Department of Clinical Physiology, Nuclear Medicine & Pet

Home , Adjunct professor

Diagnostic Center · Rigshospitalet · University of Copenhagen Annual Report 2009 DEPARTMENT OF CLINICAL PHYSIOLOGY, NUCLEAR MEDICINE & PET

Clinical Physiology and Nuclear Medicine 177Lu-DOTA, Tyr3-octreotate KF 4011, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, DK-2100 Copenhagen Ø, Denmark Telephone: +45 3545 4011 Fax no: +45 3545 4015 [email protected] www.riget.kfnm.dk

PET & Cyclotron Unit PET 3982 Rigshospitalet, University of Copenhagen, Blegdamsvej 9, DK-2100 Copenhagen Ø, Denmark Telephone: +45 3545 3919 Annual Report 2009 Fax no: +45 3545 3898 [email protected] www.pet.rh.dk Rigshospitalet

Rigshospitalet · University of Copenhagen Contents

Editors: 4 Preface Liselotte Højgaard 7 Mission and Objectives Gitte Runge 8 Organization and Staff Layout and production: 10 Highlights of the year 2009 www.bureauLIST.dk / 14820 12 Dotatate Fotos:13 Peralust Lars Bahl Bent 14 Børgesen Nuclear Medicine Søren 15 Holm Pediatric Nuclear Medicine Andreas Kjær 16 Cyclotron Unit NRC Network University Research Conference 17 Radiochemistry Issues: 18 PET/CT scanning in Oncology 1000 ex. 19 PET/CT scanning in Radiation Therapy Copyright:20 Cardiac Studies Department of Clinical Physiology, Nuclear Medicine & PET, 21 Academic Activities KF 4011, Rigshospitalet, University of Copenhagen, Blegdamsvej 22 Patient 9, DK-2100 Investigations Copenhagen Ø, Denmark 23 Finance Contact: Professor 24 Research Liselotte Højgaard E-mail: [email protected] Rigshospitalet, University of Copenhagen 25 Cluster for Molecular Imaging Phone: +45 3545 4215 / 1792 Rigshospitalet, University of Copenhagen, was founded by King Frederik V in 1757. At pre- 26 Publications 2009 sent it has 1.200 beds, 8.000 employees and a budget of approximately 0.7 bio €. The 28 Scientific Collaboration research production is more than 1.700 publications per year, including approximately 80 higher academic degrees (PhD and doctoral of medical science). Rigshos pitalet is part of 28 Grants and Awards The Capital Region of Copenhagen. www.rigshospitalet.dk 29 MSc in Medicine and Technology

University of Copenhagen 30 Education University of Copenhagen, Faculty of Health Sciences was founded in 1479. 31 Nuclear Medicine Technologists The University is member of The International Alliance of Research Universities. 32 PET and PET/CT Scanners www.ku.dk 33 Equipment 33 Accreditation 34 European Medical Research Councils

Preface

The Department of Clinical Physiology, new Dotatate treatment. We are impressed tracerlist. Congratulations to the Radio- Young students from abroad with high am- department is functioning well and that the Leading Chief Technologist, Centre of Nuclear Medicine & PET at Rigshospitalet, by your achievements. A warm thank you! chemistry Production Team. The Cyclotron bitions in research in the broad field of staff are collaborating well and proud of Diagnostic Investigations, for excellent University of Copenhagen, had a busy Unit has been functioning well and the nuclear medicine, PET and molecular the patient studies, research and educa- help and good collaboration in 2009. 2009. We carried out more than 30,000 The Danish journal Dagens Medicin (Medi- team has succeeded in extending the CTI- imaging are welcome in our Department. tion. Thank you to everyone for this posi- patient investigations and produced more cine of Today) rated our department “Best cyclotron to a dual-beam machine. Con- In Spring 2009 we had Medical Student tive feedback. A special warm thank you to Dr. Jannik than 80 peer-reviewed papers, including Department in Denmark” in 2009 on the gratulations! Mona Lichtblau from Heidelberg as ex- Hilsted, Medical Doctor, Rigshospitalet for a report of the first randomized controlled basis of votes from our colleagues in Den- change student and in Autumn 2009 we In 2010 we are heading towards a renova- strong support and help with the Dotatate trial on the use of PET/CT for staging of mark. We are obviously very proud of this Our research mission at the department had Medical Student Yin Wu from Univer- tion of the radiochemistry lab with new project. lung cancer, published in the influential honour and we are delighted to have been states: “Everything within the framework of sity College London. At the moment our FDG-labs, and we look forward to a con- New England Journal of Medicine. evaluated in such a positive way by our nuclear medicine including PET and mole- staff represent 15 different nationalities. tinued strengthening of patient investiga- We are looking forward to exciting new own peers. cular imaging with animals, translational It is a privilege to work in a multicultural tions in an academic environment based challenges in 2010 – for the benefit of pa- The financial balance for the Department and clinical studies, development of new environment and although our everyday on the most up-to-date infrastructure. tients, research and education! was positive – as it has been for now 10 We opened the PET/CT scanner number 6 isotopes on the cyclotrons, and develop- language is Danish, our research language years. in June 2009 and now have a superb facili- ment of new tracers in the radiochemistry is English and our researchers and staff We would like to express a warm and sin- ty with PET/CT scanner 5 and PET/CT facility, is welcome. The only criterion is are to a large extent proficient in English. cere thank you to all staff members for Liselotte Højgaard and Linda M. Kragh The most important tasks for our Depart- scanner 6 adjacent to each other. These quality, quality and quality”. Professor their great effort in 2009, and a warm ment are to deliver the best patient investi- two scanners are mainly used for the large Andreas Kjær, who is responsible for our In November 2009 we had an “APV”, a thank you to all collaborators and partners gation to each individual patient in a re- daily clinical production of PET/CT scans research programme, describes our re- mandatory work environment evaluation. within the hospital and from abroad. spectful, dignified and friendly way; to within oncology. We have a large pro- search in details on page 24. The replies from the staff revealed re- undertake first class research; and to or- gramme for PET/CT scans within oncology quests for: more space, renovation of the A special thank you to Dr. Mogens Sand- ganize educational programmes for both for a variety of cancer diseases for stag- We have had an excellent research colla- old buildings and better infrastructure. The bjerg Hansen, Director of Centre of Diag- undergraduate and postgraduate studies ing, treatment evaluation and relapse eva- boration with Professor Gitte Moos Knudsen important message was, however, that the nostic Investigations, and Karin Nørgaard, for medical doctors, bioengineers, physi- luation. In addition to our 4,000 clinical and her team at the CIMBI programme. We cists and nuclear medicine technologists. PET/CT scans we also performed more look forward to continued research colla- than 700 second opinion PET scan read- boration on neurobiology, basic research, The highlight of 2009 was the initiation of ings. (Our clinicians here at the hospital translational research and drug develop- treatment of patients with neuroendocrine receive PET/CT scans performed outside ment. tumors with 177Lu-Dotatate in our new facili- the Rigshospitalet, and are asked to ties. Previously, patients from Denmark re-evaluate the scan readings.) In 2009 we We have an extensive programme in Pedi- had been treated in Basel in Switzerland, also performed 700 PET/CT scans for atric Nuclear Medicine and PET, focused but after a two-year preparatory phase we radiation therapy planning. We would like on delivering the best investigation for have now acquired the skills to deliver the to thank Professor Svend Aage Engelholm, each and individual child and family. Our treatment with the isotopes produced at Chair of the Department of Radiation The- research is performed by MDs in collabo- the Hevesy Lab at Risø, DTU. In 2009 we rapy, and his team for the excellent colla- ration with nuclear medicine technologists gave 46 treatments. For the patients it is boration on patient studies, research, de- and radiographers and we are member of both comforting and convenient that they velopment and education. We are proud of the Pediatric Nuclear Medicine Network, can receive this treatment without travel- our contribution to the advanced radiation using telemedicine to provide second ling to a different country. Our intensive re- therapy here at Rigshospitalet. Also thank opinions across the world. search programme around these patients you to Ole Bergsten, MTA for help and is part of the Rigshospitalet Neuroendo- collaboration. In the Cluster for Molecular Imaging the crine Tumor Study Group (RHINET). To- combination of animal PET/CT with new gether we have succesfully gained accre- In the field of PET the number of investi- tracers and Q-PCR for tumor markers has ditation as a “Centre of Excellence” by the gations has increased again and the pro- yielded a remarkably high output of impor- European Neuroendocrine Tumor Society. gramme in brain tumors and pediatric tant research. Professor Andreas Kjær and We would like to take this opportunity to tumors has been expanded. The radio- his group are greatly thanked for this im- express our thanks to the team behind the chemistry section has expanded the pressive effort.

4 5 Mission and Objectives

The mission of Rigshospitalet is to be the leading hospital in Denmark for patients in need of highly specialized treatment.

General objectives:

to be at the forefront of highly specialized diagnostic treatment and nursing to carry out research and development at an advanced international level to educate staff in the health services to a highly specialized level to contribute with professional advice and exchange of knowledge and expertise to the wider healthcare community to be characterized by openness and human respect

The objectives of The Department of Clinical Physiology, Nuclear Medicine & PET are:

to provide optimal clinical physiology and nuclear medicine for patient investigation to carry out research at the highest international level in clinical physiology and nuclear medicine with special emphasis on molecular imaging, isotopes and radiopharmaceuticals to deliver undergraduate and postgraduate education for all relevant professionals within the relevant expert clinical fields, nationally and internationally to provide a good patient experience and ensure the wellbeing of the staff

The staff have participated in a number of congresses, symposias, meetings and workshops with invited lectures, oral presentations, abstracts and posters. We have a comprehensive programme for all staff members at the department, and frequent visits from Danish and international research groups.

In 2009 more than 200 groups and individuals visited the department.

6 7 Organization and Staff

Physicians Head of Department Ahnlide, Jan, MD, Registrar. Berthelsen, Anne Kiil, MD, Chief Physician. Borgwardt, Lise, MD, PhD, Senior Registrar. Bouchelouche, Kirsten, MD, Professor Liselotte Højgaard, MD, DMSc Senior Reigstrar. Christensen, Charlotte Birk, MD, Registrar. Cronberg, Carin, MD, Chief Physician. Dejanovic, Danijela, MD, Registrar. Dümcke, Christine, MD, Senior Registrar. Graff, Jesper, MD, DMSc, PhD, Chief Physician. Jakobsen, Annika Loft, MD, PhD, Chief Physician. Hasbak, Philip, Chief Nuclear Medicine Technologist MD, Chief Physician. Hesse, Birger, MD, DMSc, Chief Physician. Højgaard, Liselotte, MD, DMSc, Head of Department, Professor. Høyer, Alice Linda M. Kragh Outzen Widding, MD, Consultant. Johnbeck, Camilla Bardram, MD, Registrar. Kjær, Andreas, MD, DMSc, PhD, MBA, Chief Physician, Professor. Korsholm, Kirsten, MD, Registrar. Krakauer, Martin, MD, Registrar. Law, Ian, MD, PhD, Chief Physician. Markova, Elena, MD, Chief Physician. Mar- ner, Lisbeth, MD, Registrar. Mortensen, Jann, MD, DMSc, Chief Physician, Associate Professor. Oturai, Peter, MD, Chief Physician. Reichkendler, Michala, MD, Registrar. Nielsen, Dorthe Skovgaard, MD, PhD, Registrar. Professor, Chief Physician Chief Physicist, PET Andreas Kjær, Søren Holm, MSc, PhD PhD students MD, DMSc, PhD Binderup, Tina, MSc Human Biology, PhD Student. Erritzøe, David, MD, PhD Student, NRU Researcher. Ettrup, Anders, MSc Human Biology, PhD Student, NRU Researcher. Frøkjær, Vibe, MD, PhD Student, NRU Researcher. Græbe, Martin, MD, PhD Student. Gutte, Henrik, MD, Research Fellow, PhD Student. Haahr, Mette, MD, PhD Student, NRU Researcher. Hansen, Martin, Cand.scient, PhD Student. Jensen, Mette Munk, Human Biology, Research Fellow. Jensen, Torben Hougaard, Cand.scient, PhD Student. Jørgensen, Emilie Arnth, MSc Human Biology, PhD Student. Jørgensen, Jes- Chief Physicist, KF Head Medical Secretary per Tranekær, MSc Human Biology, Research Fellow. Kalbitzer, Jan, MD, PhD Student, NRU Researcher. Kornum, Birgitte, MSc Human Biology, PhD Thomas Levin Klausen, MSc Vibeke Rønn Student, NRU Researcher. Kristoffersen, Ulrik Sloth, MD, Research Fellow, PhD Student. Louring-Andersen, Julie, MD, Research Fellow, PhD Stu- dent. Marthin, June, MD, PhD Student. Nielsen, Kristina Rue, MD, PhD Student. Persson, Morten, MSc, Research Fellow. Pfeifer, Andreas, MD, Research Fellow, PhD Student. Skovgaard, Dorthe, MD, PhD Student. Tägil, Kristina, MD, PhD Student.

