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Aim:  To test the usability and user experience of a newly self-developed eLearning tool to teach PET/CT and CT to undergraduate medical students., Methods:  The eLearning tool permits to display PET and CT DICOM images web-based. It contains a healthy subject with anatomical annotations and a clinical case study. The usability and user experience of the eLearning tool was evaluated in undergraduate medical students of the medical faculty of the RWTH Aachen. We applied a survey based on different already existing and validated questionnaires such as System Usability Scale (SUS) and User Experience Questionnaire (UEQ-S) as well as specific questions regarding the eLearning tool., Results:  38 volunteers (9 males) participated in our study. Applying the SUS resulted in a mean of 82.24, and a median of 83.75. This positive evaluation is supported by the results of the UEQ-S that were 2.2 with regard to the pragmatic quality, 2.3 with regard to hedonic quality and 2.3 for overall quality indicating a very positive evaluation. In the free-text answers, students emphasised easy and intuitive use of the eLearning tool that was additionally described as interesting and exciting. The students also positively mentioned the case study and the possibility of practice-based learning. Negative aspects were mainly problems with synchronisation of the PET and CT images., Conclusion:  The positive evaluation is encouraging and form a foundation for further development of the eLearning module. It may be the basis for the implementation of a sustainable blended learning concept in the nuclear medicine curriculum., Competing Interests: The authors declare that they have no conflict of interest., (© Georg Thieme Verlag KG Stuttgart · New York.)

Aim:  Molecular imaging and therapy as applied in nuclear medicine represent an important contribution to modern medicine. The university curricula of medical schools permit to convey knowledge of nuclear medicine. In this study, the status quo of nuclear medicine teaching at German medical schools shall be surveyed for the first time., Methods:  In cooperation with the chairs and/or lecturers, the topics organizational conditions, scope of teaching, teaching methods, examinations, evaluations, composition of teaching staff, interest of the students in the field of nuclear medicine, as well as suggestions for improvement of teaching were recorded., Results:  All 36 public German medical schools participated in the survey. In these medical schools a median of 12 hours of nuclear medicine is being taught. 52 % of the teaching consists of teacher-centered learning. 18 medical schools teach additional elective courses in nuclear medicine. Nine 9 persons (median) per department are involved in the teaching. The examinations, in all but one school, follow a multiple choice format. The students' interest in nuclear medicine is perceived by the educators to be predominately medium to high., Conclusions:  Potential improvement might be achieved with regard to the quantity of teaching lessons, innovative methods of teaching, design of the exams, the establishment of a nationwide e-learning platform, as well as measures to increase the motivation of teachers., Competing Interests: Die Autoren geben an, dass kein Interessenkonflikt besteht., (© Georg Thieme Verlag KG Stuttgart · New York.)

Aims: Implementation of the guidelines on the Competency-based Learning Objective Catalogue for Undergraduate Medical Education for a Nuclear Medicine curriculum on behalf of the committee on professional training and continuing education of the German Association of Nuclear Medicine (DGN) METHODS:: In 7 domains 100 learning objectives (LOs) were subject to a prioritization in 3 categories (A, B and C) by means of a questionnaire as part of a Delphi method, in collaboration with all members of the DGN holding a "venia legendi" as experts. Category A defined the essential LOs for each medical practitioner. The prioritization was made by ranking the frequency of the A-classifications. In the 2nd step of the Delphi method, a list of LOs with the ranking positions 1-5 in each domain was presented to the first round's experts as a core curriculum, asking either for acceptance or modifications., Results: The results of the 1st step of the Delphi method deliver a return rate of 29% of the questionnaires (55 out of 184). The 2nd round shows a return rate of 30.9% (57 out of 184) and full approval of the proposed LOs in all LO domains by in median 72 % of the experts consulted (61%-81%). The present final version contains 37 competency-based LOs in the LO domains "legal basis and radiation protection", "basic science", indications and contra-indications for "PET/CT", "scintigraphy and SPECT", "patient preparation", "image interpretation" as well as "therapy"., Conclusion: The Competency-based Learning Objective Catalogue for Nuclear Medicine describes the knowledge and competencies, every physician should have at the end of his medical studies. The LO catalogue is a living document, which needs to be adapted continuously to the progress of the medical and technological development., Competing Interests: Disclosure The authors report no conflicts of interest in this work., (Georg Thieme Verlag.)

