Nuclear Medicine Procedures Research Articles

Enhanced γ-H2AX Foci Frequency and Altered Gene Expression in Participants Exposed to Ionizing Radiation During I-131 Nuclear Medicine Procedures.

Ionizing radiation-based technologies are extensively used in the diagnosis and treatment of diseases. While utilizing the technologies, exposure to a certain amount of radiation is unavoidable. Data can be obtained from participants who received radiation during medical imaging and therapeutic purposes to predict the effects of low-dose radiation. To understand the effects of low-dose radiation, participants (n = 22) who received radioactive I-131 for scan/therapy were used as a model in this study. Blood samples were drawn pre- and post-administration of I-131. Biological effects were measured using markers of DNA damage (γ-H2AX, micronucleus (MN), and chromosomal aberrations (CA)) and response to damage through gene expression changes (ATM, CDKN1A, DDB2, FDXR, and PCNA) in blood samples. Mean frequency of γ-H2AX foci in pre-samples was 0.28 ± 0.16, and post-samples were 1.03 ± 0.60. γ-H2AX foci frequency obtained from post-samples showed significant (p < 0.0001) and a heterogeneous increase in all the participants (received I-131 for scan/therapy) when compared to pre-samples. A significant increase (p < 0.0001) in MN and CA frequency was also observed in participants who received the I-131 therapy. Gene expression analysis indicates that all genes (ATM, CDKN1A, DDB2, FDXR, and PCNA) were altered in post-samples, although with varying degrees, suggesting that the cellular responses to DNA damage, such as damage repair, cell cycle regulation to aid in repair and apoptosis are increased, which priority is given to repair, followed by apoptosis. The results of this study indicate that the participants who received I-131 (low doses of β- and γ-radiation) can produce substantial biological effects.

Exposure to ionizing radiation of medical staff performing vascular and interventional radiology procedures.

Vascular and interventional radiology procedures are characterized by high exposure of personnel to ionizing radiation. This study assessed the exposure of medical personnel to ionizing radiation during vascular radiology and mechanical thrombectomy procedures. During vascular radiology procedures, the exposure of 4 groups of workers participating in the procedures was analyzed, i.e., the main operating physician, an assistant physician, a sterile nurse, and a nurse. Measurements of exposure to ionizing radiation were performed using thermoluminescent dosimetry. The registered effective dose during 1 treatment in individual groups is, respectively: mean (M) ± standard deviation (SD) 75±15 μSv, 24±5 μSv, 13±3 μSv, and 8±2 μSv. During mechanical thrombectomy, the operating physician receives an effective dose of M±SD 9±2 μSv. The equivalent doses for the lenses for the operating physician and the doctor assisting during vascular radiology procedures are M±SD 1419±285 μSv and 987±198 μSv, respectively, and for the hands, including the left and right hands, M±SD 4605±930 μSv, 1420±284 μSv, 1898±380 μSv, 1371±274 μSv. If the principles of optimizing radiological protection are not applied during vascular radiology procedures, the permissible dose limits and operational limits equivalent to doses to lenses and hands may be exceeded. Exposure during vascular radiology procedures is comparable to exposure during nuclear medicine procedures in terms of the use of glucose labeled with radioactive fluorine. Int J Occup Med Environ Health. 2024;37(4).

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.

Exploring the gamma counting function in PET for sample activity measurement

With the widespread availability of small animal PET scanners globally, there exists a significant opportunity to enhance their operational utility. Our research introduces a novel utilization pathway by integrating gamma-counting functionalities within PET systems. This approach leverages the shared gamma counting technology between PET systems and traditional gamma counters, enabling direct radioactivity measurement from PET-derived raw count data. We established a correlation between the raw data from all-digital PET and the radioactivity of samples, conducting experiments to assess the system's measurement capabilities. The system demonstrated high accuracy and stability across a detectable range of 25.53–1900.69 kBq in single-photon mode and 19.61–1107.04 kBq in coincidence mode, with the difference between the sample activity and the linear function being no more than 5 %. Due to the multi-channel characteristic of PET detectors, our system exhibits a tenfold higher upper detection limit than that of gamma counters, without dead-time correction. This study demonstrates that all-digital PET can directly measure radioactivity, simplifying nuclear medicine procedures by integrating gamma counting within PET systems. This strategy not only reduces the need for multiple instruments but also has the potential to improve quantitative accuracy by minimizing cross-calibration errors, thereby maximizing the operational utility of existing all-digital PET scanners.

