Journal of Nuclear Medicine Technology (J Nucl Med Tech)
Published by the technologist section of the Society of Nuclear Medicine, the Journal of Nuclear Medicine Technology focuses entirely on the technology crucial to nuclear medicine. In peer-reviewed articles, every quarter the journal offers recent technically centered articles on imaging and instrumentation, radiopharmacy, quality assurance, radiation safety, and more. JNMT also serves as an invaluable continuing education tool, with teaching editorials, reviews of programs and certification updates, and continuing education articles.
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Publications in this journal
- [Show abstract] [Hide abstract] ABSTRACT: Methods: Eight normal volunteers (7 men, 53 ± 19 years) underwent(13)N-ammonia cardiac PET/CT study at rest. Firstly misregistration of PET/CT images was manually corrected to generate reference images. Then,(13)N-ammonia PET/CT images were misregistered by shifting PET images by 1-, 2-, 3-, 4-, 5-, 10- and 15-mm along both the x-axis (left) and z-axis (cranial) from the reference. PET images were reconstructed using the attenuation CT images in each setting. Left ventricle (LV) short-axis PET/CT image was divided into 4 segments (anterior, septum, inferior, lateral). Degree of erroneous reduction of LV myocardial(13)N-ammonia uptake was visually graded using a 4-point scale (0: none, 1: mild, 2: moderate, 3: severe) on basal, mid and apical slices. Uptake ratios of anterior, lateral and inferior walls to the septum (A/S, L/S, I/S) were evaluated on basal, mid and apical segments. Results: Statistically significant reduction of regional myocardial(13)N-ammonia uptake in anterior ( ITALIC! P< 0.01) and lateral walls ( ITALIC! P< 0.05) was observed when the misregistration was greater than 10 mm. The uptake ratios of A/S, L/S and I/S were 1.00 ± 0.04, 0.96 ± 0.08 and 0.91 ± 0.03 in the reference images, respectively. The A/S and L/S ratios significantly decreased when misregistration exceeded 10 mm (A/S, 0.80 ± 0.06, ITALIC! P< 0.0001; L/S, 0.82 ± 0.07, ITALIC! P< 0.01), while the decrease of I/S was relatively small throughout 7 different misregistration conditions (I/S, 0.86 ± 0.05 at 15-mm misregistration, ITALIC! P= 0.06). Conclusion: In the current study employing 3D PET/CT with 3D OSEM, TOF and PSF algorithms, statistically significant artifactual reduction in tracer uptake was observed in the heart regions that extended into the lung on misregistered CT when the amount of misregistration exceeds 10 mm.
- [Show abstract] [Hide abstract] ABSTRACT: Within the last three years, a new type of technology has emerged for Positron Emission Tomography (PET) imaging that uses a continuous bed motion (CBM) acquisition. For technologists, this technology requires some modifications of the standard approach to PET protocols and imaging workflows. There are a number of key things technologists needs to learn and understand when transitioning from traditional Step and Shoot (SS) PET imaging to this new technology including the difference in acquisition types, image quality, protocol setup, and finally the impact CBM can have on workflow. This article provides key information on how CBM differs from SS and focuses on the critical items technologist may encounter when using this technology.
- [Show abstract] [Hide abstract] ABSTRACT: Coccidioidomycosis is an infection caused by inhalation of the Coccidioides fungus. Most infections remain subclinical or are confined to the pulmonary system. Disseminated disease is rare. Traditionally, a combination of imaging modalities have been utilized to determine disease extent. We suggest F18-Fluorodeoxyglucose (FDG) PET/CT as a single first-line imaging exam to assess disease extent. We present a case of disseminated coccidioidomycosis to the lung, mediastinum, soft tissues, and skeletal system. To our knowledge, no prior case reports demonstrate such widespread disease utilizing PET/CT.
