Nuclear Medicine and PET/CT: Technology and Techniques PDF
Preview Nuclear Medicine and PET/CT: Technology and Techniques
Nuclear Medicine and PET/CT Technology and Techniques Seventh Edition Paul E. Christian, BS, CNMT, FSNMTS, PET Associate Director, Molecular Imaging Program Director, Cyclotron Radiochemistry Laboratory Huntsman Cancer Institute University of Utah Salt Lake City, Utah Kristen M. Waterstram-Rich, MS, CNMT, FSNMTS Professor Director, Premedical Studies Biomedical Sciences Program Director Rochester Institute of Technology Rochester, New York 3251 Riverport Lane St. Louis, Missouri 63043 NUCLEAR MEDICINE AND PET/CT TECHNOLOGY ISBN: 978-0-323-07192-5 AND TECHNIQUES, SEVENTH EDITION Copyright ©2012, 2007, 2004, 1997, 1994, 1989, 1981 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. No part of this publication may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying, recording, or any information storage and retrieval system, without permission in writing from the publisher. Details on how to seek permission, further information about the Publisher’s permissions policies and our arrangements with organizations such as the Copyright Clearance Center and the Copyright Licensing Agency, can be found at our website: www.elsevier.com/permissions. This book and the individual contributions contained in it are protected under copyright by the Publisher (other than as may be noted herein). Notices Knowledge and best practice in this field are constantly changing. As new research and experience broaden our understanding, changes in research methods, professional practices, or medical treatment may become necessary. Practitioners and researchers must always rely on their own experience and knowledge in evaluating and using any information, methods, compounds, or experiments described herein. In using such information or methods they should be mindful of their own safety and the safety of others, including parties for whom they have a professional responsibility. With respect to any drug or pharmaceutical products identified, readers are advised to check the most current information provided (i) on procedures featured or (ii) by the manufacturer of each product to be administered, to verify the recommended dose or formula, the method and duration of administration, and contraindications. UnitedVRG. It is the responsibility of practitioners, relying on their own experience and knowledge of their patients, to make diagnoses, to determine dosages and the best treatment for each individual patient, and to take all appropriate safety preTcoa uthtieo nfus.llest extent of the law, neither the Publisher nor the authors, contributors, or editors, assume any liability for any injury and/or damage to persons or property as a matter of products liability, negligence or otherwise, or from any use or operation of any methods, products, instructions, or ideas contained in the material herein. ISBN: 978-0-323-07192-5 Acquisitions Editor: Jeanne Olson Developmental Editor: Luke Held Publishing Services Manager: Julie Eddy Senior Project Manager: Laura Loveall Design Direction: Margaret Reid Working together to grow libraries in developing countries Printed in the United States www.elsevier.com | www.bookaid.org | www.sabre.org Last digit is the print number: 9 8 7 6 5 4 3 2 1 C O N T R I B U T O R S Carolyn J. Anderson, PhD Helen H. Drew, MT(ASCP), William Hubble, MA, CNMT, Professor CNMT(NMTCB) RT(R)(N)(CT), FSNMTS Radiology, Biochemistry & Technical Specialist, Core Special Academic Chair/NMT Program Molecular Biophysics and Chemistry Laboratories Director Chemistry Department Department of Pathology Associate Professor Washington University Johns Hopkins Hospital Saint Louis University St. Louis, Missouri Baltimore, Maryland Doisy College of Health Sciences Department of Medical Imaging Crystal Botkin, MPH, CNMT, PET Tracy L. Faber, PhD and Radiation Therapeutics NMT Clinical Coordinator Professor of Radiology St. Louis, Missouri Saint Louis University Emory University Doisy College of Health Sciences Atlanta, Georgia Kathy Thompson Hunt, MS, CNMT Department of Medical Imaging Program Chair, Nuclear Medicine and Radiation Therapeutics James R. Galt, PhD Technology St. Louis, Missouri Assistant Professor, Emory Baptist College of Health Sciences University Memphis, Tennessee Paul H. Brown, PhD Nuclear Medicine, Emory Associate Professor of University Hospital Peter Jenkins, MS, CHP Radiology Atlanta, Georgia Medical Physicist Oregon Health Sciences University University of Utah Hospitals and Portland, Oregon David Gilmore, MS, CNMT, NCT, Clinics RT(R)(N) Salt Lake City, Utah Paul E. Christian, BS, CNMT, Program Director, School of FSNMTS, PET Nuclear Medicine Karen S. Langley, MS Associate Director, Molecular Technology Radiation Safety Officer, Director Imaging Program Beth Israel Deaconess Medical Radiological Health Department Director, Cyclotron