minus sign and the units are carried cor-
rectly. Now using ln(0.001) = −6.908 yields:
t = −6.01 hr × (−6.908 0.693) = 59.9 hr
The two minus signs are multiplied and cancel each other.
Approximately 60 hours (or approximately 10 half-lives) is nec-
essary for the radioactivity of 99mTc to decay to 1⁄1000 of its original
value. For a radionuclide such as 131I, it is still true that 10 half-
lives cause decay to approximately 1⁄1000 of the original activity,
but for 131I, 10 half-lives is 10 × 8.04 days = 80.4 days.
As another example, an experiment finds that a sample of
radioactivity decays to 30% of its original value in 5 hours.
What is the t1/2?
A A0 = e−0.693 × (t t1 2)
0.30 = e−0.693 × (5 hr t1 2)
ln(0.30) = −0.693 × (5 hr t1 2)
−1.204 = −0.693 × (5 hr t1 2)
so
5 hr
t1 2 = −0.693 × = 2.9 hr
−1.204
Do the mental check. Does this seem a reasonable
answer? If 2.9 hours is the correct t1/2, then a decay time
of 5 hours is not quite 2 half-lives. Therefore, the expected
answer is that 5 hours of decay with a 2.9-hour t1/2 should
leave slightly more than 25% of the radioactivity remaining.
The problem has sensible results: 30% remaining at time just
less than 2 half-lives.
Decay Factor Tables for Radioactive Decay
Tables of radioactive decay factors provide an alternative meth-
odology for doing calculation of radioactive decay problems,
instead of using a calculator or spreadsheet. The decay factor
is the fraction of radioactivity remaining at some time after the
calibration time. Refer to Table 1-3, a decay factor table for 99mTc.
Example 1. Using Table 1-3, what is the decay factor,
the fraction of 99mTc activity remaining, at 3 hours past
calibration time? Entering the row of the first column of
Table 1-3 for a decay time of 3 hours, Table 1-3 yields a decay
factor of 0.71. If there was for example 5 mCi present at the
calibration time = 0, then 3 hours later the remaining activity
is 0.71 × 5 = 3.6 mCi.
Example 2. Using Table 1-3, what is the decay factor,
the fraction of 99mTc activity remaining, at 9.5 hours past
calibration time? Because this decay time is not a time
found exactly in any of rows of the first column of Table 1-3,
the best that can be said from Table 1-3 (using the rows of
TABLE 1-3 Radioactive Decay Factors for
99mTc
Decay Factor (Fraction
99mTc Decay Time (hr) of Activity Remaining)
0 1.00
1 0.89
2 0.80
3 0.71
4 0.63
5 0.56
6 0.50
7 0.45
8 0.40
9 0.36
10 0.32
11 0.28
12 0.25
the first column of the table for 9 and 10 hours) is that the
fraction remaining, the decay factor, is less than 0.36 but
more than 0.32. If, for example, there were 7 mCi present at
the calibration time = 0, then 9.5 hours later the remaining
activity is less than 0.36 × 7 = 2.5 mCi, but more than 0.32
× 7 = 2.2 mCi. Interpolation between two adjacent rows of
Table 1-3 would be necessary to produce a more specific
decay factor. Of course the use of a calculator and the exact
equations would produce an exact number for the remaining
activity without the need for any interpolating between rows
of a decay factor table.
Because there is a wide range of the half-lives for radio-
nuclides that are commonly used in nuclear medicine, it
is impossible to have a decay factor table for every com-
mon radionuclide. However, Appendix A offers radioactive
decay tables for 18F, 67Ga, 123I, 131I, 111In, 99mTc, 201Tl, and
133Xe. Alternatively, instead of using a decay factor table
specific to any one radionuclide, Table 1-4 presents a uni-
versally applicable decay factor table that can be used with
any radionuclide. Extreme care, however, must be exercised
to ensure that the time since calibration and the half-life
used with Table 1-4 are both expressed in the same units
of time.
Example 1. Using Table 1-4, what fraction of 111In (t1/2 = 2.81
days) activity is remaining at 11 am on Tuesday, given that the
calibration time was the day before, Monday at 8 am? In this
case, the decay time is 27 hours, which much be expressed in
days (to be in same units as is t1/2) before entering Table 1-4.
Because 27 hours is 1.12 days, the (decay time/t1/2) to use for
the first column in Table 1-4 is:
(decay time t1 2) = 1.12 days 2.81days = 0.40
Entering Table 1-4 for the value 0.4 in the first column,
the fraction of activity remaining, the decay factor, is 0.76 at
11 am Tuesday. If, for example, the calibration activity were
3 mCi at 8 am Monday, then the activity remaining is 0.76 × 3
= 2.3 mCi at 11 am Tuesday.
 CHAPTER 1 Mathematics and Statistics 13

TABLE 1-4 Radioactive Decay Factors, to draw out of the vial for proper patient dosing. In this exam-
Universally Applicable for any Radionuclide ple, 20 mCi represents ⅔ of a 30 mCi vial, so the technologist
would need to draw ⅔ of the liquid from that vial. But how
Decay Factor (Fraction much volume do you draw? You need some more information
(Decay Time)/(t1/2)* of Activity Remaining) to make this calculation. The radiopharmacy should provide
0.0 1.00 you with the concentration, amount of activity, and volume in
0.1 0.93 the vial. Although all that information is useful, if the radio-
0.2 0.87 pharmacy provides you with any two of those variables, the
0.3 0.81 third one is simple to figure out. The basic formula to use is:
0.4 0.76
0.5 0.71 Activity = Concentration × Volume
0.6 0.66
0.7 0.62 which can be solved for any one of the three variables. Here
0.8 0.57 are some examples.
0.9 0.54
1.0 0.50 Example 1. The vial is labeled: concentration 10 mCi/ml,
1.1 0.47 volume 3 ml. How much activity is in the vial? Using the formula:
1.2 0.44
1.3 0.41 Activity = Concentration × Volume
1.4 0.38 Activity = (10 mCi ml) × (3 ml)
1.5 0.35 Activity = 30 mCi
1.6 0.33
Example 2. The vial is labeled: activity 30 mCi, concentration
1.7 0.31
1.8 0.29
10 mCi/ml. How many milliliters is the volume in this vial?
1.9 0.27 Volume = Activity/Concentration
2.0 0.25 Volume = 30 mCi (10 mCi ml)
*Decay time and t1/2 must be expressed in same units of time. Volume = 3 ml
Example 3. The vial is labeled: activity 30 mCi, volume 3 ml,
Example 2. Using Table 1-4, what fraction of 18F (t1/2 = concentration 10 mCi/ml. How much volume do you draw
109 minutes) activity is remaining at 11 am, given that the out of the vial if you need to inject 20 mCi?
calibration time was at 8 am? In this case, the decay time is 3 Volume = Activity/Concentration
hours, which much be expressed in minutes (to be in same units Volume = 20 mCi (10 mCi ml)
as is t1/2) before entering Table 1-4. As 3 hours is 180 minutes, Volume = 2 ml
the (decay time/t1/2) to use for the first column in Table 1-4 is:
(decay time t1 2) = 180 minutes 109 minutes = 1.65 The technologist will need to draw 2 ml from the vial to
obtain a 20-mCi dose.
Because this is not a number found exactly in the first col- There are many important calculations to make in a clinic
umn of Table 1-4, the best that can be said from Table 1-4, when a dose needs to be adjusted to give a patient a specified
using the rows of the first column in the table for (decay activity. Although many nuclear medicine clinics receive unit
time/t1/2) of 1.6 and 1.7, is that at 11 am the decay factor is doses, technologists still need to have the skill of adjusting the
between 0.33 and 0.31. If for example the calibration time patient dose. In a day-to-day operation of a nuclear medicine
activity were 15 mCi, then 3 hours later the remaining activ- clinic, a variety of factors require dose adjustment including
ity would be less than 0.33 × 15 = 5.0 mCi but more than but not limited to patients coming to their appointment early
0.31 × 15 = 4.7 mCi. Interpolation between two adjacent rows or late, weight, pediatric, or change in prescription.
of Table 1-4 would be necessary to produce a more specific Along with drawing a certain volume for a specific activity
decay factor. amount, technologists are also asked to dilute doses. Diluting
a dose is done to increase the volume of a dose, decrease con-
Concentration-Volume Calculations centration, or both. Dilution requires an addition of a liquid,
The majority of nuclear medicine isotopes are administered usually saline, which always increases volume and decreases
to a patient in liquid form. When a radiopharmacy prepares concentration (inverse relationship). To calculate the necessary
nuclear medicine isotopes, pharmaceutical activity is pro- volume needed for proper dilution, use the following formula:
vided in a concentration of liquid. The concentration—that is,
Volume (to add to vial) = Volume (final) – Volume (initial)
the activity (typically in mCi) per volume (typically in ml)—
holds essential information for identifying the exact amount
of nuclear isotope in a volume. Example 4. A radiologist orders a heart shunt study with
When a clinic receives a vial containing 30 mCi of an isotope 20 mCi 99mTc-pertechnetate to be injected as a 0.5-ml bolus. The
but needs to inject a patient with only 20 mCi, concentration 99mTc-pertechnetate vial from the radiopharmacy is labeled:

