Diagnostic Nuclear Medicine Procedures Research Articles

Update of the competence-based catalog of learning objectives in nuclear medicine for the study of human medicine in Germany.

To update the subject-specific, competence-based catalog of learning objectives for medical studies in Germany published by the German Society of Nuclear Medicine (DGN) in 2018, prioritizing relevant learning objectives. Based on the previous catalog, the writing group compiled nuclear medicine topics and formulated competence-based learning objectives, including medical developments, device innovations and new radiopharmaceutical approvals. These were presented for prioritization to the 180 habilitated DGN members as an expert group in a Delphi process. The first round of voting assessed firstly the topics in terms of necessity or dispensability, and secondly the detailed learning objectives of the topics were assessed for their relevance to academic teaching in nuclear medicine. The results of the first survey were used to draft a catalog of learning objectives with final approval by the expert group in a second survey. The time available for teaching nuclear medicine was also recorded. The writing group developed 240 competence-based learning objectives from 41 topics. After a first Delphi round, 73 detailed competence-based learning objectives from 15 topics were compiled. The mean teaching time was 8.4 h for lectures, 3.7 h for seminars and 3.6 h for practical courses. In a second Delphi round, the agreement of the expert group was at least 95% for the selected topics and at least 90% for the detailed learning objectives. The catalog of subject-specific learning objectives, updated by expert consensus, provides basic knowledge, skills and competences related to the most relevant diagnostic and therapeutic procedures in nuclear medicine, taking into account both long-established topics and recently introduced innovations.

A Review of Organ Dose Calculation Methods and Tools for Patients Undergoing Diagnostic Nuclear Medicine Procedures

Exponential growth has been observed in nuclear medicine procedures worldwide in the past decades. The considerable increase is attributed to the advance of positron emission tomography and single photon emission computed tomography, as well as the introduction of new radiopharmaceuticals. Although nuclear medicine procedures provide undisputable diagnostic and therapeutic benefits to patients, the substantial increase in radiation exposure to nuclear medicine patients raises concerns about potential adverse health effects and calls for the urgent need to monitor exposure levels. In the current article, model-based internal dosimetry methods were reviewed, focusing on Medical Internal Radiation Dose (MIRD) formalism, biokinetic data, human anatomy models (stylized, voxel, and hybrid computational human phantoms), and energy spectrum data of radionuclides. Key results from many articles on nuclear medicine dosimetry and comparisons of dosimetry quantities based on different types of human anatomy models were summarized. Key characteristics of seven model-based dose calculation tools were tabulated and discussed, including dose quantities, computational human phantoms used for dose calculations, decay data for radionuclides, biokinetic data, and user interface. Lastly, future research needs in nuclear medicine dosimetry were discussed. Model-based internal dosimetry methods were reviewed focusing on MIRD formalism, biokinetic data, human anatomy models, and energy spectrum data of radionuclides. Future research should focus on updating biokinetic data, revising energy transfer quantities for alimentary and gastrointestinal tracts, accounting for body size in nuclear medicine dosimetry, and recalculating dose coefficients based on the latest biokinetic and energy transfer data.

Development of Porous MoO2 Pellet Target for 99Mo/99mTc Generator.

Technetium-99m(99mTc) is used worldwide in 85% of nuclear medicine diagnostic imaging procedures. We developed porous MoO2 pellets as an alternative to reactor-based targets in an (n,γ) reaction for producing Technetium-99m (99mTc) in nuclear medicine. The pellets, formed through a manufacturing process involving mixing, sintering, eluting, and drying, offer advantages such as selective dissolution and improved yield. This research offers a potential solution for stable 99mTc production, focusing on porous molybdenum dioxide (MoO2) as a target material due to its insolubility in water. Using potassium molybdate (K2MoO4) as a pore former, we developed porous MoO2 pellets that facilitate efficient technetium extraction and target recycling. This approach offers control over pore formation and shows promise in addressing supply challenges and enhancing 99mTc production.

