AAPM/SNMMI Joint Task Force: report on the current state of nuclear medicine physics training.

The American Association of Physicists in Medicine (AAPM) and the Society of Nuclear Medicine and Molecular Imaging (SNMMI) recognized the need for a review of the current state of nuclear  medicine physics training and the need to explore pathways for improving nuclear medicine physics training opportunities. For these reasons, the two organizations formed a joint AAPM/SNMMI Ad Hoc Task Force on Nuclear Medicine Physics  Training. The mission of this task force was to assemble a representative group of stakeholders to:• Estimate the demand for board-certified nuclear medicine physicists in the next 5-10 years,• Identify the critical issues related to supplying an adequate number of physicists who have received the appropriate level of training in nuclear medicine physics, and• Identify approaches that may be considered to facilitate the training of nuclear medicine physicists.As a result, a task force was appointed and chaired by an active member of both organizations that included representation from the AAPM, SNMMI, the American Board of Radiology (ABR), the American Board of Science in Nuclear Medicine (ABSNM), and the Commission for the Accreditation of Medical Physics Educational Programs (CAMPEP). The Task Force first met at the AAPM Annual Meeting in Charlotte in July 2012 and has met regularly face-to-face, online, and by conference calls. This manuscript reports the findings of the Task Force, as well as recommendations to achieve the stated mission.

The relationship between uncinate fasciculus white matter integrity and verbal memory proficiency in children.

During childhood, verbal learning and memory are important for academic performance. Recent functional MRI studies have reported on the functional correlates of verbal memory proficiency, but few have reported the underlying structural correlates. The present study sought to test the relationship between fronto-temporal white matter integrity and verbal memory proficiency in children. Diffusion weighted images were collected from 17 Black children (age 8-11 years) who also completed the California Verbal Learning Test. To index white matter integrity, fractional anisotropy values were calculated for bilateral uncinate fasciculus. The results revealed that low anisotropy values corresponded to poor verbal memory, whereas high anisotropy values corresponded to significantly better verbal memory scores. These findings suggest that a greater degree of myelination and cohesiveness of axonal fibers in uncinate fasciculus underlie better verbal memory proficiency in children.

An 8-month exercise intervention alters frontotemporal white matter integrity in overweight children.

In childhood, excess adiposity and low fitness are linked to poor academic performance, lower cognitive function, and differences in brain structure. Identifying ways to mitigate obesity-related alterations is of current clinical importance. This study examined the effects of an 8-month exercise intervention on the uncinate fasciculus, a white matter fiber tract connecting frontal and temporal lobes. Participants consisted of 18 unfit, overweight 8- to 11-year-old children (94% Black) who were randomly assigned to either an aerobic exercise (n = 10) or a sedentary control group (n = 8). Before and after the intervention, all subjects participated in a diffusion tensor MRI scan. Tractography was conducted to isolate the uncinate fasciculus. The exercise group showed improved white matter integrity as compared to the control group. These findings are consistent with an emerging literature suggesting beneficial effects of exercise on white matter integrity.

Improved frontoparietal white matter integrity in overweight children is associated with attendance at an after-school exercise program.

Aerobic fitness is associated with white matter integrity (WMI) in adults as measured by diffusion tensor imaging (DTI). This study examined the effect of an 8-month exercise intervention on WMI in children. Participants were 18 sedentary, overweight (BMI≥85th percentile) 8- to 11-year-old children (94% Black), randomly assigned to either an aerobic exercise (n=10) or sedentary attention control group (n=8). Each group was offered an instructor-led after-school program every school day for approximately 8 months. Before and after the program, all subjects participated in DTI scans. Tractography was conducted to isolate the superior longitudinal fasciculus and investigate whether the exercise intervention affected WMI in this region. There was no group by time interaction for WMI in the superior longitudinal fasciculus. There was a group by time by attendance interaction, however, such that higher attendance at the exercise intervention, but not the control intervention, was associated with increased WMI. Heart rate and the total dose of exercise correlated with WMI changes in the exercise group. In the overall sample, increased WMI was associated with improved scores on a measure of attention and improved teacher ratings of executive function. This study indicates that participating in an exercise intervention improves WMI in children as compared to a sedentary after-school program.

