Status and Development of Nuclear Medicine Over One Decade in Beijing.

Objective Our objective was to investigate the basic information of the personnel and facilities of nuclear medicine in Beijing. Methods This survey was performed by the Beijing Quality Control Center in 2018. The investigation included personnel, equipment, and clinical applications, and data were then compared with previous surveys. The paper questionnaires were used for the survey, which required information about the personnel, devices, and clinical applications. Results About 38 nuclear medicine departments in Beijing were involved in the survey. The number of nuclear medicine staff was 531 in 2018, showing an increase of 58.7% over the past decade. Positron emission tomography/computed tomography (PET/CT), single-photon emission computed tomography (SPECT), and single-photon emission computed tomography/computed tomography (SPECT/CT) represented the main nuclear medicine facilities, and the total number of surveyed departments was 18, 24, and 34, respectively. The quality control results showed significant improvement from the 2005 levels. The total number of scintigraphy procedures was estimated at 199,607 (153,185 SPECT and 46,422 PET/CT). The estimated annual number of scintigraphy images was 8.9 per 1,000 population for SPECT and 2.7 per 1,000 population for PET/CT during 2018. The most frequent radioiodine-targeted therapy was 131 I-targeted therapy for hyperthyroidism in 2018. Conclusion Nuclear medicine has experienced rapid growth in the past 10 years in Beijing, either in personnel, equipment, and scintigraphy. Future efforts will focus on the use of new isotopes in the diagnosis, implementing quality strategy, and enhancing training.

Skeletal standardized uptake values obtained using quantitative SPECT/CT for the detection of bone metastases in patients with lung adenocarcinoma.

Purpose: To assess the utility of skeletal standardized uptake values (SUVs) obtained using quantitative single-photon emission computed tomography/computed tomography (SPECT/CT) in differentiating bone metastases from benign lesions, particularly in patients with lung adenocarcinoma. Methods: Patients with lung adenocarcinoma who had undergone whole-body Tc-99m methyl-diphosphonate (99mTc-MDP) bone scans and received late phase SPECT/CT were retrospectively analyzed in this study. The maximum SUV (SUVmax); Hounsfield units (HUs); and volumes of osteoblastic, osteolytic, mixed, CT-negative metastatic and benign bone lesions, and normal vertebrae were compared. Receiver operating characteristic curves were used to determine the optimal cutoff SUVmax between metastatic and benign lesions as well as the cutoff SUVmax between CT-negative metastatic lesions and normal vertebrae. The linear correlation between SUVmax and HUs of metastatic lesions as well as that between SUVmax and the volume of all bone lesions were investigated. Results: A total of 252 bone metastatic lesions, 140 benign bone lesions, and 199 normal vertebrae from 115 patients with lung adenocarcinoma were studied (48 males, 67 females, median age: 59 years). Metastatic lesions had a significantly higher SUVmax (23.85 ± 14.34) than benign lesions (9.67 ± 7.47) and normal vertebrae (6.19 ± 1.46; P < 0.0001). The SPECT/CT hotspot of patients with bone metastases could be distinguished from benign lesions using a cutoff SUVmax of 11.10, with a sensitivity of 87.70% and a specificity of 80.71%. The SUVmax of osteoblastic (29.16 ± 16.63) and mixed (26.62 ± 14.97) lesions was significantly greater than that of osteolytic (15.79 ± 5.57) and CT-negative (16.51 ± 6.93) lesions (P < 0.0001, P = 0.0003, and 0.002). SUVmax at the cutoff value of 8.135 could distinguish CT-negative bone metastases from normal vertebrae, with a sensitivity of 100.00% and a specificity of 91.96%. SUVmax showed a weak positive linear correlation with HUs in all bone metastases and the volume of all bone lesions. Conclusion: SUVmax of quantitative SPECT/CT is a useful index for distinguishing benign bone lesions from bone metastases in patients with lung adenocarcinoma, particularly in the diagnosis of CT-negative bone metastases, but other factors that may affect SUVmax should be considered.

Revisiting sea-level budget by considering all potential impact factors for global mean sea-level change estimation.