- [Show abstract] [Hide abstract] ABSTRACT: Positron Emission Tomography (PET) imaging has pitfalls and pearls of wisdom which may begin at the point of scheduling and continue through the patient interview, resting phase, scan and image review. A patient interview at the time of scheduling, followed by a confirming telephone call shortly before the appointment can save a nuclear medicine department the financial loss of wasted doses as well as missed appointment slots in the schedule. The pitfalls and pearls of wisdom for 18F Fluorodioxyglucose (FDG) tumor imaging are ever changing. The technologist is in a constant state of questioning and considering the patient's disease process and ability to comply. The worksheets listed in this article and the consideration of each item affects every scan. Upon completion of this article, the reader will be able to identify questions which should be asked in the scheduling and patient interviews, interpret answers to those questions, adapt the patient scan based on answers to those questions, and assess images affected by responses to those questions.
- [Show abstract] [Hide abstract] ABSTRACT: Introduction: (18)F-FDG PET/CT has emerged as one of the fastest growing imaging modalities. A shorter protocol results in lower target-to-background ratio, which can make identification of mildly FDG-avid lesions and differentiation of inflammatory or physiologic from malignant activity more challenging. The purpose of this study was to find the optimal time delay between radiotracer injection and imaging (TI) that would achieve a better target-to-background ratio, while maintaining adequate counting statistics to ensure scan sensitivity. Methods: Patient population-140 patients (66 male, 74 female; age 42-95) with suspicious hepatic lesions evaluated by an (18)F-FDG PET scan were studied. SUV = region of interest activity/ (dose/total body weight). Results: The mean injected dose was 16.5 +/-1.8 mCi, with a mean glucose level of 107 +/- 26.6 (standardized to 90) mg/dl. The uptake time before imaging ranged from 61 to 158 minutes, with a mean of 108.8 +/- 24.8 minutes. The p-values of the correlation of SUV to time were 0.004, 0.003, and 0.0001 for malignant lesions, benign lesions, and background liver respectively. Conclusion: An approximate 90-minute window from the time of injection of (18)F-FDG to PET imaging would lead to a significant improvement in target-to-background ratio, and thus more clinically valuable quantitation and more accurate visual interpretation. This benefit outweighs the minimal loss in patient throughput.
Article: The Highlights Lectures, 1981-2009
- [Show abstract] [Hide abstract] ABSTRACT: Methods: Acceptance tests for a PET/CT scanner are a set of quality control tests performed after installation to verify various parameters specified by the manufacturer before utilizing the scanner for clinical use. We have performed the NEMA NU-2 2007 quality control test of this system and analyzed the results of continuous evaluation of gain calibration, timing resolution and energy resolution for a subsequent period of eighteen months. Results: Gemini TF 16 whole-body PET/CT scanner passed the entire NEMA NU-2 acceptance testing and there were not many fluctuations observed in energy and timing resolutions during this period of observation. Conclusion: Our study shows that Gemini TF 16 whole-body PET/CT scanner is able to perform excellently for the study period of eighteen months despite high volume work.
- [Show abstract] [Hide abstract] ABSTRACT: Aims and objectives: Assessment of renal toxicity profile of (177)Lu-DOTATATE based Peptide Receptor Radionuclide therapy (PRRT) in patients of Metastatic Neuroendocrine tumor (NET) with a single functioning kidney. Materials and methods: This was a retrospective analysis of NET patients, who had undergone PRRT with (177)Lu-DOTATATE at a large tertiary care centre. The patients selected for the study fulfilled the following criteria: (i) all patients were cases of somatostastin receptor (SSTR) positive neuroendocrine tumours who had received at least 3 cycles of PRRT with (177)Lu-DOTATATE and (ii) had a documented single functioning kidney. The selected patients were analyzed under the following parameters: (i) the patient characteristics, (ii) associated metastatic burden, (iii) renal parameters at diagnosis and during the course of therapy, (iv) evaluation of associated nephrotoxic factors. For renal assessment, following parameters were studied before each PRRT cycle: (i) glomerular filtration rate (GFR) estimated by (99m)Tc-DTPA renogram study, (ii) Effective Renal Plasma Flow (ERPF) by (99m)Tc-EC renogram study, (iii) blood urea and serum creatinine levels. Renal toxicity was