Nuclear Medicine

A.Y. 2020/2021
8
Max ECTS
80
Overall hours
SSD
BIO/12 FIS/07 ING-INF/07 MED/36 MED/50
Language
Italian
Learning objectives
The teaching is intended to steer the student about the most common diagnostic techniques regarding nuclear medicine imaging in the following fields: cardiology, oncology, neurology, nephron-urology, endocrinology and diagnostics of infectious processes, as well as the use, management and production of radiopharmaceuticals. Special attention will be given to integrated imaging techniques (SPECT and PET-CT) and radiation protection of the patient with reference to the Italian legislation and the recommendations in the European context. It's also goal of the teaching to give students knowledge about the equipment used in nuclear medicine (gamma cameras and positron emission tomography), their functionality and the quality controls performed on them.
Expected learning outcomes
After completing the course, students must:
- have acquired theoretical knowledge on the activities of the Radiology Technician inside a Nuclear Medicine Service
- know the daily used equipment in a service of Nuclear Medicine
- have acquired the basics regarding management and production of radiopharmaceuticals
- be able to describe the equipment using guidelines, in relation to the types of procedures to be conducted
- know the main exam protocols in Nuclear Medicine.
Course syllabus and organization

Single session

Didactic methods.
Half of the students, according to pre-established shifts, will participate from time to time in face-to-face lessons in classrooms suitably equipped for the Covid emergency, where safety conditions allow it.
Furthermore, to allow them to be used both in synchronous and asynchronous mode for students not present in the classroom, the lessons will be held simultaneously on the Microsoft Teams platform and can be followed both in synchrony on the basis of the first semester and in asynchronous mode, because they will be registered and left on the same platform available to students not present in the classroom.
Lessons may also include pre-recorded materials.
If the situation worsens, the lessons will be delivered through the Microsoft Teams platform and can be followed both in synchronous according to the scheduled time and asynchronously, because they are recorded through the same platform.

Program and reference material.
The program and reference material will not change. The teaching material (slides displayed during the lectures) will be available on the Ariel platform dedicated to teaching.

Methods for verifying learning and evaluation criteria.
The exam will take place in writing in the presence or in the event of an aggravation of the pandemic, with the moodle + seb + webconference modality to be activated in collaboration with the Center for educational innovation and multimedia technologies of the University of Milan.
Prerequisites for admission
In-depth knowledge of the contents of the courses "Physical and mathematical principles", "Radiobiology and Radioprotection" and "Morphological and functional foundations of life". Knowledge of the contents of the modules of "Biochemistry" and "Pharmacology".
Assessment methods and Criteria
Written exam with 33 quizzes (with 4 answer options). Each exact answer will be assigned 1 point. There is a penalty for incorrect answers. The test can be taken twice in the same session.
The final exam aims to assess the achievement of the set educational objectives.
Previous registration on the UNIMIA portal is mandatory for the examination, within the dates established for each exam.
Radiopharmaceuticals
Course syllabus
General principles of distribution and localization of radio-drugs. Technetium-99m in medical-nuclear diagnostics.
The main characteristics of the most frequently used radionuclides.
Examples of conventional diagnostic radiopharmaceuticals.
Radiopharmaceuticals for Positron Emission Tomography.
Teaching methods
The course is composed by a series of lectures with slides. Additional teaching material is available on the Ariel website.
Teaching Resources
VOLTERRANI, ERBA, MARIANI - Fondamenti di Medicina Nucleare; tecniche e applicazioni - Springer, 2010
Atomic physics, x-ray protection, and dosimetry
Course syllabus
Interaction of ionizing radiation with matter.
Radiation field quantities.
Interactions of charged particles (directly ionizing) with matter.

Interactions of particles not directly ionizing.
Photons.
Attenuation of a photon beam in the matter.
Interaction of neutrons with matter.

Dosimetry of ionizing radiation.
Exposure.
Energy imparted.
Absorbed dose.
Kerma.
Relationship between absorbed dose and exposure (in air and by photons).
Relationship between absorbed dose in different materials and tissues (photons).

Radioactivity and radioactive sources.
Alpha and beta radioactive decay, gamma and x radiation.
Activities and units of measurement.
Radioactive series.
Radioactive decay constant and half-life.
Dosimetry applied to radioactive sources: point source.

