Barcelona, Spain Annual Congress of the European Association of Nuclear Medicine October 12 - 16, 2019 Barcelona, Spain - EANM 2019
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Barcelona, Spain
Annual Congress of the
European Association of Nuclear Medicine
October 12 – 16, 2019
Barcelona, Spain
Technologist Abstract Book
eanm19.eanm.org
Visit us on
.com/officialEANM
PU B L I S HER CONTENT
European Association of Nuclear Medicine No responsibility is taken for the correctness of this
Schmalzhofgasse 26, 1060 Vienna, Austria information. Information as per date of printing.
Phone: +43 1 890 44 27 | Fax: +43 1 890 44 27 - 9
Email: office@eanm.org | URL: www.eanm.org
L AYOUT & DESI GN
Barbora Trnena, EANM Executive Office
E D I TO R S
Andrea Santos, Chair EANM Technologist Committee
PRI NT
MarieClaire Attard, EANM Technologist Committee
Print Alliance HAV Produktions GmbH,
Marius Mada, EANM Technologist Committee
2540 Bad Vöslau
Barbora Trnena, EANM Executive Office
WORLD LEADING MEETING EANM'19
TECHNOLOGIST ABSTRAC T BOOK
TECHNOLOGIST
SESSIONS
on the occassion of the 32nd Annual Congress of
the European Association of Nuclear Medicine,
CCIB, Barcelona, Spain | October 12 – 16, 2019
Technologist Committee
Chair A. Santos (Portugal)
Vice Chair L. Camoni (Italy)
Members C. Terwinghe (Belgium)
S. Rep (Slovenia)
S. Rac (Croatia)
M.C. Attard (Netherlands)
A. Pietrzak (Poland)
M. Mada (United Kingdom)
Senior Advisor P. Fragoso Costa (Germany)
Technologist Committee Interest Group Meeting:
Tuesday, October 15, 2019, 13:00 - 14:30, Level P1, Hall 117
O C T O B E R 1 3 – 1 7 , 2 0 1 9 | B A R C E LO N A , S PA I N 3
EANM’19 WORLD LEADING MEETING
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Table of
Contents
Message from the Technologist Committee 7
Contents
Technologist Awards 2018 8
Programme 10
SUNDAY, OCTOBER 13, 2019
CTE 1 - with ANZSNM/CAMRT - Technologist Approach to Global Dose Optimization
ose Optimization Principles
D
Pedro Fragoso Costa (Essen, Germany) 16
Dose Reference Levels in Nuclear Medicine
Elizabeth A. Bailey (Sydney, Australia / ANZSNM) 17
ET/CT Dose Optimization and Occupational Exposure
P
Tina M. Alden (Vancouver, Canada / CAMRT) 18
Cardiac Imaging Methods for Dose Reduction
Luca Camoni (Brescia, Italy) 19
CTE Session 2 - Interactive - with the Radiation Protection Committee - Risk and Incidents
isks and Incidents in Nuclear Medicine - A Medical Physics Perspective
R
Klaus Bacher (Ghent, Belgium) 22
Potential Risk and Incidents in HotLab
Aljaz Socan (Ljubljana, Slovenia) 23
Management of Risks and Incidents in Nuclear Medicine
Giorgio Testanera (London, United Kingdom) 24
Mini Course 1 - Research Methodology
esearch Methodology for Technologists
R
Christina Malamateniou (London, United Kingdom) 26
Mini Course 2 - Interactive - Stress Testing for Technologists
Stress Testing for Technologists
MarieClaire Attard (Zwolle, Netherlands) 28
Mini Course 3 - Theranostics - Fundamental
General Aspects of Theranostics in Nuclear Medicine
Siroos Mirzaei (Vienna, Austria) 30
Theranostics for Technologists in the Context of NET
Nick Gulliver (London, United Kingdom) 31
MONDAY, OCTOBER 14, 2019
Technologist Oral Presentations 1 32
Technologist e-Poster Presentations 1- 4 33
4 O C T O B E R 1 2 – 1 6 , 2 0 1 9 | B A R C E LO N A , S PA I N
WORLD LEADING MEETING EANM’19
TECHNOLOGIST ABSTRAC T BOOK
CTE 3 - Preclinical Studies, from Bench to Bedside
ow to Develop the Ideal Radiopharmaceutical
H Contents
Guy Bormans (Leuven, Belgium) 46
Preclinical PET Imaging and Quantification
Michel Koole (Leuven, Belgium) 47
Nanobody Applications for Radionuclide Imaging and Therapy - Process from Camel to Patient
Marleen Keyaerts (Brussels, Belgium) 48
CTE 4 - with SNMMI - Technologist's Guide Launch - Radiopharmacy: An Update
Technologist's Guide Launch
MarieClaire Attard (Zwolle, Netherlands) 50
Generators used in Nuclear Medicine
Mark Crosthwaite (Richmond, United States of America / SNMMI) 51
Theoretical Basics of Radiopharmacy
Zéna Wimana (Brussels, Belgium) 52
TUESDAY, OCTOBER 15, 2019
Technologist Oral Presentations 2 53
Technologist Oral Presentations 3 54
CTE 5 - Interactive - Patient Communication
Health Communication through Design Thinking and Idea Reframing
Débora Miranda (Lisbon, Portugal) 56
Patient Welfare and Advocacy - A View from the Inside
Martin Lee (London, United Kingdom) 57
Risk Communication - Why and How to Communicate about Ionizing Radiation?
Tanja Perko (Mol, Belgium) 58
CTE 6 - Parathyroid Imaging
Comparison of [99mTc]Tc-MIBI and [18F] Fluorocholin Scintigraphy in Localization of Hyperfunctioning Parathyroid Tissue
Luka Lezaic (Ljubljana, Slovenia) 60
[11C]Methionine PET-CT Imaging in Hyperparathyroidism
Giovanna Pepe (Milan, Italy), Giorgio Testanera (London, United Kingdom) 61
The role of a technologist in the preparation of acquisition protocols and the processing of image data
in Nuclear Medicine Parathyroid Imaging
Sebastijan Rep (Ljubljana, Slovenia) & Giorgio Testanera (London, United Kingdom) 62
WEDNESDAY, OCTOBER 16, 2019
CTE 7 - Updates in Lung Imaging
ew PET Radiotracers for Lung Imaging
N
Domenico Albano (Brescia, Italy) 64
Metabolic Volumes Delineation for External Beam Radiotherapy and its Prognostic Role in Lung Cancer
Witold Cholewinski (Poznan, Poland) 65
Radiomic Features in Non-Small-Cell Lung Cancer FDG-PET/CT Studies
Margarita Kirienko (Milan, Italy) 66
O C T O B E R 1 2 – 1 6 , 2 0 1 9 | B A R C E LO N A , S PA I N 5
Join the
TECHNOLOGIST
COMMITTEE INTEREST
GROUP MEETING
Tuesday, October 15, 2019 | 13:00 - 14:30, Level P1, Hall 117
eanm19.eanm.org
WORLD LEADING MEETING EANM’19
TECHNOLOGIST ABSTRAC T BOOK
Dear Colleagues
and Friends,
It is with great satisfaction and happiness that I welcome you
to the 32nd Annual Congress of the EANM in Barcelona, Spain.
