Choose Your Collimator Wisely: Inappropriate Collimator Selection During a Lu-DOTATATE Posttreatment Scan.

Proper collimator selection is critical to obtaining high-quality, interpretable nuclear medicine images. Collimators help eliminate scatter, which leads to poor spatial resolution and blurry images. We present the case of a posttherapy Lu-DOTATATE (Lutathera) patient who was initially imaged with a low-energy, high-resolution collimator routinely used in Tc imaging.

When in Doubt, Add SPECT/CT: A Case of Mistaken Identity.

A 63-y-old woman with a history of breast cancer presented with concerns of osseous metastasis. Initial whole-body planar bone scintigraphy revealed a focus of concern overlying the sternum. SPECT/CT images revealed the anomaly-localized activity in the needleless hub attached to the chemotherapy port.

Use of a Fatty Meal Cholecystagogue Protocol in Hepatobiliary Scintigraphy for Chronic Functional Gallbladder Disease.

Chronic functional gallbladder disorder, characterized by biliary pain in the absence of structural pathology, poses a diagnostic challenge necessitating reliable cholecystagogues for accurate evaluation. However, recurrent shortages of synthetic cholecystokinin analogs have prompted the exploration of alternative agents. This paper describes the efficacy of Ensure Plus as a viable fatty meal substitute for hepatobiliary scintigraphy in assessing chronic functional gallbladder disorder.

Accelerating medical education with ChatGPT: an implementation guide.

Chatbots powered by artificial intelligence have revolutionized many industries and fields of study, including medical education. Medical educators are increasingly asked to perform more administrative, written, and assessment functions with less time and resources. Safe use of chatbots, like ChatGPT, can help medical educators efficiently perform these functions.

Improving DXA Quality by Avoiding Common Technical and Diagnostic Pitfalls: Part 1.

Dual-energy x-ray absorptiometry (DXA) is an accurate means to assess bone mineral density, determine the risk of a fragility fracture, and monitor response to therapy. Despite its seemingly straightforward nature-the review of 2-to-3 nondiagnostic images and a few automatically generated numbers-the proper performance and interpretation of DXA can often be complex. It is complex because it is highly dependent on many factors, such as image acquisition, processing, analysis, and subsequent examination interpretation.

Diuretic Renal Scintigraphy Protocol Considerations.

Diuretic renal scintigraphy plays a critical diagnostic role by providing a physiologic means for differentiating between obstructive and nonobstructive hydronephrosis as well as assessing the function of the affected kidney. The exam accuracy is highly dependent upon and benefits from close attention to the protocol. This article reviews kidney anatomy and physiology, patient preparation, available radiopharmaceuticals, diuretic administration, acquisition, processing, quantification, and interpretation criteria.

F-Fluciclovine-Avid Axillary Lymph Nodes After COVID-19 Vaccination on PET/CT for Suspected Recurrence of Prostate Cancer.

Abnormally increased F-FDG avidity of axillary lymph nodes has become a frequent diagnostic dilemma on PET/CT in the current climate of global vaccinations directed against severe acute respiratory syndrome coronavirus 2. This avidity is due to the inflammatory response evoked by vaccines and the nonspecific nature of F-FDG uptake, which is increased in both malignant and inflammatory processes. Similarly, F-fluciclovine, an amino acid analog indicated for the assessment of biochemical recurrence of prostate cancer, may also demonstrate nonspecific inflammatory uptake.

The "Ultimate Triple PET": 68Ga-DOTATATE, 18F-FDG, and 18F-Fluciclovine PET/CT Findings in a Single Patient With Metastatic Abdominal Carcinoid and Prostate Cancer.

A 71-year-old man with a history of carcinoid and prostate adenocarcinoma underwent 68Ga-DOTATATE PET/CT to evaluate new mediastinal lymphadenopathy. The scan revealed new carcinoid metastases, but the mediastinal nodes were not avid. 18F-FDG PET/CT was performed to evaluate for cardiac and mediastinal sarcoidosis, revealing a lack of cardiac sarcoidosis, but probable mediastinal sarcoidosis.

Diuretic Renal Scintigraphy: The State of Practice and a Potential Opportunity for Standardization.

Objective: The aim of this study was to assess variation in diuretic renal scintigraphy (DRS) practice patterns and quantify compliance with the national guidance in a large cohort of laboratories from different institutions and practice settings across the United States.

Methods: By means of an institutional review board-approved protocol, we extracted 107 facility-specific, adult DRS protocols and associated 174 reports from the Intersocietal Accreditation Commission database, representing all laboratories applying for genitourinary scintigraphy certification during the 2016 to 2018 accreditation cycle. From these, we assessed 40 variables regarding facilities and staffing, patient preparation, examination technique and acquisition, image processing, and reporting.

A Case of Lu-DOTATATE Therapy Without the Use of Antiemetics.

Recommended Lu-DOTATATE treatment regimens involve prophylaxis with antiemetics to counteract the emetogenic properties of the nephroprotective amino acid solution infusion. We describe a 58-y-old woman treated with Lu-DOTATATE for metastatic small-bowel carcinoid, who was allergic to many classes of antiemetics. Therefore, she was treated with Lu-DOTATATE without antiemetic prophylaxis.

U.S. Diagnostic Reference Levels and Achievable Administered Activities for Adult Renal Scintigraphy: An Analysis of the Intersocietal Accreditation Committee Nuclear Laboratories.

The goal of this work was to determine U.S. diagnostic reference levels (DRLs) and achievable administered activities (AAAs) for adult renal scintigraphy.

