ARTICLE

APPLICATIONS OF RADIOISOTOPES IN MEDICINE

TAPAS DAS*

‘N
uclear medicine’ is the medical specialty, which to treat various heart ailments, leukemia and for providing
utilizes the nuclear properties of radioactive pain relief to the patients suffering from metastatic bone
substances in diagnosis, therapy and research to cancer. Nuclear medicine has always been perhaps the most
evaluate metabolic, physiologic and pathologic conditions exciting area of investigation in medicine2. Today, it is
of human body. As an integral part of patient care, nuclear considered as one of the important diagnostic and
medicine is presently used in the diagnosis, treatment and therapeutic specialty in the armamentarium of medical
prevention of many serious ailments. Now-a-days, nuclear sciences in spite of its modest beginning less than a century
medicine offers procedures that are immensely helpful to ago.
a broad spectrum of medical sciences ranging from
oncology to cardiology to psychiatry. Today physicians are Nuclides having fixed number of protons but variable
equipped with a wide variety of nuclear imaging procedures numbers of neutrons are known as isotopes. There are 2500
and these uniquely provide information about the function known isotopes; however, only 280 of them are stable. The
of virtually every major organ/tissue of the human body. rest of the nuclides are unstable. Radioisotopes are these
Nuclear medicine imaging procedures often identify unstable nuclides, which emit some kinds of energetic rays
abnormalities at the very early stage of the progression of and/or particles in the process of becoming a more stable
the disease, long before it could be detected by other isotope. Although there are a few naturally occurring
alternative diagnostic modalities and this allows the disease radioisotopes, including 40K, 87Rb, 113Cd, 115In, 124Sn, 144Nd
to be treated early in its course. However, the actual and 147Sm, there half-lives are generally so long or their
strength of nuclear medicine lies in its ability to monitor abundances so low, or both; that they are unsatisfactory
both anatomical and physiological functions in-vivo, which for nuclear medicine applications3. Hence, the radionuclides
is not possible by the other contemporary imaging used in nuclear medicine are mostly artificial and produced
modalities, such as, computed tomography (CT) scanning, either in a cyclotron or in a nuclear reactor. For the 20-25
nuclear magnetic resonance imaging (MRI) and ultrasound years, which followed the 1939-1945 war, radionuclide
imaging1. Though, these imaging modalities are able to production for biomedical applications was mostly centered
delineate anatomical features with a much superior on major nuclear reactor installations4,5. However, soon
resolution, they provide only limited information on the
after, particle accelerators, mainly cyclotrons also started
physiological functions1. Although the field of nuclear
playing a crucial role for this purpose owing to the
medicine is dominated by the diagnostic procedures, it also
favorable characteristics of accelerator-produced neutron
has valuable therapeutic applications, which include
deficient radionuclides in these applications6,7. The type
treatment of hyperthyroidism, rheumatoid arthritis,
of radionuclides produced in a cyclotron or a nuclear
Hodgkin’s disease and a wide range of cancers, like cancers
reactor depend on many factors, such as, nature of the target
in breast, ovary, prostate, liver, colon, lung and endocrine
glands. Nuclear medicine has also been extensively used materials used, nature of the bombarding particles, its
energy etc. Apart from these, medically useful short-lived
radionuclides can conveniently and readily be obtained at
* Radiopharmaceuticals Chemistry Section, Radiochemistry and
Isotope Group, Bhabha Atomic Research Centre, Trombay,
the desired site by using the radionuclide generator
Mumbai-400085, Email: tdas@barc.gov.in systems8.

