Publications by authors named "Francesco Giammarile"

97 Publications

Selective internal radiation therapy of hepatic tumors: Morphologic and functional imaging for voxel-based computer-aided dosimetry.

Biomed Pharmacother 2020 Dec 3;132:110865. Epub 2020 Nov 3.

Division of Human Health, International Atomic Energy Agency, Wagramer Str. 5, 1220 Vienna, Austria. Electronic address:

Introduction: Selective Internal Radiation Therapy (SIRT) is used for the treatment of hepatic tumors. The aim of this retrospective study was to compare two dosimetric approaches based on Tc-MAA SPECT/CT and Y PET/CT, using SimplicitY™ versus the supplier suggested method of activity calculation.

Material And Methods: A total of 19 patients underwent 21 SIRT after baseline angiography and 99mTc-MAA SPECT/CT, followed by 90Y PET/CT. Overlap between 99mTc-MAA and 90Y-microspheres was quantified with different thresholds isocontours. The perfused volume and tumor absorbed dose were estimated using Simplicit90Y™ based on SPECT/CT and PET/CT, then compared with the supplier suggested method. These data were related to overall survival to evaluate their prognostic impact.

Results: The overlap between PET/CT and SPECT/CT was dependent on thresholds, decreasing with an increasing threshold. The overlap between the 99mTc-MAA and 90Y-microspheres biodistributions versus the tumor distribution on morphological imaging was suboptimal, in particular for small tumor volume. The tumor absorbed dose estimated after 90Y PET/CT was not different from tumor absorbed dose estimated after SPECT/CT. The Perfused lobe absorbed dose was significantly lower while the volume of the perfused lobe was significantly higher when estimated by Simplicit90Y™ compared to the supplier suggested conventional approach. A statistical parameter based on overlap between tumor and 90Y-microspheres distribution as well as tumoral dosimetry was significantly related to the overall survival.

Conclusion: Post-treatment imaging remains paramount to estimate the irradiation dosimetry, due to an imperfect overlap. The perfused volume could be estimated from functional imaging, given its impact on dosimetry. Finally, survival seems related to tumoral overlap and dosimetry.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.biopha.2020.110865DOI Listing
December 2020

Lymphoscintigraphy for Sentinel Node Mapping in Head and Neck Cancer.

Semin Nucl Med 2021 Jan 2;51(1):39-49. Epub 2020 Aug 2.

Nuclear Medicine and Diagnostic Imaging Section, International Atomic Energy Agency (IAEA), Vienna, Austria; Centre Léon Bérard, Lyon, France. Electronic address:

The aim of this comprehensive review is to describe and analyze the role of the sentinel node mapping in head and neck cancers. For this purpose, head and neck neoplasms have been categorized in cutaneous malignancies and neoplasms of the upper aerodigestive tract. A concise description of lymphatic drainage will be the "prelude" for each section, as well as the description of the injection techniques, when specific. Concisely, the attention has been focused on detection rate of the sentinel node by lymphoscintigraphy for each cancer, and for those patients in which the sentinel lymph node has been identified, true-positives rates, false-negative rates, and overall accuracy has been pointed out. Overall, in cutaneous neoplasms of the head and neck, the detection rate is higher than 90%, however the false-negative rate is still an issue, in particular in melanoma, inducing the need for newer developments. In fact, new tracers and techniques are already available, while prospective multicenter trials exploring the outcome impact are needed in the near future. For the upper aerodigestive tract and in particular oral cavity and oropharynx, sentinel lymph node identification by lymphoscintigraphy allows avoiding unnecessary neck dissection and/or node irradiation. Even in this case, the main limit remains the risk of false-negative rates. While, for patients affected by laryngeal and hypopharyngeal cancers the data seem very limited and, although the feasibility has been demonstrated, performances of this lymphoscintigraphy still need to be confirmed by multicenter studies.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1053/j.semnuclmed.2020.07.004DOI Listing
January 2021

Comparison of MRI, [F]FDG PET/CT, and Tc-UBI 29-41 scintigraphy for postoperative spondylodiscitis-a prospective multicenter study.

Eur J Nucl Med Mol Imaging 2020 Nov 18. Epub 2020 Nov 18.

Regional Centre of Nuclear Medicine, Department of Translational Research and Advanced Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy.

Purpose: Postoperative infection still constitutes an important complication of spine surgery, and the optimal imaging modality for diagnosing postoperative spine infection has not yet been established. The aim of this prospective multicenter study was to assess the diagnostic performance of three imaging modalities in patients with suspected postoperative spine infection: MRI, [F]FDG PET/CT, and SPECT/CT with Tc-UBI 29-41.

