Advances in imaging instrumentation for nuclear cardiology.

Advances in imaging instrumentation and technology have greatly contributed to nuclear cardiology. Dedicated cardiac SPECT cameras incorporating novel, highly efficient detector, collimator, and system designs have emerged with the expansion of nuclear cardiology. Solid-state radiation detectors incorporating cadmium zinc telluride, which directly convert radiation to electrical signals and yield improved energy resolution and spatial resolution and enhanced count sensitivity geometries, are increasingly gaining favor as the detector of choice for application in dedicated cardiac SPECT systems. Additionally, hybrid imaging systems in which SPECT and PET are combined with X-ray CT are currently widely used, with PET/MRI hybrid systems having also been recently introduced. The improved quantitative SPECT/CT has the potential to measure the absolute quantification of myocardial blood flow and flow reserve. Rapid development of silicon photomultipliers leads to enhancement in PET image quality and count rates. In addition, the reduction of emission-transmission mismatch artifacts via application of accurate time-of-flight information, and cardiac motion de-blurring aided by anatomical images, are emerging techniques for further improvement of cardiac PET. This article reviews recent advances such as these in nuclear cardiology imaging instrumentation and technology, and the corresponding diagnostic benefits.

The association of imaging equipment age with other quality metrics and successful laboratory accreditation by the Intersocietal Accreditation Commission.

BACKGROUND: Intersocietal Accreditation Commission (IAC) accreditation is granted or delayed depending on the fulfillment of several quality metrics. Investing in up-to-date equipment might reflect a commitment to quality. METHODS: Data from echocardiography (n = 3079) and nuclear cardiology (n = 1835) accreditation applications submitted between 2012 and 2014 were evaluated to determine the mean age of laboratory equipment. Laboratory quality was assessed by the number of missing quality metrics, and a composite quality score was calculated as the sum of missing quality metrics. A lower score thus represented better laboratory quality. The relationship between equipment age and quality was explored as an interaction term between equipment age and the composite quality score and was incorporated into regression models for prediction of accreditation status. RESULTS: During the study period, 49% of echocardiography and 42% of nuclear laboratories were granted accreditation without delay. For both echocardiography and nuclear laboratories, there was a statistically significant trend toward an increasing number of missing quality metrics with increasing quartiles of equipment age. The interaction between equipment age and the composite quality score was a significant predictor of delay of accreditation for both echocardiography and nuclear cardiology laboratories, with a stronger association for 1st-time applicants. Among sites applying for accreditation in both modalities simultaneously, accreditation in one modality predicted the accreditation decision for the other. CONCLUSIONS: Laboratory quality is an important determinant of IAC accreditation, and equipment age is an effect modifier of this relationship. Contemporary equipment likely reflects a commitment to quality, for both echocardiography and nuclear laboratories.

Perspectives on the Use of Liquid Extraction for Radioisotope Purification.

The reliable and efficient production of radioisotopes for diagnosis and therapy is becoming an increasingly important capability, due to their demonstrated utility in Nuclear Medicine applications. Starting from the first processes involving the separation of 99mTc from irradiated materials, several methods and concepts have been developed to selectively extract the radioisotopes of interest. Even though the initial methods were based on liquid-liquid extraction (LLE) approaches, the perceived difficulty in automating such processes has slowly moved the focus towards resin separation methods, whose basic chemical principles are often similar to the LLE ones in terms of chelators and phases. However, the emerging field of flow chemistry allows LLE to be easily automated and operated in a continuous manner, resulting in an even improved efficiency and reliability. In this contribution, we will outline the fundamentals of LLE processes and their translation into flow-based apparatuses; in addition, we will provide examples of radioisotope separations that have been achieved using LLE methods. This article is intended to offer insights about the future potential of LLE to purify medically relevant radioisotopes.

Proceedings of the cardiac PET summit meeting 12 may 2014: Cardiac PET and SPECT instrumentation.

