Personalized Feedback on Staff Dose in Fluoroscopy-Guided Interventions: A New Era in Radiation Dose Monitoring

Radiation safety and protection are a key component of fluoroscopy-guided interventions. We hypothesize that providing weekly personal dose feedback will increase radiation awareness and ultimately will lead to optimized behavior. Therefore, we designed and implemented a personalized feedback of procedure and personal doses for medical staff involved in fluoroscopy-guided interventions. Medical staff (physicians and technicians, n = 27) involved in fluoroscopy-guided interventions were equipped with electronic personal dose meters (PDMs). Procedure dose data including the dose area product and effective doses from PDMs were prospectively monitored for each consecutive procedure over an 8-month period (n = 1082). A personalized feedback form was designed displaying for each staff individually the personal dose per procedure, as well as relative and cumulative doses. This study consisted of two phases: (1) 1-5th months: Staff did not receive feedback (n = 701) and (2) 6-8th months: Staff received weekly individual dose feedback (n = 381). An anonymous evaluation was performed on the feedback and occupational dose. Personalized feedback was scored valuable by 76% of the staff and increased radiation dose awareness for 71%. 57 and 52% reported an increased feeling of occupational safety and changing their behavior because of personalized feedback, respectively. For technicians, the normalized dose was significantly lower in the feedback phase compared to the prefeedback phase: [median (IQR) normalized dose (phase 1) 0.12 (0.04-0.50) A mu Sv/Gy cm(2) versus (phase 2) 0.08 (0.02-0.24) A mu Sv/Gy cm(2), p = 0.002]. Personalized dose feedback increases radiation awareness and safety and can be provided to staff involved in fluoroscopy-guided interventions

Functional and Radiological Imaging of Neuroendocrine Neoplasms

Imaging of neuroendocrine neoplasms (NENs) is extremely rich and varied. Conventional techniques of morphological imaging (ultrasound, CT, MRI) are complementary to other imaging techniques such as endoscopic explorations and functional imaging using radiopharmaceutical imaging techniques. NENs have very distinct functional characteristics, which make them ideal targets for functional molecular imaging. Functional imaging plays a crucial role in the assessment of initial tumor distribution (staging), disease assessment after therapy (restaging), disease follow-up, and planning for somatostatin receptor (SSTR) 2-based radiopeptide treatment. Other tracers, such as 123I-metaiodobenzylguanidine (123I-MIBG) scintigraphy or 18F-DOPA (dihydroxyphenylalanine) and the SSTR2-antagonist (NODAGA-JR11) PET/CT have been developed for specific indications or to gain sensitivity and specificity. The more aggressive, less differentiated neuroendocrine carcinomas tend to have less SSTR2 receptor expression, and the tumor cell metabolism shifts toward anaerobic glycolysis. In these patients, receptor-based imaging should be complemented or replaced by metabolic 18F-FDG (18F-fluorodeoxyglucose) PET/CT. The continuum from well-differentiated neuroendocrine tumor to a more aggressive neuroendocrine carcinoma makes functional imaging sometimes challenging