Methods: Patients had to undergo at least 2 out of the 3 imaging modalities investigated. Sixty-three patients enrolled fulfilled such criteria and were included in the final analysis: 15 patients underwent all 3 imaging modalities, while 48 patients underwent at least 2 imaging modalities (MRI + PET/CT, MRI + SPECT/CT, or PET/CT + SPECT/CT). Final diagnosis of postoperative spinal infection was based either on biopsy or on follow-up for at least 6 months. The MRI, PET/CT, and SPECT/CT scans were read blindly by experts at designated core laboratories. Spine surgery included metallic implants in 46/63 patients (73%); postoperative spine infection was diagnosed in 30/63 patients (48%).

Results: Significant discriminants between infection and no infection included fever (P = 0.041), discharge at the wound site (P < 0.0001), and elevated CRP (P = 0.042). There was no difference in the frequency of infection between patients who underwent surgery involving spinal implants versus those who did not. The diagnostic performances of MRI and [F]FDG PET/CT analyzed as independent groups were equivalent, with values of the area under the ROC curve equal to 0.78 (95% CI: 0.64-0.92) and 0.80 (95% CI: 0.64-0.98), respectively. SPECT/CT with Tc-UBI 29-41 yielded either unacceptably low sensitivity (44%) or unacceptably low specificity (41%) when adopting more or less stringent interpretation criteria. The best diagnostic performance was observed when combining the results of MRI with those of [F]FDG PET/CT, with an area under the ROC curve equal to 0.938 (95% CI: 0.80-1.00).

Conclusion: [F]FDG PET/CT and MRI both possess equally satisfactory diagnostic performance in patients with suspected postoperative spine infection, the best diagnostic performance being obtained by combining MRI with [F]FDG PET/CT. The diagnostic performance of SPECT/CT with Tc-UBI 29-41 was suboptimal in the postoperative clinical setting explored with the present study.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s00259-020-05109-xDOI Listing
November 2020

Addressing Global Inequities in Positron Emission Tomography-Computed Tomography (PET-CT) for Cancer Management: A Statistical Model to Guide Strategic Planning.

Med Sci Monit 2020 Aug 27;26:e926544. Epub 2020 Aug 27.

Nuclear Medicine and Diagnostic Imaging Section, International Atomic Energy Agency, Vienna International Centre, Vienna, Austria.

BACKGROUND According to the World Health Organization (WHO), non-communicable diseases are responsible for 71% of annual global mortality. National governments and international organizations are increasingly considering medical imaging and nuclear medicine access data in strategies to address epidemiologic priorities. Our objective here was to develop a statistical model to assist countries in estimating their needs for PET-CT systems for the management of specific cancer types. MATERIAL AND METHODS We introduce a patient-centered statistical model based on country-specific epidemiological data, PET-CT performance, and evidence-based clinical guidelines for PET-CT use for cancer. The output of the model was integrated into a Bayesian model to rank countries or world regions that would benefit the most from upscaling PET-CT scanners. RESULTS We applied our model to the IMAGINE database, recently developed by the International Atomic Energy Agency (IAEA). Our model indicates that at least 96 countries should upscale their PET-CT services and more than 200 additional PET-CT scanners would be required to fulfill their needs. The model also provides quantitative evidence indicating that low-income countries would benefit the most from increasing PET-CT provision. Finally, we discuss several cases in which the standard unit [number of scanners]/[million inhabitants] to guide strategic planning or address inequities is misleading. CONCLUSIONS Our model may help in the accurate delineation and further reduction of global inequities in access to PET-CT scanners. As a template, the model also has the potential to estimate the costs and socioeconomic impact of implementing any medical imaging modality for any clinical application.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.12659/MSM.926544DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7476356PMC
August 2020

COVID-19 pneumonia: relationship between inflammation assessed by whole-body FDG PET/CT and short-term clinical outcome.

Eur J Nucl Med Mol Imaging 2021 01 25;48(1):260-268. Epub 2020 Jul 25.

Nuclear Medicine Department, Centre Hospitalier Princesse Grace, 1 Avenue Pasteur, 98000, Monaco, Monaco.

Purpose: [18F]-2-Fluoro-2-deoxy-D-glucose PET/CT (FDG PET/CT) is a sensitive and quantitative technic for detecting inflammatory process. Glucose uptake is correlated with an increased anaerobic glycolysis seen in activated inflammatory cells such as monocytes, lymphocytes, and granulocytes. The aim of the study was to assess the inflammatory status at the presumed peak of the inflammatory phase in non-critically ill patients requiring admission for COVID-19.

Methods: Patients admitted with COVID-19 were prospectively enrolled. FDG PET/CT was performed from day 6 to day 14 of the onset of symptoms. Depending on FDG PET/CT findings, patients' profiles were classified as "inflammatory" or "low inflammatory." FDG PET/CT data were compared with chest CT evolution and short-term clinical outcome. All inflammatory sites were reported to screen potential extra-pulmonary tropism.