Radiochemistry Center, a Harvard Medical University of Utah Laboratory School Affiliate Salt Lake City, Utah Huntsman Cancer Institute Boston, Massachusetts University of Utah Janice Leggett, RTNM Salt Lake City, Utah Stanley J. Goldsmith, BA, MD Supervisor, Division of Nuclear Director, Nuclear Medicine & Medicine Gary L. Dillehay, MD, FACNP, Molecular Imaging British Columbia Children’s Hospital FACR Professor of Radiology and Radiology Department Professor of Radiology Medicine Vancouver, British Columbia Department of Nuclear Medicine Weill Medical College of Cornell Canada Northwestern Memorial Hospital University Chicago, Illinois NewYork-Presbyterian Hospital/ Mark T. Madsen, PhD, FAAPM, Weill Cornell Medical FACR Kevin Donohoe, MD Center Professor of Radiology Staff Physician, Division of Nuclear New York, New York University of Iowa Medicine Iowa City, Iowa Beth Israel Deaconess Medical Ravinder K. Grewal, MD Center Assistant Attending Physician Leon S. Malmud, MD Assistant Professor of Nuclear Medicine Service Dean Emeritus, Temple University Radiology Memorial Sloan Kettering Cancer School of Medicine Harvard Medical School Center Temple University Hospital Boston, Massachusetts New York, New York Philadelphia, Pennsylvania v vi Contributors Donna C. Mars, MEd, CNMT, Sally Schwarz, RPh, MS Jean-Luc Urbain, MD NCT Washington University School of St. Joseph Hospital Assistant Professor, Allied Health Medicine London, Ontario Division Department of Radiology/Division Canada Baptist College of Health Sciences of Nuclear Medicine Memphis, Tennessee St. Louis, Missouri Mark Wallenmeyer, MBA, CNMT, FSNMTS Derek McGuire, RTNM, CDT Akash Sharma, MD Assistant Professor of Nuclear Nuclear Medicine Technologist Instructor in Radiology Medicine Imaging Sciences British Columbia Children’s Division of Nuclear Medicine University of Arkansas for Medical Hospital Mallinckrodt Institute of Radiology Sciences Radiology Department Washington University School of Little Rock, Arkansas Vancouver, British Columbia Medicine Canada St. Louis, Missouri Kristen M. Waterstram-Rich, MS, CNMT, FSNMTS Denise A. Merlino, CPC, CNMT, H. William Strauss, MD Professor MBA Attending Physician Director, Premedical Studies President, Merlino Healthcare Nuclear Medicine Service Biomedical Sciences Program Consulting Corp. Memorial Sloan Kettering Cancer Director Magnolia, Massachusetts Center Rochester Institute of Technology New York, New York Rochester, New York Frances L. Neagley, CNMT, FSNMTS Nancy M. Swanston, CNMT, PET, Katherine Zukotynski, BASc, MD, Editor, Journal of Nuclear Medicine RT(N) FRCP(C) Technology Manager, Diagnostic Imaging Staff Radiologist, Dana-Farber Society of Nuclear Medicine Section of Positron Emission Cancer Institute Reston, Virginia Tomography Associate Radiologist, Brigham and Division of Diagnostic Imaging Women’s Hospital Neeta Pandit-Taskar, MD The University of Texas MD Instructor in Radiology, Harvard Associate Attending Physician Anderson Cancer Center Medical School Nuclear Medicine Service Houston, Texas Boston, Massachusetts Memorial Sloan Kettering Cancer Center Kathy Thomas, MHA, CNMT, New York, New York PET Applications/Technical Support Henry Royal, MD Capintec, Inc. Professor, Radiology Battle Ground, Washington Associate Director, Division of Nuclear Medicine Mallinckrodt Institute of Radiology Washington University School of Medicine St. Louis, Missouri F O R E W O R D The production of a textbook is a labor of love. To have The chapter on computer science has undergone a reached the status of a seventh edition shows a level of major revision with the focus shifting more to computer dedication amongst the authors and editors that is applications and practical digital imaging. The reader of unusual. For almost three decades, this book has pro- this chapter will also be introduced to basics of PACS, vided a mainstay in the education of nuclear medicine networking, and image co-registration (fusion) of digital technologists. When one looks back, nuclear medicine images. The chapter on radiochemistry and radiophar- was much simpler when the first edition of this book was macology has been updated with increased focus on the published. Without significant change from either the operation of the 99Mo-99mTc generator and more infor- first or the sixth edition, this book would not be of much mation on PET radiopharmaceuticals. Further, the reader use. A look at the book today, now in its seventh edition, is introduced to some of the new regulatory changes, shows it to be current and demonstrates a blending of including USP Chapter <797>. Other chapters have had old and new while also addressing future developments. facelifts as appropriate to keep them current. The changes to the current edition make it ideal for the A feature that I particularly like is the outline at the education of the nuclear medicine technologist. (It is also beginning