Gamma rays

Uses of gamma rays in

surgery

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 Gamma Ray
An electromagnetic wave, a gamma ray is similar to ordinary visible
light but differs in energy or wavelength. Sunlight consists of a
mixture of electromagnetic rays of various wavelengths, from the
longest, infrared, through red, orange, yellow, green, blue, indigo and
violet, to the shortest in wavelength, ultraviolet. A gamma ray's
wavelength is far shorter than ultraviolet (i.e. it is far higher in
energy). Gamma rays are produced following spontaneous decay of
radioactive materials, such as cobalt-60 and cesium-137. A cobalt-60
gamma ray can penetrate deeply into the human body, so it has been
widely used for cancer radiotherapy.
Gamma-rays have the smallest wavelengths and the most energy of any
other wave in the electromagnetic spectrum. These waves are generated
by radioactive atoms and in nuclear explosions. Gamma-rays can kill
living cells, a fact which medicine uses to its advantage, using gamma-
rays to kill cancerous cells

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G a m m a -ra ys tra ve lto u s a cro ss va st d ista n ce s o f th e u n ive rse , o n ly
to b e a b so rb e d b y th e E a rth 's a tm o sp h e re . D iffe re n t w a ve le n g th s o f
lig h t p e n e tra te th e E a rth 's a tm o sp h e re to d iffe re n t d e p th s.
In stru m e n ts a b o a rd h ig h -a ltitu d e b a llo o n s a n d sa te llite s like th e
C o m p to n O b se rva to ry p ro vid e o u r o n ly vie w o f th e g a m m a -ra y sky .

Gamma-rays are the most energetic form of light and are produced by
the hottest regions of the universe. They are also produced by such
violent events as supernova explosions or the destruction of atoms,
and by less dramatic events, such as the decay of radioactive material
in space. Things like supernova explosions (the way massive stars die),
neutron stars and pulsars, and black holes are all sources of
celestial gamma-rays.

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 Wavelength : 3 x 10 ^ - 11 m and
down

Discovery
Gamma rays were discovered by Villard , a French physicist
in 1900

How Gamma Rays are

produced:

Gamma rays can be produced in labs through the process of nuclear

collision and also through the artificial radioactivity that
accompanies these interactions . The high - energy nuclei needed for
the collisions are accelerated by devices such as the cyclotron
and synchrotron .

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 Uses :

Gamma rays are used in medicine to kill and treat certain

types of cancers and tumors . Gamma rays passing through
tissue of the body produce ionization in tissue . Gamma rays
can harm the cells in our body . The rays can also detect
brain and cardiovascular abnormalities .

Dangers:

Gamma rays bombard our bodies constantly . They come from

the naturally radioactive materials in rocks and the
soil . We take some of these materials into our bodies
from the air we breathe and the water we drink . Gamma
rays passing through our body produce ionization in
tissue . High levels of gamma rays can produce dangerous
ionization of the tissue and can cause skin cancer .
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 Precautions

Protection from gamma rays can be obtained

using a sheet of iron that is a 1 / 2 inch
thick . This kind of shielding will block
only 50 % of 1 million electron volts of
gamma rays . We can also protect ourselves
from gamma rays with 4 inches of water .
Lead provides the most protection from
gamma rays . A 1 / 4 of an inch lead absorbs
all the gamma ray exposure .

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 Gamma Knife

What Is Gamma Knife

Gamma Knife Radiosurgery replaces the surgeon's scalpel with a single,
high dose of gamma radiation. Like the surgeon's scalpel, the Gamma
Knife eradicates the diseased area with a safe and effective approach.
The patient wears a lightweight head frame that attaches to a helmet,
through which 201 beams of gamma radiation precisely focus at a single
target. Only the tissue being treated receives a very strong dose of
radiation while the surrounding tissue remains unharmed.
The painless, bloodless procedure is usually performed under local
anesthesia with mild sedation. Although the entire procedure takes
several hours, the actual treatment takes just 15 minutes to one hour,
depending on the size of the lesion being treated. If there are
multiple tumors or if the tumor spreads to another area, radiosurgery
can be repeated.
There is no risk of surgical complications like infection, hemorrhage
or leakage of cerebral spinal fluid. Gamma knife radiosurgery has
proven effective to over 200,000 candidates for brain surgery who have
chosen this option over invasive neurological procedures.

