Nuclear Medicine Department Research Articles

Fire scenario in a nuclear medicine department: an impact assessment

Fire scenario in a nuclear medicine department: an impact assessment

Characteristics and prognosis of hepatocellular carcinoma patients after direct-acting antiviral hepatitis C virus therapy in a single medical center in Egypt

Objective: Hepatocellular carcinoma (HCC) incidence has increased dramatically over the previous two decades and is anticipated to rise further in some countries, notably the United States, by 2030. HCC is most widespread in Asia and Africa, where hepatitis B and C are ubiquitous and lead to the development of chronic liver disease and, finally, HCC. In this study, we examined changes in the characteristics and prognosis of HCC patients, as well as the risk of developing HCC after direct-acting antiviral (DAA) medication.Methods: The study enrolled all individuals who attended the Clinical Oncology and Nuclear Medicine Department, Suez Canal University Hospital, Ismailia, Egypt, with a proven diagnosis of HCC in the period between January 2020 and December 2021. HCC is diagnosed based on radiographic appearance (arterial enhancement phase and delayed washout phase) or compatible histology.Results: This retrospective cohort included 254 HCC patients, separated into three groups. Kaplan-Meier curves with log-rank analysis revealed that hepatitis C virus (HCV) treatment therapy considerably reduced the time to HCC development following hepatitis diagnosis (p < .001). HCV therapy had a substantial impact on progression-free survival and overall survival in HCC patients (p < .001).Conclusions: The emergence of DAA medication has greatly altered the management of HCV patients in the context of HCC. DAAs have been shown to be both safe and beneficial in these individuals, particularly in terms of lowering the risk of hepatic decompensation. DAAs have been reported to enhance overall survival in patients with cirrhotic HCV-related HCC, most likely due to decreased hepatic decompensation.

Analysis of the radiation accidents prevalence in nuclear medicine in the Russian Federation

Radiation events (accidents) appearance is an integral part of the use of ionizing radiation sources in medicine in general and nuclear medicine in particular. To minimize the negative impact on patients, workers, and public due to such events, it is necessary to have reliable information about real prevalence of the radiation events (accidents). The current work presents the analysis of the radiation accidents with medical ionizing radiation sources registered in the “Data bank of radiation accidents and incidents” of the Rospotrebnadzor Information and Analytical Centre for Radiation Safety and the results of workers questionnaires conducted in 25 nuclear medicine departments (about 30% of all nuclear medicine departments in the Russian Federation). The results of the analysis showed that the most common registered radiation accidents in the “Data bank of radiation accidents and incidents” are identification of passengers with high external dose rate as well as identification of waste contaminated by medical radionuclides. The results of the questionnaire showed that the most common radiation accidents (events) in nuclear medicine are contamination of work clothes or work surfaces with radionuclides, or patient fluids containing radionuclides; conducting examination without proper referral; extravasation of radiopharmaceutical. Existing systems of identification and registration of radiation accidents do not allow to identify radiation events (accidents) specific to nuclear medicine. The further research aimed at developing a classification of radiation events (accidents) in medicine and methods for responding to such events are feasible.

Synthetic and natural antibacterial carbon adsorbents for clinical nuclear waste management

