Newsbriefs NEMA Releases and Radiological Health (CDRH) at will apply assessment methods devel- Intraoperative Gamma the FDA announced on April 1 the oped by the group to their own prob- Probe Standard signing of an interagency agreement lems, and carry with them the princi- establishing a joint Laboratory for the ples and tools for longer-term use The National Electrical Manufac- Assessment of Sys- when they leave. turers Association (NEMA) announced tems (LAMIS). The purpose of this Codirectors of the program are on March 1 the release of a standard effort is to assess and optimize high- Peter Kirchner, MD, acting director that provides uniform criteria for resolution, high-dimensional medical of the Intramural Science Program at

NEWSLINE conducting and reporting perfor- imaging systems. NIBIB, and David Brown, PhD, di- mance measures and quality control According to a joint press release, rector of the Division of Electronics tests on nonimaging intraoperative the goals of LAMIS are to develop and Computer Science, Office of Sci- gamma probes for surgical applica- evaluation methodology based on ad- ence and Technology at CDRH. tions. NU 3-2004, Performance Mea- vanced statistical tools, determine National Institute of Biomedical surements and Quality Control fundamental limitations imposed on Imaging and Bioengineering Guidelines for Non-Imaging Intraop- imaging systems, characterize and erative Gamma Probes, is the first Center for Devices and optimize medical imaging systems standard to address instrumentation Radiological Health and components, build consensus, in the rapidly emerging clinical prac- provide advanced image evaluation tice of sentinel lymph node detection methods, and develop an environ- March NRC ACMUI in diagnosis and treatment planning ment conducive to rapid deployment Meeting in cancer. of improved imaging systems and The Nuclear Regulatory Com- “This standard will make it pos- components to the patient commu- mission (NRC) held a meeting of the sible to compare devices from differ- nity. In addition, optimal hardware Advisory Committee on the Medical ent manufacturers against the com- designs and approaches for image re- Uses of Isotopes (ACMUI) on March mon criteria to ensure that devices construction and extracting features 1 and 2 at its Rockville, MD, head- operate properly, and it will allow will be pursued. quarters. users to be confident in the devices “The joint agreement with CDRH A closed session on the first they select,” said Carl Bosch, chair of is an exciting opportunity for the morning focused on ethical and the NEMA Intraoperative Gamma NIBIB and will provide us with an- security-related issues. In addition to Probe Task Force, which developed other avenue for exploring innovative a briefing for NRC Commissioners, the standard. and high-quality technologies and in- the open segments of the meeting in- The advantages of sentinel node terdisciplinary research that will lead cluded discussions on proposed identification and biopsy are cur- to improved healthcare. The CDRH changes to abnormal occurrence cri- rently being investigated in breast medical imaging program is stellar, teria and defining medical events in- cancer, melanoma, urologic tumors and we are proud to collaborate with volving prostate seed implants. Tran- and a range of other malignancies. an organization of this caliber,” said scripts of the meeting and written Other clinical applications of gamma NIBIB Director Roderic I. Pettigrew, comments are available at www. probes, such as localization of para- PhD, MD. “CDRH welcomes this op- nrc.gov/reading-rm/doc-collections/ thyroid tumors around the thyroid portunity to collaborate with NIBIB,” acmui/tr. gland, are also expected to benefit said CDRH Director David W. Nuclear Regulatory Commission from the standard’s guidance about Feigal, MD, MPH. “Not only will performance and routine quality as- this new agreement strengthen the NRC Proposes New Fees surance. imaging programs of both organiza- The Nuclear Regulatory Com- Information about purchase of tions, but it will also benefit the pub- mission announced on February 3 its NU 3-2004 is available at www. lic by leading to the earlier availabil- proposed amendments to regulations nema.org/r/std/nu3/. ity of safe, effective medical imaging for the licensing, inspection, and an- National Electrical Manufacturers technologies.” nual fees it charges applicants and Association To carry out the mission of the licensees for fiscal year (FY) 2004. new laboratory, a multidisciplinary The agency is required to collect NIBIB and CDRH team of clinicians, scientists, and nearly all of its annual appropriated Establish Joint mathematicians/statisticians will be budget from licensing and inspection Laboratory assembled. The team will work with services and from annual fees paid by The National Institute of Biomed- visiting scientists and trainees who licensees. The proposed annual fees ical Imaging and Bioengineering may range from graduate and medi- were determined under the “re-base- (NIBIB) at the National Institutes of cal students to senior researchers and lining” method, with some licensees Health and the Center for Devices clinicians. Visitors to the laboratory (including transporters) seeing higher

