Nuclear Medicine Centers Research Articles

Outcomes of Gamma Knife Radiosurgery for Drug-Resistant Primary Trigeminal Neuralgia.

To evaluate the result of gamma knife radiosurgery (GKRS) for drug-resistant primary trigeminal neuralgia (TN). Patients who were diagnosed with drug-resistant primary TN were treated with GKRS at the Nuclear Medicine and Oncology Center, Bach Mai Hospital from January 2015 to June 2020. Using the pain rating scale of the Barrow Neurological Institute (BNI), follow-ups and evaluations were conducted at 1 month, 3 months, 6 months, and 9 month, and 1, 2 years, 3 years, and 5 years after radiosurgery. Comparisons of pain levels was performed before and after radiosurgery according to the BNI scale. From January 2015 to June 2020, 33 patients were treated with GKS. There were 23 female patients and 10 male patients; the average age was 61.9. The average onset time of disease was 4.42 years. Among all patients, 84.8% of patients were relieved from pain and 78.8% were pain-free without medication. The mean time for pain relief was 3 months and was not related to the dose of GKS (<80 Gy and ≥80 Gy). The efficacy of pain relief is not related to blood vessel contact with the trigeminal nerve, the dose of GKS, and the onset of disease. The rate of recurrence after the first pain relief was low (14.3%). Gamma knife is an effective method for the treatment of primary drug-resistant TN, especially in elderly patients with underlying medical conditions. The analgesic effect does not depend on the presence of nerve-vascular conflict.

A qualitative study on women’s breast cancer diagnosis disclosure preferences and disclosure experiences in a middle-income country

With the increasing cancer incidence in Ghana especially breast cancer among women, its diagnosis and prognosis present enormous fear and worry for women and their families. Thus, breaking the news of breast cancer diagnosis to patients presents enormous difficulty to healthcare professionals. AimThis study sought to explore the preferences of people living with breast cancer regarding the disclosure of their diagnosis. MethodsThe study used an exploratory-descriptive qualitative design to recruit and interviewed 17 women diagnosed with breast cancer and receiving treatment in a National Radiotherapy and Nuclear Medicine Center of a major Teaching Hospital in Ghana. Data were analyzed using Braun and Clarke’s 2006 thematic analysis approach. FindingsTwo major themes, six subthemes, and five sub-subthemes were generated from the data. The study found that patients preferred detailed information on the stage of their cancer diagnosis, treatment options, and the lifestyle necessary to enhance their health. The participants preferred that the news of their diagnosis be broken to them gradually in the form of a conversation with consolatory gestures, without any hidden information. From the study, clinicians do not follow any specific systematic method in the disclosure process, clinicians used a conversation approach involving consolation, encouragement, comic words, and pampering mostly in disclosing cancer diagnosis which was found relieving.In conclusion, People living with breast cancer prefer full gradual disclosure of diagnosis in a conducive environment in the presence of loved ones in a humane manner.

Clinical Implication of Hepatic Phosphatases in Hyperthyroidism

Thyroid hormones significantly affect the proper growth, development and functioning of liver. It has been seen that the drugs indicated for thyroid abnormalities also cause troubles in liver function. Objective: To check the effect of thyroid abnormality on liver function. Methods: Patients were recruited from Center of Nuclear Medicine and examined for their thyroid status and liver functions. Results: The results obtained through biochemical tests for potential biomarkers were further explored through statistical analysis which showed the strong correlation between disturbed function of thyroid gland and liver working. Any variation in thyroid function brings change in liver functioning. Conclusions: Therefore, while treating thyroid patients, combination therapy must be recommended to effectively treat the associated disorder and increasing the better social and psychological status of the patient. Furthermore, patients coming with thyroid dysfunction must also be examined for liver abnormalities so that culprit cause of this thyroid abnormality could be treated from the root if present.

