Nuclear medicine practice in Japan: a report of the sixth nationwide survey in 2007

Nuclear medicine practice in Japan: a report of the ninth nationwide survey in 2022

Subcommittee on Survey of Nuclear Medicine Practice in Japan has performed a nationwide survey of nuclear medicine practice every 5 years since 1982 to survey contemporary nuclear medicine practice and its changes over the years. The subcommittee sent questionnaires, including the number and category of examinations as well as the kind of the radiopharmaceuticals during the 30 days of June 2022 to all nuclear medicine institutes in Japan. The total numbers of them for the year 2022 were estimated depends on the 1-month data. A total of 1095 institutes responded to the survey, including 364 positron emission tomography (PET) centers. The recovery rate was 90.6%. The number of gamma cameras installed was 1299 in total, with 2.5% decrease in 5 years. Dual-head cameras and hybrid SPECT/CT scanners accounted for 83.8% and 35.5%, respectively. The number of single-photon tracer studies in 2022 was 1.11 million which means increase in 2.7% in 5 years. Bone scintigraphy was a leading examination (31.0%), followed by myocardial scintigraphy (27.1%) and cerebral perfusion study (23.8%) in order. The percentage of SPECT studies showed an increase from 63.5% in previous survey to 66.8% in this survey. PET centers have also increased from 389 to 412, as compared with the previous one. One hundred and twenty-two PET centers have installed one or two in-house cyclotrons. Increasing trends of the PET studies were observed from 1992 to 2017, the trend changed and PET studies showed 1.5% decrease in 5 years. 18F-FDG accounted for 98.6% (610,497 examinations). PET examinations using 11C-methionine, 13N-NH3 and 11C-PIB have decreased, with 1624, 2146 and 525 examinations, respectively in 2022. The total number of nuclear medicine examination was eventually increased by 1.0%. Therapies for pheochromocytoma or paraganglioma (PPGL) with 131I-MIBG and for neuroendocrine tumor with 177Lu-DOTA-TATE were newly started, however, a total number of targeted radionuclide therapy was decreased by 17.7% because 131I-radioiodine and 223Ra targeted therapies were decreased and supply of some radioisotopes was discontinued. 131I-radioiodine targeted therapy showed a decrease in 5 years (- 15.9%), including 4099 patients for thyroid cancer. The number of out-patient thyroid bed ablation therapy with 1110 MBq of 131I was also decreased to 1015 per year. The number of admission rooms specialized for radionuclide targeted therapy increased from 157 to 160. The number of 223Ra targeted therapies for castration-resistant metastatic prostate cancer (mCRPC) was 1041 patients. This survey was performed during COVID-19 pandemic, however, total number of nuclear medicine examinations was almost same as previous survey (+ 1.0%). Radionuclide therapies with 131I-MIBG and 177Lu-DOTA-TATE were newly started, and new radionuclide therapy will be available in future, therefore, the development of radionuclide therapy will be continued. We are convinced that this survey report is useful in understanding the current status of the nuclear medicine practice in Japan, and in devising the new strategy to strengthen a role of nuclear medicine.

Nuclear oncology as seen by me in Japan: a historical review and future perspective

Since 1964 the author has seen and experienced the progress of nuclear medicine in Japan. The purpose of this review article is to trace the application of radiopharmaceuticals and instruments for the diagnosis of tumors and treatment of cancers in the past 55 years. The application of various radiopharmaceuticals for the detection of tumors and therapy of cancers are historically reviewed based on the author's personal clinical experience and research work. Nuclear medicine has been advanced by coordinated developments of instruments and radiopharmaceuticals like two wheels of a vehicle. The journey of nuclear medicine in the past was not necessarily a smooth one having met with periodic difficulties that changed its direction. The ways by which nuclear oncology has progressed by having overcome episodic problems are described. Future perspectives focusing on the recent trend of theranostics are described with the emphasis on efforts being made by the leadership of JSNM to contribute to the progress of nuclear medicine worldwide. The author believes that the multi-and trans-disciplinary collaboration of related specialists as well as other concerned parties will be necessary for the further progress of nuclear oncology in the future.

Nuclear medicine practice in Japan: a report of the eighth nationwide survey in 2017

OBJECTIVE

Subcommittee on Survey of Nuclear Medicine Practice in Japan has performed a nationwide survey of nuclear medicine practice every 5 years since 1982 to survey contemporary nuclear medicine practice and its changes over the years.