28N THE JOURNAL OF ¥ Vol. 45 ¥ No. 4 ¥ April 2004 Newsbriefs fees, and others, including 2 of 3 agency to agency. For example, it is biomedical industries with total sales nuclear medicineÐrelated licensee the policy of CMS is to post all elec- of more than $100 million per year. categories, seeing lower fees. Pro- tronic comments (including person- Industry participants were asked to posed fees include: radiographers, ally identifiable and confidential in- address 2 questions: (1) what is the $12,000 (down from $12,200 in the formation within the comment) on major problem that needs to be second half of 2003); broad scope their Web site for the public to re- solved or research advance needed medical, $25,100 (up from $24,700); view after the comment period that will provide a significant im- and distribution of radiopharmaceuti- closes. Other agencies may have dif- provement in health care from your NEWSLINE cals, $4,500 (down from $4,700). ferent policies regarding the publica- industry, and (2) how can NIBIB and Nuclear Regulatory Commission tion of comments. industry collaborate to facilitate translation of research results to pa- Government Agencies NIBIB Focuses on Optical tient applications and anticipated per- Accept Comments on sonnel needs? The final report pre- Technologies, Biomedical sents the proceedings, including Proposed Regulations Industry problems and research needs identi- Online The National Institute of Biomed- fied and recommendations for Private citizens, companies, and ical Imaging and Bioengineering NIBIB and industry activities. The others who want to respond to pro- (NIBIB) and the Department of En- report can be accessed at www. posed federal regulations, including ergy (DOE) Office of Biological and nibib.nih.gov/events/Industry/NIBIB_ those affecting the Nuclear Regula- Environmental Research (OBER) IndustryWorkshop_FinalReport.pdf. tory Commission and the Centers for partnered to sponsor a “Joint NIBIB/ The National Institute of Biomedical Medicare & Medicaid (CMS), may DOE Workshop on Biomedical Im- Imaging and Bioengineering now submit their comments electron- aging: Optical and X-Ray Technolo- ically via a new Web site, www. gies” on February 10 and 11 at the Regulations.gov. Bethesda (MD) Marriott Hotel. Two Nuclear Medicine The Regulations.gov website was days of information exchange that in- Facilities Struggle in Iraq designed to serve as the central on- cluded presentations, plenary discus- During 2003, Iraq’s 240 public line rulemaking portal of the United sions, and poster displays were aimed hospitals and 95% of its private clin- States government. Regulations.gov at communicating and identifying po- ics reopened to patients, but scattered enables users to search, view, and tential synergies and collaborations reports coming from workers indicate comment on proposed regulations based on (l) biomedical research that shortages remain in physicians, from approximately 160 federal de- needs that could be addressed using nursing and auxiliary staff, pharma- partments and agencies. The site al- optical technologies at DOE labora- ceuticals, equipment, and even furni- lows visitors to search by keyword, tories, (2) related DOE national lab- ture such as beds and chairs. Nuclear department, or agency to find pro- oratory capabilities and programs for medicine and therapy are posed regulations, each with a link to NIH intramural and extramural staff, among the hardest hit specialties, a form for submitting comments di- and (3) funding opportunities for fu- with supplies of radioisotopes and ra- rectly to the appropriate department ture research. About 100 attendees diopharmaceuticals erratic when or agency. participated in the meeting, including available at all. “They are talking but In addition to comments on pro- DOE national laboratory investiga- we’ve got nothing since the arrival of posed or final regulations, the new tors, NIH intramural investigators, the Americans,” Baghdad radiologist