Oxidative stress and cardiovascular risk in overweight children in an exercise intervention program.

BACKGROUND: This study aimed to determine whether oxidative stress was related to cardiovascular risk indices in children, and whether an exercise intervention would reduce oxidative stress. METHODS: A randomized trial of two different doses of exercise and a no-exercise control group included 112 overweight and obese children, 7-11 years old. Plasma isoprostane levels were obtained at baseline and after the intervention. Cross-sectional analysis of oxidative stress and metabolic markers at baseline was performed. The effect of the exercise training on oxidative stress was tested. RESULTS: Lower isoprostane levels were observed in blacks. At baseline, isoprostane was positively related to measures of fatness (BMI, waist circumference, percent body fat), insulin resistance and ß-cell function (fasting insulin, insulin area under the curve, Matsuda index, disposition index, oral disposition index), and several lipid markers (low-density lipoprotein, triglycerides, total cholesterol), and inversely with fitness [peak oxygen consumption (VO(2))], independent of race, sex, and cohort. No relation was found with visceral fat, blood pressure, or glycemia. Independent of percent body fat, isoprostane predicted triglycerides, ß=0.23, total cholesterol-to-high-density lipoprotein (TC/HDL) ratio, ß=0.23, and insulin resistance (insulin area under the curve, ß=0.24, Matsuda index, ß=-0.21, oral disposition index, ß=0.33). Exercise did not reduce oxidative stress levels, despite reduced fatness and improved fitness in these children. CONCLUSIONS: Isoprostane levels were related to several markers of cardiovascular risk at baseline; however, despite reduced fatness and improved fitness, no effect of exercise was observed on isoprostane levels. To our knowledge, this is the first report in children to demonstrate a correlation of oxidative stress with disposition index, fitness, and TC/HDL ratio, the first to test the effect on oxidative stress of an exercise intervention that reduced body fat, and the first such exercise intervention study to include a substantial proportion of black children.

Exercise dose and diabetes risk in overweight and obese children: a randomized controlled trial.

CONTEXT: Pediatric studies have shown that aerobic exercise reduces metabolic risk, but dose-response information is not available. OBJECTIVES: To test the effect of different doses of aerobic training on insulin resistance, fatness, visceral fat, and fitness in overweight, sedentary children and to test moderation by sex and race. DESIGN, SETTING, AND PARTICIPANTS: Randomized controlled efficacy trial conducted from 2003 through 2007 in which 222 overweight or obese sedentary children (mean age, 9.4 years; 42% male; 58% black) were recruited from 15 public schools in the Augusta, Georgia, area. INTERVENTION: Children were randomly assigned to low-dose (20 min/d; n = 71) or high-dose (40 min/d; n = 73) aerobic training (5 d/wk; mean duration, 13 [SD, 1.6] weeks) or a control condition (usual physical activity; n = 78). MAIN OUTCOME MEASURES: The prespecified primary outcomes were postintervention type 2 diabetes risk assessed by insulin area under the curve (AUC) from an oral glucose tolerance test, aerobic fitness (peak oxygen consumption [VO2]), percent body fat via dual-energy x-ray absorptiometry, and visceral fat via magnetic resonance, analyzed by intention to treat. RESULTS: The study had 94% retention (n = 209). Most children (85%) were obese. At baseline, mean body mass index was 26 (SD, 4.4). Reductions in insulin AUC were larger in the high-dose group (adjusted mean difference, -3.56 [95% CI, -6.26 to -0.85] × 10(3) µU/mL; P = .01) and the low-dose group (adjusted mean difference, -2.96 [95% CI, -5.69 to -0.22] × 10(3) µU/mL; P = .03) than the control group. Dose-response trends were also observed for body fat (adjusted mean difference, -1.4% [95% CI, -2.2% to -0.7%]; P < .001 and -0.8% [95% CI, -1.6% to -0.07%]; P = .03) and visceral fat (adjusted mean difference, -3.9 cm3 [95% CI, -6.0 to -1.7 cm3]; P < .001 and -2.8 cm3 [95% CI, -4.9 to -0.6 cm3]; P = .01) in the high- and low-dose vs control groups, respectively. Effects in the high- and low-dose groups vs control were similar for fitness (adjusted mean difference in peak VO2, 2.4 [95% CI, 0.4-4.5] mL/kg/min; P = .02 and 2.4 [95% CI, 0.3-4.5] mL/kg/min; P = .03, respectively). High- vs low-dose group effects were similar for these outcomes. There was no moderation by sex or race. CONCLUSION: In this trial, after 13 weeks, 20 or 40 min/d of aerobic training improved fitness and demonstrated dose-response benefits for insulin resistance and general and visceral adiposity in sedentary overweight or obese children, regardless of sex or race. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT00108901.