Results: Thirteen patients were included. Maximum standardized uptake values ranged from 4.7 to 16.3 in lungs. All patients demonstrated increased mediastinal lymph nodes glucose uptake. Three patients (23%) presented mild nasopharyngeal, two patients (15%) bone marrow, and five patients (38%) splenic mild increase in glucose uptake. No patient had significant digestive focal or segmental glucose uptake. There was no significant physiological myocardial glucose uptake in all patients except one. There was no correlation between PET lung inflammatory status and chest CT evolution or short-term clinical outcome.

Conclusion: Inflammatory process at the presumed peak of the inflammatory phase in COVID-19 patients is obvious in FDG PET/CT scans. Glucose uptake is heterogeneous and typically focused on lungs.

Trial Registration: NCT04441489. Registered 22 June 2020 (retrospectively registered).
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s00259-020-04968-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7382557PMC
January 2021

Global Impact of COVID-19 on Nuclear Medicine Departments: An International Survey in April 2020.

J Nucl Med 2020 Sep 24;61(9):1278-1283. Epub 2020 Jul 24.

Department of Nuclear Medicine, University Hospital Essen, Essen, Germany.

The coronavirus disease 2019 (COVID-19) pandemic has placed significant challenges on health-care systems worldwide, whether in the preparation, response, or recovery phase of the pandemic. This has been primarily managed by dramatically reducing in- and outpatient services for other diseases and implementing infection prevention and control measures. The impact of the pandemic on nuclear medicine departments and their services has not yet been established. The aim of this online survey was to evaluate the impact of COVID-19 on nuclear medicine departments. A web-based questionnaire, made available from April 16 to May 3, 2020, was designed to determine the impact of the pandemic on in- and outpatient nuclear medicine departments, including the number of procedures, employee health, availability of radiotracers and other essential supplies, and availability of personal protective equipment. The survey also inquired about operational aspects and types of facilities as well as other challenges. A total of 434 responses from 72 countries were registered and analyzed. Respondents reported an average decline of 54% in diagnostic procedures. PET/CT scans decreased by an average of 36%, whereas sentinel lymph-node procedures decreased by 45%, lung scans by 56%, bone scans by 60%, myocardial studies by 66%, and thyroid studies by 67%. Of all participating centers, 81% performed radionuclide therapies, and they reported a reduction of 45% on average in the last 4 wk, ranging from over 76% in Latin America and South East Asia to 16% in South Korea and Singapore. Survey results showed that 52% of participating sites limited their Tc/Mo generator purchases, and 12% of them temporarily cancelled orders. Insufficient supplies of essential materials (radioisotopes, generators, and kits) were reported, especially for Tc/Mo generators and I, particularly in Africa, Asia, and Latin America. Both diagnostic and therapeutic nuclear medicine procedures declined precipitously, with countries worldwide being affected by the pandemic to a similar degree. Countries that were in the postpeak phase of the pandemic when they responded to the survey, such as South Korea and Singapore, reported a less pronounced impact on nuclear medicine services; however, the overall results of the survey showed that nuclear medicine services worldwide had been significantly impacted. In relation to staff health, 15% of respondents experienced COVID-19 infections within their own departments.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.2967/jnumed.120.249821DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7456173PMC
September 2020

Adapting palliative radiation therapy for bone metastases during the Covid-19 pandemic: GEMO position paper.

J Bone Oncol 2020 Jun 13;22:100291. Epub 2020 Apr 13.

University department of Rheumatology, Lille University hospital; Oscar Lambret Center; CNRS UMR9020, INSERM UMR1277, University of Lille, Institut Pasteur, Lille.

The current health crisis caused by COVID-19 is a challenge for oncology treatment, especially when it comes to radiotherapy. Cancer patients are already known to be very fragile and COVID-19 brings about the risk of severe respiratory complications. In order to treat patients safely while protecting medical teams, the entire health care system must optimize the way it approaches prevention and treatment at a time when social distancing is key to stemming this pandemic. All indications and treatment modalities must be re-discussed. This is particularly the case for radiotherapy of bone metastases for which it is possible to reduce the number of sessions, the frequency of transport and the complexity of treatments. These changes will have to be discussed according to the organization of each radiotherapy department and the health situation, while medical teams must remain vigilant about the risks of complications of bone metastases, particularly spinal metastases. In this short piece, the members of the GEMO (the European Study Group of Bone Metastases) offer a number of recommendations to achieve the above objectives, both in general and in relation to five of the most common situations on radiation therapy for bone metastases.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jbo.2020.100291DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7152868PMC
June 2020

Impact of liver tumour burden, alkaline phosphatase elevation, and target lesion size on treatment outcomes with Lu-Dotatate: an analysis of the NETTER-1 study.

