This paper provides an overview of the curricula of undergraduate training in nuclear medicine in 77 European medical departments and, for comparison, in nine departments outside Europe. The data show a high level of variation in the number of hours (0-62) devoted to nuclear medicine in the different departments. In most cases this teaching is integrated into one of the radiology or clinical modules, and in some cases also into training in clinical physiology. The paper discusses the differences in the particular approaches to nuclear medicine teaching.

Curriculum↗

PubMed2003

Neuroanatomical correlates of the post-stroke aphasias studied with cerebral blood flow SPECT scanning.

BACKGROUND: Researchers are not in complete agreement over the extent to which specific language functions are subserved by certain brain areas. The purpose of this article was to determine neuroanatomical correlates of aphasia following cerebrovascular accident. MATERIAL/METHODS: The participants included 50 stroke patients with a single left-hemisphere lesion and residual mild to severe aphasia. Language, assessed by the Boston Diagnostic Aphasia Examination (BDAE), was affected to various degrees by a wide range of pathologies. Single-photon emission computed tomography (SPECT) images of the brain were acquired with 740 MBq (20 mCi) of Tc-99m-labeled ECD on a triple-headed gamma camera equipped with low-energy, high-resolution collimator. Correlation between reduced cerebral perfusion and the BDAE score was analyzed. RESULTS: The most prominent perfusion abnormalities in Broca's aphasia, as determined by the laterality index, were found in the frontal lobe, and to a lesser degree, the parietal lobe and striatum, whereas the most prominent deficits in Wernicke's aphasia were found in the left temporal and parietal areas. In global aphasia, SPECT images evidenced the most extensive damage throughout the perisylvian region of the left hemisphere. CONCLUSIONS: There is need for reinterpretation of the anatomical correlation of selected aphasic syndromes, especially classic Broca's and Wernicke's aphasias. The present study highlights the integrative role of some subcortical structures in language and speech functions. The results support the usefulness of regional cerebral blood flow SPECT imaging as a diagnostic aid in the post-stroke aphasias.

Adult↗

PubMed2003

The usefulness of CBF brain SPECT in forensic medicine: the civil law code cases. A description of four cases.

BACKGROUND: The aim of this report was to assess the usefulness of cerebral blood flow (CBF) scanning utilising the SPECT technique in forensic medicine cases in the area of civil law cases. MATERIAL AND METHODS: CBF SPECT scanning was performed in four patients utilising (99m)Tc-ECD and a triple-head gammacamera. In the analysis both the asymmetry index and cerebellar normalisation were applied. Reference values were obtained by studying 30 healthy volunteers. RESULTS: In those cases CBF SPECT scanning played an important role in forensic argument. It influenced the sentence and the amount of financial compensation. CONCLUSIONS: CBF SPECT scanning may provide valuable information in forensic medicine argument in civil law cases, but only when taken together with psychometric tests and other neuroimaging methods (CT, MRI). The value of CBF SPECT scanning alone may be limited in judicial proceedings.

Accidents, Traffic↗

PubMed2003

Undergraduate teaching of nuclear medicine: a comparison between Central & Eastern Europe and European Union countries.

This paper overviews the curricula of nuclear medicine (NM) undergraduate training in 34 Central & Eastern European (CEE) and 37 European Union (EU) medical faculties. The data show enormous variation in the number of hours devoted to nuclear medicine, varying between 1-2 to 40 hours and highly differentiated concepts/ideas of nuclear medicine training in particular countries. In most EU countries this teaching is integrated with that of radiology or clinical modules, also with training in clinical physiology. In many CEE countries teaching and testing of NM are independent, although integration with other teaching modules is frequent. The paper discusses the differences in particular approaches to nuclear medicine teaching.

Curriculum↗

PubMed2003

[Regional cerebral blood flow single photon emission tomography (SPECT) and magnetic resonance imaging (MRI) may be useful in the diagnosis of patients with cortico-basal degeneration, progressive supranuclear palsy and multiple system atrophy].

Differential diagnosis of idiopathic Parkinson's Disease is still very difficult. Even in movement disorders centers 25% of patients with clinical diagnosis of Parkinson's disease is misdiagnosed with other neurodegenerative disorders. Clinical symptoms of so called atypical parkinsonian disorders may emerge late in the course of the disease, not at the same time and good or moderate response to levodopa at early stages may be a source of misdiagnosis. Most difficult to differentiate seems to be Progressive supranuclear palsy (PSP), corticobasal degeneration (CBD) and multiple system atrophy (MSA). Authors present in selected cases usefulness of neuroimaging with rCBF SPECT and MRI in clinical diagnosis of these disorders. For PSP typical (although not pathognomonic) is decrease of metabolism and flow in frontal lobes (hypofrontalism), and in CBD asymmetrical, contralateral to the side of dominating symptoms cerebral (frontal, parietal, temporal and within striatum) atrophy. In MSA more useful (but not seen in all cases) is MRI examination with hyperintensities in putamen, pons and cerebellum or cerebellar atrophy. Due to low sensitivity of clinical criteria other tests (EMG of anal sphincter or clonidine test) with specially neuroimaging examination may be helpful in establishing of the diagnosis.

