Problems and Solutions

in Medical Physics
Series in Medical Physics and Biomedical Engineering
Series Editors: John G. Webster, E. Russell Ritenour, Slavik Tabakov, and
Kwan Hoong Ng
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Problems and Solutions in Medical Physics: Diagnostic Imaging Physics
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Advanced and Emerging Technologies in Radiation Oncology Physics
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Problems and Solutions
in Medical Physics
Nuclear Medicine Physics

Kwan Hoong Ng
Chai Hong Yeong
Alan Christopher Perkins
CRC Press
Taylor & Francis Group
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Contents

About the series xi

Preface xv
Authors xvii
Acknowledgements xix
List of abbreviations xxi
List of physical constants xxiii

1 Radioactivity and Nuclear Transformation 1

1.1 Nuclear Stability Curve 1
1.2 Alpha Decay 2
1.3 Beta Decay 2
1.4 Positron Decay 3
1.5 Electron Capture 4
1.6 Isomeric Transition 5
1.7 Radiation Penetrability 6
1.8 Calculation: Number of Atoms 6
1.9 Calculation: Sample Count Rate 7
1.10 Calculation: Thyroid Uptake 8
1.11 Physical Half-Life (I) 9
1.12 Physical Half-Life (II) 9
1.13 Effective Half-Life (I) 10
1.14 Effective Half-Life (II) 11
1.15 Radioactive Decay Equation 11
1.16 Radioactive Decay Calculation (I) 12
1.17 Radioactive Decay Calculation (II) 13
1.18 Radioactive Decay Calculation (III) 14
1.19 Attenuation 15
1.20 Gamma Ray Constant 15
1.21 Alpha Particle Range 16

2 Radionuclide Production and Radiopharmaceuticals 19

2.1 Characteristics of Ideal Radiopharmaceutical for
Diagnostic Nuclear Medicine 19
2.2 Characteristics of Ideal Radiopharmaceutical for
Therapeutic Nuclear Medicine 20

v
vi Contents

2.3 Physical Properties and Decay Scheme of Tc-99m 20

2.4 Cyclotron 21
2.5 Cyclotron-Produced Radionuclides 22
2.6 Nuclear Fission 23
2.7 Reactor-Produced Radionuclides 24
2.8 Mo-99/Tc-99m Radionuclide Generator (I) 25
2.9 Mo-99/Tc-99m Radionuclide Generator (II) 26
2.10 Undesirable Al3+ in Tc-99m Elution 27
2.11 Transient Equilibrium 27
2.12 Tc-99m Transient Equilibrium 29
2.13 Mo-99 Transient Equilibrium Calculation 30
2.14 Secular Equilibrium Equation 31
2.15 Mo-99 Breakthrough Test 31
2.16 Preparation of Radiopharmaceutical 32
2.17 Administration of Radiopharmaceuticals 33
2.18 PET Radiopharmaceutical 34
2.19 F-18-Fluorodeoxyglucose 34
2.20 Quality Control of Radiopharmaceuticals 35

3 Non-imaging Detectors and Counters 37

3.1 Dead Time 37
3.2 Paralysable and Non-paralysable Counting Systems 37
3.3 Paralysable and Non-paralysable Counting Systems:
Count Rate Response 38
3.4 Basic Principle of Gas-Filled Detectors 39
3.5 Noble Gas 40
3.6 Gas-Filled Detectors 41
3.7 Radionuclide Activity (Dose) Calibrator 43
3.8 Factors Affecting Measurement Accuracy of an Activity
Calibrator 44
3.9 Quality Control of an Activity Calibrator 45
3.10 Basic Principles of Scintillation Detectors 45
3.11 Scintillation Detectors 46
3.12 Basic Principles of a Gamma Well Counter 47
3.13 Clinical Applications of Gamma Well Counter 48
3.14 Basic Principles of a Thyroid Probe 49
3.15 Thyroid Uptake Measurement 50

4 Instrumentation for Gamma Imaging 53

4.1 X-Ray versus Gamma-Ray Imaging 53
4.2 Gamma Camera System 54
4.3 Gamma Rays Detection 56
 Contents vii

4.4 Scintillating Crystal (I) 56

4.5 Scintillating Crystal (II) 57
4.6 Function of the Collimator 57
4.7 Collimator Design 58
4.8 Types of Collimators 58
4.9 Collimator Septa Thickness 60
4.10 Minification Factor for Diverging Collimator 61
4.11 Magnification Factor for Converging Collimator 62
4.12 Photomultiplier Tube (PMT) 63
4.13 X-, Y-Positioning Circuit 64
4.14 Energy Discrimination Circuit 65
4.15 Digital Data Acquisition 66
4.16 Digital Images in Nuclear Medicine 67
4.17 Effects of Matrix Size and Statistical Noise 68
4.18 Static Study 69
4.19 Dynamic Study 69
4.20 Gated Study 70

5 SPECT and PET Imaging 71

5.1 Physical Principles of SPECT 71
5.2 Comparison of SPECT and Planar Imaging 72
5.3 SPECT Data Acquisition 72
5.4 Principle of Noise Filtering Using the Fourier Method 74
5.5 Principle of Noise Filtering Using the Convolution Method 74
5.6 Image Processing Using Iterative Reconstruction 75
5.7 Physical Principles of PET 76
5.8 Annihilation Coincidence Detection 77
5.9 True, Scatter and Random Coincidence Events 78
5.10 Time-of-Flight in PET Imaging 79
5.11 Resolution of PET Imaging 80
5.12 2D versus 3D PET Imaging 80
5.13 Comparison of Tc-99m and F-18 81
5.14 Comparison of Imaging Techniques Between SPECT
and PET 81
5.15 Comparison of Spatial Resolution and Detection
Efficiency Between SPECT and PET 83

6 Imaging Techniques in Nuclear Medicine 85

6.1 Whole Body Bone SPECT Imaging 85
6.2 Cardiac Imaging 87
6.3 Renogram 88
viii Contents

6.4 Radioimmunoassay (RIA) 90

6.5 Standardised Uptake Value (SUV) 90
6.6 PET Imaging Applications 91

7 Radionuclide Therapy 93
7.1 Sealed and Unsealed Source Therapy 93
7.2 Therapeutic Procedures in Nuclear Medicine 94
7.3 Hyperthyroidism Absorbed Dose Calculation 94
7.4 I-131 Treatment Guidelines 95
7.5 Calculation of Administered Activity for I-131 Treatment 96
7.6 Radioiodine Therapy and Pregnancy 97
7.7 Safe Administration of I-131 98
7.8 Guidance Level for Hospitalisation of I-131 Patients 99
7.9 Radioembolisation 99
7.10 Radioimmunotherapy (RIT) 100

8 Internal Radiation Dosimetry 101

8.1 Internal Radiation Dosimetry 101
8.2 Factors Affecting Absorbed Dose to an Organ 102
8.3 Source and Target Organ 102
8.4 Monte Carlo Modelling 103
8.5 MIRD Formula 103
8.6 Absorbed Fraction 104
8.7 S-Value 105
8.8 Absorbed Dose Calculation (I) 105
8.9 Absorbed Dose Calculation (II) 106
8.10 Absorbed Dose Calculation (III) 107
8.11 Absorbed Dose Calculation (IV) 107
8.12 MIRD Formalism Assumptions 109

9 Quality Control in Nuclear Medicine 111

9.1 Quality Control of Dose Calibrator 111
9.2 Extrinsic and Intrinsic Measurement 112
9.3 Quality Control Methods 112
9.4 Uniformity 114
9.5 Spatial Resolution 115
9.6 Sensitivity 116
9.7 Collimator Efficiency 116
9.8 Collimator Resolution 117
9.9 Modulation Transfer Function (MTF) 118
9.10 Multienergy Spatial Registration 120
 Contents ix

9.11 Cold Spot Artefact 121

9.12 Centre of Rotation (COR) 121
9.13 Partial Volume Effect 123
9.14 SPECT Quality Control Phantom 124

10 Radiation Protection in Nuclear Medicine 125

10.1 Radiation Protection Terminology 125
10.2 Annual Dose Limits 126
10.3 Classification of Radiation Work Areas 127
10.4 Exposure Rate 128
10.5 Half Value Layer (HVL) 128
10.6 Accidental Exposure to High Activity Source 129
10.7 Foetal Dose Calculation for High-Dose Radionuclide
Therapy 130
10.8 Radiation Workers During Pregnancy 133
10.9 Radiation Workers Dose Limit 133
10.10 Radioactive Waste Management 134
10.11 Decontamination Principles 135
10.12 Out-patient Advice 135
10.13 Radioiodine Ward Nursing Staff 136
10.14 Handling of the I-131 Patient After Death 137

Bibliography 139
About the series

The Series in Medical Physics and Biomedical Engineering describes the

applications of physical sciences, engineering and mathematics in medicine
and clinical research.
The series seeks (but is not restricted to) publications in the following
topics:

• Artificial organs
• Assistive technology
• Bioinformatics
• Bioinstrumentation
• Biomaterials
• Biomechanics
• Biomedical engineering
• Clinical engineering
• Imaging
• Implants
• Medical computing and mathematics
• Medical/surgical devices
• Patient monitoring
• Physiological measurement
• Prosthetics
• Radiation protection, health physics and dosimetry
• Regulatory issues
• Rehabilitation engineering
• Sports medicine
• Systems physiology
• Telemedicine
• Tissue engineering
• Treatment

xi
xii About the series

THE INTERNATIONAL ORGANIZATION

FOR MEDICAL PHYSICS
The International Organization for Medical Physics (IOMP) represents over
18,000 medical physicists worldwide and has a membership of 80 national
and 6 regional organisations, together with a number of corporate members.
Individual medical physicists of all national member organisations are also
automatically members.
The mission of IOMP is to advance medical physics practice worldwide by
disseminating scientific and technical information, fostering the educational
and professional development of medical physics and promoting the highest
quality medical physics services for patients.
A World Congress on Medical Physics and Biomedical Engineering is
held every three years in cooperation with International Federation for Medical
and Biological Engineering (IFMBE) and International Union for Physics
and Engineering Sciences in Medicine (IUPESM). A regionally based inter-
national conference, the International Congress of Medical Physics (ICMP)
is held between world congresses. IOMP also sponsors international confer-
ences, workshops and courses.
The IOMP has several programmes to assist medical physicists in develop-
ing countries. The joint IOMP Library Programme supports 75 active libraries
in 43 developing countries, and the Used Equipment Programme coordinates
equipment donations. The Travel Assistance Programme provides a limited
number of grants to enable physicists to attend the world congresses.
IOMP co-sponsors the Journal of Applied Clinical Medical Physics.
The IOMP publishes, twice a year, an electronic bulletin, Medical Physics
World. IOMP also publishes e-Zine, an electronic newsletter, about six
times a year. IOMP has an agreement with Taylor & Francis Group for the
publication of the Medical Physics and Biomedical Engineering series of
textbooks. IOMP members receive a discount.
IOMP collaborates with international organisations, such as the World
Health Organization (WHO), the International Atomic Energy Agency
(IAEA) and other international professional bodies, such as the International
Radiation Protection Association (IRPA) and the International Commission on
Radiological Protection (ICRP), to promote the development of medical phys-
ics and the safe use of radiation and medical devices.
 About the series xiii

Guidance on education, training and professional development of medical

physicists is issued by IOMP, which is collaborating with other professional
organisations in development of a professional certification system for medical
physicists that can be implemented on a global basis.
The IOMP website (www.iomp.org) contains information on all the activi-
ties of the IOMP, policy statements 1 and 2, and the ‘IOMP: Review and Way
Forward’, which outlines all the activities of IOMP and plans for the future.
Preface

In view of the increasing number and popularity of master’s and higher-level

training programmes in medical physics worldwide, there is an increasing
need for students to develop problem-solving skills in order to grasp the com-
plex concepts which are part of ongoing clinical and scientific practice. The
purpose of this book is, therefore, to provide students with the opportunity to
learn and develop these skills.
This book serves as a study guide and revision tool for postgraduate
students sitting for examinations in nuclear medicine physics. The detailed
problems and solutions included in the book cover a wide spectrum of topics,
following the typical syllabi used by universities on these courses worldwide.
The problems serve to illustrate and augment the underlying theory and
provide a reinforcement of basic principles to enhance learning and informa-
tion retention. No book can claim to cover all topics exhaustively, but additional
problems and solutions will be made available periodically on the publisher’s
website: https://crcpress.com/9781482239959.
One hundred and forty-eight solved problems are provided in ten chapters
on nuclear medicine physics topics, including radioactivity and nuclear trans-
formation, radionuclide production and radiopharmaceuticals, non-imaging
detectors and counters, instrumentation for gamma imaging, SPECT and PET/
CT imaging techniques, radionuclide therapy, internal radiation dosimetry,
quality control and radiation protection in nuclear medicine. The approach
to the problems and solutions covers all six levels in the cognitive domain of
Bloom’s taxonomy.
This book is one of a three-volume set containing medical physics prob-
lems and solutions. The other two books in the set tackle diagnostic imaging
physics and radiotherapy physics.
We would like to thank the staff at Taylor & Francis Group, especially
Francesca McGowan and Rebecca Davies, for their unfailing support.

Kwan Hoong Ng, Chai Hong Yeong, Alan Christopher Perkins

xv
Authors

Kwan Hoong Ng, PhD, FinstP, DABMP, received his MSc (medical phys-
ics) from the University of Aberdeen and PhD (medical physics) from the
University of Malaya, Malaysia. He is certified by the American Board of
Medical Physicists. Professor Ng was honoured as one of the top 50 medical
physicists in the world by the International Organization of Medical Physics
(IOMP) in 2013. He also received the International Day of Medical Physics
Award in 2016. He has authored/co-authored over 230 papers in peer-reviewed
journals and 25 book chapters and has co-edited 5 books. He has presented
over 500 scientific papers and has more than 300 invited lectures. He has also
organised and directed several workshops on radiology quality assurance,
digital imaging and scientific writing. He has directed research initiatives in
breast imaging, intervention radiology, radiological safety and radiation dosim-
etry. Professor Ng serves as a consultant for the International Atomic Energy
Agency (IAEA) and is a member of the International Advisory Committee of
the World Health Organization (WHO), in addition to previously serving as a
consulting expert for the International Commission on Non-Ionizing Radiation
Protection (ICNIRP). He is the founding and emeritus president of the South
East Asian Federation of Organizations for Medical Physics (SEAFOMP) and
is a past president of the Asia-Oceania Federation of Organizations for Medical
Physics (AFOMP).

Chai Hong Yeong, PhD, is a medical physicist and an associate professor at

the School of Medicine, Taylor’s University, Subang Jaya, Malaysia. Dr. Yeong
received her BSc degree in health physics in 2005, master of medical phys-
ics in 2007, and PhD in medical physics in 2012. She is currently a council
member of the Asia-Oceania Federation of Organizations for Medical Physics
(AFOMP), the South East Asia Federation of Organizations for Medical Physics
(SEAFOMP), the Malaysian Institute of Physics (IFM) and a founding member
of the ASEAN College of Medical Physics (ACOMP). Dr. Yeong has published
more than 36 peer-reviewed journal papers, one academic book, 2 book chapters,
10 proceedings and more than 80 scientific papers. Her research interests focus
on theranostics, image-guided minimally invasive cancer therapies, nanothera-
peutics, 3D printing and radiation protection in medicine. She is currently lead-
ing the Cancer Innovation and Metabolic research group at Taylor’s University.

xvii
xviii Authors

Alan Christopher Perkins, PhD, FIPEM, HonFRCP, is a clinical professor

of medical physics in the School of Medicine at the University of Nottingham
and honorary consultant clinical scientist at Nottingham University Hospitals
NHS Trust where he is a divisional lead for research and innovation. He
has had over 35 years’ experience in nuclear medicine and medical physics
and broad managerial experience in the NHS. He has undertaken extensive
research and development work with clinical, academic and industrial col-
laborators in nuclear medicine, gastroenterology, radiopharmacology, drug
delivery and radiation protection. His contribution to this work has resulted
in authorship of over 200 peer-reviewed publications and 6 published books.
Professor Perkins is a past president of the British Nuclear Medicine Society
and the International Research Group on Immuno-scintigraphy and Therapy, a
previous vice president of the Institute of Physics and Engineering in Medicine
and currently a governor and chair of the Research Strategy Board for Coeliac
UK. He is an editor of the UK journal Nuclear Medicine Communications, and
for over nine years has represented the UK on the High-Level Group for the
Security of Medical Radioisotope Supplies at the Organisation for Economic
Co-operation and Development (OECD). He has consulted for a number of
commercial organisations and has acted as an expert witness for pharmaceuti-
cal litigation in the United States.
Acknowledgements

We acknowledge the contribution from the following people:

Azlan Che Ahmad Mohammad Nazri Md Shah

Department of Biomedical Imaging Department of Biomedical Imaging
Faculty of Medicine Faculty of Medicine
University of Malaya University of Malaya
Kuala Lumpur, Malaysia Kuala Lumpur, Malaysia

Muhammad Shahrun Nizam

Li Kuo Tan
Daman Huri
Department of Biomedical Imaging
Department of Biomedical Imaging
Faculty of Medicine
Faculty of Medicine
University of Malaya
University of Malaya
Kuala Lumpur, Malaysia
Kuala Lumpur, Malaysia

David Lurie Ngie Min Ung

Bio-Medical Physics Clinical Oncology Unit
School of Medicine, Medical Faculty of Medicine
Sciences & Nutrition University of Malaya
University of Aberdeen Kuala Lumpur, Malaysia
Aberdeen, United Kingdom
Wil van der Putten
Juergen Meyer
Department of Medical Physics and
Radiation Oncology Department
Bioengineering
University of Washington Medical
Galway University Hospitals
Center
Galway, Ireland
Washington, District of Columbia

Khadijah Ramli Jeannie Hsiu-Ding Wong

Department of Biomedical Imaging Department of Biomedical Imaging
Faculty of Medicine Faculty of Medicine
University of Malaya University of Malaya
Kuala Lumpur, Malaysia Kuala Lumpur, Malaysia

xix
List of abbreviations

A mass number
ACD annihilation coincidence detection
C-11 carbon-11
CFOV central field-of-view
COR centre of rotation
Cr-51 chromium-51
CT computed tomography
CZT cadmium zinc telluride
ECG electrocardiogram
ELISA enzyme-linked immunosorbent assay
F-18 fluorine-18
FDA Food and Drug Administration
FDG fluorodeoxyglucose
FOV field-of-view
FWHM full width at half maximum
He helium
HVL half value layer
I-125 iodine-125
I-131 iodine-131
IAEA International Atomic Energy Agency
ICRP International Commission on Radiological Protection
In-111 indium-111
LEHR low-energy high-resolution
LOR line-of-response
LSF line spread function
mAbs monoclonal antibodies
MIRD medical internal radiation dosimetry
Mo-99 molebdenum-99
MRI magnetic resonance imaging
MTF modulation transfer function
MUGA multiple-gated acquisition
NEMA National Electrical Manufacturers Association

xxi
xxii List of abbreviations

N-13 nitrogen-13
NaI sodium iodide
NaI(Tl) sodium iodide doped with thallium
O-15 oxygen-15
O-18 oxygen-18
P-32 phosphorus-32
Pb lead
PET positron emission tomography
PHA pulse height analyser
PMT photomultiplier tube
Po-210 polonium-210
PSF point spread function
PSPMT position sensitive photomultiplier tube
QC quality control
Ra-223 radium-223
Re-188 rhenium-188
RIA radioimmunoassay
RIT radioimmunotherapy
ROI region-of-interest
RPO radiation protection officer
Sm-153 samarium-153
SPECT single photon emission computed tomography
SUV standardised uptake value
t1/2 half-life
Te effective half-life
Tb biological half-life
Tp physical half-life
Tc-99m technetium-99m
TOF time-of-flight
TVL tenth value layer
U-235 uranium-235
UFOV useful field-of-view
Y-90 yittrium-90
Z atomic number
List of physical
constants

Avogadro’s number Na = 6.022 × 1023 atoms∙mol−1

Speed of light in vacuum c = 2.998 × 108 m/s ≈ 3 × 108 m·s−1
Electron charge e = 1.602 × 10−19 C
Electron and positron rest mass me = 9.109 × 10−31 kg or 0.511 Me·V·c−2
Proton rest mass mp = 1.673 × 10−27 kg or 938.3 Me·V·c−2
Neutron rest mass mn = 1.675 × 10−27 or 939.6 Me·V·c−2
Planck’s constant h = 6.626 × 10−34 J·s
Electric constant (dielectric ε0 = 8.854 × 10−12 c·V−1·m−1
permittivity of vacuum)
Magnetic constant (permeability μ0 = 4π × 10−7 V·s·a−1·m−1
of vacuum)
Newtonian gravitation constant G = 6.672 × 10−11 m3·kg−1·s−2
Proton mass/electron mass mp/me = 1836.0
Specific charge of electron e/me = 1.758 × 1011 c∙kg−1

xxiii
Radioactivity
and Nuclear
Transformation
1
1.1 NUCLEAR STABILITY CURVE
PROBLEM
Figure 1.1 shows the nuclear stability curve. Name the types of radioactive
decays that tend to happen at regions A, B and C.

Solution
A: Beta decay
B: Positron emission or electron capture
C: Alpha decay

FIGURE 1.1 Nuclear stability curve.

1
2 Problems and Solutions in Medical Physics

1.2 ALPHA DECAY

PROBLEM
Explain the radioactive decay process through alpha decay. Your answer
should include the physical principle, mechanism and decay equation.

Solution
Alpha decay is the spontaneous emission of an alpha particle (24 He or α)
from an unstable nucleus (Figure 1.2). It typically occurs for heavy nuclides
(A > 150 or Z > 83) when the nuclear binding energy can no longer hold the
nucleons together. Alpha decay is often followed by gamma or characteris-
tic X-ray emission resulting from the competing processes, such as internal
conversion and Auger electron emission. An alpha particle has two protons
and two neutrons and carries an electronic charge of 2+. Alpha decay can be
expressed by the following equation:
A
Z X → AZ−−42Y + 24 He + transition energy

FIGURE 1.2 Graphical illustration of alpha decay.

