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Chapter 1 CERTAIN PRELIMINARIES1

Who Should Train？1

The Medical Student1

The Intern and Resident1

The Postgraduate in Private Practice2

Recommendations and Requirements by the Atomic Energy Commission2

A Minimum Knowledge of Radioactivity25

The Atom25

Isotopes26

Radioactivity27

Measurement of Radioactivity31

Half Life32

Interaction of Radiation with Matter37

The Energy Unit－The Mev37

The Alpha Particle38

The Beta Particle38

Positrons and Annihilation Radiation39

Gamma Rays40

Shielding of Gamma Rays40

Inverse Square Law41

The Roentgen41

The Rep，RBE，Rem and Rad42

The Detection of Radiation42

Gas-Filled Detectors43

Ionization Chamber43

Proportional Counters44

Geiger Counters44

Self-Quenching Counters (Organic)46

Bismuth Cathode Geiger-Mueller Tubes46

Scintillation Counters47

Scalers48

Count Rate Meter49

Problems in Counting50

Background50

Statistics of Counting51

Comparative Counting52

Absolute Counting54

Chapter 2 THYROID PHYSIOLOGY AND RADIOACTIVE IODINE，I13156

Definitions56

Anatomy of the Thyroid Gland57

Pituitary-Thyroid Axis59

I131 Absorption，Transport and Excretion59

Functions of the Thyroid Gland60

1．Uptake of Iodine and Tyrosine60

I131 Practical Considerations62

2．Protein Binding of Iodine67

Mechanism of Action of Antithyroid Drugs67

I131 Practical Considerations68

3．Storage of Thyroid Hormone70

I131 Practical Considerations70

4．Release of Thyroid Hormone71

I131 Practical Considerations72

Transport，Action and Metabolism of Thyroid Hormone72

Action of Thyroxine72

Chapter 3 I131 TESTS OF THYROID FUNCTION78

Thyroid Function versus Patient Function78

I131 Tests of Thyroid Function in General80

I131 Excretion in the Urine80

Thyroid I131 Uptake81

Inorganic or Organically Bound I131 Level in Serum83

The Mechanics of Three Thyroid Function Tests85

The Two Hour I131 Uptake Test85

Technique85

Reporting the Impression90

The 24 Hour Uptake Test91

Technique91

Helpful Adjuncts to the 24 Hour I131 Thyroidal Accumulation Text93

The One Hour Uptake Test96

Chapter 4 I131 THYROIDECTOMY99

Treatment of Hyperthyroidism with I13199

Contraindications to I131 Treatment of Hyperthyroidism99

Carcinogenic Effect99

Carcinoma Present in Thyroid102

Large Mass of Thyroid102

Pregnancy103

Severe Hyperthyroidism103

Indications for Radioiodine Treatment in Hyperthyroidism103

Previous Thyroidectomy for Hyperthyroidism103

Exophthalmic Goiter in Persons over Forty Years of Age104

Impractically Long Preoperative Preparation104

Hyperthyroidism in the Presence of Well Accepted Contraindications for Surgery104