Aim: Updated presentation of the spectrum of nuclear medicine in-vivo examinations and therapies from officially available statistics on out-patient and in-patient care as well as trends of structural data on nuclear medicine in Germany., Methods: Data from the German Federal Health Monitoring, from the frequency statistics of the statutory health insurance for out-patients and from the German Medical Association were used and supplemented by data from selective literature searches., Results: In descending order, thyroid, bone and cardiac scans continue to be the most frequent nuclear medicine procedures. With a marked increase of PET/CT and SPECT/CT, the number of basic scintigraphies is declining. Cardiac, lung and brain scans as well as lymph scintigraphies are increasingly requested, bone and thyroid scan decrease. The consultation of nuclear medicine physicians in private practices is increasing by 4 % per year (2009: 2 164 664; 2015: 2 687 359). The number of nuclear medicine physicians in the out-patient sector rose significantly (2009: 756, 2015: 939, growth 24 %) and has remained constant due to restrictions since 2013. The specialist recognitions of women in nuclear medicine increased (proportion currently 46 %). In hospitals, more PET(/CT) scanners (2009: 97; 2015: 125) and fewer gamma cameras (2009: 594; 2015: 550) are operated. The number of non-thyroid (and also out-patient) radionuclide therapies continued to increase., Conclusion: With increased use of hybrid technologies, the nuclear medicine spectrum shows positive trends especially in nuclear cardiology and extra-thyroid therapy. These developments must be taken into account when amending regulations of specialist training and medical student teaching.

Background: In about 20% there is an involvement of the retropharyngeal lymph nodes in patients with locally advanced carcinoma of the hypopharynx and cervical esophagus. A case report should demonstrate the diagnostic and therapeutic impact of FDG-PET/CT in the radiotherapeutic management of a locally advanced carcinoma of the hypopharynx in special consideration of the RPLN., Patient and Method: A pretherapeutic FDG-PET/CT was performed with the patient fixed in the radiotherapy mask in order to integrate the anatomic and metabolic information into the radiotherapy planning system by an exact matching of the data., Results: Only the FDG-PET could detect a retropharyngeal lymph node involvement (RPLN) by an intensive glucose utilisation with a consecutive modification of the target volume and dose increase in this region., Conclusion: This case report demonstrates that FDG-PET/CT facilitates the imaging of metabolic active and otherwise hardly detectable lymph nodes in locally advanced head and neck cancer with consequences on target volume definition and dose application in radiotherapy.

Aims: Major controversies exist regarding the treatment of papillary microcarcinoma of the thyroid (PMC). Prior to 2003 PMC was defined by the WHO as a papillary carcinoma of 1 cm or less in diameter. In 2004 that definition changed, with the new classification requiring that the tumour also must be found incidentally., Patients, Methods: In this study we reviewed the clinical records of 67 patients with papillary tumours of the thyroid

Aim: The development of new diagnostic techniques and the implementation of a modern quality control management system requires the continuous adaptation of existing data processing tools to the nuclear medicine diagnostic workflow. Furthermore, PACS connected to HIS facilitates and enhances the transfer of data and pictures, and satisfies the legal requirements for data retention as regulated by law. Therefore, the aim of this work is to present the architecture, structure and results of such a system newly installed in a department of nuclear medicine., Methods: Initially, the nuclear medicine workflow was carefully analyzed and each step was correlated to the corresponding module. The standard SAP R/3 and IS-H/IS-H(*)med based software used for patient administration at the University of Regensburg Hospital was adapted to the needs of the Nuclear Medicine Department. The networking of the imaging systems was done by integration of a PACS. Finally, the PACS was connected to the HIS to allow the attachment of images to the medical report., Results, Conclusion: By connecting the HIS to the nuclear medicine PACS, the workflow was significantly improved. The data management sequence starting at the reception desk, continuing through the nuclear medical examination, to the physician's final written and image report is clearly structured. Although high demands exist on technical support and administration the integration of PACS and HIS into the nuclear medicine workflow leads to enhanced efficiency and reduction in hospital costs. Patient and data management are considerably improved in this way.

