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PubMed1991

An interactive report generator for bone scan studies.

An interactive report generator for bone scintigraphy will be demonstrated. It comprises a controlled reporting vocabulary, an adaptive user interface, and a text generator. The controlled vocabulary represents the relevant concepts for bone scan reports: anatomical sites, scintigraphical phenomena, and diagnoses, and various attributes for these concept domains. Within the vocabulary selectional constraints are defined that restricts to meaningful combination of concepts. The interface provides intelligent views on the vocabulary, and presents only those terms that are relevant in a certain context. Through the interface the user may choose appropriate terms and combine them to complex findings. A German text generator for a restricted finding language transforms the entered data into morpho-syntactic surface structures and produces acceptable reports.

Bone and Bones↗
PubMed1995

Use of a tantalum-178 generator and a multiwire gamma camera to study the effect of the Mueller maneuver on left ventricular performance: comparison to hemodynamics and single photon emission computed tomography perfusion patterns.

During the Mueller maneuver, there is a decrease in intrathoracic pressure and an increase in transmural left ventricular pressure. The changes in loading conditions cause transient left ventricular dysfunction. This study examined the effects of the Mueller maneuver on left ventricular performance using tantalum (Ta)-178 (half-life 9.3 min) and a multiwire gamma camera. First-pass radionuclide angiograms were obtained at baseline and during Mueller maneuver in 41 patients aged 58 +/- 10 years. In 34 patients, stress single photon emission computed tomography (SPECT) myocardial perfusion imaging with thallium-201 or sestamibi was also performed. Hemodynamic measurements during the Mueller maneuver (n = 10) showed a decrease in systemic pressure (139 +/- 25 mm Hg vs 123 +/- 24 mm Hg, p < 0.001) and pulmonary artery pressure (24 +/- 6 mm Hg vs 14 +/- 12 mm Hg, p = 0.01) and an increase in heart rate (67 +/- 10 bpm vs 75 +/- 14 beats/min, p = 0.001). Among the 34 patients who had perfusion imaging, the left ventricular ejection fraction remained unchanged or increased in 17 patients (group 1) (48% +/- 19% vs 49% +/- 21%, p not significant) and decreased (> or = 5%) in 17 patients (group 2) (55% +/- 13% vs 40% +/- 16%, p = 0.001). The stress SPECT images showed no or only fixed defects in 11 (65%) patients in group 1 and 3 (18%) patients in group 2 (p = 0.02), and reversible defects in 6 (35%) patients in group 1 and 14 (82%) patients in group 2 (p = 0.04).(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1998

Superiority of triple-detector single-photon emission tomography over single- and dual-detector systems in the minimization of motion artefacts.

A patient motion-related artefact is one of the most important artefacts in single-photon emission tomography (SPET) imaging. This study evaluated the effect of the number and configuration of SPET detectors on motion artefacts. The following acquisition conditions were simulated based on original 360 degrees projection images: (1) single-detector 180 degrees rotation (S180), (2) a dual-detector rectangular (L-shaped) 180 degrees acquisition (D180L), (3) dual-detector cameras mounted opposite each other with 360 degrees acquisition (D360) and (4) triple-detector 360 degrees acquisition (T360). The motion artefacts were introduced using a syringe and a myocardial phantom. Clinical cases with technetium-99m methoxyisobutylisonitrile and thallium-201 studies were analysed to confirm the validity of this phantom simulation. The effect of continuous alternate rotation acquisition and summing the projections on the reduction of motion artefacts was investigated in each model. The effect of motion depended on the number and the configuration of the SPET detectors. A 1-pixel (6.4 mm) motion in the S180, D180L and D360 models generated only slight artefacts, and a 2-pixel motion led to an apparent decrease in activity or created hot areas in the myocardium. On the other hand, a T360 rotation created few artefacts even with a 2-pixel motion of the last quarter of the projections. Despite the difference in attenuation with 201Tl and 99mTc, similar artefact patterns were observed with both radionuclides in selected patient model studies. Continuous alternate rotation could reduce artefacts caused by less than a 2-pixel motion. In conclusion, calculating the average of the sum of the projections of triple-detector 360 degrees rotations with alternate rotation is the best method to minimize motion artefacts. This "averaging" effect of motion artefacts is a key to this simulation.

