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April 2001An introduction to the unique research funded bythe Medical Sciences DivisionBiological and Environmental Research (BER)Office of Science, U.S. Department of Energy

NuclearMedicine

Every

where in HealthcareAnd so does BER

Nucle

arMedicine Helps Patients

the Office of Biological and EnvironmentalResearch (BER) of the United States Departmentof Energy (DOE) has been investing to advanceenvironmental and biomedical knowledge

connected to energy. The BER Medical Sciencesprogram fosters research to develop beneficial

applications of nuclear technologies for medical diagnosisand treatment of many diseases. Today, nuclear medicine helpsmillions of patients annually in the United States. Nearly everynuclear medicine scan or test used today was made possible bypast BER-funded research on radiotracers, radiation detectiondevices, gamma cameras, PET and SPECT scanners, andcomputer science.

The heart of biological research within BERhas always been the pursuit of improved human health. The nuclear medicine of tomorrowwill depend greatly on today’s BER-supported research, particularly inthe discovery of radiopharmaceuticalsthat seek specific molecular andgenetic targets, the design ofadvanced scanners needed to createmeaningful images with these futureradiotracers, and the promise of newradiopharmaceutical treatments forcancers and genetic diseases.”

Note: Before the U.S. Department of Energy was created in 1977,BER existed under different names within other federal agencies.

Michael V. Viola, M.D., DirectorMedical Sciences Division, BER

50 years“For over

Nuclear Medicine Helps Patients Everywhere in Healthcare

And so does BER Medical Sciences(DOE Office of Biological and Environmental Research)

Doctors Rely on Nuclear Medicine To Help Many Types of Patients–––––––––––– 2

How Does Nuclear Medicine Work?Radiopharmaceutical Energy Reveals World of Biology ––––––––––––––––––––– 6

BER Medical Sciences ––––––––––––––––––––––––––––––––––––––––––––––– 9

Wise Investments in Future HealthcareToday’s BER Research Leads to the Nuclear Medicine of Tomorrow –––––––––– 10

Searching for answers to drug addiction, aging, prostate and breast cancers,mental illness, schizophrenia, heart disease, lymphoma, leukemia, diabetes,Alzheimer’s and Parkinson’s diseases, chronic diseases, genetic diseases . . .

Brookhaven National Laboratory, New York –––––––––––––––––– 10Lawrence Berkeley National Laboratory, California –––––––––––– 12Oak Ridge National Laboratory, Tennessee –––––––––––––––––– 13Memorial Sloan-Kettering Cancer Center, New York ––––––––––– 14University of California, Los Angeles (UCLA) –––––––––––––––– 15Washington University, St. Louis –––––––––––––––––––––––––– 16University of Michigan, Ann Arbor ––––––––––––––––––––––––– 17

The Vital Legacy of BER Medical Sciences50-Year Commitment to Improved Healthcare through Nuclear Medicine –––––– 18

Published April 2001 by the Medical Sciences Division of the Office of Biological and Environmental Research (BER) of theOffice of Science of the U.S. Department of Energy (DOE)

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CardiologyPatients with Heart DiseaseNuclear medicine provides several ways to evaluate heartdisease. Heart scans can show whether certain regions of theheart muscle lack an adequate supply of blood, which canhelp cardiologists decide whether a patient needs angioplasty,bypass surgery, or changes in lifestyle. Images that showmetabolic activity can help predict the success of theserevascularization procedures. Other nuclear medicine tests canevaluate the strength of heart muscle contraction.

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Doctors Rely on Nuclear Medicine To Help Many Types of Patients

uclear medicine is an exciting field in healthcare that provides importantinformation for diagnosing, evaluating, and managing disease. Virtually all hospitals, as well as many clinics and private doctors’ offices, perform

nuclear medicine tests and scans. About 13 million nuclear medicine proceduresare performed on patients each year (35,000 a day) in the United States.Previous research, carried out from the 1940s through the 1990s—funded by theU.S. Department of Energy’s (DOE) Office of Biological and EnvironmentalResearch (BER)—made it possible for today’s doctors to rely on nuclearmedicine to help patients. These photographs represent several types ofpatients who benefit every day from clinical nuclear medicine procedures.Nuclear medicine truly helps patients “everywhere in healthcare”—and so doesBER Medical Sciences through its 50-year legacy of nuclear medicine research.

OncologyPatients with Cancer

Nuclear medicine scans can detect andstage many types of cancer. These scans can

also show how well a patient responds totreatment, such as surgery, chemotherapy, or

radiation therapy. In some cases, nuclear medicine can be used

to treat selected cancers.

NeurologyPatients at Risk for, or Recovering from, StrokeNuclear medicine brain imaging can show regions ofthe brain with inadequate blood flow or metabolism,which can help doctors choose therapy for preventinga stroke. Brain scans obtained after a stroke can helpdoctors monitor the patient’s recovery.

