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1.
Biomédica (Bogotá) ; 41(4): 692-705, oct.-dic. 2021. tab, graf
Article in Spanish | LILACS | ID: biblio-1355743

ABSTRACT

Resumen | Introducción. La modificación de las normas sobre medicina nuclear en Colombia ha afectado la administración de la terapia de yodo radioactivo en el tratamiento del cáncer de tiroides. Objetivos. Determinar las áreas de acuerdo en torno al problema, los requisitos actuales y los nuevos exigidos en la normativa para el funcionamiento de los servicios de medicina nuclear. Materiales y métodos. Se hizo un estudio Delphi de dos rondas con cada grupo de expertos, 'clínicos' y 'de entidades reguladoras'. En la primera ronda se exploraron los puntos de vista sobre las implicaciones de la normativa en medicina nuclear y, en la segunda, se calificaron las declaraciones de la primera según su relevancia. Resultados. La problemática de los servicios de medicina nuclear está relacionada con la claridad normativa, y la falta de sinergia y coherencia entre los organismos de inspección, vigilancia y control. Las exigencias del sistema de gestión de desechos requieren una alta inversión económica que puede influir en la oferta del servicio y repercutir en el control integral del cáncer de tiroides. Entre las necesidades presentes y futuras, se encuentran la unificación de criterios entre los auditores, la delimitación de funciones de los actuantes, la asistencia técnica para cumplir con la normativa, y la veeduría a los organismos de inspección, vigilancia y control por parte de los entes reguladores. Conclusión. Los hallazgos del estudio sugieren que los servicios de medicina nuclear atraviesan un momento de múltiples desafíos institucionales, normativos y económicos, que ponen en riesgo el desarrollo y mantenimiento de la medicina nuclear en la atención oncológica.


Abstract | Introduction: Colombia has modified the nuclear medicine norms that impact the administration of radioactive iodine therapy in the treatment of thyroid cancer. Objective: To identify the areas of agreement regarding the issue, as well as the current and emergent requirements associated with the normative for the operation of nuclear medicine services that have an impact on the care of patients with thyroid cancer in Colombia. Materials and methods: We conducted a two-round Delphi study for each expert, clinical, and regulatory group. The first round explored views on the implications of the regulations that apply to nuclear medicine. The second round rated the statements from the first round by their relevance. Results: The issues regarding nuclear medicine services were related to the normative clarity and the lack of synergy and coherence among inspection, surveillance, and control bodies. The demands on the waste management system require a high economic investment that can influence the service offer and have an impact on the integral control of thyroid cancer. Unification of the auditors' criteria, delimitation of the acting agent functions, technical assistance to the services to comply with the normative, and the oversight of the inspection, surveillance, and control bodies by the regulatory entities are among the current and future needs. Conclusions: Our findings suggest that nuclear medicine services are going through a time of multiple institutional, regulatory, and economic challenges that put at risk the development and maintenance of nuclear medicine in cancer care.


Subject(s)
Thyroid Neoplasms , Nuclear Medicine , Radioisotopes , Radioactive Waste , Health Services
2.
Rev. cuba. endocrinol ; 32(2): e277, 2021. tab, graf
Article in Spanish | LILACS, CUMED | ID: biblio-1347402

