Current Nuclear-medicine-technologist News Results

Totally automatic definition of renal regions of interest from 99mTc-MAG3 renograms: validation in patients with normal kidneys and in patients with suspected renal obstruction.

Nucl Med Commun. 2010 Feb 6;
Garcia EV, Folks R, Pak S, Taylor A

INTRODUCTION: An image-processing algorithm (AUTOROI) has been developed to totally automatically (or with manual assistance) detect whole-kidney contours and generate renal regions of interest (ROI) for the extraction of the quantitative measurements used in the interpretation of Tc-mercaptoacetyltriglycine (Tc-MAG3) renograms. METHODS: The 18-20th min dynamic frames post-MAG3 injection were used to automatically define boxes surrounding each kidney, which were then transposed to an early composite image for interpolative and directional background subtraction. Sobel operator and unsharp masking were applied for edge enhancement, and the resulting image histograms were equalized to better define poorly functioning kidneys. AUTOROI searched radially from the center of mass to define each kidney's ROI coordinates. AUTOROI was validated using MAG3 studies from 79 patients referred for suspected obstruction (79 left, 77 right kidneys) and 19 kidney donors with normal kidney function and no obstruction. Renal ROIs were manually defined by a nuclear medicine technologist with 20+ years of experience (reference standard) and an American Board of Nuclear Medicine certified physician. AUTOROI and physician ROIs were automatically compared with the reference standard to determine the border definition error. RESULTS: AUTOROI totally automatically detected the renal borders in 89% (172 of 194) of the kidneys from the entire group of 98 patients. The 22 kidneys missed automatically were subsequently detected with the assistance of a single manually placed fiducial point demarcating the liver/kidney boundary. These 22 kidneys were shown to be associated with markedly reduced MAG3 clearance. The mean error of AUTOROI for all 194 kidneys was 6.66+/-3.77 and 7.31+/-4.52 mm for the left and right kidney, respectively. The physician's error was 6.78+/-2.42 and 6.65+/-2.05 mm for the left and right kidney, respectively. This error difference between AUTOROI and the physician was not statistically significant. CONCLUSION: AUTOROI provides an objective and promising approach to automated renal ROI detection.

Breast-specific gamma-imaging: molecular imaging of the breast using 99mTc-sestamibi and a small-field-of-view gamma-camera.

J Nucl Med Technol. 2009 Dec; 37(4): 201-5
Jones EA, Phan TD, Blanchard DA, Miley A

Breast-specific gamma-imaging (BSGI), also known as molecular breast imaging, is breast scintigraphy using a small-field-of-view gamma-camera and (99m)Tc-sestamibi. There are many different types of breast cancer, and many have characteristics making them challenging to detect by mammography and ultrasound. BSGI is a cost-effective, highly sensitive and specific technique that complements other imaging modalities currently being used to identify malignant lesions in the breast. Using the current Society of Nuclear Medicine guidelines for breast scintigraphy, Legacy Good Samaritan Hospital began conducting BSGI, breast scintigraphy with a breast-optimized gamma-camera. In our experience, optimal imaging has been conducted in the Breast Center by a nuclear medicine technologist. In addition, the breast radiologists read the BSGI images in correlation with the mammograms, ultrasounds, and other imaging studies performed. By modifying the current Society of Nuclear Medicine protocol to adapt it to the practice of breast scintigraphy with these new systems and by providing image interpretation in conjunction with the other breast imaging studies, our center has found BSGI to be a valuable adjunctive procedure in the diagnosis of breast cancer. The development of a small-field-of-view gamma-camera, designed to optimize breast imaging, has resulted in improved detection capabilities, particularly for lesions less than 1 cm. Our experience with this procedure has proven to aid in the clinical work-up of many of our breast patients. After reading this article, the reader should understand the history of breast scintigraphy, the pharmaceutical used, patient preparation and positioning, imaging protocol guidelines, clinical indications, and the role of breast scintigraphy in breast cancer diagnosis.

The effects of technological developments on nuclear medicine technologist productivity: a systematic review.