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 Who Determines If Gamma Knife Radiosurgery Is
Appropriate?

Medical necessity can be determined by a neurosurgeon, radiation

oncologist or other medical specialist after evaluating a
prospective patient's medical condition. Treatment options are then
determined and discussed with the patient and family, so an informed
decision can be made.
Is It Effective?
Over 200,000 patients worldwide have chosen Gamma Knife Radiosurgery
for treatment of benign tumors such as acoustic neuromas, meningiomas,
pituitary adenomas, pineal tumors; malignant tumors like metastatic
tumors, astrocytomas and glioblastomas. The Gamma Knife has also been
used to eradicate arteriovenous malformations (AVM) and treatment
protocols are under investigation for certain functional disorders
such as chronic pain, trigeminal neuralgia, and Parkinson's disease.
Patients may be eligible for Gamma Knife Radiosurgery even if they
have previously had open brain surgery, radiation therapy,
chemotherapy, or in the case of AVM, embolization procedure. Results
have proven to be superior or comparable to conventional neurosurgery,
depending on the specific condition treated
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 Is It Safe?
Gamma Knife Radiosurgery is unique because no surgical incision
is performed to "expose" the lesion. Consequently, the risk of
surgical complication is greatly reduced. Patients are routinely
administered a mild sedative, eliminating the side effects of
general anesthesia

hat's Involved In A Treatment?

On the day of the treatment, the Gamma Knife patient will have a
lightweight frame attached to the head. Local anesthesia is used
before the frame is secured in place. The frame is used in
conjunction with an imaging procedure to accurately locate the
diseased area.

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W ith th e fra m e in p la ce , th e p a tie n t h a s e ith e r a n M R I o r C T
im a g in g stu d y o r, in th e ca se o f a rte rio ve n o u s m a lfo rm a tio n s,
a n g io g ra p h y , in o rd e r to p re cise ly lo ca te th e d ise a se d a re a to b e
tre a tefro
D a ta d . m th e im a g in g stu d y is tra n sfe rre d to th e G a m m a K n ife
co m p u te r syste m . W h ile th e p a tie n t re sts, th e G a m m a K n ife
C e n te r te a m u se s a d va n ce d so ftw a re to d e te rm in e th e tre a tm e n t
p la n . T h is ta ke s o n e o r tw o h o u rs to co m p le te d e p e n d in g o n th e
co m p lexity a n d lo ca tio n o f th e d ise a se
W h e n th e in d ivid u a lize d tre a tm e n t p la n is
co m p le te d , th e p a tie n t is p la ce d o n th e
G a m m a K n ife co u ch a n d is p re cise ly
p o sitio n e d

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T h e p a tie n t is th e n m o ve d a u to m a tica lly , h e a d first in to th e
G a m m a K n ife a n d tre a tm e n t b e g in s. Tre a tm e n t typ ica lly la sts
fro m 1 5 m in u te s to a n h o u r, d u rin g w h ich tim e th e p a tie n t fe e ls
n o th in g u n u su a l. A t th e co m p le tio n o f th e tre a tm e n t th e p a tie n t
is a u to m a tica lly m o ve d o u t o f th e G a m m a K n ife a n d th e h e a d
fra m e is re m o ve d . A fte r a p e rio d o f re st th e p a tie n t m a y b e
d isch a rg e d o r if m e d ica lly n e ce ssa ry sta y o ve rn ig h t in th e
h o sp ita lfo r o b se rva tio n .