Physicists, pharmacists, chemists, technicians, engineers, computer scientists, QA-assistants Andersen, Flemming, MSc, PhD, Computer Scientist. Boudrealt, Gislain, MSc, PhD, Substitute Cyclotron Physicist. Brandt-Larsen, Malene, MSc, PhD, Chemist. Christensen, Jan Damgaard, Cyclotron Technician. Dahan, Daniel, Cyclotron Technician. de Nijs, Robin, Medical Physicist, MSc, Clinical Physiology/ PET Cyclotron Radiochemistry Whole Body PDEng. Denholt, Charlotte Lund, MSc, PhD, Chemist. Dähnhardt, Andreas, Computer Assistant. Gillings, Nicolas, MSc, PhD, Chief Radio Chemist. Nuclear Medicine Camera Unit Unit Unit Counter Heilmann, Helene, QA-Pharmacist. Hollesen, Christian, MSc Bioengineer, PhD student. Holm, Søren, MSc, PhD, Chief Physicist. Jensen, Bjørn Neu- Chief Physician Chief Physician Cyclotron Chief Chief Radiochemist Chief Nuclear Medicine mann, Electro Engineer. Jensen, Holger, MSc, PhD, Physicist, Cyclotron Chief. Jensen, Tina Gade, QA-Assistant. Jørgensen, Jesper, MSc, Cyclotron Physicist. Keller, Sune Høgild, MSc, PhD, Computer Scientist. Klausen, Thomas Levin, MSc, Chief Physicist. Madsen, Jacob, MSc, PhD, Chemist, Jann Mortensen Annika Loft Holger Jensen QA Manager Technologist Chief Production Manager. Nielsen, Carsten Haagen, MSc Bioengineer, PhD student. Någren, Kjell, MSc, Research Radiochemist. Olesen, Oline, MD, DMSc Jakobsen, MD, PhD MSc, PhD Nic Gillings, MSc, PhD Linda M. Kragh MSc Bioengineer, PhD student. Sibomani, Merence, IT-expert. Skott, Ulla, MSc, Departmental manager. Szabolcs, Lehel, MSc, PhD, Chemist. Deputy Chief Deputy Chief Substitute Cyclotron Chief Radiochemist Chief Physician Weihrauch, Per, Cyclotron Technician. Nuclear Medicine Nuclear Medicine Physicist Production Manager Peter Oturai Technologist Technologist Ghislain Boudrealt Jacob Madsen MD Nuclear medicine technologists (NMT), radiographers and nurses Tim Lundby Kate Pedersen MSc, PhD MSc, PhD Abrahamsson, Elisabeth, Radiographer. Albers, Mia C. Hjorth, NMT. Christensen, Pia, NMT. Cortsen, Annette, NMT. Dall, Bente, NMT. Dunbar, Douglas, NMT. Elkington, Sakeena, NMT. Federspiel, Marianne, NMT. Frederiksen, Mette Borggreen, NMT. Gudmundsson, Sven, NMT. Hansen, Anja Vallin, NMT. Hansen, Lasse, NMT. Hassan, Mariam, NMT. Heiberg, Therese, Cand.scient.san., NMT. Høybye, Lene, NMT. Jensen, Martin Ravn, NMT. Jørgensen, Hanne, NMT. Jørgensen, Mette Møller, NMT. Kahveci, Zuhal, NMT. Kernchen, Ulla, Staff Nurse. Knudsen, Camilla Sloth, NMT. Kragh, Lin- da M., Chief NMT. Kronvall, Johanna, NMT. Lindell, Elin, NMT. Linnet, Solveig, NMT. Lundby, Tim, Deputy Chief NMT. Myschetzky, Rebecca, NMT. Nehme, Ghina, NMT. Osinska, Dorota, NMT. Pedersen, Birgitte, NMT. Pedersen, Kate, Deputy Chief NMT. Setterberg, Victoria, NMT. Stahr, Karin, NMT. Svalling, Susanne, NMT. Sørensen, Anne, NMT. Sørensen, Anne B., NMT. Sørensen, Louise Sørup, NMT. Theil, Merete Søndersø, NMT. Wikke, Tina, NMT.

Secretaries Department of Clinical Physiology, Nuclear Medicine & PET is part of The Diagnostic Center, Hansen, Lissa, Secretary. Hildebrand, Sanne, Secretary. Jørgensen, Tina, Medical Secretary. Marquardsen, Joan, Medical Secretary. Myltoft, Mette headed by Mogens Sandbjerg Hansen, Director, MD, DMSc and Karin Nørgaard, Vicedirector. Gylling, Medical Secretary. Nielsen, Mariane, Service Assistant. Nielsen, Tina Vikmann, Medical Secretary. Nissen, Rikke Gammelbo, Medical Secre- tary Student. Runge, Gitte, PA to Professor, Medical Secretary. Rønn, Vibeke, Head Medical Secretary. Semitoje, Gudrun, Medical Secretary.

Students Andersen, Julie Bjerglund. Andreasen, Nis Bo. Christensen, Anders. Christensen, Rune. Dohn, Asmus Ougaard. Jensen, Simon Bøgh. Kamstrup, Andreas. Kjøller, Niels-Kristian. Petersen, Stefan Alaric. Øberg, Mikkel.

8 9 Highlights of the year 2009

The highlight of 2009 was the initiation of AMI, SNM, EANM and gave many lectures all treatment of patients with neuroendocrine tu- over the world, as reflected in the illustrations. Bedst til klinisk fysiologi mors with 177Lu-Dotatate in our new facilities. Our Consultant, Dr. Jann Mortensen, MD, Hitherto, patients from Denmark have been DMSc has from 2009 also had responsibility treated in Basel in Switzerland. The isotope is for the Danish National Board of Health produced at the Hevesy Lab, Risø, DTU. In Accreditation for the small Department of 2009 we gave 46 treatments. It is comforting Nuclear Medicine at the Torshavn Hospital. and convenient for these patients that they We are proud of this Nordic collaboration. can be treated in Denmark rather than have to travel to a different country. At EMRC, the European Medical Research Councils, the highlight of the year was the On 21st June 2009 The John & Birthe Meyer publication in March of the Forward Look “In- Foundation donated 2 million Kroners for an vestigator-Driven Clinical Trials”, with the aim automatic chemistry system for our PET and of improving conditions for clinical research in Cyclotron Unit. We are grateful for this gene- academia. To pay tribute to our Core Group rousity. Thank you very much to The John & member Professor Roger Bouillon, Liselotte Birthe Meyer Foundation. Højgaard was in Leuven for Professor Bouil- lon’s’ Retirement Symposium and the old aca- The new PET/CT 6 scanner for clinical oncolo- demic traditions at the Leuven University gy patient investigations and our new rooms founded 1425 can be seen on the portrait of started to be used in June 2009. The PET/CT Professor Bouillon and Professor Højgaard in 5 and PET/CT 6 scanners next to each other academic gowns. are very fine patient facilities. Professor Harald zur Hausen, Nobel Laureate The Department was elected “Best Depart- 2008, was appointed Honorary Professor in ment in Denmark” in Clinical Physiology, Nu- Cancer Virology, University of Copenhagen, clear Medicine and PET by the Danish journal Faculty of Health Sciences. Liselotte Højgaard Dagens Medicin with votes from our collegues and Harald zur Hausen gave lectures together in Denmark. We are grateful for this apprecia- at the Solstrand meeting "Nordic University CPH tion. Research Conference" in Bergen. 177Lu-DOTA, Tyr3-octreotate

Professor Andreas Kjær and his team at the Twice a year we hold a party for the staff. In Cluster for Molecular Imaging presented lec- June 2009 we were in the Tivoli Gardens and tures, talks and posters at many meetings and in November we had a “Gangster Party” as conferences around the world, reflecting the seen in the illustration opposite. In spite of our Basel 90 3 excellent research activity carried out by the serious task of attending very sick patients Y-DOTA, Tyr -octreotide team. Doctors, physicists, bioengineers, with the best of our professional skills, it is chemists, nuclear medicine technologists and important that we as staff do our best to col- secretaries participated in several congresses laborate and help each other in a joyful and throughout the year, including those held by positive atmosphere.

10 11 Dotatate Peralust

In May 2009, we gave the first treatment The rationale for this new treatment, also The world’s first randomized study on the frequency of futile (unnecessary) with 177Lu-DOTATATE in Denmark to a called peptide receptor radionuclide thera- PET/CT was published in the New England thoracotomies were reduced in the PET/ patient with neuroendocrine tumor meta- py, is that the radiolabelled 177Lu somato- Journal of Medicine in 2009. It was a ran- CT group compared to the group without stases. Through 2009 a total of 46 treat- statin analogue binds to neuroendocrine domized prospective study of the value of PET/CT. In fact, the absolute reduction ments have been given to 16 patients. In tumors expressing somatostatin recep- preoperative staging of lung cancer with was approximately 20%, which means that collaboration with the Department of tors. The emitted beta-particles from the and without PET/CT from Rigshospitalet. for every fifth patient that had a preopera- Gastro Surgery, Rigshospitalet, and the 177Lu-isotope destroy the tumor cells. In The study was initiated by us in 2000 and tive PET/CT, one thoracotomy was avoided. Hevesy Laboratory at Risø DTU, where addition the emission of gamma photons performed in collaboration with several de- the 177Lu-DOTATATE is synthesized and la- from 177Lu allows for scintigraphic imaging partments and hospitals in Denmark. We PET/CT has been placed centrally in the belled, we treat two patients every week. and dosimetry. recruited 189 patients between 2002 and newest Danish guidelines for lung cancer 177Lu-DOTATATE is administered in our new 2007. All PET/CT scans were performed staging (lungecancerpakken). Thus, PET/ dedicated facilities in section 4114. Pa- The indications for 177Lu-DOTATATE thera- in the Department of Clinical Physiology, CT is now mandatory in the preoperative tients stay overnight at the surgical ward py are inoperable patients with neuroendo- Nuclear Medicine & PET, Rigshospitalet. staging of a potentially curable patient before returning to us the next day for crine tumors that either show progression Our main findings were that: according to the Danish National Board of scintigraphic imaging to visualize tumor or cannot tolerate standard treatment. A Health. uptake of 177Lu-DOTATATE and for dosimet- prerequisite is an 111In-octreotide scan de- 1) more patients were found to be inope- ric calculations. We aim for a total of four monstrating a high density of somatostatin rable if PET/CT was included in the Jann Mortensen 177Lu-DOTATATE treatments over a period receptors in the tumors. staging procedures of six months in every patient. 2) the frequency of thoracotomies and

