Fundamental uncertainty equations for nuclear dating applied to the 140Ba-140La and 227Th-223Ra chronometers

Basic equations for age dating through activity ratio measurements are presented and applied to nuclear chronometers based on parent-daughter decay. Uncertainty propagation formulae are derived which relate the relative uncertainty on the half-lives and measured activity ratios with the relative uncertainty on the calculated time of a nuclear event. Particular attention is paid to the case of relatively short-lived radionuclides for which the change in decay rate during the measurement is non-negligible. Mathematical solutions are presented to correct the perceived activity ratio and adapt the uncertainty propagation formulae to complete the uncertainty budget. The formulae have been applied to ¹⁴⁰Ba-¹⁴⁰La chronometry, which is particularly useful for dating a nuclear explosion through measurement of the produced activity ratio of ¹⁴⁰La and ¹⁴⁰Ba in a finite time interval. They were also applied to the ²²⁷Th-²²³Ra parent-daughter pair produced for therapeutic use. The impact of inaccuracies in the nuclear decay data on the performance of these nuclear chronometers is shown and discussed.

A simple method for checking the proper functioning of a thin-layer radiochromatograph for radiochemical purity control of radiopharmaceuticals

Thin-layer radiochromatography is used for carrying out radiochemical purity control of gamma-emitter radiopharmaceuticals by using thin-layer radiochromatography scanners. It has been developed and implemented a simple method for validating the proper functioning of these instruments. This method helps to ensure accurate results in the radiochemical purity controls of gamma-emitter radiopharmaceuticals.

Vertebral Uptake of Tc-99m Macroaggregated Albumin (MAA) with SPECT/CT Occurring in Superior Vena Cava Obstruction

A 67-year-old male presented with dyspnea for which lung scintigraphy was ordered to rule out pulmonary embolus. Planar images demonstrated abnormal midline uptake of Tc-99m macroaggregated albumin, which SPECT/CT localized to several thoracic vertebrae. Thoracic vertebral uptake on perfusion lung scintigraphy was previously described on planar imaging. Radionuclide venography and contrast-enhanced CT subsequently demonstrated superior vena cava (SVC) obstruction with collateralization through the azygous/hemiazygous system and vertebral venous plexus. SPECT/CT differentiated residual esophageal/tracheal ventilation activity, a clinically insignificant finding, from vertebral uptake indicative of SVC obstruction, a potentially life-threatening condition.

Trends in the utilization of nuclear medicine and radiopharmaceuticals in an aging population

AIM

To investigate the trends in the utilization of nuclear medicine procedures and radiopharmaceuticals in an aging population and to establish the prediction models.

METHODS

Based on Taiwan's National Health Insurance Research Database, a longitudinal study was conducted from 2000 to 2012. Descriptive statistics were adopted to analyze the frequencies and distributions of nuclear medicine procedures. Multiple linear regression analysis was applied to establish the prediction model for the utilization of nuclear medicine.

RESULTS

The utilization of myocardial perfusion imaging increased most significantly, i.e. 250 per million population (pmp) increment annually, followed by the whole-body bone scan (176 pmp) and whole-body PET scan (100 pmp) in Taiwan during the period of 2000-2012. The use rate of nuclear medicine procedure which the first quartile (Q1) of age at examination above 35 years fits the regression model: Use rate expected year = 0.03 Q1 of age at examination × use rate baseline year + 14797 life expectancy expected year / life expectancy baseline year - 15030. Adversely, the use rate of procedure which Q1 of age at examination below 35 years fits the model: Use rate expected year = 0.01 Q1 of age at examination × use rate baseline year - 4565 life expectancy expected year / life expectancy baseline year + 4749. In addition, the similar models were found in the applications of radiopharmaceuticals.

CONCLUSION

This study demonstrates the age at examination and life expectancy can be used to predict the utilities of nuclear medicine procedures and radiopharmaceuticals in an aging population. Nuclear medicine practice applied in the geriatrics would increase significantly with the aging of population.

Varying levels of small microcalcifications and macrophages in ATTR and AL cardiac amyloidosis: implications for utilizing nuclear medicine studies to subtype amyloidosis

BACKGROUND

Recently, there has been much interest in using nuclear medicine studies to noninvasively identify and subtype cardiac amyloidosis. In particular, modified bone scans using (99m)Tc-3,3-diphosphono-1,2-propanodicarboxylic acid ((99m)Tc-DPD) and (99m)Tc-pyrophosphate ((99m)Tc-PYP) are being used to selectively identify patients with ATTR amyloidosis rather than AL amyloidosis. The morphologic basis underlying the selectivity of these imaging modalities for ATTR amyloidosis has been unclear.

METHODS

To determine if variations in microcalcifications and/or macrophages within ATTR and AL amyloidosis might be responsible for the selectivity for these imaging modalities, 8 endomyocardial biopsies of ATTR amyloidosis and 7 endomyocardial biopsies of AL amyloidosis were stained with von Kossa calcium stains and with immunohistochemistry for the macrophage marker CD68.

RESULTS

Compared with AL amyloidosis, there was a greater density of small microcalcifications in cases of ATTR amyloidosis (mean=16.8 vs. 6.5 per 200× field, P=.008). In contrast, there were fewer macrophages in ATTR amyloidosis compared with AL amyloidosis (mean=2.5 vs. 11.7 per 200× field, P=.0004). The density of microcalcifications within each group was not related to patient age, echocardiographic features of cardiac function, or serum levels of calcium and creatinine.

CONCLUSIONS

These data suggest that microcalcifications but not macrophages likely underlie the selectivity of modified bone scans for ATTR amyloidosis and suggest that other pathologic entities containing microcalcifications might also result in positive scans with these imaging modalities.

Evaluation of pulmonary perfusion by SPECT imaging using an endothelial cell tracer in supine humans and dogs

Background

Pulmonary perfusion is not spatially homogeneously distributed, and its variations could be of diagnostic value in lung vascular disease. PulmoBind is a ligand of the adrenomedullin receptor densely expressed in endothelial cells of lung capillaries. The aim of this study was to evaluate spatial distribution of human lung perfusion by using this novel molecular tracer of the pulmonary vascular endothelium.

Methods

Normal humans (n = 19) enrolled into the PulmoBind phase I trial were studied (Clinicaltrials.gov.NCT01539889). They were injected with ^99mTc-PulmoBind for SPECT imaging. Results were compared with ^99mTc-PulmoBind in quadruped mammals (dogs, n = 5). Imaging was performed in the supine position and distribution of activity was determined as a function of cumulative voxels along the different anatomical planes.

Results

PulmoBind uptake in humans was 58 ± 1 % (mean ± SEM) of the injected dose. Dorsal activity was 18.1 ± 2.1 % greater than ventral, and caudal activity was 25.7 ± 1.6 % greater than cranial. Lateral activity was only mildly higher than medial by 7.0 ± 1.0 %. In supine dogs, similar but higher PulmoBind gradients were present: dorsal 28.6 ± 2.5 %, caudal 34.1 ± 5.0 % and lateral 18.1 ± 2.0 %.