The European Association of Nuclear Medicine Mirroring the international outreach of
Technologist Committee (EANM-TC) is very proud the EANM-TC, sessions will be held with the
of the diverse and up-to-date programme that participation of representatives from the Society
it is offering at the congress. From Oct 12 to 16, of Nuclear Medicine and Molecular Imaging –
2019, a vast number of professionals from across Technologist Section (SNMMI-TS), the Canadian
the entire world will come together at this unique Association of Medical Radiation Technologists
event, creating an excellent opportunity to share (CAMRT) and the Australian and New Zealand
knowledge and experience and to strengthen Society of Nuclear Medicine – Technologist Special
bonds. Interest Group (ANZSNM-T).
The focus of the technologist programme Three sessions of oral presentations and four
is topics of great relevance for practice in the e-poster sessions have been organised to promote
field of nuclear medicine, where scientific and the exchange of ideas and report on the work
technological developments continue to be so that is being undertaken across the world. As an
influential. The coverage ranges from preclinical additional motivating factor, awards will be given
studies to theranostics, without neglecting the for the best two oral presentations as well as the
importance of patient communication in the best two e-Poster Session presentations.
practice of the nuclear medicine technologist. Finally, I highly recommend that you attend
Following last year’s good experience, we will the Technologist Interest Group Meeting. During
again be providing seven sessions of Continuous this meeting, the EANM-TC will share the current
Technologist Education (CTE) and three Mini- endeavours of the Committee, as well as future
Courses (MC) where specialists in each topic will perspectives. In addition, we will be announcing
share their expertise and knowledge. There will the prize winners during this session!
be scope for debating and active participation I wish you a great experience at the EANM
through special interactive sessions. Congress. Bearing in mind all of the above events
As a reflection of the multidisciplinary approach and activities, I truly believe that you will find it a
adopted in the EANM-TC’s work, we will count most fruitful occasion.
on the collaboration of the Radiation Protection
Committee in the organisation of CTE 2. Also,
a joint session with the EANM Neuroimaging
Committee will take place during the Congress, With my best regards,
aiming to cast light on the artefacts and pitfalls in Andrea Santos
brain imaging (Pitfalls & Artefacts, session 5). Chair, EANM Technologist Committee
O C T O B E R 1 2 – 1 6 , 2 0 1 9 | B A R C E LO N A , S PA I N 7
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TECHNOLOGIST ABSTRAC T BOOK
EANM Congress Düsseldorf 2018 –
Technologist Awards
B E S T OR AL P R ES EN TATIO N
Awards
Semi-quantitative criteria for the diagnosis of the myocarditis using 99mTc-Pyrophosphate SPECT/CT
J. Ilyushenkova, S. Sazonova, K. Zavadovsky
2 ND N OMIN EE F O R BES T O R AL P RESENTATI ON
Usefulness of SPECT for the semiquantitative assessment of regional 123I MIBG myocardial uptake in heart
failure: comparison between iterative reconstruction (OSEM) versus filtered back projection
A. Ruzza, I. Andreoli, G. Romagna, P. Basile, L. Filippi, O. Bagni
3 RD N OMINEE F O R BES T O R AL P RESENTATI ON
Comparison of Gastric Emptying Results Using 60min, 90min and 120min Protocol – A Retrospective Study
D. Teixeira Maçarico, C. Laurins, A. Nicol
B E S T e -P O S TER AWAR D
99mTc-MAA SPECT/CT-based dosimetry in SIRT: Why personalized dosimetry matters –
A retrospective study
L. Esteves, B. Collette, E. El Darazi, G. Verset, V. Lucidi, S. Goldman, R. Moreno-Reyes
2 ND N OMIN EE F O R BES T e -P O S TER PRESENTATI ON
Standardised Uptake Value & Hounsfield Unit in lumber spine & head of the femur for Alkaptonuria measured from 18F-
NaF PET/CT bone scan
E. H. M. A. Alawadhi, S. Vinjamuri, J. Gallagher, R. Lakshminarayan
3 RD N OMINEE F O R BES T e -P O S TER PRESENTATI ON
Incidence of asymptomatic nephroptosis detected by 99mTc-MAG3 renogram
S. Mendes, R. Silva, G. Costa, P. Soeiro, C. Barbosa, J. Rodrigues, I. Ferreira, J. P. Lima
8 O C T O B E R 1 2 – 1 6 , 2 0 1 9 | B A R C E LO N A , S PA I N
W O R L D L E A D I N G M E E T I N G
EANM'19
CME/CTE CERTIFICATES
1) SCAN YOUR BADGE
Scan your badge at the beginning of each session when
entering the room in order to acquire CME or CTE credits.
N!
ATTENTIorOy Evaluation
Mandat 2) EVALUATE (Deadline - October 30, 2019)
A short evaluation has to be completed for each attended
CME/CTE session until Oct 30, 2019.
Evaluation has to be done online at evaluation.eanm.org
3) DOWNLOAD YOUR CERTIFICATE
Once the steps above are completed, your certificate will
be available within 24 hours in your vEANM area.
To obtain your CME/CTE credits (for single sessions as well as the congress
itself ) the respective evaluations are mandatory. Deadline: October 30, 2019.
After this date, or without proper evaluation, no points will be accredited.
EVALUATION.EANM.ORG
O C T O B E R 1 2 – 1 6 , 2 0 1 9 | B A R C E LO N A , S PA I N 9
E A N M ’' 1 9 WORLD LEADING MEETING
TECHNOLOGIST ABSTRAC T BOOK
Programme
Sunday, October 13, 2019
Programme 08:00 – 08:10 Opening Technologist Track
08:10 – 09:30 C TE - with ANZSNM /CAMRT - Technologist Approach to Global
Dose Optimization
Chair: Luca Camoni (Brescia, Italy), Pedro Fragoso Costa (Essen, Germany)
08:10 – 08:30 ose Optimization Principles
D
Pedro Fragoso Costa (Essen, Germany)
08:30 – 08:50 Dose Reference Levels in Nuclear Medicine
Elizabeth A. Bailey (Sydney, Australia / ANZSNM)
08:50 – 09:10 ET/CT Dose Optimization and Occupational Exposure
P
Tina M. Alden (Vancouver, Canada / CAMRT)
09:10 – 09:30 Cardiac Imaging Methods for Dose Reduction
Luca Camoni (Brescia, Italy)
10:00 – 11:15 Plenary 1 - Radiomics and Artificial Intelligence (incl. Marie Curie Lecture)
Chair: Francesco Giammarile (Vienna, Austria), Jan Pruim (Groningen, Netherlands)
11:30 – 13:00 C TE 2 - Interactive - with Radiation Protection - Risk and Incidents
Chair: Sebastijan Rep (Ljubljana, Slovenia), Giorgio Testanera (London, United Kingdom)
11:30 – 12:00 Risks and Incidents in Nuclear Medicine - A Medical Physics Perspective (incl. 10 Min. Discussion)