Accurate estimates of global sea-level change from the observations of Altimetry, Argo and Gravity Recovery and Climate Experiment (GRACE) and GRACE Follow-on (GRACE-FO) are of great value for investigating the global sea-level budget. In this study, we analyzed the global sea-level change over the period from January 2005 to December 2019 by considering all potential impact factors, i.e. three factors for Altimetry observations (two Altimetry products, ocean bottom deformation (OBD) and glacial isostatic adjustment (GIA)), three factors for Argo observations (four Argo products, salinity product error and deep-ocean steric sea-level change), and seven factors for GRACE/GRACE-FO observations including three official RL06 solutions, five spatial filtering methods, three GIA models, two C20 (degree 2 order 0) products, Geocenter motion, GAD field and global mass conservation. The seven impact factors of GRACE/GRACE-FO observations lead to ninety combinations for the post-procession of global mean barystatic sea-level change estimation, whose rates range from 2.00 to 2.45 mm/year. The total uncertainty of global barystatic sea-level change rate is ± 0.27 mm/year at the 95% confidence level, estimated as the standard deviation of the differences between the different datasets constituting the ensembles. The statistical results show that the preferred GIA model developed by Caron et al. in 2018 can improve the closure of the global sea-level budget by 0.20-0.30 mm/year, which is comparable with that of neglecting the halosteric component. About 30.8% of total combinations (GRACE/GRACE-FO plus Argo) can close the global sea-level budget within 1-sigma (0.23 mm/year) of Altimetry observations, 88.9% within 2-sigma. Once the adopted factors including GRACE/GRACE-FO solutions from Center for Space Research (CSR), Caron18 GIA model, SWENSON filtering and Argo product from China Second Institute of Oceanography, the linear trend of global sterodynamic sea-level change derived from GRACE/GRACE-FO plus Argo observations is 3.85 ± 0.14 mm/year, nearly closed to 3.90 ± 0.23 mm/year of Altimetry observations.

A Formula to Calculate the Threshold for Radiotherapy Targets on PET Images: Simulation Study.

BACKGROUND: Positron emission tomography (PET) images are being applied for defining radiotherapy targets. However, a recognized method for defining radiotherapy targets is lacking. We investigate the threshold to outline the radiotherapy target of a tumor on PET images and its influencing factors, and then expressed it by formula. METHODS: PET imaging for spherical tumors with a different tumor diameter (D), under different system resolutions [full width at half maximum (FWHM)], in different backgrounds with different pixel sizes, was simulated. PET images were analyzed to determine the relationship between the threshold and the factors mentioned above. Finally, the simulation results were verified by phantom experiments. RESULTS: The threshold decreased sharply with D for D < 2 FWHM, reached the minimum of 31% at D = 2 FWHM and then increased slowly, and it tended to constant for D > 8 FWHM. The threshold decreased with FWHM for FWHM < D/2, reached a minimum at FWHM = D/2, and then increased. The threshold increased with pixel size for D ≤ FWHM and decreased for D > FWHM. The threshold was independent of the background. The relationship between the threshold and its influencing factors was expressed as a formula. The results of the phantom verification indicated that the error of the target volume delineation that was calculated by the formula was less than 9%. CONCLUSIONS: The threshold changes with tumor size, resolution of the PET system and pixel size according to certain rules. The formula to calculate the threshold could provide a method to estimate threshold to outline the radiotherapy target (tumor).

Effective Attributes Quantification to Bridge Gap between Elastic Properties and Reservoir Parameters in Self-Resource Rocks.

The successful production of unconventional resources such as shale gas is highly dependent on its two reservoir properties, organic matter and rock brittleness. High resolution spatially characterization of these two unconventional reservoir properties needs surface reflection seismic data. However, to delineate these two parameters on seismic scale is a challenging task because poor correlation is observed between these parameters and elastic properties of the rock. To encounter this adversity in current study we proposed effective attributes method in which organic shale reservoir properties are divided into their hard and soft elastic response. From the analysis of worldwide laboratory dataset, we find that hard and soft components have shown us much better linear correlation with P- and S- wave impedance. The proposed effective attributes, helped us to reduce the gap between unconventional reservoir properties and seismic characteristics. These attributes are the main controlling factor for rock elastic properties and exhibit information about hydrocarbon generation capacity and rock brittleness. A well data example from Sembar shale has also shown successful results for proposed effective attributes methodology. These attributes application on inverted P-wave impedance seismic data of employed organic shale reservoir have shown productive results to quantify its unconventional prospect on seismic scale. The approach used in this study can be confidently employed to assess unconventional reservoir potential in other parts of the world.

Association of the Cumulative Dose of Radioactive Iodine Therapy With Overall Survival in Patients With Differentiated Thyroid Cancer and Pulmonary Metastases.