Conclusions

The perfused pulmonary circulation of supine humans, assessed by an adrenomedullin receptor ligand, is not homogeneously distributed with more prominent distribution in dorsal and caudal regions. It is qualitatively similar to a supine quadruped mammal confirming the presence of a microcirculatory gravitational perfusion gradient detectable with this tracer. Future studies are needed to determine if this novel endothelial cell tracer could be used to detect physiologic and pathologic variations of lung perfusion such as in pulmonary hypertension.

Clinical trial

ClinicalTrial.gov, NCT01539889

The Role of Nuclear Medicine in the Staging and Management of Human Immune Deficiency Virus Infection and Associated Diseases

Human immune deficiency virus (HIV) is a leading cause of death. It attacks the immune system, thereby rendering the infected host susceptible to many HIV-associated infections, malignancies and neurocognitive disorders. The altered immune system affects the way the human host responds to disease, resulting in atypical presentation of these disorders. This presents a diagnostic challenge and the clinician must use all diagnostic avenues available to diagnose and manage these conditions. The advent of highly active antiretroviral therapy (HAART) has markedly reduced the mortality associated with HIV infection but has also brought in its wake problems associated with adverse effects or drug interaction and may even modulate some of the HIV-associated disorders to the detriment of the infected human host. Nuclear medicine techniques allow non-invasive visualisation of tissues in the body. By using this principle, pathophysiology in the body can be targeted and the treatment of diseases can be monitored. Being a functional imaging modality, it is able to detect diseases at the molecular level, and thus it has increased our understanding of the immunological changes in the infected host at different stages of the HIV infection. It also detects pathological changes much earlier than conventional imaging based on anatomical changes. This is important in the immunocompromised host as in some of the associated disorders a delay in diagnosis may have dire consequences. Nuclear medicine has played a huge role in the management of many HIV-associated disorders in the past and continues to help in the diagnosis, prognosis, staging, monitoring and assessing the response to treatment of many HIV-associated disorders. As our understanding of the molecular basis of disease increases nuclear medicine is poised to play an even greater role. In this review we highlight the functional basis of the clinicopathological correlation of HIV from a metabolic view and discuss how the use of nuclear medicine techniques, with particular emphasis of F-18 fluorodeoxyglucose, may have impact in the setting of HIV. We also provide an overview of the role of nuclear medicine techniques in the management of HIV-associated disorders.

An update on radiation absorbed dose to patients from diagnostic nuclear medicine procedures in Tehran: A study on four academic centers

Purpose:

Use of radiopharmaceuticals for diagnostic nuclear medicine procedures is one of the main sources of radiation exposure. We performed this study with respect to the rapid growth in nuclear medicine in Iran and lack of updated statistics.

Materials and Methods:

The data were obtained for all active Nuclear Medicine Centers affiliated to Shahid Beheshti University of Medical Sciences during 2009 and 2010.

Results:

The most frequently performed procedures were bone (30.16%), cardiac (28.96%), renal (17.97%), and thyroid (7.93%) scans. There was a significant decrease in the number of thyroid scintigraphies with ¹³¹I and ^99mTc-sulfur colloid liver/spleen scans and tremendous increase in the frequencies of cardiac and bone scintigraphies compared to one decade ago.

Conclusion:

Compared to previous studies, there were striking changes in trends of diagnostic nuclear medicine procedures in Tehran. This field is still evolving in the country, and this trend will further change with the introduction of positron emission tomography scanners in future.

Overview of ICRP Committee 3: protection in medicine

Committee 3 of the International Commission on Radiological Protection (ICRP) develops recommendations and guidance for protection of patients, staff, and the public against radiation exposure when ionising radiation is used for medical diagnosis, therapy, or biomedical research. This paper presents a summary of the work that Committee 3 has accomplished over the past few years, and also describes its current work. The most recent reports published by the Commission that relate to radiological protection in medicine are 'Radiological protection in cone beam computed tomography' (Publication 129), 'Radiation dose to patients from radiopharmaceuticals: a compendium of current information related to frequently used substances' (Publication 128, in cooperation with Committee 2), 'Radiological protection in ion beam radiotherapy' (Publication 127), 'Radiological protection in paediatric diagnostic and interventional radiology' (Publication 121), 'Radiological protection in cardiology' (Publication 120), and 'Radiological protection in fluoroscopically guided procedures outside the imaging department' (Publication 117). A new report on diagnostic reference levels in medical imaging will provide specific advice for interventional radiology, digital imaging, computed tomography, nuclear medicine, paediatrics, and hybrid (multi-modality) imaging procedures, and is expected to be published in 2016. Committee 3 is also working on guidance for occupational radiological protection in brachytherapy, and on guidance on occupational protection issues in interventional procedures, paying particular attention to the 2011 Commission's recommendations on the occupational dose limit for the lens of the eye (Publication 118). Other reports in preparation deal with justification, radiological protection in therapy with radiopharmaceuticals, radiological protection in medicine as related to individual radiosusceptibility, appropriate use of effective dose (in cooperation with other Committees), and guidance for healthcare practitioners on radiological and patient protection. Committee 3 has also suggested specific priorities for research on radiological protection in medicine to the Commission.

Diagnostic imaging and radiation exposure in inflammatory bowel disease

Diagnostic imaging plays a key role in the diagnosis and management of inflammatory bowel disease (IBD). However due to the relapsing nature of IBD, there is growing concern that IBD patients may be exposed to potentially harmful cumulative levels of ionising radiation in their lifetime, increasing malignant potential in a population already at risk. In this review we explore the proportion of IBD patients exposed to high cumulative radiation doses, the risk factors associated with higher radiation exposures, and we compare conventional diagnostic imaging with newer radiation-free imaging techniques used in the evaluation of patients with IBD. While computed tomography (CT) performs well as an imaging modality for IBD, the effective radiation dose is considerably higher than other abdominal imaging modalities. It is increasingly recognised that CT imaging remains responsible for the majority of diagnostic medical radiation to which IBD patients are exposed. Magnetic resonance imaging (MRI) and small intestine contrast enhanced ultrasonography (SICUS) have now emerged as suitable radiation-free alternatives to CT imaging, with comparable diagnostic accuracy. The routine use of MRI and SICUS for the clinical evaluation of patients with known or suspected small bowel Crohn’s disease is to be encouraged wherever possible. More provision is needed for out-of-hours radiation-free imaging modalities to reduce the need for CT.

Nuclear medicine imaging of posttraumatic osteomyelitis

Introduction

Early recognition of a possible infection and therefore a prompt and accurate diagnostic strategy is essential for a successful treatment of posttraumatic osteomyelitis (PTO). However, at this moment there is no single routine test available that can detect osteomyelitis beyond doubt and the performed diagnostic tests mostly depend on personal experience, available techniques and financial aspects. Nuclear medicine techniques focus on imaging pathophysiological changes which usually precede anatomical changes. Together with recent development in hybrid camera systems, leading to better spatial resolution and quantification possibilities, this provides new opportunities and possibilities for nuclear medicine modalities to play an important role in diagnosing PTO.

