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Nuclear Medicine: The Essentials

Edition: 1
9781496300645
ISBN/ISSN:
9781496300645
Publication Date:
December 10, 2021
2021-12-10
9781496300645
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Perfect for residents and fellows to use during rotations, or as a quick review for practicing radiologists and nuclear medicine ...
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  • Perfect for residents and fellows to use during rotations, or as a quick review for practicing radiologists and nuclear medicine physicians, Nuclear Medicine: The Essentials is a complete, concise overview of the most important knowledge in this challenging and evolving field. Each chapter begins with learning objectives and ends with board-style questions that help you focus your learning. A self-assessment examination in print and additional self-assessment material online test your mastery of the content and prepare you for exams. 
     
    • Follows the proven Essentials series format to provide a comprehensive yet concise overview of clinical nuclear medicine. 

    • Features image-rich, case-based multiple-choice questions with answers and explanations that mimic what you’re likely to see on exams. 

    • Covers all relevant imaging modalities, including hybrid imaging systems such as SPECT/CT, PET/CT, and PET/MRI, as well as targeted radionuclide therapy, theranostics, and translational molecular imaging as it relates to nuclear medicine in adults and children. 

    • Puts indispensable information at your fingertips in a compact and practical, high-yield format. 

    Enrich Your Ebook Reading Experience 

    • Read directly on your preferred device(s), such as computer, tablet, or smartphone. 

