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 THE REQUISITES

NUCLEAR MEDICINE
AND MOLECULAR IMAGING
5th EDITION

JANIS P. O’MALLEY, MD, FACR Series Editor

Professor of Radiology
University of Alabama at Birmingham JAMES H. THRALL, MD
Division of Molecular Imaging & Therapeutics Radiologist-in-Chief Emeritus
Birmingham, Alabama Massachusetts General Hospital
Distinguished Juan M. Taveras Professor of
Radiology
HARVEY A. ZIESSMAN, MD Harvard Medical School
Professor of Radiology Boston, Massachusetts
Division of Nuclear Medicine and Molecular Imaging
The Johns Hopkins University
Baltimore, Maryland
Elsevier
1600 John F. Kennedy Blvd.
Ste 1800
Philadelphia, PA 19103-2899

NUCLEAR MEDICINE AND MOLECULAR IMAGING:

THE REQUISITES, 5th EDITION ISBN: 978-0-323-530378
Copyright © 2021, Elsevier Inc. All rights reserved.
2014, 2006, 2001, 1995 by Mosby, Inc., an affiliate of Elsevier Inc.

No part of this publication may be reproduced or transmitted in any form or by any means, electronic or
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en our understanding, changes in research methods, professional practices, or medical treatment may
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3 2 1
 CONTRIBUTOR

Frederic H. Fahey, DSc

Director of Nuclear Medicine/PET Physics, Department of Radiology,
Boston Children’s Hospital, Boston; Professor, Department of
Radiology, Harvard Medical School, Boston, Massachusetts
Chapter 1: Radioactivity and Radionuclides;
Chapter 2: Radiation Detection and Ancillary Instrumentation;
Chapter 3: Single-Photon Emission Tomography, Positron Emission
Computed Tomography, and Hybrid Imaging

iii
F OR EWOR D

Nuclear Medicine and Molecular Imaging: The Requisites is a new Readers of Nuclear Medicine and Molecular Imaging: The Requi-
title for this well-received text now appearing its fifth edition. sites will feel this vitality almost palpably as they work their way
The change in title reflects the remarkable advances in trac- through the book. In particular, PET and PET/CT have become
er-based medical imaging that have taken place over the last two cornerstones in cancer diagnosis and management with PET/
decades. These advances have clearly extended the diagnostic MRI becoming more important in both cancer diagnosis and
utility and value of nuclear medicine and molecular imaging in neurological studies.
clinical patient care. The Requisites in Radiology titles have now become old
Predictably much of the fifth edition of Nuclear Medicine and friends to generations of radiologists. The original intent of the
Molecular Imaging: The Requisites is focused on new molecular series was to provide the resident or fellow with a text that might
imaging methods and the latest advances in their clinical appli- be reasonably read within several days at the beginning of each
cation including positron emission tomography (PET), SPECT/ subspecialty rotation and perhaps reread several times during
CT, PET/CT and PET/MRI hybrid imaging. The intense interest subsequent rotations or during board preparation. The series is
in hybrid imaging provides clear recognition of the increased not intended to be exhaustive but rather to provide the basic
value now placed on functional and molecular information in conceptual, factual, and interpretive material required for clin-
disease diagnosis. ical practice. After more than 30 years of experience with the
Although retitled, Nuclear Medicine and Molecular Imaging: series, it is now clear that the books are also sought out by prac-
The Requisites continues to follow the format of the first four ticing imaging specialists for the efficiency of their presenta-
editions. The basic science chapters are designed to present tion format and the quality of their material. With more people
important principles of physics, instrumentation, and nuclear reaching the point of requiring re-certification, the Requisites
pharmacy in the context of how they help shape clinical prac- books are again proving helpful.
tice. The physics content of the fifth edition has been expanded The first four editions of Nuclear Medicine and Molecular
and integrated to reflect current technology. Topics on regula- Imaging: The Requisites were well received in the radiology
tory issues, radiation safety and quality control have been added and nuclear medicine community. For the retitled fifth edi-
as well as material on the “non-interpretive” aspects of nuclear tion, Dr. Janis M. O’Malley and Dr. Harvey A. Ziessman have
medicine and molecular imaging practice. again done a terrific job in putting together this substantially
The clinical chapters continue to follow a logical progression updated edition. Congratulations to them. I expect that this
from basic principles of tracer distribution and localization to fifth edition will be deemed to be even more outstanding than
practical clinical applications. Knowledge of how radiopharma- its predecessors.
ceuticals localize temporally and spatially in normal and dis- We hope that Nuclear Medicine and Molecular Imaging: The
eased tissues is the best deductive tool available for analyzing Requisites will serve residents in radiology as a concise and
images. The best use of new tracers such as Ga-68 DOTA, the useful introduction to the subject and will also serve as a very
F-18 amyloid agents and F-18 PMSA agents requires this kind manageable text for review by fellows and practicing nuclear
of knowledge of the underlying mechanisms of disease and medicine specialists and radiologists.
therewith tracer localization. James H. Thrall, MD
Adding new tracers and new SPECT, PET, PET/CT, and Radiologist-in-Chief Emeritus, Massachusetts General Hospital
PET/MRI applications to the nuclear medicine armamentar- Distinguished Juan M. Taveras Professor of Radiology, Harvard
ium has injected new, unprecedented, vitality into the specialty. Medical School, Boston, Massachusetts

iv
P R E FA C E T O T H E 5 T H E D I T I O N
OF THE REQUISITES, NUCLEAR
MEDICINE

This is the 5th edition of Nuclear Medicine: The Requisites. How- agents highlighted. The popular chapter, “Pearls, Pitfalls, and
ever, we are now titled Nuclear Medicine and Molecular Imaging: Frequently Asked Questions,” again provides an excellent con-
The Requisites. We are deeply indebted to Dr. James H. Thrall for cluding summary. Protocols and key facts are again organized
developing the concept of the Requisite series and his involve- in many boxes and tables for easy identification.
ment as a coauthor of Nuclear Medicine: The Requisites for the Over the years, it has been an honor to help guide and train
first four editions, in 1995, 2001, 2006, and 2014. Since the last the most incredibly gifted physicians and introduce them to
edition, there have been many exciting changes in the field, par- the incredible field of nuclear medicine. Our students have
ticularly concerning new PET agents and therapy techniques. also taught us a lot along the way, and their feedback has been
The 5th edition builds on the success of the prior editions, pro- essential as we continue to strive to improve as educators. In
viding a concise, easy to read review that is suitable not only for addition, hearing from colleagues around the globe how the text
radiology and nuclear medicine residents and fellows preparing has helped them or their trainees has been another wonderful
for their service rotations or board exams but also serves a use- way to continue developing new material. Hopefully, our expe-
ful tool for those in practice at all levels of expertise, particularly riences are reflected here and provide a foundation for another
when targeting knowledge gaps during maintenance of board successful text.
certification reviews.
All chapters have been significantly updated and contain
numerous stunning new images. The first section of the book
ACKNOWLEDGEMENTS
is again devoted to technical matters: basic principles and con- We would like to thank those who have contributed to the
cepts of radiation production, instrumentation and detection, preparation of this book. Selected images were provided by:
radiopharmaceuticals and quality control, radiation safety, and Suzanne Lapi, PhD; Kirk Fry, MD, PhD; Jonathon McConathy,
regulatory matters. New topics have been introduced including MD, PhD; Steven P Rowe, MD, Bital Savir Baruch MD, Corina
PET/MR, and important facts the Authorized Users of radio- M Millo, MD; Khun Visith Keu, MD; Lauren L Radford, PhD;
pharmaceuticals are highlighted. The second section of the Mark Muzi, PhD; Les Foto; Farrokh Dehdashti, MD; and Hong-
book is focused on clinical imaging and therapy, emphasizing gang Liu. Hong-gang Liu also produced some of graphics in
physiological mechanisms and pharmacokinetics. Because animated images. Suzy Lapi and Jon McConathy helped with
of the rapid progress in oncology, particularly in the areas of editing the chapters on brain imaging and Molecular Imaging.
prostate cancer and neuroendocrine tumor imaging and treat- We would also like to thank our spouses and family for all
ment, these section have been extensively updated with import- their support during our work on each of these editions.
ant details on the use of newly approved imaging and therapy Janis O’Malley thanks her mom, Lanis Petrik.

v
PART 1 Basic Principles 10 Gastrointestinal System, 220
11 Urinary Tract. 256
1 Radioactivity and Radionuclides, 1
12 Oncology: F-18 Fluorodeoxyglucose Positron
2 Radiation Detection & Ancillary Instrumentation, 14
Emission Tomography, 288
3 Single-Photon Emission Computed Tomography, Positron
13 Oncology-Beyond Fluorodeoxyglucose, 339
Emission Tomography, and Hybrid Imaging, 28
14 Central Nervous System, 364
4 Radiopharmaceuticals, 42
15 Inflammation and Infection, 409
5 Molecular Imaging, 64
16 Cardiovascular System, 441
17 Pearls, Pitfalls, and Frequently Asked Questions, 480
PART 2 Clinical Studies
6 The Skeletal System, 75
Appendix 1: Dosimet ry, 493
7 The Pulmonary System, 125
Appendix 2: The Periodic Table of the Elements, 495
Index, 496
8 Endocrine System, 152
9 Hepatic, Biliary, and Splenic Scintigraphy, 180