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 How Is Gamma Knife Surgery Performed?
After administering local anesthesia and intravenous sedation, a stereotactic
frame is attached to the patient's head. Next the head is imaged using a CT or
MRI scanner while the patient wears the stereotactic frame. For vascular
malformations, an angiogram is obtained as well.
The patient returns to the Gamma Knife Center while a treatment plan is made.
A treatment plan is developed by computer using the brain images. This is done
by the coordinated efforts of the neurosurgeon, radiation oncologist and
radiation physicist.
The completed plan outlines the gamma ray dose and location within the brain
for each treatment.
The patient lies on the treatment bed of the Gamma Knife unit while the frame
is affixed to the appropriate collimator which determines the size of the
treatment.
The treatment table is moved into the Gamma Knife where the patient rests for
a few minutes during each painless treatment.
Usually more than one treatment is given to completely cover the abnormal
brain tissue. Between each treatment the patient is moved out of the Gamma
Knife so minor adjustments in the stereotactic frame and collimator can be
made.
After Gamma Knife surgery, the head frame is removed and after a period of
rest, the patient may be discharged or if medically necessary, stay overnight
in the hospital for observation.
The physician will arrange periodic follow-up examinations and brain imaging
to follow the effects of treatment.
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hen Will the patient Get Better?
The effects of Gamma Knife Radiosurgery occur over a
period of time that can range from days to several years,
depending on the type of medical condition treated. Some
abnormalities dissolve gradually, eventually disappearing.
Others simply exhibit no further growth.

Is It Cost Effective?
Cost studies have shown Gamma Knife Radiosurgery to be less
expensive than conventional neurosurgery because it eliminates
lengthy post-surgical hospital stays, expensive medication and
sometimes months of rehabilitation. Importantly, there are virtually
no post-surgical disability and convalescent costs with this
procedure.

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What Disorders Can Gamma Knife Treat?
*Tumors within the head from a primary site
elsewhere in the body: metastatic tumors.
*Tumors originating within the brain itself or
its coverings: pituitary tumors, acoustic
neuromas, certain gliomas and meningiomas, etc.
*Abnormal blood vessels: arteriovenous
malformations.
*Also specific centers within the brain can be
destroyed to treat pain, tremors and other
functional disturbances.

*Trigeminal neuralgia

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‫؟‬What abnormalities can the Gamma Knife treat

Here is a partial list of some of the disorders amenable to radiosurgery:

 
 

Brain Tumors:  Skull Base Tumors: 

Glioblastoma Invasive squamous and basal 
Anaplastic astrocytoma cell carcinoma
Gliomas / Astrocytoma Chordoma
Oligodendroglioma Chondrosarcoma
Ependymoma Esthesioneuroblastoma 
Pilocytic astrocytoma Functional Problems: 
Meningioma Trigeminal neuralgia 
Pituitary tumors Parkinson's disease 
Pineal region tumors Essential tremor 
Acoustic Neuroma  Obsessive Compulsive Disorder 
Neuromas of the cranial nerves Ocular Tumors: 
Glomus jugulare tumor Uveal melanoma
Metastatic brain tumors  Orbital metastases
Vascular Abnormalities:  Optic nerve sheath meningioma
Arteriovenous malformations 
Cavermous malformations

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 What Are The Results Of Gamma Knife
Surgery?
The majority of brain tumors selected for treatment will disappear or
stop growing over time.
 

Metastatic brain Metastatic brain tumor 2

tumor before months after treatment
treatment

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 A fte r o n e ye a r 4 0 % o f a rte rio ve n o u s m a lfo rm a tio n s a re
cu re d in cre a sin g to 8 0 % tw o ye a rs a fte r tre a tm e n t. T h e
risk o f sp o n ta n e o u s b le e d in g d u rin g th is tim e is n o t m o re
th a n u n tre a te d m a lfo rm a tio n s.