1.3 BETA DECAY

PROBLEM
Explain the radioactive decay process through beta decay. Your answer should
include the physical principle, mechanism and decay equation.
 1 • Radioactivity and Nuclear Transformation 3

Solution
When a nucleus has an excessive number of neutrons compared to protons
(i.e. high N/Z ratio), the excess neutron will be converted into a proton, an
electron and an antineutrino (ν e ). The proton remains in the nucleus, but the
electron is emitted as a beta (β−) particle (Figure 1.3). Beta decay increases the
number of protons by 1 and hence transforms the atom into a different element
with atomic number Z + 1. The mass number remains unchanged because of
simultaneous decrease of a neutron only. Beta decay can be expressed by the
following equation:

A
Z X → Z +A1Y + β − +ν e + energy

FIGURE 1.3 Graphical illustration of beta decay.

1.4 POSITRON DECAY

PROBLEM
Explain the radioactive decay process through positron decay. Your answer
should include the principle, mechanism and decay equation.

Solution
When a nucleus has excess of protons compared to neutrons (i.e. low N/Z
ratio), the excessive proton will be converted into a neutron, a positron (β+),
and a neutrino (ν) (Figure 1.4). The neutron will remain in the nucleus, but a
positron will be emitted. Positron decay reduces the number of protons by 1
and hence transforms the atom into a different element with atomic number
Z–1. The mass number remains unchanged because of the simultaneous incre-
ment of a neutron only.
4 Problems and Solutions in Medical Physics

FIGURE 1.4 Graphical illustration of positron decay.

Positron decay can be expressed by the following equation:

A
Z X → Z −A1Y + β + + ν e + energy

1.5 ELECTRON CAPTURE

PROBLEM
Explain the radioactive decay process through electron capture. Your answer
should include the principle, mechanism and decay equation.

Solution
Electron capture is an alternative process to positron decay when the nucleus
has excessive number of protons compared to neutrons (i.e. low N/Z ratio).
During electron capture, the nucleus captures an inner orbital (i.e. K- or
L-shell) electron, thereby changing a proton to a neutron with the simultane-
ous emission of a neutrino (νe). The capture of an electron from the inner shell
creates a vacancy in the orbit, which is then filled by an outer shell electron,
and the energy difference between the electron shells results in the emission of
a characteristic X-ray (Figure 1.5).
Electron capture can be expressed by the following equation:

A
Z X + e − → Z −1AY + νe + energy
 1 • Radioactivity and Nuclear Transformation 5

FIGURE 1.5 Graphical illustration of electron capture.

1.6 ISOMERIC TRANSITION

PROBLEM
Explain the radioactive decay process through isomeric transition. Your answer
should include the principle, mechanism and decay equation.

Solution
During radioactive decay, a daughter is often formed in an excited (metastable
or isomeric) state. Gamma rays are emitted when the daughter nucleus under-
goes an internal rearrangement and transitions from the excited state to a lower
energy state (Figure 1.6). This process is called isomeric transition. Therefore,
isomeric transition is a decay process that yields gamma radiation without the
emission or capture of a particle by the nucleus. There is no change in atomic
number (Z), mass number (A), or neutron number (N). Thus, this decay mode
is isobaric and isotonic, and it occurs between two nuclear energy states with
no change in the neutron-to-proton (N/Z) ratio. Isomeric transition can be
expressed by the following equation:
A
Z X * → ZA X + Energy

Note: An example of isomeric transition is the decay of Tc-99m.

6 Problems and Solutions in Medical Physics

FIGURE 1.6 Graphical illustration of isomeric transition.

1.7 RADIATION PENETRABILITY

PROBLEM
Discuss the penetrability of alpha, beta, gamma and neutron radiation in mat-
ters, and suggest the suitable shielding materials for these radiations.

Solution
An alpha particle has the least penetrability, followed by beta and gamma radi-
ation. Alpha can be stopped by a sheet of paper or skin, beta by aluminium,
and gamma radiation by very thick concrete or lead. The penetrability of a
neutron is dependent on its energy. Neutrons may penetrate through concrete
and lead but can be slowed down by water or low atomic number materials,
such as boron.

1.8 CALCULATION: NUMBER OF ATOMS

PROBLEM
Calculate the total number of atoms and total mass present in 370 MBq of
Po-210, given the physical half-life of Po-210 is 138.4 days.
 1 • Radioactivity and Nuclear Transformation 7

Solution

ln 2
λ= = 5.795 × 10 −8 s−1
138.4 d × 24 h × 60 min × 60 s
A = 370 MBq = 3.7 × 108 Bq = 3.7 × 108 dps

• The activity, A, is related to the number of radioactive atoms as the

following:

A = λN

3.7 × 108 dps

• Hence, N = A = = 6.38 × 1015 atoms
λ 5.795 × 10−8 s−1
• Total mass of Po-210 in 370 MBq = NN
A

• Where NA is the Avogadro’s number, NA = 6.02 × 1023

6.38 ×1015 × 210 g
• Therefore, the total mass of Po-210 = = 2.23 ×10 −6 g
6.02 ×1023
• Hence, 370 MBq Po-210 contains 6.38 × 1015 atoms and the total
mass is 2.23 μg.

1.9 CALCULATION: SAMPLE COUNT RATE

PROBLEM
During radioactive counting, a 10-minute counting period of a sample plus back-
ground yields 10000 counts, and a 6-minute count of background alone yields
1296 counts. What are the net sample count rate and its standard deviation?

Solution

10000 counts
=
• Sample plus background count rate, A = 1000 cpm
10 min
1296 counts
=
• Background count rate, B = 216 cpm
6 min
• Net sample count rate = 1000 – 216 cpm = 784 cpm
1000 counts
=
• Standard deviation for A = 10 cpm
10 min
8 Problems and Solutions in Medical Physics

216 counts
=
• Standard deviation for B = 6 cpm
6 min

• Therefore, net sample count rate = 784 ± 102 + 62 cpm = 784 ±

12 cpm

1.10 CALCULATION: THYROID UPTAKE

PROBLEM
The following data were obtained from the thyroid uptake study of a patient
after administration of I-131 sodium iodide. Calculate the percentage and stan-
dard deviation of thyroid uptake in this patient.

REGION COUNTS TIME (MIN)

Standard 85500 2
Room background 952 2
Thyroid 42100 2
Thigh 2200 2

Solution
• Net standard count = 85500 − 952 = 84548
• Standard deviation for the standard counts, σ s = 85500 + 952 = 294
• Net thyroid count = 42100 – 2200 = 39900
• Standard deviation for the thyroid counts, σ t = 42100 + 2200 = 210
39900
• % thyroid uptake = 84548 × 100% = 47.2%

( 84548 ) + ( 39900 )
2 2
• Standard deviation of the uptake = 39900 × 294 210
84548
= 0.472 × 0.00001209 + 0.00002770

= 0.472 × 0.006308

= 0.003
• % standard deviation of the uptake = 00..472
003 × 100% = 0.6%

• Therefore, the percentage of I-131 uptake in the thyroid of the

patient is 47.2 ± 0.6%.
 1 • Radioactivity and Nuclear Transformation 9

1.11 PHYSICAL HALF-LIFE (I)

PROBLEM
If a radionuclide decays at a rate of 25% per hour, what is its physical half-life?

Solution
Decay constant, λ = 0.25 h−1

0.693
λ =
t1 2

0.693 0.693
Therefore, the physical half-life, t1 2 = = = 2.77 h
λ 0.25 h −1

1.12 PHYSICAL HALF-LIFE (II)

PROBLEM
An unknown radioactive source found in a nuclear medicine department decays
to 1/16 of its original activity after 24 hours. What is the physical half-life of
this radioactive source? Based on your answer, suggest a possible name of the
radioactive source.

Solution

1
activity equals to four half-lives.
16
24 h
= 6h
4 half-lives

The physical half-life of the source is six hours. The source is most prob-
ably Tc-99m, which is the most common radionuclide used in nuclear
medicine.
10 Problems and Solutions in Medical Physics

1.13 EFFECTIVE HALF-LIFE (I)

PROBLEM
a. Explain what is effective half-life.
b. If Tc-99m with a physical half-life of six hours is used to radio-
label a compound that clears from the body with a biologi-
cal half-life of four hours, what is the effective half-life of the
radiopharmaceutical?

Solution
a. The effective half-life is defined as the time interval required to
reduce the radioactivity level of an internal organ or the whole body
to one-half of its original activity due to radioactive decay (physical
half-life) and biological elimination (biological half-life). Effective
half-life, Te, is expressed as the following:

1 1 1
= +
Te Tp Tb

or

T p × Tb
Te =
T p + Tb

where:
Tp = physical half-life, which is defined as the time interval
required for a radioactive substance to decay to half of its
original activity.
Tb = biological half-life, which is defined as the time interval
required for an organ or the whole body to eliminate 50% of
its original activity by normal routes of elimination: metabolic
turnover and excretion.
T p × Tb
b. Te =
T p + Tb

6h × 4h
Therefore, Te =
6h + 4h

Te = 2.4 h
 1 • Radioactivity and Nuclear Transformation 11

Note: Effective half-life is always smaller than the biological half-life and
physical half-life. For a permanently implanted radionuclide (which no
biological half-life is applied), the effective half-life is the same as the physical
half-life.

1.14 EFFECTIVE HALF-LIFE (II)

PROBLEM
Consider 10% of Tc-99m-DTPA is eliminated from the body of a patient by
renal excretion, 25% by faecal excretion and 3% by perspiration within six
hours. What is the effective half-life of the radiopharmaceutical, given that the
physical half-life, Tp, for Tc-99m is six hours?

Solution
• Total biological elimination = 10 + 25 + 3 = 38%
• Given that 38% elimination in six hours.
• To achieve 50% elimination (biological half-life, Tb), it takes:

Tb = 50
38 × 6 h = 7.89 h
Tb × T p 7.89 h × 6 h
Te = = = 3.4 h
Tb + T p 7.89 + 6 h

• Therefore, the effective half-life, Te = 3.4 h

1.15 RADIOACTIVE DECAY EQUATION

PROBLEM
Derive the radioactive decay formula, starting from
A = −λN
where:
A = activity (Bq)
λ = decay constant (s−1)
N = number of particles
12 Problems and Solutions in Medical Physics

Solution
Given:

dN
A = − λN =
dt

dN
− = λ dt
N

By applying integration to the formula above:

Nt t
dN
−
∫
N0
N ∫
= λ dt
0

N 
ln  t  = −λt
 N0 

Nt
= e( )
− λt

N0

N t = N 0e(
− λt )

1.16 RADIOACTIVE DECAY

CALCULATION (I)
PROBLEM
A patient is injected with 1110 MBq Tc-99m-MDP (Tp1/2 = 6.02 hours) for a
whole-body bone scan. Two hours later, the patient is imaged with a gamma
camera. Assuming that 20% of the activity has been excreted by the kidneys,
how much activity remains at the time of imaging?
 1 • Radioactivity and Nuclear Transformation 13

Solution
Given:
A0 = 1110 MBq

Tp1/ 2 = 6.0 2 h

50%
Tb1/ 2 = × 2h = 5 h
20%
T × Tb 6.02 × 5
Te = p = = 2.73 h
Tp + Tb 6.02 + 5
ln 2 ln 2
λ= = = 0.254 h −1
Te 2.73 h
A = A 0e − λ t
−0.254 h −1 ( 2 h )
= 1110 MBq e

= 667.88 MBq
Therefore, the remaining activity at the time of imaging is approximately
668 MBq.

1.17 RADIOACTIVE DECAY

CALCULATION (II)
PROBLEM
A thyroid cancer patient received an oral administration of 3700 MBq radioio-
dine (I-131), and 50% of the I-131 was excreted from the body after 48 hours.
What is the remaining activity in the patient’s body on the third day of the
treatment? Assume the physical half-life for I-131 is eight days.

Solution
T p × Tb 8 d × 2 d
Te = = = 1.6 d
T p + Tb 8 d + 2 d
ln 2 ln 2
λ= = = 0.433 d −1
Te 1.6 d

A = A 0e − λt
14 Problems and Solutions in Medical Physics

−0.433 d −1 ( 3 d )
= 3700 MBq e

= 1009 MBq

Therefore, the remaining activity in patient’s body on the third day of the treat-
ment is approximately 1009 MBq.

1.18 RADIOACTIVE DECAY

CALCULATION (III)
PROBLEM
How long does it take for a sample of 370 MBq I-123 (t1/2 = 13.2 h) and a
sample of 1850 MBq Tc-99m (t1/2 = 6 h) to reach the same activity?

Solution

ln 2
λ=
t1/ 2

ln 2
λ1 = = 0.0525 h −1
13.2 h

ln 2
λ2 = = 0.1155 h −1
6h

A1e − λ1t = A2e − λ2t

370e −0.0525t = 1850e −0.1155t

e −0.0525t 1850 MBq

=
e −0.1155t 370 MBq

e(
−0.0525t )−( −0.1155t )
=5

e 0.063t = 5

0.063t = 1.609

t = 25.5 h
 1 • Radioactivity and Nuclear Transformation 15

Therefore, 370 MBq I-123 and 1850 MBq Tc-99m will achieve the same activ-
ity at 25.5 hours later.

1.19 ATTENUATION
PROBLEM
The mass attenuation coefficient of bone with a density of 1.8 g · cm−3 is
0.2 cm2g−1 for an 80 keV gamma ray. Calculate the percentage of a photon
beam attenuated by 5 cm thickness of bone.

Solution
µ
Mass attenuation coefficient =
ρ

µ
= 0.2 cm 2g −1
1.8 g ⋅ cm −3

μ = 0.36 cm−1

Fraction transmitted:
Nt
= e−µ x
N0

Nt −0.36 cm −1 ( 5 cm )
=e = 0.165
N0

Percentage attenuated = (1 – 0.165) × 100% = 83.5%

1.20 GAMMA RAY CONSTANT

PROBLEM
a. What is the specific gamma ray constant (Γ)?
b. Why should a radionuclide for imaging have a high specific gamma
ray constant?
16 Problems and Solutions in Medical Physics

Solution
a. The specific gamma ray constant (Γ) is the exposure rate at a specific
distance from a given amount of a photon-emitting radionuclide.
These constants are used frequently for dosimetry and radiation
protection purposes. The SI unit for Γ is Ckg−1s−1Bq−1 at 1 m, but it
is often expressed in its traditional units, R h−1mCi−1 at 1 cm.
b. A high Γ means there are large numbers of gamma rays emitted
and available to form the image. Some radionuclides decay by more
than one mechanism, so the radionuclides that produce more useful
gamma rays are preferable for nuclear medicine imaging.

1.21 ALPHA PARTICLE RANGE

PROBLEM
Calculate the range of a 6.3 MeV alpha particle in:

a. Air (density = 0.001293 g·cm−3, atomic mass number ~ 14.8)

b. Plastic (density = 1.13 g·cm−3, atomic mass number ~ 11.81)
c. Mylar (density = 1.4 g·cm−3, atomic mass number ~ 12.88)
d. Human tissue (density = 1.04 g·cm−3, atomic mass number ~ 13.6)

Solution
a. To calculate alpha particle range in air for 4 < E < 8 MeV, the
following equation is used:
R (cm) = 0.325 E3/2 (MeV)
R = 0.325(6.3)3/2
R = 5.14 cm

b. To calculate the alpha particle range in other material, the scaling

law is used:
R1 ρ0 A1
=
R0 ρ1 A0

Rplastic ρair Aplastic

=
Rair ρ plastic Aair
 1 • Radioactivity and Nuclear Transformation 17

0.001293 11.81
Rplastic = (5.14 cm)
1.13 14.8

0.00444
Rplastic = (5.14 cm )
4.3472

Rplastic = 0.0053 cm

c. Rmylar ρair Amylar

=
Rair ρ mylar Aair

0.001293 12.88
Rmylar = (5.14 cm )
1.4 14.8

0.00464
Rmylar = (5.14 cm )
5.3859

Rmylar = 0.0044 cm

d. Rhuman tissue ρair Ahuman tissue

=
Rair ρ human tissue Aair

0.001293 13.6
Rhuman tissue = (5.14 cm )
1.04 14.8

0.00477
Rhuman tissue = (5.14 cm )
4.0009

Rhuman tissue = 0.0061 cm

Radionuclide
Production and
Radiopharmaceuticals
2
2.1 CHARACTERISTICS OF IDEAL
RADIOPHARMACEUTICAL FOR
DIAGNOSTIC NUCLEAR MEDICINE
PROBLEM
List eight criteria of an ideal radiopharmaceutical used for diagnostic nuclear
medicine imaging studies.

Solution
The criteria of an ideal radiopharmaceutical for diagnostic nuclear medicine
include:

• Low radiation dose to patient.

• Appropriate physical half-life for the duration of the studies.
• A pure gamma emitter.
• Appropriate energy for imaging purposes (about 100 to 200 keV).
• Decays to a stable nuclide.
• High target to non-target uptake of activity.
• Good chemical reactivity (ability to form stable complexes with car-
rier molecules).
• Cost-effective and readily available.

19
20 Problems and Solutions in Medical Physics

2.2 CHARACTERISTICS OF IDEAL

RADIOPHARMACEUTICAL FOR
THERAPEUTIC NUCLEAR MEDICINE
PROBLEM
List seven criteria of an ideal radiopharmaceutical used for therapeutic nuclear
medicine.

Solution
The criteria of an ideal radiopharmaceutical for therapeutic nuclear medicine
include:

• Moderately long, effective half-life (measured in days).

• High linear energy transfer, such as α- and β-particles.
• Emission of high-radiation energy, for example, >1 MeV.
• High target-to-non-target ratio to minimize radiation dose to
non-target tissues.
• Decays into stable daughter products.
• Minimal radiation exposure to personnel in contact with patient.
• Cost-effective and readily available.

2.3 PHYSICAL PROPERTIES AND

DECAY SCHEME OF Tc-99m
PROBLEM
a. Describe the physical properties of Tc-99m.
b. Sketch and label the radioactive decay scheme of Tc-99m.

Solution
a. Tc-99m is a colourless metallic chemical element. It has an atomic
number, Z, of 43, and mass number, A, of 56. It is metastable (as
indicated by the symbol ‘m’) and thereby decays into Tc-99 through
gamma emission (88%) and isomeric transition (12%). It has a physi-
cal half-life of 6.02 hours and emits 140 keV gamma rays, which
 2 • Radionuclide Production and Radiopharmaceuticals 21

are readily detectable by a gamma camera. Tc-99m has multiple

valence states. There are 21 known isotopes and numerous isomers
from the family of technetium whereby all of them are radioactive.
b. The radioactive decay scheme of Tc-99m is illustrated in Figure 2.1.

FIGURE 2.1 Radioactive decay scheme of Tc-99m.

2.4 CYCLOTRON
PROBLEM
With the aid of a diagram, explain the basic principles of radionuclide produc-
tion in a cyclotron. Use In-111 as an example.

Solution
Figure 2.2 shows the basic structure of a cyclotron. A cyclotron consists of
two large dipole magnets (known as Dees) that produce a uniform magnetic
field. An oscillating voltage is applied to produce an electric field across the
gap between the Dees. Charged particles, such as protons and electrons, are
injected into the magnetic field region of the Dees. The electric field in the
gap then accelerates the particles as they pass through it. The particles now
have higher energy so they follow a semi-circular path in the next Dee with
a larger radius and then reach the gap again. The field in the gap accelerates
them, and they enter the first Dee again. Thus, the particles gain energy as
they spiral outwards until they gain sufficient velocity and are deflected into
a target.
22 Problems and Solutions in Medical Physics

FIGURE 2.2 Basic structure of a cyclotron.

In the production of In-111, the accelerated particles are protons. The tar-
get atoms are Cd-111. When a proton enters the nucleus of a Cd-111 atom, the
Cd-111 is transformed into In-111 by discharging a neutron. This interaction in
the form of nuclear reaction is as follows:
Target atom (bombarding particle, emitted particle) product nuclide
For example:

Cd-111 (proton, neutron) In-111

2.5 CYCLOTRON-PRODUCED
RADIONUCLIDES
PROBLEM
Name three radionuclides other than In-111 that are produced by a cyclotron.
State their nuclear reaction equations and physical half-lives.

Solution

RADIONUCLIDE NUCLEAR REACTION PHYSICAL HALF-LIFE

Fluorine-18 O-18 (p, n) F-18 110 min
Nitrogen-13 C-12 (d, n) N-13 10 min
Oxygen-15 N-14 (d, n) O-15 or N-15 (p, n) O-15 2 min
 2 • Radionuclide Production and Radiopharmaceuticals 23

2.6 NUCLEAR FISSION

PROBLEM
• Define nuclear fission.
• Explain the fission mechanism in a nuclear reactor using
Uranium-235 (U-235) as the fuel.

Solution
Nuclear fission is the splitting of a heavy nuclide into daughter products
(smaller atoms) with the release of energy (Figure 2.3).

• In a nuclear reactor, fission is triggered by a neutron splitting the

nucleus of a heavy atom, such as U-235.
• When U-235 absorbs a neutron, the resulting nucleus (U-236)
is in an extremely unstable excited energy state that usually
promptly splits into two smaller nuclei, known as the fission
fragments.
• The fission fragments travel with very high kinetic energies, with
the simultaneous release of gamma radiation and two to five free
neutrons (the number of ejected neutrons depends on how the
U-235 atom splits).
• Some neutrons are absorbed by non-fissionable material in the reac-
tor, whereas others are moderated and absorbed by U-235 atoms
and induce additional fissions. This is known as the nuclear chain
reaction.
• The ratio of the number of fissions in one generation to the num-
ber of fissions in the previous generation is called the multiplication
factor.
• When the multiplication factor = 1, the number of fissions per gen-
eration is constant and the reactor is said to be critical.
• When the multiplication factor > 1, the rate of the chain reaction
increases and the reactor is said to be supercritical.
• When the multiplication factor < 1, the rate of the chain reaction
decreases (more neutrons being absorbed than produced) and the
reactor is said to be subcritical.
• The energy released by the nuclear fission of a U-235 atom is
approximately 200 MeV.
24 Problems and Solutions in Medical Physics

FIGURE 2.3 The process of nuclear fission.

2.7 REACTOR-PRODUCED
RADIONUCLIDES
PROBLEM
• Name three radionuclides other than Mo-99 that are produced by a
nuclear reactor.
• State their nuclear reaction equations and physical half-lives.

Solution

RADIONUCLIDE REACTION PHYSICAL HALF-LIFE

Phophorus-32 31 P(n, γ) P
32 14.3 days
Chromium-51 50 Cr(n, γ)51Cr 27.8 days
EC or β +
Iodine-125 124 Xe(n, γ)125Xe → 125 I 59.4 days
 2 • Radionuclide Production and Radiopharmaceuticals 25

2.8 Mo-99/Tc-99m
RADIONUCLIDE GENERATOR (I)
PROBLEM
Sketch a labelled diagram of a Mo-99/Tc-99m radionuclide generator and
describe the process of Tc-99m elution.

