BOOK
LIC - Essentials of Nuclear Medicine and Molecular Imaging
Fred A. Mettler | Milton J. Guiberteau
(2018)
Additional Information
Book Details
Abstract
Covering both the fundamentals and recent developments in this fast-changing field, Essentials of Nuclear Medicine and Molecular Imaging, 7th Edition, is a must-have resource for radiology residents, nuclear medicine residents and fellows, nuclear medicine specialists, and nuclear medicine technicians. Known for its clear and easily understood writing style, superb illustrations, and self-assessment features, this updated classic is an ideal reference for all diagnostic imaging and therapeutic patient care related to nuclear medicine, as well as an excellent review tool for certification or MOC preparation.
- Provides comprehensive, clear explanations of everything from principles of human physiology, pathology, physics, radioactivity, radiopharmaceuticals, radiation safety, and legal requirements to hot topics such as new brain and neuroendocrine tumor agents and hybrid imaging, including PET/MR and PET/CT.
- Covers the imaging of every body system, as well as inflammation, infection and tumor imaging; pearls and pitfalls for every chapter; and pediatric doses and guidelines in compliance with the Image Gently and Image Wisely programs.
- Features a separate self-assessment section on differential diagnoses, imaging procedures and artifacts, and safety issues with unknown cases, questions, answers, and explanations.
- Includes new images and illustrations, for a total of 430 high-quality, multi-modality examples throughout the text.
- Reflects recent advances in the field, including updated nuclear medicine imaging and therapy guidelines • Updated dosimetry values and effective doses for all radiopharmaceuticals with new values from the 2015 International Commission on Radiological Protection • Updated information regarding advances in brain imaging, including amyloid, dopamine transporter and dementia imaging • Inclusion of Ga-68 DOTA PET/CT for neuroendocrine tumors • Expanded information on correlative and hybrid imaging with SPECT/CT • New myocardial agents • and more.
- Contains extensive appendices including updated comprehensive imaging protocols for routine and hybrid imaging, pregnancy and breastfeeding guidelines, pediatric dosages, non-radioactive pharmaceuticals used in interventional and cardiac stress imaging, and radioactivity conversion tables.
Table of Contents
| Section Title | Page | Action | Price |
|---|---|---|---|
| Front Cover | cover | ||
| Inside Front Cover | ifc1 | ||
| Essentials of Nuclear Medicine and Molecular Imaging | i | ||
| Copyright Page | iv | ||
| Dedication | v | ||
| Preface | vi | ||
| Acknowledgments | vii | ||
| Table Of Contents | viii | ||
| 1 Radioactivity, Radionuclides, and Radiopharmaceuticals | 1 | ||
| Chapter Outline | 1 | ||
| Basic Isotope Notation | 1 | ||
| Nuclear Stability and Decay | 1 | ||
| Radionuclide Production | 3 | ||
| Radioactive Decay | 4 | ||
| Radionuclide Generator Systems | 5 | ||
| Radionuclides and Radiopharmaceuticals for Imaging | 6 | ||
| Single Photon | 6 | ||
| Technetium-99m | 6 | ||
| Iodine-123 and -131 | 8 | ||
| Xenon-133 | 10 | ||
| Gallium-67 | 10 | ||
| Indium-111 | 10 | ||
| Thallium-201 | 11 | ||
| Positron Emitters | 11 | ||
| Fluorine-18 | 11 | ||
| Other Positron Emitters | 12 | ||
| Biologic Agents and Nanoparticles | 12 | ||
| Adverse Reactions | 12 | ||
| Investigational Radiopharmaceuticals | 13 | ||
| Radiopharmacy Quality Control | 13 | ||
| Generator and Radionuclide Purity | 14 | ||
| Radiochemical Labeling | 15 | ||
| Unsealed Radionuclides Used for Therapy | 17 | ||
| Phosphorus-32, Yttrium-90, and Gold-198 | 17 | ||
| Iodine-131 | 17 | ||
| Strontium-89, Samarium-153, Rhenium-186, and Radium-223 | 17 | ||
| Suggested Readings | 18 | ||
| 2 Instrumentation and Quality Control | 19 | ||
| Chapter Outline | 19 | ||
| Geiger-Mueller Counter | 19 | ||
| Ionization Chamber | 19 | ||
| Sodium Iodide Well Counter | 20 | ||
| Single Probe Counting Systems | 21 | ||
| Dose Calibrator | 22 | ||
| Gamma Scintillation Camera | 23 | ||
| Collimator | 23 | ||
