Practical Nuclear Medicine

Practical Nuclear Medicine

Peter F. Sharp, Howard G. Gemmell and Alison D. Murray (Eds)

Practical Nuclear Medicine

Third Edition

With 222 Figures including 17 Color Plates

iii

Peter F. Sharp, PhD, FInstP, FIPEM, FRSE

Department of Biomedical Physics and Bioengineering Aberdeen University and NHS Grampian, UK

Howard G. Gemmell, PhD, FIPEM Department of Nuclear Medicine Aberdeen Royal Infirmary NHS Grampian, UK

Alison D. Murray, FRCP, FRCR Department of Radiology University of Aberdeen, UK

The authors wish to acknowledge their gratitude to OUP for the use of the following figures from the second edition of this book:

1.6, 1.7, 2.1, 2.3, 2.4, 2.5, 2.7, 3.1, 3.3, 3.5, 5.1, 5.2, 5.3, 5.4, 5.5, 5.6, 5.7, 5.8, 5.9, 5.10, 5.11, 5.12, 6.1, 6.2, 7.1, 7.4, 7.5, 7.6, 7.7, 10.1, 10.2, 10.3, 10.4, 10.8, 13.1, 13.10, 13.14, 13.15, 13.16, 14.1, 14.2, 14.3, 14.4, 14.5, 14.9, 14.10, 14.11, 14.12, 14.13, 14.14, 15.1, 15.4

British Library Cataloguing in Publication Data

A catalogue record for this book is available from the British Library Library of Congress Cataloguing-in-Publication Data

Sharp, Peter F.

Practical nuclear medicine/Peter F. Sharp, Howard G. Gemmell, Alison D. Murray.–3rd ed.

p. cm.

Includes bibliographical references and index.

ISBN 1-85233-875-X (alk. paper)

1. Nuclear medicine. I. Gemmell, H. G. II. Murray, Alison D. III. Title.

R895.S45 2005

616.07

575–dc22 2004061448

Apart from any fair dealing for the purposes of research or private study, or criticism or review, as permitted under the Copyright, Designs and Patents Act 1988, this publication may only be reproduced, stored or transmitted, in any form or by any means, with the prior permission in writing of the publishers, or in the case of reprographic reproduction in accordance with the terms of licences issued by the Copyright Licensing Agency. Enquiries concerning reproduction outside those terms should be sent to the publishers.

ISBN-10: 1-85233-875-X 3rd edition Printed on acid-free paper ISBN-13: 978-1-85233-875-6

First published in 1996 by Oxford University Press; ISBN 0199630321 Second edition published in 1998 Oxford University Press; ISBN 0192628429 Third edition 2005

C

Springer–Verlag London Limited 2005

The use of registered names, trademarks, etc. in this publication does not imply, even in the absence of a specific statement, that such names are exempt from the relevant laws and regulations and therefore free for general use.

Product liability: The publisher can give no guarantee for information about drug dosage and application thereof contained in this book. In every individual case the respective user must check its accuracy by consulting other pharmaceutical literature.

Printed in Singapore (TB/KYO)

9 8 7 6 5 4 3 2 1 SPIN 10931226

Springer Science+Business Media

springeronline.com

Foreword

There have been several significant advances in nuclear medicine since the publication of the second edition of Practical Nuclear Medicine. The last seven years have seen great strides in instrumentation, including new coincidence detectors, the development of a wider variety of crystals, and the advent of combined anatomical/functional imaging devices, including PET/CT and SPECT/CT. PET imaging with

F-FDG has become a mainstay of many clinical settings, and other radiotracers are finding their way into the rapidly expanding field of oncologic PET. However, radiopharmaceutical breakthroughs during this period have not been confined to one single imaging modality. Refinements in diagnostic applications of monoclonal antibodies, radiolabeled peptides, neuroreceptors, and a whole spectrum of new molecular targeting agents are steadily strengthening the clinical nuclear medicine armamentarium.

