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Introduction to
Nuclear Medicine
What is Nuclear medicine?
 It is the use of radioactive materials in medicine.
 It may be either diagnostic or therapeutic
 In the therapeutic issue we must differentiate between
 Brachytherapy (internal radiotherapy) sealed source
radiotherapy is a form of radiotherapy where a
radiation source is placed inside or next to the area requiring
treatment. Brachytherapy is commonly used as an effective
treatment for cervical, prostate, breast, and skin cancer
 and Teletheraby (External beam radiotherapy). Kilovoltage
("superficial") X-rays are used for treating skin cancer and
superficial structures. Megavoltage ("deep") X-rays are used
to treat deep-seated tumors (e.g. bladder, bowel, prostate, lung,
or brain).
Nuclear Medicine Procedures
 Nuclear medicine procedures may be:
 diagnostic studies, which are tests of body function
 therapeutic procedures in which the radiation is used to
treat disease.
 Radionuclide therapy is used in the treatment of both
benign disease (eg hyperthyroidism and arthritis) and
malignant disease (eg thyroid cancer, Suprarenal
gland tumors and hepatocellular carcinoma)
Nuclear Medicine Diagnoses What?
Radiopharmaceuticals
 The radioactive materials administered to patients are
known as radiopharmaceuticals.
 These consist of :
 a chemical molecule which determines the behavior of the
radiopharmaceutical in the body
 a radionuclide. The radiation emitted by the radionuclide
may be detected from outside the body by a radionuclide
imaging device (a gamma camera) or may be detected in a
sample of a body fluid (eg plasma or urine)
Radiopharmaceuticals
 Diagnostic radiopharmaceuticals must deliver the
minimum possible radiation dose to the patient
while still obtaining the required diagnostic
information.
 Therapy radiopharmaceuticals must deliver the
maximum radiation dose to the diseased organ or
tumor, while minimizing the radiation dose to non-
target tissues such as the bone marrow.
The Ideal Radionuclide for
In-vivo Imaging
 It must emit photons in high abundance in energies
which can be efficiently detected by the gamma
camera (100 keV - 300 keV)
 It should not emit charged particles as these are
absorbed within a few millimetres of tissue. These
can not be detected outside of the body and greatly
increase the radiation dose to the patient.
 It should have a short half-life, again to keep the
radiation dose as low as possible.
The Ideal Radionuclide for
Therapy
 Must emit energetic charged particles. These are
usually beta particles but may be Auger electrons,
internal conversion electrons or even alpha particles.
 Low cost, available, safe.
 A fairly short half-life, typically several days.
Targeting the Right Tissue or
Organ
The metabolism of the radiopharmaceutical in the
body will depend on its chemical properties.
 Some are simple ions, such as 67Ga citrate and sodium
131
Iodide
 Some are particles or aggregates of molecules
labelled with a radionuclide
 Some are radio-labelled blood cells (red cells or white
cells)
 The remainder are labelled complex molecules, such
as phosphonates, peptides and antibodies.
Clinical applications
 Bone scintigraphy: is a study of the skeletal system
that uses a form 99mTc injected intravenously absorbed
by the bone.
 Genitourinary studies: provides both an anatomic
and functional evaluation of the kidneys especially
after transplantation.
 Brain scan: evaluate various neurologic conditions
as Alzheimer and Parkinson disease.
 Thyroid uptake study: to evaluate functions of the
thyroid gland using sodium iodide 131I.
Radionuclides in Common Use
Four radionuclides account for the large majority of

clinical procedures. These are :
 99mTc T½ 6 hours principal energy 140 keV
 131I T½ 8 days principal  energy 360 keV
 67Ga T½ 3.3 days principal  energies 93 keV,
184 keV and 296 keV
 201Tl T½ 3 days x-ray emission at 70-80 keV
Nuclear Medicine Team
 Nuclear medicine technologist: responsible for
handling, assessment, and administration of
radionuclides, patient safety, statistical analysis for
digitally processed images, decontaminate the area.
 Nuclear medicine physician: radiologist has
received training in the performance and
interpretation of nuclear medicine procedures.
 Medical nuclear physicist: received advanced
training in nuclear physics, computers, and radiation
safety. Responsible for preparing radioactive
materials and calibration and maintenance of imaging
Radionuclide Imaging and
Radiation Safety (1)
 Unlike Diagnostic Radiology and Radiotherapy,
Nuclear Medicine imaging devices do not emit
radiation.
 The technologist may take as many images as
required to provide the diagnosis without changing
the radiation exposure of the patient.
Radionuclide Imaging and
Radiation Safety (2)
 However, a malfunctioning gamma camera may result in
errors in diagnosis or an non-interpretive study so that the
patient gets no benefit from the radiation exposure arising
from the administered radiopharmaceutical.
 It is therefore essential that the principles of radionuclide
imaging are well understood, that the quality control
procedures are routinely performed and that the gamma
camera is serviced when required.
Advantages of Nuclear medicine
imaging
 Functional
 Sensitive, quantitative.
 Very safe.
 Low radiation.
 Screening & Follow up
 Whole body evaluation without increased
radiation dose to the patient.
 Very high specificity (no natural radioactivity
from the body).
Disadvantages of Nuclear medicine
imaging
 Not widely available.
 Poor SNR.
 Require NM instruments & radiopharmaceuticals.
 Relatively higher cost than X-ray or US.
 Radiation exposure to the patient.
 Low spatial resolution (5-10mm).
 Slow image acquisition.

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Introduction to

Four radionuclides account for the large majority of

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