Solution
Figure 2.4 shows the basic structure of a Mo99/Tc-99m generator. The
generator is heavily shielded in a lead container known as the ‘lead pig’.
Chemically purified Mo-99 is loaded in the form of ammonium molybdenate
(NH4+ MoO4−) onto a porous column containing 5–10 g of alumina (Al2O3)
resin. The ammonium molybdenate is attached to the surface of the alumina

FIGURE 2.4 Block diagram of a Mo-99/Tc-99m generator.

26 Problems and Solutions in Medical Physics

molecules through adsorption. The column is adjusted to an acid pH to pro-

mote binding. When the Mo-99 decays, it forms pertechnetate (TcO4−), which
is less tightly bound to the alumina compared to Mo-99 because of its single
charge. By passing normal saline solution (NaCl) over the column, Tc-99m is
removed or washed off from the column and collected by negative pressure
into a vacuum vial at the collecting port in the form of sodium pertechnetate
(NaTcO4). The vacuum vial is placed inside a lead shielding for radiation
protection purposes.
Note: In some generator systems, the sterile saline solution is held in a reser-
voir. Elution of the required amount of product is controlled by the vacuum in
the collection vial. Sterility is ensured by terminal filtration at the point just
before the solution enters the collection vial.

2.9 Mo-99/Tc-99m
RADIONUCLIDE GENERATOR (II)
PROBLEM
Differentiate between the wet and dry systems of the Mo-99/Tc-99m
generator.

Solution
The wet system has a saline reservoir connected by tubing to one end of the
column, and an evacuated vial draws the saline through the column, hence
keeping the column wet. During eluation, a vacuum vial is placed at the exit
port to collect the Tc-99m eluent.
The dry system does not have a saline reservoir in the generator; therefore,
it requires a small vial containing normal saline to be attached at the entry port
and a vacuum vial at the collection port during eluation.
Note: Evacuated (vacuum) vials are used since this creates a condition of nega-
tive pressure during generator elution. This prevents the egress of solution and
the possibility of area contamination should any parts of the generator or tub-
ing develop a puncture or leak.
 2 • Radionuclide Production and Radiopharmaceuticals 27

2.10 UNDESIRABLE Al3+

IN Tc-99m ELUTION
PROBLEM
a. Why is Mo-99 undesirable in the Tc-99m eluate from a generator?
b. Why is Al3+ undesirable in the Tc-99m eluate from a generator?

Solution
a. Mo-99 is the parent radionuclide of Tc-99m and is bound to the
alumina column in the generator. It is essential that no Mo-99 sepa-
rates from the column during elution, as this would both degrade the
gamma camera image and contribute unnecessary additional radia-
tion doses to the patient. Mo-99 has a physical half-life of 66 hours
and emits high energy of 740 keV gamma rays.
b. Al3+ is a trace metal that should not be administered into the patients.
It will interfere with the preparation of Tc-99m radiopharmaceuti-
cals, such as Tc-99m-labelled colloid and Tc-99m bone-scanning
agents by forming larger particles, which will be trapped in the
small capillaries of the lungs following intravenous injection. It will
also agglutinate the red blood cells during labelling.
Note: According to the FDA rules and regulations, the concentration of
aluminium ion should not be more than 10 μg/mL of the generator eluate.

2.11 TRANSIENT EQUILIBRIUM

PROBLEM
If a parent radionuclide, p, decays to a daughter radionuclide, d, which in turn
decays to another radionuclide, the rate of growth of d is given as:

dN d (2.1)
= λ p N p − λd N d
dt
28 Problems and Solutions in Medical Physics

By integrating the above equation, we get:

λd ( Ap )0 − λ pt −λd t
( Ad )t = λd N d = (e −e ) (2.2)
(λd − λ p )

where:
Np = number of particles of the parent radionuclide
Nd = number of particles of the daughter radionuclide
λp = decay constant for the parent radionuclide
λd = decay constant for the daughter radionuclide
Ap = activity of the parent radionuclide
Ad = activity of the daughter radionuclide
t = time

From Equations 2.1 and 2.2, derive an equation that shows transient equilib-
rium. What is the condition for transient equilibrium to happen?

Solution
If λd > λp, that is (t1/2)d < (t1/2)p, then e−λdt is negligible compared to e−λpt when
t is sufficiently long.
The equation becomes:

λd ( Ap )0
( λd − λ p ) ( )
( Ad )t = e −λ pt

λd
= ( Ap )t
( λd − λ p )
0.693
(t1/ 2 ) p
= (A )
0.693 0.693 p t
−
(t1/ 2 ) p (t1/ 2 )d

(t1/ 2 ) p
= ( Ap ) t
(t1/ 2 ) p − (t1/ 2 )d

This equation is known as transient equilibrium. The equilibrium only holds

good when (t1/2)p and (t1/2)d differ by a factor between 10 and 50.
 2 • Radionuclide Production and Radiopharmaceuticals 29

2.12 Tc-99m TRANSIENT EQUILIBRIUM

PROBLEM
Figure 2.5 shows the activity-time plot of Mo-99 and Tc-99m decay.

i. What does curve X indicate?

ii. What does curve Y indicate?
iii. Explain briefly the phenomenon demonstrated by the plot.

FIGURE 2.5 Activity-time plot of Mo-99 and Tc-99m.

Solution
i. Curve X indicates the radioactive decay of the parent radionuclide,
that is, Mo-99.
ii. Curve Y indicates the radioactivity of the daughter (i.e. Tc-99m) at
subsequent time intervals.
iii. The plot demonstrates the phenomenon of transient equilibrium.
The activity of Mo-99 (curve X) and Tc-99m (curve Y) versus time
were plotted on a logarithm graph. The activity of the daughter,
Tc-99m, initially builds up as a result of the decay of the parent,
30 Problems and Solutions in Medical Physics

reaches a maximum at approximately 23 hours, then achieves tran-

sient equilibrium whereby the daughter decays at the same rate as
the parent. Generally, the daughter activity is higher than the parent
activity at equilibrium. However, in Mo-99 decay, only 87.6% of
Mo-99 decays to Tc-99m and the remaining 12.4% decays to Tc-99
directly; hence, in the time-activity plot, the Tc-99m activity is
lower than the Mo-99.

2.13 Mo-99 TRANSIENT

EQUILIBRIUM CALCULATION

PROBLEM
Mo-99 (t1 /2 = 66 hours) and Tc-99m (t1/2 = 6 hours) are in transient equilibrium
in a Mo generator. If 1000 MBq of Mo-99 is present in the generator, what
would be the activity of Tc-99m after 82 hours, assuming that 87% of Mo-99
decays to Tc-99m?

Solution
 0.693 
− ( 82 h )
( Ap ) t = ( Ap ) 0 e  66 h 

= 1000 MBq e(
−0.861)

= 422.74 MBq

Activity of Tc-99m after 82 hours is:

(t1 2 ) p
( Ad )t = ( ( Ap )t ( 0.87 )
(t1 2 ) p − (t1 2 )d

 66 
=   ( 422.74 MBq)(0.87)
 60 

= 404.56 MBq
 2 • Radionuclide Production and Radiopharmaceuticals 31

2.14 SECULAR EQUILIBRIUM EQUATION

PROBLEM
As a continuation from Section 2.11, derive the equation that shows secular
equilibrium. What is the condition for secular equilibrium to happen?

Solution
When λd is much greater than λp, that (t1/2)d is much shorter than (t1/2)p, the λd
can be neglected compared to λp. Equation 2.2 now becomes:

λd ( Ap )0
( Ad )t =
λd
(e )−λ pt

( Ad )t = ( Ap )0 ( e −λ t )
p

= ( Ap ) t

The condition for secular equilibrium to happen is when the physical half-life
of the parent is much longer than the daughter, by a factor of 100 or greater.

2.15 Mo-99 BREAKTHROUGH TEST

PROBLEM
With the aid of a diagram, describe briefly the quality control procedures of
the Mo-99 breakthrough test.

Solution
Figure 2.6 illustrates the method for the Mo-99 breakthrough test. The vial
containing the Tc-99m eluate is placed in a thick (~6 mm) lead container
and then placed into a radionuclide calibrator. The high-energy photons of
Mo-99 can be detected, whereas virtually all of the Tc-99m 140 keV photons
are attenuated by the lead container. The acceptance limit for Mo-99 break-
through is 5.55 kBq Mo-99 per 37 MBq of Tc-99m eluate.
32 Problems and Solutions in Medical Physics

Note: This procedure should be undertaken on the first elution from each new
generator and at any time when it is suspected that the generator has not been
used according to accepted normal standard procedures. It is also good prac-
tice to check for breakthrough at the end of use of the generator to confirm the
integrity of the column.

FIGURE 2.6 Mo-99 breakthrough test.

2.16 PREPARATION OF
RADIOPHARMACEUTICAL
PROBLEM
A vial containing 5 mL of Tc-99m-MDP is prepared in the nuclear medicine
hot-lab for radionuclide bone imaging. At 8.00 a.m., the calibrated activity
of the radiopharmaceutical is 3700 MBq. What volume of the preparation is
needed to give a 740 MBq injection at 12.00 p.m., given the physical half-life
of Tc-99m is six hours?
 2 • Radionuclide Production and Radiopharmaceuticals 33

Solution
Decay constant λ for Tc-99m:

0.693 0.693
λ = = = 0.115 h −1
t1/ 2 6h
Using the decay equation,

N = Noe−λt

N = 3700 e
( )
− 0.115 h −1 ( 4 h )
= 2335 MBq

5 mL → 2335 MBq

? mL → 740 MBq
740 MBq
Volume of preparation = × 5 mL = 1.58 mL
2335 MBq

2.17 ADMINISTRATION OF
RADIOPHARMACEUTICALS

PROBLEM
A patient was given a radioactive meal labelled with 1110 MBq In-111 for a
colonic transit study. The patient was imaged 24 hours later. Assuming that
none of the activity was excreted, what is the remaining total activity at the
time of imaging, given the physical half-life for In-111 is 67.9 hours?

Solution
A = Aoe −λt

Ao = 1110 MBq
0.693
λ= = 0.01 h −1
67.9 h

A = 1110 MBq e
( −0.01 h−1 )( 24 h ) = 873 MBq
34 Problems and Solutions in Medical Physics

Note: Non-absorbable tracers are commonly used for gastric emptying and
gastrointestinal transit.

2.18 PET RADIOPHARMACEUTICAL

PROBLEM
Name four radiopharmaceuticals used for positron emission tomography
(PET) imaging, each containing a different positron emitting radionuclide,
state the physical half-life in each case.

Solution

RADIOPHARMACEUTICAL PHYSICAL HALF-LIFE (MIN)

F-18-FDG or fluorodeoxyglucose 110

O-15-carbon dioxide or O-15-carbon monoxide 2.05
C-11-acetate or C-11-carbon monoxide or 20.4
C-11-carbon dioxide
N-13-ammonia 10

2.19 F-18-Fluorodeoxyglucose
PROBLEM
What is F-18-FDG? Explain the metabolism of F-18-FDG in human tissues
that makes it a useful radiopharmaceutical in detecting and staging of malig-
nant tumours.

Solution
F-18-FDG stands for fluorine-18-flurodeoxyglucose. It is a glucose ana-
logue, with the positron emitting radionuclide, F-18 substituted for the
normal hydroxyl group (-OH) at the C-2 position in the glucose molecule.
Figure 2.7 shows the difference between the F-18-FDG and glucose mol-
ecule structures.
 2 • Radionuclide Production and Radiopharmaceuticals 35

FIGURE 2.7 Comparison of the F-18-FDG and glucose molecule structures.

F-18-FDG follows the same transport route as glucose. After adminis-

tration via intravenous injection, F-18-FDG is actively transported into the
cells by specific glucose transporters. Once inside the cell, F-18-FDG is
phosphorylated by hexokinase enzyme and forms F-18-FDG-6 phosphate.
Normally, once phosphorylated, glucose continues along the glycolytic
pathway for energy production. However, F-18-FDG cannot undergo gly-
colysis because the (−OH) group is missing. The F-18-FDG-6-phosphate
molecules are therefore effectively trapped inside the cells. As a result,
the distribution of F-18-FDG is a good reflection of the glucose uptake
and phosphorylation by cells in the body. Malignant cells replace oxygen
respiration by fermentation of sugar and so accumulate the F-18-FDG at
a higher rate than normal cells. The uptake can be imaged and measured
using a PET scanner.

2.20 QUALITY CONTROL OF

RADIOPHARMACEUTICALS
PROBLEM
What are the factors that may induce radiochemical impurities in a
radiopharmaceutical?
36 Problems and Solutions in Medical Physics

Solution
Radiochemical impurities may be due to:

• Temperature changes in storage and manufacturing areas.

• Presence of unwanted oxidizing or reducing agents.
• pH changes.
• Radiation damage to the chemical constituents of the radiopharma-
ceuticals.
• Poor standards of handling and lack of sterile preparation procedures.

Note: Radiopharmaceuticals should always be prepared in an appropriate

radiopharmacy environment according to accepted standards with appropriate
batch manufacturing recording and quality control measures in place.
Non-imaging
Detectors and
Counters
3
3.1 DEAD TIME
PROBLEM
Define ‘dead time’ of a counting system.

Solution
‘Dead time’ of a counting system refers to the period where the counter cannot
process a second event after the first event has been detected. Typical values of
dead time are between 250 and 1000 ns.

3.2 PARALYSABLE AND

NON-PARALYSABLE COUNTING SYSTEMS
PROBLEM
With the aid of diagrams, explain the differences between paralysable and
non-paralysable counting systems.

37
38 Problems and Solutions in Medical Physics

Solution
Figure 3.1 shows the differences between paralysable and non-paralysable
counting systems. The black bars indicate processed signals, whereas the grey
bars indicate non-processed signals. In non-paralysable systems, a fixed dead
time, τ, follows each event that occurs during the live period of the detector.
Signals that arrive during the dead time are not recorded and have no effect on
the system (i.e. signals 3 and 5). However, in paralysable systems, in addition
to the usual dead time effect (signals 3 and 5), the arrival of a secondary signal
before complete processing of the previous signals will extend the dead time,
causing the secondary signal to be rejected (i.e. signal 6).

FIGURE 3.1 Paralysable and non-paralysable counting systems.

Note: In extreme cases, where the count rate is high, paralysable systems can
be completely unresponsive (switched off) as the signals and dead times over-
lap and no signal is registered, hence the term ‘paralysed’.

3.3 PARALYSABLE AND

NON-PARALYSABLE COUNTING
SYSTEMS: COUNT RATE RESPONSE
PROBLEM
Refer to Figure 3.2. If A is the theoretical response of an ideal detection sys-
tem, name the detection systems of B and C. Explain your answers.
 3 • Non-imaging Detectors and Counters 39

FIGURE 3.2 Observed count rate versus input count rate of different types of
detection systems.

Solution
B is the non-paralysable system. The dead time increases with increasing input
count rate and becomes saturated in the plateau region.
C is the paralysable system. As the input count rate increases beyond the
saturation region, the system becomes paralysed and loses its detection effi-
ciency rapidly beyond the saturation region.

3.4 BASIC PRINCIPLE OF

GAS-FILLED DETECTORS
PROBLEM
With the aid of a diagram, explain briefly the principle of operation of a gas-
filled detector.

Solution
Figure 3.3 illustrates the basic operational principle of a gas-filled detector.
A gas-filled detector contains a volume of compressed gas (normally a noble
gas such as helium or argon) between two electrodes. A potential difference
(voltage) is applied between the electrodes. When ionising radiation interacts
with the atoms of the gas, it will form ion pairs due to the ionisation process.
The positive ions (cations) are attracted to the negative electrode, whereas the
40 Problems and Solutions in Medical Physics

negative ions (anions) are attracted to the positive electrode. In most detectors,
the cathode is the wall of the container, and the anode is an insulated wire
placed at the centre of the container. When the electrons reach the anode, they
will travel through the circuit to the cathode, where they recombine with the
cations. The electrical current that is formed by the flow of the electrons can
then be measured with a sensitive ammeter. The response is proportional to
the ionisation rate. Hence, the activity, exposure or dose rate can be calculated.

FIGURE 3.3 Basic principle of a gas-filled detector.

Note: This type of ionisation chamber is used in the radioactivity calibrator in

radiopharmacy units and nuclear medicine departments. The activity can be
displayed directly in units of radioactivity (Bq or Ci) after accounting for the
nature of the decay emissions and sample geometry.

3.5 NOBLE GAS

PROBLEM
Explain why noble gas is commonly used in gas-filled detectors.

Solution
Noble gases, such as argon and xenon, are commonly used in gas-filled detec-
tors because of their inert nature. Chemical reactions will not occur within a
noble gas following ionisation events. Such reactions could change the charac-
teristics and performance of the detector.
 3 • Non-imaging Detectors and Counters 41

Note: The noble gas is normally placed under pressure within the chamber.
Loss of pressure can affect the performance of the detector.

3.6 GAS-FILLED DETECTORS

PROBLEM
Figure 3.4 shows the logarithmic plot of the number of electrical charges
collected after a single interaction as a function of the applied voltage.

a. Name and describe the mechanisms that happen in the regions A, B,

C, D and E.
b. Give estimated applied voltage ranges for A through E.

FIGURE 3.4 Plot of number of ion pairs formed versus applied voltage.

Solution
a. Region A: Recombination region
The applied voltage is relatively low in this region. When a
small voltage is applied, ion pairs form where electrons are
attracted to the anode, and positive ions are attracted to the
cathode before they are recombined. As the voltage increases,
more ions are collected and fewer ions are recombined. The cur-
rent increases as the voltage increases until a saturation point.
42 Problems and Solutions in Medical Physics

Region B: Ionisation chamber region

As the voltage increases, a plateau is reached. In this region,
the applied voltage is sufficiently high to collect almost all ion
pairs. An additional increment in the applied voltage does not
significantly increase the current. This is the region where the
ionisation chamber operates.
Region C: Proportional region
Beyond the ionisation region, the collected current increases
again as the applied voltage increases. In this region, the elec-
trons approaching the anode are accelerated to such a very
high kinetic energy that they can cause additional ionisation.
This mechanism is known as gas multiplication. The amount of
amplification increases as the applied voltage increases. This is
the region where the proportional counter operates.
Region D: Geiger-Müller region
Beyond the proportional region, the amount of charges collected
from each event is the same regardless of the amount of energy
deposited by the interaction. The applied voltage is very high that
even a minimally ionising particle will produce a very large current.
The initial ionisation produced by the radiation triggers a complete
gas breakdown as an avalanche of electrons accelerates towards and
spreads along the anode. This region is called the Geiger-Müller
region and is the underlying principle of the Geiger counter.
Region E: Spontaneous discharge
At this region, the applied voltage is too high since this causes
continuous discharge of the gas; hence, a gas-filled detector
cannot be operated at this region.
b. Estimated applied voltage range for A through E:
A: 0 – 200 V
B: 200 – 400 V
C: 400 – 800 V
D: 1000 – 1400 V
E: above 1400 V

Note: In nuclear medicine departments, ionisation chambers are used to assay

the activity of radiopharmaceuticals, and Geiger-Müller detectors are used for
contamination monitoring, particularly of beta emitters.
 3 • Non-imaging Detectors and Counters 43

3.7 RADIONUCLIDE ACTIVITY

(DOSE) CALIBRATOR
PROBLEM
a. What is an activity calibrator? Does the activity calibrator measure
the patient dose contributed by a radionuclide?
b. Sketch the internal structure of an activity calibrator and explain its
principle of operation.

Solution
a. The activity calibrator is a well-typed ionisation chamber used to
measure the activity of administered radiopharmaceuticals. The
activity calibrator does not measure the radiation dose contributed
by the radionuclide, but it measures the amount of radioactivity con-
tained within the ‘dose’ of a radiopharmaceutical drawn up to be
administered to a patient.
Note: An activity calibrator is commonly known as the ‘dose’ calibrator.
Strictly speaking, the term ‘dose’ should not be used since dose is measured in
Gy; however, it is a common term still used by many people.
b. Figure 3.5 shows the internal structure of an activity calibrator.
An activity calibrator comprises an ionisation chamber, high-voltage
power supply, electrometer, a radionuclide selector, and a display
unit. The ionisation chamber contains pressurised gas (such as argon
gas), and the hermetically sealed chamber contains two co-axial
cylindrical electrodes, which are connected to a high-voltage supply.
The wall of the chamber is connected to the cathode, and the collector
electrodes are connected to the anode. When a sample is placed into
the chamber, the gas is ionised. The ion pairs then migrate towards
the anode and cathode and generate an electrical current. The current
is proportional to the activity of the sample. An electrometer is used
to measure the very small current (about a few μA). A calibration
factor is applied according to the selected radionuclide to convert
the current to activity. The output is usually displayed in MBq or
mCi. The activity calibrator is operated in current mode; therefore,
dead-time effect is minimal. It can accurately assay activity up to
74 GBq (or 2 Ci); however, it is relatively insensitive and cannot
measure activity less than 3.7 × 105 GBq (or 1 μCi).
44 Problems and Solutions in Medical Physics

FIGURE 3.5 Sketch of a radionuclide activity calibrator.

3.8 FACTORS AFFECTING

MEASUREMENT ACCURACY OF
AN ACTIVITY CALIBRATOR
PROBLEM
What are the factors that may affect the measurement accuracy of an activity
calibrator?

Solution
Factors that may affect the measurement accuracy of an activity calibrator
include:

• Energy and abundance of the photons produced by the radionuclide.

• Geometry of the detector, for example cylindrical versus rectangu-
lar shape.
• Geometry of the radioactive source, including the vial or container
that is used, such as syringe or vial size, type of material (plastic or
glass) and the thickness of the container’s wall.
• Condition of the activity calibrator which can be evaluated through
periodical quality control tests.
• Loss of pressure of the gas contained within the chamber.
 3 • Non-imaging Detectors and Counters 45

• Inadequate shielding from other radioactive source and background

radioactivity.
• Ambient pressure and temperature that should not be changed
abruptly.

3.9 QUALITY CONTROL OF AN

ACTIVITY CALIBRATOR
PROBLEM
List the common quality control tests that should be carried out on an activity
calibrator.

Solution
The common quality control tests include:

• Precision and accuracy tests using long half-life standard radioactive

sources, for example, Cs-137.
• Linearity of the activity response over the range of activities used.
• Reproducibility test (or constancy test) carried out over time.
• Background activity and shielding check.
• Geometry dependence test (only during installation).