Esthesioneyroblastoma. Retrospective analysis of 10 observations

Background. Esthesioneyroblastoma is a rare malignant tumor arising from olfactory neuroepithelium of the nasal cavity. It is an aggressive local tumor. It accounts for 3 to 6% of cases of nasal and sinus cancer. Occurs at any age. Due to the rarity of the disease, there are no uniform standards of treatment. A multimodal and interdisciplinary approach is recommended.&#x0D; Aim. To present the results of a retrospective study of patients with esthesioneuroblastoma.&#x0D; Materials and methods. The retrospective study was carried out using the database of departments of radionuclide diagnostics of Nuclear Medicine Centres from 2012 to 2022. Ten patients with histologically confirmed diagnosis of esthesioneyroblastoma were identified.&#x0D; Results. Age of patients from 29 to 67 years, median 51 years. Men and women equal. The clinical picture was dominated by a sense of nasal congestion and various nose impairments 8 and 7 patients. The tumor was more often confined to the left side of the nose. Computer tomography (CT), magnetic resonance imaging and positron emission tomography combined with CT (PET/CT) were used for diagnosis, estimation of tumor process prevalence and outpatient observation. Stage A by Kadish was identified in 2 cases, and stage B in 1 patient. Stage C 6 patients predominated. D was diagnosed in 1 patient. The use of PET/CT clarifies the primary stage, the effect of therapy, provides disease control during dynamic observation. The SUVmax median for primary tumor was 7.43 (4.319.1). A multi-modal approach is used to treat esthesioneuroblastoma. The surgical method is performed by 4 patients with subsequent radiation therapy. Radiation therapy was carried out at the first stage of 3 patients, the total focal dose was 66 Gy. Polychemotherapy followed by radiotherapy was used in 3 cases. Duration of observation ranged from 8 to 108 months, median 47.5 months.&#x0D; Conclusion. Esthesioneyroblastoma is a rare malignant nasal tumor. The peak of the disease falls on 5070 years. No gender differences have been identified. The main clinical symptoms are nasal congestion 8 patients and various smelling disorders 7 patients. PET/CT is the main imaging method in the diagnostic, evaluation and observation phases. In this case, most often (6 patients) is determined stage C by Kadish.

Challenges in clinical, imaging, and intraoperative frozen-section diagnosis of ovarian cancer

Ovarian cancer (OC) ranks 8th among cancers in women. It is a non-visualizable, non-screenable cancer with late onset of symptoms and diagnosis, which translates into low recurrence-free and overall survival rates. The 5-year survival decreases as the OC stage increases. The World Health Organization has predicted a 47 % increase in the OC incidence by 2040 to approximately 434,000 newly diagnosed cases and an annual 59 % increase in OC mortality (up to 293,000 cases). There are several difficulties in the current clinical, imaging, and intraoperative frozen-section diagnosis of OC. Patients seek medical attention when the disease has reached the advanced stage. However, specific treatment often starts late due to a long time between the first patient-physician contact and the histological verification of the diagnosis. It is vital to know the limitations and complexities of diagnostic tools, overcome them in routine practice, and use an interdisciplinary approach to the evaluation of their findings. Goal: to review the difficulties in making clinical, imaging, and intraoperative frozen-section diagnosis of OC based on Russian and worldwide literature data.Materials and methods: articles focused on the diagnostic modalities for OC that had been published in the PubMed, Cochrane Library, and eLIBRARY databases over the past 15 years were reviewed. The review outlines the limitations and difficulties in making clinical, imaging, and intraoperative frozen-section diagnosis of OC based on data from international publications and experience of gynecological oncologists and pathologists of the Chelyabinsk Regional Clinical Center of Oncology and Nuclear Medicine.

Effectiveness of a modified biopsy technique in endobronchial ultrasound (EBUS) in the diagnosis of peripheral lung neoplasms: results of a clinical study