evaluated using Common Terminology Criteria for Adverse Events v4.0 (NCI-CTCAE score). The percentage reduction in the GFR and ERPF for all patients was also assessed. Calculation of filtration fraction (FF) was undertaken to clarify whether there has been a relatively greater reduction in one of the two indices of renal function compared to the other. Results: At the time of analysis, six patients with single functioning kidney with metastatic NET received PRRT with (177)Lu-DOTATATE between 3-5 cycles and cumulative activity of 16.6 GBq to 36.2 GBq. Duration of follow-up ranged from 12 - 56 months. Overall toxicity profile (as per the NCI-CTCAE score) showed no patients had any acute renal toxicity. Three patients had no overall chronic renal toxicity; one patient had grade II chronic renal toxicity and two patients had grade I chronic renal toxicity level . All the patients who showed overall chronic renal toxicity showed compromised renal function at the onset (baseline chronic renal toxicity). Interestingly, the two patients with resultant grade I chronic renal toxicity level post-PRRT had grade II chronic renal toxicity before commencement of PRRT with gradual improvement over the subsequent cycles. One patient had grade II chronic renal toxicity before commencement of PRRT with transient worsening to grade III toxicity after first cycle PRRT with gradual improvement and return to basal levels post second cycle of PRRT (values revert back to the grade II toxicity grade). Only two patients showed reduction in GFR (one patient had 5.3% reduction whereas one patient had 13.84% reduction). Four patients showed a reduction in the ERPF (with one patient showing maximum reduction in ERPF it being 31.39% from basal ERPF) and all the four demonstrated rise in filtration fraction signifying that tubular parameters are more affected compared to the glomerular parameters. Conclusion: The preliminary results of this analysis show the feasibility of 177-Lu DOTATATE based PRRT in patients of NET with single functioning kidney, along with proper renal protection and dose fractionation. Further studies are required to assess the long term renal consequences of the changes in ERPF and FF parameters in these patients.
- [Show abstract] [Hide abstract] ABSTRACT: The (18)F-FDG-PET/CT imaging features in pulmonary inflammatory pseudotumor are illustrated, in a proven case both at initial diagnosis and in the context of early monitoring of corticosteroid therapy in this "great mimicker of malignancy". Complete surgical resection had to be finally undertaken in view of relative non-response to corticosteroid therapy advocated first line, though the patient had shown some symptomatic response and modest reduction of SUVmax. (18)F-FDG avidity in untreated cases of the pulmonary inflammatory pseudotumor has been quite characteristic and may be potentially utilized to evaluate early response to administered non-surgical treatment and also detect residual disease/recurrence following therapeutic intervention of this IgG4 related disease.
- [Show abstract] [Hide abstract] ABSTRACT: Primary hyperparathyroidism is predominantly caused by a single parathyroid adenoma (1). Knowledge of normal and ectopic locations of parathyroid glands is crucial to help guide surgeons who plan targeted unilateral parathyroidectomy to reduce surgical time and risk. We describe a female patient with clinical primary hyperparathyroidism who underwent a failed initial parathyroidectomy, with subsequent imaging localizing an ectopic parathyroid adenoma in the carotid sheath.
- [Show abstract] [Hide abstract] ABSTRACT: Hypergastrinemia is a prominent feature of a segment of gastroenetropancreatic neuroendocrine tumours, the gastrinomas, mostly occurring in the gastrinoma triangle. Hypergastrinemia due to a thoracic NET is a very rare occurrence with paucity of literature elucidating the same. We report a case of thoracic NET who had initially presented with symptoms of peptic ulcer disease of 3 years duration. On evaluation, the fasting serum gastrin levels were raised. Conventional imaging modalities and endoscopic evaluation did not identify the location of possible gastrinoma or any other mass in the abdomen. In view of hypergastrinemia, somatostatin receptor (SSTR) targeted imaging with (68)Ga-DOTATATE PET/CT was undertaken which showed a SSTR expressing paravertebral para-aortic mass (next to thoracic aorta) in the left lung. The mass was excised and the histopathology was suggestive of metastatic neuroendocrine tumour (Mib1 labeling index of 2%). The present case underscores the importance of (68)Ga-DOTATATE PET-CT in both detecting and characterizing the causative lesion missed on ceCT, that was not easily amenable to a biopsy.