Int J Technol Assess Health Care. 2009 Jul; 25(3): 383-90
Adams E, Cox J, Schofield D, Adamson B

OBJECTIVES: Nuclear medicine has changed rapidly as a result of technological developments. Very little is reported on the effects these developments may have on technologist productivity. This study aims to determine whether advances have created a workplace where more patient studies can be performed with fewer technologists. The level of change in automation or time taken to perform a routine task by the nuclear medicine technologist as a result of technological development over the past decade is reported. METHODS: A systematic review was conducted using Embase.com, Medline, INSPEC, and Cinahl. Two authors reviewed each article for eligibility. Technological developments in routine areas over the past decade were reviewed. The resultant automation or time effects on data acquisition, data processing, and image processing were summarized. RESULTS: Sixteen articles were included in the areas of myocardial perfusion, information technology, and positron emission tomography (PET). Gamma camera design has halved the acquisition time for myocardial perfusion studies, automated analysis requires little manual intervention and information technologies and filmless departments are more efficient. Developments in PET have reduced acquisition to almost one-fifth of the time. CONCLUSIONS: Substantial efficiencies have occurred over the decade thereby increasing productivity, but whether staffing levels are appropriate for safe, high quality practice is unclear. Future staffing adequacy is of concern given the anticipated increasing service needs.

Comparison of automated 4D-MSPECT and visual analysis for evaluating myocardial perfusion in coronary artery disease.

Kaohsiung J Med Sci. 2008 Sep; 24(9): 445-52
Hsu CC, Chen YW, Hao CL, Chong JT, Lee CI, Tan HT, Wu MS, Wu JC

The aim of this study was to assess the reproducibility and diagnostic performance for coronary artery disease (CAD) of an automated software package, 4D-MSPECT, and compare the results with a visual approach. We enrolled 60 patients without previously known CAD, who underwent dual-isotope rest Tl-201/stress Tc-99m sestamibi myocardial perfusion imaging and subsequent coronary angiography within 3 months. The automated summed stress score (A-SSS), summed rest score (A-SRS) and summed difference score (A-SDS) were obtained using a 17-segment five-point scale model with 4D-MSPECT. For intraobserver and interobserver variability assessment, automated scoring was done by a nuclear medicine physician twice and by a nuclear medicine technologist. The visual summed stress score (V-SSS), summed rest score (V-SRS), and summed difference score (V-SDS) were obtained by consensus of two nuclear medicine physicians. The intraobserver and interobserver agreements of automated segmental scores were excellent. The intraobserver and interobserver summed scores also correlated well. Agreements between visual and automated segmental scores were moderate (weighted kappa of 0.55 and 0.50 for stress and rest images, respectively). Correlations between automated and visual summed scores were high, with correlation coefficients of 0.89, 0.85 and 0.82 for SSS, SRS and SDS, respectively (all p < 0.001). The receiver operating characteristic area under the curve for diagnosis of CAD by V-SSS, V-SDS, A-SSS and A-SDS were 0.78 +/- 0.06, 0.87 +/- 0.05, 0.84 +/- 0.05 and 0.90 +/- 0.04, respectively. A-SDS had better diagnostic performance than A-SSS and V-SSS (p = 0.043 and p = 0.032, respectively), whereas there was no statistically significant difference between A-SDS and V-SDS (p = 0.56). Using V-SDS > or = 2 as a diagnostic threshold, the sensitivity, specificity, and accuracy for CAD were 83.7%, 76.5% and 81.7%, respectively. Using A-SDS > or = 3 as a diagnostic threshold, the sensitivity, specificity, and accuracy for CAD were 79.1%, 82.4% and 80.0%, respectively. In conclusion, the reproducibility of automated semiquantitative analysis with 4D-MSPECT was excellent. The diagnostic performance of automated semiquantitative analysis with 4D-MSPECT was comparable with the visual approach.

Can nuclear medicine technologists assess whether a myocardial perfusion rest study is required?

