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of antigens (for example, hormone levels in the blood) without the need to use a bioassay.
Although the RIA technique is extremely sensitive and extremely specific, it requires specialized
equipment, but remains the least expensive method to perform such tests. It requires special precautions
and licensing, since radioactive substances are used. Today it has been supplanted by
the ELISA method, where the antigen-antibody reaction is measured using colorimetric signals instead of
a radioactive signal. However, because of it's robustness, consistent results and low price per test , RIA
methods are again becoming popular.
The RAST test (radio allergosorbent test) is an example of radioimmunoassay. It is used to detect the
causative allergen for an allergy.
Contents
[hide]
• 1 Method
• 2 History
• 3 References
• 4 External
links
Method
To perform a radioimmunoassay, a known quantity of an antigen is made radioactive, frequently by
labeling it with gamma-radioactive isotopes of iodine attached to tyrosine. This radiolabeled antigen is
then mixed with a known amount of antibody for that antigen, and as a result, the two chemically bind to
one another. Then, a sample of serum from a patient containing an unknown quantity of that same
antigen is added. This causes the unlabeled (or "cold") antigen from the serum to compete with the radio
labeled antigen ("hot") for antibody binding sites.
As the concentration of "cold" antigen is increased, more of it binds to the antibody, displacing the radio
labeled variant, and reducing the ratio of antibody-bound radiolabeled antigen to free radiolabeled
antigen. The bound antigens are then separated from the unbound ones, and the radioactivity of the free
antigen remaining in the supernatant is measured using a gamma counter. Using known standards,
a binding curve can then be generated which allows the amount of antigen in the patient's serum to be
derived.
Thyroid Nuclear Medicine Scan
Definition
A thyroid nuclear medicine scan is a diagnostic procedure to evaluate the thyroid gland, which is located
in the front of the neck and controls the body's metabolism. A radioactive substance that concentrates in
the thyroid is taken orally or injected into a vein (intravenously), or both. A special camera is used to take
an image of the distribution of the radioactive substance in and around the thyroid gland. This is
interpreted to evaluate thyroid function and to diagnose abnormalities.
Purpose
A thyroid scan may be ordered by a physician when the gland becomes abnormally large, especially if the
enlargement is greater on one side, or when hard lumps (nodules) are felt. The scan can be helpful in
determining whether the enlargement is caused by a diffuse increase in the total amount of thyroid tissue
or by a nodule or nodules.
When other laboratory studies show an overactive thyroid (hyperthyroidism) or an underactive thyroid
(hypothyroidism), a radioactive iodine uptake scan is often used to confirm the diagnosis. It is frequently
done along with a thyroid scan.
Precautions
Women who are pregnant should not have this test.
Description
This test is performed in a radiology facility, either in an outpatient x ray center or a hospital department.
Most often, the patient is given the radioactive substance in the form of a tasteless liquid or capsule. It
may be injected into a vein (intravenously) in some instances. Images will be taken at a specified amount
of time after this, depending on the radioisotope used. Most often, scanning is done 24 hours later, if the
radioisotope is given orally. If it is given intravenously, the scan is performed approximately 20 minutes
later.
For a thyroid scan, the patient is positioned lying down on his or her back, with the head tilted back. The
radionuclide scanner, also called a gamma camera, is positioned above the thyroid area as it scans. This
takes 30-60 minutes.
The uptake study may be done with the patient sitting upright in a chair or lying down. The procedure is
otherwise the same as described for the thyroid scan. It takes approximately 15 minutes. There is no
discomfort involved with either study.
A thyroid scan may also be referred to as a thyroid scintiscan. The name of the radioactive substance
used may be incorporated and the study called a technetium thyroid scan or an iodine thyroid scan. The
radioactive iodine uptake scan may be called by its initials, an RAIU test, or an iodine uptake test.
Preparation
Certain medications can interfere with iodine uptake. These include certain cough medicines, some oral
contraceptives, and thyroid medications. The patient is usually instructed to stop taking these medicines
for a period of time before the test. This period may range from several days up to three to four weeks,
depending on the amount of time the medicine takes to clear from the body.
Other nuclear medicine scans and x ray studies using contrast material performed within the past 60 days
may affect this test. Therefore, patients should tell their doctors if they have had either of these types of
studies before the thyroid scan is begun, to avoid inaccurate results.
Some institutions prefer that the patient have nothing to eat or drink after midnight on the day before the
radioactive liquid or capsule is to be taken. A normal diet can usually be resumed two hours after the
radioisotope is taken. Dentures, jewelry, and other metallic objects must be removed before the scanning
is performed. No other physical preparation is needed.
The patient should understand that there is no danger of radiation exposure to themselves or others. Only
very small amounts of radioisotope are used. The total amount of radiation absorbed is often less than the
dose received from ordinary x rays. The scanner or camera does not emit any radiation, but detects and
records it from the patient.
Normal results
A normal scan will show a thyroid of normal size, shape, and position. The amount of radionuclide uptake
by the thyroid will be normal according to established laboratory figures. There will be no areas where
radionuclide uptake is increased or decreased.
Abnormal results
An area of increased radionuclide uptake may be called a hot nodule or "hot spot." This means that a
benign growth is overactive. Despite the name, hot nodules are unlikely to be caused by cancer.