230 SCIENCE AND CULTURE, SEPTEMBER-OCTOBER, 2015

 Particle accelerators, mainly cyclotron is a major radionuclides used in radiopharmaceuticals is the (n,)
source for the production of neutron-deficient radionuclides, reaction. The advantage of this method is its inherent
which decay either by electron capture or by positron simplicity and almost all the elements undergo this reaction,
emission. In a cyclotron, a high energy beam of accelerated though with varying probabilities. However, specific activity
particles are generated by circulating the charged particles, of the radioisotopes obtained by this method is relatively
such as, protons, deuterons, -particles, tritium and so forth low as the target and product are the isotopes of same
under vacuum by means of an electromagnetic field and element and hence, cannot be separated by any easy means.
the targets of stable elements are bombarded with this Many bio-medically important radionuclides, such as, 24Na,
particle beam. By varying the type of target and its position 99Mo, 153Sm, 165Dy, 166Ho, 177Lu, 186Re, 192Ir and 198Au

in the cyclotron, several types of conditions can be are produced by using the (n,) reaction10.
established which make the machine adaptable for
Use of radionuclide generator system is also a popular
production of a wide variety of radionuclides 9 . As
route for obtaining some of the short-lived radionuclides
radionuclides produced by cyclotron are not isotopic with
at the hospital radiopharmacies. Radionuclide generators
the target material, post-irradiation chemical separation
may be defined as a device containing a longer-lived parent
usually yields a high specific activity (activity per unit
nuclide in equilibrium with its daughter nuclide from which
mass) product. Cyclotron produced radionuclides, such as,
67Ga, 111In, 123I and 201Tl decays by electron capture and
the daughter nuclide with a shorter half-life can be obtained
at regular intervals. The radionuclide generator is the most
used in diagnostic nuclear medicine while short-lived
convenient method of making short-lived radionuclides
radioisotopes such as, 11C, 13N, 15O and 18F are useful in
available at long distances from the production site8. In a
PET (positron emission tomography) imaging.
longer-lived parent - shorter-lived daughter chain, a fraction
A large number of radionuclides used in nuclear of the daughter atoms that undergo radioactive decay is
medicine are also produced in nuclear reactors. Nuclear replaced by new daughter atoms formed from the
reactor is a device in which the nuclear fission chain radioactive decay of the parent. The net result of this
reaction takes place, in a controlled manner, for the combination of continual growth and decay on the part of
production of energy and neutrons. Most of the reactor the daughter is that the activity of the daughter, while in
produced radionuclides available for biomedical usages are the presence of the regenerating parent, decreases at a
produced either through the recovery of fission products slower rate than in the absence of the parent. Therefore,
or by neutron activation of the specific targets. In nuclear the apparent half-life of the shorter-lived daughter is
fission several radioisotopes and stable isotopes of different increased and in equilibrium mixture equals that of the
elements are produced and very elaborate and extensive parent. This provides more time for shipment, permits a
processing facilities are required to ensure the production longer shelf-life and results in a continuous source of the
of a particular radioisotope with high radionuclidic purity. daughter radionoelide within the user’s laboratory8.
The most important advantage of this method is that,
Applications of radioisotopes in human health care
several medically useful radionuclides can be obtained with
are extensively wide-spread and cover both the diagnostic
higher specific activity than that obtainable from
and therapeutic domains. The diagnostic procedures could
corresponding neutron activation method. However, the
be performed either by in-vivo use of radiopharmaceuticals
need of highly sophisticated processing facilities with
or by in-vitro use of radioimmunoassay. On the other hand,
remote handling equipments and good infrastructure for
therapeutic procedures could be effected either by using
highly active and long-lived waste disposal increases the
the sealed sources or by the systematic administration of
cost of the radionuclide. In the neutron activation method,
radiopharmaceuticals.
the target nucleus first absorbs a neutron and then emits
either a gamma photon or a charged particle depending ‘Radiopharmaceuticals’ are a special class of
upon the energetics of the reaction. In some cases, radiochemical formulations having high purity and safety
multistage neutron capture process involving successive for human administration and used for either diagnosis or
neutron capture also takes place, though this route is of therapy. Radiopharmaceuticals take the advantage of both
limited utility owing to the production of radionuclide with the nuclear properties of the radionuclides and the
very low specific activity. On the other hand, neutron pharmacological properties of the pharmaceuticals.
capture followed by particle emission type reactions has Radiopharmaceuticals usually have no pharmacologic effect
the advantage of involving transmutations thereby providing as in most of the cases they are injected in tracer quantities.
radionuclides with very high specific activity. However, the They do not show any dose-response relationship and thus
most common route employed for the production of differ from conventional drugs. In majority of cases, a

