Nuclear Medicine History

Nuclear medicine is a branch of medicine that deals with the use of radiation to diagnose and
treat a disease. It is safe, non-invasive and less expensive and often used to detect disease before
symptoms appear. It is performed by a medical specialist called radiologist. Nuclear medicine
uses radiation to provide diagnostic information.
Nuclear Medicine Therapy

Nuclear medicine is a new treatment modality and imaging technique used to diagnose and treat
diseases and track disease progression. This radiological subspecialty includes various studies in
which radioactive materials are given to patients, to scatter through the body, and after that
image spectrum will be obtained. Various techniques used in this involve X-ray radiography,
ultrasound, computed tomography (CT), nuclear medicine, positron emission tomography (PET)
and magnetic resonance imaging (MRI) etc.
Nuclear Medicine Applications

Nuclear medicine has applications across a broad spectrum of disease, focussing particularly on
oncology, cardiology, nephro-urology, orthopaedics, rheumatology and neuropsychiatry. Nuclear
medicine therapies for lymphoma, bone, liver and neuro-endocrine malignancies are advancing
rapidly. Nuclear medicine techniques in oncology can localise primary tumours, delineate extent
of disease, and monitor response to treatment. Radionuclide treatment is used in
hyperthyroidism, thyroid cancer, palliation of bone pain, and neural crest tumours.
Nuclear Magnetic Resonance

The absorption of electromagnetic radiation by a nucleus having a magnetic moment when in an

external magnetic field, used mainly as an analytical technique and in diagnostic body imaging.
Nuclear Medicine Imaging

Nuclear medicine imaging non-invasively provides functional information at the molecular and
cellular level that contributes to the determination of health status by measuring the uptake and
turnover of target-specific radiotracers in tissue. Nuclear medicine imaging is also called
radionuclide scanning.
Nuclear Medicine Scans

Nuclear medicine scans use a special camera (gamma) to take pictures of tissues and organs in
the body after a radioactive tracer (radionuclide or radioisotope) is put in a vein in the arm and is
absorbed by the tissues and organs. The radioactive tracer shows the activity and function of the
tissues or organs.
Radioisotopes for Medicine

Radioisotopes are extensively used in nuclear medicine to explore body structures and functions
in vivo (in the living body) with a minimum of invasion to the organ or treatment site.
Radioisotopes, containing unstable combinations of protons and neutrons. Radioisotopes are also
used in radiotherapy (radiation therapy) to treat some cancers and other medical conditions that
require destruction of harmful cells.
Radiotherapy

Radiation therapy also called as radiotherapy is an effective technique used to treat cancer by
ultimate destruction of cancer cells. Intense radiations are used to kill cancer cells in this method.
This treatment modality is being used along with others such as surgery, chemotherapy, or
immunotherapy. Radiation therapy is having range of applications in treating variety of cancers
with different treatment procedures.
Image Guided Radiation Therapy

Image-guided radiation therapy (IGRT) is utilization of imaging, while the patient undergoes
radiation. This enables us to directly view the process of radiation and accurate and precise
treatment can be expected.
Positron Emission Tomography

Positron emission tomography (PET) is a nuclear medicine imaging technique that produces a
three-dimensional image of functional processes in the body. The tracer may be injected,
swallowed or inhaled, depending on which organ or tissue is being studied by the PET scan. The
tracer collects in areas of body that have higher levels of chemical activity, which often
correspond to areas of disease. On a PET scan, these areas show up as bright spots.
Radionuclide Imaging

A radionuclide scan is a way of imaging bones, organs and other parts of the body by using a
small dose of a radioactive chemical. There are different types of radionuclide chemical.
Radionuclide imaging exposes to less radiation than do comparable x-ray studies.
Radioactive Material

Radioactive materials are given to patients, to scatter through the body to obtain image spectrum
of the specified organ. Radioactive products which are used in medicine are referred to as
radiopharmaceuticals.
Radiopharmaceuticals

A radiopharmaceutical is a radioactive drug used for diagnosis or therapy in a tracer quantity

with no pharmacological effect. It is composed of two parts; a radionuclide and a
pharmaceutical. Pharmaceutical drugs which have radioactivity can be used as Diagnostic and
therapeutic agents.
Radionuclide Therapy in Solid Tumors

Radionuclide Therapy in Solid Tumours is done by introducing radial dose of beta-particleemitting and alpha-particle-emitting molecules localized either solely within endothelial cells of
tumour vasculature or diffusing from the vasculature throughout the adjacent viable tumour cells.
Radiation Therapy Accidents

Radiation therapy is a treatment modality which is commonly used in the treatment of metastatic
diseases. There are some common accidents that occur during this curative therapy. They are
radiation overexposure, massive overdoses, failures in equipment design and design testing etc.
The fatal radiation overdoses are one of the prominent among these and it causes nausea, vision
problems, inability to hear, severe pain etc. Apart from the potential benefits this treatment
method is also associated with life threatening hazards.
Radiation Dose

Radiation Dose is the amount of radiation energy absorbed by the body or exposure level of rays
during the treatment. This doses are usually measured in mGy/mSv. There are four different but
interrelated units for measuring radioactivity, exposure, absorbed dose, and dose equivalent.
Radiation Dose is measured by dosimeter device.
Radioimmunotherapy

Radioimmunotherapy (RIT) is a combination of radiation therapy and immunotherapy where a

laboratory-produced molecule called a monoclonal antibody is introduced on to surface of cell to
recognize and bind to cell. Monoclonal antibodies mimic the antibodies naturally produced by
the bodys immune system that attack invading foreign substances. The two agents mostly used
are Yttrium-90 Ibritumomab Tiuxetan (Zevalin) and Iodine-131 Tositumomab (Bexxar) in
radioimmunotherapy treatment.
Radioactive Iodine Therapy

Radioactive iodine treatment is used to treat certain thyroid diseases and thyroid cancer. The
procedure is done with a radioactive form of the element iodine. Radioactive iodine therapy
improves the survival rate of patients with papillary or follicular thyroid cancer. Radioactive
iodine is given either in a capsule or in a tasteless solution in water.
Nuclear Medicine and Radiology

