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What is Nuclear Medicine?

**NEW**
What Is PET information added to the website - 6/25/02
Nuclear medicine is a medical secialt! that uses safe" ainless" and
cost-effecti#e techni$ues both to ima%e the bod! and treat disease&
Nuclear medicine ima%in% is uni$ue in that it documents or%an
function and structure" in contrast to dia%nostic radiolo%!" which is
based uon anatom!& It is a wa! to %ather medical information that
ma! otherwise be una#ailable" re$uire sur%er!" or necessitate more
e'ensi#e dia%nostic tests&
(s an inte%ral art of atient care" nuclear medicine is used in the
dia%nosis" mana%ement" treatment" and re#ention of serious
disease& Nuclear medicine ima%in% rocedures often identif!
abnormalities #er! earl! in the ro%ression of a disease -lon% before
some medical roblems are aarent with other dia%nostic tests&
This earl! detection allows a disease to be treated earl! in its course
when there ma! be a more successful ro%nosis&
Nuclear medicine uses #er! small amounts of radioacti#e materials or radioharmaceuticals to
dia%nose and and treat disease& )adioharmaceuticals are substances that are attracted to
secific or%ans" bones" or tissues& The radioharmaceuticals used in nuclear medicine emit
%amma ra!s that can be detected e'ternall! b! secial t!es of cameras* %amma or PET
cameras& These cameras wor+ in con,unction with comuters used to form ima%es that ro#ide
data and information about the area of bod! bein% ima%ed& The amount of radiation from a
nuclear medicine rocedure is comarable to that recei#ed durin% a dia%nostic '-ra!&
Toda!" nuclear medicine offers rocedures that are helful to a broad san of medical secialties"
from ediatrics to cardiolo%! to s!chiatr!& There are nearl! one hundred different nuclear
medicine ima%in% rocedures a#ailable and not a ma,or or%an s!stem which is not ima%ed b!
nuclear medicine&
What Patients Should Know About Nuclear Medicine Procedures
-our doctor has referred !ou or a famil! member for a test in the nuclear medicine deartment
because the information obtained from the test will be imortant in determinin% the dia%nosis and
treatment of the medical roblem !ou ma! ha#e& -ou robabl! ha#e a number of $uestions such
as*
What is a nuclear medicine test.
What rearation is needed for the test.
What will haen durin% the test.
This section ro#ides information on some of the more commonl! erformed dia%nostic and
theraeutic nuclear medicine rocedures& /irst" an o#er#iew of nuclear medicine is discussed0
answers to fre$uentl! as+ed $uestions as well as +e! oints to +now are ro#ided& 1astl!"
rocedures for secific tests are outlined&
2owe#er" the material resented here is for informational uroses onl! and is not intended as a
substitute for discussion between !ou and !our h!sician& If !ou re$uire more information about a
nuclear medicine rocedure" lease consult !our h!sician or the nuclear medicine deartment of
the institution where the test will be erformed&
What Is Nuclear Medicine?
Nuclear medicine in#ol#es the use of small amounts of radioacti#e materials 3or tracers4 to hel
dia%nose and treat a #ariet! of diseases& Nuclear medicine determines the cause of the medical
roblem based on the function of the or%an" tissue or bone& This is how nuclear medicine differs
from an '-ra!" ultrasound or other dia%nostic test that determines the resence of disease based
on structural aearance&
5illions of nuclear medicine tests are erformed each !ear in the 6nited 7tates alone& Nuclear
medicine tests 3also +nown as scans" e'aminations" or rocedures4 are safe and ainless& In a
nuclear medicine test" the radioacti#e material is introduced into the bod! b! in,ection"
swallowin%" or inhalation& 8ifferent tracers are used to stud! different arts of the bod!& The
amount of tracer used is carefull! selected to ro#ide the least amount of radiation e'osure to
the atient but ensure an accurate test& ( secial camera 3scintillation or %amma camera4 is used
to ta+e ictures of !our bod!& The camera does this b! detectin% the tracer in the or%an" bone or
tissue bein% ima%ed and then records this information on a comuter screen or on film& 9enerall!"
nuclear medicine tests are not recommended for re%nant women because unborn babies ha#e a
%reater sensiti#it! to radiation than children or adults& If !ou are re%nant or thin+ that !ou are
re%nant" !our doctor ma! order a different t!e of dia%nostic test&