J Nucl Med Technol. 2008 Dec; 36(4): 181-5
Johansson L, Lomsky M, Gjertsson P, Sallerup-Reid M, Johansson J, Ahlin NG, Edenbrandt L

Both stress and rest imaging are usually performed to diagnose ischemia or infarction in the left ventricle. If the stress study is performed first and the images indicate normal findings, it might be unnecessary to perform the rest study. The current study determines whether nuclear medicine technologists can assess the necessity of a rest study. METHODS: The results of gated SPECT performed using a 2-d nongated stress and gated rest (99m)Tc-sestamibi protocol for 532 consecutive patients were studied. Myocardial perfusion imaging was performed for diagnosing coronary artery disease (CAD) in 421 patients and for managing known CAD in 107 patients; 4 patients were examined for other reasons. Seventy-nine patients had previous myocardial infarction. Visual interpretation by 1 experienced physician at the time of clinical reporting was used as the gold standard for determining the scintigraphic presence of myocardial infarction or ischemia; rest, stress, and gated rest images and clinical information were available to this physician. All cases categorized as infarction or ischemia present or probably present were categorized as the group requiring a rest study (i.e., the "rest-study-required group"), whereas all other cases were categorized as the group not requiring a rest study (i.e., the "no-rest-study-required group"). A total of 3 physicians and 3 technologists independently interpreted the nongated stress images (slice images and polar plots) and decided whether a rest study was required. RESULTS: In the rest-study-required group, the 3 technologists correctly classified on average 171 of the 172 cases, and the 3 physicians correctly classified 169 (a difference that was not statistically significant). In the no-rest-study-required group, the physicians correctly classified 32% and the technologists 21% of the cases (P = 0.001). The risk that a patient sent home without a rest study would have been diagnosed with infarction or ischemia using the combined stress-rest interpretation was 1.3% (1/75) for the technologists and 2.6% (3/115) for the physicians. CONCLUSION: The nuclear medicine technologists were able to assess whether a rest study was needed; the risk that this assessment would be incorrect was not higher for the technologists than it was for the physicians. This type of assessment by a nuclear medicine technologist could be of value in efforts to improve effectiveness at a nuclear medicine clinic.

NRC inspections: risk-informed and performance-based.

J Nucl Med Technol. 2008 Sep; 36(3): 129-31; quiz 144
Beardsley MR

In 2002, the U.S. Nuclear Regulatory Commission (NRC) revised its regulations governing the use of byproduct materials for medical purposes (10 CFR Part 35). These changes were the result of a detailed, 4-year examination of the issues surrounding the medical use program of the NRC and are stated in the latest revision to its medical policy statement, published in the Federal Register on August 3, 2000. As part of an overall program for revising its regulatory framework for medical use, the NRC revised its medical policy statement in keeping with the goal of focusing regulation on those medical procedures that pose the highest risk and structuring the regulations to be risk-informed. NRC inspection procedures were also revised to focus on high-risk activities through a performance-based approach, that is, through observations and interviews with licensee personnel performing NRC-regulated tasks. The purpose of this article is to inform the radiation worker (nuclear medicine technologist or authorized user physician) of the revised focus of the medical use program of the NRC and inspection procedures relative to nuclear medicine-licensed activities. After reading this article, the radiation worker should be able to describe the concept of risk-informed, performance-based regulations and inspections, identify areas of high-risk activities in the nuclear medicine laboratory, and describe techniques used by the NRC inspector to determine the licensee's compliance with the regulations.

Iodinated contrast media and their adverse reactions.

J Nucl Med Technol. 2008 Jun; 36(2): 69-74; quiz 76-7
Singh J, Daftary A

Cross-use of technology between nuclear medicine and radiology technologists is expanding. The growth of PET/CT and the increasing use of intravenous contrast agents during these procedures bring the nuclear medicine technologist into direct contact with these agents and their associated complications. A basic understanding of the occurrence, risk factors, clinical features, and management of these procedures is of increasing importance to the nuclear medicine technologist. After reading this article, the technologist will be able to list the factors that increase the risk of contrast reactions; understand ways to minimize the occurrence of contrast reactions; and develop a plan to identify, treat, and manage the reactions effectively.

Will the Australian nuclear medicine technologist workforce meet anticipated health care demands?

Aust Health Rev. 2008 May; 32(2): 282-91
Adams E, Schofield D, Cox J, Adamson B

Determination of national nuclear medicine technologist workforce size was made from census data in 2001 and 1996 and from the professional body in 2004. A survey conducted by the authors in 2005 provided retention patterns in north-eastern Australia and suggested causes. Utilisation of nuclear medicine diagnostic services was established through the Medicare Benefits Schedule group statistics. More than half the nuclear medicine technologist workforce is under 35 years of age. Attrition commences from age 30, with very few workers over 55 years. In 2005 there was a 12% attrition of the survey workforce. In the past decade, service provision increased while workforce size decreased and the nuclear medicine technologist workforce is at risk of failing to meet the anticipated rise in health service needs.

