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Eseonu K, Oduoza U, Robinson P, Easty M, Nadarajah R, Biassoni L. Bone scintigraphy with SPECT/CT in paediatric patients with neck and back pain in comparison with other imaging modalities: the experience of a tertiary paediatric referral centre. Nucl Med Commun 2024; 45:278-286. [PMID: 38214085 DOI: 10.1097/mnm.0000000000001811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2024]
Abstract
OBJECTIVE Retrospective review of the additional clinical value provided by single photon emission computed tomography-computed tomography (SPECT/CT) in children and adolescents with back pain. METHODS A total of 207 consecutive paediatric patients (94 males, 113 females, age range 5-17 years, median age 14 years) were reviewed after referral to the spinal surgery clinic of a paediatric teaching hospital between November 2009 and February 2021. All patients had either only whole spine X-rays or whole spine x-rays and MRI, along with bone scan with planar whole-body images and SPECT/CT (with spot views of painful area). RESULTS X-ray identified the pain generator in 23 of 177 (13.0%) cases. MRI identified the pain generator in 49 of 165 (29.7%) cases. SPECT/CT reported relevant positive findings which identified the pain generator in 107 of 185 (57.8%) cases. SPECT/CT changed patients' management in 72 of 185 (38.9%) cases. SPECT/CT was most effective at identifying the pain generator in cases of facet arthropathy, previous vertebral fracture and patients with previous deformity correction, where the pain generator was identified in 76.5% (13 of 17), 71.4% (5 of 7) and 63.4% (26 of 41) of cases, respectively. CT settings were adjusted to minimise the radiation burden (50 mAs/80kVp under 8 years, 24 mAs/110 kVp over 8 years). CONCLUSION The role of SPECT/CT in diagnosing back pain is justified in selected paediatric patients, particularly with diagnostic uncertainty using conventional imaging. The CT component of the SPECT/CT study produced a lower radiation dose than conventional CT imaging, whilst producing bone images of diagnostic quality.
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Affiliation(s)
| | | | - Phillip Robinson
- Radiology, Great Ormond Street Hospital for Children NHS Foundation Trust
| | - Marina Easty
- Radiology, Great Ormond Street Hospital for Children NHS Foundation Trust
| | | | - Lorenzo Biassoni
- Radiology, Great Ormond Street Hospital for Children NHS Foundation Trust
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Chiu CH, Yeh SHH, Chen MR, Peng NJ, Huang WS. Radiation issue in clinical nuclear molecular imaging. J Chin Med Assoc 2023; 86:624-626. [PMID: 37191943 DOI: 10.1097/jcma.0000000000000937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/17/2023] Open
Abstract
Radiation is ubiquitous in nature, and radiation is also widely used in various fields of medicine, agriculture, and industry. Current biological doses below 100 mSv are called low-dose radiation (LDR). Scientists have no consensus of effects on humans below this dose, so a variety of dose-response curve theories have been derived. This approach makes the public believe that even a small dose of radiation has adverse side effects, and overreact to refuse the related medical procedures for fear of radiation. The linear non-threshold (LNT) model has been used in radiation protection for over 40 years however, adverse effects from low dose, low-dose rate (LDDR) exposures are not detectable. Nuclear molecular imaging is LDR, using different radionuclides or combining with specific ligands (carries) to form "radiopharmaceuticals" for functional or pathological evaluations of diseases. As an integral part of patient care, nuclear medicine is used in the diagnosis, management, treatment, follow-up, and prevention of diseases. Therefore, this paper discusses literature review and provides appropriate scientific data and communication to help the peers and the public understand its advantage and disadvantage.
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Affiliation(s)
- Chuang-Hsin Chiu
- Department of Nuclear Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, ROC
| | | | - Ming-Rong Chen
- Department of Pharmacy, Cheng-Hsin General Hospital, Taipei, Taiwan, ROC
| | - Nan-Jing Peng
- Department of Nuclear Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Wen-Sheng Huang
- Department of Nuclear Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, ROC
- Department of Nuclear Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Department of Nuclear Medicine, Cheng-Hsin General Hospital, Taipei, Taiwan, ROC
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Molecular Imaging Diagnosis of Renal Cancer Using 99mTc-Sestamibi SPECT/CT and Girentuximab PET-CT-Current Evidence and Future Development of Novel Techniques. Diagnostics (Basel) 2023; 13:diagnostics13040593. [PMID: 36832081 PMCID: PMC9954934 DOI: 10.3390/diagnostics13040593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 01/17/2023] [Accepted: 02/01/2023] [Indexed: 02/07/2023] Open
Abstract
Novel molecular imaging opportunities to preoperatively diagnose renal cell carcinoma is under development and will add more value in limiting the postoperative renal function loss and morbidity. We aimed to comprehensively review the research on single photon emission computed tomography/computed tomography (SPECT/CT) and positron emission tomography computed tomography (PET-CT) molecular imaging and to enhance the urologists' and radiologists' knowledge of the current research pattern. We identified an increase in prospective and also retrospective studies that researched to distinguish between benign and malignant lesions and between different clear cell renal cell carcinoma subtypes, with small numbers of patients studied, nonetheless with excellent results on specificity, sensitivity and accuracy, especially for 99mTc-sestamibi SPECT/CT that delivers quick results compared to a long acquisition time for girentuximab PET-CT, which instead gives better image quality. Nuclear medicine has helped clinicians in evaluating primary and secondary lesions, and has lately returned with new and exciting insights with novel radiotracers to reinforce its diagnostic potential in renal carcinoma. To further limit the renal function loss and post-surgery morbidity, future research is mandatory to validate the results and to clinically implement the diagnostic techniques in the context of precision medicine.
