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Basic Physics and Radiation Safety in Nuclear Medicine
Address for correspondence: Prof. Bhagwant Rai Mittal, Department of Nuclear Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh - 160 012, India. E-mail: brmittal@yahoo.com
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This article was originally published by Wolters Kluwer - Medknow and was migrated to Scientific Scholar after the change of Publisher.
During Caltech's commencement address of 1974, Richard Feynman famously said “The first principle is that you must not fool yourself and you are the easiest person to fool.” This phrase might sound simple at first but has several deep layers and connotations to it. As students and lifelong learners, it is of utmost importance that we label with caution our process of understanding and not be content with merely the acquisition of random and ubiquitous data. The correct approach to understanding any subject under the universe should always be a logical one and howsoever complex the topic may be, building a conceptual foundation is the primary step. Einstein aptly said that if you wish to gauge your understanding of a subject, try explaining it to a 6-year-old. If you can’t explain it simply, you haven’t understood it well enough.
In the field of Physics as a whole, and Physics in Nuclear Medicine, in particular, the significance of getting the concepts right cannot be overemphasized. Choosing the right book which takes us through the topic in a simplified and directional manner is thus of utmost importance.
The textbook on “Basic Physics and Radiation Safety in Nuclear Medicine” by Dr. G. S. Pant has been published in its 2nd edition, with significant additions and improvement over the first edition that was released in 2008. The textbook is designed to serve as a primary text for the trainees in understanding the relevant physics, radiobiology, and radiation safety in Nuclear Medicine, as well as work as a ready reckoner for the physicians and scientists engaged in the practice of Nuclear Medicine. Dr. Pant has immense experience in Medical Physics. He has served for 36 years in the All India Institute of Medical Sciences, New Delhi, India, entrusted with training numerous batches of students/trainees, and retired from the post of Professor (Medical Physics). His academic achievements are themselves an indication that this book has been crafted under meticulous hands.
The book has a total of 41 chapters, arranged in six parts, with each chapter written by relevant subject experts. The first section covers basic physics and imaging techniques in nuclear medicine. It is imperative for the young trainees to be initially acquainted, and gradually well versed in the physics component of nuclear medicine. The basic principles of radioactivity, radioactive decay, the interaction of radiation with matter, radiation detectors and imaging techniques, form the foundation toward an adequate understanding of the nuclear medicine methods and techniques. However, since a significant number of trainees have a limited exposure of nuclear physics in their prior training, it becomes especially important to introduce the subject and gradually delve into its intricacies in a simplified manner. Dr. Pant has ensured that the text does not overwhelm the students with complicated mathematical terms and formulae or with extensive physics jargon, but instead approach the matter by establishing basic concepts and slowly build over those concepts as the complexities increase. The chapters have a logical sequence, the initial ones discussing the terminologies used in nuclear physics, various nuclear interactions, and their significance in the practice of nuclear medicine and the later ones directed toward the working principles of different nuclear medicine instruments used in counting and imaging.
The second section deals with dosimetry methods employed in both diagnostic and therapeutic nuclear medicine. Separate chapters on dosimetry in 131I-, 177 Lu-, and 90Y-based therapies provide a practical understanding of dosimetry calculations in these commonly performed therapies, particularly in the Indian scenario. Of particular note, is the chapter on the use of OLINDA/EXM software for dose estimation in diagnostic procedures. This software is frequently employed for dosimetry and acquiring practical knowledge about its working is a necessary skill for nuclear medicine trainees.
The third section is a brief overview of the radionuclides used in nuclear medicine. This part includes the approved SPECT and PET radiopharmaceuticals in routine clinical practice and the investigational agents, primarily in preclinical and clinical research. While details of radionuclides and radiopharmaceuticals, their preparation and mechanism of action falls into the domain of radiochemistry, an overview in the present text serves to familiarize the reader with the commonly used radiopharmaceuticals in diagnostic and therapeutic areas. Several tables enlisting these radiopharmaceuticals along with their physical characteristics, mechanism of action and indications serve as a quick review source for students and professionals alike.
The fourth section includes chapters on positron emission tomography/computed tomography (PET/CT), medical cyclotron and has inducted a new chapter on magnetic resonance imaging (MRI), introduction to PET/MR and its associated challenges. PET/CT is a major workhorse of nuclear medicine imaging and with the ever-increasing clinical indications and research opportunities forms a high patient volume avenue. Readers are introduced to the instrumentation and functioning principles of PET and CT early in this section, leading on to its numerous clinical applications and research potential. PET/MRI fusion imaging is a relatively new modality in India with only a few centers equipped with the instrumentation for clinical use. The text introduces the readers to the concepts behind this unique fusion imaging as well as its current challenges and directions toward eliminating them.
The fifth section on tracer kinetic modeling deals with the radiotracer transit through physiologic systems and mathematical analysis of this process to yield quantitative output parameters. These chapters have been simplified to a great extent and despite their strong mathematical background, are easy to comprehend.
The last section on health physics and radiation safety is one of the lead attractions of the textbook. Knowledge of radiobiology, dealing with the effect of radiation on biologic systems (tissues and organs) is essential, from a therapeutic and radiation safety point of view. Understanding the basics of radiobiology is imperative for planning treatment in patients and gauging its effectiveness. Radiation safety forms a critical aspect of the nuclear medicine curriculum, and its practical knowledge is of utmost importance for day-to-day dealing with open sources of radiation. The textbook adequately covers the different aspects of radiation safety, patient-related safety procedures, and protocols in case of radioactive contamination. The last chapter and the annexures include reference values of radiopharmaceuticals used in nuclear medicine procedures, routes of administration, common radiation units, and routinely employed parameters such has half value/tenth value layers.
This book forms an essential text in the Nuclear Medicine curriculum and serves as a primary resource in Nuclear Medicine Physics, Radiobiology, and Radiation safety for MD/DNB/DRM trainees and BSc/MSc Nuclear Medicine technology students. The book encompasses all the essential aspects of the subject in around 650 odd pages and thus is suitable as a primary text and a preparatory examination manual. The writing style is lucid and concise, preserving the natural flow of thoughts across chapters. The ample use of line diagrams, flowcharts, and tables is a welcome feature, helping the reader to quickly browse through the salient features after a first thorough read. All in all, the book achieves its purpose of being a concise manual on Basic Physics and Radiation Safety in Nuclear Medicine. The true judge of any book, worth its name is the reader, and I am positive that my thoughts would be reflected by them as well.
I conclude by saying and as Richard Feynman put it, “I learned very early the difference between knowing the name of something and knowing something.” The difference between knowledge, wisdom, and insight is immense, and yet, the majority does not know which to aspire for. I hope this text leads you aptly.