The Biodistribution and Utility of 99mTc-Ethylenedicysteine-Deoxyglucose (99mTc-Glucosamine) in the Identification of Active Disease in Patients with Rheumatoid Arthritis-a Single Center Prospective Study.

Purpose: Our objectives were to investigate the utility of 99mTc-ethylenedicysteine-deoxyglucose (ECDG) in identifying active disease in the joints of patients with rheumatoid arthritis (RA), as well as to evaluate the biodistribution of this radiopharmaceutical. Methods: A prospective study was conducted at the Department of Nuclear Medicine of the University of the Free State/Universitas Academic Hospital in Bloemfontein, South Africa. Twenty-two participants from the rheumatology department diagnosed with RA according to the ACR/EULAR classification criteria were enrolled. Participants were injected with 20-25 mCi of 99mTc-ECDG. Flow, blood pool, whole body, delayed static, and SPECT/CT images were acquired. Known sites of disease were qualitatively assessed for intensity of uptake, and disease severity was graded (Grade 0-3). Results: Twenty-two participants were studied. The median (interquartile range) age was 59 (49-68) years, and the majority (n = 21; 95.5%) were females. There was abnormal increased uptake of 99mTc-ECDG noted in majority of the sites of known disease, including unknown sites. SPECT/CT imaging localized radiotracer uptake specifically to the synovial space. Similar biodistribution of radiotracer was noted in all patients, irrespective of disease severity or fasting status. Conclusion: 99mTc-ECDG can efficiently assess disease activity in the joints of patients with RA. It accumulates in sites of both clinical and subclinical disease and might be a very useful tool for the rheumatologist in the management of patients with RA.

The prognostic value of 99m Tc-glucosamine imaging in patients with rheumatoid arthritis: a single center prospective study.

OBJECTIVES: Poor prognostic factors in rheumatoid arthritis (RA) are associated with a more severe form of the disease. Nuclear medicine functional imaging has shown remarkable merit at identifying active disease in patients with RA and is increasingly being used in this regard. However, its prognostic value has not been evaluated thoroughly. We aimed to assess the prognostic value of technetium-99m ( 99m Tc-) glucosamine imaging in patients with RA. METHODS: Twenty-two participants diagnosed by an experienced rheumatologist with RA were recruited for inclusion in the study. Blood samples were obtained from each participant for baseline C-reactive protein, erythrocyte sedimentation rate, rheumatoid factor (RF) and anti-cyclic citrullinated peptide (anti-CCP) antibody titer. On the same day, each participant was injected with 20-25 millicurie (mCi) of 99m Tc-glucosamine. Planar and single-photon emission computed tomography images of known disease sites were acquired up to 2 hours after radiopharmaceutical administration. Affected joints were qualitatively assessed and graded for 99m Tc-glucosamine uptake and compared with blood results. RESULTS: All participants affected joints had an increased uptake of the radiopharmaceutical, with 14 (63.6%) having elevated RF and anti-CCP antibody titers. Eight of the 14 patients with increased RF and anti-CCP antibodies had grade 3 uptake of 99m Tc-glucosamine. The remaining 6 had grade 2 uptake. A significant correlation between higher grade uptake and increased levels of RF and anti-CCP antibodies ( P  = 0.031) was observed. CONCLUSION: We found a strong correlation between high-grade disease on imaging and the presence of RF and anti-CCP antibodies in patients with RA.

Optimal home and hospital laundering of reusable surgical scrubs: Systematic literature review.

Background: Theatre personnel can spread healthcare-associated infections through contaminated surgical scrubs. Decontamination of surgical scrubs through optimal methods is important to minimise transmission of microorganisms from theatre personnel's clothing to different areas in the hospital and their homes. Aim: This study aimed to review the literature on the optimal home and hospital laundering methods for the decontamination of reusable surgical scrubs worn by theatre personnel. Method: A systematic literature review of previous studies on laundering reusable surgical scrubs was performed. A review question was formulated using the patient, intervention, comparison and outcome (PICO) framework. A literature search was performed using ScienceDirect, Web of Science, ProQuest, EBSCOhost and Google Scholar. Results: A direct link could be established between the cycle length and water temperature. The higher the water temperature, the shorter the washing cycle required. After a load has been washed in low or medium water temperatures, tumble drying and ironing should follow. Despite the water temperature, a disinfectant must be added to the load. Conclusion: Health professionals and hospital management should be aware of optimal laundering guidelines for hospital and home laundering as part of infection control. Water temperature, time, mechanical action, type of disinfectant and heat are factors influencing the successful removal of bacteria and other pathogens and represent the baseline of this article. Contribution: Home-laundering of reusable surgical scrubs should follow strict guidelines. When these specific guidelines are applied, the effects of home-laundered scrubs will not negatively impact either the theatre or the home environment.

Evaluating the knowledge and training of forensic pathologists and registrars performing forensic radiography at a forensic pathology mortuary in the Free State province, South Africa.

