Trends in Occupational Radiation Doses for U.S. Radiologic Technologists Performing General Radiologic and Nuclear Medicine Procedures, 1980-2015.

Background Occupational doses to most medical radiation workers have declined substantially since the 1950s because of improvements in radiation protection practices. However, different patterns may have emerged for radiologic technologists working with nuclear medicine because of the higher per-procedure doses and increasing workloads. Purpose To summarize annual occupational doses during a 36-year period for a large cohort of U.S. radiologic technologists and to compare dose between general radiologic technologists and those specializing in nuclear medicine procedures. Materials and Methods Annual personal dose equivalents (referred to as doses) from 1980 to 2015 were summarized for 58 434 (62%) participants in the U.S. Radiologic Technologists (USRT) cohort who responded to the most recent mailed work history survey (years 2012-2014) and reported never regularly performing interventional procedures. Doses were partitioned according to the performance of nuclear medicine (yes or no, frequency, procedure type) by calendar year. Annual dose records were described by using summary statistics (eg, median and 25th and 75th percentiles). Results Median annual doses related to performance of general radiologic procedures decreased from 0.60 mSv (interquartile range [IQR], 0.10-1.9 mSv) in 1980 to levels below the limits of detection by 2015, whereas annual doses related to performance of nuclear medicine procedures remained relatively high during this period (median, 1.2 mSv; IQR, 0.12-3.0 mSv). Higher median annual doses were associated with more frequent (above vs below the median) performance of diagnostic nuclear medicine procedures (≥35 vs <35 times per week; 1.6 mSv [IQR, 0.30-3.3 mSv] and 0.9 mSv [IQR, 0.10-2.6 mSv]). Higher and more variable annual doses were associated with more frequent performance of cardiac nuclear medicine (≥10 times per week) and PET (nine or more times per week) examinations (median, 1.6 mSv [IQR, 0.30-2.2 mSv] and 2.2 mSv [IQR, 0.10-4.6 mSv], respectively). Conclusion Annual doses to U.S. radiologic technologists performing general radiologic procedures declined during a 36-year period. However, consistently higher and more variable doses were associated with the performance of nuclear medicine procedures, particularly cardiac nuclear medicine and PET procedures. © RSNA, 2021 Online supplemental material is available for this article. See also the editorial by Mettler and Guiberteau in this issue.

Global Issues of Radiopharmaceutical Access and Availability: A Nuclear Medicine Global Initiative Project.

The Nuclear Medicine Global Initiative was formed in 2012 by 13 international organizations to promote human health by advancing the field of nuclear medicine and molecular imaging by supporting the practice and application of nuclear medicine. The first project focused on standardization of administered activities in pediatric nuclear medicine and resulted in 2 articles. For its second project the Nuclear Medicine Global Initiative chose to explore issues impacting on access and availability of radiopharmaceuticals around the world. Methods: Information was obtained by survey responses from 35 countries on available radioisotopes, radiopharmaceuticals, and kits for diagnostic and therapeutic use. Issues impacting on access and availability of radiopharmaceuticals in individual countries were also identified. Results: Detailed information on radiopharmaceuticals used in each country, and sources of supply, was evaluated. Responses highlighted problems in access, particularly due to the reliance on a sole provider, regulatory issues, and reimbursement, as well as issues of facilities and workforce, particularly in low- and middle-income countries. Conclusion: Strategies to address access and availability of radiopharmaceuticals are outlined, to enable timely and equitable patient access to nuclear medicine procedures worldwide. In the face of disruptions to global supply chains by the coronavirus disease 2019 outbreak, renewed focus on ensuring a reliable supply of radiopharmaceuticals is a major priority for nuclear medicine practice globally.

Impact of COVID-19 on nuclear medicine in the UK.

