GST 211: History and Philosophy of Science

Topic: Radioisotopes in Medicine

by

Terver Daniel, Ph.D

Preamble: The Nucleus of an Atom.
For us to understand the topic; Radioisotopes in Medicine, it is evidently recommended
that, what a nucleus is should be explored, also detailing summarized information on what
is nuclear radiation and the types of radiation and how useful these are in medicine.
A nucleus is the integral central part of an atom comprising only two components: the
Neutrons and the Protons. It was discovered by Sir Ernest Rutherford in 1911 based on the
1909 Geiger-Marsden gold foil experiments.

shows the nuclear symbol and how it is represented.

When a particular nucleus of an atom has the same
symbol with the same number of Z but with a
varying N number, it is called an ISOTOPE.

Some examples of nuclear isotopes are as given: 12C, 13C, 14C for the carbon nucleus. This
shows that the mass number for each isotopic element in carbon is 12, 13 and 14
respectively, with the atomic number, Z as 6.
Other isotopic examples are: 30Cl, 31Cl, 32Cl, 33Cl etc. whose atomic number, Z is 17. The
neutron numbers in each case can be determined from the expression of A = Z + N;
where Z – proton ( or atomic) number, N – neutron number and A – the mass number.

Exercise: Add other nuclei isotopes Z = 1 to 5. Remarks: It is when the Z is the same but
N changes that we refers to such nuclei as isotopes.
What is then a Nuclear Radiation?
The energy released in the form of electromagnetic waves or high-speed charged particles
is known as nuclear radiation. And, this radiation can come from many sources, both
manufactured and natural. All living things are continually exposed to low doses of
radiation from sunlight, rocks, and cosmic rays.
Nuclear radiation consists of an electromagnetic spectrum with its energetic portion, the x-
rays and the gamma rays. There are three types of this radiation, namely; the alpha, beta
and gamma radiation.

Gamma Radiation: The electromagnetic radiation of very high frequency is known as γ-

radiation. X-rays, visible rays, ultraviolet rays, infrared rays, radio waves and microwaves
are also some other parts of the electromagnetic spectrum but not as intense as γ-radiation.
They have a wavelength ranging between 4 x 10-10 and 5 x 10-13 m.
Radioisotopes in Medicine
Nuclear medicine uses radiation to provide diagnostic information about the functioning of
a person's specific organs, or to treat them. Diagnostic procedures using radioisotopes are
now routine.
Radiotherapy can be used to treat some medical conditions, especially cancer,
using radiation to weaken or destroy particular targeted cells.
Over 40 million nuclear medicine procedures are performed each year, and
demand for radioisotopes is increasing at up to 5% annually.
Sterilization of medical equipment is also an important use of radioisotopes.

The attributes of naturally decaying atoms, known as radioisotopes, give rise to several
applications across many aspects of modern day life.

There is widespread awareness of the use of radiation and radioisotopes in medicine,

particularly for diagnosis (identification) and therapy (treatment) of various medical
conditions. In developed countries (a quarter of the world population) about one person in
50 uses diagnostic nuclear medicine each year, and the frequency of therapy with
radioisotopes is about one-tenth of this.

So, what does Nuclear Medicine do?

Nuclear medicine uses radiation to provide information about the functioning of a

person's specific organs, or to treat disease. In most cases, the information is used by
physicians to make a quick diagnosis of the patient's illness. The thyroid, bones, heart,
liver, and many other organs can be easily imaged, and disorders in their function revealed.
In some cases radiation can be used to treat diseased organs, or tumours. Five Nobel
Laureates (example; Georg de Hevesy, a Hungarian Chemist, 1943 – was awarded
Nobel prize in Chemistry for this contribution, Samuel Ruben between 1937 -1938,
University of California, USA) have been closely involved with the use of radioactive
tracers (used in imaging tests that help find problems inside the body) in medicine.

Over 10,000 hospitals worldwide use radioisotopes in medicine, and about 90% of the
procedures are for diagnosis. The most common radioisotope used in diagnosis is
technetium-99 (Tc-99), with some 40 million procedures per year, accounting for about
80% of all nuclear medicine procedures and 85% of diagnostic scans in nuclear medicine
worldwide.

In developed countries (about one-quarter of world population) the frequency of diagnostic

nuclear medicine is 1.9% per year, and the frequency of therapy with radioisotopes is
about one-tenth of this. In the USA there are over 20 million nuclear medicine procedures
per year, and in Europe about 10 million, with 2 million of these being therapeutic. In
Australia there are about 560,000 per year, 470,000 of these using reactor isotopes. The
use of radiopharmaceuticals in diagnosis is growing at over 10% per year.

Nuclear medicine was developed in the 1950s by physicians with an endocrine

emphasis, initially using iodine-131 to diagnose and then treat thyroid disease. In
recent years specialists have also come from radiology, as dual PET/CT (positron emission
tomography with computerized tomography) procedures have become established,
increasing the role of accelerators in radioisotope production. However, the main
radioisotopes such as Tc-99m cannot effectively be produced without reactors.