An area of decreased radionuclide uptake may be called a cold nodule or "cold spot." This indicates that
this area of the thyroid gland is under active. A variety of conditions, including cysts, nonfunctioning
benign growths, localized inflammation, or cancer may produce a cold spot.
A thyroid nuclear medicine scan is rarely sufficient to establish a clear diagnosis. Frequently, the
information revealed will need to be combined with data from other studies to determine the problem.
Positron emission tomography
If the biologically active molecule chosen for PET is FDG, an analogue of glucose, the
concentrations of tracer imaged then give tissue metabolic activity, in terms of regional glucose
uptake. Although use of this tracer results in the most common type of PET scan, other tracer
molecules are used in PET to image the tissue concentration of many other types of molecules of
interest.
Contents
1 Description
1.1 Operation
1.6 Limitations
2 History
3 Applications
5 Safety
Description
Operation
To conduct the scan, a short-lived radioactive tracer isotope is injected into the living subject
(usually into blood circulation). The tracer is chemically incorporated into a biologically active
molecule. There is a waiting period while the active molecule becomes concentrated in tissues of
interest; then the research subject or patient is placed in the imaging scanner. The molecule most
commonly used for this purpose is fluorodeoxyglucose (FDG), a sugar, for which the waiting
period is typically an hour. During the scan a record of tissue concentration is made as the tracer
decays.
PET-MRI: At the Jülich Institute of Neurosciences and Biophysics, the world's largest
PET/MRI device began operation in April 2009: a 9.4-tesla magnetic resonance tomograph
(MRT) combined with a positron emission tomograph (PET). Presently, only the head and brain
can be imaged at these high magnetic field strengths.[3]
Radio nuclides
Radio nuclides used in PET scanning are typically isotopes with short half lives such as carbon-
11 (~20 min), nitrogen-13 (~10 min), oxygen-15 (~2 min), and fluorine-18 (~110 min). These
radio nuclides are incorporated either into compounds normally used by the body such as glucose
(or glucose analogues), water or ammonia, or into molecules that bind to receptors or other sites
of drug action. Such labeled compounds are known as radiotracers. It is important to recognize
that PET technology can be used to trace the biologic pathway of any compound in living
humans (and many other species as well), provided it can be radio labeled with a PET isotope.
Thus the specific processes that can be probed with PET are virtually limitless, and radiotracers
for new target molecules and processes are being synthesized all the time; as of this writing there
are already dozens in clinical use and hundreds applied in research. Presently, however, by far
the most commonly used nuclide in clinical PET scanning is fluorine-18 in the form of FDG.
Due to the short half lives of most radioisotopes, the radiotracers must be produced using a
cyclotron and radiochemistry laboratory that are in close proximity to the PET imaging facility.
The half life of fluorine-18 is long enough such that fluorine-18 labeled radiotracers can be
manufactured commercially at an offsite location.
Limitations
The minimization of radiation dose to the subject is an attractive feature of the use of short-lived
radio nuclides. Besides its established role as a diagnostic technique, PET has an expanding role
as a method to assess the response to therapy, in particular, cancer therapy,[4] where the risk to
the patient from lack of knowledge about disease progress is much greater than the risk from the
test radiation.
Limitations to the widespread use of PET arise from the high costs of cyclotrons needed to
produce the short-lived radio nuclides for PET scanning and the need for specially adapted on-
site chemical synthesis apparatus to produce the radiopharmaceuticals. Few hospitals and
universities are capable of maintaining such systems, and most clinical PET is supported by
third-party suppliers of radiotracers which can supply many sites simultaneously. This limitation
restricts clinical PET primarily to the use of tracers labeled with fluorine-18, which has a half life
of 110 minutes and can be transported a reasonable distance before use, or to rubidium-82, which
can be created in a portable generator and is used for myocardial perfusion studies. Nevertheless,
in recent years a few on-site cyclotrons with integrated shielding and hot labs have begun to
accompany PET units to remote hospitals. The presence of the small on-site cyclotron promises
to expand in the future as the cyclotrons shrink in response to the high cost of isotope
transportation to remote PET machines [5]
Because the half-life of fluorine-18 is about two hours, the prepared dose of a
radiopharmaceutical bearing this radionuclide will undergo multiple half-lives of decay during
the working day. This necessitates frequent recalibration of the remaining dose (determination of
activity per unit volume) and careful planning with respect to patient scheduling.
Image reconstruction
The raw data collected by a PET scanner are a list of 'coincidence events' representing near-
simultaneous detection of annihilation photons by a pair of detectors. Each coincidence event
represents a line in space connecting the two detectors along which the positron emission
occurred. Modern systems with a high time resolution also use a technique (called "Time-of-
flight") where they more precisely decide the difference in time between the detection of the two
photons and can thus limit the length of the earlier mentioned line to around 10 cm.
Coincidence events can be grouped into projections images, called sinograms. The sinograms are
sorted by the angle of each view and tilt, the latter in 3D case images. The sinogram images are
analogous to the projections captured by computed tomography (CT) scanners, and can be
reconstructed in a similar way. However, the statistics of the data is much worse than those
obtained through transmission tomography. A normal PET data set has millions of counts for the
whole acquisition, while the CT can reach a few billion counts. As such, PET data suffer from
scatter and random events much more dramatically than CT data does.