Eur J Nucl Med Mol Imaging 2020 09 2;47(10):2372-2382. Epub 2020 Mar 2.

Department of Nuclear Medicine, Cyclotron Rotterdam BV, Erasmus University Medical Center, Rotterdam, Netherlands.

Purpose: To assess the impact of baseline liver tumour burden, alkaline phosphatase (ALP) elevation, and target lesion size on treatment outcomes with Lu-Dotatate.

Methods: In the phase 3 NETTER-1 trial, patients with advanced, progressive midgut neuroendocrine tumours (NET) were randomised to 177Lu-Dotatate (every 8 weeks, four cycles) plus octreotide long-acting release (LAR) or to octreotide LAR 60 mg. Primary endpoint was progression-free survival (PFS). Analyses of PFS by baseline factors, including liver tumour burden, ALP elevation, and target lesion size, were performed using Kaplan-Meier estimates; hazard ratios (HRs) with corresponding 95% CIs were estimated using Cox regression.

Results: Significantly prolonged median PFS occurred with Lu-Dotatate versus octreotide LAR 60 mg in patients with low (< 25%), moderate (25-50%), and high (> 50%) liver tumour burden (HR 0.187, 0.216, 0.145), and normal or elevated ALP (HR 0.153, 0.177), and in the presence or absence of a large target lesion (diameter > 30 mm; HR, 0.213, 0.063). Within the Lu-Dotatate arm, no significant difference in PFS was observed amongst patients with low/moderate/high liver tumour burden (P = 0.7225) or with normal/elevated baseline ALP (P = 0.3532), but absence of a large target lesion was associated with improved PFS (P = 0.0222). Grade 3 and 4 liver function abnormalities were rare and did not appear to be associated with high baseline liver tumour burden.

Conclusions: Lu-Dotatate demonstrated significant prolongation in PFS versus high-dose octreotide LAR in patients with advanced, progressive midgut NET, regardless of baseline liver tumour burden, elevated ALP, or the presence of a large target lesion. Clinicaltrials.gov : NCT01578239, EudraCT: 2011-005049-11.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s00259-020-04709-xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7396396PMC
September 2020

Lymphoscintigraphy and sentinel lymph node biopsy in vulvar carcinoma: update from a European expert panel.

Eur J Nucl Med Mol Imaging 2020 05 2;47(5):1261-1274. Epub 2020 Jan 2.

Department of Nuclear Medicine, Fondazione IRCCS Istituto Nazionale Tumori di Milano, Milan, Italy.

Purpose: This study aimed to update the clinical practice applications and technical procedures of sentinel lymph node (SLN) biopsy in vulvar cancer from European experts.

Methods: A systematic data search using PubMed/MEDLINE database was performed up to May 29, 2019. Only original studies focused on SLN biopsy in vulvar cancer, published in the English language and with a minimum of nine patients were selected.

Results: Among 280 citations, 65 studies fulfilled the inclusion criteria. On the basis of the published evidences and consensus of European experts, this study provides an updated overview on clinical applications and technical procedures of SLN biopsy in vulvar cancer.

Conclusions: SLN biopsy is nowadays the standard treatment for well-selected women with clinically negative lymph nodes. Negative SLN is associated with a low groin recurrence rate and a good 5-year disease-specific survival rate. SLN biopsy is the most cost-effective approach than lymphadenectomy in early-stage vulvar cancer. However, future trials should focus on the safe extension of the indication of SLN biopsy in vulvar cancer. Although radiotracers and optical agents are widely used in the clinical routine, there is an increasing interest for hybrid tracers like indocyanine-Tc-nanocolloid. Finally, it is essential to standardise the acquisition protocol including SPECT/CT images, and due to the low incidence of this type of malignancy to centralise this procedure in experienced centres for personalised approach.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s00259-019-04650-8DOI Listing
May 2020

Endorsement of International Consensus Radiochemistry Nomenclature Guidelines.

EJNMMI Radiopharm Chem 2019 Apr 16;4(1). Epub 2019 Apr 16.

Department of Radiology and Medical Physics, Hospital de Sant Pau, Barcelona, Spain.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1186/s41181-018-0050-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6465369PMC
April 2019

Sentinel Node Mapping in Gynecologic Cancers: A Comprehensive Review.

Semin Nucl Med 2019 11 29;49(6):521-533. Epub 2019 Jun 29.

