Frontiers in nuclear medicine (Lausanne, Switzerland)最新文献

{"title":"The decision to reimage following extravasation in diagnostic nuclear medicine.","authors":"Jackson W Kiser","doi":"10.3389/fnume.2023.1171918","DOIUrl":"10.3389/fnume.2023.1171918","url":null,"abstract":"<p><p>The primary goal of diagnostic nuclear medicine is to provide complete and accurate reports without equivocation or disclaimers. If specific clinical questions cannot be answered because of radiopharmaceutical extravasation, the imaging study may have to be repeated. The decision to reimage is based on several factors including the diagnostic quality of the images, additional patient radiation dose, patient burden, and administrative constraints. Through process improvement efforts, nuclear medicine departments can significantly reduce the frequency of extravasation and thereby also the need for reimaging. Communication with the patient is important any time extravasation may impact their immediate or future care. The circumstances and potential ramifications should be explained, and patient concerns should be addressed. Although recent arguments have been made in favor of investigating and addressing only those extravasations which result in serious patient injury, patients and their referring physicians deserve to know any time their nuclear medicine study may have been impacted.</p>","PeriodicalId":73095,"journal":{"name":"Frontiers in nuclear medicine (Lausanne, Switzerland)","volume":" ","pages":"1171918"},"PeriodicalIF":0.0,"publicationDate":"2023-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11440986/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46425663","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Integration of advanced 3D SPECT modelling for pinhole collimators into the open-source STIR framework.","authors":"Matthew Strugari, Carles Falcon, Kjell Erlandsson, Brian F Hutton, Kimberly Brewer, Kris Thielemans","doi":"10.3389/fnume.2023.1134774","DOIUrl":"10.3389/fnume.2023.1134774","url":null,"abstract":"<p><p>Single-photon emission computed tomography (SPECT) systems with pinhole collimators are becoming increasingly important in clinical and preclinical nuclear medicine investigations as they can provide a superior resolution-sensitivity trade-off compared to conventional parallel-hole and fanbeam collimators. Previously, open-source software did not exist for reconstructing tomographic images from pinhole-SPECT datasets. A 3D SPECT system matrix modelling library specific for pinhole collimators has recently been integrated into STIR, an open-source software package for tomographic image reconstruction. The pinhole-SPECT library enables corrections for attenuation and the spatially variant collimator-detector response by incorporating their effects into the system matrix. Attenuation correction can be calculated with a simple single line of response or a full model. The spatially variant collimator-detector response can be modelled with a point spread function and depth of interaction corrections for increased system matrix accuracy. In addition, improvements to computational speed and memory requirements can be made with image masking. This work demonstrates the flexibility and accuracy of STIR's support for pinhole-SPECT datasets using measured and simulated single-pinhole SPECT data from which reconstructed images were analysed quantitatively and qualitatively. The extension of the open-source STIR project with advanced pinhole-SPECT modelling will enable the research community to study the impact of pinhole collimators in several SPECT imaging scenarios and with different scanners.</p>","PeriodicalId":73095,"journal":{"name":"Frontiers in nuclear medicine (Lausanne, Switzerland)","volume":" ","pages":"1134774"},"PeriodicalIF":0.0,"publicationDate":"2023-04-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11459977/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44422358","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"¹⁸F-FDG PET/CT as a molecular biomarker in the diagnosis of amyotrophic lateral sclerosis associated with prostate cancer and progressive supranuclear palsy: A case report.","authors":"Emilly A Cortés Mancera, Fabio A Sinisterra Solis, Francisco R Romero-Castellanos, Ivan E Diaz-Meneses, Nora E Kerik-Rotenberg","doi":"10.3389/fnume.2023.1137875","DOIUrl":"10.3389/fnume.2023.1137875","url":null,"abstract":"<p><strong>Introduction: </strong>Amyotrophic lateral sclerosis (ALS) is a neurodegenerative, multisystem disorder. Its clinical presentation typically consists of progressive focal muscle atrophy and weakness. In addition to motor disorders, the association between ALS and cancer has been researched, such as frontotemporal dementia and progressive supranuclear palsy. The diagnosis is based primarily on the clinical history, physical examination, electrodiagnostic tests (with an EMG needle), and neuroimaging, such as MRI and ¹⁸F-FDG PET/CT.</p><p><strong>Presentation of the case: </strong>A 67-year-old male patient was diagnosed with prostate adenocarcinoma with a clinical picture of muscle weakness in the lower limbs that caused falls and was associated with fasciculations in the thighs and arms, alterations in the tone of voice, poor memory, and difficulty articulating words. In the neurological assessment, he described walking supported by a walker with decreased strength in both lower limbs and sensitivity without alterations. The diagnoses of upper and lower motor neuron disease and probable ALS were integrated. Furthermore, the probable coexistence of frontotemporal dementia/disorder (FDD) with ALS was considered. The main findings in the ¹⁸F-FDG PET/CT study was hypometabolism in the cortex of the bilateral motor and premotor areas, the anterior cingulate, both caudate and putamen, a metabolic pattern compatible with ALS, and progressive supranuclear palsy.