of chapters and the list of learning objectives a great source of information for anyone in the first who and key terms for the chapter. Preceding the objectives wants an eminently readable text.) is a standard outline of the chapter that is directed at Today’s seventh edition is as up-to-date as a book can those looking for a quick reference on a given topic. For be. A completely new chapter on instrumentation by educators, this structure is particularly useful. The Mark Madsen brings into focus all of the current devices quality of illustrations is excellent, and they have and is filled with excellent illustrations and descriptive been chosen to drive home or illustrate principles in material that is current and understandable. In the sixth the text. The illustrations and captions are clear and edition, a new chapter was added on CT physics. Now understandable. a new addition to this text is a chapter on the physics One of the interesting features of this text is its inte- and principles of MRI. At first glance, this would seem gration with the Evolve website. This integration allows to be a somewhat unusual addition to a nuclear medicine the instructor to enrich their own materials with images text; however, it shows how the editors and authors are from the textbook. Downloadable examination ques- preparing the reader to deal with future clinical develop- tions permit the use of the most current thinking ments in imaging. A completely new chapter on brain to assess the student’s comprehension of the presented imaging from the Boston group with so much experience material. Although this text is directed primarily at the in this area is another example of the forward-looking nuclear medicine technology student, its organization nature of this text. In the group of new and updated and quality make it a text useable by radiology and chapters is a complete revision of the chapter on cardiac nuclear medicine residents as well an absolute necessity imaging that incorporates imaging guidelines for clinical on everyone’s reference shelf. appropriateness. The nuclear medicine technologist is going to find himself/herself right in the middle of imple- Robert E Henkin, MD, FACNM, FACR mentation of appropriateness criteria, and this is a won- Professor Emeritus of Radiology derful starting place to get accustomed to the terminology Loyola University Stritch School of Medicine and implementation of such guidelines. Maywood, Illinois vii This page intentionally left blank P R E F A C E CONTENT into changes and advancements that are under investiga- Writing a book is definitely a labor of love and a testa- tion. The many expert contributors of the chapters have ment to patience. The process takes over two years, and reviewed and updated the information in this edition to the work waxes and wanes throughout the time period; bring the materials and figures to the current level of but it is not until the very end that one gets a glimpse of clinical practice. There are several chapters that have how the book will look in print. undergone notable revisions. Chapter 3, “Instrumenta- This book, now in its seventh edition, has stood the tion,” has been replaced with a new chapter by a test of time. It continues to keep pace with the changes new contributing author in an effort to make this topic in the field of nuclear medicine and healthcare as it more easily understood and comprehensive and to expands and evolves to meet the needs of the profession- provide an uptake to changes in this expanding area als facing the challenges of changing technology and and new device configurations. Chapter 12, “Principles medical practice. Through all of the revisions, it has of Magnetic Resonance Imaging,” is a completely new stayed true to its focus of providing information that chapter. Chapter 12 has been added to provide the reader covers all aspects of nuclear medicine, thereby serving as with a familiarity of magnetic resonance and magnetic a comprehensive introductory text for nuclear medicine resonance imaging, and it is not intended to be a com- professionals to enter practice in this field. This book is prehensive study of MRI. Chapter 14, “Central Nervous intended for use by technologists and student technolo- System,” was revised by a new group of contributing gists, and it is also intended as a reference guide for authors from Boston who have provided a major revi- physicians and scientists entering nuclear medicine. It is sion to the chapter. There are also new co-authors in used by many nuclear medicine technologist educational Chapters 15, 19, 21, and 23. Chapter 22 has a new title programs and as a resource in many nuclear medicine “Inflammatory/Tumor/Oncology Imaging and Therapy.” departments worldwide. As described by its title, the chapter has expanded to The textbook remains divided into two main sections: include the growing area of nuclear medicine therapy