International Atomic Energy Agency, Vienna, Austria. Electronic address:

Gynecologic cancers are one of the most important causes of women death worldwide. The sentinel lymph node concept was introduced by Cabanas in 1977 for the penile cancer. This technique was proven safe and feasible in selected cancers such as breast cancer, melanoma, or some gynecologic cancers. Sentinel lymph node mapping is increasingly used in early stages of cervical or vulvar cancer in particular due to the safety, high detection rate, and sensitivity of the technique. In this review, we will discuss in depth the most recent evidence of nuclear medicine and other techniques used to determine the status of the sentinel lymph node in women affected by gynecologic neoplasms. Although significant efforts have been already done in order to address several issues, there are still determined questions without a clear answer, in particular for endometrial, ovarian, and vaginal neoplasms.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1053/j.semnuclmed.2019.06.012DOI Listing
November 2019

Letter to the editor-in-chief of Head and Neck.

Head Neck 2019 12 5;41(12):4234-4235. Epub 2019 Aug 5.

Department of Nuclear Sciences and Applications, International Atomic Energy Agency, Austria.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1002/hed.25902DOI Listing
December 2019

Role of F-FDG PET/CT in establishing new clinical and therapeutic modalities in lung cancer. A short review.

Rev Esp Med Nucl Imagen Mol 2019 Jul - Aug;38(4):229-233. Epub 2019 Jun 13.

Department of Imaging (Nuclear Medicine, Medical Physics, Radiology) and of Clinical Laboratory (Laboratory, Transfusional Centre, Microbiology, Pathology, Rovigo Hospital, Italy. Electronic address:

Lung cancer is a fairly common malignancy. An early diagnosis and a reliable staging and re-staging with the aim to detect both local and distant relapse are of utmost importance in planning the therapeutic management. The imaging diagnostic work-up of patients with lung cancer usually includes conventional imaging (chest X-ray, contrast-enhanced CT, bone scan) and more recently F-FDG PET/CT. Great advances in the management of lung cancer are based on the information provided by F-FDG PET/CT, as it supplies both metabolic and anatomic information (better localisation). There is vast evidence in the literature demonstrating its utility in (a) characterising benign versus malignant solitary nodules, (b) staging and re-staging lung cancer, (c) guiding the type of therapy, (d) monitoring treatment response and (e) predicting outcome. In particular, given its specificity in differentiating F-FDG-avid relapse from post-surgical changes or post-radiation fibrosis (which do not take up F-FDG), PET/CT can detect recurrent disease after initial treatment and (being a whole-body technique) has demonstrated high accuracy in the detection of distant metastases or secondary tumours. In conclusion, F-FDG PET/CT can be considered a highly accurate and reliable method for staging and re-staging lung cancer, and is highly effective in guiding personalised therapies.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.remn.2019.02.003DOI Listing
January 2020

Diuresis renography in equivocal urinary tract obstruction. A historical perspective.

Biomed Pharmacother 2019 Aug 25;116:108981. Epub 2019 May 25.

Department of Nuclear Medicine, Radiology, Neuroradiology, and Clinical Pathology, Santa Maria della Misericordia Hospital, Rovigo, Italy. Electronic address:

Obstructive nephropathy may be suspected for the incidental detection of dilated renal collecting system at ultrasonography, CT or MRI. A dilated renal collecting dilation (calyco-pelvis or ureteres) might be related 1) to an anatomical variant of the excretory tract without obstruction and, therefore, without consequence on renal function, or 2) to an obstruction/stenosis of the urinary tract that may cause a damage of kidney function. In the present review we annotated the various methods proposed for Diuresis Renography (DR) used with the purpose to make early diagnosis of obstructive nephropathy. First, the F + 20 method (i.e. furosemide 40 mg injected IV 20 min after radiotracer injection) in seated position (sp) (F + 20) was reported to distinguish between an anatomical dilation from an anatomical obstruction of the urinary tract. It was also suggested to perform DR with the patient in supine or prone position in order to minimize possible furosemide-induced hypotension and patient's movements during exam. Other DR methods were proposed administering furosemide EV to the patient in supine position at different times: F-15 (furosemide injected IV 15 min prior to radiotracer), F0 (furosemide injected contemporary to radiotracer), F + 20 (furosemide injected 20 min after the radiotracer), F-20 and Well Tempered (other than F + 20 this modality requires saline infusion for all duration of the test plus bladder catheterization). Unfortunately, in all the above described DR methods with patientin supine position, despite the furosemide administration, a sensitive slowing down of urinary outflow could be related to the supine position itself of the patient during the examination. Lastly, there are reports of a new DR method based on furosemide IV injection 10 min after radiotracer with the patient in seated position, F+10. This method allows a better timing between hydration (400 mL of water) at 5 min, and the injection of relatively low dose of furosemide (20 mg), thus avoiding side effects as diuretic-induced hypotension and favouring bladder filling, therefore ameliorating patient compliance and reducing equivocal responses.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.biopha.2019.108981DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7104806PMC
August 2019

Improvement of early detection of breast cancer through collaborative multi-country efforts: Observational clinical study.

