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In the search for high-energy cathode materials for Na-ion batteries (NIBs), Fe-doped layered transition metal oxides have been recently proposed as promising systems that can ensure improved reversible capacity at high working voltage. Exploiting the anionic redox chemistry in this class of materials represents a great advance for the energy storage community, but uncontrolled oxidation process can lead to the formation of unbound molecular oxygen, with detrimental effects on overall capacity and stability upon cycling. The higher TM–O covalency provided by Fe doping seems to prevent oxygen loss and ensure full capacity recovery. Understanding anionic processes and the underlying mechanism with atomistic details can reinforce the experimental efforts and help to outline rational design strategies for novel high-performing NIB cathodes. To this end, we present a state-of-the-art first-principles study on the P2-type NaxTMO2 (TM = Fe, Ni, and Mn—NFNMO) oxide. We compare structural and electronic features of stoichiometric (NaxFe0.125Ni0.125Mn0.75O2) and Mn-deficient (NaxFe0.125Ni0.125Mn0.68O2) NFNMO to identify and discuss the contribution of each element sublattice on charge compensation processes. Although Mn deficiency is predicted to increase the cathode working voltage, we find the charge compensation being mostly exerted by the Ni and Fe sublattices. Oxygen redox is unfold via the formation of superoxide species at low Na loads with a preferential breaking of more labile Ni–O bonds and binding to Fe atoms. Our calculations predict no release of molecular O2 upon desodiation, thus highlighting the key role of Fe dopant that provides a good TM–O bond strength, preventing oxygen loss while still enabling anionic redox reactions at high voltages with extra reversible capacity.

Engineering a solid-electrolyte interphase (SEI) with purposely designed molecules represents a promising strategy to achieve durable and effective anodes for lithium metal batteries (LMBs). The use of vinylene carbonate (VC) as an additive in conventional electrolytes has been shown to promote the formation of a stable and protective SEI at the Li metal interface. The fine-tuning and control of the underlying reactions still represent a major issue, due to complex VC decomposition and polymerization processes that may occur upon battery cycling. To dissect the tangled VC reactivity, here we present new atomistic insights into VC-induced SEI formation at the Li(001) interface: Density Functional Embedding Theory (DFET) is employed to combine the best feasible computational approaches to treat molecular species with localized charge (i.e., VC derivatives upon the reductive decomposition process) and the Li metal surface by means of hybrid DFT and semi-local GGA-based methods, respectively. Exploring VC adsorption and dissociation paths, our DFET investigation reveals that the thermodynamically accessible mechanisms for the VC ring-opening reductive reaction on Li(001) feature energy barriers in the range of 0.29–0.34 eV. Dissociation via cleavage at vinylic sites (i.e., CV–OV) is more likely to occur and leads to a highly reactive intermediate that can undergo either further decomposition towards C2H2 and Li2CO3 formation or a polymerization process, in close agreement with experimental observations. By setting solid scientific foundations for advanced understanding of initial SEI formation, our theoretical results can drive future experimental efforts towards the rational design of Li/electrolyte interfaces with tailored properties for high-performing LMB devices.

Na-ion batteries are emerging as convenient energy-storage devices for large-scale applications. Enhanced energy density and cycling stability are key in the optimization of functional cathode materials such as P2-type layered transition metal oxides. High operating voltage can be achieved by enabling anionic reactions, but irreversibility of O2-/O2n-/O2 evolution still limits this chance, leading to extra capacity at first cycle that is not fully recovered. Here, we dissect this intriguing oxygen redox activity in Mn-deficient NaxNi0.25Mn0.68O2 from first-principles, by analyzing the formation of oxygen vacancies and dioxygen complexes at different stages of sodiation. We identify low-energy intermediates that release molecular O2 at high voltage, and we show how to improve the overall cathode stability by partial substitution of Ni with Fe. These new atomistic insights on O2 formation mechanism set solid scientific foundations for inhibition and control of this process toward the rational design of new anionic redox-active cathode materials.

Na-ion batteries (NIBs) are emerging as promising energy storage devices for large-scale applications. Great research efforts are devoted to design new effective NIB electrode materials, especially for the anode side. A hybrid 2D heterojunction with graphene and MoS2 has been recently proposed for this purpose: while MoS2 has shown good reversible capacity as a NIB anode, graphene is expected to improve conductivity and resistance to mechanical stress upon cycling. The most relevant processes for the anode are the intercalation and diffusion of the large Na ion, whose complex mechanisms are determined by the structural and electronic features of the MoS2/graphene interface. Understanding these processes and mechanisms is crucial for developing new nanoscale anodes for NIBs with high performances. To this end, here we report a state-of-the-art DFT study to address (a) the structural and electronic properties of heterointerfaces between the MoS2 monolayers and graphene, (b) the most convenient insertion sites for Na, and (c) the possible diffusion paths along the interface and the corresponding energy barrier heights. We considered two MoS2 polymorphs: 1T and 3R. Our results show that 1T-MoS2 interacts more strongly with graphene than 3R-MoS2. In both cases, the best Na host site is found at the MoS2 side of the interface, and the band structure reveals a proper n-type character of the graphene moiety, which is responsible for electronic conduction. Minimum-energy paths for Na diffusion show very low barrier heights for the 3R-MoS2/graphene interface (

