Algorithms are able to compute myocardial blood flow (MBF) from dynamic PET data for each of the 17 left ventricular segments, with global MBF obtained by averaging segmental values. This study was undertaken to compare MBFs with and without the basal–septal segments. Methods: Data were examined retrospectively for 196 patients who underwent rest and regadenoson-stress 82Rb PET/CT scanning for evaluation of known or suspected coronary artery disease. MBF data were acquired in gated list mode and rebinned to isolate the first-pass dynamic portion. Coronary vascular resistance (CVR) was computed as mean arterial pressure divided by MBF. MBF inhomogeneity was computed as the ratio of SD to mean MBF. Relative perfusion scores were obtained using 82Rb-specific normal limits applied to polar maps of myocardial perfusion generated from myocardial equilibrium portions of PET data. MBF and CVRs from 17 and 14 segments were compared. Results: Mean MBFs were lower for 17- than 14-segment means for rest (0.78 ± 0.50 vs. 0.85 ± 0.54 mL/g/min, paired t test P < 0.0001) and stress (1.50 ± 0.88 vs. 1.67 ± 0.96 mL/g/min, P < 0.0001). Bland–Altman plots of MBF differences versus means exhibited nonzero intercept (−0.04 ± 0.01, P = 0.0004) and significant correlation (r = −0.64, P < 0.0001), with slopes significantly different from 0.0 (−7.2% ± 0.6% and −8.3% ± 0.7% for rest and stress MBF; P < 0.0001). Seventeen-segment CVRs were higher than 14-segment CVRs for rest (159 ± 86 vs. 147 ± 81 mm Hg/mL/g/min, paired t test P < 0.0001) and stress CVR (85 ± 52 vs. 76 ± 48 mm Hg/mL/g/min, P < 0.0001). MBF inhomogeneity correlated significantly (P < 0.0001) with summed perfusion scores, but values correlated significantly more strongly for 14- than 17-segment values for rest (r = 0.67 vs. r = 0.52, P = 0.02) and stress (r = 0.69 vs. r = 0.47, P = 0.001). When basal segments were included in MBF determinations, perfusion inhomogeneity was greater both for rest (39% ± 10% vs. 31% ± 10%, P < 0.0001) and for stress (42% ± 12% vs. 32% ± 11%, P < 0.0001). Conclusion: Averaging 17 versus 14 segments leads to systematically 7%–8% lower MBF calculations, higher CVRs, and greater computed inhomogeneity. Consideration should be given to excluding basal–septal segments from standard global MBF determination.
算法能够从17个左心室节段的动态PET数据中计算心肌血流量(MBF)，并通过平均节段值获得全局MBF。本研究是为了比较有基底-间隔段和没有基底-间隔段的mbf。方法:回顾性分析196例接受休息和再腺苷酸应激82Rb PET/CT扫描以评估已知或疑似冠状动脉疾病的患者的资料。MBF数据以门控列表模式获取，并重新排序以隔离第一次通过的动态部分。冠状动脉阻力(CVR)计算为平均动脉压除以MBF。MBF不均匀性计算为SD与平均MBF的比值。相对灌注评分采用82rb特异性正常限，应用于由PET数据的心肌平衡部分生成的心肌灌注极坐标图。比较17和14节段的MBF和cvr。结果:17段平均MBFs低于14段平均休息(0.78±0.50比0.85±0.54 mL/g/min，配对t检验P < 0.0001)和应激(1.50±0.88比1.67±0.96 mL/g/min, P < 0.0001)。MBF与均值差异的Bland-Altman图显示出非零截距(- 0.04±0.01,P = 0.0004)和显著相关性(r = - 0.64, P < 0.0001)，其中休息和应激MBF的斜率显著不同于0.0(- 7.2%±0.6%和- 8.3%±0.7%);P < 0.0001)。17段CVR在休息时(159±86比147±81 mm Hg/mL/g/min，配对t检验P < 0.0001)和应激时(85±52比76±48 mm Hg/mL/g/min, P < 0.0001)均高于14段CVR。MBF不均匀性与总灌注评分显著相关(P < 0.0001)，但休息(r = 0.67 vs. r = 0.52, P = 0.02)和应激(r = 0.69 vs. r = 0.47, P = 0.001)时14节段值的相关性明显强于17节段值。当基底节段被纳入MBF测定时，休息时(39%±10% vs 31%±10%，P < 0.0001)和应激时(42%±12% vs 32%±11%，P < 0.0001)的灌注不均匀性都更大。结论:平均17节段与平均14节段相比，MBF计算降低7%-8%，cvr更高，计算不均匀性更大。应考虑将基底-间隔段排除在标准的全球MBF测定之外。
{"title":"Effect of Outflow Tract Contributions to 82Rb-PET Global Myocardial Blood Flow Computations","authors":"A. Van Tosh, N. Reichek, C. Palestro, K. Nichols","doi":"10.2967/jnmt.116.173005","DOIUrl":"https://doi.org/10.2967/jnmt.116.173005","url":null,"abstract":"Algorithms are able to compute myocardial blood flow (MBF) from dynamic PET data for each of the 17 left ventricular segments, with global MBF obtained by averaging segmental values. This study was undertaken to compare MBFs with and without the basal–septal segments. Methods: Data were examined retrospectively for 196 patients who underwent rest and regadenoson-stress 82Rb PET/CT scanning for evaluation of known or suspected coronary artery disease. MBF data were acquired in gated list mode and rebinned to isolate the first-pass dynamic portion. Coronary vascular resistance (CVR) was computed as mean arterial pressure divided by MBF. MBF inhomogeneity was computed as the ratio of SD to mean MBF. Relative perfusion scores were obtained using 82Rb-specific normal limits applied to polar maps of myocardial perfusion generated from myocardial equilibrium portions of PET data. MBF and CVRs from 17 and 14 segments were compared. Results: Mean MBFs were lower for 17- than 14-segment means for rest (0.78 ± 0.50 vs. 0.85 ± 0.54 mL/g/min, paired t test P < 0.0001) and stress (1.50 ± 0.88 vs. 1.67 ± 0.96 mL/g/min, P < 0.0001). Bland–Altman plots of MBF differences versus means exhibited nonzero intercept (−0.04 ± 0.01, P = 0.0004) and significant correlation (r = −0.64, P < 0.0001), with slopes significantly different from 0.0 (−7.2% ± 0.6% and −8.3% ± 0.7% for rest and