Nuclear Medicine

Publié par : EDP Sciences

Nuclear medicine is a specialized medical field based on the application of radiopharmaceuticals, i.e. drugs associated to radioactivity, for diagnosis or therapeutic purposes. In the past fifty years, nuclear medicine has progressed in such a way that it is now a major tool in hospitals. Nowadays, this technology enables to better detect, observe and describe diseases, and also to improve treatments. Cancer therapy is the main application of this speciality. Once injected to the patient, the radiopharmaceutical drug aims selectively at the tumoral cells, including the metastases, settles there and emits radiation. Depending on the type of radiation, the drug will either help to identify the cells or to destroy them. Recent breakthroughs in this technology bring new perspectives to oncology, haematology and neurology. At the same time, since the beginning of the 21st century nuclear medicine has also benefited from a double revolution in terms of imaging technology. On the one hand, the Positron Emission Tomography (PET) made a real impact with a polyvalent imaging drug called FDG. On the other hand, a new tool combining functional and morphological imaging (PET-CT) was very recently made available to the medical community. This scientific book aims to introduce nuclear medicine to a larger audience, pointing out, among other things, the difficulties both physicians and patients meet when trying to access new technologies. There are still some issues to overcome, but recent scientific breakthroughs bring great hopes for patients in the near future. Richard Zimmermann is an organic chemistry PhD (Strasbourg, France) with a post-doctoral experience at Georgetown University (Washington DC, USA). He has spent the past twenty years working in the pharmaceutical industry throughout Europe (France, Germany, the Netherlands, Switzerland) mainly in research and development in fields such as cardiology, immunology, gastro-enterology and finally neurology until 1999, when he became head of the French-based Nuclear Medicine Research and Development Department of an international pharmaceutical group. Since 2004, he is also in charge of the Development Programme of the PET technology for this same company.

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Nuclear medicine covers the area of a medical practice based on the resources of physics, its tools and products nuclear meaning related to the nucleus of the atom in order to be applied both for diagnosis and therapeutics. In both cases, a substance containing a radioactive isotope or radionuclide (one speaks about a labelled substance) is administered to a patient. It goes straight towards a biological tissue or organ after having selectively searched for it. The concentration of this radionuclide in the targeted tissue or organ is favoured by the design of the organic or biological substrate or vector on which it is grafted. The emitted radioactivity will then be used either to locate the radionuclide (diagnosis) or to initiate the deterioration of surrounding cells (therapy).

The term radiotracer refers to the notion of minute (trace) amounts of the substances in use, and also to the advantageous ability to "trace" the dissemination of the molecule in the body. The selection of the radionuclide, based on the nature of the emitted radiation, its physical properties, i.e. energy and half-life, and its chemical properties, will define the final purpose of this molecule, called a radiopharmaceutical. The diagnosis imaging technology, also called scintigraphy, is obtained with substances labelled with ?-emitter isotopes.

The use of radionuclides as an external source of radioactivity, of temporary radioactive implants for therapy purposes or of particle beam generators (neutrontherapy and protontherapy, which are both external therapies) is controlled by radiotherapists. Hence, it does little or not concern nuclear physicians. The same applies to brachytherapy, or curietherapy as it is known in some countries, a technology that is devoted to the use of permanent or temporary radioactive implants. These areas will however be described in this work. Finally, analogue sources (mainly X-rays) are used in radiology to obtain organ image data from different angles around the body.

After about fifty years of practice and experience, nuclear medicine reached a turning point. The new imaging modalities that appeared on the market at the dawn of the new millennium, as well as the new molecules and therapeutic technologies associated to radioactivity open new and promising perspectives that fascinate experts from other medical disciplines, and more particularly oncologists, haematologists and neurologists.

This work does not intend to put forward new therapies and original answers to pathologies that seem hopeless. Physicians do have all the competencies required to prescribe the most appropriate treatments for specific patients and diseases. This book simply aims to provide detailed information, using a vocabulary that is as accessible as possible, to a public that is usually not even aware that this discipline does exist and that it brings a new breath of life to diagnosis and therapy, especially in oncology.

For a long time, therapy by means of nuclear medicine was restricted to very difficult cases and last chance treatments. Physicians usually think of using metabolic radiotherapy only after chemotherapy and external radiotherapy protocols repeatedly failed.

In this introductory chapter, we will see how patients can benefit from the knowledge acquired in nuclear medicine during the past half century, and learn about the revolutionary aspect of these new techniques and medicinal products; then, we will take a look at all the opportunities brought by this technology when it is associated to other innovative medical modalities. All these aspects will be developed in detail further in this book.

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Auteur : ZIMMERMANN Richard

Editeur : EDP Sciences

Parution : 2007

ISBN : 9782759802555

Tags : Ebook sciences, ebook scientifique, Nuclear Medecine
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