Aged↗

PubMed2002

Nuclear medicine technologist training in European countries.

This article overviews the training of nuclear medicine technologists in chosen European countries, the United States and Canada. There are basically two types of training: at medical schools following secondary school, without any university degree, usually on a 2- or 3-year basis, or else as a university course, leading to a BSc degree after 3 years, and in some countries to an MSc degree after an additional 2 years. In the United States both systems coexist, while in Europe the picture varies from country to country. The number of hours devoted to nuclear medicine also varies between curricula. Some efforts are being made to unify this system by transition to the university model of education in many European countries.

Canada↗

PubMed2002

Decortication in chronic pleural empyema - effect on lung function.

OBJECTIVE: The aim of the present study is to evaluate the lung function before and after the lung decortication in patients with chronic pleural empyema (CPE). METHODS: Twenty-six patients with diagnosis of CPE were evaluated in a prospective manner by lung perfusion scintigraphy, blood gas analysis and spirometry before and 35 weeks (+/-17) after the lung decortication. RESULTS: Preoperative scintigraphy showed reduction of lung perfusion on the affected side to 24.5% (+/-12.6%) in 11 right side empyemas (predicted value 55%) and to 18% (+/-8%) in 15 left side empyemas (predicted value 45%). The postoperative measurements showed improvement in perfusion to 45.2% (+/-7.7%) in patients with right side empyema and 34.1% (+/-8.5%) with the left side affection. The preoperative vital capacity (VC) was reduced to 62.3% (+/-13.8%) of the predicted value and forced expiratory volume in 1s (FEV1) to 50% (+/-15.5%) of the predicted value. Postoperatively, slight improvement was achieved to 79.8 % (+/-12.9%) for VC and 69.2% (+/-12.7%) for FEV1. Blood gas analysis showed decreased values in majority of the patients before operation and significant improvement in postoperative evaluation. CONCLUSIONS: Perfusion and spirometry improves significantly in patients with CPE after the lung decortication but function of the affected lung remains impaired. There was no influence of the age, gender, side of the disease, bacteriology or duration of the empyema before operation on lung function.

Adult↗

PubMed2002

[Radionuclides for metastatic bone pain palliation].

The paper overviews the role of systemic radionuclide therapy in patients with disseminated bone metastases. Most patients with bone metastases experience painful symptoms. Systemic radioisotope therapy is an alternative to traditional hemibody radiation in cases of multiple, diffuse metastases. Usually given as a single i.v. slow infusion it provides a pain relief beginning in one to three weeks, with a mean duration up to several months, depending on the kind of radioisotope applied. The paper overviews the role of unsealed source therapy with these bone-seeking radiopharmaceuticals in palliating pain, improving quality of life, indications, contraindications and complications of this therapy are discussed, as well as cost-benefit aspects.

Bone Neoplasms↗

PubMed2002

[Scintimammography in breast cancer imaging].

Scintimammography is a rarely used method of breast cancer imaging. The aim of the study was to find its place among other radiological methods. Routine methods of breast cancer detection were compared considering their advantages and disadvantages. Scintimammography seems to be a promising complementary method. Indications for scintimammography are considered and suggestion of a diagnostic algorithm in breast cancer, including of this method is proposed.

Algorithms↗

PubMed2002

Comparison of peritumoral and subareolar injection of Tc99m sulphur colloid and blue-dye for detection of the sentinel lymph node in breast cancer.

BACKGROUND: The new trend in diagnosis of the lymph node is sentinel node biopsy. This method has become increasingly accepted as a minimally invasive alternative to routine axillary dissection. Although the results of numerous studies have shown that sentinel node biopsy can accurately determine the axillary nodal status, the identification rates and false-negative rates have been variable. The sentinel lymph node is defined as the first node in the lymphatic basin that receives the primary lymphatic flow. MATERIAL AND METHODS: Between September 1998 and August 2002 123 patients with primary operative breast cancer without clinical palpable axillary lymph nodes were enrolled in the study. There were two groups of patients according to sentinel node identification technique: 51 patients (Group I) received parenchymal, peritumoral injection of 1.0 ml of 16 MBq Tc(99m)-radiolabelled sulphur colloid and single intradermal injection of blue-dye over the tumour. The next 72 patients (Group II) received intradermal, periareolar one-site injection of 0.5 ml of 16 MBq Tc(99m)-radiolabelled sulphur colloid and blue-dye. RESULTS: Sentinel lymph node was found in 41 (80.4%) cases in Group I and in 67 (93.0%) cases in Group II (p = 0.028). The localisation of the axillary lymph node as a "hot spot" visualised by lymphoscintigraphy was successful in 39/51 (76.5%) cases in Group I and 67/72 (93.0%) in Group II, p = 0.004). In both groups the success of sentinel node identification in the axillary region by lymphoscintigraphy was connected with sentinel lymph node finding during surgery (Group I: p < 0.001, Group II: p < 0.001). CONCLUSIONS: This study shows that intradermal, periareolar one-site injection of Tc(99m)-radiolabelled sulphur colloid and blue-dye is superior to peritumoral 4-sites injections Tc(99m)-radiolabelled sulphur colloid and single intradermal injection of blue-dye over the tumour in sentinel lymph node identification.

