Top 10 Isotopes

Everyone loves “top ten” lists. So, I have prepared a list of the top ten isotopes mentioned in Intermediate Physics for Medicine and Biology. These isotopes range from light to heavy, from abundant to rare, and from mundane to exotic. I have no statistics to back up my choices; they are just my own view about which isotopes play a key role in biology and medicine. Feel free to sound off in the comments about your favorite isotope that I missed. Let’s count them down to number one.

10. ¹H (hydrogen-1). This simplest of all isotopes has a nucleus that consists of only a single proton. Almost all magnetic resonance imaging is based on imaging ¹H (see Chapter 18 about MRI). Its importance arises from its large abundance and its nuclear dipole moment.
9. ²²²Rn (radon-222). While radon doesn’t have a large role in nuclear medicine, it is responsible for a large fraction of our annual background radiation dose (see Chapter 16 about the medical uses of x-rays). ²²²Rn is created in a decay chain starting with the long-lived isotope ²³⁸U. Because radon is a Nobel gas, it can diffuse out of uranium-containing rocks and enter the air, where we breath it in, exposing our lungs to its alpha particle decay.
8. ¹³¹I (iodine-131). ¹³¹I is used in the treatment of thyroid cancer. Iodine is selectively taken up by the thyroid, where it undergoes beta decay, providing a significant dose to the surrounding tissue. A tenth of its radiation arises from gamma decay, so we can use the isotope for both imaging and therapy (see Chapter 17 about nuclear medicine).
7. ¹⁹²Ir (iridium-192). This gamma emitter is often used in stents placed in blocked arteries. It is also an important source for brachytherapy (Chapter 17), when a radioactive isotope is implanted in a tumor.
6. ¹²⁹Xe (xenon-129). This isotope is used in magnetic resonance images of the lung. Although the isotope is not abundant, its polarization can be increased dramatically using a technique called hyperpolarization (Chapter 18).
5. ¹⁰B (boron-10). This isotope or boron plays the central role in boron neutron capture therapy (Chapter 16). in which boron-containing drugs accumulate in a tumor. When irradiated by neutrons, the boron decays into an alpha particle (⁴He) and ⁷Li, which both have high energy and are highly ionizing.
4. ⁶⁰Co (cobalt-60). For many years cobalt-60 was used as a source of radiation during cancer therapy (Chapter 16). The gamma knife uses ⁶⁰Co sources to produce its 1.25 MeV radiation. The isotope is used less nowadays, replaced by linear accelerators.
3. ¹²⁵I (iodine-125). Iodine is the only element with two isotopes in this list. Unlike ¹³¹I, which emits penetrating beta and gamma rays, ¹²⁵I deposits much of its energy in short-range Auger electrons (see Chapter 15 on the interaction of x-rays with matter). They deliver a large, concentrated dose when ¹²⁵I is used for radioimmunotherapy.
2. ¹⁸F (florine-18). A classic positron emitter, ¹⁸F is widely used in positron emission tomography (Chapter 17). Often it is attached to the sugar molecule as ¹⁸F-fluorodeoxyglucose, which is taken up and is then trapped inside cells, providing a PET marker for high metabolic activity.
1. ^99mTc (technitium-99m). The king of all nuclear medicine isotopes, ^99mTc is used in diverse imaging applications (Chapter 17). It emits a 141-keV gamma ray that is ideal for most detectors. The isotope is often bound to other molecules to produce specific radiopharmaceuticals, such as ^99mTc-sestamibi or ^99mTc-tetrofosmin. If you are only familiar with one isotope used in nuclear medicine, let it be ^99mTc.