An IAEA survey of radiotherapy practice including quality assurance extent and depth.

Background: The IAEA recommends a quality assurance program in radiotherapy to ensure safe and effective treatments. In this study, radiotherapy departments were surveyed on their current practice including the extent and depth of quality assurance activities.Methods: Radiotherapy departments were voluntarily surveyed in three stages, firstly, in basic facility information, secondly, in quality assurance activities and treatment techniques, and thirdly, in a snapshot of quality assurance, departmental and treatment activities.Results: The IAEA received completed surveys from 381 radiotherapy departments throughout the world with 100 radiotherapy departments completing all three surveys. Dominant patterns were found in linac-based radiotherapy with access to treatment planning systems for 3D-CRT and 3D imaging. Staffing levels for major staff groups were on average in the range recommended by the IAEA. The modal patient workload per EBRT unit was as expected in the range of 21-30 patients per day, however significant instances of high workload (more than 50 patients per day per treatment unit) were reported. Staffing levels were found to correlate with amount of treatment equipment and patient workload. In a self-assessment of quality assurance performance, most radiotherapy departments reported that they would perform at least 60% of the quality assurance activities itemized in the second survey, with particular strength in equipment quality control. In a snapshot survey of quality assurance performance, again equipment quality control practice was well developed, particularly for the treatment equipment.Conclusions: The IAEA surveys provide a snapshot of current radiotherapy practice including quality assurance activities.

How COVID-19 pandemic affected cancer progression: Three different scenarios evidenced by PET imaging.

COVID-19 pandemic is having a strong impact on healthcare providers around the world, by refocusing and reducing non-essential medical activities. Nuclear medicine departments among others, have been reorganizing and reprioritizing diagnostic and theragnostic procedures. This reorganizing had a negative impact on the supply of positron emission tomography (PET) services to oncologic patients, whose health was affected. We herein present the PET findings in three different cancer scenarios in which disease course was dramatically affected by the COVID-19 outbreak.

[Nuclear Medicine in Germany. Key data from official statistics]. / Nuklearmedizin in Deutschland. Kennzahlen aus offiziellen Statistiken.

AIM: To explain the spectrum and number of in-vivo nuclear medicine examinations and therapies based on official statistics about out-patient and in-patient care. Trends in time of the frequency and spectrum of procedures as well as data on the health care structure for nuclear medicine in Germany should be collected. METHODS: Data from the Gesundheitsberichterstattung des Bundes, from the frequency statistics of the statutory health insurance for out-patients and from the Bundesärztekammer were used. Customized queries were performed to analyse temporal changes. RESULTS: Nuclear medicine physicians are more frequently consulted by out-patients over the last years (2008: 2024498; 2009: 2164664) and the number of colleagues in private practice increased. For in-patients, the frequency of conventional nuclear medicine procedures (mainly for brain, lymphatic system, lung and heart) increased since 2008 after a decline in previous years (2009: 323515; +4.6%) and the number of PET(/CT) examinations continued to rise (2009: 25123; +18%), even if changes in OPS keys may hamper comparisons. Nearly 600 gamma cameras and 76 PET(/CT) scanners were installed in hospitals in 2008. Nuclear medicine procedures are increasingly performed as cross sectional imaging like SPECT(/CT) and PET(/CT). With the supply shortfall with 99Mo, the frequency of thyroid scans with 123I iodine increased as well as the use of 18F PET as a substitute for conventional bone scans. The number of radionuclide therapies, in particular non-thyroid treatments, increased since the mid-nineties and stabilized at nearly 50000 cases per year with shorter lengths of stay. CONCLUSION: The details of the present analysis may help to understand the positive evolution of key numbers for nuclear medicine.

[Impact of COVID-19 on Nuclear Medicine Procedures in Germany 2020 - Results of a National Survey]. / Auswirkungen von COVID-19 auf nuklearmedizinische Untersuchungen und Therapien im Verlauf von 2020 ­ Ergebnisse einer nationalen Umfrage.

