Enhanced Neutron-Gamma Discrimination Using Deep Neural Networks for Precision Nuclear Medicine

Purpose: To study the specifics of legal and regulatory framework governing the specialties of Radiology (nuclear medicine) and Radiotherapy in the Russian Federation with regard to defining their nomenclature and further regulation. Material and methods: Radiology, commonly referred to as nuclear medicine, originated in the late 19th century after the discovery of radioactivity. It is now extensively utilized in both diagnostic procedures and therapeutic treatments. However, there is significant confusion surrounding the definition of fundamental terms and concepts related to this branch of medicine, necessitating additional clarifications. The authors analyzed literary sources and legislative bases dedicated to issues of terminological and normative uncertainty in the field of nuclear medicine (radiology) in Russia. Discussed are differences in definitions of key terms such as “nuclear medicine,” “radiopharmaceutical preparation,” “radionuclide therapy,” and “radionuclide diagnostics.” Additionally, the problem of a lack of clear standards and rules in the field of nuclear medicine is raised, leading to difficulties in regulating and financing medical services. Results: Proposed measures for improving the situation include developing unified terminology and standards, introducing the position of chief external radiotherapist, creating professional standards for radiologists and radiotherapists, and involving professional communities in addressing this issue. Conclusion: The conducted research underscores the importance of resolving existing problems in legal and regulatory frameworks and terminological discrepancies in the fields of radiology and nuclear medicine in Russia. Emphasis is placed on the necessity of unifying terminology and definitions, establishing clear professional standards for specialists, and developing guidelines for conducting radionuclide studies. These measures should contribute to enhancing the quality of medical care, increasing the efficiency of professionals’ work, and ensuring proper funding of medical services through the compulsory health insurance system. The article proposes solving the identified problem by developing and approving terminology in the specialties of Radiology and Radiotherapy and making amendments to regulatory documentation.

Message from the New Editor-in-Chief.

The radiographer`s profession holds a significant place among the healthcare professionals in Bulgaria. Applying the medical imaging methods and techniques, performing the nuclear medicine tests and the radiotherapy procedures would be unthinkable without the participation of highly competent radiographers. The introduction of new high-tech equipment and technologies as well as of diagnosing and treating methods pose new challenges to the radiographers who now have to adopt new knowledge and skills and to perfect their competences in order to respond to the challenges of modern healthcare. This study aims at establishing the attitudes and tendency of practicing radiographers towards expanding their professional competences in their field of practice. Documentary, sociological and statistical methods have been used. Sources related to the topic have been researched. The study presents the opinion of 182 radiographers practicing in the North-Eastern region of Bulgaria regarding the attitudes and the tendency to expand the professional competences of radiographers. The interviewees have been distributed as follows: 137 radiographers (75.27%) practicing in the field of medical imaging, 42 (23.08%) – in radiotherapy and 3 (1.65%) in the field of nuclear medicine. The data has been processed mathematically and statistically and the results have been presented as graphs. The study showed that the radiographers from all three fields of practice and within the age group 22-40 years (professional experience up to 15 years) are more willing to expand their professional competences in the field of practice but after additional training compared to the age group 40-60 years (professional experience more than 15 years) who consider the competence they already possess allows them to perform the assigned tasks and that adopting new competences would increase their work load. The data obtained from the study in terms of the field of practice is quite interesting. The radiographers practicing in the field of radiotherapy are more willing to adopt new competences compared to those practicing in the field of medical imaging and nuclear medicine. This is due to some extent to the fact that radiographers working in the field of medical imaging have to deal with more work load, often in emergency situations and this would make difficult assuming new responsibilities.

