Tc is normally supplied to hospitals through a radionuclide generator containing the parent radionuclide molybdenum-99. Mo is typically obtained as a fission product of U in nuclear reactors, however global supply shortages have led to the exploration of other methods of production. About a third of the worlds supply, and most of Europes supply, of medical isotopes is produced at the Petten nuclear reactor in the Netherlands. Another third of the worlds supply, and most of North Americas supply, was produced at the Chalk River Laboratories in Chalk River, Ontario, Canada until its permanent shutdown in 2018.
The most commonly used radioisotope in PET, F, is not produced in a nuclear reactor, but rather in a circular accelerator called a cyclotron. The cyclotron is used to accelerate protons to bombard the stable heavy isotope of oxygen O. The O constitutes about 0.20% of ordinary oxygen (mostly oxygen-16), from which it is extracted. The F is then typically used to make FDG.
A typical nuclear medicine study involves administration of a radionuclide into the body by intravenous injection in liquid or aggregate form, ingestion while combined with food, inhalation as a gas or aerosol, or rarely, injection of a radionuclide that has undergone micro-encapsulation. Some studies require the labeling of a patient's own blood cells with a radionuclide (leukocyte scintigraphy and red blood cell scintigraphy). Most diagnostic radionuclides emit gamma rays either directly from their decay or indirectly through electron–positron annihilation, while the cell-damaging properties of beta particles are used in therapeutic applications. Refined radionuclides for use in nuclear medicine are derived from fission or fusion processes in nuclear reactors, which produce radionuclides with longer half-lives, or cyclotrons, which produce radionuclides with shorter half-lives, or take advantage of natural decay processes in dedicated generators, i.e. molybdenum/technetium or strontium/rubidium.
The most commonly used intravenous radionuclides are technetium-99m, iodine-123, iodine-131, thallium-201, gallium-67, fluorine-18 fluorodeoxyglucose, and indium-111 labeled leukocytes. The most commonly used gaseous/aerosol radionuclides are xenon-133, krypton-81m, (aerosolised) technetium-99m.