Radiation-induced double-strand breaks by internal ex vivo irradiation of lymphocytes: Validation of a Monte Carlo simulation model using GATE and Geant4-DNA

This study describes a method to validate a radiation transport model that quantifies the number of DNA double-strand breaks (DSB) produced in the lymphocyte nucleus by internal ex vivo irradiation of whole blood with the radionuclides 90Y, 99mTc, 123I, 131I, 177Lu, 223Ra, and 225Ac in a test vial using the GATE/Geant4 code at the macroscopic level and the Geant4-DNA code at the microscopic level. MethodsThe simulation at the macroscopic level reproduces an 8 mL cylindrical water-equivalent medium contained in a vial that mimics the geometry for internal ex vivo blood irradiation. The lymphocytes were simulated as spheres of 3.75 µm radius randomly distributed, with a concentration of 125 spheres/mL. A phase-space actor was attached to each sphere to register all the entering particles. The simulation at the microscopic level for each radionuclide was performed using the Geant4-DNA tool kit, which includes the clustering example centered on a density-based spatial clustering of applications with noise (DBSCAN) algorithm. The irradiation source was constructed by generating a single phase space from the sum of all phase spaces. The lymphocyte nucleus was defined as a water sphere of a 3.1 µm radius. The absorbed dose coefficients for lymphocyte nuclei (dLymph) were calculated and compared with macroscopic whole blood absorbed dose coefficients (dBlood). The DBSCAN algorithm was used to calculate the number of DSBs. Lastly, the number of DSB∙cell−1∙mGy−1 (simulation) was compared with the number of radiation-induced foci per cell and absorbed dose (RIF∙cell−1∙mGy−1) provided by experimental data for gamma and beta emitting radionuclides. For alpha emitters, dLymph and the number of α-tracks∙100 cell−1∙mGy−1 and DBSs∙µm−1 were calculated using experiment-based thresholds for the α-track lengths and DBSs/track values. The results were compared with the results of an ex vivo study with 223Ra. ResultsThe dLymph values differed from the dBlood values by −1.0% (90Y), −5.2% (99mTc), −22.3% (123I), 0.35% (131I), 2.4% (177Lu), −5.6% (223Ra) and −6.1% (225Ac). The number of DSB∙cell−1∙mGy−1 for each radionuclide was 0.015 DSB∙cell−1∙mGy−1 (90Y), 0.012 DSB∙cell−1∙mGy−1 (99mTc), 0.014DSB∙cell−1∙mGy−1 (123I), 0.012 DSB∙cell−1∙mGy−1 (131I), and 0.016 DSB∙cell−1∙mGy−1 (177Lu). These values agree very well with experimental data. The number of α-tracks∙100 cells−1∙mGy−1 for 223Ra and 225Ac where 0.144 α-tracks∙100 cells−1∙mGy−1 and 0.151 α-tracks∙100 cells−1∙mGy−1, respectively. These values agree very well with experimental data. Moreover, the linear density of DSBs per micrometer α-track length were 11.13 ± 0.04 DSB/µm and 10.86 ± 0.06 DSB/µm for 223Ra and 225Ac, respectively. ConclusionThis study describes a model to simulate the DNA DSB damage in lymphocyte nuclei validated by experimental data obtained from internal ex vivo blood irradiation with radionuclides frequently used in diagnostic and therapeutic procedures in nuclear medicine.

Preface to the first issue of SJORANM

Radiology with its increasing numbers of steadily improving diagnostic and minimal invasive therapeutic methods in combination with the skills of diagnostic and therapeutic procedures in nuclear medicine are meanwhile essential tools on a very high level of patient treatment and care in tight cooperation with the clinicians. Our new Journal (SJORANM) wants to give the chance for quick online access to new ideas, new scientific research and results in the diagnostic and therapeutic field of Radiology and Nuclear Medicine.

Breakeven Analysis for Imaging Devices: Basic Introduction with Presentation of a User-Friendly Tool for in-clinic Calculation Using PET/CT as an Example