Careers in Nuclear Medicine: Ph!sicians Technolo%ists Pharmacist :ob ;an+
Nuclear h!sicians are usuall! based in a uni#ersit! or hosital" or both" and ha#e limited
in#ol#ement in direct atient care& Nuclear 5edicine h!sicians articiate in the intellectual
challen%e resented in assistin% with the formulation of atient dia%noses and treatment
where#er indicated& This secialt! offers clinical #ariet!" freedom to conduct research and ma+e
ori%inal obser#ations&
The nuclear medicine technolo%ist is a seciali<ed healthcare rofessional who wor+s directl!
with atients durin% an ima%in% rocedure and wor+s closel! with the nuclear medicine h!sician&
( nuclear harmacist seciali<es in the rocurement" comoundin%" $ualit! control testin%"
disensin%" distribution" and monitorin% of radioharmaceuticals& The! also ro#ide consultation
re%ardin% health and safet! issues as well as the use of non-radioacti#e dru%s and atient care&

The History O Nuclear Medicine
(lso see* JNM's Newsline 2istor! =orner (rchi#es
Nuclear medicine has a comle' and multifaceted herita%e& Its ori%ins stem from man! scientific
disco#eries" most notabl! the disco#er! of '-ra!s in >?@5 and the disco#er! of Aartificial
radioacti#it!A in >@BC& The first clinical use of Aartificial radioacti#it!A was carried out in >@BD for
the treatment of a atient with leu+emia at the 6ni#ersit! of =alifornia at ;er+ele!&
( landmar+ e#ent for nuclear medicine occurred in >@C6 when a th!roid cancer atientEs
treatment with radioacti#e iodine caused comlete disaearance of the sread of the atientEs
cancer& This has been considered b! some as the true be%innin% of nuclear medicine& Wide-
sread clinical use of nuclear medicine" howe#er" did not start until the earl! >@50s&
The #alue of radioacti#e iodine became aarent as its use increased to measure the function of
the th!roid and to dia%nose th!roid disease& 7imultaneousl!" more and more h!sicians be%in to
use Anuclear medicineA for the treatment of atients with h!erth!roidism& The concet of nuclear
medicine was a dramatic brea+throu%h for dia%nostic medicine& 5oreo#er" the abilit! to treat a
disease with radioharmaceuticals and to record and ma+e a AictureA of the form and structure
of an or%an was in#aluable&
In the mid-si'ties and the !ears that followed" the %rowth of nuclear medicine as a secialt!
disciline was henomenal& The ad#ances in nuclear medicine technolo%! and instrument
manufacturers were critical to this de#eloment&
The >@D0s brou%ht the #isuali<ation of most other or%ans of the bod! with nuclear medicine"
includin% li#er and sleen scannin%" brain tumor locali<ation" and studies of the %astrointestinal
trac+&
The >@?0s ro#ided the use of radioharmaceuticals for such critical dia%noses as heart disease
and the de#eloment of cuttin%-ed%e nuclear medicine cameras and comuters& Toda!" there are
nearl! >00 different nuclear medicine rocedures that uni$uel! ro#ide information about #irtuall!
e#er! ma,or or%an s!stem within the bod!& Nuclear medicine is an inte%ral art of atient care"
and an imortant dia%nostic and theraeutic secialt! in the armamentarium of medical science&
I!"ortant #ates in the History o Nuclear Medicine
$%&' 2enri ;ec$uerel disco#ered m!sterious Ara!sA from uranium&
$%&( 5arie =urie named the m!sterious ra!s Aradioacti#it!&A
$&)$ 2enri (le'andre 8anlos and Eu%ene ;loch laced radium in contact with a tuberculous s+in
lesion&
$&)* (le'ander 9raham ;ell su%%ested lacin% sources containin% radium in or near tumors&
$&$* /rederic+ Proescher ublished the first stud! on the intra#enous in,ection of radium for
thera! of #arious diseases&
$&+, 9eor% de 2e#es!" :&(& =hristiansen and 7#en 1omholt erformed the first radiotracer 3lead-
2>0 and bismuth-2>04 studies in animals&
$&*+ Ernest F& 1awrence and 5& 7tanle! 1i#in%ston ublished the first article on Athe roduction
of hi%h seed li%ht ions without the use of hi%h #olta%es&A It was a milestone in the
roduction of usable $uantities of radionuclides&
$&*' :ohn 2& 1awrence" the brother of Ernest" made the first clinical theraeutic alication of an
artificial radionuclide when he used hoshorus-B2 to treat leu+emia&
$&*( :ohn 1i#in%ood" /red /airbrother and 9lenn 7eabor% disco#ered iron-5@& >@B? :ohn
1i#in%ood and 9lenn 7eabor% disco#ered iodine->B> and cobalt-60&
$&*& Emilio 7e%re and 9lenn 7eabor% disco#ered technetium-@@m&
$&,) The )oc+efeller /oundation funded the first c!clotron dedicated for biomedical radioisotoe
roduction at Washin%ton 6ni#ersit! in 7t& 1ouis&
$&,' 7amuel 5& 7eidlin" 1eo 8& 5arinelli and Eleanor Fshr! treated a atient with th!roid cancer
with iodine->B>" an Aatomic coc+tail&A
$&,( ;enedict =assen used radioiodine to determine whether a th!roid nodule accumulates
iodine" helin% to differentiate beni%n from mali%nant nodules&
$&,% (bbott 1aboratories be%an distribution of radioistoes&
$&-) G&)& =risell and :ohn P& 7toraasli used iodine->B> labeled human serum albumin 3)I7(4
for ima%in% the blood ool within the heart&
$&-$ The 6&7& /ood and 8ru% (dministration 3/8(4 aro#ed sodium iodide >->B> for use with
th!roid atients& It was the first /8(-aro#ed radioharmaceutical&
$&-* 9ordon ;rownell and 2&2& 7weet built a ositron detector based on the detection of
annihilation hotons b! means of coincidence countin%&
$&-, 8a#id Guhl in#ented a hotorecordin% s!stem for radionuclide scannin%& This de#eloment
mo#ed nuclear medicine further in the direction of radiolo%!&
$&-- )e' 2uff measured the cardiac outut in man usin% iodine->B> human serum albumin&
$&-% 2al (n%er in#ented the Ascintillation camera"A an ima%in% de#ice that made it ossible to
conduct d!namic studies&
$&') 1ouis 9& 7tan%" :r&" and Powell 3:im4 )ichards ad#ertised technetium-@@m and other
%enerators for sale b! ;roo+ha#en National 1aborator!& Technetium-@@m had not !et been
used in nuclear medicine&
$&'+ 8a#id Guhl introduced emission reconstruction tomo%rah!& This method later became
+nown as 7PE=T and PET& It was e'tended in radiolo%! to transmission H-ra! scannin%"
+nown as =T&
$&'* The /8( e'emted the Anew dru%A re$uirements for radioharmaceuticals re%ulated b! the
(tomic Ener%! =ommission&
2enr! Wa%ner first used radiolabeled albumin a%%re%ates for ima%in% lun% erfusion in
normal ersons and atients with ulmonar! embolism&
$&'& =&1& Edwards reorted the accumulation of %allium-6D in cancer& >@D0 The /8( announced
that it would %raduall! withdraw the e'emtion %ranted to radioharmaceuticals and start
re%ulatin% them as dru%s& The chan%e would be comleted b! :an& 20" >@DD&
$&($ The (merican 5edical (ssociation officiall! reco%ni<ed nuclear medicine as a medical
secialit!&
$&(* 2& William 7trauss introduced the e'ercise stress-test m!ocardial scan&
$&(' :ohn Ge!es de#eloed the first %eneral urose sin%le hoto emission comuted
tomo%rah! 37PE=T4 camera& )onald :as<c<a+ de#eloed the first dedicated head 7PE=T
camera&
$&(% 8a#id 9oldenber% used radiolabeled antibodies to ima%e tumors in humans&
$&%$ :&P& 5ach used radiolabeled monoclonal antibodies for tumor ima%in%&
$&%+ 7te#e 1arson and :eff =arras$uillo treated cancer atients with mali%nant melanoma usin%
iodine->B> labeled monoclonal antibodies&
$&%& The /8( aro#ed the first ositron radioharmaceutical 3rubidium-?24 for m!ocardial
erfusion ima%in%&
$&&+ The /8( aro#ed the first monoclonal antibod! radioharmaceutical for tumor ima%in%&

