the historical origins of nuclear medicine and pet...discovery to the world. •14 february 1896,...
TRANSCRIPT
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The Historical Origins of
Nuclear Medicine and PET
Tim Marshel R.T.
(R)(N)(CT)(MR)(NCT)(PET)(CNMT)
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SNMTS Approved
45-Hour PET Registry Review Course
The Historical Origins of Nuclear Medicine and PET• SNM Voice Reference Number: 028600, .5 CEH’s
• Participants must answer at least an 80% of the post-test questions correctly in order to receive CE credit.
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Program Objectives:
• Upon completion of this section, the student should be able to
discuss the founders and the events that marked the historic
beginning of the science of Nuclear Medicine and PET.
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In The Beginning ...
• On 8 November 1895, William Conrad Roentgen
discovered the x-ray.
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The First X-Ray
On 22 December 1895, Mr.
Roentgen made the first x-ray
photograph (Mrs. Roentgen’s
hand).
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The Aftermath• On 1 January 1896, Roentgen announced his
discovery to the world.
• 14 February 1896, four days after news of the discovery reached the U.S, x-rays were used
to guide surgery in New York.
• In early 1896, the Italian military began using x-rays to diagnose and treat wounded
soldiers
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At the same time ...
• In February 1896, Henri Becquerel discovered radioactivity.
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Historical Timeline
• Nuclear Medicine
• PET/CT Imaging
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Origins of Nuclear Medicine
• 1895 Wilhelm Roentgen discovers x-rays
• 1896 Henri Becquerel discovered mysterious "rays" from uranium.
• 1897 Marie Curie named the mysterious rays "radioactivity."
• 1901 Henri Alexandre Danlos and Eugene Bloch placed radium in contact with a tuberculous skin lesion.
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• 1903 Alexander Graham Bell suggested placing sources containing radium in or near tumors.
• 1913 Frederick Proescher published the first study on the intravenous injection of radium for therapy of various diseases.
• 1924 Georg de Hevesy, J.A. Christiansen and Sven Lomholt performed the first radiotracer (lead-210 and bismuth-210) studies in animals.
Origins of Nuclear Medicine
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• 1936 John H. Lawrence, the brother of Ernest, made the first clinical therapeutic application of an artificial radionuclide when he used phosphorus-32 to treat leukemia.
• 1942 Enrico Fermi and his associates demonstrated the first controlled chain reaction under the bleachers at Stagg Field at the University of Chicago.
Origins of Nuclear Medicine
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• 1951 The U.S. Food and Drug Administration (FDA) approved sodium iodide 1-131 for use with thyroid patients. It was the first FDA-approved radiopharmaceutical.
• 1951 Benedict Cassen, Lawrence Curtis, Clifton Reed and Raymond Libby automated a scintillation detector to "scan" the distribution of radioiodine within the thyroid gland.
Origins of Nuclear Medicine
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• 1957 W.D. Tucker's group at the Brookhaven National Laboratory invented the iodine-132 and technetium-99m generator, making these short-lived radionuclides available at distant sites from the production of the parent radionuclides.
• 1958 Hal Anger invented the "scintillation camera," an imaging device that made it possible to
conduct dynamic studies.
Origins of Nuclear Medicine
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• 1959 Berson and Yalow invented the technique of radioimmunoassay to detect insulin antibodies in human serum.
• 1959 Picker X-Ray Company delivered the first 3-inch rectilinear scanner.
• 1960 Louis G. Stang, Jr., and Powell (Jim) Richards advertised technetium-99m and other generators for sale by Brookhaven National Laboratory. Technetium-99m had not yet been used in nuclear medicine
Origins of Nuclear Medicine
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• 1961 Allis-Chalmers installed the first U.S. "medical center" cyclotron at Washington University Medical School. The cyclotron was designed by M.M. Ter-
Pogossian. • 1962 David Kuhl introduced emission reconstruction
tomography. This method later became known as SPECT and PET. It was extended in radiology to transmission X-ray scanning, known as CT.
Origins of Nuclear Medicine
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• 1962 John Kuranz, Nuclear Chicago, delivered the first commercial Anger camera to William Myers at Ohio State University.
• 1963 Henry Wagner first used radiolabeled albumin aggregates for imaging lung perfusion in normal persons and patients with pulmonary embolism.
• 1964 Paul Harper and Katherine Lathrup developed radiotracers labeled with Tc-99m for the study of brain, thyroid and liver.
Origins of Nuclear Medicine
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• 1970 W. Eckelman and P. Richards developed Tc-99m "instant kit" radiopharmaceuticals. The first one was Tc-99m-DTPA.
• 1971 The American Medical Association officially recognized nuclear medicine as a medical speciality.
• 1973 H. William Strauss introduced the
exercise stress-test myocardial scan.
• 1973 Elliot Lebowitz introduced thallium-201 for myocardial perfusion imaging, first proposed by Kawana.
Origins of Nuclear Medicine
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• 1976 John Keyes developed the first general purpose single photo emission computed tomography (SPECT) camera. Ronald Jaszczak developed the first dedicated head SPECT camera.
• 1977 The FDA required manufacturers to obtain an approved new drug application for new and existing radiopharmaceuticals. The requirements are essentially the same as those for other prescription drugs.
Origins of Nuclear Medicine
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• 1983 Henry Wagner carried out the first successful PET imaging of a neuroreceptor using himself as the experimental subject.
• 1990 Loyola University Nuclear Information System (LUNIS), the first educational worldwide interactive computer network for nuclear medicine, went on line.
• 1995 ADAC Laboratories shipped the first SPECT camera to offer coincidence detection capable of
FDG/PET imaging.
