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Fluorine-18-fluorodeoxyglucose positron emission tomography (FDG-PET) has been used successfully for the staging and re-staging of breast cancer. Another significant indication is the evaluation of therapy response. There are only few data on FDGPET in breast cancer after radiation therapy. The same holds true for chemotherapy. Only the therapy response in locally advanced breast cancer after chemotherapy has been investigated thoroughly. Histopathologic response could be predicted with an accuracy of 88-91% after the first and second course of therapy. A quantitative evaluation is of course a prerequisite when FDG-PET is used for therapy monitoring. Only few studies have focussed on hormone therapy. Here, a flare phenomenon with increasing SUVs after initiation of tamoxifen therapy has been observed. More prospective multicenter trials will be needed to make FDG-PET a powerful tool in monitoring chemotherapy in breast cancer. Whole body imaging with fluorine-18 deoxyglucose PET (FDG-PET) has gained widespread acceptance for the staging and restaging of breast cancer (Biersack et at. 2001; Kostakoglu and Goldsmith 2003; Grahek et al. 2004). Another significant indication for FDG-PET is the evaluation of therapy response. Above that the proof of viability of tumour tissue after termination of chemotherapy is another indication for PET. The evaluation of therapy response is usually done by CT, sonography or MRI (Biersack and Palmedo 2003). These imaging procedures allow the detection of changes of the tumour size or volume. Because the majority of cells within a tumour mass are in a resting state, reduction of tumour volume requires time and might be masked by unspecific effects (edema as a result of necrosis). In contrast, cellular uptake of FDG is a function of cell viability and seems to be associated with the increased cell turnover. Animal models have shown that, after therapy, the amount of tumour FDG uptake reflects the number of viable tumour cells present (Haberkorn et al. 1987). Already in 1989, Minn et al. (1989) studied patients with breast cancer before and after therapy using FDG-PET. Even using a planar gamma camera equipped with thick lead collimators, they could show that increasing FDG uptake over time was associated with tumour progression. These data make evident that new cumbersome sophisticated FDG imaging procedures may further increase the diagnostic significance of FDG-PET in therapy monitoring. [ABSTRACT FROM AUTHOR]

Over the last 5-10 years, the role of brain single photon emission computed tomography (SPECT) and positron emission tomography (PET) in the assessment of cerebrovascular disease (CVD) has changed dramatically. These changes have largely occurred as a result of continuing advances in computed tomography (CT) and more importantly magnetic resonance imaging (MRI) and functional magnetic resonance (fMR) imaging technology. In addition, there has been a declining interest in the use of SPECT and PET imaging for CVD in the United States although interest remains much stronger in Europe, Japan and other select areas in Asia. Part of the decline in the US relates to the lack of widespread availability of appropriate multi-detection brain imaging devices and also to the lack of logistical support to perform emergency brain SPECT imaging for acute stroke and finally to the limitations of brain SPECT imaging compounds for detecting acute stroke in the face of confounding "luxury per fusion" masking the presence and/or extent of the area of infarction (Mountz et al. 2003). [ABSTRACT FROM AUTHOR]

Polycythemia vera (Vaquez-Osler disease) — PCV — was first described in the year 1892 by Vaquez. Today the understanding is that PCV is a clonal neoplastic disease with the proliferation of erythrocytes. Together with chronic myelocytic leukemia, osteomyelofibrosis (OMF) and thrombocythemia, it is included in the group of myeloproliferative diseases (MPD). All the bone marrow elements (erythrocytes, megacaryocytes, granulocytes, and fibroblasts) are involved in the hyperplasia but erythropoiesis is the dominant factor. Also extramedullary hematopoiesis is possible. Hypervolemia, increased cardiac output, hyperviscosity and the resultant impaired blood flow are the reasons for most clinical manifestations. [ABSTRACT FROM AUTHOR]

Radiosynoviorthesis (RSO) is a proven important instrument for local treatment of chronic inflammatory joint diseases in the context of medical and orthopaedic efforts. The term radiosynoviorthesis was created by Delbarre et al. 1968, meaning the restoration (orthesis) of the synovium by means of radionuclides. By local administration of radioactive agents an attempt is made to influence the synovial process favourably as an alternative to surgical synovectomy. In the Anglo-American literature the term"radiosynovectomy" or"radiation synovectomy" came into use. [ABSTRACT FROM AUTHOR]