.eneits O Nuclear Medicine
Nuclear medicine is a safe" ainless" and cost-effecti#e wa! of %atherin% information that ma!
otherwise be una#ailable or re$uire more e'ensi#e and ris+! dia%nostic test& ( uni$ue asect of
a nuclear medicine test is its e'treme sensiti#it! to abnormalities in an or%anEs structure or
function& (s an inte%ral art of atient care" nuclear medicine is used in the dia%nosis"
mana%ement" treatment and re#ention of serious disease& Nuclear medicine ima%in% rocedures
often identif! abnormalities #er! earl! in the ro%ression of a disease --lon% before some medical
roblems are aarent with other dia%nostic test& This earl! detection allows a disease to be
treated earl! in its course when there ma! be a more successful ro%nosis&
(lthou%h nuclear medicine is commonl! used for dia%nostic uroses" it also has #aluable
theraeutic alications such as treatment of h!erth!roidism" th!roid cancer" blood imbalances"
and ain relief from certain t!es of bone cancer&
Saety o Nuclear Medicine
Nuclear medicine rocedures are amon% the safest dia%nostic ima%in% e'ams a#ailable& ( atient
onl! recei#es an e'tremel! small amount of a radioharmaceutical" ,ust enou%h to ro#ide
sufficient dia%nostic information& In fact" the amount of radiation from a nuclear medicine
rocedure is comarable to" or often times less than" that of a dia%nostic '-ra!&
(lthou%h we donEt thin+ much about it" e#er!one is continuall! e'osed to radiation from natural
and manmade sources& /or most eole" natural bac+%round radiation from sace" roc+s" soil"
and e#en carbon and otassium atoms in his or her own bod!" accounts for ?5 ercent of their
annual e'osure& (dditional e'osure is recei#ed from consumer roducts such as household
smo+e detectors" color tele#ision sets" and luminous dial cloc+s& The remainder is from '-ra!s
and radioacti#e materials used for medical dia%nosis and thera!& With most nuclear medicine
rocedures" the atient recei#es about the same amount of radiation as that ac$uired in a few
months of normal li#in%&
;ecause of his or her secial trainin%" the nuclear medicine h!sician is able to select the most
aroriate e'amination for the atientEs articular medical roblem" and thereb! a#oid an!
unnecessar! radiation e'osure&