Radiation detectors and nuclear and dosimetric instrumentation.
Active and passive instrumentation.
Gas detectors: ionization chamber, proportional chamber and Geiger-Muller counter.
Solid state detectors.
Phosphorescence detector.
Other types of detectors: track detectors and photographic emulsions.
Applications: gamma spectrometry.
Radiation protection.
Dosimetric radioprotection quantities.
Collective effective dose and calculation of radiation risk.
Types of exposure: occupational, medical and population. Occupational exhibition.
Operational radiation protection in medical settings.
Teaching methods
The course is composed by a series of lectures with slides. Additional teaching material is available on the Ariel website.
Teaching Resources
POLVANI: Elementi di radioprotezione - Ed. ENEA
PELLICCIONI: Fondamenti fisici della radioprotezione - Pitagora Editrice, Bologna, 1993
MARENGO: La fisica in medicina nucleare - ed. Patron Editore, Bologna
LEO: Tecniques for nuclear and particle physics experiments - Springer-Verlag
Nuclear-medicine devices, training, and processing images, quality control
Course syllabus
The gamma-camera: principal elements, physical performance and acquisition/processing of planar studies.
Single photon emission tomography (SPECT and SPECT/CT): principle and data acquisition.
Positron emission tomography (PET and PET/CT) principal elements, physical performance and data acquisition.
Corrections for scatter, attenuation and spatial resolution of tomographic images.
Basic principle of tomographic reconstruction algorithms.
Multimodal imaging.
"Functional/Metabolic" imaging with scintigraphic, SPECT, PET studies.
Patient exposure in nuclear medicine.
Metabolic models for the calculation of effective dose.
Quality controls in nuclear medicine and instrumentation.
Diagnostic reference levels in nuclear medicine.
Teaching methods
The course is composed by a series of lectures with slides. Additional teaching material is available on the Ariel website.
Teaching Resources
METTLER JR., GUIBERTEAU: Instrumentation & Quality Control in Essential of Nuclear Medicine - Elsevier Saunders, Philadelphia 2012, 6th edition, chap. 2
LIN, ALAVI: PET and PET/CT, A Clinical Guide - Thieme, New York 2008, 2nd edition
GOLDFARD, PARMETT, ZUCKIER, ONGSENG, KARAM, COOPER: Nuclear Medicine Board Review -Thieme, New York, 2007, 2nd edition
JUWEID, HOEKSTRA: Positron Emission Tomography - Springer Protocols, Humana Press, 2011
SCHOBER, HEINDEL: PET-CT Hybrid Imaging - Thieme, Stuttgart-New York, 2010
CHERRY, SORENSON, PHELPS: Physics in Nuclear Medicine - PA. Saunders, an imprint of Elsevier Science, Philadelphia, 2003, 3rd edition
Conventional diagnostics in nuclear medicine and radiometabolic therapy (RMT)
Course syllabus
Introduction to nuclear medicine diagnostics.
Applications in the study of the cardiovascular and pulmonary apparatus.
Applications in the study of urogenital and gastrointestinal systems; applications in pediatrics.
Applications in the study of the endocrine system and applications in oncology.
Applications in the study of the osteoarticular apparatus.
Applications in the study of the central nervous system and in infections.
Applications of PET in oncology; other PET applications.
Review of radiobiology.
Review of radioactive decay modalities and effects on the matter of the various types of particles.
Review of radiopharmaceuticals (and concepts in general).
General concepts of radiometabolic therapy and radioimmunotherapy.
General information on dose estimation in radiometabolic therapy (hints of dosimetry).
Regulatory and logistic aspects, concepts of radiation protection in therapy.
Organizational aspects.
Scintigraphic studies for dose evaluation, therapy planning and control: total body scintigraphy with 131I, skeletal scintigraphy, other scintigraphy.
Oncological applications: differentiated thyroid tumors, neuroblastoma, pheochromocytoma, palliative therapy of skeletal metastases, receptor therapies, monoclonal antibody therapies.
Non-oncological applications: hyperthyroidism therapy, Radiosynoviorthesis (Radiation Synovectomy).
Teaching methods
The course is composed by a series of lectures with slides. Additional teaching material is available on the Ariel website.
Teaching Resources
FANTI, LOPCI, MONETTI: Compendio di Diagnostica Medico-Nucleare - Soc. Editrice Esculapio (2a edizione)
VOLTERRANI, ERBA, MARIANI: Fondamenti di Medicina Nucleare - Springer
Techniques in nuclear medicine
Course syllabus
Introduction to diagnostic imaging techniques in nuclear medicine.
Technical characteristics of the studies devoted to the cardiovascular and pulmonary apparatus.
Technical characteristics of the studies dedicated to the urogenital and gastrointestinal system; applications in pediatrics.
Technical characteristics of the studies dedicated to the endocrine system and applications in oncology.
Technical characteristics of the studies dedicated to the osteoarticular apparatus.
Technical characteristics of PET studies in oncology.
Technical characteristics of PET studies with 68Ga and other radiopharmaceuticals.

Technical aspects in Nuclear Medicine inherent to therapies with radiopharmaceuticals (introductory notes).
The gamma camera.
Notes on radiopharmaceuticals.
Acquisition techniques.

Acquisition techniques in traditional diagnostics.
Bone scintigraphy and treatment of skeletal metastases.
Thyroid scintigraphy.
Renal and adrenal scintigraphy.
Scintigraphy with receptor tracers.
Post-therapy control scan.
The techniques for performing PET/CT examinations.
Teaching methods
The course is composed by a series of lectures with slides. Additional teaching material is available on the Ariel website.
Teaching Resources
TAYLOR, SCHUSTER, ALAZRAKI: Medicina Nucleare - Manuale - Edizioni Minerva Medica
LYNCH: PET-TC nella pratica clinica - Edizioni Springer
Linee guida AIMN - Procedure di Medicina Nucleare (www.aimn.it)
LAGALLA: Radiologia (D.U. per TSRM) - Idelson-Gnocchi
AA.VV.: Manuale per TSRM - Ambrosiana
DONDI: Manuale per TSRM - Medicina Nucleare nella pratica clinica - Patron
VOLTERRANI, ERBA, MARIANI: Fondamenti Di Medicina Nucleare - Edizioni Springer
Atomic physics, x-ray protection, and dosimetry
FIS/07 - APPLIED PHYSICS - University credits: 1
Lessons: 10 hours
Conventional diagnostics in nuclear medicine and radiometabolic therapy (RMT)
MED/36 - IMAGING AND RADIOTHERAPY - University credits: 3
Lessons: 30 hours
Nuclear-medicine devices, training, and processing images, quality control
ING-INF/07 - ELECTRICAL AND ELECTRONIC MEASUREMENT - University credits: 1
Lessons: 10 hours
Radiopharmaceuticals
BIO/12 - CLINICAL BIOCHEMISTRY AND MOLECULAR BIOLOGY - University credits: 1
Lessons: 10 hours
Professor: Maioli Claudio
Techniques in nuclear medicine
MED/50 - APPLIED MEDICAL TECHNOLOGY AND METHODOLOGY - University credits: 2
Lessons: 20 hours