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Crișan G, Moldovean-Cioroianu NS, Timaru DG, Andrieș G, Căinap C, Chiș V. Radiopharmaceuticals for PET and SPECT Imaging: A Literature Review over the Last Decade. Int J Mol Sci 2022; 23:ijms23095023. [PMID: 35563414 PMCID: PMC9103893 DOI: 10.3390/ijms23095023] [Citation(s) in RCA: 61] [Impact Index Per Article: 30.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Revised: 04/23/2022] [Accepted: 04/28/2022] [Indexed: 02/04/2023] Open
Abstract
Positron emission tomography (PET) uses radioactive tracers and enables the functional imaging of several metabolic processes, blood flow measurements, regional chemical composition, and/or chemical absorption. Depending on the targeted processes within the living organism, different tracers are used for various medical conditions, such as cancer, particular brain pathologies, cardiac events, and bone lesions, where the most commonly used tracers are radiolabeled with 18F (e.g., [18F]-FDG and NA [18F]). Oxygen-15 isotope is mostly involved in blood flow measurements, whereas a wide array of 11C-based compounds have also been developed for neuronal disorders according to the affected neuroreceptors, prostate cancer, and lung carcinomas. In contrast, the single-photon emission computed tomography (SPECT) technique uses gamma-emitting radioisotopes and can be used to diagnose strokes, seizures, bone illnesses, and infections by gauging the blood flow and radio distribution within tissues and organs. The radioisotopes typically used in SPECT imaging are iodine-123, technetium-99m, xenon-133, thallium-201, and indium-111. This systematic review article aims to clarify and disseminate the available scientific literature focused on PET/SPECT radiotracers and to provide an overview of the conducted research within the past decade, with an additional focus on the novel radiopharmaceuticals developed for medical imaging.
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Affiliation(s)
- George Crișan
- Faculty of Physics, Babeş-Bolyai University, Str. M. Kogălniceanu 1, 400084 Cluj-Napoca, Romania; (G.C.); (N.S.M.-C.); (D.-G.T.)
- Department of Nuclear Medicine, County Clinical Hospital, Clinicilor 3-5, 400006 Cluj-Napoca, Romania;
| | | | - Diana-Gabriela Timaru
- Faculty of Physics, Babeş-Bolyai University, Str. M. Kogălniceanu 1, 400084 Cluj-Napoca, Romania; (G.C.); (N.S.M.-C.); (D.-G.T.)
| | - Gabriel Andrieș
- Department of Nuclear Medicine, County Clinical Hospital, Clinicilor 3-5, 400006 Cluj-Napoca, Romania;
| | - Călin Căinap
- The Oncology Institute “Prof. Dr. Ion Chiricuţă”, Republicii 34-36, 400015 Cluj-Napoca, Romania;
| | - Vasile Chiș
- Faculty of Physics, Babeş-Bolyai University, Str. M. Kogălniceanu 1, 400084 Cluj-Napoca, Romania; (G.C.); (N.S.M.-C.); (D.-G.T.)
