H. Kvaternik, Jakob Gatterer, Elisabeth Plhak, J. Schwarzgruber, R. Aigner
The phenomenon of adsorption of several 99mTc-radiopharmaceuticals onto disposable syringes is common knowledge and can reach a level of up to 50%, with the result being inadequate dosing. The resulting underdosing has a substantial influence on the quality of imaging, especially in pediatric patients. Therefore, we aimed to establish a standardized in vitro assessment to investigate the adsorption of several 99mTc-radiopharmaceuticals on various brands of syringes. Methods: The 99mTc-radiopharmaceuticals were prepared according to manufacturer instructions. For the assessment, the disposable syringes (n = 3) were filled to one third of capacity with the 99mTc preparation and incubated for 30 min at room temperature. The syringes were emptied into evacuated vials, and the radioactivity of the syringes was measured before and after they were emptied. Furthermore, the dilution effect of 99mTc preparations was studied. We used 2 different brands of syringes and systematically examined 99mTc-pertechnetate, 99mTc-butedronate, 99mTc-oxidronate, 99mTc-medronate, 99mTc-tetrofosmin, 99mTc-sestamibi, 99mTc(V)-dimercaptosuccinic acid, and 99mTc-succimer. Additionally, 99mTc-succimer was retested with 5 brands of syringes. Results: 99mTc-pertechnetate, 99mTc-phosphonates, and 99mTc(V)-dimercaptosuccinic acid showed no significant adsorption. The measured radioactive retention of 2%–5% was equivalent to the determined dead volume. Using 99mTc-tetrofosmin, we found a slight but significant adsorption of 4%–7%. The 99mTc-sestamibi preparation showed a nonsignificant retention of 3%–5%. However, when the 99mTc-sestamibi was diluted 1:10 with saline, the adsorption rate increased to 9%–13%. 99mTc-succimer displayed different adsorption levels depending on the brand of syringe and the preparation technique. The adsorption of 99mTc-succimer, prepared from kits according to the instructions, did not exceed 15%. The 1:10 saline dilution of a 99mTc-succimer kit preparation, as well as an in-house preparation, demonstrated a radioactive syringe adsorption rate of more than 30%. Conclusion: The results revealed the significance of syringe adsorption of radiopharmaceuticals in the prevention of underdosing. Therefore, a quality assurance assessment is recommended before the introduction of new brands of plastic syringes or routine application of diluted or in-house radiopharmaceuticals.
{"title":"Systematic Assessment of the Adsorption of 99mTc-Radiopharmaceuticals onto Plastic Syringes","authors":"H. Kvaternik, Jakob Gatterer, Elisabeth Plhak, J. Schwarzgruber, R. Aigner","doi":"10.2967/jnmt.119.235432","DOIUrl":"https://doi.org/10.2967/jnmt.119.235432","url":null,"abstract":"The phenomenon of adsorption of several 99mTc-radiopharmaceuticals onto disposable syringes is common knowledge and can reach a level of up to 50%, with the result being inadequate dosing. The resulting underdosing has a substantial influence on the quality of imaging, especially in pediatric patients. Therefore, we aimed to establish a standardized in vitro assessment to investigate the adsorption of several 99mTc-radiopharmaceuticals on various brands of syringes. Methods: The 99mTc-radiopharmaceuticals were prepared according to manufacturer instructions. For the assessment, the disposable syringes (n = 3) were filled to one third of capacity with the 99mTc preparation and incubated for 30 min at room temperature. The syringes were emptied into evacuated vials, and the radioactivity of the syringes was measured before and after they were emptied. Furthermore, the dilution effect of 99mTc preparations was studied. We used 2 different brands of syringes and systematically examined 99mTc-pertechnetate, 99mTc-butedronate, 99mTc-oxidronate, 99mTc-medronate, 99mTc-tetrofosmin, 99mTc-sestamibi, 99mTc(V)-dimercaptosuccinic acid, and 99mTc-succimer. Additionally, 99mTc-succimer was retested with 5 brands of syringes. Results: 99mTc-pertechnetate, 99mTc-phosphonates, and 99mTc(V)-dimercaptosuccinic acid showed no significant adsorption. The measured radioactive retention of 2%–5% was equivalent to the determined dead volume. Using 99mTc-tetrofosmin, we found a slight but significant adsorption of 4%–7%. The 99mTc-sestamibi preparation showed a nonsignificant retention of 3%–5%. However, when the 99mTc-sestamibi was diluted 1:10 with saline, the adsorption rate increased to 9%–13%. 