PURPOSE Recently new mobile systems for dispensing positron emitters have been produced, designed to guarantee dispensing cycles in an aseptic environment. The aim of the present work was to assess the advantage of one of these systems in radiation protection of operators in clinical settings. METHODS Recently, in our centre the new self-dispensing system named KARL100 by Tema Sinergie was adopted for 18F-FDG radiopharmaceuticals. The system is associated with an automatic Rad-inject infuser. The system that was previously used was a fixed isolator NMC DSI (Tema Sinergie), equipped with a μDDS-An activity fractioning system, together with a pneumatic post for the syringe delivery. The dosimetric evaluations on both systems were carried out through environmental measurements with an ionisation chamber and with the use of personal dosimeters. RESULTS The operations of preparation and administration of 18F-FDG dose to the patient, with the use of Karl100 + RadInject, involve exposures much lower than those obtained by the fixed isolator. The average body exposure of the technician was reduced by 31%, and for the physician by 77%. On the extremities, the equivalent dose to the hands of the technician was reduced by 78%, and for the physician by 96%. Also the additional dosimeters worn by the technician confirmed the estimated environmental assessments. CONCLUSIONS The exposures of the working personnel were significantly reduced with the introduction of the new KARL100 system.

Na-ion batteries (NIBs) are attracting widespread interest as a potentially more convenient alternative to current state-of-the-art Li-ion batteries (LIBs), chiefly for large-scale energy storage from renewables. Developing novel active materials is essential for the deployment of NIBs, especially in terms of negative electrodes that can accommodate the larger sodium ions. We focus on TiO2 anatase, which has been proposed as a promising anode material for the overall balance of performance, stability and cost. As the exposed crystal facets in different morphologies of nanostructured anatase can affect the electrochemical performances, here we report a theoretical investigation of Na+ adsorption and migration through (101), (100) and (001) surface terminations, thus explaining the different activities toward sodiation reported in the literature. Energy barriers computed by means of the CI-NEB method at the DFT+U level of theory show that the (001) surface is the most effective termination for Na+ insertion. We also provide a detailed analysis to elucidate that the energy barriers are due to structural modifications of the lattice upon sodiation. From these results we derive new design directions for the development of cheap and effective oxide-based nanostructured electrode materials for advanced NIBs.

The first-principles investigation of M-doped BiVO4-based materials (M = Mo, W) provides a comprehensive understanding of the dopant role in enhancing the photocatalytic properties for Oxygen Evolution Reaction (OER), which is the key-process for water splitting. We found that the beneficial effect of Mo/W doping on bismuth vanadate stems from structural surface re-organizations with the formation of a peculiar site (Biopp), which stabilizes both hydration and catalytic capabilities. Water adsorption is more favourable on Biopp site rather than on top of the dopant Mo/W atoms. Also, the catalytic performances for OER are significantly improved at Biopp site thanks to a stabilization of the crucial intermediate along the OER mechanism. Therefore, the Mo/W dopants exert a non-innocent indirect effect on the catalysis by activating the under-coordinated Biopp site via a long-range pull-back mechanism. These findings pave the route to new design strategies based on doping and defect engineering to push further the development of new photocatalysts for water splitting.

Na-ion batteries (NIBs) are promising devices for large-scale energy-storage facilities. Nanostructured TiO2 is an efficient NIB negative electrode, showing good cycling performance and rate capability, but its activity depends on the crystalline facets exposed by anatase nanoparticles. Hence, we propose here a DFT+U study of Na+ adsorption and insertion at (101), (100) and (001)-TiO2 surfaces under the influence of external electric fields, which are simulated by adding a sawtooth-like electrostatic potential to the bare ionic potential. We find that field polarization affects Na+ uptake as well as titania electronic features, promoting redox processes within Ti sublattice, as in battery charge/discharge cycling. Our results highlight the high-energy (001) surface to be the most active, for both directions of external fields, proving its activity to be exerted reversibly. Besides further insights, these outcomes pave the route for further exploration and design of electrode materials by simulation of battery in operando conditions. Graphical Abstract

In this manuscript, we report a detailed physico-chemical comparison between the α- and β-polymorphs of the NaMnO2 compound, a promising material for application in positive electrodes for secondary aprotic sodium batteries. In particular, the structure and vibrational properties, as well as electrochemical performance in sodium batteries, are compared to highlight differences and similarities. We exploit both laboratory techniques (Raman spectroscopy, electrochemical methods) and synchrotron radiation experiments (Fast-Fourier Transform Infrared spectroscopy, and X-ray diffraction). Notably the vibrational spectra of these phases are here reported for the first time in the literature as well as the detailed structural analysis from diffraction data. DFT+U calculations predict both phases to have similar electronic features, with structural parameters consistent with the experimental counterparts. The experimental evidence of antisite defects in the beta-phase between sodium and manganese ions is noticeable. Both polymorphs have been also tested in aprotic batteries by comparing the impact of different liquid electrolytes on the ability to de-intercalated/intercalate sodium ions. Overall, the monoclinic α-NaMnO2 shows larger reversible capacity exceeding 175 mAhg−1 at 10 mAg−1.