Using Abnormal Respiratory Motion on Myocardial Perfusion Scintigraphy as an Opportunity to Screen for Obstructive Sleep Apnea.

A pilot study was performed to determine whether the raw data from routinely obtained upright and supine myocardial perfusion scan (MPS) imaging could be used as an opportunity to screen for obstructive sleep apnea (OSA). We hypothesized that abnormal respiratory motion seen only on supine imaging (not upright imaging) corresponds with OSA. MPS supine-only respiratory motion was compared with known OSA diagnoses and with risk factors known to be associated with OSA.

It's About Quality, Not Quantity: Qualitative FDG PET/CT Criteria for Therapy Response Assessment in Clinical Practice.

FDG PET/CT has emerged as an effective tool for the timely accurate assessment of how tumors respond to therapy. To standardize interpretation and reporting, numerous response criteria have been developed. This article will review the evolution of these criteria along with their strengths and weaknesses.

Radiology, Mobile Devices, and Internet of Things (IoT).

Radiology by its nature is intricately connected to the Internet and is at the forefront of technology in medicine. The past few years have seen a dramatic rise in Internet-based technology in healthcare, with imaging as a core application. Numerous Internet-based applications and technologies have made forays into medicine, and for radiology it is more seamless than in other clinical specialties.

Utilizing the Cholecystagogue, Ensure Plus, Results in Similar Hepatobiliary Scintigraphy Study Results and Patient Outcomes Status Post Cholecystectomy, in Comparison With Sincalide.

Objective: To determine if use of the oral cholecystagogue, Ensure Plus (EP), in hepatobiliary scintigraphy (HBS) leads to a similar distribution of normal and abnormal gallbladder ejection fractions (GBEFs) versus other historical secondary findings of chronic biliary disease in a similar patient population compared with the conventional cholecystokinin analog, sincalide. The HBS findings analyzed included the GBEF, small bowel transit time, gallbladder fill time, and reversal of the normal gallbladder versus small bowel transit. The secondary objectives were to determine whether patient outcomes were significantly different for EP and sincalide HBS study patients following cholecystectomy, namely, the surgical pathology and patient-reported biliary-type pain.

Achiasma and Kapur-Toriello syndrome: Two rare entities.

Purpose: Describe a unique case of achiasma in a patient with Kapur-Toriello syndrome.

Observations: We provide a brief review of achiasma with common findings on examination and imaging studies, and a published classification system. In addition, consistent with the rare Kapur-Toriello syndrome, he had a right unilateral cleft lip and palate, neurologic abnormality in his achiasma, anal atresia, vesicoureteral reflux, hypospadias, and growth deficiency.

Review of F-Fluciclovine PET for Detection of Recurrent Prostate Cancer.

Fluorine 18 (F) fluciclovine (anti-1-amino-3-F-fluorocyclobutane-1-carboxylic acid [FACBC]) is a radiolabeled amino acid analog that takes advantage of the amino acid transport upregulation in several types of cancer cells. FACBC is taken up to a greater extent in prostate cancer cells than in surrounding normal tissue, providing an opportunity for its use in cases of this common cancer. In 2016, the U.

Optimizing the Diagnosis of Parkinsonian Syndromes With I-Ioflupane Brain SPECT.

The purpose of this article is to provide a review of I-ioflupane SPECT in the evaluation of suspected parkinsonian syndromes (PSs). This collection of diseases presents frequent diagnostic challenges, even by movement disorder and dementia specialists. The I-ioflupane scan serves as an imaging biomarker of the status of presynaptic dopamine transporters (DATs) in the striatum.

Split-Dose F-FDG PET/CT-Guided Microwave Ablation for Liver Metastasis Recurrence with Immediate Treatment Assessment.

A 48-y-old man with a history of colon cancer presented with recurrent hepatic metastasis along a prior microwave ablation bed. Split-bolus, intraprocedural F-FDG PET was performed to guide repeat microwave ablation and immediately confirm complete treatment. PET-guided ablation is highly accurate for targeting and treating malignant hepatic lesions and feasible for nonspecialized tertiary care hospitals without an onsite cyclotron.

Scintigraphic Findings Beyond Ejection Fraction on Hepatobiliary Scintigraphy: Are They Correlated With Chronic Gallbladder Disease?

Objective: To determine if classically reported findings associated with chronic cholecystitis on hepatobiliary scintigraphy (HBS), such as delayed small bowel (SB) transit, slow gallbladder (GB) filling, and reversal of the normal GB and SB transit, are associated with a depressed GB ejection fraction (GBEF). The secondary objectives were to determine whether GBEF is correlated with the time of GB filling, time of SB transit, or reversal of normal GB/SB filling sequence. We hypothesize that an association between a depressed GBEF and these classical HBS findings could validate them as surrogate markers for chronic GB disease.

Risk of Delayed Lymph Node Metastasis in Clinically N0 Esthesioneuroblastoma.

 To determine both the rate of delayed cervical lymph node metastasis in patients with esthesioneuroblastoma (ENB) and a clinically N0 untreated neck and the effectiveness of salvage treatment.  Retrospective review.  Tertiary academic medical center.

Armband activity monitor data do not correlate with reported pain scores in patients receiving vertebroplasty.

Background: Prior research on the efficacy of vertebroplasty has focused primarily on subjective, patient-reported outcomes.

Objective: To apply an armband activity monitor (SenseWear by BodyMedia Inc, USA) to patients presenting for consideration for vertebroplasty and to determine the correlation between patient-reported outcomes and quantitative activity metrics at baseline and 30 days after presentation.

Materials And Methods: Nineteen patients were enrolled (15 receiving vertebroplasty, 4 not receiving vertebroplasty).