This paper describes the evolution of nuclear cardiology techniques in the setting of acute coronary syndromes. Since the 1970s, the contribution of nuclear cardiology has been fundamental in ...delineating the physiopathology and diagnosis of acute myocardial infarction, when electrocardiogram (ECG) did not provide the diagnosis and when cardiac enzyme assessments were at a very early stage. In this clinical situation, at that time the role of pyrophosphate scintigraphy and antimyosin antibodies was important in ensuring diagnostic precision. However, these methods showed limitations and were abandoned in the late 80s and early 90s when therapeutic applications such as thrombolytic therapy, and primary-and rescue-percutaneous coronary intervention (PCI) were introduced. Beginning in the mid-80s, the introduction and widespread use of perfusion tracers such as 99mTc labelled compounds and technological advances such as SPECT, allowed to assess the efficacy of thrombolysis and early revascularization, as well as to assess in depth myocardial salvage. Currently, perfusion SPECT, especially using fast imaging techniques and dedicated cardiac SPECT with solid-state detectors, allows a quick confirmation or exclusion of acute coronary syndromes, particularly in low-to-intermediate likelihood of coronary artery disease (CAD), especially when there are absolute or relative contraindications to the use of coronary computed tomographic angiography (CCTA).
One of the major mechanisms of implementing the International Atomic Energy Agency’s (IAEA) programs in nuclear medicine has been through coordinated research projects (CRPs). In recent years, the ...IAEA has initiated a new type of CRP, called Doctoral CRP, in an attempt to further improve the effectiveness of its programs. The structure of the Doctoral CRP has been built on the structure of the existing CRP concept, but with a broader “thematic” approach. The word “thematic” indicates that these CRPs should both have a fairly broad scope and be designed so that their outcome, in terms of practical applications, might readily fit into the selected nuclear applications that are offered to Member States under the IAEA’s mechanism for thematic planning. The Nuclear Medicine Section of IAEA’s Division of Human Health initiated the first Doctoral CRP of IAEA in the year 2000, entitled, “Management of Liver Cancer Using Radionuclide Methods with Special Emphasis on Trans-Arterial Radio-conjugate Therapy and Internal Dosimetry.” Since then, the CRP has accomplished several milestones, including development of a new therapeutic radiopharmaceutical (188 Re lipiodol) and successfully carrying out Phase I and Phase II clinical trials on patients using the new therapeutic radiopharmaceutical.
Liver cancer is one of the most dreaded cancers, and it is highly prevalent in the developing countries, where the resources are extremely scarce to deal with this disease using the current ...commercially available and expensive therapeutic radiopharmaceuticals. The International Atomic Energy Agency (IAEA), in pursuit of its mandate to promote the application of nuclear technology in the health care in its Member States, has developed and clinically evaluated a new and cost-effective therapeutic radio-conjugate, rhenium-188 (188 Re)-lipiodol for the treatment of hepatocellular carcinoma through its first Doctoral Coordinated Research Project. The ready availability of no-carrier-added188 Re from the tungsten-188/188 Re generator represents a potentially important source of a therapeutic radioisotope for a broad range of therapeutic applications in nuclear medicine. The alumina-based tungsten-188/188 Re generator system comes with reasonable cost and exhibits attractive therapeutic properties, excellent performance and very long useful shelf-life. Because of the long shelf-life of several months, the use of this generator offers a unique opportunity for the cost-effective and routine availability of a versatile therapeutic radioisotope on an on-demand basis. Further, using its extensive global network and outreach, the IAEA has also transferred the technology of the in-house preparation and use of188 Re-labeled lipiodol to many institutions around the world, which can now prepare188 Re-labeled lipiodol in their own radiopharmacy laboratories and treat patients. This effort of the IAEA in trying to address some of the challenges of liver cancer therapy in developing countries has been and truly a global venture with involvement and contributions from several organizations, institutions and numerous individuals. This article discusses some of the implementation aspects of this very important activity of the Agency.