PURPOSE: COVID-19 brought about unprecedented challenges to healthcare, with nuclear medicine (NM) being no exception. The British Nuclear Medicine Society (BNMS) COVID-19 survey assessed the impact of the first wave of pandemic on NM services in the UK. With COVID-19 resurge compounded by seasonal winter pressures, we reflect and share lessons learnt from the first wave of pandemic to guide future strategy. METHODS: A questionnaire consisting of 34 questions was sent out to all BNMS members over 2 weeks in May 2020, to evaluate the impact of 'lockdown'. RESULTS: One hundred thirty-eight members (92 sites) from a multidisciplinary background responded. There was a 65% reduction across all services; 97.6% of respondents reported some reduction in diagnostic procedures and 71.3% reduction in therapies; 85% worked with a reduced workforce. The North East of England, Greater London and South East and Wessex were most affected by staff absences. The North East reported the highest number of COVID-19 positive staff; London reported the greatest lack of testing. The reported time required to clear the backlog was 1-12 months. Seventy-one percent of participants used BNMS COVID-19 guidance. CONCLUSION: The first wave caused a major disruption of NM service delivery and impacted on the workforce. The departmental strategies should tailor services to evolving local and regional differences in prevalence of COVID-19. A blanket shutdown of services with a 'one size fits all' strategy would likely have a severe impact on future delivery of NM and health services in general. Timely testing of staff and patients remains of paramount importance.

Patients' perspectives on radiation in health care.

As radiation therapy is needed by approximately 50% of patients with cancer there needs to be ongoing research to ensure that radiation therapy targets the tumour effectively and minimises potential side effects. Major advances in radiation therapy, due to improvements in engineering and computing, have made it more precise, reducing side effects and improving cancer control. Patients need to be informed of its risks, both short and long term, to enable them to be active participants in their cancer treatment path.

Nuclear Medicine Clinical Practice in the United States During the COVID-19 Era and Beyond.

Traditionally, practice in nuclear medicine has involved strong emphasis on radiation safety principles. Nuclear medicine technologists (NMTs) focus on practices that keep patients, the public, and the technologist safe from potentially harmful effects of unnecessary radiation exposure using concepts of time, distance, and shielding as well as ALARA (As low as reasonably achievable) principles. The current COVID-19 pandemic has brought to light the need to apply focus on infection prevention in practice and update knowledge and procedures on such measures. In this article, the authors outline the need for NMTs to develop practices and values focused on infection prevention measures.

Impact of COVID-19 on Nuclear Medicine in Germany, Austria and Switzerland: An International Survey in April 2020.

INTRODUCTION: Preparations of health systems to accommodate large number of severely ill COVID-19 patients in March/April 2020 has a significant impact on nuclear medicine departments. MATERIALS AND METHODS: A web-based questionnaire was designed to differentiate the impact of the pandemic on inpatient and outpatient nuclear medicine operations and on public versus private health systems, respectively. Questions were addressing the following issues: impact on nuclear medicine diagnostics and therapy, use of recommendations, personal protective equipment, and organizational adaptations. The survey was available for 6 days and closed on April 20, 2020. RESULTS: 113 complete responses were recorded. Nearly all participants (97 %) report a decline of nuclear medicine diagnostic procedures. The mean reduction in the last three weeks for PET/CT, scintigraphies of bone, myocardium, lung thyroid, sentinel lymph-node are -14.4 %, -47.2 %, -47.5 %, -40.7 %, -58.4 %, and -25.2 % respectively. Furthermore, 76 % of the participants report a reduction in therapies especially for benign thyroid disease (-41.8 %) and radiosynoviorthesis (-53.8 %) while tumor therapies remained mainly stable. 48 % of the participants report a shortage of personal protective equipment. CONCLUSIONS: Nuclear medicine services are notably reduced 3 weeks after the SARS-CoV-2 pandemic reached Germany, Austria and Switzerland on a large scale. We must be aware that the current crisis will also have a significant economic impact on the healthcare system. As the survey cannot adapt to daily dynamic changes in priorities, it serves as a first snapshot requiring follow-up studies and comparisons with other countries and regions.

Nuclear Cardiology in Asia.