vi
 PART 1 Basic Principles

1
Radioactivity and Radionuclides

In nuclear medicine, radiopharmaceuticals given to the patient Elements are organized in the periodic table of the elements
emit the radiation used to create images or perform therapy. In (see Appendix 2). All atoms of the same element have the same
order to understand how these agents perform and what safety number of protons. The proton number is also referred to as the
considerations are involved in their use, it is necessary to be famil- atomic number or Z. Thus, all carbon atoms have 6 protons, all oxy-
iar with some basic aspects of the physics behind radioactive decay. gen atoms have 8 protons, and all iodine atoms have 53 protons—
This chapter discusses radioactive molecules, different types of that is, they have Z numbers of 6, 8, and 53, respectively. Atoms of
radioactive decay, and how these emissions interact with matter. a particular element can, however, have a varying number of neu-
trons (referred to as the neutron number, N). For example, in addi-
ATOMIC STRUCTURE OF MATTER tion to their 8 protons, some oxygen atoms have 8 neutrons, and
others have 7 or 10 neutrons. The total number of nucleons (Z plus
Electronic Structure of the Nucleus N) is known as the atomic mass or atomic number, A. Therefore, in
All matter is made up of atoms, which in turn are made up of the oxygen example, A would be 15, 16, and 18 for atoms that have
protons, electrons, and neutrons. Positively charged protons 8 protons plus 7, 8, or 10 neutrons, respectively.
and uncharged neutrons have a similar mass and are known as Unlike an element, which is characterized only by its number
nucleons because they are located in the nucleus. Although of protons (Z), a nuclide is a nuclear entity characterized by a
much less massive, electrons orbiting the nucleus possess an certain nuclear composition of protons and neutrons as well as
opposite negative charge equal in magnitude to that of the pro- a certain energy level. Shorthand notation has been agreed on to
tons (Table 1.1). Some properties of atomic particles are listed, describe the makeup of specific nuclides:
along with important constant values, in Table 1.2.
Atomic mass Element
The attraction of the opposite charges keeping the electron in
orbit around the nucleus is known as an electrostatic force (or A
ZX N
coulombic force; the coulomb is the unit for electric charge). On
the other hand, there is also a repulsive, electrostatic force in the
nucleus from the like-charged protons pushing apart. The Proton number Neutron number
nucleus is held together by the attractive strong nuclear force
each nucleon exerts on the other nucleons. Although more To illustrate this, consider the element iodine, which has 53
powerful than electrical forces, these strong forces act only over protons (Z = 53). If one particular nuclide of the element iodine
extremely short distances. The actual atomic mass is less than has 78 neutrons (N = 78), the atomic mass (A) of 53 + 78 equals
the sum of the masses of all its nucleons. This difference in mass, 131. It can be written as:
or mass deficit, is manifest in the nuclear binding energy hold-
A
ing the nucleus together (as related by the equation E = mc2).
131
I
53 78
TABLE 1.1 Properties of Atomic Particles Z
Mass N
Particle Charge (amu or u)a Mass (MeV)b Mass (kg)
Because the atomic number can be inferred by the element’s
Proton +1 1.0073 938.21 1.673 × 10–27
symbol, and N = A – Z, this can be shortened:
Neutron 0 1.0087 939.51 1.675 × 10–27
Electron –1 0.000549 0.511 9.11 × 10–31 131 131 131
I I I
53 78 78
aOne amu = 1.661 × 10–27 kg or 1/12 atomic mass carbon (1 nucleon
from carbon-12 atom). This can also be written as I-131 or iodine-131. The term iso-
bEnergy as related by E = mc2.
tope describes nuclides of the same element, that is, nuclides
1
2 PART 1 Basic Principles

TABLE 1.2 Summary of Physical Constants BOX 1.1 Important Terms Related
Unit of charge 1 amp·sec to Atomic Matter
Coulomb (C) 6.24 × 1018 electrons Nucleon—components of the atomic nucleus: protons and neutrons
Electron volt (eV) 1.602 × 10–19 J Atomic number Number of protons, or Z
Charge of 1 electron –1.6 × 10–19 C Neutron number Number of neutrons, or N
Charge of 1 proton + 1.6 × 10–19 C Atomic mass Sum of the nucleons—protons and neutrons (Z + N)—or
Planck’s constant (h) 6.63 × 10–34 m2·kg/s atomic number or A
Elements Atoms with the same number of protons (Z)
Avogadro’s number 6.02 × 1023 molecules/g·mole
Nuclides Nuclear entity comprised of a particular number of protons
Calorie (cal) 4.2 Joules (Z) and neutrons (N) as well as energy state of the
Speed of light in a vacuum 3.0 × 108 m/sec nucleus
Angstrom (Å) 10–10 m Radionuclides Unstable nuclides: isotopes emitting radiation attempting
to reach stability
Isotopes Atoms with the same number of protons: P for proton,
with the same number of protons (Z) but potentially differing P for isotope.
atomic numbers. Radioisotopes are isotopes that undergo radio- Isotones Atoms with the same number of neutrons: N for isotone
active decay. For example, some common isotopes of iodine are Isobars Atoms with the same atomic number A: A for isobar
as follows: Isomer Nuclide with same Z and N (so same A) but a different
energy level
131
I I
125
I
124 123
I
53 78 , 53 72, 53 71, 53 70
M for metastable; M for isomer.
In medicine, different isotopes have varying properties, such
as the types of radiation they emit and how long they remain
radioactive, which can determine their usefulness. For example,
the beta and high-energy gamma emitter 131I (I-131) is used for
treating thyroid cancer and performing thyroid uptake mea-
surements; 125I (I-125), a low-energy gamma and x-ray emitter,
is used in biological assays and prostate cancer brachytherapy;
124I (I-124), a positron emitter, can image thyroid cancer with a

positron emission tomography (PET) scanner; and 123I, a mod-

erate-energy gamma emitter, is very commonly used to image
benign thyroid diseases and thyroid cancers as well as to calcu- N M L K Nucleus
Z = 19
late thyroid activity (radioactive iodine uptake).
In addition to isotopes, other special terms include isotones,
nuclides with the same number of neutrons
(e.g.,148 O, 137 N, 126 C where N = 6); and isobars, those with simi-
lar atomic mass numbers (e.g., 14O, 14N, 14C). Nuclides that
have the same Z and N numbers (and, therefore, A) but differ in
their energy states are called isomers. A well-known example of
an isomer in nuclear medicine is technetium-99 (Tc-99) and its
metastable state technetium-99m (Tc-99m). Several key terms
Fig. 1.1 Bohr model diagram of the potassium atom. Potassium has an
to know concerning atomic structure are listed in Box 1.1. atomic (Z) number of 19; that is, it has 19 protons in the nucleus and 19
orbital electrons.
Structure of the Orbital Electrons
Our understanding of the atom has evolved, but it is still useful ELECTROMAGNETIC RADIATION
to picture the classic Bohr atom (Fig. 1.1) with electrons arrang-
ing themselves into discrete orbital shells (Table 1.3). The inner- Electromagnetic (EM) radiations, such as visible light, have
most shell is referred to as the K shell, and subsequent shells are long been known to have a duality to their nature: behaving in
referred to as L, M, N, O, and beyond. Each shell holds only a set some situations as a wave and in others as a particle, or photon.
maximum number of electrons, given by 2n2, where n is the The EM spectrum (Fig. 1.3) varies in wavelength and frequency,
shell number). Based on this, for example, the K shell (n = 1) from low-energy radio waves up to high-energy x-rays and
contains 2 electrons, and the L shell (n = 2) has 8. gamma (γ) rays as used in medical imaging and therapy.
Because electrons are bound by the electrical forces, energy The unit of energy typically used in atomic and nuclear phys-
is required to remove an electron from an atom. This orbital ics is the electron volt (eV), which is the amount of energy an
binding energy (BE) is characteristic for each particular atom, electron garners when crossing an electronic potential difference
depending on its Z number, as well as which shell is involved of 1 volt. One eV is equivalent to 1.6 × 10–9 joules. EM radiations
(i.e., it is harder to remove an inner-shell electron than an out- travel at the speed of light (c) with the known relationship:
er-shell electron; Fig. 1.2). c = vλ
 Chapter 1 Radioactivity and Radionuclides 3

TABLE 1.3 Terms Used to Describe where ν is frequency, λ is the wavelength, and c = 3 × 108 m/s.
Electrons The photon energy (E) is related to the frequency of the EM
wave by
Term Comment
Electron Basic elementary particle E = hv
Orbital electron Electron in one of the shells or orbits in an atom where h is Planck’s constant (6.626 × 10–34 J/s)
Electron in the outermost shell of an atom; responsible
Valence electron for chemical characteristics and reactivity Relating these equations, v = c so E = hc , thus:
Electron ejected from an atomic orbit by energy
Auger electron released during an electron transition 12.4
E (keV) = with the λ measured in angstroms Å .
Electron ejected from an atomic orbit because of Å
internal conversion phenomenon as energy is given
Conversion electron off by an unstable nucleus Visible light has energy slightly less than 1 eV, whereas x-rays
Electron ejected from an atomic orbit as a conse- and gamma rays have energies in the range of several thousand
quence of an interaction with a photon (photoelectric eV (or keV) to tens of millions eV (MeV).
interaction) and complete absorption of the photon’s
X-rays and gamma-ray photons do not differ in their energy
Photoelectron energy
levels but in their origin. X-rays are generated from interactions
Electron ejected from orbit after absorbing a portion of
outside the nucleus, whereas gamma rays are generated by tran-
Compton electron a photon’s energy during Compton scatter
sitions within the nucleus. Once created, nothing distinguishes
an x-ray from a gamma ray (e.g., A 100-keV x-ray is absolutely
identical and indistinguishable from a 100-keV gamma ray).
Potential Binding
Energy Energy Production of X-Rays
orbital shell
X-rays are produced in two ways: (1) as a result of the transition
Highest Lowest of atomic electrons from one orbit to another and (2) from the
N
deacceleration of passing charged particles as they interact with
other charged particles, usually as a result of columbic electrical
M
interactions.
L
Characteristic X-Rays
In the first instance, excited electrons may be removed from their
K
atomic orbit or elevated to a higher-energy orbit. An electron from
an outer orbit can drop down to fill the vacancy, and the excess
energy, the difference in the binding energy of the shells, can be
nucleus emitted as an x-ray photon, a fluorescent x-ray (Fig. 1.4A). This is
also known as a characteristic x-ray because it is specific to not only
each element but also to the orbital shell from which it originated.
Lowest Highest Consider the case of fluorescent or characteristic x-rays from elec-
Fig. 1.2 Orbital binding energy. tronic transitions within an iodine atom with the following binding