Klaus Bacher (Ghent, Belgium)
12:00 – 12:30 Potential Risk and Incidents in HotLab (incl. 10 Min. Discussion)
Aljaz Socan (Ljubljana, Slovenia)
12:30 – 13:00 anagement of Risks and Incidents in Nuclear Medicine (incl. 10 Min. Discussion)
M
Giorgio Testanera (London, United Kingdom)
14:30 – 15:30 Mini Course 1 - Research Methodology
Chair: Marius Mada (Cambridge, United Kingdom)
14:30 – 15:30 esearch Methodology for Technologists
R
Christina Malamateniou (London, United Kingdom)
15:45 – 16:45 Mini Course 2 - Interactive - Stress Testing for Technologists
Chair: MarieClaire Attard (Zwolle, Netherlands)
15:45 – 16:45 Stress Testing for Technologists
MarieClaire Attard (Zwolle, Netherlands)
17:00 – 18:00 Mini Course 3 - Theranostics - Fundamental
Chair: Sonja Rac (Rijeka, Croatia), Sebastijan Rep (Ljubljana, Slovenia)
17:00 – 17:25 General Aspects of Theranostics in Nuclear Medicine
Siroos Mirzaei (Vienna, Austria)
17:30 – 17:55 Theranostics for Technologists in the Context of NET
Nick Gulliver (London, United Kingdom)
10 O C T O B E R 1 2 – 1 6 , 2 0 1 9 | B A R C E LO N A , S PA I NWORLD LEADING MEETING EANM’19
TECHNOLOGIST ABSTRAC T BOOK
Programme
Monday, October 14, 2019
08:00 – 09:30 Technologist Oral Presentations 1 Programme
Chair: Pedro Fragoso Costa (Essen, Germany), Wendy Kemps (Brussels, Belgium)
10:00 – 11:15 Plenary 2 - Prostate Cancer - Reload
Chair: Jolanta Kunikowska (Warsaw, Poland), Stefano Fanti (Bologna, Italy)
11:30 – 13:00 Technologist e-Poster Presentation1- 4
e-Poster Presentation 1: Chair: Edgar Pereira (Almada, Portugal), Agata Pietzak (Poznan, Poland);
(Room 133/134)
e-Poster Presentation 2: Chair: Marie Claire Attard (Zwolle, Netherlands), Rodrigo Garcia Gorga
(Sabadell, Spain); (Meeting Room 120/121)
e-Poster Presentation 3: Chair: Luísa Pereira (Maidstone, United Kingdom), Marius Mada
(Cambridge, United Kingdom); (Meeting Room 130)
e-Poster Presentation 4: Chair: Sonja Rac (Rijeka, Croatia), Louise Rimanic (Vancouver, Canada);
(Meeting Room 118/119)
14:30 – 16:00 C TE 3 - Preclinical Studies, from Bench to Bedside
Chair: Christelle Terwinghe (Leuven, Belgium), Jan Grimm (New York, United States of America)
14:30 – 15:00 ow to Develop the Ideal Radiopharmaceutical
H
Guy Bormans (Leuven, Belgium)
15:00 – 15:30 Preclinical PET Imaging and Quantification
Michel Koole (Leuven, Belgium)
15:30 – 16:00 Nanobody Applications for Radionuclide Imaging and Therapy - Process from Camel to Patient
Marleen Keyaerts (Brussels, Belgium)
16:30 – 18:00 C TE 4 - with SNMMI - Technologist's Guide Launch - Radiopharmacy: An Update
Chair: MarieClaire Attard (Zwolle, Netherlands), Mark Crosthwaite (Richmond,
United States of America / SNMMI)
16:30 – 17:00 Technologist's Guide Launch
MarieClaire Attard (Zwolle, Netherlands)
17:00 – 17:30 Generators used in Nuclear Medicine
Mark Crosthwaite (Richmond, United States of America / SNMMI)
17:30 – 18:00 Theoretical Basics of Radiopharmacy
Zéna Wimana (Brussels, Belgium)
O C T O B E R 1 2 – 1 6 , 2 0 1 9 | B A R C E LO N A , S PA I N 11EANM’19 WORLD LEADING MEETING
TECHNOLOGIST ABSTRAC T BOOK
Programme
Tuesday, October 15, 2019
Programme 08:00 – 09:30 Technologist Oral Presentations 2
Chair: Pedro Costa (Porto, Portugal), Giorgio Testanera (London, United Kingdom)
10:00 – 11:15 Plenary 3 - Next Generation PET Technology in the Clinical Setting
Chair: Michael Lassmann (Würzburg, Germany), Wolfgang Wadsak (Vienna, Austria)
11:30 – 13:00 Technologist Oral Presentations 3
Chair: Sebastijan Rep (Ljubljana, Slovenia), Ana Resende Geão (Ramada, Portugal)
14:30 – 16:00 C TE 5 - Interactive - Patient Communication
Chair: Pedro Fragoso Costa (Essen, Germany), Karren Fader (Halifax, Canada)
14:30 – 15:00 Health Communication through Design Thinking and Idea Reframing
Débora Miranda (Lisbon, Portugal)
15:00 – 15:30 Patient Welfare and Advocacy - A View from the Inside
Martin Lee (London, United Kingdom)
15:30 – 16:00 Risk Communication - Why and How to Communicate about Ionizing Radiation?
Tanja Perko (Mol, Belgium)
16:30 – 18:00 C TE 6 - Parathyroid Imaging
Chair: Sebastijan Rep (Ljubljana, Slovenia), Claudiu Pestean (Cluj, Romania)
16:30 – 17:00 Comparison of [99mTc]Tc-MIBI and [18F] Fluorocholin Scintigraphy in Localization of Hyperfunctioning
Parathyroid Tissue
Luka Lezaic (Ljubljana, Slovenia)
17:00 – 17:30 [11C]Methionine PET-CT Imaging in Hyperparathyroidism
Giovanna Pepe (Milan, Italy)
17:30 – 18:00 The role of a technologist in the preparation of acquisition protocols and the processing of image
data in Nuclear Medicine Parathyroid Imaging
Sebastijan Rep (Ljubljana, Slovenia) & Giorgio Testanera (London, United Kingdom)
12 O C T O B E R 1 2 – 1 6 , 2 0 1 9 | B A R C E LO N A , S PA I NWORLD LEADING MEETING EANM’19
TECHNOLOGIST ABSTRAC T BOOK
Programme
Wednesday, October 16, 2019
10:00 – 11:30 C TE 7 - Updates in Lung Imaging Programme
Chair: Andrea Santos (Lisbon, Portugal), Agata Pietrzak (Poznan, Poland)
10:00 – 10:25 ew PET Radiotracers for Lung Imaging
N
Domenico Albano (Brescia, Italy)
10:25 – 10:50 Metabolic Volumes Delineation for External Beam Radiotherapy and its Prognostic
Role in Lung Cancer
Witold Cholewinski (Poznan, Poland)
10:50 – 11:30 Radiomic Features in Non-Small-Cell Lung Cancer FDG-PET/CT Studies (incl. 15 Min. Discussion)
Margarita Kirienko (Milan, Italy)
11:45 – 12:45 Plenary 4 - Highlights Lecture
Chair: Wim Oyen (Arnhem, Netherlands), Francesco Giammarile (Vienna, Austria)
O C T O B E R 1 2 – 1 6 , 2 0 1 9 | B A R C E LO N A , S PA I N 13EANM’19 WORLD LEADING MEETING
TECHNOLOGIST ABSTRAC T BOOK
Programme
Overview
Sunday, October 13 Monday, October 14 Tuesday, October 15 Wednesday, October 16
Programme 08:00 - 104 604 1104
08:30 Technologists‘ Technologists Technologists
Opening
(08:00-08:10)
08:30 - Oral Oral
09:00 CTE 1
Technologist Committee / Presentations 1 Presentations 2
ANZSNM / CAMRT
09:00 - Technologist Approach to
09:30 Global Dose Optimization
09:30 -
10:00
10:00 - 204 704 1204 1704
10:30 (in Auditorium) (in Auditorium) (in Auditorium) CTE 7
Plenary 1 incl. Plenary 2 Plenary 3
10:30 - Marie Curie Lecture
Prostate Next Generation Updates in Lung Imaging
11:00 Radiomics and Artificial Cancer-Reload
Intelligence PET Technology in
11:00 - the Clinical Setting
11:30
11:30 - 304 804 1304
12:00 CTE 2 - Technologists 1804
Interactive Technologists (in Auditorium)
12:00 - Technologist + e-Poster Presentations 1-4 Oral Marie Curie Award