Imaging devices such as PET/CT are becoming increasingly important in view of the growing range of innovative nuclear medicine diagnostic procedures. Since the procurement and commissioning as well as the ongoing operation of imaging devices leads to comparatively high costs, it is of great interest for clinics and practices to know the number of scans from which the (planned) device operation leads to a profit. In the following, we will introduce the breakeven point analysis and present a calculation tool that users in nuclear medicine clinics and practices can use in everyday operations using PET/CT as an example. In the breakeven point analysis, the intersection point is determined from which the organisation- or device-specific revenues exceed the total costs incurred for personnel, material resources, etc. For this purpose, the fixed and variable (planned) cost components for the procurement and operation of the device must be prepared on the cost side and the respective device-related (planned) revenue structure on the revenue side. The authors present the break-even analysis method with the data processing required for this using the example of the planned procurement or ongoing operation of a PET/CT. In addition, a calculation tool was developed, that interested users can use to prepare a device-specific break-even analysis. For this purpose, various cost and revenue data are discussed, which have to be compiled and processed within the clinic and entered into prepared spreadsheets. The breakeven point analysis can be used to determine the profit/loss (point) for the (planned) operation of imaging devices such as PET/CT. Users from imaging clinics/practices and administration can adapt the calculation tool presented to their specific facility and thus use it as a basic document for both the planned procurement and the ongoing operational control of imaging devices in everyday clinical practice.

Radiation safety measures in diagnostic nuclear medicine, based on the potential radiation dose emitted by radioactive patients.

To measure the potential radiation dose emitted by patients who have recently undergone diagnostic nuclear medicine procedures, in order to establish optimal radiation safety measures for such procedures. We evaluated the radiation doses emitted by 175 adult patients in whom technetium-99m, iodine-131, and fluorine-18 radionuclides were administered for bone, kidney, heart, brain, and whole-body scans, as measured with a radiation detector. Those values served as the basis for evaluating whole-body radiopharmaceutical clearance, as well as the risk for the exposure of others to radiation, depending on the time elapsed since administration of the radiopharmaceutical. The mean time to clearance of the radiopharmaceuticals administered, expressed as the effective half-life, ranged from 1.18 ± 0.30 h to 11.41 ± 0.02 h, and the mean maximum cumulative radiation dose at 1.0 m from the patients was 149.74 ± 56.72 µSv. Even at a distance of 0.5 m, the cumulative dose was found to be only half and one tenth of the limits established for exposure of the general public and family members/caregivers (1.0 mSv and 5.0 mSv per episode, respectively). Cumulative radiation doses emitted by patients immediately after diagnostic nuclear medicine procedures are considerably lower than the limits established by the International Commission on Radiological Protection and the International Atomic Energy Agency, and precautionary measures to avoid radiation exposure are therefore not required after such procedures.

NUCLEAR MEDICINE PROCEDURE VOLUME AND ESTIMATION OF COLLECTIVE EFFECTIVE DOSE IN TAMIL NADU TOWARDS THE ESTABLISHMENT OF DIAGNOSTIC REFERENCE LEVEL.

With an objective to establish adult diagnostic reference levels in the practice of nuclear medicine (NM) in the state of Tamil Nadu (TN), data on the predominant NM procedures carried out in the state are analyzed. In this study, data on total NM diagnostic procedures during the years 2015-19 along with patient-specific diagnostic NM procedure data for the period April-June 2021 from all centers in Tamil Nadu are collected and analyzed using SPSS statistical software. Nine predominant types of NM scans are analyzed. Collective effective dose from NM scans and per capita dose for the TN population are estimated. The 75th percentile of the distribution and average administered activity (AAA) has been derived and local reference levels are reported. Based on the statistical analysis, it is observed that the whole-body positron emission tomography (PET), renal diethylenetriamine pentaacetate (DTPA) scan, bone methylene diphosphonate (MDP) scan, iodine-131 whole body scan, thyroid studies using Technetium per technetate, renal dimercaptosuccinic acid (DMSA), myocardial perfusion methoxyisobutyl isonitrile sestamibi (MIBI), mebrofenin, Galium-68 prostate-specific membrane antigen (PSMA) are the most common procedure covering >90% of the practices carried out. The collective effective dose is 410 man-Sv in the year 2019, leading to a mean effective dose of 0.006mSv per capita of the TN state population. The 75th percentile of the distribution of AA is slightly higher than diagnostic reference level (DRL) as compared with Australian DRL (310MBq). It is also observed that F-18 PET procedures are primarily responsible for most of the collective effective dose, local DRL is 316MBq and it is important to establish national DRLs for NM diagnostic scans to optimize the NM examinations.