Aim

In this overview paper the techniques and available literature results for PTO are discussed for the three most commonly used nuclear medicine techniques: the three phase bone scan (with SPECT-CT), white blood cell scintigraphy (also called leukocyte scan) with SPECT-CT and ¹⁸F-fluorodeoxyglucose (FDG)-PET/CT. Emphasis is on how these techniques are able to answer the diagnostic questions from the clinicians (trauma and orthopaedic surgeons) and which technique should be used to answer a specific question. Furthermore, three illustrative cases from clinical practice are described.

Detection of bladder metabolic artifacts in (18)F-FDG PET imaging

Positron emission tomography using (18)F-fluorodeoxyglucose ((18)F-FDG-PET) is a widely used imaging modality in oncology. It enables significant functional information to be included in analyses of anatomical data provided by other image modalities. Although PET offers high sensitivity in detecting suspected malignant metabolism, (18)F-FDG uptake is not tumor-specific and can also be fixed in surrounding healthy tissue, which may consequently be mistaken as cancerous. PET analyses may be particularly hampered in pelvic-located cancers by the bladder׳s physiological uptake potentially obliterating the tumor uptake. In this paper, we propose a novel method for detecting (18)F-FDG bladder artifacts based on a multi-feature double-step classification approach. Using two manually defined seeds (tumor and bladder), the method consists of a semi-automated double-step clustering strategy that simultaneously takes into consideration standard uptake values (SUV) on PET, Hounsfield values on computed tomography (CT), and the distance to the seeds. This method was performed on 52 PET/CT images from patients treated for locally advanced cervical cancer. Manual delineations of the bladder on CT images were used in order to evaluate bladder uptake detection capability. Tumor preservation was evaluated using a manual segmentation of the tumor, with a threshold of 42% of the maximal uptake within the tumor. Robustness was assessed by randomly selecting different initial seeds. The classification averages were 0.94±0.09 for sensitivity, 0.98±0.01 specificity, and 0.98±0.01 accuracy. These results suggest that this method is able to detect most (18)F-FDG bladder metabolism artifacts while preserving tumor uptake, and could thus be used as a pre-processing step for further non-parasitized PET analyses.

Characterization of Large-Area SiPM Array for PET Applications

The performance of an 8 × 8 array of 6.0 × 6.0 mm² (active area) SiPMs was evaluated for PET applications using crystal arrays with different pitch sizes (3.4 mm, 1.5 mm, 1.35 mm and 1.2 mm) and custom designed five-channel front-end readout electronics (four channels for position information and one channel for timing information). The total area of this SiPM array is 57.4 × 57.4 mm², and the pitch size is 7.2 mm. It was fabricated using enhanced blue sensitivity SiPMs (MicroFB-60035-SMT) with peak spectral sensitivity at 420 nm. The performance of the SiPM array was characterized by measuring flood histogram decoding quality, energy resolution, timing resolution and saturation at several bias voltages (from 25.0 V to 30.0 V in 0.5 V intervals) and two different temperatures (5 °C and 20 °C). Results show that the best flood histogram was obtained at a bias voltage of 28.0 V and 5 °C and an array of polished LSO crystals with a pitch as small as 1.2 mm can be resolved. No saturation was observed up to a bias voltage of 29.5 V during the experiments, due to adequate light sharing between SiPMs. Energy resolution and timing resolution at 5 °C ranged from 12.7 ± 0.8% to 14.6 ± 1.4 % and 1.58 ± 0.13 ns to 2.50 ± 0.44 ns, for crystal array pitch sizes of 3.4 mm and 1.2 mm respectively. Superior flood histogram quality, energy resolution and timing resolution were obtained with larger crystal array pitch sizes and at lower temperature. Based on our findings, we conclude that this large-area SiPM array can serve as a suitable photodetector for high-resolution small-animal PET or dedicated human brain PET scanners.

Improvement of Left Ventricular Asynchrony: Cases of Functional Recovery After Revascularization

Assessment of regional contraction is considered important for diagnosis of coronary artery disease (CAD). We evaluated the synchronicity in regional contraction and assessed recovery from contraction insufficiency after revascularizations. Myocardial contraction parallel to the left ventricular (LV) wall was calculated using the method called quantification of segmental function by solving the Poisson equation (QSFP) from an electrocardiogram (ECG)-gated (99m)Tc-methoxyisobutylisonitrile (MIBI) single-photon emission computed tomographic (ECG-SPECT) image. Myocardial synchronous contraction was quantified using the synchronous contraction index (SCI), defined as the temporal correlation coefficient between LV volume and regional myocardial shortening. SCI was evaluated in 20 subjects, of whom 10 had CAD and 10 were normal. ECG-SPECT was performed in all the CAD patients before and after revascularization. In the 10 patients with CAD, the mean SCI before the revascularization was 62.7 ± 19.1%, which was significantly lower than that in the normal subjects (95.0 ± 3.0%, p = 0.002). After revascularization, a significant improvement in SCI was recorded (74.8 ± 11.1%, p = 0.01). The territorial improvement in SCI was 12.0 ± 15.6% (p = 0.03). Locations of abnormal cardiac contraction due to CAD were delineated by using QSFP. Therefore, SCI can be considered a valuable index for cardiac function assessment.

Aptamers as radiopharmaceuticals for nuclear imaging and therapy

Today, radiopharmaceuticals belong to the standard instrumentation of nuclear medicine, both in the context of diagnosis and therapy. The majority of radiopharmaceuticals consist of targeting biomolecules which are designed to interact with a disease-related molecular target. A plethora of targeting biomolecules of radiopharmaceuticals exists, including antibodies, antibody fragments, proteins, peptides and nucleic acids. Nucleic acids have some significant advantages relative to proteinaceous biomolecules in terms of size, production, modifications, possible targets and immunogenicity. In particular, aptamers (non-coding, synthetic, single-stranded DNA or RNA oligonucleotides) are of interest because they can bind a molecular target with high affinity and specificity. At present, few aptamers have been investigated preclinically for imaging and therapeutic applications. In this review, we describe the use of aptamers as targeting biomolecules of radiopharmaceuticals. We also discuss the chemical modifications which are needed to turn aptamers into valuable (radio-)pharmaceuticals, as well as the different radiolabeling strategies that can be used to radiolabel oligonucleotides and, in particular, aptamers.

Optimization of OSEM parameters in myocardial perfusion imaging reconstruction as a function of body mass index: a clinical approach

OBJECTIVE

The present study is aimed at contributing to identify the most appropriate OSEM parameters to generate myocardial perfusion imaging reconstructions with the best diagnostic quality, correlating them with patients' body mass index.

MATERIALS AND METHODS

The present study included 28 adult patients submitted to myocardial perfusion imaging in a public hospital. The OSEM method was utilized in the images reconstruction with six different combinations of iterations and subsets numbers. The images were analyzed by nuclear cardiology specialists taking their diagnostic value into consideration and indicating the most appropriate images in terms of diagnostic quality.