information becomes essential to knowing how much volume activity 20 mCi, volume 0.2 ml, concentration 100 mCi/ml.
14 SECTION 1 Foundations
How much saline should be added to the vial, and what
will the concentration be once it is diluted? Using the follow-
ing formula:
Volume (to add to vial) = Volume (final) – Volume (initial)
Volume (to add to vial) = 0.5 – 0.2 = 0.3 ml
The technologist should add 0.3 ml of saline to the vial.
What is the concentration in the new 0.5 ml volume?
Concentration = Activity/Volume
Concentration = 20 mCi/0.5 ml = 40 mCi/ml
Often it is necessary to combine radioactive decay calcu-
lations with concentration-volume problems. The nuclear
medicine department may obtain its radioactivity from a
99Mo-99mTc generator through an early-morning elution of
the generator. This eluate decays throughout the day, resulting
in a change in concentration (mCi/ml). For example, a gen-
erator is eluted at 7 am, yielding 900 mCi in 20 ml of eluate
solution. What volume should be withdrawn from the eluate
vial into a syringe to yield 15 mCi for a scan at 2 pm? First,
calculate the radioactivity remaining in the eluate vial at 2 pm:
A = 900 mCi × e−0.693 × (7 hr 6.01 hr) = 402 mCi
(A quick mental check confirms the reasonableness of this
answer: slightly less than 50% remaining at a time slightly
greater than t1/2.) The concentration (radioactivity per vol-
ume) in the eluate vial is then 402 mCi/20 ml at 2 pm. The
volume needed to be withdrawn into the syringe for a 15-μCi
dose at 2 pm can be calculated from the equation: Activity =
Concentration × Volume.
A=C×V
 402 mCi 
15 mCi =  ×V
 20 ml 
20.1 mCi
15 mCi =  ×V
 ml 
so
15 mCi
V= = 0.75 ml
 mCi
20.1
ml 
99Mo-99mTc Radionuclide Generators
Another common problem for radioactive decay is to cal-
culate the ratio of 99Mo (t1/2 = 65.9 hours) activity to 99mTc
activity in generator eluate. The problem is that some 99Mo is
also eluted out along with the 99mTc in the morning elution.
The 99Mo is a radionuclidic impurity that is limited by regu-
latory agencies to be less than 0.15 μCi 99Mo per mCi 99mTc at
the time of injection into a patient. Consider a generator that
is eluted at 7 am and yields an eluate vial containing 30 μCi
99Mo along with 250 mCi 99mTc. Can this eluate be used for a
brain scan at the elution time of 7 am? Calculate the ratio of
99Mo to 99mTc activity at 7 am as:
99
Mo 30 µCi99Mo µCi99Mo
99m
= = 0.12
Tc 250 mCi99mTc mCi99mTc
In this example, you must solve for the decay of 99Mo and
99mTc and then calculate the 99Mo to 99mTc ratio. This eluate is
less than the regulatory limit (0.15) and may be used.
Could this same eluate be used 6 hours later to prepare a
lung scan? Now the ratio of activities at 1 pm is:
99
Mo 30 µCi × e−0.693 × (6 hr 65.9 hr)
99m
=
Tc 250 mCi × e−(0.693) × (6 hr 6.01 hr)
30 µCi × 0.939 28.17 Ci99Mo
= =
250 mCi × 0.500 125 mCi99mTc
µCi99Mo
= 0.23
mCi99mTc
This eluate cannot be used because the 99Mo/99mTc ratio
is greater than the 0.15 regulatory limit. The 99Mo has not
changed very much in the 6 hours since generator elution,
but the 99mTc activity has halved, resulting in a large increase
in the 99Mo/99mTc ratio.
The mathematics of this type of radionuclide generator
are governed by the laws of radioactivity,2 relating radionu-
clides denoted as a parent-daughter-granddaughter (and so
on) decay chain. The parent radionuclide 99Mo decays to the
daughter 99mTc, which in turn decays to the granddaughter
99Tc, and the decay chain continues. Without dealing with the
exponential algebra for this type of decay, it is possible to cal-
culate the 99mTc radioactivity expected to be eluted from the
generator by knowing three values:
1. The activity of 99Mo in the generator, which is given by the
manufacturer’s calibration date and the decay law for 99Mo
(t1/2 = 65.9 hours).
2. The time since the last elution of the generator, which is
commonly 24 hours for daily elutions.
3. The ratio of 99mTc to 99Mo in the generator, which depends
on the time since the last elution (99mTc to 99Mo ratios
are shown in Table 1-5 as a function of the time since last
­elution).
For example, a generator is delivered on Saturday and cali-
brated by the manufacturer for the following Monday at 6 pm
to contain 2 Ci of 99Mo. The generator is eluted daily (Monday
through Friday) at 7 am. What activity of 99mTc is available in
the generator at 7 am on Tuesday? The required data are as
follows:
1. 99Mo activity Tuesday 7 am, 13 hours after calibration time
A = 2 Ci × e−0.693×(13 hr 65.9 hr)
A = 1744 mCi of 99Mo in the generator,Tuesday 7 AM
2. Time since last elution is 24 hours, since the generator is
eluted daily
3. From Table 1-5, the 99mTc/99Mo ratio is 0.87 for 24 hours
since last elution, so:
Activity 99mTc = 0.87 × Activity 99Mo
= 0.87 × 1744 mCi
= 1518 mCi
Depending on the quality of the generator, only a percent-
age of this 1518 mCi of 99mTc will appear in the eluate. This
 CHAPTER 1 Mathematics and Statistics 15

is known as the elution efficiency of the generator. If the elu- or, in a format that is much easier for calculation purposes:
tion efficiency is 95%, then the 99mTc found in the Tuesday tP × tB
morning eluate would be calculated as 0.95 × 1518 mCi = tE =
( tP + tB)
1442 mCi and would be for patient studies.
For example, if the liver excretes a 99mTc radiopharmaceu-
Half-Life: Biological, Physical, and Effective tical with tB = 3 hours, then the gamma camera over the liver
In most clinical applications, the nuclear medicine gamma would observe an effective half-life of
camera measures the radioactive counts over an organ of 6 hr × 3 hr
interest in the patient’s body. Typically, the patient’s organ tE = = 2 hr
(6 hr + 3 hr)
excretes the radiopharmaceutical with some biological half-
life tB, while the radioactivity decays physically with a physi- The effective half-life is always less than or equal to the
cal half-life that is denoted as tP. The biological half-life is an smaller of tP or tB.
indicator of the physiological fate of the radiopharmaceutical,
tB. The counts observed by the gamma camera follow an expo- Attenuation of Radiation
nential decay law based on the effective half-life tE, where: The calculation of the intensity (I) of x-ray or γ-ray photons
1 1 1 transmitted through some thickness (x) of absorbing material
= + follows exactly the same algebra as the equations for radioac-
tE tP tB
tive decay. Figure 1-1 shows a beam of monoenergetic x-ray
or γ-ray photons striking a thickness of absorbing material.
TABLE 1-5 Generator 99mTc/99Mo Activity Monoenergetic means that the photons all have the same
Ratio energy, such as a beam of photons from a 99mTc radionuclide
source that emits photons with an energy of 140 keV. The
Time Since Last Elution (hr) 99mTc/99Mo Activity Ratio electron volt (eV) is a common unit for specifying energy.
1 0.094 In nuclear medicine, the energy of photons is commonly
2 0.18 expressed in units of thousands of electron volts, abbreviated
3 0.25 keV. The initial intensity (number of photons per second)
4 0.32 entering the absorbing material is called I0. The material atten-
5 0.39
uates, or absorbs, some fraction of the photons, and the photon
6 0.44
beam emerges with a transmitted (i.e., not absorbed) intensity
7 0.49
8 0.54 I. The intensity of the transmitted radiation is given by:
10 0.61 I = I0e−µx
12 0.68
14 0.73 where μ is the linear attenuation coefficient, or the fraction of
16 0.78 the beam absorbed in some (very small) thickness x. The linear
18 0.80 attenuation coefficient μ is the analog of the decay constant λ in
20 0.83 radioactive decay. The linear attenuation coefficient μ depends
22 0.85 on the type of absorbing material and the energy of the photons.
24 0.87 A large μ value means a strong absorbing material. For example,
26 0.88 99mTc γ-rays the μ value in lead is about 23 cm−1, whereas the μ
30 0.91
value in water is only 0.15 cm−1. Since 23 cm−1 is greater than
∞ 0.95
0.15 cm−1, lead is much more absorbent than water.

