Nuclear Medicine and Molecular Imaging: The Requisites (Requisites in Radiology Original)

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THE REQUISITES NUCLEAR MEDICINE AND MOLECULAR IMAGING
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FOREWORD
PREFACE TO THE 5TH EDITION OF THE REQUISITES, NUCLEAR MEDICINE
CONTENTS
1 - Radioactivity and Radionuclides
	ATOMIC STRUCTURE OF MATTER
		Electronic Structure of the Nucleus
		Structure of the Orbital Electrons
	ELECTROMAGNETIC RADIATION
		Production of X-Rays
		Characteristic X-Rays
		Auger Electrons
		Particle Deceleration and Bremsstrahlung X-Rays
	RADIOACTIVITY AND RADIOACTIVE DECAY
		Modes of Radioactive Decay
			Alpha Decay
			Beta-Minus Decay
			Beta-Plus (Positron) Decay
		Radioactive Decay Calculations
	INTERACTIONS BETWEEN RADIATION AND MATTER
		Charged-Particle Interactions With Matter
		Photon Interactions in Matter
		Photoelectric Effect
		Compton Scatter
2 - Radiation Detection & Ancillary Instrumentation
	RADIATION DETECTION
	SCINTILLATION DETECTORS
	ANCILLARY NUCLEAR MEDICINE EQUIPMENT
	THE PATIENT AS A RADIOACTIVE SOURCE
	GAMMA CAMERAS
	COLLIMATORS
	QUALITY CONTROL
3 - Single-Photon Emission Computed Tomography, Positron Emission Tomography, and Hybrid Imaging
	DATA ACQUISITION OF EMISSION TOMOGRAPHYN
		Tomographic Reconstruction
		Attenuation Correction
		Display of Emission Tomographic Data
		Single Photon Emission Computed Tomography
		Positron Emission Tomography
		Annihilation Coincidence Detection
		PET Quality Control
		Hybrid Imaging
4 - Radiopharmaceuticals
	PRODUCTION OF RADIONUCLIDES
		Radionuclide Generators
		Generator Equilibrium
		Molybdenum-99/Technetium Generator Systems
		Generator Operation and Yield
	RADIOPHARMACEUTICALS
	RADIOPHARMACEUTICAL PREPARATION
		Technetium Radiolabeling
		Commonly Used Single-Photon Radiopharmaceuticals
		Radioiodine I-131 and I-123
		Indium-111
		Gallium-67
		Thallium-201
		Radioactive Inert Gases
		Dual-Photon Radiopharmaceuticals for Positron Emission Tomography
	NEW RADIOACTIVE DRUG DEVELOPMENT
	QUALITY ASSURANCE IN RADIONUCLIDES AND RADIOPHARMACEUTICALS
		Radionuclide Production Quality Control
			Mo-99/Tc-99m Generator QC
			Radionuclide Purity
			Chemical Purity
			Radiochemical Purity
			Limits for Other Radionuclides
		Quality Assurance of Technetium-99m–Labeled Radiopharmaceuticals
		Quality Control of Non-Technetium-Based Radiopharmaceuticals
		Sterility and Pyrogen Testing
	DISPENSING RADIOPHARMACEUTICALS
		Normal Procedures
		Special Considerations
			Pregnancy and Lactation
			Dosage Selection for Pediatric Patients
			Nuclear Regulatory Commission and Agreement States
			Authorized User
			Medical Event
			Adverse Reactions to Diagnostic Radiopharmaceuticals
	RADIATION ACCIDENTS (SPILLS)
	QUALITY CONTROL IN THE NUCLEAR PHARMACY
		Sterility and Pyrogen Testing
			Radiopharmaceutical Dose Calibrators
	RECEIVING RADIOACTIVE PACKAGES
	RADIATION DOSIMETRY
5 - Molecular Imaging
	IMAGING TECHNIQUES
		Radionuclide Imaging
		Functional Magnetic Resonance Imaging
			Magnetic Resonance Spectroscopy
		Optical Imaging
		Ultrasound
	BIOMARKERS
		Background
	CELL METABOLISM AND PROLIFERATION
		Glucose Utilization: Fluorine-18 Fluorodeoxyglucose
		DNA Synthesis: Fluorine-18 Fluorothymidine