핵의학과에서 시행되는 일반 영상 검사는 수검자의 검사 접수로부터 의사의 판독까지의 과정 동안 오류가 발생된다. 이러한 오류는 최종단계인 의사 판독 시에 확인되어 재검사나 추가촬영, 결과의 재분석, 그리고 PACS 영상의 수정등의 내용을 영상실 검사 담당자에게 지시한다. 이러한 과정을 거쳐 얻어진 결과는 검사에서부터 판독까지의 시간 지연을 초래하고 또한 추가검사가 발생될 경우 환자 만족도와 병원의 신뢰도가 하락하게 된다. 따라서 영상 검사의 접수부터 결과 확정까지 발생되는 오류를 개선하여 수검자들의 불만 감소에 따른 환자 만족도 증가와 근무자들의 업무 효율 증가를 목적으로 한다. 2008년 3월부터 12월까지 9개월간 서울아산병원 핵의학과 일반 영상 검사를 하는 수검자의 검사 오류를 분석하여 2009년 1월부터 12월까지 12개월간 1차 개선 활동으로 검사 절차서의 재 확립 및 검사 업무기술서 작성, 2010년 1월부터 6월까지 6개월간 2차 개선 활동으로 Pre-filtering & Post-Filtering, 2010년 7월부터 10월까지 3개월간 3차 개선 활동 Cross-Check와 스티커 제작 및 부착 실시 이후 검사 오류 건수를 수집하여 비교하였다. 연도별 오류 건 수는 92건에서 1차, 2차 개선 후 32건, 3차 개선 후 46건으로 나타났고, 검사자에 의한 오류는 전체 오류원인의 94.6%이던 것이 74.3%로 감소되었다. 핵의학 일반 영상 검사는 다양한 검사의 종류와 서로 다른 전처치 및 결과산출, 영상의 구성, PACS 전송 영상의 차이로 인하여 검사자의 실수가 발생될 가능성이 높기 때문에 이를 줄이기 위한 개선 활동이 지속되어야 하며 각 영상실 담당자들의 지속적인 Cross-Check와 판독실의 Confirm 과정을 통하여 개인별 편차를 줄여나가야 할 것이다. To n the field of nuclear medicine, with regard to checking regular patients, from the moment they register up to the doctor's diagnosis, the person in charge of the checks can find errors in the diagnosis, reexamine, reanalyze the results or save images to PACS. Through this process, the results obtained from the readings are delayed due to checks and additional tests which occur in hospitals, causing patient satisfaction and affected reliability. Accordingly, the purpose is to include visual inspection of the results to minimize error, improve efficiency and increase patient satisfaction. Nuclear medicine and imaging tests from examines at Asan Medical Center, Seoul, from March 2008 to December 2008, were analyzed for errors. The first stage, from January 2009 to December 2009, established procedures and know-how. The second stage from January 2010 until June 2010 conducted Pre-and Post-filtering assessment, and the third stage from July 2010 until October 2010 consisted of cross-checks and attaching stickers and comparing error cases. Of 92 errors, the 1st, 2nd and 3rd stage had 32 cases, and there were 46 cases after the 4th stage, with the overall errors reduced by 74.3% from 94.6%. In the field of general nuclear medicine, where various kinds of checks are performed according to the patient's needs, analysis, image composition, differing images in PACS, etc, all have the potential for mistakes to be made. In order to decrease error rates, the image can continuously Cross-Check and Confirm diagnosis.

A new positron-gamma discriminating phoswich detector based on wavelength discrimination (WLD)

Background: The demand for nuclear medicine procedures is growing in recent years but training of medical students in this subject is not appropriately developed. There is no well defined program for training medical students in the field of nuclear medicine. Purpose: To evaluate the knowledge of the general practitioners from clinical applications of nuclear medicine. Methods: One hundred and six general practitioners (58 male and 48 female) participated in an exam with 14 multiple questions (Four question on general nuclear medicine and 10 questions on clinical applications of nuclear medicine). Also their idea was asked regarding training in nuclear medicine. Validity of questions was confirmed by nuclear medicine specialists and consensus of four reference text books(3-5). Minimum score was 0 and maximum score was 14. Correct answering of less than 50% of questions were considered as poor, 50-70% were intermediate and >70% as good. Results: Of all participants, 95% were under 40 years old , 92% graduated in the last 10 years and 52% were trained in Mashad universities. The study showed that 32% of participants have poor results and only 12% of participants had good results. About 62% of participants correctly answered to less than 58% of questions. Overall mean score was 7.53± 2.72. Doctors graduated from Tabriz universities had significantly higher scores than graduates from other universities. Sixty nine percent of participants had no training in nuclear medicine at all and the rest had a variety of 3-15 hours of training. About 90% of participants needed more information in nuclear medicine as they checked in the questionnaire. Conclusion: Our study showed that knowledge of general practitioners in the field of nuclear medicine is poor and they need to improve their knowledge. Key words: KNOWLEDGE, MEDICAL STUDENT, NUCLEARMEDICINE