INTRODUCTION: The COVID-19 pandemic imposed an unimaginable challenge to the healthcare systems worldwide. This online survey captured the impact of the COVID-19 pandemic on nuclear medicine services in Germany comparing 2020 to 2019. MATERIALS AND METHODS: A web-based questionnaire was developed to record the 2020 numbers of nuclear medicine procedures and, in particular, the change compared with 2019. The changes in nuclear medicine diagnostics and therapy were queried, as well as the extent to which "Coronavirus SARS-CoV-2" recommendations provided by the DGN were implemented. RESULTS: 91 complete responses were recorded and evaluated. This corresponds to about 20 % of all German nuclear medicine facilities. Nuclear medicine diagnostic tests showed a decrease in scintigraphies for thyroid (15.9 %), bone (8.8 %), lung (7.6 %), sentinel lymph nodes (5.5 %), and myocardium (1.4 %) with small increases in PET/CT examinations (1.2 %) compared with 2019. Among nuclear medicine therapies, reductions were highest for benign indications (benign thyroid 13.3 %, RSO 7.7 %), while changes from 2019 were less pronounced for malignant indications (PRRT: + 2.2 %, PSMA: + 7.4 %, SIRT: -5.9 %, and RJT for thyroid carcinoma -2.4 %). The DGN recommendations for action were fully or partially applied in 90 %. CONCLUSIONS: The initial significant reduction in nuclear medicine procedures in the first three weeks of the COVID-19 pandemic did not continue, but there was no compensation of the previously not performed services. The decrease in diagnostics and therapy procedures of benign diseases was particularly severe.

[Analysis of the number of patients needed to treat by coronary revascularisation in relation to the presence of myocardial viability in gated SPECT images: a prospective cohort study from a nuclear cardiology unit]. / Análisis del número de pacientes que es necesario tratar mediante revascularización coronaria en relación con la presencia de viabilidad miocárdica en las imágenes de la gated-SPECT: estudio de cohorte prospectivo desde una unidad de cardiología nuclear.

OBJECTIVE: To evaluate the number of patients needed to treat (NNT) to assess the magnitude of benefit of coronary revascularisation (CR) in patients with ischaemic cardiomyopathy (IC) in relation to the presence or absence of myocardial viability in myocardial perfusion gated-SPECT (single photon emission computed tomography) images. METHOD: We studied 198 consecutive patients with IC using rest gated-SPECT with technetium-based agents. The cardiac mortality was analysed in four groups: viable with CR (n = 50), viable with medical treatment (MT) (n = 90), non-viable with CR (n = 18), and non-viable with medical treatment (n = 40). RESULTS: During 2.3 +/- 1.2 years of follow-up, the cardiac mortality rate in patients with scintigraphic viability criteria undergoing revascularisation was 5.9/100 patients/year and 12.9/100 patients/year in those who received medical treatment. In patients without viability who underwent revascularisation, the cardiac mortality rate was 6.2/100 patients/year and in those who received MT it was 1.9/100 patients/year. In patients with myocardial viability the NNT was 4, while in patients without myocardial viability, the NNT was 24. CONCLUSIONS: In patients with scintigraphic viability criteria, the NNT to obtain one survival with CR was 6 times lower with respect to patients without viability, with lower cost and mortality.

[Study of physician satisfaction as a quality criterion in Nuclear Medicine]. / Estudio de satisfacción de facultativos como criterio de calidad en Medicina Nuclear.