Nuclear cardiology for patients with ischemic heart disease and cardiac failure is expanding in Asia, although quite heterogeneously. In Asia, Israel showed the highest utilization with more than 1000 scans/100,000 inhabitants a year followed by Korea, Japan, UAE, Turkey, Australia (250-999 scans/100,000). Saudi Arabia, Kuwait, Jordan, Lebanon, Iran, and Pakistan practiced 60-99 scans/100,000. Most of South East Asian countries, China, India, and Bangladesh practiced 1-50 scans/100,000 per year. Countries in Central Asia, Mongolia, Vietnam, Cambodia, Lao, Myanmar, Nepal, and Bhutan showed limited use or no nuclear cardiology practice. Myocardial perfusion imaging (MPI) in Asia was characterized by more frequent use of 201Tl, less use of weight-based 99mTc dosing, and a trend toward a lower rate of stress-only imaging. Accordingly, the effective dose in nuclear cardiology practices was higher than those of the rest of the world. 99Mo-99mTc generators are available in most countries, relying mainly on the global supply chain because there is little supply chain beyond countries within the region. In practice, the threshold values of left ventricular ejection fraction, end-systolic volume, and end-diastolic volume between normal and pathologic states were set based on the regional normal database in China and Japan because these values were dependent on age, gender, and body weight. The purpose of the MPI SPECT study was to evaluate myocardial ischemia in symptomatic patients with chest pain, effects of percutaneous coronary intervention and coronary artery bypass-graft, and cardiac function in patients with chronic heart failure. The ability of 99mTc-based MPI for predicting hard cardiac events was confirmed in Asian inhabitants with low risk of ischemic heart disease. Human resource development of nuclear medicine professional and public awareness of nuclear medicine is key issues to promote nuclear cardiology in Asia. International organizations such as the International Atomic Energy Agency and academic organizations in the region such as Asia Oceania Federation of Nuclear Medicine and Biology, Asia Regional Cooperative Council for Nuclear Medicine, East Asia Nuclear Medicine Association, and Arab Society of Nuclear Medicine have an important role in addition to national Societies of Nuclear Medicine in each country and region.

Patient Exposure from Radiologic and Nuclear Medicine Procedures in the United States: Procedure Volume and Effective Dose for the Period 2006-2016.

Background Comprehensive assessments of the frequency and associated doses from radiologic and nuclear medicine procedures are rarely conducted. The use of these procedures and the population-based radiation dose increased remarkably from 1980 to 2006. Purpose To determine the change in per capita radiation exposure in the United States from 2006 to 2016. Materials and Methods The U.S. National Council on Radiation Protection and Measurements conducted a retrospective assessment for 2016 and compared the results to previously published data for the year 2006. Effective dose values for procedures were obtained from the literature, and frequency data were obtained from commercial, governmental, and professional society data. Results In the United States in 2006, an estimated 377 million diagnostic and interventional radiologic examinations were performed. This value remained essentially the same for 2016 even though the U.S. population had increased by about 24 million people. The number of CT scans performed increased from 67 million to 84 million, but the number of other procedures (eg, diagnostic fluoroscopy) and nuclear medicine procedures decreased from 17 million to 13.5 million. The number of dental radiographic and dental CT examinations performed was estimated to be about 320 million in 2016. Using the tissue-weighting factors from Publication 60 of the International Commission on Radiological Protection, the U.S. annual individual (per capita) effective dose from diagnostic and interventional medical procedures was estimated to have been 2.9 mSv in 2006 and 2.3 mSv in 2016, with the collective doses being 885 000 and 755 000 person-sievert, respectively. Conclusion The trend from 1980 to 2006 of increasing dose from medical radiation has reversed. Estimated 2016 total collective effective dose and radiation dose per capita dose are lower than in 2006. © RSNA, 2020 See also the editorial by Einstein in this issue.

Top-cited articles versus top Altmetric articles in nuclear medicine: a comparative bibliometric analysis.

BACKGROUND: The impact of any scientific article has traditionally been measured by the number of citations received. More recently, alternative metrics (altmetrics) reflect the digital dissemination of knowledge across the online mediasphere. PURPOSE: To evaluate and compare the characteristics of top-cited articles with those of top Altmetric articles related to nuclear medicine (NM). MATERIAL AND METHODS: We performed a search of the Web of Science and Altmetric databases using 114 search terms to identify the 50 top-cited and 50 top Altmetric articles, respectively, in the field of NM. We then compared the following characteristics of the selected articles: publication type; journal category; country of origin; year of publication; topic; imaging modality; and accessibility. Chi-square tests were performed for statistical analysis. RESULTS: There were no overlaps between the 50 top-cited and 50 top Altmetric articles. In general, compared to the leading Altmetric articles in this field, the cited articles were: more frequently review works published in NM and radiology journals (76% vs. 13%, P = 0.000); published in or before 2005 (84% vs. 0%, P = 0.000); the majority were related to oncology (56% vs. 44%, P = 0.000); and originated from the Netherlands (12% vs. 0%, P = 0.000). Compared to the top-cited articles, the leading Altmetric articles were: more frequently original articles published in other clinical field journals (54% vs. 0%, P = 0.000); primarily published between 2016 and 2018 (70% vs. 0%, P = 0.000); focused on neurology (50% vs. 22%, P = 0.000); and originated from the UK (18% vs. 2%, P = 0.000). CONCLUSION: Citation counts and Altmetric scores represent unique perspectives for evaluating the impact of NM research.