99mTc-succimer displayed different adsorption levels depending on the brand of syringe and the preparation technique. The adsorption of 99mTc-succimer, prepared from kits according to the instructions, did not exceed 15%. The 1:10 saline dilution of a 99mTc-succimer kit preparation, as well as an in-house preparation, demonstrated a radioactive syringe adsorption rate of more than 30%. Conclusion: The results revealed the significance of syringe adsorption of radiopharmaceuticals in the prevention of underdosing. Therefore, a quality assurance assessment is recommended before the introduction of new brands of plastic syringes or routine application of diluted or in-house radiopharmaceuticals.","PeriodicalId":22799,"journal":{"name":"The Journal of Nuclear Medicine Technology","volume":"71 1","pages":"168 - 173"},"PeriodicalIF":0.0,"publicationDate":"2019-12-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86387062","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}
TO THE EDITOR: I read with great interest the article by Blum et al. recently published in the Journal of Nuclear Medicine Technology (1). The authors aimed to assess the reliability of the selfreported weight and height of nuclear medicine patients in view of recommendations for weight-dependent tracer application for imaging and therapy. In total, 824 patients (334 men and 490 women) were asked to report their weight and height before imaging or therapy, along with their level of confidence that the weight and height they were reporting were correct. Subsequently, the weight and height of each patient were measured, and body mass index, body surface area, and lean body mass were calculated. Differences between the reported and true values were compared for statistical significance. The results indicated that an overor underestimation of weight by at least 10% was observed in 2% of the patients, and height was overestimated by 1% of the patients. Surprisingly, the authors concluded that most self-reported weights and heights of nuclear medicine patients are accurate. However, there were some methodologic issues regarding accuracy and reliability. First, it is crucial to realize that accuracy and reliability are two completely different methodologic issues. The term accuracy means the degree to which the result of a measurement, calculation, or specification conforms to the correct value or a standard. In other words, accuracy is the most important criterion for the quality of a test and refers to whether the test measures what it claims to measure. The core design for determining and measuring the accuracy of a test is a comparison between an index test and a reference standard by applying both on similar people who are suspected of having the target result of interest. The term reliability denotes refinement of a measurement, calculation, or specification, especially as represented by the number of digits given. Accuracy studies should report significant and comprehensive information together with the absolute number of true-positive, false-positive, false-negative, and true-negative results or should provide information that allows calculation of a minimum of one diagnostic performance indicator (i.e., sensitivity, specificity, predictive values, or likelihood ratio). Therefore, we recommend applying the most appropriate estimates to evaluate the accuracy of the self-reported weight and height. The Pearson r or the Spearman r can be applied to assess accuracy for quantitative variables. However, for qualitative (binary) variables, some of the well-known ways to assess accuracy include sensitivity, specificity, positive predictive value, negative predictive value, positive likelihood ratio (ranging from 1 to infinity; the higher the positive likelihood ratio, the more accurate the test), negative likelihood ratio (ranging from 0 to 1; the lower the negative likelihood ratio, the more accurate the test), diagnostic accuracy, and odds ratio (rati
