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Overview  

Nuclear medicine involves the use of radioactive substances (radionuclides), to assess the metabolic, structural, and functional details of various organs in the body. The radionuclides are used mainly for diagnostic purposes, and also for therapeutic purposes in certain conditions. The specialized nature of the radiopharmaceuticals, which require manufacturing and handling of regulated and potentially hazardous radioactive material, has also made ‘nuclear pharmacy’ an essential ally in the growth of this multidisciplinary, challenging, and exciting field.

History of Nuclear Medicine
This branch originated in the 1930s when animal studies were conducted using radioactive isotopes of iodine for their potential clinical application. In 1942, radioactive iodine (I-131) was first used in the treatment of hyperthyroidism and malignant thyroid tumor. Scientists also discovered the diagnostic potential of the isotope about the same time, when they found that the localization of radioactivity in metastatic lesions helped in detecting cancer metastases. Radioisotopes were made available for medical use in the United States from August 1, 1946 through the Atomic Energy Act (AEA).

The American Medical Association recognized nuclear medicine as a specialty in 1971. Since its initial days, the field has seen tremendous advances in terms of the range and variety of nuclear pharmaceuticals available and the conditions for which they are being used. Nuclear medicine has now become an integral part of mainline medical management, providing a safe and non-invasive option for diagnosis and management of various disease conditions.

Diagnostic Nuclear Medicine
Nuclear imaging (Scintigraphy) provides information about both functional and anatomical correlates of a condition. It can be used for soft tissue and bone imaging, and can detect abormalities at very early stages, making it an extremely versatile tool. The procedure is carried out by administering radionuclides, which are injected, inhaled or swallowed. Radionuclides used in diagnosis, contain unstable nuclei in their atoms, and they generally give out gamma radiation before decaying. These gamma rays are detected using an external device called a Gamma Camera or Scintillator, and processed using computers to produce an image. A series of images reveal functional abnormalities in the target organs that are seen as hot spots or cold spots, where the isotope is taken up in greater or lesser amounts than normally expected. The radioisotopes can be tagged to different biological substances, to produce radioactive tracers that selectively concentrate in different organs, depending on the function and physiology of the organ. Diagnostic procedures for examining the blood flow to various organs like brain and kidney; functioning of liver, lungs, heart, and bone; procedures like cancer staging and assessment of treatment efficiency, detecting infectious focus etc., can be carried out using this technique.

Safety Considerations for patients
The radiation dose received through the administered radionuclide is generally very small and normally about the same as that received during an X-ray examination, or what a human body receives from exposure to naturally occuring background radiation in the environment over a period of few months. The radionuclide is eliminated from the body in a short duration.

Therapeutic Nuclear Medicine
Rapidly dividing cells like the cancer cells are highly succeptible to damage from radiation. External radiotherapy, using focussed gamma beam (Cobalt-60) or internal radiotherapy, by administering beta rays emitting radionuclides, are used to destroy cancer cells in the target area. Targeted Alpha Therapy (TAT) is another technique, which uses high energy, short-range alpha radiation, using an alpha emitting radionuclide, and is currently being used for treatment of dispersed cancer. A therapeutic radioisotope generally emits strong beta rays, which destroys the cancer cells, and small amounts of gamma rays, which is used for detection and localization. Radionuclides are also used in certain other conditions like the management of hyperthyroidism. 

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