Gamma Cameras↗
PubMed2002

Tumour targeting of humanised cross-linked divalent-Fab' antibody fragments: a clinical phase I/II study.

Antibody engineering has made it possible to design antibodies with optimal characteristics for delivery of radionuclides for tumour imaging and therapy. A humanised divalent-Fab' cross-linked with a bis-maleimide linker referred to as humanised divalent-Fab' maleimide was produced as a result of this design process. It is a humanised divalent antibody with no Fc, which can be produced in bacteria and has enhanced stability compared with F(ab')(2). Here we describe a clinical study in patients with colorectal cancer using humanised divalent-Fab' maleimide generated from the anti-carcinoembryonic antigen antibody A5B7 radiolabelled with iodine-131. Ten patients received an i.v. injection of iodine-131-labelled A5B7 humanised divalent-Fab' maleimide, and positive tumour images were obtained by gamma camera imaging in eight patients with known lesions, and one previously undetected lesion was identified. True negative results were obtained in two patients without tumour. Area under the curve analysis of serial blood gamma counting and gamma camera images showed a higher tumour to blood ratio compared to A5B7 mF(ab')(2) used previously in the clinic, implying this new molecule may be superior for radioimmunotherapy. MIRD dose calculations showed a relatively high radiation dose to the kidney, which may limit the amount of activity that could be administered in radioimmunotherapy. However the reduction in immunogenicity was also a major advantage for A5B7 humanised divalent-Fab' maleimide over murine versions of this antibody suggesting that humanised divalent-Fab' maleimide should be a useful vehicle for repeated therapies.

Area Under Curve↗
PubMed1995

[Continuous ambulatory measurement of left ventricular function by an isotopic method].

Ambulatory cardiac radionuclide monitoring is a relatively new technique of non-invasive assessment of left ventricular function. This technique, which uses a portable gamma-ray detector, enables continuous recording over a number of hours of global left ventricular ejection fraction after red cell labelling with technetium. The detector is placed in contact with the skin over the apical region in a 45 degrees left anterior oblique view. Adequate collimation enables the variations in left ventricular volume during the cardiac cycle to be quantified and the ejection fraction to be deduced without having to generate an image. The authors review this method and describe the different available systems. They may be classified in two groups as to whether the technique is limited to continuous bed-side monitoring or if used for ambulatory monitoring (the only commercially available model being the Vest). Validation studies and trials in normal subjects are envisaged. The information acquired by this new method is analysed in the different clinical fields: post-infarction, stable angina, asymptomatic coronary artery disease, hypertension. The role of this new technique in the investigation of coronary artery disease is discussed with respect to other non-invasive techniques. The limitations of the technique and the material are reviewed and possible future developments are described.

Coronary Disease↗
PubMed1983

Quantitative activation patterns of cerebral blood flow during mental stimulation after intravenous injection of 195mAu.

A previously reported theory for quantitative cerebral blood flow measurement for nondiffusible radiotracers has been applied to patients after stroke and to volunteers undergoing a mental stimulation exercise. Quantitative measurements of cerebral blood flow pattern in p-a and lateral projections of the brain are obtained using the short lived (30s) isotope 195mAu from the recently developed generator. The energy spectrum of the eluate from the generator shows two strong photon peaks, one at an energy level of 68 KeV and a second at 262 KeV. The low-energy peak is suitable for perfusion studies of the cerebral hemispheres in lateral projection, being without "look through" effect. The high-energy level is good for studies in the p-a-projection. Studies last less than 1 min and can be repeated after 3 min. Parametric images for quantitative regional cerebral blood flow can be generated, in which the avascular region following stroke can be detected. Quantitative activation patterns of cerebral blood flow during mental stimulation can be generated. The results show that it is possible to measure cerebral blood-flow patterns not only with freely diffusible indicators like Xenon but also with nondiffusible indicators.

Adult↗
PubMed1999

A generic mixing system for achieving conditions suitable for single point representative effluent air sampling.

