Field Of Nuclear Medicine Research Articles

The origins and early years of the American Society of Nuclear Cardiology

In 1971 and 1973, Drs Strauss and Zaret published the seminal descriptions of stress radionuclide myocardial perfusion imaging and of ECG-gated blood pool imaging, marking the beginning of what we know now as nuclear cardiology. In the later years (1975-1980), radionuclide cardiac imaging emerged as a distinct entity within the field of nuclear medicine. The publication by Dr Gould on pharmacologic stress perfusion imaging was also pivotal for the development of this field. Of relevance for later developments, it was predominantly cardiologists who investigated and introduced the use of nuclear medicine techniques for clinical imaging of the heart. At the national meetings of the American College of Cardiology (ACC) and the American Heart Association (AHA), an increasing number of scientific sessions were devoted to clinical applications of radionuclide cardiac imaging. However, the daylong symposium on cardiovascular imaging at the annual meeting of the Society of Nuclear Medicine (SNM) became the most important annual educational and scientific event for those involved in nuclear cardiac imaging. The increasing interest in Nuclear Cardiology led to the formation of the Cardiovascular (CV) Council of the SNM on November 12, 1985. Dr Elias Botvinick was the founder and the first president, who was joined by a small core group of mainly cardiologists. Subsequent presidents were all prominent investigators in the field of nuclear cardiology, and many of them were cardiologists (Table 1). With 1,012 members, the CV Council became the most dynamic and largest council of the SNM. Thirty-six percent of the members were nuclear physicians, 32% cardiologists, 22% technologists, and 10% representatives of industry. Nevertheless, cardiologists were the predominant forces within the CV Council with regard to educational and research activities. After several years of very successful and wellattended cardiovascular imaging symposia, many cardiac imaging investigators felt that nuclear cardiology should expand as a field on its own and become more widely inclusive to those physicians who were becoming interested in this area of medicine. Early attempts to develop this concept within the SNM were not very successful. The leadership of the SNM exercised their official power to limit the operation of the CV Council as a mainly educational activity for its own nuclear medicine community and obviously had no desire to initiate a separate and potentially independent professional society within its own ranks. To many of the members of the CV Council, it became increasingly clear that a more effective and likely independent representation might be needed to advance the field. It was also recognized that such an effort should include clear guidelines for clinical training and practice that would lead to more consistent quality of nuclear cardiology services. The lack of such standards and the perception that there was wide variation in the field of nuclear cardiology practice was felt to significantly harm its credibility.

Clinical and Translational Imaging: reviews in nuclear medicine and molecular imaging

Clinical and Translational Imaging is the new official organ of the Italian Association of Nuclear Medicine and Molecular Imaging (AIMN). This association, long committed to consistently raising the standard and impact of its scientific publications, and feeling that the time is ripe for a qualitative leap forward, is embarking on this exciting project strengthened by the support and experience of a prestigious partner, Springer, whose vision and priorities are very much in line with its own. Clinical and Translational Imaging is an international peer-reviewed journal specifically devoted to review articles on translational and clinical imaging in the field of nuclear medicine and molecular imaging. The journal aims to offer this fast-evolving field a new perspective and a new kind of publication. Indeed, the intention, in launching this journal, is not to compete with existing ones, but rather to complement them. Traditional imaging journals tend to devote most of their space to original scientific papers, but these, by definition, often present highly specific and sometimes controversial data and, therefore, fail to convey a clear message to the more clinically oriented reader. These valuable data urgently need to be translated, compiled and delivered to the reader in a readily comprehensible and applicable format, thereby increasing their diffusion and impact. Furthermore, the increasingly large volume of scientific papers published in the field of imaging has created a real need for a more systematic appreciation and overview of the different currents of thought and future directions that are stemming from specific research findings, and thus for in-depth critical reviews that provide methodologically sound and clinically useful analyses of these data. In short, Clinical and Translational Imaging intends, through its targeted review articles, to draw attention to on going efforts to translate basic science into clinical application. To this end, our policy is to publish papers that present, in a descriptive manner, evidence-based diagnostic and therapeutic strategies and best practices, but we will also be looking for papers that are visionary and anticipate new developments, including policy recommendations designed to advance the field of medical imaging worldwide. The journal will welcome timely and updated summaries on clinical practice and translational research and clinical applications of approved and experimental radiopharmaceuticals for diagnostic and therapeutic use. Papers dealing with advanced preclinical evidence in the fields of physics, dosimetry, radiation biology and radiopharmacy with relevance to upcoming applications in human subjects are also within the scope of the journal. Thanks to the support of expert peer-reviewers and a distinguished editorial board, which includes internationally renowned experts, Clinical and Translational Imaging is expected to rapidly establish itself as a valuable, authoritative and selective reference tool. The journal will appear bimonthly and will be made available through Springer’s online platform SpringerLink, thereby guaranteeing articles rapid international exposure. All manuscripts will undergo the rigorous peer-review process that is required by any international journal aiming to furnish a reliable body of research data and knowledge. The editorial board has decided to publish a limited number of monographic issues, each of which will have a guest editor or editors and feature contributions from invited authors. These invited papers will be peerreviewed. G. Lucignani (&) Universita degli Studi di Milano, A.O. San Paolo, Milan, Italy e-mail: giovanni.lucignani@unimi.it