Filtered back projection (FBP) has been frequently used to reconstruct images from the
projections. This algorithm has the advantage of being simple while having a low requirement
for computing resources. However, shot noise in the raw data is prominent in the reconstructed
images and areas of high tracer uptake tend to form streaks across the image.
Iterative expectation-maximization algorithms are now the preferred method of reconstruction.
The advantage is a better noise profile and resistance to the streak artifacts common with FBP,
but the disadvantage is higher computer resource requirements.
Attenuation correction: As different LORs must traverse different thicknesses of tissue, the
photons are attenuated differentially. The result is that structures deep in the body are
reconstructed as having falsely low tracer uptake. Contemporary scanners can estimate
attenuation using integrated x-ray CT equipment, however earlier equipment offered a crude
form of CT using a gamma ray (positron emitting) source and the PET detectors.
While attenuation-corrected images are generally more faithful representations, the correction
process is itself susceptible to significant artifacts. As a result, both corrected and uncorrected
images are always reconstructed and read together.
2D/3D reconstruction: Early PET scanners had only a single ring of detectors, hence the
acquisition of data and subsequent reconstruction was restricted to a single transverse plane.
More modern scanners now include multiple rings, essentially forming a cylinder of detectors.
There are two approaches to reconstructing data from such a scanner: 1) treat each ring as a
separate entity, so that only coincidences within a ring are detected, the image from each ring can
then be reconstructed individually (2D reconstruction), or 2) allow coincidences to be detected
between rings as well as within rings, then reconstruct the entire volume together (3D).
3D techniques have better sensitivity (because more coincidences are detected and used) and
therefore less noise, but are more sensitive to the effects of scatter and random coincidences, as
well as requiring correspondingly greater computer resources. The advent of sub-nanosecond
timing resolution detectors affords better random coincidence rejection, thus favoring 3D image
reconstruction.
Applications
Maximum intensity projection (MIP) of a F-18 FDG whole body PET acquisition, showing
abnormal focal uptake in the region of the stomach. Normal physiological isotope uptake is seen
in the brain, renal collection systems and bladder. In this animation, it is important to view the
subject as rotating clockwise (note liver position).
PET is both a medical and research tool. It is used heavily in clinical oncology (medical imaging
of tumors and the search for metastases), and for clinical diagnosis of certain diffuse brain
diseases such as those causing various types of dementias. PET is also an important research tool
to map normal human brain and heart function.
PET is also used in pre-clinical studies using animals, where it allows repeated investigations
into the same subjects. This is particularly valuable in cancer research, as it results in an increase
in the statistical quality of the data (subjects can act as their own control) and substantially
reduces the numbers of animals required for a given study.
Alternative methods of scanning include x-ray computed tomography (CT), magnetic resonance
imaging (MRI) and functional magnetic resonance imaging (fMRI), ultrasound and single photon
emission computed tomography (SPECT).
While some imaging scans such as CT and MRI isolate organic anatomic changes in the body,
PET and SPECT are capable of detecting areas of molecular biology detail (even prior to
anatomic change). PET scanning does this using radiolabelled molecular probes that have
different rates of uptake depending on the type and function of tissue involved. Changing of
regional blood flow in various anatomic structures (as a measure of the injected positron emitter)
can be visualized and relatively quantified with a PET scan.
PET imaging is best performed using a dedicated PET scanner. However, it is possible to acquire
PET images using a conventional dual-head gamma camera fitted with a coincidence detector.
The quality of gamma-camera PET is considerably lower, and acquisition is slower. However,
for institutions with low demand for PET, this may allow on-site imaging, instead of referring
patients to another center, or relying on a visit by a mobile scanner.
PET is a valuable technique for some diseases and disorders, because it is possible to target the
radio-chemicals used for particular bodily functions.
Oncology: PET scanning with the tracer fluorine-18 (F-18) fluorodeoxyglucose (FDG), called
FDG-PET, is widely used in clinical oncology. This tracer is a glucose analog that is taken up by
glucose-using cells and phosphorylated by hexokinase (whose mitochondrial form is greatly
elevated in rapidly growing malignant tumours). A typical dose of FDG used in an oncological
scan is 200-400 mBq for an adult human. Because the oxygen atom which is replaced by F-18 to
generate FDG is required for the next step in glucose metabolism in all cells, no further reactions
occur in FDG. Furthermore, most tissues (with the notable exception of liver and kidneys) cannot
remove the phosphate added by hexokinase. This means that FDG is trapped in any cell which
takes it up, until it decays, since phosphorylated sugars, due to their ionic charge, cannot exit
from the cell. This results in intense radiolabeling of tissues with high glucose uptake, such as
the brain, the liver, and most cancers. As a result, FDG-PET can be used for diagnosis, staging,
and monitoring treatment of cancers, particularly in Hodgkin's lymphoma, non-Hodgkin
lymphoma, and lung cancer. Many other types of solid tumors will be found to be very highly
labeled on a case-by-case basis—a fact which becomes especially useful in searching for tumor
metastasis, or for recurrence after a known highly active primary tumor is removed. Because
individual PET scans are more expensive than "conventional" imaging with computed
tomography (CT) and magnetic resonance imaging (MRI), expansion of FDG-PET in cost-
constrained health services will depend on proper health technology assessment; this problem is
a difficult one because structural and functional imaging often cannot be directly compared, as
they provide different information. Oncology scans using FDG make up over 90% of all PET
scans in current practice.