Arteriovenous malformation After treatment

before treatment 17
Cavernous sinus meningioma before treatment After treatment 18
What Are The Advantages Of Gamma Knife
Radiosurgery?
*Gamma Knife surgery is different from conventional radiation
therapy of the brain because it is only directed to the target and
spares unnecessary treatment of adjacent, normal brain.
*It differs because only a one day treatment is required rather than
many treatments over several weeks and can be repeated if needed.
*It can be used in conjunction with conventional surgery as a boost
and can be used in previously inoperable cases.
*Gamma Knife surgery can replace brain surgery in some patients with
brain tumors and vascular malformations . . . ask your doctor about
these options.
*An individual who would be at high risk for complications by
conventional surgery may be a candidate for Gamma Knife surgery. It
can be used when prior surgery or radiation therapy has failed to
control the disease process.
*It can be used in conjunction with conventional surgery as a boost
and can be used in cases previously considered inoperable
. *Cost effective .
*Bloodless , virtually painless , no loss of hair with rapid return to
activities of every day living.
*Established effectiveness after 25 years of world wide experience
with no reported mortality and few complications.

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What Are The Complications Of Gamma Knife
Radiosurgery?
arly complications
common
*local pain and swelling in the
scalp
*headache
rare

*skin reddening and irritation

*nausea
*seizure

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Delayed complications

uncommon
*local loss of hair in
superficial lesions
*local brain swelling in
treatment site
*local necrosis in the
treatment site
rare
*visual loss (dependent on
diagnosis)
*deafness (dependent on
diagnosis

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Comparison to radiation therapy
 *Professor Leksell’s concept has proved to be a true advance
in the treatment of intracranial disease.
 *Stereotactic techniques can also be used to accurately aim
fractionated doses of gamma rays or x-rays to a target;
administering the treatment in small doses over days to
weeks.
 *This technique is a compromise between radiosurgery and
conventional radiotherapy and is termed stereotactic
radiotherapy.


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 T h e G a m m a C a m e ra
Once a radiopharmaceutical has been administered , it is
necessary to detect the gamma ray emissions in order to
attain the functional information . The instrument used in
Nuclear Medicine for the detection of gamma rays is known
as the Gamma camera . The components making up the gamma
camera are the collimator , detector crystal ,
photomultiplier tube array , position logic circuits , and
the data analysis computer . The purpose of each is
briefly described below .

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 C a m e ra C o llim a to r
The first object that an emitted gamma photon encounters
after exiting the body is the collimator . The collimator is
a pattern of holes through gamma ray absorbing material ,
usually lead or tungsten , that allows the projection of the
gamma ray image onto the detector crystal . The collimator
achieves this by only allowing those gamma rays traveling
along certain directions to reach the detector ; this
ensures that the position on the detector accurately
depicts the originating location of the gamma ray .

Scintillation Detector
In order to detect the gamma photon we use scintillation
detectors . A Thallium - activated Sodium Iodide [ NaI ( Tl )]
detector crystal is generally used in Gamma cameras . This
is due to this crystal's optimal detection efficiency for
the gamma ray energies of radionuclide emission common to
Nuclear Medicine . A detector crystal may be circular or
rectangular . It is typically 3 / 8 " thick and has dimensions
of 30 - 50 cm . A gamma ray photon interacts with the
detector by means of the Photoelectric Effect or Compton
Scattering with the iodide ions of the crystal . This
interaction causes the release of electrons which in turn
interact with the crystal lattice to produce light , in a 24
 P h o to m u ltip lie r
Tu b e s
O n ly a v e ry sm a ll a m o u n t o f lig h t is g iv e n o ff fro m th e
scin tilla tio n d e te cto r. T h e re fo re , p h o to m u ltip lie r tu b e s
a re a tta ch e d to th e b a ck o f th e cry sta l. A t th e fa ce o f a
p h o to m u ltip le r tu b e ( P M T ) is a p h o to ca th o d e w h ich , w h e n
stim u la te d b y lig h t p h o to n s , e je cts e le ctro n s . T h e P M T is
a n in stru m e n t th a t d e te cts a n d a m p lifie s th e e le ctro n s
th a t a re p ro d u ce d b y th e p h o to ca th o d e . F o r e v e ry 7 to 1 0
p h o to n s in cid e n t o n th e p h o to ca th o d e , o n ly o n e e le ctro n
is g e n e ra te d . T h is e le ctro n fro m th e ca th o d e is fo cu se d
o n a d y n o d e w h ich a b so rb s th is e le ctro n a n d re - e m its
m a n y m o re e le ctro n s ( u su a lly 6 to 1 0 ) .

