VP69 Mapping Brazilian Nuclear Medicine Installed Capacity And Perspectives

2017 ◽  
Vol 33 (S1) ◽  
pp. 180-181
Author(s):  
Lorena Pozzo ◽  
Evelinda Trindade
Keyword(s):  
Nuclear Medicine ◽  
Regional Analysis ◽  
Reticuloendothelial System ◽  
Myocardial Scintigraphy ◽  
National Commission ◽  
The South ◽  
North East ◽  
Pet Ct ◽  
Nuclear Medicine Procedures

INTRODUCTION:Guidelines compliance, with a priori non-invasive and earlier tests and interventions, depends on access. This study investigates the Brazilian Unified Health System (SUS) outpatient access to nuclear medicine procedures through SUS data comparison with those from the National Commission of Nuclear Energy (CNEN: Comissão Nacional de Energia Nuclear).METHODS:Data provided by the SUS outpatient database (SIA-DATASUS) regarding procedures performed from 2013 to 2016 was compared with data from institutions (Nuclear Medicine Services and Cyclotron Facilities) and radioprotection supervisors with numbers certified by CNEN.RESULTS:CNEN has authorized 420 nuclear medicine institutions (.20 per million inhabitants) and certified 294 radioprotection supervisors (.14 per million inhabitants), and 1.4 services per supervisor. There are 457 graduated professionals qualified for radioactive sources preparation, use and handling for diagnostic and therapeutic radiopharmaceuticals (.9 professionals / installation). During the last four years, 08 new nuclear medicine facilities were authorized by CNEN. The number of nuclear medicine procedures performed slightly increased in the South, but remained constant in other regions. Annual SUS reimbursements increased by 21.2 percent on average for the 03 PET/CT (Positron emission tomography–computed tomography) adopted procedures: regional analysis showed the Central-West as the highest growth area (70.8 percent), compared to the South (53.4 percent), North-East region (30.8 percent), and the South-East (5 percent). Currently, thirteen Cyclotron Facilities operate in Brazil: South-East (six), South (three), North-East (three) and Central-West (one). Some nuclear medicine procedures largely outnumber the average increase: for example, reticuloendothelial system scintigraphy (513.9 percent), gastric transit scintigraphy (112.8 percent), and thyroid screening with suppression/stimulation test (100.6 percent). However, myocardial scintigraphy (stress and rest) and bone scintigraphy with or without blood flow still correspond to 82 percent of total nuclear medicine in vivo procedures.CONCLUSIONS:Regional disparity is quantitatively depicted in Brazil and reflects access to SUS nuclear medicine procedures. This denotes a potential for improvements related to nuclear medicine areas, for example developments concerning new PET/CT coverage, new radiopharmaceuticals research, and national and international training.

Nuklearmedizin in Deutschland

2011 ◽  
Vol 50 (02) ◽  
pp. 53-67 ◽  
Author(s):  
A. Grgic ◽  
J. Kotzerke ◽  
C.-M. Kirsch ◽  
D. Hellwig
Keyword(s):  
Nuclear Medicine ◽  
Cross Sectional ◽  
Lengths Of Stay ◽  
Health Care Structure ◽  
Pet Ct ◽  
Care Structure ◽  
Cross Sectional Imaging ◽  
Nuclear Medicine Procedures ◽  
Bone Scans

SummaryAim: To explain the spectrum and number of in-vivo nuclear medicine examinations and therapies based on official statistics about out-patient and in-patient care. Trends in time of the frequency and spectrum of procedures as well as data on the health care structure for nuclear medicine in Germany should be collected. Methods: Data from the Gesundheitsberichterstattung des Bundes, from the frequency statistics of the statutory health insurance for out-patients and from the Bundes - ärztekammer were used. Customized queries were performed to analyse temporal changes. Results: Nuclear medicine physicians are more frequently consulted by out-patients over the last years (2008: 2 024 498; 2009: 2 164 664) and the number of colleagues in private practice increased. For in-patients, the frequency of conventional nuclear medicine procedures (mainly for brain, lymphatic system, lung and heart) increased since 2008 after a decline in previous years (2009: 323 515; +4.6%) and the number of PET(/CT) examinations continued to rise (2009: 25 123; +18%), even if changes in OPS keys may hamper comparisons. Nearly 600 gamma cameras and 76 PET(/CT) scanners were installed in hospitals in 2008. Nuclear medicine procedures are increasingly performed as cross sectional imaging like SPECT(/CT) and PET(/CT). With the supply shortfall with 99Mo, the frequency of thyroid scans with 123I iodine increased as well as the use of 18F PET as a substitute for conventional bone scans. The number of radionuclide therapies, in particular non-thyroid treatments, increased since the mid-nineties and stabilized at nearly 50 000 cases per year with shorter lengths of stay. Conclusion: The details of the present analysis may help to understand the positive evolution of key numbers for nuclear medicine.

