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Prof Jasmina Vujic

Department of Nuclear Engineering
U C Berkeley

Pictures from www.ge.com

 Nuclear Medicine, X-Rays, CT, and
MRI
‡ Nuclear medicine began approximately 50 years ago and has evolved into a major medical specialty
for both diagnosis and therapy of serious disease. More than 3,900 hospital-based nuclear medicine
departments in the United States perform over 10 million nuclear medicine imaging and therapeutic
procedures each year. Despite its integral role in patient care, nuclear medicine is still often confused
with other imaging procedures, including general radiology, CT, and MRI.

‡ Nuclear medicine studies document organ and function and structure, in contrast to conventional
radiology, which creates images based upon anatomy. Many of the nuclear medicine studies can
measure the degree of function present in an organ, often times eliminating the need for surgery.
Moreover, nuclear medicine procedures often provide important information that allows the
physician to detect and treat a disease early in its course when there may be more success. It is
nuclear medicine that can best be used to study the function of a damaged heart or restriction of
blood flow to parts of the brain. The liver, kidneys, thyroid gland, and many other organs are
similarly imaged.
 eneral Radiology
‡ The image, or a x-ray film, is produced when a small amount of radiation passes through
the body to expose sensitive film on the other side. The ability of x-rays to penetrate
tissues and bones depends on the tissue's composition and mass. The difference between
these two elements creates the images.

‡ The chest x-ray is the most common radiological examination. Contrast agents, such as
barium, can be swallowed to highlight the esophagus, stomach, and intestine and are
used to help visualize an organ or film.
 Computed Tomography

‡ Computed tomography or CT, shows organs of interest at selected levels of the body.
They are visual equivalent of bloodless slices of anatomy, with each scan being a single
slice. CT examinations produce detailed organ studies by stacking individual image
slices. CT can image the internal portion of organs and separate overlapping structures
precisely. The scans are produced by having the source of the x-ray beam encircle or
rotate around the patient. X-rays passing through the body are detected by an array of
sensors. Information from the sensors is computer processed and then displayed as an
image on a video screen.
 Magnetic Resonance Imaging
‡ Like CT, MRI produces images, which are the visual equivalent of a slice of anatomy. MRI,
however, is also capable of producing those images in an infinite number of projections through the
body. MRI use a large magnet that surrounds the patient, radio frequencies, and a computer to
produce its images.
‡ As the patient enters a MRI scanner, his body is surrounded by a magnetic field up to 8,000 times
stronger than that of the earth. The scanner subjects nuclei of the body's atoms to a radio signal,
temporarily knocking select ones out of alignment.
‡ When the signal stops, the nuclei return to the aligned position, releasing their own faint radio
frequencies from which the scanner and computer produce detailed images of the human anatomy.
‡ Patients who cannot undergo a MRI examination include those people dependent upon cardiac
pacemakers and those with metallic foreign bodies in the brain or around the eye.
  |   

0 e process involves injecting into t e body a small amount

of c emical substance tagged wit a s ort lived radioactive
tracer. Depending on t e c emical substance used, t e
radiop armaceutical concentrates in t e part of t e body
being investigated and gives off gamma rays. A gamma
camera t en detects t e source of t e radiation to build a
picture. 0 ese are called scans.

  0reatments or 0 erapy
Radiot erapy using external beam treatment is used commonly for treatment of
cancers (see Oncology). However t e use of unsealed, liquid sources in t e
treatment of disease is important in a few, specialized situations. For example Iodine-
131 is taken orally to treat overactive t yroid and cancer of t e t yroid.
 



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   #
 |   cans

ࣤ $ ! 0 ese investigate blood circulation and diseases of t e

brain suc as infection, stroke or tumor. 0ec netium is injected into t e
blood so t e image is t at of blood patterns.
ࣤ   %! 0 ese are used to diagnose disorders of
t e t yroid gland. Iodine 131 is given orally , usually as sodium iodide
solution. It is absorbed into t e blood t roug t e digestive system and
collected in t e t yroid.
ࣤ ! 0 ese are used to detect blood clots in t e lungs.
Albumen, w ic is part of uman plasma, can be coagulated,
suspended in saline and tagged wit tec netium.


 





 


 
 |   cans

ࣤ
 ! 0 ese are used to study blood flow to t e eart and

can indicate conditions t at could lead to a eart attack. Imaging of t e
eart can be sync ronised wit t e patient's ECG allowing assessment
of wall motion and cardiac function.
ࣤ $! 0 ese are used to detect areas of bone growt , fractures,
tumors, infection of t e bone etc. A complex p osp ate molecule is
labeled wit tec netium. If cancer as produced secondary deposits in
t e bone, t ese s ow up as increased uptake or ot spots.
 