12:30 Radiation Protection Presentations 3 (11:45 - 12:15)
Committee
Risk and Incidents Plenary 4 -
12:30 - Highlights Lecture
13:00 (12:15 - 13:15)
Closing
13:00 - Technologist Committee (13:15 - 13:20)
14:30 Interest Group Meeting
(Hall 117)
14:30 - 404a 904 1404
15:00 Mini Course 1 CTE 3 CTE 5-
Interactive
15:00 - Research Methodology Preclinical Studies, from Technologists
15:30
Bench to Bedside Patient
15:30 - Communication
16:00
404b
16:00 - Mini Course 2-
16:30 Interactive
Stress Testing for
16:30 - Technologists 1004 1504
17:00 CTE 4 CTE 6
Technologists Committee
17:00 - 404c /SNMMI Parathyroid Imaging
17:30 Mini Course 3 Technologist's Guide
Theranostics - Launch -
17:30 - Fundamental
Radiopharmacy:
18:00 An Update
14 O C T O B E R 1 2 – 1 6 , 2 0 1 9 | B A R C E LO N A , S PA I NEANM’19
WORLD LEADING MEETING EANM’19
TECHNOLOGIST ABSTRAC T BOOK
1 TECHNOLOGIST ABSTRAC T BOOK
WORLD LEADING MEETING
CTE SESSION 1
October 13, 2019 | 08:00 - 09:30
Technologist Approach to
Global Dose Optimization
O C T O B E R 1 2 – 1 6 , 2 0 1 9 | B A R C E LO N A , S PA I N 15EANM’19 WORLD LEADING MEETING
TECHNOLOGIST ABSTRAC T BOOK
Dose Optimization Principles
Pedro Fragoso Costa (Essen, Germany)
Health professionals working with ionising radiation to ionising radiation, a unique conjugation of
CTE Session
1
have faced a continuous development of the evidence-based knowledge, international standards
radiation protection system. Integrating evidence- harmonisation and clear definition of responsibilities
based knowledge into this system is a key factor and tasks has been achieved. Particularly, in the field
for a successful implementation on the different of medicine, much more detail has been granted to a
applications. set of exposures and related concepts that contribute
Historically, the principles of radiation protection greatly to a more informed and organised radiation
October 13, were defined at a very early stage, just after the protection practice.
08:00 - 09:30 discovery of radiation. However, these have been Nuclear Medicine Technologists (NMT) are
issued at the light of very limited knowledge of the constantly facing optimisation opportunities during
health impact of ionising radiation on organisms and their daily practice. It is their duty and responsibility to
quite bond to the technical equipment particularly review all practices at the light of recent discoveries
used for the investigations of that early stage. After in the field, with the available means.
the widespread use of ionising radiation in many This session will provide an overview on the
sectors and the maturation of radiation protection as coordinated campaign including technologist
a discipline, with an international body representing associations from Europe, United States of America,
it, the three fundamental principles were drawn: Australia and New Zealand and Canada, which goal
justification of uses, limitation of exposure and was to diffuse the involvement of NMT in dose
radiation protection optimisation. optimisation around the world. Laying down the
In the recently reviewed European directive principles of dose optimisation and the available
laying down basic safety standards for protection resources and systematic views on optimising
against the deleterious effects arising from exposure radiation exposure in the daily routine.
References:
1. Council Directive 2013/59/Euratom of 5 December 2013 laying down basic safety standards for protection against the dangers arising from
exposure to ionising radiation, and repealing Directives 89/618/Euratom, 90/641/Euratom, 96/29/Euratom, 97/43/Euratom and 2003/122/
Euratom. Official Journal of the European Union. 2014;L 013:1-73
2. ICRP. The 2007 Recommendations of the International Commission on Radiological Protection. Ann ICRP. 2007;37(2-4)
3. Fragoso Costa P, Testanera G, Camoni L, et al. Technologist Approach to Global Dose Optimization. J Nucl Med Technol. 2019 Mar;47(1):75-82
16 O C T O B E R 1 2 – 1 6 , 2 0 1 9 | B A R C E LO N A , S PA I NWORLD LEADING MEETING EANM’19
TECHNOLOGIST ABSTRAC T BOOK
Dose References Levels in Nuclear
Medicine
Elizabeth A. Bailey (Sydney, Australia)
There has been an increasing requirement for individual patient. However they should be used as
CTE Session
1
professionals working in nuclear medicine to consider a general principal for minimizing patient radiation
patient radiation exposure prior to performing dose and modifying an individual protocol to ensure
the procedure. Internationally, many guidelines compliance with current best practice for that
and regulatory documents exist that specify the procedure.
maximum dose thresholds for safe exposure as Professional associations globally have been
well as instructions on how to optimize patient active in revising and educating nuclear medicine
dose without compromising image quality and the professionals in collaboration with the regulatory October 13,
diagnostic accuracy of the procedure. authorities specific to your local practice to provide 08:00 - 09:30
In medical imaging the standard used to for tools for implementing dose optimization techniques
defining and guiding radiation exposure to the on a daily basis. These include initiatives such as
patient is the Diagnostic Reference Level (DRL) the SNMMI ‘Image Gently’ approach to nuclear
which is defined as the ‘level of activity for a typical medicine practice, the revised DRLs using 25th, 50th
examination for groups of standard sized patients and 75th percentile guidelines adopted by the IAEA
or standard phantoms for broadly defined types of and ANZSNM (ARPANSA) and the EANM paediatric
examinations’(1). It is accepted that the DRL should dosage card.
be used to guide best practice and should not be At the conclusion of this presentation, you should
exceeded for the majority of routine practice and have a better understanding of the importance of
procedures. dose reference levels in nuclear medicine, how to
In understanding the best method for interpreting use them in daily clinical practice and the resources
and using DRL in clinical practice, it is important to available to better assist with reducing patient
recognize that DRL refer to a typical practice for a radiation dose without compromising image quality
specific examination and do not apply to a specific and diagnostic accuracy.