Introduction. The problem of lung malignant neoplasms diagnosis is extremely urgent. Verification of peripheral lung malignancies using ultrasound bronchoscopy does not exceed 70.6 %.The aim of the work is to demonstrate an increase in the verification of peripheral lung malignancies by endobronchial lung ultrasound examination.Materials and methods The study was conducted on the basis of the endoscopic department of the Chelyabinsk Regional Clinical Center of Oncology and Nuclear Medicine from 2019 to 2021, in which 142 patients were included. The patients were divided into 2 groups. The main group included 68 patients whose examination included fibrobronchoscopy with endo ultrasound with biopsy according to a modified technique. The comparison group included 74 patients who underwent ultrasound bronchoscopy with biopsy according to the standard technique. The manipulation time with biopsy according to the standard technique ranged from 12 to 42 minutes, on the average 29 ± 5 minutes. Ultrasound bronchoscopy with biopsy to the modified technique lasted from 14 to 44 minutes, on average – 30 ± 5 minutes.Results The modified technique of biopsy with endosonographic control of endoscopic instrument position in the pathological focus during ultrasound bronchoscopy allows to increase the percentage of peripheral lung malignant neoplasms verification by 19.8% (p &lt; 0.05). Ultrasound bronchoscopy with biopsy according to a modified technique is a relatively safe manipulation, complications were detected in 2.9 % of patients and were successfully treated conservatively.Discussion Endobronchial ultrasound examination of the lungs is a sufficiently effective and informative technique. Introduction of modified biopsy technique into clinical practice and its wide application will allow to replace more invasive and traumatic diagnostic procedures, to increase informative value of ultrasound bronchoscopy.Conclusion The use of a modified biopsy technique during ultrasound bronchoscopy will increase the verification by 19.8 % (p &lt; 0.05), thus allowing to reduce the period of examination of patients and prescribe antitumor treatment earlier.

Proposal of Brazilian National Program for Quality Control in the small animal PET scanners

In Brazil, currently there are six preclinical molecular imaging centers and seven different small animal PET systems in use. However, there is still no national specific legislation for research laboratories focused on preclinical molecular images, unlike clinical nuclear medicine centers. A standardization of quality control protocols is needed to harmonize the use of small animal PET scanners in the research field. Thus, the aim of this work was to propose a National Program for Quality Control (NPQC) for the preclinical PET imaging systems in Brazil. This work was based on the quality control tests performed in Molecular Image Laboratory LIM/CDTN based on NEMA NU 4-2008 as described and presented in doctoral thesis of GONTIJO, 2019. The proposal of the NQCP was based on the CNEN NN 3.05 Publication (2013) and includes fundamental tests to be adopted, if possible, in laboratory practice to corroborate the experimental data. The Quality Control Program implemented in LIM/CDTN is an innovative and unprecedented proposal in the scope of preclinical molecular imaging services in Brazil. Therefore, the LIM/CDTN Program was carried out as a pilot to evidence the applicability and viability of the NQCP using small animal PET scanners. Summarizing, this work presents a viable set of Quality Control tests and their periodicities like a proposal for standardization to harmonize the use of this imaging technology in the field of research. Therefore, a National Quality Control Program (NQCP) applied to small animal PET scanners.

Assessment of Radiation Exposure Dose for Nuclear Medicine Workers from 18F-FDG, 99mTc MDP, and 99mTc.

Nuclear medicine or diagnostic radiology personnel are always exposed to low-level radiation from radionuclides used in medical diagnostics, which lead to potential biological hazards or effects. External exposure for workers in two nuclear medicine centers was measured by recruiting 120 patients. Three nuclear medicine examinations were performed using F18-FDG PET/CT,99mTc- MDP bones scan, and 99mTc thyroid scan by a digital radiation dosimeter. The average received accumulative radiation dose for workers was found to be 0.838±0.17, 0.527±0.11, and 0.270±0.05 µSv for F18-FDG PET/CT, 99mTc-MDP bones scan, and 99mTc thyroid scan, respectively. The annual effective dose for workers was estimated to be 2.09±0.42, 1.34±0.27, and 0.68±0.14 mSv, respectively. Moreover, the average patient-to-staff dose coefficients were found to be 0.024±0.005, 0.003±0.001, and 0.007±0.002 µSv m2/MBq h for F18- FDG PET/CT, 99mTc-MDP bones scan, and 99mTc thyroid scan, respectively. It is clear from the results that the radiation doses received by workers during the nuclear medicine imaging examinations were less than the doses recommended by the International Commission on Radiological Protection (ICRP) for such examinations.