- Institute for Research, Development and Innovation in Applied Natural Sciences, Babeș-Bolyai University, Str. Fântânele 30, 400327 Cluj-Napoca, Romania
- Correspondence:
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Assessment of extremity occupational exposure at a nuclear medicine department. JOURNAL OF RADIATION RESEARCH AND APPLIED SCIENCES 2022. [DOI: 10.1016/j.jrras.2022.03.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Schreuder N, de Romijn I, Jager PL, Kosterink JGW, van Puijenbroek EP. Safe use of radiopharmaceuticals in patients with chronic kidney disease: a systematic review. EJNMMI Radiopharm Chem 2021; 6:27. [PMID: 34417933 PMCID: PMC8380202 DOI: 10.1186/s41181-021-00145-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 08/09/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Patients with chronic kidney disease (CKD) may need to have their radiopharmaceutical dosage adjusted to prevent adverse effects and poor outcomes, but there are few recommendations on radiopharmaceutical dosing for this group of patients. The aim of this study is to provide an overview of the available information on radiopharmaceutical dose recommendations for patients with CKD. METHODS We performed a systematic literature review according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. We conducted a literature search in the MEDLINE (PubMed) and Embase databases and screened potentially relevant studies using inclusion and exclusion criteria. We independently assessed the included observational studies' methodologies and extracted relevant data. RESULTS Of the 5795 studies first identified, 34 were included in this systematic review. These studies described three radiopharmaceuticals: [131I]sodium iodine, [18F]fludeoxyglucose, and [131I]iobenguane. Twenty-nine studies (85.3%) reported data on patients with CKD stage 5, while only three studies mentioned CKD patients in other stages (8.8%). CONCLUSION We found no consistent recommendations for radiopharmaceutical dosing in patients with CKD. Although some studies do mention dosing difficulties in patients with CKD, information is available for only a few radiopharmaceuticals, and recommendations are sometimes contradictory. Further research on radiopharmaceutical dosing in patients with CKD is needed to determine whether these patients require specific dosing, especially for therapeutic radiopharmaceuticals where a non-optimised dose may lead to an increased risk of toxicity for non-targeted organs. Including patients with CKD in studies and providing specific information about dosing in these patients should be a priority for the radiopharmaceutical community.
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Affiliation(s)
- Nanno Schreuder
- Groningen Research Institute of Pharmacy, Unit of PharmacoTherapy, Epidemiology and Economics, University of Groningen, Groningen, The Netherlands.
- GE Healthcare Radiopharmacy Zwolle, Zwolle, The Netherlands.
| | - Iris de Romijn
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands
| | - Pieter L Jager
- Department of Nuclear Medicine, Isala Hospital, Zwolle, The Netherlands
| | - Jos G W Kosterink
- Groningen Research Institute of Pharmacy, Unit of PharmacoTherapy, Epidemiology and Economics, University of Groningen, Groningen, The Netherlands
- Department of Clinical Pharmacy and Pharmacology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Eugène P van Puijenbroek
- Groningen Research Institute of Pharmacy, Unit of PharmacoTherapy, Epidemiology and Economics, University of Groningen, Groningen, The Netherlands
- Netherlands Pharmacovigilance Centre Lareb, 's-Hertogenbosch, The Netherlands
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Tulik M, Tulik P, Kowalska T. On the optimization of bone SPECT/CT in terms of image quality and radiation dose. J Appl Clin Med Phys 2020; 21:237-246. [PMID: 33111500 PMCID: PMC7700938 DOI: 10.1002/acm2.13069] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Revised: 10/03/2020] [Accepted: 10/05/2020] [Indexed: 12/24/2022] Open
Abstract
INTRODUCTION The purpose of this study was to present the optimization process of CT parameters to reduce patient exposure during bone SPECT/CT without affecting the quality of SPECT images with attenuation correction (AC). MATERIAL AND METHODS A fillable phantom reflecting realistic bone scintigraphy conditions was developed and acquired on an AnyScan SC. SPECT/CT scans were carried out with different x-ray tube current values (10, 20, 30, 40, 50, 60, 70, 90, 110, 130, 150, and 200 mA) at three different high-voltage values (80, 100, and 120 kV). The contrast (C) and coefficients of variation (CV) in the SPECT images as well as the signal-to-noise ratio (SNR) and noise (SDCT ) in the CT images with CTDIvol were measured. An optimal acquisition protocol that obtained SPECT/CT images with no artifacts on both CT and SPECT images, acceptable C, SNR, CV, and SDCT values, and the largest reduction in patient exposure compared to the reference acquisition procedure was sought. RESULTS The optimal set of parameters for bone SPECT/CT was determined based on a phantom study. It has been implemented in clinical practice. Two groups of patients were examined according to the baseline and optimized protocols, respectively. The new SPECT/CT protocol substantially reduced patients' radiation exposure compared to the old protocol while maintaining the required diagnostic quality of SPECT and CT images. CONCLUSIONS In the study, we present a methodology that finds a compromise between diagnostic information and patient exposure during bone SPECT/CT procedures.
