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SUBMITTED BY:
      Rupal Patle
      BDS IV Year
Peoples Dental Academy
INTRODUCTION
 DEFINITION:           Nuclear imaging is a method of producing
  images by detecting radiation from different parts of the body
  after a radioactive tracer material is administered.

 The images are recorded on computer and on film.

 The nuclear imaging physician interprets the images to make a
  diagnosis.

 Radioactive tracers used in nuclear medicine are, in most
  cases, injected into a vein.
Nuclear imaging equipment
DIFFERENCE FROM OTHER
  RADIOLOGIC TECHNIQUES
 Nuclear imaging assesses  how organs function (FUNCTIONAL IMAGING).

 Whereas other imaging methods Eg. Film radiography, CT, MRI, Diagnostic
  ultrasonography assess  anatomy, or how the organs look (MORPHOLOGIC
  IMAGING).

 In some human diseases (bone disorders eg. Condylar hyperplasia) abnormal
  biochemical process occur prior to the anatomic change. In such diseases, such
  abnormal biochemical changes can be assessed with the help of nuclear imaging
  technique.

 It would not be wrong to call Nuclear Medicine as "Radiology” done inside out" or
  "Internal Radiology" because it records radiation emitting from within the body rather
  than radiation that is generated by external sources like Xrays.

 This technique allows measurement of tissue function and provides an early marker
  of disease through measurement of biochemical change.
PRINCIPLE OF NUCLEAR IMAGING TECHNIQUE


 THE STEPWISE PROCEDURE OF
  NUCLEAR IMAGING:

Radionuclides are administered via vein or
                   mouth

 They distribute in the body according to
   their affinity for particular tissues so
            called target tissues.

 Radionuclides emit gamma radiations.

    Detected by γ-scintillation camera

Which forms images showing location of
       radionuclides in the body.
MAIN INDICATIONS OF NUCLEAR IMAGING


 Nuclear imaging technique is used for assessing function
   of:
- Salivary gland as salivary scans
- Brain
- Thyroids
- Heart
- Lungs
- Gastro-intestinal system

 It is also used for diagnosis of:
- Metastatic diseases
- Bone tumors as bone scans
RADIOISOTOPES AND RADIOACTIVITY


 RADIOACTIVITY:           Spontaneous emission of radiation, from unstable
  atomic nuclei.
                                         Or
It is the process by which an atomic nucleus of an unstable atom loses energy by
                    emitting ionizing particles (ionizing radiation).

 RADIOISOTOPES:          Radioisotopes are isotopes with unstable nuclei which
  undergo radioactive disintegration.

 This disintegration is often accompanied by emission of radioactive particles or
  radiation. The important emissions include:
  - Alpha particles
  - Beta- (electron) particles
  - Beta+ (positron) particles
  - Gamma radiation.
The main properties & characteristics of these
  emissions are summarized in table given below:
   PROPERTY             ALPHA         BETA- PARTICLES     GAMMA RAYS               BETA+
                     PARTICLES                                                   PARTICLES
NATURE            Particulate – two   Particulate –     Electromagnetic      Particulate –
                  protons and two     electrons         radiation –          positron interacts
                  neutrons                              identical to X-rays very rapidly with a
SIZE              Large               Small             Nil                  negative electron
CHARGE            Positive            Negative          Nil                  to produce 2
SPEED             Slow                Fast              Very fast            gamma rays –
RANGE IN TISSUE   1 – 2 mm            1 – 2 cm          As with X-rays       annihilation
                                                                             radiation –
ENERGY RANGE      4 – 8 MeV           100 keV – 6 MeV   1.24 keV – 12.4      properties as
CARRIED                                                 MeV                  shown in adjacent
DAMAGE CAUSED     Extensive           Ionization        Ionization – similar column
                  ionization                            damage to X-rays
USE IN NUCLEAR    Banned              Very limited      Main emission       PET
MEDICINE                                                used
RADIOISOTOPES USED IN
CONVENTIONAL NUCLEAR MEDICINE

 An ideal radionuclide has following properties:
  -      A short half life.
  -      Emits γ-rays.
  -      Capable of binding to a variety of biomolecules.

