RADIONUCLIDE IMAGING AND THERAPY OF NEUROENDOCRINE TUMOURS

The incidence and prevalence of neuroendocrine tumours (NETs) are on the rise. Although NETs are a heterogeneous group of tumours, they have some similar properties, for example, that they can concentrate neuroamines and tend to have a high degree of somatostatin receptor (SSR) expression. These mechanisms can be exploited and this article discusses the important role of radionculide imaging and radionculide therapy in the management of NETs based on these mechanisms. This article reviews the current literature and discusses the role of radionuclide imaging in NETs both in terms of SSR imaging and neuroamine (metaiodobenzylguanidine [MIBG]) imaging. We discuss state-of- the-art 68Ga-radiopeptide imaging and indications for it use. We also discuss the role of 18F-FDG and other tracers in the management of NETs. The second half of the article focuses on radiotargeted treatment of NETs, discussing I-131 MIBG therapy and focussing on the emergence of peptide receptor radionuclide therapy. We discuss the clinical results, toxicities and patient selection for PRRT. Key words: DOTA octreotide, DOTATATE, Ga-68, Lu-177, metaiodobenzylguanidine, neuroendocrine tumours, peptide receptor radionuclide therapy, Y-90

The Study Of Temperature Analysis On Fusible Metal Bonding Application

High frequency packages become very important due to the rapid growth of wireless communication system. They require compactness, low cost and high performances ever at frequency up to 60 GHz. Flip-chip device assembly using organic substrates at very high frequency has become a cost competitive packaging method in semiconductor industries. This thesis discusses the influence of temperature on copper pillar solder joints contact to the surface of the substrate after reflow respect to staging time by using flip chip device. Samples of the flip chip devices will be bonded under selected temperature and then will undergo cross section of sample to determine the failure analysis of flip chip bonded after reflow process .Therefore, different temperature and staging time in bonding process can cause the bonding mechanism of flip chip copper pillar to have less adhesion and copper pillar crack at the neck of the pillar. Besides that, the nature of solder contributes to poor solder wetting and low thermal conductivity. For an example, the behavior of Sn-based solder in term of thermal conductivity and solder wetting characteristic. The test results shows that, the copper pillar solder can be productively sustain the solder joint of the thermal fatigue life cycle and the formation of intermetallic compound (IMC). The basic requirements of the joining material and the process will be discuss in this study. In future, experimental research on the performance of solder joint with different type of temperature is required. In summary, improvement towards the flip chip die bonding process which by controlling the optimum temperature and staging time would overall be a driving force towards the development of similar packages with more demanding requirements towards the existing flip chip packages

Methods to assess the biodistribution of radiolabelled somatostatin analogues and treatment response of neuroendocrine tumours.

Introduction: During the past decade, proof of the principle that somatostatin receptors can be successfully used for in vivo targeting of neuroendocrine tumours (NETs) has been provided. These tumours are imaged with 111Indium-pentetreotide and treated with 90Yttrium labeled somatostatin analogues. The aim of this study was to assess (a) the biodistribution and residency of 90Y labelled agents using the brehmsstrahlung imaging technique (b) the tumour response to various treatment modalities using a simplified scintigraphic method [Functional SPECT tumour volume (STV)]. Material and methods: 1) 19 patients with NETs were imaged with 111In-pentetreotide and 14 of them underwent treatment with 90Y-lanreotide. The rest underwent treatment with 90Y-SMT. All the patients were imaged 24 hours post-therapy. Brehmsstrahlung images obtained post therapies were used to assess the 90Y-lanreotide biodistribution in 14 patients and the 5 patients treated with 90Y-SMT, comparing them with 111In-pentetreotide. 2) In 42 patients with NETs a retrospective analysis was performed of the 111In-pentetreotide imaging and CT scan in patients treated with different therapies. A simplified scintigraphic method using 111In-pentetreotide SPECT liver imaging was used to monitor changes in tumour response and to determine how this correlates with CT scan and clinical response. Results: 1) 90Y-lanreotide and 90Y-SMT (with amino acids) have much lower uptake in the kidney (p 0.000 and 0.041 respectively) than 111In-pentetreotide. G Gnanasegaran MD 2 2) 22/42 patients had a good clinical response. A mean fall in total functional STV of 37% was seen in patients with symptomatic relief and a mean increase of 72 % was seen in patients with no symptomatic relief STV predicted the clinical outcome in 34 patients (81%) and CT predicted the outcome in 21 (50%) patients. Conclusion: There was a difference in biodistribution between 111In-pentetreotide and 90Y-lanreotide/ 90Y-SMT, especially in the kidneys, which may explain why there is minimal renal toxicity reported with 90Y-lanreotide/ 90Y-SMT therapies. Finally, the assessment of functional STV is more useful in monitoring the tumour response after treatment than CT. The changes in functional volumes after therapy correlate well with clinical response