OBJECTIVE: To determine the perception and satisfaction level of referring physicians requesting scans as final users of the Nuclear Medicine Department. MATERIAL AND METHODS: A self-administered questionnaire was designed; it was composed of 10 closed questions (5 categorised and 5 with numerical scale) and 3 open questions. The indicators evaluated were: physician's information about available tests, test indications and diagnostic information, accessibility, delay in the examination and reception of the diagnostic report, usefulness of diagnostic information and overall satisfaction with the department. Two hundred and fifteen questionnaires were sent. RESULTS: Seventy eight questionnaires were returned, so the response index was 36.3 %. The 44.6 % of physicians surveyed considered that they had sufficient information about the tests and 59.5 % were satisfied with the indications and diagnostic information. The accessibility was 7 or more out of 10 for 78.5 %. The 64.9 % of physicians considered the delay in performing examinations to be correct but the satisfaction was lower in the delay between performance and reception of the diagnostic report. The diagnostic information was considered useful by 81.9 % and relevant in the management of patients by 70.5 % of the participants surveyed. The overall satisfaction was > or = 7 out of 10 in 86.8 %. CONCLUSIONS: Overall satisfaction was high, although the level of knowledge about available tests and the delay between test performance and report reception could be improved.

Factors associated with appointment non-attendance at a medical imaging department in regional Australia: a retrospective cohort analysis.

INTRODUCTION: Appointment non-attendance contributes added cost to the healthcare sector through wasted resource allocations. Medical imaging departments commonly schedule appointments for most modalities; however, no study has quantified patient attendance rates in the Australian regional setting. This is despite evidence that regional, rural and remote Australians tend to demonstrate poorer health than metropolitan counterparts. This study aims to identify the factors that influence appointment non-attendance at a teaching hospital in regional Australia. METHODS: Categories restricted to age, gender, indigenous status, distance from investigation site, referral source and imaging modality were collected for all appointments (N = 13,458) referred to the medical imaging department in 2015. The likelihood of each of these factors correlating with a patient not attending a scheduled appointment was calculated using the chi-squared analysis and binary logistic regression. RESULTS: Gender, indigenous status as well as specific imaging modalities, referral sources and age categories were significantly associated with non-attendance. Overall, male patients were 1.57 (P < 0.001) times more likely to miss a scheduled appointment than female patients. Patients who identified as Aboriginal and Torres Strait Islander were 2.66 (P < 0.001) times more likely to miss a scheduled appointment than patients who did not identify as Aboriginal and Torres Strait Islander. CONCLUSIONS: Several key factors appear to affect medical imaging appointment non-attendance. Key factors include indigenous status, gender, image modality, referral source and age. Further improvement is required to better meet the needs of underrepresented patient demographics.

Nuclear medicine scans in Beijing: insights from the Beijing Quality Control Centre Survey 2005-2006.

OBJECTIVE: To survey nuclear medicine scans carried out in Beijing during 2005. METHODS: Forty-two nuclear medicine departments were surveyed by using mailed questionnaires sent during September 2006. RESULTS: By the end of January 2007, 30 out of 42 hospitals had replied to our survey. The estimated annual number of SPECT procedures was 6.72 per 1000 population during 2005. Among SPECT applications, whole-body bone scans (n=23,090) were performed with the highest frequency, followed by myocardial perfusion imaging (n=19,092), and renal function imaging (n=10,287). The estimated number of myocardial perfusion scintigraphy scans was 1530 procedures per million population. The annual number of PET procedures was 0.25 per 1000 population. Most of these PET and SPECT examinations used relative monotonous radiotracers and most patients were in the age group of 40-70 years. However, for each cancer and each type of application, age distributions slightly varied. In addition, the analysis of gender distribution revealed that the number of male patients was higher than for female patients. CONCLUSION: The number of nuclear medicine scans carried out in Beijing during 2005 was considerable, with unbalanced clinical applications. Excluded myocardial perfusion scintigraphy, the frequencies of some applications were still lower than in western countries. Furthermore, most procedures used relatively monotonous radiotracers. Most patients were in the age group of 40-70 years and were male.

A work observation study of nuclear medicine technologists: interruptions, resilience and implications for patient safety.