致编辑:我怀着极大的兴趣阅读了Blum等人最近发表在《核医学技术杂志》(Journal of Nuclear Medicine Technology)上的一篇文章(1)。作者的目的是评估核医学患者自我报告的体重和身高的可靠性，并建议将体重依赖性示踪剂应用于成像和治疗。总共有824名患者(334名男性和490名女性)被要求在成像或治疗前报告他们的体重和身高，以及他们对所报告的体重和身高的自信程度。随后测量每位患者的体重和身高，计算体重指数、体表面积和瘦体重。比较报告值与真实值之间的差异是否具有统计学意义。结果表明，2%的患者体重高估或低估至少10%，1%的患者身高高估。令人惊讶的是，作者得出结论，大多数核医学患者自我报告的体重和身高都是准确的。然而，在准确性和可靠性方面存在一些方法学问题。首先，认识到准确性和可靠性是两个完全不同的方法论问题是至关重要的。准确度一词是指测量、计算或规范的结果符合正确值或标准的程度。换句话说，准确性是测试质量最重要的标准，它指的是测试是否测量了它声称要测量的东西。确定和测量测试准确性的核心设计是将索引测试和参考标准进行比较，将两者应用于怀疑具有目标结果的相似人群。“可靠性”一词表示测量、计算或规范的改进，特别是用所给出的数字表示的。准确性研究应报告重要和全面的信息，包括真阳性、假阳性、假阴性和真阴性结果的绝对数量，或应提供允许计算至少一个诊断性能指标的信息(即敏感性、特异性、预测值或似然比)。因此，我们建议应用最适当的估计来评估自我报告的体重和身高的准确性。皮尔逊r或斯皮尔曼r可用于评估定量变量的准确性。然而，对于定性(二元)变量，一些众所周知的评估准确性的方法包括灵敏度，特异性，正预测值，负预测值，正似然比(范围从1到无穷大;正似然比越高，检验越准确)，负似然比(取值范围为0 ~ 1;负似然比越低，测试越准确)，诊断准确性和优势比(真结果与假结果的比率)(2-8)。其次，至关重要的是可靠性，这在概念上不同于准确性。因此，我们评估可靠性的方法和统计方法应该是不同的。根据变量的类型，评估可靠性的适当估计与评估准确性的适当估计是完全不同的。对于定量变量，我们可以应用类内相关系数或Bland-Altman图。对于定性变量，我们可以分别应用加权k或Fleiss k来评估观察者内部或观察者之间的可靠性。因此，由于不恰当地使用统计检验(学生t检验和方差分析)进行准确性和可靠性分析，以及对结果的误解，Blum等人的结论可能存在高度的不确定性。证据不足以断定核医学患者自我报告的体重和身高是准确的。
{"title":"Self-Reported Weight and Height in Nuclear Medicine Patients: A Common Mistake Confusing Reliability and Accuracy","authors":"S. Sabour","doi":"10.2967/jnmt.119.232546","DOIUrl":"https://doi.org/10.2967/jnmt.119.232546","url":null,"abstract":"TO THE EDITOR: I read with great interest the article by Blum et al. recently published in the Journal of Nuclear Medicine Technology (1). The authors aimed to assess the reliability of the selfreported weight and height of nuclear medicine patients in view of recommendations for weight-dependent tracer application for imaging and therapy. In total, 824 patients (334 men and 490 women) were asked to report their weight and height before imaging or therapy, along with their level of confidence that the weight and height they were reporting were correct. Subsequently, the weight and height of each patient were measured, and body mass index, body surface area, and lean body mass were calculated. Differences between the reported and true values were compared for statistical significance. The results indicated that an overor underestimation of weight by at least 10% was observed in 2% of the patients, and height was overestimated by 1% of the patients. Surprisingly, the authors concluded that most self-reported weights and heights of nuclear medicine patients are accurate. However, there were some methodologic issues regarding accuracy and reliability. First, it is crucial to realize that accuracy and reliability are two completely different methodologic issues. The term accuracy means the degree to which the result of a measurement, calculation, or specification conforms to the correct value or a standard. In other words, accuracy is the most important criterion for the quality of a test and refers to whether the test measures what it claims to measure. The core design for determining and measuring the accuracy of a test is a comparison between an index test and a reference standard by applying both on similar people who are suspected of having the target result of interest. The term reliability denotes refinement of a measurement, calculation, or specification, especially as represented by the number of digits given. Accuracy studies should report significant and comprehensive information together with the absolute number of true-positive, false-positive, false-negative, and true-negative results or should provide information that allows calculation of a minimum of one diagnostic performance indicator (i.e., sensitivity, specificity, predictive values, or likelihood ratio). Therefore, we recommend applying the most appropriate estimates to evaluate the accuracy of the self-reported weight and height. The Pearson r or the Spearman r can be applied to assess accuracy for quantitative variables. However, for qualitative (binary) variables, some of the well-known ways to assess accuracy include sensitivity, specificity, positive predictive value, negative predictive value, positive likelihood ratio (ranging from 1 to infinity; the higher the positive likelihood ratio, the more accurate the test), negative likelihood ratio (ranging from 0 to 1; the lower the negative likelihood ratio, the more accurate the test), diagnostic accuracy, and odds ratio (rati","PeriodicalId":22799,"journal":{"name":"The Journal of Nuclear Medicine Technology","volume":"50 1","pages":"386 - 386"},"PeriodicalIF":0.0,"publicationDate":"2019-12-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86992203","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}
We present a 72-y-old woman with an osseous metastasis to the spine that had an atypical appearance on both nuclear medicine and radiologic modalities and was misdiagnosed as an abscess. We discuss the pitfalls of bone scintigraphy and the causes of photopenic metastatic lesions.