Lead collimator
Absorbing
material
with
I0 absorption I Detector
properties
described
Monoenergetic beam by µ or HVL Attenuated beam
of x-rays or γ-rays. Lead collimator
Intensity = I
Intensity = I0

Thickness X

I = I0e–µX = I0e–0.693(X/HVL)
FIGURE 1-1 Attenuation of radiation in an absorbing medium.
16 SECTION 1 Foundations

A typical calculation deals with the fraction I/I0 transmit- Remember the units of x and HVL must be the same, and
ted through a thickness x. For example, what percentage of remember that this equation calculates the transmitted inten-
140-keV photons are transmitted through 10 cm of water (μ sity. A fraction (0.22) of the photons is transmitted. This is
= 0.15 cm−1)? precisely the same result that was obtained previously in this
section using the attenuation equation with μ. The problem,
I/I0 = e−µx
−1 however, asks what fraction is attenuated by the water; there-
I/I0 = e−0.15 cm × 10 cm
fore, 1 − 0.22 = 0.78 is the attenuated fraction, and 10 cm of
I/I0 = e−1.5 = 0.22, or 22%
water absorbs 78% of the photons emitted by 99mTc. This type of
Because 22% are transmitted, it can also be said that 78% calculation can be performed easily on the scientific calculator.
are absorbed in 10 cm of water. 0.693 enter value
Consider a problem that asks what fraction of 131I photons +/− change sign key
at energy 364 keV is transmitted through a half inch of lead × multiply key
(μ = 2.2 cm−1 at 364 keV). An initial inclination might be to 10 enter thickness value
calculate as follows: ÷ divide key
I/I0 = e−µx 4.6 enter HVL value
= (see result of division)
but −1 × 0.5 in
I/I0 ≠ e−2.2 cm INV and ln x or ex key (see result of 0.22 in display)
A quick mental check of the calculator result is useful. The
The calculation is incorrect because the units in the expo- thickness here (10 cm) is slightly more than 2 HVLs (since
nent do not cancel each other. A dimensionless number must HVL = 4.6 cm); therefore, the attenuation answer should be
be in the exponent to make the result independent of the units slightly less than 25%.
used to describe μ and x. Any units can be used as long as the Another problem might require solving the attenuation
units of μ and x are inverse of each other. It is easiest to look equation for either x or the HVL, both of which are con-
up the μ values, from published tables, and then convert the tained in the exponent in the attenuation equation. Just as in
thickness x to the corresponding units, rather than convert radioactive decay (where t or t1/2 needed to be solved for), the
the units of μ to correspond with those of x. For this problem, exponent with the natural logarithm can be eliminated as the
convert x = 0.5 inch to 1.27 cm to obtain inverse function of ex:
I/I0 = e−µx − e−0.693 × (x/HVL)
−1 × 1.27 cm
I/I0 = e−2.2 cm = 0.061
Therefore, 0.5 inch of lead transmits only 6.1% of a beam or
of 364-keV photons from 131I; this also means that the lead ln(I/I0) = −µx = −0.693 × (x/HVL)
absorbs 93.9% of the photons. The linear attenuation coeffi-
cient suffers from the same problem as λ; it is difficult to con- For example, if 10 cm is known to transmit 22% of the
ceptualize. It is therefore common to follow the method used photon beam, what is the HVL?
in radioactive decay and define a half-value layer (HVL) as
ln(0.22) = −0.693 × (10 cm/HVL),
the thickness of material that absorbs 50% of the photons.
The HVL is the analog of t1/2 in radioactive decay. One HVL so
transmits 50% of the photons, two HVLs transmit 25% of the −0.693 × 10 cm
HVL =
original beam, and so on. The absorption line looks like the ln(0.22)
following: −0.693 × 10 cm
= = 4.6 cm
–1.51
Photon intensity = →100%→50%→25%→12.5%
Thickness = → 0 → 1 HVL → 2 HVL → 3 HVL...
Note how the minus signs cancel and how the units are
The equation of photon attenuation then can be expressed as carefully carried. To calculate the HVL on the scientific cal-
culator, perform the following steps:
I = I0e−µx = I0e−0.693 × (x/HVL)
0.693 enter value
and a relationship exists between μ and HVL, given by μ = +/− change sign key
0.693/HVL. If the HVL or μ value is known, it is a straightfor- × multiply key
ward calculation to find the other and use whichever attenua- 10 enter x value
tion equation is most convenient. ÷ divide key
As an example, what percentage of 140-keV photons from 0.22 enter fraction value
99mTc are attenuated by 10 cm of water? The HVL for 140 pho- ln x natural logarithm key
tons in water is 4.6 cm. = (see result of 4.6 cm in display)
l/l0 = e–0.693 × (x/HVL) One additional nuance occurs for attenuation of pho-
I/I0 = e–0.693 × (10 cm/4.6 cm) tons. The μ value, or the corresponding HVL value, for any
l/l0 = 0.22,or 22% material also depends on the physical density ρ (g/cm3); the
HVL in water vapor is different from the HVL in liquid water,
 CHAPTER 1 Mathematics and Statistics 17

which is also different from the HVL in ice, and so on. This 100
makes calculations using the μ or HVL values somewhat dif-

Percentage of radioactivity
ficult because the μ values are usually tabulated only for the 75
Activity
gone
common physical state of the material in question (e.g., for
liquid water). To circumvent this problem, a new parameter is
defined as the mass attenuation coefficient μm (cm2/g) = μ/ρ. 50
The mass attenuation coefficient is independent of the physi-
cal density of the absorber and is therefore easily tabulated. Activity
25 remaining
The transmission of photons can then be expressed in one of
three equivalent forms:
2 4 6 8 10 12
I/I0 = e−µx
Time (hours)
I/I0 = e−0.693 × (x/HVL) FIGURE 1-2 Linear plot of radioactive decay for t1/2 = 6 hours.
I I0 = e−ρµmx
100
Calculation of a result using the more easily tabulated 90
80 Activity
value of mass attenuation coefficient also requires looking up 70
gone