Eur J Radiol 2019 Jun 27;115:31-38. Epub 2019 Mar 27.

International Atomic Energy Agency, Vienna, Austria.

Aim: The aim of this paper is to present baseline imaging data and the improvement that was achieved by the participating centers after applying practice-specific interventions that were identified during the course of a multicentric multinational research coordinated project.

Introduction: The incidence and mortality rates from breast cancer are rising worldwide and particularly rapidly across the countries with limited resources. Due to lack of awareness and screening options it is usually detected at a later stage. Breast cancer screening programs and even clinical services on breast cancer have been neglected in such countries particularly due to lack of available equipment, funds, organizational structure and quality criteria.

Materials And Methods: A harmonized form was designed in order to facilitate uniformity of data collection. Baseline data such as type of equipment, number of exams, type and number of biopsy procedures, stage of cancer at detection were collected from 10 centers (9 countries: Bosnia-Herzegovina, Costa Rica, Egypt, India, North Macedonia, Pakistan, Slovenia, Turkey, Uganda) were collected. Local practices were evaluated for good practice and specific interventions such as training of professionals and quality assurance programs were identified. The centers were asked to recapture the data after a 2-year period to identify the impact of the interventions.

Results: The data showed increase in the number of training of relevant professionals, positive changes in the mammography practice and image guided interventions. All the centers achieved higher levels of success in the implementation of the quality assurance procedures.

Conclusion: The study has encountered different levels of breast imaging practice in terms of expertise, financial and human resources, infrastructure and awareness. The most common challenges were the lack of appropriate quality assurance programs and lack of trained skilled personnel and lack of high-quality equipment. The project was able to create higher levels of breast cancer awareness, collaboration amongst participating centers and professionals. It also improved quality, capability and expertise in breast imaging particularly in centers involved diagnostic imaging.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.ejrad.2019.03.020DOI Listing
June 2019

Endorsement of International Consensus Radiochemistry Nomenclature Guidelines.

Eur J Nucl Med Mol Imaging 2019 Jul 16;46(7):1399. Epub 2019 Apr 16.

Department of Radiology and Medical Physics, Hospital de Sant Pau, Barcelona, Spain.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s00259-018-4243-5DOI Listing
July 2019

Response to Prof. Ingo Brink and Prof. Aubalewska-Dydejczyk regarding Their "Letter to the Editor".

Neuroendocrinology 2019 27;108(4):366. Epub 2019 Mar 27.

Department of Internal Medicine, Erasmus MC, Rotterdam, The Netherlands.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1159/000497419DOI Listing
March 2019

F-fluorodeoxyglucose positron emission tomography is useful for the diagnosis of intraocular sarcoidosis in patients with a normal CT scan.

Br J Ophthalmol 2019 11 18;103(11):1650-1655. Epub 2019 Jan 18.

Service de Médecine Interne, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Université Claude Bernard Lyon 1, Lyon, France

Aim: To assess the usefulness of F-fluorodeoxyglucose positron emission tomography (F-FDG PET/CT) and the predictive factors for the diagnosis of sarcoidosis in patients with uveitis who have normal thoracic tomography.

Methods: We retrospectively reviewed 67 consecutive patients with uveitis of unknown aetiology or a suspected sarcoidosis. All patients with normal thoracic tomography underwent an F-FDG PET/CT, which was blindly reinterpreted. We then assessed the proportion of positive F-FDG PET/CT and the impact on the final aetiology, using Abad's criteria for the diagnosis of intraocular sarcoidosis.

Results: 19 of the 67 patients (28.4%) had mediastinal hypermetabolic foci on their F-FDG PET/CT consistent with sarcoidosis. It identified a biopsy site in two cases, which were consistent with sarcoidosis. At the end of the study, six patients (10%) had a proven sarcoidosis, six patients (9%) were considered as having a presumed sarcoidosis and 18 patients (26.9%) as having indeterminate sarcoidosis. F-FDG PET/CT enabled the diagnosis of presumed sarcoidosis in these six patients. An older age at diagnosis (p=0.004) and the presence of synechiae (p=0.02) were significantly related to an abnormal F-FDG PET/CT, with a trend for an elevated ACE (p=0.0993). We established a nomogram to estimate the probability of having positive findings on the F-FDG PET/CT according to different predictive factors.