| Crystal and Other Photon Detector Devices | 26 | ||
| Photon Transducers | 27 | ||
| Solid-State Photon Detectors | 27 | ||
| Pulse Height Analyzer | 28 | ||
| Console Controls | 29 | ||
| Resolution | 29 | ||
| Count Rate and Dead Time | 31 | ||
| Field Uniformity | 31 | ||
| Image Acquisition: Memory and Matrix Size | 31 | ||
| Image Display and Processing | 32 | ||
| Spatial Filters | 32 | ||
| Temporal Filters | 33 | ||
| Frame Manipulation | 33 | ||
| Operator Interaction | 33 | ||
| Dedicated Molecular Breast Imaging Cameras | 33 | ||
| Single-Photon Emission Computed Tomography (SPECT) | 34 | ||
| Instrumentation | 34 | ||
| Dedicated Cardiac SPECT Cameras | 35 | ||
| Data Acquisition | 35 | ||
| Attenuation Correction | 36 | ||
| Acquisition Time | 36 | ||
| Image Matrix Size | 36 | ||
| Number of Views | 36 | ||
| Tomographic Image Production | 36 | ||
| Image Reconstruction | 36 | ||
| Image Filtering | 37 | ||
| Image Display and Quantitation | 37 | ||
| SPECT/CT | 37 | ||
| Positron Emission Tomography (PET) | 38 | ||
| Overview of PET Cameras | 38 | ||
| PET Scintillation Detectors | 42 | ||
| PET Detector Geometry | 42 | ||
| Attenuation Correction | 44 | ||
| System Sensitivity and Resolution | 45 | ||
| PET Image Acquisition and Processing | 45 | ||
| PET/CT | 46 | ||
| PET/MRI | 47 | ||
| Instrumentation Quality Control | 47 | ||
| Gamma Cameras | 49 | ||
| Spatial Resolution and Linearity Testing | 49 | ||
| Field Uniformity Assessment | 50 | ||
| SPECT Quality Control | 51 | ||
| Field Uniformity Assessment and Correction | 52 | ||
| Center of Rotation Determination and Correction | 52 | ||
| Detector Head Alignment With the Axis of Rotation | 53 | ||
| Collimator Evaluation | 53 | ||
| System Performance | 53 | ||
| PET/CT Quality Control | 53 | ||
| Ambient Temperature | 53 | ||
| Normalization Scan | 53 | ||
| Blank Scan | 54 | ||
| Image Plane Calibration | 54 | ||
| CT Scanner | 54 | ||
| Technical Artifacts | 54 | ||
| Areas of Decreased Activity | 54 | ||
| Areas of Increased Activity | 56 | ||
| Suggested Readings | 59 | ||
| 3 Central Nervous System | 60 | ||
| Chapter Outline | 60 | ||
| Radionuclide Brain Imaging | 60 | ||
| Planar Brain Perfusion Imaging | 60 | ||
| Technique | 60 | ||
| Normal Planar Brain Scan | 60 | ||
| SPECT and PET Brain Imaging | 62 | ||
| Radiopharmaceuticals | 62 | ||
| Normal SPECT Perfusion Brain Scan | 63 | ||
| SPECT Brain Perfusion Image Interpretation | 63 | ||
| PET/CT Image Interpretation | 63 | ||
| Clinical Applications | 63 | ||
| Brain Death | 63 | ||
| Cerebrovascular Disease | 66 | ||
| Cerebral Infarction | 66 | ||
| Transient Ischemic Attack | 66 | ||
| Carotid Stenosis | 66 | ||
| Brain Tumors | 67 | ||
| Cerebellar Diaschisis | 69 | ||
| Epilepsy | 71 | ||
| Ictal Imaging for Temporal Lobe Epilepsy | 71 | ||
| Interictal Imaging for Temporal Lobe Epilepsy | 71 | ||
| Extratemporal Lobe Epilepsy | 72 | ||
| Dementia | 72 | ||
| Alzheimer Disease | 72 | ||
| Alzheimer Disease: Amyloid Imaging in Dementia | 74 | ||
| Frontotemporal Dementia (Pick Disease) | 77 | ||
| Dementia With Lewy Bodies | 78 | ||
| Multi-Infarct Dementia | 78 | ||
| Huntington Disease | 78 | ||
| Parkinson Disease and Syndromes | 78 | ||
| Cerebrospinal Fluid Imaging | 79 | ||
| Radiopharmaceuticals and Technique | 79 | ||
| Normal Examination | 79 | ||
| Clinical Applications | 80 | ||
| Communicating Hydrocephalus | 80 | ||
| Cerebrospinal Fluid Leaks | 80 | ||
| Cerebrospinal Fluid Shunt Patency | 81 | ||
| Suggested Readings | 84 | ||
| 4 Thyroid, Parathyroid, and Salivary Glands | 85 | ||
| Chapter Outline | 85 | ||
| Thyroid Radioiodine Uptake and Imaging | 85 | ||
| Radiopharmaceuticals | 85 | ||
| Iodine-131 | 85 | ||
| Iodine-123 | 86 | ||
| Technetium-99m | 86 | ||
| Dosimetry | 86 | ||
| Radioiodine Uptake Test | 86 | ||
| Principle and Technique | 86 | ||
| Factors Affecting Iodine Uptake | 87 | ||
| Elevated Radioiodine Uptake | 88 | ||
| Reduced Radioiodine Uptake | 88 | ||
| Thyroid Gland Imaging | 89 | ||
| Technical Imaging Protocol | 89 | ||
| Iodine-123 | 89 | ||
| Technetium-99m Pertechnetate | 89 | ||
| Normal Images | 89 | ||
| Clinical Applications: Nodular and Other Benign Diseases | 90 | ||
