Number Of Nuclear Medicine Procedures Research Articles

Nuclear medicine and molecular imaging advances in the 21st century.

Currently, Nuclear Medicine has a clearly defined role in clinical practice due to its usefulness in many medical disciplines. It provides relevant diagnostic and therapeutic options leading to patients' healthcare and quality of life improvement. During the first two decades of the 21stt century, the number of Nuclear Medicine procedures increased considerably.Clinical and research advances in Nuclear Medicine and Molecular Imaging have been based on developments in radiopharmaceuticals and equipment, namely, the introduction of multimodality imaging. In addition, new therapeutic applications of radiopharmaceuticals, mainly in oncology, are underway.This review will focus on radiopharmaceuticals for positron emission tomography (PET), in particular, those labeled with Fluorine-18 and Gallium-68. Multimodality as a key player in clinical practice led to the development of new detector technology and combined efforts to improve resolution. The concept of dual probe (a single molecule labeled with a radionuclide for single photon emission computed tomography)/positron emission tomography and a light emitter for optical imaging) is gaining increasing acceptance, especially in minimally invasive radioguided surgery. The expansion of theranostics, using the same molecule for diagnosis (γ or positron emitter) and therapy (β minus or α emitter) is reshaping personalized medicine.Upcoming research and development efforts will lead to an even wider array of indications for Nuclear Medicine both in diagnosis and treatment.

Using radiation safely in cardiology: what imagers need to know

### Learning objectives Exposure to ionising radiation is an important healthcare concern, primarily due to the potential increased lifetime risk of malignancy. This is important for patients and staff who...

Estimated Organ Doses to Patients from Diagnostic Nuclear Medicine Examinations over Five Decades: 1960-2010.

Ionizing radiation exposure to the general U.S. population nearly doubled between 1980 and 2006, due almost entirely to the significant increase in the number of radiologic and nuclear medicine procedures performed. Significant changes in the types of procedures and radionuclides used in nuclear medicine, as well as in detection technology, have led to notable changes over time in absorbed doses to specific organs. This study is the first to estimate per-procedure organ doses to nuclear medicine patients and trends in doses over five decades. Weighted average organ doses per examination to 14 organs of interest were calculated for 17 examination types over 10 5-y time periods (1960-2010) as the product of the percentage of use of each radiopharmaceutical in those diagnostic procedures based on comprehensive literature review, the administered activity, and ICRP dose coefficients; doses per radiopharmaceutical were also provided for each organ, procedure, and time period. The weighted doses to adult nuclear medicine patients from cardiac procedures increased to all organs of interest between 1960 and 2010 except for the urinary bladder wall. From high radiation doses for most other procedures in the 1960s, with up to 0.7 Gy in the specific case of radioiodinated thyroid scans, organ-absorbed doses generally decreased from 1960 to 1990. In contrast, during the 1990s and 2000s, the weighted doses were gradually increased for some procedures, such as brain and skeleton scans. The increasing number of nuclear medicine procedures, specifically cardiac scans and changes in weighted doses, underscore the need to monitor exposure levels and radiation-related disease risks in nuclear medicine patients.

VP69 Mapping Brazilian Nuclear Medicine Installed Capacity And Perspectives

INTRODUCTION:Guidelines compliance, with a priori non-invasive and earlier tests and interventions, depends on access. This study investigates the Brazilian Unified Health System (SUS) outpatient access to nuclear medicine procedures through SUS data comparison with those from the National Commission of Nuclear Energy (CNEN: Comissão Nacional de Energia Nuclear).METHODS:Data provided by the SUS outpatient database (SIA-DATASUS) regarding procedures performed from 2013 to 2016 was compared with data from institutions (Nuclear Medicine Services and Cyclotron Facilities) and radioprotection supervisors with numbers certified by CNEN.RESULTS:CNEN has authorized 420 nuclear medicine institutions (.20 per million inhabitants) and certified 294 radioprotection supervisors (.14 per million inhabitants), and 1.4 services per supervisor. There are 457 graduated professionals qualified for radioactive sources preparation, use and handling for diagnostic and therapeutic radiopharmaceuticals (.9 professionals / installation). During the last four years, 08 new nuclear medicine facilities were authorized by CNEN. The number of nuclear medicine procedures performed slightly increased in the South, but remained constant in other regions. Annual SUS reimbursements increased by 21.2 percent on average for the 03 PET/CT (Positron emission tomography–computed tomography) adopted procedures: regional analysis showed the Central-West as the highest growth area (70.8 percent), compared to the South (53.4 percent), North-East region (30.8 percent), and the South-East (5 percent). Currently, thirteen Cyclotron Facilities operate in Brazil: South-East (six), South (three), North-East (three) and Central-West (one). Some nuclear medicine procedures largely outnumber the average increase: for example, reticuloendothelial system scintigraphy (513.9 percent), gastric transit scintigraphy (112.8 percent), and thyroid screening with suppression/stimulation test (100.6 percent). However, myocardial scintigraphy (stress and rest) and bone scintigraphy with or without blood flow still correspond to 82 percent of total nuclear medicine in vivo procedures.CONCLUSIONS:Regional disparity is quantitatively depicted in Brazil and reflects access to SUS nuclear medicine procedures. This denotes a potential for improvements related to nuclear medicine areas, for example developments concerning new PET/CT coverage, new radiopharmaceuticals research, and national and international training.