Patients undergoing high-dose radioiodine ablation (RAI) therapy in Nuclear Medicine Department need to be isolated in a special designed ward for a few days. Large amount of clinical radioactive wastewater from patient body is produced during high-activity RAI therapy. The radioactive wastewater needs to store in a delay tank until the radioactivity decayed below acceptable limit before being discharged and indirectly limit the patient admission and treatment. This study is to propose an alternative antibacterial adsorbent for I-131 extraction from clinical radioactive wastewater at the nuclear medicine department using graphene oxide silver (GOAg) and bamboo activated carbon (BAC). The synthesised adsorbents and their sediments (filtered sample) were analysed using field emission scanning electron microscopy (FESEM) for morphological analysis and analysed using X-ray photoelectron spectroscopy (XPS), Fourier transform infrared (FTIR) and X-ray diffraction (XRD). XPS spectra for C 1s adsorbents show intensity peaks at 284.45 eV (C=C) and 285.3 eV (C–C) for GOAg and its sediments, and 284.35 eV (C–C), 287.00 eV (C=O), and 290.07 eV (π–π∗ transitions) for BAC and its sediments. FTIR spectra reveal various functional groups of adsorbents: C=C (1637.50772 cm−1), C=O (1340.48041 cm−1), and C–O–C (1031.88060 cm−1) for GOAg and its sediments, and C=C (1635.57897 cm−1), C–C (1257.54421 cm−1), and C–O (1188.10925 cm−1) for BAC and its sediments. XRD patterns exhibit peaks at 2θ = 27.82°, 29.39°, 32.24°, and 46.22°, which can be attributed to the (002) diffraction plane, (220) crystallographic plane, (111) plane of Ag2O, and (200) crystallographic plane, respectively, for GOAg and its sediments. Meanwhile, the peaks at 2θ = 26.56° and 42.41°, which correspond to (002) and (100) planes, respectively, for BAC and its sediments. The d-spacing and the crystallinity index of each adsorbent were also determined. The estimation of the remaining β− particles during the adsorption of I-131 was carried out using PHITS. The finding of this study is beneficial for alternative radionuclide extractions technique from clinical radioactive wastewater in nuclear medicine.

Between Two Worlds: Investigating the Intersection of Human Expertise and Machine Learning in the Case of Coronary Artery Disease Diagnosis.

Coronary artery disease (CAD) presents a significant global health burden, with early and accurate diagnostics crucial for effective management and treatment strategies. This study evaluates the efficacy of human evaluators compared to a Random Forest (RF) machine learning model in predicting CAD risk. It investigates the impact of incorporating human clinical judgments into the RF model's predictive capabilities. We recruited 606 patients from the Department of Nuclear Medicine at the University Hospital of Patras, Greece, from 16 February 2018 to 28 February 2022. Clinical data inputs included age, sex, comprehensive cardiovascular history (including prior myocardial infarction and revascularisation), CAD predisposing factors (such as hypertension, dyslipidemia, smoking, diabetes, and peripheral arteriopathy), baseline ECG abnormalities, and symptomatic descriptions ranging from asymptomatic states to angina-like symptoms and dyspnea on exertion. The diagnostic accuracies of human evaluators and the RF model (when trained with datasets inclusive of human judges' assessments) were comparable at 79% and 80.17%, respectively. However, the performance of the RF model notably declined to 73.76% when human clinical judgments were excluded from its training dataset. These results highlight a potential synergistic relationship between human expertise and advanced algorithmic predictions, suggesting a hybrid approach as a promising direction for enhancing CAD diagnostics.

Determination of Decay Tank Capacity and Minimum Storage Time for Liquid Radioactive Effluent in Nuclear Medicine Departments Based on Environmental Requirements

Determination of Decay Tank Capacity and Minimum Storage Time for Liquid Radioactive Effluent in Nuclear Medicine Departments Based on Environmental Requirements

51Cr Red Blood Cells in the Study of Hematologic Disease: A Historical Review.

The early years of nuclear medicine included the development and clinical use of several invitro or nonimaging procedures. The use of radionuclides as replacements for nonradioactive dyes brought improved accuracies and less subjective measurements to indicator dilution studies of body compartments such as the gastrointestinal system, lungs, urinary system, and vascular space. A popular nuclear medicine procedure was the radionuclide dilution method for quantitation of whole-blood volume or red blood cell volume or mass using 51Cr-labeled red blood cells-an important diagnostic element in patients suspected of having polycythemia vera, congestive heart failure, hypertension, shock, syncope, and other abnormal blood volume disorders. The radionuclide dilution method led to improved evaluation of red blood cell survival, which is important for clinical treatment planning in anemia and confirmation of splenic sequestration of damaged red blood cells. Although it was discovered that 51Cr was a chemically stable radiolabel of red blood cells after binding to intracellular hemoglobin, few nuclear medicine departments offered the clinical study for referring physicians because it required laboratory expertise for technologists, patient coordination, and a time-consuming procedure. The introduction of improved methods that are less time-consuming and have clinically acceptable results, along with the discontinuation of the sodium chromate 51Cr injection radiopharmaceutical by manufacturers, has consigned 51Cr red blood cells for red blood cell volume, mass, or survival evaluation to the list of retired nuclear medicine studies.