The Development of Wireless Power Transfer Technologies for Mobile Charging in Vehicles using Inductive Approach

Nowadays, the mobile charging in vehicle is a must and therefore, such technology is now available in every vehicle through wired connection approach. Using this wired connection to power up mobile device in the vehicle might be inconvenience to the user. Thus, this project aims to develop a wireless power transfer technology to power up the mobile device in a vehicle. Through this, the users will not facing difficulty of charging their device while driving. To be specific, the Inductive Power Transfer (IPT) is applied here due to its advantages where it can transfer power wirelessly with a higher efficiency in a short range. To make this work, a Class E inverter is designed to convert a direct current (DC) supply into alternating current (AC) supply at a high frequency with a higher efficiency. Furthermore, pi-2-a impedance matching circuit is also applied in this work in order to improve the efficiency of such system. To validate the efficiency of the proposed method, analysis on the gap distance between the two magnetic coils, transmitter and receiver, are performed through simulation and experimental work. At the end of this work, the designed prototype is able to yield approximately 70 % in terms of output efficiency and able to power up the mobile device wirelessly

SPECT/CT imaging of the lumbar spine in chronic low back pain: a case report

Mechanical low back pain is a common indication for Nuclear Medicine imaging. Whole-body bone scan is a very sensitive but poorly specific study for the detection of metabolic bone abnormalities. The accurate localisation of metabolically active bone disease is often difficult in 2D imaging but single photon emission computed tomography/computed tomography (SPECT/CT) allows accurate diagnosis and anatomic localisation of osteoblastic and osteolytic lesions in 3D imaging. We present a clinical case of a patient referred for evaluation of chronic lower back pain with no history of trauma, spinal surgery, or cancer. Planar whole-body scan showed heterogeneous tracer uptake in the lumbar spine with intense localisation to the right lateral aspect of L3. Integrated SPECT/CT of the lumbar spine detected active bone metabolism in the right L3/L4 facet joint in the presence of minimal signs of degenerative osteoarthrosis on CT images, while a segment demonstrating more gross degenerative changes was more quiescent with only mild tracer uptake. The usefulness of integrated SPECT/CT for anatomical and functional assessment of back pain opens promising opportunities both for multi-disciplinary clinical assessment and treatment for manual therapists and for research into the effectiveness of manual therapies

Predictors of antiproliferative effect of lanreotide autogel in advanced gastroenteropancreatic neuroendocrine neoplasms

PURPOSE: The antiproliferative properties of lanreotide autogel (LAN) in gastroenteropancreatic neuroendocrine neoplasms (GEP NENs) were demonstrated in the CLARINET study. However, there is limited literature regarding factors that affect progression-free survival (PFS) in patients with GEP NENs treated with LAN. METHODS: We identified a total of 191 treatment-naive patients with advanced GEP NENs and positive SSTR uptake on imaging (Octreoscan or 68Gallium DOTATATE Positron Emission Tomography [68GaPET]) who received first-line LAN monotherapy, albeit at various starting doses (60, 90 or 120 mg/month). A group of 102 patients who initiated treatment at the standard dose of 120 mg/month were included in the study and further evaluated by univariate and multivariate analyses to identify predictors of PFS. RESULTS: The location of tumour primary was in the small bowel in 63 (62%), pancreas in 31 (30%) and colon/rectum in 8 patients (8%). The tumours were well-differentiated, and the majority were grade 1 (52%), or 2 (38%). About 60% of cases had progressive disease at the time of treatment initiation. Most patients with available pretreatment nuclear medicine imaging (Octreoscan or 68Ga PET) had a Krenning score of 3 (44%) or 4 (50%). The median PFS for the entire cohort was 19 months (95% CI 12, 26 months). The univariate analysis demonstrated that grade 2 tumours, progressive disease at baseline and metastatic liver disease were associated with a significantly shorter PFS, while other evaluated variables did not affect PFS at a statistically significant level. However, at multivariate analysis only the tumour grade remained statistically significant. CONCLUSIONS: The current study showed that, of many evaluated variables, only the tumour grade was predictive of PFS duration and this should be considered during patient selection for treatment

Guiding principles on the education and practice of theranostics.