Hyperthyroidism with＂Malignant＂Exophthalmos at Any Age104

Principal Reason for I131 Treatment105

Dosage of I131106

One Dose Method106

Fractionation of Dosage110

Prediction Tests110

Unpleasant Effects from I131111

Thyroiditis111

Worsening of Thyrotoxicosis111

Hypothyroidism111

Persistent or Recurrent Hyperthyroidism after I131 Treatment112

Goiter in Relation to I131114

Additional Aspects of I131 Thyroidectomy115

Nodules in Recurrent Exophthalmic Goiter115

Thyroidectomies after I131116

Pathology116

Auricular Fibrillation117

Exophthalmos118

Results to be Expected and Follow-up Care118

Carcinogenic Effects118

Fertility118

Radioactivity118

Expenses118

Thyroiditis119

Delay in Effect119

Hypothyroidism119

Persistent Hyperthyroidism119

Persistent Goiter120

Exophthalmos120

Iodine Reaction120

Prognosis120

Summary：Use of I131 in Treatment of Hyperthyroidism120

Indications and Contraindications120

Dose121

I131 Therapy for Angina Pectoris or Intractable Congestive Failure121

Rationale121

Indications122

Contraindications122

Preparation and Dosage123

Results124

I131 Therapy for Intractable Symptoms of Pulmonary Insufficiency125

Rationale125

Indications125

Contraindications125

Preparation and Dosage125

Results125

I131 Therapy for Intractable Parkinsonism126

Rationale126

Indications126

Dose126

Results126

I131 Therapy for Intermittent Claudication127

Rationale127

Indications127

Chapter 5 I131 IN THE DIAGNOSIS AND TREATMENT OF THYROID NEOPLASMS131

Diagnosis and Treatment of Goiters Not Yet Proved to Harbor Carcinoma131

Non-nodular Toxic Goiter131

Nodular Toxic Goiter132

Diagnostic Use of I131 When Surgery Is Contraindicated132

Recurrence after Previous Thyroidectomy132

Nodular Non-toxic Goiters132

Solitary Nodules132

Non-toxic Multinodular Goiter138

Recurrent Goiter with Hyperthyroidism142

Carcinoma142

Colloid Goiter142

Exophthalmic Goiter142

Adenomatous Goiter142

I131 in the Differential Diagnosis of Carcinoma142

Thyroiditis142

Other Forms of Struma143

Radioiodine Treatment of Proved Carcinoma of the Thyroid Gland147

Surgical Treatment of Thyroid Carcinoma147

Roentgen Ray Therapy149

Indications for I131149

I131 Concentration in Relation to Type of Carcinoma150

Follicular Carcinoma150

Papillary Carcinoma150

Papillary and Follicular Carcinoma152

More Undifferentiated Types155

Primary and Metastatic Types156

Methods of Determining I131 Concentration by Tissue156

Radioautography156

External Gamma Counting158

I131 Urinary Excretion167

Blood I131 Level168

Indices of Thyroid Function168

Enhancing Uptake of I131 by Thyroid Carcinoma Metastases168

General Program of Treatment and Follow-up170

Some Clinical Aspects of Thyroid Cancer Seen in a Radioisotope Unit170

Age of Patient and Colloid Production of Carcinoma170

Presenting Symptom172

Patterns Exhibited by Metastases of Thyroid Carcinoma in Lungs172

Treatment Dosage of I131174

Toxic Effects of Treatment Dose175

Local Swelling175

Irradiation Sickness179

Radiation Sialadenitis179

Urinary Tract Effects180

Depression of Bone Marrow Function180

Ovarian Function182

Urinary Excretion of I131 after Treatment Dose182

Post-treatment Hypothyroidism183

Treatment of the Thyroid Carcinoma Patient and Concomitant Desiccated Thyroid Administration184