RETRACTION: Multi-Stimuli Nanocomposite Therapeutic: Docetaxel Targeted Delivery and Synergies in Treatment of Human Breast Cancer Tumor.

R. Taheri-Ledari, W. Zhang, M. Radmanesh, S. S. Mirmohammadi, A. Maleki, N. Cathcart and V. Kitaev, "Multi-Stimuli Nanocomposite Therapeutic: Docetaxel Targeted Delivery and Synergies in Treatment of Human Breast Cancer Tumor," Small 16, no. 41 (2020): 2002733, https://doi.org/10.1002/smll.202002733. The above article, published online on 18 September 2020 in Wiley Online Library (wileyonlinelibrary.com), has been retracted by agreement between the journal Editor-in-Chief, Neville Compton; and Wiley-VCH GmbH. Following publication, concerns wereraised by a third-party regarding the appearance of Figures 7d, 11a and 12a. The subsequent investigation uncovered inappropriate duplication of images (panels of Figures 7d and 12a) between this and other articles that werepreviously published in a different scientific context elsewhere and the manipulation of images in Figure 11a. The investigation also revealed that the animal experiments wereneither conducted at, nor received ethical approval from the Department of Nuclear Medicine, West China Hospital, Sichuan University. Given the extent of the identified issues, the editors have decided to retract the article.

Reproducibility and Repeatability in Focus: Evaluating LVEF Measurements with 3D Echocardiography by Medical Technologists.

Three-dimensional echocardiography (3DE) is currently the preferred method for monitoring left ventricular ejection fraction (LVEF) in cancer patients receiving potentially cardiotoxic anti-neoplastic therapy. In Denmark, however, the traditional standard for LVEF monitoring has been rooted in nuclear medicine departments utilizing equilibrium radionuclide angiography (ERNA). Although ERNA remains a principal modality, there is an emerging trend towards the adoption of echocardiography for this purpose. Given this context, assessing the reproducibility of 3DE among non-specialized medical personnel is crucial for its clinical adoption in such departments. To assess the feasibility of 3DE for LVEF measurements by technologists, we evaluated the repeatability and reproducibility of two moderately experienced technologists. They performed 3DE on 12 volunteers over two sessions, with a collaborative review of the results from the first session before the second session. Two-way intraclass correlation values increased from 0.03 to 0.77 across the sessions. This increase in agreement was mainly due to the recognition of false low measurements. Our findings underscore the importance of incorporating reproducibility exercises in the context of 3DE, especially when operated by technologists. Additionally, routine control of the acquisitions by physicians is deemed necessary. Ensuring these hurdles are adequately managed enables the adoption of 3DE for LVEF measurements by technologists.

A Multi-Modal Machine Learning Methodology for Predicting Solitary Pulmonary Nodule Malignancy in Patients Undergoing PET/CT Examination