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  • Edition
    1
    ISBN/ISSN
    9781496300645
    Product Format
    Hardcover Book
    Trim Size
    8.375 x 10.875
    Pages
    310
    Illustration
    1025
    Series
    Essentials Series
    Edition
    1
    Publication Date
    December 10, 2021
  • Hossein Jadvar MD, PhD, MPH, MBA
    Department of Radiology
    Keck School of Medicine
    University of Southern California
    Los Angeles, California
    Patrick M. Colletti MD
    Department of Radiology
    University of Southern California
    Los Angeles, California 
  • CONTENTS
    Contributors vii
    Series Foreword ix
    Preface xi
    Chapter 1 Basics of Nuclear Medicine Physics and Radiation Safety 1
    The Atomic Structure 1
    Radioactive decay 1
    Isomeric transition 2
    Positron decay 2
    Electron capture 2
    Characteristic X-rays 3
    Radioactivity 3
    Universal decay table 3
    Radioactivity Equilibrium 4
    Interaction of radiation with matter 4
    Radiation safety 5
    Radiation exposure limits 5
    Release of patients following I-131 therapy 6
    Radiation Safety Fundamentals 6
    Radiation monitoring 6
    Radiation exposure to pregnant personnel 6
    Area designation and posting 6
    Controlled area 6
    Restricted area 6
    Radiation area 7
    High radiation area 7
    Radioactive materials 7
    Ordering, receipt, and disposal of radioactive materials 7
    Radiation safety surveys 7
    Waste disposal 7
    Spill of radioactive materials 8
    Minor spills 8
    Major spills 8
    Medical events 8
    Chapter Self-Assessment Questions 9
    Chapter 2 Basics of Radiochemistry 11
    Introduction 11
    Basic Concepts of Radionuclide 11
    Atomic nucleus 11
    Forces in the nucleus 12
    Isotopes and radioactive decay 12xiv Contents
    Interaction of radiation with matter 12
    Production of radionuclides 13
    Basic Concepts of Radiolabeling 13
    Isotopic labeling 13
    Nonisotopic labeling 13
    Specific activity 13
    Radiochemistry for positron emission tomography tracers 14
    Radionuclide selection 14
    Radiochemistry with positron emission tomography radionuclides 14
    Radiolabeling with F-18 14
    Nucleophilic reactions 14
    Electrophilic reactions 16
    Radiolabeling using prosthetic agents 16
    Automation radiosynthesis 16
    Radiolabeling with C-11 17
    Radiolabeling with other positron emission tomography radionuclides 17
    Radiopharmaceuticals 18
    Quality Control of Radiopharmaceuticals 18
    Chapter Self-Assessment Questions 21
    Chapter 3 Basics of Instrumentation 22
    Introduction 22
    Gas detectors 22
    Geiger–Muller survey meters 23
    Scintillation detectors 25
    Pulse height analyzer 26
    Gamma cameras 26
    Collimator geometry 27
    Scintillation crystal 28
    Photomultiplier tubes 28
    Energy and position logic computer 28
    Single-photon emission computed tomography 28
    Single-photon emission computed tomography image quality 28
    Positron emission tomography 29
    Problems with reconstruction of positron emission tomography images 29
    Positron emission tomography/computed tomography instrumentation 30
    Time of flight positron emission tomography/computed tomography 31
    Chapter Self-Assessment Questions 32
    Chapter 4 Thyroid Imaging and Therapy 34
    Introduction 34
    Hyperthyroidism 34
    Background 34
    General diagnostic and treatment algorithm 34
    Role of nuclear imaging 34
    Radioiodine therapy 36
    Side effects and radiation precautions 37
    Thyroid Cancer 37
    Background 37
    Treatment overview 37
    Role of nuclear imaging and therapy 40Contents xv
    Radioiodine scans 41
    Radioiodine therapy 42
    Post-therapy scans 43
    Side effects and radiation precautions 43
    Non-iodine avid disease 43
    Conclusion 44
    Chapter Self-Assessment Questions 46
    Chapter 5 Parathyroid Scintigraphy 48
    Background 48
    Parathyroid scintigraphy 48
    Chapter Self-Assessment Questions 53
    Chapter 6 Neuroendocrine Tumor Imaging and Therapy 55
    Introduction 55
    Background 55
    Somatostatin receptors 55
    Somatostatin receptor imaging 56
    Somatostatin receptor therapy 57
    Clinical Trials of Peptide Receptor Radionuclide Therapy 57
    Phase I or II experience 57
    177
    Lu-Dotatate Therapy 58
    Patient selection 58
    Future directions and controversies 60
    Performing the therapy 63
    Efficacy 64
    Neuroblastoma 64
    Pheochromocytoma or paraganglioma 64
    Medullary thyroid cancer 64
    Conclusion 64
    Chapter Self-Assessment Questions 67
    Chapter 7 Central Nervous System 68
    Introduction 68
    Clinical Applications 68
    Cerebrospinal fluid flow imaging 68
    Brain death 69
    Epilepsy 70
    Movement disorders 70
    Cerebrovascular disease 71
    Parametric brain SPECT or PET mapping 72
    Chapter Self-Assessment Questions 77
    Chapter 8 Bone Scintigraphy 78
    Introduction 78
    Normal Biodistribution 78
    Clinical Applications 78
    Bone vascularity and viability 79
    Prosthesis evaluation 80xvi Contents
    Metabolic bone disease 80
    Malignant disease 82
    Extra-Osseous Uptake 83
    Chapter Self-Assessment Questions 84
    Chapter 9 Infection and Inflammation 85
    Introduction 85
    Basic principles of imaging labeled white blood cell scintigraphy 85
    Basic principles of imaging FDG 86
    Clinical imaging strategies in selected clinical settings 87
    Systemic infection and inflammation 87
    Localized or organ specific infection and inflammation 89
    Novel and future aspects 92
    Nuclear medicine aspects of COVID-19 92
    Chapter Self-Assessment Questions 97
    Chapter 10 Cardiovascular Nuclear Medicine 99
    Myocardial Function 99
    Myocardial perfusion 100
    Myocardial Viability 103
    Infective, Inflammatory, and Deposition-Related Conditions 104
    Chapter Self-Assessment Questions 108
    Chapter 11 Pulmonary Scintigraphy 109
    Introduction 109
    Clinical Aspects of Pulmonary Embolism 109
    Overall Imaging Strategies in Pulmonary Embolism 110
    Practical Aspects of V/Q Scan 110
    Interpretation of V/Q Scintigraphy—Pulmonary Embolism or No Pulmonary
    Embolism 111
