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The radionuclides used in nuclear medicine imaging emit numerous mono-energetic electrons responsible for dose heterogeneity at the cellular level. Sself, the self-dose per unit cumulated activity (which results from the radionuclide located in the target cell), and Scross, the cross-dose per unit cumulated activity (which comes from the surrounding cells) delivered to a target cell nucleus by electron emissions of technetium-99m, iodine-123, indium-111, gallium-67 and thallium-201 were computed at the cellular level. An unbounded close-packed hexagonal cell arrangement was assumed, with the same amount of radioactivity per cell. Various cell sizes and subcellular distributions of radioactivity (nucleus, cytoplasm and cell membrane) were simulated. The results were compared with those obtained using conventional dosimetry. Sself and Scross values depended closely on cell dimensions. While the self-dose depended on the tracer distribution, the latter affected the cross-dose by less than 5%. When the tracer was on the cell membrane, the self-dose was particularly low compared to the cross-dose, as the self-dose to cross-dose ratio was always less than 11%. In the case of cytoplasmic or cell membrane distribution of radioactivity, conventional electron dosimetry slightly overestimated the dose absorbed by the target cell nucleus (by 1.08- to 1.7-fold). In contrast, conventional dosimetry strongly underestimated the absorbed dose (1.1- to 75-fold) when the radioactivity was located in the nucleus. The discrepancies between conventional and cellular dosimetry call for calculations at the cellular level for a better understanding of the biological effects of radionuclides used in diagnostic imaging.

To evaluate the prognostic significance of increased mediastinal (18)F-FDG uptake in PET/CT for the staging of advanced ovarian cancer.We retrospectively evaluated patients managed for FIGO stage III/IV ovarian cancer between 1 January 2006 and 1 June 2009. Patients were included if they had undergone (18)F-FDG PET/CT and surgery for initial staging. Exclusion criteria were age younger than 18 years, inability to undergo general anaesthesia, recurrent ovarian cancer, and borderline or nonepithelial malignancy. Whole-body PET/CT was performed after intravenous (18)F-FDG injection. The location of abnormal hot spots and (18)F-FDG maximal standard uptake values (SUV(max)) were recorded. We compared the complete cytoreduction and survival rates in groups defined based on mediastinal (18)F-FDG uptake and SUV(max) values. Kaplan-Meier curves of overall survival and disease-free survival were compared using the log-rank test. Hazard ratios with their 95% confidence intervals were computed. Adjusted hazard ratios were obtained using a multivariate Cox model.We included 53 patients, of whom 17 (32%) had increased mediastinal (18)F-FDG uptake. Complete cytoreduction was achieved in 14 (87.5%) of the 16 patients managed with primary surgery and in 21 (75%) of the 28 patients managed with interval surgery. Complete cytoreduction was achieved significantly more often among patients without increased mediastinal (18)F-FDG uptake (80.6% vs. 35.3%; p = 0.001). Disease-free survival was comparable between the two groups. By univariate analysis, overall mortality was significantly higher among patients with increased mediastinal (18)F-FDG uptake (hazard ratio 5.70, 95% confidence interval 1.74-18.6). The only factor significantly associated with overall survival by multivariate analysis was complete cytoreduction (adjusted hazard ratio 0.24, 95% confidence interval 0.07-0.89).Increased mediastinal (18)F-FDG uptake was common in patients with advanced ovarian cancer. However, complete cytoreduction, which was significantly more frequent among patients without mediastinal (18)F-FDG uptake, was the only factor independently associated with survival.

Simultaneous dual-isotope (rest thallium-201/stress technetium-99m sestamibi) myocardial single-photon emission tomography (SPET) would be an ideal procedure; however, (99m)Tc cross-talk on the (201)Tl window hampers its routine use. Photon energy recovery (PER) is a spectral deconvolution technique validated for scatter and cross-talk removal in phantom studies and a limited series of patients. In this study we aimed to validate the technique in 295 patients within a context of clinical routine practice. Conventional separate rest (201)Tl myocardial SPET data sets were visually compared with simultaneous dual-isotope data sets corrected by PER. Conventional separate rest (201)Tl data sets were identical to dual PER-corrected (201)Tl data sets in 173 (58.6%) patients. As dual PER (201)Tl data sets are corrected for (99m)Tc cross-talk but also for (201)Tl scatter, they were compared with separate rest (201)Tl data sets corrected by PER in the 122 discordant patients. No difference was found in 77 (26.1%) patients. In 26 (8.8%) patients, the difference consisted in the presence of a defect on dual PER (201)Tl data sets only, mirroring an ischaemic defect on (99m)Tc-sestamibi data sets. This difference can be attributed to the influence of stress on the kinetics of (201)Tl injected at rest. In the remaining 19 (6.4%) patients, the difference between separate and simultaneous PER-corrected data sets was scored as mild in 11 and moderate in eight patients and seemed to be related to multiple methodological factors. It is concluded that PER correctly removes (99m)Tc cross-talk. With the addition of an appropriate attenuation correction, the PER technique may allow the routine use of simultaneous dual-isotope myocardial scintigraphy in the near future.