INTRENSHIP REPORT

PINUM CANCER HOSPITAL, FAISALABAD

Submitted to: Dr. Humaira Noreen

Submitted by: Batch-II
Batch members and their details:
Sana Zahra: 2015-GCWUF-2204 Roll # 15-188

Maira Zahid: 2015-GCWUF-2199 Roll # 15-183

Maleeha Saleem: 2015-GCWUF-2162 Roll # 15-146

Batool Saeed: 2015-GCWUF-2080 Roll #15-76

Programme: BS(hons) in Physics

Department of Physics

Government College Women University Faisalabad

.

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Acknowledgment
We would like to thank Almighty Allah for giving us opportunity, determination and strength to
do our Internship. His continuous grace and mercy were with us throughout our life and ever
more during the tenure of our internship.

Now, we would like to say thanks and express our deep and sincere gratitude to our supervisor
Dr. Humaira Noreen, our head of department Madam Asma Khurshid and Dr Yusra Arooj
for taking part in useful decision & giving necessary guidance and arranged all facilities to make
our internship easier. We also want to say thanks and highly appreciate the efforts expended by
all lecturers of PINUM for their careful and precious guidance which were extremely valuable
for our study both theoretically and practically.

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Introduction to the Institute:
Punjab Institute of Nuclear Medicine (PINUM) is one of the thirteen medical centers of Pakistan
atomic energy commission PAEC, providing facilities to many people of Faisalabad and its
surroundings. Basically, it is a cancer hospital and it is working more efficiently in the field of
nuclear medicine. PINUM deals with the cancer and as an approach to diagnose and treat cancer
wit efforts of expert doctors and other well-trained officers.
PINUM has advanced laboratories and equipment’s which deals with diseases and hence it
provides a good approach to diagnose the disease.

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Contents
Acknowledgment .......................................................................................................................................... 2
Introduction to the Institute:.................................................................................................................. 3
One month (13-04-2019 to 13-05-2019) ............................................................................................... 5
Introduction to Nuclear Medicine ................................................................................................................. 6
HOT LAB ..................................................................................................................................................... 7
Background: .............................................................................................................................................. 7
Procedure. ................................................................................................................................................. 7
PRECAUTIONS: ...................................................................................................................................... 8
Gamma Camera ............................................................................................................................................ 8
Procedure: ................................................................................................................................................. 8
Parts .......................................................................................................................................................... 8
Quality Control ......................................................................................................................................... 9
Intrinsic Quality control: ........................................................................................................................... 9
Values Are OF Two Types ................................................................................................................... 9
Extrinsic quality Control ........................................................................................................................... 9
Example of gamma camera scene: ............................................................................................................ 9
Two Parts .............................................................................................................................................. 9
X-RAY .......................................................................................................................................................... 9
What are uses of X-rays? ........................................................................................................................ 10
Is it safe to have X-rays while pregnant? ................................................................................................ 11
How is an X-ray is performed? ............................................................................................................... 11
DXA: Dual X-ray absorptiometry............................................................................................................... 13
Mammography ............................................................................................................................................ 14
Background: ............................................................................................................................................ 14
Types:...................................................................................................................................................... 14
1. Screening mammogram .............................................................................................................. 14
2. Diagnostic mammogram ............................................................................................................. 15
Benefits vs. Risks:................................................................................................................................... 15
Benefits ............................................................................................................................................... 15
Risks.................................................................................................................................................... 15
Results:.................................................................................................................................................... 15
REFERENCES. .......................................................................................................................................... 16

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 Duration of my
internship:
One month (13-04-2019 to 13-05-2019)

Detail of lectures delivered by Doctors and Principle Scientists of PINUM:

Sr. Date Lecturer Title

no
1. 17-04-2019 Dr. Humaira Noreen Medical Physics

2. 18-04-2019 Dr. Sajid Gamma Camera room

and Statistical distribution
3. 19-04-2019 Dr. Dilbar Physics in Nuclear
Medicine
4. 20-04-2019 Dr. Humaira Noreen Report Writing

4. 24-04-2019 Dr. Tania Quality control of

radiopharmaceuticals and
generator
5. 25-04-2019 Mr. Shahbaz Nuclear medicine

6. 26-04-19 Dr Humaira Noreen Discussion on Report

writing and Seminar
presentation
7. 27-04-2019 Dr.Zarafshhan Breast cancer awareness