{"title":"Metastatic Osseous Disease Masquerading as Infection, Diagnosed on Bone Scintigraphy and SPECT/CT","authors":"Gracie Ann Keown, S. Jayaraman, J. Davidson","doi":"10.2967/jnmt.119.232850","DOIUrl":"https://doi.org/10.2967/jnmt.119.232850","url":null,"abstract":"We present a 72-y-old woman with an osseous metastasis to the spine that had an atypical appearance on both nuclear medicine and radiologic modalities and was misdiagnosed as an abscess. We discuss the pitfalls of bone scintigraphy and the causes of photopenic metastatic lesions.","PeriodicalId":22799,"journal":{"name":"The Journal of Nuclear Medicine Technology","volume":"35 1","pages":"179 - 180"},"PeriodicalIF":0.0,"publicationDate":"2019-12-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76323246","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}
Excellent front-line caregivers are often promoted to supervisory positions because of their abilities, knowledge, and superior communication and critical thinking skills. However, they often lack knowledge of the 5 essential leadership domains. These newly appointed supervisors and managers are eager to learn these new competencies, but their organization is frequently not able to provide this education. Management and leadership skills are often learned on the job. Professional development is left up to the individual. It becomes crucial for upper-management professionals, as stewards of their organization, to ensure that those in first-line and middle management are given the opportunity to develop their skills and advance their careers. In this article, I describe my journey of organizing and developing a self-directed imaging leadership team and the success and professional growth that can be achieved if one remains committed to the goal. This journey paralleled Bruce Tuckman’s description of team development. As such, this article is formatted to highlight each of these stages.
{"title":"A Team Approach to Professional Development and Accountability","authors":"L. Roy","doi":"10.2967/jnmt.119.226886","DOIUrl":"https://doi.org/10.2967/jnmt.119.226886","url":null,"abstract":"Excellent front-line caregivers are often promoted to supervisory positions because of their abilities, knowledge, and superior communication and critical thinking skills. However, they often lack knowledge of the 5 essential leadership domains. These newly appointed supervisors and managers are eager to learn these new competencies, but their organization is frequently not able to provide this education. Management and leadership skills are often learned on the job. Professional development is left up to the individual. It becomes crucial for upper-management professionals, as stewards of their organization, to ensure that those in first-line and middle management are given the opportunity to develop their skills and advance their careers. In this article, I describe my journey of organizing and developing a self-directed imaging leadership team and the success and professional growth that can be achieved if one remains committed to the goal. This journey paralleled Bruce Tuckman’s description of team development. As such, this article is formatted to highlight each of these stages.","PeriodicalId":22799,"journal":{"name":"The Journal of Nuclear Medicine Technology","volume":"208 1","pages":"332 - 335"},"PeriodicalIF":0.0,"publicationDate":"2019-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75757714","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}
Before Arrival in PET/CT Department • Allow the patient to take prescribed medications with small sips of water. • Instruct the patient not to take any food or water by mouth for at least 4 h before receiving the 18F-fluciclovine injection. • Instruct the patient to avoid significant strenuous exercise for 24 h before receiving the 18F-fluciclovine injection. • Instruct the patient to avoid voiding the urinary bladder for at least 1 h before receiving the 18F-fluciclovine injection and undergoing imaging.
{"title":"18F-Fluciclovine","authors":"Jason Colloton","doi":"10.2967/jnmt.119.236141","DOIUrl":"https://doi.org/10.2967/jnmt.119.236141","url":null,"abstract":"Before Arrival in PET/CT Department • Allow the patient to take prescribed medications with small sips of water. • Instruct the patient not to take any food or water by mouth for at least 4 h before receiving the 18F-fluciclovine injection. • Instruct the patient to avoid significant strenuous exercise for 24 h before receiving the 18F-fluciclovine injection. • Instruct the patient to avoid voiding the urinary bladder for at least 1 h before receiving the 18F-fluciclovine injection and undergoing imaging.","PeriodicalId":22799,"journal":{"name":"The Journal of Nuclear Medicine Technology","volume":"17 1","pages":"267 - 268"},"PeriodicalIF":0.0,"publicationDate":"2019-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86896047","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}
Tamara F. Lundeen, Matthew F. Covington, E. Krupinski, R. Avery, H. Lei, S. Sherman, P. Kuo
Racial and ethnic disparities in the prevalence of neurodegenerative diseases exist. This study examined the agreement between gold standard diagnosis and visual assessment of dopamine transporter (DaT) imaging in Hispanic and non-Hispanic patients being evaluated for Parkinsonian syndromes (PS). Methods: A retrospective review of DaT imaging and demographic data was performed with institutional review board approval. Documented interpretation by visual assessment was used to classify scans as normal or abnormal. The gold standard for the final diagnosis of PS was determined by a neurologist after 2 or more years of clinical follow-up. Data were analyzed with a z-test for uncorrelated samples. Results: In 30 Hispanic patients, DaT imaging was abnormal in 17, normal in 12, and nondiagnostic in 1. Of those with abnormal imaging, PS was confirmed in 16 of 17. Of those with normal imaging, no PS was confirmed in any patient. Sensitivity was 100%, and specificity was 92%. The single patient with nondiagnostic imaging was excluded. Of 77 non-Hispanic patients, visual assessment of DaT imaging was abnormal in 51. Of those with abnormal imaging, PS was confirmed in 48 of 51. Of those with normal imaging, no PS was confirmed in 22 of 26. Sensitivity was 92%, and specificity was 88%. There was no statistically significant difference (z = 0.34) in the rates of agreement between the gold standard and DaT imaging in Hispanic versus non-Hispanic patients. The study sample size afforded a power of 0.60. Conclusion: No significant difference was found in the accuracy of DaT imaging between Hispanic and non-Hispanic patients. Accuracy was high for both groups.