 Examples of radionuclides together with their target tissues
  or target diseases:
    - Technetium (99mTc)       – Salivary glands, thyroid, bone,
                                       blood, liver, lung & heart.
      - Iodine (131I )         – Thyroid
      - Gallium ( 67Ga)        – Tumors & inflammation
      - Krypton (81K)          – Lung
For imaging Technetium is used extensively, as it
           has following properties:
A. Technetium is a gamma emitter. This is important as the rays need
     to penetrate the body so the camera can detect them.

B. It has a short half life of 6 1/2 hours. Thus the amount of radioactive
   exposure is limited.

C. It is readily attached to a variety of different substances that are
   concentrated in different organs, eg:
 Tc + MPD (methylene disphosphonate) in bone
 Tc + sulphur colloid in the liver and spleen.

D. It is easily produced, as and when required, on site.
 Technetium-99m generator or technetium cow or moly cow, is a
  device used to extract the isotope 99mTc from a source of decaying
  molybdenum-99.
γ – SCINTILLATION CAMERA
 A gamma camera, also called a scintillation camera or
 Anger camera, is a device used to image gamma emitting
 radioisotopes, a technique known as scintigraphy.

 These cameras capture photons and convert them to light
 and then to a voltage signal.

 This signal is reconstructed to an image that shows
 distribution of radionuclide in the patient.
Parts of γ – scintillation camera:
A. Collimator: First part of the
    camera that absorbs γ-rays that
    do not travel parallel to its plates.
    The figure illustrates a magnified
    view of a parallel-hole collimator
    attached to a crystal. The
    collimator simply consists of a
    large number of small holes
    drilled in a lead plate. Gamma-
    rays entering at an angle to the
    crystal get absorbed by the lead
    and that only those entering
    along the direction of the holes
    get       through      to      cause
    scintillations in the crystal. If the
    collimator was not in place these
    obliquely incident gamma-rays
    would blur the images produced
    by the gamma camera. In other
    words the images would not be
    very clear.
B. Scintillation crystal:
 The γ-rays that pass
   through the collimator then
   strike scintillation crystal.

 Made up of sodium iodide
  with trace amount of
  thallium.

 This      crystal    shows
  florescence when it absorbs
  γ-rays.

 These flashes of light are
  detected by photomultiplier
  tubes coupled to the crystal.
C. Photomultiplier
  tubes:
 These tubes detects
  the flashes of light
  and convert the light
  into electronic signal
  & amplify the signal.

 Size   of signal is
  directly proportional
  to      energy     of
  absorbed photon.
D. Analog to digital
  converter:
 The signals from
  photomultiplier tubes
  go through an analog
  to digital converter
  (ADC)
 This component is
  used to convert the
  analogue information
  produced by the
  imaging system so
  that it is coded in the
  form       of     binary
  numbers.
 In this way the analog
  signal is digitalized &
  used to produce
  image by computer.
BONE SCANS
 Bone scan can detect 10 – 15 % mineral loss
Indications:
1. Metabolic bone diseases such as fibrous dysplasia
2. Pagets disease
3. Osteoarthritis
4. Osteomyelitis
5. Metastasis to bone
 Bone scan phases:
            PHASE                    TIME                   IMPORTANCE

  FIRST PHASE:                     First 30 sec      Differences in vascularity to
  Radionuclide angiography                           region.
  phase/ dynamic vascular
  flow phase

  SECOND PHASE:                     At 5 min         Difference in blood flow
  Blood pool phase                                   and vascular permeability in
                                                     bone
  THIRD PHASE:                   2 – 4 hours later   Distribution of radioisotope
  Bone scintigraphy phase/                           in   bone   and    metabolic
  osseous delayed static image                       activity of bone
Bone scan
SALIVARY SCANS
 Principle:
The ability of the salivary glands' intercalated duct
 epithelial cells to transport large monovalent
 anions, including iodide and pertechnetate, from the
 surrounding capillaries and secrete them into the
 saliva provides the principle for imaging the salivary
 glands with Tc-99m pertechnetate. The functional
 capabilities, structural integrity and location of the
 glands can be assessed.
Indications for salivary gland imaging include:
 Evaluation of functional status of salivary glands
     presentation of xerostomia
     presentation of pain
 Detection and evaluation of duct patency
     pain upon salivation
     presentation of xerostomia
   Detection and evaluation of mass lesions
   Preoperative localization of tumors
   Detecting aplasia of agenesis of gland
   Obstructive disorders
   Traumatic lesions and fistulas
   Function of gland after surgery
Salivary scan phases
        PHASE                    TIME                       IMPORTANCE

