Diagnostic and Therapeutic uses of Radioisotopes of Cobalt

Three radioisotopes of Cobalt used in medical practice are Cobalt-57 (⁵⁷Co), Cobalt-58 (⁵⁸Co), and Cobalt-60 (⁶⁰Co). Cobalt-60 (⁶⁰Co) has a half life of 5.27 years and it emits gamma rays (g-rays). Half life of Cobalt-57 (⁵⁷Co) is 270 days and that of Cobalt-58 (⁵⁸Co) is 71 days only. It is important to note that the radioisotopes with shorter half life are always good for diagnostic use whereas with longer half life are good for radiotherapy or radiation therapy. Cobalt-60 (⁶⁰Co) is a preferred source of radiation for radiotherapy at present; though earlier it was in dual use. Cobalt-57 (⁵⁷Co) and Cobalt-58 (⁵⁸Co) are preferred for diagnostic applications due to shorter half life.

Use of Cobalt-57 and Cobalt-58 in Diagnosis:

The most common use of Cobalt-57 (⁵⁷Co) or Cobalt-58 (⁵⁸Co) is in the diagnosis of pernicious anemia (fetal anemia caused by vitamin B-12 deficiency due to poor absorption of vitamin B-12 by small intestine due to intrinsic factor defect). Cyanocobalamin (vitamin B-12) and hydroxycobalamin labeled with ⁵⁷Co or ⁵⁸Co are commercially available for diagnostic use. The dose is 0.5 microCurie (mCi) to 2 microCurie (mCi). The administration is oral after 24 hours of fasting and the patient is not allowed to eat for 2 hours following the administration of vitamin B-12 labeled with radioisotope. The patient does not need hospitalization for this investigation. The excretion of radioactive is measured in the 24 hour urine specimen of the patient after the administration of radioactive labeled vitamin B12.

Use of Cobalt-60 in Therapy:

The gamma rays (g-rays) emitted by Cobalt-60 (⁶⁰Co) are like high energy x-rays. The radiotherapy or radiation therapy is helpful in some types of cancers. The patients are usually hospitalized for radiotherapy with Cobalt-60 (⁶⁰Co). The exposure time is worked out by the Radiation Physicist. Smaller radiation sources of Cobalt-60 (⁶⁰Co) are called seeds and needles, and are used for intra-cavity and intra-interstitial radiation therapy. The seeds or needles of Cobalt-60 (⁶⁰Co) are removed from the body cavities or interstitial tissue after the optimal time of exposure. The large sources of Cobalt-60 (⁶⁰Co) are used for 'teletherapy' or external radiation like high energy x-rays.

Therapeutic use of Phosphorus-32

Phosphorus-32 (³²P) is a radioactive isotope of phosphorus with mass number as 32. It has a half life of 14.3 days and emits beta-particles. In the chemical form of Sodium hydrogen phosphate, ³²P is used in the treatment of leukemia (a type of blood cancer) and polycythemia (abnormal high count of erythrocytes in blood due to a variety of causes). It is also used for relief from pain in the patients affected by metastatic cancer of bone and the patient needs not to be hospitalized for such treatment. The doses range from 1 mCi to 10 mCi. In the colloidal form the radioisotope is used in the body cavities in the same manner as Gold-198 (¹⁹⁸Au) and the patient may need hospitalization for such therapy.

Phosphorus-32 (³²P) could also used in the differential diagnosis of tumors of the eye. A dose of 500 microCurie (mCi) to 750 microCurie (mCi) needs to be administered intravenously and after an hour, two hours and 4 hours, the radioactive concentration is measured in the diseased eye and the normal eye. If the tumor is malignant, the involved eye would take up more ³²P. The investigation may be performed on an out patient basis taking all the aseptic precautions by an eye specialist. It is worth to remember that after 10 half lives (143 day) this radioactive would almost exhaust in its content of radioactivity.

Role of Gold-198 in Arresting the Growth of Cancer

The radioisotope of gold (Gold-198, ¹⁹⁸Au) has a Half Life of 2.7 days and its radiations are beta particles (b-particles) and gamma rays (g-rays). In the form of colloidal suspension ¹⁹⁸Au is used as the cancer therapy. The most common use of ¹⁹⁸Au is in the treatment of ascites (accumulation of fluid in the peritoneal cavity) and pleural effusion due to metastasis of cancer in the serous surface of cavities. Only the medical practitioners associated with nuclear medicine, administer such therapy. The dose for the treatment of pleural effusion is 25 - 75 mCi and for the treatment of ascites, the dose is 50 - 150 mCi. The patient needs to be hospitalized for the first few days during the course of treatment with the radioisotope.