Cancer and circulatory disease risks in US radiologic technologists associated with performing procedures involving radionuclides

ObjectivesThe number of nuclear medicine procedures has increased substantially over the past several decades, with uncertain health risks to the medical workers who perform them. We estimated risks of incidence...

Virtual Reality for Dose Optimization in Pediatric Nuclear Medicine: Better Than the Real Thing: FIGURE 1.

See page [1923][1] The use of nuclear medicine imaging and CT has grown dramatically over the last several decades. In the Unites States, the annual number of nuclear medicine procedures increased 3-fold (from 7 to 20 million) and the annual number of CT procedures 20-fold (from 3 to 60 million)

Long-term monitoring of radiation exposure of employees in the department of nuclear medicine (Szczecin, Poland) in the years 1991-2007

Occupational radiation exposure is a hazard that should be avoided or at least minimised. This study aimed to evaluate the radiation exposure of nuclear medicine department employees monitored during the 1991-2007 period, and to investigate the relationship between the annual effective doses of the personnel and the number of radioisotope procedures performed. Overall, 2014 quarterly effective whole-body doses, categorised into six occupational groups, monitored with personal dosemeters, were analysed statistically. There was a wide variation in the average annual doses among the different occupational groups. During the 17 years covered by this study, there was no incidence of a dose exceeding the annual dose limit of 20 mSv. There was a weak correlation between the average annual dose for monitored employees and the number of nuclear medicine procedures performed. Apart from exposure, personal skill in dealing with radioactive substances, compliance with radiation protection rules is an important factor to minimise the effective dose.

