1. Nuclear Medicine and PET rev 2016-02-22 this is now slide 1do not print it to pdf things to do (check off when complete): add revision date to cover page remove triangles create list for pages to print in the handout 2-5,7-9,12-17,19-20,23 add captions for photo slides incorporate notes taken during presentation add Key Points page 3 useful characters: ° degrees‎Ω ohmsμ micro ☑ checkbox ☐ slash-zero ØCO 2 O 2 SpO 2 N 2 O ® ™ trademarks à 224 E0 á 225 E1 â 226 E2 ã 227 E3 ä 228 E4 å 229 E5 æ 230 E6 ç 231 E7 Ð 208 D0 è 232 E8 é 233 E9 ê 234 EA ë 235 EB ì 236 EC í 237 ED î 238 EE ï 239 EF Ñ 209 D1 Ò 210 D2 Ó 211 D3 Ô 212 D4 Õ 213 D5 Ö 214 D6 Ø 216 D8 ß 223 DF Þ 222 DE Ù 217 D9 Ú 218 DA Û 219 DB Ü 220 DC Ý 221 DD Þ 222 DE ß 223 DF

2. Nuclear Medicine and PET © D. J. McMahon 150504rev cewood 2016-02-22

3. Key Points Nuclear Medicine and PET: Understand how Nuc Med & PET differ from Radiography & CT by the source of radiation. Understand the difference between the scintillation camera and the PET scanner Be aware of the chemical 18 F FDG (fluorodeoxyglucose) & the element Tc (Technetium) Understand what the color spectrum means in a PET visualization. Be aware of As Low As Reasonably Practicable, ALARP

4. Nuclear Medicine -The application of radioactive substances in the diagnosis and treatment of disease. -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. -Nuclear medicine scans differ from radiology as the emphasis is not on imaging anatomy but the function and for such reason, it is called a physiological imaging modality. -In nuclear medicine imaging, radiopharmaceuticals are taken internally, intravenously or orally. Then, external detectors (gamma cameras) capture and form images from the radiation emitted by the radiopharmaceuticals. -All human radiation exposures should be kept As Low As Reasonably Practicable, ALARP (replaces ALARA).

5. John Lawrence Hal Anger

12. GE Maxicamera 400 Gamma Camera PET Scanner

14. Patient with infection: Patient with joint disease: 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. Often referred to as image fusion or co-registration.

15. Before-&-after isotope studies of two patients treated with a study medication for Non-Hodgkins Lymphomas:

16. PET: Positron Emission Tomography PET is both a medical and research tool. It is used heavily in clinical oncology. A tomographic technique that uses isotopes which emit two gamma rays rather than one, enabling images with a high signal-to-noise ratio and good spatial resolution. PET is used for physiology and function rather than anatomy. PET scans are more expensive than "conventional" imaging using computed tomography (CT) and magnetic resonance imaging (MRI) Oncology scans using 18 F FDG (fluorodeoxyglucose) tracer make up over 90% of all PET scans in current practice This tracer is a glucose analog that is taken up by glucose-using cells. This results in intense radiolabeling of tissues with high glucose uptake, such as the brain, the liver, and most cancers.

18. 47 y/o female, pre- & post chemotherapy for leukemia:

19. MRI and PET scans of brain, normal and with Alzheimer’s Disease:

20. Maximum Intensity Projection (MIP) of a wholebody positron emission tomography (PET) acquisition of a 79 kg (174 lb) weighting female after intravenous injection of 371 MBq of 18 F-FDG (one hour prior measurement). The investigation has been performed as part of a tumor diagnosis prior to applying a radiotherapy (tumor staging step) Besides normal accumulation of the tracer in the heart, bladder, kidneys and brain, liver metastases of a colorectal tumor are clearly visible within the abdominal region of the image. https://commons.wikimedia.org/wiki/File:PET- MIPS-anim.gif

23. PET videos: Scans of brain injury for a lawsuit:http://www.youtube.com/watch?v=5kWICOzwf_4 iPhone app for PET visualization:http://www.youtube.com/watch?v=Wgc58CwzGlU Major players in Nuc Med – > ADAC/Philips > GE > Hitachi/Vision > IS 2 > Siemens > SMV > Sopha > Toshiba > NuQuest Workstations > Segami Workstations