The U.S. EPA has approved Alternate Reference Methodologies for sampling radionuclide aerosol particles from stacks and ducts of U.S. DOE facilities. The approach allows use of single point sampling with shrouded probes from locations where both fluid momentum and contaminant concentration are well mixed across the flow cross section. For existing stacks and ducts that do not have locations where there is adequate mixing, we have developed a generic mixing system that will generate conditions suitable for single point sampling. The coefficients of variation of the velocity, tracer gas, and 10 microm aerodynamic diameter aerosol particles profiles are all less than 10%, which are well within the EPA limit of 20%. Mixing is affected neither by size of the system nor by flow rate, provided the flow is turbulent.

Air Pollution, Radioactive↗
PubMed1987

The implications of decreased performance of new generation gamma-cameras on the interpretation of 131I-Hippuran renal images.

Several patients with renal failure in whom the kidneys were more clearly imaged with 99Tcm-DTPA than 131I-Hippuran were recently observed. We have postulated that our newer generation gamma-cameras have a reduced capacity to image 131I in comparison to older generation cameras. This hypothesis was tested by comparing representative older and newer imaging systems. Full-width tenth-maximum 99Tcm linespread functions were 1.20 and 1.55 cm for the older and newer cameras, respectively. The 99Tcm count rate on the newer camera was 111% that of the older camera, and the observed kidney to background count ratios in a phantom model were virtually identical for the two cameras imaging a number of simulated 99Tcm count distributions. Full-width tenth-maximum 131I linespreads were 1.55 and 4.78 cm, respectively, on the older and newer cameras and the 131I count rate on the newer camera was 27% of the count rate on the older system. The phantom model demonstrated a consistently lower 131I perceived kidney to background count ratio on the newer gamma-camera compared to the older system. These findings should be considered in the interpretation of 131I-Hippuran studies on newer-generation equipment until revised criteria of interpretation have been established. Non-visualization of the kidney may not have the same prognostic implication using modern cameras as has been reported from studies with older generation detector systems.

Adult↗
PubMed1990

An edge extraction technique for noisy images.

We present an algorithm for extracting edges from noisy images. Our method uses an unsupervised learning approach for local threshold computation by means of Pearson's method for mixture density identification. We tested the technique by applying it to computer-generated images corrupted with artificial noise and to an actual Thallium-201 heart image and it is shown that the technique has potential use for noisy images.

Algorithms↗
PubMed1985

Extraction efficiency and biliary excretion of hepatobiliary imaging agents in the rat perfused liver.

A multitude of transitional metal complexes has recently been introduced into clinical practice as hepatobiliary imaging agents; the kinetics of these substances are often poorly understood. To gain better insight into characteristics of these different agents, we measured the extraction efficiency and mean biliary transit time of a variety of iminodiacetate derivatives in the in-situ rat perfused liver. First pass hepatic extraction efficiency averaged 59% for 99mTc N-(p-isopropylacetanilide) iminodiacetate, 73% for 99mTc N-(2,6-diethylacetanilide) iminodiacetate, 74% for 99mTc N-(3-bromo-2,4,6-trimethylacetanilide) iminodiacetate, 90% for 99mTc N-(p-butylacetanilide) iminodiacetate, and 93% for 99mTc N-pyridoxyl-5-methyltryptophan. By comparison, extraction of another organic anionic compound, 131I Rose bengal, was only 12.4%. Mean hepatocyte transit times varied from 2.3 to 7.5 min. Shorter mean transit times were observed for diortho substituted and longer mean transit times for para substituted metal complexes. Radioactivity was quantitatively recovered in bile, and excretion kinetics overall were consistent with data generated in whole animals. These studies demonstrate the value of the in-situ rat perfused liver as a screening tool to characterize hepatobiliary imaging agents.

Animals↗
PubMed1999

Automatic three-dimensional multimodality registration using radionuclide transmission CT attenuation maps: a phantom study.

