Challenges and Promise for Nuclear Medicine in Africa

Abstract Introduction Preparations of health systems to accommodate large number of severely ill COVID-19 patients in March/April 2020 has a significant impact on nuclear medicine departments. Materials and Methods A web-based questionnaire was designed to differentiate the impact of the pandemic on inpatient and outpatient nuclear medicine operations and on public versus private health systems, respectively. Questions were addressing the following issues: impact on nuclear medicine diagnostics and therapy, use of recommendations, personal protective equipment, and organizational adaptations. The survey was available for 6 days and closed on April 20, 2020. Results 113 complete responses were recorded. Nearly all participants (97 %) report a decline of nuclear medicine diagnostic procedures. The mean reduction in the last three weeks for PET/CT, scintigraphies of bone, myocardium, lung thyroid, sentinel lymph-node are –14.4 %, –47.2 %, –47.5 %, –40.7 %, –58.4 %, and –25.2 % respectively. Furthermore, 76 % of the participants report a reduction in therapies especially for benign thyroid disease (-41.8 %) and radiosynoviorthesis (–53.8 %) while tumor therapies remained mainly stable. 48 % of the participants report a shortage of personal protective equipment. Conclusions Nuclear medicine services are notably reduced 3 weeks after the SARS-CoV-2 pandemic reached Germany, Austria and Switzerland on a large scale. We must be aware that the current crisis will also have a significant economic impact on the healthcare system. As the survey cannot adapt to daily dynamic changes in priorities, it serves as a first snapshot requiring follow-up studies and comparisons with other countries and regions.

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Nuclear Medicine Board Review

10.1055/b-006-160160 ◽

2018 ◽

Keyword(s):

Nuclear Medicine ◽

Board Review

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Time-Dependent Characteristics of Sn-Complexes for Preparing 99mTc-Labelled Radiopharmaceuticals and their Bioavailabilities - a Review

Nuklearmedizin ◽

10.1055/s-0037-1620680 ◽

1978 ◽

Vol 17 (03) ◽

pp. 110-125 ◽

Cited By ~ 3

Author(s):

O.P.D Noronha

Keyword(s):

Nuclear Medicine ◽

Time Dependent ◽

Factors Affecting ◽

99Mtc Radiopharmaceuticals

A review is made of some of the factors affecting bioavailability of diagnostic 99mTc-radiopharmaceuticals currently used in the practice of nuclear medicine.

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Myocardial perfusion scintigraphy in Germany

Nuklearmedizin ◽

10.1055/s-0037-1621023 ◽

2007 ◽

Vol 46 (02) ◽

pp. 49-55 ◽

Cited By ~ 7

Author(s):

W. Burchert ◽

F. M. Bengel ◽

R. Zimmermann ◽

J. vom Dahl ◽

W. Schäfer ◽

...

Keyword(s):

Nuclear Medicine ◽

Myocardial Perfusion ◽

Attenuation Correction ◽

Working Group ◽

Primary Care Physicians ◽

Gated Spect ◽

Myocardial Perfusion Scintigraphy ◽

German Society ◽

University Hospitals ◽

Perfusion Scintigraphy

SummaryThe working group Cardiovascular Nuclear Medicine of the German Society of Nuclear Medicine (DGN), in cooperation with the working group Nuclear Cardiology of the German Cardiac Society (DGK), decided to conduct a national survey on myocardial perfusion scintigraphy (MPS). Method: A questionnaire to evaluate MPS for the year 2005 was sent. Results: 346 completed questionnaires had been returned (213 private practices, 99 hospitals and 33 university hospitals). MPS of 112 707 patients were reported with 110 747 stress and 95 878 rest studies. The majority (>75%) was performed with 99mTc-MIBI or tetrofosmin. 201Tl stress-redistribution was used in 22 637 patients (20%). The types of stress were exercise in 78%, vasodilation with adenosine or dipyridamol in 21% and dobutamine in 1%. 99.97% of all MPS were SPECT studies. Gated SPECT was performed in 36% of the stress and in 32% of the rest studies. An attenuation correction was used in 21%. 29 institutions (8%) performed gated SPECT (stress and rest) and attenuation correction. 47% of all MPS were requested by ambulatory care cardiologists, 17% by internists, 12% by primary care physicians, 21% by hospital departments and 2% by others. Conclusion: In Germany, MPS is predominantly performed with 99mTc-perfusion agents. The common type of stress is ergometry. Gated SPECT and attenuation correction do not yet represent standards of MPS practice in Germany, which indicates some potential of optimization.

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

Nuklearmedizin ◽

10.1055/s-0037-1620557 ◽

1982 ◽

Vol 21 (03) ◽

pp. 85-91 ◽

Cited By ~ 2

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.