Photon energy 106 103 100 101 106 1010

electron Volt (eV) 1MeV 1keV 1eV

Increasing Wavelength

0.0001 nm 0.01 nm 10 nm 1000 nm 0.01 cm 1 cm 1m 100 m

Ultra-
Gamma rays X-rays Infrared Radio waves
violet
Radar TV FM AM

Visible light
Fig. 1.3 Electromagnetic energy spectrum. Photon energies (eV) and wavelengths of x-rays and gamma
ultraviolet, visible light, infrared, and radio waves.
4 PART 1 Basic Principles

Characteristic
Orbital Orbital energy transfer
X-ray
electron electron
vacancy e- vacancy e-

e- e-
M L K n e- M L K n Auger
electron

A B
Fig. 1.4 Interactions may result in (A, left) emission of characteristic (fluorescent) x-rays or (B, right) Auger
electrons.

energies: K = 35, L = 5, and M = 1 keV. Thus, the energy of the flu- 160
orescent x-rays resulting from the transition of electrons from the L Neutron rich
to the K shell (referred to as Kα fluorescent x-rays) is 30 keV 140 (Beta minus decay) Proton rich
(35 − 5 keV) and that from the transition from the M to the K shell
(referred to as Kβ x-rays) is 34 keV (35 − 1 keV). (Electron
capture
120 and
Auger Electrons positron
decay)
There is an alternative outcome to characteristic x-ray emission, 100
where the transition can cause an outer-shell electron to be ejected.

”
ility
This electron is called an Auger (pronounced oh-zhey) electron
Neutron number N

tab
80
(see Fig. 1.4B). The kinetic energy (KE) of the resultant Auger elec-

f “s
tron is determined by the binding energy of the orbits involved:

eo

N
Lin
60


KEAuger = BEInner − BEOuter − BEAuger

Z
Using the example of the iodine atom binding energies again for
40
the transitions shown in Fig. 1.4B, the calculation would then be:
KEAuger = BEK shell − BEL shell − BEM shell
20
= 35keV − 5keV − 1keV = 29keV
The probability of an Auger electron being emitted is greater
in lower Z elements and from outer shells where the binding 0
energy is lower. X-ray fluorescence, on the other hand, is the 20 40 60 80 100
more likely outcome when binding energy is higher, such as in Atomic number Z
higher Z elements and from inner-shell electrons. Fig. 1.5 Graph of neutrons (N) versus protons (P) for various nuclides. For
elements with a low atomic number, the two are roughly equal (Z = N).
Particle Deceleration and Bremsstrahlung X-Rays With increasing atomic number, the relative number of neutrons increases.
Stable nuclear species tend to occur along the “curve of stability.”
X-rays can also be produced as a charged particle deaccelerates
as it passes an atom. In nuclear medicine, this commonly
involves electrons or beta particles passing through soft tissue.
RADIOACTIVITY AND RADIOACTIVE DECAY
In this case, the negatively charged particle is slowed as it inter- The protons and neutrons can only exist in the nucleus in a
acts with the positively charged nucleus it is passing, causing it limited number of combinations. The remaining unstable
to slow. The energy it loses is emitted as radiation referred to as atoms may transform to a lower-energy stable state through
bremsstrahlung (from the German for “braking”) radiation. The radioactive decay (or disintegration), with the excess energy
magnitude of the bremsstrahlung production increases linearly resulting in either particulate emissions or electromagnetic
with the kinetic energy of the incident electron and the Z num- radiation. The initial nuclide, or radionuclide, is known as the
ber of the target material. Thus, bremsstrahlung x-ray produc- parent, and the resultant one after radioactive decay is known
tion is more likely to occur at higher energies and with high-Z as the daughter. Although the daughter nucleus created from a
targets. As a result, radiographic systems can generate x-rays by radioactive decay has a lower energy than the parent nucleus,
directing an energetic electron beam into a tungsten (Z = 74) it may not be stable, and thus subsequent radioactive decays
target. On the other hand, the intensity of the bremsstrahlung may result.
radiation is relatively low when beta particles pass through soft Fig. 1.5 shows a plot of the stable nuclides as a function of
tissue. the Z number on the x-axis and the N number on the y-axis. At
 Chapter 1 Radioactivity and Radionuclides 5

B C
Fig. 1.6 “Proton-rich” radionuclides that decay by positron emission can be made in a cyclotron or particle
accelerator. (A) Varying in size and appearance, cyclotrons may be self-shielded or housed in a thick cement
vault (as shown) to reduce radiation exposure. Beam lines (arrow) extending from the central unit direct high-
speed charged particles to bombard desired targets. (B) The bottom of the cyclotron contains the accelerating
electrodes (short arrows). (C) Electromagnetic fields created by a large magnet (arrowhead) in the upper por-
tion of the cyclotron constrain the particles to circular orbits. (Photos courtesy of Anthony F. Zagar, University
of Alabama at Birmingham.)

low Z numbers, stable elements tend to have equal numbers of Proton-rich radionuclides can be created by bombarding a cer-
protons and neutrons (e.g., carbon-12, nitrogen-14, and oxy- tain target material with high-energy protons that can overcome
gen-16) and lie along or near the Z = N line. However, as the nuclear forces. Typically, a particle accelerator such as a cyclotron is
nucleus becomes larger, the repulsive force of the nuclear pro- used, increasing kinetic energy by accelerating charged particles to
tons grows, and more neutrons are necessary in the stable high speeds in a spiral path using alternating high-frequency volt-
nucleus to provide additional attractive nuclear force. Other age and electromagnetic fields (Fig. 1.6). Conversely, in artificial
factors also contribute to the stability and instability of the production of neutron-rich radionuclides, one typically must use a
nucleus. For example, nuclides with even numbers of protons nuclear reactor to bombard a target with a neutron flux (Fig. 1.7).
and neutrons tend to be more stable than those with odd Z and
N configurations. Modes of Radioactive Decay
Unstable nuclides fall to either the right or the left of the A decay scheme is a way to illustrate the transition from parent
curve of stability, with those to the right considered proton rich to daughter nuclides. In a decay scheme, higher energy levels
and those to the left neutron rich. As unstable radionuclides are toward the top of the figure, and higher Z numbers are to the
decay to entities that are closer to the curve of stability, pro- right of the figure. Transitions that lead to a reduction in energy
ton-rich radionuclides tend to decay in a manner that will are represented by an arrow pointing down. If it also results in a
reduce the Z number and increase the N number, and neu- daughter nuclide with a change in the Z number, the arrow will
tron-rich radionuclides tend to decay in a way that decreases the point to the left with a decrease in the Z number and to the right
N number and increases the Z number. if Z is increased.
6 PART 1 Basic Principles

Alpha Decay
An unstable heavy atom may decay to a nuclide closer to the
curve of stability by emitting an alpha particle (α) consisting of
2 protons and 2 neutrons (essentially an ionized helium atom):
A A −4 A −4 4
Z
X→ Z−2Y + α = Z−2Yjo 9 + 2 He

The daughter nucleus may not be stable, and thus the emis-
sion of an alpha particle often will lead to the emission of a
series of radiations until the nucleus is stable. The decay scheme
for the decay of radium-226 (Ra-226) to radon-222 (Rn-222) is
shown in Fig. 1.8.

Beta-Minus Decay
Neutron-rich radionuclides tend to stabilize by decreasing
the number of neutrons through a radioactive-decay process
referred to as beta-minus (β–), also known as negatron or
beta decay. Factors such as weak forces between nucleons
transfer energy, transforming a neutron into a proton (N – 1
and Z + 1). This is an isobaric transition with no change to
Fig. 1.7 Fission and neutron capture radionuclide production in a nuclear
the atomic mass (A). An example of the beta-minus decay
reactor. Samples can be lowered into the reactor as shown, with water scheme for I-131 is shown in Fig. 1.9. Excess energy is emit-
acting as shielding against neutrons. The blue glow is caused by the ted from the nucleus as an antineutrino and a negative beta
emission of electrons from the radioactive products; when charged par- particle (or negatron). This process can be written as
ticles move faster than the speed of light in a medium such as water, follows:
the emitted radiation is called Cherenkov radiation. (Courtesy of the Uni-
A A
versity of Missouri Research Reactor Center.) X
Z N
= Z+1YN−1 + β − + −υ antineutrino

226
Ra (1600 yr)
88

448 keV


2
186 keV


1

222
Rn (3.8 days)
86
Fig. 1.8 Alpha decay. The emission of an alpha particle (2 protons and 2 neutrons) results in the atomic
number (Z) decreasing by 2 and the atomic mass (Z + N) decreasing by 4. Decay of radium-226 to the daugh-
ter Rn-222 shows the arrow pointed down, indicating a decrease in energy, and to the left because of the
decrease in Z.
 Chapter 1 Radioactivity and Radionuclides 7

131 18
I (8 days)
53 9 F (110 min)


364 keV


 (81%)