stress MBF; P < 0.0001). Seventeen-segment CVRs were higher than 14-segment CVRs for rest (159 ± 86 vs. 147 ± 81 mm Hg/mL/g/min, paired t test P < 0.0001) and stress CVR (85 ± 52 vs. 76 ± 48 mm Hg/mL/g/min, P < 0.0001). MBF inhomogeneity correlated significantly (P < 0.0001) with summed perfusion scores, but values correlated significantly more strongly for 14- than 17-segment values for rest (r = 0.67 vs. r = 0.52, P = 0.02) and stress (r = 0.69 vs. r = 0.47, P = 0.001). When basal segments were included in MBF determinations, perfusion inhomogeneity was greater both for rest (39% ± 10% vs. 31% ± 10%, P < 0.0001) and for stress (42% ± 12% vs. 32% ± 11%, P < 0.0001). Conclusion: Averaging 17 versus 14 segments leads to systematically 7%–8% lower MBF calculations, higher CVRs, and greater computed inhomogeneity. Consideration should be given to excluding basal–septal segments from standard global MBF determination.","PeriodicalId":22799,"journal":{"name":"The Journal of Nuclear Medicine Technology","volume":"32 1","pages":"78 - 84"},"PeriodicalIF":0.0,"publicationDate":"2016-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84847379","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}
S.G. Johnson, M.B. Farrell, A.M. Alessi, and M.C. Hyun Reston, VA: Society of Nuclear Medicine and Molecular Imaging, 2015, 210 pages, $199 This second edition of Nuclear Cardiology Technology Study Guide offers a complete study of nuclear cardiology from basic cardiac anatomy to advanced
{"title":"Nuclear Cardiology Technology Study Guide","authors":"S. Johnson","doi":"10.2967/JNMT.116.175018","DOIUrl":"https://doi.org/10.2967/JNMT.116.175018","url":null,"abstract":"S.G. Johnson, M.B. Farrell, A.M. Alessi, and M.C. Hyun\u0000\u0000Reston, VA: Society of Nuclear Medicine and Molecular Imaging, 2015, 210 pages, $199 \u0000\u0000This second edition of Nuclear Cardiology Technology Study Guide offers a complete study of nuclear cardiology from basic cardiac anatomy to advanced","PeriodicalId":22799,"journal":{"name":"The Journal of Nuclear Medicine Technology","volume":"39 1","pages":"164 - 165"},"PeriodicalIF":0.0,"publicationDate":"2016-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74005103","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}
Our objective was to assess the renal toxicity profile of 177Lu-DOTATATE peptide receptor radionuclide therapy (PRRT) in patients with a metastatic neuroendocrine tumor (NET) and a single functioning kidney. Methods: This was a retrospective analysis of NET patients who had undergone 177Lu-DOTATATE PRRT at a large tertiary-care center. All patients selected for the study had somatostatin receptor–positive NETs, had received at least 3 cycles of 177Lu-DOTATATE PRRT, and had a documented single functioning kidney. The analyzed parameters included patient characteristics, metastatic burden, renal characteristics at diagnosis and during therapy, and nephrotoxic factors. For the renal assessment, the following characteristics were studied before each PRRT cycle: glomerular filtration rate (GFR) as estimated by 99mTc-diethylenetriamine pentaacetic acid renography, effective renal plasma flow (ERPF) as measured by 99mTc-ethylenedicysteine renography, and blood urea and serum creatinine levels. Renal toxicity was evaluated using version 4.0 of the Common Terminology Criteria for Adverse Events (NCI-CTCAE score). The percentage reduction in GFR and ERPF was also assessed. Filtration fraction was calculated to clarify whether there was a relatively greater reduction in one index of renal function than in the other. Results: At the time of analysis, 6 patients met the inclusion criteria, having received between 3 and 5 cycles of therapy with a cumulative activity of 16.6–36.2 GBq. The duration of follow-up ranged from 12 to 56 mo. The overall toxicity profile (as per the NCI-CTCAE score) showed no acute renal toxicity in any patient. Regarding overall chronic renal toxicity, 3 patients had none, 1 patient had grade II, and 2 patients had grade I. All patients with overall chronic renal toxicity showed compromised renal function at the outset (baseline). The 2 patients with grade I chronic renal toxicity after PRRT had grade II at baseline and gradual improvement over the subsequent cycles. One patient with grade II at baseline showed transient worsening to grade III after the first cycle followed by gradual improvement and a return to baseline after the second cycle. Only 2 patients showed a reduction in GFR (5.3% in one and 13.84% in the other). Four patients showed a reduction in ERPF (31.4% in the patient with the greatest reduction), and all had a rise in filtration fraction signifying that tubular parameters were more affected than glomerular parameters. Conclusion: With proper renal protection and dose fractionation, it is feasible to use 177Lu-DOTATATE PRRT in patients with NET and a single functioning kidney. Further studies are required to assess the long-term renal consequences of changes in ERPF and filtration fraction in these patients.
