Nuclear Medicine

Introduction
What is nuclear medicine?
• The use of radioactive tracers (radiopharmaceuticals) to obtain
diagnostic information [and for targeted radiotherapy].

• Radiation is emitted from inside the human body cf transmitted

radiation in x-ray imaging.
 
Tracers :-
• Trace the paths of various biochemical molecules in our body.

• Hence can obtain functional information about the bodies workings

(i.e. physiology).
 Radiopharmaceuticals

+
Biochemical Radioactive
Pharmaceutical
Bonding nuclide
Traces physiology /
Emits radiation for
localises in organs
detection or therapy
of interest
 The Pharmaceutical
– The ideal tracer/pharmaceutical should follow only
the specific pathways of interest, e.g. there is
uptake of the tracer only in the organ of interest
and nowhere else in the body. In reality this is
never actually achieved.

– Typically want no physiological response from the

patient

– The mechanism of localisation can be as simple

as the physical trapping of particles or as
sophisticated as an antigen-antibody reaction
 Radionuclides in Nuclear Medicine
The ideal radionuclide for in-vivo diagnosis :
• Optimum half life
– of same order as the length of the test (this minimises the radiation dose to the
patient)

• Pure gamma emitter

– No alpha or beta particles, these do not leave the body so merely increase the
radiation dose.

• Optimum energy for  emissions

– High enough to exit the body but low enough to be easily detected. Useful
range for gamma cameras is 50 - 500 keV (optimum ~ 150 keV).

• Suitable for incorporating into a pharmaceutical without altering

its biochemical behaviour
• Readily and cheaply available on the hospital site.
 Some Commonly Used Radionuclides in
Nuclear Medicine
Radionuclide Half-life Pure  Energy of main Source of
emissions ? ’s (KeV) production
99
Tcm (Technecium) 6h y 140 On site generator
111
In (Indium) 2.8 days y 173, 247 Cyclotron
123
I (Iodine) 13 h y 160 Cyclotron
131
I 8 days n 280, 360, 640 Reactor
201
Tl (Thallium) 73.5 h y 68-80 Cyclotron

Radionuclide Production:
• Neutron Capture
• Nuclear Fission
• Charged Particle Bombardment
• Radionuclide Generator
 Producing the Radiopharmaceutical
Radiopharmaceutical kits
• Most common radiopharmaceuticals are available as kits. These
contain all the necessary freeze-dried ingredients in an air-tight
vial, usually the pharmaceutical, a stannous compound and
stabilizer. On addition of 99Tcm 04- , the stannous reduces the
99
Tcm 04- , makes it charged and "sticky", and Tc forms a bond
with the pharmaceutical, labelling it.

• For the longer half-life isotopes, the full radiopharmaceutical can be

obtained directly from the manufacturer, e.g. SeHCAT labelled with
75
Se.
Detection of the radiopharmaceutical
• Non-imaging
– In-vitro (measuring radiation levels in bodily fluids outside the body)
– e.g. Blood sample counting for GFR analysis:

Inject radioactive
tracer

Measure fluid sample

in sample detector

Extract sample of Electronics and

bodily fluid count-rate meter
(e.g. blood)

Patient
Detection of the radiopharmaceutical
• Non-imaging
– In-vivo (Uptake measurements in organs using a radiation detector probe)
– e.g. SeHCAT study for bile salt malabsorption .

Collimator

Scintillation Electronics and

probe count-rate meter
 Detection of the radiopharmaceutical

• In Vivo imaging - the gamma camera

Gamma
Radioactive rays
tracer

Image

Gamma
camera

Patient

Properties of gamma rays

• High energy electromagnetic radiation
• Can be scattered and absorbed
• Cannot be focused
The Gamma Camera

Collimator

NaI
Crystal

Photo Multiplier
Tubes

Analogue to
Digital Converters

Digital
Position
circuitry circuitry

Output position
X Y Z
& energy signals
 The Collimator
• The purpose of the collimator is to project an image of the radioactive distribution in the
patient onto the scintillation crystal.
• It is a crude and highly inefficient device, which is required because no gamma-ray lens
exists.

PARALLEL
LENS COLLIMATOR

Object Image Object Image

• In the parallel hole collimator, only incident photons that are normal to the collimator
surface will pass through it.

• All other photons should be absorbed by the lead septa between the holes
• The collimator defines the field of view, and essentially determines the system spatial
resolution and sensitivity.
 Spatial Resolution & Sensitivity
Spatial resolution of an imaging device defines its ability to distinguish between
two structures close together and is characterised by the blurred image
response to a point-source input. For a gamma camera, the overall spatial
resolution in the image depends on the collimator (collimator resolution) and the
other gamma-camera components (intrinsic resolution).

To improve collimator resolution

0
Collimator cm Output from • Increase the septa depth (d)
collimator • Reduce the size of the holes (s)
Radioactive
• Resolution ↓ as the source is moved
5 cm
pt. source away from the collimator
- important to image with the camera
10 cm as close to the patient as possible

Spread of response To improve collimator sensitivity

15 cm to pt. source defines
s
collimator resolution
• Dependent on the number of photons
d Spatial distance passing through the collimator
20 cm • Improved with larger hole sizes and
smaller length septa

resolution and sensitivity are conflicting parameters

 Scintillation Crystal
NaI(Tl) Scintillation
crystal

Incident
gamma
ray

Light
Photons (~415nm)

• The gamma ray causes an electron release in the

crystal via the Photoelectric Effect, Compton Scattering
or the electron­positron pair production (E > 1.022 MeV),
this excess energy gives rise to subsequent visible light
emission within the crystal (scintillation).

• Number of light photons produced is roughly  E

Hence, this is an energy discriminating detector
(important feature as we can use this to reject scattered photons)
 Image Types
In Nuclear Medicine various forms of data acquisition can be performed:
• Static Imaging
– The distribution of the radiopharmaceutical is fixed
over the imaging period.
– Multiple images can be acquired, viewing from different
angles (e.g. anterior, oblique).
– e.g. kidneys (DMSA), thyroids, bone, lung 99 Tcm Thyroid Scan

• Whole Body imaging

– the camera scans over the whole body to cover more
widespread distributions or unknown locations
– e.g. bone scan, infection imaging, tumour imaging

99
Tcm HDP Bone Scan

• Dynamic Imaging
– Consecutive images are acquired over a period of time
(with the camera in a fixed position) showing the changing
distribution of the radiopharmaceutical in the organ of interest.
– e.g. renogram, GI bleed, meckel’s diverticulum

Tcm labelled red blood cells

99

– GI bleed