Patient Exposure and Radiation Risk in Bulgarian Diagnostic Nuclear Medicine I. Survey of Diagnostic Nuclear Medicine Procedures in Bulgaria in 1980

1982 ◽  
Vol 21 (03) ◽  
pp. 85-91 ◽  
Author(s):  
R. Poppitz
Keyword(s):  
Nuclear Medicine ◽  
Radiation Risk ◽  
Patient Exposure ◽  
Diagnostic Nuclear Medicine ◽  
Nuklearmedizinische Diagnostik ◽  
Nuclear Medicine Procedures

Um die Strahlenexposition und das Strahlenrisiko für die Bevölkerung durch die nuklearmedizinische Diagnostik in Bulgarien zu ermitteln, wurde eine Erhebung für das Jahr 1980 über die Arten und Anzahl der Applikationen von Radiopharmaka, über die verwendeten Aktivitäten und über die Geschlechts- und Altersverteilung der untersuchten Patienten durchgeführt. Die Gesamtzahl diagnostischer in vivo Applikationen betrug 116418 (davon 40,5% bei Männern und 59,5% bei Frauen), d.h. 13,1 Applikationen per 1000 Einwohner. Die applizierte Gesamtaktivität aller 44 verwendeter Radiopharmaka betrug ca. 2,1 TBq (56 Ci). Die Geschlechts- und Altersverteilung der untersuchten Patienten war ähnlich jener in anderen Ländern: nur 17,4% aller Patienten waren im reproduktionsfähigen Alter, 52,7% waren über 45 Jahre alt. Im Vergleich zu anderen entwickelten Ländern war in Bulgarien im Jahr 1980 der Anteil der 131J-Jodid-Untersuchungen verhältnismäßig hoch.

scholarly journals Paediatric nuclear medicine practice: an international survey by the IAEA

2019 ◽  
Vol 47 (6) ◽  
pp. 1552-1563 ◽  
Author(s):  
G. L. Poli ◽  
L. Torres ◽  
M. Coca ◽  
M. Veselinovic ◽  
M. Lassmann ◽  
...  
Keyword(s):  
Nuclear Medicine ◽  
Latin America ◽  
Fdg Pet ◽  
Single Photon ◽  
International Standards ◽  
Current Status ◽  
High Dose ◽  
Pet Ct ◽  
Nuclear Medicine Procedures ◽  
Fdg Pet Ct

Abstract Purpose The International Atomic Energy Agency (IAEA) decided to initiate a survey to evaluate the current status of the practice of paediatric nuclear medicine worldwide, with the focus mainly on low and middle-income countries specifically in Latin America, Eastern Europe, Africa and Asia. This investigation sought to determine if the practice in paediatric nuclear medicine in these countries differed from that indicated by the survey of the Nuclear Medicine Global Initiative (NMGI) and if nuclear medicine practitioners were following established paediatric nuclear medicine guidelines. Methods A total of 133 institutes took part in the survey from 62 different IAEA member states within Africa (29), Asia (39), Europe (29) and Latin America (36). The four most frequent conventional (single-photon) nuclear medicine procedures were 99mTc labelled MDP, DSMA, MAG3 and pertechnetate thyroid scans. In addition, 46 centres provided data on FDG PET/CT, including exposure data for the CT component. Nearly half of the sites (48%) perform less than 200 paediatric nuclear medicine studies per year, while 11% perform more than 1000 such studies per year. Results Administered activities largely exceeded the recommendations for most of the sites for DMSA, MAG3 and pertechnetate, while compliance with international standards was somehow better for MDP studies. For FDG PET, the results were more uniform than for conventional nuclear medicine procedures. However, the use of CT in PET/CT for paediatric nuclear medicine revealed a high variability and, in some cases, high, dose-length product (DLP) values. This observation indicates that further attention is warranted for optimizing clinical practice in FDG PET/CT. Conclusions Overall, in most parts of the world, efforts have been undertaken to comply either with the EANM dosage card or with the North American Consensus Guidelines. However, variability in the practice of paediatric nuclear medicine still exists. The results of this survey provide valuable recommendations for a path towards global standardization of determining the amount of activity to be administered to children undergoing nuclear medicine procedures.

