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Camoni L, Santos A, Luporsi M, Grilo A, Pietrzak A, Gear J, Zucchetta P, Bar-Sever Z. EANM procedural recommendations for managing the paediatric patient in diagnostic nuclear medicine. Eur J Nucl Med Mol Imaging 2023; 50:3862-3879. [PMID: 37555902 PMCID: PMC10611649 DOI: 10.1007/s00259-023-06357-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Accepted: 07/23/2023] [Indexed: 08/10/2023]
Abstract
PURPOSE The manuscript aims to characterize the principles of best practice in performing nuclear medicine procedures in paediatric patients. The paper describes all necessary technical skills that should be developed by the healthcare professionals to ensure the best possible care in paediatric patients, as it is particularly challenging due to psychological and physical conditions of children. METHODS We performed a comprehensive literature review to establish the most relevant elements of nuclear medicine studies in paediatric patients. We focused the attention to the technical aspects of the study, such as patient preparation, imaging protocols, and immobilization techniques, that adhere to best practice principles. Furthermore, we considered the psychological elements of working with children, including comforting and distraction strategies. RESULTS The extensive literature review combined with practical conclusions and recommendations presented and explained by the authors summarizes the most important principles of the care for paediatric patient in the nuclear medicine field. CONCLUSION Nuclear medicine applied to the paediatric patient is a very special and challenging area, requiring proper education and experience in order to be performed at the highest level and with the maximum safety for the child.
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Affiliation(s)
- Luca Camoni
- University of Brescia, 25123, Brescia, Italy.
- Nuclear Medicine Department, University of Brescia, ASST Spedali Civili Di Brescia, P.Le Spedali Civili 1, 25123, Brescia, Italy.
| | - Andrea Santos
- Nuclear Medicine Department, CUF Descobertas Hospital, Lisbon, Portugal
| | - Marie Luporsi
- Department of Nuclear Medicine, Institut Curie, PSL Research University, 75005, Paris, France
- LITO Laboratory INSERM U1288, Institut Curie, 91440, Orsay, France
| | - Ana Grilo
- H&TRC - Health and Technology Research Center, ESTeSL - Escola Superior de Tecnologia da Saúde, Instituto Politécnico de Lisboa, Lisbon, Portugal
- CICPSI, Faculdade de Psicologia, Universidade de Lisboa, Alameda da Universidade, Lisbon, Portugal
| | - Agata Pietrzak
- Electroradiology Department, Poznan University of Medical Sciences, Poznan, Poland
- Nuclear Medicine Department, Greater Poland Cancer Centre, Poznan, Poland
| | - Jonathan Gear
- Joint Department of Physics, Royal Marsden Hospital and Institute of Cancer Research, Sutton, UK
| | - Pietro Zucchetta
- Nuclear Medicine Department, Padova University Hospital, 35128, Padua, Italy
| | - Zvi Bar-Sever
- Department of Nuclear Medicine, Schneider Children's Medical Center, Tel-Aviv University, Petach Tikva, Israel
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Hu Y, Zheng Z, Yu H, Wang J, Yang X, Shi H. Ultra-low-dose CT reconstructed with the artificial intelligence iterative reconstruction algorithm (AIIR) in 18F-FDG total-body PET/CT examination: a preliminary study. EJNMMI Phys 2023; 10:1. [PMID: 36592256 PMCID: PMC9807709 DOI: 10.1186/s40658-022-00521-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Accepted: 12/20/2022] [Indexed: 01/03/2023] Open
Abstract
PURPOSE To investigate the feasibility of ultra-low-dose CT (ULDCT) reconstructed with the artificial intelligence iterative reconstruction (AIIR) algorithm in total-body PET/CT imaging. METHODS The study included both the phantom and clinical parts. An anthropomorphic phantom underwent CT imaging with ULDCT (10mAs) and standard-dose CT (SDCT) (120mAs), respectively. ULDCT was reconstructed with AIIR and hybrid iterative reconstruction (HIR) (expressed as ULDCT-AIIRphantom and ULDCT-HIRphantom), respectively, and SDCT was reconstructed with HIR (SDCT-HIRphantom) as control. In the clinical part, 52 patients with malignant tumors underwent