18
8O (stable)
131 Fig. 1.10 Positron (β+) decay results in a loss of 1 proton (Z – 1) in pro-
Xe (stable)
54 ton-rich radionuclides. Because 1 neutron is gained, the atomic mass of
Fig. 1.9 Beta minus (β –) decay scheme for iodine-131 to the daughter the daughter is unchanged, another example of isobaric transition. F-18
Xe-133. β– decay (negatron emission) results in the daughter with one decay by positron emission results in the daughter product, O-18. The
more proton in the nucleus (Z + 1), so the arrow points to the right. arrow points down and to the left, indicating the decrease in Z.
Because a neutron is lost (N – 1), this is an isobaric transition with the
atomic mass unchanged.
201
81Tl (73 hr)
The antineutrino is very difficult to measure because it has
virtually no mass or charge associated with it, only energy. The
negative beta particle is indistinguishable from an electron
with the same mass and electric charge, differing only in that EC
the beta particle is emitted from the nucleus and the electron
orbits the nucleus. In addition to the Mo-99 used to make
Tc-99m, several β–-emitting radionuclides play an important
167 keV
role in nuclear medicine for therapy applications: I-131, phos-
 (3%)
phorus-32 (P-32), yttrium-90 (Y-90), and lutetium-177 32 keV
 (10%)
(Lu-177).
201
Beta-Plus (Positron) Decay 80 Hg (stable)
Unstable proton-rich radionuclides can reduce Z and increase Fig. 1.11 Electron capture is an alternate transition that can occur to
N numbers through either beta-plus decay or electron capture. In reduce the proton number and does not require that an energy thresh-
beta-plus decay, the parent nucleus emits a positively charged old be met. Tl-201 decays by electron capture, with the daughter (Hg-
beta particle, a positron (β+). The resulting daughter nucleus has 201) containing one fewer proton (Z – 1) than the parent.
one fewer proton and one more neutron than the parent, an iso-
baric transition: Electron Capture. An alternative to beta-plus decay for
A A proton-rich radionuclides is electron capture (EC). In this
X = Y
Z N Z−1 N+1
+ β + + υ neutrino process, an inner-shell, orbital electron is absorbed into the
average β + kinetic energy: Eβ + ≈ Emax /3 nucleus, leading to the reduction of Z and increase of N by 1.
The positron has the same mass as a beta-minus particle or However, no energy threshold exists for EC to occur. In cases in
electron, with a charge of the same magnitude but the opposite. which the transition energy is less than the 1022-keV threshold,
In fact, the positron is the antiparticle of the electron; if they are EC is the only possible decay process, but either process is
brought into close contact, they will be annihilated and trans- possible when the energy is greater than 1022 keV. For F-18,
formed into two 511-keV photons, traveling at 180 degrees in positron decay occurs 97% of the time, and EC occurs 3% of the
opposite directions. This annihilation process is the basis of time. The capture of an orbital electron leads to an inner-shell
PET imaging. The 511-keV value derives from the energy equiv- vacancy, which in turn leads to the emission of fluorescent
alence of the mass of the beta particle, similar to the rest mass of x-rays or Auger electrons. Radionuclides that decay through EC
an electron (using E = mc2 as previously discussed). exclusively include thallium-201 (Tl-201; Fig. 1.11), gallium-67
For positron decay to occur, the transition energy must be in (Ga-67), and indium-111 (In-111). These are all produced in a
excess of a 1022-keV threshold (twice 511 keV) to overcome the cyclotron.
production of the positron and addition of an orbital electron to Isomeric Transition. In some cases, an excited radionuclide
maintain electric neutrality. These radionuclides are typically decays from one energy level to another while retaining the
produced using a cyclotron. Some positron-emitting radionu- same Z and N numbers. This is referred to as an isomeric
clides of interest include fluorine-18 (F-18; Fig. 1.10), nitro- transition because the nuclide decays from one isomer (energy
gen-13 (N-13), carbon-11 (C-11), gallium-68 (Ga-68), and level) to another. This transition may result in the emission of a
rubidium-82 (Rb-82). gamma ray, the energy of which is determined by the energy
8 PART 1 Basic Principles

99m reciprocal of Tm, the fraction of the radioactive atoms that decay
43 Tc (6.01 hr) per unit time, is referred to as the decay constant, λ:
1
λ=
Tm
Thus, the number of atoms (dN) that decay in a short time
 140.5 keV (89%) interval (dt) is given by:
dN = λdt
Integrating this equation over time leads to:
N = N0e−λt
where N0 is the initial number of radioactive atoms, and N is the
99 number remaining after some time, t.
43 Tc This equation describes exponential decay in which a certain
Fig. 1.12 Isomeric transitions involve a change in the energy state of a fraction of the material is lost in a set period. This fraction is
radionuclide, such as Tc-99m to Tc-99.
referred to as the decay fraction, DF:

99 DF = e−λt
42Mo (2.8 days or 66 hr)
Thus, the number of radioactive atoms remaining, N, is also
given by:

N = N0 × DF
142.7 keV
Also, Nd is the number of atoms that have decayed in time, t,
 140.5 keV
and can be calculated with:
 Nd = N0 × (1 − DF)
0.0
The time necessary for half of the material to decay is defined
99 5 as the half-life (T1/2). The half-life is related to the mean life and
43Tc (2.1  10 yr)
the decay constant by the following equations:
Fig. 1.13 Decay scheme of Mo-99. Beta-minus emission to Tc-99m,
followed by isomeric transition to Tc-99. 0.693
T1/2 = ln (2) Tm =
difference of the initial and eventual energy levels. In some λ
cases, an alternate process called internal conversion can occur, Alternatively, one can determine the decay constant from the
resulting in the emission of an orbital electron, a conversion half-life by:
electron. The kinetic energy is calculated as the difference in the 0.693
two energy levels minus the electron’s binding energy. λ=
T1/2
Perhaps the most important isomeric transition for
nuclear medicine involves technetium. The term metastable One can also express the radioactive decay equation using
(i.e., almost stable) is used if the daughter nucleus remains the half-life:
in the excited state for a considerable amount of time (>1 − 0.693t
microsecond, which is long by nuclear standards). Mo-99 N = N0e T1/2

decays to an excited, or metastable, Tc-99m that in turn

If a sample contains 10,000 radioactive atoms at a partic-
transitions to Tc-99 (Figs. 1.12 and 1.13). Tc-99m has a
ular point in time, one half-life later, there will be 5000
6-hour half-life. Tc-99m is so commonly used because of its
atoms; another half-life later, there will be 2500 atoms; and
reasonable half-life, as well as its gamma-ray energy (140
so on. This process of a certain fraction of the material
keV) and lack of beta- or alpha-particle emissions. Another
decaying in a certain time is representative of exponential
example of isomeric transition is seen in the decay scheme of
decay (Fig. 1.14A). When graphed using a log scale on the
I-131 (see Fig. 1.9). Xenon-131 (Xe-131), formed from the
y-axis (semilog plot), the result is a straight line with the
beta-minus decay of I-131, is in an excited state and imme-
negative slope equal in magnitude to the decay constant
diately decays by isomeric transition with the emission of a
(Fig. 1.14B).
364-keV gamma ray.
The amount of activity (A) is the number of nuclear transfor-
Radioactive Decay Calculations mations—decays or disintegrations—per unit time. The activity
is characterized by the number of radioactive atoms in the sam-
Atoms in a sample containing a certain number (N) of radioac-
ple, N, divided by the mean time to radioactive decay, Tm:
tive atoms will not all decay at the same time but with a mean
time (Tm) that is characteristic of a particular radionuclide. The A = N/Tm
 Chapter 1 Radioactivity and Radionuclides 9

Radioactivity (fraction remaining) 1 1.0

Radioactivity (fraction remaining)

0.9
0.8
0.7
0.6
0.5 0.1
0.4
0.3
0.2
0.1
0 0.01
0 6 12 18 24 30 36 42 0 6 12 18 24 30 36 42
A Time (hr) B Time (hr)
Fig. 1.14 Decay plot for Tc-99m. (A) Standard graph showing the exponential loss. (B) Semilog graph.

Activity is thus the product of the decay constant and the

number of radioactive atoms: BOX 1.2 Conversion of International
System and Conventional Units of
A = λN Radioactivity
Conversely, if the amount of activity of a particular radionu- Mathematical
clide is known, the number of radioactive atoms can be c (centi-) 10–2
calculated: m (milli-) 10–3
k (kilo-) 103
N = A/λ μ (micro-) 10–6
Because the activity is directly related to the number of M (mega-) 106
n (nano-) 10–9
radioactive atoms, all of the equations for radioactive decay
G (giga-) 109
apply to activity, as well as the number of atoms:
p (pico-) 10–12
A = A0e−λt T (tera-) 1012

And Conventional Unit

1 curie (Ci) = 3.7 × 1010 disintegrations per second (dps)
A = A0e−(0.693t)/(T 1/2)
SI Unit
The units associated with activity are the becquerel (1 Bq = 1 1 becquerel (Bq) = 1 dps
disintegration per second) and the curie (1 Ci = 3.7 × 1010 disin- Curies → Becquerels
tegrations per second; Box 1.2). Their relationship is as follows: 1 Ci = 3.7 × 1010 dps = 37 GBq
1 mCi = 37 MBq, and 1 MBq = 27 μCi 1 mCi = 3.7 × 107 dps = 37 MBq
1μCi = 3.7 × 104 dps = 37 KBq
Example 1. The radiopharmacy is preparing a dose of an
I-123–labeled agent (13-hour half-life) for the clinic. If 10 mCi Becquerels → Curies
is to be administered at 1 pm, how much activity should be 1 Bq = 1 dps = 2.7 × 10–11 Ci = 27 pCi
1 MBq = 106 dps = 2.7 × 10–5 Ci = 0.027 mCi
placed in the syringe at 7 am?
1 GBq = 109 dps = 27 mCi
A = A0e−(0.693t)/(T 1/2) Probability of radiative losses directly proportional to Z of target and energy
incident particle.
Thus
(−0.693)(6 hr)/(13 hr)
10mCi = A0e

(−6.693)(6 hr)/(13 hr)

A = A0e−(0.693t)/(T 1/2)
A0 = 10mCi/e = 10mCi/0.726 = 13.8mCi

Example 2. The staff at the nuclear medicine clinic is testing Thus

their equipment with a cobalt-57 source (270-day half-life) that
–0.693 × 243 days
was calibrated to contain 200 MBq on January 1 of this year.
A = 200e 270 days = 200 MBq × 0.536 = 107 MBq
How much activity remains on September 1 (243 days)?
10 PART 1 Basic Principles

