Clinical Use of RadioisotopesPDF电子书下载

Chapter 1 CERTAIN PRELIMINARIES 1

Who Should Train？ 1

The Medical Student 1

The Intern and Resident 1

The Postgraduate in Private Practice 2

Recommendations and Requirements by the Atomic Energy Commission 2

A Minimum Knowledge of Radioactivity 25

The Atom 25

Isotopes 26

Radioactivity 27

Measurement of Radioactivity 31

Half Life 32

Interaction of Radiation with Matter 37

The Energy Unit－The Mev 37

The Alpha Particle 38

The Beta Particle 38

Positrons and Annihilation Radiation 39

Gamma Rays 40

Shielding of Gamma Rays 40

Inverse Square Law 41

The Roentgen 41

The Rep，RBE，Rem and Rad 42

The Detection of Radiation 42

Gas-Filled Detectors 43

Ionization Chamber 43

Proportional Counters 44

Geiger Counters 44

Self-Quenching Counters (Organic) 46

Bismuth Cathode Geiger-Mueller Tubes 46

Scintillation Counters 47

Scalers 48

Count Rate Meter 49

Problems in Counting 50

Background 50

Statistics of Counting 51

Comparative Counting 52

Absolute Counting 54

Chapter 2 THYROID PHYSIOLOGY AND RADIOACTIVE IODINE，I131 56

Definitions 56

Anatomy of the Thyroid Gland 57

Pituitary-Thyroid Axis 59

I131 Absorption，Transport and Excretion 59

Functions of the Thyroid Gland 60

1．Uptake of Iodine and Tyrosine 60

I131 Practical Considerations 62

2．Protein Binding of Iodine 67

Mechanism of Action of Antithyroid Drugs 67

I131 Practical Considerations 68

3．Storage of Thyroid Hormone 70

I131 Practical Considerations 70

4．Release of Thyroid Hormone 71

I131 Practical Considerations 72

Transport，Action and Metabolism of Thyroid Hormone 72

Action of Thyroxine 72

Chapter 3 I131 TESTS OF THYROID FUNCTION 78

Thyroid Function versus Patient Function 78

I131 Tests of Thyroid Function in General 80

I131 Excretion in the Urine 80

Thyroid I131 Uptake 81

Inorganic or Organically Bound I131 Level in Serum 83

The Mechanics of Three Thyroid Function Tests 85

The Two Hour I131 Uptake Test 85

Technique 85

Reporting the Impression 90

The 24 Hour Uptake Test 91

Technique 91

Helpful Adjuncts to the 24 Hour I131 Thyroidal Accumulation Text 93

The One Hour Uptake Test 96

Chapter 4 I131 THYROIDECTOMY 99

Treatment of Hyperthyroidism with I131 99

Contraindications to I131 Treatment of Hyperthyroidism 99

Carcinogenic Effect 99

Carcinoma Present in Thyroid 102

Large Mass of Thyroid 102

Pregnancy 103

Severe Hyperthyroidism 103

Indications for Radioiodine Treatment in Hyperthyroidism 103

Previous Thyroidectomy for Hyperthyroidism 103

Exophthalmic Goiter in Persons over Forty Years of Age 104

Impractically Long Preoperative Preparation 104

Hyperthyroidism in the Presence of Well Accepted Contraindications for Surgery 104