The recent development and approval of new diagnostic imaging and therapy approaches in the field of theranostics have revolutionised nuclear medicine practice. To ensure the provision of these new imaging and therapy approaches in a safe and high-quality manner, training of nuclear medicine physicians and qualified specialists is paramount. This is required for trainees who are learning theranostics practice, and for ensuring minimum standards for knowledge and competency in existing practising specialists. To address the need for a training curriculum in theranostics that would be utilised at a global level, a Consultancy Meeting was held at the IAEA in May 2023, with participation by experts in radiopharmaceutical therapy and theranostics including representatives of major international organisations relevant to theranostics practice. Through extensive discussions and review of existing curriculum and guidelines, a harmonised training program for theranostics was developed, which aims to ensure safe and high quality theranostics practice in all countries. The guiding principles for theranostics training outlined in this paper have immediate relevance for the safe and effective practice of theranostics

Changes observed in radionuclide bone scans during and after teriparatide treatment for osteoporosis

# The Author(s) 2011. This article is published with open access at Springerlink.com Purpose Visual changes on radionuclide bone scans have been reported with teriparatide treatment. To assess this, serial studies were evaluated and quantified in ten postmenopausal women with osteoporosis treated with teriparatide (20 μg/day subcutaneous) who had 99m Tc-methylene diphosphonate (MDP) bone scans (baseline, 3 and 18 months, then after 6 months off therapy). Methods Women were injected with 600 MBq 99m Tc-MDP, and diagnostic bone scan images were assessed at 3.5 h. Additional whole-body scans (10 min, 1, 2, 3 and 4 h) were analysed for 99m Tc-MDP skeletal plasma clearance (Kbone). Regional Kbone differences were obtained for the whole skeleton and six regions (calvarium, mandible, spine, pelvis, upper and lower extremities). Bone turnover markers (BTM) were also measured. Results Most subjects showed visual changes on 3- and 18month bone scan images that disappeared after 6 months off therapy. Enhanced uptake was seen predominantly in the calvarium and lower extremities. Whole skeleton Kbone displayed a median increase of 22 % (3 months, p=0.004) and 34 % (18 months, p=0.002) decreasing to 0.7% (6 months off therapy). Calvarium Kbone changes were three times larger than other sites. After 6 months off therapy, all Kbone and BTM values returned towards baseline

Nuclear medicine services after COVID-19 : gearing up back to normality

The COVID-19 pandemic is in transition. It may pass or may define a “new normal” over a variable period and might force us to turn our united and undivided attention as a global nuclear medicine community to address the global health of our specialty jointly. The severe acute respiratory syndromecoronavirus-2 (SARS-CoV-2) and the disease it causes (coronavirus disease-2019 or COVID-19 for short) have been the topic of much discussion in the nuclear medicine and radiology literature. Since the first reports of the new virus emerged from China in late December 2019, the World Health Organization (WHO) declared it a public health emergency of international concern on 30 January 2020. WHO declared COVID-19 as a pandemic on 11 March 2020 ; it has swept the globe, with no respect for national boundaries, causing widespread infections, mortality, human suffering, and upending lives in all socioeconomic groups. Governments around the world have rushed to implement measures aimed initially at containing the spread of the virus, but after that, mainly at slowing the COVID-19 spread and mitigating the impact of the virus on local healthcare systems and supply chains. Despite this, there is significant heterogeneity in the degree of success of the various measures, in keeping with differing political, sociological, and economic factors around the world.http://link.springer.com/journal/2592021-05-04pm2020Nuclear Medicin

Stem cells from human extracted deciduous teeth expanded in foetal bovine and human sera express different paracrine factors after exposure to freshly prepared human serum

Background: The response of stem cells to paracrine factors within the host’s body plays an important role in the regeneration process after transplantation. The aim of this study was to determine the viability and paracrine factor profile of stem cells from human extracted deciduous teeth (SHED) pre-cultivated in media supplemented with either foetal bovine serum (FBS) or pooled human serum (pHS) in the presence of individual human sera (iHS). Methods: SHED (n=3) from passage 4 were expanded in FBS (FBS-SHED) or pHS (pHS-SHED) supplemented media until passage 7. During expansion, the proliferation of SHED was determined. Cells at passage 7 were further expanded in human serum from four individual donors (iHS) for 120 hours followed by assessment of cell viability and profiling of the secreted paracrine factors. Results: Proliferation of SHED was significantly higher (p<0.05) in pHS supplemented media compared to FBS supplemented media. pHS-SHED also maintained their higher proliferation rate compared to FBS-SHED in the presence of iHS. In iHS supplemented media, FBS-SHED expressed significantly higher levels of SDF-1A (p<0.05) after 24 hours compared to pHS-SHED. Similar results were found for HGF (p<0.01), LIF (p<0.05), PDGF-BB (p<0.05), SDF-1A (p<0.01), and IL-10 (p<0.05) when cell culture supernatants from FBS-SHED was profiled 120 hours post-incubation. Conclusion: SHED expanded in pHS instead of FBS have higher proliferative capacity and show an altered secretion profile. Further studies are needed to determine whether these differences could result in better engraftment and regeneration following transplantation