We ask the ascetics to come down from the columns Burroni, Luca
Clinical and translational imaging : reviews in nuclear medicine and molecular imaging,
2023/2, Letnik:
11, Številka:
1
Journal Article
PET/CT in senior patients: “cui prodest?” Burroni, Luca; Chiti, Arturo
European journal of nuclear medicine and molecular imaging,
03/2021, Letnik:
48, Številka:
3
Journal Article
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Author Affiliation: (1) Department of Nuclear Medicine, "Ospedali Riuniti di Torrette" Hospital, Via Conca 71, 60126 Ancona, Italy (2) Humanitas Clinical and Research Center--IRCCS, Via Manzoni 56, ...20089, Rozzano, Milan, Italy (3) Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20090, Pieve Emanuele, Milan, Italy (a) luca.burroni@ospedaliriuniti.marche.it Article History: Registration Date: 08/20/2020 Online Date: 08/25/2020 Byline:
Indicators of expected quality of service in public contracts are often based on some kind of “punctuality”, usually defined in terms of the percentage of trains arriving at the final destination ...(and/or at intermediate significant stops) within a given delay. Passengers, however, tend to use the word “punctuality” with a more general meaning, mostly as a synonym for expected delay at their own destination, and especially in case of commuters are much less tolerant of even smaller delays than train operators would normally allow. In particular, measuring the delay only at the final destination is perceived as largely inadequate, leading to underestimation of the actual percentage of late trains, and in turn undermining passengers’ trust in official performance statistics. In this paper, we take the passengers’ perspective, introducing a family of delay indices called D-indices aimed at capturing the overall performance of a train “as a whole”, taking into account both the delays at the sampling points and the mutual location and order of such sampling points. In this paper, all indicators have the physical dimension of time in order to be easily replaceable to other delay measures. We first present typical approaches and definitions of punctuality in the literature, then introduce D-indices while exploring their features, pros and cons, and relevant properties. We validate and discuss our approach by comparing this model with existing approaches both theoretically and by comparison with selected datasets consisting of about one hundred trains transcribed over the last three years.
Purpose
Healthcare organizations using Lean Management have the potential to decrease the number of errors, reduce wait time and increase productivity. The aim of this review is to assess the ...literature with regard to the use and efficacy of Lean thinking and Lean methodologies within a Department of Nuclear Medicine.
Methods
Several health departments have adopted lean thinking as a consistent approach to quality improvement. We considered studies that demonstrated improvements across a variety of outcomes: the common factor was the aim to improve services to the patient. Lean methodology was selected because it is widely used in the healthcare environment and many Lean tools (VSM, one-piece flow, 5S, spaghetti diagram, A3, cell design, SMED) were analyzed for different processes.
Results
Many Lean studies have resulted in shortened queuing time, in cost-saving, in reducing defects, in increasing patient volume and in increasing staff and patient safety and satisfaction.
Conclusion
Lean tools have the potential to reduce error and costs and improve quality. Because Radiology and Nuclear Medicine departments are similar concerning patient processes, they have plenty of potentials to benefit from systematic Lean adoption. We believe these principles can be applied to other health care delivery areas.
Objective: Recently, a multicenter study in differentiated thyroid cancer (DTC) patients showed that 3700 MBq 131-iodine (131I) after recombinant human TSH (rhTSH) had a successful thyroid ablation ...rate similar to that obtained after thyroid hormone withdrawal. We investigated whether 1850 MBq 131I had a similar successful rate to 3700 MBq in patients prepared with rhTSH.
Design: A total of 72 patients with DTC were randomly assigned to receive 1850 (group A, n = 36) or 3700 MBq (group B, n = 36) 131I after rhTSH. One injection of 0.9 mg rhTSH was administered for 2 consecutive days; 131I therapy was delivered 24 h after the last injection, followed by a posttherapy whole-body scan. Successful ablation was assessed 6–8 months later.
Results: Successful ablation (no visible uptake in the diagnostic whole-body scan after rhTSH stimulation) was achieved in 88.9% of group A and B patients. Basal and rhTSH-stimulated serum thyroglobulin was undetectable (<1 ng/ml) in 78.9% of group A and 66.6% of group B patients (P = 0.46). Similar rates of ablation were obtained in both groups also in patients with node metastases.
Conclusion: Therapeutic 131I activities of 1850 MBq are equally effective as 3700 MBq for thyroid ablation in DTC patients prepared with rhTSH, even in the presence of node metastases.
Radiotherapy with concurrent 5-fluorouracil/mitomycin-C based chemotherapy has been established as definitive standard therapy approach for anal cancer. Intensity Modulated Radiotherapy (IMRT) leads ...to a precise treatment of the tumor, allowing dose escalation on Gross Tumor Volume (GTV), with a surrounding healthy tissues sparing. Our study assessed the impact of 18-Fluorodeoxyglucose positron emission tomography (18FDG-PET/CT) on the radiotherapy contouring process and its contribution to lymphatic spread detection, resulting to a personalization of Clinical Target Volume (CTV) and dose prescription.