What is the use of Iodine-131 in Medical Practice?

There are two main uses of Iodine-131 (¹³¹I) in medicine or medical practice.

1. Diagnostic application in some procedures


2. Therapy for thyroid disorders or thyroid cancer

The Iodine-131 (¹³¹I) has a radioactive half life of 8.1 days and its radiations are beta particles(b^- particles) and gamma rays (g-rays). This is most widely used radioisotope in the management of hyperthyroidism and thyroid cancer and thyroid function related diagnostic procedures. There are half a dozen investigations associates with the thyroid function which involve the oral or intravenous administration of a few microCuries (mCi) of ¹³¹I. Subsequent study of the patient, either by the direct measurement of ¹³¹I deposited in the thyroid gland through measurement of ¹³¹I excreted in the urine of the patient or by assessment of radioactivity in the blood samples drawn at different time intervals after the administration of ¹³¹I. The part of the ¹³¹I retained or excreted depends on the normal, hyperthyroid or hypothyroid conditions. The uptake or excretion of ¹³¹I exhibits a diagnostic parameter. After absorption of ¹³¹I by the thyroid gland the iodine is elaborated into the thyroid hormone which is discharged in the blood. The hyperactive gland produces too much hormone which would be detected in the blood samples taken at 24 to 96 hours after the administration of radioactive iodine (¹³¹I). The measurement of the iodine content is computed from the counts of radioactivity detected in the blood samples. The radioactivity is measured as gamma rays (g-rays) by a Geiger Muller counter or it may be measured as beta particles (b-particles) by a Scintillation counter at a 'Hot Laboratory'.

The therapeutic use of Iodine-131 (¹³¹I) could be culminated through optimal doses of this radioisotope with reference to the thyroid disorder and the age and weight of the patient. There are specialized clinics at the authorized medical centers having facilities for the Nuclear Medicine and associated research.

Units of Radiation Dose and Maximum Permissible Doses

The radiation energy from the radioisotope is absorbed by the living tissue of the patient subjected to the radiation therapy or radiotherapy. The traditional unit of radiation dose is called Rad and one Rad stand for 100 egrs of radiation energy absorbed per gram of the absorber tissue Therapeutic doses are usually measured in hundreds or thousands of Rads. In diagnostic procedures where it is desirable to keep the dose very low, the unit is millirad (mr). One millirad is the thousandths part of a Rad and only a few hundred millirads are permissible dose.

The radiation protection is an important precaution to avoid over exposure of a patient as well as the radiation worker. The radiation protection unit is called dose equivalent and its traditional unit is REM (Rad equivalent man).

• REM = Rad Equivalent Man


• REM = Rad x Relative Badge Effect


• REM = Rad x RBE

RBE depends upon the type of the radiation energy. RBE for x-rays, g-rays and b-particles is an energy up to 3 MeV (3 MeV = 1 Rad). RBE for positrons, neutrons and a-particles is 10 rem (REM). It is evident that positrons, neutrons and a-particles exert lesser side effects as compared to x-rays, g-rays and b-particles. The S.I. unit of radiation protection is Seivert(Sv).

• 1 Sv = 100 Rem


• 1 Sv = 1000 milliSeivert (mSv) = 100 Rem


• 10 mSv = 1 Rem

Maximum permissible dose (MPD) or maximum limit of per year exposure to radioactivity could be computed separately for the patients (general public) and radiation workers. As a rule anybody below the age of 18 years is never permitted to become a radiation worker. The permissible dose can be worked out by the following formula:

D = 5 (N-18); Here D=Dose in Rem, N= Age in years.

A radiation worker who joins the duty after acquiring the age of 18 years could have maximum exposure of 5 x (20-18) = 5 x 2 = 10 Rem only up till the completion of 20 years of age or 5 Rem per year exposure. General public or a patient could be exposed to radiation energy at a MPD of one tenth (¹/₁₀) of the dose for a radiation worker and that comes out to be 0.5 Rem per year (⁵/₁₀ Rem per year). Hands and feet could be exposed at a higher dose if desired but not more than 75 Rem/year or 40 Rem/3 months. Thyroid, Bone and skin could be exposed at 40 Rem/year and other organs at 15 Rem/year. The fetus should not be exposed to a radiation dose of more than 0.5 Rem.