Theranostics – present and future

Theragnostics in nuclear medicine constitute an essential element of precision medicine. This notion integrates radionuclide diagnostics procedures and radionuclide therapies using appropriate radiopharmaceutics and treatment targeting specific biological pathways or receptors. The term theragnostics should also include another aspect of treatment: not only whether a given radioisotopic drug can be used, but also in what dose it ought to be used. Theragnostic procedures also allow predicting the effects of treatment based on the assessment of specific receptor density or the metabolic profile of neoplastic cells. The future of theragnostics depends not only on the use of new radiopharmaceuticals, but also on new gamma cameras. Modern theragnostics already require unambiguous pharmacokinetic and pharmacodynamic measurements based on absolute values. Only dynamic studies provide such a possibility. The introduction of the dynamic total-body PET-CT will enable this type of measurements characterizing metabolic processes and receptor expression on the basis of Patlak plot.

Портативная радиометрическая система, ее основные элементы и варианты применения

The paper discusses the main elements of the developed portable radiometric system (PRS) and options for its application. Silicon photomultipliers were used in the development of the PRS detector modules. It made possible to significantly reduce their size. Such devices and systems find their application in solving various problems of medical radionuclide diagnostics that require an increased field of view, an extended research time range and mobility. The main goal of the work was to find the optimal configuration of the PRS elements to ensure its minimum size and, at the same time, the maximum radiation detection efficiency, taking into account the features of the objects under study and the kinetics of the processes occurring in them. In addition, an algorithm for selecting the minimum amount of activity of a radioactive preparation required for each study is additionally considered.

Myths about inexpediency of carrying out peptide receptor radionuclide diagnostics in patients with neuroendocrine tumors

he disease incidence of neuroendocrine tumors (NET) is increasing every year. Neuroendocrine tumors Grade 1 and 2 have a more favorable prognosis than Grade 3. When we are talking about NET with non-detected initial focus, the 10-year survival rate is 22 % [1]. Therefore, it is necessary to make every effort and use all technical abilities to localize the primary tumor, even in the presence of metastases, because resection of the primary tumor(s) can increase disease-free and overall survival rate. Also, the choice of chemotherapy drug or the appointment of biotherapy may depend on this. Finding tumor localization remains challenging and must involve a combination of radiological, nuclear medicine and endoscopic imaging techniques. There are many different myths about the purpose of nuclear medicine examinations and interpretation of the results in NET patients. And in this article we will try to debunk some of them, using examples from our experience in our center. We choose 111 patients with NET (histologically confimed). All patients underwent scintigraphy of neuroendocrine tumors with 99mTc-EDDA/HYNICTOC (99mTc-Tektrotyd) in the «whole body» mode and additional SPECT or SPECT/CT examination of the chest,abdomen and pelvis.

Science research experience in the use of radiopharmaceuticals at the N.N. Petrov NMRC of Oncology

Radionuclide diagnostics and therapy with open radionuclide sources are one of the most promising and fast-growing areas ofmodern oncology. The paper presents the main achievements of the N.N. Petrov National Medical Research Center of Oncology, one of the leading departments of radionuclide diagnostics in Russia. Scientific and clinical results of using the new hybrid device in everyday clinical practice have been submitted. The advantages and opportunities of using hybrid SPECT-CT and PET-CT devices to diagnose different types of cancer, to assess the degree of its spread and to monitor the results of therapy have been demonstrated. The problems associated with the demand for new radiopharmaceuticals in practice have been highlighted. The need to simplify normative documents regulating the use of modern therapeutic radionuclide drugs has been substantiated.

Prospects for Using Radionuclide Research Methods for Diagnosing and Evaluating Effectiveness of Treating Consequences of Coronavirus Diseasr (COVID-19

Purpose: to determine the role of nuclear medicine methods in the diagnosis and quality control of treatment and rehabilitation of patients with complications after coronavirus diseasr (COVID-19) The article provides a brief analysis of the incidence of COVID-19 and highlights the role of diagnosis, treatment and rehabilitation of patients suffering from the consequences of coronavirus diseasr after the end of the pandemic. The most common clinical manifestation of coronavirus diseasr is bilateral interstitial pneumonia, one of the complications of which is the development of acute respiratory distress syndrome, its pathogenesis is highlighted. It is also noted that the leading link in the development of the disease is a systemic lesion of the endothelial vascular wall, which is the cause of thrombosis and its complications, primarily pulmonary embolism, ischemic brain infarctions and cardiovascular catastrophes. Specific methods of radionuclide diagnostics are described for individual organs and systems: respiratory, cardiovascular, brain, and others. The need to diagnose and control the quality of treatment and rehabilitation of patients with post-inflammatory changes in the parenchyma of internal organs and a decrease in their functional ability due to sclerotic changes, patients with changes in the state due to the transition of inflammation to the chronic stage, as well as with an overactive immune response to inflammatory changes. Conclusion: at the stage of diagnosis and treatment of the consequences of a previous coronavirus diseasr and subsequent rehabilitation, molecular imaging methods are essential in a complex of studies.

Radiation Safety in Nuclear Medicine: Report I. Topical Problems

The current state and prospects of ensuring radiation safety in the nuclear medicine divisions of Russia are analyzed. The literature data and the main results of our own research to ensure the radiation safety of patients, staff, caregivers and the environment in the departments of radionuclide diagnostics and radionuclide therapy are presented. The most important and requiring solutions to ensure radiation safety in nuclear medicine are considered.

Prospects for the Development of Judicial Protection and Legal Regulation of the Provision of Radionuclide Diagnostics and Therapy for Vulnerable Groups of Citizens (Victims of Crime, Disabled People, Pensioners)

In Russia there is currently a great need for high-tech methods of radionuclide diagnostics and therapy. However, given the relatively small number of medical institutions that carry out radionuclide diagnostic and therapeutic methods, the provision of this type of medical care to vulnerable groups of citizens is of particular relevance. The absence of appropriate judicial and legal protection measures in case of failure to provide this type of high-tech assistance is a legislative gap.

Nuclear medicine and molecular imaging in clinical practice: yesterday, today and tomorrow

Over the past 40 years, nuclear medicine has grown to be the largest non-invasive diagnostic and therapeutic industry in the world, playing a pivotal role in various fields and disciplines of clinical practice and contributing to improved quality of life and patient prognosis. Over the first 20 years of the XXI century, the number of radionuclide procedures in the world has increased significantly, primarily due to innovations in radiopharmaceuticals, continuous improvement of the technical properties of equipment and the expansion of the boundaries of multimodal imaging. The review examines the historical and current trends in the development of nuclear medicine in the world and in Russia, including those related to radionuclide diagnostics, therapy and theranostics.

Actual problems of nuclear medicine in pediatrics (review)

On the basis of literature data and personal experience, the current state and prospects for the development of nuclear medicine in pediatrics are analyzed. The main directions of radionuclide diagnostics and radionuclide therapy in children are briefly considered. The importance of accu-rate determination of the optimal value of the activity of a specific radiopharmaceutical adminis-tered to a child, taking into account his body weight and the study protocol, was noted. A tendency for an increase in the radiation load on patients is shown due to the widespread introduction into clinical practice of hybrid installations for radionuclide studies, when using which the dose of in-ternal radiation from radiopharmaceuticals is supplemented by the dose of external radiation from X-ray CT. The need to take into account the risk of radiation-induced carcinogenesis in nu-clear medical procedures, the probability of which in children is significantly higher than in adults, is emphasized. The technological and psychological features of these procedures in children are discussed. The necessity of substantial revision of domestic normative documents regulating the use of means and methods of nuclear medicine in pediatrics has been substantiated.