BACKGROUND: Errors by nuclear medicine technologists during the preparation of radiopharmaceuticals or at other times can cause patient harm and may reflect the impact of interruptions, busy work environments and deficient systems or processes. We aimed to: (a) characterise the rate and nature of interruptions technologists experience and (b) identify strategies that support safety. METHODS: We performed 100 hours of observation of 11 technologists at a major public hospital and measured the proportions of time spent in eight categories of work tasks, location of task, interruption rate and type and multitasking (tasks conducted in parallel). We catalogued specific safety-oriented strategies used by technologists. RESULTS: Technologists completed 5227 tasks and experienced 569 interruptions (mean, 4.5 times per hour; 95% CI 4.1 to 4.9). The highest interruption rate occurred when technologists were in transit between rooms (10.3 per hour (95% CI 8.3 to 12.5)). Interruptions during radiopharmaceutical preparation occurred a mean of 4.4 times per hour (95% CI 3.3 to 5.6). Most (n=426) tasks were interrupted once only and all tasks were resumed after interruption. Multitasking occurred 16.6% of the time. At least some interruptions were initiated by other technologists to convey important information and/or to render assistance. Technologists employed a variety of verbal and non-verbal strategies in all work areas (notably in the hot-lab) to minimise the impact of interruptions and optimise the safe conduct of procedures. Although most were due to individual choices, some strategies reflected overt or subliminal departmental policy. CONCLUSIONS: Some interruptions appear beneficial. Technologists' self-initiated strategies to support safe work practices appear to be an important element in supporting a resilient work environment in nuclear medicine.

A new era for Nuclear Medicine neuroimaging in Spain: Where do we start from in Spain? / Nuevos tiempos para la neuroimagen de Medicina Nuclear en España: ¿de dónde partimos?

OBJECTIVE: To determine the status of neuroimaging studies of Nuclear Medicine in Spain during 2013 and first quarter of 2014, in order to define the activities of the neuroimaging group of the Spanish Society of Nuclear Medicine and Molecular Imaging (SEMNIM). MATERIAL AND METHODS: A questionnaire of 14 questions was designed, divided into 3 parts: characteristics of the departments (equipment and professionals involved); type of scans and clinical indications; and evaluation methods. The questionnaire was sent to 166 Nuclear Medicine departments. RESULTS: A total of 54 departments distributed among all regions completed the questionnaire. Most departments performed between 300 and 800 neuroimaging examinations per year, representing more than 25 scans per month. The average pieces of equipment were three; half of the departments had a PET/CT scanner and SPECT/CT equipment. Scans performed more frequently were brain SPECT with 123I-FP-CIT, followed by brain perfusion SPECT and PET with 18F-FDG. The most frequent clinical indications were cognitive impairment followed by movement disorders. For evaluation of the images most sites used only visual assessment, and for the quantitative assessment the most used was quantification by region of interest. CONCLUSIONS: These results reflect the clinical activity of 2013 and first quarter of 2014. The main indications of the studies were cognitive impairment and movement disorders. Variability in the evaluation of the studies is among the challenges that will be faced in the coming years.

Preliminary analysis of the resources in brachytherapy in Europe and its variability of use.

PURPOSE: The main objective of the program <> is to establish a group with detailed information on brachytherapy throughout Europe. METHODS: The data was compiled by the general coordinator, the ESTRO, and the <> through a website. RESULTS: A total of 32 countries reported data from at least 50% of their centres (criteria of inclusion). Countries were grouped in three categories based on the time of incorporation to the European Union. The majority of treatments belonged to gynaecological tumours. A large spread was found regarding workload of specialists depending on centre and group. CONCLUSION: Collection of information by a website is a feasible methodology. An increase in brachytherapy treatment was observed in all 3 groups by a rate of more than 20% (year 2002 versus year 1997). These results advocate for the continuation of the PCBE study to demonstrate the development in the field, such as an increase or decrease of patient numbers per tumour category.

UK nuclear medicine survey 2003-2004.

