Handheld gamma probe used to detect accessory spleens during initial laparoscopic splenectomies

Summary Aim of this study was to localize the sentinel lymph node by lymphoscintigraphy using technetium-99m colloidal rhenium sulphide (Nanocis®), a new commercially available radiopharmaceutical. Due to the manufacturers’ instructions it is licensed for lymphoscintigraphy. Patients, methods: 35 consecutive patients with histologically proved malignant melanoma, but without clinical evidence of metastases, were preoperatively examined by injecting 20-40 MBq Nanocis® with (mean particle size: 100 nm; range: 50-200 nm) intradermally around the lesion. Additionally blue dye was injected intaoperatively. A hand-held gamma probe guided sentinel node biopsy. Results: During surgery, the preoperatively scintigraphically detected sentinel lymph nodes were identified in 34/35 (97%) patients. The number of sentinel nodes per patient ranged from one to four (mean: n = 1.8). Histologically, metastatic involvement of the sentinel lymph node was found in 12/35 (34%) patients; the sentinel lymph node positive-rate (14/63 SLN) was 22%. Thus, it is comparable to the findings of SLN-mapping using other technetium-99m-labeled nanocolloides. Conclusion: 99mTc-bound colloidal rhenium sulphide is also suitable for sentinel node mapping.

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Development and characterization of an all-in-one gamma probe with auto-peak detection for sentinel lymph node biopsy based on NEMA NU3-2004 standard

Annals of Nuclear Medicine ◽

10.1007/s12149-021-01581-z ◽

2021 ◽

Author(s):

Aram Radnia ◽

Hamed Abdollahzadeh ◽

Behnoosh Teimourian ◽

Mohammad Hossein Farahani ◽

Mohammad Esmaeil Akbari ◽

...

Keyword(s):

Lymph Node ◽

Sentinel Lymph Node ◽

Gamma Probe ◽

Peak Detection ◽

Cesium Iodide ◽

Shielding Effectiveness ◽

Scattering Medium ◽

Silicon Photomultiplier ◽

Regional Lymph Nodes ◽

Handheld Device

Abstract Background A gamma probe is a handheld device used for intraoperative interventions following interstitial injection of a radiotracer to locate regional lymph nodes through the external detection of radiation. This work reports on the design and performance evaluation of a novel fully integrated gamma probe (GammaPen), recently developed by our group. Materials and methods GammaPen is an all-in-one pocket gamma probe with low weight and adequate dimensions, consisting of a detector, a control unit and output all together. The detector module consists of a cylindrical Thallium-activated Cesium Iodide [CsI (Tl)] crystal optically coupled to a Silicon photomultiplier (SiPM), shielded using Tungsten housing on side and back faces. The electronics of the probe consists of two small boards to handle signal processing and analog peak detection tasks. A number of parameters, including probe sensitivity in air/water, spatial resolution in air/water, angular resolution in air/water, and side and back shielding effectiveness, were measured to evaluate the performance of the probe based on NEMA NU3-2004 standards. Results The sensitivity of the probe in air at distances of 10, 30, and 50 mm is 18784, 3500, and 1575 cps/MBq. The sensitivity in scattering medium was also measured at distances of 10, 30, and 50 mm as 17,680, 3050, and 1104 cps/MBq. The spatial and angular resolutions in scattering medium were 47 mm and 87 degree at 30 mm distance from the probe, while they were 40 mm and 77 degree in air. The detector shielding effectiveness and leakage sensitivity are 99.91% and 0.09%, respectively. Conclusion The performance characterization showed that GammaPen can be used effectively for sentinel lymph node localization. The probe was successfully used in several surgical interventions by an experienced surgeon confirming its suitability in a clinical setting.

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Synchronous intrathyroidal parathyroid carcinoma and thyroid carcinoma: case report and review of the literature

BMC Endocrine Disorders ◽

10.1186/s12902-021-00724-7 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Nadia De Falco ◽

Giuseppe Santangelo ◽

Fabrizio Chirico ◽

Angelo Cangiano ◽

Maria Giulia Sommella ◽

...

Keyword(s):

Literature Review ◽

Thyroid Carcinoma ◽

Papillary Carcinoma ◽

Parathyroid Carcinoma ◽

Malignant Tumors ◽

Gamma Probe ◽

Differentiated Thyroid Carcinoma ◽

Thyroid Carcinomas ◽

First Case ◽

Well Differentiated

Abstract Background Parathyroid carcinoma is a rare endocrine malignancy, rarer when synchronous with a non medullary well differentiated thyroid carcinoma. Parathyroid carcinoma accounts of 0.005% of all malignant tumors and it is responsible for less than 1% of primary hyperparathyroidism. The intrathyroidal localization of a parathyroid gland is not frequent with a reported prevalence of 0.2%. Carcinoma of parathyroids with intrathyroidal localization represents an even rarer finding, reported in only 16 cases described in literature. The rare constellation of synchronous parathyroid and thyroid carcinomas has prompted us to report our experience and perform literature review. Case presentation We herein report a case of a 63-years-old man with multinodular goiter and biochemical diagnosis of hyperparathyroidism. Total thyroidectomy with radio-guide technique using gamma probe after intraoperative sesta-MIBI administration and intraoperative PTH level was performed. The high radiation levels in the posterior thyroid lobe discovered an intrathyroidal parathyroid. Microscopic examination revealed a parathyroid main cell carcinoma at the posterior thyroidal left basal lobe, a classic papillary carcinoma at the same lobe and follicular variant of papillary carcinoma at the thyroidal right lobe. To the best of our knowledge, this is the first case documenting a synchronous multicentric non medullary thyroid carcinomas and intrathyroidal parathyroid carcinoma. Conclusions Our experience was reported and literature review underlining challenging difficulties in diagnostic workup and surgical management was carried out.