References:
1. Diagnostic Reference Levels Position Paper, The Medical Council Regulations for Medical Profession in Ireland, September 2004
2. Radiation Protection in the Medical Applications of Ionizing Radiation. Australian Radiation Protection a d Nuclear Safety Agency. Radiation
Protection Series No. 14 May 2008
3. Nuclear Medicine Diagnostic Reference Levels (DRLs). Australian Radiation Protection a d Nuclear Safety Agency, August 2017
4. Role of Reference Levels in Nuclear Medicine: A Report of the SNMMI Dose Optimisation Task Force. A.M Alessio, M.B Farrell and F Fahey. JNM Vol
56 No. 12 Dec2015; p1960-1964
5. ICRP, 2017. Diagnostic reference levels in medical imaging. ICRP Publication 135. Ann. ICRP 46(1)
O C T O B E R 1 2 – 1 6 , 2 0 1 9 | B A R C E LO N A , S PA I N 17EANM’19 WORLD LEADING MEETING
TECHNOLOGIST ABSTRAC T BOOK
PET/CT Dose Optimization and
Occupational Exposure
Tina M. Alden (Vancouver, Canada)
Dose optimization is relevant in all diagnostic radiopharmaceuticals is more than technologists
CTE Session
1
imaging modalities that use radiation. In PET/CT employed in general Nuclear Medicine departments.
imaging, dose optimization goals include minimizing It is essential that PET imaging departments
the dose to the patient while generating high quality evaluate the shielding and workflow, as well as the
images. In addition to dose optimization, workflows techniques of the individual technologists, during
should be designed so the technologists receive the the dose drawing and injection phases due to higher
lowest possible radiation exposure while working levels of technologist radiation exposure occurring
October 13, with the patients. during those stages of the PET procedure. With
08:00 - 09:30 CT imaging parameters and PET radio the introduction of auto-injectors, departments
pharmaceutical administered activities contribute to are finding a reduction in technologists’ dosimeter
the radiation impact on patients. The CT parameters readings. Increasing the distance from the patient
of a PET/CT scan should be reviewed on a regular after the injection and when positioning the patient
basis to establish if the CT dose to the patient can on the PET/CT scanner, being mindful that patient
be decreased while preserving the technical quality care and safety is the priority, can also reduce
of the CT images. Determining the necessity for a technologists’ occupational radiation exposure.
diagnostic CT scan rather than a low-dose CT scan Continually monitoring and reviewing group
is another important consideration. Technological and individual’s dosimeter reports is beneficial in
advances in PET scanners, such as improved scanner identifying changes or trends of increasing radiation
sensitivity, provides departments the ability to lower levels that should be addressed promptly.
the administered radiopharmaceutical activities to a In this presentation, dose optimization goals and
range that still produces high quality PET images with methods for reducing technologist exposure will
less radiation to the patient. be discussed. This talk could prompt a technologist
Occupational radiation exposure of technologists to review the radiation impact on patients and to
working predominantly with higher energy PET evaluate the technologists’ daily workflow in one’s
own department.
References:
1. Quinn B, Dauer Z, Pandit-Taskar N, Schoder H, Dauer LT. Radiation dosimetry of 18F-FDG PET/CT: incorporating exam-specific parameters in
dose estimates. BMC Med Imaging. 2016;16:41
2. Boellaard R, Delgado-Bolton R, Oyen WJ, et al. FDG PET/CT: EANM procedure guidelines for tumour imaging: version 2.0. Eur J Nucl Med Mol
Imaging. 2015;42:328–354
3. Willowson KP, Bailey EA, Bailey DL. A retrospective evaluation of radiation dose associated with low dose FDG protocols in whole-body PET/CT.
Australas Phys Eng Sci Med. 2012;35:49–53.
4. Leide-Svegborn S. Radiation exposure of patients and personnel from a PET/CT procedure with 18F-FDG. Radiat Prot Dosimetry. 2010;139:208–
213
5. Costa PF, Reinhardt M, Poppe B. Occupational exposure from F-18-FDG PET/ CT: implementation to routine clinical practice. Radiat Prot Dosim-
etry. 2018;179:291–298
6. Wrzesien M, Napolska K. Investigation of radiation protection of medical staff ´ performing medical diagnostic examinations by using PET/CT
technique. J Radiol Prot. 2015;35:197–207
7. Schleipman AR, Gerbaudo VH. Occupational radiation dosimetry assessment using an automated infusion device for positron-emitting radio-
tracers. J Nucl Med Technol. 2012;40:244–248
18 O C T O B E R 1 2 – 1 6 , 2 0 1 9 | B A R C E LO N A , S PA I NWORLD LEADING MEETING EANM’19
TECHNOLOGIST ABSTRAC T BOOK
Cardiac Imaging Methods for Dose
Reduction
Luca Camoni (Brescia, Italy)
According to the European Council Directive 2013/59 optimization. Starting from the choice of a fixed-
CTE Session
1
the optimization must take into account the current activity protocol or a weight-based to the selection
state of technical knowledge, including selection of of a stress-first or a rest-first protocol.
equipment, to obtain a clinical diagnosis. In the nuclear cardiac imaging context also,
The selection of the equipment for the dose the injected activity depends on the imaging
optimization in the myocardial perfusion imaging instrumentation: PET or SPECT, scintillation camera
is a complex topic where a great number of or a cadmium-zinc-telluride (CZT) detector, imaging
factors are considered. The main categories are: time, pixel size, gated acquisition, reconstruction October 13,
radiopharmaceutical, protocol selection and imaging algorithms, CT based attenuation correction, MR 08:00 - 09:30
instrumentation. Each one has a high influence on imaging. Advances in technology have greatly
the final clinical output. contributed to nuclear cardiology and highly
The radiopharmaceutical selection, strongly influenced the dose reduction. Despite this, it is
connected to the exam request and to the justification not possible to make precise quantification and
process, is one of the gatekeepers of the optimization standardization of the injected activities; they must
process. The growing number of radioisotopes used fit to the software- or hardware-based features of the
in the nuclear cardiology field requires an accurate available instrumentation in the laboratory.
selection by the practitioner to reduce the patient This talk would try to lead the technologist
and staff exposure. to an awareness of the instruments’ operating
Protocol selection is another key strategy in dose performance and how to adapt them to the best
practice procedures.
References:
1. Council Directive 2013/59/Euratom of 5 December 2013 laying down basic safety standards for protection against the dangers arising from
exposure to ionising radiation, and repealing Directives 89/618/Euratom, 90/641/Euratom, 96/29/Euratom, 97/43/Euratom and 2003/122/
Euratom. Official Journal of the European Union. 2014; L 013:1-73.
2. Lindner O, Pascual TN, Mercuri M, et al. Nuclear cardiology practice and associated radiation doses in
3. Europe: results of the IAEA Nuclear Cardiology Protocols Study (INCAPS) for the 27 European countries. Eur J Nucl Med Mol Imaging. 2016;
43:718-728.
4. Einstein AJ. Multiple opportunities to reduce radiation dose from myocardial perfusion imaging. Eur J Nucl Med Mol Imaging. 2013; 40:649-651
5. Cardiol. 2017. Marcassa C, Zoccarato O, Calza P, Campini R. Temporal evolution of administered activity in cardiac gated SPECT and patients’
effective dose: analysis of an historical series. Eur J Nucl Med Mol Imaging. 2013;40:325-330
6. Lee JS, Kovalski G, Sharir T, Lee DS. Advances in imaging instrumentation for nuclear cardiology. J Nucl
O C T O B E R 1 2 – 1 6 , 2 0 1 9 | B A R C E LO N A , S PA I N 19Level
European School of Multimodality Imaging and Therapy
1
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TECHNOLOGIST ABSTRAC T BOOK
Risks and Incidents in Nuclear Medicine -
A Medical Physics Perspective
Klaus Bacher (Ghent, Belgium)
A significant amount of incidents and accidents from the equipment will directly affect image quality and
CTE Session
2
medical radiation exposure have been reported in thereby the diagnostic accuracy.