Understanding the transport of sodium ions in ionic liquids is key to designing novel electrolyte materials for sodium-ion batteries. In this work, we combine molecular dynamics simulation and experiments to study how molecular interactions and local ordering affect relevant physico-chemical properties. Ionic transport and local solvation environments are investigated in electrolytes composed of sodium bis(fluorosulfonyl)imide, (Na[FSI]), in N,N-methylpropylpyrrolidinium bis(fluorosulfonyl)imide, [C3C1pyr][FSI], at different salt concentrations. The electrolyte systems are modelled by means of molecular dynamic simulations using a polarizable force field. We show that including polarization effects explicitly in the molecular simulations is required in order to attain a reliable description of the transport properties of sodium in the [C3C1pyr][FSI] electrolyte. The validation of the computational results upon comparison with experimental data allows us to assess the suitability of polarizable force fields in describing and interpreting the structure and dynamics of the sodium salt-ionic liquid system, which is essential to enable the application of IL-based electrolytes in novel energy-storage technologies.

Coronavirus disease (COVID-19) outbreak has profoundly changed the organization of hospital activities. We present our experience of reorganization of a nuclear medicine service settled in Northern Italy during the pandemic period of March and April 2020 characterized a government-mandated lockdown. Our service remained open during the whole period, performing approximately 80% of the routine practice, while maintaining it COVID-free despite the geographical context characterized by a high risk of infection. Reorganization involved all aspects of a nuclear medicine department, following local, national, and international guidelines for prioritizing patients, telephone and physical triages, deployment of appropriate personal protective equipment, social distancing, and logistic changes for scheduling examinations and disinfection procedures. All staff remained COVID-19-negative despite the unintentional admission of 4 patients who later turned out to be positive for the severe acute respiratory syndrome coronavirus 2. These adopted measures would serve as the basis for safe nuclear medicine services in the post-lockdown phase.

Na-ion batteries (NIBs) are attracting widespread interest as a potentially more convenient alternative to current state-of-the-art Li-ion batteries (LIBs), chiefly for large-scale energy storage from renewables. Developing novel active materials is essential for the deployment of NIBs, especially in terms of negative electrodes that can accommodate the larger sodium ions. We focus on TiO

This chapter highlights the effective use of first-principles tools for the rational design of perovskite-based transition metal oxides for application in innovative energy conversion devices such as the traditional solid oxide fuel cell (SOFC) and the innovative proton-conducting SOFCs. Through the analysis of ab initio calculations, we highlight the key processes to optimize oxide and proton transport across electrode materials: (1) oxygen vacancy formation energy, (2) oxide diffusion barrier heights, and (3) proton migration. Electrocatalysis of oxygen reduction reaction and oxygen evolution reaction at the perovskite oxide surface is also discussed, pointing out the possible strategies to obtain bifunctional electrodes. Overall, the examples covered in this chapter prove the pivotal role of quantum-chemical approaches in dissecting complex experimental data and in the rational design of new heterogeneous functional materials.

Recently new mobile systems for dispensing positron emitters have been produced, designed to guarantee dispensing cycles in an aseptic environment. The aim of the present work was to assess the advantage of one of these systems in radiation protection of operators in clinical settings.Recently, in our centre the new self-dispensing system named KARLThe operations of preparation and administration ofThe exposures of the working personnel were significantly reduced with the introduction of the new KARL

EGA-MS (evolved gas analysis–mass spectrometry) and Py(HMDS)-GC/MS (pyrolysis-gas chromatography coupled with mass spectrometry with in situ derivatisation using hexamethyldisilazane as a silylating agent) were used to study the behaviour under pyrolytic conditions of fructose, inulin and topinambour (Jerusalem artichoke), a tuber, in which inulin coexists with other organic and inorganic species. The aim was to acquire a complete picture of the chemical characteristics and reactivity of fructose and its polymers (fructans). In fact, fructans constitute the reserve carbohydrates of several botanical species and are important substrates for obtaining high value-added products. EGA-MS of inulin and topinambour provided information on their different thermal and chemical complexities. Despite tuber being constituted mostly by inulin, its thermogram was much more complex than obtained for inulin alone. The EGA curve of topinambour extended for a wider temperature range and provided mass spectra containing several peaks related to the fragmentation of compounds different from those obtained in the analysis of inulin. The evolution of levoglucosan clearly indicates the presence of glucose units in the tuber. The pyrolysis of fructose and inulin carried out by Py-GC/MS generated a high number of pyrolysis products, the main ones being dihydroxyacetone, 5-hydroxymethyl-2-furaldehyde, and 2,6-anhydrofructofuranose. The similarity between the two pyrograms suggests that under pyrolysis conditions, one of the first reactions of inulin is the cleavage of the glycosidic bond. An important difference was obtained in the pyrolysis of inulin alone, which led to the formation of di-fructose dianhydrides. A different quali-quantitative distribution of the pyrolysis products was obtained for topinambour likely due to the different monosaccharides in the topinambour composition from fructose, as well as to the presence of significant amounts of inorganics.