Advances in PET and SPECT and imaging hardware and software are vastly improving the noninvasive evaluation of myocardial perfusion and function. PET perfusion imaging has benefitted from the introduction of novel detectors that now allow true 3D imaging, and precise attenuation correction (AC). These developments have also resulted in perfusion images with higher spatial and contrast resolution that may be acquired in shorter protocols and/or with less patient radiation exposure than traditional PET or SPECT studies. Hybrid PET/CT cameras utilize transmission computed tomographic (CT) scans for AC, and offer the additional clinical advantages of evaluating coronary calcium and myocardial anatomy but at a higher cost than PET scanners that use (68)Ge radioactive line sources. As cardiac PET systems continue to improve, dedicated cardiac SPECT systems are also undergoing a profound change in their design. The scintillation camera general purpose design is being replaced with systems with multiple detectors focused on the heart yielding 5 to 10 times the sensitivity of conventional SPECT. As a result, shorter acquisition times and/or lower tracer doses produce higher quality SPECT images than were possible before. This article reviews these concepts and compares the attributes of PET and SPECT instrumentation.

Kinetically Inert Bispidol-Based Cu(II) Chelate for Potential Application to (64/67)Cu Nuclear Medicine and Diagnosis.

A family of 2,4-pyridyl-disubstituted bispidol derivatives bearing methylene carboxylic acid ethyl esters (L1-L3), methylene carboxylic acids (L4 and L5), or methylenethiophene (L6) groups were synthesized. In water, all ligands form rigid 1:1 complexes in the presence of Zn(II) in which the bicycle adopts a chair-chair conformation (cis isomer), as observed by (1)H NMR and, in the case of ligand L1, by an X-ray diffraction crystal structure. Interestingly, addition of Zn(II) ions on ligand L1 induces a metal-mediated selective hydrolysis of the ethyl esters. This selective hydrolysis was not observed upon addition of other cations such as Na(+), Mg(+), and Ca(2+). Reduction of the central ketone was achieved to prevent ring opening via retro Diels-Alder reactions and to afford highly stable and water-soluble ligands (L4, L5, L6). The complexation properties of L4 and L6 were studied in solution, with a particular interest for ligand L4. Fast complexation occurs in strongly acidic media (pH = 1), with a high affinity toward Cu(II) (log KCuL4 = 19.2(3), pCu = 17.0 at pH 7.4, pCu = -log[Cufree], [Cu] = 1 × 10(-6) M, [L] = 1 × 10(-5) M) and high selectivity versus Co(II), Ni(II), and Zn(II), as shown by the values of the binding constants obtained from potentiometric and spectrophotometric titrations. Reversible redox potential with E1/2 = -430 mV (vs normal hydrogen electrode) was measured. The complex was found to be fairly inert from acid-assisted dissociation experiments in 5 M HClO4 (t1/2 = 110 d at 25 °C).

EANM Dosimetry Committee series on standard operational procedures for pre-therapeutic dosimetry II. Dosimetry prior to radioiodine therapy of benign thyroid diseases.

The EANM Dosimetry Committee Series "Standard Operational Procedures for Pre-Therapeutic Dosimetry" (SOP) provides advice to scientists and clinicians on how to perform patient-specific absorbed dose assessments. This particular SOP describes how to tailor the therapeutic activity to be administered for radioiodine therapy of benign thyroid diseases such as Graves' disease or hyperthyroidism. Pretherapeutic dosimetry is based on the assessment of the individual (131)I kinetics in the target tissue after the administration of a tracer activity. The present SOP makes proposals on the equipment to be used and guides the user through the measurements. Time schedules for the measurement of the fractional (131)I uptake in the diseased tissue are recommended and it is shown how to calculate from these datasets the therapeutic activity necessary to administer a predefined target dose in the subsequent therapy. Potential sources of error are pointed out and the inherent uncertainties of the procedures depending on the number of measurements are discussed. The theoretical background and the derivation of the listed equations from compartment models of the iodine kinetics are explained in a supplementary file published online only.

Determining the current status and potential of nuclear medicine in Poland.