METHODS

The subcommittee sent questionnaires, including the number and category of examinations as well as the kind and dose of the radiopharmaceuticals during the 30 days of June 2017, to all nuclear medicine institutes. The total numbers for the year 2017 were then estimated.

RESULTS

A total of 1132 institutes responded to the survey, including 351 PET centers. The recovery rate was 90.6%. The number of gamma cameras installed was 1332 in total, with 7.0% decrease in 5 years. Dual-head cameras and hybrid SPECT/CT scanners accounted for 88.2 and 23.6%, respectively. The number of single-photon tracer studies in 2017 was 1.08 million which means a decrease in 5.7% in 5 years and 23.6% in 10 years. All but neurotransmitter system, sentinel lymph node, and liver scintigraphy decreased. Bone scintigraphy was a leading examination (32.3%), followed by myocardial scintigraphy (24.1%) and cerebral perfusion study (18.0%) in order. SPECT studies showed an increase from 47.2% to 63.5%. PET centers have also increased from 295 to 389, as compared to the last survey. The 112 PET centers have installed one or two in-house cyclotrons. PET studies showed 24.5% increase in 5 years, with oncology accounting for 88.9%. ¹⁸F-FDG accounted for 98.2% (630,570 examinations). PET examinations using ¹¹C-methionine have decreased, with 2440 examinations in 2017. PET examinations using ¹³N-NH₃ have been increasing, with 2363 examinations in 2017. The number of PET studies using ¹¹C-PIB was 904. ¹³¹I-radioiodine targeted therapies showed an increase in 5 years (23.1%), including 4487 patients for thyroid cancer. Out-patient thyroid bed ablation therapy with 1,110 MBq of ¹³¹I accounted for 36.6% of cancer patients. The number of admission rooms increased from 135 to 157 in 5 years. The number of ²²³Ra targeted therapies for castration-resistant metastatic prostate cancer was 1194 patients.

CONCLUSIONS

Single-photon examinations showed a continuous tendency toward a decline in the survey. In contrast, the number of hybrid SPECT/CT scanner examinations has increased. PET/CT study and radionuclide targeted therapy have steadily increased.

Nuklearmedizin in Deutschland

Aim: To explain the spectrum and number of in-vivo nuclear medicine examinations and therapies based on official statistics about out-patient and in-patient care. Trends in time of the frequency and spectrum of procedures as well as data on the health care structure for nuclear medicine in Germany should be collected. Methods: Data from the Gesundheitsberichterstattung des Bundes, from the frequency statistics of the statutory health insurance for out-patients and from the Bundes - ärztekammer were used. Customized queries were performed to analyse temporal changes. Results: Nuclear medicine physicians are more frequently consulted by out-patients over the last years (2008: 2 024 498; 2009: 2 164 664) and the number of colleagues in private practice increased. For in-patients, the frequency of conventional nuclear medicine procedures (mainly for brain, lymphatic system, lung and heart) increased since 2008 after a decline in previous years (2009: 323 515; +4.6%) and the number of PET(/CT) examinations continued to rise (2009: 25 123; +18%), even if changes in OPS keys may hamper comparisons. Nearly 600 gamma cameras and 76 PET(/CT) scanners were installed in hospitals in 2008. Nuclear medicine procedures are increasingly performed as cross sectional imaging like SPECT(/CT) and PET(/CT). With the supply shortfall with 99Mo, the frequency of thyroid scans with 123I iodine increased as well as the use of 18F PET as a substitute for conventional bone scans. The number of radionuclide therapies, in particular non-thyroid treatments, increased since the mid-nineties and stabilized at nearly 50 000 cases per year with shorter lengths of stay. Conclusion: The details of the present analysis may help to understand the positive evolution of key numbers for nuclear medicine.

Nuclear medicine practice in Japan: a report of the seventh nationwide survey in 2012

OBJECTIVE

The Subcommittee on the Survey of Nuclear Medical Practice in Japan has performed a nationwide survey of nuclear medicine practice every 5 years since 1982 to survey contemporary nuclear medicine practice and its changes over the years.

METHODS

The subcommittee sent questionnaires, including the number and category of examinations as well as the kind and dose of the radiopharmaceuticals during the 30 days of June 2012, to all the nuclear medicine institutes. The total numbers for the year 2012 were then estimated.