Treatment of patients with progression of cerebral medulloblastoma in adults

The aim of this work was to evaluate the results of treatment of patients with progression of primary cerebral medulloblastomas in adults. The study included 10 patients with progression of brain medulloblastomas, who had been treated since 2016 to 2021 treatment was carried out on the basis of the Chelyabinsk Regional Centre for Oncology and Nuclear Medicine. The mean age of patients with relapse of brain medulloblastoma was 27.14 ± 4.30 years (from 23 to 35 years). Males predominated (n = 9) and in one case a relapse was recorded in a woman. The median time to relapse was 56 months (12 to 144 months). According to the method of recurrence treatment, in 3 cases, for recurrence, repeated stereotaxic radiation therapy was performed using the CyberKnife device with ROD = 7 Gy in three fractions up to SOD = 24 Gy, the remaining 7 patients underwent chemotherapy according to the PCV scheme. The median overall survival was 130 months (CI: 59.6–200.3), 1-year overall survival rates were 100 %; 5-year-old – 76.7 %; 7-year-old – 53.7 %. When analyzing the relationship between the size of the residual tumor and survival rates, we found that with a residual tumor size of more than 1.5 cm, the 5-year overall survival rate was significantly lower compared to a small residual tumor – 54 % and 77 % respectively (p = 0.005). The best indicators of method-specific survival were observed during polychemotherapy: 27 months compared to 21 months when performing stereotactic radiation therapy (p = 0.782).

Differentiating high-grade glioma progression from treatment-related changes with dynamic [18F]FDOPA PET: a multicentric study.

Diagnostic accuracy of amino-acid PET for distinguishing progression from treatment-related changes (TRC) is currently based on single-center non-homogeneous glioma populations. Our study assesses the diagnostic value of static and dynamic [18F]FDOPA PET acquisitions to differentiate between high-grade glioma (HGG) recurrence and TRC in a large cohort sourced from two independent nuclear medicine centers. We retrospectively identified 106 patients with suspected glioma recurrences (WHO GIII, n = 38; GIV, n = 68; IDH-mutant, n = 35, IDH-wildtype, n = 71). Patients underwent dynamic [18F]FDOPA PET/CT (n = 83) or PET/MRI (n = 23), and static tumor-to-background ratios (TBRs), metabolic tumor volumes and dynamic parameters (time to peak and slope) were determined. The final diagnosis was either defined by histopathology or a clinical-radiological follow-up at 6 months. Optimal [18F]FDOPA PET parameter cut-offs were obtained by receiver operating characteristic analysis. Predictive factors and clinical parameters were assessed using univariate and multivariate Cox regression survival analyses. Surgery or the clinical-radiological 6-month follow-up identified 71 progressions and 35 treatment-related changes. TBRmean, with a threshold of 1.8, best-differentiated glioma recurrence/progression from post-treatment changes in the whole population (sensitivity 82%, specificity 71%, p < 0.0001) whereas curve slope was only significantly different in IDH-mutant HGGs (n = 25). In survival analyses, MTV was a clinical independent predictor of progression-free and overall survival on the multivariate analysis (p ≤ 0.01). A curve slope > -0.12/h was an independent predictor for longer PFS in IDH-mutant HGGs CONCLUSION: Our multicentric study confirms the high accuracy of [18F]FDOPA PET to differentiate recurrent malignant gliomas from TRC and emphasizes the diagnostic and prognostic value of dynamic acquisitions for IDH-mutant HGGs. • The diagnostic accuracy of dynamic amino-acid PET, for distinguishing progression from treatment-related changes, is currently based on single-center non-homogeneous glioma populations. • This multicentric study confirms the high accuracy of static [18F]FDOPA PET images for differentiating progression from treatment-related changes in a homogeneous population of high-grade gliomas and highlights the diagnostic and prognostic value of dynamic acquisitions for IDH-mutant high-grade gliomas. • Dynamic acquisitions should be performed in IDH-mutant glioma patients to provide valuable information for the differential diagnosis of recurrence and treatment-related changes.

Study of Serum Lipid Profile and Aminotransferases (ALT and AST) in Non-obese, Non-diabetic Nonalcoholic Fatty Liver Disease