Nuclear medicine is a branch of medical imaging that uses small amounts of radioactive material
to diagnose and determine the severity of or treat a variety of diseases. Nuclear medicine scans
are usually conducted by Radiographers. Radiology uses imaging technologies, such as X-ray
radiography, magnetic resonance imaging (MRI), nuclear medicine, ultrasound, computed
tomography (CT), and positron emission tomography (PET).
Nuclear Scanner

Nuclear scans use radioactive substances to see structures and functions inside your body by
using special camera that detects radioactivity. All type of tissue that may be scanned like bones,

organs, glands, blood vessels etc. by using different radioactive compound as a tracer. The tracer
remains in the body temporarily before it is passed in the urine or stool (feces).
Nuclear medicine and Thyroid Scan

Thyroid scan (thyroid scintigraphy) is a nuclear medicine examination used to evaluate thyroid
tissue. Thyroid Scan is a nuclear medicine test that provides information about the function and
structure of the thyroid gland. The scan involves injection of a radiopharmaceutical into a vein in
your arm and imaging with a gamma camera.
Nuclear Medicine and Bone Scan

A bone scan is a nuclear imaging test that helps diagnose and track several types of bone disease.
Nuclear medicine bone scan shows the effects of injury or disease such as cancer or infection on
the bones. A radioactive material (radiopharmaceutical) is injected into a vein, attaches to the
bones and is detected by a special camera (gamma camera) that takes images or pictures that
show how the bones are working.
Cancer Radiation Therapy

Radiation therapy uses high-energy radiation to shrink tumors and kill cancer cells. X-rays,
gamma rays, and charged particles are types of radiation used for cancer treatment by killing
cancer cells by damaging their DNA (the molecules inside cells that carry genetic information
and pass it from one generation to the next). Radiation therapy can either damage DNA directly
or create charged particles (free radicals) within the cells that can in turn damage the DNA.
Nuclear Medicine Radioisotopes

Radioisotopes are radioactive isotopes of an element. Different isotopes of the same element
have the same number of protons in their atomic nuclei but differing numbers of neutrons.
Radioisotopes are an essential part of radiopharmaceuticals. Radioisotopes are commonly used in
industrial radiography. Radioisotopes used in nuclear medicine have very short half-lives, which
makes them suitable for therapeutic purposes.
Anticancer Therapy

Anticancer, or antineoplastic, drugs are used to treat malignancies, or cancerous growths. Drug
therapy may be used alone, or in combination with other treatments such as surgery or radiation
therapy. Anticancer drugs are used to control the growth of cancerous cells.
Journal of Nuclear Medicine & Radiation Therapy is supporting International Conference on
Nuclear Medicine & Radiation Therapy" during June 09-10, 2016 at Cologne, Germany with the
respective theme Fusion of Emerging Technologies: Nuclear Medicine & Radiation Therapy".
Nuclear medicine is a branch or specialty of medicine and medical imaging that
uses radioactive isotopes (radionuclides) and relies on the process of radioactive
decay in the diagnosis and treatment of disease. In nuclear medicine procedures,

radionuclides are combined with other chemical compounds or pharmaceuticals to

form radiopharmaceuticals.

Cancer therapy can be much more effective using a new way to customize nuclear medicine
treatment, researchers say in the December 2014 issue of The Journal of Nuclear Medicine. The
process could also be useful for other diseases that could benefit from targeted radiation.
Targeted therapy with radiopharmaceuticals--radioactive compounds used in nuclear medicine
for diagnosis or treatment--has great potential for the treatment of cancer, especially for cancer
cells that have migrated from primary tumors to lymph nodes and secondary organs such as bone
marrow. These disseminated tumor cells can be difficult to treat with a single targeting agent
because there are dramatic differences in the number of targetable receptors on each cell.
In the study, breast cancer cells were treated with different concentrations of a cocktail of four
fluorochrome-conjugated monoclonal antibodies. The amount of each antibody bound to each
cell was determined using flow cytometry. Formulas were developed to "arm" the antibodies
with the desired radionuclide and activity, calculate the absorbed dose to each cell, and perform a
simulation of the surviving fraction of cells after exposure to cocktails of different antibody
combinations. Simulations were performed for three alpha-particle emitters.
"Our approach moves radiation treatment planning for cancer therapy from the tumor level to the
molecular and cellular level, with nuclear medicine serving as the treatment engine," stated
Roger Howell, Ph.D., lead researcher. "The concepts are not restricted to cancer therapy but can
be applied more widely to other diseases that may benefit from a targeted approach with
cocktails of radiopharmaceuticals. The approach can also be extended to cocktails consisting of
radiopharmaceuticals and non-radioactive agents."
The effect of the radiopharmaceutical cocktails was compared to that of single antibodies. In
certain activities, cocktails outperformed single antibodies by a factor of up to 244. These
findings suggest that targeted alpha therapy can be improved with customized radiolabeled
antibody cocktails. Depending on the antibody combination and specific activity of the
radiolabeled antibodies, cocktails can provide a substantial advantage in tumor cell killing. The
methodology used in this analysis provides a foundation for pretreatment prediction of tumor cell
survival in the context of personalized cancer therapy.
"This method is preferable, as it accounts for behavior of the drugs in the patient's body," Howell
continues. "The beauty of either approach for planning a treatment is that the patient is not
subjected to any radiopharmaceutical injections during the planning phase, which uses only
fluorescent-labeled drugs. The patient is not injected with radiopharmaceuticals until the
treatment phase, whereupon only a cocktail specifically optimized for that individual is
administered. This spares the patient from receiving ineffective cocktails that may damage
normal tissues and prevent further treatment."