Radiomics: Data Are Also Images.

The aim of this review is to provide readers with an update on the state of the art, pitfalls, solutions for those pitfalls, future perspectives, and challenges in the quickly evolving field of radiomics in nuclear medicine imaging and associated oncology applications. The main pitfalls were identified in study design, data acquisition, segmentation, feature calculation, and modeling; however, in most cases, potential solutions are available and existing recommendations should be followed to improve the overall quality and reproducibility of published radiomics studies. The techniques from the field of deep learning have some potential to provide solutions, especially in terms of automation. Some important challenges remain to be addressed but, overall, striking advances have been made in the field in the last 5 y.

U.S. PET/CT and Gamma Camera Diagnostic Reference Levels and Achievable Administered Activities for Noncardiac Nuclear Medicine Studies.

Existing surveys of radiopharmaceutical doses for U.S. nuclear medicine laboratories are of limited scope and size. Dose data are important because they can be used to benchmark individual laboratories, understand geographic variations in practice, and provide source data for societal guidelines and appropriateness criteria. Diagnostic reference levels (DRLs) and achievable administered activities (AAAs) for 13 noncardiac adult gamma camera and PET/CT examinations were derived retrospectively from American College of Radiology accreditation data (January 1, 2015, to December 31, 2017). The calculated DRL and AAA are consistent with previously published surveys. The distributions of radiopharmaceutical doses across facilities are in general consistent but show variation within a particular examination. Analysis of dose distribution suggests this variation results from differences in clinical protocols, educational gaps, and/or equipment factors. The AAA for the surveyed facilities exceeds dose ranges proposed in societal practice guidelines for several common nuclear medicine studies. Compared with similar surveys from Europe and Japan, geographic variation is observed, with some doses greater and others lower than used in the United States. Overall, radiopharmaceutical dose variation within the United States and internationally, and deviation from societal guidelines, imply that these dose-related benchmarks may be used to further standardize and improve clinical practice.

Quantitative SPECT: a survey of current practice in the UK Nuclear Medicine Community.

OBJECTIVES: Nuclear Medicine is a quantitative imaging modality. However, until recently, quantitative single photon emission computed tomography (SPECT) has been limited to ratios or comparisons to databases, or indeed volume measurements, and therefore has not truly quantified uptake in areas of interest. Following the growth of dosimetry associated with nuclear medicine therapies, tools to perform quantitative SPECT in terms of kBq/cc or standardised uptake value (SUV) have become more readily available, although its use does not appear to be widespread. The aim of this study was to get a snapshot of quantitative SPECT use, and to determine where the future of this technology may lie. METHODS: The data for this survey were collected through a web-based form made available at a national quantitative SPECT meeting, and later distributed to the UK nuclear medicine community. A series of questions looking at current practice, technique and future thoughts were presented to respondents in the form of multiple-choice questions where single and multiple selections could be made. RESULTS: The responses showed significant use of quantitative SPECT for established techniques, in alignment with the prevalence of the relevant imaging studies. There was a significant minority of respondents performing kBq/cc and SUV SPECT, and SPECT for radionuclide therapy dosimetry. Technique for quantitative SPECT varied significantly typically but nevertheless the predicted future for quantitative SPECT was positive: particularly for kBq/cc and SUV SPECT. Impediments to the success of the technology were mostly around software availability and uncertainties around usefulness. CONCLUSION: The results of this survey suggest that the future of truly quantitative SPECT looks promising.

Nuclear medicine practice in Japan: a report of the eighth nationwide survey in 2017.