Van Gogh Yellow refers to a family of lead chromate pigments widely used in the 19th century and often mixed with lead sulfate to obtain different yellow hues. Unfortunately, some paintings, such as the famous Sunflowers series, suffered degradation problems due to photoactivated darkening of once bright yellow areas, especially when irradiated with UV light. Recent advanced spectroscopic analyses have proved that this process occurs mostly where the pigment presents a sulfur-rich orthorhombic phase of a PbCr(1-x)S x O4 solid solution, while chromium-rich monoclinic phases are lightfast. However, the question of whether degradation is purely a surface phenomenon or if the bulk properties of sulfur-rich pigments trigger the process is still open. Here, we use first-principles calculations to unveil the role of sulfur in determining important bulk features such as structure, stability, and optical properties. From our findings, we suggest that degradation occurs via an initial local segregation of lead sulfate that absorbs at UV light wavelengths and provides the necessary energy for subsequent reduction of chromate ions into the greenish chromic oxide detected in experiments. In perspective, our results set reliable scientific foundations for further studies on surface browning phenomena and can help to chose the best strategy for the proper conservation of art masterpieces.

The current state-of-the-art quantum mechanics methodologies were applied to derive information on the bulk and surface properties of the P2-type layered oxide Na0.85Li0.17Ni0.21Mn0.64O2 (NLNMO), a cathode material. The special quasi-random structure (SQS) approach was employed to identify the arrangement of Li, Ni, and Mn ions in a supercell containing 115 atoms. Both the cell parameters and atomic positions were determined from DFT-PBE+U calculations to highlight specific distortions induced by the dopants (Ni and Li). The analysis of atomic partial charges and atomic magnetic moments revealed that Li has a purely structural role, while Ni and Mn actively participate in both redox processes and electronic conduction. Using a new surface slab model, the interaction between the layered Na0.85Li0.17Ni0.21Mn0.64O2 (001) surface and the Na ions was examined to identify the most favorable adsorption sites and the possible paths for the migration of the Na ions on the electrode surface.

The recombination of injected electrons with oxidized redox species and regeneration behavior of copper redox mediators are investigated for four copper complexes, [Cu(dmby)2]2+/1+ (dmby = 6,6′-dimethyl-2,2′- bipyridine), [Cu(tmby)2]2+/1+ (tmby = 4,4′,6,6′- tetramethyl-2,2′-bipyridine), [Cu(eto)2]2+/1+ (eto = 4-ethoxy-6,6′-dimethyl-2,2′-bipyridine), and [Cu- (dmp)2]2+/1+ (dmp = bis(2,9-dimethyl-1,10-phenantroline). These complexes were examined in conjunction with the D5, D35, and D45 sensitizers, having various degrees of blocking moieties. The experimental results were further supported by density functional theory calculations, showing that the low reorganization energies, λ, of tetra-coordinated Cu(I) species (λ = 0.31−0.34 eV) allow efficient regeneration of the oxidized dye at driving forces down to approximately 0.1 eV. The regeneration electron transfer reaction is in the Marcus normal regime. However, for Cu(II) species, the presence of 4-tert- butylpyridine (TBP) in electrolyte medium results in penta-coordinated complexes with altered charge recombination kinetics (λ = 1.23−1.40 eV). These higher reorganization energies lead to charge recombination in the Marcus normal regime instead of the Marcus inverted regime that could have been expected from the large driving force for electrons in the conduction band of TiO2 to react with Cu(II). Nevertheless, the recombination resistance and electron lifetime values were higher for the copper redox species compared to the reference cobalt redox mediator. The DSC devices employing D35 dye with [Cu(dmp)2]2+/1+ reached a record value for the open circuit voltage of 1.14 V without compromising the short circuit current density value. Even with the D5 dye, which lacks recombination preventing steric units, we reached 7.5% efficiency by employing [Cu(dmp)2]2+/1+ and [Cu(dmby)2]2+/1+ at AM 1.5G full sun illumination with open circuit voltage values as high as 1.13 V.

This work reports the synthesis and characterization of three novel carbazole-based push-pull dyes that have been purposely designed to be applied in p-type dye-sensitized solar cells (DSSCs). By using the same electron-donor moiety (the carbazole group) and three different electron acceptor groups, we explore how these new substituents affect the optical and electrochemical properties of the dye. State-of-the-art theoretical characterization at the DFT and TD-DFT levels of theory provides the means to understand and elucidate the connection between the chemical composition, the structure and the electronic features of these dyes. The interface between the dyes and the prototypical p-DSSC electrode (i.e. NiO) is also investigated by first-principles calculations, highlighting the importance of taking into account the dye/electrode mutual polarization for a correct alignment of the relevant electronic states (e.g., dye HOMO and NiO valence band edge). Following these characterizations, preliminary studies on the photoelectrochemical performances of the new dyes in p-DSSCs provide promising results and motivate future investigations on these new systems.