{"title":"177Lu-DOTATATE PRRT in Patients with Metastatic Neuroendocrine Tumor and a Single Functioning Kidney: Tolerability and Effect on Renal Function","authors":"R. Ranade, S. Basu","doi":"10.2967/jnmt.115.168146","DOIUrl":"https://doi.org/10.2967/jnmt.115.168146","url":null,"abstract":"Our objective was to assess the renal toxicity profile of 177Lu-DOTATATE peptide receptor radionuclide therapy (PRRT) in patients with a metastatic neuroendocrine tumor (NET) and a single functioning kidney. Methods: This was a retrospective analysis of NET patients who had undergone 177Lu-DOTATATE PRRT at a large tertiary-care center. All patients selected for the study had somatostatin receptor–positive NETs, had received at least 3 cycles of 177Lu-DOTATATE PRRT, and had a documented single functioning kidney. The analyzed parameters included patient characteristics, metastatic burden, renal characteristics at diagnosis and during therapy, and nephrotoxic factors. For the renal assessment, the following characteristics were studied before each PRRT cycle: glomerular filtration rate (GFR) as estimated by 99mTc-diethylenetriamine pentaacetic acid renography, effective renal plasma flow (ERPF) as measured by 99mTc-ethylenedicysteine renography, and blood urea and serum creatinine levels. Renal toxicity was evaluated using version 4.0 of the Common Terminology Criteria for Adverse Events (NCI-CTCAE score). The percentage reduction in GFR and ERPF was also assessed. Filtration fraction was calculated to clarify whether there was a relatively greater reduction in one index of renal function than in the other. Results: At the time of analysis, 6 patients met the inclusion criteria, having received between 3 and 5 cycles of therapy with a cumulative activity of 16.6–36.2 GBq. The duration of follow-up ranged from 12 to 56 mo. The overall toxicity profile (as per the NCI-CTCAE score) showed no acute renal toxicity in any patient. Regarding overall chronic renal toxicity, 3 patients had none, 1 patient had grade II, and 2 patients had grade I. All patients with overall chronic renal toxicity showed compromised renal function at the outset (baseline). The 2 patients with grade I chronic renal toxicity after PRRT had grade II at baseline and gradual improvement over the subsequent cycles. One patient with grade II at baseline showed transient worsening to grade III after the first cycle followed by gradual improvement and a return to baseline after the second cycle. Only 2 patients showed a reduction in GFR (5.3% in one and 13.84% in the other). Four patients showed a reduction in ERPF (31.4% in the patient with the greatest reduction), and all had a rise in filtration fraction signifying that tubular parameters were more affected than glomerular parameters. Conclusion: With proper renal protection and dose fractionation, it is feasible to use 177Lu-DOTATATE PRRT in patients with NET and a single functioning kidney. Further studies are required to assess the long-term renal consequences of changes in ERPF and filtration fraction in these patients.","PeriodicalId":22799,"journal":{"name":"The Journal of Nuclear Medicine Technology","volume":"109 1","pages":"65 - 69"},"PeriodicalIF":0.0,"publicationDate":"2016-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80726551","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 conventional dynamic cardiac phantom used in the field of nuclear medicine has a structure for which the size of the external side of the heart (the outer membrane substituting the myocardial layer) is fixed and only the inner side (the inner membrane substituting the ventricle part) moves anteroposteriorly. Therefore, its usefulness in technical evaluation is limited. Hence, we developed a new dynamic cardiac phantom in which the outer and inner membranes freely move. Methods: Using a SPECT/CT system, we performed validation by filling the myocardial layer of the dynamic cardiac phantom with solution and the ventricle part with contrast medium. We evaluated myocardial wall motions of 3 segments (basal, mid, and apical) by setting the stroke ratios at 20:20 and 10:10 (ventricle-to-myocardial layer ratio). Results: The myocardial wall motions (mean ± SD) at the stroke ratio of 20:20 were 7.50 ± 0.44, 11.15 ± 0.56, and 9.90 ± 0.24 mm in the basal, mid, and apical segments, respectively. The wall motions (mean ± SD) at the stroke ratio of 10:10 were 3.82 ± 0.43, 5.63 ± 0.39, and 4.53 ± 0.10 mm, respectively. Conclusion: In our dynamic cardiac phantom, different movements could be induced in the myocardial wall by freely changing the stroke ratio. These results suggest that the use of this phantom can realize technical evaluation that presumes various clinical conditions.