FIRST PHASE: Initial            At 5 min            Distribution of radioisotope
phase                                               in gland
SECOND PHASE:          At 10 min (saliva stimulated Retention of radioisotope in
Washout phase             by sour drink / candy)    gland
 Fig 3- Salivary glands scan
 Region of interest on
    scintigraphic image:
   area 7, oral cavity
   areas 1 and 2, parotid glands
   areas 4 and 5, submandibular
    glands
   area 3, background for parotid
    glands
   area 6, background for
    submandibular glands and oral
    cavity.
ADVANTAGES OF NUCLEAR
MEDICINE OVER CONVENTIONAL
       RADIOGRAPHY

 Target tissue function is investigated.

 All similar target tissues can be examined during
 one investigation, e.g. the whole skeleton can be
 imaged during one bone scan.

 Computer analysis and enhancement of results are
 available.
DISADVANTAGES

 Poor image resolution – only minimal information of
  target tissue is obtained.

 The radiation dose to the whole body can be relatively
  high.

 Images are not usually disease-specific.

 Difficult to localize exact anatomical site of source of
  emission.

 Fascilities are not widely available.
Further developments in radioisotope
     imaging techniques include:

 SPECT (single photon emission computed tomography)
 PET (Positron emission tomography)
SINGLE PHOTON EMISSION
 COMPUTED TOMOGRAPHY (SPECT)

 SPECT is a method of acquiring tomographic slices
  through a patient.

 Most gamma cameras have SPECT capability.


 In this technique either a single or multiple gamma
  cameras is rotated 360 degrees about the patient.

 Image acquisition takes about 30 – 45 min.
 Recent SPECT images have been fused with CT images
 to improve identifying of the location of the
 radionuclide.

 Distribution of radioactivity is displayed as a cross-
 sectional image or SPECT scan.

 This image gives the exact anatomical site of the
 source of the emissions to be determined.
ADVANTAGES OF SPECT
1. Better detailed resolution

2. Enhanced contrast

3. Localization of defects is more precise and more clearly
seen.

4. Extend and size of defects is better defined.
APPLICATIONS OF SPECT
 1. Heart Imaging
 2. Brain Imaging
 4. Tumor detection SPECT can be used to detect tumors in
       cancer patients in the early stages.
 5. Bone Scans

 In maxillofacial region, the most common use of nuclear medicine is
    to investigate abnormal metabolite bone activity, for instance, in
    assessing growth activity in cases of condylar hyperplasia.
                           Traditionally a combination of 99mTc MDP and
    gallium citrate is used to assess bone activity.
+
POSITRON EMISSION TOMOGRAPHY (PET)


 PET is more advanced imaging modality in nuclear medicine.

 The distribution of radioactivity in slices of organs can be
  obtained in a more accurate way using PET.

 In the PET camera two cameras called Anger cameras are place on
  opposite sides of the patient. This increases the collection angle and
  reduces the collection times which are the limitations of SPECT.

 PET, radiopharmaceuticals are labeled with positron emitting
  isotopes. A positron combines rather quickly with an electron. As a
  result the two gamma quanta are emitted almost in opposite
  directions .
 The mass of the two         particles is annihilated (the
 destruction of a particle and its antiparticle when they
 collide) with the emission of 2 gamma rays of high energy
 (511 keV) at 180 degree to each other.

 These emissions, known as annihilation radiation, can then
 be detected simultaneously (in coincidence) by opposite
 radiation detectors which are arranged in a ring around the
 patient.