the total-body PET/CT scan. ULDCT with AIIR (ULDCT-AIIR) and HIR (ULDCT-HIR), respectively, was reconstructed for PET attenuation correction, followed by the SDCT reconstructed with HIR (SDCT-HIR) for anatomical location. PET/CT images' quality was qualitatively assessed by two readers. The CTmean, as well as the CT standard deviation (CTsd), SUVmax, SUVmean, and the SUV standard deviation (SUVsd), was recorded. The signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) were calculated and compared. RESULTS The image quality of ULDCT-HIRphantom was inferior to the SDCT-HIRphantom, but no significant difference was found between the ULDCT-AIIRphantom and SDCT-HIRphantom. The subjective score of ULDCT-AIIR in the neck, chest and lower limb was equivalent to that of SDCT-HIR. Besides the brain and lower limb, the change rates of CTmean in thyroid, neck muscle, lung, mediastinum, back muscle, liver, lumbar muscle, first lumbar spine and sigmoid colon were -2.15, -1.52, 0.66, 2.97, 0.23, 8.91, 0.06, -4.29 and 8.78%, respectively, while all CTsd of ULDCT-AIIR was lower than that of SDCT-HIR. Except for the brain, the CNR of ULDCT-AIIR was the same as the SDCT-HIR, but the SNR was higher. The change rates of SUVmax, SUVmean and SUVsd were within [Formula: see text] 3% in all ROIs. For the lesions, the SUVmax, SUVsd and TBR showed no significant difference between PET-AIIR and PET-HIR. CONCLUSION The SDCT-HIR could not be replaced by the ULDCT-AIIR at date, but the AIIR algorithm decreased the image noise and increased the SNR, which can be implemented under special circumstances in PET/CT examination.
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Affiliation(s)
- Yan Hu
- grid.8547.e0000 0001 0125 2443Department of Nuclear Medicine, Zhongshan Hospital, Fudan University, 180 Fenglin Rd, Shanghai, 200032 China ,grid.8547.e0000 0001 0125 2443Nuclear Medicine Institute of Fudan University, Shanghai, 200032 China ,grid.413087.90000 0004 1755 3939Shanghai Institute of Medical Imaging, Shanghai, 200032 China
| | - Zhe Zheng
- grid.8547.e0000 0001 0125 2443Department of Nuclear Medicine, Zhongshan Hospital, Fudan University, 180 Fenglin Rd, Shanghai, 200032 China ,grid.8547.e0000 0001 0125 2443Nuclear Medicine Institute of Fudan University, Shanghai, 200032 China ,grid.413087.90000 0004 1755 3939Shanghai Institute of Medical Imaging, Shanghai, 200032 China
| | - Haojun Yu
- grid.8547.e0000 0001 0125 2443Department of Nuclear Medicine, Zhongshan Hospital, Fudan University, 180 Fenglin Rd, Shanghai, 200032 China ,grid.8547.e0000 0001 0125 2443Nuclear Medicine Institute of Fudan University, Shanghai, 200032 China ,grid.413087.90000 0004 1755 3939Shanghai Institute of Medical Imaging, Shanghai, 200032 China
| | - Jingyi Wang
- grid.497849.fUnited Imaging Healthcare Co., Ltd., Shanghai, China
| | - Xinlan Yang
- grid.497849.fUnited Imaging Healthcare Co., Ltd., Shanghai, China
| | - Hongcheng Shi
- grid.8547.e0000 0001 0125 2443Department of Nuclear Medicine, Zhongshan Hospital, Fudan University, 180 Fenglin Rd, Shanghai, 200032 China ,grid.8547.e0000 0001 0125 2443Nuclear Medicine Institute of Fudan University, Shanghai, 200032 China ,grid.413087.90000 0004 1755 3939Shanghai Institute of Medical Imaging, Shanghai, 200032 China
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Ho Shon I, Hennessy T, Guille J, Gotsbacher MP, Lay AJ, McBride B, Codd R, Hogg PJ. A first-in-human study of [ 68Ga]Ga-CDI: a positron emitting radiopharmaceutical for imaging tumour cell death. Eur J Nucl Med Mol Imaging 2022; 49:4037-4047. [PMID: 35779082 PMCID: PMC9525422 DOI: 10.1007/s00259-022-05880-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Accepted: 06/14/2022] [Indexed: 11/29/2022]
Abstract
