Nuclear medicine technologist education and training in Europe: literature and web-based findings

Purpose - The education and training of a nuclear medicine technologist (NMT) is not homogeneous among European countries, which leads to different scope of practices and, therefore, different technical skills are assigned. The goal of this research was to characterize the education and training of NMT in Europe. Materials and methods - This study was based on a literature research to characterize the education and training of NMT and support the historical evolution of this profession. It was divided into two different phases: the first phase included analysis of scientific articles and the second phase included research of curricula that allow health professionals to work as NMT in Europe. Results - The majority of the countries [N=31 (89%)] offer the NMT curriculum integrated into the high education system and only in four (11%) countries the education is provided by professional schools. The duration in each education system is not equal, varying in professional schools (2-3 years) and high education level system (2-4 years), which means that different European Credit Transfer and Accumulation System, such as 240, 230, 222, 210 or 180 European Credit Transfer and Accumulation System, are attributed to the graduates. The professional title and scope of the practice of NMT are different in different countries in Europe. In most countries of Europe, nuclear medicine training is not specific and curriculum does not demonstrate the Nuclear Medicine competencies performed in clinical practice. Conclusion - The heterogeneity in education and training for NMT is an issue prevalent among European countries. For NMT professional development, there is a huge need to formalize and unify educational and training programmes in Europe.

Research practice development for nuclear medicine technologists: an innovative experience

Introduction - European nuclear medicine technologist’s education is delivered by Higher Education Institutions and students obtain a grade of Bachelor of Sciences (BSc), during which they are initiated to research during their studies. Once BSc nuclear medicine technologists are in professional practice, they have very few opportunities to develop a real research experience and they rather become passive users than active contributors the growth of scientific knowledge in nuclear medicine. Aim - To describe and discuss an innovative educational and professional experience aimed in strengthen research knowledge, skills and competencies of former nuclear medicine technologists student in the context of an international mobility stay.

Validation of a new reference values’s database for semiquantification of 123I‐FP‐CIT SPECT scans in one nuclear medicine department

The DatScanTM and its Semiquantification (SQ) can provide advantages in the diagnosis of Parkinsonian Syndromes (PS). To improve the SQ is recommended the creation of adapted database (DB) with reference values for the Nuclear Medicine Departments. Previously to this work was created a adapted database (DBRV) to Nuclear Medicine Department's protocol and population of Infanta Cristina's Hospital located in Badajoz, for patients between the ages of 60 and 75, and reference values of the SQ were calculated. Aim: To evaluate the discrimination capacity of a department's adapted DB reference's values of healthy controls for DatScanTM.

Clinical classification versus semiquantification with adapted reference values for 123I-FP-CIT SPECT in a nuclear medicine department

Semi quantification (SQ) in DaTScan® studies is broadly used in clinic daily basis, however there is a suspicious about its discriminative capability, and concordance with the diagnostic classification performed by the physician. Aim: Evaluate the discriminate capability of an adapted database and reference's values of healthy controls for the Dopamine Transporters (DAT) with 123I–FP-IT named DBRV adapted to Nuclear Medicine Department's protocol and population of Infanta Cristina's Hospital, and its concordance with the physician classification.

Genotoxicity biomarkers micronucleus, nucleoplasmic bridges and nuclear buds

The increase of mortality from cancer brought urgency in identification and validation of predictive markers of risk and therefore early diagnosis. There is evidence that cytogenetic biomarkers are positively correlated with risk of cancer, and this is validated by studies of cohort and case-control. Cytokinesis-blocked micronucleus (CBMN) assay is used extensively in molecular epidemiology, and can be considered as a “cytome” assay covering cell proliferation, apoptosis, necrosis and chromosomal changes. The chromosomal alterations most reported and studied by the CBMN are: micronucleus (MN), nucleoplasmic bridges (NPB) and nuclear buds (NBUDS). The use of the MN assay in biomonitoring studies had a large increase in the last 15 years and international projects such as the HUMN have helped to increase the applicability and reliability of these tests.