the density (ρ) of the absorbing material.
It should also be noted that these equations for the trans-
mitted fraction of photons apply only to a situation known
as good geometry, or narrow-beam geometry, meaning that a
very thin, pencil-like beam of photons enters the absorber
and is detected by a small collimated detector. Scattered pho-
tons (photons not traveling in a straight line between the
origin of the photon and the detector) are excluded by the
good geometry. In most practical applications, such as pho-
tons arising from a patient’s heart and being detected by a
gamma camera, the geometry is broad-beam. The photons
can leave the patient’s heart and move toward the thyroid, for
example, and then scatter in the thyroid and travel toward the
gamma camera to be detected as a photon apparently arising
from the thyroid. The scattered photons increase the apparent
transmission through the patient’s body, and the equation is
typically modified by a multiplicative buildup factor B, with
B ≥ 1. Buildup factors are dependent on the absorbing mate-
rial, energy of the photon, and geometry. A large patient has a
buildup factor greater than that of a thin patient, so in broad-
beam geometry:
I I0 = Be−µx
Specification of the buildup factor, or some other correc-
tion for scatter, such as arbitrarily using a smaller μ value, may
be necessary for accurate quantification of photons originat-
ing inside a patient.
Graphs
In the modern technological world, people are inundated
with data. Graphs provide a practical, visual way to con-
vey large amounts of information. They can also be used to
predict one variable based on another. The most common
type of graph uses a linear set of x and y axes in the familiar
Cartesian coordinate system. Figure 1-2 shows a graph or
plot of the remaining radioactivity level versus time from a
sample of radioactive material with t1/2 = 6 hours. The x-axis
(or abscissa) shows the time of each data point (for 0, 2, 6,
and 12 hours), and the y-axis (or ordinate) shows the activ-
ity in millicurie for each data point. One variable is often
Percentage of radioactivity
60
50
40
30
Activity
20 remaining
10
2 4 6 8 10 12
Time (hours)
FIGURE 1-3 Semilog plot of radioactivity for t1/2 = 6 hours.
The y-axis is logarithmic.
considered to depend on another independent variable. The
independent variable is generally plotted on the x-axis, with
the dependent variable on the y-axis. In Figure 1-3, time
is considered the independent variable on the x-axis, and
activity level is considered the dependent variable on the
y-axis.
Mathematically, activity (y) is a function of time, or y =
f(t). The data points in Figure 1-3 are called discrete data
points because a measurement of activity was taken at four
discrete, individual data points (0, 2, 6, and 12 hours). Graphs
of discrete data points may or may not, at the user’s discretion,
show the data points joined by smooth curves or a connect-
the-dots type of straight line. Knowledge of the decay process
suggests a smooth curve should best represent radioactive
decay. On the other hand, a graph of the number of monthly
kidney scans might be graphed as discrete data points joined
in a connect-the-dots fashion because no reason implies a
smoother curve.
Figure 1-2 shows a continuous curve of activity versus
time for the radioactive decay equation:
A = A0e−λt
The t1/2 for the data in Figure 1-2 is 6 hours because the
radioactivity drops 100%, 50%, and 25% in 0, 6, and 12 hours,
respectively. If the natural logarithm is taken on both sides
18 SECTION 1 Foundations

of the equation, the curve in Figure 1-3 will simplify into the
straight line shown in Figure 1-3 because:
lnA = ln(A0e−λt)
lnA = lnA0 + ln(e−λt)
lnA = lnA0 − λt
or
y = a + bt
This is the equation of a straight line with y-intercept
a = ln A0, and slope b = −λ. This is an important prac-
tical result: the logarithm of radioactive decay data plot-
ted versus time is a straight-line graph with negative slope
equal to the decay constant. Note that the logarithmic plot
of activity still shows the activity dropping by 50% every
6 hours.
A brief review of the graphic interpretation of straight-line
data seems pertinent. A straight-line graph of y versus x is
represented by the general formula:
y = a + bx
The y-intercept, which is the value of y at x = 0, is rep-
resented by a. The slope, which represents the steepness of
the line, is represented by b. Figure 1-4 shows a straight-line
graph with b = 0.5 as the slope. The slope is calculated from
any two arbitrary points on the line as:
∆y (y2 − y1)
Slope = = the necessity of calculating the logarithm of the y-axis data.
∆x (x2 − x1)
In Figure 1-4 the slope is calculated from the points (x1, y1)
= (0, 5) and (x2, y2) = (10, 10).
(10 − 5)
Slope = = 0.5
(10 − 0)
20
For a straight-line graph, it does not matter which two
points on the line are chosen to calculate the slope; the same
answer is obtained. In Figure 1-4 the y-intercept a = 5 because
the value of y is 5 at x = 0. Hence, the equation of the straight
line in Figure 1-4 is given by:
y = 5 + 0.5x
Given any x value, the equation can be used to calculate
the y value. The sign of the slope merely reflects whether the
curve slopes upward (a positive slope) or downward (a nega-
tive slope). Straight-line curves are generally used in nuclear
medicine to prove a direct or linear relationship between two
variables or to predict some y variable based on the value of
the x variable.
Mathematical relationships or curves that are nonlinear,
such as radioactivity versus time, are often transformed by a
mathematical operation to make the graph a straight line. For
exponential curves such as radioactive decay, taking the natu-
ral logarithm of the activity transforms the data into a straight
line. The straight-line form might be preferred because sub-
sequent interpretations or calculations are simplified. The
use of logarithms as a process to transform curvilinear data
into straight lines is so common that a special type of graph
paper is often used to simplify the process (see Figure 1-5).
Semilogarithmic graph paper has axes with divisions that
are proportional to the logarithm of the y-axis so that the
y values are simply plotted at the appropriate point without
Semilogarithmic graph paper is available with a varying num-
ber of cycles, or powers of 10, on the y-axis. Figure 1-5 shows
10
9
8
7
6
5
4

Y = 5 + 0.5 (X) 3

15 2

1
Y 10 9
8
7
∆Y=5 6
5
5 4

3
∆ X = 10
2
0
0 5 10 15 20
X
FIGURE 1-4 Straight-line graph with slope = 0.5 and inter- 1
cept = 5. FIGURE 1-5 Two-cycle semilog graph paper.

two-cycle graph paper, which can accommodate y values that
span a range of no more than 102. The user simply relabels
the numeric values on the y-axis to correspond to the range
of the data involved. For example, the y values could range
from 0.23 to 7.9, with the y-axis labeled with 0.1 at the bot-
tom, 1.0 in the middle, and 10.0 at the top. Alternatively, the
data might fall into the range of 200 to 8000, with the cycles
labeled from 100 through 1000 to 10,000.
Measurement of Effective Half-Life
A typical procedure with nuclear medicine data is to calculate
the effective t1/2 of excretion from some organ in the body. As
an example, consider a patient who is given a meal of radio-
active food to determine the t1/2 of the emptying of the stom-
ach. The radioactivity counts emanating from the stomach
are plotted on semilogarithmic graph paper (Figure 1-6).
The t1/2 of excretion can be determined by drawing a free-
hand visual-estimate straight line through the data points.
Each data point is contaminated with statistical and system-
atic noise, or uncertainty, in the actual y value; therefore,
the straight line will probably not pass exactly through all, if
any, of the data points. Use of this method to determine t1/2
relies on the data points being reasonably well represented
as a straight line on a semilogarithmic plot. Often the data
appear more like a straight line at later time values; therefore,
these values are used to estimate the straight-line fit. After
the straight line is drawn, the t1/2 can be determined as the
interval needed for the straight line to decrease by a factor of
½. Just pick any convenient starting value for y and then read
from the graph the time needed to reach y⁄2. In Figure 1-6,
the visual-estimate best-fit straight line has a y-intercept (or
y0) of 7800 ct, and the line falls to 3900 ct (y0/2) in 12.5 min-
utes; therefore, t1/2 = 12.5 minutes by the visual-­estimate
best-fit line.
10k
9k
8k Y0
7k
6k
5k
Log (stomach counts)
4k
Y0/2
3k
2k
1k
0 5
FIGURE 1-6 Measurement of effective t1/2 = 12.5 minutes in the stomach by visual estimate of
best-fit line on semilog plot.
CHAPTER 1 Mathematics and Statistics 19
In some cases the data never decrease by a factor of ½ over
the time of the experiment, but it is still desired to calculate
the t1/2. In this case, the proper calculation (remembering that
radioactive decay follows the equation ln y = ln y0 − λt) is to
find the slope, which is equal to −λ, and the negative decay
constant, which is based on the counts (y) and time (t) of any
two points on the straight line.
[In(y2) − In(y1)]
−λ =
[t2 − t1]
Next, the t1/2 is calculated from the t1/2 = 0.693/λ. Note that
the equation for the decay constant slope requires calculation
of the natural logarithm of the count values in the numerator.
The logarithm need not be calculated to plot the data (because
of the convenience of semilogarithmic graph paper), but cal-
culation of the slope λ does require calculation of the loga-
rithm of any two arbitrary points on the straight line. Suppose
that the data were acquired through only 10 minutes and that
it was desired to still calculate t1/2, although the data do not
decrease to y0/2 in only 10 minutes. Using two points on the
estimated best-fit straight line—(0, 7800) and (10, 4400)—the
decay constant is calculated as follows:
[In(4400) − In(7800)] −0.573
−λ= =
[10 min − 0 min] 10 min
so
λ = 0.0573 min−1
Next, t1/2 = 0.693/λ is calculated as 12.1 minutes, in close
agreement with the graphic method, which estimated t1/2 =
12.5 minutes.
Note that many nuclear medicine procedures yield graphs
of counts versus time that do not follow a simple straight line
Eyeball best fit line
T1/2
10 15 20 25 30
Time (minutes)
20 SECTION 1 Foundations