ABSTRACT

Introducción: La aplicación de actividades fijas en el tratamiento del hipertiroidismo con I131 (yoduro de sodio, conocido también como radioyodo), es el método más usado en nuestro país, a pesar de la individualidad morfo-funcional que caracteriza esta afección. Sin embargo, no existe aún, un consenso internacional sobre la dosis más conveniente para cada caso, y por ende, los resultados no siempre son los deseados. Objetivo: Evaluar la aplicabilidad de varios métodos de cálculo de dosis paciente-específica para el tratamiento de hipertiroidismo con yoduro de sodio. Métodos: Se realizó un análisis de los resultados de varios métodos de cálculo de dosis recomendados internacionalmente a partir de la actividad fija prescrita en 10 pacientes, con el empleo de tecnologías y herramientas ya desarrolladas y disponibles en el país. Se evaluó la variabilidad inter-especialista y su impacto en la dosis planificada para el tratamiento. Resultados: El uso de la información incompleta de la biodistribución y farmacocinética del paciente produjo diferencias entre -42 por ciento y 37 por ciento de las dosis para el mismo paciente. El resultado de la comparación del método de cálculo recomendado por la Sociedad Europea de Medicina Nuclear, manejando la masa por gammagrafía-2D / 3D y por ultrasonido, arrojó diferencias no significativas entre sí. La variabilidad inter-especialista de las actividades prescrita mostró diferencias significativas, que arrojan sobre el mismo paciente, discrepancias entre 44Gy y 243Gy de las dosis terapéuticas a recibir, situación que puede comprometer el éxito del tratamiento y producir efectos secundarios no deseados. Conclusiones: Las técnicas dosimétricas paciente-específicas se pueden implementar satisfactoriamente en nuestro país. Las diferencias numéricas encontradas, especialmente la variabilidad inter-especialista, demuestran la no estandarización terapéutica, lo que apoya el uso de la farmacocinética paciente-específica pre terapéutica y la masa por gammagrafía-3D para planificar el tratamiento siempre que sean posible(AU)


Introduction: Despite of its typical morpho-functional individuality, fixed activities remain as the most used method in Cuba for hyperthyroidism treatment with I (sodium iodide, also known as radioiodine). However, there is not yet an international consensus on the most convenient doses for each case, so, the results are not always the desired ones. Objective: To evaluate the applicability of various patient-specific dose calculation methods for the treatment of hyperthyroidism with sodium iodide. Methods: It was carried out an analysis in 10 patients of the results of some methods for dose calculation from the prescribed fixed activity recommended internationally, with the use of technologies and tools already developed and available in the country. The inter-specialist variability and its impact in the planned dose for the treatment were assessed. Results: The use of uncompleted biodistribution and pharmacokinetics information of the patient showed differences between -42 percent and 37 percent in the doses for the same patient. The outcome of the comparison of the calculation method recommended by the European Society of Nuclear Medicine managing the mass by 3D/2D gammagraphy and ultrasound, presented no significant discrepancies among them. The inter-specialist variability of prescribed activity was statistically significant, and it can produce in the same patient differences between 44Gy and 243Gy of the therapeutic doses, which could affect the treatment success and lead to unnecessary side effects. Conclusions: The patient´s personalized calculation methods can be satisfactorily applied in Cuba. The numeric differences found, especially inter-specialist variability, show the lack of therapeutic standardization, which supports the use of pre-therapeutic patient-specific pharmacokinetics and the mass by 3D-gammagraphy to plan the treatment when possible(AU)


Subject(s)
Humans , Male , Female , Adult , Sodium Iodide/therapeutic use , Pharmacokinetics , Hypothyroidism/therapy , Nuclear Medicine/methods , Reference Standards
3.
Article in English | AIM, AIM | ID: biblio-1342407

ABSTRACT

The ingestion of smoked foods has been linked to the development of cancer. Polycyclic aromatic hydrocarbons have been recognized as carcinogenic compounds which contaminate smoked foods; their ingestion has been linked to the development of cancers such as breast cancer. Breast cancer may be evaluated using the nuclear bone scan as an imaging modality. This study reviewed bone scan results of patients with a positive history of consumption of smoked foods who presented at a Nuclear Medicine facility in South-West Nigeria. Our results show a significant association between a positive history of consumption of smoked foods and the presence of advanced breast cancer on the bone scan ((χ2 = 11.190, p = 0.001, df = 2; Crude Odds Ratio (95% CI) = 1.692 (1.242-2.304). Thus, those patients with a history of eating smoked foods have between 50-100% increase in the risk of having abnormal scan findings. In a logistic regression, this association was retained (AOR=0.591 (0.434-0.805). Recommendations are made to address the significance of these findings