system, rolled out on January 30, will NIH extramural program directors, Shaemaa al-Hiali told Reuters news be open for comment on other docu- and representatives from other gov- service on February 4. “Our hospitals ments, including policy notices solic- ernment agencies. Peter Kirchner, are old with old machines and the iting public input and notices asking MD, of NIBIB served as chair. A number of patients are increasing. for other information, such as nomi- summary of the meeting is available We are complaining about the defi- nations for advisory committees. at www.nibib.nih.gov. ciencies. We are writing to the min- Federal agencies will continue to NIBIB also announced in Febru- ister of health and we are waiting.” consider written comments delivered ary the online availability of the sum- The problem is compounded by the either by hand or through the mail by mary report issued for the Workshop enormous backlog of cancer patients the close of each comment period. on Biomedical Industry Research and waiting to be seen in the country. Individuals filing electronic com- Training Opportunities, which was New cancer cases registered at Bagh- ments will receive automatic confir- conducted on December 16 and 17, dad’s Hospital of Radiation and Nu- mation of timely receipt. in Bethesda. A total of 45 people clear Medicine rose from around Policies regarding publication of attended this meeting, including 23 6,000 per year in 1990 to nearly submitted comments can vary from representatives from a broad range of 10,000 per year in 2002. It is widely

30N THE JOURNAL OF NUCLEAR MEDICINE ¥ Vol. 45 ¥ No. 4 ¥ April 2004 Newsbriefs/Literature believed that this increase was caused molecular imaging. Each award car- of scientific research. In a survey ar- in part by carcinogens released during ries a $20,000 cash prize. ticle published in the December issue the 2 Gulf Wars, with a dearth of treat- Gambhir is director of the Molec- of Cancer Biotherapy and Radio- ment options exacerbated by 13 years ular Imaging Program at Stanford pharmeuticals (2003;18:861Ð877), of United Nations sanctions. Delivery University and chief of nuclear med- Bodei et al. from the European Insti- and transport of radioactive materials icine and a professor in the depart- tute of Oncology (Milan, Italy) re- remain problematic in the region. ment of radiology at the Stanford ported on ongoing research into the Newsline would welcome reports from School of Medicine. Among his use of 125I and other Auger-electron- NEWSLINE nuclear medicine specialists in Iraq on many accomplishments is the devel- emitting as attractive efforts to rebuild their diagnostic and opment of novel reporter genes and alternatives to ␤-particle emitters in therapeutic centers. Correspondence probes used in cell trafficking mod- the treatment of cancer. The authors can be addressed to the Newsline editor els, gene therapy models, and in surveyed published results in a range at: [email protected]. transgenic models for studying can- of animal tumor models where the cer biology. thymidine analog 5-radioiodo-2’-de- PET Isotope Production Townsend is a professor in the oxyuridine has been shown to be System with Linac department of medicine and radiol- therapeutically beneficial. A limited Hitachi, Ltd., and its subsiduary ogy and director of cancer imaging number of studies in humans have AccSys Technology, Inc., announced and tracer development at the Uni- shown promise for locoregional on January 22 the delivery of the first versity of Tennessee Cancer Institute administration of Auger-electron- dedicated radioisotope production (Knoxville). Widely known for his emitting radionuclides and metabolic system for PET incorporating a linear work in developing PET/CT technol- modulation of uptake by tumor cells, accelerator (linac). Hitachi General ogy, he was cited for the 2002 Med- where the emitters act directly on nu- Hospital (Ibaraki, Japan) will begin ical Invention of the Year by TIME clear DNA. Investigators continue magazine. using 18F-FDG produced with the to look for new molecules that can Academy of Molecular Imaging system in PET imaging in the spring carry radionuclides to provide higher of 2004. It is anticipated that the sys- Auger-electron yields. tem will reach the market in 2005. Newsbriefs from the Literature One such investigation, described AccSys introduced its Positron by Panyutin et al. from the National Each month the editor of Tracer Production System line in Institutes of Health (Bethesda, MD) Newsline selects articles on thera- 1998 as an alternative to older cyclo- in December in the Annals of the New