INTERACTIONS BETWEEN RADIATION AND The β– kinetic energy is variable because it shares energy with
the antineutrino produced during the decay event. The maxi-
MATTER mum kinetic energy of the beta particle (Emax) is defined by the
Charged-Particle Interactions With Matter difference in the energy levels of the parent and daughter
A charged particle may transfer energy in different ways. First, nuclide. However, it is the average kinetic energy that is used
it can be attracted and slowed by the opposite charge of the when calculating the impact of the β– on cells and tissues, esti-
nucleus or orbiting electrons in target material atoms. The mated as 1/3 of Emax (Eβ ≈ Emax /3), similar to the calculation
resulting kinetic energy loss is released as radiation (radiative previously described for positrons.
losses). Bremsstrahlung radiation occurring with a β– emitter is
one example of this type of interaction. The energy of radiative Photon Interactions in Matter
losses is directly proportional to the Z number of the target as High-energy photons (gamma rays, x-rays, bremsstrahlung
well as to the incident particle’s energy. radiation, and annihilation radiation) can also transfer energy
Charged particles can also directly transfer energy to the to the electrons, nuclei, or atoms as a whole that they encoun-
atom’s orbital electrons, resulting in electron excitations and ter. Unlike charged particles, which directly create ionized
ionizations. While excited, electrons can temporarily move to a atoms, the high-energy photons act indirectly, transferring
shell farther from the nucleus. As de-excitation occurs, trans- their energy to charged particles, specifically electrons, which
ferred energy leads to the emission of Auger electrons or elec- in turn create most of the excitations and ionizations that occur
tromagnetic radiation. This radiation can have a wide range of in the matter. Thus they are considered secondary ionizing
energies, including visible or ultraviolet radiation for outer-shell radiations.
transitions and fluorescent x-rays for the inner-shell At low energy levels (a few keV), photons are scattered in a
transitions. manner that does not deposit energy, referred to as Rayleigh
When the energy from charged-particle interactions pro- scattering. Photons with energy in excess of several MeV can
duces ionized electrons and atoms in tissues, the majority of the result in pair production of a negatron and a positron (effectively
ionized electrons are low energy. However, some interactions a negative and positive electron). However, in energy ranges
result in high-energy electrons, referred to as delta rays, which most common in nuclear medicine (from several tens of keV to
in turn can also cause excitation and ionization. In the energies approximately 1 MeV), the two most prominent modes of pho-
of practical interest in nuclear medicine, nearly all of the energy ton interaction are the photoelectric effect and Compton scatter-
from a charged-particle interaction (greater than 99%) is ing. Factors involved in the various types of interaction are
expended in excitation and ionization (or collisional losses) outlined in Table 1.4.
compared with radiative losses.
The rate at which a material causes a charged particle to lose Photoelectric Effect
energy (per unit length of the matter) is referred to as its stop- The photoelectric effect (Fig. 1.15) occurs when a photon trans-
ping power. A related quantity is linear energy transfer (LET), fers all of its energy to an orbital electron, causing it to be ejected
which is the amount of energy deposited locally (i.e., not lost to from the atom and creating an electron-shell vacancy. The
energetic electrons, delta rays, or radiative loss) per unit length. kinetic energy of the liberated photoelectron equals the incident
The stopping power and LET values depend on the type of radi- photon’s energy minus the binding energy of the electron’s ini-
ation, its energy, and the density of the material through which tial orbital shell. As the shell vacancy is filled by electrons from
it travels. Radiation with a higher LET value has been shown to outer shells, fluorescent x-rays and Auger electrons are also
cause more damage to cells. Alpha particles have a higher LET emitted. Paradoxically, the probability of photoelectric interac-
than beta particles or electrons. tions is highest for tightly bound orbiting electrons (i.e., those in
Although densely ionizing, alpha particles deposit their the inner shells of high Z elements). These electrons are most
energy over a very short distance, a small fraction of a millime- likely the ones in the innermost orbital shell where the binding
ter in soft tissues. Also, although they are easily stopped by the energy is just under the photon’s energy. In addition, the chance
skin, these high-energy particles cause substantial cell death of this interaction dramatically decreases as incident photon
when internalized, making them both extremely dangerous if energy increases. The probability of the photoelectric interac-
accidentally ingested as well as highly effective in therapeutic tion (or PPE) is given by:
applications (e.g., Ra-223 in prostate cancer).
3 3
Comparatively, β– particles travel for much longer distances, PPE α Z /E
ranging from several millimeters to several centimeters depend-
ing on their initial energy. They can be stopped by material such where Z = atomic number, and E = incident photon kinetic
as a thin sheet of aluminum or a few millimeters of soft tissue. energy.
 Chapter 1 Radioactivity and Radionuclides 11

TABLE 1.4 Photon Interactions in Matter

Resulting
Effect of Target Incident Photon Particle Secondary Photon
Interaction Occurrence Material Z E Range (E0) Target Emissions Emissions
Compton Predominant in Nearly independent of Z Mid E range (≈26 keV–30 Outer-shell e– Recoil e– Scattered photon
soft tissues at Depends on e– density MeV) Degrades image
diagnostic E (therefore on target
range density)
Hydrous > anhydrous
material
Photoelectric Predominates in High-Z materials Low-E photon Innermost-shell Photoelectrons Characteristic x-ray
effect shielding and Z3/E3 e– possible Auger e–
detector crys-
tals/PMT
e– cascade produces
Characteristic x-ray ↑ with ↑ Z-detector mate- ↑ when weakly bound valence (e.g.,
rial, shielding PMT photocathode materials)
Auger e– ↑ in soft tissues e– binding E less a
factor in tissue
Pair production Not typically 1.02-MeV minimum but Usually nucleus, β+ and β– Annihilation photons (from
seen in ener- actually sometimes orbital (or e+ and e–) β+)
gies used in >>1.02 MeV (not present at e– Two 5110 keV at 180
medicine diagnostic E ranges) degrees
E, Energy; Z, atomic number (number of protons); PMT, photomultiplier tube; e–, electron; β+, positron (or a positive electron); β –, negatron (same
as negative electron or beta-minus particle).

In soft tissues (low Z), the photoelectric effect is much less occurring. Higher-energy incident photons lose less energy to
common than Compton scatter. It is, however, more prevalent the electron, and deflection is less significant (i.e., the scatter
in the high-Z materials used for shielding (e.g., lead) or for pho- angle is narrower), such that both the scattered photon and elec-
ton detection (sodium iodide crystals). Photoelectric effect tron tend to travel in a more forward direction.
interactions can also occur in the gamma camera’s photomulti- Whereas the photoelectric effect is important at lower
plier tubes, which contain high-Z materials, such as cesium. energies and more likely involves inner-shell electrons in
high-Z materials, Compton scatter predominates in soft tis-
Compton Scatter sues in the moderate-energy ranges of gamma-ray and x-ray
The incident photon does not disappear in Compton scatter. photons in nuclear medicine imaging and tends to involve
Rather, it transfers a portion of its energy to an orbital electron outer-shell electrons. Because the energy of the incident pho-
(a Compton electron), which is then ejected from the atom. The ton is much greater than the shell’s binding energy, the colli-
photon is deflected or scattered, at an angle θ from its original sion occurs as if involving a free electron. Compton
path (Fig. 1.16). The electron and scattered photon may go on to interactions tend to depend on electron density but are rela-
ionize or excite other atoms. tively independent of the Z number or incident photon
The sum of the kinetic energies of the scattered photon and energy. Because electron density is fairly consistent among
the Compton electron will equal the initial photon’s energy. the atoms in soft tissues, the probability increases with
With lower-energy incident photons, more energy is transferred increasing material density rather than its Z number. Electron
to the electron, and there is greater backscatter of the resulting density is higher when hydrogen atoms are present, so tissues
photon (i.e., the angle between the incident and scattered pho- with high water content are more affected than anhydrous
tons tends to be wider), with even 180 degrees of backscatter tissues.
12 PART 1 Basic Principles

Photoelectron

Nucleus

Nucleus

Vacancy

Incident photon
A B

Characteristic
x-ray

Vacancy
Nucleus
Electron
transition
between
shells

C
Fig. 1.15 Photoelectric absorption. (A) An incident photon interacts with an orbital electron. (B) The electron
is ejected from its shell, creating a vacancy. The electron is either ejected from the atom or moved to a shell
further from the nucleus. (C) The orbital vacancy is filled by the transition of an electron from a more distant
shell. Consequently, a characteristic x-ray is given off.
 Chapter 1 Radioactivity and Radionuclides 13

SUGGESTED READING
Chandra R, Rahmin A. Nuclear Medicine Physics: The Basics. 8th ed.
Philadelphia: Williams & Wilkins; 2012.
Cherry SR, Sorenson JA, Phelps ME. Physics in Nuclear Medicine. 4th
ed. Philadelphia: WB Saunders; 2012.
Compton
Eckerman KF, Endo A. MIRD: Radionuclide Data and Decay Schemes.
Nucleus
electron 2nd ed. Reston, VA: Society of Nuclear Medicine; 2008.
Loevinger R, Budinger TF, Watson EE. MIRD Primer for Absorbed
Dose Calculations. Reston, VA: Society of Nuclear Medicine; 1988.
Powsner RA, Powsner ER. Essentials of Nuclear Medicine Physics. 3rd
ed. West Sussex, UK: Wiley-Blackwell; 2013.