Background: Non-alcoholic fatty liver disease (NAFLD) comprises a spectrum of liver diseases characterized by simple steatosis to nonalcoholic steatohepatitis (NASH), fibrosis, and cirrhosis. It is the most common cause of cryptogenic cirrhosis. NAFLD is associated with obesity, insulin resistance, hypertension, type 2 diabetes mellitus, and dyslipidemia.&#x0D; Objective: The study aimed to assess the changes in lipid profile and aminotransferases (ALT and AST) in Non-alcoholic fatty liver disease (NAFLD).&#x0D; Methods: This observational cross-sectional study was carried out in the department of Biochemistry, Mymensingh Medical College in cooperation with the Centre for Nuclear Medicine and Ultrasound, Mymensingh from January 2012 to June 2013 after the approval of the protocol. A total of 120 subjects were included through purposive sampling, among them, 60 subjects were with fatty liver disease (group-I) and another 60 were without fatty liver (group-II) with ultrasonography. The sampling method was purposive (non-random). Relevant laboratory investigations were performed by using established methods to achieve the objectives.&#x0D; Results: The majority of the subjects with NAFLD (33.33%) were in 51-60 years (in Group-I). Mean serum total cholesterol, triacylglycerol, LDL-cholesterol, and HDL-cholesterol were 203.33±21.83, 184.41±33.31, 126.28±18.75, and 40.17±6.32 mg/dl in group-I and 167.65±9.83, 128.77±11.65, 101.74±9.29 and 40.16±3.55 mg/dl in group-II respectively. Significant differences were found in the case of total cholesterol (p&lt;0.001), triacylglycerol (p&lt;0.001), and LDL-cholesterol (&lt;0.001), but no significant difference was found in the case of HDL-cholesterol (p&gt;0.05). Serum ALT and AST were 49.43±16.98, 45.20±13.56 U/L in group-I and 32.83±4.54, 28.68±4.31 U/L in the group- II respectively. Significant differences were found in case of ALT (p &lt;0.001) and AST (p &lt;0.001).&#x0D; Conclusion: Nonalcoholic fatty liver disease is associated with dyslipidemia and with the elevation of serum ALT and AST.&#x0D; J Rang Med Col. September 2022; Vol. 7, No. 2:35-39

PET/MR: primary inferior vena cava leiomyosarcoma

Positron emission tomography (PET) combined with a magnetic resonance (MR) scanner (PET/MR) with 18F-fluorodeoxyglucose (FDG) tracer is being used in quite a few nuclear medicine centers. The aim of this study is to illustrate two uncommon cases of primary inferior vena cava leiomyosarcoma which were formerly evaluated with anatomical images such as computed tomography and ultrasound. These techniques were inferior in the definition of the tumor and its characteristics. F-18 FDG PET/MR was essential and provided all the necessary information: its origin, local extension, anatomo-metabolic behavior, form of presentation, and distant metastasis in one single diagnostic technique. PET/MR accurately contributed to the diagnosis in a shortened period of time and, therefore, in the prognosis of this disease with greater benefits.

Improving the quality of diagnosis and verification of peripheral lung neoplasms by using a modified biopsy technique for ultrasonic bronchoscopy (EBUS)

BACKGROUND: The problem of diagnosis and treatment of malignant neoplasms of the lungs is extremely relevant. Verification of the malignant process in the case of peripheral localization of the neoplasm in the lung when using ultrasound bronchoscopy does not exceed 70.6%.&#x0D; AIMS: This study aimed to improve the effectiveness of ultrasound bronchoscopy in the State Medical Institution Chelyabinsk Regional Clinical Center of Oncology and Nuclear Medicine by introducing into clinical practice a modified biopsy technique for ultrasound bronchoscopy. The technique is patented, patent for invention no. RU2719666 C1.&#x0D; MATERIALS AND METHODS: From 2019 to 2021, a study was conducted based on the endoscopic department of the State Medical Institution Chelyabinsk Regional Clinical Center of Oncology and Nuclear Medicine, which included 137 patients. The patients were divided into two groups: the main group included 66 patients in whose examination FBS with endoussis with biopsy by a modified technique was used; the comparison group included 71 patients who underwent ultrasound bronchoscopy with biopsy by a standard technique. The time of biopsy manipulation according to the standard procedure ranged from 14 to 41 min, averaging 305 min. Ultrasound bronchoscopy with biopsy by a modified technique lasted from 16 to 45 minutes, on average 315 min.&#x0D; RESULTS: In the main group, where FBS with ENDOUSSI with biopsy was used in the diagnosis of patients using a modified technique with endosonographic control of the position of the endoscopic instrument in the pathological focus, the diagnosis of malignant neoplasm was verified in 52 patients (in 78.8% of cases). In the comparison group, where the standard biopsy technique was used in patients with ultrasound bronchoscopy, the diagnosis of malignant neoplasm was verified in 41 patients (in 57.7% of cases). Thus, the verification of peripheral lung malignancies when using a modified biopsy technique increases by 21.1% (p 0.05). FBS with endoussis with biopsy using a modified technique is satisfactorily tolerated by patients and is a relatively safe manipulation.&#x0D; CONCLUSION: modified biopsy technique developed by us with endosonographic control of the position of the endoscopic instrument in the pathological focus during ultrasound bronchoscopy makes it possible to increase the percentage of verification of peripheral lung malignancies by 21.1% (p 0.05). The introduction and widespread use of the modified biopsy technique for ultrasound bronchoscopy in the diagnosis of peripheral lung malignancies will reduce the time of examination of patients and prescribe antitumor treatment earlier.