peutic, diagnostic, research, and tron accelerator technology. The new York Academy of Science (2003; practice issues in nuclear medicine linac-supported system will be 1002:134Ð140), focused on research from a range of international publi- lighter, more easily installed, and less into cellular mechanisms facilitating cations. Most selections come from expensive than hospital-based cyclo- targeted radiodamage with 125I- outside the standard canon of nu- trons, according to Hitachi sources. labeled triplex-forming oligonucleo- clear medicine and radiology publi- Hitachi, Ltd. tides (TFOs). The authors used a cations. These briefs are offered as a 125 monthly window on the broad arena TFO labeled with I to attempt to Gambhir and Townsend produce DNA strand breaks at spe- Receive AMI of medical and scientific endeavor in which nuclear medicine now plays an cific binding sites. They found that Distinguished Scientist essential role. double-strand breaks in the target se- Awards quence were detected in purified nu- clei and digitonin-permeabilized cells SNM members David Townsend, Therapy PhD, and Sanjiv Gambhir, MD, PhD, but not in intact cells when TFOs were honored during the annual were delivered with liposomes. They 125 meeting of the Academy of Molecu- I and Antigene hypothesized that as yet unidentified lar Imaging (AMI), March 27Ð30, in Therapy cytoplasmic factors succeed in bind- Orlando, FL. AMI President Michael Antigene radiotherapy, delivering ing such TFOs and delivering them Phelps, PhD, presented Townsend highly targeted doses of radiation into the nucleus but render them un- with the Distinguished Clinical Sci- to damage selected genes via a able to release them inside the nu- entist of the Year award and Gambhir sequence-specific DNA-binding mol- cleus, with the result that the TFOs with the Distinguished Basic Scien- ecule, is a rapidly expanding area of do not bind with their genomic tar- tist of the Year award. These awards nuclear medicine. As in almost every gets. Subsequent investigations con- are given to those who have made pioneering medical molecular en- jugating a nuclear localization se- major contributions to the develop- deavor, this effort is involving pro- quence peptide with the TFOs ment and enhancement of PET and/or fessionals from across the spectrum suggested a range of new insights

32N THE JOURNAL OF NUCLEAR MEDICINE ¥ Vol. 45 ¥ No. 4 ¥ April 2004 Newsbriefs/Literature into the intracellular transport of oli- duced pulmonary emboli (PEs) and was cited as the most important rea- gonucleotides. lower extremity deep-vein thrombi son for this change. The authors cau- Cancer Biotherapy and (DVTs). Thoracic and lower extrem- tioned that a number of factors, includ- Radiopharmeuticals ity SPECT imaging was performed ing better access to early diagnosis and at 2-hour intervals after injection of more sensitive preliminary testing Annals of the New York Academy of ϳ260 MBq 99mTc-labeled deimmu- should be considered when drawing Science nized antifibrin Fab[[rad]]. At 4 conclusions from these results. They hours after infusion, all PEs and noted that “such changes in medical,

NEWSLINE 125 I-Labeled mAb DVTs with masses Ն 0.4 g were as well as in surgical and pathologi- Treatment of High-Grade clearly visualized on SPECT. The au- cal, practices must be taken into ac- Brain Glioma thors noted that, “the technique reli- count in incidence measurement.” The results of a decade-long ably identified even peripheral European Journal of Endocrinology phase I/II clinical trial on the efficacy thromboemboli of relatively small of 125I-labeled monoclonal antibody size, which are difficult to diagnose with currently available imaging Ginkgo Biloba Effects on (mAb) 425 treatment in controlling 99m high-grade brain gliomas were pub- techniques, and may enable imaging Tc Labeling lished in the March issue of the of PEs, DVTs, or both in the same Researchers from the Univer- International Journal of Radiation patient.” sidade Federal Fluminense (Rio de Oncology, Biology, Physics (2004; American Journal of Respiratory Janeiro, Brazil) reported in the Feb- 58:972Ð975) by Quang and Brady and Critical Care Medicine ruary issue of the Brazilian Journal from the Hahnemann University of Medical and Biological Research (2004;37:267Ð271) on a study assess- ؍ Hospital (Philadelphia, PA). The trial Better Diagnosis included 180 patients who were diag- ing the effects of different concentra- nosed with glioblastoma multiforme Higher Reported Thyroid tions of ginkgo biloba extract on the and astrocytoma with anaplastic foci Cancer Rates? labeling of blood constituents with 