8 | IAEA Bulletin 55-4-December 2014
1. What are radioisotopes?
Each atomic element knows exactly how
many protons and neutrons it needs at its
centre (nucleus) in order to be stable (stay in
its elemental form). Radioisotopes are atomic
elements that do not have the correct proton
to neutron ratio to remain stable. With an
unbalanced number of protons and neutrons,
energy is given o by the atom in an attempt to
become stable
1
.
For example, a stable carbon atom has six
protons and six neutrons. Whereas its unstable
(and therefore radioactive) isotope carbon-14,
has six protons and eight neutrons. Carbon-14
and all other unstable elements are called
radioisotopes.
This movement towards stability, which involves
emitting energy from the atom in the form of
radiation, is known as radioactive decay.
This radiation can be tracked and measured,
making radioisotopes very useful in industry,
agriculture and medicine.
2. Where do radioisotopes come
from? How are they made?
There are both naturally occurring and man-
made radioisotopes. But for medical purposes,
we only use the ones made by nuclear reactors
and cyclotrons
2
because they are easy to
produce, have the characteristics needed for
imaging and typically have much shorter half-
lives than their naturally occurring cousins.
Half-life is the amount of time it takes for
half of the radioisotope to decay to half of its
original activity, which tells us how long the
radioisotope will remain. The very long half-lived
radioisotopes are more stable and are therefore
less radioactive. The half-lives of radioisotopes
used in medicine range from a few minutes to a
few days.
For example, rubidium-82, which is used
for myocardial perfusion imaging has a half-
life of 1.26 minutes, while iodine-131, used in
thyroid treatment and diagnosis, has a half-
life of eight days. Overall, there are about 1800
radioisotopes, and approximately 50 are being
used in medicine.
3. How do we use radioisotopes in
medicine?
Some radioisotopes give o alpha or beta
radiation, and these are used for treating
diseases such as cancer.
Others give o gamma and/or positron
radiation, which is used in conjunction with
powerful medical scanners and cameras*
to take images of processes and structures
inside the body, and for disease diagnosis.
Radioisotopes have various uses in hospital
(clinical) settings. They are used to treat thyroid
diseases and arthritis, to relieve arthritic pain
and pain associated with bone cancer, and to
treat liver tumours. In cancer brachytherapy, a
form of internal radiation therapy, radioisotopes
are used to treat prostate, breast, ocular and
brain cancer. They are also eective for the
diagnosis of coronary artery disease and heart
muscle death.
In medicine, two of the most commonly
used radioisotopes are technetium-99m and
iodine-131. The gamma emitting technetium-
99m is used to image the skeleton and heart
muscle in particular, but also for imaging the
brain, thyroid, lungs (perfusion and ventilation),
liver, spleen, kidney (structure and ltration
rate), gall bladder, bone marrow, salivary and
lacrimal glands, heart blood pool, infection
and numerous other specialized medical
studies. Iodine-131 is widely used to treat over-
functioning thyroid glands, thyroid cancer
and in imaging the thyroid. It is a beta emitter,
making it useful for therapy
3
. Radioisotopes are
also used for medical research to study normal
and abnormal functioning of organ systems. It
can also help in drug development research.
*These powerful imaging devices include single photon
emission computed tomography and positron emission
tomography cameras, which are often used with
computed tomography scanners and magnetic resonance
imaging.
SEVEN THINGS TO KNOW ABOUT RADIOISOTOPES
3
World Nuclear Association | Radioisotopes in Medicine
www.world-nuclear.org/info/Non-Power-Nuclear-
Applications/Radioisotopes/Radioisotopes-in-Medicine
1
Stable isotopes exist as well, but they are beyond the
scope of this article.
2
A cyclotron is a complex machine that accelerates
charged particles in a vacuum outwards from the
centre along a spiral path. During the acceleration
process, charged particles gain signicant energy.
The energized charged particles then interact
with stable material that is placed in their path.
The interaction transforms stable materials into
medically useful radioisotopes that are used to make
radiopharmaceuticals.
IAEA Bulletin 55-4-December 2014 | 9
4. Why do we use radioisotopes in
medicine? What’s so special about
them?
Radioisotopes are special because certain
organs in the body respond in unique ways
to dierent substances. For example, the
thyroid absorbs iodine, more so than any
other chemical, so the radioisotope iodine-131
is widely used to treat thyroid cancer and
in imaging the thyroid. Similarly, specic
radioactive chemicals are picked up and
metabolized by other organs like the liver,
kidney and brain. But most radioisotopes need
to piggyback on something else (a biologically
active molecule) to get to the desired organ.
For example, technetium-99m is often tagged
to six methoxyisobutylisonitrile molecules to
get to heart tissues for the diagnosis of cardiac
disorders.
Formulations of radioisotopes tagged
molecules (called radiopharma-ceuticals) are
inhaled, ingested or injected to help physicians
measure organ size and function, identify
abnormalities, and target treatment to a
particular area.
Radioisotopes are also special because their
use provides patients and doctors with the
option of using minimally-invasive surgical
techniques, rather than the far more risky
large-scale surgeries, from which it is harder
to recover, that were used in the past to treat
most conditions. Radioisotopes allow targeted
treatment to all visible and invisible sites of
disease in the body.
5. Are radioisotopes dangerous to
patients?
The radioisotopes given to patients under-
going diagnosis or treatment decay and quickly
become stable (non-radioactive) elements
within minutes or hours depending on their
half-lives or they are rapidly eliminated from
the body.
Doctors choose to use radioisotopes that
have the appropriate half-lives and energy
in order to get the best treatment, diagnosis
or information possible without any harm to
normal organ tissue. For example, technetium-
99m has a half-life of six hours and gives o
140 keV (kiloelectronvolts) of energy, which is
quite low and not enough to harm patients.
Doctors are also very careful about the amount
of radioisotopes given to patients to minimize
radiation dose while ensuring images of
acceptable quality.
Short-lived and very short-lived radioisotopes
are used in order to minimize the already small
radiation dose the patient receives from the use
of radiopharmaceuticals.
6. Are radioisotopes inside a patient
dangerous to the public?
Medical sta follow strict rules and are trained
to ensure that those patients who are given
therapeutic doses of radioisotopes (these
are only used for cancer treatment and other
kinds of therapy, never for diagnosis) are
kept isolated in their hospital rooms until the
patient’s exposure to the worker and public is
reduced to a safe level. The nurses, doctors and
porters charged with their care also maintain a
safe distance during any interaction and wear
personal dosimeters that keep track of their
radiation doses at work to ensure that their
doses do not exceed a specied limit, which is
far below the safety threshold.
As soon as the radioisotopes decay to a level
where the radiation exposure is low enough,
the patients are free to go about their normal
lives and return to their normal routines.
7. If medical staff are cautioned to
keep a distance, then why are these
treatments allowed for patients?
Patients benet from the properties of
radiation in the treatment of cancer. Those
who need the procedure are justied in having
the procedure. It all relates to ’justication’, a
key concept in nuclear medicine. Justication
means that the benet derived from the use of
radiation must outweigh the potential harm to
the patient. And for someone who has cancer,
the use of a short lived radioisotope during
treatment could cure them from the cancer
or extend their lives. Health care workers are
trained on clinical practices to appropriately
manage exposure as they provide support
for patients undergoing radiation therapy.
Therefore these treatments are often justied
in the eyes of both the patient and their
physician.
Sasha Henriques, IAEA Oce of Public
Information and Communication