Asia Oceania Journal of Nuclear Medicine & Biology; A big step forward to advance scientific publication & cooperation in the region.

Asia Oceania Journal of Nuclear Medicine & Biology; A big step forward to advance scientific publication & cooperation in the region.

RadNuc: a graphical user interface to deliver dose rate patterns encountered in nuclear medicine with a 137Cs irradiator.

The temporal variations in absorbed dose rates to organs and tissues in the body are very large in diagnostic and therapeutic nuclear medicine. The response of biological endpoints of relevance to radiation safety and therapeutic efficacy is generally modulated by dose rate. Therefore, it is important to understand how the complex dose rate patterns encountered in nuclear medicine impact relevant biological responses. Accordingly, a graphical user interface (GUI) was created to control a cesium-137 irradiator to deliver such dose rate patterns. Visual Basic 6.0 was used to create a user-friendly GUI to control the dose rate by varying the thickness of a mercury attenuator. The GUI facilitates the delivery of a number of dose rate patterns including constant, exponential increase or decrease, and multi-component exponential. Extensive visual feedback is provided by the GUI during both the planning and delivery stages. The GUI controlled irradiator can achieve a maximum dose rate of 40 cGy/h and a minimum dose rate of 0.01 cGy/h. Addition of machined lead blocks can be used to further reduce the minimum dose rate to 0.0001 cGy/h. Measured dose rate patterns differed from programmed dose rate patterns in total dose by 3.2% to 8.4%. The GUI controlled irradiator is able to accurately create dose rate patterns encountered in nuclear medicine and other related fields. This makes it an invaluable tool for studying the effects of chronic constant and variable low dose rates on biological tissues in the contexts of both radiation protection and clinical administration of internal radionuclides.

Calculation of beta induced Bremsstrahlung exposure from therapeutic radionuclide 198Au in tissues, DNA and RNA

Abstract Gold-198 (βmax=0.96MeV (98.6%), γmax=0.412MeV (95.5%) and T1/2=2.7 days) is a well-known therapeutic beta emitter in the field of nuclear medicine, and is being used for the treatment of many different cancers. In the present study, the Bremsstrahlung exposure induced by 198Au in different human tissues, DNA and RNA has been calculated. The specific Bremsstrahlung constant (ΓBr), Probability of energy loss by beta during Bremsstrahlung emission (PBr) and Bremsstrahlung activity (Arelease)Br were estimated. We strongly recommend these parameters should be considered in absorbed dose calculations of radionuclide therapy via 198Au.

A Practical Guide to Quality Improvement in Nuclear Medicine

Innovations and improvements in the field of nuclear medicine have created remarkable image accuracy and detail, which allow physicians to better diagnose disease. This ability has led to dramatic differences in patient care. To ensure that these diagnoses are reliable, imaging facilities must constantly monitor and seek to improve their practices. Quality improvement is a formal process of examining and improving performance through the analysis of data with the primary goal of enhancing patient care. Quality improvement activities in a nuclear medicine laboratory should emphasize accuracy and efficiency, patient and staff safety, and the patient's experience during care. Quality improvement in the nuclear medicine laboratory can potentially reduce the number of studies that need to be repeated because of poor quality, increase diagnostic accuracy, reduce radiation exposure, increase patient satisfaction, and save resources. This article will review the process of quality improvement; provide detailed, step-by-step instructions with special emphasis on project selection and data collection; and show examples of how to perform quality improvement projects.