Distributed Center for Nuclear Medicine of the NRC “Kurchatov Institute”: Historical Background, Current Status, and Evolution Outlook

Distributed Center for Nuclear Medicine of the NRC “Kurchatov Institute”: Historical Background, Current Status, and Evolution Outlook

Directions of Effective Interaction of the Subjects of Regional Policy in the Sphere of Health Care for the Purpose of Ensuring the Economic Security of the Regions

The analysis of modern health problems presented in the article revealed the need to more fully ensure the availability of medical services in the conditions of underfunding of the industry, the preservation of the able-bodied population, which actualizes the feasibility of studying at the regional level the possibilities for effective interaction between subjects of regional health policy as a contribution to strengthening the economic security of the regions. Today in Russia, the interaction between subjects in the field of regional healthcare is fragmented, an integrative intersectoral, interdepartmental approach is required in the field of protecting the health of the population of the region. Author's directions of effective interaction of subjects of regional policy in the field of health care are offered. Opportunities for improving the performance of regional health care on the part of government authorities are considered on the basis of determining the most priority areas for its development, developing tools to achieve the most significant targets in terms of preserving the population, reducing losses in the labor potential of the population of the region. Various options for integrative interdepartmental interaction of subjects of regional health care policy are presented on the example of the Sverdlovsk region. The possibility of achieving a significant improvement in medical and demographic indicators, including in comparison with the indicators of other regions, high economic effects due to the coordination of efforts of the regional health authorities, various departments, organizations in the implementation of programs for the development ofchildren's health care, injury prevention, and reduction of damage from chemical environmental pollution for the health of the population of the Sverdlovsk region. To solve the problems of resource provision of regional health care, the expediency of more actively attracting the participation of business, the development of public-private partnerships, and voluntary medical insurance is substantiated. The effectiveness of the creation of the Center for Nuclear Medicine in the Sverdlovsk Region within the framework of a public-private partnership has been proven. The proposed directions for effective interaction between the subjects of regional health policy will help preserve the population, reduce its mortality, including the working-age population, and ensure the economic security of the regions.

1392P Lutetium-177-prostate-specific membrane antigen therapy (177Lu-PSMA) in patients (Pts) with prior radium-223 (223Ra): Safety and effectiveness outcomes

