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Bzowski P, Borys D, Gorczewski K, Chmura A, Daszewska K, Gorczewska I, Kastelik-Hryniewiecka A, Szydło M, d'Amico A, Sokół M. Efficiency of 124I radioisotope production from natural and enriched tellurium dioxide using 124Te(p,xn) 124I reaction. EJNMMI Phys 2022; 9:41. [PMID: 35666325 PMCID: PMC9170869 DOI: 10.1186/s40658-022-00471-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Accepted: 05/19/2022] [Indexed: 11/23/2022] Open
Abstract
Background 124I Iodine (T\documentclass[12pt]{minimal}
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\begin{document}$$_{1/2}$$\end{document}1/2 = 4.18 d) is the only long-life positron emitter radioisotope of iodine that may be used for both imaging and therapy as well as for 131I dosimetry. Its physical characteristics permits taking advantages of the higher Positron Emission Tomography (PET) image quality, whereas the availability of new molecules to be targeted with 124I makes it a novel innovative radiotracer probe for a specific molecular targeting. Results In this study Monte Carlo and SRIM/TRIM modelling was applied to predict the nuclear parameters of the 124I production process in a small medical cyclotron IBA 18/9 Cyclone. The simulation production yields for 124I and the polluting radioisotopes were calculated for the natural and enriched 124TeO2 + Al2O3 solid targets irradiated with 14.8 MeV protons. The proton beam was degraded energetically from 18 MeV with 0.2 mm Havar foil. The 124Te(p,xn)124I reactions were taken into account in the simulations. The optimal thickness of the target material was calculated using the SRIM/TRIM and Geant4 codes. The results of the simulations were compared with the experimental data obtained for the natural TeO2 +Al2O3 target. The dry distillation technique of the 124-iodine was applied. Conclusions The experimental efficiency for the natural Te target was better than 41% with an average thick target (>0.8 mm) yield of 1.32 MBq/μAh. Joining the Monte Carlo and experimental approaches makes it possible to optimize the methodology for the 124I production from the expensive Te enriched targets.
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Affiliation(s)
- Paweł Bzowski
- Department of Nuclear Medicine and Endocrine Oncology, PET Diagnostics Unit, Maria Skłodowska-Curie National Research Institute of Oncology, Gliwice Branch, Gliwice, Poland.,Department of Systems Biology and Engineering, Silesian University of Technology, Akademicka 16, 44-100, Gliwice, Poland.,Biotechnology Center, Silesian University of Technology, Krzywoustego 8, 44-100, Gliwice, Poland
| | - Damian Borys
- Department of Nuclear Medicine and Endocrine Oncology, PET Diagnostics Unit, Maria Skłodowska-Curie National Research Institute of Oncology, Gliwice Branch, Gliwice, Poland. .,Department of Systems Biology and Engineering, Silesian University of Technology, Akademicka 16, 44-100, Gliwice, Poland. .,Biotechnology Center, Silesian University of Technology, Krzywoustego 8, 44-100, Gliwice, Poland.
| | - Kamil Gorczewski
- Department of Nuclear Medicine and Endocrine Oncology, PET Diagnostics Unit, Maria Skłodowska-Curie National Research Institute of Oncology, Gliwice Branch, Gliwice, Poland
| | - Agnieszka Chmura
- Radiopharmacy and Preclinical PET Imaging Unit, Maria Skłodowska-Curie National Research Institute of Oncology, Gliwice Branch, Gliwice, Poland
| | - Kinga Daszewska
- Radiopharmacy and Preclinical PET Imaging Unit, Maria Skłodowska-Curie National Research Institute of Oncology, Gliwice Branch, Gliwice, Poland
| | - Izabela Gorczewska
- Department of Nuclear Medicine and Endocrine Oncology, PET Diagnostics Unit, Maria Skłodowska-Curie National Research Institute of Oncology, Gliwice Branch, Gliwice, Poland
| | - Anna Kastelik-Hryniewiecka
- Radiopharmacy and Preclinical PET Imaging Unit, Maria Skłodowska-Curie National Research Institute of Oncology, Gliwice Branch, Gliwice, Poland
| | - Marcin Szydło
- Radiopharmacy and Preclinical PET Imaging Unit, Maria Skłodowska-Curie National Research Institute of Oncology, Gliwice Branch, Gliwice, Poland
| | - Andrea d'Amico
- Department of Nuclear Medicine and Endocrine Oncology, PET Diagnostics Unit, Maria Skłodowska-Curie National Research Institute of Oncology, Gliwice Branch, Gliwice, Poland