| Thyroid Nodules | 90 | ||
| Cold Nodule | 91 | ||
| Hot Nodule | 92 | ||
| Discordant Thyroid Nodule | 92 | ||
| Indeterminate (“Warm”) Nodule | 92 | ||
| Multinodular Gland | 93 | ||
| Diffuse Toxic Goiter (Graves Disease) | 93 | ||
| Thyroiditis | 95 | ||
| Ectopic Thyroid Tissue | 95 | ||
| Congenital Organification Defects | 96 | ||
| Clinical Applications: Thyroid Cancer Imaging | 96 | ||
| Differentiated Thyroid Cancer | 97 | ||
| Post-Thyroidectomy Imaging of DTC | 97 | ||
| Whole Body Scan Technique | 98 | ||
| Iodine-131 WBS Interpretation (Box 4.3) | 98 | ||
| Imaging Non–Iodine-Avid Thyroid Cancers | 100 | ||
| Iodine-131 Therapy in Benign Thyroid Disease | 100 | ||
| Principle | 102 | ||
| Iodine-131 Therapy in Hyperthyroidism | 103 | ||
| Patient Preparation and Post-Treatment Expectations for Iodine-131 Hyperthyroid Therapy | 103 | ||
| Diffuse Toxic Goiter | 105 | ||
| Toxic Nodular Goiter | 106 | ||
| Nontoxic Multinodular Goiter | 106 | ||
| Iodine-131 Therapy of Hyperthyroidism in Children | 106 | ||
| Iodine-131 Therapy in Thyroid Cancer | 106 | ||
| Patient Preparation for Iodine-131 Cancer Therapy | 107 | ||
| Postsurgical Thyroid Remnant Ablation and Adjuvant Therapy | 107 | ||
| Iodine-131 Treatment of Recurrent Thyroid Cancer and Functioning Metastases | 108 | ||
| Iodine-131 Therapy of Thyroid Cancer in Children | 108 | ||
| Early Side Effects and Late Sequelae of Iodine-131 Therapy | 108 | ||
| Hyperthyroidism Therapy | 108 | ||
| Thyroid Cancer Therapy | 110 | ||
| Radiation Safety Aspects of Iodine-131 Therapy | 110 | ||
| Parathyroid Imaging and Localization | 110 | ||
| Radiopharmaceuticals | 111 | ||
| Salivary Gland Imaging | 113 | ||
| Suggested Readings | 115 | ||
| 5 Cardiovascular System | 116 | ||
| Chapter Outline | 116 | ||
| Anatomy and Physiology | 116 | ||
| SPECT Myocardial Perfusion Imaging | 117 | ||
| Principle | 117 | ||
| Radiopharmaceuticals | 120 | ||
| Technetium-99m Labeled Radiopharmaceuticals | 120 | ||
| Technetium-99m Sestamibi | 121 | ||
| Technetium-99m Tetrofosmin | 122 | ||
| Thallium-201 Chloride | 122 | ||
| Conventional and Dedicated Cardiac SPECT and SPECT/CT Cameras | 123 | ||
| Imaging Protocols | 123 | ||
| Technetium-99m Radiopharmaceutical SPECT Rest and Stress Imaging Protocols | 124 | ||
| One-Day Rest–Stress Protocol (“Low-Dose Rest, High-Dose Stress”) | 124 | ||
| Two-Day Protocol | 124 | ||
| Stress-Only Protocol | 125 | ||
| Thallium SPECT Stress–Rest Imaging Protocol | 125 | ||
| Thallium-201 Postexercise Imaging | 125 | ||
| Thallium-201 Redistribution Imaging | 125 | ||
| Dual Isotope Imaging: 201Tl-99mTc Sestamibi/Tetrofosmin Protocol | 126 | ||
| Patient Absorbed Dose Considerations | 126 | ||
| Myocardial SPECT Image Processing and Display | 127 | ||
| Image Processing | 127 | ||
| SPECT Image Display | 129 | ||
| Bull’s Eye (Polar Map Display) | 129 | ||
| Image Interpretation | 129 | ||
| Approach to Interpretation | 129 | ||
| Alignment of Images | 130 | ||
| Artifacts | 130 | ||
| Attenuation Artifacts | 131 | ||
| Attenuation Correction and SPECT-CT Image Misregistration Issues | 133 | ||
| Motion Artifacts | 134 | ||
| Technical Artifacts | 134 | ||
| Normal Appearance and Variants | 134 | ||
| Abnormal Scans | 134 | ||
| Visual Analysis of Myocardial Activity | 134 | ||
| Reversible (Transient) Defects | 134 | ||
| Nonreversible (Fixed) Defects | 134 | ||
| Reverse Perfusion Defects (Reverse Redistribution) | 136 | ||
| Description of Myocardial Perfusion Abnormalities | 136 | ||
| Lung Activity | 136 | ||
| Transient Ischemic Dilatation | 137 | ||
| Right Ventricular Activity | 137 | ||
| Splanchnic Activity | 137 | ||
| Semiquantitative Analysis | 137 | ||
| SPECT With Gated Acquisition (G-SPECT) | 139 | ||
| Technique | 139 | ||
| Data Display and Interpretation | 140 | ||
| G-SPECT Clinical Applications | 140 | ||
| Patient Stress Protocols | 140 | ||
| Physical Exercise | 141 | ||
| Patient Preparation | 142 | ||
| Exercise Protocols | 142 | ||
| Pharmacologic Stress | 142 | ||
| Vasodilator Stress Agents | 142 | ||
| Regadenoson Stress Imaging | 144 | ||
| Patient Preparation | 144 | ||
