Measurement of thyroid uptake is perhaps one of the most basic procedures performed in nuclear medicine today. The uptake procedure assesses iodide trapping and organification within the gland ([1][1]). It is most commonly performed to differentiate thyroiditis from other forms of thyrotoxicosis and
{"title":"Thyroid Uptake Exceeding 100%: How Is That Possible?","authors":"K. Thomas, A. M. Alessi, Art Hall","doi":"10.2967/jnmt.119.233601","DOIUrl":"https://doi.org/10.2967/jnmt.119.233601","url":null,"abstract":"Measurement of thyroid uptake is perhaps one of the most basic procedures performed in nuclear medicine today. The uptake procedure assesses iodide trapping and organification within the gland ([1][1]). It is most commonly performed to differentiate thyroiditis from other forms of thyrotoxicosis and","PeriodicalId":22799,"journal":{"name":"The Journal of Nuclear Medicine Technology","volume":"132 1","pages":"213 - 214"},"PeriodicalIF":0.0,"publicationDate":"2019-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79384936","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}
Artificial intelligence (AI) in nuclear medicine and radiology represents a significant disruptive technology. Although there has been much debate about the impact of AI on the careers of radiologists, the opportunities in nuclear medicine enhance the capability of the physician and at the same time have an impact on the responsibilities of physicists and technologists. This transformative technology requires insight into the principles and opportunities for seamless assimilation into practice without the associated displacement of human resources. This article introduces the current clinical applications of machine learning and deep learning.
{"title":"Intelligent Imaging: Artificial Intelligence Augmented Nuclear Medicine","authors":"G. Currie","doi":"10.2967/jnmt.119.232462","DOIUrl":"https://doi.org/10.2967/jnmt.119.232462","url":null,"abstract":"Artificial intelligence (AI) in nuclear medicine and radiology represents a significant disruptive technology. Although there has been much debate about the impact of AI on the careers of radiologists, the opportunities in nuclear medicine enhance the capability of the physician and at the same time have an impact on the responsibilities of physicists and technologists. This transformative technology requires insight into the principles and opportunities for seamless assimilation into practice without the associated displacement of human resources. This article introduces the current clinical applications of machine learning and deep learning.","PeriodicalId":22799,"journal":{"name":"The Journal of Nuclear Medicine Technology","volume":"1182 1","pages":"217 - 222"},"PeriodicalIF":0.0,"publicationDate":"2019-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72741088","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}
As Program Director of the only Nuclear Medicine Technology program in Northeast Ohio, I am always looking for ways to simulate real life to the students before they enter the clinical experience at the local hospitals. Through the community bond initiative, our classroom was granted funds to acquire the Human Patient Simulator (HPS) JUNO, supplied through CAE Health Care, which was delivered late 2018.
{"title":"JUNO Jubilee: Bringing Real-Life Experiences to the Classroom!*","authors":"T. R. Taggart","doi":"10.2967/jnmt.119.232991","DOIUrl":"https://doi.org/10.2967/jnmt.119.232991","url":null,"abstract":"As Program Director of the only Nuclear Medicine Technology program in Northeast Ohio, I am always looking for ways to simulate real life to the students before they enter the clinical experience at the local hospitals. Through the community bond initiative, our classroom was granted funds to acquire the Human Patient Simulator (HPS) JUNO, supplied through CAE Health Care, which was delivered late 2018.","PeriodicalId":22799,"journal":{"name":"The Journal of Nuclear Medicine Technology","volume":"1 1","pages":"215 - 216"},"PeriodicalIF":0.0,"publicationDate":"2019-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78802875","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}
The emergence of artificial intelligence (AI) in nuclear medicine and radiology has been accompanied by AI commentators and experts predicting that AI would make radiologists, in particular, extinct. More realistic perspectives suggest significant changes will occur in medical practice. There is no escaping the disruptive technology associated with AI, neural networks, and deep learning, the most significant perhaps since the early days of Roentgen, Becquerel, and Curie. AI is an omen, but it need not be foreshadowing a negative event; rather, it is heralding great opportunity. The key to sustainability lies not in resisting AI but in having a deep understanding and exploiting the capabilities of AI in nuclear medicine while mastering those capabilities unique to the human resources.