scholarly journals Determination of 99Mo contamination in a nuclear medicine patient submitted to a diagnostic procedure with 99mTc

2005 ◽  
Vol 48 (spe2) ◽  
pp. 215-220 ◽  
Author(s):  
Bernardo Maranhão Dantas ◽  
Ana Letícia Almeida Dantas ◽  
Fábio Luiz Navarro Marques ◽  
Luiz Bertelli ◽  
Michael G. Stabin
Keyword(s):  
Nuclear Medicine ◽  
Radiation Dose ◽  
Myocardial Scintigraphy ◽  
High Energy ◽  
Internal Contamination ◽  
Beta Particles ◽  
In Vivo Measurement ◽  
Direct Measurements

99mTc is a radionuclide widely used for imaging diagnosis in nuclear medicine. In Brazil it is obtained by elution from 99Mo-99mTc generators supplied by the Nuclear Energy Research Institute (IPEN). The elution is carried out in radiopharmacy laboratories located in hospitals and clinics. Depending of the quality of the generator and conditions of use during the elution process, 99Mo can be extracted from the column of the generator, becoming a radionuclidic impurity of the eluate used for the obtention of the radiopharmaceutical to be administered to the patient. 99Mo emits high-energy photons and beta particles and its presence degrades the quality of the image and unnecessarily increases the radiation dose delivered to the patient. An in-vivo measurement technique was developed to verify the occurrence of internal contamination by 99Mo in nuclear medicine patients. Direct measurements were made in a volunteer who underwent myocardial scintigraphy with 99mTc-sestamibi. The results indicated the presence of internal contamination of the patien by 99Mot. The activity was tracked for several days, and an assessment of the radiation dose from the contaminant 99Mo was made.

First-in-human imaging of nanoparticle entrapped docetaxel (CPC634) in patients with advanced solid tumors using 89Zr-Df-CPC634 PET/CT.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. 3093-3093 ◽  
Author(s):  
Iris H.C. Miedema ◽  
Gerben J.C. Zwezerijnen ◽  
Daniela E. Oprea-Lager ◽  
Henk M.W. Verheul ◽  
Danielle J. Vugts ◽  
...  
Keyword(s):  
Solid Tumors ◽  
Prolonged Exposure ◽  
Reticuloendothelial System ◽  
Whole Body ◽  
Tracer Injection ◽  
Epr Effect ◽  
Focal Uptake ◽  
Pet Ct ◽  
Tumor Retention

3093 Background: CPC634 is a nanoparticle entrapping docetaxel designed to improve tumor accumulation and tolerability compared to conventionally administered docetaxel by taking advantage of the presumed enhanced permeability and retention (EPR) effect. In vivo imaging with zirconium-89 (89Zr)-desferal (Df)-CPC634 will provide valuable information on its biodistribution and will quantify tumor retention. Methods: Patients with solid tumors not amenable to standard therapy received 37 MBq, 0.1-2mg of 89Zr-Df-CPC634 tracer and whole body PET/CT scans were obtained at 2, 24 and 96h post-injection (p.i.). Patients were administered CPC634 (60mg/m2) two weeks later followed by a second tracer injection and scans at 24 and 96h p.i. Biodistribution was quantified by delineating organs of interest and calculating mean %ID/kg. Visual tumor retention was defined as focal uptake in tumor lesions exceeding local background and quantified as standardized uptake peak values (SUVpeak) in volumes of interest. Results: Five patients were included. Biodistribution of 89Zr-Df-CPC634 showed significant retention in healthy liver, and spleen compared to lung (respectively 2.54, 1.61 and 0.56 mean %ID/kg at 96h p.i.), supporting apparent opsonization of nanoparticles in cells of the reticuloendothelial system. Visual retention was observed in 16/37 evaluable tumor lesions with the highest intensity at 96h p.i, compatible with the assumed EPR effect. Tumor retention showed intra- and interpatient heterogeneity, with a mean %ID/kg of 3.43 [1.14-9.32]. Pre-administering unlabeled CPC634 did not change the mean tumor retention of 89Zr-Df-CPC634 (at 96h p.i. mean 3.50 %ID/kg [1.64-9.97]), however, four additional lesions were visible in comparison to tracer only. Conclusions: The biodistribution of 89Zr-Df-CPC634 was consistent with a prolonged exposure of nanoparticle containing docetaxel. 89Zr-Df-CPC634 showed high retention in tumors confirming the EPR effect of these nanoparticle in humans, and supporting their further development for tumor targeting of therapeutic agents. A Phase II efficacy study in platinum resistant ovarian cancer (NTC03742713) is currently ongoing. Clinical trial information: NCT03712423.