VOL. 81, NOS. 9–10 231

radiopharmaceutical has two components, namely, a are equipped to image any organ system of human body
radionuclide and ligating moiety, usually known as carrier using the 99mTc-labeled radiopharmaceuticals. Apart from
molecule. The usefulness of a radiopharmaceutical is 99mTc, several other radionuclides such as, 123I, 67Ga, 111In,

dictated by the characteristics of these two components11. 201Tl find regular use in nuclear medicine imaging, which

The carrier molecule, which is often, although not always, is termed as Single Photon Emission Computed
is an organic moiety; governs the preferential localization Tomography (SPECT). Table-1 lists some of the commonly
of the radiopharmaceutical in the organ of interest or its used diagnostic radiopharmaceuticals employed for SPECT
participation in the physiologic function of a particular studies along with their applications.
organ/tissue while the tagged radionuclide is responsible
In a comparatively newly developed imaging modality,
for bringing the imaging or therapeutic efficacy of the
known as ‘Positron Emission Tomography’ (PET),
radiopharmaceuticals.
radionuclides which emit positrons are used for imaging
Diagnostic radiopharmaceuticals may be defined as the organ of interest. The two 511 keV photons, which
radiolabeled molecules designed to produce images of the come out due to the annihilation of positron when it meets
specific disease sites. Present day nuclear medicine with an electron, are detected in coincidence in this
physicians are equipped with more than one hundred modality to record the image10. PET is rapidly becoming
nuclear medicine imaging procedures and these uniquely a major diagnostic imaging modality in nuclear medicine
provide information about the function of virtually every owing to its ability to record images with much superior
major organ system of the human body. It is estimated that sensitivity and better resolution. Currently PET imaging is
30-50 million diagnostic nuclear medicine investigations reported to contribute 10-15% of all imaging applications
are performed annually world-over. As the main objective in nuclear medicine. As the radioisotopes used for this
of using a diagnostic radiopharmaceutical is to image the modality is usually short-lived, presence of a medical
organ of interest or to know its physiologic function, the cyclotron is needed either in the hospital premises or nearby
radioisotope must be a pure gamma emitter and hence, regions. In India, although the first medical cyclotron was
should decay by electron capture or isomeric transition established in 2002 at the ‘Radiation Medicine Centre’,
without any internal conversion. 99m Tc is the most Mumbai, the field saw a rapid growth since then. 18F is
commonly used diagnostic radionuclide as more than 70% the radionuclide of choice for most of the PET imaging
of the nuclear medicine procedures are based on this and [18F]-2-Fluoro-2-Deoxy-Glucose (18F-FDG) has been
radionuclide. The emission of suitable energy gamma termed as the ‘Molecule of the Millennium’ owing to its
photons (140 keV) with high abundance, optimum half- extensive applications in various medical fields such as,
life (6 h), availability from a 99Mo-99mTc generator and oncology, neurology, cardiology and psychiatry12. A list of
versatile chemistry of Tc has made 99mTc the ‘Work-horse some of the PET radiopharmaceuticals along with their
of Nuclear Medicine’10. In fact, nuclear medicine physicians applications is provided in Table-2.