{"title":"Intelligent Imaging: Anatomy of Machine Learning and Deep Learning","authors":"G. Currie","doi":"10.2967/jnmt.119.232470","DOIUrl":"https://doi.org/10.2967/jnmt.119.232470","url":null,"abstract":"The emergence of artificial intelligence (AI) in nuclear medicine and radiology has been accompanied by AI commentators and experts predicting that AI would make radiologists, in particular, extinct. More realistic perspectives suggest significant changes will occur in medical practice. There is no escaping the disruptive technology associated with AI, neural networks, and deep learning, the most significant perhaps since the early days of Roentgen, Becquerel, and Curie. AI is an omen, but it need not be foreshadowing a negative event; rather, it is heralding great opportunity. The key to sustainability lies not in resisting AI but in having a deep understanding and exploiting the capabilities of AI in nuclear medicine while mastering those capabilities unique to the human resources.","PeriodicalId":22799,"journal":{"name":"The Journal of Nuclear Medicine Technology","volume":"1 1","pages":"273 - 281"},"PeriodicalIF":0.0,"publicationDate":"2019-08-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75994195","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}
Neuroendocrine tumors (NETs) of the skin or soft tissue are rare (mostly described as sites of metastasis), whereas primary soft-tissue NETs are extremely rare; they are usually diagnosed at advanced stages with distant metastases because of their indolent nature. We herein describe our experience with 2 such cases. In the first case, the NET originated in the retroperitoneal soft tissue, and in the second case, the patient was a middle-aged lady with NET arising from soft tissue in the pelvis. Both patients were treated with 177Lu-DOTATATE in view of their somatostatin receptor–expressing metastatic lesions, demonstrating an excellent outcome as reflected by a complete metabolic response and near-complete anatomic response to the administered peptide receptor radionuclide therapy. The noteworthy factors of the reported cases were, first, unusual sites of primary tumor and, second, near-complete to complete symptomatic, anatomic, and metabolic resolution of the recurrent primary tumor and metastatic lesions with peptide receptor radionuclide therapy alone. NETs arising from rare anatomic locations are usually nonfunctioning, with good clinical outcomes, and 177Lu-DOTATATE peptide receptor radionuclide therapy can be considered promising in patients with metastatic or advanced disease.
{"title":"Rare-Site Primary Soft-Tissue Neuroendocrine Tumor with Metastases and Near-Complete Resolution with 177Lu-DOTATATE: Documenting a Promising Clinical Application of Peptide Receptor Radionuclide Therapy","authors":"Aadil Adnan, S. Basu","doi":"10.2967/jnmt.119.227058","DOIUrl":"https://doi.org/10.2967/jnmt.119.227058","url":null,"abstract":"Neuroendocrine tumors (NETs) of the skin or soft tissue are rare (mostly described as sites of metastasis), whereas primary soft-tissue NETs are extremely rare; they are usually diagnosed at advanced stages with distant metastases because of their indolent nature. We herein describe our experience with 2 such cases. In the first case, the NET originated in the retroperitoneal soft tissue, and in the second case, the patient was a middle-aged lady with NET arising from soft tissue in the pelvis. Both patients were treated with 177Lu-DOTATATE in view of their somatostatin receptor–expressing metastatic lesions, demonstrating an excellent outcome as reflected by a complete metabolic response and near-complete anatomic response to the administered peptide receptor radionuclide therapy. The noteworthy factors of the reported cases were, first, unusual sites of primary tumor and, second, near-complete to complete symptomatic, anatomic, and metabolic resolution of the recurrent primary tumor and metastatic lesions with peptide receptor radionuclide therapy alone. NETs arising from rare anatomic locations are usually nonfunctioning, with good clinical outcomes, and 177Lu-DOTATATE peptide receptor radionuclide therapy can be considered promising in patients with metastatic or advanced disease.","PeriodicalId":22799,"journal":{"name":"The Journal of Nuclear Medicine Technology","volume":"117 1","pages":"36 - 39"},"PeriodicalIF":0.0,"publicationDate":"2019-08-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86711557","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}
