THE SNMTS NEWSLETTER Volume 17 No. 5 September/October 2011 SNMTS is dedicated to the advancement of molecular and nuclear medicine technologists by providing education, advocating for the profession, and supporting research to achieve Image Gently 2 clinical excellence and optimal patient outcomes. Call for Nominations 2 The Use of DaTscan for Imaging of Parkinson’s Advocacy Corner 4 ACR NMAA Resolution 5 Disease VOICE Box 5 By Chad Wiltz, CNMT, RT(R)(N) New Rates for Recent Grads 6 arkinson’s disease (PD) is a progressive each year, and this number does not reflect the Calendar 6 degenerative disorder of the central many thousands of cases that go undetected. Abstract Award Winners 7 Pnervous system. Early in the course of Historically, a diagnosis of PD is usually the disease, the most obvious symptoms are made based on the patient’s medical history movement-related, including shaking, rigid- and a neurological examination. The physician cially available following U.S. Food and ity, slowness of movement and difficulty with conducts an interview specifically looking for Drug Administration approval in June walking and gait. The pathology of the disease cardinal motor symptoms while attending to 2011. Prior to release in the United is characterized by insufficient formation and other possible symptoms that would exclude States, DaTscan had been widely used activity of dopamine produced in certain neu- a diagnosis of PD. There are four motor symp- in Europe with over 100,000 recorded rons of parts of the midbrain. toms which are considered cardinal in PD: procedures since 2002. DaTscan is indi- PD is the second most common neurode- tremor, rigidity, slowness of movement and cated for striatal dopamine transporter generative disorder after Alzheimer’s disease. postural instability. Common presentations of visualization using single photon emis- The prevalence is estimated at 0.3 percent of the disease are usually easily diagnosed. Diag- sion computed tomography (SPECT) the whole population in industrialized coun- nosis can be difficult when the symptoms are brain imaging to assist in the evaluation tries, rising to one percent in those over 60 not fully typical of PD since Parkinsonism can of adult patients with suspected Parkin- years of age and to four percent of the popu- occur due to a range of causes, and the differ- sonian Syndromes (PS). DaTscan may lation over 80 years of age. The mean age of ence with PD may be subtle, particularly in the be used to help differentiate Essential onset is around 60 years, although 5–10 per- early stages when symptoms may be mild. Tremor (ET) from tremor due to PS cent of cases, classified as young onset, begin Iodine-123 (I-123) Ioflupane (DaTscan) is (idiopathic PD, multiple system atro- between the ages of 20 and 50. Approximate- a novel proprietary radiopharmaceutical mar- ly 60,000 Americans are diagnosed with PD keted by GE Healthcare that became commer- Continued on page 2, see DaTscan Message from the SNMTS President-Elect By Brenda King, CNMT, FSNMTS his is my first opportunity to reach out and thank NMT student, Nuclear Medicine Advanced Associ- you for your vote of confidence. Please consider ate (NMAA) graduate or NMAA student you are well Tthis message as your personal “thank you” note. aware that our world is changing. Predicting where we Your confidence that I can represent you, speak for you will be in 2020 is like attempting to peer into a crystal and assist in continuing to shape our future is deeply ball. History has always shown that “survival goes to humbling. My transition from Speaker of the National the fittest.” To determine what NMTs and the SNMTS Council of Representatives to SNMTS president-elect BRENDA KING, CNMT, will look like in 2020, we must begin defining what it FSNMTS is a career highlight that you have made happen. Once means to be “fit” in nuclear medicine in order to sur- again, I thank you. vive. For the next several months, I will be listening to our current Today, the current NMT is struggling to hold a job. The new leadership, learning what challenges lay ahead and asking many, graduate is also desperate for work, so making the choice for a many questions. Keeping up with SNMTS president, Ann Marie lesser salary versus no salary is a no brainer. Meanwhile, many Alessi, BS, CNMT, NCT, RT(N), may be my biggest hurdle! working NMTs are clamoring for schools to stop taking new stu- If you are a practicing nuclear medicine technologist (NMT), dents. One thing is for sure, in 2020, many of the boomer NMTs Continued on page 4, see SNMTS President-Elect Image Gently and Nuclear Medicine By Nanci A. Burchell, MBA, CNMT, RT(N), FSNMTS Editorial Board Jacqueline Allen, CNMT y now, most of us have been introduced to the Image Gently Martha V. Mar, CNMT, PET, R(CT) campaign. The goal of Image Gently is to increase aware- David J. Perry, CNMT, PET, FSNMTS ness of opportunities to reduce radiation dose when