PURPOSE This study assesses human biodistribution, radiation dosimetry, safety and tumour uptake of cell death indicator labelled with 68Ga ([68Ga]Ga-CDI), a novel radiopharmaceutical that can image multiple forms of cell death. METHODS Five participants with at least one extracranial site of solid malignancy > 2 cm and no active cancer treatment in the 8 weeks prior to the study were enrolled. Participants were administered 205 ± 4.1 MBq (range, 200-211 MBq) of [68Ga]Ga-CDI and 8 serial PET scans acquired: the first commencing immediately and the last 3 h later. Participants were monitored for clinical, laboratory and electrocardiographic side effects and adverse events. Urine and blood radioactivity was measured. Spherical volumes of interest were drawn over tumour, blood pool and organs to determine biodistribution and calculate dosimetry. In one participant, tumour specimens were analysed for cell death using terminal deoxynucleotidyl transferase dUTP nick end labelling (TUNEL) staining. RESULTS [68Ga]Ga-CDI is safe and well-tolerated with no side effects or adverse events. [68Ga]Ga-CDI is renally excreted, demonstrates low levels of physiologic uptake in the other organs and has excellent imaging characteristics. The mean effective dose was 2.17E - 02 ± 4.61E - 03 mSv/MBq. It images constitutive tumour cell death and correlates with tumour cell death on histology. CONCLUSION [68Ga]Ga-CDI is a novel cell death imaging radiopharmaceutical that is safe, has low radiation dosimetry and excellent biodistribution and imaging characteristics. It has potential advantages over previously investigated radiopharmaceuticals for imaging of cell death and has progressed to a proof-of-concept trial. TRIAL REGISTRATION ACTRN12621000641897 (28/5/2021, retrospectively registered).
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Affiliation(s)
- Ivan Ho Shon
- Department of Nuclear Medicine and PET, Prince of Wales Hospital, Sydney, Australia. .,The Centenary Institute, University of Sydney, Sydney, Australia. .,Prince of Wales Clinical School, University of New South Wales, Sydney, Australia.
| | - Thomas Hennessy
- Department of Nuclear Medicine and PET, Prince of Wales Hospital, Sydney, Australia
| | - Jennifer Guille
- Department of Nuclear Medicine and PET, Prince of Wales Hospital, Sydney, Australia
| | | | - Angelina J Lay
- The Centenary Institute, University of Sydney, Sydney, Australia
| | - Bruce McBride
- Department of Nuclear Medicine and PET, Prince of Wales Hospital, Sydney, Australia
| | - Rachel Codd
- School of Medical Sciences, University of Sydney, Sydney, Australia
| | - Philip J Hogg
- The Centenary Institute, University of Sydney, Sydney, Australia
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Ultra-low dose whole-body CT for attenuation correction in a dual tracer PET/CT protocol for multiple myeloma. Phys Med 2021; 84:1-9. [PMID: 33799056 DOI: 10.1016/j.ejmp.2021.03.019] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Revised: 02/22/2021] [Accepted: 03/13/2021] [Indexed: 01/17/2023] Open
Abstract
PURPOSE To investigate within phantoms the minimum CT dose allowed for accurate attenuation correction of PET data and to quantify the effective dose reduction when a CT for this purpose is incorporated in the clinical setting. METHODS The NEMA image quality phantom was scanned within a large parallelepiped container. Twenty-one different CT images were acquired to correct attenuation of PET raw data. Radiation dose and image quality were evaluated. Thirty-one patients with proven multiple myeloma who underwent a dual tracer PET/CT scan were retrospectively reviewed. 18F-fluorodeoxyglucose PET/CT included a diagnostic whole-body low dose CT (WBLDCT: 120 kV-80mAs) and 11C-Methionine PET/CT included a whole-body ultra-low dose CT (WBULDCT) for attenuation correction (100 kV-40mAs). Effective dose and image quality were analysed. RESULTS Only the two lowest radiation dose conditions (80 kV-20mAs and 80 kV-10mAs) produced artifacts in CT images that degraded corrected PET images. For all the other conditions (CTDIvol ≥ 0.43 mGy), PET contrast recovery coefficients varied less than ± 1.2%. Patients received a median dose of 6.4 mSv from diagnostic CT and 2.1 mSv from the attenuation correction CT. Despite the worse image quality of this CT, 94.8% of bone lesions were identifiable. CONCLUSION Phantom experiments showed that an ultra-low dose CT can be implemented in PET/CT procedures without any noticeable degradation in the attenuation corrected PET scan. The replacement of the standard CT for this ultra-low dose CT in clinical PET/CT scans involves a significant radiation dose reduction.
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