R.J. Kowalsky and K.D. Weatherman Washington, DC: American Pharmacists Association, 2020, 943 pages, $249.95 The fourth edition of Radiopharmaceuticals in Nuclear Pharmacy and Nuclear Medicine further builds on the strong foundation of the previous editions. This latest edition reorganizes the
{"title":"Radiopharmaceuticals in Nuclear Pharmacy and Nuclear Medicine","authors":"Nic J Mastascusa","doi":"10.2967/jnmt.120.253674","DOIUrl":"https://doi.org/10.2967/jnmt.120.253674","url":null,"abstract":"R.J. Kowalsky and K.D. Weatherman\u0000\u0000Washington, DC: American Pharmacists Association, 2020, 943 pages, $249.95 \u0000\u0000The fourth edition of Radiopharmaceuticals in Nuclear Pharmacy and Nuclear Medicine further builds on the strong foundation of the previous editions. This latest edition reorganizes the","PeriodicalId":22799,"journal":{"name":"The Journal of Nuclear Medicine Technology","volume":"34 1","pages":"388 - 389"},"PeriodicalIF":0.0,"publicationDate":"2020-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84520812","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
M. Posch, M. Kay, A. Harhash, J. Huang, E. Krupinski, A. Abidov, N. McMillan, P. Kuo
Regadenoson is an adenosine A2A receptor agonist widely used as a pharmacologic stress agent for myocardial perfusion imaging. Approximately 3.4 million regadenoson pharmacologic stress tests were performed annually as of 2011. Caffeine is a competitive antagonist of all adenosine receptor subtypes; thus, caffeine is typically withheld 12–24 h before stress with regadenoson. However, the effects of daily caffeine intake on regadenoson stress are unknown. This study assessed the effects of daily caffeine intake on symptoms and hemodynamic changes during stress testing with regadenoson. Methods: Patients presenting for regadenoson stress myocardial perfusion imaging were asked their amounts of daily caffeine intake. Chart review was used to collect data on demographics, comorbidities, and use of β-blockers. Data collected from the regadenoson stress test included symptoms, administration of aminophylline, heart rate, blood pressure, and arrhythmias. χ2 testing and ANOVA were used to analyze data divided into 3 categories of caffeine intake (<200, 200–400, and >400 mg daily). χ2 testing was used for nominal data, and unpaired t testing was used for continuous data. Results: In total, 101 patients were enrolled: 53% men and 47% women. Of the 101 patients, 89% reported caffeine intake, with 13% reporting heavy caffeine intake (>400 mg daily). The last intake of caffeine was at least 12 h before the test. During the test, 63% of patients reported symptoms, but the test was completed successfully in all patients. Compared with those who do not use caffeine, intake for caffeine users was associated with less chest pain (P = 0.0013), less aminophylline administration (P = 0.0371), lower resting and peak heart rate (P = 0.0497 and 0.0314, respectively), and lower diastolic blood pressure response (P = 0.0468). No associations were found between caffeine intake and arrhythmia or systolic blood pressure response. Conclusion: The use of regadenoson stress for myocardial perfusion imaging in caffeine consumers is very common, safe, and associated with a lower incidence of certain symptoms than in non–caffeine consumers. Specifically, caffeine intake was associated with less aminophylline use and chest pain.
