Nuclear Medicine PET/CT and TECHNOLOGY AND TECHNIQUES This page intentionally left blank EIGHTH EDITION Nuclear Medicine PET/CT and TECHNOLOGY AND TECHNIQUES Kristen M. Waterstram-Rich, MS, CNMT, FSNMMI-TS Professor Interim Associate Dean College of Health Sciences and Technology Rochester Institute of Technology Rochester, New York David Gilmore, ABD, CNMT, NCT, RT (R)(N), FSNMMI-TS Chair & Assistant Professor of Medical Imaging Program Director, Nuclear Medicine & Molecular Imaging Medical Imaging Department Regis College Weston, Massachusetts 3251 Riverport Lane St. Louis, Missouri 63043 NUCLEAR MEDICINE AND PET/CT: TECHNOLOGY AND TECHNIQUES, EIGHTH EDITION ISBN: 978-0-323-35622-0 Copyright © 2017 by Elsevier, Inc. All rights reserved. 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Beauvais, RPh, BCNP, FAPhA Nancy McDonald DeLoatch, RT, CNMT, NCT Associate Professor Clinical Coordinator School of Health Sciences Nuclear Medicine Technology Program Oakland University St. Vincent’s Medical Center Rochester, Michigan; Jacksonville, Florida Director of Radiopharmacy (Retired) Nuclear Medicine Gary Dillehay, MD, FACNM, FACR William Beaumont Hospital Professor of Radiology Royal Oak, Michigan Department of Nuclear Medicine Northwestern Memorial Hospital Erin Beloin, MBA, CNMT, RT(CT) Chicago, Illinois Assistant Professor of Medical Imaging Program Director, Post-Licensure Programs Mary Beth Farrell, MS, CNMT, NCT, FSNMMI-TS Medical Imaging Department Director of Research Regis College Intersocietal Accreditation Commission Weston, Massachusetts Ellicott City, Maryland Leslie A. Bishop, PhD Maureen Ferran, PhD Associate Professor of Chemistry Associate Professor STEM Department Thomas H. Gosnell School of Life Sciences Regis College College of Science Weston, Massachusetts Rochester Institute of Technology Rochester, New York Norman E. Bolus, MSPH, MPH, CNMT, FSNMMI-TS Director, Assistant Professor UAB NMT Program Deborah M. Gibbs, MEd, RT(N), CNMT, PET, FASNC Clinical & Diagnostic Sciences Department Radiology Imaging Supervisor University of Alabama at Birmingham Radiology/Imaging Birmingham, Alabama Charlie Norwood VA Medical Center Augusta, Georgia Crystal Botkin, MPH, CNMT, PET Assistant Professor and NMT Clinical Coordinator David Gilmore, ABD, CNMT, NCT, RT (R)(N), Doisy College of Health Sciences FSNMMI-TS Department of Medical Imaging and Radiation Therapeutics Chair & Assistant Professor of Medical Imaging Saint Louis University Program Director, Nuclear Medicine & Molecular Imaging St. Louis, Missouri Medical Imaging Department Regis College Lance D. Burrell, MS, CNMT, PET, RT(CT) Weston, Massachusetts Center for Quantitative Cancer Imaging Huntsman Cancer Institute Krystle Worthington Glasgow, BS, CNMT, MIS, NMAA Salt Lake City, Utah Teacher and Clinical Coordinator University of Alabama at Birmingham Patrick Byrne, DABR, CHP, DABSNM Department of Clinical and Diagnostic Sciences Nuclear Medicine Physicist Nuclear Medicine Technology Program Medical Physics Consultants, Inc. Birmingham, Alabama Indianapolis, Indiana Bennett S. Greenspan, MD, MS Paul E. Christian, BS, CNMT, FSNMTS, PET Professor, Department of Radiology and Imaging Associate Director, Molecular Imaging Program (Retired) Medical College of Georgia, Augusta University; Director, Cyclotron Radiochemistry Laboratory Co-Medical Director, Huntsman Cancer Institute Nuclear Medicine Technology Program University of Utah College of Allied Health Sciences, Augusta University Salt Lake City, Utah Augusta, Georgia v vi CONTRIBUTORS William L. Hubble, MA, CNMT, RT (R)(N)(CT), Mary Anne Owen, MHE, RT(N), FSNMMI FSNMMI-TS Associate Professor Emerita Academic Chairman and NMT Director, Associate Professor College of Allied Health Sciences Doisy College of Health Sciences Department of Medical Laboratory, Imaging, and Radiologic Department of Medical Imaging and Radiation Therapeutics Sciences Saint Louis University Georgia Regents University St. Louis, Missouri Augusta, Georgia Kathy Thompson Hunt, MS, CNMT, FSNMMI-TS Reiko Oyama, RPh Program Chair, Nuclear Medicine Technology Nuclear Pharmacist and PET Quality Control Manager Baptist College of Health Sciences Department of Radiology Memphis, Tennessee Washington University School of Medicine St. Louis, Missouri Diwaker Jain, MD Professor of Medicine Sally W. Schwarz, MS, RPh, BCNP Section of Cardiovascular Medicine Professor Director of Nuclear Cardiology Department of Radiology New York Medical College Washington University School of Medicine Westchester Medical Center St. Louis, Missouri Valhalla, New York Lauren Shanbrun, MS, CNMT, RT(N)(CT) Frances Keech, DHSc, MBA, RT(N), FSNMMI-TS Assistant Professor of Medical Imaging Associate Professor