Neurology: PET neuro imaging is based on an assumption that areas of high radioactivity are
associated with brain activity. What is actually measured indirectly is the flow of blood to
different parts of the brain, which is generally believed to be correlated, and has been measured
using the tracer oxygen-15. However, because of its 2-minute half-life O-15 must be piped
directly from a medical cyclotron for such uses, and this is difficult. In practice, since the brain is
normally a rapid user of glucose, and since brain pathologies such as Alzheimer's disease greatly
decrease brain metabolism of both glucose and oxygen in tandem, standard FDG-PET of the
brain, which measures regional glucose use, may also be successfully used to differentiate
Alzheimer's disease from other dementing processes, and also to make early diagnosis of
Alzheimer's disease. The advantage of FDG-PET for these uses is its much wider availability.
PET imaging with FDG can also be used for localization of seizure focus: A seizure focus will
appear as hypo metabolic during an interracial scan. Several radiotracers (i.e. radio ligands) have
been developed for PET that are ligands for specific neuro receptor subtypes such as [11C]
raclopride and [18F] fallypride for dopamine D2/D3 receptors, [11C]McN 5652 and [11C]DASB
for serotonin transporters, or enzyme substrates (e.g. 6-FDOPA for the AADC enzyme). These
agents permit the visualization of neuro receptor pools in the context of a plurality of
neuropsychiatric and neurologic illnesses. A novel probe developed at the University of
Pittsburgh termed PIB (Pittsburgh Compound-B) permits the visualization of amyloid plaques in
the brains of Alzheimer's patients. This technology could assist clinicians in making a positive
clinical diagnosis of AD pre-mortem and aid in the development of novel anti-amyloid therapies.
[11C]PMP (N-[11C] methylpiperidin-4-yl propionate) is a novel radiopharmaceutical used in PET
imaging to determine the activity of the acetyl cholinergic neurotransmitter system by acting as a
substrate for acetyl cholinesterase. Post-mortem examinations of AD patients have shown
decreased levels of acetyl cholinesterase. [11C]PMP is used to map the acetyl cholinesterase
activity in the brain which could allow for pre-mortem diagnosis of AD and help to monitor AD
treatments.[9]
Cardiology, atherosclerosis and vascular disease study: In clinical cardiology, FDG-PET can
identify so-called "hibernating myocardium", but its cost-effectiveness in this role versus SPECT
is unclear. Recently, a role has been suggested for FDG-PET imaging of atherosclerosis to detect
patients at risk of stroke [3].
Pharmacology: In pre-clinical trials, it is possible to radiolabel a new drug and inject it into
animals. Such scans are referred to as bio distribution studies. The uptake of the drug, the tissues
in which it concentrates, and its eventual elimination, can be monitored far more quickly and
cost effectively than the older technique of killing and dissecting the animals to discover the
same information. Much more commonly, however, drug occupancy at a purported site of action
can be inferred indirectly by competition studies between unlabeled drug and radio labeled
compounds known apriori to bind with specificity to the site. A single radioligand can be used
this way to test many potential drug candidates for the same target. A related technique involves
scanning with radio ligands that compete with an endogenous (naturally occurring) substance at
a given receptor to demonstrate that a drug causes the release of the natural substance.
PET technology for small animal imaging: A miniature PET tomography has been constructed
that is small enough for a fully conscious and mobile rat to wear on its head while walking
around.[10] This Rat CAP (Rat Conscious Animal PET) allows animals to be scanned without the
confounding effects of anesthesia. PET scanners designed specifically for imaging rodents or
small primates are marketed for academic and pharmaceutical research.
The pulse Shape Discrimination (PSD) is a technique used to define which pulse is related to
each crystal. Different Techniques were introduced to discriminate between two-types of pulses
according to its shape (indeed due to the decay time).
Safety
PET scanning is non-invasive, but it does involve exposure to ionizing radiation. The total dose
of radiation is not insignificant, usually around 11 mSv.[citation needed] When compared to the
classification level for radiation workers in the UK, of 6 mSv it can be seen that PET scans need
proper justification. This can also be compared to 2.2 mSv average annual background radiations
in the UK, 0.02 mSv for a chest x-ray and 6.5 - 8 mSv for a CT scan of the chest, according to
the Chest Journal and ICRP.[11][12] A policy change suggested by the IFALPA member
associations in year 1999 mentioned that an aircrew member is likely to receive a radiation dose
of 4–9 mSv per year.[13]
What are the limitations of Positron Emission Tomography – Computed Tomography (PET/CT)?
Positron emission tomography, also called PET imaging or a PET scan, is a type of nuclear
medicine imaging.
Nuclear medicine is a branch of medical imaging that uses small amounts of radioactive material
to diagnose or treat a variety of diseases, including many types of cancers, heart disease and
certain other abnormalities within the body.
Nuclear medicine or radionuclide imaging procedures are noninvasive and, with the exception of
intravenous injections, are usually painless medical tests that help physicians diagnose medical
conditions. These imaging scans use radioactive materials called radiopharmaceuticals or
radiotracers.