</p><p><strong>Conclusion: </strong>Through the PET/CT studies, we demonstrated a case in which ALS, prostate cancer and progressive supranuclear palsy coexisted molecularly; it was clinically difficult to diagnose. Molecular imaging has potential in the diagnostic and prognostic evaluation of ALS. It is crucial to identify the disease early and reliably through metabolic patterns that allow us to confirm the disease or differentiate it from other pathologies.</p>","PeriodicalId":73095,"journal":{"name":"Frontiers in nuclear medicine (Lausanne, Switzerland)","volume":" ","pages":"1137875"},"PeriodicalIF":0.0,"publicationDate":"2023-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11440934/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45490240","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Insights into handling and delivery of Y-90 radioembolization therapies.","authors":"Dustin R Osborne, Gregory Minwell, Bradley Pollard, Chris Walker, Shelley N Acuff, Kristen Smith, Cain Green, Rachel Taylor, Christopher D Stephens","doi":"10.3389/fnume.2023.1075782","DOIUrl":"10.3389/fnume.2023.1075782","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Introduction: &lt;/strong&gt;The use of Y-90 radioembolization techniques has become a standard tool for the treatment of liver cancer and metastatic diseases that result in liver lesions. As there are only two approved forms of radioembolization therapy, the procedures for use are also fairly standardized even though exact international and interdepartmental procedures can vary. What has been less published over the years are the nuanced differences in delivery techniques and handling of the two available Y90 radioembolization therapies. This paper seeks to examine various aspects of delivery techniques, product handling, and radiation exposure that differ between the available and approved products. Understanding these differences can assist with providing more efficient treatment, confirmation of accurate therapy, more informed handling of the products, and improved training of physicians and other hospital staff.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;Two commercially available and approved radioembolization devices were compared to assess nuanced, but key differences between the available products regarding therapy delivery, handling of the products, and radiation exposure to patients and staff. This work is broken into two sections: (1) Therapy Delivery, (2) Radiation Safety. Therapy delivery characteristics were assessed by using an external radiation detector system with detectors placed inside of each delivery system facing the dose vial and on the output catheter lines to the patient. Additional detectors were placed near the liver of the patient and on top of the foot to measure extremities. Data were acquired continuously throughout therapy delivery to collect time activity curves (TACs) for the characterization of each therapy. These data were analyzed to assess if (a) real-time monitoring of radiation could be used to provide an accurate assessment of residual dose before the patient leaves the procedure room, and (b) can dose delivery characteristics be observed that enable improved training and quality control. Calculation of residual dose using the external detector TACs was performed by analyzing initial and final activity peaks to determine measured count rate differences. Radiation safety aspects were assessed by monitoring radiation exposure to staff handling each of the available therapy products. Nuclear medicine technologists and interventional radiology physician body and hand doses were measured for each delivered therapy using standard body and ring dosimeters. The TACs noted above collected for the liver and extremities were used to assess if any off-target or leached Y90 activity could be detected for each therapy. Blood was collected at times before, during, and after treatment and then counted on a gamma counter to assess differences in free Y90 circulating in the blood. Each patient in this study also received a post-treatment whole-body PET/CT at 2-4 h post-infusion to assess for any aggregate free Y90 deposition th","PeriodicalId":73095,"journal":{"name":"Frontiers in nuclear medicine (Lausanne, Switzerland)","volume":" ","pages":"1075782"},"PeriodicalIF":0.0,"publicationDate":"2023-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11440876/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46660223","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Active monitoring improves radiopharmaceutical administration quality.","authors":"James R Crowley, Iryna Barvi, Jackson W Kiser","doi":"10.3389/fnume.2023.1126029","DOIUrl":"10.3389/fnume.2023.1126029","url":null,"abstract":"<p><strong>Introduction: </strong>In 2016, our center adopted technology to routinely monitor ¹⁸F-FDG radiopharmaceutical administrations. Within six months of following basic quality improvement methodology, our technologists reduced extravasation rates from 13.3% to 2.9% (<i>p</i> < 0.0001). These same technologists administer other radiopharmaceuticals (without monitoring technology) for general nuclear medicine procedures in a separate facility at the clinic. Our hypothesis was that they would apply ¹⁸F-FDG lessons-learned to ^99mTc-MDP administrations and that ^99mTc-MDP manual injection extravasation rate would be consistent with the ongoing ¹⁸F-FDG manual injection extravasation rate (3.4%). We tested our hypothesis by following the same quality improvement methodology and added monitoring equipment to measure extravasation rates for ^99mTc-MDP administrations.