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Affiliation(s)
- Monika Tulik
- Maria Sklodowska-Curie National Research Institute of Oncology Krakow Branch, Krakow, Poland
| | - Piotr Tulik
- Warsaw University of Technology, Faculty of Mechatronics, Institute of Metrology and Biomedical Engineering, Warsaw, Poland
| | - Teresa Kowalska
- Maria Sklodowska-Curie National Research Institute of Oncology Krakow Branch, Krakow, Poland
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Lei Y, Dong X, Wang T, Higgins K, Liu T, Curran WJ, Mao H, Nye JA, Yang X. Whole-body PET estimation from low count statistics using cycle-consistent generative adversarial networks. Phys Med Biol 2019; 64:215017. [PMID: 31561244 DOI: 10.1088/1361-6560/ab4891] [Citation(s) in RCA: 49] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Lowering either the administered activity or scan time is desirable in PET imaging as it decreases the patient's radiation burden or improves patient comfort and reduces motion artifacts. But reducing these parameters lowers overall photon counts and increases noise, adversely impacting image contrast and quantification. To address this low count statistics problem, we propose a cycle-consistent generative adversarial network (Cycle GAN) model to estimate diagnostic quality PET images using low count data. Cycle GAN learns a transformation to synthesize diagnostic PET images using low count data that would be indistinguishable from our standard clinical protocol. The algorithm also learns an inverse transformation such that cycle low count PET data (inverse of synthetic estimate) generated from synthetic full count PET is close to the true low count PET. We introduced residual blocks into the generator to catch the differences between low count and full count PET in the training dataset and better handle noise. The average mean error and normalized mean square error in whole body were -0.14% ± 1.43% and 0.52% ± 0.19% with Cycle GAN model, compared to 5.59% ± 2.11% and 3.51% ± 4.14% on the original low count PET images. Normalized cross-correlation is improved from 0.970 to 0.996, and peak signal-to-noise ratio is increased from 39.4 dB to 46.0 dB with proposed method. We developed a deep learning-based approach to accurately estimate diagnostic quality PET datasets from one eighth of photon counts, and has great potential to improve low count PET image quality to the level of diagnostic PET used in clinical settings.
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Affiliation(s)
- Yang Lei
- Department of Radiation Oncology, Emory University, Atlanta, GA, United States of America. Co-first author
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Gauthé M, Breton M, Jehanno N, Cellier C, Michon J, Sarnacki S, Schleiermacher G, Wartski M. Prognostic impact of postoperative 123I-metaiodobenzylguanidine scintigraphy: added value of SPECT/CT and semiquantification of the uptake at the surgical site. 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 RADIOPHARMACEUTICAL CHEMISTRY AND BIOLOGY 2018; 64:131-138. [PMID: 29409315 DOI: 10.23736/s1824-4785.18.03031-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND The aim of this study was to assess the prognostic value of postoperative 123I-MIBG scintigraphy, including systematic SPECT/CT and semiquantification of the uptake at the surgical site, in a prospective series of NB patients. METHODS Patients operated for neuroblastoma and who had benefited from postoperative 123I-MIBG scintigraphy were prospectively and consecutively included. Completeness of surgery was assessed on operative report. One month postoperative 123I-MIBG scintigraphy included planar acquisition and SPECT/CT. Semi-quantification of the 123I-MIBG SPECT/CT uptake at the surgical site was performed and ratios to reference (liver and mediastinum) areas were calculated. RESULTS Thirty patients were included between August 2012 and July 2015. Median follow-up was 36 months (range 10-98). Surgery was considered as complete in 23 patients and incomplete in 7 patients. Eight patients (26.7%) presented progressive disease (1 progression and 7 recurrences). Seven patients died (23.3%), all from NB. Six (20%) patients had positive 123I-MIBG scintigraphy (3 on planar acquisitions and 6 on SPECT/CT) and 24 patients had negative 123I-MIBG scintigraphy. Five of the 6 patients (83%) with positive 123I-MIBG scintigraphy presented progressive disease. Ratio of the uptake at the surgical site to mediastinum was strongly and independently correlated with disease-free interval and overall survival (P=0.02 and 0.01 respectively). The amplified MYCN status was also confirmed as correlated with poorer outcomes. CONCLUSIONS Postoperative 123I-MIBG scintigraphy including SPECT/CT and semiquantification of the uptake at the surgical site appeared to be a valuable prognostic tool in neuroblastoma.