In this paper, a new methodological approach to using PET information in radiotherapy treatment planning has been discussed. Computed tomography (CT) represents the primary modality to plan personalized radiation treatment, because it provides the basic electron density map for correct dose calculation. If PET scanning is also performed it is typically coregistered with the CT study. This operation can be executed automatically by a hybrid PET/CT scanner or, if the PET and CT imaging sets have been acquired through different equipment, by a dedicated module of the radiotherapy treatment planning system. Both approaches have some disadvantages: in the first case, the bore of a PET/CT system generally used in clinical practice often does not allow the use of certain bulky devices for patient immobilization in radiotherapy, whereas in the second case the result could be affected by limitations in window/level visualization of two different image modalities, and the displayed PET volumes can appear not to be related to the actual uptake into the patient. To overcome these problems, at our centre a specific procedure has been studied and tested in 30 patients, allowing good results of precision in the target contouring to be obtained. The process consists of segmentation of the biological target volume by a dedicated PET/CT console and its export to a dedicated radiotherapy system, where an image registration between the CT images acquired by the PET/CT scanner and a large-bore CT is performed. The planning target volume is contoured only on the large-bore CT and is used for virtual simulation, to individuate permanent skin markers on the patient.

Lung cancer (LC) still represents one of the most common tumours in both women and men. PET/CT is a whole-body non-invasive imaging procedure that has been increasingly used for the assessment of LC patients. In particular, PET/CT added value to CT is mainly related to a more accurate staging of nodal and metastatic sites and to the evaluation of the response to therapy. Although the most common PET tracer for LC evaluation is 18F-FDG, new tracers have been proposed for the evaluation of lung neuroendocrine tumours (68Ga-DOTA-peptides, 18F-DOPA) and for the assessment of central nervous system metastasis (11C-methionine). This review focuses on the main clinical applications and accuracy of PET/CT for the detection of non-small cells lung cancer (NSCLC), broncho-alveolar carcinoma (BAC), small cells lung cancer (SCLC), lung neuroendocrine tumours (NET) and solitary pulmonary nodules (SPN).

The introduction and successful implementation of minimally invasive radio-guided parathyroidectomy (MIRP) has revolutionized the surgical approach to remove parathyroid adenomas. A prerequisite for such success is an accurate localization of the offending adenoma. To achieve this goal, a multimodality approach is commonly employed using a combination of anatomical and functional imaging. Of the anatomical cross-sectional techniques, ultrasonography is the most widely available but is operator-dependent and has reduced sensitivity, specially in the presence of thyroid nodules. Similarly, computed tomography and magnetic resonance imaging have low sensitivities but provide value in detecting retrotracheal, retro-oesophageal and mediastinal adenomas. Functional imaging with ⁹⁹(m)Tc-Sestamibi is currently the most vital imaging procedure in this respect with variable protocols including dual-phase and dual isotope imaging. The sensitivity and specificity can improve by acquiring in single photon emission tomography (SPECT) mode and using co-registration with low dose CT to provide anatomical data (SPECT/CT). The current recommended approach is the combination of functional imaging with ⁹⁹(m)Tc-Sestamibi and high-resolution ultrasound (US), supplemented with intraoperative gamma probe in certain cases and quick persurgical measurement of parathyroid hormone. This review aims to explore the utility of various imaging modalities, alone and in combination, in detecting parathyroid adenoma and facilitating the current approach of MIRP.

The most common malignancy affecting the liver is metastasis from a wide variety of tumors, particularly those of gastrointestinal origin. Successful surgical removal of a solitary liver metastasis may significantly extend survival and optimal preoperative assessment in this regard is a mandatory prerequisite for proper patient selection. The addition of positron emission tomography/computed tomography (PET/CT) to other more conventional imaging procedures (e.g., ultrasound (US), CT, and magnetic resonance) has the potential to greatly improve the selection process by the combination of high-resolution anatomy afforded by CT directly combined with the functional scintigraphic map of intra- and extrahepatic lesions depicted by 2-deoxy-2-[F-18]fluoro-D-glucose (FDG)-PET. In this study, we assess the additional value of PET/CT in the management strategy of patients with solitary liver metastasis from colorectal and other cancers identified by conventional imaging methods.We evaluated 43 consecutive patients (17 males, 26 females, mean age 53 +/- 6 years) with known solitary liver metastasis. This sample consisted of 18 patients with colorectal cancer, 15 with nonsmall cell lung cancer, six with breast carcinoma, and four ovarian cancers. In addition to contrast-enhanced CT and US, all patients were studied with FDG-PET/CT before surgery. PET/CT was performed within 3 weeks of the initial diagnosis and the scans were read by two experienced radiologists/nuclear medicine specialists blinded to the clinical data. A final diagnosis was obtained at surgery in 31 patients, by fine needle biopsy in five, and long-term clinical, biochemical, and follow-up imaging in seven patients.In 12 out of 43 patients (28%), PET/CT resulted in restaging disease and a change in therapy. Twenty-two of 31 patients with confirmed solitary liver lesions (71%) were disease-free, eight of 31 (26%) developed a new recurrence, and one of 31 (3%) died from disease progression over a 17 +/- 6-month follow-up interval. Nine of 12 patients (75%) with multiple metastases demonstrated by FDG-PET/CT were alive with disease and three of 12 (25%) deceased due to disease progression (p0.01) over a 17 +/- 6-month follow-up interval.The addition of FDG-PET/CT to the routine assessment of patients with liver metastasis has a significant impact on disease staging and selection of suitable candidates for solitary liver metastasis resection and outcome.