Depending on the type of nuclear medicine exam you are undergoing, the radiotracer is either
injected into a vein, swallowed or inhaled as a gas and eventually accumulates in the organ or
area of your body being examined, where it gives off energy in the form of gamma rays. This
energy is detected by a device called a gamma camera, a (positron emission tomography) PET
scanner and/or probe. These devices work together with a computer to measure the amount of
radiotracer absorbed by your body and to produce special pictures offering details on both the
structure and function of organs and tissues.
In some centers, nuclear medicine images can be superimposed with computed tomography (CT)
or magnetic resonance imaging (MRI) to produce special views, a practice known as image
fusion or co-registration. These views allow the information from two different studies to be
correlated and interpreted on one image, leading to more precise information and accurate
diagnoses. In addition, manufacturers are now making single photon emission computed
tomography/computed tomography (SPECT/CT) and positron emission tomography/computed
tomography (PET/CT) units that are able to perform both imaging studies at the same time.
A PET scan measures important body functions, such as blood flow, oxygen use, and sugar
(glucose) metabolism, to help doctors evaluate how well organs and tissues are functioning.
CT imaging uses special x-ray equipment, and in some cases a contrast material, to produce
multiple images or pictures of the inside of the body. These images can then be interpreted by a
radiologist on a computer monitor as printed images. CT imaging provides excellent anatomic
information.
Today, most PET scans are performed on instruments that are combined PET and CT scanners.
The combined PET/CT scans provide images that pinpoint the location of abnormal metabolic
activity within the body. The combined scans have been shown to provide more accurate
diagnoses than the two scans performed separately.
• Detect cancer.
• Determine the effects of a heart attack, or myocardial infarction, on areas of the heart.
• Identify areas of the heart muscle that would benefit from a procedure such as
angioplasty or coronary artery bypass surgery (in combination with a myocardial
perfusion scan).
• Evaluate brain abnormalities, such as tumors, memory disorders and seizures and other
central nervous system disorders.
You may be asked to wear a gown during the exam or you may be allowed to wear your own
clothing.
Women should always inform their physician or technologist if there is any possibility that they
are pregnant or if they are breastfeeding their baby.
You should inform your physician and the technologist performing your exam of any
medications you are taking, including vitamins and herbal supplements. You should also inform
them if you have any allergies and about recent illnesses or other medical conditions.
You will receive specific instructions based on the type of PET scan you are undergoing.
Diabetic patients will receive special instructions to prepare for this exam.
If you are breastfeeding at the time of the exam, you should ask your radiologist or the doctor
ordering the exam how to proceed. It may help to pump breast milk ahead of time and keep it on
hand for use after the PET radiopharmaceutical and CT contrast material are no longer in your
body.
Metal objects including jewelry, eyeglasses, dentures and hairpins may affect the CT images and
should be left at home or removed prior to your exam. You may also be asked to remove hearing
aids and removable dental work.
Generally, you will be asked not to eat anything for several hours before a whole body PET/CT
scan since eating may alter the distribution of the PET tracer in your body and can lead to a
suboptimal scan. This could require the scan to be repeated on another day, so following
instructions regarding eating is very important. You should not drink any liquids containing
sugars or calories for several hours before the scan. Instead, you are encouraged to drink water.
If you are diabetic, you may be given special instructions. You should inform your physician of
any medications you are taking and if you have any allergies, especially to contrast materials,
iodine, or seafood.
You will be asked and checked for any conditions that you may have that may increase the risk
of using intravenous contrast material.
A positron emission tomography (PET) scanner is a large machine with a round, doughnut
shaped hole in the middle, similar to a CT or MRI unit. Within this machine are multiple rings of
detectors that record the emission of energy from the radiotracer in your body.
The CT scanner is typically a large, box like machine with a hole, or short tunnel, in the center.
You will lie on a narrow examination table that slides into and out of this tunnel. Rotating around
you, the x-ray tube and electronic x-ray detectors are located opposite each other in a ring, called
a gantry. The computer workstation that processes the imaging information is located in a
separate room, where the technologist operates the scanner and monitors your examination.
Combined PET/CT scanners are combinations of both scanners and look similar to both the PET
and CT scanners.
A computer aids in creating the images from the data obtained by the camera or scanner.
With ordinary x-ray examinations, an image is made by passing x-rays through your body from
an outside source. In contrast, nuclear medicine procedures use a radioactive material called a
radiopharmaceutical or radiotracer, which is injected into your bloodstream, swallowed or
inhaled as a gas. This radioactive material accumulates in the organ or area of your body being
examined, where it gives off a small amount of energy in the form of gamma rays. A gamma
camera, PET scanner, or probe detects this energy and with the help of a computer creates
pictures offering details on both the structure and function of organs and tissues in your body.
Unlike other imaging techniques, nuclear medicine imaging studies are less directed toward
picturing anatomy and structure, and more concerned with depicting physiologic processes
within the body, such as rates of metabolism or levels of various other chemical activity. Areas
of greater intensity, called "hot spots", indicate where large amounts of the radiotracer have
accumulated and where there is a high level of chemical activity. Less intense areas, or "cold
spots", indicate a smaller concentration of radiotracer and less chemical activity.