Digestive DiseasesPatients with Abdominal PainNuclear medicine tests can show whether thegallbladder functions normally or whether a patienthas gallbladder disease. These scans are also used after surgery to detect abnormal bile drainage from the liver.

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Sports MedicineAthletes at Risk for Stress FracturesNuclear medicine bone scans play amajor role in sports medicine since theycan detect stress fractures before theyshow up on x-rays.

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SurgeryFor Children with Epilepsy

Nuclear medicine brain scans can guidesurgeons to operate on the region of the

brain that causes a child’s epilepsy when theseizures cannot be controlled with drugs.

Doctors Rely on Nuclear Medicine To Help Many Types of Patients

Thyroid DisordersPatients with Graves’ Disease

Nuclear medicine tests help evaluate many thyroiddisorders. Moreover, therapy with radioactive

iodine has become the treatment of choice foroveractive thyroids (Graves’ disease) and for most

thyroid cancers following surgery.

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Gastrointestinal DiseasePatients with GI Bleeding

Nuclear medicine tests can determine whether a patient isactively bleeding into the bowel. Such gastrointestinal (GI)

bleeds can be caused by polyps, ulcers, tumors, inflam-mation, diverticulitis, and other GI disorders. Frequently, the

nuclear medicine scan also discloses the location of thebleeding site so the problem can be treated more efficiently.

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InfectionPatients with Hidden AbscessNuclear medicine scans can identify ahidden abscess in a patient with an internalinfection. Typically, these patients have feverof unknown origin, a sign of infection.

PulmonologyPatients with Lung DiseaseNuclear medicine lung tests are used to evaluate respi-ratory disorders. These tests provide information aboutthe extent and severity of such disorders as emphysema,cystic fibrosis, chronic obstructive pulmonary disease(COPD), and life-threatening blood clots in the lung.

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DementiaPatients with Alzheimer’s DiseaseNuclear medicine brain scans can helpdoctors diagnose Alzheimer’s disease,and differentiate it from other types of dementia early in the course ofdisease when treatments are more effective.

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How Does Nuclear Medicine Work?

Radiopharmaceutical Energy Reveals World of Human Biology

uclear medicine images are produced by the energy emitted fromradiopharmaceuticals inside a patient’s body with imaging systems(“scanners”) that detect and process the energy signals. The special

ability of radiopharmaceuticals to visualize human biology, both healthy anddiseased, arises from their distribution through the body as “radiotracers.” Nearlyall radiopharmaceuticals (i.e., medically useful radiotracers) and imagingsystems described here were discovered, designed, or developed by scientistssupported by the BER Medical Sciences program during the past 50 years.

Biological ImagingOf a Physiologic Process, Not AnatomyDisease is a biological process, and nuclear medicine provides imagesof these biological processes. Most radiotracers interact with abiological process—such as bone mineral turnover, potassium transportin heart muscle, or glucose (sugar) metabolism in various organs ortumors—and emit low levels of radiation. Highly sensitive detectorsystems collect these energy signals, and computer programsreconstruct them into diagnostic images. Because it provides images ofa biological process (physiology), nuclear medicine differs from otherimaging techniques—such as x-rays, computed tomography (CT),magnetic resonance imaging (MRI), and ultrasound—which primarilyvisualize structure and shape (anatomy).

A single image from a brain scan (top left), a bone scan (bottom left), and a series of images from a heart scan (right) duringexercise (“stress”) and “rest.” The brain scan shows reduced glucose metabolism in a pattern characteristic of Huntington’sdisease, evident years before the patient exhibited abnormal movements or other symptoms of this hereditary disease. Thebone scan is from a patient with prostate cancer that has spread to the spine and other bones. The radiopharmaceutical,similar to the mineral in bone, accumulates at bone tumors (dark spots) because the diseased bone has faster mineralturnover. The heart scan, from a patient with coronary artery disease, shows where the heart muscle lacks adequate bloodflow. The radiopharmaceutical, thallium-201, mimics potassium and accumulates more in regions of normal blood flow.

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Energy Signals From the Inside OutLike an x-ray image, a nuclear medicine scandepends on energy passing through the bodytoward a detection device. In nuclear medicine,radiopharmaceuticals placed in the body emitradiation from the inside out. Diagnostic nuclearmedicine scans expose patients to levels ofradiation comparable to what patients receive inroutine x-ray procedures.

Tumor cell with various membrane

receptors

F-18

In-111

I-131

Tc-99m

Radionuclide Carrier Molecule

Gamma Rays(Nuclear Medicine)

X-rays(Radiography)

X-rayUnit

X-rayFilm orDetector

GammaCameraDetector

GammaCameraDetector

Targeting individual receptors with specific radiopharmaceuticals

Imaging SystemsGamma Cameras Use Large Wafer-Like DetectorsSpecialized imaging systems (e.g., gamma camerasor other scanners) stop gamma rays emitted from thepatient. Fast, sophisticated computers map theenergy signals into medically useful pictures that represent a biological process. The gamma camera was invented by a BER scientist in 1952.