Subject(s)
Humans , Polycyclic Aromatic Hydrocarbons , Nuclear Medicine , Breast Neoplasms , Radionuclide Imaging , Food
4.
Rev. cuba. hematol. inmunol. hemoter ; 37(supl.1): e1367, 2021. graf
Article in Spanish | LILACS, CUMED | ID: biblio-1351995

ABSTRACT

Introducción: En diciembre 2019 emergió una nueva enfermedad, la COVID-19, hasta ser declarada por la Organización Mundial de la Salud como pandemia. Internacionalmente se han publicado artículos y guías útiles para la protección del personal y guías de actuación en los Servicios de Medicina Nuclear para la práctica de exploraciones o tratamientos a pacientes positivos al SARS CoV-2 o altamente sospechosos. Objetivo: Analizar las experiencias y recomendaciones para los Servicios de Medicina Nuclear de diferentes grupos de trabajo ante los retos que plantea mantener la asistencia médica en tiempos de COVID-19 e identificar cuáles son las que podrían aplicarse en Cuba. Métodos: Se realizó una revisión bibliográfica, en español e inglés, de publicaciones en el transcurso de este año. Se utilizaron los motores de búsqueda de Google, Google Académico y Pubmed. Se recolectó y organizó toda la información de las recomendaciones y guías para el trabajo de los Servicios de Medicina Nuclear en la etapa pandémica de la COVID-19 y los hallazgos encontrados en estudios de medicina nuclear en pacientes asintomáticos, que muestran imágenes morfológicas y funcionales características de la neumonía causada por COVID-19. Análisis y síntesis de la información: Se analizaron las diferentes medidas que han propuesto grupos de trabajo en Asia, Europa y América del Norte, se identificaron las más relevantes y se evidenció que son también las que coinciden en casi todas las recomendaciones. Conclusiones: Se propone qué medidas generales podrían adoptarse en los Servicios de Medicina Nuclear cubanos en el contexto de la pandemia de COVID-19(AU)


Introduction: In December 2019, a new disease emerged, COVID-19, until it was declared by the World Health Organization as a pandemic. Articles and useful guides have been published internationally for the protection of personnel and guidelines for action in the Nuclear Medicine Services for the practice of examinations or treatments for patients who are positive for SARS CoV-2 or highly suspicious. Objective: To analyze the experiences and recommendations for the Nuclear Medicine Services of different working groups in the face of the challenges posed by maintaining medical care in times of COVID-19 and to identify which ones could be applied in our country. Methods: A bibliographic review was carried out, in Spanish and English, of publications in the course of this year. The search engines Google, Google Scholar and Pubmed were used. All the information on the recommendations and guidelines for the work of the Nuclear Medicine Services in the pandemic stage of COVID-19 and the findings found in nuclear medicine studies in asymptomatic patients, showing morphological and functional images characteristic of the pneumonia caused by COVID-19, was collected and organized. Analysis and synthesis of the information: The different measures proposed by working groups in Asia, Europe and North America were analyzed, the most relevant were identified and it was shown that they are also the ones that coincide in almost all the recommendations. Conclusions: It is proposed what general measures could be adopted in Cuban Nuclear Medicine Services in the context of the COVID-19 pandemic(AU)


Subject(s)
Humans , Male , Female , World Health Organization , Severe Acute Respiratory Syndrome , Pandemics , COVID-19 , Medical Assistance , Nuclear Medicine/methods , Cuba , Occupational Groups
5.
Biomédica (Bogotá) ; 40(supl.2): 27-33, oct. 2020. graf
Article in Spanish | LILACS | ID: biblio-1142445

ABSTRACT

La COVID-19 es la infección viral causada por el SARS-CoV-2 y declarada por la Organización Mundial de la Salud (OMS) como pandemia. Los pacientes con cáncer tienen un mayor riesgo de adquirir la infección y un peor pronóstico, ya que deben asistir a visitas médicas en diferentes centros hospitalarios, reciben tratamientos médicos y quirúrgicos y deben someterse a estudios diagnósticos como la PET/CT en servicios de medicina nuclear, lo que es ocasión para el hallazgo incidental de la infección. Se presentan las imágenes de tomografías computarizadas por emisión de positrones con 18-fluorodesoxiglucosa (F18) (Positron Emission Tomography and Computed Tomography with 2-deoxy-2-[fluorine-18]fluoro-D-glucose, PET/CT F18-FDG) en las que se evidenció la COVID-19 en pacientes con diversas enfermedades oncológicas, pero sin sintomatología respiratoria.