Variation in diethylenetriamine pentaacetic acid and mercaptoacetyltriglycine renal scans: clinical implications of interobserver and intraobserver differences.

J Urol. 2008 Mar; 179(3): 1132-6; discussion 1137
Snow BW, Gatti JM, Renschler TD, Corneli HM, Cartwright PC

PURPOSE: Diethylenetriamine pentaacetic acid and mercaptoacetyltriglycine renal scans are commonly used to evaluate infants and children with hydronephrosis to assess for changes in kidney function and drainage. We evaluate the certified nuclear medicine technologist intraobserver and interobserver variability of data processing in diuretic renal scan interpretation of the percent differential function of the right kidney so that true physiological changes can be understood by the clinician. MATERIALS AND METHODS: A total of 30 renal scans (diethylenetriamine pentaacetic acid in 20 patients and mercaptoacetyltriglycine in 10) were randomly selected for evaluation by 3 technologists who processed the scan data for each patient on 5 different occasions at least 1 week apart. Regions of interest were drawn and background areas were subtracted, and percent differential function of the right kidney was calculated. Technologists were blinded to patient identification and previous interpretation results. The data were then statistically analyzed. RESULTS: The data focused on percent differential function of the right kidney. Confidence limits for the single scan interpretation at the 95% level showed +/-5.8% differential function variation, although this scan was the same renal scan processed 1 week later. CONCLUSIONS: For differential function determined on diethylenetriamine pentaacetic acid or mercaptoacetyltriglycine diuretic renal scan the single scan 95% confidence limits were +/-5.8% differential function. From one renal scan to the next the differential percent of kidney function must change +/-11.6% differential function for a clinician to be 95% confident that a real change in kidney function has occurred. This uncertainty is substantial and is likely larger than is currently allowed for in clinical practice.

A profile of Australian nuclear medicine technologist practice.

Nucl Med Commun. 2008 Jan; 29(1): 83-90
Adams EJ, Cox JM, Adamson BJ, Schofield DJ

BACKGROUND: Nuclear medicine in Australia has encountered significant change over the past 30 years, with a move to privately owned practices, technological advances and the transfer of education of the nuclear medicine technologist (NMT) from technical college apprenticeships to university degrees. Currently, shortages of nuclear medicine technologists are reported in some states of Australia. It is not known whether changes in NMT practice or the type of centre in which an NMT works have an influence on retention of staff. AIM: The primary objective of this survey was to establish a profile of NMT practice in Australia, with the aim of producing baseline data that could be used in further research to establish levels of retention and job satisfaction. METHODS: Chief technologists in three states of Australia were invited to respond to a written questionnaire. The questionnaire included data about staffing levels, imaging modalities, procedures performed, and movement of staff. Findings presented will relate to the profile of practice data only. RESULTS: Forty-eight (54%) chief technologists responded to the questionnaire with 73% working in privately owned practices. The majority of centres employ up to two full-time equivalent nuclear medicine technologists and have two gamma cameras and one full-time equivalent nuclear medicine physician. Most centres perform a limited range of studies with bone scans predominating. More than half the centres make some use of a centralized radiopharmacy service. CONCLUSION: Further research is required to determine how these changes may impact on workplace satisfaction and in turn, on retention.

Navigating the biomedical research system as a full participant: strategies and opportunities for the nuclear medicine technologist.

J Nucl Med Technol. 2007 Sep; 35(3): 170-5
Schleipman AR

2006 Nuclear Medicine Technologist Certification Board salary survey results.

J Nucl Med Technol. 2007 Sep; 35(3): 162-9
Knight AW

Lymphoscintigraphy and radiation--occupational exposure during sentinel node assay.

Bosn J Basic Med Sci. 2006 Nov; 6(4): 42-4
Kucukalić-Selimović E, Skopljak-Beganović A, Beslić N, Begić A, Begović-Hadzimuratović S, Drazeta Z

Ionizing radiation has many practical applications, but it is also, as it is well known, dangerous to human health. The purpose of this study was to estimate the dose and exposure for medical staff involved in sentinel node assay and to determine how safe this assay really is. The theoretical method was used for calculation. Three groups of medical staff were selected: nuclear medicine specialist, nuclear medicine technologist and a surgeon. The results obtained show that the most exposed staff member is nuclear medicine specialist and that dose received by the surgeon is smaller then the dose limit.