The information superhighway provides nearly instant instructions for almost anything one may wish to do or learn. Need to fix a kitchen sink? YouTube videos will walk you through it. Wondering who won the World Series in 1922? A quick online search provides all you need to know with a few keystrokes. Even nuclear medicine and PET concepts and terms can be accessed with an internet connection and a browser. Information for patients is readily available in answer to questions such as “What is a PET scan?” and “How much radiation is there in a nuclear medicine scan?” If you google “PET imaging,” you will find personal stories from patients, videos that show a patient being scanned, and scientific explanations of PET imaging from experts. If one had time to spare, sitting with a search engine and keyboard could produce a lot of information about PET imaging. But even with a huge volume of facts and figures available online, until now there hasn’t been a specific location for technologists to quickly look up how to position the head for optimal brain PET or refresh their memory about the correct uptake time for an amyloid PET scan. And if a search resulted in information that could help, would a technologist have confidence that it is accurate and up to date? The Tech TIME (Technical ImagingMultidisciplinary Education) series has been created by the Technologist Section of the Society of Nuclear Medicine and Molecular Imaging (SNMMI-TS) to address the information gap between traditional continuing education and immediately available online reference materials. Envisioned by Past SNMMI-TS President Sara G. Johnson and implemented under SNMMI-TS President Kathleen Krisak, the goal of the Tech TIME task force is to create accurate and up-to-date online tools to quickly answer questions and solve problems in the daily workplace. The tools provided in the Tech TIME series come in the form of fact sheets that can be easily read or downloaded from the SNMMI website, short (2–3 min) videos to answer specific how-to questions, case studies with relevant patient examples, and lists of resources for follow-up learning or continuing education credit if desired. The task force that evolved into the Tech TIME project was initially funded in late 2016 by a partnering agreement between the SNMMI-TS and Eli Lilly & Co. to create noncredit training and informational tools about PET brain imaging specifically for technologists. The task force recognized that brain imaging has not been widely performed in the United States and technologists may need access to more than traditional continuing education symposia. The first project undertaken by the task force was to create fact sheets for 18F-FDG brain PET, amyloid brain PET, and other neurology procedures in nuclear medicine. These fact sheets can be quickly accessed on the SNMMI website and provide basic but relevant information for someone who needs to refresh on dosing, administration, contraindications, and basic acq
{"title":"Introducing Tech TIME: Online Quick References for Nuclear Medicine Technologists","authors":"L. Trembath, Dawn Holley","doi":"10.2967/JNMT.117.204974","DOIUrl":"https://doi.org/10.2967/JNMT.117.204974","url":null,"abstract":"The information superhighway provides nearly instant instructions for almost anything one may wish to do or learn. Need to fix a kitchen sink? YouTube videos will walk you through it. Wondering who won the World Series in 1922? A quick online search provides all you need to know with a few keystrokes. Even nuclear medicine and PET concepts and terms can be accessed with an internet connection and a browser. Information for patients is readily available in answer to questions such as “What is a PET scan?” and “How much radiation is there in a nuclear medicine scan?” If you google “PET imaging,” you will find personal stories from patients, videos that show a patient being scanned, and