Background: Forensic radiography is an important component in forensic sciences. There seems to be a lack of recent studies in the literature on the knowledge and training of forensic pathologists and registrars performing forensic radiography at forensic pathology mortuaries in South Africa. Aim: To evaluate the knowledge and training of forensic pathologists (consultants) and registrars performing forensic radiography at a forensic pathology mortuary in the Free State province, South Africa. Setting: A prospective study was conducted at a conveniently selected forensic pathology mortuary located in the Free State province of South Africa. Method: Personnel performing forensic radiography at the selected mortuary were invited to participate in the study. An exploratory quantitative study design was used. The research tool was a self-administered questionnaire comprising open- and closed-ended questions. Four registrars and four consultants (n = 8) completed the questionnaire. Results: Training was only received on computed tomography (n = 1; 12.5%), the C-arm machine (n = 1; 12.5%) and the digital X-ray mobile machine (n = 1; 12.5%) Lodox on corpse positioning (n = 7; 87.5%) and setting of exposure factors (n = 2; 25%). Conclusion: Lack of training of the personnel performing forensic radiography, at the selected mortuary was identified. Training is required in image acquisition protocols, quality control tests of the X-ray machines, setting technical factors and operation of various X-ray machines. Contribution: Training of registered radiation workers who perform forensic radiography in mortuaries is essential to produce high-quality ionising radiation images and ensure their own and other staff members' safety.

A practical guide for paediatric diagnostic reference levels (PiDRLs).

This guide was designed to provide a foundation for developing paediatric diagnostic reference levels (PiDRLs) for conventional radiography. In principle, the calculation of diagnostic reference levels (DRLs) is recommended for diagnostic x-ray imaging examinations for radiosensitive patients, such as paediatric patients. PiDRLs are fundamentally important when considering dose optimisation in diagnostic radiology, computed tomography and interventional radiology for paediatric patients. DRLs can assist to point to non-optimised practices and the improvement of paediatric dose optimisation. The purpose of this continuing medical education article is to give medical radiation professionals an overview of PiDRLs for conventional radiography, an understanding of the benefits, the data collection process and some of the calculation methods. The readers can use these steps to establish and implement PiDRLs for different examinations.

Diagnostic contribution of the standard lateral compared to the coned lateral L5/S1 projection for specific lumbar pathologies in the digital era.

INTRODUCTION: The aim of this study was to compare the diagnostic contribution of the standard lateral and coned lumbar vertebra five and sacral vertebra one (L5/S1) projection in diagnostic radiology for specific pathologies in the digital era. METHODS: The study used a retrospective qualitative design through a systematic stepwise process. The steps included a retrospective analysis of lumbar spine radiology reports over 20 months. The objective of this step was to identify the most common lumbar spine pathologies observed among the source population records (N=354). A radiologist identified five different pathologies on standard lateral and coned lateral L5/S1 projections (n=96). Fischer's exact test was performed to examine the significance of the association between the standard lateral and coned lateral L5/S1 projection classifications for each of the top five lumbar spine pathologies separately. RESULTS: The five most prevalent lumbar spine pathologies indicated were degenerative disc disease (n=235; 66.4%), disc space narrowing (n=175; 49.4%), osteophytes (n=92; 26.0%), endplate sclerosis 19.21% (n=68; =9.2%) and malalignment (n=61; 17.2%). The Fisher's exact test executed to compare the top five lumbar spine pathologies visible on the standard lateral and coned lateral L5/S1 indicated that except for endplate sclerosis (p=0.0023), no significant difference in additional diagnostic information was observed between the standard lateral and coned lateral L5/S1 projections at α=0.05. CONCLUSION: Compared to the standard lateral projection, the coned lateral L5/S1 projection did not contribute statistically significant additional diagnostic information for specific lumbar spine pathologies in the digital era.

Correlation of radioiodine doses for 6-hr and 24-hour iodine-131 thyroid uptake values for Graves' hyperthyroidism.

The destruction of thyroid follicular cells by iodine-131 treatment for Graves' hyperthyroidism to a large extent depends on the amount of intrathyroidal activity absorbed (IAA). A thyroid weighing 50 g should receive an iodine-131 therapeutic dosage of between 110 MBq and 350 MBq for the effective treatment of Graves' hyperthyroidism. An IAA received of more than 350 MBq to the thyroid will bestow an unnecessary high iodine-131 therapeutic dosage. The objective of the study was to determine if the IAA would remain between 110 MBq and 350 MBq if the calculated administered activity (CAA) has been used with the highest radioactive iodine uptake (RAIU) value. A retrospective analysis was made of the 6- and 24-hr iodine-131 RAIU results of Graves' hyperthyroid patients (n = 124). Male (n = 18) and female (n = 106) patients from different racial groups and ranging from 15 to 75 years of age were included in the study. Overall, the CAA using the 6-hr RAIU value was higher. The CAA by the 6-hr RAIU values was used with the 24-hr RAIU values to calculate the IAA. 53.3% (n = 66) of the study group would have received IAA higher than 350 MBq when the CAA by the 6-hr RAIU values was used with the 24-hr RAIU values to calculate the IAA. These results suggested that the 24-hr RAIU value was most valuable for the calculation of an administered activity so that IAA of between 110 and 350 MBq can be achieved.