Conclusion: F-FDG PET/CT enabled the diagnosis of intraocular sarcoidosis even in patients with a normal CT scan. Older age at diagnosis, presence of synechiae and elevated ACE are associated with positive findings on F-FDG PET/CT consistent with sarcoidosis.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1136/bjophthalmol-2018-313133DOI Listing
November 2019

The EANM practical guidelines for sentinel lymph node localisation in oral cavity squamous cell carcinoma.

Eur J Nucl Med Mol Imaging 2019 03 18;46(3):623-637. Epub 2018 Dec 18.

University Hospital San Pedro and Centre for Biomedical Research of La Rioja (CIBIR), Logroño, La Rioja, Spain.

Purpose: Sentinel lymph node biopsy is an essential staging tool in patients with clinically localized oral cavity squamous cell carcinoma. The harvesting of a sentinel lymph node entails a sequence of procedures with participation of specialists in nuclear medicine, radiology, surgery, and pathology. The aim of this document is to provide guidelines for nuclear medicine physicians performing lymphoscintigraphy for sentinel lymph node detection in patients with early N0 oral cavity squamous cell carcinoma.

Methods: These practice guidelines were written and have been approved by the European Association of Nuclear Medicine (EANM) and the International Atomic Energy Agency (IAEA) to promote high-quality lymphoscintigraphy. The final result has been discussed by distinguished experts from the EANM Oncology Committee, and national nuclear medicine societies. The document has been endorsed by the Society of Nuclear Medicine and Molecular Imaging (SNMMI). These guidelines, together with another two focused on Surgery and Pathology (and published in specialised journals), are part of the synergistic efforts developed in preparation for the "2018 Sentinel Node Biopsy in Head and Neck Consensus Conference".

Conclusion: The present practice guidelines will help nuclear medicine practitioners play their essential role in providing high-quality lymphatic mapping for the care of early N0 oral cavity squamous cell carcinoma patients.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s00259-018-4235-5DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6351508PMC
March 2019

Guidelines on nuclear medicine imaging in neuroblastoma.

Eur J Nucl Med Mol Imaging 2018 10;45(11):2009-2024

Nuclear Medicine and Diagnostic Imaging Section, International Atomic Energy Agency, Vienna, Austria.

Nuclear medicine has a central role in the diagnosis, staging, response assessment and long-term follow-up of neuroblastoma, the most common solid extracranial tumour in children. These EANM guidelines include updated information on I-mIBG, the most common study in nuclear medicine for the evaluation of neuroblastoma, and on PET/CT imaging with F-FDG, F-DOPA and Ga-DOTA peptides. These PET/CT studies are increasingly employed in clinical practice. Indications, advantages and limitations are presented along with recommendations on study protocols, interpretation of findings and reporting results.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s00259-018-4070-8DOI Listing
October 2018

Implementation of Quality Systems in Nuclear Medicine: Why It Matters. An Outcome Analysis (Quality Management Audits in Nuclear Medicine Part III).

Semin Nucl Med 2018 05 9;48(3):299-306. Epub 2018 Feb 9.

Nuclear Medicine and Diagnostic Imaging Section, Division of Human Health; IAEA, Vienna, Austria.

The International Atomic Energy Agency (IAEA) developed a comprehensive program-Quality Management Audits in Nuclear Medicine (QUANUM). This program covers all aspects of nuclear medicine practices including, but not limited to, clinical practice, management, operations, and services. The QUANUM program, which includes quality standards detailed in relevant checklists, aims at introducing a culture of comprehensive quality audit processes that are patient oriented, systematic, and outcome based. This paper will focus on the impact of the implementation of QUANUM on daily routine practices in audited centers. Thirty-seven centers, which had been externally audited by experts under IAEA auspices at least 1 year earlier, were invited to run an internal audit using the QUANUM checklists. The external audits also served as training in quality management and the use of QUANUM for the local teams, which were responsible of conducting the internal audits. Twenty-five out of the 37 centers provided their internal audit report, which was compared with the previous external audit. The program requires that auditors score each requirement within the QUANUM checklists on a scale of 0-4, where 0-2 means nonconformance and 3-4 means conformance to international regulations and standards on which QUANUM is based. Our analysis covering both general and clinical areas assessed changes on the conformance status on a binary manner and the level of conformance scores. Statistical analysis was performed using nonparametric statistical tests. The evaluation of the general checklists showed a global improvement on both the status and the levels of conformances (P < 0.01). The evaluation of the requirements by checklist also showed a significant improvement in all, with the exception of Hormones and Tumor marker determinations, where changes were not significant. Of the 25 evaluated institutions, 88% (22 of 25) and 92% (23 of 25) improved their status and levels of conformance, respectively. Fifty-five requirements, on average, increased from nonconformance to conformance status. In 8 key areas, the number of improved requirements was well above the average: Administration & Management (checklist 2); Radiation Protection & Safety (checklist 4); General Quality Assurance system (checklist 6); Imaging Equipment Quality Assurance or Quality Control (checklist 7); General Diagnostic (checklist 9); General Therapeutic (checklist 12); Radiopharmacy Level 1 (checklist 14); and Radiopharmacy Level 2 (checklist 15). Analysis of results related to clinical activities showed an overall positive impact on both the status and the level of conformance to international standards. Similar results were obtained for the most frequently performed clinical imaging and therapeutic procedures. Our study shows that the implementation of a comprehensive quality management system through the IAEA QUANUM program has a positive impact on nuclear medicine practices.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1053/j.semnuclmed.2017.12.001DOI Listing
May 2018