99m and received a cumulative dose of A major evolution in clinical Tc-pertechnetate and on the mo- 140 mCi 125I-mAb 425 as adjuvant practices from 1980 to 2000 led to a bility of a plasmid DNA treated with treatment after surgery and external significant increase in the reported SnCl2 (the reducing agent most often beam . Increased incidence of thyroid cancer in used in 99mTc labeling). Moreno et al. uptake was demonstrated in brain tu- France. This finding was detailed in noted that although ginkgo biloba is mor cells. All patients were followed the February issue of the European widely used as a dietary supplement for at least 5 years, and the authors Journal of Endocrinology (2004;150: and over-the-counter remedy, the ex- concluded that “this adjuvant therapy 133Ð139) by Leenhardt and a consor- act nature of its action is not fully 99m demonstrates a significant increase in tium of researchers from 6 French known. SnCl2 and Tc were added median survival and should be con- endocrinology and nuclear medicine to blood incubated with gingko bi- sidered in the management of high- centers. The study focused on a rep- loba, and soluble and insoluble frac- grade brain gliomas.” resentative selection of 471 patients tions of plasma and red blood cells International Journal of Radiation referred during this time period for were isolated. The plasmid DNA was Oncology, Biology, Physics evaluation of nodular thyroid disease incubated with gingko biloba and/or or thyroid dysfunction. Population SnCl2, then stained and assessed by Diagnosis characteristics, diagnostic procedures, fluorescence. The authors found that and changing trends in management gingko biloba decreased the labeling were included in the analysis. The of red blood cells and insoluble Anti-D-Dimer SPECT of authors found a significant increase plasma. The supercoiled form of the Pulmonary Emboli and in the use of ultrasound (from 3% to DNA plasmid was modified by treat- Venous Thrombi 84.8%) and cytologic analysis (from ment with SnCl2 alone but protected In an article e-published ahead of 4.5% to 23%) over the time period from this modification by the gingko print on February 12 in the American and a decrease (from 89.4% to biloba. The authors drew no conclu- Journal of Respiratory and Critical 49.6%) in radionuclide scans. The sions about the possible effects that Care Medicine, Morris et al. from the proportion of patients undergoing longtime or heavy gingko biloba use University of California San Diego surgery remained constant at 24.8%. might have on nuclear medicine im- reported on experiments using SPECT However, the percentage of patients aging procedures but did hypothesize and intravenous 99mTc-labeled deim- found to have cancer at surgery in- that the effects associated with munized antifibrin Fab[[rad]] frag- creased from 12.5% to 37%. The gingko biloba in the tests “may be ments to diagnose thromboemboli. benefits of cytologic analyses on due to its chelating action with the The study included 5 dogs with in- identification of patients for surgery stannous ions and/or pertechnetate or

34N THE JOURNAL OF NUCLEAR MEDICINE ¥ Vol. 45 ¥ No. 4 ¥ April 2004 Newsbriefs/Literature to the capability to generate reactive available to the nuclear medicine positive for the 14-3-3 protein, and oxygen species that could oxidize the market for evaluation of gallbladder pattern-reversal visual evoked poten- NEWSLINE stannous ion.” ejection fraction during hepatobiliary tials showed prolonged P100 laten- Brazilian Journal of Medical and . Many imaging centers cies and increased N/5/P100 ampli- Biological Research turned to the use of pharmacy- tudes. The ability to associate these compounded sincalide, with the as- assessment parameters with early di- PET in the Assessment of sumption that its effects were equiva- agnosis does little to alter the inevi- Radiofrequency Ablation lent to those of the proprietary product. table course for patients with CJD. It for Liver Metastases Guarasci et al. from the University of does, however, illuminate the course Buffalo (New York) reported in the of clinical deterioration, avoid exten- Donckier et al. from the Univer- March issue of the Annals of Phar- sive testing for differential diagnoses, site Libre de Bruxelles (Belgium) re- macotherapy (2004;38:428Ð432) on and allow for earlier initiation of sup- ported in the December issue of the 2 case studies comparing proprietary portive measures. Journal of Surgical Oncology (2003; and pharmacy-compounded sincalide. Journal of Neuroimaging 84:215Ð223) on the effectiveness of Two patients who were referred for 18F-FDG PET as a tool