Purpose: The optimal cumulative dose of radioactive iodine therapy (RAIT) for patients with differentiated thyroid cancer (DTC) and pulmonary metastases (PM) is not known, therefore we evaluated the association between the cumulative dose of RAIT and overall survival (OS). Methods: A total of 202 patients with DTC and PM who underwent thyroidectomy and RAIT were analyzed in this study. The median cumulative dose of RAIT was 530 mCi. OS was compared with an age- and sex-matched general population from China to assess relative survival. Multivariable proportional hazards model smoothing by penalized spline was applied to identify independent predictors and examine the adjusted non-linear association of cumulative dose of RAIT and patient age with mortality. Results: The observed survival and relative survival at 10 years was 54.96 and 60.81%, respectively, with the standardized mortality ratio being 5.34. The cumulative dose of RAIT was associated with mortality in a dose-dependent fashion without an apparent cutoff point after adjustment of other variables. A linear but moderate association was found in the dose of 300 to 1,000 mCi. Cumulative dose of RAIT, patient age, diameter of pulmonary metastases, and extrapulmonary metastases were identified as independent predictors for OS. The increasing patient age was associated with mortality in a non-linear pattern, with the optimal threshold being 40 years. With advancing age, the risk of death increases rapidly in patients aged 40 years and younger, but slowly in patients over 40 years. Conclusions: RAIT should be assigned to RAI-avid patients until disease has been controlled or RAIT becomes refractory after consideration of the potential long-term side-effects. Patient age was associated with OS in a non-linear pattern, with a threshold at 40 years. Consideration of age as a binary variable could elucidate a more accurate prognosis in such patients.

Measurement and Evaluation of Quantitative Performance of PET/CT Images before a Multicenter Clinical Trial.

To ensure the reliability of the planned multi-center clinical trial, we assessed the consistence and comparability of the quantitative parameters of the eight PET/CT units that will be used in this trial. PET/CT images were scanned using a PET NEMA image quality phantom (Biodex) on the eight units of Discovery PET/CT 690 from GE Healthcare. The scanning parameters were the same with the ones to be used in the planned trial. The 18F-NaF concentration in the background was 5.3 kBq/ml, while the ones in the spheres of diameter 37 mm, 22 mm, 17 mm and 10 mm were 8:1 as to that of the background and the ones in the spheres of diameter 28 mm and 13 mm were 0 kBq/ml. The consistency of hot sphere recovery coefficient (HRC), cold sphere recovery coefficient (CRC), hot sphere contrast (QH) and cold sphere contrast (Qc) among these 8 PET/CTs was analyzed. The variation of the main quantitative parameters of the eight PET/CT systems was within 10%, which is acceptable for the clinical trial.

Prognostic value of cancer antigen -125 for lung adenocarcinoma patients with brain metastasis: A random survival forest prognostic model.

Using random survival forest, this study was intended to evaluate the prognostic value of serum markers for lung adenocarcinoma patients with brain metastasis (BM), and tried to integrate them into a prognostic model. During 2010 to 2015, the patients were retrieved from two medical centers. Besides the Cox proportional hazards regression, the random survival forest (RSF) were also used to develop prognostic model from the group A (n = 142). In RSF of the group A, the factors, whose minimal depth were greater than the depth threshold or had a negative variable importance (VIMP), were firstly excluded. Subsequently, C-index and Akaike information criterion (AIC) were used to guide us finding models with higher prognostic ability and lower overfitting possibility. These RSF models, together with the Cox, modified-RPA and lung-GPA index were validated and compared, especially in the group B (CAMS, n = 53). Our data indicated that the KSE125 model (KPS, smoking, EGFR-20 (exon 18, 19 and 21) and Ca125) was the best in survival prediction, and performed well in internal and external validation. In conclusions, for lung adenocarcinoma patients with brain metastasis, a validated prognostic nomogram (KPS, smoking, EGFR-20 and Ca125) can more accurately predict 1-year and 2-year survival of the patients.

Therapeutic response and long-term outcome of differentiated thyroid cancer with pulmonary metastases treated by radioiodine therapy.