Angle Saha GP. Physics and Radiobiology of Nuclear Medicine. 4th ed. New
of scatter Compton- York: Springer; 2013.
scattered
photon

Incident
photon
Fig. 1.16 Compton scatter. An incident photon interacts with an outer
or loosely bound electron, giving up a portion of its energy to the elec-
tron and undergoing a change in direction at a lower kinetic energy level.
 2
Radiation Detection & Ancillary
Instrumentation
Janis M. O’Malley, Harvey Ziessman, Frederic Fahey

The passage of radiation, such as x-rays and gamma rays, through of the detector. For photons, the intrinsic efficiency, DI, is given
a given material leads to ionizations and excitations that can be to first order by:
used to quantify the amount of energy deposited. This property
DI = (1 − e ‐ μx )
allows measurement of the level of intensity of a radiation beam
or small amounts of radionuclides, including from within the where μ is the linear attenuation coefficient for the material of
patient. The appropriate choice of detection approach depends interest at the incident photon energy, and x is the thickness of
on the purpose. In some cases, the efficient detection of min- the detector. Thus the intrinsic efficiency can be improved by
ute amounts of the radionuclide is essential, whereas in other using a thicker detector or choosing a photon energy and detec-
cases the accurate determination of the energy or location of the tor material that optimizes the value of μ.
radiation deposited is most important. A variety of approaches The extrinsic efficiency is the fraction of photons or particles
to radiation detection are used, including those that allow for emitted from the source that strike the detector. It depends on
in vivo imaging of radiopharmaceuticals. the size and shape of the detector and the distance of the source
from the detector. If the detector is a considerable distance from
the source (i.e., a distance that is >5 times the size of the detec-
RADIATION DETECTION tor), the extrinsic efficiency, DE, is given by:
Consider the model of a basic radiation detector, as shown DE = A/ 4πd 2
in Fig. 2.1. The detector acts as a transducer that converts
radiation energy to electronic charge. Applying a voltage where A is the area of the detector, and d is the distance from the
across the detector yields a measurable electronic current. source to the detector. This equation defines the inverse square
Radiation detectors typically operate in either of two modes, law. For example, if the source-to-detector distance is doubled,
current mode or pulse mode. Detectors that operate in cur- the intensity of the radiation beam is reduced by a factor of 4.
rent mode measure the average current generated within the The total detection efficiency is the product of the intrinsic and
detector over some characteristic integration time. This aver- extrinsic efficiencies:
age current is typically proportional to the exposure rate to DT = DI × DE
which the detector is subjected or the amount of radioactivity
within the range of the detector. In pulse mode, each individ- In pulse mode, the pulse height is proportional to the energy
ual detection is processed with respect to the peak current (or deposited within the detector. However, the uncertainty in the
pulse height) for that event. This pulse height is proportional energy estimation, referred to as the energy resolution, depends
to the energy deposited in the detection event. The histogram on the type of detector used and the energy of the incident radi-
of pulse heights is referred to as the pulse-height spectrum. It ation. For a photon radiation source of a particular energy, the
is also referred to as the energy spectrum because it plots a feature associated with that energy is referred to as the photo-
histogram of the energy deposited within the detector. peak, as shown in Fig. 2.2. The width of the photopeak, as char-
Certain properties of radiation detectors characterize their oper- acterized by the full width at half of its maximum (FWHM)
ation. Some are applicable to all detectors, whereas others are used value normalized by the photon energy represented as a per-
for detectors that operate in pulse mode. These characterizations centage, is used as a measure of the energy resolution of the
are not only useful for describing the operation but can also give detector.
insight into the benefits and limitations of the particular detector. When the detector is subjected to a radiation beam of low
The detection efficiency depends on several factors, includ- intensity, the count rate is proportional to the beam intensity.
ing the intrinsic and extrinsic efficiency of the detector. The However, the amount of time it takes for the detector to process
intrinsic efficiency is defined as the fraction of the incident radi- an event limits the maximum possible count rate. Two models
ation particles that interact with the detector. It depends on the describe the count rate limitations: nonparalyzable and paralyz-
type and energy of the radiation and the material and thickness able. In the nonparalyzable model, each event takes a certain

14
 Chapter 2 Radiation Detection & Ancillary Instrumentation 15

Voltage source
+ –
+ Anode Geiger-Müller
Incident region

Amplitude of output pulse

ionizing Air or
radiation e– other
e–
e–
Current
+ e– e– gas I measuring
+ + + + device
Ionization
chamber region
– Cathode
Fig. 2.1 Block diagram of basic detector. The radiation detector basi- Proportional
cally acts as a transducer, converting radiation energy deposited into an counter region
electrical signal. In general, a voltage has to be supplied to collect the
signal, and a current or voltage measuring device is used to measure
the signal. In some instances, the average current over a characteris-
tic integration time is measured, which is referred to as current mode.
In other cases, the voltage pulse of each detection event is analyzed, Applied voltage
referred to as pulse mode. (From Cherry, Sorenson JA, Phelps ME. Fig. 2.3 Amplitude of gas detector output signal as a function of applied
Physics in Nuclear Medicine. 3rd ed. Philadelphia: WB Saunders; 2003.) voltage. This graph shows the relationship between the magnitude of
the output signal from the gas detector (related to the amount of ion-
ized charge collected) as a function of the voltage applied across the
detector. There is no signal with no voltage applied. As the voltage is
increased, the detector signal starts to increase until the saturation volt-
age is reached, the start of the plateau defining the ionization chamber
region, where all of the initially liberated charge is collected. Further
increasing the voltage leads to the proportional counter region, at which
the liberated electrons attain sufficient energy to lead to further ion-
ization within the gas. Finally, the Geiger-Müller region is reached, at
which each detection yields a terminal event of similar magnitude (i.e.,
a “click”). (From Cherry, Sorenson JA, Phelps ME. Physics in Nuclear
Medicine. 3rd ed. Philadelphia: WB Saunders; 2003.)

A gas radiation detector is filled with a volume of gas that

acts as the sensitive material of the detector. In some cases it
is air, and in others it is an inert gas such as argon or xenon,
depending on the particular detector. Electrodes are located at
Fig. 2.2 Spectrum for technetium-99m (Tc-99m) in air. The energy res- either end of the sensitive volume. The detector circuit also con-
olution is characterized by the width of the photopeak (the full width tains a variable voltage supply and a current detector. As radi-
at half maximum [FWHM]) normalized by the photon energy. For the ation passes through the sensitive volume, it causes ionization
particular detector system illustrated, the FWHM is 18 keV. The energy
in the gas. If a voltage is applied across the volume, the result-
resolution of the detector system for Tc-99m is 13% (100 × 18/140).
ing ions (electrons and positive ions) will start to drift, causing
a measurable current in the circuit. The current will last until
amount of time to process, referred to as the dead time, which all of the charge that was liberated in the event is collected at
defines the maximum count rate at which the detector will satu- the electrodes. The resulting current entity is referred to as a
rate. For example, if the dead time is 4 μs, the count rate will sat- pulse and is associated with a particular detection event. If only
urate at 250,000 counts per second. With the paralyzable model, the average current is measured, this device operates in current
the detector count rate not only saturates but can “paralyze”— mode. If the individual events are analyzed, the device is oper-
that is, lose counts at very high count rates. Gamma cameras, for ating in pulse mode.
example, are paralyzable systems. Fig. 2.3 shows the relationship between the charge collected
The three basic types of radiation detectors used in nuclear in the gas detector and the voltage applied across the gas vol-
medicine are gas detectors, scintillators, and semiconductors. ume. With no voltage, no electric field exists within the volume
These three operate on different principles and are typically to cause the ions liberated in a detection event to drift, and thus
used for different purposes. no current is present and no charge is collected. As the voltage is
Gas detectors are used every day in nuclear medicine for increased, the ions start to drift, and a current results. However,
assaying the amount of radiopharmaceutical to be administered the electric field may not be sufficient to keep the electrons and
and to survey packages and work areas for contamination. How- positive ions from recombining, and thus not all of the originally
ever, because of the low density of gas detectors, even when the liberated ions are collected. This portion of Fig. 2.3 is referred
gas is under pressure, the sensitivity of gas detectors is not high to as the recombination region. As voltage is increased, the level
enough to be used for clinical counting and imaging applications. is reached at which the strength of the electric field is sufficient
16 PART 1 Basic Principles

