Journal of nuclear medicine technology最新文献

It has been some time since the Journal of Nuclear Medicine and Technology has published an article on best practices in amyloid imaging. In light of the recent Food and Drug Administration approval of new antiamyloid therapies (AATs) to decrease amyloid plaques in the brain and slow progression of mild cognitive impairment, and the potential increase in the number of amyloid PET scans being acquired to document amyloid plaques, the Journal of Nuclear Medicine and Technology felt it was a perfect time to publish a refresher on best practices. AATs are administered to help slow progression of mild cognitive impairment, allowing patients to live independently a little longer before having to give up their independence and move in with family or into an assisted living facility. Neurologists prescribing AATs must first document that the patient has amyloid plaques. To do this, amyloid PET can be performed, or a lumbar puncture can be used to look for amyloid plaques in the cerebrospinal fluid. Although the latter is more cost-effective and has no associated radiation exposure, it is highly invasive compared with amyloid PET. High-quality amyloid PET scans interpretated by a trained nuclear medicine physician are the first step and key to providing the dementia expert and patient with accurate information on amyloid status, allowing for the best decisions on patient management.

Asymmetric hot spots in the axial skeleton on bone scintigraphy may confound diagnosis. We describe an unexpected artifact of ^99mTc-methylene diphosphonate near the breast in a 55-y-old woman with breast cancer. The initial whole-body bone scintigraphy revealed a solitary focal lesion in the anterior ribs on the left side. After careful tracking, we determined that this hot spot originated from the adhesive bandage. The patient had placed it in her left front pocket after removing it from the injection site. She was rescanned after the bandage had been removed from her pocket.

Many nuclear medicine technologists find themselves in the role of clinical instructor, often without much in the way of educational background. This article provides a few recommendations on how to get started in this role. After distinguishing between the roles of affiliate education supervisor and clinical instructor, the article discusses 2 basic tools: the clinical course learning outcomes and the student handbook. Expectations for students are reviewed. An important aspect of clinical instruction is the attitude of the instructor. Clinical instructors can motivate students or demotivate them, with this choice having a significant impact on the student's development. Overall, the desire and determination to be pleasant and helpful to students make the greatest difference in their development into nuclear medicine technologists.

In the world of nuclear medicine, health care professionals face the challenge of safeguarding themselves and their patients from occupational radiation exposure. As the field experiences exponential growth, driven by the surge in approvals of radiopharmaceuticals for diagnostic and therapeutic applications, it becomes vital to delve into the delivery methods of radiopharmaceuticals. Health care professionals take precautions during radiopharmaceutical administration, including maintaining distance from radioactive sources, using shielding, limiting exposure time, and monitoring radiation levels with badges. Regular evaluations provide compliance with recommended exposure limits, yet concerns persist, especially regarding the cumulative radiation exposure from manual injections over time. Understanding the long-term effects of radiation exposure has spurred the development of cutting-edge medical device technologies, such as autoinjectors, designed to administer radiopharmaceuticals accurately while minimizing total radiation dose to health care professionals. The U.S. Pharmacopeia 825 regulation refers to these devices as "direct infusion systems." Nuclear medicine technologists commonly refer to them as "autoinjectors," whereas device manufacturers may use terms such as injection system, radiopharmaceutical injector, or infusion system. Despite variations in terminology, these devices hold a pivotal role in shaping the future of radiopharmaceutical delivery. In an era of escalating demand for PET procedures worldwide, skilled health care professionals ensure the safe and precise dosing of radiopharmaceuticals. This article explores the state-of-the-art medical devices in radiopharmaceutical delivery, spotlighting transformative medical devices currently revolutionizing the nuclear medicine landscape in the global market.

Disparity among gender and ethnicity remains an issue across medicine and health science. Only 26%-35% of trainee radiologists are female, despite more than 50% of medical students' being female. Similar gender disparities are evident across the medical imaging professions. Generative artificial intelligence text-to-image production could reinforce or amplify gender biases. Methods: In March 2024, DALL-E 3 was utilized via GPT-4 to generate a series of individual and group images of medical imaging professionals: radiologist, nuclear medicine physician, radiographer, nuclear medicine technologist, medical physicist, radiopharmacist, and medical imaging nurse. Multiple iterations of images were generated using a variety of prompts. Collectively, 120 images were produced for evaluation of 524 characters. All images were independently analyzed by 3 expert reviewers from medical imaging professions for apparent gender and skin tone. Results: Collectively (individual and group images), 57.4% (n = 301) of medical imaging professionals were depicted as male, 42.4% (n = 222) as female, and 91.2% (n = 478) as having a light skin tone. The male gender representation was 65% for radiologists, 62% for nuclear medicine physicians, 52% for radiographers, 56% for nuclear medicine technologists, 62% for medical physicists, 53% for radiopharmacists, and 26% for medical imaging nurses. For all professions, this overrepresents men compared with women. There was no representation of persons with a disability. Conclusion: This evaluation reveals a significant overrepresentation of the male gender associated with generative artificial intelligence text-to-image production using DALL-E 3 across the medical imaging professions. Generated images have a disproportionately high representation of white men, which is not representative of the diversity of the medical imaging professions.