Hepatocellular carcinoma (HCC) is one of the most frequent cancers worldwide; in fact, it is ranked fifth in importance with approximately 437,000 new cases per annum (Bosch et al. 1999). Its incidence is increasing in many countries (Trinchet and Beaugrand 1999; Taylor-Robinson et al. 1997; Deuffic and Poynard 1998; El-Serag and Mason 1999). The first recognized risk factor is the presence of a cirrhosis that may be associated with various possible aetiologies (B and C viral infections, alcohol, haemochromatosis). This increased incidence is related to the better health care of patients suffering from cirrhosis, but also to a strong increase in chronic hepatitis C (Trinchet and Beaugrand 1999; Taylor-Robinson et al. 1997; Deuffic and Poynard 1998; Okuda 2000). Indeed, in France, approximately 500,000 people would appear to be infected by the hepatitis C virus (Trinchet and Beaugrand 1999). It is estimated that about 66 % present with chronic hepatitis and that 20 % will develop cirrhosis in 10-20 years in the absence of treatment. In France, it is estimated that the mortality linked to HCC occurring with hepatitis C virus cirrhosis will increase by 150% in men and 200% in women from now until 2020 (Deuffic et al. 1999). We may thus consider that, in the years to come, HCC will pose a problem for public health. [ABSTRACT FROM AUTHOR]

Since Paul Ehrlich proposed the hypothesis (Scitenkettentheorie) more than a century ago that bacteria can be killed by selective usage of certain compounds having specific affinity to the bacteria and thus acting as a "magic bullet," antibodies have captured the imagination of scientists dealing with diseases. Cancer was and still remains among the most intriguing and challenging of diseases for which the exact cure for its many forms is not available to date. Parallel to the development of certain compounds such as sulfur and nitrogen mustard, with the capacity to modify the DNA and thus retard and kill the growth of cancer cells (Sausville and Longo 2005), Pressman and colleagues showed that radiolabeled antibodies had the potential to localize tumors in rabbits (Pressman and Keighley 1948; Pressman und Korngold 1953; Pressman et al. 1957). This was soon followed by first attempts by Beierwaltes and his colleagues at curing cancer in patients using radiolabeled polyclonal antibodies. An inability to find a way to purify the antitumor globulin from other globulins in order to increase the specificity was the major limitation of the study (Bale and Spar 1957; Pressman and Korngold 1953). [ABSTRACT FROM AUTHOR]

Uptake of radiopharmaceuticals in the adrenal medulla was first demonstrated in 1967, using C-14-labeled epinephrine and precursors (Morales et al. 1967). In subsequent years this tracer was shown to depict neuroblastomas and pheochromocytomas (Lieberman et al. 1969; Anderson et al. 1973). In 1976 an iodinated compound of dopamine and a year later a radioiodinated bretylium analog were introduced (Ice et al. 1975; Korn et al. 1977). In 1980 the concentration of I-131-iodo-benzylguanidine in the adrenal medulla was reported (Wieland et al. 1980). [ABSTRACT FROM AUTHOR]

This chapter is based on an earlier article with the same title and by the same authors which appeared in Best Practice & Research: Clinical Gastroenterology, August 2005 [ABSTRACT FROM AUTHOR]

It was more than 60 years ago in 1943 that thyroid cancer was treated for the first time. The story of radioiodine started in 1935 at the Massachusetts Institute of Technology in cooperation with the Thyroid Unit of the Massachusetts General Hospital (Stanbury 1991). Diagnostic thyroid studies were performed for the first time in 1937 using iodine-128. In 1938, not more than 1 year later, I-130 and I-131 were discovered, followed by the first treatment of benign thyroid disease in 1941. In 1946 the Oak Ridge National Laboratory produced I-131 for routine use and from this time on I-131 treatment was increasingly performed not only in benign thyroid diseases but also in differentiated thyroid cancer (DTC). It was as early as 1949 that a patient with metastasizing thyroid cancer was treated for the first time in Europe. With 1 - 2 % of all malignancies, thyroid cancer is counted among the rare neoplastic diseases (Langsteger et al. 1993). The incidence of thyroid cancer is variable in different regions but is increasing worldwide. The figures range from 1.1 in the UK up to 15.4/100,000/year in Hawaii. [ABSTRACT FROM AUTHOR]

Radionuclide therapy of bone metastases represents a systemic therapy with intravenous administration of open radioactive agents. It is the aim of each radiation therapy to apply a maximal dose to the target — in this case bone metastases — and a minimal dose to the rest of the body. The dose to the rest of the body determines the frequency and intensity of side effects and limits treatment efficacy. [ABSTRACT FROM AUTHOR]

Diseases of the thyroid constitute the most common form of endocrine disorders and, over the past 60 years, nuclear medicine has contributed significantly to the management of thyroid patients, both in terms of diagnosis and treatment (Williams et al. 1949). Radionuclide therapy for both benign disease (thyrotoxicosis and goitre) and thyroid cancer has served as a model for the development of other radionuclide therapies in recent years. [ABSTRACT FROM AUTHOR]