COVID-19 is the viral infection caused by SARS-CoV-2 declared by the World Health Organization (WHO) as a pandemic. Patients with cancer have a higher risk to acquire the infection and worse prognosis as they have to attend more medical visits in healthcare institutions, receive medical and surgical treatments, and be subjected to diagnostic studies such as PET/CT in nuclear medicine services where the infection may be an incidental finding. We present here F18-FDG PET/CT (Positron Emission Tomography and Computed Tomography with 2-deoxy-2-[fluorine-18]fluoro-D-glucose), images with findings of COVID-19 from patients with different oncological conditions but no respiratory symptoms.


Subject(s)
Coronavirus Infections , Positron-Emission Tomography , Neoplasms , Reverse Transcriptase Polymerase Chain Reaction , Nuclear Medicine
6.
San Salvador; MINSAL; jun. 01, 2020. 21 p.
Non-conventional in Spanish | LILACS, BISSAL | ID: biblio-1141024

ABSTRACT

La presente norma técnica tiene como objetivo establecer los requisitos de seguridad radiológica que deben cumplir los titulares de autorización, responsables de protección radiológica, trabajadores expuestos e instalaciones que realicen la práctica de medicina nuclear


The objective of this technical standard is to establish the radiological safety requirements that must be met by authorization holders, those responsible for radiation protection, exposed workers and facilities that carry out the practice of nuclear medicine


Subject(s)
Technical Standards , Nuclear Medicine
7.
Rev. habanera cienc. méd ; 19(1): 167-179, ene.-feb. 2020. tab, graf
Article in Spanish | LILACS, CUMED | ID: biblio-1099154

ABSTRACT

Introducción: El análisis de riesgo en la gestión de la calidad y seguridad permite la mejora continua de los servicios médicos en Cuba. En Medicina Nuclear Terapéutica es requisito regulador que permite la continuidad de estos servicios a la población. Objetivo: Analizar los riesgos radiológicos con enfoque integrador dirigido a causas básicas de fallo en la práctica citada. Material y métodos: Se revisó y adaptó el modelo genérico de riesgo para cada caso de estudio. Los métodos prospectivos de matriz de riesgo y análisis de modos y efectos de fallo y reactivo de aprendizaje de las lecciones de sucesos registrados fueron utilizados con el código cubano SECURE MR-FMEA versión 3.0. Se determinó el riesgo inherente, su tratamiento y el riesgo residual por práctica. Se identificaron las etapas del proceso, las medidas y las causas básicas más contribuyentes. Resultados: No se obtuvo riesgo superior al del nivel alto. La radiosinoviortesis y el tratamiento radiactivo de la policitemia vera tuvieron la mayor cantidad de modificaciones al modelo genérico. Las etapas más significativas son prescripción clínica, preparación del radiofármaco y administración. Las medidas preventivas de mayor importancia son mantener una carga de trabajo moderada para el personal, las capacitaciones de los médicos nucleares y del técnico que realiza la administración. Conclusiones: Existe una no uniformidad en el nivel de calidad y seguridad entre los servicios analizados. Para el cambio, la adopción de decisiones se ve beneficiada en su eficacia y eficiencia, al integrarse los métodos prospectivos y reactivos de análisis de riesgo(AU)