Assessment of Molybdenum Concentration in 99Mo/99mtc Generators (PAKGEN): 6 Years Experience

Background Technitium-99m (99mTc) is a widely used radioisotope for the diagnostic procedures in nuclear medicine. The radioisotope is eluted from 99Mo/99mTc generator. Ideally there should be no Molybdenum-99 (99Mo) or any other contamination; however, sometimes traces of 99Mo are co-eluted from the generator. This impurity interferes labeling of 99mTc with pharmaceuticals result in poor quality radiopharmaceutical and unnecessary exposure to patients. The purpose of this study is to assess the contamination level of 99Mo in the eluted activity of 99mTc used for the diagnostic procedures at Swat Institute of Nuclear Medicine, Oncology and Radiotherapy (SINOR), Swat Pakistan. Also the purpose is to check the integrity of the generators being transported by road, and it is a part of quality audit of PAKGEN 99Mo/99mTc generators. Methods The data was collected for 166-PAKGEN 99Mo/99mTc generators used over 6 years at SINOR. The generators were procured from Isotope Production Division (IPD), Pakistan Institute of Nuclear Science and Technology (PINSTECH), Islamabad, Pakistan. The 99Mo impurity concentration was measured for each elution with dose calibrator (Capintech Inc. CRC-25R) and canister. Results Results for most of the generators (99.4%) were within the permissible limit (0.15 μCi of 99Mo/mCi of 99mTc) as per Pakistan Nuclear Regulatory Authority (PNRA), Nuclear Regulatory Commission (NRC), and other regulatory authorities. Only one generator (0.6%) had the values out of range. Conclusion 99Mo breakthrough concentration for most of the generators was within permissible range which shows integrity of 99Mo/99mTc PAKGEN generators and approves the quality of locally prepared 99Mo/99mTc PAKGEN generators. The study replicates excellent manufacturing and quality control of PAKGEN generators which offers a confirmation of safe medical practices.

Assessment of occupational exposure from PET and PET/CT scanning in Saudi Arabia

Nuclear medicine diagnostic procedures such as positron emission tomography (PET) scans and hybrid imaging using a combination of PET and computed tomography (CT), commonly referred to as PET-CT scanning. Hybrid imaging, which allows accurate visualization of internal anatomical structure and the consequent physiological processes simultaneously, is extensively used in oncology and other departments. Nevertheless, this exposes patients and medical personnel in such departments to significant doses of ionizing radiation, especially in hybrid imaging, where two sources of radiation (the radiopharmaceutical infusion and the CT scanner) are used. This necessitates strict compliance with international guidelines and regulations on radiation protection. Recent reports showed that occupational staff exposure might exceed the annual dose limits. This study evaluated occupational exposure associated with diagnostic hybrid PET-CT imaging and the consequent risks. Twenty medical personnel: 5 physicists, ten technologists, two medical doctors, and three nurses are included in this study. The assessment includes measuring occupational ambient doses using calibrated optical stimulating-luminescent dosimeters (OSL) (Al2O3:C). These badges were read using an automatic OSL reader. The results, displayed as (mean ± standard deviation): (range) of the effective dose (mSv) for the different personnel, can be summarized as follows(mean standard deviation and range). Physicists 0.72 ± 0.14 (0.49–0.83) mSv in 2019 and 0.67 ± 0.07 (0.59–0.78) in 2020; technologist 1.4 ± 0.96 (0–3.27) mSv in 2019 and 1.395 ± 1.27 (0.64–4.36) mSv; medical doctors 0.445 ± 0.42 (0.15–0.74) mSv in 2019 and 0.70 ± 0.04 (0.67–0.73) in 2020; and nurses 1.38 ± 0.25 (1.21–1.66) mSv in 2019 and 1.41 ± 0.17 (1.23–1.55) in 2020. The tube voltage of the scanner used in this study had a constant value of 120 kVp for all patients. Staff working in PET or PET-CT departments receive significant doses from the radiopharmaceuticals and the energetic gamma rays from the CT scanners. Hence, optimizing the CT acquisition parameter is necessary to optimize the occupational doses and restrict them to acceptable dose limits.

SORGENTINA-RF FUSION NEUTRON PLANT: PRELIMINARY DESIGN OF THE BIOSHIELDING IN COMPLIANCE WITH DOSE CONSTRAINTS FOR WORKERS EXPOSURE.