| | - Maria Sokół
- Department of Medical Physics, Maria Skłodowska-Curie National Research Institute of Oncology, Gliwice Branch, Gliwice, Poland
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[Anticipating Criteria for Discharge after Lu-177-PSMA Treatment - Discussion of Several Scenarios]. Nuklearmedizin 2022; 61:111-119. [PMID: 35170005 DOI: 10.1055/a-1697-8126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
AIM The aim is to add a pragmatic contribution to the discussion of an algorithm to discharge patients treated with Lu-177-PSMA under the aspect of radiation protection. This also may be applied to therapies with other radioactive tracers in the future. MATERIAL AND METHODS 478 cycles of Lu-177-PSMA-617 (140 patients) were analyzed. The remaining activity in the patient and the dose rate were correlated. From frequent intratherapeutic measurements (biexponential fit) scenarios for discharging patients are deduced. RESULTS Thirty-four per cent of all patients treated with Lu-177-PSMA received 3 to 5 cycles per calendar year. The dose limit of 1 mSv per calendar year (German Law) at a distance of 2 m from the patient would be exceeded in 10 % and 15 % of the treated patients if discharged 72 hours after treatment given 3 and 4 cycles per calendar year, respectively. Mean specific dose rate was 0.00462µSv/(h MBq) at a distance of 1 m. A universal correlation between dose rate and the remaining activity in the patient could not be found. CONCLUSION The multi cycle concept of the therapies with Lu-177 PSMA has to be taken into account prospectively when discharging the patients. Given the physical half-life of Lu-177 an anticipation of 4 treatment cycles per calendar year leads to a clearly arranged, conservative rule.
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Happel C, Kranert WT, Gröner D, Baumgarten J, Halstenberg J, Bockisch B, Sabet A, Grünwald F. Focus on radioiodine-131 biokinetics: the influence of methylprednisolone on intratherapeutic effective half-life of 131I during radioiodine therapy of Graves' disease. Endocrine 2021; 73:125-130. [PMID: 33439464 PMCID: PMC8211592 DOI: 10.1007/s12020-020-02593-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Accepted: 12/15/2020] [Indexed: 12/13/2022]
Abstract
AIM Radioiodine therapy (RIT) may trigger the development of Graves' ophthalmopathy (GO) or exacerbate pre-existing subclinical GO. Therefore, glucocorticoid administration is recommended for patients with pre-existing GO. Aim of this study was to analyze the influence of glucocorticoid therapy with methylprednisolone on intratherapeutic effective half-life (EHL) of radioiodine-131 in patients with Graves' disease (GD) as recent studies showed an effect for prednisolone. METHODS In a retrospective study, 264 patients with GD who underwent RIT without any additional antithyroid medication were evaluated. Intrathyroidal EHL was determined pre- and intratherapeutically. Patients with co-existing GO (n = 43) received methylprednisolone according to a fixed scheme starting 1 day prior to RIT, patients without GO (n = 221) did not receive any protective glucocorticoid medication. The ratios of EHL during RIT and during radioiodine uptake test (RIUT) were compared. RESULTS Patients receiving methylprednisolone showed a slight decrease of the mean EHL from 5.63 d (RIUT) to 5.39 d (RIT) (p > 0.05). A comparable result was obtained in patients without glucocorticoids (5.71 d (RIUT) to 5.47 d (RIT); p > 0.05). The ratios of the EHL between RIT and RIUT failed to show a significant difference between the two groups. EHL is therefore not significantly influenced by an additional protective treatment with methylprednisolone. CONCLUSIONS In the present study a decreased intrathyroidal EHL under glucocorticoid medication with methylprednisolone could not be detected. Therefore, co-medication with methylprednisolone in patients with GO may be preferred to avoid an intratherapeutic decrease of EHL by accompanying protective glucocorticoides.
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Affiliation(s)
- C Happel
- Department of Nuclear Medicine, Goethe University Frankfurt, University Hospital, Theodor Stern Kai 7, D-60590, Frankfurt/Main, Germany.
