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Nuclear Medicine

Nuclear Medicine. Imaging and the treatment of Cancer. Gamma photons are the most energetic photons in the electromagnetic spectrum. Gamma rays (gamma photons) are emitted from the nucleus of some unstable (radioactive) atoms. What are the properties of gamma radiation? .

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Nuclear Medicine

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  1. Nuclear Medicine Imaging and the treatment of Cancer

  2. Gamma photons are the most energetic photons in the electromagnetic spectrum. Gamma rays (gamma photons) are emitted from the nucleus of some unstable (radioactive) atoms.

  3. What are the properties of gamma radiation? Gamma radiation is very high-energy ionizing radiation. Gamma photons have no mass and no electrical charge--they are pure electromagnetic energy. Gamma Radiation

  4. Gamma Radiation • Because of their high energy, gamma photons travel at the speed of light and can cover hundreds to thousands of meters in air before spending their energy. They can pass through many kinds of materials, including human tissue

  5. Gamma Radiation • What is the difference between gamma rays and x-rays? • Gamma rays and x-rays, like visible, infrared, and ultraviolet light, are part of the electromagnetic spectrum. While gamma rays and x-rays differ in their origin. Gamma rays originate in the nucleus. X-rays originate in the electron fields surrounding the nucleus.

  6. Gamma Radiation • How do we use gamma emitters? • The penetrating power of gamma photons has many applications. Gamma rays penetrate many materials, they do not make them radioactive. The three radionuclides by far most useful are cobalt-60 and cesium-137 and technetium-99m.

  7. Gamma Radiation • Uses of Cesium-137: • cancer treatment • Uses of Cobalt-60: • sterilize medical equipment in hospitals • treat cancer

  8. Gamma Radiation • Uses of Technetium-99m: • TC-99m is the most widely used radioactive isotope for diagnostic studies. (Technetium-99m is a shorter half-life version of technetium-99.) Different chemical forms are used for brain, bone, liver, spleen and kidney imaging and also for blood flow studies.

  9. Radioactive Measurements • 1. Competitive Binding Assays • 2. Time Dependent Measurements • 3. Radio Nucleotide Imaging • Gamma Camera – scintillation camera • 4. Tomography • SPECT imaging • PET imaging

  10. 1. Competitive Binding Assays • No radioactive substance is given to the patient • Blood from a patient is mixed with a radioactive substance in the laboratory • Radioimmunoassay • Thyroid Hormone and Iron Binding Sites most common.

  11. 1. Competitive Binding Assays

  12. 2. Time Dependent Measurements • Radioactive Tracers are to the patient administered. • Allows the volume of a compartment to be measured.

  13. An Intravenous Pyelogram (IVP) is an x-ray examination of the kidneys, ureters, and urinary bladder. Intravenous Pyelogram

  14. Intravenous Pyelogram

  15. HIDA Scan This is a test done to diagnose obstruction of the bile ducts (for example, by a gallstone or a tumor), disease of the gallbladder, and bile leaks.

  16. Coronary angiography is performed to detect obstruction in the coronary arteries of the heart. During the procedure a catheter is inserted into an artery in your groin and then threaded carefully into the heart. The blood vessels of the heart are then studied by injection of contrast media through the catheter. A rapid succession of X-rays is taken to view blood flow. Cardiac Angiography

  17. The arrow indicates a blockage in the right coronary artery.

  18. Cerebral Angiogram This image taken before angioplasty: This patient had episodes of weakness, leading to the angiogram. The angiogram shows a very narrowed artery supplying the right side of brain. This vessel is within the skull on the surface of the brain

  19. Cerebral angiogram taken after angioplasty: The narrowing is less severe and the branches beyond the narrowing fill better

  20. Image is generated using radioactive decay from an organ Usually a function of time. Provide functional information 3. Radionucleotide Imaging

  21. Single detectors are used for thyroid studies. 3. Radionucleotide Imaging

  22. Scintillation Camera Shows two dimensional data Studies physiologic function 3. Radionucleotide Imaging

  23. Ventilation-Perfusion Scan of a lung looking for a blood clot.

  24. A bone scan is used to find bone problems, such as cancer, infections, or fractures, to check joint replacements, and to find joint problems, such as arthritis.  A small amount of injected radioactive matter (tracer) and a camera to form an image.    Bone scan looking for metastatic bone cancer.