RadiopharmaceuticalsEqual Radionuclides Plus Carrier MoleculesMost radiopharmaceuticals have twocomponents: a radionuclide and a carriermolecule. The radionuclide is an “excited” atomthat emits energy so that the atom can convert toa more stable form. Common radionuclides usedin nuclear medicine include technetium-99m,thallium-201, fluorine-18, indium-111, gallium-67,iodine-123, iodine-131, and xenon-133. Once aradiopharmaceutical is injected into a patient, thecarrier molecule travels through the body until itinteracts with its target cell, tissue, or organ system.Almost all the radionuclides, and many of thecarrier molecules, used in nuclear medicine todaywere discovered or developed by BER scientistsover the past 50 years.

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Radiopharmaceutical Energy Reveals World of Human Biology

PET and SPECTAdvanced Imaging SystemsSpecial imaging systems called “positron emissiontomography” (or PET) and “single-photon emissioncomputed tomography” (or SPECT) scannersproduce 3-dimensional (tomographic) images. Thescans look like multiple slices through the body. InSPECT (scanner at left), a gantry rotates one or moredetectors around the body to acquire many imageprojections. PET scanners usually surround the bodywith a stationary ring of detectors. PET and SPECTwere first conceived by BER scientists anddeveloped over the 1950s, 1960s, and 1970s.

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PET and SPECTAdvanced RadiopharmaceuticalsSPECT radiopharmaceuticals emit gamma rays, whereas PET radiopharmaceuticals emit anotherform of energy, positrons, which converts to gammarays. These radiopharmaceuticals “interrogate” cells and molecules. They are “molecular probes”designed to provide answers about healthy, normalbiology, the biological process of disease, and even the molecular errors that cause disease.

These PET scans (on the left) were obtained withfluorine-18 fluorodeoxyglucose (FDG, a form ofsugar). F-18 FDG, the most common PETradiopharmaceutical used in medicine today, wasdeveloped by BER scientists in the 1970s.

Glucose (a sugar, the primary fuel for cells) is just oneexample of the thousands of molecules related tohuman biology that can serve as carrier moleculesfor radiopharmaceuticals. In the future, PET andSPECT radiopharmaceuticals may target genefunction and expression to answer questions aboutthe genetic causes of disease.

Whole-body PET scans from two patients. The left scanis normal; the right scan is from a patient with a lung

tumor that spread from primary breast cancer. Thisscan shows increased F-18 FDG uptake in the tumor

(arrow) because a growing tumor has a higher rate ofsugar metabolism than the surrounding normal tissue.

RadiopharmaceuticalsFuture Molecular Probes

There are hundreds of possibleradionuclides and thousands ofpotential carrier molecules to

explore living body functions or toprovide radionuclide therapy. Thekey requirement for an effectivecarrier molecule (e.g., a protein,hormone, antibody, fatty acid,

neurotransmitter, DNA, RNA, etc.) isits ability to probe a specificbiochemical process. BER

researchers are developingradiopharmaceuticals that haveincreased “functional specificity.”

Imaging SystemsFuture Scanners and Detectors

To provide accurate and clearimages of very specific

biochemical activities targeted byradiopharmaceuticals, BER

scientists are designing moresensitive detectors and scanning

equipment. In addition, advanceddata acquisition, image processing,

mathematical, computer, andengineering techniques are in

development to measure extremelysmall amounts of a radiotracermore accurately anywhere in a

patient’s body.

BER Medical Scienceshe Office of Biological and Environmental Research (BER) is part of the Office of Sciencein the U.S. Department of Energy (DOE). The Medical Sciences Division of BER manages the nuclear medicine research program, which pursues two main

areas of scientific investigation—Imaging Systems and Radiopharmaceuticals.

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Bringing the Human Genome to LifeNuclear medicine can visualize biochemistry of Genetic DiseasesDefects in genes may cause about 5,000 hereditary diseases, such as Parkinson’sdisease, cystic fibrosis, Huntington’s disease, sickle-cell anemia, diabetes, andcancer. It’s possible that most diseases have a genetic factor since geneticinstructions control how all cells, normal and abnormal, function.

BER nuclear medicine is developing methods to study beneficial or harmfulgenetic changes with molecular probes for three targets:

• Altered DNA (deoxyribonucleic acid)• Altered messenger RNA (ribonucleic acid)• Abnormal cell or organ function induced by altered DNA.

BER scientists have successfully created images of genetically altered organfunction in animals (see page 15). Now, BER Medical Sciences has initiatedexploratory research to develop new messenger RNA-based radiotracers fordynamic imaging of gene expression in animals in real time. In the future, drugsmay be custom-made for individual patients based on genetic “fingerprinting.”Nuclear medicine will play a crucial role in this pursuit.

