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The authors reflect on the appropriateness of referrals for single-photon emission computed tomography myocardial perfusion imaging (SPECT-MPI) in Iran, which is one of the most widely used procedures of nuclear medicine to detect perfusion abnormalities. The authors say that they conducted a study to describe the ordering practices of physicians in Iran. They add that there was no vital difference between governmental and private medicine centers in regard to the level of appropriateness.

The authors discuss the past, present, and future trends of scientific journalism on nuclear medicine in Iran. They explore the history of publication of scientific issues starting in 1961. They cite that scientific publication began increasing in the 2000s when nuclear medicine was made an independent medical specialty in the country. They note that the nuclear medicine community should attempt to connect with other disciplines.

Background: At the present time, only visual analysis is implemented on dacryoscintigraphic images and quantitative assessments are not routinely obtained. The authors have designed a novel, simple, quantitative method for the diagnosis of sac and post-sac obstructions based on the dacryoscintigraphic images. Method: Fifty-nine patients with severe unilateral epiphora were included and the contralateral asymptomatic eyes were used as controls. After ocular instillation of 0.1 cc isotonic saline containing 4 MBq 99mTcO4, dynamic images were obtained for 20 minutes. Visual interpretation was done by two blinded specialists in nuclear medicine. A Time-Activity Curve (TAC) was generated for each eye and its pattern was divided to plateau type, shallow-down sloping and deep-down sloping. The excretion ratio (expressed as the percentage of drained activity) in the 2nd, 3rd, 5th, 7th, 10th, 15th and 20th minute of the study was calculated based on the following formula: (the total count in the region of interest (ROI) in the 1st minute - the total ROI count in the 2nd, 3rd, 5th, 7th, 10th, 15th or 20th minute/the total ROI count in the 1st minute) × 100. The results of the quantitative analysis were compared with the clinical symptoms, visual analysis and TAC pattern. Results: At the optimal cut-off points for the 2nd, 3rd, 5th and 7th minute, the sensitivity of the prediction of obstruction was 76%, 72%, 71% and 69%, respectively. The correlation between visual interpretation and the TAC pattern was statistically significant. Conclusion: The quantitative evaluation of dacryoscintigraphic images would contribute greatly to achieving an easier and more objective interpretation of the scintigraphic results and also provides a reliable tool for inter-individual comparison and the follow-up of patients. As it is the first time that this innovative method has been examined clinically, it will be necessary to investigate its clinical utility in a larger series of patients. [ABSTRACT FROM AUTHOR]

A 65 year-old overweight man with a history of prostate cancer was referred to our nuclear medicine department for bone scanning. Anterior projection images showed two small foci of increased radiotracer uptake corresponding to the anterior arcs of the right and left sixth ribs, which were interpreted as suspicious for metastatic involvement. Eight months later the patient was referred for follow-up bone scan. In the follow-up scan, those two foci of abnormal radiotracer activity were outside the limits of the bony structures of the chest. In fact, those foci changed their position and were due to radiotracer uptake by the enlarged breasts of this gentelman (Gynecomastia). Previously, it has been just one report concerning radiotracer uptake in the breasts of a man. Based on our case report, this abnormal finding is not exclusively observed in women and it can be also seen in men who suffer from gynecomastia. Physical examination in these settings can be extremely helpful. Oblique, lateral and SPECT (Single Photon Emission Tomography) views can also confirm the extraskeletal origin of radiotracer uptake. [ABSTRACT FROM AUTHOR]