Why do we need accreditation of nuclear medicine departments?

Nuclear medicine is one of the most dynamic areas of medicine with continual technological innovations and developments of new radiotracers. The International Atomic Energy Agency (IAEA) defines nuclear medicine as a medical specialty that uses techniques with high cost-benefit index to obtain functional and anatomical information, constituting a tool for the detection, staging, treatment, prognosis and monitoring of patients [1]. Nuclear medicine has been an independent European medical specialty since 1988. The Section of Nuclear Medicine was created in 1990 within the European Union of Medical Specialists (UEMS), the entity that represents the medical specialties inside the European Union (EU) and that defines the basic principles of training in medical specialties in Europe in order to achieve a comparable level of knowledge and to allow the free movement of specialists among the member countries. The European Board of Nuclear Medicine (EBNM) was established in 1993 with the main objective of ensuring the highest possible levels of quality in the field of nuclear medicine. In 2000 the European Association of Nuclear Medicine (EANM) set up a Task Group on departmental accreditation. In 2003, the UEMS Section and the EBNM merged as the UEMS/EBNM to unify and facilitate their activities and created several committees, including the Committee for Accreditation of Nuclear Medicine Departments (CANMD). This was the EANM Task Group which transferred from the EANM. In practice, the UEMS/EBNM and the CANMD work in cooperation with the EANM. Technological innovations and advances in the field of new radiopharmaceuticals are very important for the continuous development of the nuclear medicine specialty. Any department of nuclear medicine must assure minimum quality requirements according to its available resources. Quality! Never has this word been used so frequently. In fact, in recent times there has been a significant reorganization of the concept of quality. Since 1947, the year the International Standards Organization (ISO) was created, there has been increasing emphasis on the quality of products and services. What before had been performed in a routine local way, nowadays attempts are made to globalize the process through standards and a good quality program and well-defined operating procedures, all of which, in our case, are to be applied to a department of nuclear medicine. Whether a department of nuclear medicine is public or private, it is assumed that it works correctly and assures minimum quality requirements. On this basis, one could ask: “what do I need to get an official accreditation by EANM?—why, in addition to possible certification by ISO and all the daily problems of budget cuts or concern for expenses generated by the cost of new equipment?” It is possible that many European nuclear medicine doctors have received training in concepts such as total quality, standardization, Deming circles, development of quality policies, objectives and indicators, and that they may now be applying those concepts in their daily work, in an effort to improve patient care and the quality of the services provided by their departments of nuclear medicine, in order to stand out from the other competitors and (why not) to survive in these very competitive times marked by the rampant crisis in all sectors. But it is also true that some other nuclear medicine physicians are unaware of these concepts. At CANMD we believe that the accreditation of nuclear medicine services is not the mere collection of a diploma to hang on the wall. To have this official accreditation is relevant and provides multiple benefits that outweigh any sacrifice. Eur J Nucl Med Mol Imaging (2012) 39:1643–1645 DOI 10.1007/s00259-012-2184-y

Curriculum for education and training of Medical Physicists in Nuclear Medicine: Recommendations from the EANM Physics Committee, the EANM Dosimetry Committee and EFOMP