Nuclear Medicine Procedures
A Partial /ist o Why Physicians Order Nuclear Medicine Studies
Neurolo%ic (lications*
8ia%nose 7tro+e
8ia%nose (l<heimerEs 8isease
8emonstrate =han%es in (I87 8ementia
E#aluate Patients for =arotid 7ur%er!
1ocali<e 7ei<ure /oci
E#aluate Post =oncussion 7!ndrome
8ia%nose 5ulti-Infarct 8ementia
Fncolo%ic (lications*
Tumor 1ocali<ation
Tumor 7ta%in%
Identif! 5etastatic 7ites
:ud%e )esonse to Thera!
)elie#e ;one Pain =aused b! =ancer
Frthoedic (lications*
Identif! Fccult ;one Trauma 37orts In,uries4
8ia%nose Fsteom!elitis
E#aluate (rthritic =han%es and E'tent
1ocali<e 7ites for ;ios! in Tumor Patients
5easure E'tent of =ertain Tumors
Identif! ;one Infarcts in 7ic+le =ell 8isease
)enal (lications*
8etect 6rinar! Tract Fbstruction
8ia%nose )eno#ascular 2!ertension
5easure 8ifferential )enal /unction
8etect )enal Translant )e,ection
8etect P!elonehritis
8etect )enal 7cars
=ardiac (lications*
8ia%nose =oronar! (rter! 8isease
5easure Effecti#eness of ;!ass 7ur%er!
5easure Effecti#eness of Thera! for 2eart /ailure
8etect 2eart Translant )e,ection
7elect Patients for ;!ass or (n%iolast!
Identif! Patients at 2i%h )is+ of 2eart (ttac+s %oin% to 7ur%er! for Fther )easons
Identif! )i%ht 2eart /ailure
5easure =hemothera! =ardiac To'icit!
E#aluate Ial#ular 2eart 8isease
Identif! 7hunts and Juantif! Them
8ia%nose and 1ocali<e (cute 2eart (ttac+s ;efore En<!me =han%es
Pulmonar! (lications*
8ia%nose Pulmonar! Emboli
8etect Pulmonar! =omlications of (I87
Juantif! 1un% Ientilation and Perfusion
8etect 1un% Translant )e,ection
8etect Inhalation In,ur! in ;urn Patients
Fther (lications*
8ia%nose and Treat 2!erth!roidism 39ra#eEs 8isease4
8etect (cute =holec!stitis
8etect (cute 9astrointestinal ;leedin%
8etect Testicular Torsion
8etect Fccult Infections
8ia%nose and Treat ;lood =ell 8isorders
7ee Patient Information for more details on secific nuclear medicine rocedures&