Origins of Nuclear Medicine
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• 1999 Sentinel node studies approved by HCFA for improved diagnosis and management of cancers.
• 2000 Time Magazine recognizes Siemens Biograph as the invention of the year.
• 2001 16.9 million nuclear medicine procedures were performed in the United States.
Origins of Nuclear Medicine
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The History of PET/CT Imaging
• PET/CT History
• Invented by Dr. Ron Nutt and Dr. David Townsend, the PET/CT scanner was named the Invention of the Year in 2000 by Time Magazine. In 2001, PET/CT was named Product of the Year by Frost and Sullivan.
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The first generation of PET/CT scanners included
a single slice spiral CT integrated with a PET
camera which utilized BGO detectors. Today, the
configurations have changed dramatically. You
can now select between a dual slice CT scanner
integrated with a high-end, high-throughput PET
camera incorporating the new and much faster
LSO crystals; or you may select a clinically
advanced 16 row CT scanner integrated with the
same high-end LSO PET system.
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Some of the early systems required two
consoles to operate the system, one for the CT
and one for the PET, and some of them
incorporated a patient bore size that started
at 70 cm for the CT and tapered to about 59
cm for the PET system. These types of systems
were not patient friendly, and also would not
allow for easy adaptation for radiation therapy
planning due to the inconsistent patient bore
size.
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Today, nearly all vendors have overcome these
shortcomings and now offer a variety of multi-
slice CT configurations. All systems are typically
operated from one control console and have a
consistent 70 cm bore which can accommodate
RT pallets and provide better patient comfort.
The industry has made great strides in a short
time to better serve the PET/CT market.
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The past 20 years have seen significant
advances in the development of
imaging instrumentation for PET.
Current high-performance clinical PET
scanners comprise more than 20,000
individual detector elements, with an
axial coverage of 16 cm and around
15% energy resolution. Can you identify
the most important factors that have
contributed to this remarkable
development in PET?
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This impressive progress is due essentially to
developments in detector construction, new
scintillators, better scanner designs, improved
reconstruction algorithms, high-performance
electronics and, of course, the vast increase in
computer power, all of which have been achieved
without an appreciable increase in the selling price
of the scanners.
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The PET/CT image is one of the most exciting
developments in nuclear medicine and
radiology, its significance being the merging
not simply of images but of the imaging
technology. Why is the recent appearance of
combined PET and CT scanners that can
simultaneously image both anatomy and
function of particular importance?
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Initial diagnosis and staging of tumours are
commonly based on morphological changes seen
on CT scans. However, PET can differentiate
malignant tissue from benign tissue and is a more
effective tool than CT in the search for
metastases. Clearly, valuable information can be
found in both, and by merging the two it is
possible now to view morphological and
physiological information in one fused image.
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To acquire the PET/CT image, a patient
passes through the CT portion of the
scanner first and then through the PET
scanner where the metabolic information
is acquired. When the patient has passed
through both portions, a merged or fused
image can be created.
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One of the first suggestions to use positron-emitting tracers
for medical applications was made in 1951 by W H Sweet
and G Brownell at Massachusetts General Hospital, and
some attempts were made to explore the use of positron-
emitting tracers for medical applications in the 1950s.
During the late 1950s and 1960s, attempts were made to
build a positron scanner, although these attempts were not
very successful. After the invention of the CT scanner in
1972, tomography in nuclear medicine received more
attention, and during the 1970s a number of different
groups attempted to design and construct a positron
scanner.
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S Rankowitz and J S Robertson of Brookhaven National
Laboratory built the first ring tomograph in 1962. In 1975,
M Ter-Pogossian, M E Phelps and E Hoffman at Washington
University in St Louis presented their first PET tomograph,
known as Positron Emission Transaxial Tomograph I (PETT
I). Later the name was changed to PET, because the
transaxial plane was not the only plane in which images
could be reconstructed. In 1979, G N Hounsfield and A M
Cormack were awarded the Nobel Prize for Physiology and
Medicine in recognition of their development of X-ray CT.
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Since the very early development of nuclear-
medicine instrumentation, scintillators such as
sodium iodide (NaI) have formed the basis for
the detector systems. The detector material
used in PET is the determining factor in the
sensitivity, the image resolution and the count-
rate capability.
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The only detector of choice in the mid-1970s was
thallium-activated NaI - NaI(Tl) - which requires care
when manufactured because of its hygroscopic
nature. More importantly, it also has a low density
and a low effective atomic number that limits the
stopping power and efficiency to detect the 511 keV
gamma rays from positron annihilation. Which other
scintillators have contributed to modern PET
tomography?
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Thanks to its characteristics, bismuth
germanate, or BGO, is the crystal that has
served the PET community well since the late
1970s, and it has been used in the fabrication of
most PET tomographs for the past two decades.
The first actual tomograph constructed that
employed BGO was designed and built by Chris
Thompson and co-workers at the Neurological
Institute in Montreal in 1978.
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Although the characteristics of BGO are good, a new
scintillator, lutetium oxyorthosilicate (LSO) (discovered by C
Melcher, now at CTI Molecular Imaging in Knoxville, TN), is a
significant advance for PET imaging. BGO is very dense but
has only 15% of the light output of NaI(Tl). LSO has a slightly
greater density and a slightly lower effective atomic number,
but has five times more light output and is seven times faster
than BGO. The first LSO PET tomograph, the MicroPET for
small animal imaging, was designed at the University of
California in Los Angeles (UCLA) by Simon Cherry and co-
workers. The first human LSO tomograph, designed for high-
resolution brain imaging, was built by CPS Innovations in
Knoxville, TN, and delivered to the Max Planck Institute in
February 1999.
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