RESULTS

An overall scoring analysis demonstrated that the combination of four iterations and four subsets has generated the most appropriate images in terms of diagnostic quality for all the classes of body mass index; however, the role played by the combination of six iterations and four subsets is highlighted in relation to the higher body mass index classes.

CONCLUSION

The use of optimized parameters seems to play a relevant role in the generation of images with better diagnostic quality, ensuring the diagnosis and consequential appropriate and effective treatment for the patient.

EANM procedural guidelines for radionuclide myocardial perfusion imaging with SPECT and SPECT/CT: 2015 revision

Since the publication of the European Association of Nuclear Medicine (EANM) procedural guidelines for radionuclide myocardial perfusion imaging (MPI) in 2005, many small and some larger steps of progress have been made, improving MPI procedures. In this paper, the major changes from the updated 2015 procedural guidelines are highlighted, focusing on the important changes related to new instrumentation with improved image information and the possibility to reduce radiation exposure, which is further discussed in relation to the recent developments of new International Commission on Radiological Protection (ICRP) models. Introduction of the selective coronary vasodilator regadenoson and the use of coronary CT-contrast agents for hybrid imaging with SPECT/CT angiography are other important areas for nuclear cardiology that were not included in the previous guidelines. A large number of minor changes have been described in more detail in the fully revised version available at the EANM home page: http://eanm.org/publications/guidelines/2015_07_EANM_FINAL_myocardial_perfusion_guideline.pdf.

Future U.S. supply of Mo-99 production through fission based LEU/LEU technology

Coquí RadioPharmaceuticals Corp. (Coquí) has the goal of establishing a medical isotope production facility for securing a continuous domestic supply of the radioisotope molybdenum-99 for U.S. citizens. Coquí will use an LEU/LEU proven and implemented open pool, light-water, 10 MW, reactor design. The facility is being designed with twin reactors for reliability an on-site hot lab chemical processing and a waste conditioning area and a possible generator producing radio-chemistry lab. Coquí identified a 25 acre site adjacent to an existing industrial park in northern central Florida. This land was gifted and transferred to Coquí by the University of Florida Foundation. We are in the process of developing licensing documents related to the facility. The construction permit application for submission to the U.S. Nuclear Regulatory Commission is currently being prepared. Submission is scheduled for mid to late 2015. Community reaction to the proposed development has been positive. We expect to create 220 permanent jobs and we have an anticipated to be operational by 2020.

Preoperative iodine-123 meta-iodobenzylguanidine imaging is a novel predictor of left ventricular reverse remodeling during treatment with a left ventricular assist device

Although left ventricular reverse remodeling (LVRR) is accompanied with an improved clinical course during LV assist device (LVAD) treatment, its preoperative prediction remains uncertain. Twenty-seven heart failure patients with dilated cardiomyopathy were enrolled in this study. Patients underwent (123)I-meta-iodobenzylguanidine (MIBG) scintigraphy before LVAD implantation, and were monitored at our institute from 2010 to 2014. This study investigated the prognostic value of preoperative (123)I-MIBG parameters for predicting postoperative LVRR. Of the preoperative variables studied, including (123)I-MIBG data, washout rate (WR) ≤ 39 % was the only significant, independent predictor of LVRR (defined as LV ejection fraction ≥35 % at 6 months post-LVAD implant using univariate and multivariate logistic regression analyses) (p = 0.036, odds ratio [OR]:14.45). Improved exercise capacity and more frequent opening of the native aortic valve, as well as lower B-type natriuretic peptide plasma levels, were observed in LVRR patients (p < 0.05 for all), although β-blocker doses were comparable with those of non-LVRR patients throughout the 6-month LVAD support period. In conclusion, preoperative (123)I-MIBG is a novel predictive tool of LVRR during LVAD support.

New models for prediction of micronuclei formation in nuclear medicine department workers

Background

Ionizing radiation causes detrimental health effects such as cancer and genetic damage. The study aim was to determine predictors for micronuclei (MN) occurrence and frequency in peripheral blood lymphocytes of health workers professionally exposed to radiation.

Methods

Health workers, age matched, selected for the study on regular check-ups, were divided according to the radiation exposure. The exposed group involved nuclear medicine department employees (54) and the control group comprised workers from other departments (36). Data about workers characteristics and habits, received annual doses (AD), total years of service (TYS) and exposed years of service (EYS) were taken from each subject. Blood samples were taken and micronuclei (MN) number in peripheral blood lymphocytes was calculated using CBMN assay according to standard protocols.

Results

Most workers were female, technicians, with mean age of 45.67 years and EYS about 15 years. Health workers exposed to radiation had significantly more MN than controls (p = 0.001). Female gender, older age, higher received annual doses, longer EYS and TYS increased the MN number. Technicians and laboratory workers have higher risk for MN occurrence. Significant predictors of MN formation according to constructed model were workers age, sex, AD and EYS. One EYS year increases MN frequency 1.017 times, while receiving 0.1 mSy raises MN frequency by 26 %. EYS accurately predicts 86.30 % of MN frequencies and AD 64.60 %.

Conclusions

The model, developed for the first time in this study, showed that received annual doses and duration of exposure to radiation can be used for prediction of MN numbers.

Medical Physics: Forming and testing solutions to clinical problems

According to the European Federation of Organizations for Medical Physics (EFOMP) policy statement No. 13, "The rapid advance in the use of highly sophisticated equipment and procedures in the medical field increasingly depends on information and communication technology. In spite of the fact that the safety and quality of such technology is vigorously tested before it is placed on the market, it often turns out that the safety and quality is not sufficient when used under hospital working conditions. To improve safety and quality for patient and users, additional safeguards and related monitoring, as well as measures to enhance quality, are required. Furthermore a large number of accidents and incidents happen every year in hospitals and as a consequence a number of patients die or are injured. Medical Physicists are well positioned to contribute towards preventing these kinds of events". The newest developments related to this increasingly important medical speciality were presented during the 8th European Conference of Medical Physics 2014 which was held in Athens, 11-13 September 2014 and hosted by the Hellenic Association of Medical Physicists (HAMP) in collaboration with the EFOMP and are summarized in this issue.

Freeware for reporting radiation dosimetry following the administration of radiopharmaceuticals

This work describes the development of a software application for reporting patient radiation dosimetry following radiopharmaceutical administration. The resulting report may be included within the patient's medical records. The application was developed in the Visual Basic programming language. The dosimetric calculations are based on the values given by the International Commission on Radiological Protection (ICRP). The software is available in both Spanish and English and can be downloaded at no cost from www.radiopharmacy.net.

