Nuclear medicine

Insight about Nuclear medicine

1. NUCLEAR MEDICINE BY M.Vharshini 4 th year Biomedical Sciences

2. Introduction Nuclear medicine is the medical specialty in which unsealed radionucleotides , chemically manipulated to form radiopharmaceuticals, are used for diagnosis and therapy. Radiopharmaceuticals localize in various target tissues and organs and provide better display of physiology and metabolism .

3. Principles Of Nuclear Medicine A wide range of radionucleotides are used in the diagnostic nuclear medicine that meets the necessary requirements for effective and efficient imaging. All radionucleotides are produced artificially, using four principle routes of manufacture . CYCLOTRON BOMBARDMENT: gallium-67, indium-111, thallium-201, cobalt-57, carbon-11, oxygen-15, nitrogen-13 and fluorine-18 REACTOR IRRADIATION: chromium-51, selenium-75, iodine-125 and iodine-131. FISSION PRODUCTS : iodine-131, xenon-133 and strontium-90 GENERATORS THAT PROVIDE SECONDARY DECAY PRODUCTS FROM LONGER LIVED PARENT RADIONUCLIDES: Column generators incorporating molybdenum-99 for the provision of technetium-99m.

4. The use of radiopharmaceuticals for diagnosis or therapy is based on the accumulation or concentration of the isotope in the organ of interest referred as Target organ . A radiopharmaceutical may have an affinity for a certain organ that is not necessarily the target organ, in which case this organ is termed as Critical organ . The risk to which the patient is subjected is clearly a function of the doses received in all organs and is expressed in terms of the effective dose. The risk must be balanced against the expected advantages and benefits rendered by the procedure. Principles Of Nuclear Medicine

5. Nuclear Medicine In Diagnosis Nuclear Medicine imaging procedures are generally non-invasive. The Nuclear Medicine imaging scans use radioactive materials called radiopharmaceuticals or radiotracers . Depending on the type of nuclear medicine exam, the radiotracer is either injected into the body, swallowed or inhaled as a gas and eventually accumulates in the organ or area of the body to be examined.

6. Single Photon Emission Computed Tomography (SPECT) SPECT imaging instrument provide 3 D images of the distribution of radioactive tracer molecules that have been introduced into the patient’s body. SPECT imagers have the gamma camera detectors that can detect the γ ray emissions from the radiotracers that have been injected into the patients.

7. Positron Emission Tomography (PET) PET scans also use radiopharmaceuticals to create three dimensional images. The main difference between SPECT and PET scans is the type of radiotracers used. The radiotracers used in PET scans decay to produce small particles called Positrons .

8. Positrons have equal mass of that of electron but opposite charge. When a positron collides with an electron, annihilation occurs. It results in the production of two or more gamma ray photons that shoot off in opposite directions. Positron Emission Tomography (PET)

9. The detectors in the PET scanner measure these photons and use the information to create images of internal organs. Positron Emission Tomography (PET)

10. LIST OF RADIOPHARMACEUTICALS USED IN DIAGNOSIS AND THERAPY

11. Carbon-11 Chemical Symbol: 11 C Chemical Form: Carbon-11 Choline Half-life:  20.334 minutes . Diagnostic use: Indicated for PET imaging of patients with suspected prostate cancer recurrence based upon elevated blood prostate specific antigen (PSA ).

12. Carbon-14 Chemical Symbol: 14 C Chemical Form: Carbon-14 urea Half-life :   5,730 years Trade name(s): PYtest Diagnostic use: Detection of gastric urease as an aid in the diagnosis of H.pylori infection in the stomach

13. Fluorine-18 Chemical Symbol: 18 F Chemical Form: Fluorine-18 sodium fluoride Half-life:  109.771 minutes Manufacturer: Various Diagnostic use: PET bone imaging agent to delineate areas of altered osteogenesis

14. Fluorine-18 Chemical Symbol: 18 F Chemical Form: Fluorine-18 fludeoxyglucose Half-life:  109.771 minutes Diagnostic use: As a PET imaging agent to: > Assess abnormal glucose metabolism in oncology > Assess myocardial hibernation > Identify regions of abnormal glucose metabolism associated with foci of epileptic seizures

15. Gallium-67 Chemical Symbol: 67 Ga Chemical Form: Gallium-67 Gallium Citrate Half-life:  3.26 days Trade name(s): Neoscan ( GE), DuPont Ga-67, Mallinckrodt Ga-67 Diagnostic use: Useful to demonstrate the presence/extent of: >Hodgkin’s disease >Lymphoma > Bronchogenic carcinoma >Aid in detecting some acute inflammatory lesions

16. Indium-111 Chemical Symbol: 111 In Chemical Form: Indium-111 Capromab Pendetide Half-life:   3.2 days Trade name(s): ProstaScint ® Diagnostic use: A diagnostic imaging agent in newly-diagnosed patients with biopsy-proven prostate cancer , who are at high-risk for pelvic lymph node metastases. A diagnostic imaging agent in post-prostatectomy patients with a rising PSA.