UNLABELLED: Coregistration of images from a single subject, acquired by different modalities, is important in clinical diagnosis, surgery and therapy planning. The purpose of this study was to evaluate, using a physical torso phantom, a novel, fully automated method for three-dimensional image registration of CT and SPECT, using radionuclide transmission (RNT) attenuation maps. METHODS: We obtained CT scans and SPECT scans paired with RNT maps of an anthropomorphic cardiac phantom. RNT attenuation maps were acquired using an uncollimated 99mTc-filled flood source. RNT and SPECT scans were acquired in the same spatial orientation (usual clinical practice in nonuniform attenuation correction). In addition, CT attenuation maps (CTMAPs) for 99mTc SPECT were generated from CT by linear energy scaling. RNT maps were registered to CT and CTMAPs by iterative simplex minimization of count difference and uniformity index (sum of RNT map intensity variances corresponding to each intensity level in the CT volume). In each iteration, three shifts and three angles were adjusted. To register SPECT to CT, we applied the RNT transformation parameters to SPECT. RESULTS: RNT maps could be registered to CT and CTMAP images using both criteria. The average three-dimensional distance between landmark and automated registration was 2.5 +/- 1.2 mm for count difference and 3.3 +/- 1.3 mm for uniformity index. The three-dimensional reproducibility errors were 1.2 +/- 0.7 mm for count difference, 2.1 +/- 0.5 mm for uniformity index and 2.3 +/- 1.0 mm for manual marker registration. The minimization of uniformity index was robust when up to 50% CT or RNT slices were missing and was not affected significantly (<2 mm) by realistic variation in CT values (+/- 12 Hounsfield units). CONCLUSION: In addition to typical use in nonuniform attenuation correction, RNT maps can be used for fully automated three-dimensional registration of SPECT to CT. Such registration is not affected by features and quality of SPECT images and avoids difficulties associated with fiducial markers. Our method can be applied to SPECT-CT registration of various organs, such as brain, heart, lungs, breasts and abdomen, including oncological scans.

Image Processing, Computer-Assisted↗
PubMed1985

Regional lung function: physiology and clinical applications.

The current status of tests of regional lung function has been reviewed from the physiological and clinical standpoint. Recent technical innovations include the use of single photon and positron emission computerized tomography (SPECT and PET). For PET work, neon-19 (t 1/2 17 sec) has been introduced as a ventilation tracer, and fluorine-18 deoxyglucose as a marker of glucose metabolism. Indium-111 labelled neutrophils have been studied. Physiological measurements of the distribution of blood flow and ventilation are concentrating on non-gravitational influences such as the pattern of force generation by the respiratory muscles and vasomotor tone. Ventilation and perfusion imaging of the lung with the gamma camera has established itself as an essential screening test for the diagnosis of pulmonary embolic disease. Inhalation of a radio-labelled aerosol of small particle size (1 micron) may be an acceptable substitute for a radioactive gas ventilation scan. Mucociliary clearance has been investigated with radionuclide techniques. Measurements of regional lung water have been replaced by tracers sensitive to alterations of epithelial (inhaled 99Tcm-DTPA) or endothelial (i.v. 113Inm-transferrin) permeability. New techniques using positron emission tomography, such as measurements of extravascular lung density, regional ventilation (19Ne) and regional glucose metabolism (18F-deoxyglucose) have been discussed briefly.

Humans↗
PubMed1998

Lipoprotein(a) level does not predict restenosis after percutaneous transluminal coronary angioplasty.