What Is P0T
Positron Emission Tomo%rah! 3PET4 is raidl! becomin% a ma,or dia%nostic ima%in% modalit!
used redominantl! in determinin% the resence and se#erit! of cancers" neurolo%ical conditions"
and cardio#ascular disease& It is currentl! the most effecti#e wa! to chec+ for cancer recurrences&
7tudies demonstrate that PET offers si%nificant ad#anta%es o#er other forms of ima%in% such as
=T or 5)I scans in dia%nosin% disease& 1ast !ear more than 200"000 PET scans were erformed
at more than D00 sites around the countr!& If !ouEre interested in learnin% how a PET scan can
benefit !ou and need additional information" tal+ with !our local health care ro#ider or referrin%
h!sician& (t the end of this a%e are lin+s to other sites with PET information too&
PET ima%es demonstrate the chemistr! of or%ans and other tissues such as tumors& (
radioharmaceutical" such as /89 3fluorodeo'!%lucose4" which includes both su%ar 3%lucose4
and a radionuclide 3a radioacti#e element4 that %i#es off si%nals" is in,ected into the atient and its
emissions are measured b! a PET scanner&
( PET scanner consists of an arra! of detectors that surround the atient& 6sin% the %amma ra!
si%nals %i#en off b! the in,ected radionuclide" PET measures the amount of metabolic acti#it! at a
site in the bod! and a comuter reassembles the si%nals into ima%es& =ancer cells ha#e hi%her
metabolic rates than normal cells" and show u as denser areas on a PET scan& PET is useful in
dia%nosin% certain cardio#ascular and neurolo%ical diseases because it hi%hli%hts areas with
increased" diminished or no metabolic acti#it!" thereb! inointin% roblems&
Cancer 1 P0T
PET is considered articularl! effecti#e in identif!in% whether cancer is resent or not" if it has
sread" if it is resondin% to treatment" and if a erson is cancer free after treatment& =ancers for
which PET is considered articularl! effecti#e include lun%" head and nec+" colorectal"
esoha%eal" l!mhoma" melanoma" breast" th!roid" cer#ical" ancreatic" and brain as well as
other less-fre$uentl!-occurrin% cancers&
0arly #etection: ;ecause PET ima%es biochemical acti#it!" it can accuratel!
characteri<e a tumor as beni%n or mali%nant" thereb! a#oidin% sur%ical bios! when the
PET scan is ne%ati#e& =on#ersel!" because a PET scan ima%es the entire bod!"
confirmation of distant metastasis can alter treatment lans in certain cases from sur%ical
inter#ention to chemothera!&
Sta2in2 o Cancer: PET is e'tremel! sensiti#e in determinin% the full e'tent of disease"
eseciall! in l!mhoma" mali%nant melanoma" breast" lun%" colon and cer#ical cancers&
=onfirmation of metastatic disease allows the h!sician and atient to more accuratel!
decide how to roceed with the atientEs mana%ement&
Chec3in2 or recurrences: PET is currentl! considered to be the most accurate
dia%nostic rocedure to differentiate tumor recurrences from radiation necrosis or ost-
sur%ical chan%es& 7uch an aroach allows for the de#eloment of a more rational
treatment lan for the atient&
Assessin2 the 0ecti4eness o Che!othera"y: The le#el of tumor metabolism is
comared on PET scans ta+en before and after a chemothera! c!cle& ( successful
resonse seen on a PET scan fre$uentl! recedes alterations in anatom! and would
therefore be an earlier indicator of tumor resonse than that seen with other dia%nostic
modalities&
P0T and CT or M5I
;ecause PET measures metabolism" as oosed to 5)I or =T" which AseeA structure" it can be
suerior to these modalities" articularl! in searatin% tumor from beni%n lesions" and in
differentiatin% mali%nant from non-mali%nant masses such as scar tissue formed from treatments
li+e radiation thera!& PET is often used in con,unction with an 5)I or =T scan throu%h AfusionA
to %i#e a full three-dimensional #iew of an or%an and the location of cancer within that or%an&
Newer PET scanners are bein% made that are a combination of PET/=T de#ices&
Neurolo2ical #isease
PETEs abilit! to measure metabolism also has si%nificant imlications in dia%nosin% (l<heimerEs
disease" Par+insonEs disease" eiles! and other neurolo%ical conditions" because it can #i#idl!
illustrate areas where brain acti#it! differs from the norm&
(l<heimerEs 8ia%nosis* 6ntil recentl!" autos! has been considered the onl! definiti#e test for
(l<heimerEs disease 3(84& )ecent studies indicate that PET can sul! imortant dia%nostic
information and confirm an (l<heimerEs dia%nosis 3:ournal of Nuclear 5edicine" No#ember 20004&
When comarin% a normal brain #ersus an (8-affected brain on a PET scan" a distincti#e ima%e
aears in the area of the (8-affected brain& This attern is seen #er! earl! in the (8 course&
=on#entionall!" the confirmation of (8 is a lon% rocess of elimination that a#era%es between two
and three !ears of dia%nostic and co%niti#e testin%& Earl! dia%nosis can ro#ide the atient
access to theraies" which are more effecti#e earlier in the disease&
PET also is useful in differentiatin% (l<heimerEs disease from other forms of dementia
disorders" such as #ascular dementia" Par+insonEs disease" 2untin%tonEs disease" etc&
Eiles!* PET is one of the most accurate methods a#ailable to locali<e areas of the
brain causin% eiletic sei<ures and to determine if sur%er! is a treatment otion&
Cardio4ascular #isease
;! measurin% both blood flow 3erfusion4 and metabolic rate within the heart" h!sicians usin%
PET scans can inoint areas of decreased blood flow such as that caused b! bloc+a%es" and
differentiate muscle dama%e from li#in% muscle" which has inade$uate blood flow 3m!ocardial
#iabilit!4& This information is articularl! imortant in atients who ha#e had re#ious m!ocardial
infarction and who are bein% considered for a re#asculari<ation rocedure&
Cost 1 5ei!burse!ent:
PET scan char%es ran%e from K>200-KB500" deendin% on the t!e of scan& Insurance
comanies will co#er the cost of man! PET scans& 5edicare reimburses for PET scans for the
followin% cancers* colorectal" lun%" l!mhoma" and melanoma" head and nec+ and esoha%eal
cancers" and also for refractor! sei<ures 3eiles!4& 5edicare will be%in PET reimbursement to
initiall! sta%e" to determine recurrence and to measure effecti#eness of treatment of breast
cancer as well as for m!ocardial #iabilit!& These new reimbursement cate%ories become effecti#e
Fctober >" 2002& 5edicare is constantl! udatin% reimbursements" so #isit the 7N5 website
3www&snm&or%4 to find the latest information&
History o P0T
In the >@D0Es PET scannin% was formall! introduced to the medical communit!& (t that time it was
seen as an e'citin% new research modalit! that oened doors throu%h which medical researchers
could watch" stud!" and understand the biolo%! of human disease&
In >@D6" the radioharmaceutical fluorine->?-2-fluoro-2-deo'!%lucose 3/894" a mar+er of su%ar
metabolism with a half-life of >>0 minutes" enabled tracer doses to be administered safel! to the
atient with low radiation e'osure& The de#eloment of radioharmaceuticals li+e /89 made it
easier to stud! li#in% bein%s" and set the %roundwor+ for more in-deth research into usin% PET
to dia%nose and e#aluate the effect of treatment on human disease& To erform PET studies in
the late >@D0Es" a lar%e staff was needed* h!sicists to run the c!clotron that roduces the /->?
and to o#ersee the scanner" chemists to ma+e the tracers such as /89" and dedicated" secialist
h!sicians&
8urin% the >@?0Es the technolo%! that underlies PET ad#anced %reatl!& =ommercial PET
scanners were de#eloed with more recise resolution and ima%es& (s a result" man! of the
stes re$uired for roducin% a PET scan became automated" and able to be erformed b! a
trained technician and e'erienced h!sician" thereb! reducin% the cost and comle'it! of the
rocedure& 7maller" self-shielded c!clotrons were de#eloed" ma+in% it ossible to install
c!clotrons at more locations&
P0T Today
6ntil recentl! a PET center re$uired a c!clotron and a radiochemistr! laborator! on site to
roduce the /89& (s a result there was a scarcit! of centers& 2owe#er" there are now multile
sites that ma+e /89 and distribute it to the centers that onl! need to ha#e a PET scanner to
erform the ima%in% stud!&
3)adioisotoe 7cannin%" )adionuclide Isotoe In,ection" Nuclear Ima%in%" 5!ocardial Perfusion
Ima%in%" Perfusion Ima%in%4