imag- Kathy Thomas, CNMT, PET, FSNMTS, Chair B Laura A. Wall, MBA, CNMT, NCT, RT(N) ing children. The consensus guidelines for administered radio- Jessica Williams, CNMT, RT(N) pharmaceutical activities, published in the February 2011 issue of Joyce Zimmerman, CNMT The Journal of Nuclear Medicine, have been implemented at major children’s and academic hospitals. These guidelines, based on pa- Issue Editor David J. Perry, CNMT, PET, FSNMTS tient weight, are consistently providing high quality imaging with reduced radiation dose to pediatric patients. But what about chil- Managing Editor dren who are imaged at other institutions and clinics? What can Susan Martonik you do to ensure the administered activity is low and quality high? First, look at the child’s medical and imaging history. If there Graphic Designer are questions about the appropriateness of the imaging study or- Laura J. Mahoney dered, your nuclear medicine physician can consult with the refer- Uptake is published six times a year by SNMTS. All editorial communications should be directed to Kathy Thomas at 360.241.8869 or [email protected] ring physician to ensure that you are performing the right exam, at ©2011 by SNM the right time, at a low radiation dose to the patient. Second, incorporate the new weight-based pediatric dosing consensus guidelines into your protocols. If you don’t have pediat- Call for Nominations: Technologist ric-specific protocols or if your protocols need updating, you can go the SNM Web site to find the procedure guidelines (http://inter- Section 2012-2013 General Election active.snm.org/index.cfm?PageID=772). You will find protocols for many of the most frequently ordered pediatric exams. he SNMTS would like to announce the following positions for election by the general membership Third, really communicate with your patient and/or family. Let for the 2012–2013 leadership year: president-elect, them know that their exam is being performed by a professional. T secretary and one delegate-at-large position. Elected posi- As nuclear medicine technologists, we are trained to ensure we are tions have specific qualifications including active member- giving the patient the lowest dose possible while still obtaining ship in SNMTS, holding or have recently held a national diagnostic quality images. If they have questions, answer them if position (for example, chair of an SNMTS committee/task you can or arrange for your nuclear medicine physician or medical force, elected National Council of Representatives member health physicist to consult with them. Make sure they know where or member of the executive board) and endorsement by his/ to go for trusted medical information. One of the best resources is her chapter’s leadership. www.imagegently.org. Here they will find specific information on Detailed qualifications, duties, time commitments and nuclear medicine exams, including positron emission tomography. responsibilities for each office can be found on the SNM Web It is important that protocols be reviewed at least annually and site at http://interactive.snm.org/index.cfm?PageID=1678. that administered activities in the consensus guidelines are used. The first call for nominations for the general election will be distributed and posted on the SNM Web site by September The Image Gently campaign has developed a poster—“Go With 12, 2011. Each candidate’s completed application must be the Guidelines”— that includes dosing information for pediatric submitted no later than December 5, 2011. nuclear medicine procedures. The poster will be available in the For additional information, please contact Kathy Hunt, coming months for technologists to display in their hot laborato- MS, CNMT, SNMTS Nominating Committee chair, at Kathy. ries. For more information about the Image Gently campaign, visit [email protected], or Nikki Wenzel-Lamb, SNM director of www.imagegently.com. n leadership, at [email protected]. n DaTscan continued from page 1 phy, and progressive supranuclear palsy). DaTscan has a high binding Ioflupane is a phenyltropane compound which is a family of affinity for dopamine transporters, particularly in the striatal region drugs that are cocaine analogs. Because of its chemical composi- of the brain. A feature of PD is a marked reduction in dopaminergic tion, I-123 Ioflupane (DaTscan) is a federally controlled substance neurons in the striatal region. By introducing an agent that binds to (Schedule II). Drug Enforcement Administration (DEA) Schedule II the dopamine transporters, a quantitative measure and spatial distri- drugs include opiates, stimulants, depressants, and hallucinogens. A bution of the transporters can be obtained. Differentiation between DEA license is required for handling or administering this controlled ET and PS is assessed by the shape and intensity of the striatal signal substance. This aspect of DaTscan affects not only who can offer following DaTscan administration.