scientific explanations of PET imaging from experts. If one had time to spare, sitting with a search engine and keyboard could produce a lot of information about PET imaging. But even with a huge volume of facts and figures available online, until now there hasn’t been a specific location for technologists to quickly look up how to position the head for optimal brain PET or refresh their memory about the correct uptake time for an amyloid PET scan. And if a search resulted in information that could help, would a technologist have confidence that it is accurate and up to date? The Tech TIME (Technical ImagingMultidisciplinary Education) series has been created by the Technologist Section of the Society of Nuclear Medicine and Molecular Imaging (SNMMI-TS) to address the information gap between traditional continuing education and immediately available online reference materials. Envisioned by Past SNMMI-TS President Sara G. Johnson and implemented under SNMMI-TS President Kathleen Krisak, the goal of the Tech TIME task force is to create accurate and up-to-date online tools to quickly answer questions and solve problems in the daily workplace. The tools provided in the Tech TIME series come in the form of fact sheets that can be easily read or downloaded from the SNMMI website, short (2–3 min) videos to answer specific how-to questions, case studies with relevant patient examples, and lists of resources for follow-up learning or continuing education credit if desired. The task force that evolved into the Tech TIME project was initially funded in late 2016 by a partnering agreement between the SNMMI-TS and Eli Lilly & Co. to create noncredit training and informational tools about PET brain imaging specifically for technologists. The task force recognized that brain imaging has not been widely performed in the United States and technologists may need access to more than traditional continuing education symposia. The first project undertaken by the task force was to create fact sheets for 18F-FDG brain PET, amyloid brain PET, and other neurology procedures in nuclear medicine. These fact sheets can be quickly accessed on the SNMMI website and provide basic but relevant information for someone who needs to refresh on dosing, administration, contraindications, and basic acq","PeriodicalId":22799,"journal":{"name":"The Journal of Nuclear Medicine Technology","volume":"42 1","pages":"24 - 25"},"PeriodicalIF":0.0,"publicationDate":"2018-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80749205","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}
Leah M. Filzen, Lacey R. Ellingson, A. Paulsen, J. Hung
99mTc, the most common radioisotope used in nuclear medicine, is produced in a nuclear reactor from the decay of 99Mo. There are only a few aging nuclear reactors around the world that produce 99Mo, and one of the major contributors, the National Research Universal (Canada), ceased production on October 31, 2016. The National Research Universal produced approximately 40% of the world’s 99Mo supply, so with its shut down, shortages of 99Mo/99mTc are expected. Methods: Nuclear pharmacies and nuclear medicine departments throughout the United States were contacted and asked to provide their strategies for coping with a shortage of 99Mo/99mTc. Each of these strategies was evaluated on the basis of its effectiveness for conserving 99mTc while still meeting the needs of the patients. Results: From the responses, the following 6 categories of strategies, in order of importance, were compiled: contractual agreements with commercial nuclear pharmacies, alternative imaging protocols, changes in imaging schedules, software use, generator management, and reduction of ordered doses or elimination of backup doses. Conclusion: The supply chain of 99Mo/99mTc is quite fragile; therefore, being aware of the most appropriate coping strategies is crucial. It is essential to build a strong collaboration between the nuclear pharmacy and nuclear medicine department during a shortage situation. With both nuclear medicine departments and nuclear pharmacies implementing viable strategies, such as the ones proposed, the amount of 99mTc available during a shortage situation can be maximized.