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Wise Investments in Future Healthcare

Today’s BER Research Leads to the n the year 2001, BER Medical Sciences funds cutting-edge nuclear medicine researchat three DOE National Laboratories and more than 20 universities and privateinstitutions. The next eight pages briefly highlight just a few BER research projects.

Brookhaven National Laboratory, New YorkLocated in Upton (Long Island) New York, Brookhaven scientists have conductedBER research since 1950, when Brookhaven opened the first nuclear medicinehospital. Today, Brookhaven is one of the world’s leading laboratories for the design,synthesis, and application of radiopharmaceuticals. As scientists discover moreinformation about the relationship between genes and disease and behavior, theycan identify new molecular targets for imaging the biologic activity of disease.

Nuclear medicine scientists at Brookhaven actively pursue new ideas for the twoessential building blocks of novel radiopharmaceuticals:

• Improved methods of using atomic particle accelerators to create a variety ofradionuclides, including positron emitters for PET.

• innovative synthetic chemistry for linking radionuclides to biologically importantcarrier molecules.

Like several other BER research sites, Brookhaven has the facilities and expertise totranslate the fruits of this basic research into medical imaging tools.

BER Scientists from Brookhaven National Laboratory enjoying a weekend get-together.

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Nuclear Medicine of Tomorrow

With PET and SPECT imaging, scientists here make vital contributions to medicalscience’s understanding of the molecular mechanisms of disease and the searchfor new treatments. Their current priorities for medical research focus on drugaddiction and substance abuse, aging and degenerative diseases, and thebiology of tumors that may lead to more effective cancer therapies.

PET brain scans reveal chemical differences in the brain between addicts and non-addicts. The normal images in the bottom row come from non-addicts; theabnormal images in the top row come from patients with addiction disorders. ThePET scans from the cocaine abuser, the alcoholic, and the obese patient with foodaddiction show reduced levels of dopamine receptors (molecules that transmitpleasure signals in the brain). Low levels of dopamine receptors suggest an under-stimulated biochemical “reward system” in the brain. The PET scan from thecigarette smoker with nicotine addiction shows lower levels of monoamine oxidase(MAO), a brain enzyme that regulates dopamine levels. BER researchers areinvestigating pharmaceutical therapies for curbing or curing addictive behaviors.

Cocaine abuse Alcoholism Obesity Tobacco

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Lawrence Berkeley National Laboratory, CaliforniaSince the 1920s and 1930s, scientists at this California site pursued the frontiers ofradiation research—inventing the cyclotron, discovering iodine-131 andtechnetium-99m, and using the first artificially produced radionuclide to treat apatient with leukemia. Today, BER researchers continue to keep Lawrence Berkeleyat the forefront of engineering, mathematics, and computer science focused onthe advancement of nuclear medicine imaging systems.

As radiotracers become more refined and sophisticated, visualizing specificmolecular reactions in the living human body, physicians will need more advancednuclear medicine scanners—with capabilities far beyond those envisioned bycommercial manufacturers—to capture those images.

Members of the Lawrence Berkeley BER Research team that built this PET scanner, known as thehighest resolution brain and animal PET system in the world.

Current BER research here includes development of:• Specialized instruments to improve the detection of prostate cancer, breast

cancer, and other cancers.• Advancements in sophisticated, quantitative PET and SPECT imaging for brain

studies of mental illness, including schizophrenia, Alzheimer’s disease, andother dementias.

• New radiopharmaceuticals to study aging, heart disease, and cancer.

Today’s BER Research Leads to the Nuclear Medicine of Tomorrow

Oak Ridge National Laboratory, TennesseeIn 1946, BER originated in Oak Ridge when the research site made a vast selectionof radionuclides available for nuclear medicine research. The laboratory alsoformed a network of universities to study the clinical potential of radiotracers. Today,scientists here continue to study the future potential of new radiopharmaceuticals.

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This group has developed a varietyof radiopharmaceuticals for bothdiagnostic and therapeutic applica-tions. One example is a generator toproduce rhenium-188, a therapeuticradionuclide used to provide econom-ical cancer treatment in developingcountries. Another potential use ofrhenium-188 is to prolong the benefi-cial effects of balloon angioplasty, aprocedure that opens up narrowedarteries of the heart in patients withcoronary artery disease. Patientsoften need repeated angioplastiesbecause the coronary arteriesgradually become reclogged.

These images show cross sections ofswine arteries after angioplasty. One artery (top), treated with arhenium-188, liquid-filled balloon,remained wide open 30 days afterthe angioplasty. The untreated artery(bottom) became reclogged withinthat same time period.

Using a fatty acid as the carriermolecule, Oak Ridge scientists havealso developed a radiopharma-ceutical (iodine-123 BMIPP) thatshows how much heart muscleremains alive after a heart attack.These scans help doctors decidewhether those portions of the heartmuscle can recover after bypasssurgery or angioplasty.