{"title":"Daily Caffeine Consumption Is Associated with Decreased Incidence of Symptoms and Hemodynamic Changes During Pharmacologic Stress with Regadenoson","authors":"M. Posch, M. Kay, A. Harhash, J. Huang, E. Krupinski, A. Abidov, N. McMillan, P. Kuo","doi":"10.2967/jnmt.118.225219","DOIUrl":"https://doi.org/10.2967/jnmt.118.225219","url":null,"abstract":"Regadenoson is an adenosine A2A receptor agonist widely used as a pharmacologic stress agent for myocardial perfusion imaging. Approximately 3.4 million regadenoson pharmacologic stress tests were performed annually as of 2011. Caffeine is a competitive antagonist of all adenosine receptor subtypes; thus, caffeine is typically withheld 12–24 h before stress with regadenoson. However, the effects of daily caffeine intake on regadenoson stress are unknown. This study assessed the effects of daily caffeine intake on symptoms and hemodynamic changes during stress testing with regadenoson. Methods: Patients presenting for regadenoson stress myocardial perfusion imaging were asked their amounts of daily caffeine intake. Chart review was used to collect data on demographics, comorbidities, and use of β-blockers. Data collected from the regadenoson stress test included symptoms, administration of aminophylline, heart rate, blood pressure, and arrhythmias. χ2 testing and ANOVA were used to analyze data divided into 3 categories of caffeine intake (<200, 200–400, and >400 mg daily). χ2 testing was used for nominal data, and unpaired t testing was used for continuous data. Results: In total, 101 patients were enrolled: 53% men and 47% women. Of the 101 patients, 89% reported caffeine intake, with 13% reporting heavy caffeine intake (>400 mg daily). The last intake of caffeine was at least 12 h before the test. During the test, 63% of patients reported symptoms, but the test was completed successfully in all patients. Compared with those who do not use caffeine, intake for caffeine users was associated with less chest pain (P = 0.0013), less aminophylline administration (P = 0.0371), lower resting and peak heart rate (P = 0.0497 and 0.0314, respectively), and lower diastolic blood pressure response (P = 0.0468). No associations were found between caffeine intake and arrhythmia or systolic blood pressure response. Conclusion: The use of regadenoson stress for myocardial perfusion imaging in caffeine consumers is very common, safe, and associated with a lower incidence of certain symptoms than in non–caffeine consumers. Specifically, caffeine intake was associated with less aminophylline use and chest pain.","PeriodicalId":22799,"journal":{"name":"The Journal of Nuclear Medicine Technology","volume":"43 1","pages":"73 - 76"},"PeriodicalIF":0.0,"publicationDate":"2020-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81193873","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
M. Kay, Lilah F. Morris-Wiseman, Alex Beazer, B. Winegar, P. Kuo
A 56-y-old man underwent total thyroidectomy and bilateral central and right lateral neck dissection for papillary thyroid carcinoma with lymph nodes metastases. Before radioiodine ablation, a 123I scan established the diagnosis of primary nasolacrimal duct obstruction (dacryostenosis).
{"title":"Primary Nasolacrimal Duct Obstruction Visualized on 123I Preablation Scan for Papillary Thyroid Carcinoma","authors":"M. Kay, Lilah F. Morris-Wiseman, Alex Beazer, B. Winegar, P. Kuo","doi":"10.2967/jnmt.119.235010","DOIUrl":"https://doi.org/10.2967/jnmt.119.235010","url":null,"abstract":"A 56-y-old man underwent total thyroidectomy and bilateral central and right lateral neck dissection for papillary thyroid carcinoma with lymph nodes metastases. Before radioiodine ablation, a 123I scan established the diagnosis of primary nasolacrimal duct obstruction (dacryostenosis).","PeriodicalId":22799,"journal":{"name":"The Journal of Nuclear Medicine Technology","volume":"35 1","pages":"77 - 78"},"PeriodicalIF":0.0,"publicationDate":"2020-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75264433","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
This article is the second part of a continuing education series reviewing the Health Insurance Portability and Accountability Act (HIPAA) of 1996. The term HIPAA should be familiar to those who work in the medical profession, but this article includes details on its rules, patients’ rights, violations, breaches, and penalties. To help administer these safeguards, HIPAA requires that every organization designate a HIPAA privacy and security officer. HIPAA violations can have serious repercussions when rules are not followed; these violations can be either negligent or willful. If breaches of unsecured protected health information occur, HIPAA requires covered entities to notify affected individuals, the Secretary of Health and Human Services, and in some cases the media. Violations in which the covered entity did not know of the violation are now punishable under the first tier of penalties. Unintended violations carry a minimum penalty of $100 per violation and a maximum of $50,000 per violation. All patients have a right to privacy and a right to confidential use of their medical records. The role of medical professionals includes understanding how and when to apply these HIPAA rules verbally and electronically.
