Nuclear medicine

Richard Zimmermann

Description

Nuclear medicine is a growing specialized medical field in which radiopharmaceuticals, i.e. drugs associated to radioactivity, are used for diagnostic or therapeutic purposes. Since 1942, nuclear medicine has progressed in such a way that it became a major diagnostic tool in hospitals. The past ten years have seen the introduction of major technical breakthroughs which will considerably modify the landscape of cancer treatment.
Once injected to the patient, the radiopharmaceutical drug aims at the tumour cell – including metastases – selectively, settles there, and emits radiation. Depending on the radiation type, the drug will either help identify the cells or destroy them. Applications are not limited to oncology; indeed, nuclear medicine has found interesting applications in cardiology and neurology as well.

The new millennium saw the introduction of the Hybrid imaging technology PET/CT which combines the Positron Emission Tomography (PET) modality with conventional high quality x-ray imaging. It took another two years until PET could be combined with Magnetic Resonance Imaging (MRI) in the hybrid equipment PET/MR. New tracers (drugs for diagnosis) also came on the market with different diseases as targets, such as prostate cancer, neuroendocrine tumours, or Alzheimer’s disease. But the recent introduction of radiotherapeutics in the treatment of cancer has brought major changes on the market, for they can be much more powerful and specific than chemotherapeutics or external radiation therapy. Combining radiodiagnostics to select positive responders to a treatment with efficient radiotherapeutics opens a highway for the development of theranostics, another word for personalized medicine.

This scientific book aims to introduce nuclear medicine to a larger audience, pointing out, among other things, the difficulties met by both physicians and patients when trying to access new technologies. This second edition shows how much progress has been made over the past ten years since the original book was published, and how much can be expected for patients within the next few years.

Sujets

• Médecine
• Spécialités médicales
• Medical Technology
• Allied Health Services
• Medical
• Nucléaire

Informations

• Publié par: EDP Sciences
• Date de parution: 05 septembre 2017
• Nombre de lectures: 0
• EAN13: 9782759821495
• Langue: English
• Poids de l'ouvrage: 5 Mo

Extrait

Nuclear  Medicine Radioactivity  for Diagnosis  and Therapy nd 2 edition

Richard Zimmermann

Nuclear Medicine Radioactivity for Diagnosis and Therapy

Nuclear Medicine

Radioactivity for Diagnosis and Therapy

RICHARD ZIMMERMANN

Illustrations by Pascal COUCHOT

2nd edition

17, avenue du Hoggar – P.A. de Courtabœuf BP 112, 91944 Les Ulis Cedex A

Layout: Patrick Leleux PAO

Translation coordinator: Susan Brown

Cover illustrations: SPECT/CT hybrid image, © University of Erlangen, Siemens Healthineers; cyclotron, © IBA Molecular/CIS Bio International; PET/CT camera, © Philips Healthcare; heart of the BR2 reactor in Mol, © SCKCEN, Mol, Belgium; Positron Emission Tomography scan of a healthy subject’s brain., CEA Orsay, France.

Printed in France

ISBN (print): 9782759821402 ISBN (ebook): 9782759821495

This work is subject to copyright. All rights are reserved, whether the whole or part of the material is concerned, specifically the rights of translation, reprinting, reuse of illustra tions, recitation, broadcasting, reproduction on microfilms or in other ways, and storage in data bank. Duplication of this publication or parts thereof is only permitted under the provisions of the French Copyright law of March 11, 1957. Violations fall under the prosecution act of the French Copyright law.

©EDP Sciences, 2017

To Christiane

This work is dedicated to all the anonymous persons who are directly or indirectly involved in the discovery, development, preparation, handling and application of radiodiagnostics and radiotherapeutics. They are technicians, cyclotronists, engineers, radiochemists, radiopharmacists, biologists, clinicians, nurses, scientists, salesmen, specialists of radioprotection and safety, experts in quality and logistics, environment professionals, regulatory affairs authorities, maintenance specialists, archivists, etc., Without their precious contribution, nuclear physicians and radiotherapists would not be able to bring to their patients – who are often affected by extremely invalidating diseases, sometimes considered as incurable – the benefit of these extremely complex and particularly efficient products. Hence, this work is also dedicated to all patients that have benefited, could benefit, or will benefit from the progress of this technology.