    Non-Pulmonary Embolism Use 113
    Take Home Points 114
    Chapter Self-Assessment Questions 115
    Chapter 12 Gastrointestinal & Hepatobiliary Scintigraphy 116
    Gastrointestinal Functional Studies 116
    Gastric Emptying Scintigraphy 116
    Scintigraphic Principle 116
    General Study Protocol 117
    Interpretation and Reporting 117
    Gastroesophageal Reflux and Pulmonary Aspiration 117
    Scintigraphic principle 118
    General study protocol 118
    Interpretation and reporting 118
    Small Bowel and Colon Transit Studies 118
    Procedure 118
    Protocols 118
    Image analysis 119
    Salivary Gland Function 120
    Protocol 122
    Applications 122Contents xvii
    Meckel’s Scintigraphy 123
    Scintigraphic principle 123
    General study protocol 123
    Interpretation and reporting 124
    Biliary Acid Recirculation 124
    Scintigraphic principle 124
    General study protocol 124
    Protein-losing Enteropathy 124
    Scintigraphic principle 124
    General study protocol 125
    Interpretation and reporting 125
    Gastrointestinal Bleeding Scintigraphy 125
    Scintigraphic principle 126
    General study protocol 126
    Interpretation and reporting 126
    Hepatobiliary and splenic scintigraphy 127
    Cholescintigraphy 127
    Radiopharmaceuticals 128
    Indications 128
    Contraindications 128
    General study protocol 128
    Postprandial epigastric pain 128
    Postsurgical complications 129
    Biliary atresia 130
    Choledochal cysts 131
    Liver function and surgical planning pre-liver resection 131
    Liver Assessment Before Selective Internal Radiation Therapy 132
    Other applications 132
    Splenic Scintigraphy 133
    Indications 133
    Protocol 133
    Acknowledgment 134
    Chapter Self-Assessment Questions 135
    Chapter 13 Renal Scintigraphy 136
    Radiopharmaceuticals 136
    Technetium-99m diethylenetriaminepentaacetic acid 136
    Iodine-131 orthoiodohippurate 136
    Technetium-99m mercaptoacetyltriglycine 136
    Technetium-99m dimercaptosuccinic acid 136
    Fluorine-18 fluorodeoxyglucose 137
    Normal Renal Function 137
    Clinical Applications 137
    Renal failure 137
    Renal infection 137
    Renal obstructive disease 138
    Renovascular disease 139
    Renal transplant assessment 139
    Renal Cancer 140
    Chapter Self-Assessment Questions 142xviii Contents
    Chapter 14 Positron Emission Tomography (PET), PET/CT, and PET/MRI 143
    Introduction 143
    Radiopharmaceuticals and instrumentation 143
    Positron emission tomography radiopharmaceuticals 146
    Technical considerations 148
    Other positron emission tomography radiopharmaceuticals in oncologic
    applications 150
    Myocardial perfusion positron emission tomography tracers 151
    Clinical applications in oncology 152
    Genitourinary malignancies 157
    Prostate 158
    Breast cancer 159
    Cardiology applications 163
    NeuroPET 164
    Interictal seizure localization 165
    Summary 168
    Chapter Self-Assessment Questions 178
    Chapter 15 Lymphoscintigraphy 179
    Lymphoscintigraphy Principles 179
    Cancer lymphatic drainage 180
    Lymphedema 180
    Reverse Lymphatic Mapping 180
    Chapter Self-Assessment Questions 183
    Chapter 16 Radio-Theranostics 184
    Introduction 184
    Radio-theranostic pairs 184
    Pseudo–radio-theranostic pairs 185
    Radio-theranostics in the clinic 187
    Summary 192
    Chapter Self-Assessment Questions 194
    Chapter 17 Essentials of Pediatric Nuclear Medicine 195
    Introduction 195
    Radiopharmaceutical Dosage and Radiation Dose 195
    Distraction Techniques, Sedation, and General Anesthesia 196
    Thyroid 196
    Congenital hypothyroidism 196
    Graves’ disease 200
    Differentiated thyroid cancer 200
    Urinary Tract 202
    Congenital anomalies of the kidneys and urinary tracts 202
    Dimercaptosuccinic Acid 213
    Voiding cystography 213
    Hepatobiliary System and Spleen 215
    Neonatal biliary atresia 215
    Other pediatric-specific hepatobiliary and splenic pathologies 215
    Gastrointestinal Tract 216Contents xix
    Gastroesophageal reflux scintigraphy, gastric emptying scintigraphy, and
    radionuclide salivagram 216
    Ectopic gastric mucosa in a Meckel diverticulum 219
    Musculoskeltal System 221
    Bone stress injuries: Stress reactions and stress fractures 221
    Back pain and spondylolysis 221
    Non-accidental trauma 223
    Complex regional pain syndrome 229
    Functional Imaging in Pediatric Oncology 229
    Metaiodobenzylguanidine in neuroblastoma 229
    18F-FDG PET/CT in pediatric neoplasms 232
    Infection and Inflammation 232
    Central Nervous System 239
    Epilepsy 239
    Nuclear medicine cerebrospinal fluid shunts 239
    Conclusion 239
    Chapter Self-Assessment Questions 247
    Chapter 18 Quality Assurance of Nuclear Medicine Instrumentation 248
    Introduction 248
    Gamma Camera Uniformity Test 248
    Resolution and Linearity 249
    Center of rotation 249
    SPECT system performance evaluation 249
    Quality assurance of CT scanners 249
    Quality assurance of PET scanners 250
    Blank scans 250
    Normalization scans 250
    Radioactivity concentration calibration 250
    PET/CT performance evaluation 251
    Summary of Quality Assurance of Nuclear Medicine Instrumentation 251
    Chapter Self-Assessment Questions 252
    Chapter 19 Nuclear Medicine Procedures in the Pregnant and Lactating Patient 253
    Introduction 253
    What Are the Risks of Radiation in Pregnancy? 253
    Recommendations regarding fetal radiation exposure 253
    Radiopharmaceutical distribution and dosimetry in the pregnant patient 253
    Imaging for suspected pulmonary embolism in pregnancy 255
    Radioiodine distribution and dosimetry in the pregnant patient 257
    Example Cases of
    131
    I Treatments in Pregnant Patients from the United States
    Nuclear Regulatory Commission Office of Nuclear Material Safety
    and Safeguards 258
    Decision-Making Regarding Imaging with Radiopharmaceuticals in
    the Pregnant Patient 260
    Radioisotopes and the lactating patient 260
    Chapter Self-Assessment Questions 264
    Index 267
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