Jann Mortensen and Peter Oturai

12 13 Nuclear Medicine Pediatric Nuclear Medicine

Weekly receptor targeted radionuclide function testing we have two Jaeger body based on our own research (Gutte et al. therapy against neuroendocrine tumors plethysmographs. In our animal facilities Detection of pulmonary embolism with was initiated 2009 in our newly esta- we have SPECT, PET and CT scanners. combined ventilation-perfusion SPECT and blished facilities. This made it possible to low-dose CT: head-to-head comparison avoid sending Danish patients abroad for The majority of the hybrid SPECT/CT with multidetector CT angiography. J Nucl appropriate treatment. Read more about scans comprise imaging of neuroendo- Med 2009; 50: 1987-92). 177Lu-DOTATATE therapy on page 12. crine tumors, pulmonary embolism and sentinel nodes. The somatostatin receptor Other frequent indications for lung physio- Many of the patient investigations in the ligand 111In-Octreotide imaging is the most logy measurements are control after Department of Clinical Physiology and Nu- important endocrine nuclear medicine im- chemotherapy and transplantation or pre- clear Medicine are related to the diagnosis aging modality and is being increasingly operative evaluation and radioaerosol mu- and monitoring of cancer patients. A new used for evaluation and monitoring of ra- cociliary clearance investigations for the single-head camera for monitoring heart dionuclide therapy in patients with inope- diagnosis of primary ciliary dyskinesia. The function in chemotherapy-treated patients rable tumors. A large prospective study sentinel node technique is increasingly and evaluation of thyroid patients was in- evaluating the diagnostic power of used, leading to optimized surgery of stalled in 2009, and a new ultrasound 111In-Octreotide scintigraphy, FDG PET and breast cancer, melanoma, oral cancer and scanner has improved the evaluation of 123I-MIBG scintigraphy was completed at other types of cancer. thyroid patients. the end of 2009. Radioisotope leakage monitoring proce- We have eight gamma cameras for routine Three-dimensional physiological and ana- dures are used during isolated limb per- Each year we perform 1,200 pediatric nu- nuclear medicine technologists from the tion between departments and staff con- clinical imaging and human research stu- tomical hybrid imaging using both perfusion with melphalan and tumor necrosis clear medicine investigations mainly for Pediatric Focus Group routinely give talks cerning pediatric patients throughout the dies, including three hybrid SPECT/CT fusion and ventilation SPECT with pulmo- alpha for recurrent melanoma and soft- the large pediatric clinics at the hospital. It at our collaborating pediatric departments entire hospital and to increase quality of di- cameras, one dual-head gamma camera nary low dose CT has been applied for tissue sarcoma. is a special focus area for our department in order to reinforce the collaboration. This agnostic examinations, treatment and the and four single-head cameras. For lung routine diagnosis of pulmonary embolism to perform these investigations at the high- year we focused on systematizing informa- experience of the hospitalization of the est level of excellence, and at the same tion about the procedures and the scanner child and parents. The focus of 2009 was Peter Oturai and Jann Mortensen time ensure that both the child and the performance, in order to continuously in- case-presentations of children with CNS-tu- parents have a positive experience. Our crease the quality of pediatric examina- mors, children with cystic fibrosis and child- department is a member of The Pediatric tions. We have also developed our “flying ren with psychosomatic diseases. Once Nuclear Medicine Network, which is itself squad” of pediatric nuclear technologists again, it was a great success and will be part of the the International Telemedicine giving talks at the referring departments. followed by a Pediatric Symposium in Network for Second Opinion and Exchange Nuclear Medicine Technologist Marianne 2010. of Ideas. Federspiel and Radiographer Elisabeth Abrahamsson gave a very successful talk Research in Pediatric Nuclear Medicine The Department has performed pediatric about Pediatric PET/CT at a course on and PET is necessary and we conduct re- PET scans as a focus area since 1999 Pediatric Radiography arranged by the search protocols in children with PET and and has now performed close to 1,000 Danish Society of Radiology. PET/CT in lymphomas, sarcomas, epilep- scans. Since our introduction of PET/CT in sy, brain tumors and MIBG SPECT/CT of 2001, we now have four PET/CT scanners To improve the interior design of waiting children with neuroblastomas. Research and perform most of the whole body stu- areas, examination and scanner rooms, protocols have shown that SPECT/CT can dies as PET/CT, with only a relevant num- our group paid a visit to the H.C. Ander- have an increasingly important role within ber as high-resolution CT scans. sens Hospital for Children in Odense. the pediatric area. Performing high quality The Children’s Programme at Rigshospita- patient studies based on research is the Our Pediatric Focus Group is still evolving. let and our Pediatric Focus Group planned aim, to assure the best diagnostic investi- Education is a high priority, both internally and held the Pediatric Symposium in 2009 gation for each little patient. in the department and externally and our at Rigshospitalet to strengthen coopera- Lise Borgwardt

14 15 Cyclotron Unit Radiochemistry

In 2009 we experienced, as in previous work, and we started to apply the same Routine Production ment of Medicinal Chemistry at the Danish 18F-FALGEA, a labelled peptide for imaging years, an increase in the need for 18F-la- ideas for improvements of specific activi- The demand for 18F-FDG continued to in- University of Pharmaceutical Sciences un- the epidermal growth factor tyrosine kinase belled FDG, whereas for most of our other ties and target yields at our CTI 11C target. crease in 2009, resulting in a further in- der CIMBI (Centre for Integrated Molecular receptor (EGFR), was developed in the de- isotopes production stayed at a constant crease in the number of productions. A new Brain Imaging) continued in 2009 and a partment in collaboration with the Depart- level. Almost 20% more 18F-productions As a consequence of the increasing de- dedicated FDG production laboratory has number of compounds were labelled with ment of Radiation Biology at Rigshospitalet were performed, with the major increase mands for 18F-FDG, we upgraded our RDS been designed and will be built in 2010. carbon-11 and tested in vivo in animals, in and the Department of Natural Sciences, This is necessary in order to accommodate on the RDS Eclipse cyclotron. We per- Eclipse cyclotron with a second beam line our search for a 5-HT2A agonist PET tracer. University of Copenhagen in 2008, and was formed approximately 1,100 successful and three new targets (18F, 13N and a solid future demand and to assure that our pro- A very promising tracer has been identified further tested in 2009 at the Cluster for productions and due to the high flexibility target system). We can now produce twice duction continues to live up to the require- and this will be evaluated in man as soon as Molecular Imaging at The Panum Institute. of running two cyclotrons we succeeded as much activity using dual beam irradia- ments of good manufacturing practice. In possible. Furthermore, we have continued We will apply for funding to continue this getting the fail rate below 0.5%. tions (2x60µA), but unfortunately the FDG 2009 we had some technical problems with to evaluate a new 11C-methane target, which promising project in 2010. yields are not scaled in the same way. The FDG production, which led to some delivery was constructed in 2008. We have opti- Another exciting project involves efforts to In 2009 we started to use the new chemical yields are considerably lower for irregularities. We apologize for any incon- mized and refined our procedures, which label a peptide known to bind to the uroki- 11C-methane target for our Scanditronix dual beam as compared to single beam venience this caused for both our internal has enabled us to routinely produce car- nase-type plasminogen activator receptor cyclotron for routine productions. In order irradiations. and external users. Production of krypton bon-11 labelled radiopharmaceuticals with (uPAR). The expression of this receptor is to make further developments for the 11C generators continued according to the well- very high specific radioactivities (up to elevated during inflammation, tissue re- target, we bought an additional target from established delivery schedule on Mondays, 2000 GBq/µmol at end of synthesis). This modelling and in many human cancers, in Scansys intended for more experimental Holger J. Jensen Wednesdays and Fridays. is of paramount importance for the study of which it frequently indicates poor prognosis. low density receptors in the brain. Initial efforts have focused on labelling the Research Production peptide with copper-64 and gallium-68, and 2009 was a busy year and a large number In collaboration with NeuroSearch A/S, two the in vivo stability of the resultant tracers is of different labelled neuroreceptor ligands alpha-7 nicotinic acetylcholine receptor currently being investigated. Fluorine-18 were produced for use in research projects ligands have been radiolabelled and tested labelled analogues will also be evaluated in by the Neurobiology Research Unit at Rigs- in animals, and this has resulted in the best 2010. hospitalet (see table). 11C-CUMI 101, a PET tracer for this system to date.

5HT1A agonist ligand, was approved for hu- Nic Gillings and Jacob Madsen man use in 2009 and will be evaluated extensively in 2010. 11C-PIB, the Alzheimer Radiopharmaceutical Batches released for human use 2006 2007 2008 2009 tracer, has been used extensively for re- 18F-FDG 256 268 390 433 search projects, clinical patients and drug 81mKr-Generator 694 869 885 890 trails in 2009. As in previous years we con- 18F-Altanserin 42 36 18 14 13 tinued to produce N-ammonia for cardiac 11C-DASB 47 49 11 21 15 blood flow measurements and O-water for 11C-SB207145 3 20 44 19 cerebral blood flow measurements. 11C-PIB - - 39 50 Synthesis of a number of new tracers was 11C-Flumazenil - 1 2 3 set up in 2009, including the angiogenesis 11C-CUMI 101 - - - 1 tracer 18F-Galacto-RGD. A number of other 13N-Ammonia 97 67 23 32 tracers are currently being validated for hu- 15O-Water 176 62 146 285 man use including the cell proliferation trac- Radiopharmaceutical Batches produced for animal/ in vitro studies er 18F-FLT, the hypoxia tracer 64Cu-ATSM, 18F-FLT - - 15 19 and the neuroendocrine tumor tracer 68Ga- 64Cu-ATSM - 10 10 15 DOTATOC. 18F-FALGEA - - 5 3 18F-Galacto-RGD - - - 1 11 Radiopharmaceutical Development C-Cimbi-5 & analogues - - 11 11 11C-CUMI 101 - - - 4 Collaboration with the Neurobiology Re- 11C-NS analogues - - 2 12 search Unit, Rigshospitalet and the Depart- Summary of radiopharmaceutical productions in 2006-2009

16 17 PET/CT scanning PET/CT scanning in Oncology in Radiation Therapy

Positron emission tomography and its use- superior to both scan results alone. Further- FDG is still the main tracer in oncology, but Correct target definition with inclusion of to the radiation dose planning system to- cancer and malignant lymphoma. It is fulness in oncology are well established. more, the patient is spared from an extra we also use 18F-choline for prostate cancer macroscopic as well as microscopic gether with the CT scan, and the informa- surprising how much the tumor changes With the introduction of the combined PET/ CT examination in the Department of Radio- and 18F-Na F for bone PET scans in research disease in the target volume and sparing tion is incorporated in the treatment plan- morphology during respiration, and we CT scanners, a new world has opened with logy as well as an extra radiation dose. protocols. of as much normal tissue as possible is ning. are eagerly awaiting the results! exciting possibilities. the main challenge in curative radiothera- In 2009, we performed 4,500 PET/CT Having worked with PET/CT for many years py, particularly with highly conformal Research in this field is necessary, and PET/CT-based radiotherapy planning can Our CT scans of PET/CT are performed as scans of which more than 90% were oncolo- now, we are convinced of the usefulness of treatment methods. The use of PET/CT we have conducted trials with nasopha- improve the therapeutic output in terms high quality diagnostic scans with the use of gical. The indications are mainly staging, PET/CT in everyday clinical work and the in radiotherapy planning of cancer pa- ryngeal and cervical cancer and malig- of target definition and non-target avoid- oral and intravenous contrast media. The therapy monitoring and detection of recur- research papers that keep coming confirm tients has increased very rapidly since nant lymphoma with encouraging results. ance and will play an important role in PET- and CT-scans are initially interpreted rent disease in patients with a variety of ma- this impression. However, clinical trials are the method was introduced in 2001. PET/CT for radiotherapy planning is now future therapeutic interventions in many separately by a nuclear medicine physician lignant diagnoses. During the past year we still necessary to verify the usefulness of used routinely for patients with cervical, malignant diseases. and a radiologist followed by a joint interpre- have introduced a supplementary CT of the the method, to refine the scanning proto- We cooperate closely with the Depart- head and neck, lung, oesophageal, car- tation of the fused images and a final, com- lungs with ‘breathhold’ techniques to impro- cols and to develop new indications. ment of Radiotherapy on the use of PET/ diac, rectal and anal cancers as well as bined conclusion taking both examinations ve the diagnostic quality. Approximately CT for treatment planning of cancer and malignant lymphoma and mesothelioma. into account. This provides the clinician with 50% of our patients participate in clinical we do more than 700 PET/CT scans for We have an ongoing study using 4D-PET/ Anne Kiil Berthelsen a more precise PET result, a better CT re- research protocols. Our main topics are gy- Annika Loft Jakobsen radiotherapy every year. Our own experi- CT for radiotherapy planning for lung and Annika Loft Jakobsen sult, and also a more useful conclusion. The naecology, malignant lymphoma and lung and Anne Kiil Berthelsen ence since 2002 is briefly summarized CT result improves in quality because PET cancer, where the results from our studies from more than 2,500 patients with vari- can help depict small tumors that can easily have resulted in a paradigm shift with PET/ ous malignant diseases undergoing radio- be overlooked even by a trained radiolo- CT at the forefront of diagnostic strategies. therapy planning with PET/CT prior to the gist’s eye. The PET positive foci are more treatment. precisely determined as correct or false We have nine weekly multidiciplinary team positive with the help of the CT information. conferences, where our PET/CT scan re- The demanding collaboration between Finally, the combined PET/CT conclusion is sults are discussed. technicians, nuclear medicine physicians and technologists, radiologists and radiology technologists, radiation oncologists, physicists, and dosimetrists must be em- phasized.