{"title":"Development of a 2-Layer Double-Pump Dynamic Cardiac Phantom","authors":"Hara Narihiro, Onoguchi Masahisa, Hojyo Osamu, Kawaguchi Hiroyuki, Murai Masakazu, Matsushima Noriko","doi":"10.2967/jnmt.115.168252","DOIUrl":"https://doi.org/10.2967/jnmt.115.168252","url":null,"abstract":"The conventional dynamic cardiac phantom used in the field of nuclear medicine has a structure for which the size of the external side of the heart (the outer membrane substituting the myocardial layer) is fixed and only the inner side (the inner membrane substituting the ventricle part) moves anteroposteriorly. Therefore, its usefulness in technical evaluation is limited. Hence, we developed a new dynamic cardiac phantom in which the outer and inner membranes freely move. Methods: Using a SPECT/CT system, we performed validation by filling the myocardial layer of the dynamic cardiac phantom with solution and the ventricle part with contrast medium. We evaluated myocardial wall motions of 3 segments (basal, mid, and apical) by setting the stroke ratios at 20:20 and 10:10 (ventricle-to-myocardial layer ratio). Results: The myocardial wall motions (mean ± SD) at the stroke ratio of 20:20 were 7.50 ± 0.44, 11.15 ± 0.56, and 9.90 ± 0.24 mm in the basal, mid, and apical segments, respectively. The wall motions (mean ± SD) at the stroke ratio of 10:10 were 3.82 ± 0.43, 5.63 ± 0.39, and 4.53 ± 0.10 mm, respectively. Conclusion: In our dynamic cardiac phantom, different movements could be induced in the myocardial wall by freely changing the stroke ratio. These results suggest that the use of this phantom can realize technical evaluation that presumes various clinical conditions.","PeriodicalId":22799,"journal":{"name":"The Journal of Nuclear Medicine Technology","volume":"54 1","pages":"31 - 35"},"PeriodicalIF":0.0,"publicationDate":"2016-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83399205","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}
Basic Science of Nuclear Medicine: The Bare Bone Essentials is a concise manual on nuclear physics, instrumentation, and radiation safety. This paperback publication contains 15 chapters and is printed in color. The colored pictorial representations of nuclear medicine technology concepts and images is what makes this publication so unique. This book would be a great complement to a student’s board prep materials, a wonderful refresher for the seasoned technologist, and a phenomenal exhibit for the inquisitive patient. The author, Lee, completes the book with a glossary, bibliography, index, and preface. In the preface, Lee describes the book as being a compilation of important points that may be obscured in more comprehensive textbooks. I would agree. Lee also operates on the assumption that many readers have an aversion to math, and therefore only necessary mathematics have been included. Concepts in the book are repeatedly supported with creative graphics, which are superb in helping the reader visualize the concepts and are a strength of the publication. The 15 chapters are logically organized by beginning with foundational radiation physics and working through instrumentation and radiation safety. Chapters 1 through 5 focus on atomic structure and how radiation is produced and interacts with matter. Chapters 6 through 12 walk the reader through the principles and quality assurance of nuclear medicine instruments; g-cameras; and SPECT, PET, CT, and MR scanners. The final chapters, 13 through 16, thoroughly cover counting statistics, dosimetry, radiation safety, and regulations. The initial 5 chapters are quite comprehensive considering how concise they are. Atomic models are briefly reviewed, whereas concepts such as decay and the table of nuclides are given considerably more attention. These chapters contain most of the math in the book, with the exception of the chapter on statistics. The math is not overwhelming, and examples are provided to demonstrate how the equations are to be used. The concepts covered in these chapters lay the foundation for understanding the chapters to follow. Chapters 6 through 12 detail the workings of an array of nuclear medicine instrumentation. There is a plethora of images of the inner parts of g-cameras, CT scanners, and MR scanners—aspects of the instrumentation that technologists rarely have an opportunity to see. In particular, the images associated with collimators in chapter 7 were helpful. As an educator, I have found the concept of collimation often difficult for new students to grasp. In the preface, Lee shares his approach to writing the book as “tell them what you want to tell them, tell them again, and repeat what you told them.” This approach is evident in chapter 7 in his description of collimators. The chapter on MR is the longest. Considering how new the modality is to nuclear medicine technology, the reader will appreciate the comprehensive overview of how MR images are generated. The chapter