{"title":"Review of HIPAA, Part 2: Limitations, Rights, Violations, and Role for the Imaging Technologist","authors":"Wilnellys Moore, Sarah A. Frye","doi":"10.2967/jnmt.119.227827","DOIUrl":"https://doi.org/10.2967/jnmt.119.227827","url":null,"abstract":"This article is the second part of a continuing education series reviewing the Health Insurance Portability and Accountability Act (HIPAA) of 1996. The term HIPAA should be familiar to those who work in the medical profession, but this article includes details on its rules, patients’ rights, violations, breaches, and penalties. To help administer these safeguards, HIPAA requires that every organization designate a HIPAA privacy and security officer. HIPAA violations can have serious repercussions when rules are not followed; these violations can be either negligent or willful. If breaches of unsecured protected health information occur, HIPAA requires covered entities to notify affected individuals, the Secretary of Health and Human Services, and in some cases the media. Violations in which the covered entity did not know of the violation are now punishable under the first tier of penalties. Unintended violations carry a minimum penalty of $100 per violation and a maximum of $50,000 per violation. All patients have a right to privacy and a right to confidential use of their medical records. The role of medical professionals includes understanding how and when to apply these HIPAA rules verbally and electronically.","PeriodicalId":22799,"journal":{"name":"The Journal of Nuclear Medicine Technology","volume":"78 1","pages":"17 - 23"},"PeriodicalIF":0.0,"publicationDate":"2020-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74474706","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Sait Sağer, Aslan Aygün, Emre Karayel, Hüseyin Pehlivanoğlu, K. Sönmezoğlu
A number of different peptides or antibodies have been labeled with 177Lu and used for clinical imaging and treatment. To our knowledge, 177Lu had never before been used to label macroaggregated albumin, and our radiopharmacy laboratory at Istanbul University–Cerrahpaşa made a special effort to do so. We present the case of a 43-y-old man whose cystic thyroid nodule was treated with an intranodular injection of 177Lu-macroaggregated albumin and imaged with SPECT/CT.
{"title":"177Lu-Labeled Macroaggregated Albumin Imaging and Treatment Effect in Patient with Cystic Thyroid Nodule","authors":"Sait Sağer, Aslan Aygün, Emre Karayel, Hüseyin Pehlivanoğlu, K. Sönmezoğlu","doi":"10.2967/jnmt.119.226340","DOIUrl":"https://doi.org/10.2967/jnmt.119.226340","url":null,"abstract":"A number of different peptides or antibodies have been labeled with 177Lu and used for clinical imaging and treatment. To our knowledge, 177Lu had never before been used to label macroaggregated albumin, and our radiopharmacy laboratory at Istanbul University–Cerrahpaşa made a special effort to do so. We present the case of a 43-y-old man whose cystic thyroid nodule was treated with an intranodular injection of 177Lu-macroaggregated albumin and imaged with SPECT/CT.","PeriodicalId":22799,"journal":{"name":"The Journal of Nuclear Medicine Technology","volume":"23 1","pages":"79 - 80"},"PeriodicalIF":0.0,"publicationDate":"2020-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75826837","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
J. Machado, S. Doshi, R. Smith, M. Evans, R. Graham, S. Redman, D. Little
Bone scintigraphy is one of the most common nuclear medicine tests. Previous work investigated the effectiveness of an asymmetric window (ASW) for planar bone scintigraphy using simulation and phantom data. Phantom studies concluded that the ASW improved both the resolution and the contrast-to-noise ratio when imaging objects with high scatter. The aim of this study was to confirm this improvement increased image quality in patients. This study also investigated whether the differences between a symmetric window (SW) and an ASW depended on body mass index. Methods: Fifty-eight patients had 2 scans: a standard scan using an SW of 140 keV ± 10% and a scan using an ASW of 140 keV + 10% and − 7.5%. Three readers independently compared the 2 image sets and scored them using a 5-score scale (ranging from 1 = ASW better [clinically important] to 5 = SW better [clinically important]). Scores from all radiologists were pooled and analyzed statistically. A P value of less than 0.05 was considered statistically significant. Results: In 93 cases (53%), the readers scored the ASW images better than the SW images. In 5 cases (3%), the ASW images were preferred, with the difference considered clinically important; there were no cases in which the SW was similarly preferred. For the sign test, we determined whether the total of 93 scores of 1 or 2 (ASW preferred) was significantly different from the 15 scores of 4 or 5 (SW preferred). The P value was less than 0.00001, demonstrating that the difference was significant. Conclusion: In patients undergoing bone scintigraphy, ASW provided an improvement in image quality that in some cases was judged clinically important.