Introduction: Risk assessment in quality and safety management allows the continuous improvement of the medical services in Cuba. In Therapeutic Nuclear Medicine, it is a regulatory requirement which allows the continuity of these services to the population. Objective: To assess radiological risks with an integrated approach focused on underlying causes of failure in the mentioned practice. Material and Methods: The generic risk model was reviewed and adapted for each case study. The prospective methods of risk assessment matrix of failure modes and effects and incident learning lessons from the events registered were used applying the Cuban code SECURE MR-FMEA version 3.0. The inherent risk, treatment, and residual risk in the practice were determined. The stages of the process, measurements, and the main contributing causes were identified. Results: There was no risk higher than the high level. Radiosynoviorthesis and the radioactive treatment of the Polycythemia Vera had the greatest amount of modifications to the generic model. The most significant stages are clinical prescription, preparation of the radiopharmaceutical formulation and administration. The most important preventive measures are to maintain a moderate workload for the personnel, and the training of the nuclear physicians and the technician who performs the administration. Conclusions: There is a non-uniformity in the level of quality and safety among the NTM services in Cuba. For change, decision-making is benefited in terms of effectiveness and efficiency by integrating prospective and reactive risk assessment methods(AU)


Subject(s)
Humans , Male , Female , Quality of Health Care/standards , Radiation Risks , Nuclear Medicine/methods , Proportional Hazards Models , Cuba
10.
Einstein (Säo Paulo) ; 18: eGS4816, 2020. graf
Article in English | LILACS | ID: biblio-1056056

ABSTRACT

ABSTRACT Objective To expose the current situation of the Brazilian Nuclear Medicine in relation to innovation, taking into account the Intellectual Property protection and the particularities of this field. Methods The number and the origin of patents filings from Brazil, United States and European Patent Convention countries were retrospectively compared in a 20-year period. Results The number of accumulated patents filings of conventional pharmaceuticals was ten times higher compared to the radiopharmaceuticals in the three regions studied. Conclusion The largest number of Brazilian patents filings corresponded to the international patent applications, which is related to the country development conditions, as well as to the difficulties in the process of patent filing.


RESUMO Objetivo Evidenciar a situação atual da Medicina Nuclear brasileira em relação à inovação, considerando a proteção à Propriedade Intelectual e suas particularidades na área. Métodos Foi realizado um levantamento comparativo do número e da origem de depósitos de patentes relacionadas a essa área no Brasil, nos Estados Unidos e em países participantes da European Patent Convention , em um período de 20 anos retroativos. Resultados O número de depósitos acumulados de patentes de medicamentos convencionais foi dez vezes maior quando comparado às famílias relacionadas aos processos que envolvem radiofármacos, nas três regiões estudadas. Conclusão O maior número de depósitos de patentes brasileiras correspondeu aos pedidos de patentes internacionais, refletindo as condições de desenvolvimento do país, bem como as dificuldades encontradas no processo de depósito de uma patente.


Subject(s)
Humans , Patents as Topic/statistics & numerical data , Radiopharmaceuticals , Nuclear Medicine/trends , Patents as Topic/legislation & jurisprudence , United States , Brazil , Inventions/legislation & jurisprudence , Inventions/statistics & numerical data
11.
Rev. argent. radiol ; 83(3): 102-112, set. 2019. ilus
Article in Spanish | LILACS | ID: biblio-1057408

ABSTRACT

El intervencionismo en mama se inició con la localización preoperatoria de lesiones no palpables. En una segunda etapa, el desarrollo de técnicas de biopsias en las tres modalidades (mamografía, ultrasonido y resonancia magnética), reforzaron las indicaciones de localización de lesiones con histología ya confirmada. La técnica de localización en Argentina se basó casi exclusivamente en la inserción de alambres con arpones e inyección de carbón. A partir del año 2001, se ofreció como alternativa a las localizaciones con arpones la inserción de semilla de Iodo-125, considerando las ventajas para la paciente, el cirujano y el sistema hospitalario al desacoplar los turnos de quirófano y servicios de imágenes, otorgando acceso a cualquier cuadrante con incisiones cosméticas. La provisión del isótopo es la clave para instalar y atender la demanda de los usuarios, una vez que han conocido los méritos del procedimiento. En todos los ámbitos y distintos países, se verificó una lenta incorporación a la rutina de localización de lesiones con material radioactivo, primariamente por las regulaciones fundamentales y justificadas para la adquisición del isótopo. En nuestro medio y en una labor conjunta con la Autoridad Regulatoria Nuclear (ARN), logramos finalmente, en el año 2017, el reconocimiento de la práctica. Revisamos la bibliografía, describimos la técnica y la logística para lograr autorización de aquellos centros interesados en aplicar un procedimiento universalmente adoptado por sus ventajas respecto a los métodos tradicionales.