Overview of ICRP Committee 3 'Protection in Medicine'

According to the 2011-2017 strategic plan, Committee 3 develops recommendations and guidance for protection of patients, staff, and the public against radiation exposure when ionising radiation is used for medical diagnosis, therapy, or biomedical research. This paper presents an overview of the work that Committee 3 has accomplished in recent years and describes its current work. The International Commission on Radiological Protection reports dealing with radiological protection in medicine from 2000 to the present cover topics on education and training in radiological protection; preventing accidental exposures in radiation therapy; doses to patients from radiopharmaceuticals; radiation safety aspects of brachytherapy; release of patients after therapy with unsealed radionuclides; and managing radiation dose in interventional radiology, digital radiology, computed tomography, paediatrics, cardiology, and other medical specialties. Current work deals with radiological protection in ion beam therapy, occupational protection in brachytherapy, justification in imaging, radiological protection in cone-beam computed tomography, occupational protection in interventional procedures, diagnostic reference levels for diagnostic and interventional imaging, and an update of an earlier publication on doses to patients and staff from radiopharmaceuticals. Committee 3 is also involved in preparation of a document on effective dose and its use in medicine.

Radiological Evaluation of Abdominal Endovascular Aortic Aneurysm Repair

Endovascular aortic aneurysm repair (EVAR) is an alternative to open surgical repair of aortic aneurysms offering lower perioperative mortality and morbidity. As experience increases, clinicians are undertaking complex repairs with hostile aortic anatomy using branched or fenestrated devices or extra components such as chimneys to ensure perfusion to visceral branch vessels whilst excluding the aneurysm. Defining the success of EVAR depends on both clinical and radiographic criteria, but ultimately depends on complete exclusion of the aneurysm from the circulation. Aortic stent grafts are monitored using a combination of imaging modalities including computed tomography angiography (CTA), ultrasonography, magnetic resonance imaging, plain films, and nuclear medicine studies. This article describes when and how to evaluate aortic stent grafts using each of these modalities along with the characteristic features of several of the main stent grafts currently used in clinical practice. The commonly encountered complications from EVAR are also discussed and how they can be detected using each imaging modality. As the radiation burden from serial follow up CTA imaging is now becoming a concern, different follow-up imaging strategies are proposed depending on the complexity of the repair and based on the relative merits and disadvantages of each imaging modality.

A Monte Carlo approach to small-scale dosimetry of solid tumour microvasculature for nuclear medicine therapies with (223)Ra-, (131)I-, (177)Lu- and (111)In-labelled radiopharmaceuticals

The small-scale dosimetry of radionuclides in solid-tumours is directly related to the intra-tumoral distribution of the administered radiopharmaceutical, which is affected by its egress from the vasculature and dispersion within the tumour. The aim of the present study was to evaluate the combined dosimetric effects of radiopharmaceutical distribution and range of the emitted radiation in a model of tumour microvasculature. We developed a computational model of solid-tumour microenvironment around a blood capillary vessel, and we simulated the transport of radiation emitted by (223)Ra, (111)In, (131)I and (177)Lu using the GEANT4 Monte Carlo. For each nuclide, several models of radiopharmaceutical dispersion throughout the capillary vessel were considered. Radial dose profiles around the capillary vessel, the Initial Radioactivity (IR) necessary to deposit 100 Gy of dose at the edge of the viable tumour-cell region, the Endothelial Cell Mean Dose (ECMD) and the Tumour Edge Mean Dose (TEMD), i.e. the mean dose imparted at the 250-μm layer of tissue, were computed. The results for beta and Auger emitters demonstrate that the photon dose is about three to four orders of magnitude lower than that deposited by electrons. For (223)Ra, the beta emissions of its progeny deliver a dose about three orders of magnitude lower than that delivered by the alpha emissions. Such results may help to characterize the dose inhomogeneities in solid tumour therapies with radiopharmaceuticals, taking into account the interplay between drug distribution from vasculature and range of ionizing radiations.

Positron emission tomography in spinal infections

Magnetic resonance imaging is the imaging method of choice for diagnosing infection of the spine in unoperated cases. 2-[(18)F]-fluoro-2deoxy-d-glucose positron emission tomography/computed tomography study is recommended to distinguish between spinal infection and common Modic change in patients with metallic implants and prosthetic replacements and for differentiating tuberculous from pyogenic spondylitis in ambiguous cases, reflecting the activity of the infection. Also, it seems to have a strong clinical impact in more than half of patients with infectious spondylitis, while it is superior to other imaging techniques in revealing residual disease after treatment and early response to therapy. New tracers as well as new hybrid modalities are under investigation.

Application for internal dosimetry using biokinetic distribution of photons based on nuclear medicine images

OBJECTIVE

This article presents a way to obtain estimates of dose in patients submitted to radiotherapy with basis on the analysis of regions of interest on nuclear medicine images.

MATERIALS AND METHODS

A software called DoRadIo (Dosimetria das Radiações Ionizantes [Ionizing Radiation Dosimetry]) was developed to receive information about source organs and target organs, generating graphical and numerical results. The nuclear medicine images utilized in the present study were obtained from catalogs provided by medical physicists. The simulations were performed with computational exposure models consisting of voxel phantoms coupled with the Monte Carlo EGSnrc code. The software was developed with the Microsoft Visual Studio 2010 Service Pack and the project template Windows Presentation Foundation for C# programming language.

RESULTS

With the mentioned tools, the authors obtained the file for optimization of Monte Carlo simulations using the EGSnrc; organization and compaction of dosimetry results with all radioactive sources; selection of regions of interest; evaluation of grayscale intensity in regions of interest; the file of weighted sources; and, finally, all the charts and numerical results.

CONCLUSION

The user interface may be adapted for use in clinical nuclear medicine as a computer-aided tool to estimate the administered activity.

SUS in nuclear medicine in Brazil: analysis and comparison of data provided by Datasus and CNEN

Objective

To investigate the outpatient access to nuclear medicine procedures by means of the Brazilian Unified Health System (SUS), analyzing the correspondence between data provided by this system and those from Comissão Nacional de Energia Nuclear (CNEN) (National Commission of Nuclear Energy).

Materials and Methods

Data provided by Datasus regarding number of scintillation chambers, outpatient procedures performed from 2008 to 2012, administrative responsibility for such procedures, type of service providers and outsourced services were retrieved and evaluated. Also, such data were compared with those from institutions certified by CNEN.

Results

The present study demonstrated that the system still lacks maturity in terms of correct data input, particularly regarding equipment available. It was possible to list the most common procedures and check the growth of the specialty along the study period. Private centers are responsible for most of the procedures covered and reimbursed by SUS. However, many healthcare facilities are not certified by CNEN.

Conclusion

Datasus provides relevant data for analysis as done in the present study, although some issues still require attention. The present study has quantitatively depicted the Brazilian reality regarding access to nuclear medicine procedures offered by/for SUS.

Knowledge about the availability of the pharmacist in the Nuclear Medicine Department: A questionnaire-based study among health-care professionals

OBJECTIVE

The objective of this study was to analyze the knowledge about the availability of the pharmacist in the nuclear medicine department among health-care professionals through a prospective cohort study.