Nuclear Medicine Diagnostic, Nuclear Imaging

Radioisotopes are an essential part of medical diagnostic procedures. In combination with
imaging devices which register the gamma rays emitted from within, they can be used for
imaging to study the dynamic processes taking place in various parts of the body.

In using radiopharmaceuticals for diagnosis, a radioactive dose is given to the patient and
the activity in the organ can then be studied either as a two dimensional picture or, using
tomography, as a three dimensional picture. Diagnostic techniques in nuclear medicine use
radioactive tracers which emit gamma rays from within the body. These tracers are
generally short-lived isotopes linked to chemical compounds which permit specific
physiological processes to be scrutinized. They can be given by injection, inhalation, or
orally.

The earliest technique developed uses single photons detected by a gamma camera which
can view organs from many different angles. The camera builds up an image from the
points from which radiation is emitted; this image is enhanced by a computer and viewed
on a monitor for indications of abnormal conditions. Single photon emission
computerized tomography (SPECT) is the current major scanning technology to
diagnose and monitor a wide range of medical conditions.
A more recent development is positron emission tomography (PET) which is a more
precise and sophisticated technique using isotopes produced in a cyclotron (A cyclotron is
a machine that accelerates charged particles or ions to high energies. It was invented
to investigate the nuclear structure by E.O Lawrence and M.S Livingston in 1934.)
A positron-emitting radionuclide is introduced, usually by injection, and accumulates in
the target tissue. As it decays it emits a positron, which promptly combines with a nearby
electron resulting in the simultaneous emission of two identifiable gamma rays in opposite
directions. These are detected by a PET camera and give very precise indications of their
origin. PET's most important clinical role is in oncology, with fluorine-18 as the tracer,
since it has proven to be the most accurate non-invasive method of detecting and
evaluating most cancers. It is also well used in cardiac and brain imaging.

New procedures combine PET with computed X-ray tomography (CT) scans to give co-
registration of the two images (PET-CT), enabling 30% better diagnosis than with a
traditional gamma camera alone. It is a very powerful and significant tool which provides
unique information on a wide variety of diseases from dementia to cardiovascular disease
and cancer.

Combining PET with MRI (PET-MRI), especially for brain imaging, enables diffusion-
weighted imaging in soft tissue with dynamic contrast and magnetic resonance
spectroscopy.

Positioning of the radiation source within (rather than external to) the body is the
fundamental difference between nuclear medicine imaging and other imaging techniques
such as X-rays. Gamma imaging by either method described provides a view of the
position and concentration of the radioisotope within the body. Organ malfunction can be
indicated if the isotope is either partially taken up in the organ (cold spot), or taken up in
excess (hot spot). If a series of images is taken over a period of time, an unusual pattern or
rate of isotope movement could indicate malfunction in the organ.

A distinct advantage of nuclear imaging over X-ray techniques is that both bone and soft
tissue can be imaged very successfully. This has led to its common use in developed
countries where the probability of anyone having such a test is about one in two and rising.

Diagnostic Radiopharmceuticals
Every organ in our bodies acts differently from a chemical point of view. Doctors and
chemists have identified a number of chemicals which are absorbed by specific organs. The
thyroid, for example, takes up iodine, whilst the brain consumes quantities of glucose.
With this knowledge, radiopharmacists are able to attach various radioisotopes to
biologically active substances. Once a radioactive form of one of these substances enters
the body, it is incorporated into the normal biological processes and excreted in the usual
ways.
Diagnostic radiopharmaceuticals can be used to examine blood flow to the brain,
functioning of the liver, lungs, heart, or kidneys, to assess bone growth, and to confirm
other diagnostic procedures. Another important use is to predict the effects of surgery and
assess changes since treatment.

The amount of the radiopharmaceutical given to a patient is just sufficient to obtain the
required information before its decay. The radiation dose received is medically
insignificant. The patient experiences no discomfort during the test and after a short time
there is no trace that the test was ever done. The non-invasive nature of this technology,
together with the ability to observe an organ functioning from outside the body, makes this
technique a powerful diagnostic tool.
A radioisotope used for diagnosis must emit gamma rays of sufficient energy to escape
from the body and it must have a half-life short enough for it to decay away soon after
imaging is completed.

The radioisotope most widely used in medicine is Tc-99, employed in some 80% of all
nuclear medicine procedures. It is an isotope of the artificially-produced element
technetium and it has almost ideal characteristics for a nuclear medicine scan, such as with
SPECT. These are:
(I) It has a half-life of six hours which is long enough to examine metabolic
processes yet short enough to minimize the radiation dose to the patient.
(ii) It decays by an 'isomeric' process, which involves the emitting of gamma rays
and low energy electrons. Since there is no high-energy beta emission the radiation
dose to the patient is low.
(iii) The low-energy gamma rays it emits easily escape the human body and are
accurately detected by a gamma camera.
(iv) The chemistry of technetium is so versatile it can form tracers by being
incorporated into a range of biologically-active substances that ensure it
concentrates in the tissue or organ of interest.
Nuclear medicine Therapy
The uses of radioisotopes in therapy are comparatively few, but nevertheless important.
Cancerous growths are sensitive to damage by radiation. For this reason, some cancerous
growths can be controlled or eliminated by irradiating the area containing the growth. This
may be called radiosurgery.