Purpose
To develop a nuclear medicine specific patient journey audit tool (PJAT) to survey and audit patient journeys in a nuclear medicine department such as staff interaction with patients, ...equipment, quality of imaging and laboratory procedures, patient protection, infection control and radiation safety, with a view to optimising patient care and providing a high-quality nuclear medicine service.
Methods
The PJAT was developed specifically for use in nuclear medicine practices. Thirty-two questions were formulated in the PJAT to test the department’s compliance to the Australian National Safety and Quality Health Service Standards, namely clinical governance, partnering with consumers, preventing and controlling health care infection, medication safety, comprehensive care, communicating for safety, blood management and recognising and responding to acute deterioration. The PJAT was also designed to test our department’s adherence to diagnostic reference levels (DRL). A total of 60 patient journey audits were completed for patients presenting for nuclear medicine, positron emission tomography and bone mineral density procedures during a consecutive 4-week period to audit the range of procedures performed. A further 120 audits were captured for common procedures in nuclear medicine and positron emission tomography during the same period. Thus, a total of 180 audits were completed. A subset of 12 patients who presented for blood labelling procedures were audited to solely assess the blood management standard.
Results
The audits demonstrated over 85% compliance for the Australian national health standards. One hundred percent compliance was noted for critical aspects such as correct patient identification for the correct procedure prior to radiopharmaceutical administration, adherence to prescribed dose limits and distribution of the report within 24 h of completion of the imaging procedure.
Conclusion
This PJAT can be applied in nuclear medicine departments to enhance quality programmes and patient care. Austin Health has collaborated with the IAEA to formulate the IAEA PJAT, which is now available globally for nuclear medicine departments to survey patient journeys.
Quality Management Audits in Nuclear Medicine (QUANUM) is an initiative conceived by the International Atomic Energy Agency to enhance global standards in Nuclear Medicine practices. Acknowledging ...the intricate regulatory frameworks and the necessity for multidisciplinary collaboration, QUANUM has gained global acceptance, demonstrating widespread implementation and positive impacts on patient care. This manuscript critically evaluates the QUANUM program through the lens of quality improvement (QI), by employing established and validated QI tools. Our analysis identifies areas of conformance, underscores key strengths inherent to QUANUM, and pinpoints further learning opportunities for continuous enhancement. Additionally, we assert that the insights derived from scrutinizing this global project within Nuclear Medicine, have valuable implications for departments aspiring for establishing good quality management systems, thereby contributing to the improvement of patient care.
Tibial nerves of 10 normal domestic ferrets (Mustela putorius furo) were evaluated by means of electrodiagnostic tests: motor nerve conduction studies (MNCSs), supramaximal repetitive nerve ...stimulation (SRNS), F waves, and cord dorsum potentials (CDPs). Values of conduction velocity, proximal and distal compound muscular action potentials, and amplitudes of MNCS were, respectively, 63.25 ± 7.56 m/sec, 10.79 ± 2.75 mV, and 13.02 ± 3.41 mV. Mean decrements in amplitude and area of compound muscular action potentials of wave 9 with low frequency SRNS were 0.3 ± 3.83% and 0.1 ± 3.51%. The minimum latency of the F waves and the F ratio were, respectively, 8.49 ± 0.65 ms and 1.92 ± 0.17. Onset latency of CDP was 1.99 ± 0.03 ms. These tests may help in diagnosing neuromuscular disorders and in better characterizing the hindlimb paresis reported in many ferrets with systemic illnesses.
A multicenter study was sponsored by the International Atomic Energy Agency (IAEA) to assess the safety and efficacy of transarterial rhenium-188 (188 Re) HDD lipiodol (radioconjugate to lipiodol ...using an HDD kit) in the treatment of unresectable hepatocellular carcinoma. During 5 years, 185 patients received at least 1 treatment of radioconjugate, and 51 were retreated. The level of radioconjugate administered was based on radiation-absorbed dose to critical normal organs, calculated after a “scout” dose of radioconjugate. The total injected activity, including the scout dose during the first treatment, ranged from 21 to 364 mCi (mean, 108 mCi/4 GBq). Immediate and late side-effects were minimal. Tumor size could be evaluated in 88 patients. Among these patients, the objective response rate was 25%; stable disease was observed in 53% and tumor progression in 22%. With a median follow-up of 455 days, the estimated 12- and 24-month overall survival was 46% and 23%. This multicenter study shows that188 Re lipiodol is a safe and cost-effective method to treat primary hepatocellular carcinoma via the transarterial route and requires further evaluation by treatment of greater numbers of patients.
