Bone scan index: A new biomarker of bone metastasis in patients with prostate cancer.

Bone scintigraphy is one of the first-line imaging modalities for the screening and follow up of bone metastasis in patients with prostate cancer. The amount (%) of bone metastasis can be calculated using a bone scan index thanks to recent advances in quantitative bone scintigraphy. Since an artificial neural network was applied for hot-spot characterization and quantitation, the bone scan index has become a simple, reproducible and practical means of quantifying bone metastasis. The bone scan index is presently considered as an imaging biomarker of bone metastasis. The present article summarizes the principles and application of bone scan index using dedicated software (EXINI bone in Europe and North America; BONENAVI in Japan), and the advantages and cautions of using the bone scan index. The bone scan index could serve as a practical marker with which to monitor disease progression and treatment effects in multicenter studies, and to manage prostate and other types of cancer in the clinical setting.

Radionuclide Evaluation of Brain Death in the Post-McMath Era.

The pronouncement of death is a determination of paramount social, legal, and ethical import. The novel construct of "brain death" was introduced 50 years ago, yet there persist gaps in understanding regarding this diagnosis on the part of medical caregivers and families. The tragic, much-publicized case of Jahi McMath typifies potential problems that can be encountered with this diagnosis and serves as an effective point of departure for discussion. This article recapitulates the historical development of brain death and the evolution of scintigraphic examinations as ancillary or confirmatory studies, emphasizing updated clinical and imaging practice guidelines and the current role of scintigraphy. The limitations of clinical and radionuclide studies are then reviewed. Finally, the article examines whether radionuclide examinations might be able to play an expanded role in the determination of brain death by improving accuracy and facilitating effective communication with family members.

Historical Patterns in the Types of Procedures Performed and Radiation Safety Practices Used in Nuclear Medicine From 1945-2009.

The authors evaluated historical patterns in the types of procedures performed in diagnostic and therapeutic nuclear medicine and the associated radiation safety practices used from 1945-2009 in a sample of U.S. radiologic technologists. In 2013-2014, 4,406 participants from the U.S. Radiologic Technologists (USRT) Study who previously reported working with medical radionuclides completed a detailed survey inquiring about the performance of 23 diagnostic and therapeutic radionuclide procedures and the use of radiation safety practices when performing radionuclide procedure-related tasks during five time periods: 1945-1964, 1965-1979, 1980-1989, 1990-1999, and 2000-2009. An overall increase in the proportion of technologists who performed specific diagnostic or therapeutic procedures was observed across the five time periods. Between 1945-1964 and 2000-2009, the median frequency of diagnostic procedures performed substantially increased (from 5 wk to 30 wk), attributable mainly to an increasing frequency of cardiac and non-brain PET scans, while the median frequency of therapeutic procedures performed modestly decreased (from 4 mo to 3 mo). Also a notable increase was observed in the use of most radiation safety practices from 1945-1964 to 2000-2009 (e.g., use of lead-shielded vials during diagnostic radiopharmaceutical preparation increased from 56 to 96%), although lead apron use dramatically decreased (e.g., during diagnostic imaging procedures, from 81 to 7%). These data describe historical practices in nuclear medicine and can be used to support studies of health risks for nuclear medicine technologists.

From Roentgen to magnetic resonance imaging: the history of medical imaging.

Medical imaging has advanced in remarkable ways since the discovery of x-rays 120 years ago. Today's radiologists can image the human body in intricate detail using computed tomography, magnetic resonance imaging, positron emission tomography, ultrasound, and various other modalities. Such technology allows for improved screening, diagnosis, and monitoring of disease, but it also comes with risks. Many imaging modalities expose patients to ionizing radiation, which potentially increases their risk of developing cancer in the future, and imaging may also be associated with possible allergic reactions or risks related to the use of intravenous contrast agents. In addition, the financial costs of imaging are taxing our health care system, and incidental findings can trigger anxiety and further testing. This issue of the NCMJ addresses the pros and cons of medical imaging and discusses in detail the following uses of medical imaging: screening for breast cancer with mammography, screening for osteoporosis and monitoring of bone mineral density with dual-energy x-ray absorptiometry, screening for congenital hip dysplasia in infants with ultrasound, and evaluation of various heart conditions with cardiac imaging. Together, these articles show the challenges that must be met as we seek to harness the power of today's imaging technologies, as well as the potential benefits that can be achieved when these hurdles are overcome.

The evolution of whole-body imaging.

This article reviews the evolution of whole-body imaging, discussing the history and development of radiography, nuclear medicine, computed tomography (CT), positron emission tomography (PET), combined PET-CT, and magnetic resonance imaging. The obstacles hindering progress toward whole-body imaging using each of these modalities, and the technical advances that were developed to overcome them, are reviewed. The effectiveness and the limitations of whole-body imaging with each of these techniques are also briefly discussed.

[A scintillating specialty. Excerpts from the history of nuclear medicine in Denmark]. / Et strålende speciale. Glimt af nuklearmedicinens historie i Danmark.

Nuclear medicine is among the youngest medical specialties but its history spans more than a century. From the earliest discoveries of radioactivity and the establishment of the novel field of nuclear physics at the turn of the twentieth century and via the developments in radiochemistry set in motion by George de Hevesy from his base in Copenhagen to the specialty of today offering a multitude of diagnostic procedures. The present work is not intended to cover the entire history of nuclear medicine exhaustively but focus on pivotal events in the development of the field with special reference to Denmark.

The evolution of nuclear medicine and the musculoskeletal system.

This article reviews the evolution of nuclear medicine in the evaluation of the musculoskeletal system over the past hundred years, from autoradiography and Geiger counters and rectilinear scanners to sophisticated imaging devices that provide both functional and morphological information. Initially synonymous with bone scanning, radionuclide evaluation of musculoskeletal disorders now includes gallium, labeled leukocytes, FDG, and fluourine-18, indications and applications of which are reviewed.

[Lymphatic system and lymphoscintigraphy].

Starting from Hippocrates era, the lymphatic system has been an interesting area of study for its anatomy, physiology, pathophysiology and imaging. The present review describes the history of the lymphatic system and lymphoscintigraphy. Lymphoscintigraphy comprises a simple, non-invasive imaging method of the lymphatic system and the sentinel lymph node or nodes. Additionally the intra-operative gamma-probe detection and the blue dye technique are also presented. The nuclear methods have been incorporated in the algorithm of the diagnostic approach and the therapeutic treatment of cutaneous melanoma and breast cancer, while further experience is warranted in other solid malignancies.

Molecular imaging of atherosclerosis.

Techniques are being developed for clinical molecular imaging of atherosclerosis to identify and characterize vulnerable plaques in each vascular territory. Molecular imaging encompasses multiple imaging modalities that depict cellular and subcellular processes. Molecular imaging can provide a "virtual histology" noninvasively about atherosclerotic disease, characterizing vascular lesions with markers of inflammation, angiogenesis, lipid metabolism, and more.