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Tc-99m Labeled Complexes of Aldehydes and Glutamate as Cholescintigraphic Agents

Nuklearmedizin ◽

10.1055/s-0038-1624914 ◽

1975 ◽

Vol 14 (04) ◽

pp. 330-338

Author(s):

L. G. Colombetti ◽

J. S. Arnold ◽

W. E. Barnes

Keyword(s):

Nuclear Medicine ◽

Gall Bladder ◽

Rose Bengal ◽

Valence State ◽

Monosodium Glutamate ◽

Kinetic Studies ◽

Scintillation Camera ◽

Blood Clearance ◽

Lower Valence ◽

Wire Basket

SummaryTc-99m pyridoxylidene glutamate has proven to be an excellent biliary scanning agent, far superior in many respect to the commonly used 1-131 rose bengal. The preparation of the compound as previously reported by Baker et al is too time consuming and requires the use of an autoclave which is not available in most nuclear medicine departments. In our facility, we have been preparing similar compounds using several aldehydes and monosodium glutamate to make labeled complexes having the same pharmacological characteristics. The mixture of monosodium glutamate, aldehyde, and Tc-99m pertechnetate is made slightly alkaline, purged with helium, and placed in a sealed vial. The vial, which is protected by a wire basket, is then heated in a laboratory oven at 130° C for a period of 15 to 20 minutes. During this time, the technetium is reduced to a lower valence state and bound to the complex formed. Chromatographic data show that these compounds are chemically similar to that previously reported. The compounds prepared concentrate in the gall bladder of the rabbit in less than 10 minutes. Kinetic studies have been performed on dogs with a scintillation camera and small digital computer to measure rates of blood clearance, liver and gall bladder uptake, and excretion into the intestine. The aldehyde — glutamate complex promises to be a useful scanning agent for the diagnosis of biliary and hepatocellular diseases.

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A Simple Method for the Evaluation of Internal Doses in Nuclear Medicine

Nuklearmedizin ◽

10.1055/s-0038-1624857 ◽

1974 ◽

Vol 13 (02) ◽

pp. 193-206

Author(s):

L. Conte ◽

L. Mombelli ◽

A. Vanoli

Keyword(s):

Nuclear Medicine ◽

Close Agreement ◽

Whole Body ◽

Simple Method ◽

Rapid Estimation ◽

Absorbed Doses ◽

The Mean ◽

The Individual ◽

Estimation Of Risk

SummaryWe have put forward a method to be used in the field of nuclear medicine, for calculating internally absorbed doses in patients. The simplicity and flexibility of this method allow one to make a rapid estimation of risk both to the individual and to the population. In order to calculate the absorbed doses we based our procedure on the concept of the mean absorbed fraction, taking into account anatomical and functional variability which is highly important in the calculation of internal doses in children. With this aim in mind we prepared tables which take into consideration anatomical differences and which permit the calculation of the mean absorbed doses in the whole body, in the organs accumulating radioactivity, in the gonads and in the marrow; all this for those radionuclides most widely used in nuclear medicine. By comparing our results with dose obtained from the use of M.I.R.D.'s method it can be seen that when the errors inherent in these types of calculation are taken into account, the results of both methods are in close agreement.

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Microcirculation of the fingers in Raynaud’s syndrome

Nuklearmedizin ◽

10.1055/s-0038-1623922 ◽

2005 ◽

Vol 44 (01) ◽

pp. 29-32 ◽

Cited By ~ 5

Author(s):

I. Garai ◽

J. Varga ◽

G. Szücs ◽

Z. Galajda ◽

C. András ◽

...

Keyword(s):

Nuclear Medicine ◽

Quantitative Data ◽

Cost Effective ◽

Semiquantitative Analysis ◽

Perfusion Scintigraphy ◽

Visual Evaluation ◽

Raynaud’S Syndrome ◽

Raynaud's Syndrome ◽

Primary Form

Summary Aim: We investigated the circulatory characteristics of patients suffering of primary and secondary Raynaud’s syndrome. Patients, methods: We examined 106 patients presenting with the classical symptoms of Raynaud’s syndrom (47 primary, 59 secondary) by hand perfusion scintigraphy developed by our Department of Nuclear Medicine. After visual evaluation we analyzed the images semiquantitatively, using the finger to palm ratio. We statistically compared the patients with primary and those with secondary Raynaud’s syndrome. Results: By visual evaluation we constated regional perfusion disturbances in 42 from 59 patients with secondary Raynaud’s syndrome. However, this was observed in only 3 from 47 patients with the primary form of this disease. This difference was statistically significant (p <0.001). Semiquantitative analysis showed that the finger/palm ratios (FPR) were significantly lower (p <0.05) for the patients with primary Raynaud’s syndrome. No differences in the FPR values concerning sex or right and left side. Conclusion: The hand perfusion scintigraphy with 99mTc-DTPA is a noninvasive, cost effective diagnostic tool, which objectively reflects the global and regional microcirculatory abnormalities of the hands, and provides quantitative data for follow-up.

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

Nuklearmedizin ◽

10.1055/s-0038-1623872 ◽

2001 ◽

Vol 40 (03) ◽

pp. 59-70 ◽

Cited By ~ 13

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.

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