Seracam: characterisation of a new small field of view hybrid gamma camera for nuclear medicine

BackgroundPortable gamma cameras are being developed for nuclear medicine procedures such as thyroid scintigraphy. This article introduces Seracam® – a new technology that combines small field of view gamma imaging with optical imaging – and reports its performance and suitability for small organ imaging.MethodsThe count rate capability, uniformity, spatial resolution, and sensitivity for 99mTc are reported for four integrated pinhole collimators of nominal sizes of 1 mm, 2 mm, 3 mm and 5 mm. Characterisation methodology is based on NEMA guidelines, with some adjustments necessitated by camera design. Two diagnostic scenarios – thyroid scintigraphy and gastric emptying – are simulated using clinically relevant activities and geometries to investigate application-specific performance. A qualitative assessment of the potential benefits and disadvantages of Seracam is also provided.ResultsSeracam’s performance across the measured characteristics is appropriate for small field of view applications in nuclear medicine. At an imaging distance of 50 mm, corresponding to a field of view of 77.6 mm × 77.6 mm, spatial resolution ranged from 4.6 mm to 26 mm and sensitivity from 3.6 cps/MBq to 52.2 cps/MBq, depending on the collimator chosen. Results from the clinical simulations were particularly promising despite the challenging scenarios investigated. The optimal collimator choice was strongly application dependent, with gastric emptying relying on the higher sensitivity of the 5 mm pinhole whereas thyroid imaging benefitted from the enhanced spatial resolution of the 1 mm pinhole. Signal to noise ratio in images was improved by pixel binning. Seracam has lower measured sensitivity when compared to a traditional large field of view gamma camera, for the simulated applications this is balanced by advantages such as high spatial resolution, portability, ease of use and real time gamma-optical image fusion and display.ConclusionThe results show that Seracam has appropriate performance for small organ 99mTc imaging. The results also show that the performance of small field of view systems must be considered holistically and in clinically appropriate scenarios.

Handling of radioactive waste from the use of radionuclides in hospitals

The waste that is generated during the different applications of radionuclides in medicine is considered as biomedical radioactive waste. This waste includes contaminated materials and syringes generated from Nuclear Medicine procedures, unused radioactive seeds from implants in Radiation Oncology as well as sealed sources used for calibration purposes, which are no longer useful. The overall goal of biomedical radioactive waste handling is to minimize the hazards posed by the waste prior to discharge or disposal. In order to plan the treatment of radionuclides in medical facilities, it is important to design an effective system for the overall management of radioactive biomedical waste. In this scientific paper I make a general assessment of the planning methods used in the handling of radioactive waste in medical facilities, including the collection, separation and packaging of radioactive biomedical waste.

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.

Establishment of National Diagnostic Reference Levels for Administered Activity in Diagnostic Nuclear Medicine in Thailand.

The diagnostic reference level (DRL) is a patient-exposure optimization tool used to evaluate radiation doses in medical imaging and provide guidance for protection from them. In Thailand, nuclear medicine DRLs have not been established yet. Therefore, this study surveyed dose levels in routine nuclear medicine procedures to provide national DRLs (NDRLs). Methods: NDRLs in Thailand were established by investigating the administered activity of radiopharmaceuticals in nuclear medicine examination studies. The NDRLs were determined on the basis of the 75th percentile (third quartile) of administered activity distribution as recommended by the International Commission on Radiological Protection. As part of a nationwide survey, datasets for the period between June 1, 2018, and August 31, 2019, were collected from 21 Thailand hospitals with nuclear medicine equipment. All hospitals were asked to report the nuclear medicine imaging devices in use, the standard protocol parameters for selected examinations, the injected activities, and the ages and weights of patients. All data were calculated to determine Thailand NDRLs, which were compared with international NDRLs. Results: The data reported by the 21 hospitals consisted of 4,641 examinations with SPECT or SPECT/CT for general nuclear medicine and 409 examinations with PET. The most widely performed examinations for SPECT were bone, thyroid, oncology, and cardiovascular imaging. The NDRLs for SPECT or SPECT/CT agreed well with published NDRLs for Europe, the United States, Japan, Korea, Kuwait, and Australia. In contrast, the NDRLs for 18F-FDG PET in oncology studies were higher than for Japan, Korea, Kuwait, and Australia but lower than for the United States, the United Kingdom, and the European Union. Conclusion: This study presents NDRL results for adults in Thailand as a way to optimize radiation protection in nuclear medicine imaging. Moreover, the reported injected activity levels were comparable to those of other countries.