8. All remaining lectures upto Dr Humaira Noreen Conducted for presenting

13-04-2019 seminar, assignments and
quizzes

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Introduction to Nuclear Medicine
Nuclear medicine is a branch of medical imaging that uses small amounts of radioactive
materials called radiotracers that are typically injected into the bloodstream, inhaled or
swallowed. The radiotracer travels through the area being examined and gives off energy in the
form of gamma rays which are detected by a special camera and a computer to create images of
the inside of body. Nuclear medicine imaging provides unique information that often cannot be
obtained using other imaging procedures and offers the potential to identify disease in its earliest
stages. Nuclear medicine includes diagnostics and therapeutics.

Nuclear Medicine Diagnostics

It often enables physicians to accurately diagnose complex diseases – including cancer,
cardiovascular and neurological disorders in their early stages – and improve follow-up.

In these nuclear medicine diagnostics procedures, patients are injected with a

radiopharmaceutical agent and imaged with PET (Positron Emission Tomography) or SPECT
(Single Photon Emission Computed Tomography) cameras.

PET is a state-of-the-art molecular imaging technique that involves detection of a pair of gamma
rays emitted from a patient’s body following administration of a radiopharmaceutical that binds
to target cells. PET is used to diagnose a wide range of conditions.

Nuclear Medicine Therapeutics

It combines two approaches: tumor targeting and radiation. Tumor targeting allows drugs to
selectively target cells associated with disease due to the affinity between the drug and certain
receptors expressed by the relevant cells.

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 HOT LAB
Background:
Hot lab is a specially designed room in a nuclear medicine hospital just like in PINUM where the
radiopharmaceuticals are delivered, stored and prepared for dispensing. 99Mo/99mTc-generator
is the major source in the hot lab used for various medical imaging. It is important to maintain a
standard for hot lab procedures to optimize the patient care and minimize radiation exposure to
all nuclear medicine personnel, patients, public, as well as environment.

Procedure.
Stepwise procedure of hot lab is given below.

• Entering the hot-lab;

• Selection of labelling kits;

• selection of accessory materials;

• Eluting the generator

• Radiolabeling with 99mTc and calculation of doses;

• Dispensing of 99mTc-MDP doses;

• Radioactive waste management;

• Exiting the hot-lab;

• Documentation.

Example of an isotope calibrator

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PRECAUTIONS:
When the radio pharmacist or technician leaves the hot lab, he should take care to follow a
number of safety procedures. These are shown in the video below:

The steps in detail are as follows:

• take off the gloves used during the work with radioactive materials and discard them in a
radioactive waste bin.

• leave his dosimeter and when appropriate ring dosimeter(s)) in a specially designated
holder

• take off the special lab-coat

• exchange the special ‘lab-shoes’ for his own shoes, or, if wearing overshoes, to remove
them and discard them in the waste bin

• check his body and clothing for possible contamination with radioactive material, taking
extra care to monitor his hands

• remove all his personal belongings from the changing room

Only after these precautions are taken can the radio pharmacist or technician leave the lab.

Gamma Camera
The gamma camera is an imaging technique used to carry out functional scans of the brain,
thyroid, lungs, liver, gallbladder, kidneys and skeleton.
Procedure:
The procedure involves giving the patient a radiopharmaceutical molecule marked with a
gamma-emitting radioisotope.
Once the molecule fix on the target organ or tissue, the highly penetrative emitted gamma rays
easily escape from the body and leave their mark on the detection panels.
‘Gamma camera’ detect scintillation produced by gamma rays emitted by a radioactive marker.
Once a large number of these scintillations have been observed the radioactive molecules
emitting these gamma rays can b located.
Parts
• Head

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 • Collimator
• Photomultiplier tubes
• NaI Crystal
• Computer
• Display

Quality Control
There are two types of quality control gamma camera:
• Intrinsic
• Extrinsic

Intrinsic Quality control:

It is performed without collimator radiopharmaceutical used is Tc-99m(30mCi).
Normal value ranges 1-9.It is performed on motherly basis.

Values Are OF Two Types:

Useful flied of value (UFOV)
Central flied of value (CFOV)
Extrinsic quality Control
This quality control is performed with collimator source used is covaled-57. This test is
performed on daily basis.
Example of gamma camera scene:
Bone scene:
A bone scene is a nuclear medicine test. This means that the procedure uses a very small amount
of a radioactive substances, which is MDP. The tracer is injected into a vein. Areas where too
much or two little tracer has been absorbed by the body may indicate cancer.