literature. Most of them are related to patient’s over In therapeutic settings, the target should receive
or underexposure due to non-optimized acquisition a sufficiently high radiation dose, whereas doses to
protocols or defective equipment. The storage, organs-at-risk should be minimized in order to avoid
manipulation and administration of unsealed side-effects of the treatment. The latter balance
radioactive sources result in specific potential hazards can be optimized by means of the individualized
October 13, in diagnostic and therapeutic nuclear medicine(1). calculation of the administered activity. Failing to do
11:30 - 13:00 Especially in therapeutic applications, the risk for so may result in significant under treatment of the
incidents and accidents is increased due to the patient or introduction of severe or even lethal side-
high amounts of activity used. Accidents of varying effects of the therapy.
severity are reported. They involve not only patients
The availability of well-defined procedures as
but also staff members.
well as an appropriate and continuing education of
Incidents and accidents in nuclear medicine can all staff members is essential to minimize incidents
originate from different phases in the workflow such and accidents. Moreover, specific duties and
as the patient reception, the radiopharmaceutical responsibilities of the staff involved should be clearly
preparation, the calculation of he administered identified. More specifically, both technologists and
activity, etc. Apart from contamination events, errors medical physicists play an important role in the
in administration, under or overexposure of patients management of incidents and accidents in nuclear
and problems in radioactive waste management are medicine. (Near) incidents and accidents should be
the most prevalent issues. reported and analyzed thoroughly in order to avoid
In diagnostic nuclear medicine, patient dose as them in the future.
well as acquisition settings and overall quality of
Reference:
1. Martin CJ. A survey of incidents in radiology and nuclear medicine in the West of Scotland. BJR, 2005:913-921
22 O C T O B E R 1 2 – 1 6 , 2 0 1 9 | B A R C E LO N A , S PA I NWORLD LEADING MEETING EANM’19
TECHNOLOGIST ABSTRAC T BOOK
Potential Risk and Incidents in HotLab
Aljaz Socan (Ljubljana, Slovenia)
The operations in a radiopharmacy generally fall in normally employed to keep microbial organisms
CTE Session
2
two distinct categories: procurement and production out of the aseptic dispensing area will effectively
of radiopharmaceuticals and maintenance of quality aid the spread of radioactive contamination and
(materials, environment, facilities and people) (1). increase the likelihood of ingestion of radioactive
Majority of radiopharmaceuticals are administered by material. A compromise is necessary, usually by
injection, usually intravenously, as this route offers the design of special cabinets or enclosures which
most immediate access to the target organs or tissues. provide containment of adventitious radioactive
Parenteral administration requires a sterile injectable material (i.e. capsules). Patient safety and operator October 13,
formulation, and all pharmacopoeial injections are and public protection must be satisfied and 11:30 – 13:00
required to be sterile. Radiopharmaceuticals must demonstrated through numerous environmental
be treated differently from conventional parenteral monitoring (microbiological and radiation) schemes
preparations due to the limited half life of the and records – a system of parametric release for the
radionuclide, and since many of the ingredients are final radiopharmaceutical (1).
not stable to heating and the preparation cannot be To ensure that patient receives radiopharmaceutical
sterilised by heating in an autoclave. These limitations o suitable quality, Quality Assurance (QA), a wide-
mean that a rapid aseptic assembly or dispensing ranging concept that covers all matters that
procedure must be used in the finished product individually or collectively influence the quality of the
released without the »seal« of a sterility test (1). In product was developed. It is the total sum of organised
these circumstances the quality of the manufacturing arrangements made with the object of ensuring that
or dispensing unit environment is paramount: the medical products are of the quality required for their
design and operation of the facility must conform intended use. QA incorporates Good Manufacturing
to strict standards specified by regulation and good Practice (GMP) plus other factors. GMP is that part
manufacturing practice (GMP). All operators must of of QA that ensures that products are consistently
be fully trained and demonstrate their competence produced and controlled to the quality standards
at working in an aseptic environment through appropriate to their intended use. GMP is concerned
competency tests at regular intervals (1). with both production and quality control (QC). QC
Radiopharmaceuticals are also radioactive and is the part of GMP that is concerned with sampling,
constitute a health hazard. Precautions must be specifications and testing, and with the organisation,
taken and procedures developed to reduce the documentation and release procedures that ensure
radiation exposure to operators, to prevent ingestion that the necessary and relevant tests are actually
of radioactive material, and to prevent contamination carried out and that materials are not released for use,
of the working area and the general environment nor products released for sale or supply, until their
enjoyed by the public at large (1). Conditions quality has been judged to be satisfactory (1).
References:
1. Theobald T. Sampson’s Textbook of Radiopharmacy. 4th ed. London:PhP; 2011.
O C T O B E R 1 2 – 1 6 , 2 0 1 9 | B A R C E LO N A , S PA I N 23EANM’19 WORLD LEADING MEETING
TECHNOLOGIST ABSTRAC T BOOK
Management of Risks and Incidents in
Nuclear Medicine
Giorgio Testanera (London, United Kingdom)
All imaging modality utilizing ionizing radiations has Unfortunately incidents do happen in Nuclear
CTE Session
2
general health and safety hazards associated with the Medicine, even when assessments are made.
radiation risk. Hazards examples are patient’s over or The potential accidents must be understood,
underexposure due to non-optimized acquisition acknowledged and respected. The most diffuse
protocols, defective equipment, wrong manoeuvres. accidents in nuclear medicine are contamination
There are specific hazards in Nuclear Medicine events, followed by overexposure of patients
procedures associated with the storage, manipulation and failure in the managements of radioactive
October 13, and administration of unsealed radioactive sources, materials. The primary means of minimising adverse
11:30 - 13:00 labelled with specific tracers. All the steps involved accidents are education of all staff (from nuclear
in the nuclear medicine workflow are subjected to medicine doctors, to radiographers and nurses)
potential accidents: from patient reception, to patient with regular updates, blank or dry tests during
preparation, radiopharmaceutical preparation, radiopharmaceutical preparation, clear identification
administration and uptake phase of the examination, of duties and responsibilities of the staff involved,
examination and quality controls of the equipment. traceability of procedural steps from patient
Risk assessments on radiation and contamination reception to patient leaving the department, and the
risks should be carried out before any new work flagging of patient notes and request forms. Incident
within Nuclear Medicine commences. In UK, these reporting is also crucial.
assessments are drafted, usually based on advice Accidents should be discussed locally and lessons
form the RPA (Radiation Protection Advisor), to ensure learned should be disseminated to the wider NM and
relevant staff are aware of risks in each area of the imaging community.
department. They need to be read by all personnel
In this talk we will discuss hazards, incidents and
who would be working in the assessed areas and
risks in Nuclear Medicine and a possible system
regularly reviewed. The review need to happen
to manage them taken from UK and European
preferably once a year or if an incident or “near miss”
experience.
has taken place. During the review process, control
measures must be updated to minimise the risk as
much as possible.