| Regadenoson Protocol | 144 | ||
| Adenosine Stress Imaging | 144 | ||
| 6 Respiratory System | 175 | ||
| Chapter Outline | 175 | ||
| Anatomy and Physiology | 175 | ||
| Radiopharmaceuticals | 177 | ||
| Perfusion Imaging Agents | 177 | ||
| Ventilation Imaging Agents | 178 | ||
| Radiolabeled Aerosols | 178 | ||
| Radioactive Gases | 178 | ||
| Technique | 179 | ||
| Normal Lung Scan | 179 | ||
| Perfusion Scan | 179 | ||
| Ventilation Scan | 180 | ||
| Clinical Applications | 181 | ||
| Pulmonary Emboli | 183 | ||
| Diagnostic Principle | 183 | ||
| Basic Concepts | 183 | ||
| Analysis of Images | 190 | ||
| Interpretive Criteria | 190 | ||
| PIOPED: Prospective Investigation of Pulmonary Embolism Diagnosis | 190 | ||
| Modified PIOPED II Interpretive Criteria | 191 | ||
| Ventilation/Perfusion Modified PIOPED II Criteria | 191 | ||
| Perfusion (Q) Only Modified PIOPED II Criteria | 191 | ||
| PISAPED Interpretive Criteria | 192 | ||
| Gestalt Interpretation | 192 | ||
| SPECT Ventilation/Perfusion Interpretation | 192 | ||
| Optimizing Interpretation | 193 | ||
| Incorporation of Clinical Information | 193 | ||
| Ancillary Signs | 194 | ||
| Special Situations | 195 | ||
| Pleural Effusions | 195 | ||
| Diffuse Lung Disease | 195 | ||
| Airway Disease (Chronic Obstructive Pulmonary Disease) | 195 | ||
| Location of Triple Matches | 197 | ||
| Lobar or Whole-Lung Defects | 197 | ||
| Incorporation of Noninvasive Deep Venous Testing | 197 | ||
| Computed Tomography Pulmonary Arteriography | 197 | ||
| Lung Scan Follow-Up of Pulmonary Emboli | 197 | ||
| Pulmonary Hypertension | 199 | ||
| Nonembolic Diseases | 201 | ||
| Chronic Obstructive Pulmonary Disease | 201 | ||
| Mucous Plugs | 203 | ||
| Asthma, Bronchiectasis, and Bronchitis | 203 | ||
| Lung Neoplasms | 203 | ||
| Inflammatory Disease | 206 | ||
| Cardiovascular Abnormalities | 208 | ||
| Lung Scanning During Pregnancy | 209 | ||
| Deep Venous Imaging and Thrombus Detection | 211 | ||
| Suggested Readings | 212 | ||
| 7 Gastrointestinal Tract | 213 | ||
| Chapter Outline | 213 | ||
| Liver-Spleen Imaging | 213 | ||
| Radiopharmaceuticals | 213 | ||
| Planar Imaging and SPECT/CT | 213 | ||
| Normal Liver Scan | 214 | ||
| Abnormal Liver Scan | 214 | ||
| Hepatic Cirrhosis | 216 | ||
| Diffuse and Infiltrative Disorders | 216 | ||
| Metastatic Disease | 216 | ||
| Primary Liver Neoplasms | 216 | ||
| Hepatoma | 216 | ||
| Focal Nodular Hyperplasia | 217 | ||
| Hepatic Cell Adenomas | 218 | ||
| Miscellaneous Focal Lesions | 218 | ||
| Abscess | 218 | ||
| Budd-Chiari Syndrome (Hepatic Vein Thrombosis) | 218 | ||
| Hepatic Blood Pool Imaging | 218 | ||
| Splenic Imaging | 219 | ||
| Normal Spleen Scan | 219 | ||
| Abnormal Spleen Scan | 219 | ||
| Focal Lesions | 219 | ||
| Splenomegaly | 219 | ||
| Trauma | 220 | ||
| Nonvisualization of the Spleen | 220 | ||
| Gastrointestinal Bleeding Studies | 220 | ||
| Interpretation | 222 | ||
| Meckel Diverticulum Imaging | 223 | ||
| Hepatobiliary Imaging | 224 | ||
| Radiopharmaceuticals | 224 | ||
| Technique | 224 | ||
| Normal Scan | 226 | ||
| Clinical Settings | 226 | ||
| Acute Cholecystitis | 226 | ||
| Chronic Cholecystitis | 228 | ||
| Biliary Obstruction | 230 | ||
| Posttraumatic and Postsurgical Biliary Scans | 231 | ||
| Biliary Atresia and Neonatal Hepatitis | 235 | ||
| Hepatic Neoplasms | 235 | ||
| Gastroesophageal Function Studies | 236 | ||
| Esophageal Transit | 236 | ||
| Gastroesophageal Reflux and Aspiration | 237 | ||
| Gastric Emptying | 237 | ||
| Small Bowel and Colon Transit | 240 | ||
| Abdominal Shunt Evaluation | 240 | ||
| Suggested Readings | 242 | ||
| 8 Skeletal System | 243 | ||
| Chapter Outline | 243 | ||
| Anatomy and Physiology | 243 | ||
| Radiopharmaceuticals | 243 | ||
| Technique | 244 | ||
| Normal Scan | 245 | ||
| Clinical Applications | 246 | ||
| Metastatic Disease | 247 | ||
| Malignant Bone Tumors | 252 | ||
| Benign Osseous Neoplasms | 253 | ||
| Soft-Tissue Uptake | 256 | ||
| Trauma | 263 | ||
| Orthopedic Prosthesis Pain | 266 | ||
| Osteomyelitis, Cellulitis, and Septic Arthritis | 268 | ||
| Benign Nonneoplastic Disease | 272 | ||
| Paget Disease | 272 | ||