(a) (b) (c)

Figure 1: Typical whole-body images recorded using 99mTc-MDP, a bone imaging agent. (a) Normal human, (b) breast cancer patient with multiple
metastases and (c) prostate cancer patient with extensive metastases

232 SCIENCE AND CULTURE, SEPTEMBER-OCTOBER, 2015

 Typical whole-body TABLE 1: Some of the commonly used diagnostic radiopharmaceuticals for
images of cancer patients SPECT studies along with their applications
having multiple metastases Radiopharmaceuticals Applications
along with the images of a
99mTc-based Radiopharmaceuticals
normal human being obtained
with 99mTc-MDP (99mTc-labeled 99mTc-L,L-ECD

methylene diphosphonic acid), a (ECD: L,L-ethylenedicysteine diethyl ester) Brain imaging

commonly used agent for 99mTc-d,l-HMPAO

skeletal imaging, are shown in (HMPAO: Hexamethyl propylene amine oxime) Brain imaging
Figure 1 (a) to (c). The 99mTc-Pertechnetate Thyroid imaging
additional uptakes observable in
99mTc(V)-DMSA
the whole-body scans of breast
(DMSA: Dimercapto succinic acid) Imaging of medullary carcinoma of thyroid
and prostate cancer patients
99mTc-SestaMIBI Myocardial imaging
(Figure b and c) clearly indicate
the extensive spreading 99mTc-Tetrofosmin Myocardial imaging
(metastases) of the disease. 99mTc-Mebrofenin Hepatobiliary imaging
The development of 99mTc-HSAMicrospheres
SPECT-CT and PET-CT in the (HSA: Human serum albumin) Lung imaging
recent past has really brought a 99mTc-Aerosol Lung imaging
revolution in the field of
99mTc-MDP
diagnostic nuclear medicine.
(MDP: Methylene diphosphonic acid) Bone imaging
These hybrid imaging
99mTc-Sulphur colloid Reticuloendothelial system imaging
modalities, which provide the
advantages of monitoring 99mTc-EC

physiological functions along (EC: L,L-Ethylene dicysteine) Renal function imaging

with very accurate anatomical 99mTc-MAG
3
visualization, has made a very (MAG3: Mercapto acetyl triglycine) Renal function imaging
significant impact in the 99mTc(III)-DTPA

management of cancer and (DTPA: Diethylenetriamine penta acetic acid) Renal function imaging
various other ailments. 99mTc(III)-DMSA

On the other hand, (DMSA: Dimercapto succinic acid) Kidney imaging

‘Radioimmunoassay’ (RIA) is a 99mTc(III)-GHA

versatile radioanalytical (GHA: Gluocoheptanoic acid) Kidney imaging

technique which is used to 99mTc-HYNIC-TOC Imaging of neuroendocrine cancers
measure minute (nanomolar) (HYNIC: Hydrazinonicotinamide)
quantities of an analyte of (HYNIC-TOC: HYNIC coupled-Tyr3-Octreotide)
clinical interest in biological 99mTc-HYNIC-TATE

specimens. This Noble prize (HYNIC-TATE: HYNIC coupled-Tyr3-Octreotate) Imaging of neuroendocrine cancers
winning technology, where 125I
Other than 99mTc-based Radiopharmaceuticals
is used as the radiotracer, is
very helpful in diagnosing 67Ga-Citrate Soft tissue tumor imaging
diseases related to hormones. A 111In-labeled peptides Imaging of tumors
variety of radiometric assay kits
111In-labeled monoclonal antibodies Imaging of tumors
have now become indispensable
in pathology laboratories and 123I-MIBG Myocardial imaging
regularly used for measuring (MIBG: meta-Iodobenzylguanidine) Imaging of neuroendocrine cancers
various types of hormones, 201Tl-thallous chloride Myocardial imaging
tumor-specific antigens, viral 133Xe
Radioactive noble gas Lung imaging
antigens and tumor markers.