This review aims to take a journey into the transformative impact of artificial intelligence (AI) on positron emission tomography (PET) imaging. To this scope, a broad overview of AI applications in the field of nuclear medicine and a thorough exploration of deep learning (DL) implementations in cancer diagnosis and therapy through PET imaging will be presented. We firstly describe the behind-the-scenes use of AI for image generation, including acquisition (event positioning, noise reduction though time-of-flight estimation and scatter correction), reconstruction (data-driven and model-driven approaches), restoration (supervised and unsupervised methods), and motion correction. Thereafter, we outline the integration of AI into clinical practice through the applications to segmentation, detection and classification, quantification, treatment planning, dosimetry, and radiomics/radiogenomics combined to tumour biological characteristics. Thus, this review seeks to showcase the overarching transformation of the field, ultimately leading to tangible improvements in patient treatment and response assessment. Finally, limitations and ethical considerations of the AI application to PET imaging and future directions of multimodal data mining in this discipline will be briefly discussed, including pressing challenges to the adoption of AI in molecular imaging such as the access to and interoperability of huge amount of data as well as the “black-box” problem, contributing to the ongoing dialogue on the transformative potential of AI in nuclear medicine.Relevance statementAI is rapidly revolutionising the world of medicine, including the fields of radiology and nuclear medicine. In the near future, AI will be used to support healthcare professionals. These advances will lead to improvements in diagnosis, in the assessment of response to treatment, in clinical decision making and in patient management.Key points• Applying AI has the potential to enhance the entire PET imaging pipeline.• AI may support several clinical tasks in both PET diagnosis and prognosis.• Interpreting the relationships between imaging and multiomics data will heavily rely on AI.Graphical

In Germany the duration of training in the field of nuclear medicine is 5 years, of which 1 year must be spent in clinical inpatient patient care, and another 6 months of training in another field is possible. It is also permissible to work for up to a year in a radiology department. In contrast, to get credit for the training in nuclear medicine in other fields such as radiology is essentially impossible or there is a very strict time limit. The reason can be found in the differences within the Federal States in Germany with regard to acknowledging nuclear medicine as a “specialty of immediate patient care” [2]. The WBO of the German Medical Association constitutes one of the guidelines dictating the content of the training. The German Radiation Protection Ordinance and the guidelines on obtaining the special qualification contain further regulations. In this ordinance specific numbers are listed for guidance, which, however, do not constitute bindingminimum numbers. In addition to the provision of the medical associations, the guideline on technical knowledge, which took effect on 1 November 2011, determines ballpark numbers and time frames for training programmes in expert knowledge of safe use of radiation. Essentially these match the provisions in the template regulation, with the exception of the number of therapies allowed for malignant thyroid diseases (only 100 instead of 200 therapies) and providing a separate regulation for endoluminal or endocavitary therapies. For this separate specialty ten documented applications are required each for selective internal radiation therapy (SIRT), endoluminal therapies and radiosynoviorthesis. In the former specialty training regulation, MRI could be found as a subspecialization in the field of nuclear medicine. In the new specialty training regulation, an additional subjectL. S. Freudenberg ZRN Grevenbroich, Dormagen, Neuss, Germany

This work presents the development of a gamma radiation detection simulation system, which is composed of a java application and a physical detector that simulates gamma radiation detection through distance measurement. The objective of the system is to simulate the behavior of 14 of the most commonly used radioactive isotopes in medical physics and nuclear medicine, using technologies that are harmless to health. This project arises to provide an educational tool in the field of medical physics and nuclear medicine that facilitates the understanding of the behavior of radioactive isotopes that generate gamma radiation. Currently the only people who have access to gamma radiation practices are people certified with a POE designation (occupationally exposed personnel), so this device is proposed as another tool in the knowledge of gamma radiation. This device is not limited to any type of public, since it is designed so that anyone can work with it, and interact with the behavior of isotopes and gamma radiation, since everything is simulated and does not generate any health risk, providing radiological safety and respecting the mathematical models that describe the behavior of radioactive isotopes.KeywordsGamma radiationRadioactive isotopesSimulator

In the recent few decades, there was a growth in the field of radioactive medicinal agents called radiopharmaceuticals. Radiopharmaceuticals are consisting of radioactive materials called radioisotopes. Radiopharmaceuticals were recently used in both therapeutic and diagnostic purposes. More than 100 radioactive substances are used in nuclear medicine. According to the decay of radioactive substances, there are three types of radioactive decays, alpha particles, beta particles, and gamma radiations. Alpha particles consist of two protons and two neutrons with large mass and charge so it has no penetration power into the skin and has a destructive effect. Beta particles have less charge and less mass so, they can penetrate the tissue and have a less destructive effect than alpha particles and can be used in therapy. Gamma radiations have no mass or charge so they can penetrate the deep tissue of organs so used in diagnosis by imaging using a gamma camera. The radiopharmaceuticals were established in the diagnostic purpose and treatment of several diseases as thyroid gland cancer, hyperthyroidism, bone pain metastasis, kidney dysfunction, and myocardial and cerebral perfusion. The radioactive substance can also be used in the sterilization of thermo-labile substances as syringes, catheters, vitamins, hormones, and surgical dressing. The field of nuclear medicine has several advantages as localization of tumors, safe diagnosis, no accumulation of radiation, and high therapeutic efficacy. Nowadays, the branch of nuclear pharmacy is directed to introduce new radioactive pharmaceutical agents which will be important and effective in the treatment of cancer. The growth in the field of radiopharmaceuticals is important to help millions of patients suffering from tumors all over the world. The data of this review were collected by searching in Google Scholar and PubMed using the following keywords.