The advantages of PET/CT are numerous: the anatomical localization and the metabolic activity of the tumor are de- fined, and the tissue heterogeneity can then be taken into account when choos- ing radiation technique and energy, and only one scan is necessary. Three of our PET/CT scanners have the possibility of performing PET/CT scans for radiotherapy planning. The nuclear medicine specialist delineates the viable tumors de- picted by PET on the fused PET/CT images after interpretation together with the radiologist. The regions are exported

Dose distribution in a patient undergoing stereotactic radiation therapy for a non-small cell carcinoma

18 19 Cardiac Studies Academic Activities

Cardiac SPECT every weekday Viability studies with PET occurs almost exclusively in atheroscle- Julie Bjerglund Andersen, Medical Student, is L’Institut National de la Sante et de la Recherch- Bioanalytikeruddannelsen i Storkøbenhavn in the Rigshospitalet provide cardiac SPECTs In patients with multi-vessel disease, in- rotic arteries, and is absent in the normal Co-founder of and Vice-chair for PUFF, the or- es Medicales, Frankrig, a member of the Sci- Capital Region (the speciality council for the every day. A large proportion of our pa- creased LV volumes and variable degrees vessel wall. Multi-detector computed ganization for young researchers at the Faculty ence Advisory Board, IMI, the Innovative Medi- education of laboratory technologists). of Health Sciences at the University of Copenha- cines Initiative a member of EC FP7 Science tients with ischemic heart disease need of regional and/or global systolic dys- tomography detected coronary artery Ian Law, Chief Physician, is responsible for the gen, (Panums Ungdoms Forsker Forening: puff- Advisory Board in Medical Research, a member an acute or sub-acute work-up that re- function, coronary revascularization may Brain imaging and Oncology specialist courses calcium can provide an estimate of total net.dk). of the ESS European Spallation Source, Preper- for Nuclear Medicine Physicians and a member quires quick decision-making regarding lead to symptomatic and prognostic im- coronary plaque burden 1) to assist in atory Group, University of Copenhagen, a mem- Anne Kiil Berthelsen, Chief Physician, is a of the Guideline Group for Sarcoma. the coronary revascularization strategy. provement and these clinical benefits are coronary heart disease (CHD) risk assess- ber of the Danish Council for Research Policy, a member of the Danish Lymphoma Group (DLG). Patients with unstable angina or nonSTE- accompanied by evidence of reverse LV ment in asymptomatic patients and 2) to member of the Council for Medical Museion (Mu- Jann Mortensen, Clinical Associate Professor, MI should be revascularized with percuta- remodelling. The main strengths of PET assess the likelihood of the presence of Lise Borgwardt, Senior Registrar, is a member seum of the History of Medicine in Copenha- Chief Physician, is a member of the board of neous coronary intervention within three compared with SPECT are its superior CHD in patients who present atypical of the Tumor Board for Pediatric Solid Tumors gen). She represents the University of Copenha- Dansk Selskab for Klinisk Fysiologi og Nuklear- at Copenhagen University Hospital, Rigshospi- gen and Rigshospitalet in the programme MSc medicin, DSKFNM (Danish Society of Clinical days after admission or with coronary ar- spatial resolution and attenuation correc- symptoms which could be consistent with talet, external member of the guideline group in Medicine and Technology in cooperation with Physiology and Nuclear Medicine), a member of tery bypass graft surgery within 5–7 days tion and cardiac PET is generally regar- myocardial ischemia. Coronary calcium for Pediatric PET under EANM and Chair of the The Technical University of Denmark (DTU), and the board of Dansk Endokrinologisk Selskab according to the Danish National Board of ded as the gold standard for viability as- measurement by coronary CT scanning Pediatric Network Group at Rigshospitalet and is a member of ATV, The Danish Academy of (Danish Society of Endocrinology) and is on the Health. We can now offer acute cardiac sessment. Clinical 13NH3 (perfusion is a routine in relevant patients and in Chair of the Pediatric Focus Group at the De- Technical Sciences. Steering Committee of Dansk Lungecancer SPECT five days a week for those pa- tracer) and 18F-FDG (glucose analogue accordance with recently published guide- partment of Clinical Physiology, Nuclear Medi- Gruppe (Danish Lung Cancer Group). He is Annika Loft Jakobsen, Chief Physician, is a tients who need further evaluation after metabolism tracer) scans are performed lines from the American Heart Associa- cine and PET. member of the Regionale videnskabsetiske member of the European Organisation for Re- komité F for Hovedstaden (the Regional Ethic coronary angiography. weekly. tion/American College of Cardiology. Kirsten Bouchelouche, Senior Registrar, is a search and Treatment of Cancer (EORTC), the Committee), a member of the subcommittees member of the ESSIC criteria group in the Euro- Functional Imaging Group, a member of the for Dansk Diagnostisk Lungecancer Gruppe pean Society for the Study of Interstitial Cysti- In 2009 our gated cardiac SPECT studies Introduction of coronary artery calcium score EANM, AMI, BIR and Oncoradiological Society (Danish Diagnostic Lung Cancer Group) and tis/Painful Bladder Syndrome. were certified by Cardiovascular Core Coronary arterial calcification is part of Philip Hasbak and Danish Society of Clinical Physiology and Lungecancer Screeningsgruppen (Screening of Laboratories, Inc., Boston, MA, US. the development of atherosclerosis, Christine Winkler Dümcke, Senior Registrar, Nuclear Medicine, Chair of the Diagnostic Imag- Lung Cancer Group), a member of the supple- ing Group under Danish Lymphoma Group is a member of the Course Committee at the mentary training committee of the Danish So- (DLG), a member of the Guideline Group for Danish Society of Clinical Physiology and Nucle- ciety of Clinical Physiology and Nuclear Medi- ar Medicine. Pharyngeal/Laryngeal Cancer, a member of Re- cine and representative for the Danish Society gional Working Groups for Cancer treatment: of Clinical Physiology and Nuclear Medicine in Nic Gillings, Chief Radiochemist, is a member Myocardial perfusion colonic, rectal, lymphoma, malignant mela-no- Dansk Medicinsk Selskab (Danish Medical So- Diastole Systole Acute Follow-up Acute Tako-Tsubo cadiomyopathy of the management committee of the EU COST Images obtained with ma, a member of National Working Groups for ciety). He is a member of the National Working Action B12 programme: Radiotracers for in vivo 99mTc-Sestamibi at rest Lymphoma, and a member of the Steering Group for planning clinical guidelines for Lung Assessment of Biological Function. during acute onset of Group for the Danish Liver and Biliary Cancer. Cancer workup and the Regional Working Group Tako-Tsubo and at three Birger Hesse, Chief Physician, is a member of Professsor Andreas Kjær, Chief Physician, is for implementation of clinical guidelines for month follow-up. The the European Council of Nuclear Cardiology the President of the Scandinavian Society of Breast Cancer workup. He is responsible for the acute images demon- (ECNC) and Chair of The Medical Research Li- Clinical Physiology and Nuclear Medicine (SSCP- specialist course in Clinical Respiratory Physio- strate a severe perfusion brary at Rigshospitalet, a member of the Cardio- NM), a member of the Board of the Research logy for nuclear medicine physicians and respi- 3 month follow-up deficit in the apex and the vascular Committee at EANM, and a member of Council at Rigshospitalet, a member of the Sci- ratory physicians, and is section editor of the mid-cavity of the left ven- the Working Group for Cardiac Imaging at the entific Committee of the Danish Cancer Society, Clinical Respiratory Journal. Gated cardiac SPECT - Tako-Tsubo in tricle. Danish Society of Cardiology. Editor-in-Chief of Open Neuroendocrinology Peter Oturai, Chief Physician, is responsible the acute setting with aneurysmal apex The scan is normal at Søren Holm, Chief Physicist, is President of Journal, leader of the project Molecular Imaging for postgraduate education. He was a member and preserved function at the basis of three month follow-up, the Danish Society for Medical Physics (DSMF), for Testing of New Drugs funded by the Danish of the board and Vice President of the Danish the left ventricle. illustrating the transient a member of the Educational Board of DSMF National Advanced Technology Foundation, Part- Society for Clinical Physiology and Nuclear Me- nature of this syndrome. and a delegate for the DSMF at the European ner of the Danish Chinese Center for Proteases dicine (DSKFNM), a representative for DSKFNM Difference plot Federation of Organizations in Medical Physics and Cancer funded by the National Natural Sci- in the Danish Medical Society (Dansk Medicinsk (EFOMP), a member of an IAEA advisory group ence Foundation of China and the Danish Na- Selskab). He is Danish delegate, representing concerned with QA/QC and image artefacts af- tional Research Foundation, Steering Commit- DSKFNM, in the European Association of Nucle- fecting quantitation in PET/CT, a member of tee member and partner of EATRIS (the ar Medicine, in the European Union of Medical Sundhedsfagligt Råd i Klinisk Fysiologi og Nuk- European Advanced Translational Research In- Specialists (UEMS), and in the World Federation learmedicin in the Capital Region, the Specialty frastructure in Medicine) under the EU 7FP, and of Nuclear Medicine and Biology. His is a mem- Tako-Tsubo, Advisory Committee (SFR) in Clinical Physiology Head of the Cluster for Molecular Imaging and ber of the UEMS – Accreditation of Nuclear Japanese for octopus trap. and Nuclear Medicine, and an external lecturer Director of the Postgraduate School for Molecu- Medicine Training Centres Committee, a mem- at Copenhagen University. lar Imaging at the Faculty of Health Sciences, ber of the Board of the Danish Thyroid Associa- University of Copenhagen. tion (DTS) and a member of the Danish Thyroid Professor Liselotte Højgaard, Head of De- Cancer Guideline Group. Tako-Tsubo cardiomyopathy partment, is Chair of the Standing Committee of Linda M. Kragh, Chief Nuclear Medicine Tech- Transient apical ballooning syndrome is a relatively rare acute cardiac syndrome with a pathophysiology which is not well understood. Patients the European Medical Research Councils nologist, is a member of Sundhedsfagligt Råd i Kate Pedersen, Nuclear Medicine Technolo- with this disorder (named after the Japanese word for an octopus trap) often present after an emotionally or physically stressful event with chest (EMRC) at the European Science Foundation, Klinisk Fysiologi og Nuklearmedicin in the Capi- gist, is a member of the Technologist Commitee pain, electrocardiographic changes, and mild elevation of cardiac markers suggestive acute coronary syndrome. Upon angiography, no obstruc- Strasbourg and member of the Science Adviso- tal Region, the Specialty Advisory Committee under EANM and member of Udvalget for tive coronary artery disease is identified. Echocardiography or ventriculography typically shows an aneurysmal or dyskinetic apex and mid ventri- ry Board at the European Science Foundation, a (SFR) in Clinical Physiology and Nuclear Medi- Ledende og Afdelingsbioanalytikere i Region cle with preserved or hyperdynamic function at the basal ventricular level. member Conseil d’Administration, INSERM, cine, and a member of Uddannelsesrådet for Hovedstaden under Dbio.

