nuklearna medicina uopste, instrumentacija, uvod, radiofarmaci
DESCRIPTION
Nuklearna Medicina Uopste, Instrumentacija, Uvod, RadiofarmaciProf. dr D. Šobić-ŠaranovićTRANSCRIPT
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Nuklearna medicina
Uvod
Instrumentacija
Prof. dr D. Šobić-Šaranović
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**NUKLEARNA MEDICINA je grana medicine u kojoj NUKLEARNA MEDICINA je grana medicine u kojoj se primenjuju radioaktivni izotopi (otvoreni se primenjuju radioaktivni izotopi (otvoreni izvori zračenja) u cilju otkrivanja (dijagnostike) iizvori zračenja) u cilju otkrivanja (dijagnostike) ilečenja različitih bolesti.lečenja različitih bolesti.
*NUKLEARNA MEDICINA prati pre svega *NUKLEARNA MEDICINA prati pre svega funkcionalne i patofiziološke poremećaje u funkcionalne i patofiziološke poremećaje u organizmu.organizmu.
*U NUKLEARNOJ MEDICINI radioaktivni izotopi se*U NUKLEARNOJ MEDICINI radioaktivni izotopi sedaju najčešće i.v. bolesniku, a GAMA KAMERAdaju najčešće i.v. bolesniku, a GAMA KAMERApredstavlja detektor zračenja. predstavlja detektor zračenja.
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Nuklearna medicina-podela
Nuklearna medicina
“In vivo”
dijagnostika
“In vitro”
dijagnostika
Radionuklidna
terapija
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- Izotopi
Različit broj neutrona Isti atomski broj, Z
- Radionuklidi I-131, Tc-99m
- Element Proton = atomski broj, No (Z) Proton + neutron = atomska masa No (A)
A
ZX 12753
I
pr) I-13I (8 Ds)I-123 (13 hr)I-125 (60 Ds)
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Radioaktivni izotopi
Izotopi T/2 Energija(KeV)
I-131
I-123
I-125
Tc-99m
T1-201
Ga-67
In-111
P-32
8.1 d
13 h
60 d
6 h
73 h
78 h
67 h
14.3 d
364
159
35
140
80,135,167
93,184
173,247,320
695(
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Proizvodnja radioaktivnih izotopa
• Nuklearni reaktor 31I, 125I, 99Mo, 133Xe, 32P, 14C, 166Ho, 186
Re
• Ciklotron, akcelerator 201Tl, 67Ga, 123I, 111In, 57Co, 11C, 13N, 15O, 18F
• Generator 99mTc, 188Re
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Radiofarmaci
• Radionuklid + Hemijska supstanca Radionuklid+biološka supstanca
99mTc – MDP (scintigrafija kostiju) 99mTc – MAA (scintigrafija pluca)
• Organ specificni mehanizam
• Optimalna energija (100 – 200 KeV)
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Priprema radiofarmaka
Tc-99m
DPD
Radiofarmak99mTC-DPD
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Metod
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Razvoj bolesti i mogućnosti dijagnostike
Genetski Problem
Biohemijske Promene PET
Fizioloske Promene SPECT, MRI
Anatomske Promene X-ray, US, CT, MRI
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• Anatomski modaliteti– Primarna morfologija– Ro, CT, MRI, US, video sequences,
• Funkcionalni modaliteti– Primarna informacija o funkciji i metaboliz
mu– Scintigrafija, SPECT, PET– fMRI, EEG, MEG, pMRI, EI
Modaliteti medicinske dijagnostike
Nuklearna medicina
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Radiologija vs. Nuklearna Medicina
Detector
External Radiation Source
Detector
Internal Radiation Source
X-rayExtra-nucleus origin
Gamma-rayNucleus origin
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Planarna slika: Ro snimak pluca
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Planarna scintigrafija-nuklearna medicina
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Tiroidni nodusi
(1) (2) (3)
(4) (5)
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Tomografsko snimanje: CT
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SPECT, Akumulacija NeoSPECta u SPN
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PET-18FDG- karcinom pluća
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*U NUKLEARNOJ MEDICINI se, kao rezultat*U NUKLEARNOJ MEDICINI se, kao rezultatprimene radioaktivnih izotopa i detekcijomprimene radioaktivnih izotopa i detekcijom
zračenja GAMA KAMEROM povezanom on line zračenja GAMA KAMEROM povezanom on line sa računarom, dobijaju slike raspodele sa računarom, dobijaju slike raspodele radioaktivnog izotopa u ciljnom organu.radioaktivnog izotopa u ciljnom organu.
*Te slike se nazivaju SCINTIGRAMI. *Te slike se nazivaju SCINTIGRAMI.