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CONTENTS

Preface............................................................................... Introduction and Definitions................................................

 1. Nuclear Medicine, What For?................................................  I. The Original Case of Thyroid Cancer...................................  II. The Diagnosis Aspect....................................................... III. The Therapeutic Aspect.................................................... 1. Cancer Therapy .......................................................... 2. Nononcological Therapeutic Application: Rheumatology ...  IV. Miscellaneous Aspects of Medical Radioactivity Applications...

 2. A Little History...................................................................

 3. Some Basic Notions of Radiation..........................................  I. Different Types of Radiation.............................................  II. Measurement Units and Doses.......................................... III. Radionuclides for Nuclear Medicine.................................... 1. Gamma Emitters (γ) ................................................... + 2. Positron Emitters (β) ................................................  3. Electron Emitters (β)................................................. 4. Alpha Emitters (α) .....................................................

11 13

15 18 19 25 25 32 32

35

43 45 50 59 60 61 63 66

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CONTENTS

5. Radionuclides for Brachytherapy and External Radiotherapy 6. Other Radionuclides ................................................... Summary..............................................................................

 4. SPECT Imaging: Gamma Ray Imaging.....................................  I. Nuclear Medicine Imaging Methods.................................... 1. Scintigraphy.............................................................. 2. The Products used in Scintigraphy ................................  II. Imaging Tools................................................................ III. Detection of the Sentinel Node......................................... Summary..............................................................................

 5. PET Imaging: Positron Emission Tomography..........................  I. The Imaging Principle.....................................................  II. The Radiation Source...................................................... III. The Labelled Product: Fludeoxyglucose...............................  IV. Production and Equipment...............................................  V. Applications in Cancerology..............................................  VI. Applications beyond Oncology........................................... VII. Positron Emitters Evolution.............................................. Summary..............................................................................

 6. Therapeutic Applications......................................................  I. Metabolic Radiotherapy...................................................  II. Local Radiotherapy......................................................... III. Radioimmunotherapy......................................................  IV. Targeted Radiotherapy.....................................................  V. Alphatherapy and Alphaimmunotherapy............................  VI. The Theranostic Approach................................................ VII. Radiotherapeutic Substances............................................ VIII.TheDoseIssue...............................................................  IX. Mechanism of Action – The Bystander Effect.......................  X. The Limitations.............................................................. Summary..............................................................................

NUCLEAR MEDICINE

68 69 71

73 80 83 85 88 90 92

95 97 99 101 102 104 106 107 108

109 110 113 114 122 123 129 130 131 133 135 136

CONTENTS

 7. The Development of Radiopharmaceuticals............................  I. The Molecule Discovery Phase...........................................  II. Pharmacological and Predinical Studies.............................. III. Pharmacokinetics...........................................................  IV. Toxicological Analysis......................................................  V. Phase I Clinical Studies...................................................  VI. Phase II Clinical Studies.................................................. VII. Phase III Clinical Studies................................................. VIII.RegulatoryIssuesandRegistration....................................  IX. Marketing......................................................................  X. Postmarketing Authorisation and Drug Monitoring............... Summary..............................................................................

 8. The Production of Radiopharmaceuticals...............................  I. Definitions....................................................................  II. Production of Radionuclides............................................. 1. Reactors ................................................................... 2. Particle Accelerators................................................... 3. Generators ................................................................ 4. Fission Products ........................................................ III. The Production of Vectors and Ligands...............................  IV. The Industrial Production of Radiopharmaceuticals...............  V. Transport and Logistics....................................................  VI. Radiopharmacies............................................................ VII. Nuclear Medicine Centres in the World................................ Summary..............................................................................

 9. The Future of Nuclear Medicine............................................  I. Hybrid Imaging Tools and Equipment Evolution...................  II. Individualised Medication and the Development  of Theranostics.............................................................. III. Orphan Diseases and Orphan Drugs....................................  IV. Ethical and Regulatory Limitations.................................... 1. Regulation and Administration .................................... 2. Side Effects and Toxicity ............................................. 3. Dosage and Indication Extensions ................................

139 142 142 144 145 147 149 152 155 157 158 159

161 162 163 164 164 167 168 168 169 171 172 175 179

181 182

183 186 188 188 188 190

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