{"title":"The Effect of an Asymmetric Energy Window on Bone Scintigraphy Image Quality","authors":"J. Machado, S. Doshi, R. Smith, M. Evans, R. Graham, S. Redman, D. Little","doi":"10.2967/jnmt.119.233577","DOIUrl":"https://doi.org/10.2967/jnmt.119.233577","url":null,"abstract":"Bone scintigraphy is one of the most common nuclear medicine tests. Previous work investigated the effectiveness of an asymmetric window (ASW) for planar bone scintigraphy using simulation and phantom data. Phantom studies concluded that the ASW improved both the resolution and the contrast-to-noise ratio when imaging objects with high scatter. The aim of this study was to confirm this improvement increased image quality in patients. This study also investigated whether the differences between a symmetric window (SW) and an ASW depended on body mass index. Methods: Fifty-eight patients had 2 scans: a standard scan using an SW of 140 keV ± 10% and a scan using an ASW of 140 keV + 10% and − 7.5%. Three readers independently compared the 2 image sets and scored them using a 5-score scale (ranging from 1 = ASW better [clinically important] to 5 = SW better [clinically important]). Scores from all radiologists were pooled and analyzed statistically. A P value of less than 0.05 was considered statistically significant. Results: In 93 cases (53%), the readers scored the ASW images better than the SW images. In 5 cases (3%), the ASW images were preferred, with the difference considered clinically important; there were no cases in which the SW was similarly preferred. For the sign test, we determined whether the total of 93 scores of 1 or 2 (ASW preferred) was significantly different from the 15 scores of 4 or 5 (SW preferred). The P value was less than 0.00001, demonstrating that the difference was significant. Conclusion: In patients undergoing bone scintigraphy, ASW provided an improvement in image quality that in some cases was judged clinically important.","PeriodicalId":22799,"journal":{"name":"The Journal of Nuclear Medicine Technology","volume":"6 1","pages":"46 - 50"},"PeriodicalIF":0.0,"publicationDate":"2020-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76001436","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Parul Thakral, I. Sen, J. Šimeček, Sebastian Marx, Jyotsna Kumari, Sunil Kumar, P. Tandon, S. Dureja, Vineet Pant
Because of the excellent ability of α-particles to transfer a high amount of energy over a short tissue range, targeted α-therapy has been attracting rising numbers of nuclear medicine centers. In this study, we estimated the radiation exposure to the occupational workers with pocket dosimeters during handling of the α-emitter 213Bi, used for targeted α-therapy of neuroendocrine tumor and castration-resistant prostate cancer patients. The dose rates from patients at different distances and time points after injection of the therapy were also evaluated. Methods: This prospective study was done in the Department of Nuclear Medicine at Fortis Memorial Research Institute, Gurgaon, India. Twelve patients with neuroendocrine tumors or castration-resistant prostate cancer were enrolled to receive 213Bi-DOTATOC or 213Bi-prostate-specific membrane antigen therapy, respectively. Each patient received 2–3 intravenous injections of 213Bi-peptide, 266–362 MBq (7.2–9.8 mCi) in a single cycle over 2–3 d. The radiation exposure to nuclear medicine personnel at the chest and extremity levels was assessed for tasks such as elution, dispensing, injecting, and collecting blood samples. Radiation levels were measured at distances of 1 cm and 1 m from patients immediately after, and at 1, 2, and 4 h after, the administration of 213Bi-peptide. Results: The external dose incurred at the chest level by radiopharmacists during synthesis, by physicians during injection, by technologists during imaging, and by nurses during sample collection was 2–7 μSv/procedure. The extremity dose was 1–14 μSv/procedure. The dose rate at 1 m from patients immediately after 213Bi-radiopharmaceutical injection was 0.02–0.03 μSv/MBq⋅h. Conclusion: The external radiation doses received by occupational workers involved in various procedures were far below the limit prescribed by the regulatory authority (20 mSv/y).