VOL. 81, NOS. 9–10 233

TABLE 2: Some of the PET radiopharmaceuticals along with their Radionuclide therapy or in-vivo
applications targeted radiotherapy involves
administration of therapeutic
Radiopharmaceuticals Applications
radiopharmaceuticals in the body.
[18F]FDG (2-fluoro-2-deoxyglucose) Imaging of tumor based on glucose Therapeutic radiopharmaceuticals
metabolism may be defined as radiolabeled
18
[ F]NaF (Sodium fluoride) Bone imaging molecules designed to deliver
therapeutic dose of ionizing radiation
[18F]FMISO (Fluoromisonidazole) Imaging of hypoxic tumors
to specific disease sites with high
[18F]FDOPA Monitoring Perkinson’s disease specificity in the body. Over the past
18
[ F]FFAZA (Fluoroazomycinarabinose) Imaging of hypoxic tumors 70 years, the most widely used
radionuclide for therapy is 131I which
[18F]FES (Fluoroestradiol) Breast cancer imaging
finds extensive applications in the
68Ga-DOTA-NOC
treatment of some forms of
(DOTA: 1,4,7,10-tetraazacyclododecane-1,4,7,10- Imaging of neuroendocrine cancers hyperthyroidism, for ablation of
tetraacetic acid)
remnant thyroid tissue after
(DOTA-TOC: DOTA coupled Nal3-Octreotide)
thyroidectomy and for treating the
[13N]-NH3 (ammonia) Heart imaging metastatic lesions from well-
differentiated thyroid carcinoma.
Therapeutic applications of radionuclides are based Apart from the management of thyroid related diseases,
on the well-known factor that the ionizing radiations, therapeutic radiopharmaceuticals find extensive applications
especially the particulate emissions, have the ability to in providing the palliative care to the cancer patients
destroy cells by depositing their energy. Therapeutic suffering from excruciating pain arising due to skeletal
efficacy of radionuclides is accomplished by effectively metastases. Although the conventional treatment modalities
manipulating the cytotoxic effects of radiation to arrest and such as, administration of analgesics and external beam
annihilate the proliferation of cells, most often tumor/cancer radiotherapy are prevalent practices for controlling the bone
cells without causing any serious damage to the surrounding pain, these modalities have multiple side effects.
normal cells. Therapeutic doses of ionizing radiation can
be delivered to the sites of disease in three different ways,
viz. external beam irradiation or ‘Teletherapy’, implantation
of radioactive needles / wires / seeds or ‘Brachytherapy’
and systematic administration of therapeutic
radiopharmaceutical or ‘Radionuclide therapy’.
External beam irradiation or ‘Teletherapy’ is
traditionally carried out with high intensity gamma radiation
sources, such as, those from 60Co (E = 1.33 and 1.17
MeV) housed in heavily shielded teletherapy units.
Indigenously developed ‘Bhabhatron’ teletherapy units are
used extensively for this purpose. More than 1,00,000
patients undergo external beam radiotherapy every year in
India during the course of their treatment.
‘Brachytherapy’ involves the implantation of a source
of radiation, usually in the form of a wire or seed or needle,
in close proximity to the tumor/diseased tissue. Although
brachytherapy started with the implantation of the radium
needles nearly a century ago, currently radioisotopes such
as, 103Pd, 125I, 137Cs, 192Ir, 198Au etc. are used. This
treatment modality is used for the management of various
types of carcinoma such as eye, breast cervical, prostate Figure 2: Typical whole-body post-therapy images of a patient with
neuroendocrine originated tumors recorded after administration of 177Lu-
etc. DOTA-TATE.