| Hypertrophic Pulmonary Osteoarthropathy | 276 | ||
| Aseptic Arthritis | 276 | ||
| Metabolic Bone Disease | 276 | ||
| Avascular Necrosis | 276 | ||
| Spontaneous Osteonecrosis of the Knee | 277 | ||
| Radiation Therapy | 277 | ||
| Complex Regional Pain Syndrome (Reflex Sympathetic Dystrophy) | 278 | ||
| Bone Marrow Imaging | 278 | ||
| Bone Mineral Measurements | 279 | ||
| Palliative Therapy of Painful Osseous Metastases | 283 | ||
| Beta-Emitter Therapy | 283 | ||
| Alpha-Emitter Therapy | 284 | ||
| Suggested Readings | 286 | ||
| 9 Genitourinary System and Adrenal Glands | 287 | ||
| Chapter Outline | 287 | ||
| Physiology | 287 | ||
| Radiopharmaceuticals | 287 | ||
| Glomerular Filtration Agents | 288 | ||
| Tubular Secretion Agents | 288 | ||
| Renal Cortical Agents | 288 | ||
| Radionuclide Renal Evaluation | 288 | ||
| Functional Renal Imaging | 288 | ||
| Renal Perfusion Phase | 289 | ||
| Renal Parenchymal Function Phase | 289 | ||
| Collecting System Phase | 289 | ||
| Renography | 289 | ||
| Quantitation of Renal Function | 291 | ||
| Plasma Sample-Based Clearances | 292 | ||
| Camera-Based Clearances | 292 | ||
| Anatomic (Cortical) Imaging | 292 | ||
| Clinical Applications of Renal Imaging | 292 | ||
| Diffuse Renal Disease | 292 | ||
| Vascular Abnormalities | 293 | ||
| Obstructive Uropathy | 293 | ||
| Routine Functional Imaging and Renography | 293 | ||
| Diuretic Renography | 295 | ||
| Urine Leak/Urinoma | 300 | ||
| Pediatric Hydronephrosis | 300 | ||
| Angiotensin-Converting Enzyme Inhibitor (Captopril) Renography | 301 | ||
| Acute Pyelonephritis and Cortical Scar | 306 | ||
| Renal Masses | 306 | ||
| Radionuclide Cystography | 306 | ||
| Renal Transplant Evaluation | 308 | ||
| Adrenal Gland Imaging | 309 | ||
| Adrenal Medullary Imaging | 310 | ||
| Clinical Applications | 311 | ||
| Pheochromocytoma | 311 | ||
| Neuroblastoma | 312 | ||
| Suggested Readings | 313 | ||
| 10 Non-PET Neoplasm Imaging and Radionuclide Therapy | 315 | ||
| Chapter Outline | 315 | ||
| Targeted Tumor Imaging | 316 | ||
| Neuropeptide Receptor Imaging | 316 | ||
| Somatostatin (Octreotide) Receptor Imaging | 316 | ||
| Adrenal Tumor Imaging | 318 | ||
| Nonspecific Tumor Imaging | 318 | ||
| Gallium-67 Imaging | 318 | ||
| Thallium-201 Chloride Imaging | 319 | ||
| Brain Neoplasms: Post-Treatment Changes Versus Recurrent Tumor | 319 | ||
| Acquired Immunodeficiency Syndrome-Related Neoplasms | 320 | ||
| Other Adult Tumors | 321 | ||
| Technetium-99m Sestamibi Tumor Imaging | 321 | ||
| Breast Cancer | 321 | ||
| Lymphoscintigraphy | 322 | ||
| Application in Oncology: Sentinel Lymph Node Biopsy | 322 | ||
| Application in Lymphedema | 324 | ||
| Radionuclide Tumor Antibody Imaging and Therapy | 324 | ||
| Treatment of Lymphoma With Radioimmunotherapy | 324 | ||
| Treatment of Neuroendocrine Tumors With Radiolabeled Somatostatin Analogs | 325 | ||
| Treatment of Hepatoma and Liver Metastases With Intravascular Microspheres | 325 | ||
| Suggested Readings | 327 | ||
| 11 Hybrid PET/CT Neoplasm Imaging | 328 | ||
| Chapter Outline | 328 | ||
| 18F-FDG PET Imaging | 328 | ||
| Indications | 328 | ||
| Patient Preparation for 18F-FDG Imaging | 328 | ||
| Normal 18F-FDG Distribution and Variants | 331 | ||
| General | 331 | ||
| Brain | 331 | ||
| Vocal Cords | 335 | ||
| Tonsils, Salivary Glands, and Thyroid | 336 | ||
| Thymus | 336 | ||
| Muscle and Brown Fat | 336 | ||
| Heart | 337 | ||
| Aorta | 337 | ||
| Lungs | 339 | ||
| Breast | 339 | ||
| Gastrointestinal Tract | 339 | ||
| Genitourinary Tract | 340 | ||
| Bone Marrow, Lymph Nodes, and Spleen | 340 | ||
| Qualitative Image Interpretation | 340 | ||
| PET Image Quantitation | 341 | ||
| Whole-Body 18F-FDG PET/CT Neoplasm Imaging | 342 | ||
| Head and Neck Cancers | 343 | ||
| Thyroid Cancer | 344 | ||
| Solitary Pulmonary Nodules and Lung Cancer | 344 | ||
| Solitary Pulmonary Nodule | 344 | ||
| Primary Lung Cancer | 345 | ||
| Lymphomas | 347 | ||
| Breast Cancer | 349 | ||
| Esophageal Cancer | 350 | ||
| Gastric Cancer | 351 | ||
| Gastrointestinal Stromal Tumors (GIST) | 351 | ||
| Colorectal Cancer | 351 | ||
| Hepatocellular Carcinoma (Hepatoma) | 352 | ||