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Affiliation(s)
- Mathieu Gauthé
- Unit of Nuclear Medicine, Curie Institute, Paris, France - .,Unit of Nuclear Medicine, Tenon Hospital, AP-HP, Paris, France -
| | | | - Nina Jehanno
- Unit of Nuclear Medicine, Curie Institute, Paris, France
| | | | - Jean Michon
- Unit of Pediatrics, Curie Institute, Paris, France
| | | | | | - Myriam Wartski
- Unit of Nuclear Medicine, Curie Institute, Paris, France
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Prieto E, García-Velloso MJ, Rodríguez-Fraile M, Morán V, García-García B, Guillén F, Morales MI, Sancho L, Peñuelas I, Richter JÁ, Martí-Climent JM. Significant dose reduction is feasible in FDG PET/CT protocols without compromising diagnostic quality. Phys Med 2018. [PMID: 29519399 DOI: 10.1016/j.ejmp.2018.01.021] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
PURPOSE To reduce the radiation dose to patients by optimizing oncological FDG PET/CT protocols. METHODS The baseline PET/CT protocol in our institution for oncological PET/CT examinations consisted of the administration of 5.18 MBq/kg of FDG and a CT acquisition with a reference current-time product of 120 mAs. In 2016, FDG activity was reduced to 4.44 and 3.70 MBq/kg and reference CT current-time-product was reduced to 100 and 80 mAs. 322 patients scanned with different protocols were retrospectively evaluated. For each patient, effective dose was calculated. The overall image quality was subjectively rated by the referring physician on a 4-point scale (IQ score: 1 excellent, 2 good, 3 poor but interpretable, 4 poor not interpretable). Image quality was quantitatively evaluated measuring noise in the liver. RESULTS CT Results: Effective dose was progressively reduced from 9.5 ± 2.8 to 8.0 ± 2.3 and 6.2 ± 1.5 mSv (p < 0.001). A mean dose reduction of 34.9% was achieved. There was a significant degradation of IQ score (p < 0.05) and noise (p < 0.001). Nevertheless, the number of poor quality studies (IQ score >2) did not increase. PET Results: Effective dose was gradually reduced from 6.5 ± 1.4 to 5.7 ± 1.3 and 5.0 ± 1.0 mSv (p < 0.001). Average dose reduction was 23.4%. IQ score (p < 0.05) and noise (p < 0.001) significantly degraded for lower activity protocols. However, all images with reduced activity were scored as interpretable (IQ score ≤ 3). CONCLUSIONS A significant radiation dose reduction of 28.7% was reached. Despite a slight reduction in image quality, the new regime was successfully implemented with readers reporting unchanged clinical confidence.
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Affiliation(s)
- Elena Prieto
- Nuclear Medicine Department, Clínica Universidad de Navarra, Pamplona, Spain; IdisNA, Instituto de Investigación Sanitaria de Navarra, Pamplona, Spain
| | - María José García-Velloso
- Nuclear Medicine Department, Clínica Universidad de Navarra, Pamplona, Spain; IdisNA, Instituto de Investigación Sanitaria de Navarra, Pamplona, Spain
| | - Macarena Rodríguez-Fraile
- Nuclear Medicine Department, Clínica Universidad de Navarra, Pamplona, Spain; IdisNA, Instituto de Investigación Sanitaria de Navarra, Pamplona, Spain
| | - Verónica Morán
- Nuclear Medicine Department, Clínica Universidad de Navarra, Pamplona, Spain
| | - Berta García-García
- Nuclear Medicine Department, Clínica Universidad de Navarra, Pamplona, Spain
| | - Fernando Guillén
- Nuclear Medicine Department, Clínica Universidad de Navarra, Pamplona, Spain
| | | | - Lidia Sancho
- Nuclear Medicine Department, Clínica Universidad de Navarra, Pamplona, Spain
| | - Iván Peñuelas
- Nuclear Medicine Department, Clínica Universidad de Navarra, Pamplona, Spain; IdisNA, Instituto de Investigación Sanitaria de Navarra, Pamplona, Spain
| | - José Ángel Richter
- Nuclear Medicine Department, Clínica Universidad de Navarra, Pamplona, Spain; IdisNA, Instituto de Investigación Sanitaria de Navarra, Pamplona, Spain
| | - Josep María Martí-Climent
- Nuclear Medicine Department, Clínica Universidad de Navarra, Pamplona, Spain; IdisNA, Instituto de Investigación Sanitaria de Navarra, Pamplona, Spain.
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Tulik P, Kowalska M, Golnik N, Budzynska A, Dziuk M. MEASUREMENTS OF THE IONISING RADIATION LEVEL AT A NUCLEAR MEDICINE FACILITY PERFORMING PET/CT EXAMINATIONS. RADIATION PROTECTION DOSIMETRY 2017; 174:501-509. [PMID: 27542812 DOI: 10.1093/rpd/ncw228] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/07/2016] [Accepted: 07/06/2016] [Indexed: 06/06/2023]
Abstract
This paper presents the results of radiation level measurements at workplaces in a nuclear medicine facility performing PET/CT examinations. This study meticulously determines the staff radiation exposure in a PET/CT facility by tracking the path of patient movement. The measurements of the instantaneous radiation exposure were performed using an electronic radiometer with a proportional counter that was equipped with the option of recording the results on line. The measurements allowed for visualisation of the staff's instantaneous exposure caused by a patient walking through the department after the administration of 18F-FDG. An estimation of low doses associated with each working step and the exposure during a routine day in the department was possible. The measurements were completed by determining the average radiation level using highly sensitive thermoluminescent detectors.