Hospitals are now able to ensure that the correct dose is administered to the 670,000 patients that
undergo nuclear medicine procedures every year due to a new device developed by scientists at
the National Physical Laboratory (NPL).
The number of nuclear medicine procedures has increased by 36% over the last 10 years. 240
NHS sites around the country now use nuclear medicine, mostly for diagnostic scans on areas
such as bone, lung perfusion, myocardium and the kidneys. Nuclear medicine is also used in
cancer and thyroid therapy.
For most diagnostic procedures, radioactive compounds are injected into the body so that
physiological images can be made with gamma cameras. Of course, the exact radioactivity of the
dose is crucial, not only to the ultimate safety of the patient but also to the quality of the
procedure. A low dose can result in inconclusive images whereas a high dose could cause harm
to the patient.
A new instrument, called 'Fidelis', allows medical physicists to check their in-house instruments
against the UK national standards for radioactivity. Once confident that their own instruments are
measuring activity correctly, the right dose should always be given to the patient.
The instrument is comprised of an ionisation chamber designed by the National Physical
Laboratory (NPL), the UK's national measurement institute and a brand new computer-controlled
electrometer module from Southern Scientific Ltd (which manufactures and sells the instrument).
An ionisation chamber is a gas filled enclosure between two conducting electrodes. When a
radioactive source is placed near to the enclosure, gamma-rays emitted by the source ionise the
gas -- thus creating a current that can be measured by the electrometer.
Previously hospitals have used off-the-shelf Radionuclide Calibrators which needed recalibrating every time new applications for nuclear medicine or a new design of vial came on
stream. With Fidelis, this problem is solved.
'The ionisation chamber is an identical version of the master chamber here,' says Piers de
Lavison, the Head of Radionuclide Metrology at NPL. 'It's like having NPL in a box -- it is a
great example of how our work contributes to quality assurance in healthcare, something that
touches all our lives.'

Nuclear medicine-induced allergic reactions

Nyakale, Nozipho E.; Lockhat, Zarina I.; Sathekge, Mike Machaba
URI: http://hdl.handle.net/2263/45857
Date: 2015-03

Abstract:
Immunologic reactions to radiopharmaceuticals are usually mild and transient and
require little or no medical treatment. As the usage of radiopharmaceuticals has
increased, the reported adverse reactions remain comparatively few in number.
Although the low reported numbers demonstrate that radiopharmaceuticals are safe
and the pharmaceutical amount used in the formulation is small, it is worrisome that
there is no single system for reporting adverse events associated with
radiopharmaceuticals. The most commonly described allergic reactions still remain
99mTc-labelled diphosphonates, colloids and albumin. The likelihood of a reaction to
PET radiopharmaceutical administration is low due to the chemical used being too
small to induce a physiologic effect. Reports on allergic reactions to therapeutic
radiopharmaceuticals are rare. Although the advent of adverse events from the
administration of this therapy may occur due to the deterministic effects of these
radiopharmaceuticals, this is usually related to the amount of radiation
administered rather than the pharmaceutical effects. The advancement in
technology has catapulted imaging into a new era allowing for hybrid imaging with
SPECT/ CT or MRI and PET/CT or MRI. This brings with it further risks for adverse
events which have been associated with these radiological modalities and
necessitates a discussion of allergic reactions from iodinated contrast media as well
as gadolinium contrast. As there is no alternative to the use of radiopharmaceuticals
for nuclear medicine and the added benefit of a diagnostic radiology in one-sitting
for certain cases, it is important to document and report on these few adverse
reactions in order to improve the imaging methodology and possi ble prophylactic
measures.

Nuclear medicine is a medical specialty involving the application of radioactive substances in

the diagnosis and treatment of disease. Nuclear medicine scans are usually conducted by
Radiographers. Nuclear medicine, in a sense, is "radiology done inside out" or "endoradiology"
because it records radiation emitting from within the body rather than radiation that is generated
by external sources like X-rays.[1]
Diagnostic medical imaging
Diagnostic

In nuclear medicine imaging, radiopharmaceuticals are taken internally, for example,

intravenously or orally. Then, external detectors (gamma cameras) capture and form images from
the radiation emitted by the radiopharmaceuticals. This process is unlike a diagnostic X-ray,
where external radiation is passed through the body to form an image.
There are several techniques of diagnostic nuclear medicine.

2D: Scintigraphy ("scint") is the use of internal radionuclides to create twodimensional images.[2]

A nuclear medicine whole body bone scan. The nuclear medicine whole body bone scan
is generally used in evaluations of various bone-related pathology, such as for bone pain,
stress fracture, nonmalignant bone lesions, bone infections, or the spread of cancer to the
bone.

Nuclear medicine myocardial perfusion scan with thallium-201 for the rest images
(bottom rows) and Tc-Sestamibi for the stress images (top rows). The nuclear medicine
myocardial perfusion scan plays a pivotal role in the noninvasive evaluation of coronary
artery disease. The study not only identifies patients with coronary artery disease; it also
provides overall prognostic information or overall risk of adverse cardiac events for the
patient.

A nuclear medicine parathyroid scan demonstrates a parathyroid adenoma adjacent to the

left inferior pole of the thyroid gland. The above study was performed with TechnetiumSestamibi (1st column) and iodine-123 (2nd column) simultaneous imaging and the
subtraction technique (3rd column).

Normal hepatobiliary scan (HIDA scan). The nuclear medicine hepatobiliary scan is
clinically useful in the detection of the gallbladder disease.

Normal pulmonary ventilation and perfusion (V/Q) scan. The nuclear medicine V/Q scan
is useful in the evaluation of pulmonary embolism.

Thyroid scan with iodine-123 for evaluation of hyperthyroidism.

3D: SPECT is a 3D tomographic technique that uses gamma camera data

from many projections and can be reconstructed in different planes. Positron
emission tomography (PET) uses coincidence detection to image functional
processes.

A nuclear medicine SPECT liver scan with technetium-99m labeled autologous red blood
cells. A focus of high uptake (arrow) in the liver is consistent with a hemangioma.

Maximum intensity projection (MIP) of a whole-body positron emission tomography

(PET) acquisition of a 79 kg female after intravenous injection of 371 MBq of 18F-FDG
(one hour prior measurement).
Nuclear medicine tests differ from most other imaging modalities in that diagnostic tests
primarily show the physiological function of the system being investigated as opposed to
traditional anatomical imaging such as CT or MRI. Nuclear medicine imaging studies are
generally more organ- or tissue-specific (e.g.: lungs scan, heart scan, bone scan, brain scan, etc.)
than those in conventional radiology imaging, which focus on a particular section of the body
(e.g.: chest X-ray, abdomen/pelvis CT scan, head CT scan, etc.). In addition, there are nuclear
medicine studies that allow imaging of the whole body based on certain cellular receptors or
functions. Examples are whole body PET scans or PET/CT scans, gallium scans, indium white
blood cell scans, MIBG and octreotide scans.