BACKGROUND: Through its use of ionising radiation, the field of nuclear medicine forms a unique and significant part of medical diagnostics and patient treatment. Objectives. To assess the operational potential of nuclear medicine in Poland based on existing database/literature sources together with conducting a survey on the relevant healthcare facilities available, staffing, expertise and performance. MATERIAL AND METHODS: To gather all available literature data on the medical use of ionising radiation in Poland several data bases were used, since currently, there are no single statistical data base devoted to this issue. Data on radiation hygiene were thus collected from the Statistical Bulletin of the Ministry of Health, Annual reports from the National Atomic Energy Agency and Central Statistics Office. Additionally, national and provincial reports were used, as well as those received from the European Society of Nuclear Medicine. RESULTS: At present, the Public Healthcare system in Poland has 55 nuclear medicine departmental facilities operating and 8 that are private/non-public. These are staffed by 252 doctors, of whom 151 are qualified as nuclear medicine specialists; constituting one specialist per 300,000 inhabitants. In addition, 170 highly qualified staff (biologists, chemists, physicists, electronics engineers and IT specialists) provide indispensable scientific/operational support and are vital for the development of nuclear medicine departments. They are mainly responsible for ensuring that all equipment functions effectively and for developing new diagnostic techniques, together with new radiopharmaceuticals. Furthermore, there are approximately 500 other staff at intermediate-level also involved in nuclear medicine departments, such as technicians, nurses and support workers. The survey demonstrated an average of 22 persons employed per nuclear medicine department. For all institutions, it is estimated that there are 127 gamma cameras, 10 PET/CT scanners and 16 hybrid SPECT/CT systems operating. In 2000, approximately 117,435 diagnostic procedures were performed, compared to 156,214 in 2008 and with the current number of around 170,000; up to 38% were simple thyroid scintigraphies, 25% were bone scans, 11% heart scintigraphies and 10% kidney scans. CONCLUSIONS: The number of diagnostic radioisotopic procedures in Poland are strongly expected to increase by 300% during the next 5-6 years. To meet this rise, additional equipment will thus be necessary, which includes having an extra 100 SPECT/CT gamma cameras.

[CT scan optimization in SPECT/CT equipment of nuclear medicine].

OBJECTIVE: In order to reduce patients' radiation doses and decrease the exposure time of the CT Tube. By summarizing experiential methods from the previous practice work, we hope to draw an optimized scheme of CT scanner. METHODS: We analyzed the continuous clinical examples in four months, changed the different levels of parameters slowly, optimized acquisition conditions and retrospected the CT radiative dose. In the meantime, we counted the monthly CT Bulb exposure time, exposure time per capita tube data and so on. RESULTS: Compared with former result, the average CT radiative dose per person is decreased 84.72%, which conventional bone, the small joints of the bone, the brain and the heart radiation reduced respectively 83.82%, 88.80%, 86.78% and 84.49%, and the differences are statistically significant. The exposure time of optimized CT Tube is 2 031 s. CONCLUSIONS: Using the CT scan optimization scheming has great efforts in the practice of clinical nuclear medicine, can reduce the exposure time of the CT Tube and improve the lifetime of the bulb. Therefore, it can be widely used.

A dose point kernel database using GATE Monte Carlo simulation toolkit for nuclear medicine applications: comparison with other Monte Carlo codes.

PURPOSE: GATE is a Monte Carlo simulation toolkit based on the Geant4 package, widely used for many medical physics applications, including SPECT and PET image simulation and more recently CT image simulation and patient dosimetry. The purpose of the current study was to calculate dose point kernels (DPKs) using GATE, compare them against reference data, and finally produce a complete dataset of the total DPKs for the most commonly used radionuclides in nuclear medicine. METHODS: Patient-specific absorbed dose calculations can be carried out using Monte Carlo simulations. The latest version of GATE extends its applications to Radiotherapy and Dosimetry. Comparison of the proposed method for the generation of DPKs was performed for (a) monoenergetic electron sources, with energies ranging from 10 keV to 10 MeV, (b) beta emitting isotopes, e.g., (177)Lu, (90)Y, and (32)P, and (c) gamma emitting isotopes, e.g., (111)In, (131)I, (125)I, and (99m)Tc. Point isotropic sources were simulated at the center of a sphere phantom, and the absorbed dose was stored in concentric spherical shells around the source. Evaluation was performed with already published studies for different Monte Carlo codes namely MCNP, EGS, FLUKA, ETRAN, GEPTS, and PENELOPE. A complete dataset of total DPKs was generated for water (equivalent to soft tissue), bone, and lung. This dataset takes into account all the major components of radiation interactions for the selected isotopes, including the absorbed dose from emitted electrons, photons, and all secondary particles generated from the electromagnetic interactions. RESULTS: GATE comparison provided reliable results in all cases (monoenergetic electrons, beta emitting isotopes, and photon emitting isotopes). The observed differences between GATE and other codes are less than 10% and comparable to the discrepancies observed among other packages. The produced DPKs are in very good agreement with the already published data, which allowed us to produce a unique DPKs dataset using GATE. The dataset contains the total DPKs for (67)Ga, (68)Ga, (90)Y, (99m)Tc, (111)In, (123)I, (124)I, (125)I, (131)I, (153)Sm, (177)Lu (186)Re, and (188)Re generated in water, bone, and lung. CONCLUSIONS: In this study, the authors have checked GATE's reliability for absorbed dose calculation when transporting different kind of particles, which indicates its robustness for dosimetry applications. A novel dataset of DPKs is provided, which can be applied in patient-specific dosimetry using analytical point kernel convolution algorithms.