The radiation exposure of the hands of nuclear medicine laboratory technicians is largely due to the dispensing of radiopharmaceuticals into syringes. To reduce this exposure, a multiradionuclide automatic dispensing system (ADS) for syringes of radiopharmaceuticals was introduced. The aim of this study was to determine the effect of this ADS on hand dose compared with manual dispensing. Methods: The total hand dose per month for all personnel (12 technicians) was measured with ring dosimeters at the base of the index finger for 13 mo: 7 mo with manual syringe dispensing (radiopharmaceuticals containing ^99mTc,¹⁸F, ¹⁷⁷Lu, ⁶⁸Ga, ⁹⁰Y, and ²²³Ra) and 6 mo with ADS (automatic: radiopharmaceuticals containing ¹⁸F and ¹⁷⁷Lu; manual: radiopharmaceuticals containing ^99mTc, ⁶⁸Ga, ⁹⁰Y, and ²²³Ra). Results: The mean total hand dose per month was reduced from 52.8 ± 10.2 mSv with manual dispensing to 21.9 ± 2.7 mSv with ADS (P < 0.001), which is an absolute decrease of 59%. Meanwhile, the total handled activity increased from 369 to 505 GBq (P < 0.001). ¹⁸F-containing radiopharmaceuticals were the most commonly dispensed, at 182 GBq per month. The increase in total handled activity was largely due to an increase in ¹⁷⁷Lu (from 25 to 123 GBq), partially because of the introduction of [¹⁷⁷Lu]Lu-PSMA-I&T. When correcting for this increase in handled activity, the hand dose was reduced by 69%. Conclusion: The introduction of a multiradionuclide syringe ADS decreased the hand dose to personnel by 69% when corrected for the increase in handled activity. Expanding the number of radiopharmaceuticals being dispensed by the system could potentially further decrease personnel hand dose.

We devised and clinically validated a schema of rapid personalized predictive dosimetry for ¹⁷⁷Lu-PSMA-I&T in metastatic castration-resistant prostate cancer. It supersedes traditional empiric prescription by providing clinically meaningful predicted absorbed doses for first-strike optimization. Methods: Prostate-specific membrane antigen PET was conceptualized as a simulation study that captures the complex dosimetric interplay between tumor, marrow, and kidneys at a single time point. Radiation principles of fractionation, heterogeneity, normal-organ constraints (marrow, kidney), absorbed dose, and dose rate were introduced. We created a predictive calculator in the form of a free, open-source, and user-friendly spreadsheet that can be completed within minutes. Our schema achieves speed and accuracy by sampling tissue radioconcentrations (kBq/cm³) to be analyzed in conjunction with clinical input from the user that reflect dosimetric preconditions. The marrow-absorbed dose constraint was 0.217 Gy (dose rate, ≤0.0147 Gy/h) per fraction with an interfraction interval of at least 6 wk. Results: Our first 10 patients were analyzed. The first-strike mean tumor-absorbed dose threshold for any prostate-specific antigen (PSA) response was more than 10 Gy (dose rate, >0.1 Gy/h). The metastasis with the lowest first-strike tumor-absorbed dose correlated the best with the percentage decrease of PSA; its threshold to achieve hypothetical zero PSA was 20 Gy or more. Each patient's PSA doubling time can be used to personalize their unique absorbed dose-response threshold. The predicted mean first-strike prescription constrained by marrow-absorbed dose rate per fraction was 11.0 ± 4.0 GBq. Highly favorable conditions (tumor sink effect) were dosimetrically expressed as the combination of tumor-to-normal-organ ratios of more than 150 for marrow and more than 4 for kidney. Our schema obviates the traditional role of the SUV as a predictive parameter. Conclusion: Our rapid schema is feasible to implement in any busy real-world theranostics unit and exceeds today's best practice standards. Our dosimetric thresholds and predictive parameters can radiobiologically rationalize each patient's first-strike prescription down to a single becquerel. Favorable tumor-to-normal-organ ratios can be prospectively exploited by predictive dosimetry to optimize the first-strike prescription. The scientific framework of our schema may be applied to other systemic radionuclide therapies.