This study explores a multi-modal machine-learning-based approach to classify solitary pulmonary nodules (SPNs). Non-small cell lung cancer (NSCLC), presenting primarily as SPNs, is the leading cause of cancer-related deaths worldwide. Early detection and appropriate management of SPNs are critical to improving patient outcomes, necessitating efficient diagnostic methodologies. While CT and PET scans are pivotal in the diagnostic process, their interpretation remains prone to human error and delays in treatment implementation. This study proposes a machine-learning-based network to mitigate these concerns, integrating CT, PET, and manually extracted features in a multi-modal manner by integrating multiple image modalities and tabular features). CT and PET images are classified by a VGG19 network, while additional SPN features in combination with the outputs of VGG19 are processed by an XGBoost model to perform the ultimate diagnosis. The proposed methodology is evaluated using patient data from the Department of Nuclear Medicine of the University Hospital of Patras in Greece. We used 402 patient cases with human annotations to internally validate the model and 96 histopathological-confirmed cases for external evaluation. The model exhibited 97% agreement with the human readers and 85% diagnostic performance in the external set. It also identified the VGG19 predictions from CT and PET images, SUVmax, and diameter as key malignancy predictors. The study suggests that combining all available image modalities and SPN characteristics improves the agreement of the model with the human readers and the diagnostic efficiency.

Clinical characteristics and surgical outcomes of vertebral lesions associated with tumor-induced osteomalacia: report of 16 patients and review of the literature

SummaryVertebral tumors in patients with tumor-induced osteomalacia (TIO) have a low diagnostic rate and poor postoperative outcomes. The application of 68 Ga-DOTATATE-PET/CT significantly increased the detection rate. Compared with tumor curettage, segmental resection was recommended as the preferred surgical type due to its high recovery rate.PurposeTumor-induced osteomalacia (TIO) is an acquired hypophosphatemic osteomalacia, and surgery is the first-line therapy. Most TIO tumors are found in the bones of the appendicular skeleton, cranium, and paranasal sinuses but rarely in the vertebrae. Tumor curettage and segmental resection are the two main surgical options for vertebral TIO patients. However, research on the clinical characteristics and surgical prognosis of vertebral TIO patients is rare. In the present study, for the first time, we investigated the clinical characteristics of 16 vertebral TIO patients and compared the surgical outcomes of patients who underwent surgery via two different surgical methods.MethodsThis was a retrospective cohort study. In this study, we included 16 adult TIO patients with lesions in vertebrae from Peking Union Medical College Hospital (PUMCH), all of whom underwent surgery. Baseline laboratory data were collected through medical records review. Technetium-99 m octreotide scintigraphy (99Tcm-OCT) and 68gallium-DOTA-TATE-positron emission tomography/computed tomography (68 Ga-DOTATATE-PET/CT) were conducted at the Department of Nuclear Medicine of PUMCH. The tumor histopathology was confirmed by a senior pathologist at our center.ResultsVertebral TIO patients had lower serum phosphorus and TmP/GFR and higher serum alkaline phosphatase (ALP), serum parathyroid hormone (PTH), and serum C-terminal cross-linked telopeptide of type I collagen (β-CTX) levels than the normal range. The sensitivity of 68 Ga‒DOTATATE PET/CT was 100%, significantly greater than that of 99Tcm-OCT (40%). After comparing the outcomes between the two surgical methods, we found that the recovery rate after segmental resection (62.5%) was greater than that after tumor curettage (12.5%). In the thoracic and sacral vertebrae, segmental resection surgery had a good prognosis.Conclusion68 Ga-DOTATATE PET/CT could serve as the first diagnostic tool in patients with vertebral TIO, and segmental resection could be used as the preferred surgery. This study would raise awareness of the clinical features and management of these rare vertebral TIO patients.

Outcomes of Low-Risk Differentiated Thyroid Cancer (DTC) without Radioactive Iodine (RAI) Ablation Therapy Post-Thyroidectomy: An Experience from a Tertiary Centre in Karachi.