Iodine-123 whole body scan for thyroid cancer evaluation. The study above was
performed after the total thyroidectomy and TSH stimulation with thyroid hormone
medication withdrawal. The study shows a small residual thyroid tissue in the neck
and a mediastinum lesion, consistent with the thyroid cancer metastatic disease.
The observable uptakes in the stomach and bladder are normal physiologic findings.

While the ability of nuclear metabolism to image disease processes from differences in
metabolism is unsurpassed, it is not unique. Certain techniques such as fMRI image tissues
(particularly cerebral tissues) by blood flow and thus show metabolism. Also, contrast-

enhancement techniques in both CT and MRI show regions of tissue that are handling
pharmaceuticals differently, due to an inflammatory process.
Diagnostic tests in nuclear medicine exploit the way that the body handles substances differently
when there is disease or pathology present. The radionuclide introduced into the body is often
chemically bound to a complex that acts characteristically within the body; this is commonly
known as a tracer. In the presence of disease, a tracer will often be distributed around the body
and/or processed differently. For example, the ligand methylene-diphosphonate (MDP) can be
preferentially taken up by bone. By chemically attaching technetium-99m to MDP, radioactivity
can be transported and attached to bone via the hydroxyapatite for imaging. Any increased
physiological function, such as due to a fracture in the bone, will usually mean increased
concentration of the tracer. This often results in the appearance of a "hot spot", which is a focal
increase in radio accumulation or a general increase in radio accumulation throughout the
physiological system. Some disease processes result in the exclusion of a tracer, resulting in the
appearance of a "cold spot". Many tracer complexes have been developed to image or treat many
different organs, glands, and physiological processes.
Hybrid scanning techniques

In some centers, the nuclear medicine scans can be superimposed, using software or hybrid
cameras, on images from modalities such as CT or MRI to highlight the part of the body in
which the radiopharmaceutical is concentrated. This practice is often referred to as image fusion
or co-registration, for example SPECT/CT and PET/CT. The fusion imaging technique in nuclear
medicine provides information about the anatomy and function, which would otherwise be
unavailable or would require a more invasive procedure or surgery.

Normal whole body PET/CT scan with FDG-18. The whole body PET/CT scan is
commonly used in the detection, staging and follow-up of various cancers.

Abnormal whole body PET/CT scan with multiple metastases from a cancer. The whole
body PET/CT scan has become an important tool in the evaluation of cancer.
Practical concerns in nuclear imaging

Although the risks of low-level radiation exposures are not well understood, a cautious approach
has been universally adopted that all human radiation exposures should be kept As Low As
Reasonably Practicable, "ALARP". (Originally, this was known as "As Low As Reasonably
Achievable" (ALARA), but this has changed in modern draftings of the legislation to add more
emphasis on the "Reasonably" and less on the "Achievable".)
Working with the ALARP principle, before a patient is exposed for a nuclear medicine
examination, the benefit of the examination must be identified. This needs to take into account
the particular circumstances of the patient in question, where appropriate. For instance, if a
patient is unlikely to be able to tolerate a sufficient amount of the procedure to achieve a
diagnosis, then it would be inappropriate to proceed with injecting the patient with the
radioactive tracer.
When the benefit does justify the procedure, then the radiation exposure (the amount of radiation
given to the patient) should also be kept as low as reasonably practicable. This means that the
images produced in nuclear medicine should never be better than required for confident
diagnosis. Giving larger radiation exposures can reduce the noise in an image and make it more
photographically appealing, but if the clinical question can be answered without this level of
detail, then this is inappropriate.
As a result, the radiation dose from nuclear medicine imaging varies greatly depending on the
type of study. The effective radiation dose can be lower than or comparable to or can far exceed
the general day-to-day environmental annual background radiation dose. Likewise, it can also be
less than, in the range of, or higher than the radiation dose from an abdomen/pelvis CT scan.
Some nuclear medicine procedures require special patient preparation before the study to obtain
the most accurate result. Pre-imaging preparations may include dietary preparation or the
withholding of certain medications. Patients are encouraged to consult with the nuclear medicine
department prior to a scan.
Analysis

The end result of the nuclear medicine imaging process is a "dataset" comprising one or more
images. In multi-image datasets the array of images may represent a time sequence (i.e. cine or
movie) often called a "dynamic" dataset, a cardiac gated time sequence, or a spatial sequence
where the gamma-camera is moved relative to the patient. SPECT (single photon emission
computed tomography) is the process by which images acquired from a rotating gamma-camera
are reconstructed to produce an image of a "slice" through the patient at a particular position. A

collection of parallel slices form a slice-stack, a three-dimensional representation of the

distribution of radionuclide in the patient.
The nuclear medicine computer may require millions of lines of source code to provide
quantitative analysis packages for each of the specific imaging techniques available in nuclear
medicine.[citation needed]
Time sequences can be further analysed using kinetic models such as multi-compartment models
or a Patlak plot.
Interventional nuclear medicine
Main articles: Unsealed source radiotherapy and Brachytherapy

Radionuclide therapy can be used to treat conditions such as hyperthyroidism, thyroid cancer,
and blood disorders.
In nuclear medicine therapy, the radiation treatment dose is administered internally (e.g.
intravenous or oral routes) rather from an external radiation source.
The radiopharmaceuticals used in nuclear medicine therapy emit ionizing radiation that travels
only a short distance, thereby minimizing unwanted side effects and damage to noninvolved
organs or nearby structures. Most nuclear medicine therapies can be performed as outpatient
procedures since there are few side effects from the treatment and the radiation exposure to the
general public can be kept within a safe limit.
Common nuclear medicine (unsealed source) therapies
Substance

Condition

Iodine-131-sodium iodide

hyperthyroidism and
thyroid cancer

Yttrium-90-ibritumomab tiuxetan (Zevalin) and Iodine131-tositumomab (Bexxar)

refractory lymphoma

131

neuroendocrine tumors

I-MIBG (metaiodobenzylguanidine)

Samarium-153 or Strontium-89

palliative bone pain

treatment

In some centers the nuclear medicine department may also use implanted capsules of isotopes
(brachytherapy) to treat cancer.
Commonly used radiation sources (radionuclides) for brachytherapy[3]

Radionuclide

Type

Half-life

Energy

Caesium-137 (137Cs)

-ray

30.17 years

0.662 MeV

Cobalt-60 (60Co)

