ACR accreditation of nuclear medicine and PET imaging departments.
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The accreditation programs of the American College of Radiology (ACR) are the most established and widely proven for all imaging modalities. For facilities committed to quality imaging, the ACR Nuclear Medicine and PET Accreditation Program provides a solid foundation for a continuous quality improvement program through a peer review and educational process. This article provides general information describing the goals and development of the ACR accreditation programs. The ACR Nuclear Medicine and PET Accreditation Program evaluates the qualifications of personnel, equipment, image quality, and quality control measures. It is believed that these are the primary factors that have an impact on the quality of patient imaging. This article describes the application process, including the clinical examinations that are required and the quality control and performance tests that are expected from each facility. Outcomes and pass/fail statistics are discussed, as are common pitfalls that may cause deficiencies. Upon completion of this article, the reader should be able to describe the application process, the components of the ACR accreditation program, the most common causes for failure, and the site survey process. (+info)
Role of nuclear medicine in the management of cutaneous malignant melanoma.
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Malignant melanoma of the skin is one of the most lethal cancers. The disease may spread either locally or regionally and to distant sites through predictable or unpredictable metastatic pathways. Accurate staging and restaging of disease are required for appropriate treatment decision making. Routine protocols based on clinical examinations and traditional radiologic evaluations are not cost-effective for the detection of systemic disease. In the last decade, nuclear medicine techniques, such as lymphoscintigraphy-directed lymphatic mapping and sentinel lymphadenectomy and (18)F-FDG PET, have played key roles in nodal and distant staging of melanoma. More recently, anatomic-functional imaging has been improved with the development of integrated PET/CT devices or combined SPECT/CT systems. (18)F-FDG-sensitive intraoperative probes have been specifically designed to detect small nodal and visceral metastases from melanoma and may become important tools for the cancer surgeon. In this article, we review the role of nuclear medicine in the assessment of malignant melanoma. (+info)
Essential role of nuclear medicine technology in tositumomab and 131I-tositumomab therapeutic regimen for non-Hodgkin's lymphoma.
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Nuclear medicine technology has traditionally focused on diagnostic imaging, with therapeutics left mostly to other medical disciplines. However, after many years in development, radioimmunotherapy (RIT) has finally become a clinical reality in many nuclear medicine departments. The nuclear medicine technologist is a key player in the successful implementation of RIT. Delivery of a therapeutic regimen of tositumomab and (131)I-tositumomab provides a model for the technologist's roles and responsibilities in the developing field of RIT. This article examines the clinical rationale, logistic requirements, and imaging and dosimetry procedures required by this treatment regimen. Upon completion of this article, the reader should be able to describe the target patient population and identify the roles and responsibilities of various members of the treatment team. The reader will also gain an understanding of the treatment process, including drug administration, imaging, and therapeutic dose calculations. (+info)
The future of infection imaging.
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Over the past 10 years, there has been an unprecedented explosion in new agents suggested for imaging infection. These agents have been based on our understanding of the processes involved in invasive infection of the body by microorganisms and the body's response to them. Work with antibodies has traditionally yielded the most likely candidates, 3 of which have entered clinical use in Europe and the USA. However, the expense and limitations of producing antibodies have resulted in investigations into the use of cytokine and anti-microbial radiolabelled peptides. This work is very promising in that these types of tracers may be more specific for infection than labelled leukocytes. There remains a big question mark, however, as to whether or not these will progress from phase I/II trials to phase III trials and, ultimately, to clinical use. Finally, the investigation of radiolabelled anti-microbials continues and may prove to be most useful with anti-fungals especially in the immuno-suppressed host. We live in exciting times in the evolution of infection imaging; time and commercial constraints will determine which, if any of these tracers make it to the market and will they do so before PET rules all nuclear medicine? (+info)
Regional cerebral glucose metabolic abnormality in Prader-Willi syndrome: A 18F-FDG PET study under sedation.