Exercise improves executive function and achievement and alters brain activation in overweight children: a randomized, controlled trial.

OBJECTIVE: This experiment tested the hypothesis that exercise would improve executive function. DESIGN: Sedentary, overweight 7- to 11-year-old children (N = 171, 56% girls, 61% Black, M ± SD age = 9.3 ± 1.0 years, body mass index [BMI] = 26 ± 4.6 kg/m², BMI z-score = 2.1 ± 0.4) were randomized to 13 ± 1.6 weeks of an exercise program (20 or 40 min/day), or a control condition. MAIN OUTCOME MEASURES: Blinded, standardized psychological evaluations (Cognitive Assessment System and Woodcock-Johnson Tests of Achievement III) assessed cognition and academic achievement. Functional MRI measured brain activity during executive function tasks. RESULTS: Intent to treat analysis revealed dose-response benefits of exercise on executive function and mathematics achievement. Preliminary evidence of increased bilateral prefrontal cortex activity and reduced bilateral posterior parietal cortex activity attributable to exercise was also observed. CONCLUSION: Consistent with results obtained in older adults, a specific improvement on executive function and brain activation changes attributable to exercise were observed. The cognitive and achievement results add evidence of dose-response and extend experimental evidence into childhood. This study provides information on an educational outcome. Besides its importance for maintaining weight and reducing health risks during a childhood obesity epidemic, physical activity may prove to be a simple, important method of enhancing aspects of children's mental functioning that are central to cognitive development. This information may persuade educators to implement vigorous physical activity.

Lower bone mass in prepubertal overweight children with prediabetes.

Childhood studies of the fat-bone relationship are conflicting, possibly reflecting the influence of metabolic abnormalities in some but not all obese children. Bone mass was compared between prepubertal overweight children with (n = 41) and without (n = 99) prediabetes. Associations of bone mass with measures of total and central adiposity, glucose intolerance, insulin sensitivity, lipid profile, systemic inflammation, and osteocalcin also were determined. In 140 overweight children aged 7 to 11 years, an oral glucose tolerance test was used to identify those with prediabetes and for determination of glucose, 2-hour glucose, glucose area under the curve (AUC), insulin, 2-hour insulin, and insulin AUC. Blood samples also were assessed for lipids, C-reactive protein, and osteocalcin. Total-body bone mineral content (BMC), fat-free soft tissue mass (FFST), and fat mass (FM) were measured by dual-energy X-ray absorptiometry (DXA). Visceral adipose tissue (VAT) and subcutaneous abdominal adipose tissue (SAAT) were assessed using MRI. Total-body BMC was 4% lower in overweight children with prediabetes than in those without prediabetes after controlling for sex, race, height, and weight (p = .03). In the total sample, FM was positively related with BMC (ß = 0.16, p = .01) after adjusting for sex, race, height, and FFST. However, VAT (ß = -0.13, p = .03) and SAAT (ß = -0.34, p = .02) were inversely associated with BMC after controlling for sex, race, height, FFST, FM, and SAAT or VAT. No significant associations were found between BMC and the biochemical measurements. Prepubertal overweight children with prediabetes may be at risk for poor skeletal development. In addition, it appears that greater levels of central rather than total adiposity may be deleterious for developing bone.