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Detekcija radioaktivnosti
• Detekcija radioaktivnosti je osnov svih dijagnostičkih procedura u nuklearnoj medicini
• Detektori se koriste da izmere:
-Radioaktivnu dozu koja ce se dati bolesniku
-Radioaktivnost u “in vitro” uzorcima
-Akumulaciju radioaktivnosti “in vivo”
-Vizualizuju distribuciju radioaktivnosti u telu
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Detekcija radioaktivnosti
Specifičnu detektori:
• Kalibrator doza
• Well counters
• Detektori u toku hiruških operacija
• Uredjaji za vizualizaciju:
-Gama kamera
- PET skener
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Detektori
• U Nuklearnoj medicini se koriste gasni detektori i scintilacioni detektori
• Detekcija of γ-fotona zavisi od interakcije sa materijom (uglavnom Compton efekat i foto električni efekat) koji izazivaju jonizaciju, oslobadjaju elektrone i pobudjuju atome.
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Detektori
• Direktna jonizacija u materijalu detektora ili merenje sekundarno stvorene svetlosti, scintilacije, dovodi do stvaranja električnog signala.
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DETEKTORI
• IONIZACIONI (GASNI) DETEKTORI
• SCINTILACIONI DETEKTORI
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SCINTILACIONI DETEKTORIUpotreba
• Surgical probes
• Thyroid uptake system
• Gamma camera
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Scintilacioni Detektor
• Kada jonizujuce zračenje reaguje sa scintilatorom, elektroni se podižu na viši energetski nivo.
• Vraćajući se na početno energetsko stanje, emituje se vidljiva ultravioletna svetlost.
+Elektricni impuls
Scintilacioni kristal Fotokatoda
Opticko ogledalo
Radijacija
Anoda
Svetlost
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• Pretvaranje svetlosnih fotona u električni signal u fotokatodi – jedan elektron se emituje sa fotokatode na svakih 5
svetlosnih fotona i multiplicira preko dinoda (51010 milliona).
• Pojačanje signala
VidljiviSvetlosni Foton
Strujni impuls
Fotocatoda Anoda
0 V 700 V
600 V
500 V300 V
200 V
100 V
Dynode
staklo
Fotomultiplikatorska cev, PMT
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Scintillation Camera
Position Logic Circuits
Collimator
NaI (Tl) Crystal
PM-Tube Array
Pulse-HeightAnalyzer
Z-Pulse
Patient
Monitor
X-PositionSignal
Y-PositionSignal
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Gama kamera
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Collimator
NaI(Tl) crystal
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Ispitivanja u nuklearnoj medicini
• Planarne scintigrafije– Anger scintillation camera
• Tomografsko snimanje– Single photon emission tomography (SPECT)– Positron emission tomography (PET)
Dinamske scintigrafije
Single Photon Imaging
Positron Imaging (Positron → 2 Photons)
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VRSTE SCINTIGRAMA:VRSTE SCINTIGRAMA:
-PLANARNIPLANARNI
-DINAMSKIDINAMSKI
-WHOLE BODY (CELOG TELA)WHOLE BODY (CELOG TELA)
-TOMOGRAFSKITOMOGRAFSKI
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Planarne scintigrafije
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SCINTIGRAFIJA CELOG TELA
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Lasix
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Single Photon Emission
Computed Tomography
(SPECT)
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SPECT
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Positron Emission Tomography
(PET)
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Nuclide T1/2 (min) Production
18F 110 18O(p, n)18F
20Ne(d, )18F
11C 20 14N(p, )11C
13N 10 16O(p, )13N
15O 2 14N(d, n)15O 15N(p, n)15O
Positron Emiteri za PETPositron Emiteri za PETPositron Emiteri za PETPositron Emiteri za PET
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RadioisotopiRadioisotopi
• F-18 : 18F-FDG
• C-11 : 11C-methionine
• N-13 : 13NH3
• O-15 : H215O, C15O2
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AnihilacijaAnihilacijaAnihilacijaAnihilacija
511 keV
5 11 keV
-ray
Positron(
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Radiofarmaci
• Glucose metabolismF-18-fluorodeoxyglucose (FDG)
• Amino acid metabolismC-11-methionine, F-18-tyrosine
• Nucleic acid metabolismF-18-thymidine
• ProtokN-13-ammonia, O-18-water
• ReceptorF-18-estradiol, progesteron
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Multi-modal Imaging (PET/CT, Fusion PET)
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Karcinom pluca sa subkarinalnim LN metastazom u
levoj nadbubreznoj zlezdi
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Metastaza u subkarinalnom LN
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Metastaza u levoj nadbubreznoj zlezdi
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Radionuklidna terapijabeta minus emiteri
1. I-131thyrotoxicosis, thyroid cancer
2. P-32polycythemia, essential throbocythemia
3. I-131 MIBGpheochrmocytoma, neuroblastoma
4. Y-90 colloidmalignant effusion
5. Re-188, Ho-166 lipiodol, microspherehepatoma, other cancer
6. Radioimmnotherapymonoclonal antibody