| | - W T Kranert
- Department of Nuclear Medicine, Goethe University Frankfurt, University Hospital, Theodor Stern Kai 7, D-60590, Frankfurt/Main, Germany
| | - D Gröner
- Department of Nuclear Medicine, Goethe University Frankfurt, University Hospital, Theodor Stern Kai 7, D-60590, Frankfurt/Main, Germany
| | - J Baumgarten
- Department of Nuclear Medicine, Goethe University Frankfurt, University Hospital, Theodor Stern Kai 7, D-60590, Frankfurt/Main, Germany
| | - J Halstenberg
- Department of Anesthesiology, Alice-Hospital, Darmstadt, Germany
| | - B Bockisch
- Department of Nuclear Medicine, Goethe University Frankfurt, University Hospital, Theodor Stern Kai 7, D-60590, Frankfurt/Main, Germany
| | - A Sabet
- Department of Nuclear Medicine, Goethe University Frankfurt, University Hospital, Theodor Stern Kai 7, D-60590, Frankfurt/Main, Germany
| | - F Grünwald
- Department of Nuclear Medicine, Goethe University Frankfurt, University Hospital, Theodor Stern Kai 7, D-60590, Frankfurt/Main, Germany
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Clerc J. Radioiodine therapy of thyroid autonomy. THE QUARTERLY JOURNAL OF NUCLEAR MEDICINE AND MOLECULAR IMAGING : OFFICIAL PUBLICATION OF THE ITALIAN ASSOCIATION OF NUCLEAR MEDICINE (AIMN) [AND] THE INTERNATIONAL ASSOCIATION OF RADIOPHARMACOLOGY (IAR), [AND] SECTION OF THE SOCIETY OF... 2021; 65:138-156. [PMID: 33565845 DOI: 10.23736/s1824-4785.21.03340-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Radioiodine therapy (RIT) of thyroid functional autonomy (TFA) is rapidly evolving, though it has been recognized for decades as a very effective treatment of toxic nodular varieties. Indeed, TFA is a frequent cause of persistent subclinical hyperthyroidism, which should be regarded as a new metabolic syndrome, with well-established adverse cardio-vascular consequences. Sensitive TSH assays and multiparametric ultrasounds are not accurate enough to reliably diagnose TFA and identify its main variants, unifocal, multifocal (UFA/MFA) and disseminated autonomy (DISA). Modern diagnostic tools are extensively presented and rely upon Thyroid Scan imaging and quantification. A new relationship allows predicting at baseline, an excess of 123I uptake as compared to the TSH stimulation in compensated TFA. Suppressed TS are useful with either isotope, otherwise. Diagnosis of the DISA variant is presented as compared to Graves' disease. Dosimetry has some specificity in TFA work-up. Indeed, the spatial distribution of the dose is as important as the mean value itself and can be eventually controlled by adjusting the TSH level with the smart use of LT3 or antithyroid drug therapy (ATD). A review of the different ways to determine the target mass from anatomical to functional approaches is presented. Main clinical and dosimetric published results of RIT are summarized according to clinical goals. Endogenous TSH stimulation using an ATD preparation has promising results in reducing big autonomously functioning goiters. Finally, we report preliminary successful results of preventive RIT using short term LT3 suppression in compensated TFA, with low administered activities and low rate of hypothyroidism.
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Affiliation(s)
- Jérôme Clerc
- Department of Nuclear Medicine, Cochin Hospital, DMU Imagina, Paris University, Paris, France -
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De la Vieja A, Riesco-Eizaguirre G. Radio-Iodide Treatment: From Molecular Aspects to the Clinical View. Cancers (Basel) 2021; 13:cancers13050995. [PMID: 33673669 PMCID: PMC7957486 DOI: 10.3390/cancers13050995] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Revised: 02/21/2021] [Accepted: 02/22/2021] [Indexed: 02/06/2023] Open
Abstract
Simple Summary This year marks the 80th commemoration of the first time that radio-iodide treatment (RAI) was used. RAI is one of the most effective targeted internal radiation anticancer therapies ever devised and it has been used for many decades, however, a thorough understanding of the underlying molecular mechanisms involved could greatly improve the success of this therapy. This is an in-depth innovative review focusing on the molecular mechanisms underlying radio-iodide therapy in thyroid cancer and how the alteration of these mechanisms affects the results in the clinic. Abstract Thyroid radio-iodide therapy (RAI) is one of the oldest known and used targeted therapies. In thyroid cancer, it has been used for more than eight decades and is still being used to improve thyroid tumor treatment to eliminate remnants after thyroid surgery, and tumor metastases. Knowledge at the molecular level of the genes/proteins involved in the process has led to improvements in therapy, both from the point of view of when, how much, and how to use the therapy according to tumor type. The effectiveness of this therapy has spread into other types of targeted therapies, and this has made sodium/iodide symporter (NIS) one of the favorite theragnostic tools. Here we focus on describing the molecular mechanisms involved in radio-iodide therapy and how the alteration of these mechanisms in thyroid tumor progression affects the diagnosis and results of therapy in the clinic. We analyze basic questions when facing treatment, such as: (1) how the incorporation of radioiodine in normal, tumor, and metastatic thyroid cells occurs and how it is regulated; (2) the pros and cons of thyroid hormonal deprivation vs. recombinant human Thyroid Stimulating Hormone (rhTSH) in radioiodine residence time, treatment efficacy, thyroglobulin levels and organification, and its influence on diagnostic imaging tests and metastasis treatment; and (3) the effect of stunning and the possible causes. We discuss the possible incorporation of massive sequencing data into clinical practice, and we conclude with a socioeconomical and clinical vision of the above aspects.