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Affiliation(s)
- P Tulik
- Institute of Metrology and Biomedical Engineering, Faculty of Mechatronics, Warsaw University of Technology, Warsaw, Poland
- Present address: Andrzeja Boboli 8, 02-525 Warsaw, Poland
| | - M Kowalska
- The Institute of Radioelectronics, Faculty of Electronics and Information Technology, Warsaw University of Technology, Warsaw, Poland
| | - N Golnik
- Institute of Metrology and Biomedical Engineering, Faculty of Mechatronics, Warsaw University of Technology, Warsaw, Poland
| | - A Budzynska
- Affidea MASOVIA PET-CT CENTER, Warsaw, Poland
| | - M Dziuk
- Affidea MASOVIA PET-CT CENTER, Warsaw, Poland
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Common strategic research agenda for radiation protection in medicine. Insights Imaging 2017; 8:183-197. [PMID: 28205026 PMCID: PMC5359143 DOI: 10.1007/s13244-016-0538-x] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2016] [Accepted: 12/14/2016] [Indexed: 11/15/2022] Open
Abstract
Reflecting the change in funding strategies for European research projects, and the goal to jointly improve medical radiation protection through sustainable research efforts, five medical societies involved in the application of ionising radiation (European Association of Nuclear Medicine, EANM; European Federation of Organizations for Medical Physics. EFOMP; European Federation of Radiographer Societies, EFRS; European Society of Radiology, ESR; European Society for Radiotherapy and Oncology, ESTRO) have identified research areas of common interest and developed this first edition of the Common Strategic Research Agenda (SRA) for medical radiation protection. The research topics considered necessary and most urgent for effective medical care and efficient in terms of radiation protection are summarised in five main themes: 1. Measurement and quantification in the field of medical applications of ionising radiation 2. Normal tissue reactions, radiation-induced morbidity and long-term health problems 3. Optimisation of radiation exposure and harmonisation of practices 4. Justification of the use of ionising radiation in medical practice 5. Infrastructures for quality assurance The SRA is a living document; thus comments and suggestions by all stakeholders in medical radiation protection are welcome and will be dealt with by the European Alliance for Medical Radiation Protection Research (EURAMED) established by the above-mentioned societies. MAIN MESSAGES • Overcome the fragmentation of medical radiation protection research in Europe • Identify research areas of joint interest in the field of medical radiation protection • Improve the use of ionising radiation in medicine • Collect stakeholder feedback and seek consensus • Emphasise importance of clinical translation and evaluation of research results.
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van Dijk JD, Ottervanger JP, Delnoy PPHM, Lagerweij MCM, Knollema S, Slump CH, Jager PL. Impact of new X-ray technology on patient dose in pacemaker and implantable cardioverter defibrillator (ICD) implantations. J Interv Card Electrophysiol 2017; 48:105-110. [PMID: 27785663 PMCID: PMC5247544 DOI: 10.1007/s10840-016-0200-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2016] [Accepted: 10/11/2016] [Indexed: 11/14/2022]
Abstract
PURPOSE New X-ray technology providing new image processing techniques may reduce radiation exposure. The aim of this study was to quantify this radiation exposure reduction for patients during pacemaker and implantable cardioverter defibrillator (ICD) implantation. METHODS In this retrospective study, 1185 consecutive patients who had undergone de novo pacemaker or ICD implantation during a 2-year period were included. All implantations in the first year were performed using the reference technology (Allura Xper), whereas in the second year, the new X-ray technology (AlluraClarity) was used. Radiation exposure, expressed as the dose area product (DAP), was compared between the two time periods to determine the radiation exposure reduction for pacemaker and ICD implantations without cardiac resynchronization therapy (CRT) and with CRT. Procedure duration and contrast volume were used as measures to compare complexity and image quality. RESULTS The study population consisted of 591 patients who had undergone an implantation using the reference technology, and 594 patients with the new X-ray technology. The two groups did not differ in age, gender, or body mass index. The DAP decreased with 69 % from 16.4 ± 18.5 to 5.2 ± 6.6 Gy cm2 for the non-CRT implantations (p < 0.001). The DAP decreased with 75 % from 72.1 ± 60.0 to 17.8 ± 17.4 Gy cm2 for the CRT implantations (p < 0.001). Nevertheless, procedure duration and contrast volume did not differ when using the new technology (p = 0.09 and p = 0.20, respectively). CONCLUSIONS Introduction of new X-ray technology resulted in a radiation exposure reduction of more than 69 % for patients during pacemaker and ICD implantation while image quality was unaffected.
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Affiliation(s)
- Joris D van Dijk
- Department of Nuclear Medicine, Isala Hospital, PO Box 10400, 8000 GK, Zwolle, The Netherlands.