To assess the outcomes of low-risk differentiated thyroid cancer (DTC) with tumour size 1 to 4 cm post-thyroidectomy in patients who never received radioactive iodine (RAI) ablation and to compare the outcomes with those who received RAI therapy. Observational study. Place and Duration of the Study: Department of Nuclear Medicine, Karachi Institute of Radiotherapy and Nuclear Medicine (KIRAN) Hospital, Karachi, Pakistan, from January 2016 to December 2020. A total of 130 consecutive patients of low-risk DTC of both genders aged between 18-75 years were identified who underwent thyroidectomy. Patients were classified as either being treated or not treated with RAI, based on RAI data post-thyroidectomy. Patients were followed up for two to five years depending on their date of diagnosis from 2016 to 2020, using thyroglobulin (Tg), anti-thyroglobulin (anti-Tg), and thyrotropin (TSH) levels and ultrasound neck. Association betweenpatients who received RAI and who did not receive RAI was determined and a p-value<0.05 was considered as statistical significance. Patients had mean age of 34.5 ± 10.4 years with majority of females (75.4%). Majority of the patients (94.6%) had total thyroidectomy with no neck dissection (83.1%). RAI therapy was conducted among 70.8% participants, of which, 56.9% participants received a dose of 100 mci. Most of the patients had positive outcomes as there was no recurrence among 96.2% participants. There was a significant difference in RAI therapy with total thyroidectomy as compared to subtotal, RAI dose, tumour stage, neck dissection, and lymph node involvement (p ≤0.001). After complete tumour resection, a highly selected group of patients with low-risk local disease have shown low rate of recurrence when managed without RAI. Interestingly, the disease recurrence was also only seen in patients who received RAI therapy in comparison to those who did not receive RAI therapy. Outcomes, Differentiated thyroid cancer, Radioactive iodine, Ablation therapy, Post-surgery.

Investigation on low-iodine diet implementation by medical staff before radioactive iodine treatment for differentiated thyroid carcinoma.

To explore the implementation of low-iodine diets by medical staff caring for patients with differentiated thyroid carcinoma prior to 131I therapy across 58 hospitals, and offer valuable insights for the development of guidelines on low-iodine diets. Convenience sampling was utilized to conduct a survey among 163 medical staff members working in nuclear medicine departments across 58 tertiary hospitals using a self-designed questionnaire. Concerning the duration of the low-iodine diet prior to treatment, the medical staff's recommendations were as follows: 58.28% suggested 2-4weeks, 31.29% recommended more than 4weeks, 9.2% opted for 7-13days, and 1.23% favored less than 1week. Regarding the timing of resuming a normal diet, the respondents' recommendations ranged from immediately after treatment (1.84%) to 3months post-treatment (8.58%), with intermediate recommendations of 2h (8.58%), 24-48h (14.11%), post-discharge (12.26%), and 1month (42.94%). Furthermore, the surveyed medical staff unanimously recommended abstaining from seafood, with 90.8% also advising against the consumption of iodized salt, 91.41% recommending avoidance of iodine-containing medications, and 71.17% advising caution with moderately high-iodine foods. Notably, 75.46% of the medical staff evaluated patient compliance with the low-iodine diet. When patients failed to adhere to the diet preparation, 33.74% of healthcare workers chose to proceed with treatment. In terms of guidance sources, 96.93% of respondents relied on relevant guidelines, 66.26% referred to the literature, and 49.69% drew upon their clinical experience. During hospitalization, 58.28% of the medical staff continued to guide patients on the low-iodine diet, while only 8.59% provided such guidance after discharge. Notably, only 20.25% of the staff considered consulting the nutrition department. This study underscored substantial variations in the duration and selection criteria for low-iodine diets, which were linked to a scarcity of standardized evaluations. Consequently, there is an urgent need for further research to establish detailed, practical, accessible, comprehensive, and dependable implementation programs for low-iodine diets.