Coronary Artery Disease

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Memorial Sloan-Kettering Cancer Center, New YorkSince the 1940s, the quest for better cancer treatment at Memorial Sloan-KetteringCancer Center has included BER radiopharmaceutical research. The nuclearmedicine group here has developed more than 30 radiopharmaceuticals—withimportant research in both the radionuclide and carrier molecule components.

BER scientists at Sloan-Kettering carry out pioneering work in the use of“monoclonal antibodies” as carrier molecules that target specific molecules(called “antigens”) on the surface of cancer cells. These antibodies can carryeither a diagnostic radionuclide (for imaging small tumors) or a more powerfultherapeutic radionuclide (for selectively killing cancer cells).

The BER research group here has also discovered novel ways to produce a varietyof radionuclides, including a bismuth-213 generator system. Bismuth-213, whichemits alpha particles with greater potential to kill cancer cells, was first used hereexperimentally to treat patients with lymphoma, leukemia, and prostate cancer.

According to Nobel Laureate Harold Varmus,president and CEO of Sloan-Kettering, medicineis moving beyond the era of chancediscoveries of partially effective treatments forchronic diseases, such as cancer. We’reentering an exciting new era with “systematicdiscoveries of more powerful therapies, basedon detailed pictures of the molecular events bywhich such disorders arise,” said Dr. Varmus.Nuclear medicine, led by BER research, willprovide many of these detailed pictures.

BER researchers at Sloan-Kettering creatediodine-124 FAIU, a highly specificradiopharmaceutical that provided the firstnuclear medicine images that showed theexpression of certain genes in tumors in a liveanimal. This rat (left) had two types of tumors,with different genes, transplanted within the leftand right sides of its body. The PET scan showsthat iodine-124 FAIU designed to target specificgenes in the left-side tumors, workedsuccessfully since the right-side tumors do notappear on the image.

Tumor Targeting

Today’s BER Research Leads to the Nuclear Medicine of Tomorrow

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University of California, Los Angeles (UCLA)UCLA has been an important BER research center since its School of Medicine was founded in the mid-1940s. The first PET clinic for patient care was established here in 1976.Today, BER research at UCLA focuses on new ways to image the biology and genetics ofseveral diseases, including cancer, diabetes, heart disease, Alzheimer’s disease, andParkinson’s disease.

BER scientists at UCLA recently invented a miniature PET scanner, the “microPET,” for imagingmice. This device enables scientists to develop new ways to provide real-time images of themolecules that transform normal cells to diseased cells in a living mouse. The sameexperimental radiopharmaceuticals can be used in human patients imaged with a PETscanner. With microPET and PET, therefore, BER scientists at UCLA now have a safe andnoninvasive way to study the same biological processes in both mice and humans.

Since mice can be biologically engineered to carry genes thatproduce disease, molecular probes are being developed to allow

scientists to “watch” (image) the initiation and progression of adisease in a living mouse. In concert with this research, scientists are

investigating highly sophisticated drugs designed to correctthe molecular errors of disease. With microPET, scientists can

watch and measure the capability of these newtherapies to correct the abnormal biology of disease.Combined with the explosive growth of knowledgefrom genome research, PET and microPET play a majorrole in the promising new era of molecular diagnosticsand therapeutics.

The microPET mouse image (at left) shows an exampleof how BER scientists at UCLA watch the genome ofcells at work in the living mouse. In this mouse, insulingenes in liver cells have initiated instructions to produceinsulin, a hormone that regulates the body’s use ofsugar. This type of research helps scientists betterunderstand diabetes—at the molecular and geneticlevels—and guides the development of futuretherapies for human patients with diabetes.

Many research programs worldwide—in nuclearmedicine, biology, genetics, and drug discovery—haveadopted UCLA’s microPET technology. These microPETstudies are constantly moving new knowledge from research labs to PET clinics, working to improve the future healthcare of patients.

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Washington University, St. Louis, MissouriWashington University has explored innovative ways to use radionuclides inmedicine since the early 1930s. Supported by BER for many decades, the nuclearmedicine research group here has made important contributions to thedevelopment of PET imaging. Today, it’s at the forefront of developing new organiccarrier molecules and a new class of PET radiopharmaceuticals based on metalradionuclides (e.g., copper-64, gallium-68, titanium-45).

PET imaging techniques developed here can help identify which patients withbreast cancer will respond to tamoxifen hormone therapy. In some patients,tamoxifen treats breast cancer as effectively as standard chemotherapy with ewer side effects. However, doctors need better methods to determine whichpatients will respond to tamoxifen.

These PET images wereobtained from a breastcancer patient beforetamoxifen therapy andabout a week afterstarting tamoxifentherapy. In the post-tamoxifen scan, thebright spot (called a“tamoxifen metabolicflare”) indicates that thispatient will likelyrespond well to

tamoxifen.