234 SCIENCE AND CULTURE, SEPTEMBER-OCTOBER, 2015

Radionuclide therapy employing the suitable cancers. MoAbs designed against various antigens or
radiopharmaceuticals (such as, 32P-Orthophosphate, 89SrCl2, receptors associated with specific tumor types serve as
153Sm-EDTMP, 186Re-HEDP/188Re-HEDP, 177Lu-EDTMP) targeted carriers of radionuclides towards the malignant
are presently considered to be the most effective method tumors over-expressing either antigens or receptors. Use
for providing pain relief to the patients suffering from of two radiolabeled MoAbs based on anti-CD20 antibody
multiple skeletal metastases13. namely, Zevalin® (90Y-labeled) and Bexxar® (131I-labeled)
has been approved by US FDA (Food and Drug
In the recent years, targeted radionuclide therapy
Administration of United States of America) for RIT and
involving molecular carriers such as, peptides, hormones
both these agents have demonstrated significant anti-tumor
and antibodies have also gained popularity and being used
response following treatment in patients with B-cell
for the treatment for various kinds of cancers. Peptide
lymphomas. At present, a host of other radiolabeled MoAbs
Receptor Radionuclide Therapy (PRRT) employing
are being evaluated for RIT applications and these agents
radiolabeled peptides, particularly using 177Lu-DOTA-TATE
are in different stages of clinical evaluation.
(177Lu-labeled DOTA coupled Tyr3-Octrotate), is now an
established therapeutic modality for the treatment of patients Radionuclides are also used in ‘Radiation
suffering from a wide variety of inoperable neuroendocrine Synovectomy’ or ‘Radiosynoviorthesis’, where the
cancers over-expressing somatostatin receptors. In the last radiolabeled preparations are used to control and counteract
decade, PRRT has gained momentum and at present is excessive proliferation of synovial membrane in arthritis
being routinely used as a therapeutic regimen in a limited affected joints. This methodology has the advantage over
number of countries including India14. Figure 2 shows the other treatment modalities such as, chemical synovectomy
whole-body scintigraphic images of a neuroendocrine and surgical intervention in terms of cost, side effects and
cancer patient treated with 177Lu-DOTA-TATE15. need for hospitalization 16. Table-3 lists some of the
commonly used therapeutic radiopharmaceuticals along with
Radioimmunotherapy (RIT) based on radiolabeled
their applications. Targeted radionuclide therapy in
monoclonal antibodies (MoAbs) has also emerged as an
combination with other treatment modalities such as,
important and useful procedure to treat various types of
chemotherapy and surgical intervention
TABLE 3: List of some of the commonly used therapeutic have now become an integral part in
radiopharmaceuticals the management of a wide variety of
cancers such as, prostate, colon, breast,
Radiopharmaceuticals Used for the treatment of
ovary.
131I-Sodium iodide Hyperthyroidism In the recent past, the concept of
(solution and capsules) Thyroid carcinoma
theranostic applications of
131I-MIBG Neuroblastoma radiopharmaceuticals is gaining
153Sm-EDTMP Bone pain palliation momentum with an aim to obtain so
(EDTMP: Ethylenediaminetetramethylene phosphonic acid) called ‘Personalized Medicine’.
89SrCl Bone pain palliation ‘Theranostic’ refers to a combination
2

186Re-HEDP
of two interdependent applications
Bone pain palliation
namely therapy and diagnosis, using the
(HEDP: 1-hydroxyethylidene-1,1-diphosphonic Acid)
same agent17. Since both diagnosis and
188Re-HEDP Bone pain palliation therapy can be effected using this
32P-Orthophosphate Bone pain palliation concept of theranosis, the treatment
Polycythemia rubra vera regime can be individualized for a
90Y-DOTA-TOC Neuroendocrine cancers specific patient which forms the basis
(DOTA-TOC: DOTA coupled-Tyr3-Octreotide) of personalized medicine. In actual
90Y-DOTA-TATE Neuroendocrine cancers practice, theranosis can be effected by
(DOTA-TATE: DOTA coupled-Tyr3-Octreotate) replacing a diagnostic radioisotope in
177Lu-DOTA-TATE Neuroendocrine cancers
a radiopharmaceutical with a
therapeutic radioisotope usually with
90Y-Microspheres Hepatocellular carcinoma
same chemical properties (i.e. 186Re/
131I-Tositumomab Non-Hodgkin’s lymphoma 188Re for 99mTc), while using the same

90Y-Ibritumomab-tiuxetan Non-Hodgkin’s lymphoma molecular vector, or by using the same