Diagnostic intervention in breast disease started with preoperative localization of non- palpable lesions. Later, with the histological diagnosis obtained through biopsy techniques in mammography, ultrasound and magnetic resonance imaging, the localization of lesions has become a must. Traditionally, in Argentina, the localization technique was exclusively based on the insertion of harpoon-shaped guided wires and carbon suspension. Since 2001, the iodine-125 radioactive seed localization has emerged as a reliable and advantageous alternative for the patient, the surgeon and the hospital system, reducing scheduling conflicts between the breast imaging department and the surgical department, and allowing access to any quadrant with cosmetic incisions. The isotope provision is the key to satisfying the users demand, once they have known the merits of the procedure. The implementation of radioactive material for the localization of lesions has been tardy in all fields and in different countries, mainly due to justified regulations related to the acquisition of the isotope. As a result of joint efforts with the Autoridad Regulatoria Nuclear (Nuclear Regulatory Authority), the practice finally gained its deserved recognition in 2017. We conducted a review of the existing literature and described the technique and the logistics to obtain the approval of the sites that were interested in the deployment of a widely used procedure that has proved to be more advantageous than traditional methods.


Subject(s)
Humans , Breast Neoplasms/diagnostic imaging , Nuclear Medicine/methods , Argentina , Breast Neoplasms/surgery , Breast Neoplasms/pathology
12.
Int. j. cardiovasc. sci. (Impr.) ; 32(3): 302-309, May-June 2019. tab, ilus
Article in English | LILACS | ID: biblio-1002221

ABSTRACT

This paper is about the Guideline for Ventilation / Perfusion Scintigraphy. It has been developed by the Brazilian Society of Nuclear Medicine to be a best practices guide used in Nuclear Medicine. Its function is to be an educational tool to help the Nuclear Medicine Services in Brazil to guarantee a quality care to the patients


Subject(s)
Humans , Male , Female , Ventilation-Perfusion Ratio , Guidelines as Topic/standards , Pulmonary Artery/pathology , Pulmonary Embolism/complications , Pulmonary Embolism/diagnostic imaging , Diagnostic Imaging/methods , Radionuclide Imaging/methods , Nuclear Medicine/standards
14.
Rev. chil. radiol ; 25(1): 19-25, mar. 2019. tab
Article in Spanish | LILACS | ID: biblio-1003746

ABSTRACT

Se sabe que las exposiciones médicas con radiaciones ionizantes son actualmente la principal fuente de exposición a la radiación artificial a nivel global. Para prevenir dosis innecesariamente altas durante estas exposiciones a los pacientes, la Comisión Internacional de Protección Radiológica (ICRP) recomienda la utilización de los Niveles de Referencia para Diagnóstico (DRLs), como una herramienta efectiva de ayuda a la optimización de la protección radiológica en la exposición médica de pacientes para diagnóstico y procedimientos de intervención. Dado que la legislación chilena no tiene incorporado aún su uso, el presente trabajo de revisión tiene como objetivo, elaborar un documento guía para los profesionales de la salud y áreas afines, que contenga de manera sucinta y con recomendaciones prácticas, los principales aspectos a tener en cuenta para establecer los DRLs en procedimientos de radiodiagnóstico, intervencionismo y medicina nuclear, basados esencialmente en la publicación N° 135 de la ICRP sobre DRLs.


It is known that medical exposition with ionizing radiation is currently the main exposition source to artificial radiation at global level. To prevent unnecessarily high doses during these patient expositions, the International Commission on Radiological Protection (ICRP) recommends the use of Diagnostic Reference Levels (DRLs), as an effective tool to support the optimization of radiological protection for patient medical exposure for diagnosis and interventional procedures. Since that the Chilean legislation does not have its use incorporated yet, the present revision work aims to elaborate a guiding document for health professionals and related fields, that succinctly and with practical recommendations, the main aspects to consider for establishing DRLs in procedures for radiodiagnostic, intervention, and nuclear medicine, mainly based in N° 135 ICRP publication about DRLs.