for early rec- imaging for hepatobiliary dysfunc- ognition of incomplete tumor de- 99m tion underwent scintigraphy first with Tc-ECD SPECT in struction after radiofrequency abla- the adjuvant use of compounded sin- Acute Stroke tion (RFA) for liver metastases. The calide and 72 hours later with propri- Mahagne et al. from the Hoˆpital study included 17 patients who were etary sincalide. Gallbladder ejection Pasteur (Nice, France) reported in the treated by radiofrequency ablation fractions in the 2 patients were 11% January issue of the Journal of Neu- for a total of 28 unresectable liver and 24% with the compounded prod- roimaging (2004;14:23Ð32) on a metastases. The patients underwent uct and 32% and 72% with the pro- study designed to correlate tracer up- imaging with both CT and PET be- prietary product. The authors con- take in 99mTc-L,L-ethyl cysteinate fore surgery and at 1 week and 1 and cluded, however, that “significant dimer (ECD) SPECT in patients with 3 months afterward. Imaging results differences in gallbladder ejection acute stroke with the extent of irre- were compared and correlated with fraction between compounded sinc- versibly damaged tissue. The authors follow-up imaging and, in some alide and sincalide in our patients are used an automatic, voxel-based ap- cases, with pathologic results. Nei- likely due to the intrinsic variability proach for probabilistic mapping of ther CT nor PET showed tumor res- in response to sincalide.” irreversibly damaged tissues to vali- idues in 24 of 28 metastases sites (in Annals of Pharmacotherapy date the previously observed 40% 13 patients) at 1 week or 1 month. 99mTc-ECD uptake threshold below None of these patients developed lo- which tissues is considered irrevers- cal recurrence at the RFA site during PET and MRI in Early ibly damaged. The retrospective follow-up. In the remaining 4 pa- Diagnosis of Creutzfeldt- study included 10 patients who had tients, PET at both 1 week and 1 Jakob Disease experienced acute stroke. 99mTc-ECD month showed peripheral hypermeta- Tsuji et al. from Kyoto Univer- SPECT images were coregistered bolic residue, but CT did not show sity (Japan) reported in the January with MRI data. Irreversibly damaged residual tumor. In 3 of these patients, issue of the Journal of Neuroimaging tissue, “at risk” tissue, and the per- local persistence of viable tumor cells (2004;14:63Ð66) on the potential of centage of voxels ultimately infarcted was proven by biopsy at a second combined PET and diffusion- and noninfarcted on late brain MRI surgery. In the fourth, follow-up CT weighted MRI, along with visual were recorded. They compared this showed subsequent development of a evoked potential recording and cere- data with assessments of subsequent local recurrence. The authors con- brospinal fluid analysis in the early neurologic recovery. The predictive cluded that 18F-FDG PET “accurately diagnosis of Creutzfeld-Jakob dis- capabilities of visual SPECT analysis monitors the local efficacy of RFA ease (CJD). In this case study, the were compared with this more com- for treatment of liver metastases, as it patient presented with visual distur- plex mapping approach. The authors early recognizes incomplete tumor bance and rapidly deteriorating found that an average of 84% of the ablation not detectable on CT.” global cognitive function. After im- voxels defined as irreversibly dam- Journal of Surgical Oncology aging and additional testing, findings aged using the uptake cut-off of 40% suggested a diagnosis of the Heide- evolved toward infarction, whereas Compounded and hain variant of CJD. PET revealed an average of 89% of at-risk voxels Proprietary Sincalide hypometabolism in the parieto- escaped infarction. The authors con- Compared occipital cortices, where diffusion- cluded that these results support the In 2001, as a result of a manufac- weighted MRI showed marked hy- validity of the 99mTc-ECD uptake turing hiatus, sincalide became un- perintensity. Cerebrospinal fluid was threshold definition of irreversibly