Previous studies suggest feasibility of using 177Lu-PSMA after 233Ra with an acceptable safety profile. Here, we investigate the safety and effectiveness of 177Lu-PSMA in pts with metastatic castration-resistant prostate cancer (mCRPC) and prior 223Ra in the RALU study. Pt data were retrospectively collected in German nuclear medicine centres from 2021 to 2022. Safety and effectiveness were evaluated in all pts and by the treatment sequence (223Ra then chemotherapy [Ct] then 177Lu-PSMA [Ra-Ct-Lu] and Ct then 223Ra then 177Lu-PSMA [Ct-Ra-Lu]). Overall, 133 pts were evaluated. Before starting 177Lu-PSMA, the proportion of pts with an Eastern Cooperative Oncology Group performance status of 0, 1 or 2 was 0%, 62% and 38%, respectively. Median prostate-specific antigen (PSA) was 285.5 ng/ml and median alkaline phosphatase (ALP) was 146.0 U/L. 56% of pts had received ≥4 life prolonging therapies, including abiraterone (71%), enzalutamide (70%), docetaxel (74%) and cabazitaxel (23%). 71% of pts had received 6 223Ra injections. All pts had bone metastases; 27% had visceral metastases. 73% of pts received 1–4 177Lu-PSMA cycles and 27% received ≥5 cycles. Safety is shown in the table. During 177Lu-PSMA treatment, PSA50 response occurred in 42% of all pts, 46% of the Ra-Ct-Lu pts and 36% of the Ct-Ra-Lu pts. ALP30 response occurred in 19% of all pts and was similar in the Ra-Ct-Lu and Ct-Ra-Lu groups (13% vs 11%, respectively). Median overall survival (OS) from the start of 177Lu-PSMA treatment was 13 (95% CI 11–16), 12 (9–15) and 14 (9–17) months in the all pts, Ra-Ct-Lu and Ct-Ra-Lu groups, respectively.Table: 1392PAll ptsRa-Ct-LuaCt-Ra-LuaAny TEAE,b n/N (%)105/133 (79)50/57 (88)39/50 (78)Grade 3/4 laboratory abnormalities,c,d n/N (%), (95% CI)Anaemia40/133 (30) (22–39)15/57 (26) (16–40)19/50 (38) (25–53)Thrombocytopenia17/133 (13) (8–20)7/57 (12) (5–24)9/50 (18) (9–31)Neutropenia3/130 (2) (1–7)0/54 (0) (0–7)1/48 (2) (0–11)ASAT2/131 (2) (0–5)1/55 (2) (0–10)1/49 (2) (0–11)ASAT, aspartate aminotransferase; N, number of pts per group; n, number of pts with specified event; TEAE, treatment-emergent adverse eventsa13 pts with multiple Cts were included in both groupsbFrom starting 177Lu-PSMA to the end of 30-day follow-upcUp to 90 days after last 177Lu-PSMA dosedNo grade 5 toxicities occurred Open table in a new tab ASAT, aspartate aminotransferase; N, number of pts per group; n, number of pts with specified event; TEAE, treatment-emergent adverse events a13 pts with multiple Cts were included in both groups bFrom starting 177Lu-PSMA to the end of 30-day follow-up cUp to 90 days after last 177Lu-PSMA dose dNo grade 5 toxicities occurred In this real-world setting, 177Lu-PSMA therapy in pts with prior 223Ra had an acceptable safety profile and effectiveness was similar to other findings with 177Lu-PSMA, indicating no cross-resistance. 223Ra and Ct order prior to 117Lu-PSMA did not alter the safety profile nor OS from the start of 177Lu-PSMA.

Patient satisfaction study in the Positron Emission Tomography Unit at the Salah Azai?ez Institute in Tunis

Background: Patient satisfaction is often assessed in the improvement of management. It is an indicator of the quality approach of the health system from an accreditation perspective. The aim of our study was to assess the satisfaction of patients in regards to their care in the PET-CT Unit of the Salah Azaïez Institute and consider improvement actions. Methods: We conducted a prospective study over a period of 5 months which involved 50 patients. These patients were consenting and answered anonymously to a satisfaction survey. It is divided into five categories: making appointments, administrative reception, the conduct of the examination, delivery of results and the overall judgment concerning the nuclear medicine center. At the end of this questionnaire, we have reserved a box for suggestions Results: The average age was 38-36 years with a female predominance (sex-ratio = 0,78). Thirty patients were still active. Responses showing "very good" satisfaction with making appointments varied between 86-98%, administrative reception 92%, the conduct of the examination between 70-86%, delivery of results between 88 -98% while the overall assessment for the nuclear medical center was 88%.The main reasons for dissatisfaction was: the discomfort of the rooms, the lack of availability of the technicians, the exaggerated phobia of irradiation and insufficient explanations given in the course of the examination. Conclusion: Even though 88% of patients expressed overall satisfaction, main reasons for dissatisfaction expressed must be taken into account to improve the quality of care in order to start the process of accreditation of our service.

Occurrence of influenza and bacterial infections in cancer patients receiving radiotherapy in Ghana.