OBJECTIVE: Subcommittee on Survey of Nuclear Medicine Practice in Japan has performed a nationwide survey of nuclear medicine practice every 5 years since 1982 to survey contemporary nuclear medicine practice and its changes over the years. METHODS: The subcommittee sent questionnaires, including the number and category of examinations as well as the kind and dose of the radiopharmaceuticals during the 30 days of June 2017, to all nuclear medicine institutes. The total numbers for the year 2017 were then estimated. RESULTS: A total of 1132 institutes responded to the survey, including 351 PET centers. The recovery rate was 90.6%. The number of gamma cameras installed was 1332 in total, with 7.0% decrease in 5 years. Dual-head cameras and hybrid SPECT/CT scanners accounted for 88.2 and 23.6%, respectively. The number of single-photon tracer studies in 2017 was 1.08 million which means a decrease in 5.7% in 5 years and 23.6% in 10 years. All but neurotransmitter system, sentinel lymph node, and liver scintigraphy decreased. Bone scintigraphy was a leading examination (32.3%), followed by myocardial scintigraphy (24.1%) and cerebral perfusion study (18.0%) in order. SPECT studies showed an increase from 47.2% to 63.5%. PET centers have also increased from 295 to 389, as compared to the last survey. The 112 PET centers have installed one or two in-house cyclotrons. PET studies showed 24.5% increase in 5 years, with oncology accounting for 88.9%. 18F-FDG accounted for 98.2% (630,570 examinations). PET examinations using 11C-methionine have decreased, with 2440 examinations in 2017. PET examinations using 13N-NH3 have been increasing, with 2363 examinations in 2017. The number of PET studies using 11C-PIB was 904. 131I-radioiodine targeted therapies showed an increase in 5 years (23.1%), including 4487 patients for thyroid cancer. Out-patient thyroid bed ablation therapy with 1,110 MBq of 131I accounted for 36.6% of cancer patients. The number of admission rooms increased from 135 to 157 in 5 years. The number of 223Ra targeted therapies for castration-resistant metastatic prostate cancer was 1194 patients. CONCLUSIONS: Single-photon examinations showed a continuous tendency toward a decline in the survey. In contrast, the number of hybrid SPECT/CT scanner examinations has increased. PET/CT study and radionuclide targeted therapy have steadily increased.

DOSIS: An integrated computational tool for patient-specific dosimetry in nuclear medicine by Monte Carlo and dose point kernel approaches.

The use of radiolabeled molecules for tumor targeting constitutes a remarkable technique for the treatment of systemic malignancies. An accurate patient-specific dosimetry in nuclear medicine procedures should be a relevant pre-requisite in order to achieve the required lethal damage to tumor cells while maintaining possible side-effects to normal tissues at tolerable levels. It is desired to assess in vivo the radiopharmaceutical distribution for further estimation of absorbed dose released to target and involved organs. In this context, it was developed a computational toolkit, called DOSIS, in order to perform patient-specific dosimetry based on personalized patient anatomy and biodistribution of radionuclides both obtained by currently available dual PET/CT or SPECT/CT facilities. This work is focused on comparing 3D dose distributions obtained by DOSIS performing full stochastic Monte Carlo simulations versus analogue distributions obtained with analytical approaches like dose point kernel convolution and local energy deposition, when considering non-homogeneous activity or density distributions at different scales. Mathematical virtual phantoms were created for this study in order to compare results with other calculation methods. Some of the beta-emitters radionuclides commonly used for therapy (90Y, 131I, 177Lu) were investigated, and emissions of beta-particles, conversion electrons, gamma radiation, and characteristic X-rays were considered. DOSIS implements a novel code devoted to managing radiation transport simulation by means of PENELOPE Monte Carlo general-purpose routines on voxelized geometries defined by 3D mass and activity distributions. Both distributions can be defined through patients-specific images, or pre-defined virtual phantoms. Results preliminary confirmed DOSIS as a reliable and accurate toolkit for personalized internal dosimetry along with highlighting advantages/drawbacks of the different calculation schemes proposed.

Radiation dose in nuclear medicine: the hybrid imaging.

Hybrid imaging procedures such as single-photon emission computed tomography/computed tomography (SPECT/CT) and positron emission tomography/computed tomography (PET/CT) showed a rapid diffusion in recent years because of their high sensitivity, specificity, and accuracy, due to a more accurate localization and definition of scintigraphic findings. However, hybrid systems inevitably lead to an increase in patient radiation exposure because of the added CT component. Effective doses due to the radiopharmaceuticals can be estimated by multiplying the administered activities by the effective dose coefficients, while for the CT component the dose-length product can be multiplied by a conversion coefficient k. However, the effective dose value is subject to a high degree of uncertainty and must be interpreted as a broad, generic estimate of biologic risk. Although the effective dose can be used to estimate and compare the risk of radiation exposure across multiple imaging techniques, clinicians should be aware that it represents a generic evaluation of the risk derived from a given procedure to a generic model of the human body. It cannot be applied to a single individual and should not be used for epidemiologic studies or the estimation of population risks due to the inherent uncertainties and oversimplifications involved. Practical ways to reduce radiation dose to patients eligible for hybrid imaging involve adjustments to both the planning phase and throughout the execution of the study. These methods include individual justification of radiation exposure, radiopharmaceutical choice, adherence to diagnostic reference levels (DLR), patient hydration and bladder voiding, adoption of new technical devices (sensitive detectors or collimators) with new reconstruction algorithms, and implementation of appropriate CT protocols and exposure parameters.