Feasibility of Liver Transplantation after 90 Y Radioembolization: Lessons from a Radiation Protection Incident.

Radioembolization using 90 Y is a growing procedure in nuclear medicine for treating hepatocellular carcinoma. Current guidelines suggest postponing liver transplantation or surgical resection for a period of 14 to 30 d after radioembolization to minimize surgeons' exposure to ionizing radiation. In light of a radiation protection incident, we reevaluated the minimum delay required between radioembolization and subsequent liver transplantation. A patient with a hepatocellular carcinoma underwent a liver transplantation 44 h after undergoing radioembolization using 90 Y (860 MBq SIR-Spheres). No specific radioprotection measures were followed during surgery and pathological analysis. We subsequently (1) evaluated the healthcare professionals' exposure to ionizing radiation by conducting dose rate measurements from removed liver tissue and (2) extrapolated the recommended interval to be observed between radioembolization and surgery/transplantation to ensure compliance with the radiation dose limits for worker safety. The surgeons involved in the transplantation procedure experienced the highest radiation exposure, with whole-body doses of 2.4 mSv and extremity doses of 24 mSv. The recommended delay between radioembolization and liver transplantation was 8 d when using SIR-Spheres and 15 d when injecting TheraSphere. This delay can be reduced further when considering the specific 90 Y activity administered during radioembolization. This dosimetric study suggests the feasibility of shortening the delay for liver transplantation/surgery after radioembolization from the 8th or 15th day after using SIR-Spheres or TheraSphere, respectively. This delay can be decreased further when adjusted to the administrated activity while upholding radiation protection standards for healthcare professionals.

An Evaluation of Gastric Emptying Scintigraphy Protocols in Health Care Institutions When Compared with the Society of Nuclear Medicine and Molecular Imaging Procedure Guidelines.

This study aimed to analyze the compliance of health care institutions with the Society of Nuclear Medicine and Molecular Imaging (SNMMI) procedure guidelines for gastric emptying scintigraphy (GES). Methods: A 19-question survey on demographics and the GES protocol was conducted using a Google form. The demographic questions covered position, number of technologists in the department, location, type of health care institution, and number of GES studies per month. The protocol questions included patient preparation, meal preparation, withholding of scheduled medications, radiopharmaceutical type, and radiopharmaceutical dose. The survey was sent to 7 nuclear medicine Facebook groups and a list of clinical affiliates provided by the Indiana University School of Medicine Nuclear Medicine Program. Descriptive statistics were compiled for most questions. A Fisher exact test with a significance level of 0.05 was used to compare the type of health care institution with compliance with the SNMMI GES protocol regarding radiolabeling time, meal preparation, and meal components, as well as to compare the type of health care institution with the number of GES studies performed per institution. Results: In total, 240 people responded to the survey. Most were nonsupervisory nuclear medicine technologists (72%) in nonacademic institutions (72%) and groups with 4 or more technologists (62%). Of the respondents, 72% followed the SNMMI guideline of adding the radiopharmaceutical before cooking, but only 37% followed the meal component guideline. There was no significant association between the type of institution or the number of GES studies and compliance with radiolabeling time or with meal preparation or components. Most respondents asked patients to withhold medications per SNMMI guidelines and used the recommended radiopharmaceutical (99mTc-sulfur colloid, 95%) at the recommended dose (18.5-37 MBq, 84%). Conclusion: Although most respondents followed most aspects of the SNMMI guidelines for GES, more than half did not use the recommended meal of liquid egg whites. Compliance did not vary between academic and nonacademic institutions or between groups performing a large or a small number of GES studies.

A patient journey audit tool (PJAT) to assess quality indicators in a nuclear medicine service

PurposeTo develop a nuclear medicine specific patient journey audit tool (PJAT) to survey and audit patient journeys in a nuclear medicine department such as staff interaction with patients, equipment, quality of imaging and laboratory procedures, patient protection, infection control and radiation safety, with a view to optimising patient care and providing a high-quality nuclear medicine service.MethodsThe PJAT was developed specifically for use in nuclear medicine practices. Thirty-two questions were formulated in the PJAT to test the department’s compliance to the Australian National Safety and Quality Health Service Standards, namely clinical governance, partnering with consumers, preventing and controlling health care infection, medication safety, comprehensive care, communicating for safety, blood management and recognising and responding to acute deterioration. The PJAT was also designed to test our department’s adherence to diagnostic reference levels (DRL). A total of 60 patient journey audits were completed for patients presenting for nuclear medicine, positron emission tomography and bone mineral density procedures during a consecutive 4-week period to audit the range of procedures performed. A further 120 audits were captured for common procedures in nuclear medicine and positron emission tomography during the same period. Thus, a total of 180 audits were completed. A subset of 12 patients who presented for blood labelling procedures were audited to solely assess the blood management standard.ResultsThe audits demonstrated over 85% compliance for the Australian national health standards. One hundred percent compliance was noted for critical aspects such as correct patient identification for the correct procedure prior to radiopharmaceutical administration, adherence to prescribed dose limits and distribution of the report within 24 h of completion of the imaging procedure.ConclusionThis PJAT can be applied in nuclear medicine departments to enhance quality programmes and patient care. Austin Health has collaborated with the IAEA to formulate the IAEA PJAT, which is now available globally for nuclear medicine departments to survey patient journeys.