20 21 Patient Investigations

CNS and peripheral nervous system Peripheral vessels Peritumoral injection of 99mTc-nanocolloid for sentinel node operation 800 15 99m Regional cerebral bloodflow, rest, 0-H20 18 Isolated limb perfusion leakage monitoring, chemotherapy 14 Spleen scintigraphy, Tc-erytrocyte, heated 3 15 Animal Studies Regional cerebral bloodflow, physiological, 0-H20 23 Total 14 Total 1.030 Regional cerebral metabolism, 18F-FDG 279 18 Regional cerebral metabolism, F-Altanserin 20 Gastrin intestinal tract, including liver, biliary tract and pancreas Other diagnostic procedures Rabbits 99mTc-Nanocoll 4 11 99m 111 Regional cerebral receptor, stat. C-DASB 20 Bleeding scintigraphy (abdomen), Tc-erythrocyt 3 Tumor scintigraphy, In-Octreotide 271 111In-labelled antibodies 4 11 99m 18 Regional cerebral receptor, stat. C-SB 18 Biliary tract scintigraphy, Tc-Mebrofenin 16 PET tumor scanning, F-FDG 3.719 Rats 18F-FDG 65 11 99m 18 Regional cerebral receptor, stat. C-PIB 29 Meckels diverticulum scintigraphy, Tc-pertechnetat 3 PET infection scanning, F-FDG 56 Mice 18F-FDG 354 11 18 Regional cerebral receptor, C-PIB, 25 Schilling-test 2 PET scanning, F-FDG 25 18F-FLT 99 18 18 Regional cerebral receptor, dyn. F-AH110690 4 Total 24 PET tumor scintigraphy, F-Cholin 13 18F-Galacto-RGD 1 11 111 Regional cerebral receptor, dyn. C-FMZ 3 White blood cell scintigraphy, In-Leucocyt 135 64Cu-ATSM 120 Total 439 Kidneys and urinary tract Whole body, contamination measurement 36 64Cu-DOTATATE 41 51 Glomerular filtration, Cr-EDTA, several samples 192 Image fusion (PET, SPECT, MRI, CT or planar), PET and KF section 4.473 64Cu-Nanoparticles 10 51 Respiratory organs Glomerular filtration, Cr-EDTA, one sample 4.096 Diagnostic CT, PET 3.442 64Cu-AE105 30 99m Lung function test, whole body plethysmography 1.235 Renal scintigraphy, Tc-DMSA 9 Diagnostic CT, KF 60 68Ga-DOTATOC 31 99m Lung function test, whole body plethysmography w/reversibility 136 Renography, Tc-MAG3, diurese 24 CT-therapy scanning 709 117Lu-DOTATATE 23 99m Lung function test, spirometry, WLHLB +WL1LB 1.158 Renography, Tc-MAG3, Dual head 1 Second opinion description of external PET, PET/CT investigations 633 Pigs 15O-H2O 1 99m Lung function test, spirometry w/reversibility 167 Renography, Tc-MAG3 1.877 Digitilization PET images 104 18F-FDG 1 99m Lung function test, spirometry, physiological provocation 17 Renography, Tc-MAG3, ACE-inhibitor 114 Extra tumor deliniation 43 11C-cerebral receptor (NRU) 13 99m 18 Lung function test, diffusioncapacity (CO) 2.632 Renography, Tc-MAG3 Graft 13 First pass F-FDG tumor scans 27 Dogs 64CU sarcom ATSM 6 Lung function test, peak flow w/reversibility 1 Total 6.326 Supplementary/repeated imaging, PET and KF section 1.485 18F-FDG 6 Max. inspiratoric and expiratoric pressure 35 Investigations without specification 8 CT-scanning, perfusion 8 99m 64 Lung perfusion scintigraphy, Tc-MAA 164 Bone and joint Cu-DOTATATE 5 99m 18 Lung perfusion scintigraphy, regional, 99mTc-MAA 39 Bone scintigraphy, Tc-HDP, regional, static 90 PET first pass F-FDG 22 Total number of animal studies: 819 Lung perfusion scintigraphy, Spect, 99mTc-MAA 147 Bone scintigraphy, 99mTc-HDP, whole body, static 1027 Total 15.266 Lung ventilation scintigraphy, Spect, 81mKr-gas 140 Bone scintigraphy, 99mTc-HDP, SPECT 35 Lung ventilation scintigraphy, 81mKr-gas 160 Bone marrow scintigraphy, 99mTc-nanocolloid 1 Radiotherapy Lung ventilation scintigraphy, regional, 81mKr-gas 49 Total 1.153 Treatment with 131I-jodide, benign thyroid 76 Mucociliary clearance, 99mTc-venticolloid 15 Isotope treatment with 90Y-Zevalin 3 Total 6.095 Endocrine organs Isotope treatment with 177Lu-DOTATATE 46 Thyroid scintigraphy, 99mTc-pertechnetat 502 Total 125 Heart and cardiovascular system Thyroid scintigraphy, 123I-jodid 1 IIsotope cardiography, first pass, 99mTc-HSA 29 Iodine absorption gl. thyroid 131I-jodid 2 Total number of patient investigations: 33.600 Isotope cardiography, LVEF, 99mTc-HSA 1.378 Parathyroid scintigraphy, 99mTc-MIBI, SPECT + CT 58 Myocardial perf. scintigr. gated, 99mTc-MIBI, pharmacol. stress, dipy. 7 Tumorscintigraphy, 123I-jodid 85 Myocardial perf. scintigr. gated. 99mTc-MIBI, pharmacol. stress, dobut. 3 Whole body scintigraphy, diagnostic 123I-jodide 45 TURNOVER 2003-2009 99m 123 Myocardial perf. scintigr. gated, Tc-MIBI, pharmacol. stress, adeno. 162 Adrenal marrow scintigraphy, I-MIBG 42 120 99m Whole body scintigraphy after 131I-therapy 100 Myocardial perf. scintigr. gated, Tc-MIBI, physiological stress 167 Finance 110 99m 177 Myocardial perf. scintigr. gated, Tc-MIBI, NTG 240 Scintigraphy after Lu-DOTATATE-therapy 123 100 99m Myocardial perf. scintigr. gated, Tc-MIBI 8 Total 958 90 123 BALANCE 2009 Myocardial I-MIBG scintigraphy 1 80

Calcium score 100 Blood and lymph system 70 Expenditure 99m PET myocardial perfusion, 13N-NH 23 Erytrocyte volume, Tc-ery 12 60 3 Running costs DKK 17.8 million 99m PET myocardial perfusion, 13N-NH , pharmacol. stress, dipy. 6 Lymph scintigraphy, extremities, Tc-HSA, stases 1 50 3 Staff DKK 43.9 million PET myocardial perfusion, 13N-NH , cold press, phys. stress 3 Sentinel node, tumor drainage, 99mTc-nanocolloid, dynamic 24 40 3 In total DKK 61.7 million PET myocardial metabolism, 18F-FDG 22 Sentinel node scintigr. tumor drainage, mamma c, 99mTc-nanocolloid 17 30 Exercise electrocardiography 21 Sentinel node scintigr. tumor drainage, malign. mel., 99mTc-nanocolloid 158 20 Receipts DKK 19.4 million Total 2.170 Sentinel node scintigr. tumor drainage, penile c, 99mTc-nanocolloid 6 10 Net sum DKK 42.3 million Sentinel node scintigr. tumor drainage, vulva c, 99mTc-nanocolloid 9 0 2003 2004 2005 2006 2007 2008 2009

22 23 Cluster for Research Molecular Imaging

A strong focus on research is a cor- ferent tracers in various forms of cancer the use of SPECT/CT the development of The change in paradigm towards individua- Two major applications of these tracers Through the formation of the Cluster for nerstone of the department. We have an in children and adults. Head-to-head com- ischaemic heart diseases is studied in se- lized, tailored therapy has led to an increa- are anticipated: 1) planning of individuali- Molecular Imaging at the Faculty of Health extensive research programme and colla- parison studies of new PET tracers and lected groups of patients. sing need for diagnosing at the molecular zed, tailored therapy, and 2) testing of new Sciences, University of Copenhagen (hea- borate with several national and interna- established imaging methods are also level. Most of the molecular biology me- drug candidates. ded by Professor Andreas Kjær) a core fa- tional partners. Our research focuses on performed. The use of PET/CT for the Lung studies thods used today need tissue sampling for cility at the Panum Institute for molecular development of new tracers for PET and planning of radiation therapy (IMRT, “do- Research is being conducted into mucoci- in vitro analysis. In contrast, molecular The development of new molecular ima- imaging in animals with PET, SPECT and nuclear medicine, on clinical evaluation of se-painting”) and the use of respiratory liary clearance of the nose and lungs, and imaging allows for non-invasive diagnosis ging tracers for PET is a very complex pro- CT has been established. This has impro- new diagnostic methods, and on the use gating are also currently being evaluated. lung function testing and lung scintigraphy at the cellular and molecular level in the cess that involves many steps from defini- ved our translational capacity since we are of methods from clinical physiology and in different patient groups, e.g. lung living, intact organism. With PET it is possi- tion of target to final use of the tracer in now able to test new tracers in animal mo- nuclear medicine to study pathophysiolo- Pediatric nuclear medicine investigations transplantation. The value of combined ble to label a whole new group of biomole- patients. dels prior to clinical use. In accordance gy. Translational research in the area of The department conducts many pediatric use of SPECT/CT for diagnosing pulmo- cules with radioactive isotopes to be used with this we have currently several new tra- molecular imaging is currently given spe- investigations. Several research proto- nary embolism has recently been evalu- for visualization of, for example, metabo- Main steps involved in tracer development cers in pre-clinical testing in animal models cial attention in order to reduce time from cols with the use of PET and SPECT are ated. Animal experiments investigating lism, receptors and gene-expression. and use that are already or soon will become avai- development to use in patients. Some carried out in cooperation with clinical de- deposition characteristics are other Especially within cancer biology, but cer- Selection of key-processes involved in lable for human use. current areas of major research are partments, particularly within oncology. examples of current lung research. tainly not limited to this, these techniques the pathophysiology of the disease detailed below. are expected to lead to a breakthrough in The Cluster for Molecular Imaging is ima- Definition of relevant molecular Neuro PET Radionuclide treatment diagnosis and treatment. Of the different ging partner in the European Advanced targets of the key-processes New tracers With the use of PET/CT, including HRRT, Localized radiation therapy using specific methods for molecular imaging only the Translational Infrastructure in Medicine Several projects aimed at the develop- studies on brain tumors are undertaken. ligands binding to certain cancer forms nuclear medicine based techniques are of Design of specific ligands (EATRIS) under EU 7FP. ment of new, specific tracers for non-inva- Studies of brain perfusion using PET or has recently been implemented. The de- a true translational nature, i.e. methods Radioactive labelling of ligands sive tissue characterization are currently DCE-CT are also performed. In addition, partment takes part in research within developed in animal models may directly Currently the main focus of translational re- undertaken. These tracers are to be used imaging of dementia with new tracers is this area by testing new ligands and pro- be transferred to and used in humans. Test of imaging ligands in relevant search in tracers for non-invasive tissue for the diagnosis of different cancer ty- studied. In cooperation with Professor ducing relevant isotopes. Cancers that animal models characterization is on their use in cancer pes as well as for planning and monito- Gitte Moos Knudsen’s group in the Neuro- are currently being targeted include cer- Our current molecular imaging research and cardiovascular disease. However, se- Use of imaging data for therapy plan- ring therapy. The projects, translational in biology Research Unit and Centre for Inte- tain types of lymphoma, ovarian cancer programme is aimed towards the use of veral other applications are also foreseen. ning and monitoring of response nature, are carried out in collaboration grated Molecular Brain Imaging, neuro re- and neuroendocrine tumors. Treatment molecular biology and imaging techniques with other departments and laboratories ceptor ligands have been developed and will in part be based on imaging using in both animals and humans to develop, Use for diagnosis, therapy planning to ensure expertise in molecular biology, used for research in neurobiology. The fo- new tracers for molecular profiling for evaluate and use non-invasive molecular and monitoring in patients Andreas Kjær chemistry, radiochemistry, cancer biology cus has mainly been on the serotonergic optimal outcome and fewer side effects. imaging for human tissue characterization. Use in testing of new drugs and imaging. For validation of tracers, we system. also have molecular biology and biomar- Whole body counting ker laboratory facilities at the depart- Atherosclerosis Together with external partners, whole ment. In collaboration with a pharmaceu- With the use of PET/CT we can non-inva- body counting is used for exact measure- tical company and supported by the sively visualize atherosclerosis and pre- ments of body composition in a series of Glycolytic activity Danish National Advanced Technology dict vulnerability of atherosclerotic studies. In addition we are investigating Cell proliferation Receptor Foundation, we have established a mole- plaques. Several studies in different absorption of certain minerals from the expression cular imaging platform for testing of new groups of patients at risk are currently gastrointestinal tract. anti-cancer drugs and for tailoring anti- undertaken. Hypoxia cancer therapy. Nuclear cardiology Andreas Kjær Angiogenesis Clinical PET/CT With the use of PET, coronary flow regula- A large number of prospective protocols tion is studied in connection with gene are performed to evaluate the diagnostic therapy and pharmacological interven- Proteolysis and prognostic value of PET/CT with dif- tions in a variety of disease states. With Apoptosis