Nuklearmedizinische Abklärung bei vermuteter Infektion einer Hüft- oder Knie-TEP

Komplikationen nach Hüftendoprothesen-Operationen treten mit einer Häufigkeit von ca. 1-2 % nach Erstoperation und ca. 3-5 % nach Revisionsoperation auf und kommen nach Knieendoprothesen-Operationen noch etwas häufiger vor. Dabei kommt der Differenzierung einer aseptischen Lockerung von einer bakteriellen Protheseninfektion besondere Bedeutung zu. Bei einer aseptischen Prothesenlockerung ist üblicherweise ein einzeitiger Prothesenwechsel möglich. Liegt dagegen eine Keimbesiedelung der Prothese vor, sollte zunächst sämtliches Fremdmaterial ausgebaut werden, damit eine Sanierung der Infektion ermöglicht wird. Erst bei einer nachgewiesenen lokalen Keimfreiheit kann schließlich die neue Prothese im Intervall eingesetzt werden. Die Diagnostik und Therapie der schmerzhaften Hüft- oder Knie-TEP ist schwierig, weil Anamnese, klinische Untersuchung, Ergebnisse der Labordiagnostik einschließlich bakteriologischer Untersuchung von Punktionsmaterial und die Ergebnisse radiologischer Untersuchungen oftmals nicht eindeutige Ergebnisse liefern. Im Laufe der Jahre wurden eine Vielzahl von nuklearmedizinischen Untersuchungen vorgestellt, um bei der schmerzhaften Hüft- oder Knie-TEP eine aseptische Prothesenlockerung von einer Prothesenentzündung zu differenzieren. Keine nuklearmedizinische Methode schneidet überragend ab. In der internationalen Literatur wird immer wieder auf die kombinierte Entzündungs- und Knochenmarkdiagnostik mit markierten Leukozyten und 99mTc-Schwefelkolloid als beste Methode bei dieser Fragestellung hingewiesen. In Deutschland ist die Methode in der publizierten Form nicht verfügbar, zudem ist die Methode zeitaufwendig, kostenintensiv und erfordert den direkten Umgang mit Blut. Daher ist zur Abklärung die Entzündungsszintigrafie mit markierten Antikörpern bzw. Antikörperfragmenten für die meisten Nuklearmediziner derzeit die Methode der ersten Wahl, wobei bei semiquantitativer Auswertung eine vergleichbare diagnostische Genauigkeit erreichbar ist. 18F-FDG-PET kann letztendlich nicht sicher zwischen Abriebmaterial, welches eine abakterielle Entzündung hervorruft und einer septischen Entzündung unterscheiden, wenngleich eine Bewertung des Anreicherungsmusters an der Hüfte eine durchaus akzeptable Differenzierung erlaubt. Auch kann ein unauffälliger 18F-FDG-PET-Befund eine Entzündung mit hoher diagnostischer Genauigkeit ausschließen. Am Knie ist eine vergleichbare Bewertung des 18F-FDG-Anreicherungsmusters bisher nicht gelungen, weshalb die Entzündungsszintigrafie mit markierten Antikörpern bzw. Antikörperfragmenten für die meisten Nuklearmediziner auch hier die Methode der ersten Wahl darstellen dürfte. Durchaus enttäuschend ist, dass ein prinzipiell attraktiver Ansatz, mit 99mTc-Ciprofloxacin eine Infektion sicher zu diagnostizieren, nicht zu den erhofften exzellenten Resultaten geführt hat. Es ist festzustellen, dass kein nuklearmedizinisches Verfahren einen direkten Erregernachweis führen kann. Daher ist es erforderlich, die Limitationen der nuklearmedizinischen Diagnostik zu kennen. Um zu einer klinischen Problemlösung zu gelangen, sind vor allem klinische Erfahrung und die zusammenschauende Wertung von Anamnese, klinischen Befunden und Ergebnissen der aufgeführten Untersuchungsmethoden erforderlich. Auch die nicht-nuklearmedizinischen Untersuchungsmethoden sind weit davon entfernt, immer eindeutige und richtige Ergebnisse zu liefern. Die zusammenschauende Wertung macht es jedoch möglich, mit hoher klinischer Treffsicherheit eher die aseptische Prothesenlockerung oder eher die Protheseninfektion zu erkennen. Bei nicht eindeutiger Festlegung soll nicht vergessen werden, dass Verlaufsuntersuchungen die Differenzialdiagnose ermöglichen können. Insbesondere ist es nicht nachzuvollziehen, wenn aus einem überbewerteten Strahlenrisiko oder unbegründeter Strahlenangst medizinisch indizierte nuklearmedizinische Untersuchungen bei den typischerweise älteren Patienten nicht vorgenommen werden. Die reale Einbuße an Lebensqualität und die real existierenden Gefährdungen durch eine nicht ordnungsgemäß funktionierende Hüft- oder Knieendoprothese überwiegen bei weitem gegenüber einem theoretischen, in die Zukunft extrapolierten Strahlenrisiko.

Nuclear medicine staff and patient doses in Manitoba (1981-1985).

The number of diagnostic in vivo nuclear medicine (NM) procedures in the Province of Manitoba (population 1 million) has been examined over the period 1981 to 1985. The annual number of procedures performed has remained relatively constant at about 25 per thousand population. The isotope 99mTc accounted for 86% of all the studies performed and the number of NM procedures per imaging system was approximately 1,300 per annum. The total number of NM operators in the province increased from 30 in 1981 to about 40 in 1985. The mean NM operator dose was reduced from 3.8 mSv to 2.5 mSv over this five-year period and the collective operator dose underwent a smaller reduction of 13% to about 100 person-mSv in 1985. The value of the mean patient effective dose equivalent (HE) was relatively constant at 5.2 mSv. The contribution of diagnostic NM procedures to the annual per caput population dose in Manitoba was 0.13 mSv. Three diagnostic procedures (brain, bone and cardiac) accounted for approximately 80% of the collective patient HE. Patient profiles (age, sex and medical history) were obtained for the patients undergoing these three procedures, which showed them to be atypical in comparison to a normal working population. These data suggested that the application of the International Commission on Radiological Protection risk factor of 1.65 X 10(-2) Sv-1 to this patient population would have significantly overestimated the expected radiation detriment.

The Role of Nuclear Imaging in the Management of the First Total Artificial Heart Recipient

On December 2, 1982, a permanent total artificial heart was implanted into the chest of a 61-year-old man with a progressive and irreversible cardiomyopathy. During the ensuing four-month hospitalization, a number of nuclear medicine procedures were obtained to assist in patient management. These procedures included gated cardiac radionuclide ventriculography, an I-123 iodoamphetamine scan for cerebral perfusion, and In-111 labeled leukocyte imaging. These radionuclide studies demonstrate the advantages of being able to monitor physiologic changes noninvasively and illustrate a potential role for nuclear cardiology in managing patients with a total artificial heart.