{"title":"Potential Ways to Address Shortage Situations of 99Mo/99mTc","authors":"Leah M. Filzen, Lacey R. Ellingson, A. Paulsen, J. Hung","doi":"10.2967/jnmt.116.185454","DOIUrl":"https://doi.org/10.2967/jnmt.116.185454","url":null,"abstract":"99mTc, the most common radioisotope used in nuclear medicine, is produced in a nuclear reactor from the decay of 99Mo. There are only a few aging nuclear reactors around the world that produce 99Mo, and one of the major contributors, the National Research Universal (Canada), ceased production on October 31, 2016. The National Research Universal produced approximately 40% of the world’s 99Mo supply, so with its shut down, shortages of 99Mo/99mTc are expected. Methods: Nuclear pharmacies and nuclear medicine departments throughout the United States were contacted and asked to provide their strategies for coping with a shortage of 99Mo/99mTc. Each of these strategies was evaluated on the basis of its effectiveness for conserving 99mTc while still meeting the needs of the patients. Results: From the responses, the following 6 categories of strategies, in order of importance, were compiled: contractual agreements with commercial nuclear pharmacies, alternative imaging protocols, changes in imaging schedules, software use, generator management, and reduction of ordered doses or elimination of backup doses. Conclusion: The supply chain of 99Mo/99mTc is quite fragile; therefore, being aware of the most appropriate coping strategies is crucial. It is essential to build a strong collaboration between the nuclear pharmacy and nuclear medicine department during a shortage situation. With both nuclear medicine departments and nuclear pharmacies implementing viable strategies, such as the ones proposed, the amount of 99mTc available during a shortage situation can be maximized.","PeriodicalId":22799,"journal":{"name":"The Journal of Nuclear Medicine Technology","volume":"58 1","pages":"1 - 5"},"PeriodicalIF":0.0,"publicationDate":"2017-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84470104","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. Farrell, M. Costello, J. McKee, L. Gordon, L. Fig
Many variables can influence the results of gastric emptying scintigraphy (GES). A lack of methodologic standardization may cause variability, limit comparisons, and decrease the credibility of the test. To address this, in 2009, the Society of Nuclear Medicine and Molecular Imaging (SNMMI) published a procedure guideline describing a standardized, validated GES protocol for adults. Laboratories must closely follow the consensus protocol to provide valid and standardized results and improve patient care. The Intersocietal Accreditation Commission (IAC) evaluates compliance with guidelines as part of the accreditation process. The rate of compliance with the GES guideline at a national level has not been assessed. The aim of this study was to quantify compliance with the standardized protocol in a large cohort of laboratories from different institutions and practice settings across the United States. Methods: The IAC Nuclear/PET database was used to extract GES protocols from all laboratories applying for accreditation from 2013 to 2015. Each protocol was assessed for compliance with the methods described in the SNMMI GES procedure guidelines. Fourteen binary variables were assessed: patient preparation (4 variables), meal content (5 variables), acquisition (2 variables), and processing (3 variables). Results: Protocols from 127 labs demonstrated that patient preparation was the category with which the laboratories were least compliant. Instructions for blood glucose monitoring and withholding of medications were problematic. Overall, 69.3% of protocols were not compliant with the content or preparation of the consensus meal: 47.3% used whole eggs instead of egg whites, and additional ingredients not recommended in the guidelines were also frequently used. Only 3.1% of laboratories were fully compliant with all 14 variables. Over half the laboratories were compliant with only 5 variables or less. Conclusion: Almost 8 y after the publication of the SNMMI GES guidelines, there is low protocol adherence among laboratories applying for IAC Nuclear/PET accreditation. This substantial degree of guideline noncompliance is concerning. The variability in GES protocols may have a significant effect on patient management, as results may be inaccurate. Consistent use of the standardized GES protocol permits interpretation of results in a standardized manner that allows interlaboratory comparisons and fosters acceptance of the test validity by referring clinicians.