The Value of Naples Prognostic Score in Predicting Ischemia on Myocardial Perfusion Scintigraphy

Objectives: Naples prognostic score (NPS) is a recently established score that measures inflammation and nutritional conditions. This score includes lymphocyte-to-monocyte ratio, neutrophil-to-lymphocyte ratio, total cholesterol levels, and serum albumin levels. Initial studies have shown that the NPS score has more prognostic value than other inflammatory parameters in some cancer diseases. Recently, the association of the NPS score with various cardiovascular diseases has started to be evaluated. The association between ischemia in myocardial perfusion scanning and the Naples score has not yet been investigated. In this study, we evaluated if the NPS may help predict ischemia in myocardial perfusion scanning. Methods: This study included a total of 110 patients. All patients underwent myocardial perfusion scintigraphy (MPS) at the nuclear medicine department, with dipyridamole or adenosine administered as the pharmaceutical stressor. The subjects were divided into two groups according to the presence or absence of ischemia on gated single-photon emission computed tomography (SPECT) MPI. Laboratory values within the past month before MPS were obtained from digital records for both groups. The NPS was calculated for each group. Laboratory values and NPSs of the groups were compared. Results: All individuals in the trial had gated SPECT MPI. The average age of individuals was 59.8±11.1 years, with 62 patients (56%) being male. Subjects were divided into two groups according to the presence or absence of ischemia on gated SPECT MPI. Table 1 displays the demographics of the whole study population. Based on the laboratory data (Table 2), there was no significant difference in the demographic features of the groups. The ischemia group had significantly higher levels of white blood cell count (cells/ μL), neutrophil count (cells/µL), hemoglobin (g/dL), CRP (mg/L), and NPS (8.6±2.2, 7.7±1.9, p=0.040; 5.0±2.1, 4.1±1.3, p=0.014; 12.6±1.7, 13.4±1.8, p=0.025; 8.2±2.0, 7.9±2.0, p=0.004; 2.6±1.0, 1.5). Other laboratory results did not differ across the groups. Conclusion: Our findings indicated an association between NPS and the detection of ischemia in MPS. NPS is an independent variable for diagnosing myocardial ischemia in stable coronary artery disease patients.

Observation of the Short-term Efficacy of Technetium-99 Conjugated with Methylene Diphosphonate Combined Therapy in the Treatment of Postmenopausal Osteoporosis.

To investigate the short-term efficacy and safety of Yunke (technetium-99 conjugated methylene diphosphonate) combined with pulsed electromagnetic field (PEMF) and Gukang capsule in the treatment of postmenopausal osteoporosis (PMOP). A total of 112 patients with PMOP who received treatment in the Department of Nuclear Medicine of the hospital from January 2019 to June 2020 were selected and randomly divided into 4 groups of 28 patients each. Group A received Yunke and PEMFs, group B received Gukang capsules and PEMFs, group C received Yunke and Gukang capsules and PEMFs, and group D received PEMFs. All groups were given adequate amounts of calcium and active vitamin D. Intervention 2 sessions of 3 months each. Outcome measures were bone mineral density (BMD) and pain improvement. Compared with 1 course of treatment, the symptoms of bone pain were relieved more significantly after 2 courses of treatment in group A (50.0% vs. 64.3%), group B (46.4% vs. 64.3%), group C (78.6% vs. 92.9%) and group D (21.4% vs. 28.6%) (P < 0.05). After 2 courses of treatment, bone pain symptoms were less relieved in group A (96.4% vs. 64.3%), group B (96.4% vs. 64.3%), and group D (96.4% vs. 28.6%) compared with group C (P < 0.05). Compared with group C, BMD values of L4 vertebrae and femoral neck were significantly decreased in groups A, B, and D (P < 0.05). Compared with those before treatment, BMD of L4 vertebrae and femoral neck increased significantly in groups A, B, C, and D after 2 courses of treatment (P < 0.05). Yunke combined therapy can effectively relieve the pain symptoms, increase BMD, and reduce the risk of fracture in patients with PMOP in a short period, which is an effective method for the treatment of PMOP.

Performance and Interpretation of Lung Scintigraphy: An Evaluation of Current Practices in Australia, Canada, France, Germany, and United States.