Note: The calibrator is usually checked with a long-lived standard source

(e.g. Cs-137) on a daily basis to ensure correct operation when measuring the
activity administered to patients.

3.10 BASIC PRINCIPLES OF

SCINTILLATION DETECTORS
PROBLEM
Explain briefly the basic operating principles of a scintillation detector.
46 Problems and Solutions in Medical Physics

Solution
Scintillators are materials that emit visible or ultraviolet light after absorb-
ing ionising radiation. When ionising radiation interacts with a scintillator,
the electrons of the scintillator atoms are raised to an excited energy level.
Eventually, these electrons will fall back to its original energy state, with the
emission of visible or ultraviolet light. A scintillation detector is obtained
when a scintillator is coupled to an electronic light sensor, such as a photomul-
tiplier tube (PMT), photodiode or silicon photomultiplier. The PMT absorbs
the light emitted by the scintillator and reemits it in the form of electrons via
a photoelectric effect. The subsequent multiplication of these electrons results
in an electrical pulse, which can then be analysed and correlate to the inten-
sity of the radiation that struck the scintillator. In all scintillators, the amount
of light emitted increases in direct proportion to the energy deposited in the
scintillator.
Note: Most scintillators have more than one mode of light emission, and each
mode has its characteristic decay constant. For example, luminescence is the
emission of light after excitation, fluorescence is the prompt emission of light,
and phosphorescence (or commonly known as afterglow) is the delayed emis-
sion of light and varies from a few nanoseconds to hours depending on the
material.

3.11 SCINTILLATION DETECTORS

PROBLEM
Name three scintillation detectors that are used in nuclear medicine applications.

Solution
• Gamma well counter (sample counter) for measuring activity within
standard preparations and biological samples, such as blood and
urine.
• Probe detector, such as a thyroid probe detector, for measuring
organ uptake.
• Gamma camera (or scintillation camera) for diagnostic imaging.
 3 • Non-imaging Detectors and Counters 47

3.12 BASIC PRINCIPLES OF A

GAMMA WELL COUNTER
PROBLEM
Draw a schematic diagram of a gamma well counter and explain its principles
of operation.

Solution
Figure 3.6 shows the schematic diagram of a gamma well counter. A gamma well
counter consists of a well-shaped scintillation detector (usually NaI[TI] crystal)
with a hole in the centre. A sample is placed inside the hole for increased geo-
metric and counting efficiency. This design gives extremely high efficiency and
allows detection of very low activity, that is, less than 37 Bq (or 1 nCi). The scin-
tillation detector is coupled to a photomultiplier tube (PMT) and connected to a
pre-amplifier and amplifier. When ionising radiation interacts with the scintillation
crystal, lights are emitted and converted to electrons by a thin photocathode layer in
front of the PMT. The electrons undergo a multiplication process in the PMT and
are then sent to a pre-amplifier and amplifier to amplify the electronic signals. The
signals are then sent to a pulse height analyser to discriminate the energy informa-
tion. Only the signals in the selected energy window are used for counting.

FIGURE 3.6 Schematic diagram of a gamma well counter.

48 Problems and Solutions in Medical Physics

3.13 CLINICAL APPLICATIONS

OF GAMMA WELL COUNTER
PROBLEM
Describe briefly three clinical applications of a gamma well counter.

Solution
i. Glomerular function rate (GFR) test
The test uses a radiopharmaceutical that is rapidly excreted by the
kidneys, such as Cr-51-EDTA or Tc-99m-DTPA. The total renal
function is measured from the clearance of the activity in a series of
blood samples taken following intravenous injection of the radio-
pharmaceutical. The activity of the blood samples is counted using
a gamma well counter. This is a valuable test in patients undergoing
chemotherapy with cytotoxic drugs that may result in renal toxicity.
ii. Plasma and red blood cells volume determination
Plasma and red blood cells volume can be determined using iso-
tope dilution method. By diluting a known activity and volume
of radiotracer in an unknown volume (plasma or red blood cells),
and then measuring the activity in a volume withdrawn after
adequate mixing, the unknown volume can be calculated. For
plasma volume determination, I-125-Human Serum Albumin is
used; whereas for red blood cell volume determination, Cr-51 is
commonly used. The most common clinical application of this
test is when evaluating patients for polycythemia vera.
Note: Several precautions need to be taken during the test. For example, samples
should be taken with the patient in the same position each time, the radiotracer
must be stably bound and the volume must be small enough as to not affect the
volume being measured. In addition, equilibrium must be reached before samples
are drawn; usually a 20-minute sample is used. However, it should be noted that
the rate of mixing varies from patient to patient, especially in conditions such as
shock or elevated haematocrits in which mixing may be delayed considerably.
iii. Radioimmunoassay (RIA)
RIA is an in-vitro assay technique used to measure the concen-
trations of an antigen (e.g. hormone levels in the blood) with
very high sensitivity. In this technique, a known quantity of
 3 • Non-imaging Detectors and Counters 49

an antigen is labelled to a radioisotope, for example I-125. The

radiolabelled antigen is then mixed with a known amount of
antibody for that antigen. As a result, the radiolabelled antigen
and antibody will be bound together. A sample of serum from
the patient containing an unknown quantity of the same antigen
is then added. This causes the unlabelled (or ‘cold’) antigen from
the serum to compete with the radiolabelled (or ‘hot’) antigen.
When the concentration of ‘cold’ antigen increases, the amount
of ‘cold’ antigen bound to the antibody will also increase. This
reduces the ratio of antibody-bound radiolabelled antigen to
free radiolabelled antigen. The bound radiolabelled antigens are
then separated from the unbound ones, and the radioactivity of
the free radiolabelled antigen remaining in the supernatant is
measured using a gamma well counter. A binding curve is then
generated, which allows the amount of antigen in the patient’s
serum to be derived.
Note: RIA is an old assay technique, but it is still widely used due to its sim-
plicity and sensitivity.

3.14 BASIC PRINCIPLES OF

A THYROID PROBE
PROBLEM
Draw a schematic diagram of a thyroid probe and explain its principles of
operation.

Solution
Figure 3.7 shows the schematic diagram of a thyroid probe. A thyroid probe
consists of a cylindrical NaI(Tl) crystal coupled to a photomultiplier tube
(PMT) which in turn is connected to a pre-amplifier and other associated
electronics, such as amplifier, pulse height analyser (PHA), timer, scaler, rate
meter and a recorder. The operation principle is similar to a gamma well coun-
ter except that a long cylindrical or conical collimator is applied on the thy-
roid probe to limit the field-of-view (FOV) of the thyroid. This reduces the
background radiation from areas outside the thyroid to reach the detector. The
probe is connected to a high-voltage power supply.
50 Problems and Solutions in Medical Physics

When ionising radiation interacts with the NaI(Tl) crystal, electrons are raised
to an excited energy state. Eventually the electrons will return to their ground
energy state by emitting the excessive energy in terms of visible or ultravio-
let light. The light photons will interact with the photocathode located at the
entrance of the PMT and are converted to electrons. The electrons are then
accelerated and focused towards a series of dynodes in the PMT. The increas-
ing voltage electrons will then impinge the anode. The resultant output signal
will then be amplified and analysed by the PHA. Only the energies in the
selected energy range will be used for counting. The timer, scaler and rate
meter are used for counting of the radioactivity signals.

FIGURE 3.7 Schematic diagram of a thyroid probe.

3.15 THYROID UPTAKE MEASUREMENT

PROBLEM
Describe briefly the methods used for thyroid uptake measurement including
‘two-capsule’ and ‘one-capsule’ methods.

Solution
Thyroid uptake measurement can be performed using one or two capsules
of I-123 or I-131 sodium iodide. A neck phantom, consisting of a Lucite or
Perspex cylinder of diameter similar to the neck and containing a hole parallel
to its axis for radioiodine capsule placement is required.
 3 • Non-imaging Detectors and Counters 51

Two-capsule method:
Two radioiodine capsules with almost identical activities are used. Firstly,
each capsule is placed in the neck phantom and counted. Secondly, one cap-
sule is given to the patient, and another one is used as the ‘standard’. The
gamma emissions from the patient’s neck are counted at 4–6 hours after
administration and repeated at 24 hours post-administration. During each
measurement, the patient’s distal thigh and background activities are also
obtained with the same duration of counting. The measurements are repeated
with the ‘standard’ capsule placed in the neck phantom for counting. Finally,
the uptake is calculated for each neck measurement as follows:

(Thyroid count − Thigh count )

Uptake =
(Count of standard in phantom − Background count )
Initial count of standard in phantom
×
Initial count of patient capsule in phantom

One-capsule method:
A single radioiodine capsule is used. The capsule is first counted in the
neck phantom, then ingested by the patient. As in the two-capsule method,
the patient’s neck, distal thigh and background activities are counted for the
same period of time at 4–6 hours and again at 24 hours post-administration.
The times of the capsule administration and neck counts are recorded.
Finally, the uptake is calculated as follows:

(Thyroid count −Thigh count )

Uptake = × e −0.693t / t1/2
(Count of capsule in phantom − Background count )

where:
t1/2 = physical half-life of the radionuclide
t = time elapsed between the measurement of capsule in the phantom
and the patient’s neck
Note: The single-capsule method reduces the cost of the examination and
requires fewer measurements, but it is more susceptible to instability of the
equipment, technologist errors and dead-time effects.
Instrumentation
for Gamma
Imaging
4
4.1 X-RAY VERSUS GAMMA-
RAY IMAGING
PROBLEM
Compare and contrast the principles of image formation between projection
X-ray and gamma scintigraphic imaging.

Solution
Figure 4.1 illustrates the differences between projection X-ray and gamma
scintigraphic imaging. In X-ray imaging, the radiation beams are emitted from
a single source (X-ray tube) in a fan or cone shape. The X-ray beams are pro-
jected in one direction only, that is, from the X-ray tube to the detector. Each
radiation beam will be attenuated by the tissues as it passes through the body
and reaches the detector. The final image formed on the detector is therefore
representing the attenuation properties of the tissues/organs.

53
54 Problems and Solutions in Medical Physics

FIGURE 4.1 Comparison between X-ray imaging and gamma scintigraphic

imaging.

In gamma scintigraphic imaging, radiopharmaceutical is administered to the

patient’s body via injection, ingestion or inhalation. The radiopharmaceutical
will be distributed in the body with uptake by the targeting tissues/organs.
Therefore, scintigraphic imaging constitutes multiple sources of radiation at
various locations in the patient’s body. The radiation beams are emitted isoto-
pically from the patient’s body and reach the detector. A collimator is neces-
sary to allow only parallel beams to pass through the collimator and reach the
detector to form a clinically useful image.
X-ray imaging provides mostly anatomical information based on tissue
attenuation; on the other hand, gamma scintigraphic imaging is organ speci-
fied and is based on the tissue uptake of the radiopharmaceutical.

4.2 GAMMA CAMERA SYSTEM

PROBLEM
Figure 4.2 shows the schematic diagram of a typical gamma camera system.

a. Name the components labelled with A, B and C in the diagram.

b. Explain the mechanism that takes place in C to form a clinically
useful gamma camera image.
 4 • Instrumentation for Gamma Imaging 55

Solution
a. A: Scintillating detector or sodium iodide doped with thallium
(NaI[Tl]) detector.
B: X-, Y-positioning circuit.
C: Energy discriminator circuit or pulse height analyser (PHA).
b. Energy discriminator circuit (known as pulse height analyser) is
used to filter the scattered photons that contain energies outside of
the pre-selected energy window(s). Firstly, the four output signals
(±X and ±Y) from the X-, Y-positioning circuit are weighted and
summed to form a voltage pulse (known as the ‘Z’ pulse), which
represents the intensity of a scintillation. Secondly, the Z-pulse is
then sent to the energy discriminator circuit and analysed if it falls
within the pre-set energy window(s) (with upper and lower energy
levels). In theory, scattered or coincidence photons can be rejected
this way because they fall outside the energy window. However, the
filtration is not perfect since the energy loss due to Compton scat-
tering is not very large, and the energy window cannot be too strict
as other factors, such as time and sensitivity need to be taken into
account.

FIGURE 4.2 Schematic diagram of a typical gamma camera system.

56 Problems and Solutions in Medical Physics

Note: The majority of clinical gamma cameras operate using scintillation

crystals and photomultiplier tubes. New solid-state detectors such as cadmium
zinc telluride (CZT) are now entering into clinical use.

4.3 GAMMA RAYS DETECTION

PROBLEM
Describe briefly the mechanisms that take place when 140 keV gamma rays
strike a thallium-activated sodium iodide (NaI[TI]) crystal.

Solution
When 140 keV gamma rays strike on a NaI(Tl) crystal, the gamma rays will
interact with the crystal via coherent scattering, photoelectric absorption or
Compton scattering, whereby the NaI molecules are raised to higher energy
states through ionisation and excitation. The ionised or excited atoms then
return to the ground state by emitting light photons. The light output is propor-
tional to the energy of the incident radiation. Approximately 38 light photons
are produced per 1 keV of deposited energy. The light photons then enter the
photomultiplier tubes (PMTs) which are attached to the NaI(Tl) crystal.

4.4 SCINTILLATING CRYSTAL (I)

PROBLEM
Describe the physical properties of NaI(Tl) crystal used in a gamma camera
system.

Solution
NaI(Tl) has relatively high density (3.67 g∙cm−3) and high stopping power
coefficient due to the high atomic number of iodine (Z = 53). Pure NaI does
not produce any scintillation after interacting with gamma ray at room tem-
perature. A trace amount (0.1%–0.4%) of thallium is therefore added as an
activator. The activating material also influences the wavelength (colour) of
the light produced by the scintillator. In NaI(Tl), the scintillation light is blue
(λmax = 415 nm). NaI(Tl) crystals are hygroscopic and fragile. Once the crystal
 4 • Instrumentation for Gamma Imaging 57

absorbs water, it would cause a colour change that reduces light transmission
to the photomultiplier tubes (PMTs). Hence, the crystal is sealed in an alu-
minium container in a gamma camera system with a Pyrex glass backing to
allow the light to be transmitted to the PMTs.

4.5 SCINTILLATING CRYSTAL (II)

PROBLEM
What is the difference between a scintillation-based gamma camera and a
solid-state gamma camera?

Solution
In a scintillation-based gamma camera, incident gamma rays deposit their
energy in the scintillator where it is converted into visible (or near-UV) light
photons, which are detected by the photomultiplier tubes. In a solid-state
gamma camera (e.g. cadmium zinc telluride [CZT] detector), radiation depos-
its energy in the crystal lattice where it results in the generation of pairs of
charge carriers (direct conversion). The application of an electric field causes
the charge carriers to be swept to the cathode and anode of the device where
they induce a current pulse that can be detected and positional information
collected. The collimators in these systems are registered to the detector array
to maximise efficiency.

4.6 FUNCTION OF THE COLLIMATOR

PROBLEM
Why is a collimator necessary in a gamma camera system?

Solution
The gamma emissions from the patient’s body are isotropic; hence, a collima-
tor is necessary to form a useful image by permitting gamma rays approaching
the camera from certain directions to reach the detector while absorbing most
of the scattered photons. Without a collimator, the acquisition of all the emit-
ted radiation would result in an almost incoherent flood image.
58 Problems and Solutions in Medical Physics

Note: Collimators consist of a series of holes in a lead plate that allows the
gamma rays to pass through to the crystal. In this way, it behaves a little like
a lens on a camera.

4.7 COLLIMATOR DESIGN

PROBLEM
What are the main factors to be considered in the design of a gamma camera
collimator?

Solution
• Sensitivity—Longer, narrower holes reduce the photon transmis-
sion, hence reduce sensitivity of the system.
• Resolution—Longer, narrower holes reduce the angle of accep-
tance, hence increase resolution of the image.
• Energy of the radioisotope—A higher energy source needs thicker
septa to block the scattered radiation again resulting in loss of
sensitivity.

Note: Collimators are designed for specific gamma energies. Usually below
180 keV are considered low energies (e.g. Tc-99m), between 180 and 370 keV
are considered medium energies (e.g. In-111), and 370–550 keV are considered
high energies (e.g. I-131). In each case, a high-resolution or high-sensitivity
collimator can be used depending on the clinical application required.

4.8 TYPES OF COLLIMATORS

PROBLEM
With the aid of diagrams, describe briefly the design and application of four
common types of gamma camera collimators.

Solution
• Parallel-hole collimator: It consists of a lead plate with all of the
holes parallel to each other. The function is to allow only photons
 4 • Instrumentation for Gamma Imaging 59

travelling in a direction perpendicular to the detector to reach the

crystal. The image:object dimension ratio is 1:1. It is the most com-
monly used collimator in gamma imaging (see Figure 4.3).

FIGURE 4.3 Four common types of gamma camera collimators.

• Converging collimator: It is a flat, multi-hole collimator in which all

holes converge to a focal point at about 40–50 cm from the collima-
tor. The focal point is normally located in the centre of the field-
of-view (FOV). The image appears larger (magnified) compared to
the object. The magnification increases as the object is moved away
from the collimator. It is usually used to image small organs such
as adrenal glands.
• Diverging collimator: When the converging collimator is flipped
over, it becomes a diverging collimator whereby the focal point is
now behind the collimator. It produces a minified image, and the
amount of minification increases as the object is moved away from
the collimator. It is usually used to image a large portion of a patient
on a small FOV camera (e.g. a mobile camera).
• Pinhole collimator: It consists of a small hole (typically 3–5 mm
diameter) in a piece of lead or tungsten mounted at the apex of a
leaded cone. It produces a reversed and magnified image. The mag-
nification decreases as the object is moved away from the pinhole.
60 Problems and Solutions in Medical Physics

When the distance between the object and the pinhole is the same
as the distance between the pinhole and the crystal, there is no mag-
nification. If the object is moved yet farther from the pinhole, the
object will be minimised. The pinhole collimator is most commonly
used in thyroid imaging and paediatric nuclear medicine.

Note: On modern gamma cameras, most magnification can be carried out

using software zoom applications. As a result, most collimators used are of a
parallel-hole design.

4.9 COLLIMATOR SEPTA THICKNESS

PROBLEM
a. How is the thickness of the septa determined in a gamma camera
collimator?
b. Calculate the septa thickness of a lead collimator required for high-
energy (364 keV) detection. The diameter of the collimator hole is
0.25 cm, and the septa length is 2.5 cm, given that the linear attenu-
ation coefficient of lead at 364 keV is 2.49 cm−1.

Solution
a. The collimator of a gamma camera is typically designed for less
than 5% photon transmission. The thickness of the septa is deter-
mined according to the purpose of the study; for example thicker or
longer septa are used for higher spatial resolution image. However,
a minimum thickness of the septa is required to form a useful image
which can be calculated using the following equation:

6d
µ
t≥
3
L− 
µ

where:
t = thickness of the septa
d = diameter of the hole
L = length of the septa
 4 • Instrumentation for Gamma Imaging 61

μ = linear attenuation coefficient of the absorber, usually lead.

μ depends on the atomic number (Z) and density (ρ) of the mate-
rial, as well as photon energy.
6d
µ
b. t ≥
3
L− 
µ
6(0.25 cm )
2.49 cm −1
t≥
 3 
2.5 cm −  −1 
 2.49 cm 
0.602 cm 2
t≥
1.295 cm
t ≥ 0.465 cm
Therefore, the thickness of the collimator septa should be at least
0.465 cm.

4.10 MINIFICATION FACTOR FOR

DIVERGING COLLIMATOR
PROBLEM
What is the minification factor for a diverging collimator 5 cm thick, with
the distance between the front of the collimator to the convergence point of
50 cm, and a source located 10 cm away from the collimator? If the object size
is 30 cm, what is the image size at this distance?

Solution

Minification factor is expressed as I = (

f − t)
O ( f + b)
where:
I and O = image and object size
f = distance from the front of the collimator to the divergence point
t = thickness of the collimator
b = front of the collimator to the source
62 Problems and Solutions in Medical Physics

Therefore,
I (50 cm − 5 cm )
= = 0.75
O (50 cm +10 cm )

I
= 0.75
30 cm
I = 22.5 cm
Therefore, the image size is 22.5 cm.
Note: A diverging collimator contains holes that diverge from the detector
face. The holes diverge from a point (divergence point) typically 40–50 cm
behind the collimator, projecting a minified, non-inverted image of the source
onto the detector.

4.11 MAGNIFICATION FACTOR FOR

CONVERGING COLLIMATOR
PROBLEM
What is the magnification factor for a converging collimator 5 cm thick, with
the distance between the front of the collimator to the convergence point of
40 cm, and a source located 15 cm away from the collimator? If the object size
is 10 cm, what is the image size at this distance?

Solution

Magnification factor,
I
=
( f +t)
O ( f + t − b)
where:
I and O = image and object size
f = distance from the front of the collimator to the convergence point
t = thickness of the collimator
b = front of the collimator to the source

Therefore,

I ( 40 cm + 5 cm )
= = 1.5
O ( 40 cm + 5 cm − 15 cm )
 4 • Instrumentation for Gamma Imaging 63

I
= 1.5
10 cm

Therefore, I = 15 cm
Note: A converging collimator contains holes that converge to a point at about
40–50 cm in front of the collimator. A converging collimator projects a magni-
fied, non-inverted image of the source onto the detector.

4.12 PHOTOMULTIPLIER TUBE (PMT)

PROBLEM
Sketch the inner structure of a photomultiplier tube and explain the process of
multiplication in the tube.

Solution
• A photomultiplier tube (PMT) consists of an evacuated glass tube
containing a photocathode, typically 10–12 electrodes (known as
dynodes) and an anode (see Figure 4.4).
• The PMT is fixed on to the NaI(TI) crystal with the photocathode
facing the crystal.
• The photocathode is usually an alloy of cesium and antimony that
releases electrons after absorption of light photons.
• A high-voltage power supply of approximately 1000 V is applied
between the photocathode and anode, with a series of resistors
dividing the voltage into equal increments.
• When a light photon strikes the photocathode, photoelectrons are
emitted via the photoemission process. The electrons are attracted
to the first dynode and are accelerated to the kinetic energies equal
to the potential difference between the photocathode and the first
dynode. For example, if the potential difference is 100 V, the kinetic
energy of each electron is 100 eV.
• Approximately five electrons are ejected for each electron that
strikes on the dynode. These electrons are then attracted to the next
dynode, reaching kinetic energy equal to the potential difference
between the first and second dynodes, and causing five electrons to
be ejected for each electron that strikes on it.
64 Problems and Solutions in Medical Physics

FIGURE 4.4 Inner structure of a photomultiplier tube.