 
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ࣤ For imaging 0ec netium is used extensively, as it as a s ort p ysical

alf life of 6 ours. However, as t e body is continually eliminating
products t e biological alf life may be s orter. 0 us t e amount of
radioactive exposure is limited.
ࣤ 0ec netium is a gamma emitter. 0 is is important as t e rays need to
penetrate t e body so t e camera can detect t em.
ࣤ Because it as suc a s ort alf life, it cannot be stored for very long
because it will ave decayed. It is generated by a molybdenum source
(parent ost) w ic as a muc greater alf life and t e 0c extracted on
t e day it is required. 0 e molybdenum is obtained from a nuclear
reactor and imported. For treatment of t erapy, beta emitters are often
used because t ey are absorbed locally.
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ࣤ 0 e tec netium eart scan is a nuclear eart scan, w ic means t at it involves t e
use of a radioactive isotope t at targets t e eart and a radionuclide detector t at
traces t e absorption of t e radioactive isotope. 0 e isotope is injected into a vein
and absorbed by ealt y tissue at a known rate during a certain time period. 0 e
radionuclide detector, in t is case a gamma scintillation camera, picks up t e gamma
rays emitted by t e isotope.
ࣤ 0 e tec netium eart scan uses tec netium 0c-99m stannous pyrop osp ate
(usually called tec netium), a mildly radioactive isotope w ic binds to calcium. After
a eart attack, tiny calcium deposits appear on diseased eart valves and damaged
eart tissue. 0 ese deposits appear wit in 12 ours of t e eart attack. 0 ey are
generally seen two to t ree days after t e eart attack and are usually gone wit in
one to two weeks. In some patients, t ey can be seen for several mont s.
ࣤ 0 e tec netium eart scan is not dangerous. 0 e tec netium is completely gone from
t e body wit in a few days of t e test. 0 e scan itself exposures t e patient to about
t e same amount of radiation as a c est x ray. 0 e patient can resume normal
activities immediately after t e test.
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ࣤ After t e tec netium is injected into a blood vessel in t e arm, it accumulates in eart
tissue t at as been damaged, leaving " ot spots" t at can be detected by t e
scintillation camera. 0 e tec netium eart scan provides better image quality t an
commonly used radioactive agents suc as t allium because it as a s orter alf life
and can t us be given in larger doses.
ࣤ During t e test, t e patient lies motionless on t e test table. Electrocardiogram
electrodes are placed on t e patient's body for continuous monitoring during t e test.
0 e test table is rotated so t at different views of t e eart can be scanned. 0 e
camera, w ic looks like an x-ray mac ine and is suspended above t e table, moves
back and fort over t e patient. It displays a series of images of tec netium's
movement t roug t e eart and records t em on a computer for later analysis.
 & !
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ࣤ 0 e test is usually performed at least 12 ours after a suspected eart attack, but it
can also be done during triage of a patient w o goes to a ospital emergency room
wit c est pain but does not appear to ave ad a eart attack. Recent clinical
studies demonstrate t at tec netium eart scans are very accurate in detecting eart
attacks w ile t e patient is experiencing c est pain. 0 ey are far more accurate t an
electrocardiogram findings.
ࣤ 0 e tec netium eart scan is usually performed in a ospital's nuclear medicine
department but it can be done at t e patient's bedside during a eart attack if t e
equipment is available. 0 e scan is done two to t ree ours after t e tec netium is
injected. cans are usually done wit t e patient in several positions, wit eac scan
taking 10 minutes. 0 e entire test takes about 30 minutes to an our. 0 e scan is
usually repeated over several weeks to determine if any furt er damage as been
done to t e eart. 0 e test is also called tec netium 99m pyrop osp ate scintigrap y,
ot-spot myocardial imaging, infarct avid imaging, or myocardial infarction scan.
 

  




 


 


 


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- multi ole collimator
- large area (e.g 5 cm ) |
()
(odium Iodide - 0 allium
activated) scintillation crystal
- lig t guide for optical coupling
array (commonly exagonal) of
p oto-multiplier tubes
- lead s ield to minimize
background radiation
A crucial component of t e modern gamma camera is t e  . 0 e collimator selects t e direction of
incident p otons. For instance a parallel ole collimator selects p otons incident O t e normal. Ot er types of
collimators include   collimator often used in t e imaging of small superficial organs and structures (e.g
t yroid,skeletal joints) as it provides image  #  .

'( (diverging) and ( (converging) collimators are often used for w ole body or medium sized
organ imaging. uc collimators are useful because t ey increase t e detection efficiency because of t e
increased solid angle of p oton acceptance.

 # 

 # * 
Features and parameters
0 e following are t e typical features of t e scintialltion crystal used in modern gamma
cameras
ࣤ most gamma cameras use t allium-activated |
(|
())
ࣤ |
() emits blue-green lig t at about 415 
ࣤ t e spectral output of suc a scintillation crystal matc es well t e response of standard
bialkali p otomultipliers (e.g bK2Cs )
ࣤ t e linear attenuation coefficient of |
() at 150 KeV is about 2.2 1/cm . 0 erefore
about 90% of all p otons are absorbed wit in about 10 mm
ࣤ |
() is yrdoscopic and t erefore requires ermetic encapsulation

ࣤ |
() as a ig refractive index ( ~ 1.85 )

and t us a lig t guide is used to couple t e
scintillation crystal to t e p otomultiplier tube
ࣤ t e scintillation crystal and associated
electronics are surrounded by a lead s ield to
minimize t e detection of unwanted radiation
ࣤ digital and/or analog met ods are used for
image capture
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