 The exact site of origin of each signal is recorded and a
 cross-sectional slice is displayed as a PET scan.
BASIC PHYSICS OF PET
The variety of radioisotopes which
can now be used clinically in PET
include:
- 11C    – Carbon
-   13N – Nitrogen

-   15O – Oxygen

-   18F – Fluorine (18F-Fluorodeoxyglucose positron

    emission tomography)
APPLICATIONS
 Oncology
 Neurology
 Cardiology
REFERENCES
Essentials of dental radiography & radiology
 ERIC WHAITES EDITION 4
 YEAR OF PUBLICATION -2008,
 Publishers – Elsevier
 Page 15

Oral radiology – principles and interpretation
 STUART WHITE & MICHAEL. J. PHAROAH EDITION 6
 YEAR OF PUBLICATION- 2009
 Publishers – Elsevier
 Page 2

Textbook of Dental & maxillofacial radiology
 FRENY R KARJODKAR SECOND EDITION
 YEAR OF PUBLICATION- 2009
 Publishers – JAYPEE
 Page 17

Internet
THANK
 YOU

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Nucleaer imaging

  • 1. SUBMITTED BY: Rupal Patle BDS IV Year Peoples Dental Academy
  • 2. INTRODUCTION  DEFINITION: Nuclear imaging is a method of producing images by detecting radiation from different parts of the body after a radioactive tracer material is administered.  The images are recorded on computer and on film.  The nuclear imaging physician interprets the images to make a diagnosis.  Radioactive tracers used in nuclear medicine are, in most cases, injected into a vein.
  • 4. DIFFERENCE FROM OTHER RADIOLOGIC TECHNIQUES  Nuclear imaging assesses  how organs function (FUNCTIONAL IMAGING).  Whereas other imaging methods Eg. Film radiography, CT, MRI, Diagnostic ultrasonography assess  anatomy, or how the organs look (MORPHOLOGIC IMAGING).  In some human diseases (bone disorders eg. Condylar hyperplasia) abnormal biochemical process occur prior to the anatomic change. In such diseases, such abnormal biochemical changes can be assessed with the help of nuclear imaging technique.  It would not be wrong to call Nuclear Medicine as "Radiology” done inside out" or "Internal Radiology" because it records radiation emitting from within the body rather than radiation that is generated by external sources like Xrays.  This technique allows measurement of tissue function and provides an early marker of disease through measurement of biochemical change.
  • 5. PRINCIPLE OF NUCLEAR IMAGING TECHNIQUE  THE STEPWISE PROCEDURE OF NUCLEAR IMAGING: Radionuclides are administered via vein or mouth They distribute in the body according to their affinity for particular tissues so called target tissues. Radionuclides emit gamma radiations. Detected by γ-scintillation camera Which forms images showing location of radionuclides in the body.
  • 6. MAIN INDICATIONS OF NUCLEAR IMAGING  Nuclear imaging technique is used for assessing function of: - Salivary gland as salivary scans - Brain - Thyroids - Heart - Lungs - Gastro-intestinal system  It is also used for diagnosis of: - Metastatic diseases - Bone tumors as bone scans
  • 7. RADIOISOTOPES AND RADIOACTIVITY  RADIOACTIVITY: Spontaneous emission of radiation, from unstable atomic nuclei. Or It is the process by which an atomic nucleus of an unstable atom loses energy by emitting ionizing particles (ionizing radiation).  RADIOISOTOPES: Radioisotopes are isotopes with unstable nuclei which undergo radioactive disintegration.  This disintegration is often accompanied by emission of radioactive particles or radiation. The important emissions include: - Alpha particles - Beta- (electron) particles - Beta+ (positron) particles - Gamma radiation.
  • 8. The main properties & characteristics of these emissions are summarized in table given below: PROPERTY ALPHA BETA- PARTICLES GAMMA RAYS BETA+ PARTICLES PARTICLES NATURE Particulate – two Particulate – Electromagnetic Particulate – protons and two electrons radiation – positron interacts neutrons identical to X-rays very rapidly with a SIZE Large Small Nil negative electron CHARGE Positive Negative Nil to produce 2 SPEED Slow Fast Very fast gamma rays – RANGE IN TISSUE 1 – 2 mm 1 – 2 cm As with X-rays annihilation radiation – ENERGY RANGE 4 – 8 MeV 100 keV – 6 MeV 1.24 keV – 12.4 properties as CARRIED MeV shown in adjacent DAMAGE CAUSED Extensive Ionization Ionization – similar column ionization damage to X-rays USE IN NUCLEAR Banned Very limited Main emission PET MEDICINE used
