Radiation exposure awareness from patients undergoing nuclear medicine diagnostic 99mTc-MDP bone scans and 2-deoxy-2-(18F) fluoro-D-glucose PET/computed tomography scans

INTRODUCTION: Medical imaging is on average the largest source of artificial radiation exposure worldwide. This study seeks to understand patient's awareness of radiation exposure derived from nuclear medicine diagnostic scans and assess if current information provided by leaflets is adequate. METHODS: Single-centre cross-sectional questionnaire study applied to bone scan and FDG PET/computed tomography patients, at a nuclear medicine and PET/computed tomography department over a 15-week period in 2018. Questionnaires on dose comparators were designed in collaboration with patients, public, and experts in radiation exposure. Qualitative data were analysed using thematic analysis and quantitative data using SPSS (V. 24). RESULTS: A total of 102 questionnaires were completed (bone scan = 50; FDG PET/computed tomography = 52). Across both groups, 33/102 (32.4%) patients reported having a reasonable understanding of nuclear medicine and 21/102 (20.6%) reported a reasonable knowledge of ionising radiations. When asked to compare the exposure dose of respective scans with common comparators 8/50 (16%) of bone scan patients and 11/52 (21.2%) FDG PET/computed tomography answered correctly. On leaflet information, 15/85 (17.6%) patients reported the leaflets do not provide enough information on radiation exposure and of these 10/15 (66.7%) commented the leaflets should incorporate more information on radiation exposure dose. CONCLUSION: More observational and qualitative studies in collaboration with patients are warranted to evaluate patients' understanding and preferences in communication of radiation exposure from nuclear medicine imaging. This will ensure communication tools and guidelines developed to comply with ionising radiation (medical exposure) regulation 2017 are according to patients needs and preferences

Targeted therapy in nuclear medicine—current status and future prospects

In recent years, a number of new developments in targeted therapies using radiolabeled compounds have emerged. New developments and insights in radioiodine treatment of thyroid cancer, treatment of lymphoma and solid tumors with radiolabeled monoclonal antibodies (mAbs), the developments in the application of radiolabeled small receptor-specific molecules such as meta-iodobenzylguanidine and peptides and the position of locoregional treatment in malignant involvement of the liver are reviewed. The introduction of recombinant human thyroid-stimulating hormone and the possibility to enhance iodine uptake with retinoids has changed the radioiodine treatment protocol of patients with thyroid cancer. Introduction of radiolabeled mAbs has provided additional treatment options in patients with malignant lymphoma, while a similar approach proves to be cumbersome in patients with solid tumors. With radiolabeled small molecules that target specific receptors on tumor cells, high radiation doses can be directed to tumors in patients with disseminated disease. Radiolabeled somatostatin derivatives for the treatment of neuroendocrine tumors are the role model for this approach. Locoregional treatment with radiopharmaceuticals of patients with hepatocellular carcinoma or metastases to the liver may be used in inoperable cases, but may also be of benefit in a neo-adjuvant or adjuvant setting. Significant developments in the application of targeted radionuclide therapy have taken place. New treatment modalities have been introduced in the clinic. The concept of combining therapeutic radiopharmaceuticals with other treatment modalities is more extensively explore

Renal fornix rupture following diagnostic coronarography

A 31-year-old man with an uneventful medical history presented at the emergency department with complaints of exercise-related chest pain for 3 weeks. ECG showed ST-elevations in the inferior leads. A diagnostic coronarography was performed and showed multivessel coronary stenosis. During this procedure 200 ml of a nonionic, low-osmolality monomeric contrast agent (Iomeron 350®) and 1250 ml of isotonic saline solution was administered intravenously. After this procedure, the patient suffered from a sudden onset and progressive severe pain in the back and the right lumbar region. A plain CT of the abdomen performed 8 hours post coronarography showed contrast enhanced fluid in the renal sinus and the perinephric/peri-ureteral space (Fig. A (scout view), B (coronal) and C (sagittal) reformatted scans). There was a bladder overdistenstion with a CT-based volumetric estimation of 995 ml. No mechanical cause of upper urinary tract obstruction was present. Subsequent urological work-up included insertion of a bladder catheter (24 hours) and administration of peroral antibiotics. Ultrasound follow-up on the next day revealed no abnormalities and the patient was discharged