Results185

Pathology of Lesions and Survival after Radioiodine185

Deaths188

Patients Apparently Well188

Chapter 6 OTHER CLINICAL USES OF I131192

Human Serum Albumin (IHSA or RISA) Labeled with Radioactive Iodine192

Chemical and Physical Properties192

Pharmacology192

Mixing with Blood192

Mixing with Extravascular Pools193

The Metabolic Degradation of the Isotopically Labeled Protein193

Localization of IHSA194

Localization in Tumors194

Localization in Ascitic Fluid194

Edema Fluid194

Radiation Hazard from IHSA195

I131 HSA Blood Volume Determination195

Other Physiologic Considerations195

Technique of I131 HSA Blood Volume198

Variations in Blood Volume203

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

Brain Tumor Localization203

Circulation Time，Dilution Curve and Cardiac Output210

Radiocardiography217

Saphenous Circulation Time220

Peripheral Circulation220

Myeloscintigram223

Diagnosis of Carcinoma Metastatic to Liver226

Diagnosis of Pancreatic Insufficiency228

Other Uses of I131231

Diagnosis of Gallbladder Disease231

Rationale231

Technique231

Results231

Liver Function Test231

Rationale231

Technique234

Interpretation234

Chapter 7 RADIOACTIVE PHOSPHORUS (P32)240

Pharmacology240

Physical Characteristics240

Rationale of Use240

Absorption and Excretion241

Diagnostic Uses of P32241

Brain Tumor Localization241

Localization241

Technique241

Uses241

Tumor Type242

Time Interval242

Age of Patient243

Eye Tumor Localization243

Rationale243

Technique243

Localization of Posterior Ocular Tumors244

Interpretation of Results244

Uses245

Determination of Viability of Tissue246

Determination of Cutaneous Burn Depth246

Determination of Circulation in Tubed Pedicle Flaps246

Blood Volume Determination247

Rationale247

Technique247

Normal Values248

Clinical Utility248

Therapeutic Use of Radioactive Phosphorus248

Radioactive Phosphorus in Polycythemia Vera248

Therapeutic Considerations248

A Therapeutic Regimen250

Duration of Remissions Produced and Comparison with Other Forms of Therapy251

Radioactive Phosphorus in Leukemia251

Selection of Patients251

Dosage251

Survival251

Chronic Granulocytic Leukemia252

Chronic Lymphatic Leukemia253

Radioactive Chromic Phosphate253

Chromic Phosphate vs．Gold253

Radiation253

Half Life253

Distribution253

Method of Preparation254

Technique255

Chapter 8 RADIOACTIVE GOLD257

Pharmacology257

Fate after Intraperitoneal or Intrapleural Injection for Treatment257

Intracavitary Use258

Indications258

Method of Administration259

Equipment259

Technique259

Dosage261

Mode of Action261

Reactions to Au198 in Therapy261

Symptoms261

Bone Marrow Depression262

Liver Function262

Therapeutic Results262

Direct Tumor Injection263

Rationale263

Equipment263

Technique263

Dosimetry in Injection Technique264

Results264

Injection into Prostatic Carcinoma265

Selection of Patients265

Rationale and Distribution of Injected Gold265

Technique265

Reactions266

Results266

Injection for Other Pelvic Cancer266

Rationale266

Technique266

Reactions267

Results267

Treatment of Carcinoma of Lung267

Rationale267

Results267

Intravenous Administration of Au198268

Distribution268

Particle Size268

Tissues and Organs268

Toxicity269

Liver269

Blood269

For Treatment of Chronic Granulocytic Leukemia269

For Treatment of Carcinoma in Liver270

Intrathecal Injection270

Rationale270

Toxicity270

Distribution270

Results270

Chapter 9 RADIOACTIVE CHROMIUM CR51，COBALT，CO60，AND IRON，FE55 AND FE59273

Radioactive Chromium273

Pharmacology of Cr51273

Physical Characteristics273

Biochemistry273

Distribution and Excretion in Man274

Blood Volume Determinations275

Rationale275

Technique275

Use of Cr51 RBC Labeling for Study of RBC Survival in Normal and Disease States280

Rationale280

Technique281

Results and Interpretation281

Cr51 Red Blood Cell Half Life282

Cr51 Quantitation of Blood Loss Through Gastrointestinal Bleeding283

Rationale283

Use of Other Radioisotopes in the Differential Diagnosis of Anemia284

Use of Radioactive Cobalt (Co60) Labeled Vitamin B12 to Diagnose Prenicious Anemia284

Rationale284

Technique284

Radioactive Iron，Fr59288

Physical Characteristics288

Rationale of Use in Diagnosis of Anemias288

Technique for Plasma Clearance，Plasma Iron Turnover and Iron Per Cent Utilization Curve290