• This multiplication process continues until the last dynode. The

total amplification of the PMT is the product of the individual mul-
tiplication at each dynode.
Note: New smaller PMTs are now available in compact camera systems. In
some cases, position sensitive PMTs (PSPMTs) are used.

4.13 X-, Y-POSITIONING CIRCUIT

PROBLEM
Describe the function(s) of the X-, Y-positioning circuit in a gamma camera
system.

Solution
Scintillation events produced in the NaI(Tl) crystal are detected by a large
number of photomultiplier tubes (PMTs) which are arranged in a 2D array.
There are typically 30–90 PMTs in a modern gamma camera. The output
 4 • Instrumentation for Gamma Imaging 65

voltages generated by the PMTs are fed to a position circuit which produces
four output signals, namely X+, X−, Y+ and Y−. These position signals con-
tain information about where the scintillations were produced within the
crystal, as well as the intensity of each scintillation. The intensity infor-
mation can be derived from the position signals by summing up the four
position signals (X+, X−, Y+ and Y−) to generate a voltage pulse (known as
the Z-pulse) which represents the intensity of a scintillation. The Z-pulse
is then sent to the pulse height analyser (PHA) to filter the scattered and
coincident photons.

4.14 ENERGY DISCRIMINATION CIRCUIT

PROBLEM
Explain the function of an energy discrimination circuit in a gamma camera
system.

Solution
Although a collimator can block >99% of the scattered radiation, there may be
conditions that some of the scattered photons escape the septa and reach the
detector. These ‘false’ signals are illustrated in Figure 4.5.
The gamma photons that reach the detector after passing through the col-
limator may undergo three possible interactions: (1) some may be absorbed
in the NaI(Tl) crystal, (2) some scatter from the crystal and (3) some pass
through the crystal without any interaction. The energy discrimination cir-
cuit filters the scattered or coincidence photons by summing the signals from
all the photomultiplier tubes (PMTs) (Z-pulse) and check if it falls within
the pre-set energy window. In principle, the Compton scattered photons will

FIGURE 4.5 Illustration of ‘false signals’ that reach the NaI(Tl) detector.
66 Problems and Solutions in Medical Physics

lose energy, and the coincidence interactions will contribute extra energy.
A pulse height analyser (PHA) is used to filter the signals that fall outside
of the preselected energy window or ‘channels’; hence, only the signals that
fall within the selected energy will be registered as a ‘true’ and count in the
image.

4.15 DIGITAL DATA ACQUISITION

PROBLEM
Digital data in nuclear medicine are acquired in either frame or list mode.

a. Describe briefly the frame and list modes acquisition techniques.

b. Discuss the advantages and disadvantages of frame and list modes.

Solution
a. In frame mode, a matrix with size approximate to the area of the
detector is defined. A position (X, Y) in the detector corresponds to
a pixel position in the matrix. Before acquisition, all pixels within
the matrix are set to zero. During acquisition, every time when a
new signal is detected, it is added to the corresponding (X, Y) pixel
in the matrix. The data acquisition continues until a preselected
time or total count is reached. Therefore, in frame mode, the size
and depth of the matrix, number of frames per study and time per
frame or total counts must be specified.
In list mode, the (X, Y) signals are stored in a list instead of
being immediately formed into an image. Each signal is coded with
‘time mark’ according to the time it is detected and stored as indi-
vidual event. After acquisition is completed, the data can be sorted
and displayed to form the desired images. Data can be manipulated
by changing matrix size, time per frame, physiological markers, etc.
after the acquisition. The ‘bad’ signals can also be discarded manu-
ally by the user.
b. The advantages and disadvantages of frame and list modes are sum-
marised below:
 4 • Instrumentation for Gamma Imaging 67

ADVANTAGES DISADVANTAGES
Frame The data are immediately The matrix (image) format
Mode displayed in a designated must be specified before
image format; hence, acquisition, and no
limited post-processing manipulation of the data is
work is required. It requires possible after the image is
lesser memory and disk formed.
space for acquisition and
storage compared to the
list mode.
List It provides flexibility to It generates a large amount of
Mode manipulating data data which requires larger
according to the way the memory for acquisition,
users want it to be greater processing power and
displayed. disk space for storage.

4.16 DIGITAL IMAGES IN

NUCLEAR MEDICINE
PROBLEM
a. How is the pixel size in a gamma camera digital image determined?
b. An image generated by a gamma camera has a dimension of
40 × 40 cm2. If a matrix size of 128 × 128 is used during image
acquisition, what is the size of each pixel?

Solution
a. A profile is obtained from two small radioactive sources placed at
a known separation, or from a single source moved to known posi-
tions on the X or Y axis of the camera. The profile will give two
spatial peaks. The distance between the maxima of the two peaks
is measured in terms of pixels and used to calculate the distance
between the two source positions. Knowing the distance and the
number of pixels allows calculation of the individual pixel size.
40 cm
=
b. Pixelsize = 0.3 cm per pixel
128 pixel
68 Problems and Solutions in Medical Physics

4.17 EFFECTS OF MATRIX SIZE

AND STATISTICAL NOISE
PROBLEM
500,000 counts are collected in a matrix size of 128 × 128 and 256 × 256,
respectively. What will be the difference in term of image noise? How many
counts do we need to attain in the matrix size of 256 × 256 in order to achieve
the same noise level in the 128 × 128 image?

Solution
For 128 × 128 matrix size:

500, 000 counts

= 30.5 counts per pixel
128 × 128 pixels

100%
Statisical =
noise = 18%
30.5

For 256 × 256 matrix size:

500, 000 counts

= 7.6 counts per pixel
256 × 256 pixels

100%
=
Statisical noise = 36%
7.6

Hence, the matrix size of 256 × 256 has 50% more noise than the matrix size
of 128 × 128.
To achieve the same noise level in 256 × 256 and 128 × 128 matrix sizes:

Total counts
= 30.5 counts per pixel
256 × 256 pixels

Therefore, total counts = 1,998,848

 4 • Instrumentation for Gamma Imaging 69

4.18 STATIC STUDY

PROBLEM
Describe briefly the acquisition method used in static planar imaging. Give
three clinical imaging examples of static study.

Solution
In static study, a single image is acquired for either a pre-set time interval or until
the total numbers of counts reaches a pre-set number. The data is acquired in frame
mode, and matrix size is predefined before acquisition. Static planar imaging is
used for studies in which the distribution of the radiopharmaceutical is effectively
static throughout the acquisition. It provides information, such as organ morphol-
ogy (size, shape and position), and regions of increased or decreased uptake.
Clinical imaging examples of static imaging studies include Tc-99m-
HDP bone scan, I-123-iodide thyroid scintigraphy and renal imaging using
Tc-99m-DMSA.

4.19 DYNAMIC STUDY

PROBLEM
Describe briefly the acquisition method used in a dynamic study. Give three
clinical imaging examples of dynamic studies.

Solution
In a dynamic study, a series of images are acquired in sequence one after
another, for a pre-set time per image. This is usually done when the biokinetics
of the tracer is relatively rapid. The frame rate (frame per second) and matrix
size can be varied between images; however, the patient’s position cannot be
changed during the whole course of study.
The clinical imaging examples of dynamic studies include oesophageal
transit, hepatobiliary imaging and renogram.
70 Problems and Solutions in Medical Physics

4.20 GATED STUDY

PROBLEM
Describe briefly the acquisition method used in a gated study. Give three clini-
cal imaging examples of a gated study.

Solution
A gated study is performed when the dynamic process of an organ occurs too
rapidly to be effectively captured by a dynamic image acquisition, and when
the dynamic process is repetitive, such as the cardiac or respiratory cycle.
Gated acquisitions require a physiological monitor that provides a trigger pulse
to mark the beginning of each cycle of the process being studied. For example,
in a gated cardiac study, an electrocardiogram (ECG) monitor provides a trig-
ger pulse to the computer whenever the monitor detects a QRS complex. Using
this technique, the image data from each desired phase of the cycle can be
stored in specific location (known as ‘bins’). When all the data in a bin are
added together, the image represents the specific phase of the cycle.
Examples of gated studies include cardiac blood pool study for calculation
of left ventricular ejection fraction, gated SPECT myocardial perfusion study
for regional wall uptake and motion and a respiratory gated study of the lungs.
SPECT and
PET Imaging 5
5.1 PHYSICAL PRINCIPLES OF SPECT
PROBLEM
Explain briefly the basic principles of single-photon emission computed
tomography (SPECT).

Solution
SPECT is performed using a gamma camera that consists of one or more
detectors. Each detector is comprised of a collimator, scintillation crystal,
array of photomultiplier tubes (PMTs) and digital positional network. During
SPECT imaging, the detectors are rotated around the patient at small-angle
increments, typically 3°–10°. The rotation can be in continuous motion or
using the ‘step-and-shoot’ method.
In most cases, a full 360° rotation is used to obtain an optimal reconstruc-
tion; however, in cardiac imaging, a rotation of 180° is sufficient. Individual
planar images are acquired at each angle for a set period of time, for example
30 seconds. In each detector, gamma rays pass through the collimator and
are absorbed by the crystal. The gamma ray energies are converted into light
photons and detected by the PMTs. The images are displayed in the form of a
digital matrix, for example, a 128 × 128 or 256 × 256 matrix. Each pixel con-
tains position and count rate information. The two-dimensional (2D) planar
images are pre-filtered and reconstructed using either an iterative process or
filtered back projection to form a three-dimensional (3D) image. The data may
then be manipulated to show thin slices along any chosen axis (e.g. transverse,
sagittal or coronal) of the body. The count rates of each voxel are commonly
displayed using a colour scale.

71
72 Problems and Solutions in Medical Physics

5.2 COMPARISON OF SPECT

AND PLANAR IMAGING
PROBLEM
Discuss the advantages and disadvantages of SPECT in comparison to the con-
ventional planar scintigraphic imaging.

Solution
In planar imaging, the radioactivity in the tissues in front and behind of an
organ reduces contrast. If the activity in these overlapping structures is not
uniform, the pattern of activity distribution from different structures will be
superimposed. This causes a source of structural noise that hinders the ability
to distinguish the activity distribution in the tissues. SPECT imaging can
greatly improve the subject contrast and reduce structural noise by eliminating
the activity in overlapping structures. In addition, SPECT imaging also allows
partial correction of tissue attenuation and photon scattering in the patient.
The possible disadvantage of SPECT includes the slight decrease of spatial
resolution compared to planar imaging. This is because the detector is usually
closer to the patient in planar imaging than in SPECT; however, the increase
in image information at depth easily compensates for any loss of resolution.
In addition, using a shorter time per angle in SPECT may necessitate the use of
a lower resolution/higher sensitivity collimator to obtain an adequate number
of counts within the time frame.

5.3 SPECT DATA ACQUISITION

PROBLEM
Describe briefly how gamma ray energy affects the following features in SPECT
imaging:

a. The choice of a camera collimator.

b. The use of attenuation correction in SPECT reconstructed images.

Solution
a. A collimator is required to project the gamma photons onto the
detector crystal. Collimators are essentially constructed as lead
 5 • SPECT and PET Imaging 73

plates with holes or lead foils to channel the photons. Any photon
not running parallel to the hole will be absorbed by the septa. For
diagnostic imaging, collimators are classified according to three
energy ranges:

EXAMPLES OF
ENERGY LEVEL ENERGY RANGE (KeV) RADIOISOTOPES
Low energy 100–200 Tc-99m (140 keV)
I-123 (159 keV)
Medium energy 200–300 In-111 (171 and
245 keV)
High energy 300–400 I-131 (364 keV)

The higher the energy, the thicker the lead septa are required to
attenuate the photon. Hence, the overall sensitivity is reduced.
In addition, the spatial resolution is also reduced at higher energy.
b. For SPECT imaging, the camera rotates around the patient. The
peripheral margins of the patient are closer to the detector, and hence
the photons originating from that area will be subjected to less atten-
uation than those arising from the centre of the patient. By defining
the size of the patient from the outline of the image (an X-ray com-
puted tomography [CT] image may be used), attenuation correction
could be applied to correct for photon attenuation with depth.

Gamma ray attenuation is expressed as:

N = N oe − µ t

where:
N = number of transmitted photons
No = number of incident photons
μ = linear attenuation coefficient of the tissue
t = thickness of the tissue
The attenuation effect will be more pronounced for lower energy
gamma rays, that is, Tc-99m (140 keV). The resulting image data will
therefore have a lower count density in the centre of the patient in
comparison to the periphery. This can be corrected by modifying the
image data using the appropriate attenuation coefficient for the energy
of the gamma rays used (i.e. Tc-99m = 0.12). In this way, counts are
added to the central regions to give a corrected uniform image.
74 Problems and Solutions in Medical Physics

5.4 PRINCIPLE OF NOISE FILTERING

USING THE FOURIER METHOD
PROBLEM
Explain the principle of noise filtering using the Fourier method in SPECT
image reconstruction.

Solution
The Fourier noise-filtering method is done in the spatial domain. It is used
to eliminate the blurring function (star artefact) from simple back projection.
In this method, the amplitude of different frequencies is modulated. The princi-
ple is to preserve the broad structures (the image) represented by low frequency
and remove the fine structure (noise) represented by high frequency. There are a
number of filters classified according to their functions. For example, a ‘low pass
filter’ (e.g. Butterworth, Parzen, and Weiner filters) rejects the high-frequency
data, and a ‘high pass filter’ (e.g. ramp filter) rejects the low to medium fre-
quency data. Often the low pass filters are applied as pre-filters to remove high-
frequency noise, and the ramp filter is then applied during back projection to
remove star artefact. This combination of filter is called ‘high pass-low pass
filter’, for example, Ramp-Parzen filter. All of the Fourier filters are character-
ised by a maximum frequency, known as the Nyquist frequency. The Nyquist
frequency is calculated as 0.5 cycle per pixel, which is the highest fundamental
frequency useful for imaging. The cut-off frequency is the maximum frequency
the filter will pass. If the cut-off frequency is higher than the Nyquist frequency,
the data will be filtered at the Nyquist frequency.

5.5 PRINCIPLE OF NOISE FILTERING

USING THE CONVOLUTION METHOD
PROBLEM
Explain briefly the principle of the convolution method that is used in filtered
back projection reconstruction.

Solution
The convolution method is carried out in the spatial domain. It uses a smooth-
ing ‘kernel’, which is basically a mathematical function to remove the 1/r
 5 • SPECT and PET Imaging 75

function, essentially by taking some counts from the neighbouring pixels

and putting them back into the central pixel of interest. The ‘1/r’ function
is the geometrically blurring effect as a function of distance away from the
point source, where r is the radial (distance from a point source). The most
commonly used kernel in filtered back projection is the ‘nine-point smooth-
ing’ kernel. An example of a smoothing calculation is illustrated below:

In the nine-point smoothing method, the individual pixel value in the acquisi-
tion matrix is multiplied with a 3 × 3 smoothing matrix. The sum of the product
is then divided by the sum of all pixel values of the smoothing matrix. In this
example, the pixel value ‘7’ is converted to ‘5’ after smoothing. Similarly, all
pixel values in the acquisition matrix are smoothed, and a smoothed image is
produced.

5.6 IMAGE PROCESSING USING

ITERATIVE RECONSTRUCTION
PROBLEM
Explain briefly the iterative reconstruction method used in image processing
of tomographic images.

Solution
• In the iterative method, an initial estimate activity is made of each ele-
ment in the N × N matrix, and values are compared to the measured
values.
• Corrections are applied according to the estimated values.
76 Problems and Solutions in Medical Physics

• If an estimated value is smaller than the measured value, each pixel

that contributes to this pixel will be raised in counts, and a compari-
son is made again until the estimated value is achieved.
• The calculation of projection images applies the point spread
function of the scintillation camera, which takes into account the
decreasing spatial resolution with distance from the camera face.
• The point spread function can be modified to incorporate the effects
of photon scattering in the patient. This technique is known as
expectation maximisation.

5.7 PHYSICAL PRINCIPLES OF PET

PROBLEM
Describe the physical principle of positron emission tomography (PET).

Solution
Figure 5.1 illustrates the basic principle of positron emission tomography.
In PET imaging, a positron emitting radiopharmaceutical, such as F-18-FDG,
is administered into the patient’s body. The positrons lose most of their energy
in matter by causing ionisation and excitation. When a positron has lost most

FIGURE 5.1 Basic principle of positron emission tomography (LOR = Line-of-

response).
 5 • SPECT and PET Imaging 77

of its energy, it interacts with an electron by annihilation, whereby the entire

mass of the electron-positron pair is converted into two 511 keV gamma pho-
tons, which are emitted in nearly opposite directions. The photons are then
detected by a ring of detectors surrounding the patient. The ring detectors
use the same fundamental detector system as the one used in the gamma
camera, which include scintillating crystals and photomultiplier tubes. The
detector electronics are linked so that two photons unambiguously detected
within a certain time window (typically 6–12 ns) may be registered as a coin-
cident event and originate from the same annihilation. Since the annihilation
photons are emitted at almost 180° to each other, it is possible to locate their
source along a straight line of coincidence (also known as the line-of-response
[LOR]) by calculating the distance between each photon with the source
according to their arrival time at each detector. This principle is known as
the ‘time-of-flight’ (TOF). The coincidence events are then being stored in
arrays corresponding to projection through the patient and reconstructed using
standard tomographic techniques, such as filtered back projection and iterative
reconstruction.
Note: A CT scanner is usually attached to a PET scanner for tissue attenua-
tion correction, image fusion and diagnostic purposes.

5.8 ANNIHILATION
COINCIDENCE DETECTION
PROBLEM
With the aid of a diagram, discuss briefly the annihilation coincidence detec-
tion (ACD) method used in PET imaging.

Solution
Figure 5.2 illustrates the principles of coincident annihilation detection method
used in PET imaging. When a positron is emitted by nuclear transformation,
it transverses through matter and loses energy. After it loses most of its energy,
it interacts with an electron, resulting in two 511 keV photons that are emitted
in nearly opposite directions. This phenomenon is known as annihilation.
When the two photons are simultaneously detected within a ring of detec-
tors surrounding the patient, it is assumed that the annihilation event occurred
on the line connecting the interactions (i.e. the line-of-response [LOR]).
78 Problems and Solutions in Medical Physics

FIGURE 5.2 Coincident annihilation detection.

Each detector will generate a timed pulse when it detects an incident photon.
These pulses are then combined in coincidence circuitry, and if the pulses fall
within a short time window (within approximately 5ns), they are deemed to be
coincident and the signal will be registered in the image.

5.9 TRUE, SCATTER AND RANDOM

COINCIDENCE EVENTS
PROBLEM
Explain with the aid of diagrams, the true, scatter and random coincidence
events that are possibly detected in a PET scanner.

Solution
a. True coincidence: the two 511 keV photons that are detected from
opposite detectors are from the actual source location (Figure 5.3).
b. Scatter coincidence: the photons are scattered in the patient’s body
before being detected by the PET detectors. The annihilation coinci-
dence detection (ACD) method does not present the actual location
of the source.
 5 • SPECT and PET Imaging 79

FIGURE 5.3 Illustrations of a) true, b) scatter, and c) random coincidence.

c. Random coincidence: the detectors detect several photons from dif-

ferent sources at the same time (or within 12 ns) and wrongly pair
them as a true coincidence event, and therefore does not present the
actual location of the source.

5.10 TIME-OF-FLIGHT IN PET IMAGING

PROBLEM
Explain how a PET scanner localizes the source of the coincident photons
using the method called ‘time-of-flight’. What are the disadvantages of using
this method in PET imaging?

Solution
A PET scanner measures time-of-flight under the assumption that the location
of the annihilation can be localised along the line of flight of the coincident
photons by measuring time of arrival of each photon at the opposing crystal.
Unless the event occurs in the exact centre of the ring, one of the photons will
arrive before the other. Typical coincidence time is 12 ns. The time difference is
proportional to the difference in distance and can be used to calculate the posi-
tion of the event.
The disadvantages of this method include lower accuracy in determining
the location of the source due to possibilities of scatter events and random
coincidence, as well as reducing spatial resolution of the image.
80 Problems and Solutions in Medical Physics

5.11 RESOLUTION OF PET IMAGING

PROBLEM
What are the main factors affecting the resolution of PET images?

Solution
The resolution of the PET image is determined mainly by the detector size.
Smaller detectors give better resolution. The ring diameter and the detector
material also affect the intrinsic resolution of the PET image. The energy of
the positron plays a minor role as higher energy positrons travel farther away
from the site of origin before annihilating.

5.12 2D VERSUS 3D PET IMAGING

PROBLEM
What is the difference between 2D and 3D acquisition of PET data, and what
are their relative advantages and disadvantages?

Solution
In 2D acquisition, coincidence events are collected by detectors in a single ring
around the source, and each detector is in coincidence with any other detector
in the ring and defines a 2D plane. In 3D acquisition, coincidence events are
collected by detectors in multiple rings or in 2D arrays of detectors around
the source. Each detector is in coincidence with any other detectors in all the
rings or in the entire opposing 2D array and helps to define a 3D image. 2D
acquisition is less prone to scatter coincidences and requires less electronics
for volumetric acquisition. 3D acquisition is more prone to false coincidence
effects and requires fast processing electronics.
 5 • SPECT and PET Imaging 81

5.13 COMPARISON OF Tc-99m AND F-18

PROBLEM
Compare the physical properties of Tc-99m and F-18, which are used in SPECT
and PET imaging, respectively.

Solution
Comparison of physical properties of Tc-99m and F-18:

Tc-99m F-18
Production method Mo-99 generator Cyclotron
Mode of decay Isomeric transition (88%) Positron emission (97%)
Internal conversion (12%) Electron capture (3%)
Decay product Tc-99 O-18 (stable)
Physical half-life 6.02 hours 110 min
Detection photon 140 keV 511 keV
energy
Detection principle Single photon detection Dual photon (511 keV each)
travelling in opposite
directions

5.14 COMPARISON OF IMAGING

TECHNIQUES BETWEEN SPECT AND PET
PROBLEM
Compare the SPECT and PET scanners in terms of the following:

a. Principle of projection data collection

b. Transverse image reconstruction
82 Problems and Solutions in Medical Physics

c. Radionuclide
d. Spatial resolution
e. Attenuation

Solution

SPECT PET
a. Principle of Using physical collimator Annihilation coincidence
projection data detection
collection
b. Transverse image Filtered back projection or Filtered back projection or
reconstruction iterative reconstruction iterative reconstruction
c. Radionuclide Any radionuclides emitting Positron emitters only
X-rays, gamma rays or
annihilation photons.
d. Spatial resolution Depends on collimator and Relatively constant across
camera orbit. Within a transaxial image, best at
transaxial image, the the centre. Typically
resolution in the radial 4.5–5 mm full width at
direction is relatively half maximum (FWHM)
uniform, but the at the centre.
tangential resolution is
degraded towards the
centre. Typically, 10 mm
full width at half
maximum (FWHM) at the
centre for a 30-cm
diameter orbit using
Tc-99m. Larger camera
orbits produce lower
spatial resolution.
e. Attenuation Attenuation is less Attenuation is more
significant. Attenuation significant. Accurate
correction methods are attenuation correction is
available. possible with a
transmission source.
 5 • SPECT and PET Imaging 83

5.15 COMPARISON OF SPATIAL

RESOLUTION AND DETECTION
EFFICIENCY BETWEEN SPECT AND PET
PROBLEM
Contrast the spatial resolution and detection efficiency between SPECT and
PET scanners based on the collimation and annihilation coincidence detection
(ACD) methods.