BER scientists at Washington University have also developed aradiopharmaceutical, fluorine-18 fluoroestradiol (FES), that targets estrogenreceptors on breast tumors. The presence or absence of abundant estrogenreceptors in breast cancer cells can help doctors select the most appropriatechemotherapy for these patients.

For some cancer patients who need chemotherapy, multi-drug resistance poses aserious problem. BER researchers here have developed radiopharmaceuticals thatcontribute to our current understanding of the molecular and genetic mechanismsthat govern the ability of cancerous tissues to resist drug effects. This work may leadto future techniques to overcome multi-drug resistance.

Breast Cancer

Today’s BER Research Leads to the Nuclear Medicine of Tomorrow

Post-tamoxifen TherapyPre-tamoxifen Therapy

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University of Michigan, Ann ArborThe BER research program at the University of Michigan covers a spectrum of research inradiopharmaceuticals, from their chemical design and synthesis to their implementation in PETand SPECT brain chemistry studies. Scientists here also have renowned expertise in thedevelopment of computer science for nuclear medicine imaging systems. This coordinatedeffort has contributed valuable insight to several neurologic disorders that affect movement,memory, aging, and dementia.

Radiochemists here have developed several techniques that now make itpractical and economical for drug companies to commercially manu-facture certain radiopharmaceuticals. In the area of imaging systems,scientists here were among the first to develop a pixel-by-pixel method foranalyzing PET data to study pharmacokinetics (i.e., the activity and fateof drugs in the body, such as absorption, distribution, and excretion).

These brain scans illustrate the functional specificity of two radiopharm-aceuticals for different biochemical processes. The patient withAlzheimer’s disease shows a diffuse pattern of decreased activity ofacetylcholine esterase, an enzyme involved in memory. In the patient withParkinson’s disease, the image shows reduced activity of a specificmonoamine transporter, a brain function crucial to the dopamine systemthat controls body movements.

BER scientists in Ann Arbor anticipate that their nuclear medicine researchwill lead to improved medical management of neurologic diseases, abetter match of patients to effective drug therapies, a more rationalpathway to the development of new drug treatments, and new insightsabout biochemical mechanisms that naturally protect the brain fromneurologic diseases.

he human body operates on millions of chemical reactions. All the characteristics of aliving human being—our hair color, the activity of the heart, how we think and remember,the way we laugh—depend on a galaxy of biochemical reactions that occur many

millions of times per minute within the cells and tissues of our body. A deranged chemicalprocess can cause disease. And a disease results in other abnormal biochemical changes.Nuclear medicine, with its unique ability to reveal biochemical processes, provides crucialinformation about numerous diseases. More than any other federal agency, the Department of Energy (DOE), through the BER Medical Sciences program, has fostered the development of nuclear medicine. The future promise of nuclear medicine, the radiopharmaceuticals and imaging systems of tomorrow, depends on the progress and creativity of today’s BER researchers (see page 21).

Future Promise of Nuclear Medicine Depends on BER

Alzheimer’s Disease

Parkinson’s Disease

1929 1930 1940 1946 1950 1951 1952 1953 1958

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Vital Legacy of BER Medical Sciences

50-Year Commitment to Improved

Ernest O. Lawrenceinvents cyclotron

At the University ofCalifornia’s RadiationLaboratory in Berkeley

(later to becomeLawrence Berkeley

National Laboratory),the cyclotron will soon

produce the firstmedically useful

radionuclides (iodine-131, thallium-201,

technetium-99m, carbon-14,

and gallium-67).For this invention,

Lawrence will receivethe Nobel Prize inPhysics in 1939.

First delivery of amedical radionuclide

to a hospital

Reactor-producedradionuclides from Oak

Ridge now becomeavailable for medicalresearch. Eugene P.

Wigner (in dark suit),director of BERresearch and

development at Oak Ridge, delivers

lead-lined container of carbon-14 to BarnardFree Skin and CancerHospital in St. Louis.

Wigner will receive theNobel Prize in 1963

for his research on thestructure of the atom

and its nucleus.

Benedict Casseninvents

rectilinear scanner

Cassen and other BERscientists at UCLA

build a scanner thatprovides images of athyroid gland basedon distribution of an

iodine radiotracer, thestart of imaging innuclear medicine.

Technetium-99mgenerator invented

BER scientists atBrookhaven (Walter

Tucker, PowellRichards, and

colleagues) invent agenerator system that

will make Tc-99mthe most widely used

radionuclide inhospitals worldwide

for millions ofnuclear medicine

patients each year.

Hal Anger inventsgamma camera

In Berkeley, California,Anger and his BER

colleagues introduce arevolutionary new

technique forradionuclide imaging.The gamma camera

will become the“workhorse” of nuclearmedicine for the next

50 years.