| Pancreatic Cancer | 353 | ||
| Bone Tumors | 353 | ||
| Malignant Melanoma | 353 | ||
| Gynecologic Cancers | 354 | ||
| Renal and Bladder Cancers | 355 | ||
| Prostate and Testicular Cancers | 355 | ||
| Miscellaneous Tumors | 357 | ||
| Multiple Myeloma | 357 | ||
| Histiocytosis | 357 | ||
| Neuroblastoma | 357 | ||
| Pheochromocytoma and Paraganglioma | 358 | ||
| Sarcomas and Soft Tissue Tumors | 358 | ||
| Bone Metastases | 358 | ||
| Screening for Occult Tumors or Unknown Primary Tumors | 359 | ||
| Other PET Radionuclides | 359 | ||
| 18F-Fluoride | 359 | ||
| 18F-Fluoroestradiol | 359 | ||
| 68Ga-DOTATATE and 68Ga-DOTATOC | 359 | ||
| 11C- and 18F-Choline and 11C-Acetate | 360 | ||
| 18F-Fluciclovine | 360 | ||
| 68Ga- and 18F-PMSA | 360 | ||
| Suggested Readings | 361 | ||
| 12 Inflammation and Infection Imaging | 362 | ||
| Chapter Outline | 362 | ||
| Radiolabeled Leukocytes | 362 | ||
| Mechanism of Localization | 362 | ||
| Indium-111 Oxine Leukocytes | 363 | ||
| Labeling Principle | 363 | ||
| Technique | 363 | ||
| Normal Scan | 364 | ||
| Clinical Applications | 364 | ||
| General Considerations | 364 | ||
| Fever of Unknown Origin (Occult Fever) | 365 | ||
| Immunocompromised Patients | 366 | ||
| Musculoskeletal Infections | 366 | ||
| Osteomyelitis | 367 | ||
| Posttraumatic Infections | 368 | ||
| Prosthetic Joint Infections | 368 | ||
| Diabetic Foot Infections | 368 | ||
| Neuropathic Joint Infections | 368 | ||
| Active Arthritis | 368 | ||
| Vascular Graft Infection | 368 | ||
| Technetium-99m HMPAO Leukocytes | 368 | ||
| Labeling | 369 | ||
| Technique | 369 | ||
| Normal Distribution | 369 | ||
| Clinical Applications | 369 | ||
| Thorax | 369 | ||
| Abdomen/Pelvis | 369 | ||
| Gallium Imaging | 370 | ||
| Mechanism of Localization | 370 | ||
| Technique | 370 | ||
| Normal Distribution | 370 | ||
| Clinical Applications | 370 | ||
| Abdominal and Retroperitoneal Inflammation and Infection | 370 | ||
| Fever of Unknown Origin | 370 | ||
| Immunocompromised Patients | 370 | ||
| Osteomyelitis | 371 | ||
| Sarcoidosis | 372 | ||
| Fluorine-18 Fluorodeoxyglucose PET/CT Imaging | 373 | ||
| Mechanism of Localization | 373 | ||
| Clinical Applications | 373 | ||
| Fever of Unknown Origin | 373 | ||
| Granulomatous Disease | 373 | ||
| Abdominal Diseases | 373 | ||
| Central Nervous System | 379 | ||
| Osteomyelitis | 379 | ||
| Vascular Disease | 379 | ||
| Future Inflammation Agents | 380 | ||
| Suggested Readings | 381 | ||
| 13 Authorized User and Radioisotope Safety Issues | 382 | ||
| Chapter Outline | 382 | ||
| Overview | 382 | ||
| Authorized User | 383 | ||
| Radiation Safety Officer | 383 | ||
| Other Authorized Personnel | 384 | ||
| NRC and Other Regulatory Agencies | 384 | ||
| Types of Licenses | 384 | ||
| Dose Limits | 385 | ||
| Occupational | 385 | ||
| Public | 385 | ||
| Embryo/Fetus | 385 | ||
| Breastfeeding | 385 | ||
| Family and Caregivers | 386 | ||
| Radiation Safety Committee | 386 | ||
| NRC Technical Requirements | 386 | ||
| Dose Calibrators and Survey Instruments | 386 | ||
| Determination and Records of Dosages | 386 | ||
| Calibration, Transmission, and Reference Sources | 387 | ||
| Labeling of Vials and Syringes | 387 | ||
| Survey of Ambient Exposure Rate | 387 | ||
| Training Required for Use of Unsealed Byproduct Material | 387 | ||
| Uptake, Dilution, and Excretion Studies (Written Directive Not Required) | 387 | ||
| Imaging and Localization Studies (Written Directive Not Required) | 387 | ||
| Unsealed Byproduct Material (Written Directive Required) | 388 | ||
| Required Training | 388 | ||
| Related Procedures | 388 | ||
| Oral Therapeutic Administration of Iodine-131 Sodium Iodide (Written Directive Required) | 389 | ||
| Less Than or Equal to 33 mCi (1.22 GBq) Iodine-131 | 389 | ||
| Greater Than 33 mCi (1.22 GBq) Iodine-131 | 389 | ||
| Training for Sealed Sources for Diagnosis | 389 | ||
| Medical Events and Required Reporting | 389 | ||
| Maintenance of Records | 390 | ||
| Transportation of Radioactive Materials | 390 | ||
| Receipt of Radioactive Shipments | 391 | ||
| Safe Handling and Administration of Radiopharmaceuticals | 391 | ||