METHODS

A total of 741 health-care professionals participated in the study by answering 10 simple questions about the role of the pharmacist in the nuclear medicine department and the availability of pharmacist in the nuclear medicine department. An online questionnaire system was used to conduct the study, and participants were invited to participate through personal communications and by promoting the study through social websites including Facebook, LinkedIn and Google (including Gmail and Google+). The study was conducted between April 2013 and March 2014 using the http://www.freeonlinesurveys.com/Webserver. Finally, the data provided by 621 participants was analyzed. Group frequency analysis was performed using Statistical Package for the Social Sciences (SPSS) version 16 (SPSS Inc. USA).

RESULTS

The participants were from Malaysia, India, Pakistan, Sri Lanka, Bangladesh, UAE and Nepal. In total, 312 (50.2%) female health-care professionals and 309 (49.8%) male health-care professionals participated in the study. Of the 621 participants, 390 were working in hospitals, and 231 were not working in hospitals. Of the participants who were working in hospitals, 57.6% were pharmacists. The proportion of study participants who were aware of nuclear pharmacists was 55.39%. Awareness about the role of the pharmacist in nuclear medicine was poor.

CONCLUSION

The role of the pharmacist in a nuclear medicine unit needs to be highlighted and promoted among health-care professionals and hence that the nuclear medicine team can provide better pharmaceutical care.

Effective dose to adult patients from 338 radiopharmaceuticals estimated using ICRP biokinetic data, ICRP/ICRU computational reference phantoms and ICRP 2007 tissue weighting factors

BACKGROUND

Effective dose represents the potential risk to a population of stochastic effects of ionizing radiation (mainly lethal cancer). In recent years, there have been a number of revisions and updates influencing the way to estimate the effective dose. The aim of this work was to recalculate the effective dose values for the 338 different radiopharmaceuticals previously published by the International Commission on Radiological Protection (ICRP).

METHOD

The new estimations are based on information on the cumulated activities per unit administered activity in various organs and tissues and for the various radiopharmaceuticals obtained from the ICRP publications 53, 80 and 106. The effective dose for adults was calculated using the new ICRP/International Commission on Radiation Units (ICRU) reference voxel phantoms and decay data from the ICRP publication 107. The ICRP human alimentary tract model has also been applied at the recalculations. The effective dose was calculated using the new tissue weighting factors from ICRP publications 103 and the prior factors from ICRP publication 60. The results of the new calculations were compared with the effective dose values published by the ICRP, which were generated with the Medical Internal Radiation Dose (MIRD) adult phantom and the tissue weighting factors from ICRP publication 60.

RESULTS

For 79% of the radiopharmaceuticals, the new calculations gave a lower effective dose per unit administered activity than earlier estimated. As a mean for all radiopharmaceuticals, the effective dose was 25% lower. The use of the new adult computational voxel phantoms has a larger impact on the change of effective doses than the change to new tissue weighting factors.

CONCLUSION

The use of the new computational voxel phantoms and the new weighting factors has generated new effective dose estimations. These are supposed to result in more realistic estimations of the radiation risk to a population undergoing nuclear medicine investigations than hitherto available values.

The contribution of medical physics to nuclear medicine: a physician's perspective

This paper is the second in a series of invited perspectives by four pioneers of nuclear medicine imaging and physics. A medical physicist and a nuclear medicine clinical specialist each take a backward look and a forward look at the contributions of physics to nuclear medicine. Here is a backward look from a nuclear medicine physician's perspective.

A computational framework for cancer response assessment based on oncological PET-CT scans

In this work we present a comprehensive computational framework to help in the clinical assessment of cancer response from a pair of time consecutive oncological PET-CT scans. In this scenario, the design and implementation of a supervised machine learning system to predict and quantify cancer progression or response conditions by introducing a novel feature set that models the underlying clinical context is described. Performance results in 100 clinical cases (corresponding to 200 whole body PET-CT scans) in comparing expert-based visual analysis and classifier decision making show up to 70% accuracy within a completely automatic pipeline and 90% accuracy when providing the system with expert-guided PET tumor segmentation masks.

U-SPECT-BioFluo: an integrated radionuclide, bioluminescence, and fluorescence imaging platform

Background

In vivo bioluminescence, fluorescence, and single-photon emission computed tomography (SPECT) imaging provide complementary information about biological processes. However, to date these signatures are evaluated separately on individual preclinical systems. In this paper, we introduce a fully integrated bioluminescence-fluorescence-SPECT platform. Next to an optimization in logistics and image fusion, this integration can help improve understanding of the optical imaging (OI) results.

Methods

An OI module was developed for a preclinical SPECT system (U-SPECT, MILabs, Utrecht, the Netherlands). The applicability of the module for bioluminescence and fluorescence imaging was evaluated in both a phantom and in an in vivo setting using mice implanted with a 4 T1-luc + tumor. A combination of a fluorescent dye and radioactive moiety was used to directly relate the optical images of the module to the SPECT findings. Bioluminescence imaging (BLI) was compared to the localization of the fluorescence signal in the tumors.

Results

Both the phantom and in vivo mouse studies showed that superficial fluorescence signals could be imaged accurately. The SPECT and bioluminescence images could be used to place the fluorescence findings in perspective, e.g. by showing tracer accumulation in non-target organs such as the liver and kidneys (SPECT) and giving a semi-quantitative read-out for tumor spread (bioluminescence).

Conclusions

We developed a fully integrated multimodal platform that provides complementary registered imaging of bioluminescent, fluorescent, and SPECT signatures in a single scanning session with a single dose of anesthesia. In our view, integration of these modalities helps to improve data interpretation of optical findings in relation to radionuclide images.

Evolution of cardiac imaging according to the number of scientific articles in medical journals: a long and fruitful journey

The use of cardiac imaging techniques as a diagnostic method in the understanding of physiopathology, as well as in cardiology research has been one of the most important revolutions in the management of cardiac patients, our understanding of physiopathology, and basic research in almost all heart diseases. This article analyzes the literature on echocardiography, cardiovascular magnetic resonance imaging, computed tomography, and nuclear medicine during the last 60 years and provides an overview of how these techniques have developed and how their introduction into daily practice has changed attitudes among cardiologists. The literature not only shows that the implementation of these techniques in daily practice requires an immense amount of research and effort by many working groups throughout the scientific world, but also that techniques that once seemed promising may finally be discarded.

Low dose four-dimensional computerized tomography with volume rendering reconstruction for primary hyperparathyroidism: How I do it?

Modification of 4-dimensional computed tomography (4D-CT) technique with volume rendering reconstructions and significant dose reduction is a safe and accurate method of pre-operative localization for primary hyperparathyroidism. Modified low dose 4D-CT with volume rendering reconstructions provides precise preoperative localization and is associated with a significant reduction in radiation exposure compared to classic preoperative localizing techniques. It should be considered the preoperative localization study of choice for primary hyperparathyroidism.