Although ventilation/perfusion (V/Q) scintigraphy is a widely used imaging test, different options are possible for the acquisition and interpretation of the scan. The aim of this study was to assess current practices regarding the use and interpretation of lung scintigraphy in various clinical indications. An online survey comprising 25 questions was sent to nuclear medicine departments in Australia, Canada, France, Germany, and United States between 2022 and 2023. A single response per department was consolidated. Four hundred nineteen responses were collected (Australia: 32, Canada: 58, France: 149, Germany: 92, and United States: 88). For acute pulmonary embolism (PE) diagnosis, 82.8% of centers reported using SPECT acquisitions (Australia: 93.3%, Canada: 91.8%, France: 99.2%, Germany: 96.2%, and United States: 32.1%). Among them, SPECT images were combined with a CT scan in 70.5% of centers. A total of 10.6% of centers reported not using ventilation for acute PE diagnosis. SPECT acquisition was used in 97.8% of centers using 99m Tc carbon particles, 97.1% 81m Kr gas, 58.7% 99m Tc-DTPA, and 19.4% 133 Xe gas, respectively. For V/Q SPECT interpretation, the EANM criteria were used in 65.0% of departments. A very wide variety of practices were observed in pregnant women and in COVID-19 patients. SPECT acquisition was widely used in the follow-up of PE and for the screening of chronic thromboembolic pulmonary hypertension (>90% of centers), with inconsistency regarding the interpretation of matched perfusion defects in this setting. This survey shows the strong adoption of SPECT in the various clinical indications of lung scintigraphy, except in the United States, where planar imaging is still mostly used. The survey also shows variability in interpretation criteria both for PE diagnosis and screening for chronic thromboembolic pulmonary hypertension, highlighting the need for further standardizations of practices.

Comprehensive Analysis of Environmental Monitoring Data from the Department of Nuclear Medicine and Molecular Imaging (NMMI) of the University Medical Center Groningen (UMCG)

Comprehensive Analysis of Environmental Monitoring Data from the Department of Nuclear Medicine and Molecular Imaging (NMMI) of the University Medical Center Groningen (UMCG)

Determining Split Renal Function in Children With Ureteropelvic Junction Stenosis: Technetium-99m Mercaptoacetyltriglycine (Tc-99m MAG-3) or Technetium-99m Dimercaptosuccinic Acid (Tc-99m DMSA)?

Background Ureteropelvic junction stenosis (UPJS) is the most common cause of clinically significant antenatal hydronephrosis. We compared separate renal function results obtained using technetium-99m-mercaptoacetyltriglycine (Tc-99m MAG-3) and technetium-99m-dimercaptosuccinic acid (Tc-99m DMSA) in pediatric patients with UPJS to evaluate the adequacy of Tc-99m MAG-3 scintigraphy and the necessity of additional Tc-99m DMSA scintigraphy during follow-up. Methodology Patients diagnosed with hydronephrosis in the Pediatric Nephrology Department of Pamukkale University Faculty of Medicine over a period of 10 years (2012-2022) were evaluated retrospectively. Patients who had been diagnosed with UPJS and underwent both Tc-99m MAG-3 and Tc-99m DMSA scintigraphy during follow-up were included in the study. Technetium-99m-labeled MAG-3 and DMSA scans were re-evaluated for all patients by the Department of Nuclear Medicine. Results The study included 52 children with unilateral UPJS (12 girls and 40 boys) with a mean age of 6.34 ± 4.81 years (range: 2.97-9.79 years). Thirty-six patients (69.2%) were diagnosed antenatally. Differential renal function in Tc-99m DMSA was 46.94 ± 10.64 and in Tc-99m MAG-3 was 43.08 ± 11.18; the functions were lower in Tc-99m MAG-3, but the values were within normal limits for both groups (p=0.0001, z=-3.893). When differential renal functions were compared between Tc-99m DMSA and Tc-99m MAG-3 results, a statistically significant positive and strong correlation was found in the kidney with ureteropelvic junction obstruction (UPJO) (p=0.0001, r=0.752). When classifying the Tc-99m MAG-3 and Tc-99m DMSA results in the kidney with UPJO (supranormal, normal, low function) for the determination of differential renal functions, there was a consistency of 76%, and it was correlated (p=0.0001, k=0.456). While two patients had supranormal function and 13 patients had low function in Tc-99m MAG-3, five patients had supranormal function, and eight patients had low function in Tc-99m DMSA. Conclusions Some studies in the literature have reported that Tc-99m MAG-3 causes supranormal function measurements in patients with UPJS; our results showed that Tc-99m DMSA resulted in a higher rate of supranormal values for affected kidneys. We believe that Tc-99m DMSA should not be performed in addition to Tc-99m MAG-3 scintigraphy in the follow-up of every patient with UPJS but can be utilized in select cases, such as patients with surgical indications and those suspected before surgery.