PurposeTo provide a guideline curriculum covering theoretical and practical aspects of education and training for Medical Physicists in Nuclear Medicine within Europe. Material and methodsNational training programmes of Medical Physics, Radiation Physics and Nuclear Medicine physics from a range of European countries and from North America were reviewed and elements of best practice identified. An independent panel of experts was used to achieve consensus regarding the content of the curriculum. ResultsGuidelines have been developed for the specialist theoretical knowledge and practical experience required to practice as a Medical Physicist in Nuclear Medicine in Europe. It is assumed that the precondition for the beginning of the training is a good initial degree in Medical Physics at master level (or equivalent). The Learning Outcomes are categorised using the Knowledge, Skill and Competence approach along the lines recommended by the European Qualifications Framework. The minimum level expected in each topic in the theoretical knowledge and practical experience sections is intended to bring trainees up to the requirements expected of a Medical Physicist entering the field of Nuclear Medicine. ConclusionsThis new joint EANM/EFOMP European guideline curriculum is a further step to harmonise specialist training of Medical Physicists in Nuclear Medicine within Europe. It provides a common framework for national Medical Physics societies to develop or benchmark their own curricula. The responsibility for the implementation and accreditation of these standards and guidelines resides within national training and regulatory bodies.

Effects of 99mTc sestamibi on antioxidant defense system and lipid peroxidation in the heart of Sprague Dawley rats

Nuclear medicine has been using radiopharmaceuticals for the diagnostic and therapeutic purposes of many diseases. Technetium-(99m) methoxyisobutylisonitrile ((99m)Tc sestamibi) is a lypophilic complex that has a positive-loaded isonitril group. Aim of the study is to investigate whether (99m)Tc sestamibi, which is one of the mostly used radiopharmaceuticals in nuclear medicine field, causes oxidative damage or not in rats' heart after an injection. A total of 16 male Sprague Dawley rats were randomly divided into two groups: group I: (99m)Tc sestamibi group, (99m)Tc sestamibi administered intravenously with the dose of 25MBq; group II: control group, one dose of isotonic sodium chloride was administered intravenous with the same volume as (99m)Tc sestamibi group. Malondialdehyde (MDA) and total oxidant status (TOS) were used as markers of oxidative stress-induced heart impairment. Superoxide dismutase (SOD), catalase (CAT), glutathione peroxidase (GSH-Px) and total antioxidant status (TAS) activities were studied to evaluate the changes in the antioxidant status. In the (99m)Tc sestamibi group (group I), animals treated with (99m)Tc sestamibi produced a significant decrease in the activities of antioxidant enzymes (SOD and CAT), while MDA level increased when compared with control group (group II) in myocardial tissue (p<0.05). On the other hand, the GSH-Px activities were significantly increased in the (99m)Tc sestamibi-treated rats compared with the untreated rats (p<0.05). There was no significant difference in the TAS and TOS levels of plasma.

MEDICINAL RADIOPHARMACEUTICAL CHEMISTRY OF METAL RADIOPHARMACEUTICALS

Metal complexes have been used as medicinal compounds. Metals have advantageous features over organic compounds. Significant applications of metal complexes are in the field of nuclear medicine. Radiopharmaceuticals are drugs containing radioisotopes used for diagnostic and therapeutic purposes.The generalized targeting strategy for molecular imaging probe consists of three essential parts: (i) reporter unit or payload, (ii) carrier, and (iii) targeting system. Medicinal radiopharmaceutical chemistry pays special consideration to radioisotopes, as a reporter unit for diagnostic application or as a payload for therapeutic application. Targeting is achieved by a few approaches but the most common is the bifunctional chelator approach. While designing a radiopharmaceutical, a range of issues needs to be considered including properties of metal radioisotopes, bifunctional chelators, linkers, and targeting molecules. Designing radiopharmaceuticals requires consideration of two key words: "compounds of biological interest" and "fit for intended use." The ultimate goal is the development of new diagnostic methods and treatment.Diagnostic metal radiopharmaceuticals are used for SPECT and PET applications. Technetium chemistry constitutes a major portion of SPECT and gallium chemistry constitutes a major portion of PET. Therapeutic radiopharmaceuticals can be constructed by using alpha-, beta minus-, or Auger electron-emitting radiometals. Special uses of medicinal radiopharmaceuticals include internal radiation therapy, brachytherapy, immunoPET, radioimmunotherapy, and peptide receptor radionuclide imaging and therapy.

ChemInform Abstract: Dendrimers in Nuclear Medical Imaging

AbstractReview: ca. 80 refs.