Towards component-based validation of GATE: aspects of the coincidence processor

GATE is public domain software widely used for Monte Carlo simulation in emission tomography. Validations of GATE have primarily been performed on a whole-system basis, leaving the possibility that errors in one sub-system may be offset by errors in others. We assess the accuracy of the GATE PET coincidence generation sub-system in isolation, focusing on the options most closely modeling the majority of commercially available scanners. Independent coincidence generators were coded by teams at Toshiba Medical Research Unit (TMRU) and UC Davis. A model similar to the Siemens mCT scanner was created in GATE. Annihilation photons interacting with the detectors were recorded. Coincidences were generated using GATE, TMRU and UC Davis code and results compared to "ground truth" obtained from the history of the photon interactions. GATE was tested twice, once with every qualified single event opening a time window and initiating a coincidence check (the "multiple window method"), and once where a time window is opened and a coincidence check initiated only by the first single event to occur after the end of the prior time window (the "single window method"). True, scattered and random coincidences were compared. Noise equivalent count rates were also computed and compared. The TMRU and UC Davis coincidence generators agree well with ground truth. With GATE, reasonable accuracy can be obtained if the single window method option is chosen and random coincidences are estimated without use of the delayed coincidence option. However in this GATE version, other parameter combinations can result in significant errors.

Cysteine rhenium colloid: a novel radiocolloid for identifying sentinel lymph nodes in breast cancer surgery

BACKGROUND

Medical isotopes are required for sentinel node lymphoscintigraphy in breast cancer, but are in critical shortage. Our center uses a modification of the standard SC, called CRC, that has been shown to require less medical isotope for the same procedure. Our objective was to determine if there was a significant difference between SC and CRC in successful lymph node identification in breast cancer patients.

PATIENTS AND METHODS

This was a retrospective cohort study using prospectively-collected data on 1205 consecutive early, clinically node-negative breast cancer patients who underwent a SNB between 2002 and 2008 at 2 tertiary hospitals in Canada.

RESULTS

There was no difference in successful lymph node identification rate (P = .50) or in the mean number of positive nodes identified between the 2 colloids (P = .88). The CRC group had a significantly lower rate of delayed adverse events (4.91% vs. 0.59%, P < .0001) even after adjusting for whether axillary dissection occurred on the same day as the biopsy (adjusted odds ratio, 0.12; 95% confidence interval, 0.04-0.40; P = .001).

CONCLUSION

Our findings suggest that there is no significant difference between CRC and SC in detecting sentinel nodes; however, CRC uses less medical isotopes. In the current climate of critical shortages of medical radioisotopes, radiocolloids should be selected for use based on amount of radioisotope required.

Rheumatoid arthritis: Nuclear Medicine state-of-the-art imaging

Rheumatoid arthritis (RA) is an autoimmune disease, which is associated with systemic and chronic inflammation of the joints, resulting in synovitis and pannus formation. For several decades, the assessment of RA has been limited to conventional radiography, assisting in the diagnosis and monitoring of disease. Nevertheless, conventional radiography has poor sensitivity in the detection of the inflammatory process that happens in the initial stages of RA. In the past years, new drugs that significantly decrease the progression of RA have allowed a more efficient treatment. Nuclear Medicine provides functional assessment of physiological processes and therefore has significant potential for timely diagnosis and adequate follow-up of RA. Several single photon emission computed tomography (SPECT) and positron emission tomography (PET) radiopharmaceuticals have been developed and applied in this field. The use of hybrid imaging, which permits computed tomography (CT) and nuclear medicine data to be acquired and fused, has increased even more the diagnostic accuracy of Nuclear Medicine by providing anatomical localization in SPECT/CT and PET/CT studies. More recently, fusion of PET with magnetic resonance imaging (PET/MRI) was introduced in some centers and demonstrated great potential. In this article, we will review studies that have been published using Nuclear Medicine for RA and examine key topics in the area.

Musculoskeletal imaging: types and indications

Musculoskeletal imaging includes radiographs, computed tomography scans, bone scans, magnetic resonance imaging, and musculoskeletal ultrasonography. Each modality has its advantages and disadvantages. This article presents general guidelines regarding which imaging modality to order when evaluating patients with musculoskeletal complaints. However, it must be remembered that imaging is not meant to replace a thorough history and physical examination, but instead should be seen as a suite of methods to confirm suspected diagnoses.

Attenuated predictive power of a normal myocardial perfusion scan in young smokers

BACKGROUND

The negative predictive value of a normal myocardial perfusion image (MPI) for myocardial infarction or cardiac death is very high. However, it is unclear whether a normal MPI, reflecting non-compromised blood flow in the stable state, would have the same prognostic implications in smokers as in patients who do not smoke.

METHODS

The incidence of total mortality, cardiovascular mortality, and myocardial infarction was evaluated in 11,812 subjects (14.6% of whom were current smokers at the time of the study) with a normal MPI study and no past history of coronary artery disease during the period 1997 to 2008.

RESULTS

During an average follow-up of 72.4 ± 32.4 months the risk for an acute myocardial infarction in current smokers was approximately 50% higher than the corresponding risk in non-smokers, despite a younger average age. Cox proportional regression models show that current smoking was associated with an increased hazard rate for the composite endpoint below age 60 (HR=2.09, 95%CI 1.43-3.07, p<0.001), but not at older ages (HR=1.16, 95% CI 0.81-1.66, p=0.4).

CONCLUSIONS

In individuals below age 60, but not at older ages, current smoking is associated with increased short- and long-term risk of cardiac death and acute myocardial infarction even in subjects with a normal MPI.

Measurement of the half-life of ⁶⁸Ga

The half-life of the positron-emitter (68)Ga has been measured by following the decay rate with two systems based on ionization chamber and Ge detectors. The decay rate was measured for periods of time up to 10 half-lives. The combination of the 6 results obtained with both systems gives a value of T1/2=67.845(18) min, in good agreement with recommended data and with an uncertainty lower than any other previously reported value.

Clinical relevance of novel imaging technologies for sentinel lymph node identification and staging

The sentinel lymph node (SLN) concept has become a standard of care for patients with breast cancer and melanoma, yet its clinical application to other cancer types has been somewhat limited. This is mainly due to the reduced accuracy of conventional SLN mapping techniques (using blue dye and/or radiocolloids as lymphatic tracers) in cancer types where lymphatic drainage is more complex, and SLNs are within close proximity to other nodes or the tumour site. In recent years, many novel techniques for SLN mapping have been developed including fluorescence, x-ray, and magnetic resonant detection. Whilst each technique has its own advantages/disadvantages, the role of targeted contrast agents (for enhanced retention in the SLN, or for immunostaging) is increasing, and may represent the new standard for mapping the SLN in many solid organ tumours. This review article discusses current limitations of conventional techniques, limiting factors of nanoparticulate based contrast agents, and efforts to circumvent these limitations with modern tracer architecture.