| Generator Breakthrough | 393 | ||
| PET Radiation Safety | 393 | ||
| ALARA and Doses to Patients | 394 | ||
| Release of Individuals After Administration of Radionuclides | 394 | ||
| Restricted Areas, Radiation Areas, and Signage Posting | 396 | ||
| Facility Radiation Survey Policies | 396 | ||
| Waste Disposal | 398 | ||
| Biological Effects of Ionizing Radiation | 398 | ||
| Radiation Dose Quantities and Units | 398 | ||
| Sources and Magnitude of Radiation Exposure | 399 | ||
| Types of Radiation Effects | 399 | ||
| Deterministic Effects | 399 | ||
| Stochastic Effects | 399 | ||
| Cancer | 399 | ||
| Hereditary | 400 | ||
| Cataracts | 400 | ||
| Cardiovascular | 400 | ||
| Pregnancy | 400 | ||
| Modifying Factors | 400 | ||
| Suggested Readings | 401 | ||
| Self-Evaluation | 402 | ||
| Unknown Case Sets | 402 | ||
| Case 1.1 | 403 | ||
| Case 1.2 | 404 | ||
| Case 1.3 | 405 | ||
| Case 1.4 | 406 | ||
| Case 1.5 | 406 | ||
| Case 1.6 | 407 | ||
| Case 1.7 | 407 | ||
| Case 1.8 | 408 | ||
| Case 1.9 | 409 | ||
| Case 1.10 | 409 | ||
| Case 2.1 | 410 | ||
| Case 2.2 | 411 | ||
| Case 2.3 | 412 | ||
| Case 2.4 | 413 | ||
| Case 2.5 | 413 | ||
| Case 2.6 | 414 | ||
| Case 2.7 | 415 | ||
| Case 2.8 | 415 | ||
| Case 2.9 | 416 | ||
| Case 2.10 | 416 | ||
| Case 3.1 | 417 | ||
| Case 3.2 | 418 | ||
| Case 3.3 | 419 | ||
| Case 3.4 | 420 | ||
| Case 3.5 | 421 | ||
| Case 3.6 | 421 | ||
| Case 3.7 | 422 | ||
| Case 3.8 | 423 | ||
| Case 3.9 | 424 | ||
| Case 3.10 | 425 | ||
| Case 4.1 | 425 | ||
| Case 4.2 | 426 | ||
| Case 4.3 | 427 | ||
| Case 4.4 | 428 | ||
| Case 4.5 | 429 | ||
| Case 4.6 | 430 | ||
| Case 4.7 | 431 | ||
| Case 4.8 | 432 | ||
| Case 4.9 | 433 | ||
| Case 4.10 | 434 | ||
| Case 5.1 | 434 | ||
| Case 5.2 | 435 | ||
| Case 5.3 | 436 | ||
| Case 5.4 | 437 | ||
| Case 5.5 | 438 | ||
| Case 5.6 | 439 | ||
| Case 5.7 | 441 | ||
| Case 5.8 | 442 | ||
| Case 5.9 | 443 | ||
| Case 5.10 | 444 | ||
| Case 6.1 | 445 | ||
| Case 6.2 | 446 | ||
| Case 6.3 | 447 | ||
| Case 6.4 | 448 | ||
| Case 6.5 | 449 | ||
| Case 6.6 | 450 | ||
| Case 6.7 | 451 | ||
| Case 6.8 | 452 | ||
| Case 6.9 | 453 | ||
| Case 6.10 | 454 | ||
| Case 7.1 | 454 | ||
| Case 7.2 | 455 | ||
| Case 7.3 | 456 | ||
| Case 7.4 | 457 | ||
| Case 7.5 | 459 | ||
| Case 7.6 | 460 | ||
| Case 7.7 | 460 | ||
| Case 7.8 | 461 | ||
| Case 7.9 | 462 | ||
| Case 7.10 | 464 | ||
| Answers to Unknown Case Sets | 465 | ||
| Case 1.1 | 465 | ||
| Case 1.2 | 465 | ||
| Case 1.3 | 465 | ||
| Case 1.4 | 465 | ||
| Case 1.5 | 465 | ||
| Case 1.6 | 465 | ||
| Case 1.7 | 466 | ||
| Case 1.8 | 466 | ||
| Case 1.9 | 466 | ||
| Case 1.10 | 466 | ||
| Case 2.1 | 466 | ||
| Case 2.2 | 466 | ||
| Case 2.3 | 467 | ||
| Case 2.4 | 467 | ||
| Case 2.5 | 467 | ||
| Case 2.6 | 467 | ||
| Case 2.7 | 467 | ||
| Case 2.8 | 467 | ||
| Case 2.9 | 468 | ||
| Case 2.10 | 468 | ||
| Case 3.1 | 468 | ||
| Case 3.2 | 468 | ||
| Case 3.3 | 468 | ||
| Case 3.4 | 468 | ||
| Case 3.5 | 468 | ||
| Case 3.6 | 469 | ||
| Case 3.7 | 469 | ||
| Case 3.8 | 469 | ||
| Case 3.9 | 469 | ||
| Case 3.10 | 469 | ||
| Case 4.1 | 469 | ||
| Case 4.2 | 469 | ||
| Case 4.3 | 470 | ||
| Case 4.4 | 470 | ||
| Case 4.5 | 470 | ||
| Case 4.6 | 470 | ||
| Case 4.7 | 470 | ||
| Case 4.8 | 470 | ||
| Case 4.9 | 470 | ||
| Case 4.10 | 470 | ||
| Case 5.1 | 471 | ||
| Case 5.2 | 471 | ||
| Case 5.3 | 471 | ||
| Case 5.4 | 471 | ||
| Case 5.5 | 471 | ||
| Case 5.6 | 471 | ||
| Case 5.7 | 471 | ||
| Case 5.8 | 472 | ||
| Case 5.9 | 472 | ||
| Case 5.10 | 472 | ||
| Case 6.1 | 472 | ||
| Case 6.2 | 472 | ||
| Case 6.3 | 472 | ||
| Case 6.4 | 473 | ||
| Case 6.5 | 473 | ||
| Case 6.7 | 473 | ||
| Case 6.8 | 473 | ||
| Case 6.9 | 473 | ||
| Case 6.10 | 473 | ||
| Case 7.1 | 474 | ||
| Case 7.2 | 474 | ||
| Case 7.3 | 474 | ||
| Case 7.4 | 474 | ||
| Case 7.5 | 474 | ||
| Case 7.6 | 475 | ||
| Case 7.7 | 475 | ||
| Case 7.8 | 475 | ||
| Case 7.9 | 475 | ||
| Case 7.10 | 475 | ||
| Appendices | 476 | ||
| Appendix A Characteristics of Radionuclides for Imaging and Therapy | 476 | ||
| Appendix B.1 Radioactivity Conversion Table for International System (SI) Units (Becquerels to Curies) | 478 | ||