Subject(s)
Humans , Radiation Protection/standards , Radiography/methods , Radiation Dosage , Radiation Protection/methods , Radiology , Reference Standards , Tomography, X-Ray Computed/adverse effects , Nuclear Medicine , Nuclear Medicine/standards
16.
Chonnam Medical Journal ; : 127-135, 2019.
Article in English | WPRIM | ID: wpr-763293

ABSTRACT

Most differentiated thyroid cancer (DTC) patients have an excellent prognosis. However, about one-third of DTC patients with recurrent or metastatic disease lose the hallmark of specific iodine uptake initially or gradually and acquire radioactive iodine-refractory DTC (RAIR-DTC) with poor prognosis. Due to the potentially severe complications from unnecessarily repeated RAI therapy and encouraging progress of multiple targeted drugs for advanced RAIR-DTC patients, it has become crucial to identify RAIR-DTC early. In this review, we focus on the progress and controversies regarding the defining of RAIR-DTC, further with subsistent approaches and promising molecular nuclear medicine imaging in identifying RAIR-DTC, which may shed light on the proper management methodsof such patients.


Subject(s)
Humans , Iodine Radioisotopes , Iodine , Molecular Imaging , Nuclear Medicine , Prognosis , Thyroid Gland , Thyroid Neoplasms
17.
Article in English | WPRIM | ID: wpr-786493

ABSTRACT

Breast cancer (BC) is themost common cancer among females withmore than 2 million new cases diagnosed worldwide in 2018. Although the prognosis in the majority of cases in the early stages combined with appropriate treatment is positive, there are still about 30% of patients who will develop locoregional diseases and distant metastases. Molecular imaging is very important in the diagnosis, staging, follow-up, and radiotherapy planning. Additionally, it is useful in characterizing lesions, prognosis, and therapy response in BC patients. Nuclear medicine imaging modalities (SPECT and PET) are of indispensable importance in diagnosis (positron emission mammography), staging (sentinel lymph node detection), and follow-up with ¹⁸F-FDG and tumor characterization. Among many available PET tracers, the most commonly used are ¹⁸F-FLT, ¹⁸F-FES, ¹⁸F-FDHT, ⁶⁴Cu DOTA trastuzumab (bevacizumab), ⁶⁸Ga-PSMA, ⁶⁸Ga-RM2 (gastrin-releasing peptide receptor), ¹⁸F-fluorooctreotide (SSTR), and ⁶⁸Ga-TRAP (RGD)-3αvβ3-integrin. Molecular imaging helps in evaluation of tumor heterogeneity, allowing a shift from one-size-fits-all-approach to era of personalized medicine and precision oncology.


Subject(s)
Breast Neoplasms , Breast , Diagnosis , Female , Follow-Up Studies , Humans , Lymph Nodes , Molecular Imaging , Neoplasm Metastasis , Nuclear Medicine , Population Characteristics , Positron-Emission Tomography , Precision Medicine , Prognosis , Radiotherapy , Trastuzumab
18.
Article in English | WPRIM | ID: wpr-786470

