Standardised quantitative radioiodine SPECT/CT Imaging for multicentre dosimetry trials in molecular radiotherapy.

The SEL-I-METRY trial (EudraCT No 2015-002269-47) is the first multicentre trial to investigate the role of 123I and 131I SPECT/CT-based tumour dosimetry to predict response to radioiodine therapy. Standardised dosimetry methodology is essential to provide a robust evidence-base for absorbed dose-response thresholds for molecular radiotherapy (MRT). In this paper a practical standardised protocol is used to establish the first network of centres with consistent methods of radioiodine activity quantification. Nine SPECT/CT systems at eight centres were set-up for quantitative radioiodine imaging. The dead-time of the systems was characterised for up to 2.8 GBq 131I. Volume dependent calibration factors were measured on centrally reconstructed images of 123I and 131I in six (0.8-196 ml) cylinders. Validation of image quantification using these calibration factors was performed on three systems, by imaging a 3D-printed phantom mimicking a patient's activity distribution. The percentage differences between the activities measured in the SPECT/CT image and those measured by the radionuclide calibrator were calculated. Additionally uncertainties on the SPECT/CT-based activities were calculated to indicate the limit on the quantitative accuracy of this method. For systems set-up to image high 131I count rates, the count rate versus activity did not peak below 2.8 GBq and fit a non-paralysable model. The dead-times and volume-dependent calibration factors were comparable between systems of the same model and crystal thickness. Therefore a global calibration curve could be fitted to each. The errors on the validation phantom activities' were comparable to the measurement uncertainties derived from uncertainty analysis, at 10% and 16% on average for 123I and 131I respectively in a 5 cm sphere. In conclusion, the dead-time and calibration factors varied between centres, with different models of system. However, global calibration factors may be applied to the same system model with the same crystal thickness, to simplify set-up of future multi-centre MRT studies.

Mapping the Physiotherapy Profession in Saskatchewan: Examining Rural versus Urban Practice Patterns.

PURPOSE: People living in rural and remote regions need support to overcome difficulties in accessing health care. The objectives of the study were (1) to compare demographic characteristics, professional engagement indicators, and clinical characteristics between physiotherapists practising in rural settings and those practising in urban settings and (2) to map the distribution of physiotherapists in Saskatchewan. METHOD: This cross-sectional study used de-identified data collected from the 2013 Saskatchewan College of Physical Therapists membership renewal (n=643), linked with the Saskatchewan Physiotherapy Association's (SPA) 2012 membership list and a list of physiotherapists who had served as clinical instructors. Employment location (rural vs. urban) was determined by postal code. RESULTS: Only 11.2% of Saskatchewan physiotherapists listed a rural primary employment location, and a higher density of physiotherapists per 10,000 people work in health regions with large urban centres. Compared with urban physiotherapists, rural physiotherapists are more likely to provide direct patient care, to provide care to people of all ages, and to have a mixed client level, and they are less likely to be SPA members. CONCLUSIONS: Rural and urban physiotherapists in Saskatchewan have different practice and professional characteristics. This information may have implications for health human resource recruitment and retention policies as well as advocacy for equitable access to physiotherapy care in rural and remote regions.

Objet : Les personnes qui vivent dans des régions rurales et éloignées ont besoin de soutien pour surmonter les difficultés liées à l'accès aux soins de santé. Les objectifs de cette étude étaient: 1) de comparer les caractéristiques démographiques, les indicateurs d'engagement professionnel et les caractéristiques cliniques entre les physiothérapeutes qui pratiquent dans des milieux ruraux et ceux qui travaillent dans des milieux urbains; 2) d'établir la répartition des physiothérapeutes en Saskatchewan. Méthode : Cette étude transversale a utilisé les données dépersonnalisées tirées du renouvellement des adhésions pour 2013 de l'Ordre des physiothérapeutes de la Saskatchewan (n=643), de la liste des membres de 2012 de l'Association de physiothérapie de la Saskatchewan et d'une liste des physiothérapeutes qui ont agi à titre d'enseignants cliniques. Le lieu de travail (rural ou urbain) était déterminé à l'aide des codes postaux. Résultats : Seulement 11,2 % des physiothérapeutes de la Saskatchewan avaient inscrit comme lieu de travail principal un milieu rural, et une plus forte densité de physiothérapeutes par 10 000 personnes travaille dans des régions sociosanitaires où il y a de grands centres urbains. Comparativement aux physiothérapeutes en milieu urbain, les physiothérapeutes en milieu rural sont plus susceptibles de prodiguer des soins directement aux patients, de s'occuper des personnes de tous les âges et de posséder une clientèle variée, mais ils sont moins susceptibles d'être membres de l'Association de physiothérapie de la Saskatchewan. Conclusions : Les physiothérapeutes en milieu rural et urbain en Saskatchewan ont des pratiques et des caractéristiques professionnelles qui diffèrent. Ces renseignements peuvent influer sur les politiques de recrutement et de rétention des ressources humaines en santé, ainsi que sur la promotion de l'accès équitable aux soins de physiothérapie dans les régions rurales et éloignées.