| Appendix B.2 Radioactivity Conversion Table for International System (SI) Units (Curies to Becquerels) | 479 | ||
| Appendix C.1 Technetium-99m Decay and Generation Tables | 480 | ||
| Appendix C.2 Other Radionuclide Decay Tables | 482 | ||
| Appendix D Injection Techniques and Pediatric Dosages | 484 | ||
| Appendix E Sample Techniques for Nuclear Imaging | 488 | ||
| Brain Death or Cerebral Blood Flow Scan | 488 | ||
| SPECT Brain Perfusion Imaging | 488 | ||
| Cisternogram | 489 | ||
| Thyroid Scan (99mTc-Pertechnetate) | 490 | ||
| Thyroid Scan and Uptake (Iodine-123) | 490 | ||
| Thyroid Cancer Scan | 490 | ||
| Parathyroid Scan | 491 | ||
| Rest Gated Equilibrium Ventriculography | 491 | ||
| SPECT Myocardial Perfusion Imaging | 492 | ||
| Exercise Protocol Using a Bruce Multistage or Modified Bruce Treadmill Exercise Protocol | 493 | ||
| Dipyridamole Pharmacologic Stress Procedure | 493 | ||
| Adenosine Pharmacologic Stress Procedure | 493 | ||
| Regadenoson Pharmacologic Stress Procedure | 493 | ||
| Pulmonary Ventilation Scan (Xenon) | 494 | ||
| Pulmonary Ventilation Scan (DTPA Aerosol) | 494 | ||
| Pulmonary Perfusion Scan | 494 | ||
| Liver and Spleen Scan | 495 | ||
| SPECT/CT Liver and Spleen Imaging | 496 | ||
| Hepatobiliary Scan | 496 | ||
| Meckel Diverticulum Scan | 497 | ||
| Gastrointestinal Bleeding Scan | 497 | ||
| Esophageal Transit | 498 | ||
| Gastroesophageal Reflux/Aspiration | 498 | ||
| Gastric Emptying | 499 | ||
| Peritoneovenous (LeVeen) Ascites Shunt Patency | 499 | ||
| Salivary Gland Imaging | 500 | ||
| Bone Scan (Technetium-99m) | 500 | ||
| SPECT Bone Imaging | 501 | ||
| Bone Marrow Scan | 501 | ||
| Renal Blood Flow Scan | 501 | ||
| Renal Scan (A) Cortical Imaging | 502 | ||
| Renal Scan (B) Glomerular Filtration | 502 | ||
| Renal Scan (C) Tubular Function | 503 | ||
| Diuretic (Lasix) Renogram | 503 | ||
| Captopril Renogram for Diagnosis of Renovascular Hypertension | 504 | ||
| Radionuclide Cystogram in Children | 504 | ||
| MIBG Scan for Pheochromocytoma and Neuroblastoma | 505 | ||
| Gallium Scan for Tumor or Infection | 505 | ||
| Somatostatin Receptor Scan With Indium-111 Pentetreotide | 506 | ||
| Lymphoscintigraphy (Sentinel Node Localization) | 506 | ||
| Molecular Breast Imaging With Breast-Specific Gamma Camera (CZT Detectors) | 507 | ||
| Leukocyte (White Blood Cell) Scan | 507 | ||
| PET/CT Tumor Imaging With Fluorine-18 Fluorodeoxyglucose (FDG) | 508 | ||
| PET Cardiac Imaging With Fluorine-18 Fluorodeoxyglucose (FDG) | 509 | ||
| PET Brain Imaging With Fluorine-18 Fluorodeoxyglucose (FDG) | 509 | ||
| PET Amyloid Brain Imaging | 509 | ||
| PET Cardiac Rest/Stress Imaging With Rubidium-82 or Nitrogen-13 Ammonia | 510 | ||
| Bone Scan PET/CT (Fluorine-18 Sodium Fluoride) | 510 | ||
| Red Blood Cell Labeling Techniques | 511 | ||
| Appendix F Nonradioactive Pharmaceuticals in Nuclear Medicine | 512 | ||
| Suggested Readings | 512 | ||
| Appendix G Pregnancy and Breastfeeding | 513 | ||
| Pregnancy | 513 | ||
| Breastfeeding | 513 | ||
| Appendix H.1 General Considerations for Hospitalized Patients Receiving Radionuclide Therapy | 516 | ||
| Appendix H.2 Special Considerations and Requirements for Iodine-131 Therapy | 520 | ||
| Nursing Instructions | 520 | ||
| Release From the Hospital | 521 | ||
| Appendix I Emergency Procedures for Spills of Radioactive Materials and Special Circumstances | 522 | ||
| Spills of Radioactive Materials | 522 | ||
| Minor Spills | 522 | ||
| Major Spills | 522 | ||
| Surface Contamination Limits | 522 | ||
| Emergency Surgery of Patients Who Have Received Therapeutic Amounts of Radionuclides | 523 | ||
| Emergency Autopsy of Patients Who Have Received Therapeutic Amounts of Radionuclides | 523 | ||
| Index | 524 | ||
| A | 524 | ||
| B | 524 | ||
| C | 525 | ||
| D | 527 | ||
| E | 528 | ||
| F | 528 | ||
| G | 529 | ||
| H | 530 | ||
| I | 531 | ||
| J | 533 | ||
| K | 533 | ||
| L | 533 | ||
| M | 533 | ||
| N | 534 | ||
| O | 535 | ||
| P | 535 | ||
| Q | 537 | ||
| R | 538 | ||
| S | 540 | ||
| T | 541 | ||
| U | 542 | ||
| V | 542 | ||
| W | 543 | ||
| X | 543 | ||
| Y | 543 | ||
| Z | 543 | ||
| Inside Back Cover | ibc1 |