
Learning Objectives

• Outline manifestations of nuclear medicine.

The field of nuclear medicine has expanded greatly in the last twenty years, particularly in the area of imaging. This section will focus on nuclear medicine involving the types of nuclear radiation introduced in this chapter. The x-ray imaging systems will not be covered.

Radioiodine $$\left( \ce{I}-131 \right)$$ Therapy involves imaging and treatment of the thyroid gland. The thyroid gland is a gland in the neck that produces two hormones that regulate metabolism. In some individuals, this gland becomes overactive and produces too much of these hormones. The treatment for this problem uses radioactive iodine $$\left( \ce{I}-131 \right)$$, which is produced for this purpose in research fission reactors, or by neutron bombardment of other nuclei.

The thyroid gland uses iodine in the process of its normal function. Any iodine in food that enters the bloodstream is usually removed by, and concentrated in, the thyroid gland. When a patient suffering from an overactive thyroid swallows a small pill containing radioactive iodine, the $$\ce{I}$$-131 is absorbed into the bloodstream just like non-radioactive iodine, and follows the same process to be concentrated in the thyroid. The concentrated emissions of nuclear radiation in the thyroid destroy some of the gland's cells and control the problem of the overactive thyroid.

Smaller doses of $$\ce{I}$$-131 (too small to kill cells) are also used for purposes of imaging the thyroid. Once the iodine is concentrated in the thyroid, the patient lays down on a sheet of film and the radiation from the $$\ce{I}$$-131 makes a picture of the thyroid on the film. The half-life of iodine-131 is approximately 8 days so after a few weeks, virtually all of the radioactive iodine is out of the patient's system. During that time, the patient is advised that they will set off radiation detectors in airports and will need to get special permission to fly on commercial flights.

Positron Emission Tomography or PET scan is a type of nuclear medicine imaging. Depending on the area of the body being imaged, a radioactive isotope is either injected into a vein, swallowed by mouth, or inhaled as a gas. When the radioisotope is collected in the appropriate area of the body, the gamma ray emissions are detected by a PET scanner (often called a gamma camera) which works together with a computer to generate special pictures, providing details on both the structure and function of various organs. PET scans are used to:

• Detect cancer.
• Determine the amount of cancer spread.
• Assess the effectiveness of treatment plans.
• Determine blood flow to the heart muscle.
• Determine the effects of a heart attack.
• Evaluate brain abnormalities, such as tumors and memory disorders.
• Map brain and heart function.

External Beam Therapy (EBT) is a method of delivering a high energy beam of radiation to the precise location of a patient's tumor. These beams can destroy cancer cells and, with careful planning, will not kill surrounding cells. The concept is to have several beams of radiation, each of which is sub-lethal, enter the body from different directions. The only place in the body where the beam would be lethal is at the point where all the beams intersect. Before the EBT process, the patient is three-dimensionally mapped using CT scans and x-rays. The patient receives small tattoos to allow the therapist to line up the beams exactly. Alignment lasers are used to precisely locate the target. The radiation beam is usually generated with a linear accelerator. EBT is used to treat the following diseases, as well as others:

• Breast cancer
• Colorectal cancer