EANM guidelines for radionuclide therapy of bone metastases with beta-emitting radionuclides.

Eur J Nucl Med Mol Imaging 2018 05 16;45(5):846-859. Epub 2018 Feb 16.

Institute of Nuclear Medicine and Endocrinology, Kepler University Hospital, Linz, Austria.

The skeleton is the most common metastatic site in patients with advanced cancer. Pain is a major healthcare problem in patients with bone metastases. Bone-seeking radionuclides that selectively accumulate in the bone are used to treat cancer-induced bone pain and to prolong survival in selected groups of cancer patients. The goals of these guidelines are to assist nuclear medicine practitioners in: (a) evaluating patients who might be candidates for radionuclide treatment of bone metastases using beta-emitting radionuclides such as strontium-89 (Sr), samarium-153 (Sm) lexidronam (Sm-EDTMP), and phosphorus-32 (P) sodium phosphate; (b) performing the treatments; and
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s00259-018-3947-xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5978928PMC
May 2018

Bone radionuclide therapy and increased survival with radium-223 is the way to go for nuclear medicine: the offer that oncologists cannot refuse.

Eur J Nucl Med Mol Imaging 2018 05 14;45(5):822-823. Epub 2018 Jan 14.

International Atomic Energy Agency (IAEA), Nuclear Medicine and Diagnostic Imaging Section, Vienna, Austria.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s00259-017-3913-zDOI Listing
May 2018

Correction to: Dosimetry in clinical radionuclide therapy: the devil is in the detail.

Eur J Nucl Med Mol Imaging 2018 04;45(4):676

European Association of Nuclear Medicine, Board, Vienna, Austria.

The above article which was published in Volume 44/ Issue 12 has incorrect page numbers. Instead of 1-3, it should have been 2137-2139.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s00259-017-3921-zDOI Listing
April 2018

Radioguided Occult Lesion Localization: Technical Procedures and Clinical Applications.

Clin Nucl Med 2017 Dec;42(12):e498-e503

From the *Regional Center of Nuclear Medicine, Hospital University of Pisa, Pisa; †Department of Nuclear Medicine, Radiology and Clinical Pathology, "S. Maria della Misericordia" Hospital, Rovigo, Italy; ‡Servicio de Medicina Nuclear, Hospital Clínico San Carlos, Madrid, Spain; §Unit of Senology Hospital University of Pisa, Pisa, Italy; ∥Nuclear Medicine and Diagnostic Imaging Section, Division of Human Health, Department of Nuclear Sciences and Applications, International Atomic Energy Agency, Vienna, Austria; and ¶Department of Radiology, University of Southern California, Los Angeles, CA.

Purpose: Regarding radioguided surgery, the concept of "radioguided occult lesion localization" (ROLL) is based on both preoperative interventional imaging and intraoperative radioguided detection of a clinically occult neoplastic lesion.

Methods: This methodology consists in the direct administration into the lesion of Tc-macroaggregated human albumin formed by relatively large particles retained at the injection site, which direct radioguided excisional biopsy.

Results: This modality has expanded from the classic application of ROLL for nonpalpable breast lesions to other tumors, such as solitary pulmonary nodules or recurrences from differentiated thyroid carcinoma. In 2011, in order to improve the classification of different radioguided surgical procedures, ROLL applications were included in the more complete concept of GOSTT (Guided intraOperative Scintigraphic Tumor Targeting). This concept was introduced to include the entire range of basic and advanced radioguided procedures necessary to supply a "road map" for the surgeon.

Conclusions: The terms ROLL and GOSTT have further developed by incorporating novel modalities such as hybrid tracers for simultaneous fluorescence and radioactive signal detection and innovative navigation systems based on mixed-reality protocols.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1097/RLU.0000000000001858DOI Listing
December 2017

Dosimetry in clinical radionuclide therapy: the devil is in the detail.

Eur J Nucl Med Mol Imaging 2017 11 10;44(12):2137-9. Epub 2017 Sep 10.

European Association of Nuclear Medicine, Board, Vienna, Austria.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s00259-017-3820-3DOI Listing
November 2017