AIM To evaluate clinical efficacy of a dual-time acquisition protocol, which included 4 and 20/24-h imaging with antigranulocyte antibody scintigraphy (LeukoScan) combined with semiquantitative analysis in the diagnosis of infection in painful hip prosthesis. METHODS Sixty-seven consecutive patients with hip prosthesis were enrolled in this research project: 35 females, 32 males, mean age of 56.3 years. All patients had clinical and biochemical suspicious of infection. Each prosthesis had been implanted 3 months to 12 years before enrollment in this study. Twenty-four patients were on antibiotic therapy at the time of scintigraphy. Seven patients had bilateral hip prosthesis, one painful and the other painless: the seven painless prostheses were considered controls. LeukoScan examination was performed both at early (4 h) and delayed (20/24 h) times. The scintigraphic data were assessed both by visual and semiquantitative methods by three experienced nuclear medicine physicians blinded to clinical, laboratory and radiographic results. The uptake was graded visually by a 4-point scale: intense=3, moderate=2, mild=1 and absent=0. The semiquantitative analysis was obtained by a region of interest (ROI) analysis used in the anterior views to measure the ratio between the mean radioactivity in the prosthesis and the background radioactivity in the early and delayed images. An increase in the intensity of uptake of at least one scale-step at visual analysis and 20% at semiquantitative ROI analysis at the dual-time (early vs. delayed) LeukoScan was considered consistent with infection, whereas a stable or decreasing pattern was judged a negative result. Three-phase 99mTc-hydroxymethane diphosphonate bone scan was also performed routinely. Final diagnosis was determined at surgery and/or long-term clinical and imaging follow-up. RESULTS At visual analysis, sensitivity for both early and delayed imaging was 94%, whereas specificity was 71% for early imaging and 83% for early and delayed imaging approach. At semiquantitative ROI analysis, sensitivity remained 94%, whereas specificity rose slightly to 73% for early imaging and to 90% for early and delayed imaging combined. Of note, four false-positive early scans were diagnosed correctly as negative on delayed imaging showing a decreasing pattern in uptake intensity. Sensitivity and specificity were similar whether patients were on or off antibiotic therapy. CONCLUSION Our data show that early imaging LeukoScan is highly sensitive in evaluating septic prosthesis, but it is not optimally specific. Although the dual-time LeukoScan is capable of significantly increasing specificity for detecting infection. The semiquantitative ROI analysis further increased the specificity. Concomitant antibiotic treatment did not seem to influence the diagnostic efficacy of LeukoScan scintigraphy in detecting infected hip prosthesis.

OBJECTIVE To evaluate clinical efficacy of a dual-time acquisition protocol consisting of early 4 h and delayed 20-24 h imaging with anti-granulocyte scintigraphy (LeukoScan) in the diagnosis of infection in painful total knee arthroplasty (TKA). MATERIALS AND METHODS Seventy-eight consecutive patients with TKA (12 bilateral) were prospectively enrolled in the study from August 2004 to July 2005. All the patients had clinical and biochemical suspicious of infection, except for the 12 patients with bilateral painless prosthesis who had no signs and symptoms of loosening and/or infection and were considered as controls. TKA prostheses had been implanted 4 months to 9.5 years before our studies. Forty-three patients were on antibiotic therapy at the moment of scintigraphic examination, and treatment was not discontinued. All patients underwent LeukoScan examination by performing both early 4 h and delayed 20-24 h imaging. In addition to planar imaging SPECT was performed in 18 cases. A decrease in radiotracer uptake from early to delayed LeukoScan imaging was interpreted as an unspecific finding (negative for infection), while an increasing uptake was interpreted as a positive finding for the presence of infection. Three-phase Tc-MDP bone scan was also routinely performed by standard technique. Sensitivity and specificity of early and delayed LeukoScan imaging were calculated. RESULTS Sensitivity for early and delayed imaging were 92.7%, while specificity was 78.4% for early imaging and 100% for delayed imaging approach. SPECT imaging did not add any significant information as regard to specificity in our experience. Eight false positive early scans were correctly diagnosed as negative at delayed imaging. Three false negative results were recorded. Sensitivity and specificity were similar when patients were on or off antibiotic therapy. Imaging was negative in all 12 controls. CONCLUSIONS Our results, based on a large group of patients, suggest that delayed LeukoScan imaging is important in identifying false positive results detect at early imaging. Thus, a dual-time, 4 h early and 20-24 h delayed LeukoScan imaging approach should be recommended to increase the diagnostic accuracy of the scintigraphy, with the exception of patients with a negative early LeukoScan examination, in whom the acquisition of delayed imaging appears unnecessary. In our experience, concomitant antibiotic therapy did not influence the diagnostic value of LeukoScan.