		Biosynthesis
			Amino Acid Transport, Metabolism, and Peptide Synthesis
			Lipid Metabolism and Phospholipid Synthesis
		Hypoxia
			Fluorine-18 Fluoromisonidazole
			Copper-144 ATSM
			Hypoxia Imaging Applications
		Signaling and Expression
		Monoclonal Antibody Use
		Receptor Expression
			Somatostatin Receptors
			Steroid Hormone Receptors
	REPORTER GENE IMAGING AND GENE THERAPY
		Strategy
		Monitoring Gene Therapy
		Nanotechnology
	IMAGING BIOMARKERS AND NEW-DRUG DEVELOPMENT
6 -
The Skeletal System
	RADIONUCLIDE IMAGING OF THE SKELETON: RADIOPHARMACEUTICALS
		Technetium-99m MDP
			Preparation
			Uptake and Pharmacokinetics
			Imaging Protocol of Tc-99m MDP
		F-18 Sodium Fluoride (F-18 NaF) PET/CT
			F-18 NaF Imaging Protocol
		Image Interpretation
			Normal and Altered Distribution
			Soft Tissues
			Comparing Different Imaging Methods
	CLINICAL USES OF SKELETAL SCINTIGRAPHY
		Metastatic Disease
			Scintigraphic Patterns in Metastatic Disease
		Imaging Findings in Specific Cancers
			Prostate Carcinoma
			Breast Carcinoma
			Lung Carcinoma
			Neuroblastoma
		Other Tumors
		Primary Bone Tumors
			Malignant Tumors
			Benign Bone Tumors
		Metabolic Bone Disease
			Paget Disease
			Hyperparathyroidism and Renal Osteodystrophy
		Skeletal Trauma
			Child Abuse
			Complex Regional Pain Syndrome
			Stress Fractures
			Rhabdomyolysis
			Heterotopic Bone Formation
		Bone Infarction and Osteonecrosis
			Legg-Calvé-Perthes Disease
			Osteonecrosis
			Sickle Cell Anemia
		Osteomyelitis
			Bone-Scan Findings of Osteomyelitis
	TARGETED RADIONUCLIDE THERAPY OF METASTATIC DISEASE IN BONE
		Radium-223 (Ra-223) Alpha-Emitter Therapy
		Samarium-153 EDTMP
		Strontium-89 (Sr-89)
		Phosphorus-32 (P-32)
		Rhenium-186 HEDP
	BONE MINERAL DENSITY ASSESSMENT
7 -
The Pulmonary System
	INTRODUCTION: THE VENTILATION–PERFUSION LUNG SCAN
	PULMONARY EMBOLISM
		Diagnosis
	VQ BACKGROUND
	RADIOPHARMACEUTICALS
		Perfusion: Tc-99m MAA
		Ventilation Agents
			Xe-133
			Tc-99m DTPA
			Tc-99m Technegas
		Radiation Exposure: VQ Versus CTPA
	TECHNIQUE
		Ventilation
		Perfusion
	IMAGE INTERPRETATION
		Perfusion Image Findings
		Ventilation Image Findings
	PIOPED
		Diagnostic Interpretation Categories
			Normal
			High Probability
			Considerations Involving Near-Normal to Nondiagnostic Scans
			Special Considerations
		SPECT in Ventilation–Perfusion Scintigraphy
		Comparisons of Planar VQ, CTPA, and SPECT VQ
	QUANTITATIVE LUNG SCAN
		Adult Respiratory Distress Syndrome
8 - Endocrine System
	THYROID DISEASE—RADIONUCLIDE DIAGNOSIS AND THERAPY
		Thyroid Anatomy and Physiology
		Radiopharmaceuticals
			Radioiodine-131 (I-131) and -123 (I-123)
			Special Considerations and Precautions
		Thyroid Uptake (%RAIU)
			Methodology for %RAIU
			Thyroid Scan
			Thyroid Nodules
		Radioiodine I-131 Therapy of Thyrotoxicosis
			Graves Disease
			Toxic Nodular Disease
		Thyroid Cancer
			Whole-Body Thyroid Cancer Scintigraphy
			Iodine-131 Therapy for Thyroid Cancer
	PARATHYROID SCINTIGRAPHY
		Anatomy and Embryology
			Physiology of the Parathyroid Gland
		Primary Hyperparathyroidism
			Clinical Presentation
			Diagnosis
			Treatment
		Radiopharmaceuticals
			Methodology
		Image Interpretation
		Accuracy
		Other Radiopharmaceuticals