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E a ch g a m m a ca m e ra h a s se v e ra l p h o to m u ltip lie r tu b e s
a rra n g e d in a g e o m e trica l a rra y . T h e ty p ica l ca m e ra h a s 3 7 to
9 1 P M T 's . A P h o to m u ltip lie r Tu b e A rra y

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 P o sitio n C ircu itry
T h e p o sitio n lo g ic circu its im m e d ia te ly fo llo w th e
p h o to m u ltip lie r tu b e a rra y a n d th e y re ce iv e th e
e le ctrica l im p u lse s fro m th e tu b e s in th e su m m in g
m a trix circu it ( S M C ) . T h is a llo w s th e p o sitio n circu its to
d e te rm in e w h e re e a ch scin tilla tio n e v e n t o ccu rre d in th e
d e te cto r cry sta l.
D a ta A n a ly sis C o m p u te r

F in a lly , in o rd e r to d e a l w ith th e in co m in g p ro je ctio n

d a ta a n d to p ro ce ss it in to a re a d a b le im a g e o f th e 3 D
sp a tia l d istrib u tio n o f a ctiv ity w ith in th e p a tie n t, a
p ro ce ssin g co m p u te r is u se d . T h e co m p u te r m a y u se
v a rio u s d iffe re n t m e th o d s to re co n stru ct a n im a g e ,
su ch a s filte re d b a ck p ro je ctio n o r ite ra tiv e
re co n stru ctio n , b o th o f w h ich a re fu rth e r d e scrib e d in
th is tu to ria l.

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C o n stru ctio n
A n e x a m p le o f lu n g scin tig ra p h y
e x a m in a tio n

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 G a m m a ca m e ra

Diagrammatic cross section of a gamma

camera detector

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D e ta ils o f th e cro ss se ctio n o f a
g a m m a ca m e ra

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fo llo w in g is a sch e m a tic d ia g ra m
d e p ictin g th e o p e ra tio n o f a g a m m a
ca m e ra :

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A h ig h - re so lu tio n g a m m a - ra y ca m e ra co u ld o ffe r
e fficie n t m a p p in g o f ra d ia tio n in th e b o d y , e n a b lin g
p h y sicia n s to u se lo w e r d o se s o f n u cle a r m e d icin e s .
R e a l- tim e “ m o v ie s ” o f h o w th e n u cle a r m e d icin e s a re
a b so rb e d m a y b e p o ssib le

S ca n n in g a n d u se in
SPECT
PET
( single photon emission computed tomograpy )
imaging , as used in nuclear cardiac stress testing , is
performed using gamma cameras , usually one , two or three
detectors or heads , are slowly rotated around the
patient's torso . Multi - headed gamma cameras can also be
used for Positron emission tomography scanning , provided
that their hardware and software can be configured to
detect 'coincidences' ( near simultaneous events on 2
different heads ). Gamma camera PET is markedly inferior
to PET imaging with a purpose designed PET scanner , as
the scintillator crystal has poor sensitivity for the
high - energy annihilation photons , and the detector area
is significantly smaller . However , given the low cost of
a gamma camera and its additional flexibility compared
to a dedicated PET scanner , this technique is useful
where the expense and resource implications of a PET 33
scanner cannot be justified .
 Prepared by
D . Usama muhammed rifa’at

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 Thank you for your attention!

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