The serum lipoprotein(a) [Lp(a)] level is a known risk factor for arteriosclerotic coronary artery disease. However, its association with restenosis after percutaneous transluminal coronary angioplasty (PTCA) is controversial. We hypothesized that the Lp(a) level is a significant risk factor for restenosis after angioplasty through a pathophysiological mechanism leading to excess thrombin generation or inhibition of fibrinolysis. We designed a prospective study of the relation of Lp(a) to outcome after PTCA, in which we measured selected laboratory variables at entry and collected clinical, procedural, lesion-related, and outcome data pertaining to restenosis. Restenosis was defined as >50% stenosis of the target lesion by angiography or as ischemia in the target vessel distribution by radionuclide-perfusion scan. Before the patients underwent PTCA, blood was obtained by venipuncture for measurement of Lp(a), total cholesterol, thrombin-antithrombin (TAT) complex, alpha2-antiplasmin-plasmin (APP) complex, and plasminogen activator inhibitor-1 (PAI-1). Evaluable outcome data were obtained on 162 subjects, who form the basis of this report. Restenosis occurred in 61 subjects (38%). The Lp(a) level was not correlated significantly with TAT, APP, PAI-1, or the TAT-APP ratio. Levels of TAT, APP, and PAI-1 were not statistically different in the patients with versus those without restenosis. The median ratio of TAT to APP was 2-fold higher in the restenosis group, and this difference approached statistical significance (P=0.07). Univariate analysis was performed for the association of clinical, lesion-related, and procedural risk factors with restenosis. Lp(a) levels did not differ significantly in the restenosis versus no-restenosis group, whether assessed categorically (>25 mg/dL versus <25 mg/dL) or as a continuous variable by Mann-Whitney U test. The number of lesions dilated and the lack of family history of premature heart disease were significantly associated with restenosis (P=0.002 and P=0.008, respectively). A history of diabetes mellitus was of borderline significance (P=0.055). By multiple logistic regression analysis, the number of lesions dilated was the only variable significantly associated with restenosis (P=0.03). We conclude that the number of lesions dilated during PTCA is a significant risk factor for restenosis, whereas the serum Lp(a) level was not a significant risk factor for restenosis in our patient population. The TAT to APP ratio merits further study as a possible risk factor for restenosis.

Adult↗
PubMed1994

Technetium-99m, rhenium-186, and rhenium-188 direct-labeled antibodies.

BACKGROUND: Antibody sulfhydryl groups can act as effective carriers of reduced technetium and rhenium species for radioimmunodetection and radioimmunotherapy. METHODS: Intact immunoglobulin G and fragments were labeled with the isotopes and examined in vitro and in vivo. RESULTS: Technetium bound to intact immunoglobulin G was found to be the most stable species in vitro, but in vivo, clearances of technetium and rhenium bound to intact antibody were similar. Serum clearances were faster than those seen for the corresponding radioiodinated antibodies. In vivo clearance rates of the radiolabeled fragments were similar, with kidney uptake and retention seen. Rhenium-labeled antibodies, despite a greater tendency toward in vitro reoxidation than technetium-labeled antibodies, did not show enhanced kidney clearance in animal models. Rhenium-188 and technetium-99m were obtained from similar generator systems in carrier-free form. Using rhenium-188 spiked with cold rhenium, it was determined that approximately one rhenium atom per molecule of antibody can be conjugated directly. Rhenium-186 also was coupled at almost a 1:1 ratio to antibody. CONCLUSIONS: Only radiolysis concerns will limit the amount of rhenium-188 conjugated to antibody. Large doses of antibody will be necessary to deliver rhenium-186 at this isotope's currently available specific activity. Otherwise, higher specific activity rhenium-186, and/or greater loading capacity of rhenium-186 onto antibody, will be needed to generate the type of product that will be usable at a clinical dose of several hundred millicuries.

Animals↗
PubMed1989

Biodistribution of Tc-99m methoxy-isobutyl-isonitrile (MIBI) in humans.

Hexakis (methoxyisobutilisonitrile) technetium(I), 99mTc-MIBI, has been proposed for myocardial perfusion studies. We have evaluated the biodistribution of this new agent in normal volunteers at rest and after stress. The biodistribution of 99mTc-MIBI is characterized by rapid blood clearance and a consequently early myocardial uptake. The initial intense hepatic activity is cleared into the gallbladder at 1 h after injection, and the best target to non target ratio is observed at 60-90 min after injection. Absorbed radiation dose calculations show that the thyroid is the critical target organ (230 mRad/mCi at rest), presumably because of 99mTc-pertechnetate generated in vivo. Our results indicate that 99mTc-MIBI is a promising tracer for myocardial perfusion imaging.

Adult↗
PubMed1995

The effect on diagnostic quality of using dual isotope imaging for 81Krm ventilation and 99Tcm-MAA perfusion lung scanning.