FDG-PET, PET/CT and conventional nuclear medicine procedures in the evaluation of lung cancer

2009 ◽  
Vol 48 (02) ◽  
pp. 59-69 ◽  
Author(s):  
R. P. Baum ◽  
C.-M. Kirsch ◽  
D. Hellwig
Keyword(s):  
Lung Cancer ◽  
Nuclear Medicine ◽  
Fdg Pet ◽  
Invasive Procedure ◽  
Standard Of Care ◽  
Small Cell ◽  
Level Of Evidence ◽  
Lung Lesions ◽  
Pet Ct ◽  
Nuclear Medicine Procedures

Summary Aim: Currently, the German and Austrian S3 guidelines on the evaluation and treatment of lung cancer are about to be published whereas the American Colleague of Chest Physicians (ACCP) guidelines were already presented in 2007. An important part of the diagnostic workup of lung cancer will be the evaluation of indeterminate lung lesions and the mediastinal and extrathoracic staging using FDG-PET or PET/CT. The results from the literature on FDG-PET and PET/ CT as well as on conventional nuclear medicine staging procedures and the clinical implications are presented. Methods: The literature data was amassed in analogy to the metaanalyses drawn for the current ACCP guidelines. In addition, relevant more recent publications were also considered. To answer the important question for the extent of pathological confirmation needed, the residual risk of mediastinal metastases was calculated for certain constellations of FDG-PET and CT findings. Suggested recommendations were characterized with the level of evidence. Results: FDG-PET (PET/CT) allows the differentiation of indeterminate lung lesions with high accuracy. FDG-PET (PET/ CT) is the most accurate non-invasive procedure to assess the mediastinal nodal stage, for non-small cell as well as for small cell lung cancer. It is justified to omit invasive evaluation of enlarged but FDG-PET negative lymph nodes under certain circumstances. Unexpected extrathoracic metastases detected by FDG-PET imply important changes in therapeutic management. Conclusion: The upcoming S3 guideline on lung cancer will recommend FDG-PET in several indications due to its clinical efficacy well proven by data from literature (high level of evidence). The selected use of conventional nuclear medicine procedures remains beyond doubt. FDG-PET (PET/CT) belongs to the standard of care in lung cancer.

In-vivo-Detektion des Betastrahlers Yttrium-90 im PET/CT nach Selektiver Interner Radiotherapie (SIRT) der Leber

2011 ◽  
Vol 183 (S 01) ◽  
Author(s):  
MK Werner ◽  
J Kupferschläger ◽  
K Brechtel ◽  
T Beyer ◽  
R Bares ◽  
...  
Keyword(s):  
Pet Ct ◽  
Yttrium 90

Patients with fever of unknown origin (FUO): diagnosis by nuclear medicine imaging

2001 ◽  
Vol 40 (03) ◽  
pp. 59-70 ◽  
Author(s):  
W. Becker ◽  
J. Meiler
Keyword(s):  
Nuclear Medicine ◽  
Fever Of Unknown Origin ◽  
Tumor Imaging ◽  
White Blood Cells ◽  
Unknown Origin ◽  
Final Diagnosis ◽  
Recurrent Fever ◽  
Nuclear Medicine Imaging

SummaryFever of unknown origin (FUO) in immunocompetent and non neutropenic patients is defined as recurrent fever of 38,3° C or greater, lasting 2-3 weeks or longer, and undiagnosed after 1 week of appropriate evaluation. The underlying diseases of FUO are numerous and infection accounts for only 20-40% of them. The majority of FUO-patients have autoimmunity and collagen vascular disease and neoplasm, which are responsible for about 50-60% of all cases. In this respect FOU in its classical definition is clearly separated from postoperative and neutropenic fever where inflammation and infection are more common. Although methods that use in-vitro or in-vivo labeled white blood cells (WBCs) have a high diagnostic accuracy in the detection and exclusion of granulocytic pathology, they are only of limited value in FUO-patients in establishing the final diagnosis due to the low prevalence of purulent processes in this collective. WBCs are more suited in evaluation of the focus in occult sepsis. Ga-67 citrate is the only commercially available gamma emitter which images acute, chronic, granulomatous and autoimmune inflammation and also various malignant diseases. Therefore Ga-67 citrate is currently considered to be the tracer of choice in the diagnostic work-up of FUO. The number of Ga-67-scans contributing to the final diagnosis was found to be higher outside Germany than it has been reported for labeled WBCs. F-l 8-2’-deoxy-2-fluoro-D-glucose (FDG) has been used extensively for tumor imaging with PET. Inflammatory processes accumulate the tracer by similar mechanisms. First results of FDG imaging demonstrated, that FDG may be superior to other nuclear medicine imaging modalities which may be explained by the preferable tracer kinetics of the small F-l 8-FDG molecule and by a better spatial resolution of coincidence imaging in comparison to a conventional gamma camera.