Such a daunting array of changes can present quite a challenge to even the most ex- perienced nuclear medicine practitioner. Consider then the magnitude of complexities that physicians, physicists, and technologists who are just beginning their training in our field are expected to assimilate! That is precisely why this book offers an easily accessible approach to both the basic science groundwork and the clinical applications of nuclear medicine. The third edition presents its material in a very pragmatic manner by dissemi- nating the various contributors’ practical experience via detailed instructions. The breadth of this hands-on knowledge and advice will likely benefit readers at all levels of expertise.

The book’s concentration on the actual practice of nuclear medicine is particularly dis- cernible in the first few chapters, which address scientific foundations of SPECT, PET, ra- diopharmaceuticals, etc. Such topics as instrumentation, data processing, and non-imaging radionuclide tests are covered in a way that accentuates specific human interaction; thus, quality assurance is an oft-recurring theme. To reflect the growing importance of PET in the clinical arena, the introductory chapter on this subject has been expanded and a new chapter on current PET radiopharmaceuticals and PET imaging in oncology, neurology, and cardiology has been added. In addition, new contributors have prepared the chapters on the skeletal system, the cardiovascular system, and the urinary tract.

This third edition of Practical Nuclear Medicine continues the text’s tradition of guiding

readers through not only the most commonly performed clinical nuclear medicine tests

but the scientific bases on which they were built. In addition, the editors of this version have

skillfully weeded out certain procedures and de-accentuated others whose use has lessened

in the clinical setting over the last few years. These efforts have produced a clinical manual

that clearly addresses many of the diagnostic dilemmas that currently appear in nuclear

medicine, which is constantly expanding the limits of its instrumentation, radiopharma-

ceuticals, and diagnostic capabilities. In the future, many aspects of current molecular

imaging research (such as targeting of tumor antigens, receptors, and metabolism; imag-

ing of hypoxia and apoptosis; and antisense targeting for both diagnosis and therapy)

will find their way into the clinical setting. Therefore, it is of paramount importance that

individuals working in nuclear medicine update their skills today in preparation for the

v

vi FOREWORD

next wave of advanced knowledge and clinical techniques. Fortunately, the third edition of Practical Nuclear Medicine will assist members of our community in accomplishing that task, and the editors and contributors are to be commended for making this possible.

Martin P. Sandler, MD

Carol D. and Henry P. Professor and Chairman Department of Radiology and Radiological Sciences Vanderbilt University School of Medicine

Nashville, Tennessee, USA

Contents

Foreword . . . . v Martin P. Sandler . . . . Contributors . . . . ix

1. Nuclear Medicine Imaging

Peter F. Sharp and Keith A. Goatman . . . . 1 2. Single Photon Emission Computed Tomography (SPECT)

Howard G. Gemmell and Roger T. Staff . . . . 21

3. Positron Emission Tomography

Peter F. Sharp and Andy Welch . . . . 35 4. Non-Imaging Radionuclide Investigations

Alex T. Elliott and Thomas E. Hilditch . . . . 49 5. Quality Assurance

Alex T. Elliott . . . . 65 6. Radiation Protection

Philip P. Dendy, Karen E. Goldstone, Adrian Parkin,

and Robert W. Barber . . . . 91 7. The Radiopharmacy

James Doherty and David Graham . . . . 113 8. The Skeletal System

Margaret E. Brooks . . . . 143 9. The Cardiovascular System

Malcolm J. Metcalfe . . . . 163

10. The Lung

Henry W. Gray . . . . 179

vii

viii CONTENTS

11. The Urinary Tract

Philip S. Cosgriff . . . . 205

12. The Brain, Salivary and Lacrimal Glands

Alison D. Murray . . . . 231 13. Thyroid, Parathyroid, and Adrenal Gland Imaging

William H. Martin, Martin P. Sandler, and Milton D. Gross . . . . 247 14. Gastrointestinal Tract and Liver