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Prader-Willi syndrome (PWS) is a genetic disorder caused by the nonexpression of paternal genes in the PWS region of chromosome 15q11-13 and is the most common cause of human syndromic obesity. METHODS: We investigated regional brain metabolic impairment in children with PWS by 18F-FDG PET. Sixteen children with PWS (9 males, 7 females; mean age +/- SD, 4.2 +/- 1.1 y) and 7 healthy children (4 males, 3 females; mean age +/- SD, 4.0 +/- 1.7 y) underwent brain 18F-FDG PET in the resting state. The images of PWS children were compared using statistical parametric mapping analysis with those of healthy children in a voxelwise manner. RESULTS: Group comparison showed that children with PWS had decreased glucose metabolism in the right superior temporal gyrus and left cerebellar vermis, regions that are associated with taste perception/food reward and cognitive and emotional function, respectively. Metabolism was increased in the right orbitofrontal, bilateral middle frontal, right inferior frontal, left superior frontal, and bilateral anterior cingulate gyri, right temporal pole, and left uncus, regions that are involved in cognitive functions related to eating or obsessive-compulsive behavior. Interestingly, no significant metabolic abnormality was found in the hypothalamus, the brain region believed to be most involved in energy intake and expenditure. CONCLUSION: This study describes the neural substrate underlying the abnormal eating behavior and psychobehavioral problems of PWS. (+info)
Nuclear medicine methods for evaluation of skeletal infection among other diagnostic modalities.
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Skeletal infection continues to be a common and difficult condition in clinical practice and early accurate diagnosis is very challenging. Clinical and laboratory features of skeletal infections are not always present, may be confusing, and are nonspecific for bone infection in its early stages, therefore, several imaging modalities are used for early detection of osteomyelitis. Plain films should always be the first step in the imaging assessment of osteomyelitis, however, the sensitivity for X-ray radiography has been reported to range from 43% to 75%, and the specificity from 75% to 83%. Over years, scintigraphic procedures have become an essential part of the diagnostic procedure for osteomyelitis. The standard approach for bone scintigraphy with tech 99mTc labeled methylene diphosphonate to assess for osteomyelitis is to perform a three-phase procedure. The positive uptake on all three phases is highly sensitive for osteomyelitis (sensitivity 73% to 100%). 67Ga citrate gained more attention for the more specific diagnosis of osteomyelitis due to its known capacity to localize in cases of active infection and pus. The reported specificity for 67Ga scintigraphy in osteomyelitis is around 67-70% and the specificity is much higher (92%) when 67Ga single photon emission tomography was obtained. Labeled white blood cell (WBC) imaging has become the procedure of choice to diagnose most cases of skeletal infections except for those of the spine. Labeling of leucocytes can be done either by 111In or 99mTc labeled hexamethylpropylene amineoxime. The sensitivity and specificity for labeled WBCs are in the high range of 80% to 90%. [18F]fluorodeoxyglucose positron emission tomography (PET) has been found to accumulate non-specifically at sites of infection and inflammation. Investigational studies showed that PET is particularly valuable in the evaluation of chronic osteomyelitis and infected prostheses. Other imaging modalities include sonography, computed tomography (CT) and magnetic resonance imaging (MRI). The sensitivity and specificity of CT for the diagnosis of osteomyelitis has not been established clearly and are in the range of 65% to 75%. The sensitivity of MRI for osteomyelitis has been generally reported as being between 82% and 100%, and specificity between 75% and 96%. Cases of osteomyelitis commonly referred to diagnostic imaging departments include chronic osteomyelitis, diabetic foot infections, vertebral osteomyelitis, joint prostheses and patients with suspected reinfection. These specific entities need special attention and careful selection of the correct tracer or combination of imaging modalities that is best suited for the proper therapeutic management protocols. (+info)
Understanding radiologic and nuclear terrorism as public health threats: preparedness and response perspectives.
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Terrorism dates back to antiquity, but our understanding of it as a public health threat is still in its nascent stages. Focusing on radiation and nuclear terrorism, we apply a public health perspective to explore relevant physical health and psychosocial impacts, the evolving national response infrastructure created to address terrorism, and the potential roles of nuclear medicine professionals in preparing for and responding to radiologic and nuclear terrorism. (+info)
Advances in cancer therapy with radiolabeled monoclonal antibodies.
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Two radiolabeled antibody products for the treatment of non-Hodgkin's lymphoma have been approved, thus indicating that cancer radioimmunotherapy (RAIT) has finally come of age as a new therapeutic modality, exemplifying the collaboration of multiple disciplines, including immunology, radiochemistry, radiation medicine, medical oncology, and nuclear medicine. Clinical trials are showing usefulness in other hematological neoplasms, but the treatment of solid tumors remains the major challenge, since the doses shown to be effective in hematological tumors are insufficient in the more common epithelial cancers. Nevertheless, use of RAIT in locoregional applications and in the treatment of minimal residual disease have shown promising RESULTS: There is also optimism that pretargeting procedures, including new molecular constructs and targets, will improve the delivery of radioactivity to tumors with less hematologic toxicity, and thus may become the next generation of RAIT. (+info)