-ray

5.26 years

1.17, 1.33 MeV

Iridium-192 (192Ir)

-particles

73.8 days

0.38 MeV (mean)

Iodine-125 (125I)

-rays

59.6 days

27.4, 31.4 and 35.5 keV

Palladium-103 (103Pd)

-ray

17.0 days

21 keV (mean)

Ruthenium-106 (106Ru)

-particles

1.02 years

3.54 MeV

History

The history of nuclear medicine is rich with contributions from gifted scientists across different
disciplines in physics, chemistry, engineering, and medicine. The multidisciplinary nature of
nuclear medicine makes it difficult for medical historians to determine the birthdate of nuclear
medicine. This can probably be best placed between the discovery of artificial radioactivity in
1934 and the production of radionuclides by Oak Ridge National Laboratory for medicine related
use, in 1946.[4]
The origins of this medical idea date back as far as the mid-1920s in Freiburg, Germany, when
George de Hevesy made experiments with radionuclides administered to rats, thus displaying
metabolic pathways of these substances and establishing the tracer principle. Possibly, the
genesis of this medical field took place in 1936, when John Lawrence, known as "the father of
nuclear medicine", took a leave of absence from his faculty position at Yale Medical School, to
visit his brother Ernest Lawrence at his new radiation laboratory (now known as the Lawrence
Berkeley National Laboratory) in Berkeley, California. Later on, John Lawrence made the first
application in patients of an artificial radionuclide when he used phosphorus-32 to treat
leukemia.[5][6]
Many historians consider the discovery of artificially produced radionuclides by Frdric JoliotCurie and Irne Joliot-Curie in 1934 as the most significant milestone in nuclear medicine.[4] In
February 1934, they reported the first artificial production of radioactive material in the journal
Nature, after discovering radioactivity in aluminum foil that was irradiated with a polonium
preparation. Their work built upon earlier discoveries by Wilhelm Konrad Roentgen for X-ray,
Henri Becquerel for radioactive uranium salts, and Marie Curie (mother of Irne Curie) for
radioactive thorium, polonium and coining the term "radioactivity." Taro Takemi studied the
application of nuclear physics to medicine in the 1930s. The history of nuclear medicine will not
be complete without mentioning these early pioneers.
Nuclear medicine gained public recognition as a potential specialty on December 7, 1946 when
an article was published in the Journal of the American Medical Association by Sam Seidlin. The

article described a successful treatment of a patient with thyroid cancer metastases using
radioiodine (I-131). This is considered by many historians as the most important article ever
published in nuclear medicine.[7] Although the earliest use of I-131 was devoted to therapy of
thyroid cancer, its use was later expanded to include imaging of the thyroid gland, quantification
of the thyroid function, and therapy for hyperthyroidism.
Widespread clinical use of nuclear medicine began in the early 1950s, as knowledge expanded
about radionuclides, detection of radioactivity, and using certain radionuclides to trace
biochemical processes. Pioneering works by Benedict Cassen in developing the first rectilinear
scanner and Hal O. Anger's scintillation camera (Anger camera) broadened the young discipline
of nuclear medicine into a full-fledged medical imaging specialty.
In these years of nuclear medicine, the growth was phenomenal. The Society of Nuclear
Medicine was formed in 1954 in Spokane, Washington, USA. In 1960, the Society began
publication of the Journal of Nuclear Medicine, the premier scientific journal for the discipline in
America. There was a flurry of research and development of new radionuclides and
radiopharmaceuticals for use with the imaging devices and for in-vitro studies5.
Among many radionuclides that were discovered for medical-use, none were as important as the
discovery and development of Technetium-99m. It was first discovered in 1937 by C. Perrier and
E. Segre as an artificial element to fill space number 43 in the Periodic Table. The development
of a generator system to produce Technetium-99m in the 1960s became a practical method for
medical use. Today, Technetium-99m is the most utilized element in nuclear medicine and is
employed in a wide variety of nuclear medicine imaging studies.
By the 1970s most organs of the body could be visualized using nuclear medicine procedures. In
1971, American Medical Association officially recognized nuclear medicine as a medical
specialty.[8] In 1972, the American Board of Nuclear Medicine was established, and in 1974, the
American Osteopathic Board of Nuclear Medicine was established, cementing nuclear medicine
as a stand-alone medical specialty.
In the 1980s, radiopharmaceuticals were designed for use in diagnosis of heart disease. The
development of single photon emission computed tomography (SPECT), around the same time,
led to three-dimensional reconstruction of the heart and establishment of the field of nuclear
cardiology.
More recent developments in nuclear medicine include the invention of the first positron
emission tomography scanner (PET). The concept of emission and transmission tomography,
later developed into single photon emission computed tomography (SPECT), was introduced by
David E. Kuhl and Roy Edwards in the late 1950s .[citation needed] Their work led to the design and
construction of several tomographic instruments at the University of Pennsylvania. Tomographic

imaging techniques were further developed at the Washington University School of Medicine.
These innovations led to fusion imaging with SPECT and CT by Bruce Hasegawa from
University of California San Francisco (UCSF), and the first PET/CT prototype by D. W.
Townsend from University of Pittsburgh in 1998 .[citation needed]
PET and PET/CT imaging experienced slower growth in its early years owing to the cost of the
modality and the requirement for an on-site or nearby cyclotron. However, an administrative
decision to approve medical reimbursement of limited PET and PET/CT applications in
oncology has led to phenomenal growth and widespread acceptance over the last few years,
which also was facilitated by establishing 18F-labelled tracers for standard procedures, allowing
work at non-cyclotron-equipped sites. PET/CT imaging is now an integral part of oncology for
diagnosis, staging and treatment monitoring. A fully integrated MRI/PET scanner is on the
market from early 2011.[citation needed]
Source of radionuclides, with notes on a few radiopharmaceuticals
Main article: Radiopharmacology