{"title":"Accuracy of Dopamine Transporter Imaging with 123I-Ioflupane in Hispanic and Non-Hispanic Patients","authors":"Tamara F. Lundeen, Matthew F. Covington, E. Krupinski, R. Avery, H. Lei, S. Sherman, P. Kuo","doi":"10.2967/jnmt.119.231423","DOIUrl":"https://doi.org/10.2967/jnmt.119.231423","url":null,"abstract":"Racial and ethnic disparities in the prevalence of neurodegenerative diseases exist. This study examined the agreement between gold standard diagnosis and visual assessment of dopamine transporter (DaT) imaging in Hispanic and non-Hispanic patients being evaluated for Parkinsonian syndromes (PS). Methods: A retrospective review of DaT imaging and demographic data was performed with institutional review board approval. Documented interpretation by visual assessment was used to classify scans as normal or abnormal. The gold standard for the final diagnosis of PS was determined by a neurologist after 2 or more years of clinical follow-up. Data were analyzed with a z-test for uncorrelated samples. Results: In 30 Hispanic patients, DaT imaging was abnormal in 17, normal in 12, and nondiagnostic in 1. Of those with abnormal imaging, PS was confirmed in 16 of 17. Of those with normal imaging, no PS was confirmed in any patient. Sensitivity was 100%, and specificity was 92%. The single patient with nondiagnostic imaging was excluded. Of 77 non-Hispanic patients, visual assessment of DaT imaging was abnormal in 51. Of those with abnormal imaging, PS was confirmed in 48 of 51. Of those with normal imaging, no PS was confirmed in 22 of 26. Sensitivity was 92%, and specificity was 88%. There was no statistically significant difference (z = 0.34) in the rates of agreement between the gold standard and DaT imaging in Hispanic versus non-Hispanic patients. The study sample size afforded a power of 0.60. Conclusion: No significant difference was found in the accuracy of DaT imaging between Hispanic and non-Hispanic patients. Accuracy was high for both groups.","PeriodicalId":22799,"journal":{"name":"The Journal of Nuclear Medicine Technology","volume":"6 1","pages":"154 - 157"},"PeriodicalIF":0.0,"publicationDate":"2019-10-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82000313","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}
Petra Lovrec, D. Schuster, R. Wagner, M. Gabriel, B. Savir-Baruch
18F-fluciclovine PET is approved for prostate cancer recurrence imaging. According to the radiopharmaceutical package insert, only 3% of the tracer is expected to be excreted in the urine over the first 4 h. Yet, in clinical practice we noticed a higher percentage of bladder excretion. We sought to evaluate and quantify early 18F-fluciclovine bladder radioactivity and determine whether refraining from voiding before 18F-fluciclovine injection would mitigate it. Methods: In total, 159 patients underwent 18F-fluciclovine PET/CT imaging as part of their clinical workup. The first 36 patients were instructed to void just before 18F-fluciclovine injection; the subsequent 123 patients were not asked to void. The SUVmax and SUVmean of the bladder, aorta, marrow, liver, and bladder volumes were determined. Comparing SUVmean of bladder to background, we characterized bladder radioactivity as insignificant (bladder < aorta), mild (bladder > aorta < marrow), moderate (bladder > marrow < liver), or intense (bladder > liver). Differences between the protocols were investigated. Results: Overall, 22% (35/159) of patients had moderate bladder activity and 8.8% (14/159) had intense bladder activity. A negative association was found between bladder volume and SUVmean. A significant difference was found between the voiding and nonvoiding groups, with 38.9% (14/36) versus 17.1% (21/123) of patients, respectively, having moderate bladder activity and 22.2% (8/36) versus 4.9% (6/123) of patients, respectively, having intense bladder activity. Conclusion: Refraining from voiding before 18F-fluciclovine injection results in significantly lower urinary bladder radioactivity than does purposeful voiding before injection. We have modified our practice accordingly, particularly as moderate and intense bladder activity may mask or mimic local prostate cancer recurrence. Mechanisms underlying this phenomenon should be further investigated.