Radiation exposure of patients undergoing nuclear medicine procedures in Germany between 1996 and 2000

2005 ◽  
Vol 44 (05) ◽  
pp. 119-130 ◽  
Author(s):  
P. Schnell-Inderst ◽  
D. Noßke ◽  
M. Weiss ◽  
A. Stamm-Meyer ◽  
G. Brix ◽  
...  
Keyword(s):  
Nuclear Medicine ◽  
Cardiovascular System ◽  
Effective Dose ◽  
Current Status ◽  
Annual Number ◽  
Statistical Parameters ◽  
Public Health Information ◽  
Nuclear Medicine Procedures ◽  
And Gender ◽  
Icrp Publication

Summary:The aim of this study was to estimate both the frequency and effective dose of nuclear medicine procedures performed in Germany between 1996 and 2000 for different subgroups of patients. Methods: Electronically archived data from 14 hospitals and 10 private practices were restored and statistically analyzed. The effective dose per examination was calculated according to ICRP publication 80 using the tissue weighting factors given in ICRP publication 60. Based on the data collected, statistical parameters were computed to characterize the frequency and effective dose of the various nuclear medicine procedures. Results: In total, 604,771 nuclear medicine procedures performed in 433,709 patients were analyzed. On average, 1.4 examinations were carried out per patient and year. The median effective dose was 1.7 [5.-95. percentile; mean: 0.4–8.5; 2.9] mSv per examination and 2.3 [0.5–11.2; 3.5] mSv per patient. Interestingly, the mean effective dose per examination, but not the number of examinations per year increased with the age of the patients. Most frequent were examinations of the thyroid (36.7%), the skeleton (27.1%) and the cardiovascular system (11.1%), which were associated with a median effective dose of 0.5 [0.5–1.1; 0.7] mSv, 3.4 [2.9–5.1; 3.6] mSv and 7.3 [3.2–21.0; 9.5] mSv, respectively. Over the five-year period examined, the total annual number of PET procedures (222.3%) as well as of examinations of thyroid (24.5%), skeleton (17.9%), and the cardiovascular system (14.9%) increased markedly, whereas a decrease was observed for brain (-39.3%), lung (-20.2%) and renal (-15.0%) scans. Conclusion: The age- and gender-specific data presented in this study provide detailed public health information on both the current status and recent trends in the practice of diagnostic nuclear medicine examinations.

Accumulation of Macromolecular Particles in the Reticuloendothelial System (RES) Mediated by Platelet Aggregation and Disaggregation

1969 ◽  
Vol 22 (03) ◽  
pp. 496-507 ◽  
Author(s):  
W.G van Aken ◽  
J Vreeken
Keyword(s):  
Platelet Aggregation ◽  
Degradation Products ◽  
Reticuloendothelial System ◽  
Caproic Acid ◽  
Carbon Particles ◽  
Carbon Clearance ◽  
Aggregation And Disaggregation ◽  
Platelet Aggregates

SummaryCarbon particles cause platelet aggregation in vitro and in vivo. Prior studies established that substances which modify thrombocyte aggregation also influence the rate at which carbon is cleared from the blood.This study was performed in order to elucidate the mechanism by which the carbon-platelet aggregates specifically accumulate in the RES.Activation of fibrinolysis by urokinase or streptokinase reduced the carbon clearance rate, probably due to generated fibrinogen degradation products (FDP). Isolated FDP decreased the carbon clearance and caused disaggregation of platelets and particles in vitro. Inhibition of fibrinolysis by epsilon-amino-caproic acid (EACA), initially accelerated the disappearance of carbon and caused particle accumulation outside the RES, predominantly in the lungs. It is supposed that platelet aggregation and locally activated fibrinolysis act together in the clearance of particles. In the normal situation the RES with its well known low fibrinolytic activity, becomes the receptor of the particles.

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