17. Iodine - 123 Chemical Symbol: 123 I Chemical Form: Iodine – 123 Ioflupane Half-life :   13.22 hours Trade name(s): DaTscan ™ Diagnostic use : I ndicated for striatal dopamine transporter visualization using SPECT brain imaging to assist in the evaluation of adult patients with suspected Parkinsonian syndromes (PS ). It may help differentiate essential tremor due to PS.

18. Iodine - 123 Chemical Symbol: 123 I Chemical Form: Iodine – 123 Sodium iodide Half-life :   13.22 hours Trade name(s): Mallinckrodt, Amersham Diagnostic use: Indicated for use in the evaluation of thyroid: • Function • Morphology

19. Iodine - 131 Chemical Symbol: 131 I Chemical Form: Iodine – 131 human serum albumin Half-life :   8.0197 days Trade name(s): Megatope Diagnostic use: Indicated for use in determinations of: • Total blood and plasma volumes • Cardiac output • Cardiac and pulmonary blood volumes and circulation times • Protein turnover studies • Heart and great vessel delineation • Localization of the placenta • Localization of cerebral neoplasm

20. Iodine - 131 Chemical Symbol: 131 I Chemical Form: Iodine – 131 sodium iodide Half-life :   8.0197 days Trade name(s): HICON ™ Diagnostic use: • Performance of the radioactive iodide ( RAI) uptake test to evaluate thyroid function. • Localizing metastases associated with thyroid malignancies Therapeutic uses: • Treatment of hyperthyroidism • Treatment of carcinoma of the thyroid

21. Iodine – 131 ( Radioimmunotherapy ) Chemical Symbol: 131 I Chemical Form: Iodine – 131 tositumomab Half-life :   8.0197 days Trade name(s): BEXXAR ® Diagnostic use: Indicated for: Treatment of patients with CD20 antigen-expressing relapsed or refractory, low grade , follicular, or transformed non-Hodgkin’s lymphoma .

22. Nitrogen-13 Chemical Symbol: 13 N Chemical Form: Nitrogen-13 Ammonia Half-life :   9.97 min Diagnostic use: Indicated for diagnostic Positron Emission Tomography (PET) imaging of the myocardium under rest or pharmacologic stress conditions to evaluate myocardial perfusion in patients with suspected or existing coronary artery disease.

23. Radium-223 Chemical Symbol: 223 Ra Chemical Form: Radium-223 dichloride Half-life :   11.4 day Trade name(s): Xofigo ® Diagnostic use: Indicated for the treatment of patients with C astration - resistant prostate cancer, S ymptomatic bone metastases and U nknown visceral metastatic disease.

24. Rubidium-82 Chemical Symbol: 223 Ra Chemical Form: Rubidium-82 chloride Half-life :   1.27 minutes Trade name(s): Cardiogen-82 ® Diagnostic use: PET myocardial perfusion agent that is useful in distinguishing normal from abnormal myocardium in patients with suspected myocardial infarction.

25. Strontium-89 Chemical Symbol: 89 Sr Chemical Form: Strontium-89 chloride Half-life :   50 days Trade name(s): Metastron Diagnostic use: Indicated for the relief of bone pain in patients with painful skeletal metastases that have been confirmed prior to therapy.

26. Technetium-99m Chemical Symbol: 99m Tc Chemical Form: Technetium-99m bicisate Half-life :   6.0058 hours Trade name(s): Neurolite ® Diagnostic use: SPECT imaging in the localization of stroke in patients already diagnosed with stroke.

27. Technetium-99m Chemical Symbol: 99m Tc Chemical Form: Technetium-99m sestamibi Half-life :   6.0058 hours Trade name(s): Cardiolite ® Diagnostic use: Myocardial perfusion agent that is indicated for: Detecting coronary artery disease by localizing myocardial ischemia (reversible defects) and infarction (non-reversible defects) Evaluating myocardial function Planar breast imaging as a second line diagnostic drug after mammography to assist in the evaluation of breast lesions in patients with an abnormal mammogram or a palpable breast mass

28. Thallium-201 Chemical Symbol: 201 Tl Chemical Form: Thallium-201 chloride Half-life :   72.912 hrs Trade name(s): DuPont, Mallinckrodt, Amersham Diagnostic use: Useful in myocardial perfusion imaging for the diagnosis and localization of myocardial infarction As an adjunct in the diagnosis of ischemic heart disease ( atherosclerotic coronary artery disease) Localization of sites of parathyroid hyperactivity in patients with elevated serum calcium and parathyroid hormone levels.

29. Yttrium-90 ( radioimmnunotherapy ) Chemical Symbol: 90 Y Chemical Form: Yttrium-90 ibritumomab tiuxetan Half-life :   64 hrs Trade name(s): Zevalin Therapeutic use: Indicated for the: • Treatment of relapsed or refractory, low-grade or follicular B-cell non-Hodgkin’s lymphoma (NHL) • Treatment of previously untreated follicular NHL in patients who achieve a partial or complete response to first-line chemotherapy

30. Bibliography Radiobiology for the radiologist by Eric Hall. National institute of biomedical imaging and bioengineering. (2017). Nuclear Medicine. http://nuclearpharmacy.uams.edu/RPLIST.html http://www.radiologyinfo.org/en/info

31. THANK YOU