Nuclear medicine imaging is usually performed on an outpatient basis, but is often performed on
hospitalized patients as well.
You will be positioned on an examination table. If necessary, a nurse or technologist will insert
an intravenous (IV) line into a vein in your hand or arm.
Depending on the type of nuclear medicine exam you are undergoing, the dose of radiotracer is
then injected intravenously, swallowed or inhaled as a gas.
It will take approximately 60 minutes for the radiotracer to travel through your body and to be
absorbed by the organ or tissue being studied. You will be asked to rest quietly, avoiding
movement and talking.
You may be asked to drink some contrast material that will localize in the intestines and help the
radiologist interpreting the study.
You will then be moved into the PET/CT scanner and the imaging will begin. You will need to
remain still during imaging. The CT exam will be done first, followed by the PET scan. On
occasion, a second CT scan with intravenous contrast will follow the PET scan. The actual CT
scanning takes less than two minutes. The PET scan takes 20-30 minutes.
Total scanning time is approximately 30 minutes.
Depending on which organ or tissue is being examined, additional tests involving other tracers or
drugs may be used, which could lengthen the procedure time to three hours. For example, if you
are being examined for heart disease, you may undergo a PET scan both before and after
exercising or before and after receiving intravenous medication that increases blood flow to the
heart.
When the examination is completed, you may be asked to wait until the technologist checks the
images in case additional images are needed. Occasionally, more images are obtained for
clarification or better visualization of certain areas or structures. The need for additional images
does not necessarily mean there was a problem with the exam or that something abnormal was
found, and should not be a cause of concern for you. You will not be exposed to more radiation
during this process.
If you had an intravenous line inserted for the procedure, it will usually be removed unless you
are scheduled for an operating room procedure that same day.
Except for intravenous injections, most nuclear medicine procedures are painless and are rarely
associated with significant discomfort or side effects.
If the radiotracer is given intravenously, you will feel a slight pin prick when the needle is
inserted into your vein for the intravenous line. When the radioactive material is injected into
your arm, you may feel a cold sensation moving up your arm, but there are generally no other
side effects.
When swallowed, the radiotracer has little or no taste. When inhaled, you should feel no
differently than when breathing room air or holding your breath.
With some procedures, a catheter may be placed into your bladder, which may cause temporary
discomfort.
It is important that you remain still while the images are being recorded. Though nuclear imaging
itself causes no pain, there may be some discomfort from having to remain still or to stay in one
particular position during imaging.
If you are claustrophobic, you may feel some anxiety while you are being scanned.
Unless your physician tells you otherwise, you may resume your normal activities after your
nuclear medicine scan. If any special instructions are necessary, you will be informed by a
technologist, nurse or physician before you leave the nuclear medicine department.
Through the natural process of radioactive decay, the small amount of radiotracer in your body
will lose its radioactivity over time. It may also pass out of your body through your urine or stool
during the first few hours or days following the test. You may be instructed to take special
precautions after urinating, to flush the toilet twice and to wash your hands thoroughly. You
should also drink plenty of water to help flush the radioactive material out of your body as
instructed by the nuclear medicine personnel.
A radiologist who has specialized training in nuclear medicine will interpret the images and
forward a report to your referring physician.
If your physician has ordered a diagnostic CT, a radiologist with specialized training in
interpreting CT exams will report the findings of the CT and forward a report to your referring
physician.
Benefits
The information provided by nuclear medicine examinations is unique and often unattainable
using other imaging procedures.
For many diseases, nuclear medicine scans yield the most useful information needed to make a
diagnosis or to determine appropriate treatment, if any.
Nuclear medicine is less expensive and may yield more precise information than exploratory
surgery.
By identifying changes in the body at the cellular level, PET imaging may detect the early onset
of disease before it is evident on other imaging tests such as CT or MRI.
greater detail with a higher level of accuracy; because both scans are performed at one time
without the patient having to change positions, there is less room for error.
Greater convenience for the patient who undergoes two exams (CT & PET) at one sitting, rather
than at two different times.
Risks
Because the doses of radiotracer administered are small, diagnostic nuclear medicine procedures
result in low radiation exposure, acceptable for diagnostic exams. Thus, the radiation risk is very
low compared with the potential benefits.
Nuclear medicine diagnostic procedures have been used for more than five decades, and there
are no known long-term adverse effects from such low-dose exposure.
Allergic reactions to radiopharmaceuticals may occur but are extremely rare and are usually
mild. Nevertheless, you should inform the nuclear medicine personnel of any allergies you may
have or other problems that may have occurred during a previous nuclear medicine exam.
Injection of the radiotracer may cause slight pain and redness which should rapidly resolve.
Women should always inform their physician or radiology technologist if there is any possibility
that they are pregnant or if they are breastfeeding their baby.
Nuclear medicine procedures can be time-consuming. It can take hours to days for the
radiotracer to accumulate in the part of the body under study and imaging may take up to several
hours to perform, though in some cases, newer equipment is available that can substantially
shorten the procedure time. You will be informed as to how often and when you will need to
return to the nuclear medicine department for further procedures.
The resolution of structures of the body with nuclear medicine may not be as clear as with other
imaging techniques, such as CT or MRI. However, nuclear medicine scans are more sensitive
than other techniques for a variety of indications, and the functional information gained from
nuclear medicine exams is often unobtainable by any other imaging techniques.