for the collection of all of the liberated ions (no recombination). efficiency because they affect the linear attenuation coefficient
This level is referred to as the saturation voltage, and the result- of the scintillation material. The amount of emitted light affects
ing plateau in Fig. 2.3 is the ionization chamber region. When both energy and, in the gamma camera, spatial resolution. Res-
operating in this region, the amount of charge collected is pro- olution is determined by the statistical variation of the collected
portional to the amount of ionization caused in the detector and light photons, which depends on the number of emitted pho-
thereby to the energy deposited within the detector. Ionization tons. Finally, the response time affects the temporal resolution
detectors or chambers typically operate in current mode and of the scintillator. The most common scintillation crystalline
are the detectors of choice for determining the radiation beam material used in nuclear medicine is thallium-doped sodium
intensity level at a particular location. They can directly mea- iodide (NaI) with lutetium oxyorthsilicate (LSO) or lutetium
sure this intensity level in either exposure in roentgens (R) or air yttrium oxyorthosilicate (LYSO) most commonly used in posi-
kerma in rad. Dose calibrators and the ionization meters used to tron emission tomography (PET).
monitor the output of an x-ray device or the exposure level from Once the light is emitted in a scintillation detector, it must be
a patient who has received a radiopharmaceutical are examples collected and converted to an electrical signal. The most com-
of ionization (or ion) chambers used in nuclear medicine. monly used device for this purpose is the photomultiplier tube
If the voltage is increased further, the drifting electrons (PMT). Light photons from the scintillator enter through the
within the device can attain sufficient energy to cause further photomultiplier entrance window and strike the photocathode,
ionizations, leading to a cascade event. This can cause substan- a certain fraction of which (approximately 20%) will lead to the
tially more ionization than with an ionization chamber. The total emission of photoelectrons moving toward the first dynode. For
ionization is proportional to the amount of ionization initially each electron reaching the first dynode, approximately a million
liberated; therefore these devices are referred to as proportional electrons will eventually reach the anode of the photomultiplier
counters or chambers. Proportional counters, which usually tube. Thus the photomultiplier tube provides high gain and
operate in pulse mode, are not typically used in nuclear med- low noise amplification at a reasonable cost. Other solid-state
icine. If the voltage is increased further, the drifting electrons light-detection approaches are now being introduced into
attain the ability to cause a level of excitations and ionizations nuclear medicine devices. In avalanche photodiodes (APDs),
within the gas. The excitations can lead to the emission of ultra- the impinging light photons lead to the liberation of electrons
violet radiation, which also can generate ionizations and fur- that are then drifted in the photodiode, yielding an electron ava-
ther excitations. This leads to a terminal event in which the level lanche. The gain of the APD is not as high as with the PMT (sev-
of ionization starts to shield the initial event, and the level of eral hundred compared with about a million), but the detection
ionization finally stops. This is referred to as the Geiger-Müller efficiency is substantially higher (approximately 80%). A second
process. In the Geiger-Müller device, every event leads to the solid-state approach is the silicon photomultiplier tube (SiPMT).
same magnitude of response, irrespective of the energy or the This device consists of hundreds of very small APD channels
type of incident radiation. Thus the Geiger-Müller meter does that operate like small Geiger-Müller detectors—that is, each
not directly measure exposure, although it can be calibrated in detection is a terminal event. The signal from the SiPMT is the
a selected energy range to milliroentgens per hour (mR/hr). number of channels that respond to a particular detection event
However, the estimate of exposure rate in other energy ranges in the scintillator. SiPMTs have moderate detection efficiency
may not be accurate. The Geiger-Müller survey meter is excel- (approximately 50%) and operate at low voltages. One further
lent at detecting small levels of radioactive contamination and advantage of APDs and SiPMTs compared with PMTs is that
thus is often used to survey radiopharmaceutical packages that they can operate within a magnetic field. Thus the development
are delivered and work areas within the nuclear medicine clinic of positron emission tomography/magnetic resonance (PET/
at the end of the day. MR) scanners has involved the use of either APDs or SiPMTs.
Solid-state technology is used to detect the light from a scin-
tillation detector and also can be used to directly detect gamma
SCINTILLATION DETECTORS rays. The detection of radiation within a semiconductor detector
Some crystalline materials emit a large number of light pho- leads to a large number of electrons liberated, resulting in high
tons upon the absorption of ionizing radiation. This process is energy resolution. The energy resolution of the lithium-drifted
referred to as scintillation, and these materials are referred to germanium (GeLi) semiconductor detector has approximately
as scintillators. As radiation interacts within the scintillator, a 1% energy resolution compared with the 10% energy resolution
large number of excitations and ionizations occur. On de-exci- associated with a sodium iodide scintillation detector. However,
tation, the number of light photons emitted is directly propor- thermal energy can lead to a measurable current in some semi-
tional to the amount of energy deposited within the scintillator. conductor detectors such as GeLi, even in the absence of radia-
In some cases, a small impurity may be added to the crystal to tion, and thus these semiconductor detectors must be operated
enhance the emission of light and minimize the absorption of at cryogenic temperatures. On the other hand, semiconductor
light within the crystal. Several essential properties of scintil- detectors such as cadmium telluride (CdTe) or cadmium zinc
lating materials can be characterized, including density, effec- telluride (CZT) can operate at room temperature. CdTe and
tive Z number (number of atomic protons per atom), amount CZT do not have the excellent energy resolution of GeLi, but
of light emitted per unit energy, and response time. The density at approximately 5%, it is still significantly better than that of
and effective Z number are determining factors in the detection sodium iodide.
 Chapter 2 Radiation Detection & Ancillary Instrumentation 17

contamination. It is routinely used to determine whether there

is contamination on packages of radiopharmaceutical that are
delivered to the clinic and to test working surfaces and the
hands and feet of workers for contamination. GM meters often
are equipped with a test source of cesium-137, with a very small
amount of radioactivity, that is affixed to the side of the meter.
On calibration, the probe is placed against the source, and the
resulting exposure rate is recorded. The probe is tested daily
using the source to ensure that the meter’s reading is the same
at the time calibration. The GM meter should be calibrated on
an annual basis.
The ionization chamber meter (ion chamber) operates in
current mode and assesses the amount of ionization within an
internal volume of gas (often air) and thus can directly measure
exposure or air kerma rate. The ion chamber is used to evalu-
Fig. 2.4 Energy spectrum for technetium-99m (Tc-99m) in air for a ate the exposure rate at various locations within the clinic. For
gamma scintillation camera with the collimator in place. Note the iodine example, it could be used to measure the exposure rate in an
escape peak at approximately 112 keV. The 180-degree backscatter
uncontrolled area adjacent to the radiopharmaceutical hot lab-
peak at 90 keV merges with the characteristic x-ray peaks for lead (Pb).
The Compton edge is at 50 keV. oratory. The ion chamber is also used to evaluate the exposure
rate at a distance from a patient who has received radionuclide
therapy (e.g., iodine-131 for thyroid cancer) to determine that
The pulse height spectrum corresponding to the detection the patient can be released without exposing the general public
of the 140-keV gamma rays from technetium-99m (Tc-99m) is to unacceptable radiation levels. The ion chamber also should
illustrated in Fig. 2.4. The photopeak corresponds to events where be annually calibrated.
the entire energy of the incident photon is absorbed within the The dose calibrator is an ionization chamber used to assay
detector. These are the events of primary interest in most count- the amount of activity in vials and syringes. This includes the
ing experiments, and thus the good events are within an energy assay of individual doses before administration to patients, as
acceptance window about the photopeak. Other events corre- required by regulation. The dose calibrator operates over a very
spond to photons scattered within the detector material and wide range of activities, from tens of microcuries to a curie
depositing energy, which can range from very low energy from (hundreds of Bq to tens of GBq). The device is also equipped
a very-small-angle scatter to a maximum 180-degree scatter (in with variable settings for each radionuclide to be measured,
the spectrum referred to as the Compton edge). Events below the with typically about 10 buttons for ready selection of the radio-
Compton edge correspond to these scattered events. In some nuclides commonly used in the clinic. In addition, buttons are
cases, photons can undergo multiple scatters and possibly result available for user-defined radionuclide selection. Others can be
in events between the Compton edge and the photopeak. Pho- selected by entering the appropriate code for that radionuclide
tons scattered within the patient and then detected may also into the system.
result in events in this energy region. Finally, the pulse-height The dose calibrator is used to assay the activity administered
spectrum will be blurred depending on the energy resolution of to the patient, and thus a comprehensive quality control pro-
the detector. Thus in Fig. 2.4, the photopeak has approximately gram is necessary. Regulations specify dose calibrator quality
a 10% spread because of the energy resolution associated with control program must meet the manufacturer’s recommenda-
NaI, rather than the narrow spike that might be expected from tions or national standards. Typically, the program comprises
the emission of a monoenergetic gamma ray. four basic quality control tests: geometry, accuracy, linearity,
and constancy.
The geometry protocol tests that the dose calibrator provides
ANCILLARY NUCLEAR MEDICINE EQUIPMENT the same reading for the same amount of activity irrespective of
Besides the imaging equipment in the nuclear medicine clinic, the volume or orientation of the sample. A reading of a certain
other additional ancillary equipment may be necessary from amount of activity in a 0.5-mL volume is obtained. The volume
either a medical or regulatory point of view or to otherwise is then increased by augmenting the sample with amounts of
enhance the operation of the clinic. This equipment will be nonradioactive water or saline and taking additional readings.
reviewed, including the quality control required for proper The subsequent readings should not vary from the original
operation. readings by more than 10%. The geometry test is performed
As previously discussed, the two basic radiation meters com- during acceptance testing and after a major repair or move of
monly used in the nuclear medicine clinic are the Geiger-Müller the equipment to another location.
(GM) meter and the ionization chamber. Both are gas detec- For accuracy, calibrated sources (typically cobalt-57 and
tors, although they operate differently. With the GM meter, all 137Cs) are assayed; the resultant reading cannot vary by more

detections lead to a terminal event of the same magnitude—a than 10% from the calibrated activity decay corrected to the
“click.” The device is excellent for detecting small amounts of day of the test. The accuracy test should be performed during
18 PART 1 Basic Principles