References:
1. Martin, C., Marengo, M., Vassileva, J., Giammarile, F., Poli, G., & Marks, P. (2019). Guidance on prevention of unintended and accidental radiation
exposures in nuclear medicine. Journal Of Radiological Protection. doi: 10.1088/1361-6498/ab19d8
2. Gauntlett, L., Amlôt, R., & Rubin, G. (2019). How to inform the public about protective actions in a nuclear or radiological incident: a systematic
review. The Lancet Psychiatry, 6(1), 72-80. doi: 10.1016/s2215-0366(18)30173-1
24 O C T O B E R 1 2 – 1 6 , 2 0 1 9 | B A R C E LO N A , S PA I NE A N M ’' 1 9
WORLD LEADING MEETING EANM’19
TECHNOLOGIST ABSTRAC T BOOK
1 TECHNOLOGIST ABSTRAC T BOOK
WORLD LEADING MEETING
MINI COURSE 1
October 13, 2019 | 14:30 - 15:30
Research Methodology
O C T O B E R 1 3 – 1 7 , 2 0 1 9 | B A R C E LO N A , S PA I N 25EANM’19 WORLD LEADING MEETING
TECHNOLOGIST ABSTRAC T BOOK
Research Methodology for Technologists
Christina Malamateniou (London, United Kingdom)
Research is vital in healthcare to ensure efficiency of conduct of research is a core NHS function and that
Mini Course
1
current techniques is improved and new methods on-going commitment to increasing research quality
are being utilised for the benefits of the patients. and quantity is vital to address future challenges in
Research in Radiography is highlighted as a key healthcare. Furthermore it stresses the need to embed
priority in the UK radiographers’ professional body, a research culture throughout the NHS (DoH, 2012).
vision and research strategy planning for 2016-2021 This is also in line with the NHS Constitution (DoH,
(Society and College of Radiographers, (SCoR) 2016). 2009), which affirms the sustained commitment of
October 13, Similar to other professions, practitioner-led research the NHS to the promotion and conduct of research
14:30 - 15:30 has shown multiple benefits to the workforce, to the as a means to improve patient outcomes.
patients and to society. First and foremost engaging Different healthcare professions offer varied
with research allows practitioners to keep up-to- approaches to embedding research into practice
date with recent technological developments, and to building a critical research capacity to ensure
which is vital for Radiography and Medical Imaging evidence-based practice.
in general as the essence of the work lies on the
Radiography is a relatively young profession and
interface between patient care and optimal use of
research capacity remains low compared to medicine,
the available medical imaging technology (Harris,
nursing and other allied health professions. Different
2013). Keeping abreast of advancements of medical
barriers to doing research include, but are not limited
imaging equipment (hardware, software) but also
to: lack of time, lack of recognition in the appraisal,
driving these forward with their unique insight is vital
lack of a research culture at work, workload, staff
for radiographers to ensure efficiency in using the
shortages, lack of funding. Different methods have
currently available resources, particularly in a financial
been employed to increase research capacity: Role
climate where demand for better results is increasing,
modelling, mentoring, up-skilling of the workforce.
whereas funds are decreasing (Hanney, 2015).
This session will discuss the following:
Research capacity building as a mechanism to
• What is considered research in the NM techno
improve patient experience and outcomes is one of logists’ community
the most contemporary issues in healthcare in the • Common enablers and barriers for practitioner
last decade. According to the Department of Health research
(DoH) Operating Framework 2008-2009 practitioner • Identify opportunities for undertaking research
research is not just an exciting opportunity but also and for disseminating results
–and perhaps most importantly- a requirement to • Realise the importance of an institution-led
research culture and the role of mentors
carry the profession forward (DoH, 2008). In a similar
fashion, the most recent NHS operating Framework It will also work with a real life example and offer
2012-2013 highlights that the promotion and top tips on how to prepare (content) and deliver (oral
skills) a high level oral presentation.
References:
1. Society and College of Radiographers, (SCoR). 2016-2021 SCoR Research Strategy
2. Hanney et al. Health Research Policy and Systems 2015, 13:1
3. Department of Health (DoH). The NHS in England. Operating Framework 2008-2009
4. Department of Health (DoH). The NHS Constitution
5. Department of Health (DoH). NHS operating Framework 2012-2013
26 O C T O B E R 1 2 – 1 6 , 2 0 1 9 | B A R C E LO N A , S PA I NE A N M ’' 1 9
WORLD LEADING MEETING EANM’19
TECHNOLOGIST ABSTRAC T BOOK
2 TECHNOLOGIST ABSTRAC T BOOK
WORLD LEADING MEETING
MINI COURSE 2
October 13, 2019 | 15:45 - 16:45
Stress Testing for
Technologists
O C T O B E R 1 3 – 1 7 , 2 0 1 9 | B A R C E LO N A , S PA I N 27EANM’19 WORLD LEADING MEETING
TECHNOLOGIST ABSTRAC T BOOK
Stress Testing for Technologists
MarieClaire Attard (Zwolle, Netherlands)
The chambers of the heart consist of the left and however, a different pharmacological stressing agent
Mini Course
2
right atria and the left and right ventricles. The is used.
electrical conductivity of the heart represents the Caffeine and caffeine-containing products and
communication between the atria and the ventricles. energy drinks should be abstained at least 24 hours
It also gives an indication of the contraction known before the start of the examination. Caffeine is a vaso-
as depolarisation and the repolarisation of the left constrictor therefore will counteract the mechanism of
atrium and left ventricle. The sinoatrial node is the action of the pharmacological stressing agent. Blood
October 13, place where electrical conductivity originates, that pressure should be measured before the start of the
15:45 - 16:45 results in what we know as systole, i.e. the contraction stress test. The reason being that low blood pressure
of the left atrium. is a contraindication to starting a pharmacological
stress test, since the pharmacological stressing agent
What happens after the stimulation from the sinoatrial is a vaso-dilator.
node can be read from an ECG. Pathologies such as
atrial fibrillation and left or right bundle branch block
A radiopharmaceutical is administered during the
can be easily diagnosed when performing an ECG.
stress test to be able to perform myocardial perfusion
Patients might have various complaints, and have
imaging. Administering the radiopharmaceutical too
different expectations and results when attending
fast might result in complaints during the stress test,
their examination.
which could be seen on the ECG.
When performing a stress test with adenosine,
The technologist should be trained to know
there are a number of points to consider before its
and decide when to start, administer and stop
administration, such as asthma or COPD, and patient
the pharmacological stressing agent, note any
preparation. Asthmatic patients usually follow
changes seen in the ECG and document the drugs
the same preparation as non-asthmatic patients,
administered in the hospital system.
References:
1. Thaler M .S., The only EKG book you’ll ever need, (2015), 8th edition, Wolters Kluwer, Philadelphia.
2. Dubin D., Rapid interpretation of EKG’s, (2000), 6th edition, Cover Publishing Company, United States.
3. de Jong J. et al, www.ecgpedia.org accessed [online], created (2006), last edited (2017).
4. de Jong J. et al, www.textbookofcardiology.org accessed [online], created (2011), last edited (2016).
28 O C T O B E R 1 2 – 1 6 , 2 0 1 9 | B A R C E LO N A , S PA I NE A N M ’' 1 9
WORLD LEADING MEETING EANM’19
TECHNOLOGIST ABSTRAC T BOOK
3 TECHNOLOGIST ABSTRAC T BOOK
WORLD LEADING MEETING
MINI COURSE 3
October 13, 2019 | 17:00 - 18:00
Theranostics –
Fundamental
O C T O B E R 1 3 – 1 7 , 2 0 1 9 | B A R C E LO N A , S PA I N 29EANM’19 WORLD LEADING MEETING
TECHNOLOGIST ABSTRAC T BOOK
General Aspects of Theranostics in
Nuclear Medicine
Siroos Mirzaei (Vienna, Austria)
A theranostic system integrates a diagnostic test to 111In, 99mTc, 68Ga, 18F, 64Cu, 90Y, 177Lu, etc..