</p><p><strong>Results: </strong>816 ^99mTc-MDP administrations were monitored during 16-month period (four 4-month periods: A, B, C, D). Period A (first four months of active monitoring) extravasation rate was not statistically different from the Measure Phase extravasation rate of the previously completed PET/CT QI Project: 12.75% compared to 13.3% (<i>p</i>-0.7925). Period A extravasation rate was statistically different from Period C (months 9-12) extravasation rate and Period D (months 13-16) extravasation rate: 12.75% compared to 2.94% and to 3.43% (<i>p</i> < 0.0001). During Period C and D technologists achieved extravasation rates comparable to the longstanding manual ¹⁸F-FDG injection extravasation rate (3.4%).</p><p><strong>Conclusion: </strong>Our initial hypothesis, that awareness of a problem and the steps need to correct it would result in process improvement, was not accurate. While those factors are important, they are not sufficient. Our findings suggest that active monitoring and the associated display of results are critical to quality improvement efforts to reduce and sustain radiopharmaceutical extravasation rates.</p>","PeriodicalId":73095,"journal":{"name":"Frontiers in nuclear medicine (Lausanne, Switzerland)","volume":" ","pages":"1126029"},"PeriodicalIF":0.0,"publicationDate":"2023-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11440977/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48567165","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Extravasation of radiopharmaceuticals: Why report?","authors":"Thomas L Morgan","doi":"10.3389/fnume.2023.1148177","DOIUrl":"10.3389/fnume.2023.1148177","url":null,"abstract":"<p><p>In this essay, I wish to discuss extravasation in the context of medical imaging and therapy with radiopharmaceuticals. Central to this discussion are two facts. First, they are easily identified, but the frequency of significant extravasations is unclear because there is no generally accepted definition of such an event. And second, there appears to be few reports of injuries from these events. The central thesis of this essay is that these events should be reported and followed so that agreement can be reached on the definition of a \"significant\" event which should be classified as a medical event in accordance with US Nuclear Regulatory Commission (NRC) regulations. I will also outline steps that can be taken to reduce the risk of extravasations.</p>","PeriodicalId":73095,"journal":{"name":"Frontiers in nuclear medicine (Lausanne, Switzerland)","volume":" ","pages":"1148177"},"PeriodicalIF":0.0,"publicationDate":"2023-03-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11440951/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42322691","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Radiomics insight into the neurodegenerative \"<i>hot\"</i> brain: A narrative review from the nuclear medicine perspective.","authors":"Gayane Aghakhanyan, Gianfranco Di Salle, Salvatore Claudio Fanni, Roberto Francischello, Dania Cioni, Mirco Cosottini, Duccio Volterrani, Emanuele Neri","doi":"10.3389/fnume.2023.1143256","DOIUrl":"10.3389/fnume.2023.1143256","url":null,"abstract":"<p><p>The application of radiomics for non-oncologic diseases is currently emerging. Despite its relative infancy state, the evidence highlights the potential of radiomics approaches to serve as neuroimaging biomarkers in the field of the neurodegenerative brain. This systematic review presents the last progress and potential application of radiomics in the field of neurodegenerative nuclear imaging applied to positron-emission tomography (PET) and single-photon emission computed tomography (SPECT) by focusing mainly on the two most common neurodegenerative disorders, Alzheimer's (AD) and Parkinson's disease (PD). A comprehensive review of the current literature was performed using the PubMed and Web of Science databases up to November 2022. The final collection of eighteen relevant publications was grouped as AD-related and PD-related. The main efforts in the field of AD dealt with radiomics-based early diagnosis of preclinical AD and the prediction of MCI to AD conversion, meanwhile, in the setting of PD, the radiomics techniques have been used in the attempt to improve the assessment of PD diagnosis, the differential diagnosis between PD and other parkinsonism, severity assessment, and outcome prediction. Although limited evidence with relatively small cohort studies, it seems that radiomics-based analysis using nuclear medicine tools, mainly [18F]Fluorodeoxyglucose (FDG) and <i>β</i>-amyloid (A<i>β</i>) PET, and dopamine transporter (DAT) SPECT, can be used for computer-aided diagnoses in AD-continuum and parkinsonian disorders. Combining nuclear radiomics analysis with clinical factors and introducing a multimodality approach can significantly improve classification and prediction efficiency in neurodegenerative disorders.