Dementia with Lewy bodies: old and new knowledge - Part 1: clinical aspects and diagnostics

Dementia with Lewy bodies (DLB) is the second most common neurodegenerative dementia after Alzheimer's disease. Patients with DLB often have apoor prognosis, with worse outcomes than patients with Alzheimer's disease in terms of important parameters, such as quality of life, caregiver burden, health-related costs, frequency of hospital and nursing home admissions, shorter time to severe dementia, and lower survival. The DLB is frequently misdiagnosed and often undertreated. Therefore, it is critical to diagnose DLB as early as possible to ensure optimal care and treatment. The aim of this review article is to summarize the main recent findings on diagnostic tools, epidemiology and genetics of DLB. Precise clinical diagnostic criteria exist for DLB that enable an etiologic assignment. Imaging techniques are used as standard in DLB, especially also to exclude non-neurodegenerative causes. In particular, procedures in nuclear medicine have ahigh diagnostic value. The diagnosis is primarily based on clinical symptoms, although the development of in vivo neuroimaging and biomarkers is changing the scope of clinical diagnosis as well as research into this devastating disease.

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.

A Quick Guide to Writing a Teaching Case Study.

Case studies published in the Journal of Nuclear Medicine Technology are brief chronologic or logical descriptions of a clinical experience that aim to share a technical outcome associated with an instrumentation or patient care scenario or demonstrate a unique finding associated with a nuclear medicine procedure. Although brief by necessity, case studies provide enough relevant detail to educate the reader about a clinical condition coupled with a diagnostic or therapeutic procedure. Case studies do not have to be about bizarre clinical conditions. Case studies can be about quality issues that directly impact the imaging or therapeutic procedure, protocol modifications when a clinical scenario requires out-of-the-box decisions, new techniques developed to address unique or difficult situations, or something as simple as an artifact that resulted in an unusual image finding. The sections of a case study, including the introduction, case report, discussion, and conclusion, are explained. The goal of this article is to teach new authors how to write a teaching case study.

ChatGPT and Patient Information in Nuclear Medicine: GPT-3.5 Versus GPT-4.

The GPT-3.5-powered ChatGPT was released in late November 2022 powered by the generative pretrained transformer (GPT) version 3.5. It has emerged as a readily accessible source of patient information ahead of medical procedures. Although ChatGPT has purported benefits for supporting patient education and information, actual capability has not been evaluated. Moreover, the March 2023 emergence of paid subscription access to GPT-4 promises further enhanced capabilities requiring evaluation. Methods: ChatGPT was used to generate patient information sheets suitable for gaining informed consent for 7 common procedures in nuclear medicine. Responses were generated independently for both GPT-3.5 and GPT-4 architectures. Specific procedures were selected that had a long-standing history of use to avoid any bias associated with the September 2021 learning cutoff that constrains both GPT-3.5 and GPT-4 architectures. Each information sheet was independently evaluated by 3 expert assessors and ranked on the basis of accuracy, appropriateness, currency, and fitness for purpose. Results: ChatGPT powered by GPT-3.5 provided patient information that was appropriate in terms of being patient-facing but lacked accuracy and currency and omitted important information. GPT-3.5 produced patient information deemed not fit for the purpose. GPT-4 provided patient information enhanced across appropriateness, accuracy, and currency, despite some omission of information. GPT-4 produced patient information that was largely fit for the purpose. Conclusion: Although ChatGPT powered by GPT-3.5 is accessible and provides plausible patient information, inaccuracies and omissions present a risk to patients and informed consent. Conversely, GPT-4 is more accurate and fit for the purpose but, at the time of writing, was available only through a paid subscription.

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.

Functional MR urography in children - update 2023.