and Program Director, Nuclear Medicine Clinical Coordinator, Nuclear Medicine Technology Technology Program Program School of Medical Imaging and Therapeutics Medical Imaging Department MCPHS University Regis College Boston, Massachusetts Weston, Massachusetts; Staff Technologist II Martha Kennedy, MA, ARMRIT, RT(MR) Nuclear Medicine and Molecular Imaging Department MRI Program Director Beth Israel Deaconess Medical Center Medical Imaging & Radiation Therapeutics Boston, Massachusetts Saint Louis University St. Louis, Missouri Akash Sharma, MD, MBA Division of Nuclear Medicine Maria Mackin, MS, CNMT, RT (N), LNMT Mallinckrodt Institute of Radiology Chief Technologist and Administrative Supervisor St. Louis, Missouri UR Medicine Nuclear Cardiology Paul N. Yu Heart Center Ambulatory Care Quality Assurance Liaison Nancy M. Swanston, CNMT, PET, RT University of Rochester Medical Center Administrative Director, DI Operations Rochester, New York Division of Diagnostic Imaging The University of Texas MD Anderson Cancer Center Donna C. Mars, MEd, CNMT, NCT Houston, Texas Associate Professor, Nuclear Medicine Technology Baptist College of Health Sciences Daniel Tempesta, BS, CNMT, RT(N)(CT) Memphis, Tennessee Nuclear Medicine Technologist Nuclear Medicine and Molecular Imaging Department Denise A. Merlino, CNMT , CPC, MBA Beth Israel Deaconess Medical Center Merlino Healthcare Consulting Corp. Boston, Massachusetts; Adjunct Lecturer of Medical Imaging Cybil Nielsen, MBA, CNMT, FSNMMI-TS Medical Imaging Department NMT Program Director, Clinical Assistant Professor Regis College Radiologic and Imaging Sciences Weston, Massachusetts Indiana University Indianapolis, Indianapolis Kathy S. Thomas, MHA, CNMT, PET Applications/Technical Support Capintec, Inc. (Retired) Battle Ground, Washington CONTRIBUTORS vii Helen Timberlake, MS Mathematics Kristen M. Waterstram-Rich, MS, CNMT, FSNMMI-TS Senior Lecturer Professor School of Mathematical Sciences Interim Associate Dean Rochester Institute of Technology College of Health Sciences and Technology Rochester, New York Rochester Institute of Technology Rochester, New York LisaAnn Trembath, CNMT, MSM, CRA, FSNMTS Associate Director of Clinical Imaging Operations Shanon M. Younglove, BS, MHA, CNMT Avid Radiopharmaceuticals, Inc. Clinical Instructor Nuclear Medicine Philadelphia, Pennsylvania Barnes Jewish Hospital St. Louis, Missouri Austin Turner, MS, CNMT, PET, RT(MR) Clinical Coordinator, Magnetic Resonance Imaging Program Katherine A. Zukotynski, MD Department of Medical Imaging and Radiation Therapeutics Associate Professor Edward and Margaret Doisy College of Health Sciences Departments of Radiology & Medicine Saint Louis University McMaster University St. Louis, Missouri Hamilton, Ontario, Canada David Wang, BHSc Faculty of Medicine University of Toronto Toronto, Ontario, Canada R E V I E W E R S Jonathan Baldwin, BSRT CNMT Kristi Klein, MS Ed(R)(M)(CT) Clinical Assistant Professor and Clinical Coordinator Program Director OUHSC MIRS Nuclear Medicine School of Health Education Oklahoma City, Oklahoma Madison Area Technical College Madison, Wisconsin Jeff L. Berry, MS, RT(R)(CT) Associate Professor, Radiography Program Director Diana E. Mishler, MBA-HM, RT(R)(S), RDMS University of Oklahoma Health Sciences Center Clinical Assistant Professor and Coordinator College of Allied Health Medical Imaging Technology Program Department of Medical Imaging and Radiation Sciences Indiana University Oklahoma City, Oklahoma Kokomo, Indiana Nicole Dhanraj, PhD Robin Rayman, AAS in Nuclear Medicine, CNMT, Independent Researcher/Contractor NMTCB-CT, PET, RT(N), EMT Mangilao, Guam Nuclear Medicine Technologist Salem, South Dakota Kerry Greene-Donnelly, MBA, RT (R)(M)(CT)(QM) Assistant Professor Upstate Medical University Syracuse, New York viii P R E FAC E CONTENT NEW TO THIS EDITION Writing a book is definitely a labor of love and testament to Each revised edition captures the changes that have occurred patience, and the production of this book was no exception. since the previous edition and gives a glimpse into changes and The process takes over 2 years and the work waxes and wanes advancements that are under investigation. The many expert throughout the time period, but it is not until the very end contributors of the chapters have reviewed and updated the that one gets a glimpse of how the book will look in print. information in this edition to bring the materials and figures This book, now in its eighth edition, has stood the test of to the current level of clinical practice. They have also added time and shows a noteworthy level of enthusiasm among its PET applications to the clinical chapters when appropriate. authors. In the