Elastomers are widely used in radioactive environments, where ionizing radiations induce a deterioration of their properties due to degradative phenomena occurring in the polymer structure. Their radiation resistance is usually assessed using γ‐rays and relatively low dose rates, but in actual applications, they are often exposed to mixed radiation fields and higher dose rates. Ethylene propylene diene monomer (EPDM) is known for its excellent resistance to γ‐rays but absorbs a larger dose by neutron interactions than fluoroelastomer (FPM). In this work, EPDM and FPM were irradiated in mixed neutron and gamma fields, using high dose rates (from 22 to 700 kGy h −1 ) and total absorbed doses between 0.2 and 3.5 MGy. The effects of irradiation were assessed by swelling tests, differential scanning calorimetry analysis and dynamic mechanical thermal analysis, and tensile tests. The results show that, even if irradiations were carried out in air, degradation took place under nonoxidative conditions owing to the high dose rates employed. Under such conditions, crosslinking is the dominant radiation‐induced reaction in both elastomers. Moreover, material degradation seems to be influenced mostly by the total absorbed dose and not by the type of radiation. Contrary to what observed at the lower dose rates employed with γ‐rays, major dose rate effects are not observed. POLYM. ENG. SCI., 59:2522–2532, 2019. © 2019 Society of Plastics Engineers

IAEA Programs in Empowering the Nuclear Medicine Profession Through Online Educational Resources

It gives me immense pleasure to bring out the supplementary issue of Indian Journal of Nuclear medicine (IJNM) to highlight the scientific contributions being presented at the 47th Annual Conference of Society of Nuclear Medicine, India (SNMI) at Puducherry from 3rd-6th Dec 2015. Puducherry-a union territory of India; is located in the southernpart of the country bordering Tamil Nadu. It has vast coastline and beautiful building/streets - a gentle reminder of the French colonization. This place is world renowned for Sri Aurobindo Ashram and Auroville. “Auroville is meant to be a universal town where men and women of all countries are able to live in peace and progressive harmony, above all creeds, all politics and all nationalities. The purpose of Auroville is to realize human unity. Hence, Puducherry is an important destination for tourists from all walks of life as well as spiritual seekers from around the world in search of inner peace and tranquility. It has more significance today in context of the recent violent attacks in Paris. The city is also known for its medical facilities and Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER) stands out like a beacon amongst them. It is an institute of national repute with various specialties catering to the nearby population and from the adjacent states. This is for the first time that JIPMER, Puducherry is hosting the prestigious Annual Conference of the SNMI. This conference would provide a suitable platform for interactive discussions and ideas exchange regarding the latest developments taking place in the field of Nuclear Medicine in India as well as the other parts of world. The conference will not only provide an opportunity to nuclear medicine physicians from whole of the country to showcase their work but also get invaluable inputs by eminent foreign and national experts. IJNM has the unique distinction in bringing out the supplementary issues coinciding with the time of annual conference to give an idea regarding the latest development and trends in the subject. The aim of publishing the abstracts of presentations in print media is to have a widenet of readership. There would be about 140 oral and poster presentations in the present conference covering areas related to clinical as well as basic nuclear medicine including cardiology, gastrointestinal, hepatobiliary, musckulo-skeletal system, nephro-urology, oncology, endocrinology, radiation safety, radiopharmacy etc. The oral and poster presentations have undergone a strict scrutiny and peer-review before being accepted for presentation. The majority of papers are from radiopharmacy constituting more than 1/3rd of total presentation. The scientific sessions have been carefully designed so that every physician/scientist gets a chance to present their work and listen to the experts’ views. The scientific committee of this conference has tried to design a very rich program with theme of the conference being “Scintillation for Maladies”. The society will also bestow honors on its distinguished speakers with oration awards. This year, the recipients of the Homi Bhabha Memorial Oration, Vikram Sarabhai Memorial Oration and Brig SK Majumdar Memorial Oration awards will be Dr. Pankaj Tandon from Mumbai, Dr. Frank Rosch from Germany and Dr. Partha S. Choudhury from New Delhi. These awards are named after three great Indian scientists/physicians who have contributed a lot in the field of Nuclear Medicine in India. In addition, there will be Dr N Ramdas prize in Nuclear Thyroidology and Dr. Shakuntla Krishnamurthy prizes in the field of Nuclear Hepatology for best papers. The whole team of IJNM wishes the organizing team of 47th annual conference of SNMI a great success. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.

Radiopharmaceutical enhancement by drug delivery systems: A review

David V Becker