Development of Simple Methods to Reduce the Exposure of the Public to Radiation from Patients Who Have Undergone 18F-FDG PET/CT.

At a time when reducing the radiation dose to patients and the public has become a major focus, we assessed the radiation exposure rate from patients after an 18F-FDG PET/CT scan and evaluated different interventions to reduce it. Methods: We enrolled 100 patients, divided into 2 groups. For both groups, the radiation dose rate was measured with an ionization survey meter immediately after the scan. For group 1, the patients then voided and their dose rate was measured again. For group 2, the patients waited 30 min before voiding, and we measured the dose rate before (group 2A) and after (group 2B) they voided. Results: In total, 74 of the 100 patients exceeded the 20 µSv/h (2 mR/h) threshold immediately after the scan. In group 1, the mean dose rate decreased by 20.0% from the postscan measurement, with 12 of 36 remaining at or above 20 µSv/h. In group 2A, the mean dose rate decreased by 23% from the postscan measurement, with 9 of 38 remaining at or above 20 µSv/h. In group 2B, the mean dose rate decreased by 35% from the postscan measurement, with 1 of 38 remaining at 20 µSv/h. Conclusion: Nearly 75% of patients undergoing an 18F-FDG PET/CT scan exceed 20 µSv/h when leaving the imaging facility. The most effective method to reduce radiation exposure was to have the patient void 30 min after the examination.

Predictors and Outcomes Associated With Adherence to Weekly Alendronate in US Military Veterans: Clinical Research Study.

Background: Poor adherence to oral bisphosphonates is a challenge to treatment and prevention of osteoporosis. The Veterans Health Administration (VA) operates the largest integrated health care system in the United States and offers certain advantages to possibly improve medication adherence. We aimed to determine adherence to weekly alendronate for osteoporosis in Veterans, and investigate predictors and outcomes related to adherence. Methods: A retrospective study cohort was generated from VA databases selecting Veterans who were treated with weekly alendronate. Adherence was measured by medication possession ratio (MPR) and persistence. Two groups were defined as low and high adherence based on MPR <80% or ≥80%, respectively. Regression models were used to investigate predictors of adherence and included clinically relevant covariates. Further regressions were used to investigate the impact of adherence on change in bone mineral density measured by dual energy X-ray absorptiometry and incident fracture. Results: In a cohort of 913 (female/male, 207/706) Veterans, 48% had high adherence in year 1. Distribution for gender, race, and age were similar between the 2 groups, MPR <80% or MPR ≥80%. Baseline fracture [odds ratio OR: 0.64, 95%CI: (0.41, 0.98)], alcohol abuse [0.40 (0.21, 0.74)] and tobacco use [0.44 (0.31, 0.63)] were associated with low adherence in the unadjusted analyses, but only tobacco use [0.45 (0.30, 0.67)] was associated with low adherence after adjustment. Among males, tobacco use was associated with low adherence while prostate cancer predicted high adherence in adjusted models. High adherence was associated with a 30% [hazard ratio HR: 0.70, 95% CI: (0.47, 1.03)] decreased risk of incident fracture in the whole cohort, and a 40% [0.60 (0.38, 0.95)] decrease risk in males. Conclusion: Year one adherence to weekly alendronate was a relevant determinant to long-term clinical outcomes including changes in bone mineral density and incident fracture in Veterans.

The Need for Increased Awareness About Potential Quality Control Problems in Aging γ-Cameras.

Quality control in a nuclear medicine department plays an important role in providing quality care for patients. Closely monitoring the uniformity values on extrinsic quality control can give insight into problems outside typical equipment issues. This facility noticed increasing uniformity values along with a photopenic image artifact. The detector required photocoupling gel replacement and a full rebuild by service engineers. This process required time for the rebuild and time for the gel to set. Another adjustment of the voltage to the photomultiplier tubes (PMTs) was required due to photocathode excitation in every cathode in every PMT in that detector. After the detector was rebuilt, the voltage was retuned with the field service engineers' knowledge that the PMTs would need to be retuned due to this excitation. Communication and understanding of equipment problems in aging γ-cameras can lead to proper equipment use and better quality in nuclear medicine departments.

Incidental Findings on Myocardial Perfusion SPECT Images.

Myocardial perfusion SPECT plays a crucial role in the diagnosis of coronary artery disease, providing a noninvasive tool to monitor ischemia and infarction. The findings can have a profound impact on diagnosis and management in these patients. However, incidental noncardiac findings on myocardial perfusion SPECT images can also affect management. These noncardiac subtleties are most often detected on the rotating raw SPECT images, which are often overlooked. The intent of this pictorial essay is to illustrate several subtle noncardiac abnormalities within nuclear cardiac imaging that can have an impact on patient management and follow-up.

Accessory spleen masquerading as a pancreatic neoplasm.

A patient with a pancreatic mass noted on a computed tomography scan was suspected of having a nonfunctioning pancreatic neuroendocrine neoplasm. The eventual diagnosis of intrapancreatic accessory spleen was made by noninvasive means, thus avoiding unnecessary surgery.