Essential role of nuclear medicine technology in tositumomab and 131I-tositumomab therapeutic regimen for non-Hodgkin's lymphoma.

J Nucl Med Technol. 2006 Jun; 34(2): 67-73; quiz 74-6
Cole WC, Barrickman J, Bloodworth G

Nuclear medicine technology has traditionally focused on diagnostic imaging, with therapeutics left mostly to other medical disciplines. However, after many years in development, radioimmunotherapy (RIT) has finally become a clinical reality in many nuclear medicine departments. The nuclear medicine technologist is a key player in the successful implementation of RIT. Delivery of a therapeutic regimen of tositumomab and (131)I-tositumomab provides a model for the technologist's roles and responsibilities in the developing field of RIT. This article examines the clinical rationale, logistic requirements, and imaging and dosimetry procedures required by this treatment regimen. Upon completion of this article, the reader should be able to describe the target patient population and identify the roles and responsibilities of various members of the treatment team. The reader will also gain an understanding of the treatment process, including drug administration, imaging, and therapeutic dose calculations.

Nuclear medicine technologist job satisfaction.

J Nucl Med Technol. 2004 Dec; 32(4): 220-8
Knight A

Research applications of selected 123I-labeled neuroreceptor SPECT imaging ligands.

J Nucl Med Technol. 2004 Dec; 32(4): 209-14
Ross SA, Seibyl JP

Neuroreceptor imaging is a promising area of brain imaging used to investigate various neurodegenerative and neuropsychiatric disorders. In the research setting, radiopharmaceuticals targeted to specific areas of the brain are used along with SPECT to assess and analyze functional mechanisms within brain structures. Utilization of the data that are collected from these studies may aid in the development of drug therapies that can be used to relieve symptoms or delay progression of certain disease states. After reading this article, the nuclear medicine technologist should be able to identify and describe the role of structures in the brain, identify various radiopharmaceuticals used and the disease states they demonstrate, and become familiar with the drugs used in treatment of these disorders.

X-ray imaging physics for nuclear medicine technologists. Part 1: Basic principles of x-ray production.

J Nucl Med Technol. 2004 Sep; 32(3): 139-47
Seibert JA

The purpose is to review in a 4-part series: (i) the basic principles of x-ray production, (ii) x-ray interactions and data capture/conversion, (iii) acquisition/creation of the CT image, and (iv) operational details of a modern multislice CT scanner integrated with a PET scanner. Advances in PET technology have lead to widespread applications in diagnostic imaging and oncologic staging of disease. Combined PET/CT scanners provide the high-resolution anatomic imaging capability of CT with the metabolic and physiologic information by PET, to offer a significant increase in information content useful for the diagnostician and radiation oncologist, neurosurgeon, or other physician needing both anatomic detail and knowledge of disease extent. Nuclear medicine technologists at the forefront of PET should therefore have a good understanding of x-ray imaging physics and basic CT scanner operation, as covered by this 4-part series. After reading the first article on x-ray production, the nuclear medicine technologist will be familiar with (a) the physical characteristics of x-rays relative to other electromagnetic radiations, including gamma-rays in terms of energy, wavelength, and frequency; (b) methods of x-ray production and the characteristics of the output x-ray spectrum; (c) components necessary to produce x-rays, including the x-ray tube/x-ray generator and the parameters that control x-ray quality (energy) and quantity; (d) x-ray production limitations caused by heating and the impact on image acquisition and clinical throughput; and (e) a glossary of terms to assist in the understanding of this information.

Nuclear medicine technologist.

Clin Privil White Pap. 2004 Aug; 1-8

The Nuclear Medicine Technologist in Europe - current status and future perspective.

Nucl Med Rev Cent East Eur. 2003; 6(2): 135-7
van den Broek WJ

Performance and responsibility guidelines for the nuclear medicine technologist (revision 2003).

J Nucl Med Technol. 2003 Dec; 31(4): 222-9
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