</p>","PeriodicalId":73095,"journal":{"name":"Frontiers in nuclear medicine (Lausanne, Switzerland)","volume":" ","pages":"1143256"},"PeriodicalIF":0.0,"publicationDate":"2023-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11440921/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41805989","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"PET tracers in glioblastoma: Toward neurotheranostics as an individualized medicine approach.","authors":"Habibullah Dadgar, Narges Jokar, Reza Nemati, Mykol Larvie, Majid Assadi","doi":"10.3389/fnume.2023.1103262","DOIUrl":"10.3389/fnume.2023.1103262","url":null,"abstract":"<p><p>Over the past decade, theragnostic radiopharmaceuticals have been used in nuclear medicine for both diagnosis and treatment of various tumors. In this review, we carried out a literature search to investigate and explain the role of radiotracers in the theragnostic approach to glioblastoma multiform (GBM). We primarily focused on basic and rather common positron emotion tomography (PET) radiotracers in these tumors. Subsequently, we introduced and evaluated the preclinical and clinical results of theranostic-based biomarkers including integrin receptor family, prostate-specific membrane antigen (PSMA), fibroblast activated protein (FAP), somatostatin receptors (SRS), and chemokine receptor-4 (CXCR4) for patients with GBM to confer the benefit of personalized therapy. Moreover, promising research opportunities that could have a profound impact on the treatment of GBM over the next decade are also highlighted. Preliminary results showed the potential feasibility of the theragnostic approach using theses biomarkers in GBM patients.</p>","PeriodicalId":73095,"journal":{"name":"Frontiers in nuclear medicine (Lausanne, Switzerland)","volume":" ","pages":"1103262"},"PeriodicalIF":0.0,"publicationDate":"2023-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11440984/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44339479","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Transparency - a patient-centric view on radiopharmaceutical extravasations.","authors":"Pam Kohl","doi":"10.3389/fnume.2023.1127692","DOIUrl":"10.3389/fnume.2023.1127692","url":null,"abstract":"<p><p>Most radiopharmaceuticals are intravenously administered during nuclear medicine imaging or therapy procedures. When a nuclear medicine clinician delivers some or all of a radioactive drug into a patient's healthy tissue rather than the vein as intended, a patient experiences an extravasation. Radiopharmaceutical extravasations provide zero patient benefit and considerable potential downsides, depending on the severity of the extravasations. What nuclear medicine patients want and need regarding the administration of radiopharmaceuticals is transparency. And yet in the year 2023, little transparency exists regarding these extravasations. From the patient perspective, transparency regarding extravasations is essential to improving care, ensuring radiation protection, reducing health inequities, and untangling the deeply disturbing and irregular relationship between the nuclear medicine community and their regulating body, The U.S. Nuclear Regulatory Commission. Transparency is also critical to help address many other questions regarding radiopharmaceutical extravasations.</p>","PeriodicalId":73095,"journal":{"name":"Frontiers in nuclear medicine (Lausanne, Switzerland)","volume":" ","pages":"1127692"},"PeriodicalIF":0.0,"publicationDate":"2023-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11440838/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46757392","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Case report: Efficacy of lutetium-177 oxodotreotide for neuroendocrine tumor with central nervous system metastases.","authors":"Nwanneka Okwundu, Christopher R Weil, Heloisa P Soares, Gabriel C Fine, Donald M Cannon","doi":"10.3389/fnume.2023.1074948","DOIUrl":"10.3389/fnume.2023.1074948","url":null,"abstract":"<p><p>Neuroendocrine tumors (NETs) rarely metastasize to the brain. However, when they occur, NET brain metastases are associated with a poor prognosis. Due to their low incidence, NET brain metastases are poorly studied, with few data to guide a consensus for management. Prior reports have documented treatment with chemotherapy, resection, whole brain radiation therapy, and stereotactic radiosurgery, all with low rates of survival. We present a case of a patient with type 3 well-differentiated gastric NET with widespread metastatic disease, including central nervous system lesions in the pineal gland and left cerebellopontine angle (CPA), which were avid on ⁶⁸Ga-dotatate positron emission tomography. The patient received four doses of 200 mCi (7.4 GBq) lutetium-177 oxodotreotide (¹⁷⁷Lu-dotatate) administered every 8 weeks over the course of 6 months. The treatments provided local control of the pineal and CPA lesions for 23 months until the development of diffuse leptomeningeal progression that necessitated further therapies. ¹⁷⁷Lu-dotatate may be a viable treatment for local control of NET brain metastases. More studies are needed to validate its efficacy in this clinical scenario.</p>","PeriodicalId":73095,"journal":{"name":"Frontiers in nuclear medicine (Lausanne, Switzerland)","volume":" ","pages":"1074948"},"PeriodicalIF":0.0,"publicationDate":"2023-02-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11440844/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41953791","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}