Clinical molecular imaging with radiotracers: current status.

Molecular imaging is defined as the visualization, characterization, and measurement of biological processes at the molecular and cellular levels in humans and other living systems. Most clinical molecular imaging is currently done using radioisotope-labeled agents to define the activity of various metabolic pathways in vivo or to determine the distribution and density of various receptors relevant to human disease. This paper briefly reviews most of the commonly used radiopharmaceuticals in nuclear medicine, as well as newer agents that are likely to become available in the near future. The metabolic pathways include those relevant to the thyroid, parathyroid, heart, brain, bones, kidneys, liver, pancreas, adrenals and tumor. The receptor systems include agents useful in evaluating movement disorders, dementia, cardiac sympathetic enervation and neoangiogenesis. Receptor systems relevant to tumors include somatostatin receptors (neuroendocrine tumors), prostate-specific membrane antigen, carbonic anhydrase IX (renal cancer), and CD-20 (lymphoma). These agents, and newer agents that are being developed, are likely to become critical in the development of personalized medicine, where it will become increasingly important to determine whether a treatment that is targeted to a specific metabolic pathway or receptor is likely to be successful.

Current research in nuclear medicine and molecular imaging: highlights of the 23rd Annual EANM Congress.

The most recent research developments in nuclear medicine and molecular imaging were presented at the 2010 Annual Congress of the EANM. This review summarizes some of the most relevant contributions made in the fields of oncology, cardiovascular science, neurology and psychiatry, technological innovation and novel tracers. Presentations covered basic and clinical research in nuclear medicine and molecular imaging, and diagnostic and therapeutic applications of radioisotopes and radiopharmaceuticals on a global scale. The results reported demonstrate that investigative strategies using nuclear medicine techniques facilitate effective diagnosis and management of patients with most prevalent disease states. At the same time novel tracers and technologies are being explored, which hold promise for future new applications of nuclear medicine and molecular imaging in research and clinical practice.

Nanotechnology and nuclear medicine; research and preclinical applications.

The birth of nanotechnology in human society was around 2000 years ago and soon found applications in various fields. In this article, we highlight the current status of research and preclinical applications and also future prospects of nanotechnology in medicine and in nuclear medicine. The most important field is cancer. A regular nanotechnology training program for nuclear medicine physicians may be welcome.

Guidelines on Setting Up Stations for Remote Viewing of Nuclear Medicine and Molecular Imaging Studies During COVID-19.

The current pandemic has created a situation where nuclear medicine practitioners and medical physicists read or process nuclear medicine images remotely from their home office. This article presents recommendations on the components and specifications when setting up a remote viewing station for nuclear medicine imaging.

Highlights of the EANM Congress Barcelona 2009: increasing our impact in diagnostic imaging.

The EANM Congress 2009 took place in Barcelona from 10 to 14 October under the chairmanship of Dr. Martin-Comin. As always, the meeting was successful with high-level scientific content and a great number of participants. In spite of the economic crisis, industry made an important contribution presenting new revolutionary equipment and tracers, and in particular the pharmaceutical industry has increased its involvement in our speciality. This article is a brief summary of the major scientific contributions presented at the annual congress 2009, highlighting the fields of nuclear medicine at a higher level of development, including those with an increased clinical impact (especially oncology, but also cardiology, neurology and other clinical sciences), new detectors and multimodality imaging, and those fields showing important progress, including radiochemistry and pharmacy (with the development of new tracers and increased collaboration of industry).

[Quality management of nuclear medicine facilities and experience during JCI certification].

In 2003, JCI certification was introduced to create our new hospital quality management system. Our department imaging facilities management level and service quality markedly improved through JCI certification and re-evaluation. It played an important role in improving the efficiency and extending the life of medical facilities, reducing maintenance costs.