Mini Course
3
determine the presence of a molecular target for These tracers are chelated to Somatostatin analoga
which a personalised treatment plan is intended. (DOTA-TATE, DOTA-TOC, DOTA-NOC) and are utilised
Molecular imaging serves this diagnostic function and in tumour diagnosis, staging and treatment. Similar
provides powerful means for noninvasively detection approaches with very promising results have been
and characterization of disease. The visualisation of performed more recently in prostate cancer with
potential targets enables the prediction whether different prostate-specific membrane antigen (PSMA)
October 13, a patient will benefit from a particular treatment, ligands (68Ga-, 64Cu-, 18F-, 44Sc-, and 177Lu-PSMA)
17:00 - 18:00 especially in oncology. Further, theranostics can be for diagnosis and treatment, since prostate cancer
useful for estimating the potential response and cells overexpress PSMA on their cell surface. Most
eventual toxicity and monitoring the therapy course. therapeutic radiopharmaceuticals are ß-emitting
Theranostics in nuclear medicine couples diagnostic isotopes, since they have a cytotoxic effect, but they
imaging and therapy using the same or similar also spare the surrounding healthy tissue due to their
molecules which are either radiolabeled differently short tissue penetration of only a few millimetres.
(123I-MIBG vs. 131I-MIBG) or given in different However, there have been also promising approaches
dosages (131I). It has its roots in the pioneering with α-particle emitters for treatment of NET and
work of G. Seaborg et al. who in 1938 discovered prostate cancer (225Ac-DOTATOC, 225Ac-PSMA).
radioactive Iodine-131. This radioisotope became Further developments are expected in the coming
the gold standard in the diagnosis and treatment of years in the field of radioimmunotherapy, i.e. for
thyroid cancer, which is still widely used throughout treatment of lymphoma. In this lecture, important
the world. During the past decades, similar models milestones of nuclear diagnostics and therapies in
have been developed for neuroendocrine tumours the context of theranostics are highlighted.
(NET) which use different radionuclides, such as
Further Readings:
1. Bodei L, Kidd MS, Singh A, van der Zwan WA, Severi S, Drozdov IA, et al. PRRT genomic signature in blood for prediction of (177)Lu-octreotate
efficacy. Eur J Nucl Med Mol Imaging. 2018;45:1155-1169.
2. Edler von Eyben F, Singh A, Zhang J, Nipsch K, Meyrick D, Lenzo N, et al. (177)Lu-PSMA radioligand therapy of predominant lymph node meta-
static prostate cancer. Oncotarget. 2019;10:2451-2461.
3. Hohloch K, Windemuth-Kieselbach C, Kolz J, Zinzani PL, Cacchione R, Jurczak W, et al. Radioimmunotherapy (RIT) for Follicular Lymphoma
achieves long term lymphoma control in first line and at relapse: 8-year follow-up data of 281 patients from the international RIT-registry. Br J
Haematol. 2019;184:949-956.
4. Kratochwil C, Bruchertseifer F, Rathke H, Hohenfellner M, Giesel FL, Haberkorn U, et al. Targeted α-Therapy of Metastatic Castration-Resis-
tant Prostate Cancer with (225)Ac-PSMA-617: Swimmer-Plot Analysis Suggests Efficacy Regarding Duration of Tumor Control. J Nucl Med.
2018;59:795-802.
5. Umbricht CA, Benešová M, Schmid RM, Türler A, Schibli R, van der Meulen NP, et al.. (44)Sc-PSMA-617 for radiotheragnostics in tandem with
(177)Lu-PSMA-617-preclinical investigations in comparison with (68)Ga-PSMA-11 and (68)Ga-PSMA-617. EJNMMI Res. 2017;7(1):9.
30 O C T O B E R 1 2 – 1 6 , 2 0 1 9 | B A R C E LO N A , S PA I NWORLD LEADING MEETING EANM’19
TECHNOLOGIST ABSTRAC T BOOK
Theranostics for Technologists
in the Context of NET
Nick Gulliver (London, United Kingdom)
Neuroendocrine tumours (NET) are a rare and is largely spared. The diagnostic gamma or positron
Mini Course
3
slow-growing group of tumours that arise from emitting radiopharmaceuticals are substituted with
cells of the diffuse neuroendocrine system and beta-emitting equivalents. SSTR analogues used
are characterized by a wide spectrum of clinical for diagnostic scintigraphy are thus replaced with
manifestations. They are often categorized according radiometals 90Y or 177Lu. Initial efficacy results were
to their histopathology (well or poorly differentiated), based on very high doses of 111In-DTPA-octreotide,
tumour proliferation (using Ki67 index: G1 (≤2 %), but more promising results were subsequently
G2 (3-20 %), or G3 (>20 %) and TNM staging. In NET found with 90Y-DOTATOC and with 177Lu-DOTATATE. October 13,
theranostics the important target is the somatostatin In Europe, 177Lu-oxodotreotide (Lutathera®) is 17:00 - 18:00
receptor (SSTR) which is overexpressed in NET indicated for the treatment of unresectable or
tumours. This can be exploited for both imaging metastatic, progressive, well differentiated (G1
and therapy. SSTR imaging with 111In-Octreoscan® and G2), SSTR-positive gastroenteropancreatic
SPECT has been available since the 1990s. It is now neuroendocrine tumors (GEP-NETs) in adults. In
largely being replaced in many centres with 99mTc- 2017 the breakthrough publication of the NETTER-1
octreotide (Tektrotide®) SPECT. Many centres also Phase III clinical trial demonstrated markedly longer
now have access to 68Ga-labelled DOTA-peptide progression-free survival and a significantly higher
PET tracers (DOTATOC, DOTANOC, and DOTATATE). response rate than high-dose long-acting release
However 68Ga is a generator-produced radionuclide (LAR) octreotide among patients with advanced
with relatively short half-life and therefore is not midgut NET. The kidney is the major critical organ
readily accessible in many EU countries. 64Cu-labelled during PRRT in addition to bone marrow and
somatostatin receptor PET tracers (with a significantly patients require thorough diagnostic workup prior
longer half-life) have been developed recently as to therapy plus an amino acid solution administered
a potential alternative. The theranostic principle is intravenously during therapy to reduce nephrotoxic
such that if there is sufficient radiopharmaceutical effects. Haematological markers and liver function
uptake in the imaging component of the theranostic are kept under surveillance following each treatment
process (overexpression of SSTR in the tumour tissue, until returned to normal and to detect any possible
with uptake at least as high as normal liver uptake delayed adverse reactions. The advantage of 177Lu
(tumour uptake score ≥2)), the individual is a suitable is the emission of low-energy gamma rays which
candidate for the therapeutic component. The not only allow assessment of biodistribution with
therapeutic part of theranostic targeting is peptide post-therapy scans but also enables individualized
receptor radionuclide therapy (PRRT) which has dosimetry, facilitating calculations of absorbed
often been referred to as a “magic bullet” – with good radiation dose to critical organs.
targeting of dose to tumour cells while normal tissue
References:
1. Virgolini I., Ambrosini V., Bomanji J. et.al. Procedure guidelines for PET/CT tumour imaging with 68Ga-DOTA-conjugated peptides: 68Ga-DO-
TA-TOC, 68Ga-DOTA-NOC, 68Ga-DOTA-TATE. Eur J Nucl Med Mol Imaging (2010) 37:2004–2010. doi: 10.1007/s00259-010-1512-3
2. Ambrosini V., Fanti S. (eds) Clinicians’ guide to radionuclide hybrid imaging: PET-CT in neuroendocrine tumours. doi: 10.1.007/978-3-319-29203-8
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