PET scanning can give false results if chemical balances within the body are not normal.
Specifically, test results of diabetic patients or patients who have eaten within a few hours prior
to the examination can be adversely affected because of altered blood sugar or blood insulin
levels.
Because the radioactive substance decays quickly and is effective for only a short period of time,
it is important for the patient to be on time for the appointment and to receive the radioactive
material at the scheduled time. Thus, late arrival for an appointment may require rescheduling
the procedure for another day.
A person who is very obese may not fit into the opening of a conventional PET/CT unit.
Since we know that the highest PET image quality is achieved by collecting the greatest number
of true counts, we designed new systems that could collect more counts and process those counts
faster.
The performance of a PET scanner depends greatly upon the physical and scintillation properties
of the crystal detector material. LSO offers the best combination of properties of any PET
scintillator known today.
LSO exhibits the fastest scintillation decay time of all PET scintillator currently in use. This
allows fast coincidence timing with efficient rejection of random events to provide the very high
count rates that are essential to high-speed PET scanning. LSO also has high density and a high
atomic number for good detection efficiency and a high light output for improved energy and
position determination.
The lightning speed of LSO crystal technology brings significant advantages to high-throughput
3-D acquisition. In combination with high-speed electronics, accurate data correction and fast
reconstruction techniques, Siemens LSO-based scanners deliver exceptional image quality in the
shortest scanning time possible today.
Staff preparing and injecting radiopharmaceuticals in hospitals may receive significant radiation
doses to their hands. These doses may be high enough to warrant that they be classified as
radiation workers. The influence of local shielding on finger doses has been investigated. Staff
preparing radioactive liquids in a radionuclide dispensary and drawing up and injecting
radiopharmaceuticals in a nuclear medicine department have been studied. Measurements have
been recorded with an electronic extremity dose monitor, an advanced extremity gamma
instrumentation system (AEGIS), worn near to the finger tip. The electronic dosimeter allows the
pattern of doses received during different procedures to be determined. Doses received for
individual manipulations during many routine sessions have been recorded for different staff
members. Dose distributions around shielded vials and syringes have also been measured using
AEGIS. In the radionuclide dispensary the vials from which radioactive liquids are dispensed are
held in tungsten shields, whereas in nuclear medicine simple lead pots are used. Syringe shields
are employed for some parts of dispensing and patient injections. Data on dose distributions have
been used in interpretation of results from monitoring. Use of syringe shields during dispensing
reduced the finger dose by 75-85%. The peaks in dose rate were 60% lower, and periods of
exposure to high dose rates were reduced in length by a third because of the restriction in the
region of high dose rate. The extremity doses to staff dispensing and injecting
radiopharmaceuticals in nuclear medicine were of similar magnitude. Doses received during
dispensing varied from 10 to 555 microGy depending upon whether the vial containing the
radiopharmaceutical was directly handled or not. Doses received from individual injections
varied from 1 to 150 microGy depending on the degree of difficulty experienced during the
injection.
The unique Compact L-Block with Dose Calibrator Shield is designed to maximize space in
facilities receiving and preparing doses of high-energy nuclides such as FDG F-18. This unit
provides convenient access and viewing of the work area and incorporates a built-in calibration
chamber shield. The special shield is designed to accommodate a chamber that is through-
mounted in a countertop (customer responsible for installation). The chamber shield
accommodates all Atom lab chambers and many others (check chamber shield specifications to
determine fit). This combination of L-Block and dose calibrator shield eliminates the need to
purchase interlocking shielding rings. This unit is constructed of lead encased in steel. It features
a large 8" x 8" x 4" lead glass window with adjustable window angle, 1.5" thickness lead
shielding in front, and 1" thick lead in the base and in the chamber shield. A special plate with a
hex-shaped recess is mounted on the L-Block base to facilitate one-handed loading and
unloading of dose pigs incorporating hex-shaped bottoms. The optional 042-434 Lead Brick
Cave fits neatly into the sides of the vertical section to provide lateral shielding around the full
perimeter of the L-Block’s base. For hot labs in mobile vans, the optional Brick Cave Cover will
prevent the cave from shifting when the vehicle is in motion.
The Atom lab Dose Calibrators are used to measure the Radioactivity of a known radioisotope.
Their primary applications the measurement of the dose administered to a patient in nuclear
imaging. The design for both units incorporates unique electronics and software which surpass
Stringent regulatory performance standards and provide fast and accurate results. The Detector
Unit uses an ionization chamber for radiation detection and an electrometer for ion current
measurement. The chamber bias is generated with an electronic high voltage supply, eliminating
the need for expensive battery changes. An optional Multi-Chamber Manual Interface is also
available. The Display Unit communicates with the Detector Unit through a serial port. An
optional RS-232 computer interface is available. This interface will allow the user to send data
and commands between the dose calibrator and a remote PC.
THE DETECTOR
The Atom lab Detector Unit is a well type ionization chamber capable of measuring activity as
low as 0.01 μCi and as high as 9999. mCi of Tc-99m. The chamber is surrounded on all sides
and on the bottom with .25-inch lead to both shield you from the source you are measuring and
shield the dose calibrator from any ambient radiation.