{"title":"Basic Science of Nuclear Medicine: The Bare Bone Essentials","authors":"R. Loch","doi":"10.2967/jnmt.115.171041","DOIUrl":"https://doi.org/10.2967/jnmt.115.171041","url":null,"abstract":"Basic Science of Nuclear Medicine: The Bare Bone Essentials is a concise manual on nuclear physics, instrumentation, and radiation safety. This paperback publication contains 15 chapters and is printed in color. The colored pictorial representations of nuclear medicine technology concepts and images is what makes this publication so unique. This book would be a great complement to a student’s board prep materials, a wonderful refresher for the seasoned technologist, and a phenomenal exhibit for the inquisitive patient. The author, Lee, completes the book with a glossary, bibliography, index, and preface. In the preface, Lee describes the book as being a compilation of important points that may be obscured in more comprehensive textbooks. I would agree. Lee also operates on the assumption that many readers have an aversion to math, and therefore only necessary mathematics have been included. Concepts in the book are repeatedly supported with creative graphics, which are superb in helping the reader visualize the concepts and are a strength of the publication. The 15 chapters are logically organized by beginning with foundational radiation physics and working through instrumentation and radiation safety. Chapters 1 through 5 focus on atomic structure and how radiation is produced and interacts with matter. Chapters 6 through 12 walk the reader through the principles and quality assurance of nuclear medicine instruments; g-cameras; and SPECT, PET, CT, and MR scanners. The final chapters, 13 through 16, thoroughly cover counting statistics, dosimetry, radiation safety, and regulations. The initial 5 chapters are quite comprehensive considering how concise they are. Atomic models are briefly reviewed, whereas concepts such as decay and the table of nuclides are given considerably more attention. These chapters contain most of the math in the book, with the exception of the chapter on statistics. The math is not overwhelming, and examples are provided to demonstrate how the equations are to be used. The concepts covered in these chapters lay the foundation for understanding the chapters to follow. Chapters 6 through 12 detail the workings of an array of nuclear medicine instrumentation. There is a plethora of images of the inner parts of g-cameras, CT scanners, and MR scanners—aspects of the instrumentation that technologists rarely have an opportunity to see. In particular, the images associated with collimators in chapter 7 were helpful. As an educator, I have found the concept of collimation often difficult for new students to grasp. In the preface, Lee shares his approach to writing the book as “tell them what you want to tell them, tell them again, and repeat what you told them.” This approach is evident in chapter 7 in his description of collimators. The chapter on MR is the longest. Considering how new the modality is to nuclear medicine technology, the reader will appreciate the comprehensive overview of how MR images are generated. The chapter","PeriodicalId":22799,"journal":{"name":"The Journal of Nuclear Medicine Technology","volume":"63 1","pages":"54 - 54"},"PeriodicalIF":0.0,"publicationDate":"2016-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79992985","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}
What is the true difference between a nuclear medicine technologist and a nuclear medicine advanced associate (NMAA)? There can be many answers to this question: a specialized advanced degree; a broader scope of practice; about $40,000 in debt; a long, uphill battle. It appears that many believe the future of the NMAA to be ill-fated and that if technologists truly want to increase their clinical knowledge and position, they should follow the route of a conventional physician assistant (PA). PAs can bill for services and are recognized by state legislators, physicians, and medical institutions. NMAAs cannot bill for services, must prove their worth to institutions (most of which do not have job descriptions or openings for NMAAs), and currently have no certification in states that require imaging professionals to obtain valid licenses. Make no mistake: this pathway is not easy, but as several practicing NMAAs can attest, it can definitely be successful. Having a conventional PA license would not prepare someone to act as a potential extender for the nuclear medicine physician. Though PAs have been used in diagnostic radiology, it is rare or impossible to find a PAwith clinical training in nuclear medicine. We do not see PAs in the interpretation room dictating ventilation–perfusion results or calculating therapy doses. The reason is multifold. To be a valuable resource in the nuclear medicine department, one must be trained as a physician extender in this specific modality. Current NMAAs have responsibilities such as making technical and clinical decisions, which requires a strong technical background; administering adjunctive medications, which requires knowledge not only of pharmacology but also of the specific imaging procedure and the physiologic response being assessed; evaluating patients and obtaining information specific for nuclear medicine procedures; and interpreting the preliminary results of molecular imaging procedures. Most of these duties are not taught in conventional PA classes. Even a seasoned nuclear medicine technologist who has completed a conventional PA program would not be prepared to function as a physician extender in nuclear medicine, as a large part of the NMAA’s role—image interpretation—is not addressed by current PA curriculums. As an example, 5 areas of study for an NMAA clinical internship might include pulmonary, endocrine, and skeletal medicine; therapeutic and PET imaging procedures; gastrointestinal, genitourinary, and neuroimaging procedures; cardiac imaging and stress testing; and administrative procedures and specialized modalities. The curriculum would have strict requirements for each of these areas. For a PA clinical internship, in contrast, the corresponding 5 areas might include emergency medicine and internal medicine procedures; pediatrics and surgery; primary care and obstetrics and gynecology; psychiatry and geriatrics; and critical care and elective courses. The NMAA program is not designed for a