Performance evaluation of commercial radionuclide calibrators in Indonesian hospitals

Dose calibrator is one of the supporting equipments in the field of nuclear medicine. At the hospitals, dose calibrator is used for activity measurement of radiopharmaceutical before it is administered to patients. Comparison of activity measurements of 131I and 99mTc with dose calibrators was organized in Indonesia during 2007–2010 with the the aim of obtaining information dose calibrator performance in the hospitals. Seven Indonesian hospitals participated in this comparison. The measurement results were evaluated using the En criteria. The result presented in this paper facilitated the evaluation of dose calibrator performance at several hospitals.

Gründung eines Medizinischen Versorgungszentrums (MVZ) an einem Universitätsklinikum

Since January 2004 hospitals have the opportunity to establish an ambulatory health-care centre (Medizinisches Versorgungszentrum - MVZ) as a result of the introduction of the Health-care Modernisation Act (Gesetz zur Modernisierung der gesetzlichen Krankenversicherung - GMG). After about a half-year preparatory phase, the UKE, in September 2004, began operation of the "Ambulanzzentrum des UKE GmbH" (a limited liability company) as the first MVZ at a university hospital in Germany. We report here on the establishment of the MVZ and the experience made. In the initial phase, only the medical fields of radiation therapy and nuclear medicine were represented. Both disciplines, especially radiation therapy, were existentially threatened by the extensive loss of ambulatory patients. The central motive for the establishment of the ambulatory health-care centre was to secure the survival of both disciplines and to preserve existing jobs. After it was put into operation, the referrals from practice-based colleagues to both radiation therapy and nuclear medicine increased quickly. The positive developments caused other departments of the UKE to express their interest in supplementing their outpatient activities with facilities in the MVZ. Over the following years, the ambulance centre grew steadily. Now 24 departments are represented in the MVZ, and the centre has a total of 49 positions for physicians contracted by and registered within the German public health insurance system. The number of salaried doctors has risen to 85, although many of these only work part time in the MVZ. Also more than 83 non-medical staff members were hired over the years. These were mostly physiotherapists, radiographers, and medical assistants. With the growing number of departments in the MVZ, the number of treated cases grew steadily. Currently approximately 20 000 cases are treated in each quarter of a year. The experience made while establishing an ambulatory health-care centre is very positive. Better cross-sectoral medicine, support of referring practice-based colleagues, content of centre-physicians and a strengthening of research and teaching summarise the experience of the last 7 years accurately. The outpatient centre of UKE GmbH will strive to continue to expand its range of medical services into other medical fields whenever it makes sense.

Développement de radiotraceurs pour l’imagerie moléculaire du microenvironnement matriciel tumoral (HIMIMT)

The HIMIMT project aims to demonstrate that a dextran derivative, functional analog of the heparan sulfates, is able to target the damaged extracellular matrix of the tumor microenvironment. The core concept is to couple a radioisotope to the heparan mimetic, in order to visualize the tumors by scintigraphy. This article introduces the underlying technology and relevance to the field of nuclear medicine, and summarizes the chemical strategies investigated to develop this novel and innovative radiopharmaceutical agent.

UEMS/EBNM endeavour

Nuclear medicine has been a recognized medical specialty for many years. In Europe it was first recognized in 1988. In 1989, together with Michel de Roo, Desmond Croft achieved “formal recognition” of nuclear medicine as a separate medical specialty within the Union Europeenne des Medecins Specialistes/European Union of Medical Specialists (UEMS). The Section of Nuclear Medicine appeared in 1990 within the UEMS, and the European Board of Nuclear Medicine (EBNM) was created in 1993. Its main objective, according to Article 2 of the Statutes, is “to ensure the highest standards in the field of nuclear medicine ...” [1]. Later in 2003 the UEMS Section of Nuclear Medicine and the EBNM merged “in order to unify and facilitate activities, mainly to improve and harmonize the training of nuclear medicine throughout European countries to the highest possible standards”, as stated in Article 1 of the Statutes [1]. The Educational and Syllabus Committee, after a careful and detailed consideration of all the changes pertinent to the state-of-the-art practice of nuclear medicine as an independent specialty, organized a well-structured document containing the up-to-date level of training required for anybody to be able to practice diagnostic and therapeutic (outpatient and inpatient) nuclear medicine. There is a need to settle the “ideal” training, including qualitative and quantitative components, in order to avoid what Hundeshagen said in a personal communication in the second half of the last century “The years after 1947 left it to the initiative of individuals, whose chiefs either tolerated—or in some cases even encouraged—them in dealing with the problems of radioisotope applications. As everywhere, nothing was available. There was but sparse information, since at that time almost no specialty journals were accessible.” This and other interesting descriptions of events that led to the establishment of nuclear medicine as an independent medical specialty can be read in the History of Nuclear Medicine in Europe by Feld and de Roo [2]. The present document (Syllabus for Postgraduate Specialization in Nuclear Medicine – 2011/2012 Update) is a guide and each country will decide on the best amount and distribution of training components, as it is stated in its preamble.

