INDOT eInvoice Application for Consultant Contracts

In 2016, INDOT began the implementation of an electronic consultant invoicing application with nine pilot firms. In March of 2018, the application was rolled out for use with most new consultant contracts. Approximately 2,500 invoices were processed through eInvoice in FY 2019, and INDOT is working on an enhancement retrofit for implementation on earlier contracts. In this session INDOT representatives will review the purpose and features of the application as well as planned future enhancements

The Best Decision by Design: Professional Services Selection

Working with a design professional will give you the advantage of his or her expertise and innovative approaches to your project to provide more successful project outcomes: durable and sustainable facilities, lower construction costs, shorter construction schedules, and lower life-cycle costs. Join us to gain a critical perspective on why owners choose to hire design professionals based on a negotiated procurement process instead of bidding

68Ga-DOTATATE PET/CT imaging of indeterminate pulmonary nodules and lung cancer.

PURPOSE:18F-FDG PET/CT is widely used to evaluate indeterminate pulmonary nodules (IPNs). False positive results occur, especially from active granulomatous nodules. A PET-based imaging agent with superior specificity to 18F-FDG for IPNs, is badly needed, especially in areas of endemic granulomatous nodules. Somatostatin receptors (SSTR) are expressed in many malignant cells including small cell and non-small cell lung cancers (NSCLCs). 68Ga-DOTATATE, a positron emitter labeled somatostatin analog, combined with PET/CT imaging, may improve the diagnosis of IPNs over 18F-FDG by reducing false positives. Our study purpose was to test this hypothesis in our region with high endemic granulomatous IPNs. METHODS:We prospectively performed 68Ga-DOTATATE PET/CT and 18F-FDG PET/CT scans in the same 30 patients with newly diagnosed, treatment-naïve lung cancer (N = 14) or IPNs (N = 15) and one metastatic nodule. 68Ga-DOTATATE SUVmax levels at or above 1.5 were considered likely malignant. We analyzed the scan results, correlating with ultimate diagnosis via biopsy or 2-year chest CT follow-up. We also correlated 68Ga-DOTATATE uptake with immunohistochemical (IHC) staining for SSTR subtype 2A (SSTR2A) in pathological specimens. RESULTS:We analyzed 31 lesions in 30 individuals, with 14 (45%) being non-neuroendocrine lung cancers and 1 (3%) being metastatic disease. McNemar's result comparing the two radiopharmaceuticals (p = 0.65) indicates that their accuracy of diagnosis in this indication are equivalent. 68Ga-DOTATATE was more specific (94% compared to 81%) and less sensitive 73% compared to 93%) than 18F-FDG. 68Ga-DOTATATE uptake correlated with SSTR2A expression in tumor stroma determined by immunohistochemical (IHC) staining in 5 of 9 (55%) NSCLCs. CONCLUSION:68Ga-DOTATATE and 18F-FDG PET/CT had equivalent accuracy in the diagnosis of non-neuroendocrine lung cancer and 68Ga-DOTATATE was more specific than 18F-FDG for the diagnosis of IPNs. IHC staining for SSTR2A receptor expression correlated with tumor stroma but not tumor cells

Contingency table categorizing the diagnostic accuracy of ¹⁸F-FDG and ⁶⁸Ga-DOTATATE PET/CT with McNemar’s chi-square test.

<p>Contingency table categorizing the diagnostic accuracy of ¹⁸F-FDG and ⁶⁸Ga-DOTATATE PET/CT with McNemar’s chi-square test.</p

SSTR2 IHC staining results—12 biopsies.

<p>SSTR2 IHC staining results—12 biopsies.</p

Discordant image, FP ¹⁸F-FDG, TN ⁶⁸Ga-DOTATATE PET/CT.

<p>Axial CT (A) with a spiculated IPN. Fused ¹⁸F-FDG PET/CT (B) with IPN intense uptake (SUVmax 5.8) vs. ⁶⁸Ga-DOTATATE (C) with no visible uptake (SUVmax 0.90). Comparison ratios of the SUVmax of the nodule to normal lung and aortic blood pool for 18F-FDG were 11.8 and 6.4, respectively, with corresponding values of ⁶⁸Ga-DOTATATE being 2.2 and 1.5. Biopsy revealed inflammatory cells; nodule resolved on CT follow-up.</p

Inflammatory cells within non-neuroendocrine tumor.

<p>A. Hematoxylin and eosin stain of squamous cell carcinoma (black arrows) with abundant plasma cells. B. SSTR2A IHC stain showing negative tumor staining (black arrows) but positive staining in inflammatory cells (original magnification 100X). C. High power field shows tumor (black arrows) with SSTR2A IHC membranous staining in plasma cells (white arrows).</p