on semilogarithmic plots. Several half-lives or several organs discussed previously. The least squares method calculates the
might be excreting a radiopharmaceutical from the body. It is a and b that minimize the sum of the square of the distance in
then not correct to calculate a single t1/2 from any data that do the y direction between the best-fit straight line and the data
not appear to follow a straight line. Analysis of multiple half- points. Use of a scientific calculator or computer program can
life data requires other methods, such as curve stripping and greatly speed calculations. Use of a computer is much simpler;
nonlinear least squares. the user enters x, y values in a spreadsheet format and instructs
the computer to plot the data and the regression line. Almost
Least Squares Curve Fitting all popular spreadsheet and graphics software packages offer
The technique of visually estimating the best-fit straight line linear regression (e.g., a computer spreadsheet program calcu-
is fraught with inaccuracy and imprecision because each lates and plots the best-fit line).
observer’s visual estimate line is unique. This could result Calculation of the regression line by hand is tedious but
in different values for the t1/2, which is based on the straight not complicated. The first step is the calculation of four sums
line, or in different values for predicting a y value at any x based on the x, y data values. Next, some simple multiplica-
value using the straight-line fit to the data. A more mathe- tion and division produce the intercept and slope as follows.
matically precise method to fit the straight line to the data First, calculate the four required sums, using the data for
is the method of least squares, or linear regression.1 In this Figure 1-7, as shown in Table 1-6:
technique, a set of n data values at the points (xi, yi), where i =
Σx = x1 + x2 + xn
1 → n, is graphed and fitted with a mathematically exact tech-
nique. No imprecision occurs; every observer who uses this = 47 + 62 + + 51 = 481
method obtains exactly same answer. This type of calculation Σy = y1 + y2 + + yn
is generally performed to show a linear relationship between = 43 + 65 + + 46 = 479
two variables or to predict some y variable based on measure- Σxy = x1y1 + x2y2 + + xnyn
ment of some x variable. = 47(43) + 62(65) + + 51(46) = 24,165
Figure 1-7 shows data for x, y values from an experiment
Σx = x12 + x22 + + x2n
2
involving measurement of cardiac ejection fraction (EF) by
two different techniques: a previously used method and the = 472 + 622 + + 512 = 24,543
new method, which involves some change in experimental
technique. Do these data show that the old method and the Next, the intercept and slope are calculated as:
new method yield identical results? Or, given some value for
EF by the old method (an x value), what would be the predicted a=
[ Σx2 ( Σ y) − Σx( Σ y)]
results for EF by the new method (a y value)? The least squares [n(Σ x2) − Σx( Σ x)]
method, or linear regression, calculates the best-fit values for
y-intercept (a) and slope (b) in the best-fit straight line: y = a + [24543(479) − 481(24165)]
a= = 9.43
bx. The intercept and slope parameters define a straight line, as [10(24543) − 481(481)]

70

Y = 9.43 + 0.800 X
r = 0.94
60 SEE = 3.9
EF New method

50 Regression
line

40

30
Line of identity

20 30 40 50 60 70
EF Old method
FIGURE 1-7 Regression analysis or least squares best-fit curve to compare old and new meth-
ods for calculating ejection fraction (EF).
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 In the more severe cases with already existing impaction of the
colon, purgatives and copious injections will be demanded as advised
under that disease.
In dogs the first object is the unloading of the rectum and colon
and this usually demands direct mechanical intervention. (See
Intestinal Indigestion with Constipation.) In case of hypertrophied
prostate this may be rendered somewhat difficult, yet with a free use
of oily, soapy or mucilaginous injections it can usually be
accomplished.
The further treatment is on the same line as for the soliped. An
abundance of exercise in the open air is a prime essential, together
with a free access to fresh water. House dogs must be taken out for
urination and defecation at regular times that are not too far apart.
The food must be of a laxative nature. At first fresh whey or
buttermilk only may be allowed, but as some action of the bowels is
obtained well salted beef tea, pulped or scraped red muscle seasoned
with salt, or milk treated in the same way is permissible. If the
bowels fail to respond when the dog is taken out at the regular times
an injection of cold water may be given. Sulphate of eserine (⅕ gr.)
may be given daily by the mouth or hypodermically, or castor oil (½
to 1 oz.) may be administered at one dose to be followed by careful
dietary and hygienic measures. Or sweet oil, calomel and jalap,
podophyllin, or colocynth may be substituted. When the bowels have
been freely opened a daily morning dose of a drop of the fluid extract
of belladonna and ½ gr. of nux vomica will often materially improve
the peristalsis. Active manipulation of the abdomen may be
employed, or, if available, a current of electricity through the torpid
bowels for 10 or 15 minutes daily.
 CONSTIPATION IN BIRDS.
Causes: Matted feathers, impacted cloaca, arrest of eggs, debility, catarrh,
parasites, nervous disorder. Symptoms: swelling of anus, pendent abdomen,
waddling gait, straining without effect. Treatment: remove obstruction by
mechanical means, cut off matted feathers, egg matter may demand laparotomy,
castor oil, tincture of rhubarb, enemata, green food, ensilage, roots, onions.
In birds torpid and obstructed bowels may come from the effects
of a previous diarrhœa, which has led to the matting together of the
feathers over the anus at once obstructing defecation and rendering
it painful. It may result in and be aggravated by a slow accumulation
of indigestible matters in the intestine or cloaca (pebbles, feathers,
etc.), and the arrest of eggs in the oviduct, pressing upon and
obstructing the bowel. In a recent case the author removed 18 ozs. of
impacted egg matter from the oviduct of a hen, which when divested
of this load weighed barely 2 lbs. Debility of the general system and
particularly of the walls of the bowels, and its various causes (old
age, exhausting disease, intestinal catarrh, parasites, nervous
diseases, etc.) retard defecation and favor impaction as in the
mammal.
The symptoms may be; hard dry droppings, matting of the
feathers over the anus with feculent matters, a firm swelling
surrounding the sphincter, a pendent condition of the abdomen
which when manipulated is felt to be firm and resistant, ruffling of
the feathers, drooping of the head, wings and tail, walking sluggishly
with legs half bent and a waddling gait, and ineffectual attempts to
defecate.
Treatment. As in dogs remove the obstructing mass by mechanical
means. Matted feathers may be clipped off, and feculent
accumulations may be dislodged by the aid of the finger, or in small
birds of a blunt prob. This may be favored by manipulation through
the abdominal walls, and the injection of soapy or oily enemata.
Accumulations of impacted egg matter may be similarly removed, or,
failing this, by an incision made through the abdominal walls and
oviduct. As a purgative give one or two teaspoonfuls castor oil
according to the size of the hen, or a few drops to a small cage bird.
For the latter Friedberger and Fröhner advise a few drops of tincture
of rhubarb in the drinking water. Injections of warm or cold
soapsuds or water may be continued as symptoms demand. Green
food, ensilage, roots, worms, snails and insects are indicated to
correct the tendency to costiveness and may be continued until the
bowels have acquired their proper tone. A moderate allowance of
onions is often of great value.
 HAIR BALLS IN THE INTESTINES—HORSE.
EGAGROPILES.
Seat, colon, cæcum; hair of oat seed, clover leaf, vine tendrils, hair of horse,
nucleus, calcic admixture, straw, in horses on dry food, with depraved appetite, or
with skin disease. Symptoms: none, or torpid bowels, colics, recurring,
fermentations, tympany, obstruction, rupture, peritonitis, rectal exploration.
Lesions: impacted ball, with excess of liquid and gas in front, rupture, ragged
bloody edges. Treatment: extraction, enemata, eserine, barium chloride.
Hair balls, received the name of egagropiles because of their
discovery in the alimentary canal of the wild goat, but they are found
in various forms in all the domestic animals. In horses they occupy
the cæcum and colon and are most frequently composed of the fine
vegetable hairs that surround the grain of the oat, or the leaf of
clover, of the woody tendrils of vines, and of the hairs of themselves
and their fellows taken in at the period of moulting. They sometimes
contain a nucleus of leather or other foreign body which has been
swallowed but in many cases no such object can be found, the hair
having become rolled and felted by the vermicular movements of the
stomach and intestines. An admixture of mucus assists materially in
the felting, and calcareous and magnesian salts may make up the
greater part of the mass, rendering it virtually a calculus. They may
further have a large admixture of straw and vegetable fibres of larger
size than oat or clover hairs. They are most frequent in horses kept
on dry food, (sweepings of oatmeal mills) and at hard work, and
which show depraved appetite and lick each other. Omnibus horses
suffer more than army horses. Skin diseases, by encouraging licking,
contribute to their production.
Symptoms. In the great majority of cases hair balls do not
seriously incommode the horse. They do not attain a large size, and
being light do not drag injuriously on the intestine and mesentery.
They do, however, retard the movement of the ingesta, and when
grown to a considerable size they may block the intestine, more
particularly the pelvic flexure, the floating colon or rectum. Under
such conditions they produce colics which may be slight, transient,
and recurrent, or severe and even fatal, having all the characteristics
of complete obstruction from other causes. Fermentations,
tympanies, and straining without defecation are common features.
When the obstruction takes place in the pelvic flexure, the floating
colon or rectum, it may often be detected by rectal exploration. When
complete obstruction occurs all the violent symptoms of that
condition are present, and these may pass into those of rupture
(Peuch, Leblanc, Neyraud), and shock or peritonitis. If the animal
has passed hair balls even months before, the colics may with
considerable confidence be attributed to other balls of the same kind.
Lesions. In case of death there are the usual lesions of gaseous
indigestion, with or without enteritis, but with the accumulation of a
great quantity of liquid contents, above the ball, which is felt as a
firm body impacted in the gut. In other cases the distended bowel
has given way and the liquid contents and often the hair ball as well
are found free in the abdominal cavity. In such a case the edges of the
laceration are covered with blood clots and thickened with
inflammatory exudation, and there is more or less peritonitis.
Treatment. Relief may sometimes be obtained by the extraction of
a hair ball lodged in the rectum or adjacent part of the floating colon.
In other cases abundant soapy or oily enemata, and the employment
of eserine or barium chloride subcutem are indicated.
 HAIR AND BRISTLE BALLS IN DOG AND
PIG.
From licking in skin disease. Symptoms: of obstruction. Treatment:
manipulation, enemata, oil, antispasmodics, eserine, barium chloride, laparotomy,
diet in convalescence.
The hair balls of dogs come mainly from licking themselves when
affected with skin diseases or parasites. In pigs they are mostly
attributed to depraved appetite.
The hair balls of the dog are small, open in texture, and easily
disintegrated, having little mucus and no earthy salts in their
composition.
The bristle balls of pigs take the form of straight or curved rods of
firm consistency, but without earthy salts. The projecting ends of the
bristles render them particularly irritating.
The symptoms are those of obstruction of the bowels, and the
treatment consists in efforts to dislodge them. If situated near the
anus they may sometimes be reached with the finger, or copious oily
injections may facilitate their passage. Manipulations through the
abdominal walls may be helpful in the dog. Oleaginous laxatives and
antispasmodics may be tried, or these failing, eserine or barium
chloride. As a last resort laparotomy may be performed, the ball
abstracted and the intestine and abdominal wall carefully sutured
(Siedamgrotzky). In such a case the diet should be restricted for a
week to beef soups, buttermilk, and well boiled gruels, especially
flaxseed.
 INTESTINAL CALCULI. ENTEROLITHS.
BEZOARS.