{"title":"Characterizing and Mitigating Bladder Radioactivity on 18F-Fluciclovine PET/CT","authors":"Petra Lovrec, D. Schuster, R. Wagner, M. Gabriel, B. Savir-Baruch","doi":"10.2967/jnmt.119.230581","DOIUrl":"https://doi.org/10.2967/jnmt.119.230581","url":null,"abstract":"18F-fluciclovine PET is approved for prostate cancer recurrence imaging. According to the radiopharmaceutical package insert, only 3% of the tracer is expected to be excreted in the urine over the first 4 h. Yet, in clinical practice we noticed a higher percentage of bladder excretion. We sought to evaluate and quantify early 18F-fluciclovine bladder radioactivity and determine whether refraining from voiding before 18F-fluciclovine injection would mitigate it. Methods: In total, 159 patients underwent 18F-fluciclovine PET/CT imaging as part of their clinical workup. The first 36 patients were instructed to void just before 18F-fluciclovine injection; the subsequent 123 patients were not asked to void. The SUVmax and SUVmean of the bladder, aorta, marrow, liver, and bladder volumes were determined. Comparing SUVmean of bladder to background, we characterized bladder radioactivity as insignificant (bladder < aorta), mild (bladder > aorta < marrow), moderate (bladder > marrow < liver), or intense (bladder > liver). Differences between the protocols were investigated. Results: Overall, 22% (35/159) of patients had moderate bladder activity and 8.8% (14/159) had intense bladder activity. A negative association was found between bladder volume and SUVmean. A significant difference was found between the voiding and nonvoiding groups, with 38.9% (14/36) versus 17.1% (21/123) of patients, respectively, having moderate bladder activity and 22.2% (8/36) versus 4.9% (6/123) of patients, respectively, having intense bladder activity. Conclusion: Refraining from voiding before 18F-fluciclovine injection results in significantly lower urinary bladder radioactivity than does purposeful voiding before injection. We have modified our practice accordingly, particularly as moderate and intense bladder activity may mask or mimic local prostate cancer recurrence. Mechanisms underlying this phenomenon should be further investigated.","PeriodicalId":22799,"journal":{"name":"The Journal of Nuclear Medicine Technology","volume":"38 1","pages":"24 - 29"},"PeriodicalIF":0.0,"publicationDate":"2019-10-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81251023","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}
L. Miller, K. Harikumar, Aditya J Desai, H. Siddiki, B. Nguyen
Cholecystokinin cholescintigraphy is used clinically to quantify gallbladder ejection fraction as an indicator of functional gallbladder disorder. It can also provide the opportunity to quantify an individual’s responsiveness to the physiologic stimulant of gallbladder contraction, cholecystokinin, which is a major regulator of appetite and postprandial satiety. Methods: In the current work, we use cholecystokinin cholescintigraphy to quantify the kinetics of gallbladder emptying, including average and peak rates, in response to a standard cholecystokinin infusion. Results: We demonstrated that patients with no gallstones or biliary obstruction who empty their gallbladders completely in response to cholecystokinin, having an ejection fraction greater than 80%, exhibit a broad range of sensitivity to this hormone. Three distinct kinetic profiles were observed, with those most sensitive to cholecystokinin achieving the earliest peak and the fastest rate of gallbladder emptying, whereas those least sensitive to cholecystokinin have the latest peak and the slowest rate of emptying. Conclusion: Patients can have abnormal cholecystokinin stimulus–activity coupling as an effect of endogenous negative allosteric modulation by membrane cholesterol. This was predicted in ex vivo studies but has not, to our knowledge, previously been demonstrated in vivo. This type of kinetic analysis provides a tool to quantify cholecystokinin responsiveness in patients and identify patients who might benefit from a drug that would positively modulate cholecystokinin action to improve their appetite regulation and to better control their weight.