THE CHAMBER
The well type chamber was carefully selected to provide a nearly "4 pi" measuring geometry
which means that the radiation detector nearly surrounds the radionuclide. This allows the Atom
lab Dose Calibrator to measure the activity of a sample no matter what its volume or shape, as
long as it fits into the Chamber Well. This is necessary, for example, when measuring syringe
doses when the volume is unimportant.
CHAMBER WELL LINER
Placed within the well is a plastic liner to protect the chamber from contamination in the event of
the source leaking during measurement.
CURRENT MEASUREMENT
The ionization current is measured by a microprocessor controlled high impedance electrometer
located within the base of the Detector Unit.
REAR PANEL
On the rear panel of the Detector Unit are the connectors for power and data communication with
the Display Unit. The Detector Unit can be located up to three meters away from the Display
Unit.
RESPONSE
The response of this type of ionization chamber has been carefully studied using radio nuclides
calibrated at the National Institute of Standards & Technology. The result is a well-defined
energy response curve which is used to determine the calibration values for many different
isotopes with high accuracy. Each chamber has been calibrated with a National Institute of
Standards & Technology traceable source. The corresponding Calibration Value has been stored
in the memory of the Detector Unit. After calibration, the chamber's accuracy is tested with
several sources of differing
gamma energies whose activity values are traceable to the National Institute of Standards &
Technology.
THE DISPLAY UNIT
The Atom lab Dose Calibrator Display Unit consists of control keys and displays that allow you
to make activity measurements. A built-in microprocessor executes commands input via the front
panel keys and computes activity values from Detector data. The Display Unit, with a molded
plastic case housing the electronics, has been specifically designed to perform Activity
Measurements in a laboratory setting. To allow easy fingertip control of the keys, the front panel
slopes gradually. The Activity Display slopes as well, providing an optimum viewing angle. On
the rear panel of the unit are the power and communication connectors, and the power switch,
which remain out of the way as they are infrequently needed.
Liquid targets
In the case of liquids, targets have similar dimensions to those of solid targets, since the target
material occupies a specific volume unless the liquid volatilizes. The difference is that the liquid
is typically added and removed from the target while it is in place on the cyclotron. A typical
liquid target for the production of 18F from 18O in water is shown in Figs
Gas targets
Gas targets are widely used and are usually some type of cylinder to hold the gas under pressure,
with a thin beam entry foil usually referred to as a window. The principal constraint on gas
targets is removal of heat from the gas, since gases are not very good heat conductors and the
targets must be quite large in comparison with solid or liquid targets in order to hold the
necessary amount of material. A schematic diagram of a typical gas target is shown in fig and a
photograph is shown in the cold finger on the bottom of the target allows the gas to be
transferred into the target more efficiently. The large volume at the front of the target was used to
capture the xenon if the front foil ruptured.
Carbon- 20.4 These are the positron emitters used in PET for
11Nitrogen- min9.97 studying brain physiology and pathology, in
13Oxygen- min2 particular for localizing epileptic focus, and in
15Fluorine-18 min110 min dementia, psychiatry and neuropharmacology
studies. They also have a significant role in
cardiology. Fluorine-18 in FDG has become
very important in detecting cancers and in
monitoring progress in their treatment, using
PET.
TABLE 2.5. RADIONUCLIDES THAT HAVE BEEN PROPOSED FOR USE AS POSSIBLE
RADIOTOXIC ISOTOPES FOR TREATMENT OF CANCER
Sc-47 Cu- Cu- Br- Y-
64 67 77 90
Rh-105 Pd- Ag- I- Pr-
103 111 124 142
Pm- Sm- Gd- Ho- Lu-
149 153 159 166 177
Re- Ir- Pt- At- Bi-
186/18 194 199 211 213
8
Question bank
On
Positron emission tomography
Short answer questions:
1. Define nuclear medicine and mention its applications?
2. What is meant by a tracer and mention its properties?
3. List out 4 radionuclides used for PET imaging?
4. List out 4 radionuclides used for SPECT imaging?
5. Differentiate PET and SPECT?
6. Differentiate Nuclear Medicine from general imaging techniques?
7. Mention few detectors used in PET?
8. What is the need of PET-CT?
9. Define annihilation, and mention its significance in PET imaging?
10. Define LOR, mention its significance?
11. List out the reconstruction techniques used in PET?
12. Define coincidence events, and sinogram?
13. What is the need of attenuation correction in PET?
14. What is meant by FDG-PET, and where it is used?
15. Name the radionuclide used in Neuro imaging, mention its half life?
16. Name the radionuclide used in psychiatry, mention its half life?
17. What are the benefits Vs Risks?
18. What are the limitations of PET?
19. Write the indications and contraindications of PET scan?
20. Differentiate PET, PET-CT?
21. What is scanning time for PET?
22. Name few hot lab equipments?
23. Write the principle of Cyclotron?
24. Classify accelerators in cyclotron?
25. Name the targets used for production of radionuclides?
26. Define radioimmunoassay?
27. Write short notes on thyroid scanning?
28. Name the radionuclides used in radiotherapy?
29. Mention the specifications of processors used in PET?
30. Mention the role of FPGA’s in PET?
31. List out the hardware details of PET?