Newsline 35N Newsbriefs/Literature damaged tissues, suggesting that Prognostic Value of 99mTc “Precise preoperative imaging enables “ECD SPECT can be useful for the MPI in Elderly Patients the careful planning of robot-assisted early detection of potentially salvage- In a study published in the Febru- surgery for ectopic parathyroids lo- able tissue and irreversible damage.” ary issue of the International Journal cated at relatively inaccessible regions They noted the special benefits of of Cardiology (2004;93:137Ð143), such as the anterior mediastinum.” such abilities when fast decision Lima et al. from the Universidade Surgical Endoscopy making is necessary after stroke. Federale de Rio de Janeiro (Brazil) re- Journal of Neuroimaging NEWSLINE ported on a study to assess the predic- SLN Detection in 99m tive value of Tc-sestamibi SPECT Gynecologic Cancers in diagnosis and risk stratification of 18F-FDG PET and The accuracy of detection of sen- coronary artery disease (CAD) in indi- tinel lymph nodes (SLNs) in gyneco- Restaging of Cervical viduals 74 years of age or older. The logic cancers using 99mTc-labeled Carcinoma study included 328 patients with sus- tracers and intraoperative gamma Lai et al. from the Chang Gung pected CAD who underwent either ex- probes is currently being assessed in Memorial Hospital and Chang Gung ercise- or dipyridamole-induced stress a number of centers, along with sub- University College of Medicine imaging with 99mTc-sestamibi SPECT. sequent effects on patient manage- (Taoyuan, Taiwan) reported in the Feb- The mean follow-up was 34 Ϯ 15 ment. In an article published in the ruary 1 issue of Cancer (2004;100: months. During the follow-up period, February issue of Gynecologic On- 544Ð552) on a study designed to assess 24 cardiac deaths, 11 myocardial in- cology (2004;92:669Ð674), Niikura the diagnostic efficacy of 18F-FDG farctions, and 21 revascularizations et al. from the Tohoku University PET in restaging cervical carcinoma at were reported. Not only were abnormal School of Medicine (Sendai, Japan) the time of first recurrence. The study scans significantly associated with car- reported on a study of 27 patients included 40 patients with cervical car- diac events, but multivariate analysis with endometrial cancer scheduled cinoma whose previous treatment had showed that an abnormal scan was the for total abdominal hysterectomy, bi- failed but who were considered candi- most important independent predictor lateral salpingo-oophorectomy, total dates for curative salvage therapy. Pa- of cardiac events. The authors con- pelvic lymphadenectomy, and paraaor- tients were restaged after undergoing cluded that “99mTc-sestamibi SPECT tic lymphadenectomy. 99mTc-labeled CT and/or MRI and dual-phase PET was demonstrated to be a powerful tool phytate was injected into the endo- performed by adding 3-hour delayed for the prognostic evaluation of elderly metrium the day before surgery. In- images to 40-minute scans. Results patients with suspected CAD.” International Journal of Cardiology traoperative gamma probes detected were analyzed on the basis of 2 end- at least 1 SLN in 23 (82%) of the points: percentage improvement in re- patients. The sensitivity and specific- staging as indicated by treatment mod- SPECT/CT Fusion Guides ity for detecting lymph node metas- ification with PET and 2-year overall Robot in tases were both 100%. The authors survival in the study group compared Parathyroidectomy concluded that the technique may with comparable previously treated pa- In a study e-published ahead of prove especially useful in early-stage tients who did not undergo restaging print on 2 February in the journal endometrial cancers. with PET. The authors found that treat- Surgical Endoscopy, a team of Aus- Van Dam et al. from Sint Au- ment was modified in 22 patients trian surgeons reported on the use of gustinus Hospital (Antwerp, Bel- (55%) as a result of PET findings. PET SPECT and CT to guide a robot- gium) reported in the January issue of was significantly superior to CT and/or assisted thoracoscopic resection of a Gynecologic Oncology (2004;92:89Ð MRI in identifying metastatic lesions. mediastinal parathyroid in the aorto- 92) on SLN detection in 4 patients Those women who proceeded to sur- pulmonary window. Profanter et al. with primary and recurrent stage I or gery on the basis of PET findings ex- from University Hospital Innsbruck II vaginal carcinoma. 99mTc-labeled perienced a significantly better 2-year based their intervention planning on colloid was injected at 4 sites in the overall survival rate than did the com- separate preoperative CT and 99mTc- vaginal mucosa, and a hand-held parable group of patients who under- sestamibi SPECT image coregistered gamma probe was used to detect the went no PET imaging. The authors to provide precise localization of the SLNs during laparascopy. One pa- concluded that not only is dual-phase parathyroid. The images were super- tient, in whom the sentinel nodes 18F-FDG PET superior to CT and/or imposed on a reproducible model of proved to be negative, was treated MRI in restaging recurrent cervical the patient’s head and neck. A Da- with a wide local excision of the tu- carcinoma, but that PET facilitates an Vinci operating robot was then used mor, pelvic and groin lymphadenec- optimal choice in management for phy- to perform minimally invasive sur- tomy, and adjuvant radiotherapy. The sicians and patients. gery. The patient did well in recov- sentinel node contained tumor metas- Cancer ery. The authors concluded that, tases in the second patient, who un-