The Physician Payment Sunshine Act: Evaluating Industrial Payments in Radiology.

RATIONALE AND OBJECTIVES: The characterization of payments made to physicians by pharmaceutical companies, device manufacturers, and group purchasing organizations is crucial for assessing potential conflicts of interest and their impact on practice patterns. This study examines the compensation received by general radiologists (GR) in the United States, as well as radiologists in the following five subspecialties: body imaging, neuroradiology, pediatric radiology, nuclear radiology and radiological physics, and vascular and interventional radiology. MATERIALS AND METHODS: Data were extracted from the Open Payments database for radiology subspecialists in the United States who received installments in calendar year 2015 from pharmaceutical and device manufacturing companies. RESULTS: In 2015, a total of $43,685,052 was paid in 65,507 payments (mean $667/payment; median $32/payment) to radiologists, including 9826 GR, 362 body imaging radiologists, 479 neuroradiologists, 127 pediatric radiologists, 175 physicians in nuclear radiology and radiological physics, and 1584 vascular and interventional radiologists. Payments were unequally distributed across these six major subspecialties of radiology (p < 0.01), with GR receiving the largest number of total payments (44,695), and neuroradiologists receiving significantly higher median payments than any other subspecialty ($80 vs $32 for all radiologists; p < 0.01). Medtronic Neurovascular was the single largest payer to all radiologists combined. CONCLUSION: Commercial entities make substantial payments to radiologists, with a significant variation in payments made to the different radiology subspecialties. While the largest number of total payments was made to GGR, the highest median payments were made to neuroradiologists, and significant dispersion in these payments was seen across different geographic regions. The impact of these payments on practice patterns remains to be elucidated.

Micro-dosimetry calculation of Auger-electron-emitting radionuclides mostly used in nuclear medicine using GEANT4-DNA.

A large number of nuclear medicine radionuclides are Auger-electron-emitters and internal conversion electrons which can transmit significant doses to the patient during diagnosis. Therefore, the dosimetry of these radioisotopes is necessary for the evaluation of their biological effects and their use for treatment and targeted-radiotherapy. In this study, dosimetry calculation of a number of widely used radioisotopes in nuclear medicine was performed on a cellular scale using Geant4-DNA simulation. S-values of some of the diagnostic radioisotopes, including 123I, 125I, 99mTc, 67Ga, 201Tl, and 111In, were evaluated in a homogeneous spherical geometry model with unit density in which the cell and nucleus were concentric. The results revealed that S-values of these diagnostic radioisotopes were mainly greater than S-values of the radioisotope 131I, which emits ß-particles; they were lower but can be compared with 211At (emitter of alpha particles) in the cellular scale. It shows better the importance of dosimetry calculation of diagnostic Auger-electron-emitting radioisotope in a cellular scale and their applicability in treatment. It should be noted that the S-values obtained out of the Geant4-DNA simulation are in line with the values of the other codes and the MIRD technique.

European research trends in nuclear medicine.

Written by associate editors of the Annals of Nuclear Medicine, this invited review article is intended to offer our readers a condensed global view on the high-quality research work that has been published in Europe last year. We have divided this article into five sections. The first three sections from the oncology category include "[18F]fluorodeoxyglucose (FDG) positron-emission tomography (PET) for therapy monitoring in malignant lymphoma", "[18F]fluoromisonidazole (FMISO) PET for hypoxia", and "lymphoscintigraphy update". It is followed by a section on "amyloid PET for Alzheimer's disease" using [11C]Pittsburgh Compound B (PiB) and [18F]florbetapir from the neurology category. The final section reviews three original articles in the field of "basic and translational molecular imaging" regardless of the category, which investigated new PET tracers such as L-4-borono-2-[18F]fluoro-phenylalanine (FBPA), O-(2-[18F]fluoroethyl)-L-tyrosine (FET) and 64Cu-NOTA-pertuzumab in small animals. We hope that this review article will arouse greater interest in our readers in recent European research trends in the field of nuclear medicine.