Earthy basis, nucleus, stratification, in cæcum or colon, multiple, size, number

up to 1000. Composition, phosphates of lime, magnesia, and ammonia, silica,
mucus, epithelium, organic matter. Ammonio-magnesian tend to crystalline form,
common phosphate of lime to smooth forms. Concretions. Source in food.
Ammonia from bacteridian fermentation, action of colloids, varied nuclei, rapid
growth. Lesions: catarrh, dilation, obstruction, rupture, peritonitis. Symptoms:
intermittent colics with obstruction, tympany, bowel distension, liquid and
gaseous, before obstruction. Diagnosis: by hand in rectum, hard obstruction with
distension in front. Treatment: purgative dangerous, but exceptionally successful,
extraction, oleaginous enemata, laparotomy.

Horse. Intestinal calculi have an earthy basis (ammonio-

magnesian phosphate, or oxalate of lime, and more or less silica)
glued together by mucus and having a central nucleus usually of
some foreign body, (a particle of sand, pebble, morsel of hair, lead,
cloth, nail, coin, blood clot, or inspissated mucus) around which the
earthy salts have been deposited layer after layer. They are usually
formed in the cæcum or double colon and may be multiple and
moulded upon each other, so that they become discoid, angular or
otherwise altered from the globular shape. The worn, flattened
surface in such cases shows concentric rings representing the layers
as deposited in succession.
The size of the masses may be from a pea or smaller, up to calculi
of six inches in diameter.
In number there may be a single calculus or there may be an
indefinite quantity. Zundel counted 400 in a single colon, and Gurlt
1,000.
 Composition. They are usually composed of phosphate of lime and
of magnesia, of ammonio-magnesian phosphate, with a little silica,
mucus, epithelium, and organic matters from the ingesta. Traces of
sodium chloride, and iron oxide may also be present.
The phosphates of lime, magnesia, and of ammonia and magnesia
usually constitute the main part of the calculus. Fürstenberg found
specimens in which the ammonio-magnesian phosphate amounted
to 72 to 94 per cent.
The calculi containing an excess of ammonio-magnesian
phosphate tend to assume a crystalline or coralline form which
causes them to be specially irritating to the mucosa. When broken
they show a radiated structure from the centre to the circumference
in addition to the concentric rings. These are usually of a yellowish
brown or a gray color and have a specific gravity of 1694 to 1706.
Calculi in which the common phosphate of lime abounds are likely
to be smooth on the surface and on section show the concentric rings
more distinctly and the radiating lines less so. The brownish calculi
of this variety are much more compact, and harder than the
crystalline or mulberry calculi, and have a higher specific gravity—
(1823).
Bluish calculi with a smooth glistening surface and lower specific
gravity—1681—, have been found of small size and in great numbers
in the colon (1000 in the colon, Gurlt).
In some calculi there is a large admixture of alimentary matters,
and a low specific gravity (1605 to 1674). These were designated as
pseudo calculi, by Fürstenberg.
In still other cases a calculous looking mass, when broken into, is
found to be composed of a mass of dried alimentary matter enclosed
in a thin layer of lime salts. These have a low specific gravity (1446 to
1566) and have been named concretions by Fürstenberg.
Causes. As a large proportion of the calculus is phosphate of lime
or ammonio-magnesian phosphate, we must look for the source of
these in the food and then at the conditions which determine their
precipitation.
The percentage of ash and of phosphoric acid in the common foods
of horses may be seen in the following table:
 Ash. PO5 in the Ash. PO5 in the entire food.
Per cent. Per cent. Per cent.
Wheat bran 7.3 50 3.65
Wheat grain 3.0 46.38 1.3914
Oats grain 2.50 26.5 0.6625
Barley grain 3.10 39.9 1.2276
Bean grain 3.10 31.6 0.9864
Pea grain 2.75 34.8 0.957
Tare grain 3.00 36.2 1.086
Indian corn grain 1.5
Rye grain 1.6 39.9 1.0384

The source of the magnesia may be found to a large extent in the

grains represented in the following table:

Ash. Mg. in Ash.

Per cent. Per cent.
Oat, grain 2.50 7.3
Barley, grain 3.10 8.5
Rye, grain 1.6 2.4
Wheat, grain 2.12 9.98
Wheat, bran 7.3 11.2
Bean 3.1 6.6
Pea 2.7 5.6