External irradiation (sometimes called teletherapy) can be carried out using a gamma
beam from a radioactive cobalt-60 source, though in developed countries the much more
versatile linear accelerators are now being used as high-energy X-ray sources (gamma and
X-rays are much the same). An external radiation procedure is known as gamma knife
radiosurgery, and involves focusing gamma radiation from 201 sources of Co-60 on a
precise area of the brain with a cancerous tumour. Worldwide, over 30,000 patients are
treated annually, generally as outpatients. Teletherapy is effective in the ablation of
tumours rather than their removal; it is not finely tuned.

Internal radionuclide therapy is administered by planting a small radiation source, usually a

gamma or beta emitter, in the target area. Short-range radiotherapy is known as
brachytherapy, and this is becoming the main means of treatment. Iodine-131 is
commonly used to treat thyroid cancer, probably the most successful kind of cancer
treatment. It is also used to treat non-malignant thyroid disorders. Iridium-192 implants
are used especially in the head and breast. They are produced in wire form and are
introduced through a catheter to the target area. After administering the correct dose, the
implant wire is removed to shielded storage. Permanent implant seeds (40 to 100) of
iodine-125 or palladium-103 are used in brachytherapy for early stage prostate cancer.
Alternatively, needles with more-radioactive Ir-192 may be inserted for up to 15 minutes,
two or three times. Brachytherapy procedures give less overall radiation to the body, are
more localized to the target tumour, and are cost-effective.

Sterilization
Many medical products today are sterilized by gamma rays from a Co-60 source, a
technique which generally is much cheaper and more effective than steam heat
sterilization. The disposable syringe is an example of a product sterilized by gamma rays.
Because it is a 'cold' process radiation can be used to sterilize a range of heat-sensitive
items such as powders, ointments, and solutions, as well as biological preparations such as
bone, nerve, and skin to be used in tissue grafts. Large-scale irradiation facilities for
gamma sterilization are installed in many countries. Smaller gamma irradiators, often
utilising Cs-137, having a longer half-life, are used for treating blood for transfusions and
for other medical applications.

Sterilization by radiation has several benefits. It is safer and cheaper because it can be done
after the item is packaged. The sterile shelf-life of the item is then practically indefinite
provided the seal is not broken. Irradiation technologies are used to sterlize almost half of
the global supply of single-use medical products. Apart from syringes, medical products
sterilized by radiation include cotton wool, burn dressings, surgical gloves, heart valves,
bandages, plastic, and rubber sheets and surgical instruments.

Supply of Radioisotopes

The main world isotope suppliers are Curium (France & USA), MDS Nordion (Canada),
IRE (Europe), NTP (South Africa), JSC Isotope (Russia), and ANM (ANSTO
Australia).

Isotopes Used in Medicine

Many radioisotopes are made in nuclear reactors, some in cyclotrons. Generally neutron-
rich ones and those resulting from nuclear fission need to be made in reactors; neutron-
depleted ones such as PET radionuclides are made in cyclotrons with energy ranging from
9 to 19 MeV. Higher-energy machines of about 30 MeV are needed for most SPECT
radionuclides. There are about 40 activation product radioisotopes and five fission product
ones made in reactors.

Some examples of Reactor Radioisotopes

Note: A nuclear reactor is a device used to initiate and control a fission nuclear chain
reaction or nuclear fusion reactions.

1. Bismuth-213 (half-life: 46 min):

Used for targeted alpha therapy (TAT), especially cancers, as it has a high energy (8.4
MeV)

2. Caesium-131 (9.7 d):

Used for brachytherapy, emits soft X-rays

3. Chromium-51 (28 d):

Used to label red blood cells for monitoring, and to quantify gastro-intestinal protein loss
or bleeding.

4. Cobalt-60 (5.27 yr):

Formerly used for external beam radiotherapy, now almost universally used for sterilising.
High-specific-activity (HSA) Co-60 is used for brain cancer treatment.

5. Erbium-169 (9.4 d):

Used for relieving arthritis pain in synovial joints.

6. Holmium-166 (26 h):

Being developed for diagnosis and treatment of liver tumours. Administered as
microspheres.

7. Iodine-125 (60 d):

Used in cancer brachytherapy (prostate and brain), also diagnostically to evaluate the
filtration rate of kidneys and to diagnose deep vein thrombosis in the leg. It is also widely
used in radioimmuno-assays to show the presence of hormones in tiny quantities.

8. Technetium-99m (6 h):
Used in to image the skeleton and heart muscle in particular, but also for brain, thyroid,
lungs (perfusion and ventilation), liver, spleen, kidney (structure and filtration rate), gall
bladder, bone marrow, salivary and lacrimal glands, heart blood pool, infection, and
numerous specialized medical studies. Produced from Mo-99 in a generator. The most
common radioisotope for diagnosis, accounting for over 80% of scans.