Hyperthyroidism with＂Malignant＂Exophthalmos at Any Age 104

Principal Reason for I131 Treatment 105

Dosage of I131 106

One Dose Method 106

Fractionation of Dosage 110

Prediction Tests 110

Unpleasant Effects from I131 111

Thyroiditis 111

Worsening of Thyrotoxicosis 111

Hypothyroidism 111

Persistent or Recurrent Hyperthyroidism after I131 Treatment 112

Goiter in Relation to I131 114

Additional Aspects of I131 Thyroidectomy 115

Nodules in Recurrent Exophthalmic Goiter 115

Thyroidectomies after I131 116

Pathology 116

Auricular Fibrillation 117

Exophthalmos 118

Results to be Expected and Follow-up Care 118

Carcinogenic Effects 118

Fertility 118

Radioactivity 118

Expenses 118

Thyroiditis 119

Delay in Effect 119

Hypothyroidism 119

Persistent Hyperthyroidism 119

Persistent Goiter 120

Exophthalmos 120

Iodine Reaction 120

Prognosis 120

Summary：Use of I131 in Treatment of Hyperthyroidism 120

Indications and Contraindications 120

Dose 121

I131 Therapy for Angina Pectoris or Intractable Congestive Failure 121

Rationale 121

Indications 122

Contraindications 122

Preparation and Dosage 123

Results 124

I131 Therapy for Intractable Symptoms of Pulmonary Insufficiency 125

Rationale 125

Indications 125

Contraindications 125

Preparation and Dosage 125

Results 125

I131 Therapy for Intractable Parkinsonism 126

Rationale 126

Indications 126

Dose 126

Results 126

I131 Therapy for Intermittent Claudication 127

Rationale 127

Indications 127

Chapter 5 I131 IN THE DIAGNOSIS AND TREATMENT OF THYROID NEOPLASMS 131

Diagnosis and Treatment of Goiters Not Yet Proved to Harbor Carcinoma 131

Non-nodular Toxic Goiter 131

Nodular Toxic Goiter 132

Diagnostic Use of I131 When Surgery Is Contraindicated 132

Recurrence after Previous Thyroidectomy 132

Nodular Non-toxic Goiters 132

Solitary Nodules 132

Non-toxic Multinodular Goiter 138

Recurrent Goiter with Hyperthyroidism 142

Carcinoma 142

Colloid Goiter 142

Exophthalmic Goiter 142

Adenomatous Goiter 142

I131 in the Differential Diagnosis of Carcinoma 142

Thyroiditis 142

Other Forms of Struma 143

Radioiodine Treatment of Proved Carcinoma of the Thyroid Gland 147

Surgical Treatment of Thyroid Carcinoma 147

Roentgen Ray Therapy 149

Indications for I131 149

I131 Concentration in Relation to Type of Carcinoma 150

Follicular Carcinoma 150

Papillary Carcinoma 150

Papillary and Follicular Carcinoma 152

More Undifferentiated Types 155

Primary and Metastatic Types 156

Methods of Determining I131 Concentration by Tissue 156

Radioautography 156

External Gamma Counting 158

I131 Urinary Excretion 167

Blood I131 Level 168

Indices of Thyroid Function 168

Enhancing Uptake of I131 by Thyroid Carcinoma Metastases 168

General Program of Treatment and Follow-up 170

Some Clinical Aspects of Thyroid Cancer Seen in a Radioisotope Unit 170

Age of Patient and Colloid Production of Carcinoma 170

Presenting Symptom 172

Patterns Exhibited by Metastases of Thyroid Carcinoma in Lungs 172

Treatment Dosage of I131 174

Toxic Effects of Treatment Dose 175

Local Swelling 175

Irradiation Sickness 179

Radiation Sialadenitis 179

Urinary Tract Effects 180

Depression of Bone Marrow Function 180

Ovarian Function 182

Urinary Excretion of I131 after Treatment Dose 182

Post-treatment Hypothyroidism 183

Treatment of the Thyroid Carcinoma Patient and Concomitant Desiccated Thyroid Administration 184

