Two Patient Studies of a Companion Diagnostic Immuno-Positron Emission Tomography (PET) Tracer for Measuring Human CA6 Expression in Cancer for Antibody Drug Conjugate (ADC) Therapy.

An antigen binding fragment (BFab) derived from a tumor-associated mucin 1-sialoglycotope antigen (CA6) targeting antibody (huDS6) was engineered. We synthesized a companion diagnostic positron emission tomography (PET) tracer by radiolabeling BFab with [64Cu] to measure CA6 expression on cancer tissues prior to anti-human CA6 (huDS6-DM4 antibody-drug conjugate) therapy for ovarian and breast cancer patients. After chemotherapy, the ovarian patient received PET scan with 18F-2-fluoro-2-deoxyglucose ([18F]FDG: 10 mCi), followed by [64Cu]-DOTA-BFab ([64Cu]BFab; 5.5 mCi) 1 week later for PET scanning of CA6 expression and subsequent surgery. The breast cancer patient was treated with chemotherapy before primary tumor resection and subsequent [18F]FDG-PET scan. 4 weeks later the patient received of [64Cu]BFab (11.7 mCi) for CA6 PET scan. Whole body [18F]FDG-PET of the breast cancer patient indicated FDG-avid tumor metastases to the liver, bilateral hila and thoracic spine, but no uptake was observed for the ovarian patient. Each patient was also imaged by PET/CT with [64Cu]BFab at 1 and 24 hours after tracer administration. The [64Cu]BFab tracer was well tolerated by both patients without adverse effects, and no significant tracer uptake was observed in both patients. Immunohistochemistry (IHC) data indicated CA6 expressions were weak to intermediate and matched with the [64Cu]BFab-PET signals.

Mammographic parenchymal patterns and breast cancer risk in New South Wales North Coast Aboriginal and Torres Strait Islander women.

INTRODUCTION: The objective of the study was to document the distribution of mammographic parenchymal patterns (MPP) of Indigenous Australian women attending BreastScreen New South Wales (NSW) North Coast, to profile breast cancer risk as it relates to breast density and to explore the correlation between MPP, breast size as described by the posterior nipple line (PNL) and age. METHODS: Ethics was granted from CQUniversity Human Research Ethics Committee, NSW Population Health Services Research Ethics Committee and the Aboriginal Health and Medical Research Council Ethics Committee. A quantitative retrospective analysis reviewed 502 screening mammograms against the Tabár I-V MPP classification system. The PNL was measured in millimetres (mm) and the age of the patient documented. RESULTS: A statistically significant variation in the distribution of MPP (P < 0.0001) was demonstrated, with patterns of I (23.9%), II (45.6%), III (10.4%), IV (15.9%) and V (4.2%). Statistically significant differences were noted in the age of subjects between patterns (P = 0.0002). Patterns I and V demonstrated statistically significant lower ages than II, III and IV (all P < 0.05). Pattern V demonstrated a statistically significant lower age than pattern I (P = 0.0393). Pattern V demonstrated a statistically significant lower PNL value than all other patterns (all P < 0.001/P < 0.0002); pattern II was statistically significantly higher in PNL value than all other patterns (P < 0.002/P < 0.001). No significant relationship was noted between PNL and age. CONCLUSION: The study demonstrated that no identifiable or unique distribution of MPP was noted in this snapshot of Indigenous women. A larger study of Indigenous Australian women is required for validation.

The role of general nuclear medicine in breast cancer.

The rising incidence of breast cancer worldwide has prompted many improvements to current care. Routine nuclear medicine is a major contributor to a full gamut of clinical studies such as early lesion detection and stratification; guiding, monitoring, and predicting response to therapy; and monitoring progression, recurrence or metastases. Developments in instrumentation such as the high-resolution dedicated breast device coupled with the diagnostic versatility of conventional cameras have reinserted nuclear medicine as a valuable tool in the broader clinical setting. This review outlines the role of general nuclear medicine, concluding that targeted radiopharmaceuticals and versatile instrumentation position nuclear medicine as a powerful modality for patients with breast cancer.

The Value of Single-photon Emission Computed Tomography/Computed Tomography in the Evaluation of Herniation Pits.

The potential role of the nuclear medicine diagnostic bone scan in identifying herniation pits of the femoral neck is yet to be adequately described. The following cases show incidental findings of subcortical cavities of the femoral neck detected on bone scans. These findings highlight the potential role of the bone scan as a useful imaging modality in identifying and stratifying herniation pits based on physiology, particularly with the addition of single-photon emission computed tomography/computed tomography to the armamentarium.

Incidental lingual thyroid informs surgery.

This case study presents an incidental noting of a lingual thyroid on thyroid scintigraphy that had implications in later breast surgery. This information changed patient management and mitigated risk during intubation for breast cancer surgery.