creation of each edition, information regarding In addition to these changes, three new chapters have been the current practice of nuclear medicine and the responsibil- added. In recognition in the growth of individualized ther- ities of nuclear medicine technologists is obtained from pro- apies and consistent with the basics of molecular imaging, a fessional organizations worldwide. As a result the textbook chapter on cellular and molecular biology is now included. continues to keep pace with the changes in the field of nuclear With an increase in the need for management skills, a chapter medicine and health care, as it expands and evolves to meet was created to expand the topics associated with department the needs of the professionals facing the challenges of chang- administration. The third new chapter provides an introduc- ing technology and medical practice. Hippocrates once said, tion to the requirements and terms associated with research “Declare the past, diagnose the present, foretell the future.” and clinical trials. Three chapters have been expanded. The This textbook follows that instruction. It is current and blends chemistry chapter now includes concepts of biochemistry, the the old and new while also addressing future developments. informatics chapter has been expanded to include additional Through all of the revisions it has stayed true to its focus of computer applications in imaging, and the MRI chapter has providing information that covers all aspects of nuclear med- been expanded to include an introduction to PET/MR. In icine, thereby serving as a comprehensive introductory text addition to new content, there are many new contributing for nuclear medicine professionals to enter practice in this authors bringing their expertise to the edition. field. This book is intended for use by technologists and stu- dent technologists and as a reference guide for physicians LEARNING ENHANCEMENTS and scientists entering nuclear medicine. It is used by many nuclear medicine technologist educational programs and as a Each chapter begins with an outline, learning objectives, and resource in many nuclear medicine departments worldwide. key terms. The key terms appear in the front of each chapter The eighth edition is divided into five sections: Foundations to aid student readers in identifying terms with which they (the basic science chapters); Patient Care, Management, and should become familiar. Each term will appear in boldface the Research; Physics and Instrumentation; Imaging Procedures and first time that it is used in the chapter. The key terms are also Protocols; and Special Considerations. A fundamental knowl- defined in the glossary at the end of the book. There are also edge base is formed from the chapters that precede the clinical summaries at the end of most chapters to highlight a few of chapters. In the clinical chapters, one can see the complexity the important concepts in each chapter. of the field of nuclear medicine and how the interconnected- Chapter 1, Mathematics and Statistics, gives readers the ness of physics, chemistry, anatomy, and physiology results opportunity to practice the basic math skills necessary to in diagnostic images or is used in clinical and therapeutic function as a nuclear medicine technologist. The answers for applications. The clinical chapters essentially start at the head these questions are provided at the end of the book so that and work their way down the body. The last two chapters are readers can assess their knowledge before proceeding to the special considerations. The chapter on Inflammatory/Tumor/ next chapter. Oncology Imaging and Therapy includes topics that span all Boxes and tables are used throughout the book to call body systems, while the chapter on the hematopoietic system attention to important information. The information and includes procedures rarely performed at the time of the pub- writing style are targeted toward readers new to nuclear lication but that exist in different locations around the world. medicine. The fundamentals are addressed first, with topics This coherent framework for the knowledge base of the book becoming increasingly more complex. provides an efficient and logical approach to study the field of nuclear medicine for it allows students to see a unifying INSTRUCTOR ANCILLARIES theme or connectedness of the information. An appendix of radiopharmaceuticals, which summarizes many of the radio- Evolve is a secure and interactive learning environment nuclide properties, radiopharmaceutical names, and clinical designed to work in coordination with Nuclear Medicine applications, is also included as an easy reference. and PET/CT: Technology and Techniques, eighth edition. ix