Edited ;! )obert I& 2amb!" 5&8&" /(==" /(=P

6isit The 5adionuclide I!a2in2 Center
Radionuclide imaging is a technique that allows physicians to obtain very clear images of
various parts of the body, such as the heart. To obtain these images, tiny amounts of
radioactive materials (called "tracers") are introduced into the patients body. The tracers
emit a certain type of energy called gamma rays, which are detected by machines. or
e!ample, a positron emission tomography ("#T) scan uses machines called
photomultiplier-scintillator detectors to detect the gamma rays. $ther tests, such as a
nuclear stress test or single photon emission computed tomography (%"#&T), use
a gamma camera to detect the energy. The information detected and recorded by these
machines is then analy'ed and reconstructed by computers to create very clear images of
the target area of the patients body.
or most people, the tracer is harmless and is flushed from the body after the test.
(owever, there are a number of people who should avoid radionuclide imaging. These
include women who are pregnant or breast)feeding. $ther patients who should avoid this
type of test include those with the following conditions*
+nflammation of the heart muscle (myocarditis)
Recent pulmonary (lung) infection
Coarctation of the aorta
%evere narrowing (stenosis) of the aortic valve
%evere heart failure
5adionuclide I!a2in2 O4er4iew
7ection > of >
Nuclear Stress Test 7ection > of C Ne7t
3=ardiac 7tress Ima%in%" E'ercise 5!ocardial Perfusion Ima%in%" )adionuclide 7tress Test"
Thallium 7tress Test" Thallium Treadmill Test" 5!o#iew" Thallium E'ercise 7can" Thallium
Ima%in%4

Edited ;! 1ee ;& Weit<man" 5&8" /(==" /==P

Summary

What is a nuclear stress test?