Two Parts:
In the first part, You receive an injection into a vein in your arm that usually takes 15-30
minutes. This includes time to explain the procedure and take any early images if required.
In the second part, you return after 1-4 hour to have delayed images taken.

X-RAY
X-rays are a form of electromagnetic radiation, similar to visible light. Unlike light, however, x-
rays have higher energy and can pass through most objects, including the body. Medical x-
rays are used to generate images of tissues and structures inside the body. For example, the
calcium in your bones makes them denser, so they absorb more radiation and appear white on X-

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rays. Thus, when a bone is broken (fractured), the fracture line will appear as a dark area within
the lighter bone on an X-ray film.

Figure A: X-RAY machine

What are uses of X-rays?

The most common form of X-ray used is X-ray radiography, which can be used to help detect or

diagnose:

• Bone Fractures

• Infections (such as pneumonia)

• Arthritis in joints

• Bone loss (such as osteoporosis)

• Dental issues

• Heart problems

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Is it safe to have X-rays while pregnant?
The risk of side effects of an X-ray while you are pregnant is extremely minimal, but it is
always important to protect the developing fetus from harm. Often the risk of not having
a necessary X-ray can be greater than the risk of the radiation.
How is an X-ray is performed?

• X-ray test works by positioning the part of the body being X-rayed between the source of

the X-ray and an X-ray detector (such as a film).

• You usually will need to lie on a table or stand against a flat surface to ensure your body

is in the right place for the X-rays to pass through the body part being examined.

• You will be asked to stay still so the image will be as clear as possible.

• This will provide the most accurate image.

• Patient should not wear any metal object or any kind of jewellery A radiology technician

aim the X-ray machine at the body part that needs to be X-rayed, and then they leave the

room or go behind a screen to turn on the machine.

• The actual X-ray usually only takes a fraction of a second, and you will not feel anything

when it occurs.

• The radiology technician may return and reposition your body or the X-ray slide to take

additional X-rays from multiple angles.

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Figure B: Cervical Spine x-ray Figure C:Chest X-ray
Table 1: Data collected by Batch-2
NAME AGE TYPE KeV , mA , mAs
Mehmood Anwar 59 X-Ray (chest) 74,250,30
Ashraf Awan 46 X-Ray (chest) 72,250,30
Nabeela 45 Cervical Spine 74,200,60
Both knee 68,200,24
Right and Left lateral 68,200,24
Anaya 10 Chest X-ray 56,250,30
PNS 58,200,60
Razia bibi 37 Shoulder X-ray 68,250,30
Shafqat 42 Chest x-ray 74,250,30
M.Arif 46 Chest x-ray 70,250,30

Table 2: General Data

POSITIONING VIEW KeV,mA,mAs
Chest PA view 70,250,30
Shoulder joint AP view 68,250,30
Skull PA 78,200,80
Lateral 60,200,80
PNS PA view 76-78,200,60
CNS AP view 64,200,60
Lateral 64,200,40
L.S.S AP view 76-78,200,60
Lateral 84-86,200,60
T.L.S AP view 84-86,200,60
Lateral 96,200,60
Pelvis 72-74,200,60
Humerus PA view 60-68,320,38
Hand 44,200,2
Wrist 44,200,4
Fingers 42,200,4

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 Femur (young pt.) AP view 54,200,10
Lateral view 60-62,200,10
Foot AP view 44,200,6
Knees AP view 50-56,200,10
Lateral 44,200,60
Arm + Elbow joint AP view 44,200,4

DXA: Dual X-ray absorptiometry

Patient’s Age Weight Heigh BMD(g/cm²)
name t
Lumbar Right Right Left Left hip
spine(total) femoral hip femoral region

technique for scanning bone and measuring bone mineral density (BMD) . A DXA scanner is a
large machine that produces 2 X-ray beams, each with different energy levels. One beam is high
energy while the other is low energy. The amount of x-rays that pass through the bone is
measured for each beam. This will vary depending on the thickness of the bone. Based on the
difference between the 2 beams, the bone density can be measured. DXA is relatively easy to
perform and the amount of radiation exposure is considered low. DXA is also called dual energy
X-ray absorptiometry or DEXA.