{"title":"Radiation Exposure to the Nuclear Medicine Personnel During Preparation and Handling of 213Bi-Radiopharmaceuticals","authors":"Parul Thakral, I. Sen, J. Šimeček, Sebastian Marx, Jyotsna Kumari, Sunil Kumar, P. Tandon, S. Dureja, Vineet Pant","doi":"10.2967/jnmt.119.230516","DOIUrl":"https://doi.org/10.2967/jnmt.119.230516","url":null,"abstract":"Because of the excellent ability of α-particles to transfer a high amount of energy over a short tissue range, targeted α-therapy has been attracting rising numbers of nuclear medicine centers. In this study, we estimated the radiation exposure to the occupational workers with pocket dosimeters during handling of the α-emitter 213Bi, used for targeted α-therapy of neuroendocrine tumor and castration-resistant prostate cancer patients. The dose rates from patients at different distances and time points after injection of the therapy were also evaluated. Methods: This prospective study was done in the Department of Nuclear Medicine at Fortis Memorial Research Institute, Gurgaon, India. Twelve patients with neuroendocrine tumors or castration-resistant prostate cancer were enrolled to receive 213Bi-DOTATOC or 213Bi-prostate-specific membrane antigen therapy, respectively. Each patient received 2–3 intravenous injections of 213Bi-peptide, 266–362 MBq (7.2–9.8 mCi) in a single cycle over 2–3 d. The radiation exposure to nuclear medicine personnel at the chest and extremity levels was assessed for tasks such as elution, dispensing, injecting, and collecting blood samples. Radiation levels were measured at distances of 1 cm and 1 m from patients immediately after, and at 1, 2, and 4 h after, the administration of 213Bi-peptide. Results: The external dose incurred at the chest level by radiopharmacists during synthesis, by physicians during injection, by technologists during imaging, and by nurses during sample collection was 2–7 μSv/procedure. The extremity dose was 1–14 μSv/procedure. The dose rate at 1 m from patients immediately after 213Bi-radiopharmaceutical injection was 0.02–0.03 μSv/MBq⋅h. Conclusion: The external radiation doses received by occupational workers involved in various procedures were far below the limit prescribed by the regulatory authority (20 mSv/y).","PeriodicalId":22799,"journal":{"name":"The Journal of Nuclear Medicine Technology","volume":"47 1","pages":"68 - 72"},"PeriodicalIF":0.0,"publicationDate":"2020-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84724522","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
PET imaging, particularly oncologic applications of 18F-FDG, has become a routine diagnostic study. To better describe malignancies, various PET parameters are used. In 18F-FDG PET studies, SUVmax is the most commonly used parameter to measure the metabolic activity of the tumor. In obese patients, SUV corrected by lean body mass (SUL), and in pediatric patients, SUV corrected by body surface area, are recommended. Metabolic tumor volume is an important parameter to determine the local and total tumor burden. Total lesion glycolysis (SUVmean × metabolic tumor volume) provides information about averages. Some treatment response assessment protocols recommend using the SUVpeak or SULpeak of the tumor. Tumor-to-liver ratio and tumor–to–blood-pool ratio are helpful when comparing studies for treatment response assessment. Dual–time-point PET imaging with retention index can help differentiate malignant from benign lesions and may help detect small lesions. Dynamic 18F-FDG PET imaging and quantitative analysis can measure the metabolic, phosphorylation, and dephosphorylation rates of lesions but are mainly used for research purposes. In this article, we will review the currently available PET parameters in 18F-FDG studies with their importance, uses, limitations, and reasons for erroneous results.