Although many types of diagnostic nuclear medicine studies are common to both adult and paediatric practice, certain studies are performed much more commonly for children. These include examinations of the urinary, hepatobiliary, gastrointestinal, cardiovascular and endocrine systems, together with those utilized in tumour imaging. The radiotracer biodistributions, common clinical indications, recommended imaging protocols and typical effective radiation doses are described for this range of procedures. [ABSTRACT FROM AUTHOR]

The characteristic feature of nuclear medicine is that it provides functional images of organs, tissues and both normal and pathological processes, revealing the uptake and the biodistribution of several radiopharmaceuticals according to their pathway of flux, concentration and metabolism. There is a strong relationship between nuclear medicine and oncology since in general nuclear medicine images are able to give both morphological information and data on molecular and cellular activity. The major advantages of this functional imaging are that this biological characterization is carried out by the direct observation in vivo of the patient (Bombardieri et al. 1999). [ABSTRACT FROM AUTHOR]

Nuclear medicine techniques have a lot to offer in visualization of infectious and inflammatory foci. Quite often these techniques do not lead immediately to a definitive diagnosis, i.e., a histological or a microbiological diagnosis. However, they point to parts in the body where a particular metabolic process is ongoing, leading to elevated uptake of a radiopharmaceutical. With the help of other techniques, such as puncture, biopsy and culture, a definitive diagnosis can be obtained. In other words, scintigraphic imaging helps to elucidate the cause of the disease, and facilitates prompt installation of a tailored therapeutic regimen. Furthermore, with these techniques it is possible to monitor the effect of therapy. [ABSTRACT FROM AUTHOR]

Lymphomas represent a diverse range of diseases with evolving pathologic classification and therapy strategies. Essentially, the lymphomas are classified into two main groups, Hodgkin's disease (HD) and non-Hodgkin's lymphoma (NHL). For both disease entities accurate determination of extent of disease at initial staging and restaging is key for optimal management. More than 75% of all newly diagnosed patients with adult HD can be cured with combination chemotherapy and/ or radiation therapy. As for NHL, effective drug combinations can produce prolonged disease-free survival in the majority of patients. A functional or metabolic diagnostic imaging modality can contribute to the assessment of a patient in various ways. Functional imaging can complement anatomic imaging modalities, mainly CT, and thereby enhances the accuracy of defining the extent of disease prior to therapy. In the posttherapy setting, the ability to differentiate residual viable disease from benign post-therapy changes could impact patient management and outcome, particularly if it helps to select patients who would require additional therapy or a change in treatment regimen. [ABSTRACT FROM AUTHOR]

One of the first areas of patient care to which the specialty of nuclear medicine contributed was hematology, when phosphorus-32 was employed by John Lawrence, MD at the Donner Laboratory, University of California at Berkeley, to treat leukemia and polycythemia vera. Hematologic techniques developed over a half-century ago can quantitate the survival and localize the site of destruction of erythrocytes and platelets with remarkable sensitivity. Measurement of the erythrocyte volume (EV) and plasma volume (PV) remains the cornerstone of any diagnostic algorithm for determining the cause of an elevated hematocrit/hemoglobin. And yet utilization of these techniques is diminishing. [ABSTRACT FROM AUTHOR]

Although sonography (US) and cytology (fine-needle aspiration, FNA) play the principal role in the diagnosis of thyroid nodules, thyroid scintigraphy remains an important tool for guiding clinical decisions in thyroid diseases. Thyroid scintigraphy is so used in the diagnosis of the cause of a patient's hyperthyroidism (Graves' disease, thyroid autonomy, subacute, silent and post-partum thyroiditis, etc.), in the evaluation of selected patients with thyroid nodules and in the identification of normal and ectopic thyroid tissue (neonatal hypothyroidism). [ABSTRACT FROM AUTHOR]

Head and neck cancers are generally defined as cancers involving all regions of the head and neck, except for the thyroid and central nervous system. Most of these cancers are squamous cell carcinomas. The most common sites are larynx, tongue, floor of the mouth, lip, tonsils, and salivary glands, although these carcinomas can arise at almost any location in the nasopharynx, oropharynx, or hypopharynx. Thyroid cancers and tumors of the central nervous system are usually not included in head and neck cancer classification. The estimated number of new cases in the United States for 2005 is 39,000, with approximately 11,000 deaths (American Cancer Society 2005). The male:female ratio is about 2:1. Primary risk factors for virtually all head and neck cancers are alcohol and tobacco use. Early stage head and neck tumors are treated with either surgery or radiotherapy with excellent prognosis. Locally advanced tumors without distant metastasis are typically treated with surgery and postoperative radiation and hemotherapy or with definitive combination chemoradiation therapy. If chemoradiation is used as the initial treatment, salvage surgery is performed if there is evidence of residual disease. Patients with distant metastatic disease have very poor prognosis and are usually referred for palliative chemotherapy or radiation [ABSTRACT FROM AUTHOR]