Leslie K. Harding and Alp Notghi . . . . 273 15. Infection and Inflammation

A. Michael Peters and Heok K. Cheow . . . . 305

16. Tumor Imaging

Alan C. Perkins . . . . 333

17. Clinical PET Imaging

Gary J. R. Cook . . . . 347

Index . . . . 365

Contributors

Robert W. Barber, MSc, BSc

Department of Medical Physics, Addenbrooke’s Hospital, Cambridge, UK

Margaret E. Brooks, MB ChB, FRCP, DMRD, FRCR

Department of Nuclear Medicine, Aberdeen Royal Infirmary, Aberdeen, UK

Heok K. Cheow, MB ChB, MRCP, FRCR Department of Nuclear Medicine, Addenbrooke’s Hospital, Cambridge, UK Gary J. R. Cook, MB BS, MD

Department of Nuclear Medicine and PET, Royal Marsden Hospital, Sutton, UK Philip S. Cosgriff, BSc, MSc

Medical Physics Department, Pilgrim Hospital, Boston, UK

Philip P. Dendy, PhD

Department of Medical Physics, Addenbrooke’s Hospital, Cambridge, UK

James Doherty, BSc, MRPharmS Pharmacy Department, Aberdeen Royal Infirmary, Aberdeen, UK

Alex T. Elliott, BA, PhD DSc, CPhys, FInstP, FIPEM, ARCP

Department of Clinical Physics and

Bioengineering, Western Infirmary, Glasgow, UK

Howard G. Gemmell, BSc, MSc, PhD, FIPEM Department of Nuclear Medicine, Aberdeen Royal Infirmary, NHS Grampian, Aberdeen, UK

Keith A. Goatman, BEng, MSc, PhD Department of Bio-Medical Physics and Bio-Engineering, University of Aberdeen, UK

Karen E. Goldstone, BSc, MSc

Department of Medical Physics, Addenbrooke’s Hospital, Cambridge, UK

David Graham, MSc, BSc, MRPharmS Pharmacy Department, Aberdeen Royal Infirmary, Aberdeen, UK

Henry W. Gray MD, FRCP, FRCR Department of Nuclear Medicine, Royal Infirmary, Glasgow, UK Milton D. Gross, MD

Departments of Radiology and Internal Medicine, University of Michigan Medical School, Nuclear Medicine Service,

Department of Veterans Affairs Health System, Ann Arbor, MI, USA

Leslie K. Harding, MB ChB, BSc, FRCP, FRCR Department of Physics and Nuclear Medicine, City Hospital NHS Trust, Birmingham, UK Thomas E. Hilditch, BSc, PhD, FInstP Department of Clinical Physics and Bioengineering, Western Infirmary, Glasgow, UK

Malcohm J. Metcalfe, MD, FRCP

Department of Cardiology, Aberdeen Royal Infirmary, Aberdeen, UK

William H. Martin, MD

Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, TN, USA

Alison D. Murray, MB ChB, FRCP, FRCR Department of Radiology, College of Life Sciences and Medicine, University of Aberdeen, UK

ix

x CONTRIBUTORS

Alp Notghi, MD, MSc, FRCP

Department of Physics and Nuclear Medicine, City Hospital NHS Trust, Birmingham, UK

Adrian Parkin, DPhil

Department of Medical Physics, Addenbrooke’s Hospital, Cambridge, UK

Alan C. Perkins, BSc, MSc, Ph.D, FIPEM, ARCP Department of Medical Physics, Medical School, Queen’s Medical Centre, Nottingham, UK

A. Michael Peters, MA, MD, MSc, FRCPath, FRCP, FRCR, FMedSci

Department of Applied Physiology, Brighton Sussex Medical School, University of Sussex, Brighton, UK

Martin P. Sandler, MD

Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, TN, USA

Peter F. Sharp, BSc, PhD, CPhys, FInstP, ARCP, FIPEM, FRSE

Department of Bio-Medical Physics and Bio-Engineering, University of Aberdeen and NHS Grampian, UK

Roger T. Staff, PhD

Department of Bio-Medical Physics and Bio-Engineering, University of Aberdeen and NHS Grampain, UK

Andy Welch, BSc, PhD

Biomedical Physics and Bioengineering, BSc,

PhD, University of Aberdeen, UK