{"title":"Don’t Be So Quick to Raise the White Flag on the Nuclear Medicine Advanced Associate as a Career Path","authors":"Vicki LaRue","doi":"10.2967/jnmt.115.168302","DOIUrl":"https://doi.org/10.2967/jnmt.115.168302","url":null,"abstract":"What is the true difference between a nuclear medicine technologist and a nuclear medicine advanced associate (NMAA)? There can be many answers to this question: a specialized advanced degree; a broader scope of practice; about $40,000 in debt; a long, uphill battle. It appears that many believe the future of the NMAA to be ill-fated and that if technologists truly want to increase their clinical knowledge and position, they should follow the route of a conventional physician assistant (PA). PAs can bill for services and are recognized by state legislators, physicians, and medical institutions. NMAAs cannot bill for services, must prove their worth to institutions (most of which do not have job descriptions or openings for NMAAs), and currently have no certification in states that require imaging professionals to obtain valid licenses. Make no mistake: this pathway is not easy, but as several practicing NMAAs can attest, it can definitely be successful. Having a conventional PA license would not prepare someone to act as a potential extender for the nuclear medicine physician. Though PAs have been used in diagnostic radiology, it is rare or impossible to find a PAwith clinical training in nuclear medicine. We do not see PAs in the interpretation room dictating ventilation–perfusion results or calculating therapy doses. The reason is multifold. To be a valuable resource in the nuclear medicine department, one must be trained as a physician extender in this specific modality. Current NMAAs have responsibilities such as making technical and clinical decisions, which requires a strong technical background; administering adjunctive medications, which requires knowledge not only of pharmacology but also of the specific imaging procedure and the physiologic response being assessed; evaluating patients and obtaining information specific for nuclear medicine procedures; and interpreting the preliminary results of molecular imaging procedures. Most of these duties are not taught in conventional PA classes. Even a seasoned nuclear medicine technologist who has completed a conventional PA program would not be prepared to function as a physician extender in nuclear medicine, as a large part of the NMAA’s role—image interpretation—is not addressed by current PA curriculums. As an example, 5 areas of study for an NMAA clinical internship might include pulmonary, endocrine, and skeletal medicine; therapeutic and PET imaging procedures; gastrointestinal, genitourinary, and neuroimaging procedures; cardiac imaging and stress testing; and administrative procedures and specialized modalities. The curriculum would have strict requirements for each of these areas. For a PA clinical internship, in contrast, the corresponding 5 areas might include emergency medicine and internal medicine procedures; pediatrics and surgery; primary care and obstetrics and gynecology; psychiatry and geriatrics; and critical care and elective courses. The NMAA program is not designed for a","PeriodicalId":22799,"journal":{"name":"The Journal of Nuclear Medicine Technology","volume":"1 1","pages":"19 - 20"},"PeriodicalIF":0.0,"publicationDate":"2016-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90400393","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}
Camilla Andersson, B. Johansson, C. Wassberg, S. Johansson, A. Sundin, H. Ahlström
The aim of this study was to investigate patients’ previous knowledge, satisfaction, and experience regarding an 18F-fluoride PET/CT examination and to explore whether any discomfort or pain during the examination was associated with reduced image quality. A further aim was to explore whether patients’ health-related quality of life (HRQoL) was associated with their satisfaction and experience regarding the examination. Methods: Between November 2011 and April 2013, 50 consecutive patients with a histopathologic diagnosis of prostate cancer who were scheduled for 18F-fluoride PET/CT were asked to participate in the study. A questionnaire was used to collect information on the patients’ previous knowledge and experience regarding the examination. Image quality was assessed according to an arbitrary scale. The European Organization for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire (QLQ-C30) and the prostate cancer–specific module (QLQ-PR25) were used to assess HRQoL. Results: Forty-six patients (96%) completed the questionnaire. Twenty-six percent did not at all know what a 18F-fluoride PET/CT examination was. Most (52%–70%) were satisfied to a very high degree with the care provided by the nursing staff but were less satisfied with the information given before the examination. Image quality was similar between patients who were exhausted or claustrophobic during the examination and those who were not. No correlations between HRQoL and the patients’ experience regarding 18F-fluoride PET/CT were found. Conclusion: Most patients were satisfied with the care provided by the nursing staff, but there is still room for improvement, especially regarding the information provided before the examination. A long examination time may be strenuous for the patient, but there was no difference in image quality between patients who felt discomfort or pain during the examination and those who did not.