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Affiliation(s)
- Antonio De la Vieja
- Endocrine Tumors Unit (Unidad Funcional de Investigación en Enfermedades Endocrinas (UFIEC), Instituto de Salud Carlos III (ISCIII), Majadahonda, 28220 Madrid, Spain
- Centro de Investigación Biomédica en Red de Cáncer (CIBERONC), Instituto de Salud Carlos III (ISCIII), 28029 Madrid, Spain;
- Correspondence: ; Tel.: +34-918223270
| | - Garcilaso Riesco-Eizaguirre
- Departamento de Endocrinología y Nutrición, Hospital Universitario de Móstoles, 28935 Madrid, Spain
- Molecular Endocrinology Group, Faculty of Medicine, Universidad Francisco de Vitoria, 28223 Madrid, Spain
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Happel C, Borowski M, Kamp A, Rudolf F, Wicke JH, Gröner D, Grünwald F, Fiebich M. [Prenatal Radiation Exposure in Nuclear Medicine]. Nuklearmedizin 2021; 60:233-239. [PMID: 33572000 DOI: 10.1055/a-1365-7954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Radiation exposure from nuclear medicine procedures during pregnancy may cause uncertainty among patients and medical professionals. In 2019, the German Society of Medical Physics (DGMP) and the German Society of Radiology (DRG) published a fully revised version of the report "Prenatal Radiation Exposure Arising from Medical Indication, Dose Calculation, Conclusions for Physicians and Pregnant Women". This report offers a basis for dose calculation and determination of radiation exposure to the unborn. This review summarizes the most notable general adaptions made in the report's newest version and specifically points out the changes relevant to the field of nuclear medicine.The DGMP report provides physicians and medical physicists with means to estimate prenatal radiation exposure to the unborn conservatively, in a prompt and comprehensible approach. The rapidly evolving field of indications in nuclear medicine and radiology gave rise to the initiative of profoundly revising the previous version of the report from 2002. It now accounts for the extended range of devices, nuclear medicine hybrid imaging and radiotracers recently introduced. The most extensive change is a shift from the former 3-step-concept for the dose calculation to a 2-step-concept. In diagnostic nuclear medicine the first step comprises a conservative approximation of radiation exposure on the basis of current diagnostic reference levels (DRL). If exposure is assessed to be below 20 mSv, risk to the unborn child is sufficiently low, no further approaches are considered necessary. If calculated doses exceed 20 mSv, for diagnostic studies without existing DRL or in case of radionuclide therapies step 2 requires dose calculation based on administered activity and the stage of pregnancy.The DGMP report on prenatal radiation exposure offers valuable guidance for physicians and medical physicists in the field of nuclear medicine. The calculation concept provides an important basis to estimate radiation exposure to the unborn. Its extensive revision in 2019 accounts for recent scientific and technical developments and a reform of the stepwise approach to dose estimation.