Solution
In SPECT, the spatial resolution and the detection efficiency are primarily
determined by the collimator. Both are ultimately limited by the compromise
between collimator efficiency and collimator spatial resolution that is a con-
sequence of collimated image formation. Larger camera orbits result in lower
resolution. This causes the spatial resolution to deteriorate from the edge to the
centre in transverse SPECT images.
In comparison, PET has better spatial resolution and detection efficiency.
ACD method is used as an electronic collimator for the PET scanner by deter-
mining the path of the detected photons. ACD allows detection of two annihila-
tion photons given off by a single positron annihilation event. The two photons
(511 keV) are considered to be from the same event if they are counted within a
defined coincidence timing window and recorded as occurring along the line-
of-response (LOR). The location of the event can then be calculated using the
principle of time-of-flight (TOF). This combination approach effectively filters
the scattered photons and determines the location of the source, hence improv-
ing the spatial resolution and detection efficiency of PET imaging.
Imaging
Techniques
in Nuclear
6
Medicine

6.1 WHOLE BODY BONE SPECT IMAGING

PROBLEM
Explain the basic principle, radiopharmaceutical used, image acquisition,
image processing and data interpretation in a whole-body bone single-photon
emission computed tomography (SPECT) imaging.

Solution
Principle
• Whole body bone SPECT imaging is a sensitive method for detect-
ing a variety of anatomical and physiological abnormalities of the
musculoskeletal system. A Tc-99m-labelled radiopharmaceutical
(such as methylene diphosphonate [MDP]), which localises in the
bone, is injected intravenously to the patient. The activity accu-
mulated in the bone is then evaluated through the SPECT images.
It helps to diagnose a number of bone conditions, including bone
cancer or metastasis, inflammation, fractures and bone infection.

Radiopharmaceutical
• The most commonly used radiopharmaceutical for bone SPECT
imaging is Tc-99m labelled with methylene diphosphonate (MDP).

85
86 Problems and Solutions in Medical Physics

MDP absorbs onto the hydroxyapatite mineral of the bone; hence, it

can be used as a marker of bone turnover and bone perfusion.
• Tc-99m-MDP is injected intravenously to the patient with typical
administered activity of 555–800 MBq for adults. Administered
activity for children is determined based on body weight. Generally,
the administered activity for children and adolescents is 9.3 MBq
per kg with a minimum administered activity of 37 MBq.

Image Acquisition
• SPECT imaging is performed at two to three hours following injec-
tion of the radiopharmaceutical to allow optimal concentration of
the radiotracer uptake by active osteoblasts. The delay also allows
time for background activity to be excreted from the body. Patients
are required to empty their bladders before the scan.
• A low-energy high-resolution (LEHR) collimator is used. The
acquisition energy window is set to 140% ± 10% keV and a matrix
size of 256 × 1024 is typically used. The patient is positioned in the
supine, arms by the side and feet first position. Anterior and pos-
terior views are acquired simultaneously if a dual-head camera is
used. The total imaging time is approximately 30 minutes. Patients
are asked to stay still during the scanning.

Image processing and data interpretation

• The tomographic images are reconstructed using either filtered back
projection or iterative method.
• In whole-body bone SPECT, about half of the radiopharmaceutical
is localised in the bones. The more active the bone turnover, the more
radionuclide concentration (hot spot) will be seen. However, abnor-
mal radionuclide concentration should not be confidently assigned
to a particular pathology without a typical pattern of radiotracer dis-
tribution, such as multiple randomly placed foci in metastatic bone
disease. In the absence of this, a correlation of radiotracer uptake
with alternative imaging modalities such as radiography, computed
tomography (CT), or magnetic resonance imaging (MRI), should
be reviewed when available, as this can significantly increase the
accuracy of bone scintigraphy interpretation.

Note: SPECT-CT hybrid imaging has been demonstrated to significantly

improve the accuracy of bone scintigraphy interpretation when the CT compo-
nent may be justified for indeterminate lesions and complex joint abnormali-
ties, such as the spine and feet.
 6 • Imaging Techniques in Nuclear Medicine 87

6.2 CARDIAC IMAGING

PROBLEM
A cardiologist would like to determine the left ventricular ejection fraction of
a patient’s heart at the end diastole and end systole cycles.

a. Suggest the best radionuclide imaging technique for this patient.

b. With the aid of a diagram, explain the principle and techniques of
the examination you suggested above.

Solution
Multiple-gated acquisition (MUGA) or gated cardiac blood pool imaging using
Tc-99m-labelled red blood cells (Figure 6.1).

FIGURE 6.1 Basic principles of multiple gated acquisitions (MUGA) for cardiac
ejection fraction study. The numbers 1 to 8 represent the frames allocated over
the cardiac cycle/heart beat.
88 Problems and Solutions in Medical Physics

Abbreviations: ED = end diastole; ES = end systole.

• Tc-99m-labelled red blood cells are administered to the patient
through intravenous injection.
• Patient is connected to an electrocardiogram (ECG) machine and
imaged using a gamma camera. As the gamma camera images are
acquired, the patient’s heartbeat is used to ‘gate’ the acquisition.
• In MUGA, data are acquired in synchronisation with the R-wave.
• R–R interval on ECG, representing one cardiac cycle, is typically
divided into eight frames of equal duration (A).
• Image data from each frame are acquired over multiple cardiac
cycles and stored separately in specific locations (‘bin’) of computer
memory (B).
• When all data in a bin are added together, the image represents a
specific phase of the cardiac cycle.
• Typically, a volume curve is obtained, which represents the endo-
cardial volume for each of the eight frames (C).
• The ejection fraction is the proportion of blood that is pumped from
the left ventricle with each heartbeat. The ejection fraction is calcu-
lated using Equation 6.1:
ED( net ) − ES ( net )
Ejection fraction (%) = (6.1)
ED ×100

6.3 RENOGRAM
PROBLEM
An adult male patient is referred for renal scintigraphy or renogram to assess
his kidney function.
a. Describe briefly the procedure of this examination including patient
preparation, radiopharmaceutical, administered activity and imag-
ing technique.
b. Explain briefly the method of quantitative analysis of the renogram
to assess the kidney function.
c. Name two examples of clinical information that can be derived
from a renogram.

Solution
a. A renogram refers to serial imaging after intravenous administra-
tion of Tc-99m-DTPA or Tc-99m-MAG3. It is used for qualitative
 6 • Imaging Techniques in Nuclear Medicine 89

and quantitative evaluation of differential renal functions. The typical

administered activity for an adult is 300 MBq for both kidneys and
150 MBq if there is only one kidney. The patient will be asked to drink
300–500 mL of water approximately 10–15 minutes prior to the scan.
For the investigation of suspected obstructed kidneys, a diuretic furose-
mide (Lasix®) will be injected to promote kidney drainage. The patient
should void his bladder just prior to the exam. Imaging begins immedi-
ately after injection of the radiopharmaceutical intravenously followed
by a rapid saline flush. The syringe and tubing residual activity is mea-
sured and recorded for further analysis. A common technique involves
dynamic acquisition of 1- to 2-second images for 1 minute (vascular
phase), followed by 15- to 60-second images for 20 to 30 minutes
(functional uptake, cortical transit and excretion phases).
b. The regions of interest (ROIs) are drawn around the heart and the
whole kidneys but occasionally are limited to the renal cortex if a
considerable amount of collecting system activity is present. A back-
ground ROI is placed adjacent to each kidney. Using the software,
time-activity curves for all the ROIs are obtained. Depending on
the ROIs drawn, the time-activity curves will reflect the functional
clearance of the whole kidney, renal cortex or collecting system. The
differential renal function is calculated based on the relative counts
accumulated in each kidney during the first two minutes of the reno-
gram. Figure 6.2 shows an example of the time-activity curve.
c. Urinary tract obstruction and renovascular hypertension.

FIGURE 6.2 Example of time-activity curve that can be obtained from a

renogram.
90 Problems and Solutions in Medical Physics

6.4 RADIOIMMUNOASSAY (RIA)

PROBLEM
Describe the principle of radioimmunoassay.

Solution
Radioimmunoassay (RIA) is a sensitive in vitro assay technique used to mea-
sure the concentration of an antigen (e.g. hormone level in the blood) using a
specific antibody. During the test, a known amount of antigen is labelled with a
radioactive source (e.g. I-125), and the radiolabelled antigen is then mixed with
a known amount of antibody. The radiolabelled antigen will bind together with
the antibody. Subsequently, a sample of serum from the patient containing
an unknown amount of the same antigen is added. This causes a competitive
binding of two antigens with the antibody. The antigen, which has a higher
concentration, will bind extensively with the antibody, displacing the other.
In this case, if the antigen in the patient’s serum has a higher concentra-
tion, it would bind with the antibody and displace the radiolabelled antigen.
The bound antigens are then separated from the unbound ones, and the
radioactivity of the unbound antigen remaining in the supernatant is measured
using a gamma counter. Using known standards and formulas, the amount of
antigen in the patient’s serum can be derived.
Note: A number of non-radioactive methods can now be used to replace RIA,
such as the enzyme-linked immunosorbent assay (ELISA).

6.5 STANDARDISED
UPTAKE VALUE (SUV)
PROBLEM
Describe the use of standardised uptake value (SUV) in positron emission
tomography (PET) and its limitations.

Solution
The SUV is used as a relative measure of radiopharmaceutical uptake, such
as FDG, standardised for the injected activity and patient weight. An ROI is
 6 • Imaging Techniques in Nuclear Medicine 91

defined on the area of the PET image, and the SUV within the ROI is calcu-
lated using the following formula:

Tracer activity in the tumour per unit mass ( Bq ⋅ kg −1 )

SUV =
Amount of injected radioactivity per unit body mass ( Bq ⋅ kg −1 )

The main purposes of SUVs are to provide a good correlation between the his-
tological grades of the tumour and to facilitate comparisons between patients.
However, there are several limitations of the use of an SUV. First, it has a
large degree of variability due to physical and biological sources of errors.
Furthermore, the suggestion of a threshold value of an SUV to characterise
benign or malignancy of a lesion remains a clinical challenge. The sensitiv-
ity and specificity of using the SUV threshold usually decreases with lesions
smaller than 7 mm. Another limitation of the SUV is in identifying the lesion
boundaries and determining the counts within the ROI. The SUV may be
influenced by image noise, low image resolution and variable user-biased ROI
selection.

6.6 PET IMAGING APPLICATIONS

PROBLEM
Discuss the clinical applications of F-18-FDG PET imaging in oncology, neu-
rology and cardiology.

Solution
In oncology, F-18-FDG PET imaging is very useful for the following
applications:
• To assess regional tumour metabolic activity by evaluating the dis-
tribution and uptake as standard uptake values (tumour staging).
• To monitor the success of therapy by comparing the pre- and post-
therapy images.
• To detect early recurrent tumours.
• To provide a whole-body survey for cancer that may have metasta-
sised, as the FDG radiopharmaceutical is distributed throughout the
body and whole-body imaging is commonly done without adding
additional activity or dose to the patient.
• To identify benign and malignant growths.
• To guide radiotherapy dose planning.
92 Problems and Solutions in Medical Physics

In neurology, F-18-FDG PET imaging can provide diagnostic information of:

• Alzheimer’s and other dementia conditions.

• Movement disorders, for example, Parkinson’s disease.
• Location of the epileptic seizures prior to surgery.

In cardiology, F-18-FDG PET imaging is commonly used to:

• Determine the viability of heart tissue following a suspected heart

attack.
• Predict the success of angioplasty (balloon) or bypass surgery.
• Determine if coronary arteries are blocked.

Note: There are many other PET radiopharmaceuticals (such as F-18-

labelled thymidine [FLT], rubidium-82 chloride, nitrogen-13-ammonia and
gallium-68-dotatate) that can be used for oncology, neurology and cardiac imag-
ing; however, F-18-FDG is the currently the most widely used PET radiophar-
maceutical due to its clinical efficacy, cost and availability.
Radionuclide
Therapy 7
7.1 SEALED AND UNSEALED
SOURCE THERAPY
PROBLEM
Differentiate between sealed and unsealed source therapy. What are the main
factors to be considered when selecting a suitable radionuclide for unsealed
source therapy?

Solution
Unsealed source therapy relates the use of soluble forms of radioactive sources,
which are administered to the patient body by either injection or ingestion.
Unsealed source therapy is commonly known as radionuclide therapy or
molecular targeted radiotherapy. Sealed source therapy uses radionuclides,
which are sealed in a capsule, rod or metal wire during therapy. Sealed source
therapy is more commonly known as ‘brachytherapy’.
The main factors to be considered when choosing a suitable radionuclide
for unsealed source therapy include its effective half-life, types of radiation,
energy range and its biochemical characteristics. Effective half-life includes
both the physical and biological half-life. A suitable range of physical half-life
is between six hours to seven days, whereas the biological half-life depends on
a number of factors, such as radiotracer delivery, uptake kinetics, metabolism,
clearance and excretion. For therapeutic purposes, radiations with high linear
energy transfer (LET), such as alpha and beta particles, are preferred because
they allow very high ionisation per length of travel and reduce the need for
additional radiological protection. For biochemical characteristics, a suitable
radionuclide should provide selective concentrations and prolonged retention
in the tumour, while maintaining minimum uptake in the normal tissue.

93
94 Problems and Solutions in Medical Physics

7.2 THERAPEUTIC PROCEDURES

IN NUCLEAR MEDICINE
PROBLEM
List five therapeutic procedures that are commonly done in nuclear medicine.

Solution
i. Hyperthyroidism treatment using I-131-sodium iodide radiopharma-
ceutical.
ii. Thyroid carcinoma treatment using high-dose I-131-sodium iodide.
iii. Treatment of polycythemia using P-32-phosphate.
iv. Bone metastases palliative treatment using Sm-153-EDTMP
(methylenephosphonic acid) or Ra-223-dichloride.
v. Treatment for hepatocellular carcinoma using Y-90-labelled micro-
spheres or Re-188-lipiodol.

7.3 HYPERTHYROIDISM ABSORBED

DOSE CALCULATION
PROBLEM
Calculate the absorbed dose to the thyroid gland of a hyperthyroidism patient
following administration of 925 MBq I-131 (t1/2 = 8.0 days), assuming 85%
uptake, a biological half-life of 3 days for thyroid clearance of I-131, and
S-value of 2.2 × 10 −3 mGy(MBq·h)−1.

Solution
T p × Tb
• Effective half-life, Te = = 2.18 days
T p + Tb
• Cumulated activity, A = 1.44 A0·Te·fh = 1.44 × 925 MBq ×
2.18 days × 0.85
= 2468.196 MBq·days × 24 h·day−1
= 59236.70 MBq·h
• Absorbed dose = A·S = 59236.70 MBq·h × 2.2 × 10 −3 mGy(MBq·h)−1
= 130.32 mGy
 7 • Radionuclide Therapy 95

7.4 I-131 TREATMENT GUIDELINES

PROBLEM
Discuss the general instructions or precautions relating to radiation protection
that are given to patients before, during and after the I-131 treatment.

Solution
Before the Treatment
• The patient will be given a list of prohibited food, dietary informa-
tion and medication that could potentially affect the thyroid uptake
of the administered radiopharmaceutical.
• Female patients who are of childbearing age must be tested for preg-
nancy prior to administration of the I-131, unless pregnancy is clini-
cally proven to be impossible in the patient.
• Patients who are breastfeeding should be excluded or feeding should
be carried out by someone else using bottled formula milk.
• The treating nuclear medicine physician should confirm that the
patient is continent of urine or an arrangement should be made to
prevent any contamination caused by urinary incontinence.
• Written informed consent must be obtained from the patient before
therapy.

During the Treatment

• The patient’s identity must be confirmed before administration of I-131.
• If the patient is to be treated as an inpatient, nursing personnel
must be instructed on radiation safety. Selected nursing personnel
must be provided with appropriate personal protective equipment
(e.g. lead apron and thyroid shield) and radiation monitoring device
(e.g. film badge and personal pocket dosimeter).
• Radiation monitoring of the thyroid glands of the patient should
be performed periodically by the medical physicists or qualified
staff.
• A patient is required to remain in the hospital until the external
dose rate from the patient is below the activity limit set by the local/
national radiation protection authorities.
• Any significant medical conditions should be noted, and contin-
gency plans should be declared in case of a medical emergency.
96 Problems and Solutions in Medical Physics

Concern about radiation exposure should not interfere with the

prompt, appropriate medical treatment of the patient should an
acute medical problem develop.

Post-Treatment
• Before discharge from the hospital, the patient needs to be briefed
on the methods to reduce unnecessary radiation exposure to the
family members and members of the public. Written instructions
should be provided to the patient.
• The patient should be advised to avoid pregnancy for a period of
time stated in the local radiation protection guidelines.
• Patients must be provided with a written document stating that they
have been given a radionuclide treatment and details of the radionu-
clide since the radioactivity may be detected by monitoring devices
at borders such as airports during travel.

7.5 CALCULATION OF ADMINISTERED

ACTIVITY FOR I-131 TREATMENT
PROBLEM
A patient with differentiated thyroid cancer is scheduled for I-131 therapy.
The weight of the thyroid is estimated to be 30 g from the ultrasonography
images. According to the thyroid uptake profile, the thyroid uptake at 24 h
post-administration is 67.3%, and the effective half-life of I-131 is 4.5 days.
Calculate the total activity to be administered for I-131 therapy for the pre-
scribed dose of 100 Gy to the thyroid.

Solution
Using the Marinelli-Quimby formula,

21.4 AW
Administered activity (MBq) =
UTe

where:
A = prescribed dose (Gy)
W = weight of the thyroid glands (g)
U = percentage uptake of I-131 at 24 h (%)
Te = effective half-life (d)
 7 • Radionuclide Therapy 97

Therefore,

21.4 (100 Gy)(30 g)

Administered activity (MBq) = = 212 MBq
(67.3%)(4.5 d)

Hence, the activity of I-131 to be administered to the patient is 212 MBq.

Note: The thyroid weight can be estimated based on the volume obtained
from either a thyroid single-photon emission computed tomography (SPECT)
imaging or ultrasonography. The density of the thyroid gland was assumed to
be 1 g·cm−3. The volume of each thyroid lobe is calculated using the following
formula based on an ellipsoid model:

π abc
Volume ( mL) =
6

where:
a = length (cm), b = width (cm) and c = thickness (cm).

The total thyroid volume is obtained by adding the volume of both lobes.

7.6 RADIOIODINE THERAPY

AND PREGNANCY
PROBLEM
What is the risk of radioiodine treatment to a foetus? Should this treatment be
avoided at all time for pregnant women?

Solution
Radioiodine can easily cross the maternal placenta, and foetal thyroid uptake
following therapeutic doses can pose significant problems for the foetus, par-
ticularly with respect to causing permanent hypothyroidism. As a general rule,
pregnant women should not be treated with any radioactive substance unless
the therapy is required to save her life. Thyroid cancers are relatively unag-
gressive compared to most other cancers. As a result, radioiodine treatment
should be delayed until after pregnancy. However, if any therapy is to be per-
formed during pregnancy, this should be restricted to after thyroid surgery
during the second or third trimester of pregnancy.
98 Problems and Solutions in Medical Physics

Note: According to the ICRP Publication 84, a major problem occurs when
a female, who is not thought to be pregnant, is treated for thyroid carcinoma
and is found to be pregnant after the administration of radioiodine. If a patient
is discovered to be pregnant shortly after a therapeutic radioiodine admin-
istration, maternal hydration and frequent voiding should be encouraged to
help eliminate maternal radioactivity and to reduce radioiodine residence time
in the bladder. If the conceptus is more than 8 weeks’ post-conception and
the pregnancy is discovered within 12 hours of radioiodine administration,
giving the mother 60–130 mg of stable potassium iodide will partially block
the foetal thyroid and reduce thyroid dose. After 12 hours post-radioiodine
administration, this intervention is not very effective.

7.7 SAFE ADMINISTRATION OF I-131

PROBLEM
Discuss the safe oral administration of I-131 in a patient.

Solution
The safe oral administration of I-131 should be practiced as following:

i. I-131 should be administered in a controlled area (e.g. hot-lab or the

treatment room).
ii. A radioactive waste disposal bag for contaminated items, such as
tissue papers or glove, should be prepared prior to administration.
iii. The patient is asked to sit at a table covered with adsorbent pads,
and the floor beneath the patient should also be covered by adsor-
bent pads.
iv. If the I-131 is administered in capsules, they should be transferred
to the patient’s mouth by tipping from a small shielded (>1 cm Pb)
container.
v. I-131 administered in oral solution should be sucked up through a
straw by the patient from a lead-shielded vial. The vial should be
flushed with water several times to ensure all the prescribed activity
has been consumed. At the end of the procedure, the patient should
then be asked to drink several glasses of water to clean the teeth
and mouth.
 7 • Radionuclide Therapy 99

7.8 GUIDANCE LEVEL FOR

HOSPITALISATION OF I-131 PATIENTS
PROBLEM
What is the guidance level for maximum activity on hospital discharge for
patients undergoing I-131 therapy, as recommended by the International
Atomic Energy Agency (IAEA)?