The amount of magnesia in each of these grains is amply sufficient

to furnish the material for the constant growth of a calculus. Wheat
bran is preëminent in the amount of its magnesia and therefore
wheat bran has been charged with predisposing to calculi. In the
perisperm as a whole, Fürstenberg found 1 per cent. of phosphate of
magnesia, and in coarse bran not less than 2.5 per cent.
The ammonia which is essential to the precipitation of the
phosphate of magnesia in the form of the compound salt (ammonio-
magnesian) can be found wherever proteids are in process of septic
fermentation. The slightest failure to peptonize every particle of such
proteids, implies septic change and the evolution of ammonia, which
on coming in contact with magnesia phosphate instantly precipitates
the insoluble salt.
This fully agrees with the doctrine of the formation of urinary
calculi through the agency of bacteria, since the ammonia is
essentially a fermentation or bacterial product.
It may also be noted that the experiments of Rainey and Ord
showed that in the presence of colloids (mucus, epithelium, pus,
blood) the earthy salts are precipitated as minute globular bodies
which by further accretions become calculi. In the absence of colloids
the salts tend to precipitate in angular crystalline forms, so that the
mulberry and coralline calculi may possibly have been precipitated in
the absence of such bodies. From the solvent quality of ammonia,
however, the contents may easily pass from a fermenting liquid
containing colloids to a non-fermenting and noncolloid mixture.
The presence of a solid body which may act as a nucleus is an
essential element, and the condition of the food or drink will often
supply this. It has been noticed that army horses in the field, feeding
from the ground and taking in sand and pebbles, are unusually liable
to intestinal calculus. Horses which lick earth in connection with
acidity of the stomach or other dyspepsia are specially subject to it.
Horses watered from shallow streams with sandy bottoms, where
they take in sand with the water, have been similarly affected.
Millers’ horses, in the days of old process milling, suffered not alone
because of the abundance of oat hairs in the feed but also on account
of the grit from the millstones. Hay and other fodders that have lain
on the ground and which contain earth and sand furnish other
sources of such nuclei. Shingle nails and other small nails, pins,
needles, coins, etc., which have mixed with the feed are common
causes of trouble, and indeed any foreign body may become the
centre and starting point of a calculus.
Catarrhal affections and other lesions of the mucosa, which furnish
excess of mucus, beside pus, lymph and even blood as nuclei, are
invoked as starting points of the calculi, but however true this may
be in particular cases, irritation and catarrh appear to be much more
frequently the result than the cause of the calculus.
Attempts have been made to estimate the time taken in the
formation of a calculus by allowing a ring for each feed and
successive deposit therefrom (Fürstenberg, Colin). Thus a calculus of
14 pounds with 720 layers, it was estimated could be formed in one
year at two feeds per day. More definite evidence was found in the
case of Pastore in which a coin with the mint mark of 1847 was found
as the nucleus of a calculus the size of the fist in 1848.
Lesions. Formed in the most spacious parts of the colon and
cæcum, calculi usually rest there for a length of time without visible
injury, and it is only when they are moved onward and get arrested at
a narrow part of the gut (pelvic flexure, floating colon, rectum) that
they cause appreciable trouble. Yet it is claimed that by their weight
they drag upon the yielding walls of the bowel, causing dilatation and
attenuation, weakening the peristalsis and predisposing to rupture.
The compression of the vessels also tends to anæmia and atrophy. In
the case of rough crystalline calculi the mucosa is subjected to
attrition, irritation, and inflammation. The more serious and urgent
trouble is that of obstruction of the narrower portions of the colon
and rectum, which may be absolute and persistent, leading to
rupture and death or a fatal inflammation on the one hand, or may
end in recovery on the other, in connection with a displacement
onward or backward of the calculus as the result of peristalsis or
anti-peristalsis.
Symptoms. These are intermittent colics, each reaching a climax
and followed by a sudden recovery as the calculus is displaced into a
more spacious part of the colon. A significant feature is the complete
obstruction, fæces being passed for a short time at first and then
suddenly and absolutely stopped. Coincident with this are tympany,
violent colics, straining, rolling, sitting on the haunches,
perspirations, anxious countenance, and all the symptoms of
obstruction.
Diagnosis is never quite certain unless the practitioner with his
oiled hand in the rectum can detect a hard stony mass obstructing
the pelvic flexure of the double colon with a tense elastic distended
bowel immediately in front of it, or a similar hard obstruction of the
terminal part of the floating colon with a similar distension in front
of it. The pelvic flexure may usually be felt below and to the right at
the entrance to the pelvis, and the floating colon above, under the
right, or more commonly the left kidney. Calculi in the more spacious
parts of the double colon or in the cæcum are inaccessible to
manipulation. The feed (bran, ground feed) will be suggestive, as will
the occupation of the proprietor (miller, baker).
Treatment. This is rather a hopeless undertaking. No effective
solvent of the calculus can be given, and purgatives usually increase
the danger by increasing the peristalsis and dangerously distending
the bowel above the point of obstruction. It is true that this is
sometimes followed by a temporary recovery the calculus being
loosened and falling back into the dilated portion of the bowel. Less
frequently the increase in the peristalsis forces on a moderately sized
calculus to complete expulsion. It is a desperate though sometimes
successful resort. A more rational course of treatment is the dilation
of the bowel back of the obstruction by copious mucilaginous, soapy
or oleaginous enemata. Trasbot suggests CO2 produced by injecting
sodium bicarbonate and tartaric acid. This may be seconded by the
hypodermic injection of barium chloride or of atropia. When the
calculus is lodged in the floating colon or rectum it may be possible
to reach it with the hand and extract it at once. The last resort, is by
laparotomy for the removal of the calculus. One such successful case
is on record in which Filizet removed a calculus as large as an
infant’s head. In other cases the horses failed to survive. Desperate as
the resort may be it is not to be neglected in a case of undoubted
calculus, solidly impacted and of such a size that its passage is
impossible. A fatal result is imminent, and even if the present attack
should pass off it can only be looked on in the light of an
intermission, so that there is practically nothing to lose in case the
result should prove fatal. Anæsthesia and rigid antiseptic measures
should of course be adopted.
 FOREIGN BODIES IN THE INTESTINES OF
SOLIPEDS.
Sand, pebbles, earth, lime, nails, pins, needles, coins, shot, cloth, leather, rubber,
sponge, tooth, bone, wood, twine. Symptoms: as in intestinal indigestion or calculi,
or sand or pebbles in fæces; peritonitis, phlegmon. Lesions: congestion, catarrh,
ulceration, abscess, needles may travel to other organs. Treatment: laxative,
enemata, or as for calculi.
All sorts of foreign bodies are taken in with food and water and
find their way to the intestines. Sand from drinking from shallow
streams with sandy bottoms, from browsing on sandy pastures where
the vegetation is easily torn up, or from feeding grain from sandy
earth will sometimes load the intestines to an extraordinary extent so
that such horses will pass sand for some weeks after leaving the
locality. Small stones and gravel are taken in in the same way or from
the habit of eating earth or licking crumbling lime walls. Nails, pins,
needles, coins, shot, pieces of cloth, leather, caouchouc, sponge, and
even a molar tooth and a piece of a dorsal vertebra have been thus
taken. Recently the author saw a small twig of hard wood transfixing
the pylorus and duodenum with fatal effect. In another case were
balls of binding twine which had been taken in with the fodder on
which it had been used.
The symptoms are usually those of intestinal indigestion or calculi.
In some cases, however, they are peculiar, thus there may be a
constant passage of sand, there may be indications of peritonitis, or
there may form a phlegmonous swelling of the abdominal walls in
the abscess of which the foreign body is found.
Lesions. Pechoux found 56 lbs. of a brownish earth in the cæcum
and colon. Congestion and ulceration of the intestines are common,
with occasionally abscess. All the lesions that attend on or follow
obstruction may be met with. Boullon saw a remarkable case of the
ingestion of needles in which these bodies were found in the small
intestine, liver, pancreas, diaphragm, kidney and lung.
Treatment varies with the character of the bodies ingested, sand
and gravel may be passed on by a laxative diet and even by the use of
mild laxatives. Bernard gave 10 quarts of water and 4 oz. Glauber
salts every hour for eight days, and the same amount by enema. For
the larger solid bodies which obstruct the intestines the treatment is
the same as for calculus. For sharp pointed bodies causing abscess
and fistulæ, we must follow the indications, ever aiming at the
discovery of the whereabouts of the offending object and its removal.
 FOREIGN BODIES IN THE INTESTINES OF
RUMINANTS.
Foreign bodies are usually arrested in the rumen of cattle and
unless sharp, pointed or rough so as to cause mechanical trouble or
caustic so as to act chemically, rarely do much harm. The most
extraordinary objects that have found their way into the intestine are
snakes. Gherardi claims that he found in the intestines a snake of 25
inches long; Jager found one of 21 inches in length, in an advanced
state of decomposition, in the rectum of a calf. It is supposed that
both had been taken in with the food. In each case there was
obstruction of the intestine with severe colicy symptoms.
 FOREIGN BODIES IN THE INTESTINES OF
CARNIVORA.

Small bodies, especially playthings, feathers, hair, bristles, bones of prey.

Lesions: congestion, inflammation, hemorrhage, ulceration, perforation,
invagination. Symptoms: colic, vomiting, tucked up belly, straining, palpitation,
rabiform symptoms, cough, convulsions. Course: emaciation, prostration, death in
five days or two weeks according to seat of obstruction. Treatment: Oleaginous
injections, laparotomy.