How does the nuclear component of a stress test
work?

How does a patient prepare for a nuclear stress test?

How is a nuclear test done?

What happens after the nuclear stress test?
6isit The 5adionuclide I!a2in2 Center
Summary
,n e!ercise stress test is a special type of
electrocardiogram (#-.) that compares the
hearts electrical activity at rest and under
e!ertion. %ometimes an additional component
needs to be done during the stress test in
order to determine which parts of the heart
are healthy and functioning, and which are
not. +f this additional component is ordered,
then the test is called a nuclear stress test.
+n addition to the procedures that are
performed as part of a standard stress test, a
patient scheduled for a nuclear stress test is
in/ected with a very small, harmless amount
of a radioactive (radionuclide) substance,
such as thallium. $nce in the patient0s body,
this substance emits rays that can be pic1ed
up by a special (gamma) camera. The rays allow the camera to produce clear pictures of
heart tissue on a video monitor. These pictures show contrasts between light and dar1
spots, which can indicate areas of damage or reduced blood flow that are present before,
during and after e!ertion.
,side from some slight discomfort that may be felt when the radionuclide substance is
in/ected (twice), this is a painless test. "atients are generally as1ed not to eat or drin1
anything for four to si! hours before the test, and to wear comfortable clothes2shoes for
e!ercising. The time needed for the test will vary because different facilities use slightly
different strategies for ta1ing pictures of the heart at rest and during some form of
exercise. "atients are encouraged to spea1 with their physician about how long the test
will ta1e. ,fter the test, they can return to their usual daily activities immediately.
3epending on what is found during the nuclear stress test, the physician is often able to
ma1e a diagnosis and treatment plan for the patient. urther testing or procedures may
need to be done.
SP0CT Scan 7ection > of 5 Ne7t
37in%le Photon Emission =omuted Tomo%rah! " 7PE=T" Emission =omuted Tomo%rah!"
E=T" 9ated 7PE=T 7can4

Edited ;! 7tehen 8& 7haell" 5&8&" /(==" /==P" /(=P

Summary

What is a SPECT scan?

How does a SPECT scan work?

What types of cardiac SPECT scans are availale?

How is a SPECT scan done?

What happens after a SPECT scan?

What tests may e ordered after a SPECT scan?
6isit The 5adionuclide I!a2in2 Center
Summary
%ingle photon emission computed tomography (%"#&T) is a noninvasive technique for
creating very clear, three)dimensional pictures of a ma/or organ (e.g., the heart). %"#&T
scans use radionuclide imaging 4 a technique that involves the in/ection of very small
amount of a radionuclide substance called a tracer. #nergy from the tracer in the body is
detected by a gamma ray camera, which then ta1es the pictures. , tracer is not a dye
(contrast medium).
"eople may e!perience some slight discomfort from the needle used to insert an
intravenous (+.5.) line in the croo1 of their arm, which is necessary to give the patient the
tracer. $therwise, these tests are painless.
,lthough the tracer is flushed harmlessly from the bodies of most people in about 67
hours, there are some people (e.g., pregnant or breast)feeding women) who should not
have a radionuclide test. "eople are encouraged to discuss with their physician any
concerns they may have about radiation.
35ulti 9ated (c$uisition 7can" /irst Pass 7can" 9ated ;lood Pool 7can" =ardiac ;lood Poolin%
Ima%in%" )adionuclide Ientriculo%rah!" Nuclear Ientriculo%rah!4

Edited ;! )onald 8& 8E(%ostino" 8&F&" /(==

7tehen 8& 7haell" 5&8&" /(==" /==P" /(=P

Summary

What is a !"#$ scan?

How does a patient prepare for a !"#$ scan?

How is a !"#$ scan done?

What happens after a !"#$ scan?

What do the results of a !"#$ scan mean?
6isit The 5adionuclide I!a2in2 Center
Summary
M89A Scan 7ection > of C Ne7t
,lso 1nown as a nuclear ventriculogram, a multi)gated acquisition (89.,) scan is a type
of radionuclide imaging that provides the physician with a comprehensive loo1 at blood
flow and the function of the lower chambers of the heart (ventricles). +t involves very
small amounts of a radioactive isotope called a tracer, which is administered through an
intravenous (+.5.) line. The substance travels through the bloodstream to the heart,
enabling a gamma camera to ta1e very clear pictures of the heart tissues.
"eople may e!perience some slight discomfort from the needle used to insert the
intravenous (+.5.) line, usually in the croo1 of the arm. $therwise, these tests are
painless. +f the physician has also ordered an e!ercise component of the test, then some
preparation will be necessary, such as wearing appropriate clothes and shoes for
e!ercising.
,lthough the tracer is flushed harmlessly from the bodies of most people in about 67
hours, there are some people (e.g., pregnant or nursing women) who should not have a
radionuclide test. "eople are encouraged to discuss with their physician any concerns they
may have about radiation.
3Positron Emission Tomo%rah!4

Edited ;! 1ee ;& Weit<man" 5&8" /(==" /==P

(ndrew I& 1ituch!" 5&8&" /(==

Summary

What is a positron emission tomography %PET& scan?