{"title":"Compliance with Gastric-Emptying Scintigraphy Guidelines: An Analysis of the Intersocietal Accreditation Commission Database","authors":"M. Farrell, M. Costello, J. McKee, L. Gordon, L. Fig","doi":"10.2967/jnmt.116.184473","DOIUrl":"https://doi.org/10.2967/jnmt.116.184473","url":null,"abstract":"Many variables can influence the results of gastric emptying scintigraphy (GES). A lack of methodologic standardization may cause variability, limit comparisons, and decrease the credibility of the test. To address this, in 2009, the Society of Nuclear Medicine and Molecular Imaging (SNMMI) published a procedure guideline describing a standardized, validated GES protocol for adults. Laboratories must closely follow the consensus protocol to provide valid and standardized results and improve patient care. The Intersocietal Accreditation Commission (IAC) evaluates compliance with guidelines as part of the accreditation process. The rate of compliance with the GES guideline at a national level has not been assessed. The aim of this study was to quantify compliance with the standardized protocol in a large cohort of laboratories from different institutions and practice settings across the United States. Methods: The IAC Nuclear/PET database was used to extract GES protocols from all laboratories applying for accreditation from 2013 to 2015. Each protocol was assessed for compliance with the methods described in the SNMMI GES procedure guidelines. Fourteen binary variables were assessed: patient preparation (4 variables), meal content (5 variables), acquisition (2 variables), and processing (3 variables). Results: Protocols from 127 labs demonstrated that patient preparation was the category with which the laboratories were least compliant. Instructions for blood glucose monitoring and withholding of medications were problematic. Overall, 69.3% of protocols were not compliant with the content or preparation of the consensus meal: 47.3% used whole eggs instead of egg whites, and additional ingredients not recommended in the guidelines were also frequently used. Only 3.1% of laboratories were fully compliant with all 14 variables. Over half the laboratories were compliant with only 5 variables or less. Conclusion: Almost 8 y after the publication of the SNMMI GES guidelines, there is low protocol adherence among laboratories applying for IAC Nuclear/PET accreditation. This substantial degree of guideline noncompliance is concerning. The variability in GES protocols may have a significant effect on patient management, as results may be inaccurate. Consistent use of the standardized GES protocol permits interpretation of results in a standardized manner that allows interlaboratory comparisons and fosters acceptance of the test validity by referring clinicians.","PeriodicalId":22799,"journal":{"name":"The Journal of Nuclear Medicine Technology","volume":"7 1","pages":"13 - 6"},"PeriodicalIF":0.0,"publicationDate":"2017-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81821911","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}
{"title":"Reply: Survey on the Use of Nuclear Renal Imaging in the United States","authors":"N. Bolus","doi":"10.2967/jnmt.117.190587","DOIUrl":"https://doi.org/10.2967/jnmt.117.190587","url":null,"abstract":"","PeriodicalId":22799,"journal":{"name":"The Journal of Nuclear Medicine Technology","volume":"10 10","pages":"65 - 65"},"PeriodicalIF":0.0,"publicationDate":"2017-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"91496622","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}
Zaid Haddadin, V. Lee, C. Conlin, Lei Zhang, Kristi Carlston, G. Morrell, Daniel Kim, J. Hoffman, K. Morton
Glomerular filtration rate (GFR) measurements are critical in patients with hepatic cirrhosis but potentially erroneous when based on serum creatinine. New equations for estimated GFR (eGFR) have shown variable performance in cirrhotics, possibly because of inaccuracies in reference methods for measured GFR (mGFR). The primary objective was to compare the performance of 4 improved eGFR equations with a 1-compartment, 2-sample plasma slope intercept 99mTc-DTPA mGFR method to determine whether any of the eGFR calculations could replace plasma 99mTc-DTPA mGFR in patients with cirrhosis. The secondary objective was to test the hypothesis that mGFR using voluntary voided urine collections introduces error compared with plasma-only methods. Methods: Fifty-four patients with hepatic cirrhosis underwent mGFR determinations from 2 plasma samples at 1 and 3 h after intravenous administration of 185 MBq of 99mTc-DTPA. GFR was also generated by a UV/P calculation derived from blood and urine samples. These mGFRs were compared with the eGFRs generated by 4 estimating equations: MDRD (Modified Diet in Renal Disease), CKD-EPI (Chronic Kidney Disease-Epidemiology Collaboration) (serum creatinine [SCr]), CKD-EPI (cystatin [CysC]), and CKD-EPI (CysC+SCr). eGFRs were compared with mGFRs by Pearson correlation, precision, bias, percentage bias, and accuracy (eGFRs varying by <10% [p10], <20% [p20] or <30% [p30] from the corresponding mGFR). Results: All eGFRs showed poorer performance when the UV/P 99mTc-DTPA mGFR was used as the reference than when the plasma 99mTc-DTPA mGFR was used. When compared with the plasma 99mTc-DTPA mGFR method, the performance of all eGFR equations was superior to most published reports. There was a moderately good positive correlation between eGFRs and mGFRs. When compared with plasma 99mTc-DTPA mGFR, precision of eGFRs was in the range of 14–20 mL/min and showed a negligible bias. Compared with the plasma 99mTc-DTPA mGFR, CKD-EPI (CysC+SCr) showed the best overall performance and accuracy, at 85.19% (p30), 75.93% (p20), and 42.59% (p10). Conclusion: Estimating equations for measuring eGFR performed better than in most published reports, attributable to use of the plasma 99mTc-DTPA mGFR method as a reference. CKD-EPI (CysC+SCr) eGFR showed the best overall performance. However, more discriminating methods may be required when accurate GFR measurements are necessary. mGFR measurements using urine collections may introduce error compared with plasma-only methods.