Utility of waist circumference percentile for risk evaluation in obese children.

OBJECTIVE: Increased waist circumference has been shown to contribute to cardiovascular risk in obese adults. This study was designed to examine whether routinely assessing waist circumference in obese children adds predictive value for the development of diabetes and other cardiovascular risk factors. METHODS: This is a cross-sectional study on a community sample of 188 apparently healthy obese children 7-11 years, 60% black, 39% male. Anthropometry, fasting lipid profile, oral glucose tolerance test, and magnetic resonance imaging of abdominal fat were done. High waist circumference was defined as > or = 90(th) percentile for age and sex. Statistical analyses were done to examine the relationship between waist circumference and the different cardiovascular risk factors. RESULTS: Those with a high waist circumference had significantly lower high-density lipoprotein, higher triglycerides, fasting insulin, insulin response to glucose, subcutaneous and visceral abdominal fat than those with a normal waist circumference. Children with a high waist circumference were 3.6 times more likely than those with a normal waist status to have a low high-density lipoprotein level, 3.0 times more likely to have high triglycerides, and 3.7 times more likely to have a high fasting insulin level. CONCLUSIONS: Obese children with waist circumference at or above the 90th percentile are at higher risk for dyslipidemia and insulin resistance than obese children with normal waist circumference. These results indicate that routine waist circumference evaluation in obese children may help clinicians identify which obese children are at greater risk of diabetes and other cardiovascular disease.

The use of novel gradient directions with DTI to synthesize data with complicated diffusion behavior.

This study demonstrates a new technique for synthesizing diffusion tensor imaging (DTI) data sets that exhibit complex diffusion characteristics by performing operations on acquired DTI data of simple structures with anisotropic diffusive properties. The motivation behind this technique is to characterize the behavior of noise in complicated data using a phantom. Compared to simulations, an advantage to this approach is that the acquired data contain noise characteristic of the scanner and protocol. Using this technique, a simple capillary phantom is employed to infer the quality of data for more clinically realistic tissue structures (e.g., crossing fiber tracts). A water-filled phantom containing capillary arrays was constructed to demonstrate this technique, which uses a DTI protocol with typical clinical parameters. Eigenvalues and fractional anisotropy were calculated for the initial prolate data. Data were adjusted to synthesize different apparent diffusion coefficient (ADC) spatial distributions, which were compared to theoretical and analytical models. RMS differences and volumetric overlap between expected and measured ADC distributions were quantified for all synthesized distributions. Differences between synthesized and actual distributions were discussed.

Non-uniform gradient prescription for precise angular measurements using DTI.

Diffusion Tensor Imaging (DTI) calculates a tensor for each voxel, representing the mean diffusive characteristics in volume-averaged tissue. Gradients that phase-encode spins according to the amount of their diffusion are usually applied uniformly over a sphere during a DTI procedure for minimal bias of tensor information. If prior knowledge of diffusion direction exists, the angular precision for determining the principle eigenvector of cylindrically-symmetric ("prolate") tensors can be improved by specifying gradients non-uniformly. Improvements in precision of 30-40% can be achieved using a restricted band of zenith angle values for gradient directions. Sensitivity to the a priori angular range of the principle eigenvector can be adjusted with the width of the band. Simulations and phantom data are in agreement; a preliminary validation is presented.

An empirical characterization of the quality of DTI data and the efficacy of dyadic sorting.