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 neck region neck total
total
Mrs. Sarwat 46 86kg 156cm 1.237 0.808 0.986 0.838 1.077
Zia

Mrs. Imtiaz 72 75kg 155cm 0.829 0.633 0.735 0.625 0.787

bibi

Table 3: DXA READINGS

Mammography
“A mammography, or mammogram, is an X-ray of the breast. It’s a screening tool used to detect
and diagnose breast cancer. Together with regular clinical exams and monthly breast self-
examinations, mammograms are a key element in the early diagnosis of breast cancer”.

Background:

Mammography has been used for about 30 years, and in the past 15 years technical progresses
have greatly better-quality both the procedure and results. Today, dedicated equipment, used
only for breast X-rays, produces studies that are high in quality, but low in radiation dose.
Radiation risks are considered to be unimportant.

Types:

There are two main types of mammography given below:

1. Screening mammogram. A screening mammogram is an X-ray of the breast used to

detect breast changes in women who have no signs or symptoms of breast cancer. It

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 usually involves 2 X-rays of each breast. Using a mammogram, it is possible to detect a
tumor that cannot be felt.
2. Diagnostic mammogram. A diagnostic mammogram is an X-ray of the breast used
to diagnose unusual breast changes, such as a lump, pain, nipple thickening or discharge,
or a change in breast size or shape. A diagnostic mammogram is also used to evaluate
irregularities detected on a transmission mammogram. It is a basic medical tool and is
appropriate in the workup of breast changes, regardless of a woman's age.

Benefits vs. Risks:

Benefits

• Screening mammography reduces the risk of death due to breast cancer. It is useful for
detecting all types of breast cancer, including invasive ductal and invasive lobular cancer.
• Screening mammography improves a physician's ability to detect small tumors. When
cancers are small, the woman has more treatment options.
• The use of screening mammography increases the detection of small abnormal tissue
growths confined to the milk ducts in the breast, called ductal carcinoma in situ (DCIS).
• No radiation remains in a patient's body after an x-ray examination.
• X-rays usually have no side effects in the typical diagnostic range for this exam.

Risks

• There is always a slight chance of cancer from excessive exposure to radiation. However,
the benefit of an accurate diagnosis far outweighs the risk.
• The effective radiation dose for this procedure varies.
• False Positive Mammograms. Five percent to 15 percent of screening mammograms
require more testing such as additional mammograms or ultrasound. Most of these tests
turn out to be normal. If there is an abnormal finding, a follow-up or biopsy may have to
be performed. Most of the biopsies confirm that no cancer was present. It is estimated
that a woman who has yearly mammograms between ages 40 and 49 has about a 30
percent chance of having a false-positive mammogram at some point in that decade and
about a 7 percent to 8 percent chance of having a breast biopsy within the 10-year period.

Results:

Mammography produces mammograms — black-and-white images of your breast tissue.

Mammograms are digital images that appear on a computer screen. A radiologist understands the
images and refers a written report of the findings to your doctor.

The radiologist looks for evidence of cancer or noncancerous (benign) conditions that may
require extra testing, follow-up or behavior.

Possible findings include:

• Calcium deposits (calcifications) in ducts and other tissues

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 • Masses or lumps
• Asymmetric areas on the mammogram
• Dense areas appearing in only one breast or one specific area on the mammogram
• New dense area that has appeared since your
last mammogram.

REFERENCES.
• knowledge gain from Sir Taqi Rafique in Hot lab-I of PINUM and Sir Azeem from X-ray
and DXA.

Henkin R.E. (1996). Nuclear Medicine, Vol-I, Mosby-Year Book Inc., Missouri, pp: 30-39.
IAEA (1999). Occupational Radiation Protection. IAEA Safety Standards Series No. RS-G-1.1.

NUREG-0714 (1997). Occupational radiation exposure, US Nuclear Regulatory Commission,

Washington, DC, US Government Printing Office. pp: 12-13. Richards P., Tucker W.D.,
Srivastava S.C. (1998). Technetium-99m: an historical perspective. Int. J. Appl. Radiat.
Isot., 33: 793-799.

UNSCEAR (2000). Sources and effects of ionizing radiation, United Nations Scientific
Committee on the Effects of Atomic Radiation, Report to General Assembly, United
Nations, New York. NRC (1987). Guide for the preparation of applications for medical
use programs, NRC Regulatory Guide 10.8, Washington, DC, Nuclear Regulatory
Commission.

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