in the basic science chapters and the clinical applications. oncology. Lastly, each chapter has protocols separated The knowledge base formed from the basic science chap- from the text for easy reference. ters (e.g., mathematics, physics, instrumentation, patient care, and radiation safety) provide the foundation on LEARNING ENHANCEMENTS which the clinical chapters build. In the clinical chapters, the science is expanded to include anatomy and physiol- Each chapter begins with an outline, learning objectives, ogy, and it is in the clinical chapters where you can see and key terms. The key terms appear in the front of the complexity of the field of nuclear medicine and how each chapter to aid students in identifying terms with the interconnectedness of physics, chemistry, anatomy, which they should become familiar. Each term will and physiology result in diagnostic images, or are used appear in boldface the first time that it used in the in clinical and therapeutic applications. The clinical chapter. The key terms are also defined in the Glossary chapters essentially start at the head and work their way at the end of the book. There are also summaries down the body. The last two chapters, “Inflammatory/ at the end of each chapter to highlight a few of the Tumor/Oncology Imaging and Therapy” and “Pediatric important concepts in each chapter. The full-color Imaging,” include topics that span all body systems. This PET/CT and cardiac scan insert has been expanded to coherent framework for the knowledge base of the book provide additional examples of realistic scans found in provides an efficient and logical approach to studying practice. the field of nuclear medicine that allows for students to Chapter 1, “Mathematics and Statistics,” gives the see a unifying theme or connectedness of the infor- reader opportunities to practice the basic math skills mation. An appendix of radiopharmaceuticals, which necessary to function as a nuclear medicine technologist. summarizes many of the radionuclide properties, radio- The answers for these questions are provided at the end pharmaceutical names, and clinical applications, is also of the book so that the reader can assess their knowledge included as an easy reference. before proceeding to the next chapter. Boxes and tables are used throughout the book to call attention to important information. The information NEW TO THIS EDITION and writing style are targeted toward readers new to Each revised edition captures the changes that have nuclear medicine. The fundamentals are addressed first, occurred since the previous edition and gives a glimpse and then topics build to become more complex. ix x Preface • An electronic image collection with all of the images INSTRUCTOR ANCILLARIES from the textbook in .jpeg and PowerPoint formats The Evolve website is a secure and interactive learning environment designed to work in coordination with Instructors may use Evolve to provide an Internet- Nuclear Medicine and PET/CT Technology and Tech- based course component that reinforces and expands niques, seventh edition. The instructor materials avail- the concepts presented in class. Evolve may be used to able on Evolve will assist the educator in preparing publish the class syllabus, outlines, and lecture notes; exams and pre senting material. The following assets are set up “virtual office hours” and email communication; included on Evolve: share important dates and information through the online class calendar; and encourage student participa- tion through chat rooms and discussion boards. Evolve • A test bank with multiple choice questions in Exam- also allows instructors to post exams and manage their View and Word formats, including rationales for grade books online. For more information, visit http:// correct answers and references to the coordinating evolve.elsevier.com/Christian/nuclear/ or contact an Else- page number in the textbook vier sales representative. A C K N O W L E D G M E N T S We would like to thank the hard work and extraordinary endured the time commitment made by the authors to efforts of the contributing authors of this text. Without ensure the delivery of quality material. their dedication and commitment to the project, it would Lastly, we would like to thank and extend our appre- not have been possible. It is also their talent in presenting ciation to our editors at Elsevier/Mosby, as well as the information that allows the reader to transform this production and design team, whose support, guidance, information into a knowledge base through which they patience, and diligent work have made this project a can practice nuclear medicine. success. We would also like to thank and recognize the co- workers, families, and loved ones of all of those involved Paul E. Christian in the book whose names do not appear in writing but Kristen M. Waterstram-Rich xi
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