Results 185

Pathology of Lesions and Survival after Radioiodine 185

Deaths 188

Patients Apparently Well 188

Chapter 6 OTHER CLINICAL USES OF I131 192

Human Serum Albumin (IHSA or RISA) Labeled with Radioactive Iodine 192

Chemical and Physical Properties 192

Pharmacology 192

Mixing with Blood 192

Mixing with Extravascular Pools 193

The Metabolic Degradation of the Isotopically Labeled Protein 193

Localization of IHSA 194

Localization in Tumors 194

Localization in Ascitic Fluid 194

Edema Fluid 194

Radiation Hazard from IHSA 195

I131 HSA Blood Volume Determination 195

Other Physiologic Considerations 195

Technique of I131 HSA Blood Volume 198

Variations in Blood Volume 203

Other Uses of I131 Labeled Human Serum Albumin (IHSA or RISA) 203

Brain Tumor Localization 203

Circulation Time，Dilution Curve and Cardiac Output 210

Radiocardiography 217

Saphenous Circulation Time 220

Peripheral Circulation 220

Myeloscintigram 223

Diagnosis of Carcinoma Metastatic to Liver 226

Diagnosis of Pancreatic Insufficiency 228

Other Uses of I131 231

Diagnosis of Gallbladder Disease 231

Rationale 231

Technique 231

Results 231

Liver Function Test 231

Rationale 231

Technique 234

Interpretation 234

Chapter 7 RADIOACTIVE PHOSPHORUS (P32) 240

Pharmacology 240

Physical Characteristics 240

Rationale of Use 240

Absorption and Excretion 241

Diagnostic Uses of P32 241

Brain Tumor Localization 241

Localization 241

Technique 241

Uses 241

Tumor Type 242

Time Interval 242

Age of Patient 243

Eye Tumor Localization 243

Rationale 243

Technique 243

Localization of Posterior Ocular Tumors 244

Interpretation of Results 244

Uses 245

Determination of Viability of Tissue 246

Determination of Cutaneous Burn Depth 246

Determination of Circulation in Tubed Pedicle Flaps 246

Blood Volume Determination 247

Rationale 247

Technique 247

Normal Values 248

Clinical Utility 248

Therapeutic Use of Radioactive Phosphorus 248

Radioactive Phosphorus in Polycythemia Vera 248

Therapeutic Considerations 248

A Therapeutic Regimen 250

Duration of Remissions Produced and Comparison with Other Forms of Therapy 251

Radioactive Phosphorus in Leukemia 251

Selection of Patients 251

Dosage 251

Survival 251

Chronic Granulocytic Leukemia 252

Chronic Lymphatic Leukemia 253

Radioactive Chromic Phosphate 253

Chromic Phosphate vs．Gold 253

Radiation 253

Half Life 253

Distribution 253

Method of Preparation 254

Technique 255

Chapter 8 RADIOACTIVE GOLD 257

Pharmacology 257

Fate after Intraperitoneal or Intrapleural Injection for Treatment 257

Intracavitary Use 258

Indications 258

Method of Administration 259

Equipment 259

Technique 259

Dosage 261

Mode of Action 261

Reactions to Au198 in Therapy 261

Symptoms 261

Bone Marrow Depression 262

Liver Function 262

Therapeutic Results 262

Direct Tumor Injection 263

Rationale 263

Equipment 263

Technique 263

Dosimetry in Injection Technique 264

Results 264

Injection into Prostatic Carcinoma 265

Selection of Patients 265

Rationale and Distribution of Injected Gold 265

Technique 265

Reactions 266

Results 266

Injection for Other Pelvic Cancer 266

Rationale 266

Technique 266

Reactions 267

Results 267

Treatment of Carcinoma of Lung 267

Rationale 267

Results 267

Intravenous Administration of Au198 268

Distribution 268

Particle Size 268

Tissues and Organs 268

Toxicity 269

Liver 269

Blood 269

For Treatment of Chronic Granulocytic Leukemia 269

For Treatment of Carcinoma in Liver 270

Intrathecal Injection 270

Rationale 270

Toxicity 270

Distribution 270

Results 270

Chapter 9 RADIOACTIVE CHROMIUM CR51，COBALT，CO60，AND IRON，FE55 AND FE59 273

Radioactive Chromium 273

Pharmacology of Cr51 273

Physical Characteristics 273

Biochemistry 273

Distribution and Excretion in Man 274

Blood Volume Determinations 275

Rationale 275

Technique 275

Use of Cr51 RBC Labeling for Study of RBC Survival in Normal and Disease States 280

Rationale 280

Technique 281

Results and Interpretation 281

Cr51 Red Blood Cell Half Life 282

Cr51 Quantitation of Blood Loss Through Gastrointestinal Bleeding 283

Rationale 283

Use of Other Radioisotopes in the Differential Diagnosis of Anemia 284

Use of Radioactive Cobalt (Co60) Labeled Vitamin B12 to Diagnose Prenicious Anemia 284

Rationale 284

Technique 284

Radioactive Iron，Fr59 288

Physical Characteristics 288

Rationale of Use in Diagnosis of Anemias 288

Technique for Plasma Clearance，Plasma Iron Turnover and Iron Per Cent Utilization Curve 290