{"title":"Comparison of Performance of Improved Serum Estimators of Glomerular Filtration Rate (GFR) to 99mTc-DTPA GFR Methods in Patients with Hepatic Cirrhosis","authors":"Zaid Haddadin, V. Lee, C. Conlin, Lei Zhang, Kristi Carlston, G. Morrell, Daniel Kim, J. Hoffman, K. Morton","doi":"10.2967/jnmt.116.180851","DOIUrl":"https://doi.org/10.2967/jnmt.116.180851","url":null,"abstract":"Glomerular filtration rate (GFR) measurements are critical in patients with hepatic cirrhosis but potentially erroneous when based on serum creatinine. New equations for estimated GFR (eGFR) have shown variable performance in cirrhotics, possibly because of inaccuracies in reference methods for measured GFR (mGFR). The primary objective was to compare the performance of 4 improved eGFR equations with a 1-compartment, 2-sample plasma slope intercept 99mTc-DTPA mGFR method to determine whether any of the eGFR calculations could replace plasma 99mTc-DTPA mGFR in patients with cirrhosis. The secondary objective was to test the hypothesis that mGFR using voluntary voided urine collections introduces error compared with plasma-only methods. Methods: Fifty-four patients with hepatic cirrhosis underwent mGFR determinations from 2 plasma samples at 1 and 3 h after intravenous administration of 185 MBq of 99mTc-DTPA. GFR was also generated by a UV/P calculation derived from blood and urine samples. These mGFRs were compared with the eGFRs generated by 4 estimating equations: MDRD (Modified Diet in Renal Disease), CKD-EPI (Chronic Kidney Disease-Epidemiology Collaboration) (serum creatinine [SCr]), CKD-EPI (cystatin [CysC]), and CKD-EPI (CysC+SCr). eGFRs were compared with mGFRs by Pearson correlation, precision, bias, percentage bias, and accuracy (eGFRs varying by <10% [p10], <20% [p20] or <30% [p30] from the corresponding mGFR). Results: All eGFRs showed poorer performance when the UV/P 99mTc-DTPA mGFR was used as the reference than when the plasma 99mTc-DTPA mGFR was used. When compared with the plasma 99mTc-DTPA mGFR method, the performance of all eGFR equations was superior to most published reports. There was a moderately good positive correlation between eGFRs and mGFRs. When compared with plasma 99mTc-DTPA mGFR, precision of eGFRs was in the range of 14–20 mL/min and showed a negligible bias. Compared with the plasma 99mTc-DTPA mGFR, CKD-EPI (CysC+SCr) showed the best overall performance and accuracy, at 85.19% (p30), 75.93% (p20), and 42.59% (p10). Conclusion: Estimating equations for measuring eGFR performed better than in most published reports, attributable to use of the plasma 99mTc-DTPA mGFR method as a reference. CKD-EPI (CysC+SCr) eGFR showed the best overall performance. However, more discriminating methods may be required when accurate GFR measurements are necessary. mGFR measurements using urine collections may introduce error compared with plasma-only methods.","PeriodicalId":22799,"journal":{"name":"The Journal of Nuclear Medicine Technology","volume":"47 1","pages":"42 - 49"},"PeriodicalIF":0.0,"publicationDate":"2017-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80728840","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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