Functional MR urography (fMRU) has developed into an innovative, radiation-free option for assessing parameters of kidney function in pediatric radiology. The importance of fMRU in comparison to the standardized established nuclear medicine procedure (99mTc-Mercapto-acetyltriglycerine, MAG3 scintigraphy) is shown using SWOT analysis. To assess the current state of research, a selective literature search was carried out in PubMed. Taking into account the current scientific status, the examination technique, preparation, and evaluation of fMRU are presented. As a result of the comparison with MAG3, fMRU is suitable for certain indications and represents an optimal combination of morphological and functional representation of the kidneys and urinary tract, especially in the case of surgical consequences. fMRU has been successfully established as a diagnostic method for assessing the morphology and function of the kidneys in competition with MAG3 scintigraphy. · Functional MRU allows reliable statements on the morphology and function of the kidneys and urinary tract.. · The results of the functional assessment of fMRU are comparable to the results of MAG3 scintigraphy.. · The complex implementation and demanding evaluation limits the spread of fMRU as a complete alternative to MAG3 scintigraphy. fMRU is reserved for special indications.. · Functional MRU has prevailed over MAG3 scintigraphy for complex renal and urinary tract anomalies (CAKUT) that require surgical correction. An example is the clarification of dribbling in girls, which is usually based on an ectopic opening of a ureter in a double system.. · Kirsch H, Krüger P, John-Kroegel U et al. Functional MR urography in children - update 2023. Fortschr Röntgenstr 2023; 195: 1097 - 1105.

Staff occupational exposure and ambient doses resulting from patients undergoing nuclear medicine procedures’

Ultrasound personnel can be occupationally exposed to ionizing radiation from radioisotopes during ultrasonography imaging of patients who received radioactive material. Thus, radiation safety assessment is required to ensure that the ultrasonography physicians practices conform with the international guidelines and that dose limits are not exceeded. This study aimed to measure staff exposure during ultrasound investigations of such patients who received radioactive material in molecular imaging procedures such positron emission tomography (PET) and single photon emission computed tomography (SPECT). Occupational doses, in terms of Hp (10) (deep dose), Hp (0.07) (skin dose) and ambient dose were monstered using calibrated thermos-luminescent dosimeters (TLDs) to ensure occupational doses exposures for the ultrasonographers over 1 year at King Faisal Specialist Hospital and Research Center in Riyadh, Saudi Arabia. The overall mean of Hp(10), Hp(0.07) for an annual occupational dose of 0.4 mSv and ambient dose (mSv) were (M) in ultrasound room, Hp(10) of 1.7 mSv and Hp(0.07) of 1.72 mSv in the Hot Lab, and Hp(10) of 0.4 mSv and Hp(0.07) of 0.02 mSv in the Stress Room. Occupational exposure was below the annual dose limits (20.0 mSv) for all practitioners, as well the extremities dose was below the annual dose limits of 500 mSv. In conclusion, since staff exposure which highly depends on radioisotope characteristics and protection measures can vary significantly for different personnel, continuous serial careful assessment of working conditions is recommended to ensure occupational doses exposures remain below annual limits.

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.

Design of feasibility study for the establishment of production of zirconium-89 radioisotope and implementation of of 89 Zr-radiopharmaceuticals in clinical practice in the Republic of North Macedonia

In the last decade, the application of radiopharmaceuticals based on zirconium-89 (89Zr) radiometal has increased in both preclinical and clinical studies. The most frequently used 89Zr-radiopharmaceutical is 89Zr-trastuzumab used in the management of patients with breast cancer. Breast cancer is the most common cancer among women in North Macedonia and the most common cause of death from malignant neoplasms in this population; therefore, the introduction of new nuclear medicine procedures in these patients might improve the management of this disease. However,the introduction of radioisotope and radiopharmaceutical production requires significant investments, both manpower and financial. The purpose of this work is to present the design conceptualization of a feasibility study for the establishment of production of zirconium-89 radioisotope and implementation of 89Zr-radiopharmaceuticals in clinical practice in the Republic of North Macedonia and to present the initial results from the first phases of the study. This feasibility study is designed to include preliminary analysis, market research, technical feasibility analysis, economic analysis, review and analysis of all data and feasibility conclusion. The evaluation of the data from the analyses conducted in all study phases is needed to identify the favourable and unfavourable factors and circumstances in order to make a final assessment of the feasibility of establishing the zirconium-89 radioisotope and 89Zr-radiopharmaceuticals production and implementation of 89Zr-trastuzumab use in nuclear medicine practice.