BackgroundInfluenza co-infection with bacteria is a leading cause of influenza-related deaths and severe respiratory infections, especially among high-risk groups like cancer patients undergoing treatment. However, acute respiratory infection (ARI)-like symptoms developed by upper-torso cancer (UTC) patients receiving radiotherapy are considered as side-effects of the radiation. Hence influenza and bacterial pathogens implicated in ARI are not investigated.MethodsThis prospective cohort study examined 85 in-patients with upper-torso cancers undergoing radiotherapy at the National Radiotherapy, Oncology and Nuclear Medicine Centre (NRONMC) of Korle-Bu Teaching Hospital (KBTH) in Accra, Ghana. Eligible patients who consented were recruited into the study from September 2018 to April 2019. Influenza viruses A and B in addition to the following bacteria species Streptococcus pneumonia, Haemophilus influenzae, Neisseria meningitidis and Staphylococcus aureus were detected from oropharyngeal and nasopharyngeal swab specimens collected at three different time points. Presence of respiratory pathogens were investigated by influenza virus isolation in cell culture, bacterial culture, polymerase chain reaction (PCR) and next generation sequencing (NGS) assays.ResultsOf the 85 eligible participants enrolled into the study, 87% were females. Participants were 17 to 77 years old, with a median age of 49 years. Most of the participants (88%) enrolled had at least one pathogen present. The most prevalent pathogen was N. meningitidis (63.4%), followed by H. influenzae (48.8%), Influenza viruses A and B (32.9%), S. pneumoniae (32.9%) and S. aureus (12.2%). Approximately, 65% of these participants developed ARI-like symptoms. Participants with previous episodes of ARI, did not live alone, HNC and total radiation less than 50 Gy were significantly associated with ARI. All treatment forms were also significantly associated with ARI.ConclusionData generated from the study suggests that ARI-like symptoms observed among UTC patients receiving radiotherapy in Ghana, could be due to influenza and bacterial single and co-infections in addition to risk factors and not solely the side-effects of radiation as perceived. These findings will be prime importance for diagnosis, prevention, treatment and control for cancer patients who present with such episodes during treatment.

Comparative study on the effectiveness of acceptance and commitment therapy (ACT) and schema therapy (ST) on problem solving styles in people with heart diseases

The aim of present study was to compare the effects of acceptance and commitment therapy and schema therapy on problem solving styles in heart patients. The research method was quasi-experimental with a pre-test-post-test and two experimental groups and one unbalanced control group. The statistical population of the study included all patients with heart diseases referred to the Nuclear Medicine Center in 2017 in Tehran for diagnostic examinations and cardiac scans. The study sample consisted of 45 people (15 people in the acceptance and commitment therapy group, 15 people in the schema therapy group and 15 people in the control group). They were selected by a non-random convenience sampling method and were randomly allocated to three groups. To collect research data, Cassidy and Long (1996) standard problem solving styles questionnaire (Aga Yousefi and Sharif, 2011) was used. After performing the pre-test for all three groups, the experimental groups received acceptance and commitment treatment protocol (Wells and Sorrell, 2007; Mesgarian, 2012) for 12 sessions (1 session per week of 120 minutes) and the schema therapy protocol (Young et al., 2012; Hamidpour and Andoz, 2012) for 10 sessions (1 session per week of 120 minutes).

ОСОБЕННОСТИ ОБЕСПЕЧЕНИЯ РАДИАЦИОННОЙ БЕЗОПАСНОСТИ В ФГБУ ФНКЦРИО ФМБА РОССИИ

Purpose of the work is to justify the safety in the operation of radiation sources in the center of nuclear medicine. The paper reflects the advanced methods of nuclear medicine using radionuclides, used at the site of the Features of Ensuring Radiation Safety in the FSCCRO of FMBA of Russia, for the purpose of diagnosing and treating malignant neoplasms. At the same time, a necessary condition is to ensure the radiation safety of medical personnel, as well as compliance with the requirements and standards governing the safe operation of radiation hazardous facilities. The paper presents an analysis of individual effective doses of medical personnel of group A of the nuclear medicine center for the period 2020-2022, as well as the risks of stochastic effects during exposure to an average individual dose for personnel of group A. Results: Conclusion: a feature of the Features of Ensuring Radiation Safety in the FSCCRO of FMBA of Russia is a large concentration of radiation-hazardous objects on one site, which implies the fulfillment and observance of radiation safety requirements. The analysis of individual exposure doses for group A personnel indicates that the established control and permissible levels are not exceeded. At the same time, measures are proposed to optimize (reduce) the radiation load on medical personnel working with sources of ionizing radiation. The unique experience gained by the Center can be replicated when carrying out work to ensure radiation safety standards for newly built and existing medical institutions in Russia in order to provide high-tech medical care in the field of nuclear medicine.