{"title":"Kinetics of Gallbladder Emptying During Cholecystokinin Cholescintigraphy as an Indicator of In Vivo Hormonal Sensitivity","authors":"L. Miller, K. Harikumar, Aditya J Desai, H. Siddiki, B. Nguyen","doi":"10.2967/jnmt.119.233486","DOIUrl":"https://doi.org/10.2967/jnmt.119.233486","url":null,"abstract":"Cholecystokinin cholescintigraphy is used clinically to quantify gallbladder ejection fraction as an indicator of functional gallbladder disorder. It can also provide the opportunity to quantify an individual’s responsiveness to the physiologic stimulant of gallbladder contraction, cholecystokinin, which is a major regulator of appetite and postprandial satiety. Methods: In the current work, we use cholecystokinin cholescintigraphy to quantify the kinetics of gallbladder emptying, including average and peak rates, in response to a standard cholecystokinin infusion. Results: We demonstrated that patients with no gallstones or biliary obstruction who empty their gallbladders completely in response to cholecystokinin, having an ejection fraction greater than 80%, exhibit a broad range of sensitivity to this hormone. Three distinct kinetic profiles were observed, with those most sensitive to cholecystokinin achieving the earliest peak and the fastest rate of gallbladder emptying, whereas those least sensitive to cholecystokinin have the latest peak and the slowest rate of emptying. Conclusion: Patients can have abnormal cholecystokinin stimulus–activity coupling as an effect of endogenous negative allosteric modulation by membrane cholesterol. This was predicted in ex vivo studies but has not, to our knowledge, previously been demonstrated in vivo. This type of kinetic analysis provides a tool to quantify cholecystokinin responsiveness in patients and identify patients who might benefit from a drug that would positively modulate cholecystokinin action to improve their appetite regulation and to better control their weight.","PeriodicalId":22799,"journal":{"name":"The Journal of Nuclear Medicine Technology","volume":"394 1","pages":"40 - 45"},"PeriodicalIF":0.0,"publicationDate":"2019-10-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77428560","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. Guardia, J. Barnes, S. Corey, J. Sims, Meaghan P Granger
131I-metaiodobenzylguanidine (131I-MIBG) is a theranostic agent useful for treatment of neuroendocrine malignancies. In this case, a child with a Curie score of 21 was administered 17.871 GBq (483 mCi) of 131I-MIBG. The elimination half-life progressively increased from 23 h to 77 h during the 11 d that the patient was hospitalized for radiation isolation. Six weeks after the posttherapy scan, a survey with an ion-chamber device yielded readings of 0.3 μSv/h (0.03 mR/h) on contact with spinal regions that had shown increased uptake on the scan. A planar image obtained using the 131I setting and a high-energy collimator did not demonstrate any focal uptake. 123I-MIBG was administered, and the 24-h scan was of diagnostic quality, without degradation from the remaining 131I-MIBG. Additional study is needed on whether the Curie score affects elimination of 131I-MIBG and on whether the period of hospitalized radiation isolation needs to be extended.
{"title":"Does Delayed Excretion of Therapeutic 131I-MIBG Interfere with a 123I-MIBG Diagnostic Scan 6 Weeks After the Therapy?","authors":"M. Guardia, J. Barnes, S. Corey, J. Sims, Meaghan P Granger","doi":"10.2967/jnmt.119.229583","DOIUrl":"https://doi.org/10.2967/jnmt.119.229583","url":null,"abstract":"131I-metaiodobenzylguanidine (131I-MIBG) is a theranostic agent useful for treatment of neuroendocrine malignancies. In this case, a child with a Curie score of 21 was administered 17.871 GBq (483 mCi) of 131I-MIBG. The elimination half-life progressively increased from 23 h to 77 h during the 11 d that the patient was hospitalized for radiation isolation. Six weeks after the posttherapy scan, a survey with an ion-chamber device yielded readings of 0.3 μSv/h (0.03 mR/h) on contact with spinal regions that had shown increased uptake on the scan. A planar image obtained using the 131I setting and a high-energy collimator did not demonstrate any focal uptake. 123I-MIBG was administered, and the 24-h scan was of diagnostic quality, without degradation from the remaining 131I-MIBG. Additional study is needed on whether the Curie score affects elimination of 131I-MIBG and on whether the period of hospitalized radiation isolation needs to be extended.","PeriodicalId":22799,"journal":{"name":"The Journal of Nuclear Medicine Technology","volume":"157 1","pages":"81 - 84"},"PeriodicalIF":0.0,"publicationDate":"2019-10-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86339151","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}