RESULTS

A total of 1,167 institutes responded to the survey, including the 14 in vitro assay institutes and 266 PET centers. The recovery rate was 92 %. The number of gamma cameras installed was 1,425 in total, with 9 % decrease in 5 years. Dual-head cameras and hybrid SPECT/CT scanners accounted for 84 and 10.5 %, respectively. The number of single-photon tracer studies in 2012 was 1.15 million which means decrease in 19 % in 5 years and 29 % in 10 years. All but cerebral perfusion study and sentinel lymphoscintigraphy have decreased. Bone scintigraphy was a leading examination (38.7 %), followed by cardiac studies (29.4 %) and cerebral perfusion study (18.5 %) in order. SPECT studies showed an increase from 42.3 to 47.2 %. PET centers have also increased from 212 to 295, as compared to the last survey. The 135 PET centers have installed one or two in-house cyclotrons. PET studies showed 25.5 % increase in 5 years, with oncology accounting for 96.3 %. (18)F-FDG accounted for 98.2 % (505,990 examinations). PET examinations using (11)C-methionine have been increasing, with 3,352 examinations in 2012. The number of new PET studies using (11)C-PIB PET was 695. (131)I-radioiodine targeted therapies showed an increase, including 3,644 patients (53.6 %) for thyroid cancer and 4,889 patients (17.9 %) for hyperthyroidism. Out-patient thyroid bed ablation therapy with 30 mCi of (131)I accounted for 21.0 % of cancer patients. The number of admission rooms decreased from 158 to 135 in 5 years. In vitro radioassays have been declining continuously since 1992, with the number of studies of 9.0 million in 2012.

CONCLUSIONS

Single-photon examinations showed a continuous tendency toward a decline in the survey. In contrast, the number of hybrid SPECT/CT scanner examinations has increased. PET/CT study in the oncology field and radionuclide targeted therapy have steadily increased.

Myocardial perfusion scintigraphy in Taiwan from 2005 to 2009

OBJECTIVE

To analyze the utilization of myocardial perfusion scintigraphy (MPS) in Taiwan within the universal healthcare system, the National Health Insurance (NHI) from 2005 to 2009, and to compare with European surveys.

METHODS

On the basis of Taiwan's National Health Insurance Research Database of 2005-2009, a retrospective population-based analysis was conducted. Descriptive statistics were provided on the frequencies of and distributions in the utilization of MPS during the period. In addition, correlation analysis was applied to identify correlated factors in the utility of MPS.

RESULTS

The annual number of MPS procedures performed was estimated to be 76 448 on average in 2005-2009 and 3361 per million population (pmp) over the period. The frequency increased by 45%, from 3008 pmp in 2005 to 4371 pmp in 2009, with an annual increase rate of 11.9%. The expenditure on MPS increased by 51%, from 12.3 million USD in 2005 to 18.55 million USD in 2009, with an annual increase rate of 12.9%. The average cost of identifying a coronary artery disease (CAD) case with MPS was 248 USD, with a 2.6% annual increase rate. Most patients were more than 50 years old when they received the MPS examination, whereas inpatients were much older. In addition, most of the MPS practices were performed in medical centers and regional hospitals, although an apparent increase was seen in district hospitals on outpatients. As a consequence, the rate of CAD diagnoses by MPS decreased over time.

CONCLUSION

The numbers, frequencies, and expenses of MPS practices have increased in Taiwan during the period 2005-2009, especially for outpatients. The application rate of MPS in Taiwan was higher than that in Europe, likely because of the high accessibility to MPS procedures within the NHI system. This experience in Taiwan may serve as a reference for illustrating the trends in the use of MPS procedures in countries with a universal healthcare system.

Measurement of absorbed doses in organs of medical staff at (18)F-FDG pet examination

In this study, the organ doses were measured using a human- body phantom simulating a medical staff member, and we considered an effective method for decreasing exposure to staff in positron emission tomography examinations. A fluorescence glass dosimeter was arranged for measurements in various organs. Regarding exposure, the average ratio of the dose at 100 cm from the source to the dose at 30 cm was 0.35. The ratio of the dose at 100 cm with a 3 cm lead shield to the dose at 100 cm with no shielding device was 0.01. To reduce the radiation exposure effectively, medical staff members should inform the patient of the details of the examination in advance, reduce the contact time with the patient during the examination, and maximize their distance from the patient when contact is necessary.