How does a patient prepare for a PET scan?

How is a PET scan done?

What happens after the PET scan?

What other tests may e ordered after a PET scan?

How does a PET scan work?
6isit The 5adionuclide I!a2in2 Center
Summary
, positron emission tomography ("#T) scan is a unique noninvasive imaging technique
that can produce three)dimensional images of the living heart, brain or other organs at
wor1. "#T scans are often used in the diagnosis and management of cancers, certain
brain disorders and heart disease. &ardiac "#T scanning is generally similar to other types
of non)invasive stress tests to help determine the presence and e!tent of &,3. +t has two
ma/or advantages over the more common nuclear stress tests. irst, the images are
less li1ely to be distorted by parts of the patients body (large breasts, obesity etc.), so
abnormal results are more reliable. %econd, it is an e!cellent tool for determining whether
portions of the heart muscle are still viable (living and functioning). The scan can also
measure how well those viable portions are functioning after a heart attack or other
event in which there is a lac1 of o!ygen)rich blood to the heart muscle. "#T scanning is
not as readily available as more conventional nuclear imaging because of its greater cost
and the need for a cyclotron device, which produces necessary isotopes on site.
:efore the test, people are encouraged to ;) wear comfortable, loose clothing, <) stop
P0T Scan 7ection > of C Ne7t
eating or drin1ing for four hours before the test, and =) discuss with their physician any
changes that need to be made in how they ta1e their medication that day. 3uring the
test, they may feel the needle pric1 when an intravenous (+.5.) line is inserted in their
arm to administer a small amount of radioactive material. $therwise, the test is painless.
The test ta1es at least an hour to complete. ,fterward, patients may drive themselves
home and go about their usual activities, drin1ing plenty of water to flush the radioactive
material from their body.
Nuclear Medicine I!a2in2 Techni:ues
The followin% techni$ues are used in the dia%nosis" mana%ement" treatment" and re#ention of
disease& Nuclear medicine is uni$ue in that it often allows for dia%nostic information to be discerned
rior to the onset of h!sical s!mtoms&
Planar
Pro#ides a two-dimensional #iew of the rocess or function of the or%an bein% ima%ed&
SP0CT
(Single Photon Emission Computed Tomography)
Pro#ides B-8 comuter-reconstructed ima%es of multile #iews and function of the or%an bein%
ima%ed&
P0T
(Positron Emission Tomography)
Produces hi%h ener%!" B-8 comuter-reconstructed ima%es measurin% and determinin% the
function or h!siolo%! in a secific or%an" tumor" or other metabolicall! acti#e site&
CT
(Computed Tomography)
shows or%ans of interest at selected le#els of the bod!&
To!o2ra"hy
/rom the 9ree+ words Ato cut or sectionA 3tomos4 and Ato writeA 3%rahein4& ( method of searatin%
interference from the area of interest b! ima%in% a cut section of the ob,ect&
M5I
(Magnetic Resonance Imaging)
Produces ima%es which are the #isual e$ui#alent of a slice of anatom!&
Nuclear Medicine Scan
The ima%es roduced as the result of a nuclear medicine rocedure" often referred to as the actual
rocedure" e'amination or test&
5adio"har!aceutical
(lso referred to as tracer or radionuclide& The basic radioacti#el! ta%%ed comound necessar! to
roduce a nuclear medicine ima%e&
9a!!a Ca!era
The basic instrument used to roduce a nuclear medicine ima%e&
In 6itro
In #itro rocedures are done in test tubes& )adioimmunoassa! 3)I(4 is a secial t!e of in #itro
rocedure that combines the use of radiochemicals and antibodies to measure the le#els of
hormones" #itamins" and dru%s in a atientEs blood&
In 6i4o
In #i#o rocedures are when trace amounts of radioharmaceuticals are %i#en directl! to a atient&
The ma,orit! of nuclear medicine rocedures are in #i#o&
http://interactive.snm.org/index.cfm?PageID=1!"#$PID=1%
http://interactive.snm.org/index.cfm?PageID=1!"#$PID=1%