OBJECTIVES: This survey was designed to assess the trends in the frequencies of nuclear medicine procedures in the UK and to determine their contributions to the annual collective effective dose to the UK population. The average activities administered by nuclear medicine departments were compared with guidance on diagnostic reference levels issued by the Administration of Radioactive Substances Advisory Committee. METHOD: The survey was carried out by e-mailing a questionnaire to every known nuclear medicine centre in the UK. RESULTS: The total number of procedures performed annually has increased by 36% over the last 10 years to a level of about 11 procedures per 1000 head of population in the financial year 2003-2004. Seventy-three per cent of all nuclear medicine administrations are for planar imaging, with single-photon emission computed tomography and positron emission tomography contributing 16% and 2%, respectively. Non-imaging diagnostic procedures represent 7% of all nuclear medicine administrations, and therapy 2%. Bone scans continue to be the most frequent procedure. The UK annual collective effective dose from diagnostic nuclear medicine is about 1600 man Sv, resulting in an annual per caput dose of nearly 0.03 mSv. Bone scans are the largest contributor to the collective dose, but myocardium scans are close behind. Planar imaging is responsible for 62% of the total collective effective dose from diagnostic nuclear medicine in the UK, with single-photon emission computed tomography, positron emission tomography and non-imaging contributing 33%, 5% and 0.3%, respectively. CONCLUSIONS: The practice of nuclear medicine is still expanding in the UK with single-photon emission computed tomography imaging of the myocardium rapidly approaching bone scans as the main contributor to population exposure. The activities administered for most procedures have remained substantially unchanged and adhere closely to those recommended by the Administration of Radioactive Substances Advisory Committee.

Preparing children for day case nuclear medicine procedures.

OBJECTIVES: To audit standards developed for children undergoing nuclear medicine procedures involving day case attendance on the renal unit. METHODS: A prospective audit was undertaken of 210 children (113 males) undergoing day case nuclear medicine procedures in a teaching hospital department catering for adult and paediatric patients. An audit sheet was completed by both ward and nuclear medicine staff at the time of the procedure over an 18-month period. RESULTS: The majority of families were given relevant information about the procedures and adequate notice before the scan date. Most patients were offered surface analgesia for the venepuncture and play preparation before the procedure. Fifty-eight per cent of patients were successfully cannulated at the first attempt and 88% after three attempts. Only 4% of children were sedated. The median delay between the scheduled and actual scan time was 15 min, with 71% of children being scanned within the standard of a 0-20-min delay. Most delays were due to logistic problems within the department (43%). Cannulation problems (35%) and patient-related factors (22%) accounted for further delays. CONCLUSIONS: The audit of these locally agreed standards has resulted in changes in practice, including nurse training for cannulation and better scheduling within the nuclear medicine department. We believe that play preparation is an essential component for all potentially painful procedures, with few patients requiring sedation. The standards could be used for comparative audits between units.

How often do patients undergo repeat PET or PET/CT examinations? Experience from a UK institution.

BACKGROUND AND AIM: According to the report of the Intercollegiate Standing Committee on Nuclear Medicine, the UK requires 40-60 positron emission tomography (PET) machines in the next decade (Intercollegiate Standing Committee on Nuclear Medicine). Positron Emission Tomography: a Strategy for Provision in the UK. London: Royal College of Physicians of London; 2003, pp. 1-9). This figure is based mainly on patients receiving only one examination and restricting the clinical indication to three primary diagnoses. The aim of this study was to assess the appropriateness of this figure and the assumptions made in the Intercollegiate report on UK PET provision. METHODS: We examined retrospectively our institution's entire PET and PET/computed tomography (CT) database, which spans 4 years and 9 months. We recorded the number of patients who received repeat examinations. RESULTS: Reports were available for 3354 PET/CT or PET-only studies; 418 of 2268 patients (18.4%) received at least one repeat PET/CT examination. The three main indications for PET examination in the Intercollegiate report only accounted for approximately 60% of the examinations undertaken. CONCLUSION: Our records suggest that basing the UK's future PET provision on a single examination and on three clinical indications only is no longer realistic.

Radiation dose to PET technologists and strategies to lower occupational exposure.