VOL. 81, NOS. 9–10 235

radiopharmaceutical for both diagnosis and therapy, albeit 9. Cyclotron produced radionuclides: Principles and practice.
Technical Report Series No. 456. International Atomic Energy
with different doses 18 . Presently several
Agency, Vienna (2008)
radiopharmaceuticals are being investigated for determining
10. G.B. Saha. Production of radinuclides. In: Fundamentals of
their suitability for theranostic applications. nuclear pharmacy. 3rd edition, Springer-Verlag, New York (2000)
46-64.
It is evident from the above discussion that
radionuclides are routinely used for diagnosis, treatment 11. S. Liu and D.S. Edwards. Bifunctional chelators for therapeutic
lanthanide radiopharmaceuticals. Bioconj. Chem. 12, 7-34 (2001).
and management of a wide variety of ailments all over the
12. IANCAS Bulletin. Positron emission tomography: Products and
world. Radionuclides play a pivotal role in human health
application (Edited by N. Ramamoorthy and M.G.R. Rajan). 12,
care and are an important tool in improving the quality of 199-260, (2014).
human life.  13. T. Das, H.D. Sarma, A. Shinto, K.K. Kamaleshwaran and S.
Banerjee. Formulation, pre-clinical evaluation and preliminary
References clinical investigation of an in-house freeze-dried EDTMP kit
suitable for the preparation of 177Lu-EDTMP. Cancer Biother.
1. S. Jurisson, D. Berning, W. Jia and D. Ma. Coordination Radiopharm. 29, 412-421 (2014).
compounds in nuclear medicine. Chem. Rev. 93, 1137-1156
(1993). 14. T. Das and S. Banerjee. Formulation of patient dose of 177Lu-
DOTA-TATE in hospital radiopharmacy in India: Preparation
2. V.R. McCready. Milestones in nuclear medicine. Eur. J. Nucl.
using in-situ methodology vis-a-vis freeze dried kit. Cancer
Med. Mol. Imaging 27, S49-S79 (2000).
Biother. Radiopharm 29, 301-302 (2014).
3. P.S. Baker. Reactor-produced radionuclides. In: (G.A. Andrews,
Ed.), Radioactive pharmaceuticals. U.S. A.E.C. Symposium 15. T. Das, S. Chakraborty, K.G. Kallur, M. Venkatesh and
Series, Oak-Ridge, Tennessee, U.S.A. (1965) 129-142. S.Banerjee. Preparation of patient doses of 177Lu-DOTA-TATE
using indigenously produced 177Lu : The Indian experience.
4. J.K. Poggenburg. The nuclear reactor and its products. Semin.
Cancer Biother. Radiopharm. 26, 395-400. (2011).
Nucl. Med. 4, 229-243 (1974).
5. T.J. Ruth, B.D. Pate, R. Robertson and J.K. Porter. Radionuclide 16. E. Deutsch, J.W. Brodack and K.F. Deutsch. Radiation
production for the biosciences. Nucl. Med. Biol. 16, 323-336 synovectomey revisited. Eur. J. Nucl. Med. Mol. Imaging 20,
(1989). 1113-1127 (1993).
6. S.M. Qaim. Nuclear data relevant to cyclotron-produced short- 17. G.L. DeNardo and S.J. DeNardo. Concept, consequences, and
lived medical isotopes. Radiochim. Acta 30, 147-162 (1982). implications of theranosis. Semin. Nucl. Med. 42, 151-163.
(2012).
7. A.P. Wolf and W.B. Jones. Cyclotrons for biomedical radioisotope
production. Radiochim. Acta 34, 1-7 (1983). 18. R.P. Baum and H.R. Kulkarni. Theranostics: From molecular
8. F.F. Knapp and S. Mirzadeh. The continuing important role of imaging using Ga-68 labeled tracers and PET/CT to personalized
radionuclide generator systems in nuclear medicine. Eur. J. Nucl. radionuclide therapy - the Bad Berka experience. Theranostics
Med. Mol. Imaging 21, 1151-1165 (1994). 2, 437-447 (2012).

236 SCIENCE AND CULTURE, SEPTEMBER-OCTOBER, 2015