An accelerator-driven 14MeV neutron source of new concept, denominated SORGENTINA-RF, will be installed in ENEA Brasimone Research Centre, to test the feasibility of producing radionuclides of medical relevance using fusion neutrons. The main goal of the facility is generating 99Mo as precursor of 99mTc, a radionuclide widely used in nuclear medicine diagnostic procedures, using the 14MeV fusion neutrons produced by the plant. This work describes the study performed for the design of a proper shielding structure that aims at fulfilling the requirement of 0.01mSv/h dose rate limit on the external surface of the shielding during beam-on operations. The proposed shielding consists of a layered structure composed of 2m standard concrete and 1m baritic concrete. The design is still in the preliminary phase to assess the feasibility and the economic issues as well as structural impact of the shielding structure.

Pregnancy and medical radiation

IntroductionA non-negligible number of pregnant patients and radiation professionals are exposed to ionizing radiation for diagnostic and therapeutic purposes, each year. The lack or even the wrong information results in excessive stress and, in many cases unjustified termination of the pregnancy. Materials and methodsInternational Commission on Radiological Protection (ICRP) Publication 84 concerns the management of pregnant patients as well as pregnant workers in medical establishments where ionizing radiation is used. Based on the above report and the recent literature, this work discusses how to deal with these matters which are: Medically necessary radiation exposure of a pregnant woman, radiation-induced malformations, pre-conception radiation, handling of pregnant or probably pregnant patient in the hospital, absorbed dose to the fetus in Conventional and Interventional Radiology, Nuclear Medicine and Radiation Therapy, dose limits for pregnant workers, research involving pregnant women, termination of pregnancy. Results & discussionWe have shown that, the vast majority of conventional radiographic procedures and the majority of diagnostic procedures in nuclear medicine are at doses much lower than the exposure associated with fetal harm. In contrast, Radiation Therapy, multiple CT scans, certain therapies in nuclear medicine, and Invasive Radiology can potentially cause serious damage to the fetus. Termination of pregnancy depends on many medical, psychological and social factors.Specific goals of this work are to outline and evaluate the risks to the conceptus when exposed to radiodiagnostic and radiotherapeutic procedures during the various stages of pregnancy, to manage and evaluate radiation doses, to recommend means to control, and to evaluate communication issues with the pregnant patients.

Nationwide survey on radiation doses received by patients in nuclear medicine imaging procedures

National diagnostic reference levels (DRLs) are essential tools for optimizing protocols and protecting patients from an unjustified radiation exposure. The aim of this study was to conduct a nationwide survey of adult patient doses received from nuclear medicine (NM) procedures and to update national DRL (NDRL) values for most common procedures. Data on the radioactivity administered to standard adult patients were collected from all Lithuanian hospitals using NM applications in practice, between 2017 and 2022. Twelve of the most commonly performed NM diagnostic procedures: myocardial perfusion scintigraphy (two parts), thyroid scintigraphy, lung perfusion scintigraphy, bone scintigraphy, dynamic renal scintigraphy (divided into two procedures), parathyroid scintigraphy, hepatobiliary scintigraphy, lymphoscintigraphy, neuroendocrine tumour scan, and oncology positron emission tomography/computed tomography (PET/CT) imaging were included. The 75th percentile of the dose distribution was estimated for establishing NDRLs. During the data collection period, the NM imaging equipment was upgraded. The procedures were completed with 12 single photon emission computed tomography (SPECT) and SPECT/CT gamma cameras (2 with cadmium zinc telluride (CZT) detectors), 2 cardiac-centred gamma cameras with CZT detectors, and 2 PET/CT scanners. Data were collected on 7979 activities administered to the patients. For each procedure, depending on its frequency, 50–580 administered radiopharmaceutical activities were selected. Based on the collected data, NDRLs were updated in 2021 for three procedures. A large part of the procedures were performed with scanners manufactured between 2008 and 2011. In the past few years, the main Lithuanian hospitals that provide NM services have updated their SPECT/CT systems. In the future, the data collection process should be continued in order to reassess DRLs with respect to new scanning systems (e.g. with CZT detectors and newer PET/CT technology). Variations in the prescribed radiopharmaceutical activities showed that optimization and harmonization procedures may be performed in some hospitals.

Diagnostic Value of Radiolabelled Somatostatin Analogues for Neuroendocrine Tumour Diagnosis: The Benefits and Drawbacks of [64Cu]Cu-DOTA-TOC.