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Simultaneous Acquisition of Ultrasound and Gamma Signals with a Single-Channel Readout

Sensors ◽

10.3390/s21041048 ◽

2021 ◽

Vol 21 (4) ◽

pp. 1048

Author(s):

Muhammad Nasir Ullah ◽

Yuseung Park ◽

Gyeong Beom Kim ◽

Chanho Kim ◽

Chansun Park ◽

...

Keyword(s):

Radiation Source ◽

Analog Circuit ◽

Single Channel ◽

Structural Information ◽

Gamma Probe ◽

Water Tank ◽

Switching Circuit ◽

Single Output ◽

Analog Switch ◽

The Us

We propose an integrated front-end data acquisition circuit for a hybrid ultrasound (US)-gamma probe. The proposed circuit consists of three main parts: (1) a preamplifier for the gamma probe, (2) a preprocessing analog circuit for the US, and (3) a digitally controlled analog switch. By exploiting the long idle time of the US system, an analog switch can be used to acquire data of both systems using a single output channel simultaneously. On the nuclear medicine (NM) gamma probe side, energy resolutions of 18.4% and 17.5% were acquired with the standalone system and with the proposed switching circuit, respectively, when irradiated with a Co-57 radiation source. Similarly, signal-to-noise ratios of 14.89 and 13.12 dB were achieved when US echo signals were acquired with the standalone system and with the proposed switching circuit, respectively. Lastly, a combined US-gamma probe was used to scan a glass target and a sealed radiation source placed in a water tank. The results confirmed that, by using a hybrid US-gamma probe system, it is possible to distinguish between the two objects and acquire structural information (ultrasound) alongside molecular information (gamma radiation source).

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Impact of PET data driven respiratory motion correction and BSREM reconstruction of 68Ga-DOTATATE PET/CT for differentiating neuroendocrine tumors (NET) and intrapancreatic accessory spleens (IPAS)

Scientific Reports ◽

10.1038/s41598-020-80855-4 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Virginia Liberini ◽

Fotis Kotasidis ◽

Valerie Treyer ◽

Michael Messerli ◽

Erika Orita ◽

...

Keyword(s):

Neuroendocrine Tumors ◽

Motion Correction ◽

Accessory Spleen ◽

Pancreatic Neuroendocrine Tumor ◽

Reconstruction Algorithm ◽

Data Driven ◽

Operating Characteristics ◽

Quantitative Pet ◽

Pet Ct ◽

Accessory Spleens

AbstractTo evaluate whether quantitative PET parameters of motion-corrected 68Ga-DOTATATE PET/CT can differentiate between intrapancreatic accessory spleens (IPAS) and pancreatic neuroendocrine tumor (pNET). A total of 498 consecutive patients with neuroendocrine tumors (NET) who underwent 68Ga-DOTATATE PET/CT between March 2017 and July 2019 were retrospectively analyzed. Subjects with accessory spleens (n = 43, thereof 7 IPAS) and pNET (n = 9) were included, resulting in a total of 45 scans. PET images were reconstructed using ordered-subsets expectation maximization (OSEM) and a fully convergent iterative image reconstruction algorithm with β-values of 1000 (BSREM1000). A data-driven gating (DDG) technique (MOTIONFREE, GE Healthcare) was applied to extract respiratory triggers and use them for PET motion correction within both reconstructions. PET parameters among different samples were compared using non-parametric tests. Receiver operating characteristics (ROC) analyzed the ability of PET parameters to differentiate IPAS and pNETs. SUVmax was able to distinguish pNET from accessory spleens and IPAs in BSREM1000 reconstructions (p < 0.05). This result was more reliable using DDG-based motion correction (p < 0.003) and was achieved in both OSEM and BSREM1000 reconstructions. For differentiating accessory spleens and pNETs with specificity 100%, the ROC analysis yielded an AUC of 0.742 (sensitivity 56%)/0.765 (sensitivity 56%)/0.846 (sensitivity 62%)/0.840 (sensitivity 63%) for SUVmax 36.7/41.9/36.9/41.7 in OSEM/BSREM1000/OSEM + DDG/BSREM1000 + DDG, respectively. BSREM1000 + DDG can accurately differentiate pNET from accessory spleen. Both BSREM1000 and DDG lead to a significant SUV increase compared to OSEM and non-motion-corrected data.

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