About a third of the world's supply, and most of Europe's supply, of medical isotopes is produced
at the Petten nuclear reactor in the Netherlands. Another third of the world's supply, and most of
North America's supply, is produced at the Chalk River Laboratories in Chalk River, Ontario,
Canada. The NRU started operating in 1957. The Canadian Nuclear Safety Commission ordered
the National Research Universal reactor reactor to be shut down on November 18, 2007 for
regularly scheduled maintenance and an upgrade of the safety systems to modern standards. The
upgrade took longer than expected, and in December 2007 a critical shortage of medical isotopes
occurred. The Canadian government passed emergency legislation allowing the reactor to restart
on 16 December 2007, and production of medical isotopes to continue. Update: In Mid-February,
2009, the reactor was shut down once again due to a mechanism problem that extracts the
isotope containing rods from the reactor. The reactor was again shut down in Mid May of the
same year because of a heavy water leak. The reactor was started again during the first quarter of
2010. The NRU will cease routine production in the fall of 2016, however the reactor will be
available for backup production until March 2018, at which point it will be shut down.[9]
The Chalk River reactor is used to irradiate materials with neutrons which are produced in great
quantity during the fission of U-235. These neutrons change the nucleus of the irradiated material
by adding a neutron, or by splitting it in the process of nuclear fission. In a reactor, one of the
fission products of uranium is molybdenum-99 which is extracted and shipped to
radiopharmaceutical houses all over North America. The Mo-99 radioactively beta decays with a
half-life of 2.7 days (or 66 hours), turning initially into Tc-99m, which is then extracted (milked)
from a "moly cow" (see technetium-99m generator). The Tc-99m then further decays, while
inside a patient, releasing a gamma photon which is detected by the gamma camera. It decays to
its ground state of Tc-99, which is relatively non-radioactive compared to Tc-99m.

The most commonly used radioisotope in PET F-18, is not produced in any nuclear reactor, but
rather in a circular accelerator called a cyclotron. The cyclotron is used to accelerate protons to
bombard the stable heavy isotope of oxygen O-18. The O-18 constitutes about 0.20% of ordinary
oxygen (mostly O-16), from which it is extracted. The F-18 is then typically used to make FDG
(see this link for more information on this process).
Common isotopes used in nuclear medicine
isotope

symbol Z

T1/2

[10][11]

decay gamma (keV) positron (keV)

Imaging:
fluorine-18

18

9 109.77 m

511 (193%)

249.8 (97%)[12]
-

31

3.26 d

ec

93 (39%),
185 (21%),
300 (17%)

81m

Kr

36

13.1 s

IT

190 (68%)

82

Rb

37

1.27 m

511 (191%)

3.379 (95%)

9.97 m

511 (200%)

1190 (100%)[13]

gallium-67

67

krypton-81m
rubidium-82

Ga

nitrogen-13

13

technetium-99m

99m

Tc

43

6.01 h

IT

140 (89%)

indium-111

111

In

49

2.80 d

ec

171 (90%),
245 (94%)

53

13.3 h

ec

159 (83%)

Xe

54

5.24 d

81 (31%)

0.364 (99%)

Tl

81

3.04 d

ec

6983* (94%),
167 (10%)

39

2.67 d

2.280 (100%)

53

8.02 d

364 (81%)

0.807 (100%)

iodine-123
xenon-133
thallium-201

123

133

201

Therapy:
yttrium-90

90

iodine-131

131

Z = atomic number, the number of protons; T1/2 = half-life; decay = mode of decay
photons = principle photon energies in kilo-electron volts, keV, (abundance/decay)
= beta maximum energy in mega-electron volts, MeV, (abundance/decay)
+ = + decay; = decay; IT = isomeric transition; ec = electron capture
* X-rays from progeny, mercury, Hg

A typical nuclear medicine study involves administration of a radionuclide into the body by
intravenous injection in liquid or aggregate form, ingestion while combined with food, inhalation
as a gas or aerosol, or rarely, injection of a radionuclide that has undergone micro-encapsulation.
Some studies require the labeling of a patient's own blood cells with a radionuclide (leukocyte
scintigraphy and red blood cell scintigraphy). Most diagnostic radionuclides emit gamma rays,
while the cell-damaging properties of beta particles are used in therapeutic applications. Refined
radionuclides for use in nuclear medicine are derived from fission or fusion processes in nuclear
reactors, which produce radionuclides with longer half-lives, or cyclotrons, which produce
radionuclides with shorter half-lives, or take advantage of natural decay processes in dedicated
generators, i.e. molybdenum/technetium or strontium/rubidium.
The most commonly used intravenous radionuclides are:

Technetium-99m (technetium-99m)

Iodine-123 and 131

Thallium-201

Gallium-67

Fluorine-18 Fluorodeoxyglucose

Indium-111 Labeled Leukocytes

The most commonly used gaseous/aerosol radionuclides are:

Xenon-133

Krypton-81m

Technetium-99m Technegas[dead link] a radioaerosol invented in Australia by Dr

Bill Burch and Dr Richard Fawdry

Technetium-99m DTPA

Radiation dose

A patient undergoing a nuclear medicine procedure will receive a radiation dose. Under present
international guidelines it is assumed that any radiation dose, however small, presents a risk. The
radiation doses delivered to a patient in a nuclear medicine investigation, though unproven, is
generally accepted to present a very small risk of inducing cancer. In this respect it is similar to
the risk from X-ray investigations except that the dose is delivered internally rather than from an

external source such as an X-ray machine, and dosage amounts are typically significantly higher
than those of X-rays.
The radiation dose from a nuclear medicine investigation is expressed as an effective dose with
units of sieverts (usually given in millisieverts, mSv). The effective dose resulting from an
investigation is influenced by the amount of radioactivity administered in megabecquerels
(MBq), the physical properties of the radiopharmaceutical used, its distribution in the body and
its rate of clearance from the body.
Effective doses can range from 6 Sv (0.006 mSv) for a 3 MBq chromium-51 EDTA
measurement of glomerular filtration rate to 37 mSv (37,000 Sv) for a 150 MBq thallium-201
non-specific tumour imaging procedure. The common bone scan with 600 MBq of technetium99m-MDP has an effective dose of approximately 3.5 mSv (3,500 Sv) (1).
Formerly, units of measurement were the curie (Ci), being 3.7E10 Bq, and also 1.0 grams of
Radium (Ra-226); the rad (radiation absorbed dose), now replaced by the gray; and the rem
(Rntgen equivalent man), now replaced with the sievert. The rad and rem are essentially
equivalent for almost all nuclear medicine procedures, and only alpha radiation will produce a
higher Rem or Sv value, due to its much higher Relative Biological Effectiveness (RBE). Alpha
emitters are nowadays rarely used in nuclear medicine, but were used extensively before the
advent of nuclear reactor and accelerator produced radionuclides. The concepts involved in
radiation exposure to humans are covered by the field of Health Physics; the development and
practice of safe and effective nuclear medicinal techniques is a key focus of Medical Physics.
See also

American Osteopathic Board of Nuclear Medicine

American Board of Nuclear Medicine

Nuclear medicine physician

List of Nuclear Medicine Societies

Radiopharmaceutical

Radiation therapy

Radiographer

Radiologist

Radiology

Background radiation

Human subject research

Nuclear medicine imaging uses small amounts of low-level radioactive

compounds, which are given as an injection or by mouth (swallowed). These
compounds are attracted to specific organs, bones or tissues, which absorb the
radioactive material.
What is General Nuclear Medicine?