- MIRA: Institute for Biomedical Technology and Technical Medicine, University of Twente, Enschede, The Netherlands.
| | | | | | | | - Siert Knollema
- Department of Nuclear Medicine, Isala Hospital, PO Box 10400, 8000 GK, Zwolle, The Netherlands
| | - Cornelis H Slump
- MIRA: Institute for Biomedical Technology and Technical Medicine, University of Twente, Enschede, The Netherlands
| | - Pieter L Jager
- Department of Nuclear Medicine, Isala Hospital, PO Box 10400, 8000 GK, Zwolle, The Netherlands
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14
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Chen J, Zhao X, Liu H, Zhou S, Yang Y, Li S, Xianyu Z, Han Y, Shen G, Li J, Ye C, Sun W, Dong L. A Point-Scoring System for the Clinical Diagnosis of Sjögren's Syndrome Based on Quantified SPECT Imaging of Salivary Gland. PLoS One 2016; 11:e0155666. [PMID: 27195488 PMCID: PMC4873230 DOI: 10.1371/journal.pone.0155666] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2016] [Accepted: 05/01/2016] [Indexed: 11/18/2022] Open
Abstract
Objective To establish a point-scoring diagnostic system for Sjögren's syndrome (SS) based on quantified SPECT imaging of salivary gland, and evaluate its feasibility and performance compared with 2002 AECG criteria and 2012 ACR criteria. Methods 213 patients with suspected SS enrolled in this study. The related clinical data of all patients were collected. All patients were evaluated and grouped on a clinical basis and posttreatment follow-up by rheumatology specialists as the unified standard (SS group with 149 cases and nSS group with 64 cases). From SPECT imaging of salivary gland, Tmax, UImax, Ts and EFs were derived for bilateral parotid and submandibular glands, and compared between the groups. A point-scoring diagnostic system for SS was established based on the quantified SPECT imaging of salivary gland. We estimated the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy for the new diagnostic system, compared with 2002 AECG criteria and 2012 ACR criteria. Results When 7.0 was used as the cut-off point, the sensitivity, specificity, PPV, NPV and accuracy for the new point-scoring system in diagnosing SS were 89.93% (134/149), 93.75% (60/64), 97.10% (134/138), 80.00% (60/75) and 91.08% (194/213), respectively. The new point-scoring diagnostic system based on quantified SPECT imaging of salivary gland keeps the specificity comparatively to 2002 AECG criteria and 2012 ACR criteria, but improves the sensitivity significantly (P<0.01). Conclusion The new point-scoring diagnostic system for SS based on quantified SPECT imaging of salivary gland may be superior to 2002 AECG criteria and 2012 ACR criteria, with higher sensitivity and similar specificity in the diagnosis of SS. Additionally, it also has good feasibility in the clinical settings.
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Affiliation(s)
- Jing Chen
- Department of Nuclear Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Hubei, Wuhan, China
| | - Xia Zhao
- Institute of Pathology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Hubei, Wuhan, China
| | - Haixia Liu
- Department of Ophthalmology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Hubei, Wuhan, China
| | - Sheng Zhou
- Institute of Pathology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Hubei, Wuhan, China
| | - Yunqiang Yang
- Department of Stomatology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Hubei, Wuhan, China
| | - Shouxin Li
- Department of Rheumatology and Immunology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Hubei, Wuhan, China
| | - Zhiqun Xianyu
- Department of Nuclear Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Hubei, Wuhan, China
| | - Yunfeng Han
- Department of Nuclear Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Hubei, Wuhan, China
| | - Guifen Shen
- Department of Rheumatology and Immunology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Hubei, Wuhan, China
| | - Jinming Li
- Department of Nuclear Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Hubei, Wuhan, China
| | - Cong Ye
- Department of Rheumatology and Immunology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Hubei, Wuhan, China
| | - Wei Sun
- Department of Stomatology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Hubei, Wuhan, China
- * E-mail: (LD); (WS)
| | - Lingli Dong
- Department of Rheumatology and Immunology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Hubei, Wuhan, China
- * E-mail: (LD); (WS)
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15
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Fahey FH, Bom HHS, Chiti A, Choi YY, Huang G, Lassmann M, Laurin N, Mut F, Nuñez-Miller R, O'Keeffe D, Pradhan P, Scott AM, Song S, Soni N, Uchiyama M, Vargas L. Standardization of Administered Activities in Pediatric Nuclear Medicine: A Report of the First Nuclear Medicine Global Initiative Project, Part 2-Current Standards and the Path Toward Global Standardization. J Nucl Med 2016; 57:1148-57. [PMID: 27033894 DOI: 10.2967/jnumed.115.169714] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2015] [Accepted: 03/02/2016] [Indexed: 11/16/2022] Open
Abstract
The Nuclear Medicine Global Initiative (NMGI) was formed in 2012 and consists of 13 international organizations with direct involvement in nuclear medicine. The underlying objectives of the NMGI are to promote human health by advancing the field of nuclear medicine and molecular imaging, encourage global collaboration in education, and harmonize procedure guidelines and other policies that ultimately lead to improvements in quality and safety in the field throughout the world. For its first project, the NMGI decided to consider the issues involved in the standardization of administered activities in pediatric nuclear medicine. It was decided to divide the final report of this project into 2 parts. Part 1 was published in this journal in the spring of 2015. This article presents part 2 of the final report. It discusses current standards for administered activities in children and adolescents that have been developed by various professional organizations. It also presents an evaluation of the current practice of pediatric nuclear medicine specifically with regard to administered activities as determined by an international survey of 313 nuclear medicine clinics and centers from 29 countries. Lastly, it provides recommendations for a path toward global standardization of the administration of radiopharmaceuticals in children.