{"title":"Assessment of Whether Patients’ Knowledge, Satisfaction, and Experience Regarding Their 18F-Fluoride PET/CT Examination Affects Image Quality","authors":"Camilla Andersson, B. Johansson, C. Wassberg, S. Johansson, A. Sundin, H. Ahlström","doi":"10.2967/jnmt.115.167536","DOIUrl":"https://doi.org/10.2967/jnmt.115.167536","url":null,"abstract":"The aim of this study was to investigate patients’ previous knowledge, satisfaction, and experience regarding an 18F-fluoride PET/CT examination and to explore whether any discomfort or pain during the examination was associated with reduced image quality. A further aim was to explore whether patients’ health-related quality of life (HRQoL) was associated with their satisfaction and experience regarding the examination. Methods: Between November 2011 and April 2013, 50 consecutive patients with a histopathologic diagnosis of prostate cancer who were scheduled for 18F-fluoride PET/CT were asked to participate in the study. A questionnaire was used to collect information on the patients’ previous knowledge and experience regarding the examination. Image quality was assessed according to an arbitrary scale. The European Organization for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire (QLQ-C30) and the prostate cancer–specific module (QLQ-PR25) were used to assess HRQoL. Results: Forty-six patients (96%) completed the questionnaire. Twenty-six percent did not at all know what a 18F-fluoride PET/CT examination was. Most (52%–70%) were satisfied to a very high degree with the care provided by the nursing staff but were less satisfied with the information given before the examination. Image quality was similar between patients who were exhausted or claustrophobic during the examination and those who were not. No correlations between HRQoL and the patients’ experience regarding 18F-fluoride PET/CT were found. Conclusion: Most patients were satisfied with the care provided by the nursing staff, but there is still room for improvement, especially regarding the information provided before the examination. A long examination time may be strenuous for the patient, but there was no difference in image quality between patients who felt discomfort or pain during the examination and those who did not.","PeriodicalId":22799,"journal":{"name":"The Journal of Nuclear Medicine Technology","volume":"1 1","pages":"21 - 25"},"PeriodicalIF":0.0,"publicationDate":"2016-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83207698","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}
A. Jha, S. Mithun, Abhijith Mohan Singh, N. Purandare, Sneha Shah, A. Agrawal, V. Rangarajan
Acceptance testing is a set of quality control tests performed to verify various manufacturer-specified parameters before a newly installed PET/CT system can be accepted for clinical use. A new PET/CT system, Gemini TF 16, installed in our department in September 2012 has a PET component capable of time-of-flight imaging using lutetium-yttrium-oxyorthosilicate crystals and operates in 3-dimensional mode. Our aim was to evaluate the system before acceptance and observe the consistency of its performance during high-volume work for 18 mo after installation (we perform an average of 30 PET/CT scans daily). Methods: We performed NEMA (National Electrical Manufacturers Association) NU-2 2007 acceptance testing on the Gemini TF 16; continuously evaluated its gain calibration, timing resolution, and energy resolution during the subsequent 18 mo; and analyzed the results. Results: The system passed the acceptance testing and showed few fluctuations in energy and timing resolutions during the observation period. Conclusion: The Gemini TF 16 whole-body PET/CT system performed excellently during the 18-mo study period despite the high volume of work.