Metrics calculated from images acquired using the diffusion tensor imaging (DTI) technique possess a systematic bias that depends on signal-to-noise ratio (SNR). Dyadic sorting provides a simple method for remediating some of this bias within a region(s) of interest (ROI). Although this bias and its removal using dyadic sorting have been studied previously within a theoretical framework, one can employ precise geometric knowledge of microstructures to perform an empirical comparison between expected DTI results and those measured with a scanner. In this project, the biasing effect of low SNR (approximately 1-10) on DTI eigenvalues was measured directly using water-filled capillary structures of two different sizes, and the magnitude of the corrective effect of dyadically sorting eigenvector-eigenvalue pairs was characterized. Multiple DTI series were acquired for determining DTI metrics at eight unique SNR values, using T(R) to vary signal intensity via T(1) contrast. Differences between the second and third eigenvalues, which should be equal for prolate geometry, ranged from approximately 23% to 45% and from 19% to 41% for large and small inner diameter capillaries after sorting eigenvalues by magnitude, and ranged from approximately 1% to 18% and from 1% to 4% after dyadic sorting. A high-resolution DTI series was used to observe the effect of ROI size on dyadic sorting. For restriction of diffusion on the scale of the small capillary at SNR approximately 18, an ROI with > or =50 pixels is adequate to determine fractional anisotropy to 99% accuracy, while larger ROI are required to resolve the two smaller eigenvalues to the same accuracy ( approximately 330-390 pixels). At low values of SNR, the iteration of dyadic sorting is suggested to achieve good accuracy. A method for the incorporation of empirical measurements into a bias-correction map, which would be useful for characterizing uncertainty and for reducing systematic bias in DTI data, is introduced.

Ten months of exercise improves general and visceral adiposity, bone, and fitness in black girls.

OBJECTIVE: The goal of this study was to evaluate the impact of a 10-month after-school physical activity (PA) program on body composition and cardiovascular (CV) fitness in young black girls. RESEARCH METHODS AND PROCEDURES: Subjects were 8- to 12-year-olds recruited from elementary schools. Body composition was measured using anthropometrics {waist circumference and BMI, DXA [percentage body fat (%BF)] and bone mineral density (BMD)}, and magnetic resonance imaging [visceral adipose tissue (VAT)]. CV fitness was measured using a graded treadmill test. The intervention consisted of 30 minutes homework/healthy snack time and 80 minutes PA (i.e., 25 minutes skills instruction, 35 minutes aerobic PA, and 20 minutes strengthening/stretching). Analyses were adjusted for age, baseline value of the dependent variable, and sexual maturation (pediatrician observation). RESULTS: Mean attendance was 54%. Compared with the control group, the intervention group had a relative decrease in %BF (p < 0.0001), BMI (p < 0.01), and VAT (p < 0.01) and a relative increase in BMD (p < 0.0001) and CV fitness (p < 0.05). Higher attendance was associated with greater increases in BMD (p < 0.05) and greater decreases in %BF (p < 0.01) and BMI (p < 0.05). Higher heart rate during PA was associated with greater increases in BMD (p < 0.05) and greater decreases in %BF (p < 0.005). DISCUSSION: An after-school PA program can lead to beneficial changes in body composition and CV fitness in young black girls. It is noteworthy that the control and intervention groups differed in change in VAT but not waist circumference. This suggests that changes in central adiposity can occur in response to PA, even in young children, but that waist circumference may not be a good indicator of central adiposity.

Relationship of visceral adiposity to cardiovascular disease risk factors in black and white teens.

OBJECTIVE: We tested the hypothesis that visceral adiposity, compared with general adiposity, would explain more of the variance in cardiovascular disease (CVD) risk factors. RESEARCH METHOD AND PROCEDURES: Subjects were 464 adolescents (238 black and 205 girls). Adiposity measures included visceral adipose tissue (VAT; magnetic resonance imaging), percent body fat (%BF; DXA), BMI, and waist girth (anthropometry). CVD risk factors were fasting insulin, fibrinogen, total to high-density lipoprotein-cholesterol ratio, triglycerides (TGs), systolic blood pressure, and left ventricular mass indexed to height2.7. RESULTS: After adjustment for age, race, and sex, all adiposity indices explained significant proportions of the variance in all of the CVD risk factors; %BF tended to explain more variance than VAT. Regression models that included both %BF and VAT found that both indices explained independent proportions of the variance only for total to high-density lipoprotein-cholesterol ratio. For TGs, the model that included both %BF and VAT found that only VAT was significant. For systolic blood pressure and left ventricular mass indexed to height2.7, anthropometric measures explained more of the variance than VAT and %BF. DISCUSSION: The hypothesis that visceral adiposity would explain more variance in CVD risk than general adiposity was not supported in this relatively large sample of black and white adolescents. Only for TGs did it seem that VAT was more influential than %BF. Perhaps the deleterious effect of visceral adiposity becomes greater later in life as it increases in proportion to general adiposity.