Simple SummaryOne of the most incredible advances in nuclear medicine is early detection of neuroendocrine tumors, which leads to appropriate and expedient treatment pathways. Advances made with somatostatin analogue derivatives radiolabeled with Gallium-68 clarified the paths of diagnosis and treatment properly. Despite the significant improvements, widespread efforts are in progress to attain the most specific radiopharmaceutical for this purpose. In this literature review, we will provide a short overview on the role of nuclear medicine in the diagnosis of neuroendocrine tumors focusing on [64Cu]Cu-DOTA-TOC as a new radiopharmaceutical with promising clinical results.Neuroendocrine tumours (NETs) arise from secondary epithelial cell lines in the gastrointestinal or respiratory system organs. The rate of development of these tumours varies from an indolent to an aggressive course, typically being initially asymptomatic. The identification of these tumours is difficult, particularly because the primary tumour is often small and undetectable by conventional anatomical imaging. Consequently, diagnosis of NETs is complicated and has been a significant challenge until recently. In the last 30 years, the advent of novel nuclear medicine diagnostic procedures has led to a substantial increase in NET detection. Great varieties of exclusive single photon emission computed tomography (SPECT) and positron emission tomography (PET) radiopharmaceuticals for detecting NETs are being applied successfully in clinical settings, including [111In]In-pentetreotide, [99mTc]Tc-HYNIC-TOC/TATE, [68Ga]Ga-DOTA-TATE, and [64Cu]Cu-DOTA-TOC/TATE. Among these tracers for functional imaging, PET radiopharmaceuticals are clearly and substantially superior to planar or SPECT imaging radiopharmaceuticals. The main advantages include higher resolution, better sensitivity and increased lesion-to-background uptake. An advantage of diagnosis with a radiopharmaceutical is the capacity of theranostics to provide concomitant diagnosis and treatment with particulate radionuclides, such as beta and alpha emitters including Lutetium-177 (177Lu) and Actinium-225 (225Ac). Due to these unique challenges involved with diagnosing NETs, various PET tracers have been developed. This review compares the clinical characteristics of radiolabelled somatostatin analogues for NET diagnosis, focusing on the most recently FDA-approved [64Cu]Cu-DOTA-TATE as a state-of-the art NET-PET/CT radiopharmaceutical.

Cumulative radiation doses due to nuclear medicine examinations: a systematic review.

To systematically review the published data regarding the cumulative exposure to radiation in selected cohorts of adults or paediatric patients due to diagnostic nuclear medicine examinations. We conducted PubMed/Medline searches of peer-reviewed papers on cumulated effective dose (CED) from diagnostic nuclear medicine procedures published between 01 January 2010 until 31 January 2021. Studies were considered eligible if the contribution of nuclear medicine examinations to total CED was >10%. Studies reporting cumulative doses in a single episode of care or in a limited time (≤1 year) were excluded. The main outcomes for which data were sought were the CED accrued by patients, the period in which the CED was accrued, the percentage of patients with CED > 100 mSv and the percentage contribution due to nuclear medicine procedures to the overall CED. The studies included in the synthesis were 18 which enrolled a total of 1,76,371 patients. Eleven (1,757 patients), three (1,74,079 patients) and four (535 patients) were related to oncological, cardiologic and transplanted patients, respectively. All the studies were retrospective; some of the source materials referred to small number of patients and some of the patients were followed for a short time. Not many studies accurately quantified the contribution of nuclear medicine procedures to the overall radiation exposure due to medical imaging. Finally, most of the studies covered an observation period which extended mainly in the 2000-2010 decade. There is a need of prospective, multicentric studies enrolling a greater number of patients, followed for longer period in selected groups of patients to fully capture the cumulative exposure to radiation in these settings. This systematic review allows to identify selected group of patients with a specific health status in which the cumulated exposure to radiation may be of concern and where the contribution of nuclear medicine procedures to the total CED is significant.

