Medical imaging is crucial in a variety of medical settings and at all levels of health care. In public health and preventive medicine as well as in both curative and palliative care, effective decisions depend on correct diagnoses. This edition addresses the most current needs and offers guidance on clinical practice, radiation safety and patient protection, human resource development and training required for the overall practice of nuclear medicine.

• 1. Introduction
  • 1.1. Background
  • 1.2. Objective
  • 1.3. Scope
  • 1.4. Structure
• 2. Needs Assessment
  • 2.1. Background
  • 2.2. Epidemiology and main clinical applications
    • 2.2.1. Nuclear medicine resource distribution
    • 2.2.2. Nuclear medicine needs
    • 2.2.3. Clinical applications
  • 2.3. Determinant of level of service
    • 2.3.1. Diagnostic nuclear medicine level l
    • 2.3.2. Diagnostic nuclear medicine level 2
    • 2.3.3. Diagnostic nuclear medicine level 3
    • 2.3.4. Therapeutic nuclear medicine level 1
    • 2.3.5. Therapeutic nuclear medicine level 2
  • 2.4. Models of positron emission tomography–computed tomography and cyclotron centres
    • 2.4.1. Inside a hospital
• 3. PLANNING A NUCLEAR MEDICINE FACILITY
  • 3.1. Infrastructure
    • 3.1.1. General concept
    • 3.1.2. Patient flow in imaging procedures
    • 3.1.3. Organizational concepts
    • 3.1.4. Specific requirements
    • 3.1.5. Specific recommendation on finishes and systems
    • 3.1.6. Licensing and regulatory aspects
    • 3.1.7. Financial resourcing and business plan
  • 3.2. Concept of operation
    • 3.2.1. General aspects
    • 3.2.2. Patient scheduling
    • 3.2.3. Registration
    • 3.2.4. Procedure
    • 3.2.5. Data processing and management
    • 3.2.6. Reporting and approval of reports
    • 3.2.7. Additional requirements for radionuclide therapy
• 4. EQUIPMENT
  • 4.1. Gamma camera
    • 4.1.1. Detector crystals
    • 4.1.2. Collimators
    • 4.1.3. Photodetectors
    • 4.1.4. Electronic pulse processing
    • 4.1.5. Image framing
    • 4.1.6. System configuration
    • 4.1.7. New trends
  • 4.2. Positron emission tomography systems
    • 4.2.1. Design considerations for PET systems
    • 4.2.2. Detector systems
  • 4.3. Hybrid multimodality systems
    • 4.3.1. The problem of attenuation correction
    • 4.3.2. SPECT–CT
    • 4.3.3. PET–CT
    • 4.3.4. PET–MR
  • 4.4. Probes for in vivo gamma counting
    • 4.4.1. Probes for thyroid uptake studies
    • 4.4.2. Probes for sentinel lymph node detection
  • 4.5. Radioaerosol systems
    • 4.5.1. Techniques of radioaerosol production
    • 4.5.2. Safety aspects
  • 4.6. Radionuclide activity calibrators
• 5. INFORMATION TECHNOLOGY, NETWORKING, ARCHIVING AND GENERAL OFFICE EQUIPMENT
  • 5.1. Information technology
    • 5.1.1. Radiology information system
  • 5.2. Picture archiving and communication system
  • 5.3. Image distribution
  • 5.4. Documents scanners
  • 5.5. Label printing
  • 5.6. Networking
    • 5.6.1. Data transfer
    • 5.6.2. Local area networks
    • 5.6.3. Servers
    • 5.6.4. Data backup
    • 5.6.5. Network speed
    • 5.6.6. Wide area network
  • 5.7. Archiving
  • 5.8. Office equipment
• 6. HUMAN RESOURCES
  • 6.1. Roles and responsibilities
    • 6.1.1. Nuclear medicine physicians
    • 6.1.2. Medical physicists
    • 6.1.3. Radiopharmacists
    • 6.1.4. Nuclear medicine technologists
    • 6.1.5. Nurses
    • 6.1.6. Supporting staff
    • 6.1.7. Coordination with other clinical services
  • 6.2. Training needs
• 7. HOSPITAL RADIOPHARMACY AND RADIOPHARMACEUTICAL PREPARATION
  • 7.1. Hospital radiopharmacy design criteria
