BASIC PRINCIPLES OF

NUCLEAR MEDICINE

Cowles Chilingulo
INTRODUCTION

 Define Medical Imaging, Nuclear medicine, Radiation,

Radioactivity

 State the brief history of Medical Imaging and nuclear

medicine

 Describe the various types of medical imaging

 Describe the basic principles of nuclear medicine

Definitions

 Medical Imaging – The process of creating visual

representations of the body parts and their physiology in
order to diagnose, monitor or treat medical conditions

 Nuclear medicine – a branch of medical imaging that uses

radioactive materials to diagnose and determine the severity
of or treat various diseases.

 Radiation -  the emission or transmission of energy in the

form of waves or particles through space or through a
material medium.

 Radioactivity - the process by which an unstable atomic

nucleus loses energy by emitting radiation, such as an alpha
particle, beta particle, gamma ray, or electron
History of medical imaging
 1895 Wilhelm Roentgen, German physicist discovered a new
type of ray which was emitted from a vacuum tube through
which a high voltage was passed – ‘X’
 The Ray was capable of passing through heavy paper and
human tissues and producing an image using a detector
(film), the first of such images was his wife’s hand
 This generated new possibilities in physics and for
investigations in medicine and surgery
 In 1896 French scientist Henri Becquerel discovered natural
radioactivity whereby it was discovered that certain types of
atoms disintegrate by themselves.
 He discovered that uranium compound gave off a type of
radiation that could penetrate heavy paper and expose
photographic film
 Pierre & Marie Curie also made discoveries of other
radioactive elements such as polonium and radium in 1898
 However nuclear medicine proper was
discovered by John Lawrence when he made
the first application in patients of an artificial
radionuclide phosphorus -32 to treat
leukemia in 1936
 It gained public recognition in 1946 when a

patient with thyroid cancer metastases was

successfully treated with using radioiodine (I-
131)
 Later other important radionuclides such as

Technetium -99 were discovered

 To date as knowledge about radionuclides

expand there is widespread clinical uses of

nuclear medicine
First x-ray image
taken in 1895
Types of medical imaging
1. Conventional radiography – using x-rays only to
produce the anatomical images of the body
2. Computerised Tomography (CT) scanning – using
x-rays plus a computer
3. Ultrasound (US) imaging – using the properties of
sound to generate anatomical images of the body
4. Magnetic Resonance Imaging – Using the
properties of magnets to generate images of the
body.
5. Nuclear Medicine is a branch of medical imaging
that uses radioactive materials to diagnose and
determine the severity of or treat diseases.
Conventional radiography
 Involves the use x-rays produced by an x-ray
machine which are passed through the
patient body.
 Some x-rays pass through the patient others

are absorbed. Those that pass through are

detected and recorded by a film
 The film can be chemically processed to

display the anatomical image of the patient

 On the resultant film (Radiograph) five

densities can be recognized

Conventional radiography
 Air/gas - appears black (eg. Lung, bowel)
 Fat - appears dark grey (eg. Subcutaneous

tissue
 Soft tissue – appears light grey (eg. Heart)
 Bone – appears white
 Contrast agent – appears white

An object will be seen if it is stands out against

underlying tissue. Eg bone is clearly seen
against soft tissue
If an organ cannot be seen a contrast agent is
used to demonstrate it. (IV injection, oral drug)
 X-ray images are produced using the
anatomical position
 If the x-ray beam passes from the anterior to
the posterior the resulting image is called
Antero-posterior (AP), if it passes through the
sides it is called lateral
 Fluoroscopy is real time radiography in which
dynamic materials can be imaged. For example
contrast agent is introduced in the body and
images are taken while the patient is
swallowing in order to detect the functioning
abnormalities of the organ
An X-ray machine
X-ray images of the Cervical spine and skull
X-ray images showing Urinary bladder, kidneys and ureters
after contrast agent
X-ray image of the uterus and
fallopian tubes after introduction of
contrast agent
Computerised Tomography (CT) Scanning
 In CT scanning x-rays are produced by the machine,
passed through the patient and then detected using
a special detector
 After the detector, the signal so obtained is
transmitted to a computer that analyzes it and
transforms it into black and white images on a
monitor.
 The x-ray tube and the detector are on opposite
ends and rotate around the patient taking the
anatomical images of the patient just like slices of
bread. (Tomo – to cut)
 This means that the CT scanner obtains a series of
images for one particular body part.
CT Scanning Cont’d
 By computer manipulation it is possible to
obtain more accurate information and much
better images of soft tissue of the body as
well as bone than using conventional x-ray
images
 The disadvantage of CT Scanning is that it

uses a lot of radiation as compared to

conventional x-rays.
 However CT Scanning has superior soft tissue

differentiation and ease of image

manipulation
CT SCANNER – PATIENT POSITIONING
CT Scanning cont’d

 CT scan images
CT Scanning Cont’d

X-ray Image of the abdomen (left) and CT Image of the

abdomen (right)
Ultrasound
 Imaging modality that utilizes the properties of sound
that we cannot hear.
 US machine produces sound waves and through a

probe/transducer the waves are transmitted into a

patient to a particular area or body organ
 Different body organs have different ways of interacting

with the sound waves

 On reaching an organ the sound waves interact with it

and the organ produces an echo

 Echo is sent back and detected by the probe. The

detected echo is transformed into an electrical signal

that is further manipulated by a computer, into an image
depicting the organ where the echo came from
 The image is then displayed on a monitor
US Scanning machine (left) using a
probe/transducer to produce images of patient
(right)
Ultrasound images of (left) the liver showing a cystic
structure and (right) showing a 17-week old pregnancy
depicting the baby’s head, abdomen and femur
US Image of the
uterus showing a
fibroid

US image of the eye

showing various parts
US cont’d
 US uses the properties of sound hence there
is no radiation used
 It is examination of choice in imaging of

abdominal/pelvic organs, obstetrics and

gynacology and other soft tissues such as
thyroid, muscle, eyes and prostate. It cannot
be used to demonstrate bones
 On US fluid appears black and soft tissue

appears grey.
Magnetic Resonance Imaging (MRI)

 Utilizes the properties of magnetism. Requires a strong magnetic field,

hydrogen protons in patient’s body, radio waves and a computer to
generate images.
 Patient is placed inside a very strong magnetic field and the hydrogen
protons (which act like tiny magnets) in the body get aligned to the main
magnetic field.
 Then a radiofrequency (RF) energy is introduced that disturbs the
alignment of the hydrogen protons.
 This is followed by the removal of the RF energy resulting into the
achievement of the original alignment of the hydrogen protons with the
main magnetic field.
 During the movement of the hydrogen protons in s strong magnetic field
an electrical signal is produced that is detected by a coil of wire place
above the patient.
 The detected signal is then sent to a computer which transforms into an
image that can be displayed on a monitor
MRI SCANNERS OPEN AND CLOSED MAGNETS
MRI IMAGES IN THREE IMAGING PLANES –
AXIAL, CORONAL AND SAGITTAL
MRI SCANS SHOWING SPINAL CORD
PATHOLOGY
Nuclear Medicine
 Is a type of medical imaging that involves the
application of radioactive substances in the diagnosis
and treatment of disease.
 A radiopharmaceutical is taken (IV, oral or inhaled)
 As it moves or circulates in the body organs, it emits
radiation
 An external detector (gamma camera) capture and
form images from the radiation emitted by the
pharmaceutical.
 This process is used in both diagnosis and treatment.
 This is unlike in diagnostic x-rays where external
radiation is passed through the body to form an
image