Myocardial perfusion scintigraphy during the COVID-19 pandemic - findings from the university teaching hospital in Slovenia

Funding AcknowledgementsType of funding sources: None.IntroductionDepartment for nuclear medicine in the University medical centre Ljubljana provides nuclear medicine diagnostic procedures for approximately 1.000.000 inhabitants of Slovenia. As many countries in Europe, Slovenia was faced with the first wave of the COVID-19 pandemic in early spring of 2020. Since our country is situated next to the northern part of Italy, where the situation was critical, our Ministry of health issued specific recommendations in March 2020. The aim was to increase hospital capacities for COVID-19 patients through limiting non-urgent diagnostic tests including myocardial perfusion scintigraphy (MPS) and to minimize the spread of the virus into hospital departments. The epidemiologic situation of the first wave resolved within 3 months. In the second wave of the pandemic in autumn 2020, the recommendations on patient care in non COVID-19 cases were less limiting to avoid worsening of non COVID-19 related diseases and patient prognosis.PurposeThe aim of our study was to evaluate the influence of the COVID-19 pandemic on MPS in our medical institution.MethodsData on numbers of MPS, clinical characteristics of the patients and findings of MPS were prospectively collected for the first wave (in spring from March 15th to June 15th 2020) and second wave (in autumn from September 15th to December 15th 2020) of the pandemic and were compared with the same periods in 2019. ResultsDuring the first wave we performed 40% less MPS, significantly more patients had pharmacological stress and were outpatients than in spring 2019. There were no significant differences in other clinical characteristics and MPS findings (Table 1 and Figure 1). In autumn 2020 we reorganized our schedule to increase the number of patients, which was once again comparable to previous year’s autumn. Although the number of patients was comparable, patients were now significantly older and had more often pharmacological stress, but there were no significant differences in other clinical data or MPS findings (Table 1 and Figure 1).ConclusionsIn our hospital, during the first wave of COVID-19 pandemic, we performed significantly less MPS than in the same period of the previous year. To minimize the possibility of virus transmission from asymptomatic patients, we followed international recommendations and avoided exercise stress tests but increased the percentage of pharmacological stress tests. A similar approach regarding the type of stress tests was chosen for the second wave in autumn of 2020. However, we decided to increase the number of MPS performed, in order to lessen the negative impact of the pandemic on non COVID-19 related diseases, focusing on coronary artery disease. Figure. Figure.

Trends in Occupational Radiation Doses for U.S. Radiologic Technologists Performing General Radiologic and Nuclear Medicine Procedures, 1980-2015.

Background Occupational doses to most medical radiation workers have declined substantially since the 1950s because of improvements in radiation protection practices. However, different patterns may have emerged for radiologic technologists working with nuclear medicine because of the higher per-procedure doses and increasing workloads. Purpose To summarize annual occupational doses during a 36-year period for a large cohort of U.S. radiologic technologists and to compare dose between general radiologic technologists and those specializing in nuclear medicine procedures. Materials and Methods Annual personal dose equivalents (referred to as doses) from 1980 to 2015 were summarized for 58 434 (62%) participants in the U.S. Radiologic Technologists (USRT) cohort who responded to the most recent mailed work history survey (years 2012-2014) and reported never regularly performing interventional procedures. Doses were partitioned according to the performance of nuclear medicine (yes or no, frequency, procedure type) by calendar year. Annual dose records were described by using summary statistics (eg, median and 25th and 75th percentiles). Results Median annual doses related to performance of general radiologic procedures decreased from 0.60 mSv (interquartile range [IQR], 0.10-1.9 mSv) in 1980 to levels below the limits of detection by 2015, whereas annual doses related to performance of nuclear medicine procedures remained relatively high during this period (median, 1.2 mSv; IQR, 0.12-3.0 mSv). Higher median annual doses were associated with more frequent (above vs below the median) performance of diagnostic nuclear medicine procedures (≥35 vs <35 times per week; 1.6 mSv [IQR, 0.30-3.3 mSv] and 0.9 mSv [IQR, 0.10-2.6 mSv]). Higher and more variable annual doses were associated with more frequent performance of cardiac nuclear medicine (≥10 times per week) and PET (nine or more times per week) examinations (median, 1.6 mSv [IQR, 0.30-2.2 mSv] and 2.2 mSv [IQR, 0.10-4.6 mSv], respectively). Conclusion Annual doses to U.S. radiologic technologists performing general radiologic procedures declined during a 36-year period. However, consistently higher and more variable doses were associated with the performance of nuclear medicine procedures, particularly cardiac nuclear medicine and PET procedures. © RSNA, 2021 Online supplemental material is available for this article. See also the editorial by Mettler and Guiberteau in this issue.