Chapter 10 OTHER LESS COMMONLY USED RADIOACTIVE ISOTOPES 296

Radioactive Arsenic，As74 296

Pharmacology 296

Rationale of Use in Brain Tumor Detection 297

Technique 298

Results 298

Astatine，At211 298

Pharmacology 298

Application 299

Boron，B10 299

Rationale 299

Technique 300

Toxicity 300

Results 300

Radioactive Bromine，Br82 (and Chlorine，Cl36) 301

Radiobromine 301

Radiochloride 301

Estimation of Total Body Chloride in Man by Radiobromide Dilution 301

Technique 301

Results 302

Radiation Hazard 302

Radioactive Calcium and Strontium 302

Pharmacology 302

Clinical Studies 303

Radioactive Carbon，C14 303

Radioactive Cerium 304

Radioactive Cesium 304

Radioactive Chlorine 304

Radioactive Cobalt 304

For Teletherapy 304

Radioactive Copper，Cu64 305

Radioactive Fluorine，F18 306

Radioactive Gallium，Ga72 306

Radioactive Germanium，Ge71 307

Hydrogen3 (Tritium) 307

Method 307

Toxicity 308

Results 308

Radioactive Iridium，Ir192 308

Radioactive Krypton (and Other Inert Gases) 309

Inert Gas Exchange 309

Study of Peripheral Circulation 309

Suppression of Gastric Acidity 310

Radioactive Lanthanum，La140 310

Radioactive Lead，Pb210 310

Radioactive Manganese，Mn52 311

Radiomercury，Hg203 311

Radioactive Potassium，K42 (and Sodium，Na22，24) 312

Method of K42 Determination of Exchangeable Potassium 312

Radioactive Sodium 314

Radiocardiogram and Peripheral Circulation Studies 314

Total Exchangeable Sodium 315

Simultaneous Determination of Both Na24 and K42 317

Exchangeable Body Sodium Determination with Sodium 318

Rubidium，Rb86 319

Radioactive Silver，Ag110，111 320

Use in Liver Function Test 320

Radioactive Sodium，Na22，24 320

Radioactive Strontium，Sr89，90 320

Radioactive Sulfur，S35 320

Determination of Extracellular Fluid Volume 321

Study of Tumors 322

Protein Metabolism 322

Thorium X (88 Ra224) 322

Radioactive Thallium，Tl204 322

Uranium233 323

Yttrium90，91 323

Distribution 323

Radioactive Zinc，Zn65 324

Chapter 11 BIOLOGIC EFFECTS OF RADIATION 329

Acute Penetrating Radiation Syndrome in Man 329

Hyperacute Reaction 329

Initial Reaction 330

Acute to Subacute Reaction 330

Treatment of Acute Penetrating Radiation Syndrome 331

The Chronic Radiation Syndrome 333

Relative Radiosensitivity of Various Human Organs 335

Cytochemistry of Radiation Injury 335

Radiosensitivity of Cells 336

Changes Observed in Tissues and Organs 337

Genetic Effects 343

Chapter 12 HEALTH PHYSICS IN THE CLINICAL USE OF RADIOISOTOPES 345

Types of Radiation Hazards 345

External Hazards 346

Tolerance Dose 346

Protection from External Radiation 346

Internal Radiation Hazards 358

Comparison of External and Internal Hazards 359

Calculation of Radiation Exposure from Internal Emitters 359

Tolerance Levels 361

Protection from Internal Hazards 361

Hazards to Experiments 362

Radioactive Waste Disposal 363

Storage 363

Liquid Waste Disposal 363

Contamination Control and Removal 365

Skin Contamination 365

Clothing and Bedding Contamination 366

Detecting Instrument Contamination 367

Glassware Contamination 367

Miscellaneous Equipment Contamination 368

Floors and Bench Tops 368

Most Common Laboratory Accidents 368

Twelve Unsafe Practices in Handling Radioisotopes 369

Chapter 13 INSTRUMENTATION IN THE CLINICAL RADIOISOTOPE UNIT 371

Scalers 371

Mechanical Register 371

Scaling Circuit 372

Input Circuit 373

High Voltage Supply 373

Timer 374

Count Rate Meters 376

External Recorder 376

Special Rate Meters 376

Gas-Filled Detectors 377

Gas Flow Detectors 379

Window Flow Counters 379

4 π Counters 380

Bernstein-Ballantine Counter 380

Solid Counters 380

Scintillation Counters 380

Linear Amplifiers 383

Pulse Height Analyzer 384

Spectrometers 385

The Medical Scintillation Spectrometer 387

Coincidence and Anticoincidence Circuits 388

Ionization Chambers 388

Determination of Operating Voltage 390

Calibration of Counters 392

Calibration of Scintillation Well-Type Counter with I131 392

Calibration of a Thin-Window Geiger Tube for P32 or I131 393

Calibration with a Radium D and E Source 393

Calibration by Coincidence Counting 395

Calibration of the Electroscope 396

Suggested Equipment for an Isotope Unit 398

Thyroid Function Tests 398

I131 Therapy－Less than 30 mc 398

I131 Therapy for Carcinoma 398

Blood Volumes：IHSA or Cr51 398

P32 Diagnosis and Therapy 399

Co60－Schilling Test 399

Au198 Therapy 399

Costs and Servicing 399

Chapter 14 STARTING AND MANAGING A CLINICAL RADIOISOTOPE UNIT 401

The Physician 401

The Hospital 401

Superintendent 401

Hospital Employees 401

Requesting Tests or Treatment Procedures 406

Space and Equipment 408

Space 408

Basic Requirements 408

Where to Locate 408

Delivery，Venting and Plumbing 409

Small Hospitals and Private Practitioners 409

Larger Clinical Radioisotope Unit Facilities 411

Expenses and Income 413

Interested Colleagues 415

The Future 416

Physician or Physicist 419

Further Training 420

Appendices 421

APPENDIX A．STATISTICS OF COUNTING 421

APPENDIX B．DECAY TABLES OF RADIOISOTOPES 427

APPENDIX C．RADIOAUTOGRAPHY OF THYROID SECTIONS 429

APPENDIX D．SHIELD THICKNESS FOR LABORATORY SOURCES 432

APPENDIX E．COMPILATIONS OF NUCLEAR DATA 434

APPENDIX F．FORMAL CLINICAL RADIOISOTOPES TRAINING COURSES 435

APPENDIX G．COMMERCIAL SUPPLIERS OF ISOTOPE-LABELED COMPOUNDS 437

INDEX 439