{"title":"Assessing PET Parameters in Oncologic 18F-FDG Studies","authors":"I. Sarikaya, A. Sarıkaya","doi":"10.2967/jnmt.119.236109","DOIUrl":"https://doi.org/10.2967/jnmt.119.236109","url":null,"abstract":"PET imaging, particularly oncologic applications of 18F-FDG, has become a routine diagnostic study. To better describe malignancies, various PET parameters are used. In 18F-FDG PET studies, SUVmax is the most commonly used parameter to measure the metabolic activity of the tumor. In obese patients, SUV corrected by lean body mass (SUL), and in pediatric patients, SUV corrected by body surface area, are recommended. Metabolic tumor volume is an important parameter to determine the local and total tumor burden. Total lesion glycolysis (SUVmean × metabolic tumor volume) provides information about averages. Some treatment response assessment protocols recommend using the SUVpeak or SULpeak of the tumor. Tumor-to-liver ratio and tumor–to–blood-pool ratio are helpful when comparing studies for treatment response assessment. Dual–time-point PET imaging with retention index can help differentiate malignant from benign lesions and may help detect small lesions. Dynamic 18F-FDG PET imaging and quantitative analysis can measure the metabolic, phosphorylation, and dephosphorylation rates of lesions but are mainly used for research purposes. In this article, we will review the currently available PET parameters in 18F-FDG studies with their importance, uses, limitations, and reasons for erroneous results.","PeriodicalId":22799,"journal":{"name":"The Journal of Nuclear Medicine Technology","volume":"1 1","pages":"278 - 282"},"PeriodicalIF":0.0,"publicationDate":"2019-12-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73106011","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
R. Spandorfer, Yin Zhu, M. Abdelfatah, P. Mekaroonkamol, Sunil Dacha, J. Galt, R. Halkar, Q. Cai
Gastroparesis is a debilitating disease of insufficient gastric emptying and visceral hypersensitivity characterized by nausea, vomiting, early satiety, and bloating. Gastric emptying scintigraphy (GES), in combination with typical symptoms and normal esophagogastroduodenoscopy findings, is used to diagnose the disease. Gastric per-oral endoscopic pyloromyotomy (G-POEM) has emerged as a novel technique for treating gastroparesis, with up to an 80% success rate. This procedure involves myotomy of the distal stomach. We hypothesize that responders to this therapy are characterized by more distal dysmotility than nonresponders, as defined by GES retention patterns. Methods: We used regional gastric emptying measurements from diagnostic GES to determine the proximal or distal predominance of disease for each patient. We then compared treatment response and symptoms in each patient to total gastric half-emptying time (T½), proximal gastric T½, and a ratio comparing the 2 values. Results: In total, 47 patients underwent G-POEM during the study period. A significant difference (P < 0.01) was found in proximal-to-total T½ ratio between responders and nonresponders. A significant difference between pre- and postprocedural proximal-to-total T½ ratios was identified for each patient. No correlations were identified between motility patterns and symptoms or in motility patterns among the different etiologies of the disease. Conclusion: Proximal-to-total T½ ratio may represent an important patient selection factor for G-POEM versus other treatment modalities going forward. Local retention patterns in GES may not inform the symptom profile in gastroparesis.