Technostress in Nuclear Medicine: A Qualitative Study of Causes, Mitigators, and Resolution Levels

BackgroundIn contemporary healthcare, information and communication technology enables specialized treatment and efficient information sharing. However, it also causes stress and frustration, so-called technostress, among healthcare staff. PurposeTo investigate the day-to-day occurrence of technostress, we ask the research question: What causes the stressful situations with technology, how are they mitigated, and to what extent are they resolved? MethodWe interviewed 15 healthcare providers in the department of nuclear medicine at a Danish hospital about their experiences with technology-induced stress in their daily work. ResultsThe interviewees described 185 stressful situations with technology, mostly technology indispensable to their work. The two most frequent causes of stressful situations are system performance (46%) and technology-related organizational procedures (18%). To mitigate the situations, the most frequent strategies are accommodating (51%), consulting others for help (18%), and repeating previous task steps (13%). The mitigation strategies indicate that the stressful situations involve adapting work practices to the technology to a much larger extent than succeeding in adapting the technology to the work. Regarding the level of resolution, as much as 66% of the stressful situations are merely solved for now, that is, the concrete situation is resolved but the underlying issue remains unsolved. The underlying issue is resolved in only 10% of the situations, thereby indicating that the vast majority of the stressful situations are likely to recur later. ConclusionThe staff at the studied hospital department repeatedly experience stressful situations with the technology they rely on in their work. This technostress is an extra stressor on top of those induced by the staff’s responsibility for providing quality patient treatment. At the individual level, technostress leads to frustration and possibly burnout; at the organizational level, it calls for preventive action.

National programme for the reliability of ionizing radiation measurements based on inter-laboratory comparisons (ILCs): ILC n°2 ‘radiopharmaceutical activities’

A national Inter-Laboratory Comparisons (ILCs) programme was organized in Italy in 2022 by the Italian National Institute of Ionizing Radiation Metrology (INMRI), belonging to ENEA (Italian National Agency for New Technologies, Energy and Sustainable Economic Development), under the auspices of the Ministry of Enterprises and Made in Italy (Mimit ex MiSe). Within this ILCs programme, six inter-laboratory comparisons were organized, including the ILC-2 which focused on activity measurements carried out with radionuclide calibrators commonly used in the nuclear medicine departments of the participants.The focus was on three short-lived radionuclides - 99mTc, 18F, 177Lu - commonly employed in nuclear medicine for both diagnostic and therapeutic purposes. All presented results were compared with the reference values provided by ENEA-INMRI to ensure the traceability of measurements to the national primary activity standards. The observed deviation from the reference values of the measured activity were mainly within ± 10% (100% for 18F, 91.7% for 99mTc, 100% for 177Lu). The En statistical estimator was used to assess the participants’ ability to estimate uncertainty in the provided activity values. The obtained values revealed that, in certain instances, the involved laboratories did not achieve the correct results for En (with failure rates of 22.7%, 16.7%, 12.5% for 18F, 99mTc, 177Lu, respectively), despite deviations from the reference values falling within the ± 10%. The aim of ILC-2 was to harmonize the activity measurements in the country within the field of nuclear medicine for the specific radionuclides studied and enhance the measurement capabilities of the participants.