Some tissue characteristics currently targeted for imaging

24 25 Publications 2009

Doctoral Thesis Back T, Haraldsson B, Hultborn R, Jensen H, Johansson Ewertsen C, Nielsen KR, Henriksen BM, Torp-Pedersen Hojgaard L et al. A vital voice. Medical Science and Re- Kupers R, Danielsen ER, Kehlet H, Christensen R, Thom- cancer diagnosis and on selection of patients for sec- Pinborg L. Molecular Imaging of receptors and trans- ME, Lindegren S, Jacobsson L. Glomerular filtration rate S, Nielsen MB. Image fusion with ultrasound. Ugeskr search. Public service review: European Union 2009; sen C. Painful tonic heat stimulation induces GABA accu- ondary cytoreductive surgery. Int J Gynecol Cancer porters in humans using PET and SPECT: after alpha-radioimmunotherapy with 211At-MX35- Laeger 2009; 171: 1069. 18: 223-4. mulation in the prefrontal cortex in man. Pain 2009; 2009; 19: 600-4. from models to methods and potentially to pitfalls. F(ab’)2: a long-term study of renal function in nude mice. 142: 89-93. Defended June 4th 2009 at University of Copenhagen, Cancer Biother Radiopharm 2009; 24: 649-58. Fischer B, Lassen U, Mortensen J, Larsen S, Loft A, Jakobsen AL, Jensen M. Picture of the month: bone Rue NK, Klyver H, Hougaard CA, Nedergaard L, Hesse Faculty of Health Sciences. Bertelsen A, Ravn J, Clementsen P, Hogholm A, Larsen scintigraphy. Ugeskr Laeger 2009; 171: 2205. Kupers R, Schneider FC, Christensen R, Naert A, Hus- B, Bachmann NM. Sentinel node detection in melano- Berthelsen AK. Blodsygdomme. In: de Muckadell OBS, K, Rasmussen T, Keiding S, Dirksen A, Gerke O, Skov B, ted H, Paulson OB, Kehlet H. No evidence for general- mas using contrast-enhanced ultrasound. Acta Radiol PhD Thesis Haunso S, Vilstrup H, eds. Medicinsk Kompendium. 17. Steffensen I, Hansen H, Vilmann P, Jacobsen G, Backer Jeppesen PB, Lund P, Gottschalck IB, Nielsen HB, Holst ized increased postoperative responsiveness to pain: a 2009; 50: 412-7. Bie-Olsen LG. Influence of hypoglycaemia and basal ed. Nyt Nordisk Forlag Arnold Busck; 2009: 1771-3. V, Maltbaek N, Pedersen J, Madsen H, Nielsen H, Hoj- JJ, Mortensen J, Poulsen SS, Quistorff B, Mortensen, combined behavioral and serial functional magnetic res- PB. Short bowel patients treated for two years with glu- renin-angiotensin system activity on regional cerebral gaard L. Preoperative staging of lung cancer with com- onance imaging study. Anesth Analg 2009; 109: 600-6. Sardanelli F, Fausto A, Di Leo G, de Nijs R, Vorbuchner blood flow different cognitive loads, a H215O PET Bie-Olsen LG, Pedersen-Bjergaard U, Kjaer TW, Lonsdale bined PET-CT. N Engl J Med 2009; 361: 32-9. cagon-like peptide 2 (GLP-2): compliance, safety, and M, Podo F. In vivo proton MR spectroscopy of the breast study. Defended September 4th 2009 at University of MN, Law I, Thorsteinsson B. Association between re- effects on quality of life. Gastroenterol Res Pract 2009: Kupers R, Frokjaer VG, Naert A, Christensen R, Budtz- using the total choline peak integral as a marker of ma- Copenhagen, Faculty of Health Sciences. gional cerebral blood flow during hypoglycemia and ge- Frisoni GB, Lorenzi M, Caroli A, Kemppainen N, Nagren 425759. Joergensen E, Kehlet H, Knudsen GM. A PET 18F-altan- lignancy. Am J Roentgenol 2009; 192: 1608-17. netic and phenotypic traits of the renin-angiotensin sys- K, Rinne JO. In vivo mapping of amyloid toxicity in Alzhe- serin study of 5-HT2A receptor binding in the human Jeppesen PB, Lund P, Gottschalck IB, Nielsen HB, Holst Chakera A. Technical challenges and clinical implica- tem. J Cereb Blood Flow Metab 2009; 29(11): 1790-5. imer disease. Neurology 2009; 72(17): 1504-11. brain and responses to painful heat stimulation. Scheinin NM, Aalto S, Koikkalainen J, Lotjonen J, Karra- JJ, Mortensen J, Poulsen SS, Quistorff B, Mortensen tions of preoperative sentinel node identification in Neuroimage 2009; 44: 1001-7. sch M, Kemppainen N Vitanen M, Nagren K, Helin S, breast cancer and cutaneuous melanoma. Defended Bie-Olsen LG, Kjaer TW, Pedersen-Bjergaard U, Lonsdale Frokjaer VG, Erritzoe D, Madsen J, Paulson OB, Knud- PB. Short bowel patients treated for two years with glu- Scheinin M, Rinne JO. Follow-up of 11C-PIB uptake and May 19th 2009 at Rigshospitalet, University of Copen- MN, Holst JJ, Law I, Thorsteinsson B. Changes of cogni- sen GM. Gender and the use of hormonal contraception cagon-like Peptide 2: effects on intestinal morphology Lehel S, Madsen J, Gillings N. HPLC methods for the pu- brain volume in patients with Alzheimer disease and tion and regional cerebral activity during acute hypogly- and absorption, renal function, bone and body composi- hagen, Faculty of Health Sciences. in women are not associated with cerebral cortical 5-HT rification of 11C-labelled radiopharmaceuticals: reversal controls. Neurology 2009; 73: 1186-92. cemia in normal subjects: A H2 15O positron emission tion, and muscle function. 2A receptor binding. Neuroscience 2009; 163: 640-5. Gastroenterol Res Pract of the retention of products and precursors. J Label Erritzoe D. In vivo serotonergic markers in overweight tomographic study. 2009; 87: 1922-8. 2009: 616054. J Neurosci Res Compd Radiopharm 2009; 52: 177-81. Sibomana M, Keller SH, Svarer C, Olesen OV, Andersen and schizophrenic human subjects. Defended April 17th Frokjaer VG, Vinberg M, Erritzoe D, Svarer C, Baare W, F, Holm S, Hojgaard L. New Attenuation Correction for 2009 at University of Copenhagen, Faculty of Health Bouchelouche K, Capala J, Oehr P. Positron emission Budtz-Joergensen E, Madsen K, Madsen J, Kessing LV, Kalbitzer J, Svarer C, Frokjaer VG, Erritzoe D, Baare WF, Loft A. PET og PET/CT. In: de Muckadell OBS, Haunso the HRRT using transmission scatter correction and To- Sciences. tomography/computed tomography and radioimmuno- Knudsen GM. High familial risk for mood disorder is as- Madsen J, Hasselbalch SG, Knudsen GM. A probabilistic S, Vilstrup H, eds. Medicinsk Kompendium. 17. ed. Nyt tal Variation Regularization. IEEE Nuclear Science Sym- therapy of prostate cancer. Curr Opin Oncol 2009; sociated with low dorsolateral prefrontal cortex seroton- approach to delineating functional brain regions. J Nucl Nordisk Forlag Arnold Busck; 2009: 1773-4. posium Conference Record, 2009. Kaltbitzer J. The serotonin transporter and behavior. 21: 469-74. in transporter binding. Neuroimage 2009; 46: 360-6. Med Technol 2009; 37: 91-5. Gene environment interactions. Defended November Marner L, Gillings N, Comley RA, Baare WF, Rabiner EA, Sibomana M, Keller SH, Holm S, Bloomfield PM, Blinder 16th 2009 at University of Copenhagen, Faculty of Brauner EV, Mortensen J, Moller P, Bernard A, Vinzents Gaster RS, Hall DA, Nielsen CH, Osterfeld SJ, Yu H, Kalbitzer J, Frokjaer VG, Erritzoe D, Svarer C, Cumming Wilson AA, Houle S, Hasselbalch SG, Svarer C, Gunn S, Hansen SB, Michel C. Component-based Normalisa- Health Sciences. P, Wahlin P, Glasius M, Loft S. Effects of ambient air Mach KE, Wilson RJ, Murmann B, Liao JC, Gambhir SS, P, Nielsen FA, Hashemi SH, Baare WF, Madsen J, Has- RN, Laruelle M, Knudsen GM. Kinetic modeling of tion for the HRRT PET Sinogram-Mode Reconstruction. particulate exposure on blood-gas barrier permeability Wang SX. Matrix-insensitive protein assays push the selbalch SG, Kringelbach ML, Mortensen EL, Knudsen 11C-SB207145 binding to 5-HT4 receptors in the human IEEE Nuclear Science Symposium Conference Record, Kornum B. A pig model for studies of serotonergic and lung function. Inhal Toxicol 2009; 21: 38-47. limits of biosensors in medicine. Nat Med 2009; GM. The personality trait openness is related to cerebral brain in vivo. J Nucl Med 2009; 50: 900-8. 2009. mechanisms in memory disorders. Defended October 15: 1327-32. 5-HTT levels. Neuroimage 2009; 45: 280-5. 29th 2009 at University of Copenhagen, Faculty of Burton CM, Iversen M, Carlsen J, Mortensen J, An- Marner L, Knudsen GM, Haugbol S, Holm S, Baare W, 18 Health Sciences. dersen CB, Steinbruchel D, Scheike T. Acute cellular re- Gerke O, Poulsen MH, Bouchelouche K, Hoilund-Carlsen Kapucu OL, Nobili F, Varrone A, Booij J, Vander Borght Skovgaard D, Kjaer M, El-Ali H, Kjaer A. F-fluorodeoxy- Hasselbalch SG. Longitudinal assessment of cerebral jection is a risk factor for bronchiolitis obliterans syn- PF, Vach W. PET/CT in cancer: moderate sample sizes T, Nagren K, Darcourt J, Tatsch K, Van Laere KJ. EANM glucose and PET/CT for noninvasive study of exercise- 5-HT2A receptors in healthy elderly volunteers: an Marner L. Molecular brain imaging of the serotonin sys- drome independent of post-transplant baseline FEV1. may suffice to justify replacement of a regional gold procedure guideline for brain perfusion SPECT using induced glucose uptake in rat skeletal muscle and ten- 18F-altanserin PET study. Eur J Nucl Med Mol Imaging don. 2009; 36: 859-68. tem: Reproducibility and evaluation of PET radiotracers. J Heart Lung Transplant 2009; 28: 888-93. standard. Mol Imaging Biol 2009; 11: 381-5. (99m)Tc-labelled radiopharmaceuticals, version 2. Eur J Eur J Nucl Med Mol Imag 2009; 36: 287-93. Defended March 13th 2009 at University of Copenha- Nucl Med Mol Imag 2009; 36: 2093-2102. gen, Faculty of Health Sciences. Chakera AH, Hesse B, Burak Z, Ballinger JR, Britten A, Gillings N. A restricted access material for rapid ana- Skovgaard D, Kjaer M, Madsen J, Kjaer A. Noninvasive Mortensen J. Billeddiagnostik af lunger. In: de Muckadell Caraco C, Cochran AJ, Cook MG, Drzewiecki KT, Essner lysis of 11C-labeled radiopharmaceuticals and their Kjaer A, Kristoffersen US, Tarnow L, Parving HH, Hesse 64Cu-ATSM and PET/CT assessment of hypoxia in rat Skovgaard D. Positron Emission Tomography in the OBS, Haunso S, Vilstrup H, eds. Medicinsk Kompendi- skeletal muscles and tendons during muscle contrac- R, Even-Sapir E, Eggermont, AM, Stopar TG, Ingvar C, metabolites in plasma. Nucl Med Biol 2009; 36: 961-5. B. Short-term oral treatment with the angiotensin II re- study of skeletal muscle and tendon: metabolic, cellular Mihm MC jr, McCarthy SW, Mozzillo N, Nieweg OE, Scol- ceptor antagonist losartan does not improve coronary um. 17. ed. Nyt Nordisk Forlag Arnold Busck; 2009: tions. J Nucl Med 2009; 50: 950-8. and matrix response to exercise. Defended December yer, RA, Starz H, Thompson JF, Trifiro G, Viale G, Vidal- Graebe M, Pedersen SF, Borgwardt L, Hojgaard L, vasomotor function in asymptomatic type 2 diabetes 1326-30. Syvanen S, Lindhe O, Palner M, Kornum BR, Rahman O, 3rd 2009 at University of Copenhagen, Faculty of Sicart S, Uren R, Waddington W, Chiti A, Spatz A, Tes- Sillesen H, Kjaer A. Molecular pathology in vulnerable patients. Diabetes Res Clin Pract 2009; 84: 34-8. Mortensen J. Lungefunktionsundersøgelse. In: de Muck- Health Sciences. tori A. EANM-EORTC general recommendations for carotid plaques: correlation with 18-fluorodeoxyglucose Langstrom B, Knudsen GM, Hammarlund-Udenaes M. adell OBS, Haunso S, Vilstrup H, eds. Medicinsk Kom- Species differences in blood-brain barrier transport of sentinel node diagnostics in melanoma. Eur J Nucl Med positron emission tomography (FDG-PET). Eur J Vasc Kornum BR, Lind NM, Gillings N, Marner L, Andersen F, pendium. 17. ed. Nyt Nordisk Forlag Arnold Busck; three positron emission tomography radioligands with Mol Imaging 2009; 36: 1713-42. Endovasc Surg 2009; 37: 714-21. Knudsen GM. Evaluation of the novel 5-HT4 receptor Agger A, von Buchwald C, Madsen AR, Yde J, Lesnikova PET ligand 11C-SB207145 in the Gottingen minipig. 2009: 1318-26. emphasis on P-glycoprotein transport. Drug Metab I, Christensen CB, Foghsgaard S, Christensen,TB, Chakera AH, Lock-Andersen J, Hesse U, Nurnberg BM, J Cereb Blood Flow Metab 2009; 29: 186-96. Dispos 2009; 37: 635-43. Gutte H, Mortensen J, Jensen CV, Johnbeck CB, von der Olesen OV, Sibomana M, Keller SH, Andersen F, Jensen Hansen HS, Larsen S, Bentzen J, Andersen E, Andersen Juhl BR, Stokholm KH, Drzewiecki KT, Hesse B. One-day Recke P, Petersen CL, Kjaergaard J, Kristoffersen US, J, Holm S, Svarer C, Hojgaard L. Spatial Resolution of L, Grau C. Squamous cell carcinoma of the nasal vesti- or two-day procedure for sentinel node biopsy in mela- Krakauer M, Law I. FDG PET brain imaging in neuro- Van Calenbergh F, Gybels J, Van Laere K, Dupont P, Kjaer A. Detection of pulmonary embolism with com- the HRRT PET Scanner using 3D-OSEM PSF Reconstruc- bule 1993-2002: a nationwide retrospective study from noma? Eur J Nucl Med Mol Imaging 2009; 36: 928-37. psychiatric systemic lupus erythematosis with choreic Plaghki L, Depreitere B, Kupers R. Long term clinical bined ventilation-perfusion SPECT and low-dose CT: tion. IEEE Nuclear Science Symposium Conference DAHANCA. Head Neck 2009; 31: 1593-9. head-to-head comparison with multidetector CT angiog- symptoms. Clin Nucl Med 2009; 34: 122-3. outcome of peripheral nerve stimulation in patients with de Nijs R, Miranda MJ, Hansen LK, Hanson LG. Motion Record, 2009. chronic peripheral neuropathic pain. 2009; raphy. J Nucl Med 2009; 50:1987-92. Surg Neurol correction of single-voxel spectroscopy by independent Kristensen CA, Nottrup TJ, Berthelsen AK, Kjaer-Kristof- 72: 330-5. Alkureishi LW, Burak Z, Alvarez JA, Ballinger J, Bilde A, Oxboel J, Binderup T, Knigge U, Kjaer A. Quantitative component analysis applied to spectra from nonanes- fersen F, Ravn J, Sorensen JB, Engelholm SA. Pulmo- Britten AJ, Calabrese L, Chiesa C, Chiti A, de Bree R, Hag AM, Kristoffersen US, Pedersen SF, Gutte H, Leb- gene-expression of the tumor angiogenesis markers thetized pediatric subjects. Magn Reson Med 2009; nary toxicity following IMRT after extrapleural pneumon- Varrone A, Asenbaum S, Vander Borght T, Booij J, Gray HW, Hunter K, Kovacs AF, Lassmann M, Leemans ech AM, Kjaer A. Regional gene expression of LOX-1, vascular endothelial growth factor, integrin alphaV and 62: 1147-54. ectomy for malignant pleural mesothelioma. Radiother Nobili F, Nagren K, Darcourt J, Kapucu OL, Tatsch K, CR, Marmelle G, McGurk M, Mortensen J, Poli, T, Shoaib VCAM-1, and ICAM-1 in aorta of HIV-1 transgenic rats. integrin beta3 in human neuroendocrine tumors. Oncol Oncol 2009; 92: 96-9. Bartenstein P, Van Laere K. EANM procedure guidelines T, Tloan P, Sorensen, JA, Stoeckli SJ, Thomsen JB, Trifi- PLoS One 2009; 4: e8170. Rep 2009; 21: 769-75. Denholt CL, Hansen PR, Pedersen N, Poulsen HS, Gill- for PET brain imaging using 18F-FDG, version 2. ro G, Werne J, Ross GL. Joint practice guidelines for Kristoffersen US, Straalman K, Schmidt G, Klyver H, ings N, Kjaer A. Identification of novel peptide ligands Hansen CL, Kuhnast B, Hinnen F, Dolle F, Gillings N, Eur J Nucl Med Mol Imaging 2009; 36: 2103-10. radionuclide lymphoscintigraphy for sentinel node locali- Mortensen J, Andersen PA, Chakera AH, Kjaer A. Radia- Pedersen JH, Ashraf H, Dirksen A, Bach K, Hansen H, for the cancer-specific receptor mutation EFGRvIII using Hansen PR, Kjaer A. Comparison of 18F-FBA and zation in oral/oropharyngeal squamous cell carcinoma. tion exposure to surgical staff during hyperthermic iso- Toennesen P, Thorsen H, Brodersen J, Skov BG, Doss- a mixture-based synthetic combinatorial library. Biopoly- 18F-FPyMe as peptide radiolabeling agents of PEPHC1 Ann Surg Oncol 2009; 16: 3190-210. lated limb perfusion with 99m Technetium labeled red ing M, Mortensen J, Richter K, Clementsen P, Seers- mers 2009; 91: 201-6. for PET imaging of EGFRvIII. Adv Exp Med Biol 2009; blood cells. Int J Hyperthermia 2009; 25: 86-9. holm N. The Danish randomized lung cancer CT screen- 611: 405-6. As in previous annual reports we have chosen Andersson H, Cederkrantz E, Back T, Divgi C, Elgqvist Elgqvist J, Andersson H, Haglund E, Jensen H, Kahu H, ing trial-overall design and results of the prevalence J, Himmelman J, Horvath G, Jacobsson L, Jensen H, Kristoffersen US, Kofoed K, Kronborg G, Benfield T, round. J Thorac Oncol 2009; 4: 608-14. to list scientific papers, and not the many Lindegren S, Warnhammar E, Hultborn R. Intraperitoneal Hesse B, Gimsing P. Can amyloidosis scintigraphy be Lindegren S, Palm S, Hultborn R. Intraperitoneal alpha- Kjaer A, Lebech AM. Changes in biomarkers of cardio- abstracts and proceedings from the depart- alpha-radioimmunotherapy in mice using different specif- useful? Ugeskr Laeger 2009; 171: 1835. particle radioimmunotherapy of ovarian cancer patients: Ptito M, Matteau I, Gjedde A, Kupers R. Recruitment of ic activities. Cancer Biother Radiopharm 2009; 24: vascular risk after a switch to abacavir in HIV-1-infected ment. the middle temporal area by tactile motion in congenital pharmacokinetics and dosimetry of (211)At-MX35 509-13. Hojgaard L et al. ESF-EMRC Position on the Proposal for individuals receiving combination antiretroviral therapy. F(ab’)2--a phase I study. J Nucl Med 2009; 50:1153-60. a Directive on the Protection of Animals used for Scien- HIV Med 2009; 10: 627-33. blindness. Neuroreport 2009; 20: 543-7. Erritzoe D, Frokjaer VG, Haugbol S, Marner L, Svarer C, tific Purposes. EMRC Publications. Positions Paper. 2nd Kristoffersen US, Kofoed K, Kronborg G, Giger AK, Risum S, Hogdall C, Markova E, Berthelsen AK, Loft A, Arveschoug AK, Hjorthaug K, Rehling M, Hojgaard L, Holst K, Baare WF, Rasmussen PM, Madsen J, Paulson Edition March 2009: 1-12. Mortensen J, Oturai PS. Peptide receptor radionuclide OB, Knudsen GM. Brain serotonin 2A receptor binding: Kjaer A, Lebech AM. Reduction in circulating markers of Jensen F, Hogdall E, Roed H, Engelholm SA. Influence of therapy of neuroendocrine tumors. Ugeskr Laeger relations to body mass index, tobacco and alcohol use. Hojgaard L et al. Investigator-Driven Clinical Trials. endothelial dysfunction in HIV-infected patients during 2-18F-fluoro-2-deoxy-D-glucose positron emission tom- 2009; 171: 1073. Neuroimage 2009; 46: 23-30. EMRC Publications. Forward Look. March 2009:1-60. antiretroviral therapy. HIV Med 2009; 10: 79-87. ography/computed tomography on recurrent ovarian