Nuclear medicine is a branch of medical imaging that uses small amounts of radioactive material
to diagnose and determine the severity of or treat a variety of diseases, including many types of
cancers, heart disease, gastrointestinal, endocrine, neurological disorders and other abnormalities
within the body. Because nuclear medicine procedures are able to pinpoint molecular activity
within the body, they offer the potential to identify disease in its earliest stages as well as a
patients immediate response to therapeutic interventions.
Diagnosis
Nuclear medicine imaging procedures are noninvasive and, with the exception of intravenous
injections, are usually painless medical tests that help physicians diagnose and evaluate medical
conditions. These 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 being
examined. Radioactive emissions from the radiotracer are detected by a special camera or
imaging device that produces pictures and provides molecular information.
In many 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 exams 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 exams at the same time. An
emerging imaging technology, but not readily available at this time is PET/MRI.
Therapy
Nuclear medicine also offers therapeutic procedures, such as radioactive iodine (I-131) therapy
that use small amounts of radioactive material to treat cancer and other medical conditions
affecting the thyroid gland, as well as treatments for other cancers and medical conditions.

Non-Hodgkin's lymphoma patients who do not respond to chemotherapy may undergo

radioimmunotherapy (RIT).
Radioimmunotherapy (RIT) is a personalized cancer treatment that combines radiation therapy
with the targeting ability of immunotherapy, a treatment that mimics cellular activity in the
body's immune system.
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What are some common uses of the procedure?

Physicians use radionuclide imaging procedures to visualize the structure and function of an
organ, tissue, bone or system within the body.
In adults, nuclear medicine is used to:
Heart

visualize heart blood flow and function (such as a myocardial perfusion scan)

detect coronary artery disease and the extent of coronary stenosis

assess damage to the heart following a heart attack

evaluate treatment options such as bypass heart surgery and angioplasty

evaluate the results of revascularization procedures

detect heart transplant rejection

evaluate heart function before and after chemotherapy (MUGA)

Lungs

scan lungs for respiratory and blood flow problems

assess differential lung function for lung reduction or transplant surgery

detect lung transplant rejection

Bones

evaluate bones for fractures, infection and arthritis

evaluate for metastatic bone disease

evaluate painful prosthetic joints

evaluate bone tumors

identify sites for biopsy

Brain

investigate abnormalities in the brain, such as seizures, memory loss and

abnormalities in blood flow

detect the early onset of neurological disorders such as Alzheimer disease

plan surgery and localize seizure foci

evaluate for abnormalities in a chemical in the brain involved in controlling

movement in patients with suspected Parkinson's disease

evaluation of brain tumor recurrence, surgical or radiation planning or

localization for biopsy

Other Systems

identify inflammation or abnormal function of the gallbladder

identify bleeding into the bowel

assess post-operative complications of gallbladder surgery

evaluate lymphedema

evaluate fever of unknown origin

locate the presence of infection

measure thyroid function to detect an overactive or underactive thyroid

help diagnose hyperthyroidism and blood cell disorders

evaluate for hyperparathyroidism

evaluate stomach emptying

evaluate spinal fluid flow and potential spinal fluid leaks

In adults and children, nuclear medicine is also used to:

Cancer

stage cancer by determining the presence or spread of cancer in various

parts of the body

localize sentinel lymph nodes before surgery in patients with breast cancer or
skin and soft tissue tumors.

plan treatment

evaluate response to therapy

detect the recurrence of cancer

detect rare tumors of the pancreas and adrenal glands

Renal

analyze native and transplant kidney function

detect urinary tract obstruction

evaluate for hypertension related to the kidney arteries

evaluate kidneys for infection versus scar

detect and follow-up urinary reflux

In children, nuclear medicine is also used to:

investigate abnormalities in the esophagus, such as esophageal reflux or

motility disorders

evaluate the openness of tear ducts

evaluate the openness of ventricular shunts in the brain

assess congenital heart disease for shunts and pulmonary blood flow

Nuclear medicine therapies include:

Radioactive iodine (I-131) therapy used to treat some causes of

hyperthyroidism (overactive thyroid gland, for example, Graves' disease) and
thyroid cancer

Radioactive antibodies used to treat certain forms of lymphoma (cancer of

the lymphatic system)

Radioactive phosphorus (P-32) used to treat certain blood disorders

Radioactive materials used to treat painful tumor metastases to the bones

I-131 MIBG (radioactive iodine labeled with metaiodobenzylguanidine) used

to treat adrenal gland tumors in adults and adrenal gland/nerve tissue tumors
in children

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How should I prepare?

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. See the Safety page for more information about
pregnancy and breastfeeding related to nuclear medicine imaging.
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.
Jewelry and other metallic accessories should be left at home if possible, or removed prior to the
exam because they may interfere with the procedure.
You will receive specific instructions based on the type of scan you are undergoing.
In some instances, certain medications or procedures may interfere with the examination ordered.
See the Radioactive Iodine (I-131) Therapy page for instructions on how to prepare for the
procedure.
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What does the equipment look like?