Chapter 10 OTHER LESS COMMONLY USED RADIOACTIVE ISOTOPES296

Radioactive Arsenic，As74296

Pharmacology296

Rationale of Use in Brain Tumor Detection297

Technique298

Results298

Astatine，At211298

Pharmacology298

Application299

Boron，B10299

Rationale299

Technique300

Toxicity300

Results300

Radioactive Bromine，Br82 (and Chlorine，Cl36)301

Radiobromine301

Radiochloride301

Estimation of Total Body Chloride in Man by Radiobromide Dilution301

Technique301

Results302

Radiation Hazard302

Radioactive Calcium and Strontium302

Pharmacology302

Clinical Studies303

Radioactive Carbon，C14303

Radioactive Cerium304

Radioactive Cesium304

Radioactive Chlorine304

Radioactive Cobalt304

For Teletherapy304

Radioactive Copper，Cu64305

Radioactive Fluorine，F18306

Radioactive Gallium，Ga72306

Radioactive Germanium，Ge71307

Hydrogen3 (Tritium)307

Method307

Toxicity308

Results308

Radioactive Iridium，Ir192308

Radioactive Krypton (and Other Inert Gases)309

Inert Gas Exchange309

Study of Peripheral Circulation309

Suppression of Gastric Acidity310

Radioactive Lanthanum，La140310

Radioactive Lead，Pb210310

Radioactive Manganese，Mn52311

Radiomercury，Hg203311

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

Method of K42 Determination of Exchangeable Potassium312

Radioactive Sodium314

Radiocardiogram and Peripheral Circulation Studies314

Total Exchangeable Sodium315

Simultaneous Determination of Both Na24 and K42317

Exchangeable Body Sodium Determination with Sodium318

Rubidium，Rb86319

Radioactive Silver，Ag110，111320

Use in Liver Function Test320

Radioactive Sodium，Na22，24320

Radioactive Strontium，Sr89，90320

Radioactive Sulfur，S35320

Determination of Extracellular Fluid Volume321

Study of Tumors322

Protein Metabolism322

Thorium X (88 Ra224)322

Radioactive Thallium，Tl204322

Uranium233323

Yttrium90，91323

Distribution323

Radioactive Zinc，Zn65324

Chapter 11 BIOLOGIC EFFECTS OF RADIATION329

Acute Penetrating Radiation Syndrome in Man329

Hyperacute Reaction329

Initial Reaction330

Acute to Subacute Reaction330

Treatment of Acute Penetrating Radiation Syndrome331

The Chronic Radiation Syndrome333

Relative Radiosensitivity of Various Human Organs335

Cytochemistry of Radiation Injury335

Radiosensitivity of Cells336

Changes Observed in Tissues and Organs337

Genetic Effects343

Chapter 12 HEALTH PHYSICS IN THE CLINICAL USE OF RADIOISOTOPES345

Types of Radiation Hazards345

External Hazards346

Tolerance Dose346

Protection from External Radiation346

Internal Radiation Hazards358

Comparison of External and Internal Hazards359

Calculation of Radiation Exposure from Internal Emitters359

Tolerance Levels361

Protection from Internal Hazards361

Hazards to Experiments362

Radioactive Waste Disposal363

Storage363

Liquid Waste Disposal363

Contamination Control and Removal365

Skin Contamination365

Clothing and Bedding Contamination366

Detecting Instrument Contamination367

Glassware Contamination367

Miscellaneous Equipment Contamination368

Floors and Bench Tops368

Most Common Laboratory Accidents368

Twelve Unsafe Practices in Handling Radioisotopes369

Chapter 13 INSTRUMENTATION IN THE CLINICAL RADIOISOTOPE UNIT371

Scalers371

Mechanical Register371

Scaling Circuit372

Input Circuit373

High Voltage Supply373

Timer374

Count Rate Meters376

External Recorder376

Special Rate Meters376

Gas-Filled Detectors377

Gas Flow Detectors379

Window Flow Counters379

4 π Counters380

Bernstein-Ballantine Counter380

Solid Counters380

Scintillation Counters380

Linear Amplifiers383

Pulse Height Analyzer384

Spectrometers385

The Medical Scintillation Spectrometer387

Coincidence and Anticoincidence Circuits388

Ionization Chambers388

Determination of Operating Voltage390

Calibration of Counters392

Calibration of Scintillation Well-Type Counter with I131392

Calibration of a Thin-Window Geiger Tube for P32 or I131393

Calibration with a Radium D and E Source393

Calibration by Coincidence Counting395

Calibration of the Electroscope396

Suggested Equipment for an Isotope Unit398

Thyroid Function Tests398

I131 Therapy－Less than 30 mc398

I131 Therapy for Carcinoma398

Blood Volumes：IHSA or Cr51398

P32 Diagnosis and Therapy399

Co60－Schilling Test399

Au198 Therapy399

Costs and Servicing399

Chapter 14 STARTING AND MANAGING A CLINICAL RADIOISOTOPE UNIT401

The Physician401

The Hospital401

Superintendent401

Hospital Employees401

Requesting Tests or Treatment Procedures406

Space and Equipment408

Space408

Basic Requirements408

Where to Locate408

Delivery，Venting and Plumbing409

Small Hospitals and Private Practitioners409

Larger Clinical Radioisotope Unit Facilities411

Expenses and Income413

Interested Colleagues415

The Future416

Physician or Physicist419

Further Training420

Appendices421

APPENDIX A．STATISTICS OF COUNTING421

APPENDIX B．DECAY TABLES OF RADIOISOTOPES427

APPENDIX C．RADIOAUTOGRAPHY OF THYROID SECTIONS429

APPENDIX D．SHIELD THICKNESS FOR LABORATORY SOURCES432

APPENDIX E．COMPILATIONS OF NUCLEAR DATA434

APPENDIX F．FORMAL CLINICAL RADIOISOTOPES TRAINING COURSES435

APPENDIX G．COMMERCIAL SUPPLIERS OF ISOTOPE-LABELED COMPOUNDS437

INDEX439