26 27 Danish–Chinese Scientific Collaboration MSc in Medicine and Technology

The Department has over the last year continued and expanded collaboration with seve- In cooperation with the Technical University of Denmark (DTU) and the University of Copen- ral Chinese partners within the field of molecular imaging. hagen (KU), the Department represented by Professor Liselotte Højgaard is involved in the MSc programme in Medicine and Technology. It is a five-year bioengineering degree at ba- Professor Andreas Kjær is partner in the Danish Chinese Center for Proteases and Can- chelor and master’s level. The first master’s graduated in 2008 with a big party celebra- cer funded by the The National Natural Science Foundation of China and the Danish Na- ting the first candidates at DTU on September 19th, 2008. Since the launch of the pro- tional Research Foundation. The centre was established to strengthen cancer research gramme in 2003 more than 200 students have applied for the 60 available places each leading to tailored therapy. Participants are in addition to Rigshospitalet, Aarhus Univer- year. You can read more about the programme at www.medicin-ing.dk sity and Chinese researchers from the Chinese Academy of Sciences, Fuzhou and Uni- versity of Hubei. The centre is headed by Professor Peter Andreasen, Institute of Mole- At present three of these bioengineers are seconded to the Department as PhD students cular Biology, Aarhus. and we have numerous students working with bachelor’s and master’s reports in collaboration with DTU, IMM (Institute for Mathematical Modelling), Professor Rasmus Larsen and In 2008 professor Andreas Kjær was selected to participate in the Danish–Chinese Part- DTU, Electro with Professor Jørgen Arendt Jensen. nership for Joint Benefit programme as part of the Asia strategy of the Danish Govern- ment to strengthen Danish–Chinese collaboration. This has led to formalized research In 2010 the course will be subject to an accreditation and the programme leader, Pro- collaborations with several partners in China. fessor Jørgen Arendt Jensen, DTU Electro and the team are awaiting this with positive entusiasm. With Shuguang Hospital in Shanghai a programme using PET for non-invasive testing of Chinese anti-cancer treatments has started. The programme includes pre-clinical animal A warm thank you to Professor Jørgen Arendt Jensen, Associate Professor Kaj-Åge Henne- models as well as testing in cancer patients in China. The research collaboration is sup- berg and Reader Jens E. Wilhjelm, DTU and Associate Professor Bente Stallknecht, Univer- ported by the Danish Ministry of Health and Prevention. sity of Copenhagen, for their great effort and our great collaboration both on education and research. Recently a research collaboration between Shanghai Innovative Research Center of Traditional Chinese Medicine (SIRC/TCM) and our department has been initiated. SIRC is Liselotte Højgaard was appointed supported by Ministry of Science and Technology of China and located in the Pudong Adjunct Professor in Advanced Medical Professor Andreas Kjær visiting Shuguang Hi-Tech Park in Shanghai. Hospital in Shanghai together with repre- Imaging at DTU, Spring 2009. sentatives from the Danish Ministry of Science, Technology and Innovation.

Danish-Chinese Centre for Proteases and Cancer Shuguang Hospital in Shanghai. The Danish National Research Foundation and The National Natural Science Foundation of China

Center for Integrated Molecular Brain Imaging University of Copenhagen, Rigshospitalet

In cooperation with the Neurobiology Grants and Foundations Research Unit, Professor Gitte Moos Knudsen and Professor Olaf B. Pauls- son, a series of neuroreceptor ligands Liselotte Højgaard has received 2 mio. DKK from The John Tina Binderup, MSc Human Biology, PhD student, received a are being developed and used for and Birthe Meyer Foundation for a radiochemistry automatic young investigator travel award for her presentation at the research in neurobiology. The focus system for tracer production. World Molecular Imaging Conference, Montreal, Canada, Sep- has mainly been on the serotonergic tember 2009. system. In 2005 Gitte Moos Knudsen Kirsten Bouchelouche has received 50,000 DKK from Region received a grant from the Lundbeck Zealand for the project "Effect of sarcosine on HER2 expression in Mette Munk Jensen, MSc Human Biology, PhD student, re- Foundation and established CIMBI, prostate cancer cells" and 120,000 DKK from Køge Hospital for ceived a young investigator travel award for her presentation at Center for Integrated Molecular Brain the project "Cellular methods for evaluation of new imaging agents the World Molecular Imaging Conference, Canada, September Imaging, where we are proud to colla- and targeted radionuclide therapy of HER2 positive cancer". 2009. borate on the PET studies.