  • 9. RADIOISOTOPES USED IN CONVENTIONAL NUCLEAR MEDICINE  An ideal radionuclide has following properties: - A short half life. - Emits γ-rays. - Capable of binding to a variety of biomolecules.  Examples of radionuclides together with their target tissues or target diseases: - Technetium (99mTc) – Salivary glands, thyroid, bone, blood, liver, lung & heart. - Iodine (131I ) – Thyroid - Gallium ( 67Ga) – Tumors & inflammation - Krypton (81K) – Lung
  • 10. For imaging Technetium is used extensively, as it has following properties: A. Technetium is a gamma emitter. This is important as the rays need to penetrate the body so the camera can detect them. B. It has a short half life of 6 1/2 hours. Thus the amount of radioactive exposure is limited. C. It is readily attached to a variety of different substances that are concentrated in different organs, eg:  Tc + MPD (methylene disphosphonate) in bone  Tc + sulphur colloid in the liver and spleen. D. It is easily produced, as and when required, on site.  Technetium-99m generator or technetium cow or moly cow, is a device used to extract the isotope 99mTc from a source of decaying molybdenum-99.
  • 11. γ – SCINTILLATION CAMERA  A gamma camera, also called a scintillation camera or Anger camera, is a device used to image gamma emitting radioisotopes, a technique known as scintigraphy.  These cameras capture photons and convert them to light and then to a voltage signal.  This signal is reconstructed to an image that shows distribution of radionuclide in the patient.
  • 12. Parts of γ – scintillation camera: A. Collimator: First part of the camera that absorbs γ-rays that do not travel parallel to its plates. The figure illustrates a magnified view of a parallel-hole collimator attached to a crystal. The collimator simply consists of a large number of small holes drilled in a lead plate. Gamma- rays entering at an angle to the crystal get absorbed by the lead and that only those entering along the direction of the holes get through to cause scintillations in the crystal. If the collimator was not in place these obliquely incident gamma-rays would blur the images produced by the gamma camera. In other words the images would not be very clear.
  • 13. B. Scintillation crystal:  The γ-rays that pass through the collimator then strike scintillation crystal.  Made up of sodium iodide with trace amount of thallium.  This crystal shows florescence when it absorbs γ-rays.  These flashes of light are detected by photomultiplier tubes coupled to the crystal.
  • 14. C. Photomultiplier tubes:  These tubes detects the flashes of light and convert the light into electronic signal & amplify the signal.  Size of signal is directly proportional to energy of absorbed photon.
  • 15. D. Analog to digital converter:  The signals from photomultiplier tubes go through an analog to digital converter (ADC)  This component is used to convert the analogue information produced by the imaging system so that it is coded in the form of binary numbers.  In this way the analog signal is digitalized & used to produce image by computer.
  • 16. BONE SCANS  Bone scan can detect 10 – 15 % mineral loss Indications: 1. Metabolic bone diseases such as fibrous dysplasia 2. Pagets disease 3. Osteoarthritis 4. Osteomyelitis 5. Metastasis to bone
  • 17.  Bone scan phases: PHASE TIME IMPORTANCE FIRST PHASE: First 30 sec Differences in vascularity to Radionuclide angiography region. phase/ dynamic vascular flow phase SECOND PHASE: At 5 min Difference in blood flow Blood pool phase and vascular permeability in bone THIRD PHASE: 2 – 4 hours later Distribution of radioisotope Bone scintigraphy phase/ in bone and metabolic osseous delayed static image activity of bone
  • 19. SALIVARY SCANS  Principle: The ability of the salivary glands' intercalated duct epithelial cells to transport large monovalent anions, including iodide and pertechnetate, from the surrounding capillaries and secrete them into the saliva provides the principle for imaging the salivary glands with Tc-99m pertechnetate. The functional capabilities, structural integrity and location of the glands can be assessed.
  • 20. Indications for salivary gland imaging include:  Evaluation of functional status of salivary glands  presentation of xerostomia  presentation of pain  Detection and evaluation of duct patency  pain upon salivation  presentation of xerostomia  Detection and evaluation of mass lesions  Preoperative localization of tumors  Detecting aplasia of agenesis of gland  Obstructive disorders  Traumatic lesions and fistulas  Function of gland after surgery
