The Historical Origins of Nuclear Medicine and PET. Tim Marshel R.T. (R)(N)(CT)(MR)(NCT)(PET)(CNMT)

Transcription

1 1 The Historical Origins of Nuclear Medicine and PET Tim Marshel R.T. (R)(N)(CT)(MR)(NCT)(PET)(CNMT)

2 2 SNMTS Approved 45-Hour PET Registry Review Course The Historical Origins of Nuclear Medicine and PET SNM Voice Reference Number: ,.5 CEH s Participants must answer at least an 80% of the posttest questions correctly in order to receive CE credit.

3 3 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.

4 4 In The Beginning... On 8 November 1895, William Conrad Roentgen discovered the x-ray.

5 5 The First X-Ray On 22 December 1895, Mr. Roentgen made the first x-ray photograph (Mrs. Roentgen s hand).

6 6 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

7 7 At the same time... In February 1896, Henri Becquerel discovered radioactivity.

8 8 Nuclear Medicine PET/CT Imaging Historical Timeline

9 9 Origins of Nuclear Medicine 1895 Wilhelm Roentgen discovers x- rays 1896 Henri Becquerel discovered mysterious "rays" from uranium Marie Curie named the mysterious rays "radioactivity." 1901 Henri Alexandre Danlos and Eugene Bloch placed radium in contact with a tuberculous skin lesion.

10 10 Origins of Nuclear Medicine 1903 Alexander Graham Bell suggested placing sources containing radium in or near tumors Frederick Proescher published the first study on the intravenous injection of radium for therapy of various diseases Georg de Hevesy, J.A. Christiansen and Sven Lomholt performed the first radiotracer (lead-210 and bismuth-210) studies in animals.

11 11 Origins of Nuclear Medicine 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 Enrico Fermi and his associates demonstrated the first controlled chain reaction under the bleachers at Stagg Field at the University of Chicago.

12 12 Origins of Nuclear Medicine 1951 The U.S. Food and Drug Administration (FDA) approved sodium iodide for use with thyroid patients. It was the first FDAapproved radiopharmaceutical Benedict Cassen, Lawrence Curtis, Clifton Reed and Raymond Libby automated a scintillation detector to "scan" the distribution of radioiodine within the thyroid gland.

13 13 Origins of Nuclear Medicine 1957 W.D. Tucker's group at the Brookhaven National Laboratory invented the iodine-132 and technetium-99m generator, making these shortlived radionuclides available at distant sites from the production of the parent radionuclides Hal Anger invented the "scintillation camera," an imaging device that made it possible to conduct dynamic studies.

14 14 Origins of Nuclear Medicine 1959 Berson and Yalow invented the technique of radioimmunoassay to detect insulin antibodies in human serum Picker X-Ray Company delivered the first 3-inch rectilinear scanner 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

15 15 Origins of Nuclear Medicine 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 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.

16 16 Origins of Nuclear Medicine 1962 John Kuranz, Nuclear Chicago, delivered the first commercial Anger camera to William Myers at Ohio State University Henry Wagner first used radiolabeled albumin aggregates for imaging lung perfusion in normal persons and patients with pulmonary embolism Paul Harper and Katherine Lathrup developed radiotracers labeled with Tc-99m for the study of brain, thyroid and liver.

17 17 Origins of Nuclear Medicine 1970 W. Eckelman and P. Richards developed Tc-99m "instant kit" radiopharmaceuticals. The first one was Tc-99m-DTPA The American Medical Association officially recognized nuclear medicine as a medical speciality H. William Strauss introduced the exercise stress-test myocardial scan Elliot Lebowitz introduced thallium-201 for myocardial perfusion imaging, first proposed by Kawana.

18 18 Origins of Nuclear Medicine 1976 John Keyes developed the first general purpose single photo emission computed tomography (SPECT) camera. Ronald Jaszczak developed the first dedicated head SPECT camera 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.

19 19 Origins of Nuclear Medicine 1983 Henry Wagner carried out the first successful PET imaging of a neuroreceptor using himself as the experimental subject Loyola University Nuclear Information System (LUNIS), the first educational worldwide interactive computer network for nuclear medicine, went on line ADAC Laboratories shipped the first SPECT camera to offer coincidence detection capable of FDG/PET imaging.

20 20 Origins of Nuclear Medicine 1999 Sentinel node studies approved by HCFA for improved diagnosis and management of cancers Time Magazine recognizes Siemens Biograph as the invention of the year million nuclear medicine procedures were performed in the United States.

21 21 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.

22 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. 22

23 23 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.

24 24 Today, nearly all vendors have overcome these shortcomings and now offer a variety of multislice 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.

25 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? 25

26 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. 26

27 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? 27

28 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. 28

29 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. 29

30 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 positronemitting 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. 30

31 S Rankowitz and J S Robertson of Brookhaven National Laboratory built the first ring tomograph in 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. 31

32 Since the very early development of nuclearmedicine 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 countrate capability. 32

33 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? 33

34 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

35 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 coworkers. The first human LSO tomograph, designed for highresolution brain imaging, was built by CPS Innovations in Knoxville, TN, and delivered to the Max Planck Institute in February