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Affiliation(s)
- Christian Happel
- Universitätsklinikum Frankfurt am Main; Klinik für Nuklearmedizin
| | - Markus Borowski
- Städtisches Klinikum Braunschweig; Institut für Röntgendiagnostik und Nuklearmedizin
| | - Alexandra Kamp
- Bundesamt für Strahlenschutz, Abteilung medizinischer und beruflicher Strahlenschutz
| | - Frank Rudolf
- Medizinische Hochschule Hannover, Stabsstelle Strahlenschutz und Abteilung Medizinische Physik
| | - Jan Henryk Wicke
- Medizinische Hochschule Hannover, Stabsstelle Strahlenschutz und Abteilung Medizinische Physik
| | - Daniel Gröner
- Universitätsklinikum Frankfurt am Main; Klinik für Nuklearmedizin
| | - Frank Grünwald
- Universitätsklinikum Frankfurt am Main; Klinik für Nuklearmedizin
| | - Martin Fiebich
- Technische Hochschule Mittelhessen Gießen; Institut für Medizinische Physik und Strahlenschutz
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Happel C, Kranert WT, Gröner D, Bockisch B, Sabet A, Vardarli I, Görges R, Herrmann K, Grünwald F. Correction for hyperfunctioning radiation-induced stunning (CHRIS) in benign thyroid diseases. Endocrine 2020; 69:466-473. [PMID: 32173798 DOI: 10.1007/s12020-020-02258-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Accepted: 03/03/2020] [Indexed: 10/24/2022]
Abstract
PURPOSE Radioiodine-131 treatment has been a well-established therapy for benign thyroid diseases for more than 75 years. However, the physiological reasons of the so-called stunning phenomenon, defined as a reduced radioiodine uptake after previous diagnostic radioiodine administration, are still discussed controversially. In a recent study, a significant dependence of thyroid stunning on the pre-therapeutically administered radiation dose could be demonstrated in patients with goiter and multifocal autonomous nodules. A release of thyroid hormones to the blood due to radiation-induced destruction of thyroid follicles leading to a temporarily reduced cell metabolism was postulated as possible reason for this indication-specific stunning effect. Therefore, the aim of this study was to develop dose-dependent correction factors to account for stunning and thereby improve precision of radioiodine treatment in these indications. METHODS A retrospective analysis of 313 patients (135 with goiter and 178 with multifocal autonomous nodules), who underwent radioiodine uptake testing and radioiodine treatment, was performed. The previously determined indication-specific values for stunning of 8.2% per Gray in patients with multifocal autonomous nodules and 21% per Gray in patients with goiter were used to modify the Marinelli equation by the calculation of correction factors for hyperfunctioning radiation-induced stunning (CHRIS). Subsequently, the calculation of the required activity of radioiodine-131 to obtain an intra-therapeutic target dose of 150 Gy was re-evaluated in all patients. Furthermore, a calculation of the hypothetically received target dose by using the CHRIS-calculated values was performed and compared with the received target doses. RESULTS After integrating the previously obtained results for stunning, CHRIS-modified Marinelli equations could be developed for goiter and multifocal autonomous nodules. For patients with goiter, the mean value of administered doses calculated with CHRIS was 149 Gy and did not differ from the calculation with the conventional Marinelli equation of 152 Gy with statistical significance (p = 0.60). However, the statistical comparison revealed a highly significant improvement (p < 0.000001) of the fluctuation range of the results received with CHRIS. Similar results were obtained in the subgroup of patients with multifocal autonomous nodules. The mean value of the administered dose calculated with the conventional Marinelli equation was 131 Gy and therefore significantly below the CHRIS-calculated radiation dose of 150 Gy (p < 0.05). Again, the fluctuation range of the CHRIS-calculated radiation dose in the target volume was significantly improved compared with the conventional Marinelli equation (p < 0.000001). CONCLUSIONS With the presented CHRIS equation it is possible to calculate a required individual stunning-independent radioiodine activity for the first time by only using data from the radioiodine uptake testing. The results of this study deepen our understanding of thyroid stunning in benign thyroid diseases and improve precision of dosimetry in radioiodine-131 therapy of goiter and multifocal autonomous nodules.
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Affiliation(s)
- C Happel
- Department of Nuclear Medicine, University Hospital, Goethe University, Frankfurt, Theodor Stern Kai 7, D-60590, Frankfurt, Germany.
| | - W T Kranert
- Department of Nuclear Medicine, University Hospital, Goethe University, Frankfurt, Theodor Stern Kai 7, D-60590, Frankfurt, Germany
| | - D Gröner
- Department of Nuclear Medicine, University Hospital, Goethe University, Frankfurt, Theodor Stern Kai 7, D-60590, Frankfurt, Germany
| | - B Bockisch
- Department of Nuclear Medicine, University Hospital, Goethe University, Frankfurt, Theodor Stern Kai 7, D-60590, Frankfurt, Germany
| | - A Sabet
- Department of Nuclear Medicine, University Hospital, Goethe University, Frankfurt, Theodor Stern Kai 7, D-60590, Frankfurt, Germany
| | - I Vardarli
- Department of Medicine I, Klinikum Vest GmbH, Knappschaftskrankenhaus Recklinghausen, Academic Teaching Hospital, Ruhr-University Bochum, Recklinghausen, Dorstener Str. 151, D-45657, Recklinghausen, Germany
| | - R Görges
- Department of Nuclear Medicine, University Hospital, Essen, Hufelandstraße 55, D-45147, Essen, Germany
| | - K Herrmann
- Department of Nuclear Medicine, University Hospital, Essen, Hufelandstraße 55, D-45147, Essen, Germany
| | - F Grünwald
- Department of Nuclear Medicine, University Hospital, Goethe University, Frankfurt, Theodor Stern Kai 7, D-60590, Frankfurt, Germany
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