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Affiliation(s)
- Frederic H Fahey
- Department of Radiology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Henry Hee-Seung Bom
- Department of Nuclear Medicine, Chonnam National University Hwasun Hospital, Hwasun Jeonnam, Republic of Korea
| | - Arturo Chiti
- Department of Biomedical Sciences, Humanitas Research Hospital, Rozzano, Italy
| | - Yun Young Choi
- Department of Nuclear Medicine, Hanyang University Hospital, Seoul, Republic of Korea
| | - Gang Huang
- Department of Nuclear Medicine, Ren Ji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Michael Lassmann
- Department of Nuclear Medicine, University Würzburg, Würzburg, Germany
| | - Norman Laurin
- Department of Nuclear Medicine, Centre Hospitalier Affilié Universitaire Régional de Trois-Rivières, Quebec, Canada
| | - Fernando Mut
- Department of Nuclear Medicine, Spanish Association Hospital, Montevideo, Uruguay
| | - Rodolfo Nuñez-Miller
- Section of Nuclear Medicine and Diagnostic Imaging, International Atomic Energy Agency, Vienna, Austria
| | - Darin O'Keeffe
- Department of Medical Physics and Bioengineering, Christchurch Hospital, Christchurch, New Zealand
| | - Prasanta Pradhan
- Department of Nuclear Medicine, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India
| | - Andrew M Scott
- Department of Molecular Imaging and Therapy, Austin Hospital, and Olivia Newton-John Cancer Research Institute and School of Cancer Medicine, La Trobe University, Melbourne, Australia
| | - Shaoli Song
- Department of Nuclear Medicine, Ren Ji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Nischal Soni
- Department of Nuclear Medicine, Inkosi Albert Luthuli Central Hospital, DurbanKwaZulu, Durban, South Africa
| | - Mayuki Uchiyama
- Department of Radiology, Jikei University School of Medicine, Tokyo, Japan; and
| | - Luis Vargas
- Department of Nuclear Medicine, Xalapa Medical Center, Xalapa, Mexico
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16
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van Dijk JD, Jager PL, Mouden M, Slump CH, Ottervanger JP, de Boer J, Oostdijk AHJ, van Dalen JA. Development and validation of a patient-tailored dose regime in myocardial perfusion imaging using CZT-SPECT. J Nucl Cardiol 2014; 21:1158-67. [PMID: 25005346 DOI: 10.1007/s12350-014-9942-0] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2014] [Accepted: 06/04/2014] [Indexed: 11/29/2022]
Abstract
BACKGROUND Guidelines for SPECT myocardial perfusion imaging (MPI) traditionally recommend a fixed tracer dose. Yet, clinical practice shows degraded image quality in heavier patients. The aim was to optimize and validate the tracer dose and scan time to obtain a constant image quality less dependent on patients' physical characteristics. METHODS 125 patients underwent Cadmium Zinc Telluride (CZT)-SPECT stress MPI using a fixed Tc-99m-tetrofosmin tracer dose. Image quality was scored by three physicians on a 4-point grading scale and related to the number of photon counts normalized to tracer dose and scan time. Counts were correlated with various patient-specific parameters dealing with patient size and weight to find the best predicting parameter. From these data, a formula to provide constant image quality was derived, and subsequently tested in 92 new patients. RESULTS Degradation in image quality and photon counts was observed for heavier patients for all patients' specific parameters (P < .01). We found body weight to be the best-predicting parameter for image quality and derived a new dose formula. After applying this new body weight-depended tracer dose and scan time in a new group, image quality was found to be constant (P > .19) in all patients. CONCLUSIONS Also in CZT SPECT image quality decreases with weight. The use of a tracer dose and scan time that depends linearly on patient's body weight corrected for the varying image quality in CZT-SPECT MPI. This leads to better radiation exposure justification.
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Affiliation(s)
- J D van Dijk
- Department of Nuclear Medicine, Isala Hospital, Zwolle, The Netherlands,
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