Sentinel lymph node (SLN) localization and biopsy represent one of the most important recent developments in surgery, which has been reflected in important changes in the management of patients affected by early infiltrating breast carcinoma. Sentinel lymph node biopsy (SLNB) was first applied in melanoma patients by Morton and colleagues (Morton et al. 1992). Subsequently, the technique was proposed as a method of disease staging in breast cancer patients (Giuliano et al. 1997), so that less aggressive surgical treatment would less compromise the patient's quality of life. In fact, removal of axillary nodes in the presence of breast cancer is performed for staging and not with curative intent (Fisher et al. 2002), and axillary dissection (AD) is burdened by a significant rate of immediate and delayed possible complications such as lymphedema, paresthesia, pain and restriction of arm motion (Shaw and Rumball 1990; Kissin et al. 1986). In this context, SLNB has been proposed as an alternative to routine axillary clearance for nodal status determination. [ABSTRACT FROM AUTHOR]

Malignant melanoma (MM) of the skin has increased dramatically throughout the world during recent years. The overall increase in incidence has been dominated by new cases in the developed countries, with most patients being diagnosed in North America and Western Europe and, relative to population size, a large number of cases in Australia and New Zealand. While it is obvious that a combination of light-colored populations and increasing exposure to ultraviolet radiation has led to an increased risk of the development of malignant melanomas, it remains largely unknown in detail which factors are responsible for the transformation of a rarely proliferating melanocyte into a highly aggressive, often fatal tumor. Recently it has been shown that surface anomalies on the melanoma cells are responsible for a loosely bound architecture of tumor clones, leading to the easy development of metastatic disease. For these reasons there is an increasing need for advanced diagnostic strategies and new therapy modalities. [ABSTRACT FROM AUTHOR]

Bone scintigraphy is used as a common screening test for suspected bone metastases because of its high sensitivity, availability, low cost, and ability to scan the entire skeleton. Historical data and clinical experience has established bone scintigraphy as the reference standard in the search for skeletal metastatic disease and many indications have become established for benign skeletal disorders (Table 10.1). Chiewitz and Hevesy first described the use of radionuclides to study the skeleton in 1935 where phosphorus-32 (32P) activity was measured in rat organs with a Geiger-Müller counter and where uptake of 32P from blood to bone was noted, suggesting that skeletal metabolism is a dynamic process. Fleming and colleagues produced the first radionuclide skeletal images in 1961 using 85Sr (Fleming et al. 1961) and this radioisotope was commonly used for bone scanning and the study of skeletal kinetics. Although 87mSr was introduced as an alternative bone scanning agent with a more suitable gamma ray for imaging of 388 keV and half-life of 2.8 h, the introduction of 18F-fluoride and then 99mTc labelled compounds superseded this. In 1971, Subramanian and McAfee successfully prepared technetium-99m-polyphosphates. [ABSTRACT FROM AUTHOR]

Radionuclide methods are ideally suited for evaluation of gastrointestinal disease because of the functional nature of the methodology. Many gastrointestinal radionuclide tests have stood the test of time. For decades, the gastric emptying study has been the gold standard for quantification of gastric motility. Motility studies of the esophagus and intestinal tract, although less commonly requested, provide valuable diagnostic and therapeutic information at many centers. The gastrointestinal bleeding study can noninvasively localize a site of active hemorrhage and guides specific intervention and therapy. Meckel's scan can detect ectopic gastric mucosa as a cause of rectal bleeding in children, and radionuclide methods confirm gastroesophageal reflux with high sensitivity, particularly in neonates and young children. [ABSTRACT FROM AUTHOR]

Conventional radionuclide techniques have, for many years, played a role in evaluating vesico-ureteral reflux and suspected testicular torsion. More recently, the advent of prostate immunoscintigraphy, positron emission tomography (PET) and PET/computed tomography (CT) has broadened nuclear medicine's role to the area of oncologic diagnosis, as well. This chapter will first discuss the older standard techniques and follow with the oncologic applications in both the male and female genitourinary tract [ABSTRACT FROM AUTHOR]