  • 21. Salivary scan phases PHASE TIME IMPORTANCE FIRST PHASE: Initial At 5 min Distribution of radioisotope phase in gland SECOND PHASE: At 10 min (saliva stimulated Retention of radioisotope in Washout phase by sour drink / candy) gland
  • 22.  Fig 3- Salivary glands scan  Region of interest on scintigraphic image:  area 7, oral cavity  areas 1 and 2, parotid glands  areas 4 and 5, submandibular glands  area 3, background for parotid glands  area 6, background for submandibular glands and oral cavity.
  • 23. ADVANTAGES OF NUCLEAR MEDICINE OVER CONVENTIONAL RADIOGRAPHY  Target tissue function is investigated.  All similar target tissues can be examined during one investigation, e.g. the whole skeleton can be imaged during one bone scan.  Computer analysis and enhancement of results are available.
  • 24. DISADVANTAGES  Poor image resolution – only minimal information of target tissue is obtained.  The radiation dose to the whole body can be relatively high.  Images are not usually disease-specific.  Difficult to localize exact anatomical site of source of emission.  Fascilities are not widely available.
  • 25. Further developments in radioisotope imaging techniques include:  SPECT (single photon emission computed tomography)  PET (Positron emission tomography)
  • 26. SINGLE PHOTON EMISSION COMPUTED TOMOGRAPHY (SPECT)  SPECT is a method of acquiring tomographic slices through a patient.  Most gamma cameras have SPECT capability.  In this technique either a single or multiple gamma cameras is rotated 360 degrees about the patient.  Image acquisition takes about 30 – 45 min.
  • 27.  Recent SPECT images have been fused with CT images to improve identifying of the location of the radionuclide.  Distribution of radioactivity is displayed as a cross- sectional image or SPECT scan.  This image gives the exact anatomical site of the source of the emissions to be determined.
  • 28. ADVANTAGES OF SPECT 1. Better detailed resolution 2. Enhanced contrast 3. Localization of defects is more precise and more clearly seen. 4. Extend and size of defects is better defined.
  • 29. APPLICATIONS OF SPECT  1. Heart Imaging  2. Brain Imaging  4. Tumor detection SPECT can be used to detect tumors in cancer patients in the early stages.  5. Bone Scans  In maxillofacial region, the most common use of nuclear medicine is to investigate abnormal metabolite bone activity, for instance, in assessing growth activity in cases of condylar hyperplasia. Traditionally a combination of 99mTc MDP and gallium citrate is used to assess bone activity. +
  • 30. POSITRON EMISSION TOMOGRAPHY (PET)  PET is more advanced imaging modality in nuclear medicine.  The distribution of radioactivity in slices of organs can be obtained in a more accurate way using PET.  In the PET camera two cameras called Anger cameras are place on opposite sides of the patient. This increases the collection angle and reduces the collection times which are the limitations of SPECT.  PET, radiopharmaceuticals are labeled with positron emitting isotopes. A positron combines rather quickly with an electron. As a result the two gamma quanta are emitted almost in opposite directions .
  • 31.  The mass of the two particles is annihilated (the destruction of a particle and its antiparticle when they collide) with the emission of 2 gamma rays of high energy (511 keV) at 180 degree to each other.  These emissions, known as annihilation radiation, can then be detected simultaneously (in coincidence) by opposite radiation detectors which are arranged in a ring around the patient.  The exact site of origin of each signal is recorded and a cross-sectional slice is displayed as a PET scan.
  • 33. The variety of radioisotopes which can now be used clinically in PET include: - 11C – Carbon - 13N – Nitrogen - 15O – Oxygen - 18F – Fluorine (18F-Fluorodeoxyglucose positron emission tomography)
  • 35. REFERENCES Essentials of dental radiography & radiology  ERIC WHAITES EDITION 4  YEAR OF PUBLICATION -2008,  Publishers – Elsevier  Page 15 Oral radiology – principles and interpretation  STUART WHITE & MICHAEL. J. PHAROAH EDITION 6  YEAR OF PUBLICATION- 2009  Publishers – Elsevier  Page 2 Textbook of Dental & maxillofacial radiology  FRENY R KARJODKAR SECOND EDITION  YEAR OF PUBLICATION- 2009  Publishers – JAYPEE  Page 17 Internet