  • 7.2. Radiation protection matters
  • 7.3. Administrative area
  • 7.4. Dispensing area
  • 7.5. Reception area
  • 7.6. General laboratory area
  • 7.7. Radioactive waste management and storage area
  • 7.8. Levels of radiopharmacy
    • 7.8.1. Operational level 1a
    • 7.8.2. Operational level 2a
    • 7.8.3. Operational level 2b
    • 7.8.4. Operational level 3a
    • 7.8.5. Operational level 3b
    • 7.8.6. Operational level 3c
  • 7.9. Hospital positron emission tomography facility
    • 7.9.1. Cyclotron
    • 7.9.2. Hot cells
    • 7.9.3. Automated radiopharmaceutical module
    • 7.9.4. Final aseptic product
    • 7.9.5. Quality control equipment
• 8. MEDICAL PHYSICS SUPPORT
  • 8.1. Main tasks of the medical physicist
    • 8.1.1. Patient dosimetry and dose optimization
    • 8.1.2. Optimization in the use of radiopharmaceuticals
    • 8.1.3. New equipment
    • 8.1.4. Calibration and verification of measurement instruments
    • 8.1.5. Records and documentation
    • 8.1.6. Computer system management and support
    • 8.1.7. Development, optimization and validation of clinical studies
    • 8.1.8. Research and development
    • 8.1.9. Education and training
  • 8.2. Education and training of the medical physicist
  • 8.3. Quality assurance
    • 8.3.1. Troubleshooting and first line service
    • 8.3.2. Occupational and public radiation protection
    • 8.3.3. Medical physics service
• 9. GENERAL CLINICAL APPLICATIONS
  • 9.1. Appropriateness
  • 9.2. Clinical indications
    • 9.2.1. Single photon emitting radiopharmaceuticals
    • 9.2.2. Positron emitting radiopharmaceuticals
    • 9.2.3. Diagnostic studies with positron emitting radiopharmaceuticals
  • 9.3. Radionuclide therapy
• 10. RADIATION PROTECTION AND SAFETY
  • 10.1. Management system for radiation protection and safety
  • 10.2. Safety assessment analysis
  • 10.3. Security of sources
  • 10.4. Radiation safety of nuclear medicine facilities and equipment
    • 10.4.1. Design of nuclear medicine facilities
    • 10.4.2. Radiopharmacies and laboratories for handling unsealed radioactive materials
    • 10.4.3. Rooms for patients undergoing radionuclide therapy
    • 10.4.4. Structural shielding
    • 10.4.5. Classification of workplaces
    • 10.4.6. Performance of medical radiological and ancillary equipment
    • 10.4.7. Quality assurance
    • 10.4.8. Calibration
  • 10.5. Occupational exposure
    • 10.5.1. Local rules and procedures
    • 10.5.2. Monitoring of the workplace
    • 10.5.3. Individual monitoring for workers
    • 10.5.4. Health surveillance
    • 10.5.5. Pregnant and breast-feeding workers
  • 10.6. Public exposure
    • 10.6.1. Non-occupationally exposed workers and visitors
    • 10.6.2. Members of the public in the wider public domain
    • 10.6.3. Death of a patient who has undergone a nuclear medicine procedure
    • 10.6.4. Radioactive waste
  • 10.7. Medical exposure
    • 10.7.1. Optimization of nuclear medicine procedure
    • 10.7.2. Pregnant patients
    • 10.7.3. Breast-feeding patient
    • 10.7.4. Carers and comforters
    • 10.7.5. Volunteers in biomedical research
    • 10.7.6. Release of patients after radionuclide therapy
    • 10.7.7. Prevention of unintended and accidental medical exposures
    • 10.7.8. Investigation of unintended and accidental medical exposures
  • 10.8. Concurrent risks
    • 10.8.1. Biological hazards
    • 10.8.2. Chemical hazards
    • 10.8.3. Physical hazards
    • 10.8.4. Ergonomic or work design hazards
    • 10.8.5. Stress and psychosocial hazards
• REFERENCES
• ABBREVIATIONS
• CONTRIBUTORS TO DRAFTING AND REVIEW