Core Areas

What is Nuclear Medicine?

Nuclear Medicine is a medical specialty that uses the nuclear properties of matter for diagnosis and treatment of various pathologies.

It involves the administration of radiopharmaceuticals and image acquisition, eminently functional, on dedicated equipment.

 

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What is Nuclear Medicine?

Intervention Areas of Nuclear Medicine

Diagnosis

 

Gamma-Camera (GC)

The Gamma-Camera, or Anger camera, is a device with one or two detectors, usually Sodium Iodide doped with thallium (NaI (Tl)). The Gamma-Camera has the capability of detecting gamma radiation which comes from the patient, allowing the construction of a representative image of pathophysiologic in vivo distribution of the radiotracer in the patient’s body. Radiopharmaceuticals used are gamma emitters, most of which are labeled with technetium-99m, with an energy of 140 keV.

In this modality, it can be done exams to study the skeletal system, cardiovascular, pulmonary, renal, endocrine, neurological, among others.

 

PET / CT

The PET / CT device is generally composed of two complete circular rings, one of them consisting in CT component, which provides an image transmission primarily to allow for correction of radiation by the field (patient's body), but also for anatomical location and another composed by a scintillation detector (eg. LYSO, LSO, BGO, etc.). This one allows an image representation of the pathophysiological in vivo distribution of the radiopharmaceutical in the patient's body. In this case, the positron-emitting radiopharmaceutical is β +, which undergo a process of annihilation with electrons in the middle of the patient's body, giving rise to two gamma photons in diametrically opposite directions and of equal energy of 511 keV, which are detected simultaneously by the detector ring.

Despite the wide application of this technique in cancer cases, there are other areas where the PET / CT may be useful, such as in cardiology and neurology, among others.

 

Nuclear Hematology

Nuclear hematology relates to the techniques set for manipulation of blood cells and their labeling with radioactive isotopes in order to study specific hematologic disorders by means of gamma-camera images or quantification in appropriate equipment.

 

In Vitro Methods and Techniques

Assay techniques / quantification of antigen (RIA) or antibodies (IRMA) labeled with a radioactive isotope.

 

Osteodensitometry

The osteodensitometry or bone densitometry, although it is a quantitative technique through the interaction of X-radiation with the patient, can also be performed in Nuclear Medicine Services.
It is a simple technique that allows to evaluate the bone mineral density of patients and make differential diagnosis between osteopeny and osteoporosis.

There are other less common applications, such as measurement index of muscle mass in athletes, for example.

 

Therapy

Therapy in Nuclear Medicine consists on the administration of radiopharmaceuticals emitting β- or α particles, witch, by their characteristics (high LET), have destructive capacity.

Depending on the dose that is determined to therapy, it may be done on an outpatient basis or in the context of admission until the emission of radiation by the patient decreases to safe levels.

 

Planning for Radiotherapy

Classically planning for radiotherapy is performed by CT. However, many doctors are increasingly resorting to PET / CT to do so. This is due not only because they have the necessary information provided by CT (Hounsfield units), but also information on the biologically active volume of the lesions to be treated, which allows to optimize the treatment fields.

 

Radiopharmacy

The Radiopharmacy is a laboratory dedicated to obtaining and handling radioactive isotopes and radiopharmaceutical preparation (chemical vector coordinated with a radioactive isotope) in specific equipments prepared for that purpose.

Radiopharmaceuticals prepared to be administered to patients are subject to a rigorous quality control process prior to being dispensed by the radiopharmacy.

Radiopharmaceuticals may be emitting various types of radiation, so, the radiopharmacy must be prepared for all service needs.

<b>Intervention Areas of Nuclear Medicine</b>

Multidisciplinary Team

The team of a Nuclear Medicine service consists of medical, technical, physical, operational assistants, administrative assistants and eventually nurses and radiopharmaceuticals.

Radiological Protection and Safety

Protection and Radiation Safety in Nuclear Medicine are mandatory.

Professionals should be closely monitored with individual dosimetry. It is also the duty of the owner of the facility to ensure that the construction of service is sufficient to shield the radiation levels insuring that there is no inadvertently exposure to the public.

The radiological protection of patients is also a key factor, guaranteed by the application of the ALARA principle (As Low As Reasonably Achievable).

Radioactive Waste Management

Proper management of radioactive waste that is generated daily in the Nuclear Medicine Service, is of utmost importance. Compliance with the relevant legislation and adequate training of professionals will ensure that patients, professionals and the environment are not put on risk.

All generated waste should be properly packaged, labeled, dated and placed in the appropriate place for decline until they leave the Service. This whole process should be documented and recorded.

Research

Opportunities to develop research studies in Nuclear Medicine are varied. From the development of new radiopharmaceuticals, optimization of image acquisition protocols, image processing tools or studies of radiological protection, in order to reduce the exposure of patients and professionals, among others.

Participation in studies conducted in other areas of knowledge that need to study physiological processes in vivo, also found in Nuclear Medicine a powerful ally.

Continuous Training

Nuclear Medicine is a constantly evolving area, so a structured and continuous professional training program is essential. Recently we have seen major developments of new radiopharmaceuticals both for diagnosis and for therapy.

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