Use of capillaries in the construction of an MRI phantom for the assessment of diffusion tensor imaging: demonstration of performance.

Although diffusion tensor imaging (DTI) shows great potential for the diagnosis of a variety of pathologies, no consensus for an appropriate assessment standard of DTI exists. This study examined the feasibility of using water-filled arrays of glass capillaries to construct a DTI phantom suitable for making repeated and reproducible measurements required in a quality assessment program. Three phantoms were constructed using arrays of capillaries with three inner diameters (23, 48, and 82 microm). Data were acquired using DTI protocols; the fractional anisotropy (FA), mean apparent diffusion coefficient (ADC) and principal eigenvectors of the diffusion tensors were calculated. This study demonstrated four results: (1) echo-planar images show that susceptibility within the capillary arrays does not lead to substantial differences in precessional frequency in regions containing the arrays and neither do the regions show noticeable image distortion; (2) principal eigenvectors of the diffusion tensors agree to within<10.3 degrees of the array orientations; (3) mean FA values (0.18-0.50) and ADC values (1.40-1.93x10-(3) mm2/s) within specified regions of interest are in general agreement with simulations after a simple noise correction; and (4) these array performance characteristics are observable using a typical clinical DTI protocol.

Study of subclinical cerebral edema in diabetic ketoacidosis by magnetic resonance imaging T2 relaxometry and apparent diffusion coefficient maps.

Cerebral edema is the most significant complication in children with diabetic ketoacidosis (DKA). Our goal was to study whether subclinical cerebral edema was preferentially vasogenic or cytotoxic. Magnetic resonance imaging (MRI)--diffusion-weighted imaging (DWI) and T2 relaxometry (T2R)--were obtained in pediatric patients presenting with severe diabetic ketoacidosis (DKA) 6-12 hours after initial DKA treatment and stabilization and 96 hours after correction of DKA. T2 relaxometry was significantly increased during treatment in both white and gray matter, in comparison to the absolute T2R values 96 hours after correction of DKA (p = .034). Classic intracellular cytotoxic edema could not be detected, based on the lack of a statistically significant decrease in ADC values. ADC values were instead elevated, implying a large component of cell membrane water diffusion, correlating with the elevated white and gray matter T2R We discuss the findings in relation to cerebral blood volume, cerebral vasoregulatory dysfunction, and cerebral hyperemia.

Neural substrates of emotion as revealed by functional magnetic resonance imaging.

OBJECTIVES: To examine the brain circuitry involved in emotional experience and determine whether the cerebral hemispheres are specialized for positive and negative emotional experience. BACKGROUND: Recent research has provided a preliminary sketch of the neurologic underpinnings of emotional processing involving specialized contributions of limbic and cortical brain regions. Electrophysiologic, functional imaging, and Wada test data have suggested positive, approach-related emotions are associated with left cerebral hemisphere regions, whereas negative, withdrawal-related emotions appear to be more aligned with right hemisphere mechanisms. METHOD: These emotional-neural associations were investigated using functional magnetic resonance imaging in 10 healthy controls with 20 positively and 20 negatively valenced pictures from the International Affective Picture System in a counterbalanced order. Pictures were viewed within a 1.5 Telsa scanner through computerized video goggles. RESULTS: Emotional pictures resulted in significantly increased blood flow bilaterally in the mesial frontal lobe/anterior cingulate gyrus, dorsolateral frontal lobe, amygdala/anterior temporal regions, and cerebellum. Negative emotional pictures resulted in greater activation of the right hemisphere, and positive pictures caused greater activation of the left hemisphere. CONCLUSIONS: Results are consistent with theories emphasizing the importance of circuitry linking subcortical structures with mesial temporal, anterior cingulate, and frontal lobe regions in emotion and with the valence model of emotion that posits lateralized cerebral specialization for positive and negative emotional experience.