Birth of positron imaging

Gordon Brownell atMIT constructs the

first detector device toexploit positron-

electron annihilationas an imaging tool,creating a precursor

of future PETscanners.

1959 1960 1961 1970 1973 1974 1976

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Healthcare through Nuclear Medicine

Development of fluorine-18 FDG

for PET

Alfred P. Wolf (right),Joanna S. Fowler (not

shown), Tatsuo Ido(middle), and otherBER colleagues at

Brookhaven developedand synthesized

fluorine-18fluorodeoxyglucose(FDG), a form of

radiolabeled sugar, forPET imaging of

glucose metabolism.

Beginning ofemission computed

tomography

David E. Kuhl andother BER scientists at

the University ofPennsylvania build the

Mark II scanner,ancestor to today’s CTand SPECT scanners.

First shipment of fluorine-18 FDG to a

hospital

Brookhaven sends F-18 FDG, a PET radiotracer, to the

University of Pennsylvania,also a BER research site.

“Headshrinker” directforerunner of PET

James S. Robertson, aBER scientist at

Brookhaven, developsthe “headshrinker,” a direct forerunner

of PET.

First PET camera builtfor human studies

Following severalprototypes,

Michael E. Phelps,Edward Hoffman, and

Michel M. Ter-Pogossian at

Washington University,with DOE and NIHsupport, build the

PETT III to useadvanced algorithmsfor computing three-dimensional images.

Thallium-201 formedical use

BER scientists atBrookhaven (ElliotLebowitz, Harold

Atkins, andcolleagues) develop afaster, more efficient

method for producingthallium-201, leading

to nuclear stresstesting as a routine

scan for heartimaging. By the

1990s, doctors willuse thallium-201

about a million timesa year, accounting for

13% of all nuclearmedicine scans.

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Iodine-131 MIBGfor diagnosing and treating

rare childhoodcancers

Newradiopharmaceutical

developed byDonald Wielandand other BERscientists at the

University ofMichigan.

PET image ofestrogen receptors

in breast tumor

The first PETradiotracer to image a

tumor based on afluorine-18-labeled

carrier molecule(fluoroestradiol) that

targets a specifichormone receptor of

the cell, developed byBER scientists MichaelJ. Welch (WashingtonUniversity, St. Louis)

and John A.Katzenellenbogen

(University of Illinois,Urbana-Champaign).

Enrico Fermi Award from DOE

Presidential awardpresented to Michael E.Phelps, a BER scientistnow at UCLA, for his

1970’s work as one ofthe developers of thefirst PET camera builtfor human studies at

Washington University,St. Louis.

PET scans show different patterns of

glucose (sugar)metabolism related

to performing variousmental tasks

At UCLA, fluorine-18 FDGPET studies, supported by

BER, show different patternsof glucose (sugar)

metabolism in the brainduring five tasks:

(1) looking at scenery,(2) listening to a mystery

story with music,(3) thinking by counting

backwards from 100 by 7s,(4) remembering objects

previously memorized, and(5) working by touching the thumb consecutively

to the four fingers.

E.O. LawrenceAward from DOE

Joanna S. Fowler, aBER scientist at

Brookhaven, receivesthis award for her

innovations inradiopharmaceutical

development and theirapplication for imagingbrain chemistry and the

biological action ofvarious drugs.

50-Year Commitment to Improved Human Health through Nuclear Medicine

Highest resolutionPET scanner in the world

BER scientists led byThomas F. Budinger(left) design more

advanced PETimaging systems.

1980 1984 1986 1987 1990 1998

2001

Current BER Scientists: Principal InvestigatorsJorge Barrio, University of California, Los Angeles, School of Medicine, California / Surinder K.

Batra, University of Nebraska Medical Center, Nebraska / Steven R. Bergmann, ColumbiaUniversity College of Physicians & Surgeons, New York / Donald J. Buchsbaum, University of

Alabama at Birmingham, Alabama / Thomas F. Budinger, Lawrence Berkeley NationalLaboratory, California / Simon Cherry, University of California, Los Angeles, School of Medicine,California / Nai-Kong V. Cheung, Memorial Sloan-Kettering Cancer Center, New York / Stephen

E. Derenzo, Lawrence Berkeley National Laboratory, California / Eugene R. DeSombre, Universityof Chicago, Illinois / Stephen Dewey, Brookhaven National Laboratory, New York / Yu-Shin Ding,Brookhaven National Laboratory, New York / Richard Ferrieri, Brookhaven National Laboratory,

New York /Ronald D. Finn, Memorial Sloan-Kettering Cancer Center, New York / Alan J.Fischman, Massachusetts General Hospital, Massachusetts / Joanna S. Fowler, Brookhaven

National Laboratory, New York / Sam Gambhir, University of California, Los Angeles, School ofMedicine, California / Samuel John Gatley, Brookhaven National Laboratory, New York / Mark

M. Goodman, Emory University Center for PET, Georgia / Harvey R. Herschman, University ofCalifornia, Los Angeles, School of Medicine, California / Donald Hnatowich, University of

Massachusetts Medical Center, Massachusetts / Edward J. Hoffman, University of California, LosAngeles, School of Medicine, California / Henry Huang, University of California, Los Angeles,

School of Medicine, California / Ronald H. Huesman, Lawrence Berkeley National Laboratory,California / Ronald J. Jaszczak, Duke University Medical Center, North Carolina / George W.