Thirty-seven patients, with histologically proven squamous cell carcinoma of the anal canal (SCCAC) were analyzed. All patients were evaluated with history and physical examination, trans-anal endoscopic ultrasound, pelvis magnetic resonance imaging (MRI), computed tomography (CT) scans of the chest, abdomen and pelvis and planning 18FDG-PET/CT. The GTV and CTV were drawn on CT, MRI and 18FDG-PET/CT fused images.
Thirty-four (91%) out of 37 patients presented lymph nodes involvement, in one or more areas, detected on 18FDG-PET/CT and/or MRI. The 18FDG-PET/CT showed positive lymph nodes not detected on MRI imaging (PET+, MRI-) in 14/37 patients (38%). In 14 cases, 18FDG-PET/CT allowed to a dose escalation in the involved nodes. The 18FDG-PET/CT fused images led to change the stage in 5/37(14%) cases: four cases from N0 to N1 (inguinal lymph nodes) and in one case from M0 to M1 (common iliac lymph nodes).
The 18FDG-PET/CT has a potentially relevant impact in staging and target volume delineation/definition in patients affected by anal cancer. In our experience, clinical stage variation occurred in 14% of cases. More investigations are needed to define the role of 18FDG-PET/CT in the target volume delineation of anal cancer.
Introduction
Fluorine-18 (
18
F) Fluciclovine (anti-1-amino-3-
18
F-fluorocyclobutane- 1-carboxylic acid FACBC) is a synthetic amino acid labeled with
18
F, currently used as PET radiopharmaceutical ...to investigating prostate cancer, namely in the recurrent setting.
Fluciclovine is transported to cell membranes by amino acid transporters, such as LAT1 and ASCT2. The upregulation of LAT-1 and ASCT2 activities is typical of prostate cancer but is also present in other pathological conditions such as non-prostatic neoplasms (e.g., lung cancer) and in benign inflammatory process (e.g., benign prostatic hyperplasia, chronic prostatitis, high-grade prostatic hyperplasia intraepithelial).
Methods
In this short essay we present a retrospective FACBC PET/CT analysis consisting of a selection of the five most relevant cases of patients referred in our centre to FACBC PET/CT for prostate cancer, with concomitant FACBC uptake in sites atyipical for prostate cancer.
Results
These five selected cases demonstrate FACBC uptake at the level of the pancreatic head, adrenal incidentalomas, pulmonary nodules, mediastinal lymph nodes and neoformative tissue of the rectal wall.
Discussion
Clinical cases selected in this pictorial essay have demonstrated that Fluciclovine is not an exclusive and specific radiotracer for prostate cancer and, therefore, can induce misdiagnosis. In fact, incidental benign and malignant uptake might occur and should be further evaluated with clinical correlation or other imaging.
to explore the diagnostic accuracy of 18F-Fluciclovine positron-emission tomography (PET) in prostate cancer (PCa), considering both primary staging prior to radical therapy, biochemical recurrence, ...and advanced setting.
A systematic web search through Embase and Medline was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. Studies performed from 2011 to 2020 were evaluated. The terms used were "PET" or "positron emission tomography" or "positron emission tomography/computed tomography" or "PET/CT" or "positron emission tomography-computed tomography" or "PET-CT" and "Fluciclovine" or "FACBC" and "prostatic neoplasms" or "prostate cancer" or "prostate carcinoma". Only studies reporting about true positive (TP), true negative (TN), false positive (FP) and false negative (FN) findings of 18F-fluciclovine PET were considered eligible.
Fifteen out of 283 studies, and 697 patients, were included in the final analysis. The pooled sensitivity for 18F-Fluciclovine PET/CT for diagnosis of primary PCa was 0.83 (95% CI: 0.80-0.86), the specificity of 0.77 (95% CI: 0.74-0.80). The pooled sensitivity for preoperative LN staging was 0.57 (95% CI: 0.39-0.73) and specificity of 0.99 (95% CI: 0.94-1.00). The pooled sensitivity for the overall detection of recurrence in relapsed patients was 0.68 (95% CI: 0.63-0.73), and specificity of 0.68 (95% CI: 0.60-0.75).
This meta-analysis showed promising results in term of sensitivity and specificity for 18F-Fluciclovine PET/CT to stage the primary lesion and in the assessment of nodal metastases, and for the detection of PCa locations in the recurrent setting. However, the limited number of studies and the broad heterogeneity in the selected cohorts and in different investigation protocols are limitation affecting the strength of these results.
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