OPTIMAX 2014 - Radiation dose and image quality optimisation in medical imaging

Medical imaging is a powerful diagnostic tool. Consequently, the number of medical images taken has increased vastly over the past few decades. The most common medical imaging techniques use X-radiation as the primary investigative tool. The main limitation of using X-radiation is associated with the risk of developing cancers. Alongside this, technology has advanced and more centres now use CT scanners; these can incur significant radiation burdens compared with traditional X-ray imaging systems. The net effect is that the population radiation burden is rising steadily. Risk arising from X-radiation for diagnostic medical purposes needs minimising and one way to achieve this is through reducing radiation dose whilst optimising image quality. All ages are affected by risk from X-radiation however the increasing population age highlights the elderly as a new group that may require consideration. Of greatest concern are paediatric patients: firstly they are more sensitive to radiation; secondly their younger age means that the potential detriment to this group is greater. Containment of radiation exposure falls to a number of professionals within medical fields, from those who request imaging to those who produce the image. These staff are supported in their radiation protection role by engineers, physicists and technicians. It is important to realise that radiation protection is currently a major European focus of interest and minimum competence levels in radiation protection for radiographers have been defined through the integrated activities of the EU consortium called MEDRAPET. The outcomes of this project have been used by the European Federation of Radiographer Societies to describe the European Qualifications Framework levels for radiographers in radiation protection. Though variations exist between European countries radiographers and nuclear medicine technologists are normally the professional groups who are responsible for exposing screening populations and patients to X-radiation. As part of their training they learn fundamental principles of radiation protection and theoretical and practical approaches to dose minimisation. However dose minimisation is complex – it is not simply about reducing X-radiation without taking into account major contextual factors. These factors relate to the real world of clinical imaging and include the need to measure clinical image quality and lesion visibility when applying X-radiation dose reduction strategies. This requires the use of validated psychological and physics techniques to measure clinical image quality and lesion perceptibility.

Guest editorial: OPTIMAX 2013

In 2012 we were awarded an Erasmus Intensive Programme grant to facilitate OPTIMAX 2013, a three week duration residential summer school held within the UK during August 2013. The summer school helped to further develop student radiographer skills in optimising x-radiation dose and image quality. With a major emphasis on visual techniques to determine image quality, lesion visibility, lesion detection performance and physical measures of image quality (eg signal to noise ratio (SNR)) we conducted controlled laboratory experiments on phantoms using Computed Radiography, CT and Full Field Digital Mammography. Mathematical modelling was used for radiation dose estimation. Sixty seven people from 5 European countries participated. This included 49 PhD, MSc and BSc students. Discipline areas included radiography, physics, biomedical science and nuclear medicine.

Influence of reconstruction parameters during filtered backprojection and ordered-subset expectation maximization in the measurement of the left-ventricular volumes and function during gated SPECT

A crucial method for investigating patients with coronary artery disease (CAD) is the calculation of the left ventricular ejection fraction (LVEF). It is, consequently, imperative to precisely estimate the value of LVEF--a process that can be done with myocardial perfusion scintigraphy. Therefore, the present study aimed to establish and compare the estimation performance of the quantitative parameters of the reconstruction methods filtered backprojection (FBP) and ordered-subset expectation maximization (OSEM). Methods: A beating-heart phantom with known values of end-diastolic volume, end-systolic volume, and LVEF was used. Quantitative gated SPECT/quantitative perfusion SPECT software was used to obtain these quantitative parameters in a semiautomatic mode. The Butterworth filter was used in FBP, with the cutoff frequencies between 0.2 and 0.8 cycles per pixel combined with the orders of 5, 10, 15, and 20. Sixty-three reconstructions were performed using 2, 4, 6, 8, 10, 12, and 16 OSEM subsets, combined with several iterations: 2, 4, 6, 8, 10, 12, 16, 32, and 64. Results: With FBP, the values of end-diastolic, end-systolic, and the stroke volumes rise as the cutoff frequency increases, whereas the value of LVEF diminishes. This same pattern is verified with the OSEM reconstruction. However, with OSEM there is a more precise estimation of the quantitative parameters, especially with the combinations 2 iterations × 10 subsets and 2 iterations × 12 subsets. Conclusion: The OSEM reconstruction presents better estimations of the quantitative parameters than does FBP. This study recommends the use of 2 iterations with 10 or 12 subsets for OSEM and a cutoff frequency of 0.5 cycles per pixel with the orders 5, 10, or 15 for FBP as the best estimations for the left ventricular volumes and ejection fraction quantification in myocardial perfusion scintigraphy.

Otimização do co-registo metabolismo-morfologia em estudos de PET/CT com 18F-DG de nódulos pulmonares: comparação de dois protocolos - 4D vs CT lento

Mestrado em Medicina Nuclear - Área de especialização: Tomografia por Emissão de Positrões.

Agentes fitoquímicos como radio-sensibilizadores na terapêutica em medicina nuclear

Mestrado em Medicina Nuclear. Área de especialização: Radiofarmácia.