  25. Looking for fibrous dysplasia that is a congenital, non-hereditary skeletal disorder Patients are often asymptomatic. Others experience pain, pathologic fractures and bone deformity

  26. Imaging of Acute Osteomyelitis in the Diabetic Foot A 65 year old male with a history of non-insulin dependent diabetes mellitus, alcohol abuse, and severe peripheral vascular disease presented with a non-healing ulcer of the left first toe.

  27. This Indium White Blood Cell Scan demonstrates areas of infection in the abdomen after surgery for colon cancer.

  28. 4. Tomography • The fourth class of imaging is the tomographic reconstruction of body slices. • Single-photon emission computer tomography - SPECT scan • Position Emission Tomography – PET scan

  29. SPECT SCANNER

  30. SPECT Imaging • The use of a brain SPECT scan is based on the principal of blood flow.  • Areas of increased blood flow take up more Radioactive tracer than areas of less blood flow. • Blood flow in the brain is directly related to brain activity.

  31. COMMON DISEASES EVALATED BY SPECT • Attention Deficit Hyperactive Disorder • Autism,  Aspergers syndrome • Unipolar and Bipolar Depression • Anxiety states - Panic, • Obsessive-Compulsive Disorder • Epilepsy and Non-epileptic seizure equivalents • Post Traumatic Stress Disorder • Migraine and common headaches  • Schizophrenia • Dementia and memory loss- Stroke- Multiple Sclerosis- Parkinson's Disease

  32. SPECT Image

  33. Blood flow to the brain is represented on a color scale, dark areas have no flow and bright yellow areas have good blood flow.  The dark "butterfly-shaped" area in the center of the brain is normal, but the dark area on the right of each picture is the region of impaired blood supply (ischemia) that corresponds to the patient's acute stroke.

  34. Prior to t-PA, the SPECT scan showed a large area of the brain that has lost its blood supply (arrow). Several hours after treatment with t-PA, the blood flow has dramatically improved, although there is still a small area ischemia (arrow).

  35. PET Scanner

  36. Image of heart which has had a mycardial infarction. The arrow points to "dead" myocardial tissue. Therefore, the patient will not benefit from heart surgery, but may have other forms of treatment prescribed. Normal PET scan of a heart.

  37. PET image showing malignant breast mass that was not revealed by conventional imaging techniques such as CT, MRI, and mammogram PET image of same patient with enlarged left axillary lymph nodes (indicated by arrows), which through biopsy were found to be metastatic. The whole body scan reveals a mass in the left breast (indicated by arrow), that was malignant and subsequently removed

  38. Normal Brain Image of the brain of a 9 year old female with a history of seizures poorly controlled by medication. PET imaging identifies the area (indicated by the arrows) of the brain responsible for the seizures. Through surgical removal of this area of the brain, the patient is rendered "seizure-free".

  39. PET measurements of cerebral blood flow (CBF) and oxygen extraction by the brain (OEF) before (top row)and after (bottom row) angioplasty of a focal severe stenosis of an artery at the base of the brain (supraclinoid internal carotid artery).

  40. 65 year old male with brain tumors imaged here with a PET scan.

  41. Treatment of Cancer • Radioactivity is very effective in the treatment of certain cancers. • The choice is basically do you administer the radiotherapy externally or internally.

  42. External Beam Therapy • External beam therapy (EBT) is a method for delivering a beam of high-energy x-rays to the location of the patient's tumor. • The beam is generated outside the patient and is targeted at the tumor site. • These x-rays can destroy the cancer cells and careful treatment planning allows the surrounding normal tissues to be spared.

  43. These cancers are commonly treated. • Breast Cancer • Colorectal Cancer (Bowel Cancer) • Head and Neck Cancer • Lung Cancer • Prostate Cancer

  44. High Energy X-Rays

  45. Linear Particle Accelerator

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