OBJECTIVE: To explore the therapeutic response (TR) and long-term outcomes of iodine-131 (I-131) treatment for patients with differentiated thyroid cancer and pulmonary metastases (DTC+PM), as well as the association between the assessment of TR and long-term outcomes. METHODS: This retrospective study comprised 151 DTC+PM patients. TR was evaluated by changes in serum levels of thyroglobulin, anatomic imaging and iodine uptake in pulmonary nodules; logistic regression was applied to identify predictors. Overall survival (OS) was calculated using the Kaplan-Meier method and predictive factors of outcome by multivariate analyses. RESULTS: After I-131 treatment, 17 patients achieved a complete response, 71 a partial response, and 63 no response. Age, pulmonary nodule size, iodine-concentration within PM, extra-PM, frequency and cumulative dose of I-131 treatment were significant for TR. OS was 72.2% at 5, 55.2% at 10 and 51.3% at 15 years. After adjustment for other factors, age, pulmonary nodule size, extra-PM, frequency and cumulative dose of I-131 treatment were significant. A significant difference of survival rate in patients with different TR group was observed. CONCLUSIONS: There was a supportive response and prognosis for I-131 treatment upon DTC+PM patients. Older patients and those with non-I-131-avid PM were more likely to have no response to I-131 treatment, and greater benefits could be achieved by patients who complete treatment. Long-term outcome was better in patients with age <45 years, pulmonary nodule size <2 cm, without extra-PM, and the frequency of iodine treatment ≥5 times. The predictive power of the TR on long-term prognosis was favorable.

Lean body mass is better than body surface area in correcting GFR.

PURPOSE: The Gates-based renography (gGFR) and plasma-based clearance rate (pGFR) are conventionally corrected with body surface area (BSA). Limited studies indicated that the lean body mass (LBM) might be better than BSA in correcting pGFR. Therefore, we suggest that LBM is also better in correcting gGFR and improve the correlation coefficient between gGFR and pGFR. METHOD: During June 2009 and December 2010, the gGFR and pGFR of 63 patients with hydronephrosis were measured and corrected with BSA and LBM, respectively. The correlation and regression analyses were conducted to illustrate the power of BSA and LBM correction. RESULTS: In a paired t test, there was no significant difference between pGFR and gGFR in patients with stages 1 and 2, although this was significant in stages 3 and 4. However, neither LBM nor BSA correction could eliminate the difference. In all patients (N = 63), the correlation coefficient (r) between pGFR and gGFR was 0.794 (P <; 0.001). After the BSA and LBM correction, r was improved to 0.809 and 0.828, respectively. In all patients, the regression line of pGFR(LBM) - gGFR(LBM) was nearer to the original point and its slope closer to 1 than pGFR(BSA) - gGFR(BSA) and pGFR - gGFR. Similar results were found in the analysis of most stages and subgroups. CONCLUSIONS: The commonsense of BSA correction should be seriously reevaluated. Lean body mass can better improve the correlation coefficient between paired GFRs than BSA can and it can be suitable in the correction.

Measurement of standard uptake value in dual-head coincidence system.

UNLABELLED: The standard uptake value (SUV) is an important semi-quantitative parameter in positron emission tomography (PET). But SUV is not available in dual-head coincidence imaging system (DHC) which is widely used in clinical practice. This study was designed to develop a method for measuring SUV in DHC system, and then compared SUV in DHC and SUV in PET. METHOD: Firstly, the calibration factor (CF) for converting the voxel count rate to radioactivity concentration was determined by a phantom study in DHC. Then the method for calculating SUV in DHC was formulated. Finally, SUV in DHC and SUV in PET were compared through another phantom study. The phantoms used in the comparing study were cylindrical and consisted of several hot lesions. RESULTS: The CF varied with the detected single count rate in a biquadratic polynomial; the lesion's radioactivity concentration was got based on the CF and the voxel count rate. From the lesion's radioactivity concentration, the lesion's SUV in DHC was obtained. The comparison study showed that SUV in PET was higher than SUV in DHC. The SUV in both DHC and PET increased with increasing sizes of lesions and were related with the reconstruction algorithm. CONCLUSIONS: SUV in DHC images could be obtained in our method; the value in DHC images was lower than that in PET image; and many factors, such as system performance, lesion's size, and reconstruction algorithm could influence the SUV accuracy in both DHC and PET.

Noise components on positron emission tomography images.

Noise components on PET images were studied. The results showed that the square of synthetic noise Delta(2) and the square of signal-to-noise ratio (N/Delta)(2) varied with the signal intensity N and the relationships were respectively expressed with: Delta(2)=0.0395N(2)+0.1427N+0.0025 (R(2)=0.9358) and (N/Delta)(2)=-1.13932N(2)+7.0185N-0.0746 (R(2)=0.9377). The synthetic noise on PET image may be categorized into three components. The first one varies directly as signal intensity, which depend on random coincidence; the second one varies directly as the square root of signal intensity, which depend on Poisson fluctuation; and the third one is independent of signal intensity.