36N THE JOURNAL OF NUCLEAR MEDICINE ¥ Vol. 45 ¥ No. 4 ¥ April 2004 Newsbriefs/Literature derwent combined chemo- and radio- of sentinel nodes using 99mTc-labeled and may provide important informa- NEWSLINE therapy. In a third patient, no sentinel colloid is feasible in patients with tion to direct further management.” node was identified. The authors con- primary and recurrent vaginal cancer Gynecologic Oncology cluded that, “Laparoscopic detection

(Continued from page 16N) REFERENCES of the likely dose. This, however, is beyond the scope of 1. Siegel JA, Kroll S, Regan D, Kaminski MS, Wahl RL. A practical methodology this case report. for patient release after tositumomab and 131I-tositumomab therapy. J Nucl All licensees should expect the NRC to perform dose Med. 2002;43:354Ð363. calculations using state-of-the-art dosimetry methods that 2. Sparks RB, Siegel JA, Wahl RL. The need for better methods to determine release criteria for patients administered radioactive material. Health Phys. result in realistic and not overly conservative dose esti- 1998;75:385Ð388. mates. This is especially important because these dose 3. Siegel JA, Marcus CS, Sparks RB. Calculating the absorbed dose from radio- estimates are used for risk assessment. The large discrep- active patients: the line-source versus point-source model. J Nucl Med. 2002; 43:1241Ð1244. ancies in methodology, criteria used, and estimated dose 4. Schleien B, Slaback LA Jr, Birky BK. Handbook of Health Physics and demonstrated in this case raise important issues. We Radiological Health. 3rd ed. Baltimore, MD: Williams and Wilkins; 1998: therefore recommend that the NRC Commissioners con- Table 5.1. sider a case-by-case review of staff dose calculations by Carol S. Marcus, PhD, MD an outside expert panel to gain valuable perspectives and Harbor-UCLA Medical Center appropriate calculation strategies to assure that these dose Torrance, CA estimates are realistic and represent values that not only Jeffry A. Siegel, PhD comply with regulatory requirements but also can be used Enterprises for appropriate risk assessment. Wellington, FL

ACKNOWLEDGMENTS This work was supported in part by Harbor-UCLA Medical Center, Torrance, CA.

(Continued from page 25N) Cecil Barrett, the Hilton employee who “made the trains run at Camp David that would result in an accord between on time” throughout the meeting; and Beatrice Smith, who Egypt and Israel. Attendees at our meeting were fasci- kept detailed minutes during the planning. nated by glimpses of Senator Ted Kennedy, Israel’s Prime Minister Menachem Begin, and other dignitaries Is It Not Time Again? passing through the hotel lobby. An important question is whether it is time again As would be expected from a meeting in the nation’s for the United States to host the World Congress of the capital, the opening ceremony included a letter from WFNMB. Six years before the date of each Congress, President Jimmy Carter and talks by Nobel laureate Ro- the WFNMB assembly meets to choose a host city. salyn Yalow and Donald Frederickson, director of the Should the SNM submit a proposal to the assembly for National Institutes of Health. On September 18, the Pres- the meeting to be held in the United States in 2014? At ervation Jazz band gave a special Kennedy Center concert that time, 36 years will have passed since the meeting for the attendees, followed by a rooftop reception. On in Washington in 1978. Some believe that the World September 20, the National Gallery of Art opened its Congresses of the WFNMB should be held only in doors for a private showing, with a performance by the developing countries. Others believe that, with respect to nuclear medicine, we are all developing countries National Gallery Orchestra. and that the goals of the Second World Congress are as The meeting was an overwhelming success and was worthy today as they were in 1975. greatly rewarding for attendees, individuals presenting sci- entific papers, and the dedicated organizers, which, in addi- Henry N. Wagner, Jr. MD tion to those mentioned already, included: Anne Wagner and Johns Hopkins Bloomberg School of Public Health Arlene Reba, who chaired the Social Program Committee; Baltimore, MD

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