- [Show abstract] [Hide abstract] ABSTRACT: Unlabelled: Incidental findings on low-dose CT images obtained during hybrid imaging are an increasing phenomenon as CT technology advances. Understanding the diagnostic value of incidental findings along with the technical limitations is important when reporting image results and recommending follow-up, which may result in an additional radiation dose from further diagnostic imaging and an increase in patient anxiety. This study assessed lesions incidentally detected on CT images acquired for attenuation correction on two SPECT/CT systems. Methods: An anthropomorphic chest phantom containing simulated lesions of varying size and density was imaged on an Infinia Hawkeye 4 and a Symbia T6 using the low-dose CT settings applied for attenuation correction acquisitions in myocardial perfusion imaging. Twenty-two interpreters assessed 46 images from each SPECT/CT system (15 normal images and 31 abnormal images; 41 lesions). Data were evaluated using a jackknife alternative free-response receiver-operating-characteristic analysis (JAFROC). Results: JAFROC analysis showed a significant difference (P < 0.0001) in lesion detection, with the figures of merit being 0.599 (95% confidence interval, 0.568, 0.631) and 0.810 (95% confidence interval, 0.781, 0.839) for the Infinia Hawkeye 4 and Symbia T6, respectively. Lesion detection on the Infinia Hawkeye 4 was generally limited to larger, higher-density lesions. The Symbia T6 allowed improved detection rates for midsized lesions and some lower-density lesions. However, interpreters struggled to detect small (5 mm) lesions on both image sets, irrespective of density. Conclusion: Lesion detection is more reliable on low-dose CT images from the Symbia T6 than from the Infinia Hawkeye 4. This phantom-based study gives an indication of potential lesion detection in the clinical context as shown by two commonly used SPECT/CT systems, which may assist the clinician in determining whether further diagnostic imaging is justified.
- [Show abstract] [Hide abstract] ABSTRACT: Purpose: To investigate the minimal required radioactivity and corresponding imaging time for reliable semi-quantification in PET-CT imaging to perform useful and comparable imaging studies in pursuit of as low as reasonably achievable (ALARA) in dose reduction. Materials and methods: We performed (18)F-FDG PET-CT study using a Jaszczak ECT phantom containing spheres of diameters (3.4, 2.1, 1.5, 1.2, 1.0 cm) filled with a fixed concentration of 165 kBq/ml and background of 23.3 kBq/ml at multiple time points over 20 hours of radioactive decay. The images were acquired for 10 minutes in a single bed position at each of 10 half-lives of decay using 3D list mode in a hybrid GE Discovery 690 PET-CT scanner. The images were reconstructed in 1, 2, 3, 4, 5, and 10 minutes per bed using ordered-subset expectation maximum (OSEM) algorithm with 24 subsets and 2 iterations with a gaussian 2-mm filter using an AW workstation (GE Healthcare) equipped with version 4.5 software. The maximum and average standardized uptake values (SUV) of each sphere were measured. Results: The minimal required activity concentration for precise SUVmax quantification in spheres (±10%) was determined to be 1.8 kBq/ml for 10 minutes, 3.7 kBq/ml for 3-5 minutes, 7.9 kBq/ml for 2 minutes, and 17.4 kBq/ml for 1 minute of acquisition per bed position. The minimal required value for the product of activity concentration and acquisition time per bed position was determined to be 10-15 kBq/ml*min for reproducible SUV measurement within the spheres without overestimation. Using the total radioactivity and count rate from the entire phantom, the minimal required values for the product with time per bed position was determined to be 17 MBq*min and 100 kcps*min, respectively. Conclusion: Our phantom study determined a threshold for minimal radioactivity and acquisition time for precise semi-quantification in FDG PET imaging that can serve as a guide in pursuit of achieving ALARA.
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