The radiopharmaceuticals available for assessment of renal function and anatomy can be grouped into three broad categories: those excreted by glomerular filtration, those primarily excreted by tubular secretion, and those retained in the renal tubules for long periods of time. [ABSTRACT FROM AUTHOR]

Nuclear medicine occupies a unique niche amongst various imaging modalities by virtue of its ability to evaluate functional and physiologic parameters in a non-invasive and quantitative manner. Although at one time scintigraphic studies were used as primary modalities to address anatomic questions, these tasks are currently performed by the higher-resolution modalities ultrasound (US), computed tomography (CT), and magnetic resonance (MR) imaging. In current practice, nuclear medicine retains a more limited though unique role in the functional and physiologic characterization of tissue (Zuckier and Freeman 2003). [ABSTRACT FROM AUTHOR]

Scintigraphic lung studies are designed to demonstrate patterns of ventilation and perfusion.In the healthy individual there is a balance between regional perfusion and ventilation to achieve optimal gas exchange.When a pulmonary disease causes a deficiency in both ventilation and perfusion, they are "matched." Mismatch implies an imbalance between perfusion and ventilation. The single most important application of lung scintigraphy is the evaluation of patients with suspected pulmonary embolism (PE). The value of scintigraphy in the detection of PE was first demonstrated byWagner in 1964, using 131I-human serum albumin (HSA) for perfusion scintigraphy and a rectilinear scanner for imaging (Wagner 1976). [ABSTRACT FROM AUTHOR]

Myocardial perfusion imaging has evolved over 30 years to the point where it can now provide diagnostic and prognostic information in nearly all patient groups. Early studies were performed with K-43 in animal models and in man, but it was only with the availability of thallium-201 (Tl-201) in the mid 1970s that the technique using planar imaging became widely utilized for detecting the presence and extent of coronary artery disease (CAD). In the mid 1980s SPECT was introduced and became the predominant method of acquisition. All the early studies were performed using exercise stress. Since not all patients are capable of exercising, the introduction of dipyridamole, adenosine and dobutamine for pharmacologic stress in the 1980s and 1990s allowed perfusion studies to be performed in nearly all patients. Tl-201 is not the ideal perfusion tracer and in the late 1980s the technetium-99m (Tc99m) labeled perfusion tracer, sestamibi, became available followed in the mid 1990s by Tc-99m tetrofosmin. These two tracers now account for the majority of perfusion studies. [ABSTRACT FROM AUTHOR]

In modern pharmaceutical development and medicine, radioactivity has an increasing impact in the field of diagnostic applications (in vitro and in vivo) as well as in therapeutic applications (Qaim and Coenen 2005; Stöcklin et al. 1995). Regarding these different forms of applications, radionuclides must be used with respect to their modes of decay. For single photon emission computed tomography (SPECT), radionuclides with a short (hours to several days) half-life and accompanying gamma emission in the range of 70-250 keV are the most useful. In addition, emission of only one photon per decay is of advantage, but not a must. The gamma emission has to be strong enough to easily penetrate the body barrier and also has to be well detectable by the common SPECT camera systems. Such radionuclides are commonly found among those with the decay mode of electron capture (EC) or internal conversion (IC). [ABSTRACT FROM AUTHOR]

The underlying principles of nuclear medicine imaging involve the use of unsealed sources of radioactivity which are administered in the form of radiopharmaceuticals; the ionizing radiations which accompany the decay of the administered radioactivity can be detected and measured with specially designed instruments (e.g., survey meters, gamma cameras). In order to appreciate the scientific and technical basis of nuclear medicine imaging, this chapter reviews atomic and nuclear structure, radioactivity and radioactive decay, and interactions of radiation with matter. This is followed by a discussion of techniques for detection and measurement of radiation, design and operating principles of detection and imaging instruments, instrument quality control, and radiation protection. [ABSTRACT FROM AUTHOR]

Treatment of malignant pleural or peritoneal effusions is one of the "oldest" therapies using radioactive isotopes and was first described by J.H. Müller more than 50 years ago (Müller 1945) [ABSTRACT FROM AUTHOR]

Several methods are available to examine the function and morphology of the lacrimal drainage system under physiological conditions. Radionuclide scintigraphy is a sensitive method which is not cumbersome for the patient. Dacryoscintigraphy was first introduced by Rossomondo et al. in 1972. Since then the method has been modified by several groups and its significance supported by numerous studies. Indications of dacryoscintigraphy are obstructive disorders of the lacrimal drainage system. The method is helpful in the diagnosis of tear flow disturbances and in the follow-up for the detection of therapy response (von Denffer et al. 1984; Brockmann et al. 2005). [ABSTRACT FROM AUTHOR]