A CMMI-based approach for medical software project life cycle study

In terms of medical techniques, Taiwan has gained international recognition in recent years. However, the medical information system industry in Taiwan is still at a developing stage compared with the software industries in other nations. In addition, systematic development processes are indispensable elements of software development. They can help developers increase their productivity and efficiency and also avoid unnecessary risks arising during the development process. Thus, this paper presents an application of Light-Weight Capability Maturity Model Integration (LW-CMMI) to Chang Gung Medical Research Project (CMRP) in the Nuclear medicine field. This application was intended to integrate user requirements, system design and testing of software development processes into three layers (Domain, Concept and Instance) model. Then, expressing in structural System Modeling Language (SysML) diagrams and converts part of the manual effort necessary for project management maintenance into computational effort, for example: (semi-) automatic delivery of traceability management. In this application, it supports establishing artifacts of “requirement specification document”, “project execution plan document”, “system design document” and “system test document”, and can deliver a prototype of lightweight project management tool on the Nuclear Medicine software project. The results of this application can be a reference for other medical institutions in developing medical information systems and support of project management to achieve the aim of patient safety.

Quantitative scintigraphic analysis of the apical seal in Thermafil/Topseal and RealSeal 1/Realseal filled root canals

AIM: To investigate the microleakage of two different root canal obturation systems, using the nuclear medicine approach.

METHODS: Twenty-six single-rooted extracted teeth were selected. The crowns were sectioned to obtain 15-mm long root segments and each tooth was prepared using rotary ProFile^® instruments. The roots were divided into 2 experimental groups using RealSeal 1 and RealSeal sealer or Thermafil and TopSeal sealer as well as two control groups. On the 7^th and the 28^th day the apices were submersed in a solution of ^99mTc-Pertechnetate during 3 h. The radioactivity was counted using a γ camera.

RESULTS: The present study showed that none of the root canal-filled teeth was leakage free. The statistical analyses were made using Kruskal-Wallis and statistical significance was assessed using α = 0.05. Although apical leakage measured in counts per minute (cpm) in the Thermafil/TopSeal group was lower than in the RealSeal/RealSeal group (363 916 ± 180 707.7 cpm vs 533 427 ± 414 020.6 cpm) on 7^th day and (1 678 200 ± 567 217.4 cpm vs 2 240 518 ± 383 356.7 cpm) on 28^th day, there was no statistical difference (P > 0.05). In the Thermafil/TopSeal group and RealSeal 1/RealSeal group it was found that over time, the number of counts increased between 7 d and 28 d (363 916 ± 180 707.7 cpm vs 1 678 200 ± 567 217.4 cpm) and (533 427 ± 414 020.6 cpm vs 2 240 518 ± 383 356.7 cpm), respectively, with statistically significant differences (Thermafil/TopSeal group, P = 0.015 and RealSeal 1/RealSeal group, P = 0.036).

CONCLUSION: Both carrier-based Realseal 1 and Thermafil techniques showed a similar sealing effect, but none of the materials was leakage free.

The effect of long-term left ventricular assist device support on myocardial sympathetic activity in patients with non-ischaemic dilated cardiomyopathy

AIMS

Dilated cardiomyopathy (DCM) patients have abundant levels of norepinephrine secondary to failure of the norepinephrine transporter uptake mechanism. Little is known about the effects of an LV assist device (LVAD) on cardiac sympathetic innervations and norepinephrine transporter dysfunction. This study examines the effects of continuous-flow HeartMate II LVAD on cardiac sympathetic innervations using [(123)I]metaiodobenzylguanidine ([(123)I]MIBG) nuclear imaging.

METHODS AND RESULTS

After injecting 431 ± 21 MBq of [(123)I]MIBG, planar scintigraphy was performed at 15 min and 4 h in 14 consecutive non-diabetic non-ischaemic DCM patients. Scans were executed early post-LVAD implantation (T1) and prior to either device explantation for myocardial recovery or transplant listing (T2). [(123)I]MIBG measured parameters included early and delayed heart-mediastinum (H/M) ratios and washout rate (W/O). Catecholamine levels were measured using liquid chromatography-mass spectrometry. Following 208.4 ± 85.5 days of LVAD support, both early and delayed H/M ratios increased by 42.1% (P < 0.001) and 54.7% (P < 0.001), respectively. The W/O rate decreased by 46% (P = 0.003). Plasma norepinephrine, epinephrine, and dopamine decreased significantly in correlation with [(123)I]MIBG parameters. Ten patients had recovered and had their device explanted as they had demonstrated a higher percentage change in delayed H/M ratio, W/O rate, and norepinephrine levels. Linear regression analysis revealed a strong correlation between percentage changes in both norepinephrine and epinephrine and myocardial recovery.

CONCLUSION

Combination therapy with LVAD and drug resulted in enhancement of [(123)I]MIBG uptake in DCM patients.

Hospital nuclear pharmacy survey: preliminary aspects in Brazil

Radiopharmaceuticals are special drugs that in the composition preserve one or more radionuclides which can be used as diagnostic or therapeutic tools in Nuclear Medicine Units. This study evaluated hospitals and clinics which have nuclear medicines services at the city of Rio de Janeiro from August to November 2010. The data were obtained through a longitudinal research. The results showed that most of the hospitals (>80%) did not have pharmacist and all them (100%) considered that a pharmacist in the nuclear pharmacy is not required.

Staging and monitoring in the treatment of lymphomas

Lymphoma staging systematically includes a CT scan of the cervical, thoracic and abdominopelvic regions. PET is indicated in diffuse large B cell lymphomas (DLBCL) and Hodgkin's disease. Evaluation of the response to treatment is based on Cheson's 1999 morphological criteria, which have been replaced by the 2007 IWC criteria, which combine morphological and metabolic responses. CT and FDG-PET are complementary in characterizing residual masses: if negative, a PET scan indicates the absence of residual disease, if positive; it directs a CT-guided biopsy to obtain the histological evidence. Monitoring clinical features and laboratory values is primordial following treatment. Imaging is performed as a second intention for investigating a relapse, if necessary associated with a PET scan. Multimodal imaging implies multidisciplinary consultation between haematologists, imaging specialists and histopathologists.

Comparison of curricula in radiation technology in the field of radiotherapy in selected European Union countries

BACKGROUND

Radiation technology is a discipline of medical science which deals with diagnostics, imaging and radiotherapy, that is treatment by ionizing radiation.

AIM

To present and compare the existing curricula of radiation technology in selected EU countries.

MATERIALS AND METHODS

The research work done for the purpose of the comparative analysis was based on the methods of diagnostic test and document analysis.

RESULTS

The comparison of curricula in selected countries, namely Austria, France, the Netherlands and Poland, showed that admission criteria to radiation technology courses are varied and depend on regulations of respective Ministries of Health. The most restrictive conditions, including written tests in biology, chemistry and physics, and psychometric test, are those in France. Contents of basic and specialist subject groups are very similar in all the countries. The difference is in the number of ECT points assigned to particular subjects and the number of course hours offered. The longest practical training is provided in the Netherlands and the shortest one in Poland. The duration of studies in the Netherlands is 4 years, while in Poland it is 3 years. Austria is the only country to offer extra practical training in quality management.

CONCLUSION

Graduates in the compared EU countries have similar level of qualifications in the fields of operation of radiological equipment, radiotherapy, nuclear medicine, foreign language and specialist terminology in the field of medical and physical sciences, general knowledge of medical and physical sciences, and detailed knowledge of radiation technology.