{"title":"18-Month Performance Assessment of Gemini TF 16 PET/CT System in a High-Volume Department","authors":"A. Jha, S. Mithun, Abhijith Mohan Singh, N. Purandare, Sneha Shah, A. Agrawal, V. Rangarajan","doi":"10.2967/jnmt.115.168492","DOIUrl":"https://doi.org/10.2967/jnmt.115.168492","url":null,"abstract":"Acceptance testing is a set of quality control tests performed to verify various manufacturer-specified parameters before a newly installed PET/CT system can be accepted for clinical use. A new PET/CT system, Gemini TF 16, installed in our department in September 2012 has a PET component capable of time-of-flight imaging using lutetium-yttrium-oxyorthosilicate crystals and operates in 3-dimensional mode. Our aim was to evaluate the system before acceptance and observe the consistency of its performance during high-volume work for 18 mo after installation (we perform an average of 30 PET/CT scans daily). Methods: We performed NEMA (National Electrical Manufacturers Association) NU-2 2007 acceptance testing on the Gemini TF 16; continuously evaluated its gain calibration, timing resolution, and energy resolution during the subsequent 18 mo; and analyzed the results. Results: The system passed the acceptance testing and showed few fluctuations in energy and timing resolutions during the observation period. Conclusion: The Gemini TF 16 whole-body PET/CT system performed excellently during the 18-mo study period despite the high volume of work.","PeriodicalId":22799,"journal":{"name":"The Journal of Nuclear Medicine Technology","volume":"15 1","pages":"36 - 41"},"PeriodicalIF":0.0,"publicationDate":"2016-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"91526889","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}
In pursuit of as-low-as-reasonably-achievable (ALARA) doses, this study investigated the minimal required radioactivity and corresponding imaging time for reliable semiquantification in PET/CT imaging. Methods: Using a phantom containing spheres of various diameters (3.4, 2.1, 1.5, 1.2, and 1.0 cm) filled with a fixed 18F-FDG concentration of 165 kBq/mL and a background concentration of 23.3 kBq/mL, we performed PET/CT at multiple time points over 20 h of radioactive decay. The images were acquired for 10 min at a single bed position for each of 10 half-lives of decay using 3-dimensional list mode and were reconstructed into 1-, 2-, 3-, 4-, 5-, and 10-min acquisitions per bed position using an ordered-subsets expectation maximum algorithm with 24 subsets and 2 iterations and a gaussian 2-mm filter. SUVmax and SUVavg were measured for each sphere. Results: The minimal required activity (±10%) for precise SUVmax semiquantification in the spheres was 1.8 kBq/mL for an acquisition of 10 min, 3.7 kBq/mL for 3–5 min, 7.9 kBq/mL for 2 min, and 17.4 kBq/mL for 1 min. The minimal required activity concentration–acquisition time product per bed position was 10–15 kBq/mL⋅min for reproducible SUV measurements within the spheres without overestimation. Using the total radioactivity and counting rate from the entire phantom, we found that the minimal required total activity–time product was 17 MBq⋅min and the minimal required counting rate–time product was 100 kcps⋅min. Conclusion: Our phantom study determined a threshold for minimal radioactivity and acquisition time for precise semiquantification in 18F-FDG PET imaging that can serve as a guide in pursuit of achieving ALARA doses.
{"title":"Determining the Minimal Required Radioactivity of 18F-FDG for Reliable Semiquantification in PET/CT Imaging: A Phantom Study","authors":"Ming-Kai Chen, David Menard, D. Cheng","doi":"10.2967/jnmt.115.165258","DOIUrl":"https://doi.org/10.2967/jnmt.115.165258","url":null,"abstract":"In pursuit of as-low-as-reasonably-achievable (ALARA) doses, this study investigated the minimal required radioactivity and corresponding imaging time for reliable semiquantification in PET/CT imaging. Methods: Using a phantom containing spheres of various diameters (3.4, 2.1, 1.5, 1.2, and 1.0 cm) filled with a fixed 18F-FDG concentration of 165 kBq/mL and a background concentration of 23.3 kBq/mL, we performed PET/CT at multiple time points over 20 h of radioactive decay. The images were acquired for 10 min at a single bed position for each of 10 half-lives of decay using 3-dimensional list mode and were reconstructed into 1-, 2-, 3-, 4-, 5-, and 10-min acquisitions per bed position using an ordered-subsets expectation maximum algorithm with 24 subsets and 2 iterations and a gaussian 2-mm filter. SUVmax and SUVavg were measured for each sphere. Results: The minimal required activity (±10%) for precise SUVmax semiquantification in the spheres was 1.8 kBq/mL for an acquisition of 10 min, 3.7 kBq/mL for 3–5 min, 7.9 kBq/mL for 2 min, and 17.4 kBq/mL for 1 min. The minimal required activity concentration–acquisition time product per bed position was 10–15 kBq/mL⋅min for reproducible SUV measurements within the spheres without overestimation. Using the total radioactivity and counting rate from the entire phantom, we found that the minimal required total activity–time product was 17 MBq⋅min and the minimal required counting rate–time product was 100 kcps⋅min. Conclusion: Our phantom study determined a threshold for minimal radioactivity and acquisition time for precise semiquantification in 18F-FDG PET imaging that can serve as a guide in pursuit of achieving ALARA doses.","PeriodicalId":22799,"journal":{"name":"The Journal of Nuclear Medicine Technology","volume":"165 1","pages":"26 - 30"},"PeriodicalIF":0.0,"publicationDate":"2016-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86434634","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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