Journal of nuclear medicine technology最新文献

A consistent and reliable intravenous infusion technique is critical for the safe and effective administration of therapeutic radiopharmaceuticals (TRPs) in clinical settings. This article aims to outline the benefits and limitations of the 3 industry-recognized TRP infusion methods: the syringe pump, gravity method, and peristaltic pump. Each infusion method was evaluated in the context of both Food and Drug Administration (FDA)-approved and investigational TRP administrations. Methods: The infusion methods were evaluated on the basis of the following criteria: safety of the TRP infusion; adherence to the As Low As Reasonably Achievable (ALARA) principle; ease of identifying the start and end of a continuous TRP infusion. The proposed intravenous infusion criteria can be applied to the FDA-approved or investigational TRP infusions. The 3 intravenous infusion methods, syringe pump, gravity method, and peristaltic pump, were evaluated at a single institution. The syringe pump was used and evaluated for 55 TRP intravenous infusions. The gravity method included extensive prepatient testing, but because of multiple issues and infusion uncertainties, this method was not used for TRP infusions. The peristaltic pump was used and evaluated for over 1,585 TRP intravenous single-vial infusions and 30 TRP dual-vial infusions. Results: On the basis of the infusion criteria compliance, ease of use, and reliability, the syringe pump and the peristaltic pump were successfully used for FDA-approved and investigational TRP intravenous infusions. Conclusion: As more intravenous TRPs are approved by the FDA and explored in investigational clinical trials, it is crucial to understand the benefits and limitations of each infusion method. The optimal infusion method should be selected on the basis of patient safety, reliability, and clinical application.

Neoadjuvant chemotherapy (NC) is a pivotal preoperative treatment for oral squamous cell carcinoma (OSCC), but its efficacy varies among patients. This study aims to predict the efficacy of NC in patients with OSCC, facilitating precise pretreatment stratification. Methods: We retrospectively collected pretreatment ¹⁸F-FDG parameters and clinical characteristics from 89 patients with locally advanced OSCC, including primary (n = 62) and recurrent (n = 27) OSCC. MRI was used to evaluate treatment response and calculate the depth of response (DpR), assessing the correlations between these factors and NC efficacy. Results: In patients with primary OSCC, metabolic tumor volume (MTV) and total lesion glycolysis (TLG) were independent predictors of therapeutic response (P = 0.019 and P = 0.012, respectively). With an MTV cutoff of 11.7 cm³ and a TLG cutoff of 84.2, the areas under the receiver-operating-characteristic curve were 0.739 (P = 0.004) and 0.782 (P < 0.001), respectively. Pathologic grade, SUV, MTV, and TLG were independent predictors of DpR (P < 0.05). Pathologic grading, SUV_max normalized to lean body mass, and MTV accounted for 52.9% (coefficient of determination) of the variance in DpR without significant collinearity (variance inflation factor < 5.0). Among patients with recurrent OSCC, the SUV in NC responders was higher than that of nonresponders (P < 0.01). Conclusion: Pretreatment ¹⁸F-FDG PET/CT parameters could predict NC response and DpR in patients with OSCC.

The 2024 update of the North American consensus guidelines for pediatric administered radiopharmaceutical activities (NAGL) is presented. Under the auspices of the Image Gently Alliance, a working group of 19 pediatric nuclear medicine experts, including clinicians, technologists, and physicists, worked for 2 y to update the 2016 NAGL, its most recent version. Building on previous success, the current recommendations regarding pediatric diagnostic nuclear medicine were reviewed systematically regarding their continued pertinence, the need for modification, and whether any recent protocols should be added. The working group reviewed and approved the 2024 update of the NAGL, and the update was subsequently approved by the Image Gently Alliance in the spring of 2024. None of the 23 protocols listed in the 2016 NAGL were removed; however, 9 were modified, and 6 new protocols (¹³N-NH₃ and ⁸³Rb for cardiac imaging; ¹⁸F-DOPA, ⁶⁸Ga-DOTATATE, ⁶⁸Ga-DOTATOC, and Na¹²³I for thyroid cancer imaging) were added. Five of 6 new protocols involve PET imaging, reflecting an increase in the routine use of PET in children in the past decade. This 2024 update addresses the impact of advances in imaging equipment, reconstruction, image processing, and clinical practice and the introduction of new radiopharmaceutical agents into the practice of pediatric nuclear medicine.

This study investigated the application of large language models (LLMs) with and without retrieval-augmented generation (RAG) in nuclear medicine, particularly their performance across various topics relevant to the field, to evaluate their potential use as reliable tools for professional education and clinical decision-making. Methods: We evaluated the performance of LLMs, including the OpenAI GPT-4o series, Google Gemini, Cohere, Anthropic, and Meta Llama3, across 15 nuclear medicine topics. The models' accuracy was assessed using a set of 600 sample questions, covering a range of clinical and technical domains in nuclear medicine. Overall accuracy was measured by averaging performance across these topics. Additional performance comparisons were conducted across individual models. Results: OpenAI's models, particularly openai_nvidia_gpt-4o_final and openai_mxbai_gpt-4o_final, demonstrated the highest overall accuracy, achieving scores of 0.787 and 0.783, respectively, when RAG was implemented. Anthropic Opus and Google Gemini 1.5 Pro followed closely, with competitive overall accuracy scores of 0.773 and 0.750 with RAG. Cohere and Llama3 models showed more variability in performance, with the Llama3 ollama_llama3 model (without RAG) achieving the lowest accuracy. Discrepancies were noted in question interpretation, particularly in complex clinical guidelines and imaging-based queries. Conclusion: LLMs show promising potential in nuclear medicine, improving diagnostic accuracy, especially in areas like radiation safety and skeletal system scintigraphy. This study also demonstrates that adding a RAG workflow can increase the accuracy of an off-the-shelf model. However, challenges persist in handling nuanced guidelines and visual data, emphasizing the need for further optimization in LLMs for medical applications.

A 70-y-old woman was referred for a dual-isotope subtraction scintigraphy with ¹²³I and ^99mTc-sestamibi in combination with SPECT/CT and ultrasound for the localization of parathyroid adenoma. Aside from a possible parathyroid adenoma, the SPECT/CT scan showed increased and focal ^99mTc-sestamibi uptake in the right upper lung. A biopsy revealed a primary non-small cell lung adenocarcinoma. Nonparathyroid findings during parathyroid scintigraphy are frequent and can lead to newly diagnosed malignant or premalignant lesions, providing an important opportunity to optimize treatment.