Mariana R. Camacho, E. Etchebehere, N. Tardelli, M. Delamain, Aline F.A. Vercosa, M. E. Takahashi, S. Q. Brunetto, I. Metze, C. Souza, J. Cerci, C. Ramos
Quantification of metabolic tumor volume (MTV) and total lesion glycolysis (TLG) can be time-consuming. We evaluated the performance of an automatic multifocal segmentation (MFS) method of quantification in patients with different stages of Hodgkin lymphoma, using the multiple VOI (MV) method as reference. Methods: This prospective bicentric study included 50 patients with Hodgkin lymphoma who underwent staging 18F-FGD PET/CT. The examinations were centrally reviewed and processed with commercial MFS software to obtain MTV and TLG using 2 fixed relative thresholds (40% and 20% of SUVmax) for each lesion. All PET/CT scans were processed using the MV and MFS methods. Interclass correlation coefficients and Bland–Altman plots were used for statistical analysis. Repeated calculations of MTV and TLG values by 2 observers with different degrees of PET/CT imaging experience were used to ascertain interobserver agreement on the MFS method. Results: The means and SDs obtained for the MTV with MV and MFS were, respectively, 736 ± 856 mL and 660 ± 699 mL for the 20% threshold and 313 ± 359 mL and 372 ± 434 mL for the 40% threshold. The time spent calculating the MTV was much shorter with the MFS method than with the MV method (median time, 11.6 min [range, 1–30 min] and 64.4 min [range, 1–240 min], respectively), especially in patients with advanced disease. Time spent was similar in patients with localized disease. There were no statistical differences between the MFS values obtained by the 2 different observers. Conclusion: MTV and TLG calculations using MFS are reproducible, generate similar results to those obtained with MV, and are much less timing-consuming. Main differences between the 2 methods were related to difficulties in avoiding overlay of VOIs in the MV technique. MV and MFS perform equally well in patients with a small number of lesions.
{"title":"Validation of a Multifocal Segmentation Method for Measuring Metabolic Tumor Volume in Hodgkin Lymphoma","authors":"Mariana R. Camacho, E. Etchebehere, N. Tardelli, M. Delamain, Aline F.A. Vercosa, M. E. Takahashi, S. Q. Brunetto, I. Metze, C. Souza, J. Cerci, C. Ramos","doi":"10.2967/jnmt.119.231118","DOIUrl":"https://doi.org/10.2967/jnmt.119.231118","url":null,"abstract":"Quantification of metabolic tumor volume (MTV) and total lesion glycolysis (TLG) can be time-consuming. We evaluated the performance of an automatic multifocal segmentation (MFS) method of quantification in patients with different stages of Hodgkin lymphoma, using the multiple VOI (MV) method as reference. Methods: This prospective bicentric study included 50 patients with Hodgkin lymphoma who underwent staging 18F-FGD PET/CT. The examinations were centrally reviewed and processed with commercial MFS software to obtain MTV and TLG using 2 fixed relative thresholds (40% and 20% of SUVmax) for each lesion. All PET/CT scans were processed using the MV and MFS methods. Interclass correlation coefficients and Bland–Altman plots were used for statistical analysis. Repeated calculations of MTV and TLG values by 2 observers with different degrees of PET/CT imaging experience were used to ascertain interobserver agreement on the MFS method. Results: The means and SDs obtained for the MTV with MV and MFS were, respectively, 736 ± 856 mL and 660 ± 699 mL for the 20% threshold and 313 ± 359 mL and 372 ± 434 mL for the 40% threshold. The time spent calculating the MTV was much shorter with the MFS method than with the MV method (median time, 11.6 min [range, 1–30 min] and 64.4 min [range, 1–240 min], respectively), especially in patients with advanced disease. Time spent was similar in patients with localized disease. There were no statistical differences between the MFS values obtained by the 2 different observers. Conclusion: MTV and TLG calculations using MFS are reproducible, generate similar results to those obtained with MV, and are much less timing-consuming. Main differences between the 2 methods were related to difficulties in avoiding overlay of VOIs in the MV technique. MV and MFS perform equally well in patients with a small number of lesions.","PeriodicalId":22799,"journal":{"name":"The Journal of Nuclear Medicine Technology","volume":"10 1","pages":"30 - 35"},"PeriodicalIF":0.0,"publicationDate":"2019-10-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85610009","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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