Novel Radiopharmaceuticals in Cardiovascular Medicine: Present and Future.

Advancements in molecular medicine technology have allowed the development of innovative and better radiopharmaceuticals to augment or replace the existing ones, allowing the acquisition of higher-quality and detailed diagnostic information and accuracy. They build on the strengths of the existing radiotracers or remove their shortcomings, thus bringing them closer to the ideal. Given the discovery of more novel molecules, it is now possible that processes in the human body indicative of predisease stage can be imaged, allowing for appropriate interventions earlier-preventing the development of late stage disease, preventing morbidity and mortality, and reducing the burden on the national health care system. Both positron emission tomography and single-photon emission computed tomography are developing in the fields of perfusion, metabolic, and innervation imaging of the heart. Newer radiotracers can yield higher-quality images with a greater diagnostic potential that are more convenient to use in the daily practice, and at a lower cost. In addition, tracers have been developed for imaging processes like cardiac apoptosis, angiogenesis, and the development of coronary atherosclerosis, enabling physicians to minimize the pathological changes at the reversible stage by promoting appropriate lifestyle changes and pharmaceutical interventions. In this article, we overview the most promising radiotracers that in the future have the potential to become established imaging agents in the field of cardiac nuclear medicine.

Internationalization, Mobilization and Social Media in Higher Education.

Although there have been significant advances in instrumentation and technology across the medical radiation sciences that changed practice and outcomes, higher education has also seen advances that challenged service delivery. This article provides an insight into higher education trends and collaborative efforts to afford leadership in those domains. Arguably, the greatest pressure in the current higher education environment is the ability to match student and institutional expectations against sustainable, cost-effective innovation. Mobilization of the classroom offers a powerful tool for enhancing educational outcomes of graduates and satisfies the current trend of globalization in the sector. Flexible delivery of materials and the advantages of authentic online applications allow a rich and diverse learning environment that is driven by the student. The essence of mobile learning adds value to the context of learning in our global world. Social media connects individuals and students via an online network. This environment is a large collective of socially autonomous, flexible, and active consumers. The role of social media in higher education includes responsibilities in hidden curriculum education as a deliverable. Particular advantage is seen as a framework for experiential learning in the clinical environment and the powerful process of reflection. It is well placed to provide autonomy to the current generation of students in an environment in which they are comfortable communicating. Medical radiation sciences exist in a dynamic and liquid environment and, thus, there is an underlying compatibility with change and innovation. Medical radiation sciences are well equipped to embrace advances in clinical, research, and higher education sectors to provide leadership across the broader health and science professions.

A Dedicated Breast Positron Emission Tomography Scanner: Proof of Concept.

PURPOSE: This study developed and tested a novel scanner constructed for dedicated positron emission tomography (PET) of the breast. The breast PET (B-PET) scanner is designed with two opposing detectors using curve plate NaI(Tl) detectors to achieve a combination of high spatial resolution and energy resolution. METHODS: Phantom and clinical studies (n = 20) with 18F-fluorodeoxyglucose were carried out on the whole-body Philips Allegro scanner and the B-PET scanner. Images were subjectively assessed by an expert panel. RESULTS: Phantom studies indicated improved contrast for B-PET over conventional PET. Of the 20 clinical studies with breast cancer demonstrated on whole-body fluorodeoxyglucose PET, 10 B-PET scans showed agreement. Of the remaining 10 studies, three had breasts that were too small to be imaged, four had lesions that were too deep to be captured in the field of view, and three were excluded due to technical errors. CONCLUSIONS: Compared with conventional PET, B-PET images provided greater detail in breast lesions suggesting that the low-cost and relatively simple design of B-PET may potentially be an important adjunct to traditional mammography in helping determine the nature of a lesion.

Radiologist views of positron emission mammography.

BACKGROUND: Early detection and diagnosis of malignant breast lesions are vital to survival. Although current imaging modalities such as mammography, ultrasonography, and magnetic resonance imaging focus on an anatomic approach, they do not provide sufficient data about the pathophysiology of malignant breast lesions. Positron emission mammography (PEM) is an innovative technology specifically designed to visualize the physiologic and metabolic processes in malignant breast lesions, but it remains underused as a diagnostic tool. OBJECTIVE: The purpose of this research is to provide quantitative and qualitative evidence from radiologists' perspective about the efficacy of physiologic imaging and the future implementation of PEM as a diagnostic tool in clinical practice. METHODS: Radiologists were asked to complete a survey designed to elicit their perspective on the role of physiologic imaging in detecting and diagnosing breast cancer and on PEM as an adjunct modality. RESULTS: Based on the survey data, 66% of participants considered physiologic imaging to be beneficial because it provides additional diagnostic data, and 67% supported the future use of PEM as an adjunct to mammography. CONCLUSION: Although preliminary indications favor the use of adjunct PEM, further research is needed before it becomes a common clinical tool.