Causes. The dog is especially liable to this form of trouble, in

consequence of his habit of carrying objects in his mouth and of
playing with different objects especially the playthings of children.
Marbles, pebbles, spinning-tops, corks, coins, nuts, peach stones,
pieces of rubber, cloth or leather, bits of wood, sponge, needles, pins,
potato, bone, cord, hair, bristles, feathers, wire, and a number of
other objects. Some of them like feathers, hair, and bones are
swallowed with food, and when that has been digested, they are
either vomited or failing in this, are passed on into the intestine.
Lately the author made a post mortem of a house dog with over 24
inches of the jejunum virtually blocked with fragments gnawed from
a caouchouc ball and pieces of twine.
Cats also swallow a variety of objects. Benjamin and Megnin
record three cases of intestinal obstruction by the crystal drops of
shades.
Lesions. When the lumen of the intestine is blocked with a round
solid body like a marble or peach stone there occur active congestion,
inflammation, blood stasis and hemorrhage, with in many cases
necrosis, ulceration and perforation. Similar lesions occur from cord.
In a recent case of impaction with gnawed fragments of caouchouc
and cord, the 24 inches of the bowel implicated were the seat of
extended patches of necrosis and of deep, and even perforating
ulcers on the lesser curvature of the intestine, evidently caused by
the tension of the stretched cord on the shorter attached border of
the gut. Cadeac says the lesions from cord are always at the point of
attachment of the mesentery, whereas those coming from round or
cubical solid bodies are mainly on the greater curvature. Mathis
found at the pylorus a piece of net from which a cord extended
through the small intestine and ended in a ravelled mass near the
ileo-cæcal valve. The dragging of the cord on the intestine often
causes invagination at one or several points.
Symptoms. There may be slight colic, dullness, a disposition to lie
curled up in some secluded place, loss or caprice of appetite,
vomiting, tucked up abdomen, arching of the back, straining, and
unless the bowels are distended with gas, the obstruction can usually
be felt by the two hands applied on opposite sides of the abdomen.
The matters vomited are at first alimentary, then bilious and in the
advanced stages always feculent.
The French veterinarians assure us that rabiform symptoms are
very common as the result of obstruction of the intestines with
foreign bodies. The indications are signs of fury without the barking
which characterizes genuine rabies. The patient becomes wicked,
cross and excitable, sometimes dull and morose, and snappish, his
eyes glittering and his mouth frothy. He has alternate paroxysms of
fury and torpor, at one time flying at and biting any living thing he
meets, or tearing some object to pieces, and at another hiding away
in secluded and dark corners. Massenat saw two dogs supposed to be
affected by rabies, but which recovered promptly after having
vomited the foreign bodies which they had swallowed. In a country
where rabies is so prevalent as in France, it would be interesting to
see the results of inoculation with some of the most pronounced of
these rabiform cases.
Beside the rabiform symptoms cough and epileptic seizures
occasionally result from the foreign bodies.
Course. Termination. Unless relief is obtained by vomiting or
purging, appetite ceases altogether, emaciation advances rapidly, the
animal becomes dull and stupid, being evidently poisoned by the
absorbed toxins, and death may ensue in four or five days if the
obstruction is near the stomach, or in one or two weeks if in the large
intestines.
Treatment. The general treatment advised for the horse is
applicable to the carnivora. Purgatives are always dangerous as
threatening the overdistension and rupture of the bowel above the
obstruction. Oleaginous and mucilaginous injections with
manipulations are more promising if the obstruction is in the colon
or rectum.
In many cases laparotomy is the only hopeful resort. Felizet and
Degive have been quite successful in removing corks in this way, and
Fröhner advises the operation to be performed under opium
narcosis, and with antiseptic precautions. Make an incision of 1¾
inch near the umbilicus and parallel to the linea alba, extract the
blocked loop of intestine, ligature it in front of the foreign body and
behind it, incise, remove the offending mass and carefully close by
sutures, bringing the muscular and serous coats in accurate
opposition. Remove the ligatures, disinfect, return the bowel into the
abdomen, close the abdominal wound with sutures and apply an
antiseptic bandage.
If such cases are to be operated on it is important that it be done
early, before the occurrence of necrosis, ulceration, perforation, or
general infection.
 RUPTURE OF THE INTESTINE. SOLIPEDS.
Causes: overdistensions in front of obstructions, softening, friability, necrosis,
suppuration or ulceration, Duodenum from worms or perforation by pointed
bodies, exudate in verminous embolism, petechial fever. Jejunum and ileum, by
disease of walls, ulcers, abscesses, neoplasms, caustics in umbilical hernia,
clamping of hernia. Cæcum, falls, blows, kicks, blows of horn, tusk, stump, calculi,
abscesses, cauterizing of hernia. Colon, external traumas, calculi, worms,
verminous thrombosis, neoplasms, abscesses, overdistensions, violent straining,
arsenic. Symptoms: follow accident, signs of obstruction, no rumbling, tympany,
stiffness, great prostration, fever. Death in short time.
Causes. Ruptures occur as we have already seen from
overdistensions of the bowel in front of some obstruction, by ingesta,
concretions, calculi, foreign bodies, etc., and this may take place in
the most healthy organs. In other cases, however, there has been
some pathological process at work rendering the intestinal wall soft,
friable, necrotic, suppurative or ulcerative, by which its substance is
attenuated or its consistency or cohesion reduced.
Duodenum. Lacerations of the duodenum are often connected
with obstruction by tumors or the ravages of worms. These latter are
mostly the ascaris megalocephala, accumulated in mass, and
sometimes engaged in pouches outside the walls of the gut. In other
cases, the walls of the intestine have been perforated by hard woody
stalks of straw or hay (Mollereau) or of still more woody plants as in
a case observed by the author, and in which the pylorus was
perforated. Sometimes the exudate or blood extravasation attending
on petechial fever, or verminous embolism will pave the way for the
rupture. Perforations by pieces of wire (Schmidt) or other metallic
bodies are also observed. Adhesive peritonitis has also rendered the
walls friable and predisposed to rupture.
Jejunum and Ileum. Lesions are most frequent toward the
termination of the ileum and resulting from obstructions of the
bowel or the weakening of the walls by disease, or both. Ulcerations,
abscess of the closed follicles opening into the peritoneum, and
neoplasms of various kinds are to be especially noted among the
causes. The impaction of the cæcum, blocking the ileo-cæcal valve is
also among the observed factors. Other instances have been traced to
deep cauterization of an umbilical hernia, the enclosed loop of small
intestine becoming inflamed and perforated. The author has
observed one instance from clamping of a hernia in which the
contained intestine was adherent to the hernial sac.
Cæcum. From its position on the lower part of the abdomen and
from its habitual plenitude with food or water, this organ is
especially exposed to direct mechanical injuries and ruptures. A
sudden fall, more especially if the umbilical region strikes on a stone
or other projecting solid body, kicks with heavy boots or with the feet
of other animals, blows with a cow’s horn or a boar’s tusks, and
violent contact with stumps, poles and other objects may be the
occasion of the rupture. These are usually found near the base of the
viscus and across its longitudinal direction.
Inflammations, connected with punctures, calculi, parasites, etc.,
may render the walls so friable that they give way under slight strain
or injury. Abscesses have been found in the walls of the viscus
leading to perforation, and extension of inflammation from an
umbilicus cauterized for hernia has determined adhesion and
perforation.
Colon. The loaded colon is even more liable to mechanical injury
than the cæcum. Occupying as it does the more lateral parts of the
abdominal floor, it is even more exposed to kicks and blows, and
extending as it does back toward the inguinal regions, it is especially
in the way of blows of horns so often delivered in this region. From
the solid nature of its contents the presence of calculi, the presence
of blood sucking worms, and its implication in the congestions and
extravasations of verminous thrombosis, this organ is especially
liable to degenerations and inflammations which render its walls
particularly friable. Neoplasms of various kinds, cancerous,
tubercular, etc., have been found on its walls as occasions of rupture.
Abscesses of strangles have ruptured into the viscus. Overdistensions
in front of an obstruction in the pelvic flexure, floating colon or
rectum are the most frequent causes of rupture. Again, cases have
been seen as the result of violent exertions, as during straining in
dystokia. It has been a complication of phrenic hernia, of volvulus of
the double colon, and of ulceration caused by the prolonged
ingestion of arsenic. In severe impaction the necrosis of the intestinal