9 - Hepatic, Biliary, and Splenic Scintigraphy Scintigraphy
	Cholescintigraphy
		Radiopharmaceuticals
		Patient Preparation
		Methodology
		Cholescintigraphic Diagnostic Patterns
			Blood Flow
			Hepatic Uptake and Function
			Gallbladder Filling
			Biliary Clearance
			Morphine Sulfate
			Cholecystokinin
			Imaging Gallbladder Contraction
		Common Clinical Applications
			Acute Cholecystitis
			Chronic Cholecystitis
			Biliary Obstruction
			Choledochal Cyst
			Biliary Atresia
			Cholescintigraphy
			Postoperative Biliary Tract Complications
	Tc-99m Macroaggregated Albumin (MAA) Hepatic Arterial Perfusion Scintigraphy
		Methodology
		Study Interpretation
	Hepatic Arterial Radiolabeled Microspheres for Tumor Therapy
		Radiopharmaceuticals
		Methodology
		Complications
		Results
	Tc-99m Red Blood Cell Liver Scintigraphy
		Methodology
		Image Interpretation
		Accuracy
	Tc-99m Sulfur Colloid Liver and Spleen Imaging
		Mechanism of Localization and Pharmacokinetics
		Clinical Applications
		Methodology
		Image Interpretation
		Liver Diseases
			Decreased Uptake
			Increased Uptake
			Superior Vena Cava Obstruction
			Focal Nodular Hyperplasia
			Budd-Chiari Syndrome
	Splenic Scintigraphy
10 - Gastrointestinal System
	GASTROINTESTINAL TRANSIT SCINTIGRAPHY
		Gastric Emptying
		Anatomy and Physiology
		Gastric Stasis Syndromes
		Patient Preparation
		Therapy of Gastroparesis
		Radiopharmaceuticals
		Standardization of Solid Gastric-Emptying Scintigraphy
			Standardized Solid Gastric-Emptying Study
			Interpretation of Solid Gastric-Emptying Studies
			Alternative Solid Meals
		Liquid Gastric Emptying
		Quantification of Gastric Emptying
			Attenuation Correction
			Liquid Gastric Emptying Quantification
			Gastric Accommodation
	ESOPHAGEAL TRANSIT SCINTIGRAPHY
		Methodology for Esophageal Transit Scintigraphy
			Analysis and Quantification
	GASTROESOPHAGEAL REFLUX DISEASE
		Diagnosis of GERD
		Scintigraphy
			Image Interpretation
			Image Interpretation and Quantification
			Accuracy
		Salivagram
		Intestinal Transit Scintigraphy
		Nonscintigraphic Methodologies
		Scintigraphy for Small Intestinal Transit
		Large Bowel Transit Scintigraphy
		Whole-Gut Transit or Comprehensive Gastrointestinal Transit Scintigraphy
	GASTROINTESTINAL BLEEDING
		Gastrointestinal Bleeding Scintigraphy
			RBC Radiolabeling
			Image Acquisition
		Image Interpretation
			Flow Phase
			Dynamic Phase
			Delayed Imaging
			Interpretative Criteria
			Interpretive Pitfalls
		Accuracy
	MECKEL SCAN
		Radiopharmaceutical
			Mechanism of Uptake
			Clinical Manifestations
		Diagnosis
		Methodology
		Pharmacological Augmentation
		Image Interpretation
		Retained Gastric Antrum
		Barrett Esophagus
	PROTEIN-LOSING ENTEROPATHY
	PERITONEAL SCINTIGRAPHY
		Methodology
		Salivary Gland Scintigraphy
		Methodology
		Dacryoscintigraphy
	HELICOBACTER PYLORI INFECTION
		Urea Breath Test for H. pylori
11 - Urinary Tract
	RENAL ANATOMY AND PHYSIOLOGY
	DYNAMIC RENAL IMAGING
		Radiopharmaceuticals: Excretion and Washout
			Tc-99m Diethylenetriaminepentaacetic acid
			Technetium-99m Mercaptoacetyltriglycine
	DYNAMIC RENOGRAPHY IMAGING PROTOCOLS
		Preparation
		Acquisition and Processing
		Interpretation
	CLINICAL APPLICATIONS OF RENAL SCINTIGRAPHY