Kabalka, University of Tennessee Medical Center, Tennessee / Joel S. Karp, University ofPennsylvania, Pennsylvania / Amin I. Kassis, Harvard Medical School, Massachusetts / John A.

Katzenellenbogen, University of Illinois, Illinois / Stephen J. Kennel, Oak Ridge NationalLaboratory, Tennessee / Michael R. Kilbourn, University of Michigan Medical Center, Michigan /F.F. (Russ) Knapp, Jr., Oak Ridge National Laboratory, Tennessee / Robert A. Koeppe, University of

Michigan Medical Center, Michigan / Harley I. Kornblum, University of California, Los Angeles,School of Medicine, California / David E. Kuhl, University of Michigan Medical Center, Michigan

/ Hank F. Kung, University of Pennsylvania, Pennsylvania / Steven M. Larson, Memorial Sloan-Kettering Cancer Center, New York / Alexander Lempicki, Boston University School of Medicine,

Massachusetts / Jean Logan, Brookhaven National Laboratory, New York / Daniel W.McPherson, Oak Ridge National Laboratory, Tennessee / William P. Melega, University of

California, Los Angeles, School of Medicine, California / Saed Mirzadeh, Oak Ridge NationalLaboratory, Tennessee / William W. Moses, Lawrence Berkeley National Laboratory, California /

Jogeshwar Mukherjee, Wright State University, Kettering Medical Center, Ohio / Marit Nilsen-Hamilton, Iowa State University, Iowa / William M. Pardridge, University of California, Los Angeles,School of Medicine, California / Michael E. Phelps, University of California, Los Angeles, MedicalCenter, California / David R. Piwnica-Worms, Washington University School of Medicine, Missouri /

Thomas P. Quinn, University of Missouri–Columbia, Missouri / N. Satyamurthy, University ofCalifornia, Los Angeles, School of Medicine, California / Heinrich R. Schelbert, University ofCalifornia, Los Angeles, Medical Center, California / David J. Schlyer, Brookhaven National

Laboratory, New York / Robert M. Sharkey, Garden State Cancer Center, New Jersey / Robert H.Singer, Albert Einstein College of Medicine, New York / Suresh C. Srivastava, BrookhavenNational Laboratory, New York / Scott E. Taylor, Lawrence Berkeley National Laboratory,

California / Henry F. Van Brocklin, Lawrence Berkeley National Laboratory, California / Wynn A.Volkert, University of Missouri–Columbia, Missouri / Nora D. Volkow, Brookhaven National

Laboratory, New York / David C. Ward, Yale University School of Medicine, Connecticut / Gene-Jack Wang, Brookhaven National Laboratory, New York / Michael J. Welch, Washington

University School of Medicine, Missouri / Eric Wickstrom, Thomas Jefferson University, Pennsylvania/ D. Scott Wilbur, University of Washington Medical Center, Washington / Michael R. Zalutsky,Duke University Medical Center, North Carolina / Jon Zubieta, Syracuse University, New York

BER supports many other senior investigators, post-doctoral fellows, and graduate students that cannot be listed.

Nuclear Medicine Helps PatientsEverywhere in Healthcare

And so does BER Medical Sciences

Research and Review

Michael V. ViolaPrem C. Srivastava

Peter T. KirchnerLarry S. James

Medical Sciences DivisionOffice of Biological and

Environmental ResearchOffice of Science

U.S. Department of Energy

Writing and Editing

Linda E. KetchumNew York, New York

Production

Office of Scientific and Technical Information

U.S. Department of Energy

This document was prepared as an account of worksponsored by the United States Government.Although this document is believed to contain cor-rect information, neither the United StatesGovernment nor any agency thereof, nor any oftheir employees, makes any warranty, express orimplied, or assumes any legal responsibility for theaccuracy, completeness, or usefulness of any infor-mation, apparatus, product, or process disclosed,or represents that its use would not infringe private-ly owned rights. Reference herein to any specificcommercial product, process, or service by its tradename, trademark, manufacturer, or otherwise, doesnot necessarily constitute or imply its endorsement,recommendation, or favoring by the United StatesGovernment or any agency thereof. The views andopinions of authors expressed herein do not neces-sarily state or reflect those of the United StatesGovernment or any agency thereof.

Prepared for the U.S. Department of EnergyOffice of Biological and Environmental Research

DOE/SC–0033 / April 2001