Development of the Software Package of the Nuclear Medicine Data Processor for Education and Research

The objective of this study was to develop a personal computer-based nuclear medicine data processor for education and research in the field of nuclear medicine. We call this software package "Prominence Processor" (PP). Windows of Microsoft Corporation was used as the operating system of this PP, which have 1024 × 768 image resolution and various 63 applications classified into 6 groups. The accuracy was examined for a lot of applications of the PP. For example, in the FBP reconstruction application, there was visually no difference in the image quality as a result of comparing two SPECT images obtained from the PP and GMS-5500A (Toshiba). Moreover, Normalized MSE between both images showed 0.0003. Therefore the high processing accuracy of the FBP reconstruction application was proven as well as other applications. The PP can be used in an arbitrary place if the software package is installed in note PC. Therefore the PP is used to lecture and to practice on an educational site and used for the purpose of the research of the radiological technologist on a clinical site etc. widely now.

Dendrimers in nuclear medical imaging

Current progress in the nuclear medicine field has been exploited in the design of tumour-targeting nanoscale carriers being able to deliver radionuclides in a selective manner to improve the outcome of both cancer diagnosis and therapy. In this field dendrimers have a role to play, thanks to their controlled architecture allowing multivalent attachment possibilities of radionuclide chelators and targeting moieties. This perspective highlights the current research focused on discrete dendritic systems as nanoprobes for nuclear medical imaging, both for Single Photon Emission Computed Tomography (SPECT) (99mTc, 111In, 125I) and Positron Emission Tomography (PET) (68Ga). Also a special emphasis is given on radiolabeled (64Cu, 18F, 76Br, 68Ga, 111In) dendrimers targeting αvβ3 integrin as it is a reliable strategy to assess the presence of angiogenesis, one of the most studied and also targeted biological processes.

Studies on dynamic dissociation constant of 99Mo–insulin complex

In this article we studied the dynamic dissociation constant (kd) of 99Mo complexed with insulin molecule at various pH. The kd values were determined by dialysis technique against deionised water. The T1/2 of the molybdenum–insulin complexes were found to be 6.41, 5.25 and 3.5 h at pH 5, 6 and 7 respectively. The half-lives indicate that insulin may act as good carrier of 99Mo to the intestine and may be useful in the field of nuclear medicine.

Mutatis Mutandis: Harmonize the Standard!

See page [4][1]4 Quantitative imaging is taking a more prominent role in the clinical arena as well as in research ([1][2],[2][3]). There is increased interest both from the radiology and nuclear medicine fields and from pharmaceutical companies to use quantitative reads from clinical images, such

Trends in Nuclear Medicine in Developing Countries

This article describes trends in nuclear medicine in the developing world as noted by nuclear medicine professionals at the International Atomic Energy Agency (IAEA). The trends identified are based on data gathered from several sources, including information gathered through a database maintained by the IAEA; evaluation of country program frameworks of various IAEA Member States; personal interactions with representatives in the nuclear medicine field from different regions of the world; official proceedings and meeting reports of the IAEA; participation in numerous national, regional, and international conferences; discussions with the leadership of major professional societies; and relevant literature. The information presented in this article relied on both objective and subjective observations. The aims of this article were to reflect on recent developments in the specialty of nuclear medicine and to envision the directions in which it is progressing. These issues are examined in terms of dimensions of practice, growth, and educational and training needs in the field of nuclear medicine. This article will enable readers to gain perspective on the status of nuclear medicine practice, with a specific focus on the developing world, and to examine needs and trends arising from the observations.