Nuclear medicine is a medical specialty involving the application of radioactive substances in the diagnosis and treatment of disease. It is referred to as ‘endoradiology’ because it records radiation emitting from within the body rather than radiation that is generated by an external source, such as an x-ray. Diagnostic nuclear medicine scans are different from radiologic scans because they show the physiological function of the system as opposed to traditional anatomical imaging such as a CT or MRI. In nuclear medicine imaging, radiopharmaceuticals are taken internally, intravenously or orally. External detectors capture and form images from the emitted radiation. Single photon emission computed tomography (SPECT) and positron emission topography (PET) scans are the two most common imaging modalities in nuclear medicine.
There are some practical concerns in nuclear imaging. Because the risks of low-level radiation are not completely understood, a cautious approach has been universally adopted. All human radiation exposures should be kept at As Low as Reasonably Practicable (ALARP).
According to this principle, before a patient is exposed to radiation through a nuclear medicine examination, the benefits of the examination must be identified. The particular circumstances of the patient must be considered. For example, if the patient cannot tolerate a sufficient amount of the procedure to achieve a diagnosis, it would be inappropriate to proceed with injecting the patient with the radioactive tracer. If the benefits from the procedure justify its use, the radiation exposure to the patient should be kept as low as is reasonably practicable. The images produced in nuclear medicine should never be better than required for a confident diagnosis. Giving larger radiation doses can reduce the noise in an image and make it more photographically appealing, but if the diagnostic questions can be answered without that level of detail, it is inappropriate to increase the radiation dosage.
The radiation dose from nuclear medicine imaging varies depending upon the type of study. An effective radiation dose can be lower than, comparable to, or far exceed the general day-to-day environmental background radiation dose. It can also be less than, in the same range, or higher than the radiation dose from a CT scan on the abdomen area or the pelvis. Some nuclear medicine procedures require that patients prepare before the study to obtain the most accurate results. This preparation may include dietary restrictions or the withholding of certain medications.
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