Avaliação da cultura de segurança num serviço de medicina nuclear

Mestrado em Gestão e Avaliação de Tecnologias em Saúde

Assessment of the quality of brain regions and neuroimaging metrics as biomarkers of Alzheimer’s disease

Alzheimer Disease (AD) is characterized by progressive cognitive decline and dementia. Earlier diagnosis and classification of different stages of the disease are currently the main challenges and can be assessed by neuroimaging. With this work we aim to evaluate the quality of brain regions and neuroimaging metrics as biomarkers of AD. Multimodal Imaging Brain Connectivity Analysis (MIBCA) toolbox functionalities were used to study AD by T1weighted, Diffusion Tensor Imaging and 18FAV45 PET, with data obtained from the AD Neuroimaging Initiative database, specifically 12 healthy controls (CTRL) and 33 patients with early mild cognitive impairment (EMCI), late MCI (LMCI) and AD (11 patients/group). The metrics evaluated were gray-matter volume (GMV), cortical thickness (CThk), mean diffusivity (MD), fractional anisotropy (FA), fiber count (FiberConn), node degree (Deg), cluster coefficient (ClusC) and relative standard-uptake-values (rSUV). Receiver Operating Characteristic (ROC) curves were used to evaluate and compare the diagnostic accuracy of the most significant metrics and brain regions and expressed as area under the curve (AUC). Comparisons were performed between groups. The RH-Accumbens/Deg demonstrated the highest AUC when differentiating between CTRLEMCI (82%), whether rSUV presented it in several brain regions when distinguishing CTRL-LMCI (99%). Regarding CTRL-AD, highest AUC were found with LH-STG/FiberConn and RH-FP/FiberConn (~100%). A larger number of neuroimaging metrics related with cortical atrophy with AUC>70% was found in CTRL-AD in both hemispheres, while in earlier stages, cortical metrics showed in more confined areas of the temporal region and mainly in LH, indicating an increasing of the spread of cortical atrophy that is characteristic of disease progression. In CTRL-EMCI several brain regions and neuroimaging metrics presented AUC>70% with a worst result in later stages suggesting these indicators as biomarkers for an earlier stage of MCI, although further research is necessary.

Imaging in neurological and vascular brain diseases (SPECT and SPECT/CT)

Since the first in vivo studies of cerebral function with radionuclides by Ingvar and Lassen, nuclear medicine (NM) brain applications have evolved dramatically, with marked improvements in both methods and tracers. Consequently it is now possible to assess not only cerebral blood flow and energy metabolism but also neurotransmission. Planar functional imaging was soon substituted by single-photon emission computed tomography (SPECT) and positron emission tomography (PET); it now has limited application in brain imaging, being reserved for the assessment of brain death.

Impact of the background region of interest in the relative renal function

Renal scintigraphy with 99mTc-dimercaptosuccinic acid (99mTc-DMSA) is performed with the aim of detect cortical abnormalities related to urinary tract infection and accurately quantify relative renal function (RRF). For this quantitative assessment Nuclear Medicine Technologist should draw regions of interest (ROI) around each kidney (KROI) and peri-renal background (BKG) ROI, although, controversy still exists about BKG-ROI. The aim of this work was to evaluate the effect of the normalization procedure, number and location of BKG-ROI on the RRF in 99mTc-DMSA scintigraphy.

XRCC3 THR241MET polymorphism influence on nuclear buds frequency in exposed to formaldehyde

Formaldehyde (FA), also known as formalin, formal and methyl aldehydes, is a colorless, flammable, strong-smelling gas. It has an important application in embalming tissues and that result in exposures for workers in the pathology anatomy laboratories and mortuaries. Occupational exposure to FA has been shown to induce nasopharyngeal cancer and has been classified as carcinogenic to humans (group 1) on the basis of sufficient evidence in humans and sufficient evidence in experimental animals. Manifold in vitro studies clearly indicated that FA is genotoxic. FA induced various genotoxic effects in proliferating cultured mammalian cells. The cytokinesis-block micronucleus (CBMN) assay was originally developped as an ideal system form easuring micronucleus (MN), however it can also be used to measure nucleoplasmic bridges (NBP) and nuclear buds (NBUD). Over the past decade another unique mechanism of micronucleus formation, known as nuclear budding has emerged. NBUDS is considered as a marker of gene amplification and/or altered gene dosage because the nuclear budding process is the mechanism by which cells removed amplified and/excess DNA.