OBJECTIVE: The use of PET in Australia has grown rapidly. We conducted a prospective study of the radiation exposure of technologists working in PET and evaluated the occupational radiation dose after implementation of strategies to lower exposure. METHODS: Radiation doses measured by thermoluminescent dosimeters over a 2-y period were reviewed both for technologists working in PET and for technologists working in general nuclear medicine in a busy academic nuclear medicine department. The separate components of the procedures for dose administration and patient monitoring were assessed to identify the areas contributing the most to the dose received. The impact on dose of implementing portable 511-keV syringe shields (primary shields) and larger trolley-mounted shields (secondary shields) was also compared with initial results using no shield. RESULTS: We found that the radiation exposure of PET technologists was higher than that of technologists performing general nuclear medicine studies, with doses averaging 771 +/- 147 and 524 +/- 123 microSv per quarter, respectively (P = 0.01). The estimated dose per PET procedure was 4.1 microSv (11 nSv/MBq). Injection of 18F-FDG contributed the most to radiation exposure. The 511-keV syringe shield reduced the average dose per injection from 2.5 to 1.4 microSv (P < 0.001). For the longer period of dose transportation and injection, the additional use of the secondary shield resulted in a significantly lower dose of radiation than did use of the primary shield alone or no shield (1.9 vs. 3.6 microSv [P = 0.01] and 3.4 microSv [P = 0.03], respectively). CONCLUSION: The radiation doses currently received by technologists working in PET are within accepted occupational health guidelines, but improved shielding can further reduce the dose.

Increase in utilization of myocardial perfusion imaging in the Czech Republic: activity and practice of nuclear cardiology, 2003.

BACKGROUND: The second survey of nuclear cardiology in the Czech Republic was conducted to ascertain whether the activity had increased since the first survey in 2001; we also intended to identify new trends in clinical practice. MATERIALS AND METHODS: All 46 departments of nuclear medicine in the Czech Republic completed a questionnaire concerning nuclear cardiology activity in 2002-2003 and current clinical and technical practices. RESULTS: There were 66 SPET cameras in 2003 in comparison with 54 SPET cameras in 2001. Of the 46 centres, 39 (85%) provided nuclear cardiology service. The total number of cardiac studies was 19,261 in 2003 (i.e. 1.9 studies/1,000 population; myocardial perfusion imaging (MPI) studies accounted for 91.3% of total nuclear cardiology. In 2001-2003, the utilization rate of MPI increased annually by 10%, 13% and 21% respectively. Twenty-six departments (67%) reported that the number of MPI had increased. The utilization of gated SPET method showed a very positive trend; as only 39% of all MPI studies were acquired using ECG-gating in 2001, but in 2003, there was an increase to 61%. We observed no increase in utilization of attenuation correction (3 centres in 2003 in comparison with 5 centres in 2001). Despite new PET capacity in the Czech Republic, the total number of FDG cardiology studies was somewhat lower in 2003 than in 2001 (155 compared with 163 studies). CONCLUSIONS: Our data documented substantial growth in the number of MPI examinations in 2001-2003. However, Czech Republic nuclear cardiology activity still remained below the European average (2.2 studies/1,000 population in 1994); a further increase in MPI activity is necessary to adequately support the needs of cardiac patients.

Estimation of the collective ionizing dose in the Portuguese population for the years 2011 and 2012, due to nuclear medicine exams.

OBJECTIVES: In 2009-2010 a Portuguese consortium was created to implement the methodologies proposed by the Dose Datamed II (DDM2) project, aiming to collect data from diagnostic X-ray and nuclear medicine (NM) procedures, in order to determine the most frequently prescribed exams and the associated ionizing radiation doses for the Portuguese population. The current study is the continuation of this work, although it focuses only on NM exams for the years 2011 and 2012. MATERIAL AND METHODS: The annual frequency of each of the 28 selected NM exams and the average administered activity per procedure was obtained by means of a nationwide survey sent to the 35 NM centres in Portugal. RESULTS: The results show a reduction of the number of cardiac exams performed in the last two years compared with 2010, leading to a reduction of the annual average effective dose of Portuguese population due to NM exams from 0.08 mSv ± 0.017 mSv/caput to 0.059 ± 0.011 mSv/caput in 2011 and 0.054 ± 0.011 mSv/caput in 2012. Portuguese total annual average collective effective dose due to medical procedures was estimated to be 625.6 ± 110.9 manSv in 2011 and 565.1 ± 117.3 manSv in 2012, a reduction in comparison with 2010 (840.3 ± 183.8 manSv). CONCLUSIONS: The most frequent exams and the ones that contributed the most for total population dose were the cardiac and bone exams, although a decrease observed in 2011 and in 2012 was verified. The authors intend to perform this study periodically to identify trends in the annual Portuguese average effective dose and to help to raise awareness about the potential dose optimization.