Experimental investigation on consolidation behavior of mud: Subreport 1. Methodology study

Due to the complex nature of mud consolidation within harbours, a robust and accurate guideline to evaluate the nautical depth is still under debate. Besides, alternative dredging techniques (e.g. mud conditioning/fluidising) have proven to be an applicable method to reduce dredging costs in a number of harbours. Yet, before one can define new criteria for nautical depth or implement new dredging techniques, a deeper understanding of the temporal evolution of rheological, mechanical and biological characteristics of mud is needed. In this study, we aim to improve the understanding of the rheological properties of consolidating mud by comparing the consolidation process of mud from 5 different locations namely the harbours of Zeebrugge (ZB) and Deurganckdok (DG) in Belgium, the harbours of Rotterdam (RO) and Ijmuiden (IJ) in the Netherlands and the Emden (EM) harbour in Germany. The main objectives of this project are to examine the effect of the consolidation process on the mechanical, rheological and biological characteristics of mud as well as to explain the differences in consolidation processes between muds from different origins.This sub-report describes the properties of different mud types used for the experiments as well as the experimental setup. The experimental setup includes a detailed description of the governing parameters, experimental design and measurement techniques conducted on two different consolidation columns, small and large

Nautical bottom sediment research: Sub report 11. Cohesive sediments dimensional analysis

The dimensional analysis technique was applied in order to determine possible relationships between the measured parameters in the STT and to identify possible inconsistencies in the measurements.The present dimensional analysis focuses only in the sedimentation and consolidation processes.Relationships between parameters could be used to identify inconsistencies for measured pore pressure, effective stresses and density values. Recommendations are suggested for sampling points and measuring methods

Letter to the editor

We would like to comment on a case of Birt-Hogg-Dubé (BHD) syndrome reported in this issue by M. Schreuer et al, JBR-BTR, 2011, 94: 29-31. Individuals with this rare autosomal dominant inherited disorder – named after three dermatologists who described the syndrome in 1977 – are susceptible to develop 1) noncancerous tumors of the hair follicles, 2) renal tumors (predominantly chromophobe renal cell carcinoma) and 3) thin-walled cystic lung lesions. The diagnosis of BHD is based on these clinical findings and confirmed by molecular genetic testing. We would like to take the opportunity to emphasize the unique position of the radiologist to suggest this syndrome in patients imaged and diagnosed with both multiple solid renal tumors and cystic pulmonary lesions

Mycophenolate mofetil in IgA nephropathy: Results of a 3-year prospective placebo-controlled randomized study

Mycophenolate mofetil in IgA nephropathy: Results of a 3-year prospective placebo-controlled randomized study.BackgroundBecause humoral immunity is believed to play a pivotal role in the pathogenesis of IgA nephropathy (IgAN), a prospective placebo-controlled randomized study was started in patients with IgAN using mycophenolate mofetil (MMF).MethodsA total of 34 patients with IgAN were treated with salt intake restriction, angiotensin-converting enzyme (ACE) inhibition and MMF 2g per day (N = 21) or placebo (N = 13). After 36months of follow-up clinical, biochemical, and radiologic data were analyzed using linear mixed models for longitudinal data and Kaplan-Meier survival analysis.ResultsTherapy had to be stopped prematurely in five patients. Two patients (MMF group) evolved to end-stage renal disease (ESRD). There was no difference between groups in the percentage of patients with a decrease of 25% or more in the inulin clearance or with a serum creatinine increase of 50% or more over 3years. There was also no significant difference between groups in annualized rate of change of serum creatinine, computed by linear regression analysis. No significant difference was noted between groups for inulin clearance, serum creatinine, proteinuria, blood pressure, or other parameters of renal function. Hemoglobin and C-reactive protein were significantly lower in the MMF group compared with the placebo group. As a function of time, a significant decline in both groups was noted of proteinuria, parenchymal thickness of the kidneys and C3d.ConclusionIn patients with IgAN at risk for progressive disease, no beneficial effect of 3-year treatment with MMF 2g per day could be demonstrated on renal function/outcome or proteinuria. However, larger randomized studies are needed to confirm or reject these results