In this substudy of the Value of Gated-SPECT MPI for Ischemia- Guided PCI of non-culprit vessels in STEMI Patients with Multi vessel Disease after primary PCI trial on the value of myocardial ...perfusion imaging (MPI) for ischemia-guided percutaneous coronary intervention (PCI) of nonculprit vessels in patients with ST-segment-elevation myocardial infarction (STEMI) and multivessel disease after primary PCI we aim to assess if infarct size affects conventional measures of dyssynchrony at rest. Additionally, we explore if there is an independent correlation of stress-inducible ischemia with dyssynchrony at rest.
The 48 patients with imaging at randomization were analyzed. Gated-single-photon emission computed tomography (SPECT) MPI with vasodilator stress and technetium-99m-labeled tracers was performed. The phase histogram bandwidth (HBW), phase SD, and entropy were obtained with the QGS software. Correlation between dyssynchrony at rest and infarct size and inducible ischemia was performed using the Spearman test.
According to normal database limits dyssynchrony parameters at rest were abnormal for men. In women only HBW was abnormal. Correlation between the summed rest score with dyssynchrony was significant only for entropy (P = 0.035). No correlation was observed for dyssynchrony and stress-induced ischemia.
Entropy, as a measure of dyssynchrony, has potential in the assessment of patients with STEMI and multivessel disease after primary PCI. Smaller residual myocardial scars in PCI-reperfused patients with STEMI may contribute to the lack of correlation between dyssynchrony at rest and infarct size and stress-induced ischemia, respectively.
Besides its translational value, an improved understanding of dog longevity and mortality is necessary to guide health management decisions, breed selection, and improve dog welfare. In order to ...analyse the lifespan of dogs in Italy, identify the most common causes of death, and evaluate possible risk factors, anonymised medical records were collected from 9 veterinary teaching hospitals and 2 public health institutions. Data regarding breed, sex, neuter status, age, diagnosis, and mechanism of death were retrieved. Cause of death (COD) was classified by pathophysiologic process (PP) and organ system (OS). Of the 4957 dogs that died between 2004 and 2020 included in the study, 2920 (59.0%) were purebred, 2293 (46.2%) were female, 3005 (60.6%) were intact, 2883 (58.2%) were euthanised. Overall median longevity was 10.0 years. Median longevity was significantly longer for crossbreds, females, neutered dogs, and small-sized breeds. The breeds with the highest median age at death were the Yorkshire terrier, English cocker spaniel, West Highland white terrier, Italian volpino, and Shih Tzu, whilst the American bulldog, English bulldog, American pit bull terrier, Bernese mountain dog and the Maremma and the Abruzzes sheepdog had the lowest median age at death. The most frequent COD by PP was neoplasia (34.0%), which occurred more frequently in large breeds, namely German shepherd, Labrador retriever and Boxer. Degenerative diseases mostly affected small-sized dogs like Miniature pinscher and Dachshund. Regarding the OS involved, diseases of the renal/urinary system were most frequently responsible for COD (15.0%), prevalently degenerative and inflammatory/infectious. Substantial variation in median longevity according to causes of death by PP and OS was observed. These data are relevant for breeders, veterinary practitioners, and owners, to assist breed selection, facilitate early diagnosis, guide choice when purchasing a purebred dog and making health management decisions, and ultimately improve dog welfare.
•The overall median longevity of dogs in Italy was 10.0 years.•Mixed-breed dogs generally lived longer than purebreds.•Dog size was inversely correlated to longevity.•Neutering/spaying appeared to be positively related to longevity.•Neoplasia was the most frequent cause of death, mostly affecting large-sized dogs.
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