A regional training programme for radiotherapists and allied professionals for the west African health community.

With 47% of the population under 15 years of age and the control of infectious and other communicable diseases, cancer will likely constitute a major health problem in West Africa in future. Radiotherapy facilities and trained manpower to run them are very limited within the subregion. This paper quantifies the severity of the situation and discusses a practical approach aimed at coping with the situation through the organisation of a training programme for radiotherapists, medical physicists and radiation technologists as part of the strategies for cancer control in West Africa. A curriculum is proposed for the training of radiotherapists.

Nuclear cardiology in the UK 1994: activity relative to Europe, USA, and British Cardiac Society targets.

OBJECTIVE: To survey practice in nuclear cardiology in the UK in 1994. DESIGN: A questionnaire was sent to 219 centres performing nuclear imaging asking for details of current practice in nuclear cardiology. Replies were received from 192 centres (88%). MAIN OUTCOME MEASURES: Activity in performance of myocardial perfusion imaging (MPI) and radionuclide ventriculography (RNV), anticipated changes in activity, differences between regional and district hospitals, technical imaging parameters, and referral sources. RESULTS: Of the responding centres, 125 (65%) performed nuclear cardiology procedures. More regional than district hospitals performed nuclear cardiology procedures (85% v 55%, p < 0.0003) and regional centres performed a higher proportion (62% v 24%, p < 0.001) of nuclear cardiology activity. Nuclear cardiology activity was 0.82 scans per 1000 population per year (MPI 0.56, RNV 0.26). There has been a significant increase (24%) in nuclear cardiology since 1988. There has been a pronounced rise in MPI (350%) while RNV has fallen by 47%. Myocardial perfusion activity in the UK remains very low (25% and 5% in regional and district hospitals, respectively) compared with the 1994 figures of 2.2/1000/year for Europe or 10.8/1000/year for the USA. CONCLUSIONS: MPI has increased on average by 23%/annum (compound rate) since 1988, but in 1994 was still only 32% of the British Cardiac Society target of 2.6/1000/year. Proper resources for capital expenditure on new equipment and new staff will be important to maintain momentum in closing the gap. Also important is improved clinical understanding, as already implemented by including nuclear cardiology in guidelines for specialist cardiology training.

Outcome of 249 patients attending a nuclear medicine department with well differentiated thyroid cancer; a 23 year review.

249 patients with well differentiated thyroid cancer attended the Nuclear Medicine Department of the Royal Liverpool Hospital (formerly housed at the Liverpool Clinic) from 1967 to 1990. Papillary carcinoma was histologically evident in 68% of patients and follicular carcinoma in 32%. Fifteen percent of all patients died of their cancer. The extent of initial surgery did not appear to influence the recurrence of disease, nor the patient survival. Univariate analysis showed that males had a worse survival rate than females during the 5 years after diagnosis but thereafter survival rates were similar. Multivariate analysis indicated that unfavourable survival factors were "age over 45 years at diagnosis" and "presence of distal metastases". Survival was not significantly different with or without 131I ablation where there were no distal metastases. Outcome of pregnancy after 131I ablation gave no cause for concern. No serious complications were observed following 131I therapy. Serum thyroglobulin tests were introduced only half way through the review period and were helpful in predicting the presence of tumour recurrence but these data are to be discussed in another communication.