Solution
The guidance level as recommended by the IAEA Safety Report Series No. 63
is illustrated in Table 7.1.
TABLE 7.1 IAEA recommended guidance levels for I-131 therapy patients

ADMINISTERED ACTIVITY (MBq) RECOMMENDATION

1100 Stay in hospital
600 Stay in hospital or discharged with individual
restrictions
150 Discharged with individual restrictions
Below 150 Discharged, general restrictions

7.9 RADIOEMBOLISATION
PROBLEM
Explain the principle, techniques and advantages of radioembolisation in
cancer treatment.

Solution
Radioembolisation is a cancer treatment in which radioactive particles of specific
sizes (about 15–60 μm) are delivered to the tumour through intra-arterial injection.
The radioactive particles will be trapped in the microvessels and reside within the
tumour volume to emit radiation that kill the cancer cells. Radioembolisation is
most often used to treat unresectable or metastasised liver cancer.
100 Problems and Solutions in Medical Physics

Radioembolisation is usually performed under the radiological guid-

ance of X-ray fluoroscopy. The interventional radiologists will identify and
insert a catheter into the artery that supplies blood to the tumour. The radio-
active particles of prescribed sizes (contained in saline solution), amount and
prescribed radioactivity are then injected into the artery (or arteries) of the
tumour. The radioactive particles will remain in the tumour, blocking blood
flow to the cancer cells and killing them by the means of the ionising radiation.
The tumour may eventually shrink over time, and the radioactive particles
will gradually decay to a stable state. The particles may stay permanently in
the tissues or may be excreted by the body. Radioembolisation is often used in
combination with other forms of cancer treatment, such as surgery and chemo-
therapy, to enhance the overall therapeutic efficacy.
The advantages of radioembolisation include minimally invasive proce-
dures, less severe side effects, reduced complications and faster patient recovery
time.

7.10 RADIOIMMUNOTHERAPY (RIT)

PROBLEM
Explain briefly the basic principles and advantages of radioimmunotherapy
(RIT). Give three conditions that can be treated with RIT.

Solution
RIT is a type of cancer-cell-targeted therapy that uses monoclonal antibodies
(mAbs) directed against tumour-associated antigens labelled with a therapeu-
tic radionuclide. It is a combination of radiation therapy and immunotherapy.
When injected into the blood stream, the radiolabelled mAbs will travel to and
bind to the cancer cells, allowing a high radiation dose to be delivered directly
to the tumour. The major benefit of RIT is the ability for the antibody to spe-
cifically bind to a tumour-associated antigen, hence increasing the radiation
dose delivered to the tumour cells while decreasing the radiation dose to the
surrounding normal tissues.
RIT can be used to treat non-Hodgkin’s B-cell lymphoma, chronic
lymphocytic leukaemia and immune diseases.
Internal
Radiation
Dosimetry
8
8.1 INTERNAL RADIATION DOSIMETRY
PROBLEM
Explain why the estimation of absorbed dose in internal radiation dosim-
etry presents greater challenges than the measurement of external radiation
exposure.

Solution
The estimation of absorbed dose in internal radiation dosimetry is more com-
plicated due to the following factors:

• The distribution of radionuclide within the body and its uptake in

certain critical organs are difficult to determine.
• There is inhomogeneous distribution of the radionuclide even within
the critical target organ or tissues.
• The biological half-life of the radionuclide may vary between
patients and may be modified by disease and the pathological
conditions.

101
102 Problems and Solutions in Medical Physics

8.2 FACTORS AFFECTING ABSORBED

DOSE TO AN ORGAN
PROBLEM
List the factors that are likely to influence the absorbed dose to an organ.

Solution
Factors that are likely to influence the absorbed dose to an organ include:

• Type of radionuclide.
• Activity administered.
• Activity in the source organ.
• Activity in the other organs.
• The size and shape of the organs.
• The kinetics of the radiopharmaceutical.
• The quality of the radiopharmaceutical in terms of the radiochemi-
cal purity.

8.3 SOURCE AND TARGET ORGAN

PROBLEM
Define source and target organ used in medical internal radiation dosimetry
(MIRD) estimation.

Solution
Source organ(s) is/are the organ(s) of interest with significant uptake of
radioisotope.
Target organ(s) is/are the organ(s) that receives radiation from the other
source organs, for which the absorbed dose is to be calculated. The source and
target organs may be the same when the radiation dose, due to the radioactivity
in the target itself, is calculated.
 8 • Internal Radiation Dosimetry 103

8.4 MONTE CARLO MODELLING

PROBLEM
Explain briefly the basic principle of Monte Carlo modelling in radiation
dosimetry.

Solution
Monte Carlo modelling is a ray-tracing method in which the fate of an indi-
vidual photon or particle is determined. The method is based on randomly
sampling a probability distribution for each successive interaction. For exam-
ple, Monte Carlo modelling can be used to simulate the random trajectories of
individual photons or particles in a matter by using the knowledge of probabil-
ity distribution governing the individual interactions of photons or particles in
materials.
One keeps track of the physical quantities of interest for a large number
of histories to provide the required information about the average quantities.
Monte Carlo modelling in radiation dosimetry requires detailed knowledge of
the absorption and scattering coefficients for the specific radiation energies
and for the properties of various types of tissues.

8.5 MIRD FORMULA

PROBLEM
The medical internal radiation dosimetry (MIRD) formula is given below:

D rk = ∑ A S(r ← r )
h
h k h

A h = A0 ⋅ fh ⋅1.44Te

Name all the quantities used in the formulas above and state their SI units.
104 Problems and Solutions in Medical Physics

Solution
SYMBOLS QUANTITIES SI UNITS

Drk The mean dose for a target organ, rk Gray (Gy)

∑ The sum of all the source organs, rh No unit

h

A h Cumulated activity for each source organ, rh Becquerel∙second

(Bq∙s)
S ( rk ← rh ) Absorbed dose in the target organ, rk, per unit Gy (Bq∙s)−1
of cumulated activity in each source organ, rh
A0 Initial activity of the radionuclide Becquerel (Bq)
fh Fraction of uptake in the source organ, rh No unit
Te Effective half-life of the radionuclide Second (s)

8.6 ABSORBED FRACTION

PROBLEM
Define the absorbed fraction, ϕ, and list the factors that determine its value.

Solution
Absorbed fraction is the fraction of energy emitted by the source organ that is
absorbed in the target organ.
The value is determined by:

• The size of the source organ.

• The size of the target organ.
• The relative position of these organs in the body.
• The energy of the photons.
• The attenuation properties of the tissues between the source and the
target organs.
 8 • Internal Radiation Dosimetry 105

8.7 S-VALUE
PROBLEM
Define S-value used in the MIRD formula. What factors determine the
S-value?

Solution
S-value is defined as the dose to the target organ per unit of cumulated activity
in a specified source organ. It is determined by:
• The mass of the target organ.
• The type and amount of ionising radiation emitted per disintegration.
• The fraction of the emitted radiation energy that reaches and is
absorbed by the target organ.
• Each S factor is specific to a particular source organ/target organ
combination.

8.8 ABSORBED DOSE CALCULATION (I)

PROBLEM
Calculate the absorbed dose to the thyroid gland of a hyperthyroidism patient
following administration of 1110 MBq I-131 (t1/2 = 8.0 days), assuming 60%
uptake, a biological half-life of four days for thyroid clearance of I-131, and S
factor of 2.2 × 10 −3 mGy(MBq∙h)−1.

Solution
• Effective half-life, Te = (T p ×Tb ) / (T p + Tb )
= 2.67 days
• Cumulated activity, A = 1.44A0 f hT
= 1.44 × 1110 MBq × 2.67 × 0.6
= 2560.64 MBq days × 24 h(day)−1
= 61455 MBq ⋅ h
 S = 61455 MBq ⋅ h × 2.2 × 10 −3 mGy(MBq ⋅ h) −1
• Absorbed dose = A⋅
= 135.2 mGy
106 Problems and Solutions in Medical Physics

8.9 ABSORBED DOSE CALCULATION (II)

PROBLEM
Estimate the absorbed dose to the liver and bone marrow from the intrave-
nous injection of 37 MBq of Tc-99m-sulphur colloid that localises uniformly
and completely in the liver. Assume instantaneous uptake of the colloid in the
liver and an infinite biological half-life. The S factors for Tc-99m are given in
Table 8.1.
TABLE 8.1 S-values for Tc-99m
S-VALUES,
TARGET ORGAN Gy(MBq·s)−1

Liver 3.5 × 10−9

Ovaries 3.4 × 10−11
Spleen 6.9 × 10−11
Red bone marrow 1.2 × 10−10
Source organ: Liver

Solution

A = 1.44 A0 f h Te

= 1.44(37 MBq)(6 h)(3600 s/h)

= 1.2 ×106 MBq s

D = A S

DLi = (1.2 ×106 MBq s) (3.5 ×10 −9 Gy/MBq s)

= 4.2 × 10 −3 Gy

DBM = (1.2 ×106 MBq s) (1.2 ×10 −10 Gy/MBq s)

= 1.4 × 10 −4 Gy
 8 • Internal Radiation Dosimetry 107

8.10 ABSORBED DOSE CALCULATION (III)

PROBLEM
Calculate the absorbed dose to the lungs from the administration of 148 MBq
Tc-99m-MAA particles, assuming that 99% of the particles are trapped in the
lungs. The S-value for the lungs is 1.40 × 10 −11 mGy(Bq·h)−1. Assume that the
Tc-99m activity is uniformly distributed in the lungs, and 45% of the activity
is cleared from the lungs with a biological half-life of 3 hours and 55% with a
biological half-life of 7 hours.

Solution
Physical half-life of Tc-99m = 6 h. The effective half-life of two biological
clearances:

Te1 = (3 × 6/3 + 6) = 2 h
Te2 = (7 × 6/7 + 6) = 3.2 h
à = 1.44 A0 f hTe
= 1.44 × 148 × 106 × 0.99 × (0.45 × 2 + 0.55 × 3.2)
= 0.56 GBq·h
D =÷S
= 0.56 × 109 × 1.40 × 10 −11 = 7.89 mGy

8.11 ABSORBED DOSE CALCULATION (IV)

PROBLEM
Calculate the absorbed dose to the liver from a 111 MBq injection of Tc-99m
sulphur colloid (t1/2 = 6 h). Assume that:

• 60% of the activity trapped in the liver.

• 30% activity uptake by the spleen.
• 10% activity uptake by the red bone marrow.
• There is instantaneous uptake and no biological excretion of the
radiopharmaceutical.
108 Problems and Solutions in Medical Physics

The S factors are given as the following:

S (Liver ← Liver) = 4.6 × 10 −7 Gy·μCi−1·h−1

S (Liver ← Spleen) = 9.2 × 10 −9 Gy·μCi−1·h−1
S (Liver ← Bone Marrow) = 1.6 × 10 −8 Gy·μCi−1·h−1

Solution
Assume there is no biological excretion of the radioisotope, hence the

Te = Tp = 6 h

ÃLiver = 1.44 A0 f hTe

= 1.44 (111 MBq × 27 μCi·MBq−1) (0.6) (6 h)
= 15536 μCi·h
ÃSpleen = 1.44 A0 f hTe
= 1.44 (111 MBq × 27 μCi·MBq−1) (0.3) (6 h)
= 7768 μCi·h

ÃRed Marrow = 1.44 A0 f hTe

= 1.44 (111 MBq × 27 μCi·MBq−1) (0.1) (6 h)
= 2589 μCi·h

D(Liver ← Liver) = A Liver ⋅ S

= 15536 μCi·h (4.6 × 10 −7 Gy·μCi−1·h−1)
= 7.1 mGy

D(Liver ← Spleen) = A Liver ⋅ S

= 7768 μCi·h (9.2 × 10 −9 Gy·μCi−1·h−1)
= 0.07 mGy

D(Liver ← RM) = A Liver ⋅ S

= 2589 μCi·h (1.6 × 10 −8 Gy·μCi−1·h−1)
= 0.04 mGy

Hence, the total absorbed dose to the liver is the sum of all D above

D Liver = (7.1 + 0.07 + 0.04) mGy = 7.21 mGy

 8 • Internal Radiation Dosimetry 109

8.12 MIRD FORMALISM ASSUMPTIONS

PROBLEM
State the key assumptions made in the MIRD formalism.

Solution
i. The radioactivity is assumed to be uniformly distributed in each
source organ and absorbing target organ.
ii. The organ size and geometries are simplified for mathematical
computational.
iii. The tissue density and composition are assumed to be homogenous
in each organ.
iv. The phantoms for the ‘reference’ adult and child are only approxi-
mations of the physical dimensions of any given individual.
v. The energy deposition is averaged over the entire mass of the target
organs.
vi. Dose contributions from Bremsstrahlung and other secondary
sources are ignored.
vii. With a few exceptions, low-energy photons and all particulate radia-
tions are assumed to be absorbed locally (i.e. non-penetrating).
Quality
Control in
Nuclear
9
Medicine

9.1 QUALITY CONTROL OF

DOSE CALIBRATOR
PROBLEM
List four basic quality control (QC) tests of a dose calibrator and state when
are they carried out.

Solution
• Constancy test—daily.
• Accuracy test—at installation, annually, and after repairs.
• Linearity test—at installation, quarterly, and after repairs.
• Geometry test—at installation and after repairs.

111
112 Problems and Solutions in Medical Physics

9.2 EXTRINSIC AND INTRINSIC

MEASUREMENT
PROBLEM
Define extrinsic and intrinsic measurement of the performance of a scintilla-
tion camera.

Solution
Extrinsic measurement is the measurement of a scintillation camera perfor-
mance with collimator attached; while intrinsic measurement is the measure-
ment of a scintillation camera performance when the collimator is removed.

9.3 QUALITY CONTROL METHODS

PROBLEM
Describe the methods for measuring the following performances of a scintil-
lation camera:

a. Uniformity
b. Spatial resolution
c. Energy resolution
d. Spatial linearity
e. System efficiency

Solution
a. Uniformity is a measure of a camera’s response to uniform irradia-
tion of the detector surface. The intrinsic uniformity is measured
by placing a point radioactive source (typically 3.7–18.5 MBq
Tc-99m) in front of an uncollimated camera. The source should
be placed at a distance more than four times the largest dimension
of the crystal, and at least five times away if the uniformity image
is to be analysed quantitatively. Extrinsic uniformity is assessed
by placing a uniform planar radioactive source in front of a col-
limated camera. The planar source should be large enough to cover
the crystal of the camera.
 9 • Quality Control in Nuclear Medicine 113

The integral and differential uniformity is calculated for both useful

field-of-view (UFOV) and central field-of-view (CFOV). UFOV is
the area of the scintillator surface which is defined from the inner
walls of the collimator. It is typically about 90% of the full FOV.
Whereas CFOV is the area of the detector surface that is 75% of the
UFOV. The integral uniformity is calculated using the following
formula for both FOV:
Maximum count − minimum count
Integral uniformity (%) = ×100%
Maximum count + minimum count

According to the National Electrical Manufacturers Association

(NEMA) standards, the integral uniformity should be ≤5% at 5
million counts.
The differential uniformity is calculated by counting the dif-
ference in any five contiguous pixels for row and column of pixels
within the UFOV and CFOV, as follows:

Highest − lowest difference

Differential uniformity (%) = ×100%
Highest + lowest difference

b. Spatial resolution is a measure of camera’s ability to accurately

display spatial variations in activity concentration. High spatial
resolution is the ability to distinguish separate radioactive objects
in close proximity. The extrinsic spatial resolution is evaluated by
acquiring an image of a line (or point) source, using a computer
interfaced to the collimated camera and determining the line spread
function (LSF) or the point spread function (PSF).

The system resolution, Rs = Rc2 + RI2

where Rc is the collimator resolution defined as the full width at half

maximum (FWHM) of the radiation transmitted through the col-
limator from a line source.
RI is the intrinsic resolution, which is determined quantitatively by
acquiring an image with a sheet of lead containing thin slits placed
against the uncollimated camera using a point source. Typical values
for intrinsic resolution are from 2 to 4 mm.
c. Energy resolution is a measure of the camera’s ability to distin-
guish between interactions depositing different energies in the
detector. The energy resolution is measured by exposing the camera
to a radioactive point source, emitting monoenergetic photons and
acquiring a spectrum of the energy (Z) pulse. The energy resolution
114 Problems and Solutions in Medical Physics

is calculated from the FWHM of the photopeak and expressed as

a percentage of the central value of the peak. The typical value for
intrinsic energy resolution is 9%–11%.
d. Spatial linearity is a measure of the camera’s ability to represent
the geometric shapes of an object accurately. It is determined from
the images of a bar phantom, line sources or other phantom by
assessing the straightness of the lines in the image. Quantitatively, assess-
ment can be done by measuring the FWHM of the LSF of a line source.
e. System efficiency or efficiency is the fraction of radiation emitted
by a source that produces counts in the image. The system efficiency
(Es) is the product of three factors:

Es = Ec × Ei × f

where:
Ec = fraction of photons emitted by a source that penetrate the
collimator holes.
Ei = fraction of photons penetrating the collimator that interact
with the detector.
f = fraction of interacting photons accepted by the energy
discrimination circuits.

9.4 UNIFORMITY
PROBLEM
Discuss the common causes of non-uniformity of a gamma camera image and
ways to overcome them.

Solution
The common causes of non-uniformity of a gamma camera image include:

i. There are variations in light production from gamma ray interaction

in the detector, light transmission to photomultiplier tube (PMT) and
in the light detection and gains of the PMT. These variations result in
photopeaks of different amplitude and FWHM. Because there are
many PMTs across the detector, the amplitude and FWHM of the
photopeaks will vary spatially across the detector surface. These
variations in PMT response contribute greatly to the non-uniformity
of the images. The non-uniformity can be corrected by adjusting the
 9 • Quality Control in Nuclear Medicine 115

look-up table provided by the manufacturer. The calibration factor is

obtained by moving a collimated radioactive source across the detec-
tor face with a constant pulse height analyser (PHA) window, and
variations in the photopeak values are determined as a function of
their spatial positions.
ii. Non-linearity in the X-, Y-positioning of pulses along the field-of-
view: The spatial non-linearity is the systematic errors in the X-,
Y-positioning coordinates resulting from local count compression
and expansion. When a radioactive source is moved across from the
edge to the centre of a PMT, more counts are pulled towards the
centre. This effect is known as pincushion distortion. The counts
are lower between the edges of adjacent PMTs, causing a cold spot in
the area. The non-linearity can be corrected by using dedicated soft-
ware. The correction factors are generated by calculating the spatial
shift of the observed position of an event from its actual position.
iii. Edge packing: Edge packing is observed around the edge of an image
as a bright peripheral ring that results in non-uniformity of the image.
This is because more light photons are reflected near the edge of the
detector to the PMT. Normally a 5-cm-wide lead ring (masking ring)
is attached around the edge of the collimator to mask such effect.

9.5 SPATIAL RESOLUTION

PROBLEM
List and explain five factors that affect the spatial resolution of a gamma camera
image.

Solution
i. The collimator hole’s size and length will affect the range of
accepted photon angles. Thicker or longer septa will block more
scattered photons, hence increasing the spatial resolution.
ii. Scintillation crystal thickness can affect the probability of photons
scattering. Although thicker crystal increases the sensitivity, it also
decreases the spatial resolution of the system.
iii. Gamma ray energy may affect the probability of scatter in crystal
and probability of septal penetration. Higher energies increase the
probability of Compton scattering and septal penetration, hence
reducing the spatial resolution.
116 Problems and Solutions in Medical Physics

iv. The size and number of PMTs may affect positional accuracy. Better
spatial resolution can be achieved by using more and smaller-size
PMTs.
v. The distance of the source-to-collimator can affect the spatial
resolution. More scattered radiation can pass through the collimator
holes when the source is farther away from the collimator, hence
reducing the spatial resolution.

9.6 SENSITIVITY
PROBLEM
a. Define the sensitivity of a gamma camera.
b. What are the factors affecting the sensitivity of a gamma camera?

Solution
a. The sensitivity of a gamma camera is defined as the number of
counts per unit time detected by the camera for each unit of activity
from a radioactive source (cps∙MBq−1).
b. The factors affecting the sensitivity of a gamma camera include the
geometric efficiency of the collimator, detection efficiency of the
detector, pulse height analyser (PHA) discrimination settings and
the dead time of the system.

9.7 COLLIMATOR EFFICIENCY

PROBLEM
a. Define collimator efficiency.
b. Discuss the factors affecting collimator efficiency.

Solution
a. Collimator efficiency is also known as geometric efficiency. It is
defined as the number of gamma ray photons passing through the
collimator holes per unit activity presents in a radioactive source.
 9 • Quality Control in Nuclear Medicine 117

For the parallel hole collimator, the collimator efficiency, Ec, is

calculated as the following:

d4
Ec = K ⋅
t ( d + a )2
2
e

where:
K = constant, which is a function of the shape and arrangement
of holes in the collimator. It varies between 0.24 for round
holes in a hexagonal array to 0.28 for square holes in a
square array.
d = hole diameter
te = effective length of the collimator hole
a = septal thickness
b. The collimator efficiency, Ec, for parallel-hole collimator increases
with increasing diameter of the collimator holes (d) and decreases
with increasing collimator thickness (t) and septa thickness (a). For
parallel-hole collimators, Ec is not affected by the source-to-detector
distance for an extended planar source. However, for other types of
collimators, Ec varies with the types of collimators as a function of
source-to-collimator distance.

9.8 COLLIMATOR RESOLUTION

PROBLEM
Figure 9.1 shows the spatial resolution expressed in FWHM versus source-to-
collimator distance for three different types of collimators. Name the collima-
tors labelled with A, B and C according to their sensitivity and resolution. Give
your reasoning for the answer.

Solution
A—Low-resolution collimator
B—Medium-resolution collimator
C—High-resolution collimator

For the same source-to-collimator distance, the low-resolution collimator has

a larger FWHM.
118 Problems and Solutions in Medical Physics

FIGURE 9.1 FWHM (mm) versus source-to-collimator distance (mm).

9.9 MODULATION TRANSFER

FUNCTION (MTF)
PROBLEM
a. What is the modulation transfer function (MTF) of an imaging
system?
b. If the photomultiplier tubes (PMTs) and pulse height analyser (PHA)
of a gamma camera system have MTFs of 0.6 and 0.8, respectively,
at a certain spatial resolution, what is the overall MTF of the system?
c. Figure 9.2 shows the plot of MTF against spatial frequency. Compare
the spatial resolution of systems A, B and C.

Solution
a. MTF of an imaging system is a plot of the imaging system’s modu-
lation versus spatial frequency, where modulation is essentially the
output contrast normalised by the input contrast. The principle of
MTF is illustrated in Figure 9.3.
 9 • Quality Control in Nuclear Medicine 119

FIGURE 9.2 Plot of MTF versus spatial frequency (cm−1).

FIGURE 9.3 Principle of MTF.