		Urinary Tract Obstruction
			Background
			Methods
			Interpretation
	RENOVASCULAR HYPERTENSION
		Imaging Protocol
		Image Interpretation
	RENAL TRANSPLANT EVALUATION
		Transplant Complications
			Delayed Graft Function (ATN)
			Acute Rejection
		Immunosuppressive Drug Toxicity
		Surgical Complications and Renal Diseases
		Methods
		Interpretation
	MEASURING RENAL FUNCTION: GLOMERULAR FILTRATION RATE
	RENAL CORTICAL IMAGING
		Technetium-99m Dimercaptosuccinic Acid
			Method
		Image Interpretation
	RADIONUCLIDE CYSTOGRAPHY
		Methodology
		Interpretation
12 - Oncology: F-18 Fluorodeoxyglucose Positron Emission Tomography
	BACKGROUND
		Radiopharmaceuticals
			Physical Properties
			Kinetics and Distribution
	F-18 FDG ONCOLOGY PROTOCOL
		PET/CT Imaging
			Patient Preparation
			Dose Administration and Uptake
			PET/CT Scan Acquisition
	DEDICATED PET/MR
	IMAGE INTERPRETATION
		Normal F-18 FDG Distribution
			Pharyngeal and Parapharyngeal
			Myocardial Metabolism
			Urinary Excretion
			Gastrointestinal Tract
			Reproductive Organs
		Benign F-18 FDG Distribution Variants
			Thyroid Disease
			Brown Adipose Tissue Activation
			Inflammation, Infection, and Trauma
			Effects of Therapy
		Artifacts
		Patterns of Malignancy
		Quantification: The Standard Uptake Value
	CLINICAL F-18 FDG PET USE IN ONCOLOGY
		Cancers Not Localized to an Organ or Region
			Lymphoma
			Melanoma
		Head and Neck Cancer
			Thyroid Cancer
		Thoracic Cancers
			Lung Carcinoma
			Diagnosis of Solitary Pulmonary Nodule
			Lung Cancer
			Breast Carcinoma
		Gastrointestinal Cancers
			Esophageal Carcinoma
			Colorectal Carcinoma
			Hepatobiliary and Pancreatic Tumors
		Genitourinary Tumors
			Ovarian Cancer
			Cervical Carcinoma
			Testicular Carcinoma
			Prostate Carcinoma
			Renal and Bladder Carcinoma
		Musculoskeletal Tumors
			Multiple Myeloma
13 -
Oncology—Beyond Fluorodeoxyglucose
	NEUROENDOCRINE TUMOR IMAGING AND PEPTIDE RECEPTOR RADIOTHERAPY
		Gastroenteropancreatic and Lung Neuroendocrine Tumors
		Diagnostic SSTR Radiopharmaceuticals
			Indium-111 Pentetreotide (OctreoScan)
			Gallium-68 (Ga-68) Dotatate (DOTA-0-Tyr3-Octreotate)
		Other Neuroendocrine Tumors
		Therapeutic Radionuclides Bound to SSTRs
			Lutecium-177 (Lu-177) Dotatate (Lutathera) Therapy for Neuroendocrine Tumors
			F-18 Fluorodeoxyglucose PET/CT
	I-123 AND I-131 MIBG ADRENERGIC TUMOR IMAGING AND THERAPY
		I-123 mIBG (AdreView)
			Uptake and Distribution
			Methodology
			Clinical Applications of I-123 mIBG
	PROSTATE CANCER DIAGNOSTIC IMAGING AND THERAPY
		F-18 Fluciclovine (FACBC, Axumin)
			In-111 Capromab Pendetide (ProstaScint)
			Ga-68, F-18, and Tc-99m PSMA-Targeted Imaging Radiopharmaceuticals
			Lutetium-177 (Lu-177) PSMA-Targeted Therapy of Prostate Cancer (Lutathera)
	SENTINEL NODE MAPPING WITH LYMPHOSCINTIGRAPHY
		Radiopharmaceuticals
		Clinical Indications
			Malignant Melanoma
			Breast Cancer
			Lymphedema—Extremity Lymphoscintigraphy
	MOLECULAR BREAST IMAGING—SCINTIMAMMOGRAPHY
		F-18 Fluorodeoxyglucose PET Mammography
		Dedicated F-18 Fluorodeoxyglucose PET Breast Mammography
		Tc-99m Sestamibi Scintimammography
	RADIONUCLIDE MONOCLONAL ANTIBODY THERAPY—B-CELL LYMPHOMA
		Yttrium-90 Ibritumomab Tiuxetan (Zevalin)
			Methodology
			Toxicity