Aims: An explorative analysis of the diagnostic as well as therapeutic impact of (18)F-FDG whole body PET on patients with various tumours in the setting of an university hospital radiation therapy was performed., Patients and Methods: 222 FDG PET investigations (148 initial stagings, 74 restagings) in 176 patients with diverse tumour entities (37 lung carcinoma, 15 gastrointestinal tumours, 38 head and neck cancer, 30 lymphoma, 37 breast cancer, 19 sarcoma and 16 other carcinomas) were done. All PET scans were evaluated in an interdisciplinary approach and consecutively confirmed by other imaging modalities or biopsy. Unconfirmed PET findings were ignored. Proportions of verified PET findings, additional diagnostic information (diagnostic impact) and changes of the therapeutic concept intended and documented before PET with special emphasis on radiooncological decisions (therapeutic impact) were analysed., Results: 195/222 (88%) FDG-PET findings were verified, 104/222 (47%) FDG-PET scans yielded additional diagnostic information (38 distant, 30 additional metastasis, 11 local recurrencies, 10 primary tumours and 15 residual tumours after chemoptherapy). The results of 75/222 (34%) scans induced changes in cancer therapy and those of 58/222 (26%) scans induced modifications of radiotherapeutic treatment plan (esp. target volumes)., Conclusion: (18)F-FDG whole body PET is a valuable diagnostic tool for therapy planning in radiooncology with a high impact on therapeutic decisions in initial staging as well as in restaging. Especially in a curative setting it should be used for definition of target volumes.

The conceptual ideas of evidence based critical appraisal of diagnostic studies are described in this survey. In this context special attention is given to biases in study design such as verification- as well as information-bias limiting the validity of diagnostic studies. The practice of critical appraisal is demonstrated in an application to an example of a nuclear medicine scenario. The impact of evidence based medicine on nuclear medicine as a diagnostic discipline is discussed in detail.

A 9 1/2-year-old girl suffered from intermitting tremor and jitteriness of her left hand and oral muscles every 4 to 6 weeks with long lasting episodes. Clinically myoclonias and dystonic positioning of the left arm, hand and facial muscles were seen. No evidence of trauma, infection or inborn errors of metabolism was found. Successful therapy with carbamazepine was initiated while L-DOPA failed. An ictal 99m-Tc-HMPAO-SPECT showed severe asymmetry with focal hyperperfusion of the contralateral right thalamus and basal ganglia as well as of the bifrontal cortex, whereas no anatomical lesions were found by MRI. In contrast, an interictally performed 99m-Tc-HMPAO SPECT showed hypoperfusion of the right thalamus and normalisation of the frontal perfusion under medical treatment. These 99m-Tc-HMPAO-SPECT findings may provide new insights into the localisation and pathophysiological pathways of idiopathic childhood dystonia.

We present a 61-year-old male patient with progressive dementia. A brain SPECT with Tc-99m-bicisate was performed for confirmation of clinically suspected Alzheimer-dementia. At the time of the SPECT-investigation marked apraxia and aphasia besides severe dementia were present. Electrophysiological as well as anatomical neuroimaging findings showed non-diagnostic alterations. SPECT revealed distinct perfusion defects, which made Alzheimer Dementia unlikely. The further course of the patient was determined by rapidly progressive deterioration with development of akinetic mutism. Thereafter, increased levels of neuron-specific enolase as well as 14-3-3 proteins were found in the cerebro-spinal fluid (CSF). The patient finally died with signs of cerebral decortication. Due to the clinical course and the CSF-findings the patient's final diagnosis was Creutzfeldt-Jakob-disease, nevertheless no autopsy was performed. The presented case report underscores the clinical utility of perfusion brain SPECT in the differential diagnosis of dementias.

In this paper we present investigations on a simplified method of quantitative whole body scintigraphy by using a dual head LFOV-gamma camera and a calibration algorithm without the need of additional attenuation or scatter correction. Validation of this approach to the anthropomorphic phantom as well as in patient studies showed a high accuracy concerning quantification of whole body activity (102.8% and 97.72%, resp.), by contrast organ activities were recovered with an error range up to 12%. The described method can be easily performed using commercially available software packages and is recommendable especially for quantitative whole body scintigraphy in a clinical setting.