Changes in the global impact of COVID-19 on nuclear medicine departments during 2020: an international follow-up survey

AimAs a follow-up to the international survey conducted by the International Atomic Energy Agency (IAEA) in April 2020, this survey aims to provide a situational snapshot of the COVID-19 impact on nuclear medicine services worldwide, 1 year later. The survey was designed to determine the impact of the pandemic at two specific time points: June and October 2020, and compare them to the previously collected data.Materials and methodsA web-based questionnaire, in the same format as the April 2020 survey was disseminated to nuclear medicine facilities worldwide. Survey data was collected using a secure software platform hosted by the IAEA; it was made available for 6 weeks, from November 23 to December 31, 2020.ResultsFrom 505 replies received from 96 countries, data was extracted from 355 questionnaires (of which 338 were fully completed). The responses came from centres across varying regions of the world and with heterogeneous income distributions. Regional differences and challenges across the world were identified and analysed. Globally, the volume of nuclear medicine procedures decreased by 73.3% in June 2020 and 56.9% in October 2020. Among the nuclear medicine procedures, oncological PET studies showed less of a decline in utilization compared to conventional nuclear medicine, particularly nuclear cardiology. The negative impact was also significantly less pronounced in high-income countries. A trend towards a gradual return to the pre-COVID-19 situation of the supply chains of radioisotopes, generators, and other essential materials was evident.ConclusionThe year 2020 has a significant decrease in nuclear medicine diagnostic and therapeutic procedures as a result of the pandemic-related challenges. In June, the global decline recorded in the survey was greater than in October when the situation began to show improvement. However, the total number of procedures remained below those recorded in April 2020 and fell to less than half of the volumes normally carried out pre-pandemic.

Effective doses and associated age-related risks for common paediatric diagnostic nuclear medicine and PET procedures at a large Australian paediatric hospital.

Effective dose alone cannot be used to specify and communicate the radiation risk for an individual as risks are dependent on many factors including age and gender. There are limited published data regarding age-specific effective doses and the associated lifetime risk of developing cancers for paediatrics. In this study, we have estimated the typical effective doses for six commonly performed paediatric nuclear medicine and positron emission tomography (PET) studies at the Royal Children's Hospital, Melbourne, Australia. Effective doses were used to estimate and categorise associated stochastic risks with commonly used risk terminology. Paediatric protocols for common nuclear medicine and PET studies and the World Health Organization (WHO) 50th percentile weight-for-age data for females and males aged up to 18 years were used to estimate typical organ and effective doses using ICRP dosimetric tables for radiopharmaceuticals and lifetime risk of cancer incidence using BEIR VII Phase 2 report data. Results were used to determine standardised levels of risk. Organ doses, effective doses, corresponding lifetime risk of cancer incidence and level of risk category from six common nuclear medicine and PET studies for paediatric patients were calculated and presented for ease of communication. Typical effective doses from common paediatric nuclear medicine and PET studies and the associated lifetime risk of cancer incidence and level of risk have been established for our institution. This can be used to convey risks to health professionals, patients and carers in ways that are easy to understand and compare with other everyday risks.

SOLLID - a single centre study to develop methods to investigate the effects of low radiation doses within nuclear medicine, to enable multicentre epidemiological investigations.

There is continuing debate concerning the risks of secondary malignancies from low levels of radiation exposure. The current model used for radiation protection is predicated on the assumption that even very low levels of exposure may entail risk. This has profound implications for medical procedures involving ionising radiation as radiation doses must be carefully monitored, and for diagnostic procedures are minimised as far as possible. This incurs considerable expense. The SOLLID study (ClinicalTrials.gov Identifier: NCT03580161) aims to develop the methodology to enable a large-scale epidemiological investigation of the effect of radiopharmaceutical administrations to patients undergoing diagnostic nuclear medicine procedures. Patients will undergo a series of scans in addition to that acquired as standard of care to enable the radiation doses delivered to healthy organs to be accurately calculated. Detailed analysis will be performed to determine the uncertainty in the radiation dose calculations as a function of the number and type of scans acquired. It is intended that this will inform a subsequent long-term multicentre epidemiological study that would address the question definitively. Secondary aims of the study are to evaluate the range of absorbed doses that are delivered from diagnostic nuclear medicine procedures and to use current risk models to ascertain the relative risks from these administrations.