	TC-99M SESTAMIBI RENAL IMAGING—ONCOCYTOMA VERSUS RENAL CELL CARCINOMA
	GALLIUM-67 TUMOR IMAGING
14 - Central Nervous System
	RADIOPHARMACEUTICALS
		PET Image Acquisition
			Abnormal Proteins in Alzheimer’s Disease
			Image Analysis in AD
			Dementia With Lewy Bodies
			Frontotemporal Dementia/Frontotemporal Lobar Degeneration
	PET
		Normal-Pressure Hydrocephalus
			Cisternography Image Interpretation
15 -
Inflammation and Infection
	PATHOPHYSIOLOGY OF INFLAMMATION AND INFECTION
	RADIOPHARMACEUTICALS
		Indium-111 Oxine Leukocytes
		Tc-99m-HMPAO Leukocytes
		Fluorine-18 Fluorodeoxyglucose
		Gallium-67 (Ga-67) Citrate
		Radiopharmaceuticals Under Investigation or Not Approved by the Food and Drug Administration
	CLINICAL APPLICATIONS FOR INFECTION SCINTIGRAPHY
		Osteomyelitis
			Pathophysiology
			Acute Hematogenous Osteomyelitis
			Extension From a Contiguous Site of Infection
			Direct Introduction of Organisms Into Bone
			Diagnosis of Osteomyelitis
	COMMON CLINICAL INDICATIONS
		Diabetic Foot
		Vertebral Osteomyelitis (Spondylodiscitis)
		Prosthetic Joint Infection
		Intraabdominal Infection
		Inflammatory Bowel Disease
		Fever of Unknown Origin
		Cardiovascular Disease
		Pulmonary Infection and Inflammation
			Sarcoidosis
			Idiopathic Interstitial Pulmonary Fibrosis
			Pulmonary Drug Reactions
		Malignant External Otitis
		Renal Infection and Inflammation
16 -
Cardiovascular System
	MYOCARDIAL PERFUSION SCINTIGRAPHY
	SINGLE-PHOTON RADIOPHARMACEUTICALS FOR MYOCARDIAL SCINTIGRAPHY
		Radiopharmaceuticals
			Tc-99m Sestamibi (Cardiolite)
			Tc-99m Tetrofosmin (Myoview)
			Thallium-201 Chloride (Tl-201)
		Imaging Methodologies
			Planar Myocardial Perfusion Imaging
			Single-Photon Emission Computed Tomography
		Diagnosis and Evaluation of Coronary Artery Disease
			Cardiac Stress
			Image Interpretation
			Quantitative Analysis
			Clinical Scenarios
	MYOCARDIAL INFARCTION IMAGING
	CARDIAC AMYLOIDOSIS
	CARDIAC SYMPATHETIC HYPERACTIVITY—I-123 METAIODO-BENZYL-GUANIDINE
	CARDIAC POSITRON EMISSION TOMOGRAPHY
		Positron Emission Tomography Perfusion Scintigraphy
		Radiopharmaceuticals
			Rubidium-82 Chloride
			Oxygen-15 (O-15) Water
			Future Cardiac Positron Emission Tomography Radiopharmaceuticals
		Diagnosis of Coronary Artery Disease
			Accuracy of PET Versus SPECT
			Absolute Myocardial Blood Flow Quantification
			Coronary Flow Reserve
			Myocardial Viability/Hibernating Myocardium
			Fluorine-18 Fluorodeoxyglucose
			Cardiac Sarcoidosis
	RADIONUCLIDE VENTRICULOGRAPHY
		Equilibrium Blood-Pool Method
			Qualitative Analysis
			Quantitative Data Analysis
		Clinical Applications
			Coronary Artery Disease
			Assessment of Cardiac Toxicity
			Pulmonary Disease
			Congenital Heart Disease—Right-to-Left Shunts
17 - Pearls, Pitfalls, and Frequently Asked Questions
	RADIOPHARMACEUTICALS
	NUCLEAR MEDICINE PHYSICS
	RADIATION DETECTION AND INSTRUMENTATION
	SINGLE-PHOTON EMISSION COMPUTED TOMOGRAPHY AND POSITRON EMISSION TOMOGRAPHY
	ENDOCRINE
	BONE
	HEPATOBILIARY
	GENITOURINARY
	ONCOLOGY: POSITRON EMISSION TOMOGRAPHY
	ONCOLOGY: BEYOND FLUORODEOXYGLUCOSE
	GASTROINTESTINAL
	INFECTION AND INFLAMMATION
	CENTRAL NERVOUS SYSTEM
	CARDIAC
	PULMONARY
Appendix
	1 -
Dosimetry
	2 -
The Periodic Table of the Elements