{"title":"Proximal and Distal Gastric Retention Patterns in Gastroparesis and the Impact of Gastric Per-Oral Endoscopic Myotomy: A Retrospective Analysis Using Gastric Emptying Scintigraphy","authors":"R. Spandorfer, Yin Zhu, M. Abdelfatah, P. Mekaroonkamol, Sunil Dacha, J. Galt, R. Halkar, Q. Cai","doi":"10.2967/jnmt.119.235630","DOIUrl":"https://doi.org/10.2967/jnmt.119.235630","url":null,"abstract":"Gastroparesis is a debilitating disease of insufficient gastric emptying and visceral hypersensitivity characterized by nausea, vomiting, early satiety, and bloating. Gastric emptying scintigraphy (GES), in combination with typical symptoms and normal esophagogastroduodenoscopy findings, is used to diagnose the disease. Gastric per-oral endoscopic pyloromyotomy (G-POEM) has emerged as a novel technique for treating gastroparesis, with up to an 80% success rate. This procedure involves myotomy of the distal stomach. We hypothesize that responders to this therapy are characterized by more distal dysmotility than nonresponders, as defined by GES retention patterns. Methods: We used regional gastric emptying measurements from diagnostic GES to determine the proximal or distal predominance of disease for each patient. We then compared treatment response and symptoms in each patient to total gastric half-emptying time (T½), proximal gastric T½, and a ratio comparing the 2 values. Results: In total, 47 patients underwent G-POEM during the study period. A significant difference (P < 0.01) was found in proximal-to-total T½ ratio between responders and nonresponders. A significant difference between pre- and postprocedural proximal-to-total T½ ratios was identified for each patient. No correlations were identified between motility patterns and symptoms or in motility patterns among the different etiologies of the disease. Conclusion: Proximal-to-total T½ ratio may represent an important patient selection factor for G-POEM versus other treatment modalities going forward. Local retention patterns in GES may not inform the symptom profile in gastroparesis.","PeriodicalId":22799,"journal":{"name":"The Journal of Nuclear Medicine Technology","volume":"91 1","pages":"158 - 162"},"PeriodicalIF":0.0,"publicationDate":"2019-12-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74207079","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
J. Caskey, M. Kay, N. McMillan, P. Kuo, G. Woodhead
90Y radioembolization is a safe and efficacious treatment option for many patients with unresectable hepatocellular carcinoma. Potential candidates for radioembolization, based on clinical criteria, undergo 99mTc-labeled macroaggregated albumin imaging to determine the extent of hepatopulmonary shunting. Dose selection is based on results from shunt imaging and can exclude patients from radioembolization therapy. We present a case of miscalculated lung shunt fraction and the circumstances that led to the critical error.
{"title":"Miscalculated Lung Shunt Fraction for Planning of Hepatic Radioembolization","authors":"J. Caskey, M. Kay, N. McMillan, P. Kuo, G. Woodhead","doi":"10.2967/jnmt.119.234385","DOIUrl":"https://doi.org/10.2967/jnmt.119.234385","url":null,"abstract":"90Y radioembolization is a safe and efficacious treatment option for many patients with unresectable hepatocellular carcinoma. Potential candidates for radioembolization, based on clinical criteria, undergo 99mTc-labeled macroaggregated albumin imaging to determine the extent of hepatopulmonary shunting. Dose selection is based on results from shunt imaging and can exclude patients from radioembolization therapy. We present a case of miscalculated lung shunt fraction and the circumstances that led to the critical error.","PeriodicalId":22799,"journal":{"name":"The Journal of Nuclear Medicine Technology","volume":"33 1","pages":"184 - 186"},"PeriodicalIF":0.0,"publicationDate":"2019-12-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89330525","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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