Functional MR imaging study of language-related differences in bilingual cerebellar activation.

BACKGROUND AND PURPOSE: Reports in the monolingual literature suggest that the cerebellum has an important role in language processing. The purpose of this study was to determine whether bilingual cerebellar functional MR imaging (fMRI) activation differs during the performance of comparable tasks in subjects' primary and secondary languages. METHODS: Eight bilingual, right-handed individuals underwent echo-planar fMRI at 1.5 T. They performed semantic (noun-verb association) and phonological (rhyming) tasks in Spanish (primary language) and English (secondary language). Individual and group functional datasets were analyzed using Statistical Parametric Mapping software (SPM99; P <.001 with a 10-voxel spatial extent threshold) and overlaid on T1-weighted anatomic images normalized to a standard (Montreal Neurologic Institute) space. Analysis of variance was performed on laterality indices derived from voxel counts in cerebellar regions of interest (ROIs). Subtraction of group-averaged normalized results from the combined Spanish tasks from the combined English tasks was also performed within SPM99 (P <.001 activation threshold). RESULTS: Significantly greater lateralilty indices were noted in the English tasks than in the Spanish tasks (mean Spanish LI, 0.3286; mean English LI, 0.5141 [P =.0143]). Overall, more robust activation was seen in the English tasks than in the Spanish tasks. Areas of significantly greater activation existed in the English tasks as compared with the Spanish tasks; these areas were more prominent in the left cerebellar hemisphere. CONCLUSION: Although both English and Spanish language tasks demonstrate left cerebellar dominance, English tasks demonstrate greater left hemispheric lateralization.

18F protection issues: human and gamma-camera considerations.

OBJECTIVE: Two main issues in protecting radiation workers and the general public from (18)F radiation-distance from and lead shielding for an (18)F source-were investigated. We also examined the effect of an (18)F source on the counting rate of a neighboring gamma-camera. METHODS: The dose rates of an (18)F vial and a water-filled cylinder were measured using an ionization chamber at different distances with or without lead shielding. In addition, the counting rates of gamma-cameras in the presence of the (18)F cylinder were measured with different detector orientations, distances, and energy windows. RESULTS: The dose rate of a point or an extended source in air was proportional to the inverse square of the distance from the source. At 2 m, the dose rate for a 370-MBq (18)F source was less than 20 micro Gy in any single hour, which is the limit for unrestricted areas. The dose rate with 0.318-cm-thick lead shielding decreased to about 60%, and that with 5.08-cm-thick lead shielding decreased to about 4%; these rates were higher than those estimated using the narrow-beam attenuation formula. The scattered photons and characteristic x-rays from the lead brick and surrounding structures may have contributed to this result. The decrease in dose rate resulting from a 33% increase in distance was similar to the effect from shielding the source with 0.318-cm-thick lead. At 3 m from a 185-MBq (18)F source, the counting rate in the (99m)Tc window of an Orbiter camera was about 120,000/min when the detector faced the source. This rate was comparable to that of a typical (99m)Tc clinical study ( approximately 200,000/min). Only when the distance was increased to 11 m and the detector did not face the source did the counting rate decrease to the background level (3,234/min). The counting rate also depended on the energy window of the gamma-camera. On a Vertex camera, the counting rate of (18)F in the (99m)Tc window versus that in the (201)Tl (or (67)Ga) window was 1:1.7 (or 1:2.7). CONCLUSION: (18)F dose rate can be significantly reduced with distance. Lead shielding is not as effective as was predicted. (18)F sources should be kept substantial distances away from gamma-cameras to avoid contamination of image quality.