Special camera or imaging devices used in nuclear medicine include the gamma camera and
single-photon emission-computed tomography (SPECT).
The gamma camera, , also called a scintillation camera, detects radioactive energy that is emitted
from the patient's body and converts it into an image. The gamma camera does not emit any
radiation. The gamma camera is composed of radiation detectors, called gamma camera heads,
which are encased in metal and plastic and most often shaped like a box, attached to a round
circular donut shaped gantry. The patient lies on the examination table which slides in between

the parallel gamma camera heads which are suspended over the examination table and located
beneath the examination table. Sometimes, the gamma camera heads are oriented at a 90 degree
angle and placed over the patient's body.
SPECT involves the rotation of the gamma camera heads around the patient's body to produce
more detailed, three-dimensional images.
A 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.
A computer aids in creating the images from the data obtained by the gamma camera.
A probe is a small hand-held device resembling a microphone that can detect and measure the
amount of the radiotracer in a small area of your body.
There is no specialized equipment used during radioactive iodine therapy, but the technologist or
other personnel administering the treatment may cover your clothing and use lead containers to
shield the radioactive material you will be receiving.
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How does the procedure work?

With ordinary x-ray examinations, an image is made by passing x-rays through the patient's
body. In contrast, nuclear medicine procedures use a radioactive material, called a
radiopharmaceutical or radiotracer, which is injected into the 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. Special
cameras detect this energy, and with the help of a computer, create pictures offering details on
both the structure and function of organs and tissues in your body.
Unlike other imaging techniques, nuclear medicine imaging exams focus on depicting
physiologic processes within the body, such as rates of metabolism or levels of various other
chemical activity, instead of showing anatomy and structure. 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 or metabolic activity. Less intense areas, or "cold spots," indicate a
smaller concentration of radiotracer and less chemical activity.
In radioactive iodine (I-131) therapy for thyroid disease, radioactive iodine (I-131) is swallowed,
absorbed into the bloodstream in the gastrointestinal (GI) tract and concentrated from the blood
by the thyroid gland where it destroys cells within that organ.

Radioimmunotherapy (RIT) is a combination of radiation therapy and immunotherapy. In

immunotherapy, a laboratory-produced molecule called a monoclonal antibody is engineered to
recognize and bind to the surface of cancer cells. Monoclonal antibodies mimic the antibodies
naturally produced by the body's immune system that attack invading foreign substances, such as
bacteria and viruses.
In RIT, a monoclonal antibody is paired with a radioactive material. When injected into the
patient's bloodstream, the antibody travels to and binds to the cancer cells, allowing a high dose
of radiation to be delivered directly to the tumor.
In I-131MIBG therapy for neuroblastoma, the radiotracer is administered by injection into the
blood stream. The radiotracer binds to the cancer cells allowing a high dose of radiation to be
delivered to the tumor.
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How is the procedure performed?

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) catheter 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 can take anywhere from several seconds to several days for the radiotracer to travel through
your body and accumulate in the organ or area being studied. As a result, imaging may be done
immediately, a few hours later, or even several days after you have received the radioactive
material.
When it is time for the imaging to begin, the camera or scanner will take a series of images. The
camera may rotate around you or it may stay in one position and you will be asked to change
positions in between images. While the camera is taking pictures, you will need to remain still
for brief periods of time. In some cases, the camera may move very close to your body. This is
necessary to obtain the best quality images. If you are claustrophobic, you should inform the
technologist before your exam begins.
If a probe is used, this small hand-held device will be passed over the area of the body being
studied to measure levels of radioactivity. Other nuclear medicine tests measure radioactivity
levels in blood, urine or breath.

The length of time for nuclear medicine procedures varies greatly, depending on the type of
exam. Actual scanning time for nuclear imaging exams can take from 20 minutes to several
hours and may be conducted over several days.
Young children may require gentle wrapping or sedation to help them hold still. If your doctor
feels sedation is needed for your child, you will receive specific instructions regarding when and
if you can feed your child on the day of the exam. A physician or nurse specializing in the
administration of sedation to children will be available during the exam to ensure your child's
safety while under the effects of sedation. When scheduling the exam for a young child, ask if a
child life specialist is available. A child life specialist is trained to make your child comfortable
and less anxious without sedation and will help your child to remain still during the examination.
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.
If you had an intravenous line inserted for the procedure, it will usually be removed unless you
are scheduled for an additional procedure that same day that requires an intravenous line.
For patients with thyroid disease who undergo radioactive iodine (I-131) therapy, which is most
often an outpatient procedure, the radioactive iodine is swallowed, either in capsule or liquid
form.
Radioimmunotherapy (RIT), also typically an outpatient procedure, is delivered through
injection.
I-131MIBG therapy for neuroblastoma is administered by injection into the blood stream.
Children are admitted to the hospital for treatment as an inpatient.
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What will I experience during and after the procedure?

Except for intravenous injections, most nuclear medicine procedures are painless and are rarely
associated with significant discomfort or side effects.
When 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.
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 should also drink plenty of water to
help flush the radioactive material out of your body as instructed by the nuclear medicine
personnel.
See Safety in Nuclear Medicine Procedures for more information.
You will be informed as to how often and when you will need to return to the nuclear medicine
department for further procedures.
See the Radioactive iodine (I-131) Therapy page for information regarding the side-effects of
this treatment.
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Who interprets the results and how do I get them?

A radiologist or other physician who has specialized training in nuclear medicine will interpret
the images and forward a report to your referring physician.
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What are the benefits vs. risks?

Benefits

Nuclear medicine examinations provide unique informationincluding details

on both function and anatomic structure of the body that is 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.

Nuclear medicine offers the potential to identify disease in its earliest stage,
often before symptoms occur or abnormalities can be detected with other
diagnostic tests.

By detecting whether lesions are likely benign or malignant, PET scans may
eliminate the need for surgical biopsy or identify the best biopsy location.

PET scans may provide additional information that is used for radiation
therapy planning.

Risks

Because the doses of radiotracer administered are small, diagnostic nuclear

medicine procedures result in relatively low radiation exposure to the patient,
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 lowdose exposure.

The risks of the treatment are always weighed against the potential benefits
for nuclear medicine therapeutic procedures. You will be informed of all
significant risks prior to the treatment and have an opportunity to ask
questions.

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. See the

Safety page for more information about pregnancy, breastfeeding and

nuclear medicine exams.

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What are the limitations of General Nuclear Medicine?

Nuclear medicine procedures can be time consuming. It can take several hours to days for the
radiotracer to accumulate in the body part of interest 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.
The resolution of structures of the body with nuclear medicine may not be as high 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 other imaging techniques.
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