acceptance testing, annually thereafter, and after a major repair of standards of known activity concentration (kilobecquerel per
or move. milliliter), the patient’s GFR can be estimated.
The linearity protocol tests that the dose calibrator operates The thyroid probe consists of an NaI crystal on a stand with
appropriately over the wide activity range to which it is applied. the associated counting electronics. The patient is administered
The device is tested from 10 μCi (370 kBq) to a level higher a small amount of radioactive iodine. The probe is placed at a
than that routinely used in the clinic and perhaps as high as 1 certain distance from the thyroid, and a count is obtained. In
Ci (37 GBq). The activity readings are varied by starting with addition, a count is acquired of a known standard at the same
a sample of the radioactivity of Tc-99m at the highest value to distance. The thyroid uptake of iodine can be estimated from
be tested (e.g., tens of gigabequerels). The activity readings are these measurements.
then varied by either allowing the source to radioactively decay The quality control program for both the well counter and
over several days or using a set of lead shields of varying thick- the thyroid probe includes the energy calibration, the energy
nesses until a reading close to 370 kBq is obtained. Each reading resolution, the sensitivity, and the chi-square test. For the energy
should not vary by more than 10% from the line drawn through calibration, the energy window is set for the calibration source
the calculated activity values. The linearity test should be per- of a particular radionuclide—for example, the 662-keV peak of
formed during acceptance testing, quarterly thereafter, and after Cs-137. The amplifier gain is varied until the maximum count is
a major repair or move. found that corresponds with the alignment of the window with
The constancy protocol tests the reproducibility of the read- the 662-keV energy peak. In addition, the counts in a series of
ings compared with a decay-corrected estimate for a reference narrow energy windows across the peak can be measured to
reading obtained from the dose calibrator on a particular day. estimate the energy resolution. A standard window can be set,
Today’s constancy reading cannot vary from the decay-cor- and the counts of a known calibration source can be counted
rected reference reading by more than 10%. The constancy test and normalized by the number of nuclear transformations to
varies from accuracy in that it evaluates the precision of the estimate the sensitivity in counts per transformation (or counts
readings from day to day rather than accuracy. The constancy per second per becquerel). Finally, the chi-square test evaluates
test should be performed on every day that the device is used to the operation of the counter by comparing the uncertainty of
assay a dose to be administered to a patient. the count to that expected from the Poisson distribution.
There are two nonimaging scintillator devices, the well
counter, and the thyroid probe that are routinely used in the
nuclear medicine clinic. The well counter is used for both radi-
THE PATIENT AS A RADIOACTIVE SOURCE
ation protection and clinical protocols. The thyroid probe can In nuclear medicine, the patient is administered a radiophar-
provide clinical studies with a fraction of the equipment costs maceutical that distributes according to a specific physiological
and space requirements of the use of nuclear imaging equip- or functional pathway. The patient is then imaged using exter-
ment. However, these devices also require comprehensive qual- nal radiation detectors to determine the in vivo distribution
ity control programs. and dynamics of the radiopharmaceutical through which the
The well counter consists of an NaI crystal with a hole in it, patient’s physiology can be inferred, providing this essential
allowing for test tubes, and other samples can be placed within information to the patient’s doctor to aid in diagnosis, prog-
the device for counting. The samples to be placed in the counter nosis, staging, and treatment. The equipment used to acquire
is practically surrounded by the detector, with a geometrical these data will be described in the sections ahead. Single-pho-
efficiency in excess of 90%. Thus the well counter can measure ton emission computed tomography (SPECT) and PET are
very small amounts of radioactivity, on the order of a kilobec- described in the next chapter. However, before examining how
querel. The well counter should not be confused with the dose the instrumentation operates, it is instructive to understand the
calibrator, which is a gas-filled ionization chamber that can nature of the signal itself—that is, the radiation being emitted
measure activities up to 37 GBq. It is used to test packages of from within the patient.
radiopharmaceuticals to ensure that no radioactivity has been The radiopharmaceutical is administered to the patient most
spilled on the outside of the package or leaked from the inside. commonly by intravenous injection but also in some cases
The device also can be used to measure removable activity from through other injection routes, such as intraarterial, intraper-
working surfaces where radioactivity has been handled or from itoneal, or subdermal. In other cases, the radiopharmaceutical
sealed sources such as calibration sources to ensure that the may be introduced through the gastrointestinal tract or through
radioactivity is not leaking out. the breathing of a radioactive gas or aerosol. After administra-
The well counter can also be used for the assay of biologi- tion, the path and rate of uptake depend on the particular radio-
cal samples for radioactivity for a variety of clinical evaluations. pharmaceutical, the route of administration, and the patient’s
For example, after the administration of Tc-99m diethylenetri- individual physiology. However, the characteristics and param-
amepentaacetic acid (DTPA), blood samples can be counted at eters associated with the radiopharmaceutical in vivo distribu-
several time points (e.g., at 1, 2, and 3 hours) to estimate the tion and dynamics are of considerable clinical importance. In
patient’s glomerular filtration rate (GFR). The amount of radio- some cases, the enhanced uptake of the radiopharmaceutical in
activity in a 0.2-mL blood sample will be very small, and thus the certain tissues (e.g., the uptake of fluorodeoxyglucose [FDG] in
well counter is the appropriate instrument for these measure- tumors) may be of most clinical importance, whereas in other
ments. By making these measurements and the measurements cases it may be the lack of uptake (e.g., the absence of Tc-99m
 Chapter 2 Radiation Detection & Ancillary Instrumentation 19

sestamibi in infarcted myocardium). In the first case, this would

be referred to as a hot-spot imaging task, and in the latter would
be a cold-spot task. In other situations, it may be the rate of
uptake (wash in) or clearance (wash out) that may be considered
the essential characteristic of the study. In a Tc-99m mercapto-
acetyltriglycine (MAG3) renal study, fast wash in may indicate a
well-perfused kidney, and delayed clearance may indicate renal
obstruction. In the Tc-99m DTPA counting protocol described
previously, a slow clearance of the radiopharmaceutical from
the blood would indicate a reduced GFR. In some cases, the
ability to discern uptake in a particular structure that is adjacent
to other nonspecific uptake may require the ability to spatially
resolve the two structures, whereas other tasks may not require
such specific resolution. The choice of instrumentation, acqui-
sition protocol, and data-processing approach fundamentally
depend on the clinical task at hand. Fig. 2.5 Energy spectrum from a gamma camera with the techne-
To characterize the rate, location, and magnitude of radio- tium-99m (Tc-99m) activity in the patient. Note the loss of definition
of the lower edge of the Tc-99m photopeak. This spectrum illustrates
pharmaceutical uptake within the patient, the emitted radia-
the difficulty of discriminating Compton-scattered photons within the
tion must be detected, in most cases, by detectors external to patient using pulse-height analysis.
the patient’s body. Some instruments are specially designed
for internal use—for example, interoperative radiopharma-
ceutical imaging—but in most the cases, the imaging device only allowing photons to be counted within a narrow energy
is located outside the body while detecting radiation inter- window about the photopeak energy) will lead to the elimination
nally. This requirement limits the useful emitted radiations of a significant number of scattered photons from the nuclear
for nuclear medicine imaging to energetic photons—that medicine image. In contrast to the case of a point source, a more
is, gamma rays and x-rays. The amount of overlying tissue challenging clinical case with regard to scatter may be the imag-
between the internally distributed radiopharmaceutical and ing of a cold-spot feature, such as an infarction in a myocardial
the radiation detector may vary from several centimeters to perfusion scan or a renal scar in a Tc-99m DMSA scan. In these
as much as 20 to 30 cm. Alpha and beta particles will not be cases, scattered photons in the neighboring tissue may be dis-
of use in most cases because their ranges in tissue are lim- placed into the cold spot, leading to a loss in image contrast and
ited to a few millimeters, and thus they will not exit the body an inability to properly discern the extent of the feature. It must
and cannot be measured by external radiation detectors. Even also be kept in mind that in a true clinical case, the distribution
x-rays and gamma rays must have energies in excess of 50 of the radiopharmaceutical is unknown, and background levels
keV to penetrate 10 cm of tissue. On the other hand, once the in other tissues may compromise the situation. The pulse-height
radiation exits the patient, it is best that the radiation not be spectrum from a patient is shown in Fig. 2.5.
so energetic as to be difficult to detect with reasonable-size
detectors. Thus the radiation types optimal for most nuclear
medicine imaging applications are x-rays and gamma rays in
GAMMA CAMERAS
the 50- to 600-keV energy range, depending on the equip- In the earliest days of nuclear medicine, counting devices simi-
ment and collimation being used. lar to the thyroid probe described in the previous section were
Consider a situation in which a radiopharmaceutical labeled used to evaluate the amount of activity in a particular tissue.
with Tc-99m leads to a point source at some depth within the For example, probes could be used to evaluate the iodine uptake
patient’s body. The 140-keV gamma rays will be emitted isotrop- of the thyroid gland. However, it was not long before clinicians
ically from the point source. Therefore it would be advantageous realized that it would be helpful to not only know the total
to place the radiation detector close to the source or to place sev- uptake of the radiopharmaceutical within the tissue of inter-
eral detectors around the source to collect as many of the emitted est but also to be able to discern the spatial distribution of the
photons as possible. In fact, acquiring data from several angles uptake within the tissue. In the early 1950s, Benedict Cassan
may allow the source to be better localized. Those emitted pho- attached a focused collimator to an NaI crystal and a mecha-
tons that exit the body without interaction and are subsequently nism for acquiring the counts from the patient at multiple loca-
detected will yield the highest quality spatial information. tions in a raster fashion and plotting the spatial distribution of
Conversely, those photons that scatter within the patient com- the counts. This device, the rectilinear scanner, provided nuclear
promise spatial information. Photons that undergo very-small- medicine images of physiological function. As a result the term
angle scatter will perhaps not be of much consequence, but those scan, as in a thyroid or bone scan, has remained in the nuclear
that undergo scatter at larger angles will not be of much use. Not- medicine lexicon. However, these scans took a long time to
ing that the Compton-scattered photons have less energy than acquire and did not allow for the acquisition of time-sequence
the incident photons, and that small-angle scatter leads to less or dynamic studies. Still, the rectilinear scanner continued to be
energy loss than large-angle scatter, energy discrimination (i.e., used in nuclear medicine clinics through the late 1970s.
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Långt ut i dammen sam,
Och gossen stod vid vattnets bryn
Och njöt af denna sköna syn.
STORKARNE.
“Storkar, våra storkar kära,
Hvad kan bort från oss er locka?“

Storkarne. “Grymma vintern, som är nära

Molnen, som sig börja skocka.
Derför öfver land och haf
Nu begifva vi oss af,
Tills vi nå det mål, vi önska:
Länder med en evig grönska.“

Rätt snart det slog in, hvad som storkarne spått,

Och vintern, den stränge, sig infann så brådt.
Han skakade manteln, och flingor att falla,
Så bländande hvita, så isande kalla,
Och storkarnas näste betäcktes med snö;
Om hemma de stannat, de hade måst dö.
STORKPARET.
u skiner sol och vårens milda flägt
Har smält en obarmhertig vinters is,
Och träden kläda på sin gröna drägt
Och åter nu, från söderns paradis,
Det hem vi nått, som aldrig vi förglömt,
Hvarom vi under smärta palmer drömt.“

Nu fylla storkarne sitt gamla bo,

Och sen med halm och hö de gjort det tätt
Fru Stork helt makligt slår sig ned i ro,
Och bidar der en tillväxt af sin ätt,
Tre långa veckor inom skål och vägg
Hon ligger tåligt der på sina ägg.

Af äggen blef det ungar fem, ett mycket hungrigt slägte,

Som öppnade fem stora gap, då far dem födan räckte.

STOCKHOLM,
TRYCKTE HOS BERGSTRÖM & LINDROTH
1868.
*** END OF THE PROJECT GUTENBERG EBOOK FEMTIO FABLER
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