This study, which was based on a large series of consecutive patients imaged by 111In-pentetreotide SPECT for a neuroendocrine tumor, evaluated variability in reconstruction parameters in relation to patient body weight and the body region imaged, looking for the possibility of standardizing such parameters. Methods: One hundred twenty-four patients underwent 111In-pentetreotide scintigraphy: 4- and 24-h whole-body and planar scans and a 24-h SPECT examination. All patients were injected with 140–150 MBq of 111In-pentetreotide at least 1 wk after somatostatin analogs had been discontinued. SPECT images were systematically acquired at the levels of the head, chest, and abdomen. SPECT was performed using a dual-head γ-camera with medium-energy collimators, step-and-shoot method, no circular orbit, a 64 × 64 matrix, and 30 s per view for a total of 64 views. Two reconstruction procedures were compared: the iterative method using 10 iterations and the filtered backprojection method using a Butterworth filter with different cutoffs and orders. Results: Optimal SPECT images were obtained by applying the Butterworth filter. The reconstruction parameters could be standardized for the head and chest but were more variable for the abdomen, mainly because 111In-pentetreotide is physiologically trapped in different intestinal areas and varies over time, especially in the liver, spleen, bowel, and urinary tract. Conclusion: Filtered backprojection using a Butterworth filter appears adequate for standardizing the reconstruction parameters for 111In-pentetreotide SPECT of the head and chest. Processing of abdominal images is more operator-dependent. A 150-MBq dose of 111In-pentetreotide is recommended when planning multiple SPECT acquisitions in the same patient.

We report here a case of a paediatric hyperthyroidism due to a micro-macro-follicular thyroid adenoma in the presence of heterozygous point mutation of TSH receptor (TSHr). We describe the case from the initial diagnosis, through laboratoristic examinations and imaging techniques, until the radical surgical treatment made by a mini-cervicotomic videoassisted technique. We also explained the genetic work-up from peripheral blood and thyroid adenoma tissue.

A 67-year-old man, previously operated for a pancreatic neuroendocrine tumor (NET), had progressive increase of serum chromogranin A during follow-up. Sequential 68Ga-DOTA-NOC and F-18 FDG PET/CT were performed. 68Ga-DOTA-NOC imaging was negative, whereas F-18 FDG PET/CT showed 2 hypermetabolic hepatic lesions demonstrated at CT-guided biopsy as metastatic deposits from a high-grade (G3) aggressive NET. Despite the large consensus of SPECT or PET with radiolabeled somatostatin analogs as first choice in functional imaging for detecting NETs metastasis, F-18 FDG may occasionally be the right tracer to provide accurate diagnostic and prognostic information in aggressive G3 NET.

Purpose. (1) To evaluate a new acquisition protocol of18F-choline (FCH) PET/CT for prostate cancer patients (PC), (2) to review acquisition18F-choline PET/CT methodology, and (3) to propose a standardized acquisition protocol on FCH PET/CT in PC patients.Materials. 100 consecutive PC patients (mean age 70.5 years, mean PSA 21.35 ng/mL) were prospectively evaluated. New protocol consisted of an early scan of the pelvis immediately after the injection of the tracer (1 bed position of 4 min) followed by a whole body scan at one 1 hour. Early and 1 hour images were compared for interfering activity and pathologic findings.Results. The overall detection rate of FCH PET/CT was 64%. The early static images of the pelvis showed absence of radioactive urine in ureters, bladder, or urethra which allowed a clean evaluation of the prostatic fossae. Uptake in the prostatic region was better visualized in the early phase in 26% (7/30) of cases. Other pelvic pathologic findings (bone and lymph nodes) were visualized in both early and late images.Conclusion. Early18F-choline images improve visualization of abnormal uptake in prostate fossae. All pathologic pelvic deposits (prostate, lymph nodes, and bone) were visualized in both early and late images.

The aim of this study was to evaluate the efficacy of ¹⁸F-choline PET/CT (18FCH-PET/CT) in restaging patients previously treated by radical prostatectomy for a prostate cancer, presenting with biochemical relapse during follow-up (FU).Three hundred thirty-one patients referred to us from January 2009 to April 2011 to perform 18FCH PET/CT were evaluated: 233 of them (mean age 69.7 years) met the inclusion criteria of the study: (1) biochemical relapse after radical prostatectomy (trigger PSA0.2 ng/mL) (n=224) and (2) high risk for relapse (elevated Gleason score≥8) in spite PSA0.1 ng/mL during FU (n=9). Trigger PSA was available for all patients (mean 8 ng/mL) and in 44 of them also PSA kinetic (PSA velocity-PSAvel; PSA doubling time-PSAdt). Correlation between 18FCH PET/CT detection rate and trigger PSA, PSAvel, PSAdt, and tumoral spread distribution were evaluated by univariate and multivariate analysis. Subsequent minimum FU was 1 year (mean 26 months, range 12-40).Overall detection rate of 18FCH PET/CT was 54%, which significantly increased when the trigger PSA increases (P0.001). PET-positive patients presented a "fast" PSA kinetic (mean PSAdt=6 months and mean PSAvel=9.3 ng/mL/yr), while PET-negative patients presented a "slow" PSA kinetic (mean PSAdt=15.4 months and mean PSAvel=0.9 ng/mL/yr). Disease relapse was local in 17% of cases, distant in 66%, and combined in 17%.Overall 18FCH PET/CT detection rate was 54% (ie, similar to that reported in literature with ¹¹C-choline), which increases with the increase in trigger PSA: this condition was particularly true in patients with accelerated PSA kinetic. In about 20% of patients, 18FCH PET/CT demonstrated local relapses early enough to offer locoregional radiation therapy.