Consider a source has sinusoidal distribution with peaks (maximum

activity, Amax) and valleys (minimum activity, Amin), which give a
spatial frequency in cycles per mm. The contrast, or modulation, in
the source activity (Ms) is calculated as:

Amax − Amin
Ms =
Amax + Amin

As no imaging device is absolutely perfect, it represents the distri-

bution of activity in the image with Cmax for the peak and Cmin for
120 Problems and Solutions in Medical Physics

the valley, which are smaller in magnitude than the Amax and Amin.
Therefore, the modulation in the image (MI ) is given as:

Cmax − Cmin
MI =
Cmax + Cmin

The MTF at a spatial frequency, v, is then calculated as the ratio of

MI to MS:

MI
MTF(v) =
MS

b. MTF = MTF1 × MTF2 × MTF3 …

Therefore, the overall MTF of the system = 0.6 × 0.8 = 0.48
c. System A has the highest spatial resolution compared to sys-
tems B and C, and system B has higher spatial resolution than
system C.

9.10 MULTIENERGY SPATIAL

REGISTRATION
PROBLEM
a. Define multienergy spatial registration of a gamma camera system.
b. How is multienergy spatial registration assessed on a gamma camera?

Solution
a. Multienergy spatial registration is a measure of the camera’s ability
to maintain the same image magnification, regardless of the ener-
gies deposited in the crystal by the incident photons.
b. The multienergy spatial registration can be assessed by imaging
several point sources of Ga-67. Ga-67 has three useful photopeak
energies for imaging at 93, 184 and 300 keV. The source is placed
offset from the centre of the camera. Only one photopeak energy
is tested at a time. The centroid of the count distribution of each
source should be at the same position in the image for all three
energies.
 9 • Quality Control in Nuclear Medicine 121

9.11 COLD SPOT ARTEFACT

PROBLEM
List four factors that may contribute to the formation of a cold spot artefact in
a scintillation camera image.

Solution
i. Off-centred window setting on pulse height analyser
ii. Defective photomultiplier tube
iii. Metal in the field-of-view (metal-like jewellery)
iv. NaI crystal defect (such as a crack)

9.12 CENTRE OF ROTATION (COR)

PROBLEM
a. Illustrate with the aid of a diagram, the formation of image artefact
caused by misalignment of the centre of rotation (COR) in a single
photon emission computed tomography (SPECT) system.
b. What are the causes of COR misalignment?
c. Describe the methods to assess COR of a SPECT system and ways
to correct them.

Solution
a. Ideally, the COR of a SPECT system must be aligned exactly to the
centre, in the X-direction of all projection images (shown in the left
image in Figure 9.4). If the COR is misaligned and not corrected,
it may cause a loss of spatial resolution in the resultant transverse
images. If the misalignment is large, it can cause a point source to
appear like a ‘doughnut’ shape (as illustrated in Figure 9.4).
b. The causes of COR misalignments include improper shifting in camera
tuning (electronics), mechanics of the rotating gantry (e.g. the camera
head may not be exactly centred in the gantry, refer to Figure 9.5) and
misaligned attachment of the collimator to the detector.
c. COR can be assessed by placing a point or line source within the field-
of-view (FOV) of a camera with a collimator attached. The position
122 Problems and Solutions in Medical Physics

FIGURE 9.4 Formation of COR misalignment artefact.

FIGURE 9.5 Misalignment of COR due to mechanics of the rotating gantry.

of the source is off-centre (at some distance away from the central
axis of the detector). If a line source is used, it is placed parallel to the
axis of rotation (AOR). A set of projection images are then acquired
from different projection angles for 360° and stored in a 64 × 64
matrix. The position of the source along the X- and Y-axis from the
centre is then computed. The X-axis plot should give a symmetrical
bell-shaped curve, and the Y-axis plot should be a straight line pass-
ing through the pixel on which the source is positioned.
 9 • Quality Control in Nuclear Medicine 123

9.13 PARTIAL VOLUME EFFECT

PROBLEM
a. What is partial volume effect and how does this effect degrade the
quality of a gamma camera image?
b. Explain briefly how partial volume effect can be corrected.

Solution
a. Partial volume effect is the loss of apparent activity in small objects
or regions when the object partially occupies the sensitive volume
of the imaging device (in space or time). In gamma imaging, when
a hot spot relative to a ‘cold’ background is smaller than twice the
spatial resolution of the camera, the activity around the hot object
is smeared over a larger area (pixel in two dimensions [2D], and
voxel in three dimensions [3D]) than it occupies in the reconstructed
image. While the total counts are preserved, the object appears to be
larger and has a lower activity concentration than its actual value.
Analogously, a cold spot relative to a hot background would appear
smaller with higher activity around the object.
b. Partial volume effect can be corrected by applying a correction factor,
known as the recovery coefficient, on the image. The recovery coef-
ficient is the ratio of the reconstructed count density to the true count
density of the region of interest smaller than the spatial resolution of
the system. The recovery coefficient can be determined by measuring
the count densities of different objects containing the same activity but
with sizes larger and smaller than the spatial resolution of the system.
124 Problems and Solutions in Medical Physics

9.14 SPECT QUALITY

CONTROL PHANTOM
PROBLEM
Name one of the most common used multifunctional quality control (QC)
phantoms in SPECT. What are the QC tests that can be performed using this
phantom?

Solution
One of the most common used phantoms in SPECT QC is the ‘Jaszczak’
phantom. It can be used for semi-quantitative assessment of uniformity, spatial
resolution and image contrast of the system. This phantom may be filled with a
solution of the imaging radionuclide and is usually used for acceptance testing
and periodic QC testing of SPECT systems.
Radiation
Protection
in Nuclear
10
Medicine

10.1 RADIATION PROTECTION

TERMINOLOGY
PROBLEM
Define the following terms used in radiation protection aspects:

a. Equivalent dose (HT )

b. Effective dose (HE )
c. Committed equivalent dose (HT [50])
d. Deep dose equivalent (Hp [10])
e. Shallow dose equivalent (Hp [0.07])

Solution
a. Equivalent dose (HT ) is a measure of the radiation dose to tissue tak-
ing into consideration the different relative biological effects of dif-
ferent types of ionising radiation. The equivalent dose in tissue, T, is
given by the expression:

125
126 Problems and Solutions in Medical Physics

HT = ∑W ⋅ D
R T, R

where:
DT,R = absorbed dose averaged over the tissue or organ T, due to
radiation R
WR = radiation weighting factor due to radiation R

b. Effective dose (HE ) = sum of the weighted equivalent doses in all

the tissues and organs of the body. It is given by the expression:

HE = ∑W ⋅ H
T T

where:
HT = equivalent dose in tissue or organ T
W T = weighting factor for tissue T

c. Committed equivalent dose, HT (50), is the time integral of the

equivalent dose-rate in a specific tissue, T, following the intake of a
radionuclide into the body. Unless specified otherwise, an integra-
tion time of 50 years after intake is recommended for the occupa-
tional dose and 70 years for the members of the public.
d. Deep-dose equivalent (Hp [10]) is the dose equivalent at a tissue
depth of 1 cm (1000 mg·cm−2) due to external whole-body exposure
to ionising radiation.
e. Shallow-dose equivalent (Hp [0.07]) is the external exposure dose
equivalent to the skin or an extremity at a tissue depth of 0.07 mm
(7 mg·cm−2) averaged over an area of 1 cm2.

10.2 ANNUAL DOSE LIMITS

PROBLEM
State the annual dose limits (effective dose) for the following individuals as
recommended by the International Commission on Radiological Protection
(ICRP):

a. Radiation workers
b. Apprentices or students
c. Members of the public
 10 • Radiation Protection in Nuclear Medicine 127

Solution
a. 20 mSv per year, averaged over defined periods of five years, with
no single year exceeding 50 mSv.
b. 6 mSv per year.
c. 1 mSv per year.

10.3 CLASSIFICATION OF
RADIATION WORK AREAS
PROBLEM
Define the following classification of radiation work areas:

a. Clean area
b. Supervised area
c. Controlled area

Solution
a. Clean area is a work area where the annual dose received by a
worker is not likely to exceed the dose limit for a member of the
public, that is, 1 mSv·y−1.
b. Supervised area is a work area for which the occupational expo-
sure conditions are kept under review, even though specific protec-
tive measures and safety provision are not normally needed. The
area must be demarcated with radiation warning signs, and legible
notices must be clearly posted.
c. Controlled area is a work area where specific protection measures
and safety provisions could be required for controlling normal
exposures or preventing the spread of contamination during normal
working conditions and preventing or limiting the extent of poten-
tial exposures. Annual dose received by a worker in this area is
likely to exceed 3/10 of the annual occupational dose limit. The
area must be demarcated with radiation warning signs, and legible
notices must be clearly posted.
128 Problems and Solutions in Medical Physics

10.4 EXPOSURE RATE

PROBLEM
Calculate the exposure rate at 1 m from a vial containing 1110 MBq of
Tl-201, given that the exposure rate constant, Γ, of Tl-201 is 0.45 R·cm 2
(mCi·h)−1 at 1 cm.

Solution

ΓA
Exposure rate =
d2
where:
Γ = gamma constant (R·cm2 [mCi·h]−1)
A = activity of the source (mCi)
t = time (h)
d = distance from the source (cm)

Therefore,

cm 2  mCi 
0.45 R ⋅  1110 MBq × 
mCi ⋅ h  37 MBq 
Exposure rate = 2
(100 cm )
= 0.00135 R·h−1
= 1.35 mR·h−1

10.5 HALF VALUE LAYER (HVL)

PROBLEM
Calculate the number of half value layers (HVLs) and the thickness of lead
(Pb) required to reducing the exposure rate from a 370 GBq Ir-192 source
to less than 10 mR·h−1 at 1 m from the source, given that the exposure rate
constant, Γ, for Pb is 2.2 R·cm2 (mCi·h)−1 at 1 cm and the HVL is 3 mm.
 10 • Radiation Protection in Nuclear Medicine 129

Solution

R ⋅ cm 2  27 mCi 
2.2  370 GBq × 
mCi ⋅ h  GBq 
Exposure rate at 1 m =
(100 cm )2
= 2.198 R/h = 2198 mR·h−1
2198
mR⋅h −1 = 219.8 mR·h−1
10

A factor of 220 is required to reduce the exposure rate from 2198 to 10 mR·h−1.
In terms of HVL,

2n > 220

While 27 = 128 and 28 = 256, the number of HVLs required to reduce the
exposure rate to 10 mR·h−1 is 8.
Given that 1 HVL = 3 mm, therefore the thickness of Pb required to
reduce the exposure rate to 10 mR·h−1 is 8 × 3 mm = 24 mm.

10.6 ACCIDENTAL EXPOSURE

TO HIGH ACTIVITY SOURCE
PROBLEM
A nurse accidentally walked into a shielded room where a 3.7 TBq Ir-192
source was left exposed for testing purposes. The nurse was unaware of the
source, and she was standing approximately 1 m away from the source for
about 15 minutes. What is her estimated whole-body dose, given that the
gamma constant for Ir-192 is 1.3 mSv·h−1 at 1 cm per MBq?

Solution
An approximate dose from a small source can be calculated as following:

ΓAt
Dose =
d2
130 Problems and Solutions in Medical Physics

where:
Γ = gamma constant (mSv·cm2 [MBq·h]−1)
A = activity of the source (MBq)
t = time (h)
d = distance from the source (cm)

Therefore,

 h 
1.3
mSv
MBq ⋅ h
( 
)
3.7 ×106 MBq  15 min ×
60 min 
Dose = = 120 mSv
(100 cm )2
Note: Although this is an approximation, it is adequate given the usual uncer-
tainty with the individual’s exact distance from the source and the time spent near
it. While the radiation dose has exceeded the annual dose limit for a radiation
worker (20 mSv per year averaged for a period of five consecutive years), this
incident would result in no significant acute medical consequence to the person-
nel, as the acute radiation syndrome is only noticeable for a dose of approximately
2 Sv. Considering the stochastic effects, a dose of approximately 1 Sv would
increase the chance of cancer by 5% compared to the non-exposed population.

10.7 FOETAL DOSE CALCULATION FOR

HIGH-DOSE RADIONUCLIDE THERAPY
PROBLEM
A patient with thyroid carcinoma was administered with a diagnostic dose
of 185 MBq I-131 for a whole-body scan. Thyroid uptakes measured at 2 h
and 24 h are 5% and 24%, respectively. Three days later, a therapy dose of
2.035 GBq was administered. Percentage activities retained by the whole body
at 1 day and 2 days are 25% and 15%, respectively. The physical half-life of
I-131 is 8 days while the biological half-life is assumed to be 80 days.

a. Two weeks after the radioiodine therapy, the patient discovered that
she was pregnant. How would you estimate the gestation age?
b. Assuming that the foetus was four weeks old during the administra-
tion of I-131, what is the estimated dose to the foetus? Given that the
S-value (uterus ← thyroid) at 12th week is

3.70 × 10−17 Gy (Bq·s)−1

 10 • Radiation Protection in Nuclear Medicine 131

c. Based on the dose estimated in (b), do you advise termination of

pregnancy or continuation to full term? Give your justification.
d. If the pregnancy was discovered within 12 hours post-administration
of I-131, what would be your advice to reduce the foetal dose?

Solution
a. The gestation age can be estimated from the first day of the last
menstrual period (LMP) of the mother. If the LMP is unknown or
not regular, then the gestation age can be estimated using ultrasound
measurements of the foetus combined with the dates of first foetal
heart tones and other developmental milestones.
b. Effective half-life, Te = (Tp·Tb) (Tp + Tb)−1
= (8 d × 80 d) (8 d + 80 d)−1
= 7.3 d
= 63720 s

The cumulated activities, Ã, for different uptake fractions are calcu-

lated as following:

INITIAL
AT TIME ACTIVITY, FRACTION Ã = A0 ⋅ fh ⋅1.44Te
(h) A0 (Bq) UPTAKE, fh Te (s) (Bq·s)
2 1.85 × 108 0.05 1.44 630,720 8.40 × 1012
24 1.85 × 108 0.24 1.44 630,720 4.03 × 1013
24 2.04 × 109 0.25 1.44 630,720 4.62 × 1014
48 2.04 × 109 0.15 1.44 630,720 2.77 × 1014
Total à 7.88 × 1014

Hence, the total accumulated dose to the embryo up to 12th week is

estimated to be:

D = Ã.S
= (7.88 × 1014 Bq·s) (3.70 × 10−17 Gy[Bq·s]−1)
= 29.2 × 10−3 Gy
~30 mGy

c. I would not recommend termination of pregnancy for this patient.

The estimated threshold doses for the embryo and foetus as
132 Problems and Solutions in Medical Physics

recommended by the International Atomic Energy Agency (IAEA)

are shown in the table below:

THRESHOLD DOSE THRESHOLD DOSE

FOR LETHAL EFFECTS FOR MALFORMATIONS
AGE (mGy) (mGy)
1 day 100 No effect
14 days 250 —
18 days 500 250
20 days >500 250
50 days >1000 500
50 days to birth >1000 >500

The foetal dose estimated in this case is approximately 30 mGy

at age of ~16 days, which is lower than the threshold dose recom-
mended by the IAEA. Lethal effects and malformations of the foetus
are not expected. Furthermore, the foetal thyroid accumulates iodine
only after about 10 weeks of gestational age. The International
Commission on Radiological Protection (ICRP) also stated termina-
tion of pregnancy at foetal dose of less than 100 mGy is not justified
based upon radiation risk.
d. If the pregnancy was discovered within 12 hours post-administra-
tion of I-131, prompt oral administration of stable potassium iodide
to the mother is recommended to reduce foetal thyroid dose. This
may need to be repeated several times with the advice from the
nuclear medicine consultant.

Note: It is imperative to rule out pregnancy prior to the administration of

radioiodine therapy due to the potential detrimental side effects of foetal expo-
sure. The dose of I-131 in this particular case would be unlikely to result in
any deterministic effects. An accurate pregnancy screening protocol may be
warranted in preventing inadvertent I-131 treatment in early pregnancies. In
many countries, it is common practice to perform a pregnancy test prior to
high-dose I-131 scanning or therapy for women of childbearing age unless
there is a clear history of prior tubal ligation or hysterectomy precluding
pregnancy. It is unlikely that the inadvertent administration of a diagnostic
radiopharmaceutical to a pregnant patient would result in any action other
than patient counselling. As a result of good practice, it is extremely rare to
have to take any remedial action following the administration of therapeutic
radiopharmaceuticals.
 10 • Radiation Protection in Nuclear Medicine 133

10.8 RADIATION WORKERS

DURING PREGNANCY
PROBLEM
A nuclear medicine worker is concerned about radiation exposure during
her pregnancy. What would be your advice to the worker as well as to the
department?

Solution
For most nuclear medicine diagnostic procedures, there is no necessity for
pregnant staff to take any additional precautions other than limiting their
direct contact to the radioactive source. As the radiation exposure from the
patients who have been administered with radiopharmaceuticals is quite low,
there is no radiological reason for the pregnant worker to refrain from under-
taking the imaging procedures. According to the Basic Safety Standards,
notification of pregnancy shall not be considered a reason to exclude a female
worker from work. However, the pregnant worker should refrain from han-
dling the high-dose therapeutic radioactivities, such as I-131 therapy for thy-
roid cancer.

10.9 RADIATION WORKERS DOSE LIMIT

PROBLEM
A radiation worker receives a whole-body equivalent dose of 12 mSv, and
he is also exposed to radioiodine, which results in an equivalent dose of
80 mSv to the thyroid. What additional whole-body equivalent dose could
he still receive in order not to exceed the ICRP 103 recommendation dose
limit?

Solution
Effective dose = ∑wT HT

where:
wT = tissue weighting factor
HT = equivalent dose to organ tissue T
134 Problems and Solutions in Medical Physics

According to ICRP 103 recommendation:

wT for whole body exposure = 1

wT for thyroid = 0.04
Hence, the effective dose received by the radiation worker is:

∑wTHT = (1 × 12 mSv) + (0.04 × 80 mSv) = 15.2 mSv

The ICRP 103 recommendation dose limit for radiation workers is 20 mSv
per year.

20 mSv – 15.2 mSv = 4.8 mSv

Thus, the worker could still receive a whole-body equivalent dose of 4.8 mSv
in that particular year.

10.10 RADIOACTIVE WASTE

MANAGEMENT
PROBLEM
Describe different methods of radioactive waste disposal.

Solution
i. Decay storage: This method is usually used for radionuclides with
physical half-lives less than 120 days. The radionuclides are allowed
to decay in storage for a minimum period of 10 half-lives. After
10 half-lives, if the radioactivity cannot be distinguished from the
background activity, it can be disposed of in the normal waste after
removing all the radiation labels.
ii. Release into sewage drain system: A small amount of water-soluble
radioactive material may be disposed of in a designated sink, and
the total amount of activity does not exceed the regulatory limits.
Detailed records of all radioactive material disposals must be kept
for inspection by regulatory bodies. Radioactive excreta from
patients may be exempted from these limits and may be disposed
into the sanitary sewer. Items that are contaminated with radioactive
excreta (e.g. linen and diapers) have to follow the same limitations.
 10 • Radiation Protection in Nuclear Medicine 135

iii. Transfer of waste to an authorised recipient: This method is adopted

for long-lived radionuclides and usually involves the transfer of
radioactive waste to an authorised company for landfill or incinera-
tion at approved sites or facilities.
iv. Other disposal methods: The licensee may also adopt other disposal
methods that are approved by the regulatory bodies. The impact of
such methods on the environment, nearby facilities and the popula-
tion must be justified before approval. Incineration of solid radioactive
waste and carcasses of research animals containing radioactive mate-
rial is allowed by this method. Radioactive gases (e.g. Xe-133) can be
released by venting through a fume hood as long as their maximum
permissible concentration does not exceed the regulatory limits.

10.11 DECONTAMINATION PRINCIPLES

PROBLEM
Describe the principles used in decontamination techniques.

Solution
i. Choose wet decontamination over dry decontamination, because
the dry method could create airborne dust hazards.
ii. Use mild decontamination with non-abrasive agents first, as other
methods could damage the surface involved.
iii. Take precautions to prevent further spread of contamination during
decontamination operations.
iv. Isolate and separate contamination with short-lived activity to allow
it to decay naturally.

10.12 OUT-PATIENT ADVICE

PROBLEM
What advice would you give to out-patients who have undergone low-dose
I-131 treatment before leaving the hospital?
136 Problems and Solutions in Medical Physics

Solution
The following advice would be given to the patient:

• No drinking and eating during the first hour after treatment.

• Drink more water than usual during the following two days to stim-
ulate urinary excretion.
• Use only one toilet if possible, and flush two to three times after
each use.
• Wash hands frequently, and take a shower at least once a day.
• Avoid close contact with members of the family, especially children
and pregnant women.
• Use disposable products (e.g. paper cups, disposable utensils and
tissue paper) whenever possible.

10.13 RADIOIODINE WARD

NURSING STAFF
PROBLEM
From the radiation protection perspective, what would be your advice to
the nursing staff who are looking after the I-131 patients in radioiodine
therapy wards?

Solution
Advice to the nursing staff would include:

• Spend minimum time with the patients by planning ahead and

working efficiently.
• Work as far away as possible from the patients (inverse square law).
• Practice preventative measures against contamination, such as
wearing disposable gloves and protective aprons.
• Remove personal protection clothing before leaving the room.
 10 • Radiation Protection in Nuclear Medicine 137

10.14 HANDLING OF THE I-131

PATIENT AFTER DEATH
PROBLEM
What are the precautions that are needed in an event of the death of a patient
following I-131 treatment?

Solution
• According to the ICRP-94 recommendation, the activity limit
for burial and cremation of patients following I-131 treatment is
400 MBq.
• The preparation for burial or cremation should be supervised by a
competent authority or radiation protection officer (RPO).
• The funeral directors will need to be advised of any necessary pre-
cautions, and notification of the relevant competent authorities is
required.
• Relatives and friends should not be allowed to come into close con-
tact with the corpse.
• Clear communication is needed between the authorities, hospital
staff, funeral directors and the family members to ensure that ade-
quate controls are implemented without compromising dignity.
• All personnel involved in handling the corpse should be instructed
by the RPO and monitored.
• All objects, clothes, documents, etc. that might have been in contact
with the deceased must be monitored for any contamination.
• It may be expedient to wrap the corpse in waterproof material
immediately after death to prevent the spread of contaminated body
fluids.
• Embalming of the corpse should be avoided.
• Autopsy of a highly radioactive corpse should be avoided.
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