ABSTRACT

PURPOSE: Recently, a new Bayesian Penalized Likelihood (BPL) Reconstruction Algorithm was introduced by GE Healthcare, Q.Clear; it promises to provide better PET image resolution compared to the widely used Ordered Subset Expectation Maximization (OSEM). The aimof this study is to compare the performance of these two algorithms on several types of findings, in terms of image quality, lesion detectability, sensitivity, and specificity.METHODS: Between September 6th 2017 and July 31st 2018, 663 whole body 18F-FDG PET/CT scans were performed at the Nuclear Medicine Department of S. Martino Hospital (Belluno, Italy). Based on the availability of clinical/radiological follow-up data, 240 scans were retrospectively reviewed. For each scan, a hypermetabolic finding was selected, reporting both for OSEM and Q.Clear: SUVmax and SUVmean values of the finding, the liver and the background close to the finding; size of the finding; percentage variations of SUVmax and SUVmean. Each finding was subsequently correlated with clinical and radiological follow-up, to define its benign/malignant nature.RESULTS: Overall, Q.Clear improved the SUVvalues in each scan, especially in small findings (< 10mm), high SUVmax values (≥ 10), and medium/low backgrounds. Furthermore, Q.Clear amplifies the signal of hypermetabolic findings without modifying the background signal, which leads to an increase in signal-to-noise ratio, improving overall image quality. Finally, Q.Clear did not affect PET sensitivity or specificity, in terms of number of reported findings and characterization of their nature.CONCLUSIONS: Q.Clear is an iterative algorithm that improves significantly the quality of PET images compared to OSEM, increasing the SUVmax of findings (in particular for small findings) and the signal-to-noise ratio. However, due to the intrinsic characteristics of this algorithm, it will be necessary to adapt and/or modify the current interpretative criteria based of quantitative evaluation, to avoid an overestimation of the disease burden.


Subject(s)
Delivery of Health Care , Evaluation Studies as Topic , Fluorodeoxyglucose F18 , Follow-Up Studies , Liver , Nuclear Medicine , Positron Emission Tomography Computed Tomography , Retrospective Studies , Sensitivity and Specificity , Signal-To-Noise Ratio
19.
Article in English | WPRIM | ID: wpr-786466

ABSTRACT

The foundations of nuclear medicine in Vietnam were established from 1970. Until now, after 48 years of development, in Vietnam, we have some basic equipment including 31 SPECT, 4 SPECT/CT machines, 11 PET/CT scanners, five cyclotrons, and one nuclear reactor.Many nuclearmedicine techniques in diagnosis and treatment have been routinely performed at provincial and central level health facilities such as tumor scintigraphy, thyroid scintigraphy, bone scintigraphy, kidney scintigraphy, cardiac scintigraphy, and radio-isotope therapy with I-131 and P-32. Selective internal radiation therapy with Y-90 microsphere and I-125 radioactive seed implantation has been also successfully applied in some big hospitals. However, there are still many difficulties for Vietnam as the lack of new widely used radioisotopes such as Ga-67, Cu-64, Samarium-153, and Lutetium-177 and the lack of nuclear medicine specialists. In the future, we are putting our efforts on the applications of new isotopes in diagnosis and treatment of cancers (theranostic) like Ga-68-DOTATATE, Lutetium-177-DOTATATE, Ga-68-PSMA, and Lutetium-177-PSMA, equipping modern nuclear medicine diagnostic tools, strengthening the human resources training in nuclear medicine. At the same time, we are trying our best to strengthen the cooperation with international nuclear medicine societies in over the world.


Subject(s)
Cyclotrons , Diagnosis , Foundations , Health Facilities , Humans , Isotopes , Kidney , Microspheres , Nuclear Medicine , Positron Emission Tomography Computed Tomography , Radioisotopes , Radionuclide Imaging , Specialization , Theranostic Nanomedicine , Thyroid Gland , Tomography, Emission-Computed, Single-Photon , Vietnam
20.
Article in English | WPRIM | ID: wpr-786465

ABSTRACT

Boron neutron capture therapy and Y-90 radioembolization are emerging therapeutic methods for uncontrolled brain cancers and hepatic cancers, respectively. These advanced radiation therapies are heavily relied on theranostic nuclear medicine imaging before the therapy for the eligibility of patients and the prescribed-dose simulation, as well as the post-therapy scanning for assessing the treatment efficacy. In Taiwan, the Taipei Veterans General Hospital is the only institute performing the BNCT and also the leading institute performing Y-90 radioembolization. In this article, we present our single institute experiences and associated theranostic nuclear medicine approaches for these therapies.


Subject(s)
Boron Neutron Capture Therapy , Brain Neoplasms , Hospitals, General , Humans , Liver Neoplasms , Nuclear Medicine , Taiwan , Theranostic Nanomedicine , Treatment Outcome , Veterans
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