Journal Article↗

PubMed2002

Cerebral blood flow SPECT imaging in right hemisphere-damaged patients with hemispatial neglect. A pilot study.

BACKGROUND: Hemispatial neglect is characterised as a failure by a brain-damaged patient to attend to contralesional space. It is hypothesised to be a result of damage to a network involving the frontal, parietal and cingulated cortices, basal ganglia and thalamus. MATERIAL AND METHODS: The aim of this preliminary study was to verify this model of neglect in 22 right hemisphere-damaged acute stroke patients, using single photon emission-computed tomography (SPECT). The presence of a single right-sided vascular brain lesion was confirmed on CT and/or MRI. Hemispatial neglect, assessed with a battery of drawings, line bisection and line and shape cancellation tests, was observed in 12 cases. RESULTS: Patients with neglect (compared with those without neglect) had more extensive hypoperfusion in the frontal and parietal cortex, as well as striatum and thalamus. Left-sided hypoperfusion in the parietal cortex and the thalamus was also significantly associated with neglect on SPECT imaging. Performance in three out of five psychological tasks commonly used to detect the presence of hemispatial neglect, such as drawing tests and line bisection test, was exclusively linked with damage to the parietal cortex of the right hemisphere, while the line cancellation test might be attributable to the lesion of the right striatum. CONCLUSIONS: These findings support the model attributing hemispatial neglect to a unilateral defect in a cortico-striatothalamo-cortical loop. CBF SPECT imaging may provide a reliable description of the brain pathology associated with hemispatial neglect.

Journal Article↗

PubMed2002

An introduction to economic analysis in medicine--the basics of methodology and chosen terms. Examples of results of evaluation in nuclear medicine.

This article overviews the basic terms and methodology approaches in economic analysis in medicine: cost-benefit analysis, cost-effectiveness analysis, cost-utility analysis and costminimisation analysis. Particular emphasis is put on nuclear medicine economic evaluation, e.g. FDG - PET studies, sestamibi breast cancer imaging and radioiodine therapy of hyperthyroidism.

Journal Article↗

PubMed2002

European School of Nuclear Medicine--21st Seminar, April 18-19 2002, Prague, Czech Republic.

Explore the source record for details and available documents.

Journal Article↗

PubMedDate not supplied

[Depression in patients with Parkinson's disease].

The aim of our study was to assess the frequency of depression in group of patients with Parkinson's disease (PD) who fulfilled the diagnostic criteria of PD, had normal CT scans and responded well to L-dopa treatment. The sample consisted of 73 consecutive patients (34 women and 39 men), mean age 65.7 (41-81) years, mean duration of disease 6.7 years. Besides neurological examination, in all the patients the degree of motor impairment was evaluated using the UPDRS, H-Y, and SE scales. Moreover, a sociodemographic questionnaire, psychological tests (MADRS, MMSE), and a quality of life scale (PDQ-39) were used. Depression (MADRS scores > 19) was found in 25 (34.2%) of the patients, with major depression (scores > 28) diagnosed in 7 patients (9.5%) and moderate depression (scores between 20 and 28)--in 18 cases (24.6%). In comparison to non-depressed patients, those with depression were older by 0.9 years on the average, their onset of the disease occurred later by 1.7 years, and their mean duration of the disease was longer by 2.6 years. These differences were not statistically significant. Dementia (MMSE scores < or = 23) did not differentiate between the two groups: it was found in 27 depressed patients (37.4%) and in 26 (35.6%) of those without depression. Patients in the depressed group suffered statistically more often from sleep disorders (19 vs. 14; p < 0.001). In this group motor impairment was significantly more marked, as measured by the UPDRS (32.2 vs. 46.8; p < 0.001) and H-Y (2.54 vs 2.98; p < 0.007), and their quality of life as measured by PDQ-39 questionnaire was significantly lower (36.4 vs. 82.24; p < 0.00002). Our data indicate the presence of depression in 34.2% of the sample, i.e. a somewhat lower prevalence rate than that reported in other studies. This may be due to the fact that only outpatient population was analysed, and outpatients are seldom categorized as degree 4 and 5 on the H-Y scale. Depression on PD patients was correlated with their more severe motor disability and considerably lower quality of life. This may suggest a relationship with progression of the disease and more pronounced changes in cerebral neurotransmitters (i.e. endogenous origin), or PD patient's response to their limited mobility and isolation in later stages of the disease (i.e. reactive origin). However, the two factors--endogenous and reactive--may be overlapping, since a majority of PD patients suffer from mild to moderate depression.

Adult↗