28 29 Education Nuclear Medicine Technologists

Education at different levels for various specialist education of physicians from Denmark and the Nordic countries. Study The nuclear medicine technologists per- with the project: “Dosimetric considera- gist Solveig Linnet and Nuclear Medicine health related professionals is a central other specialities such as radiology, on- visits to our facilities from physicians, form the daily production of radiopharma- tions regarding 177Lu-Dotatate patients, Technologist Mette Frederiksen have to- activity of the Department of Clinical Phy- cology, haematology and thoracic surgery. students and nuclear medicine technolo- ceuticals and perform the daily clinical pa- implementation of treatment in the Nucle- gether with our chief physicians imple- siology, Nuclear Medicine & PET. The de- gists for periods ranging from a few tient investigations in collaboration with ar Medicine Department, Rigshospitalet”. mented the procedure with fine results. partment participates in undergraduate A high number of PhD students are asso- weeks to six months have been arranged. the physicians. Moreover they also parti- education at the Faculty of Health ciated with research activities in the de- cipate in research and development Nuclear Medicine Technologist Teacher A new PET/CT-scanner 6 arrived in June Sciences at the University of Copenhagen partment. The department’s educational activities projects. They have co-responsibility for Pia Christensen graduated in her diploma 2009 and Nuclear Medicine Technologists for medical students, human biology stu- have been accredited by both the Danish several projects and are involved in book- study with the thesis “How learning envi- Camilla Knudsen and Karin Stahr have dents and bioengineer students in colla- All staff members participate in the de- National Board of Health and by the Ac- ing, data management, quality assurance, ronments can promote learning". participated in the commissioning of the boration with DTU in many subjects, e.g. partment’s educational activities. The CT creditation of Nuclear Medicine Training patient and animal studies. Research scanner. clinical physiology, nuclear medicine, theo- course for nuclear medicine technolo- Centres Committee of the Section of Nu- results are disseminated through oral Six nuclear medicine technologists have retical physiology and medical technologists, officially acknowledged by the Nati- clear Medicine of the European Union of presentations and posters at both Danish participated in a course on sterile work- International affiliations/meetings gy. Nuclear medicine technology students onal Institute of Radiation Protection, is Medical Specialists (UEMS). and international meetings and symposia ing techniques to meet the GMP require- Marianne Federspiel has replaced Kate and radiography students receive part of arranged by and held at the department. for technologists. ments for work on labelling of blood cells. Pedersen, as a member of the EANM their education from the department. Technologists from the department at Chief Physician Peter Oturai is respon- Technologist Committee. Rigshospitalet and from departments all sible for postgraduate education of Research Eight nuclear medicine technologists par- In postgraduate education, the depart- over Denmark have participated in the physicians in the department. Clinical All projects at the department have a nu- ticipated in our own dedicated CT course, Nuclear Medicine Technologist Marianne ment contributes to the specialist educa- courses, which include 80 lectures and Associate Professor Jann Mortensen is clear medicine technologist associated gaining competence to perform PET/CT Federspiel and Radiographer Elisabeth tion of physicians in clinical physiology tutorials. This allows the staff to be in responsible for undergraduate education with the protocol and the nuclear medi- and SPECT/CT scans. The course is offi- Abrahamsson were invited speakers at and nuclear medicine. The dedicated charge of the PET/CT and SPECT/CT of medical students. Professor Liselotte cine technologists are responsible for cially recognized by the National Institute the ESTRO-meeting in Maastricht presen- courses in oncology-, cardiology-, lung-, scanners, while also contributing to the Højgaard is responsible for under- and practical procedures throughout the of Radiation Protection. ting the lecture “Workflow overview in and endocrinology-pathophysiology for CT aspects of the course. The depart- postgraduate education for bioengineers. project. Many research projects are per- PET/CT therapy planning”. this specialist education are all held at ment also delivers extensive training pro- formed outside standard hours, such as We continuously educate nuclear medi- our department and arranged by our grammes to staff from other nuclear me- the HIV CACS project. Here, myocardial cine technology students and normally we At the EANM congress in Barcelona we chief physicians and we contribute to the dicine and radiology departments in Peter Oturai and Jann Mortensen perfusion and calcium score were investi- have between three and six students in presented three posters: gated in HIV positive patients and a con- the department. E. Abrahamsson, M. Federspiel with trol group. This project involved 100 “Implementation of a new image recon- patients, and the nuclear medicine tech- According to a new directive from the struction method for clinical purpose”, nologists worked Saturdays and Sundays Danish Government all radiography stu- T. Heiberg with “Setting up a treatment to complete the project. dents are obliged to have a two-week in- scheme for 177-Lutetium-Dotatate”, and ternship in nuclear medicine and in De- G. Nehme, M.H.B. Frederiksen with “Is Education cember we welcomed the first seven monitoring of ejection fraction necessary The nuclear medicine technologists have radiography students for a two-week in- in patients treated with cardiotoxic drugs throughout the year participated in sup- ternship with great success. for multiple sclerosis?” plementary training and our technologists and radiographers were teachers on In Autumn 2009 four nuclear medicine One oral presentation was presented: courses at the Metropolitan University technology students completed their BA, B. Dall with the lecture “Technical and College, Copenhagen. Our nuclear medi- and they will defend their project reports psychological aspects regarding patient cine technologists are frequently asked in 2010. preparation, and performing high quality to provide courses and give lectures both brain PET scanning in patients with brain in Denmark and at the PET/CT course in New procedures tumors, dementia and epilepsy”. Vienna. The Department has implemented the radiopharmaceuticals treatment 177Lu- Nuclear Medicine Technologist Therese Dotatate in patients with neuroendocrine Linda M. Kragh Heiberg graduated as Cand. Scient. San. tumors. Our Nuclear Medicine Technolo-

30 31 Equipment

Equipment Product Purchase year PET and Gamma cameras Philips ADAC Thyrus 2001 Mie-Scintron 2004 PET/CT Scanners Mediso N-TH45-D 2008 SPECT cameras GE Millenium VG, Hawkeye, low dose CT 2001 Philips ADAC Skylight 2002 Mediso Nucline X-Ring-R/HR 2009 SPECT/CT cameras Philips, Precedence 16-slice 2006 New brain projects have been initiated on stic quality CT (including contrast media) The newest PET/CT, which came into rou- Philips, Precedence 16-slice 2008 our dedicated brain scanner, the HRRT and for attenuation correction of the PET tine use during the summer 2009, is a (High Resolution Research Tomograph). images. Today, the Discovery LS has Siemens Biograph 64, identical to the PET scanners GE Advance 1993 Originally intended – as the name indica- taken over ammonia heart studies from previously described machine except for HRRT Siemens/CTI 2007 tes – mainly for research, the HRRT has the Advance scanner. Also, some brain the extended number of CT-slices (64 now also become a clinically useful instru- projects that have been started on the instead of 40). It is also installed in the PET/CT scanners GE Discovery LS 2001 ment. Designed by a collaboration of se- Advance may continue at the Discovery new part of the Finsen building sharing Siemens Biograph Sensation 16 (hirez) 2005 veral research groups in Europe and USA, LS due to the very high similarity of its one large control room and the patient Siemens Biograph TrueV 40-slice CT 2007 and built by CTI in Knoxville, Tennessee PET aspects to the Advance scanner. facilities with its sister device. So now we (now owned by Siemens) the HRRT pro- have four PET/CT scanners. Siemens Biograph TrueV 64-slice CT 2009 ject has a ten-year history that finally re- Our second PET/CT, installed in 2005, Lung function Jaeger Masterscreen w/bodybox 2005 sulted in the building of one series of 18 is a Siemens Biograph with 16-slice CT. Recently a MedRad infusion cart has been instruments; the Copenhagen installation It is run in a unique and well-functioning obtained, with the intention of reducing Jaeger PFT pro w/bodybox 2007 is among the last of these, but neverthe- collaboration with the Department of Ra- (finger) doses to the technologist staff. Whole body counter WBC w/Nal counting chamber 1977 less at the forefront of the application of diotherapy, and it is extensively used for WBC w/plast counting chamber 1978 this technology. therapy planning. A third PET/CT scanner In the Cluster for Molecular Imaging, we was installed in November 2007 in the support the old GE 4096 PET scanner Cyclotrons Scanditronix 32 MeV 1991 Technically, the HRRT has a record high new extension of the Finsen building. It (suitable for larger animals such as pigs), RDS Eclipse cyclotron, CTI 2005 number of detector crystal elements has a CT scanner with 40 slices, and the and research scanners for PET and CT of (119,808). The enormous amount of data PET axial field of view is extended (in small animals. The PET is a Focus 120 NMR Varian spectrometer 400 MHz 1993 these detectors create has always been a round figures) from 15 to 20 cm. This with resolution well below 2 mm, and the Cluster for Molecular Imaging Provivo/ ADAC mobile gamma camera 1990 major challenge, but continuous improve- apparently minor change increases the CT is a microCAT II, with an ultimate 15 µ PET scanner GE 4096 1991 ment in computer performance has now overall sensitivity by 78% which allows it resolution. reached a practical level where image re- to be used to obtain (a combination of) SPECT Mediso Nucline X-Ring/R 2004 construction times are comparable to the lower doses, faster scans and improved Siemens Micro-PET Focus 120 2006 acquisition time. The images provide a re- images. Søren Holm solution of 2–3 mm in the full field of view Micro-CT Siemens Micro-CAT II 2006 by standard reconstruction methods, but Phosphor Imager Perkin Elmer cyclone 2007 by using improved reconstruction soft- ware (PSF-based) this can be reduced to The John & Birthe Meyer Foundation has donated all equipment in the PET and Cyclotron Unit. 1.5–2 mm.

The majority of clinical studies in the PET Rigshospitalet and our Department have been accredited by: department continue to be FDG whole- body scans for cancer diagnosis, staging, Center of Excellence by the European Neuroendocrine Tumor Society treatment planning and follow-up. These Certified by SIS, National Institute of Radiation Protection, The Danish National Board of Health scans are normally performed with the Danish Medicines Agency use of combined PET and CT. Our first PET/CT scanner is a GE Discovery LS, The Danish National Board of Health, MD Specialist education where the PET is a slightly updated ver- EURATOM, The European Atomic Energy Community sion of the Advance PET scanner. The Joint Commission International, the International American accreditation board Discovery LS was installed in the autumn Section of Nuclear Medicine of the European Union of Medical Specialists (UEMS)s of 2001 as the second PET/CT in Euro- “Accreditation of Nuclear Medicine Training Centres Committee”, MD Specialist Education. pe. In the combined PET/CT examination, European Association of Nuclear Medicine. the CT scan is used both as a full diagno- The Specialty Advisory Committee (SFR) in Clinical Physiology and Nuclear Medicine

32 33 European Medical Research Councils

The European Medical Research Councils (EMRC) is the membership organization of all the Editors: European medical research councils – for EU member states as well as all other European Liselotte Højgaard countries. Gitte Runge

The chair of the Committee for the European Medical Research Councils is Professor Lise- Layout and production: lotte Højgaard from the Rigshospitalet, University of Copenhagen, Denmark. www.bureauLIST.dk / 14820

The Standing Committee is composed of delegates with a high scientific profile nominated Fotos: by their ESF Member Organizations involved in biomedical sciences, together with obser- Lars Bahl vers from the European Commission, Canada, WHO-Europe, Israel, New Zealand and USA. Bent Børgesen Søren Holm In 2009 EMRC disseminated a ‘Forward Look’ document entitled Investigator-Driven Clinical Andreas Kjær Trials. This paper has been quoted widely and a workshop in Paris in July 2009 hosted by NRC Network University Research Conference EMRC has initiated an effective process for strengthening clinical research in Europe under the leadership of Dr. Ruxandra Draghia-Akli, the new Director of EC DG Research Health. Issues: 1000 ex. Further, we have worked very hard on the revision of the EU “Animal Directive for Medical Research”. Together with members and a broad circle of organizations and researchers we have worked on revising the directive, emphasizing the importance of a dignified and huma- Copyright: ne approach to research on animals for scientific purposes without hindering research pos- Department of Clinical Physiology, Nuclear Medicine & PET, sibilities. KF 4011, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, DK-2100 Copenhagen Ø, Denmark We held the EMRC Annual meeting at the Domus Medica here in Copenhagen, October 2009 and would like to express a warm thank you to the Danish Medical Association for Contact: hosting us so beautifully. Professor Liselotte Højgaard E-mail: [email protected] Rigshospitalet, University of Copenhagen A warm thank you to all members of the Plenary and the Core Group of the EMRC, to our Phone: +45 3545 4215 / 1792 Rigshospitalet, University of Copenhagen, was founded by King Frederik V in 1757. At pre- ESF CEO Professor Marja Makarow for being present at the Copenhagen Meeting. Thank you to Professor Andrésent Syrota,it has 1.200 President beds, and 8.000 Director employees General and of INSERMa budget for of updatingapproximately us 0.7 bio €. The on the developmentsresearch in France. production is more than 1.700 publications per year, including approximately 80 higher academic degrees (PhD and doctoral of medical science). Rigshos pitalet is part of At the World HealthThe Summit Capital in Berlin,Region October of Copenhagen. 2009 the www.rigshospitalet.dk major recommendations from our Forward Look Investigator-Driven Clinical Trials were the subject of a session on Clinical Re- search. These recommendationsUniversity of Copenhagen were brought forward as the top recommendations from the World Health SummitUniversity and handedof Copenhagen, over to the Faculty Ministers of Health of Health Sciences and Research was founded in 1479. in Europe. The University is member of The International Alliance of Research Universities. www.ku.dk It is a privilege for me to accept the nomination for another three-year period as Chair of EMRC.

ESF, Strasbourg

34 Diagnostic Center · Rigshospitalet · University of Copenhagen Annual Report 2009 DEPARTMENT OF CLINICAL PHYSIOLOGY, NUCLEAR MEDICINE & PET

Rigshospitalet · University of Copenhagen