It is the practice in some centres to use dual isotope imaging to reduce imaging times in lung ventilation and perfusion studies with 81Krm gas and 99Tcm-macroaggregated albumin (99Tcm-MAA) by simultaneous acquisition of the two images. The resulting loss of image caused by cross-talk between the two energy windows was investigated using two phantoms, one with cold 99Tcm lesions of varying size and contrast, and the other a uniform field of 81Krm. It was found that, under scatter conditions typical of a patient study, the use of dual isotope acquisition and a krypton generator of 470 MBq or greater resulted in a perceptible loss of image quality with lesions up to 4 cm in diameter being missed. On an older camera system, without modern energy and linearity correction facilities, a lower generator activity of only 120 MBq was sufficient to cause image degradation even under very low scatter conditions. Seventy-five patient studies were performed using both single and dual isotope imaging with generator activities ranging from 80 to 282 MBq. At these low generator activities, the studies did not demonstrate any differences between the images that would result in a different diagnosis. We conclude that the use of dual isotope V/Q scanning reduces the diagnostic value of the perfusion image if the activity of the 81Krm generator is too high, although at generator activities of 300 MBq or less no loss of image quality will occur on modern camera systems.

Humans↗
PubMed1976

Radiochemical purity of various 99mTc-labelled bone-scanning agents.

The radiochemical purity of preparations for 99mTc-bone-scanning was tested using thin-layer chromatography and electrophoresis. The investigation included ten commercial kits, comprising four types of phosphorus compounds, i.e. sodium polyphosphate, sodium pyrophosphate, disodium diphosphonate, and sodium monofluorophosphate. Out-spoken differences in the content of free pertechnetate were found between the different kits. The contents in preparations from the same kit were fairly constant, but in some cases a change could be referred to the age of the 99mTc-generator or the time of analysis. No significant difference was found between preparations made from eluate with and without oxidizer. A 99mTc-tin-colloid was sporadically present in the preparations.

Bone Diseases↗
PubMed2001

Radiological impact on the workers, members of the public, and environment from the partial decommissioning of Pakistan Research Reactor-I and its associated radioactive residues.

The Pakistan Research Reactor-I (PARR-I) is a swimming pool type research reactor originally designed and built for a thermal power of 5 MW using High Enriched Uranium (HEU) fuel. In 1990-1991 the reactor was redesigned, partially decommissioned and recommissioned to operate with Low Enriched Uranium (LEU) fuel at a thermal power of 10 MW. An essential requirement, construction and commissioning of a wet spent fuel storage bay and fabrication of an irradiated fuel transfer cask were completed before actual dismantling of the reactor core. During the partial decommissioning operations, radioactive waste generated included 600 m3 low-level liquid radioactive waste and 14 m3 of solid radioactive waste with an average specific activity of 4.52 Bq ml(-1) and 2.22 kBq g(-1), respectively. External radiation doses of the workers were determined using TLD (NG 6,7) and direct reading dosimeters. The maximum individual external radiation dose received by any worker during this practice was 5 mSv, which was 25% of the annual dose limit of 20 mSv. Detection and measurement of internal contamination was carried out using bioassay techniques. During the whole operation, not a single case of internal contamination was detected. The ambient radiation levels around waste seepage pits are periodically monitored using TLD (G-2 cards) and G. M. radiation survey meters. Underground migration of radioactivity is checked by analyzing seepage water samples taken from boreholes that have been dug at different locations in the vicinity of the radioactive residues. The monitoring around disposal sites containing radioactive residues has been continued during the last 9 y and will be continued in the future. So far, no rise in the environmental gamma radiation dose level and migration of underground radionuclides has been found in the vicinity of these disposal sites. Working personal during the decommissioning of PARR-I have been found to be radiologically safe. Adherence to the ALARA principle, sound decommissioning and proper radioactive waste disposal procedures helped to protect the working personnel, members of the public, and the environment from the harmful effects of the ionizing radiations present due to the partial decommissioning of the research reactor and its radioactive residues. Experience gained during this work, along with the current international procedures, will be helpful for full restoration of the environment from radioactive residues likely to be generated in the future from any other practices in Pakistan.

Body Burden↗