Purpose Every PET scanner suffers of the partial volume effect (PVE), that is a loss of contrast in small lesions causing a worsening in standardized uptake value (SUV) accuracy, that is critical if quantitative PET/CT imaging is used for diagnosis and therapy. Methods In order to quantify PVE and optimize our clinical protocols to minimize this effect in a last generation PET/CT scanner, we utilized a cylindrical phantom equipped with ten mini- and micro-volume hollow spheres. The lesion detectability and the SUV accuracy were evaluated at a fixed spheres to background intrinsic contrast (activity concentration ratio 8:1) but in different scan conditions: (a) acquisition modality (3D vs. 2D), (b) number of subset per iteration, (c) type of post-reconstruction filter and (d) activity concentration (i.e. total counts). Also the effect of different absorber thickness was evaluated. Results Small lesion detectability resulted better in images acquired in 3D mode rather than 2D, mainly because of the lower noise produced by the fully-3D algorithm. The number of reconstruction iterations and the post-processing filter used affected both the contrast underestimation and the spatial resolution. Decreasing the 18F activity injected according to the low-dose protocol, the small lesions could be distinguished from the background down to a diameter of 6.2 mm and the SUV accuracy did not deteriorate. Adding absorber thickness around the phantom, the image noise slightly increased while SUV accuracy did not change. Conclusions The hybrid PET/CT scanner we evaluated showed good performances, mainly in 3D acquisition modality. The phantom measurements showed that the most appropriate reconstruction protocol derived from a compromise between the contrast accuracy and the noise variance in PET images. The low-dose protocol clinically used demonstrated no loss in SUV accuracy and an adequate lesion detectability for lesions down to 6.2 mm in diameter.

This is a case of a 48-year-old man treated with surgery and (131)I for papillary thyroid carcinoma: a follow-up (18)F-FDG PET/CT incidentally evidenced pituitary uptake, also seen in (111)In-octreoscan as increased uptake in the sellar area. MRI confirmed a pituitary mass. The patient did not show any signs or symptoms related to this lesion; 1 year later, both PET/CT and MRI findings remained unchanged. Surgery confirmed nonfunctioning benign pituitary adenoma. This single case observed in 12,873 consecutive patients scanned in our center confirms the possibility that nonfunctioning benign pituitary adenomas may be FDG-avid: uptake mechanisms remain unknown, and targeted studies are needed.

L-6-fluoro 3,4-dihydroxyphenylalanine (18F-DOPA), an amino acid-based radiopharmaceutical, is increasingly being used in the detection and management of neuroendocrine tumours. Knowledge of the normal biodistribution of this radiopharmaceutical is essential for the proper interpretation of such studies, but the literature available is scanty due to the rarity of these tumours. The aim of this study is to evaluate the biodistribution pattern and normal variants of 18F-DOPA in a cohort of patients with neuroendocrine tumours using semiquantitative analysis (maximum standardized uptake value).We analysed 107 consecutive 18F-DOPA PET/CT studies of patients referred with medullary carcinoma of the thyroid (43), phaeochromocytoma including cases of Von Hippel Lindau syndrome and multiple endocrine neoplasia type IIA cases (34), paraganglioma (14) and other neuroendocrine tumours (16). The study population were divided into two groups: those with negative 18F-DOPA PET/CT scans (32) and those with positive scans (75). The biodistribution of 18F-DOPA in each group was measured and compared between the two groups.The physiological biodistribution in the basal ganglia and liver parenchyma showed no variability between the two groups. Conversely, uptake in the pancreas (particularly the uncinate process) and adrenals showed considerable variability between the groups. However, these differences were found not to be significant on statistical analysis.The data presented may provide useful information in understanding the physiologic biodistribution of DOPA and its variants, for the purpose of improving the interpretation of 18F-DOPA PET/CT.

of F-FDG-PET/CT Gaia Grassetto, Carlo Capirci, Maria Cristina Marzola, Lucia Rampin, Sotirios Chondrogiannis, Alessandra Musto, Giorgio Crepaldi, Anna Maria Minicozzi, Arianna Massaro, Domenico Rubello Department of Nuclear Medicine—PET/CT Centre, Santa Maria della Misericordia Hospital, Via Tre Martiri 89, 45100 Rovigo, Italy Radiotherapy Unit, Santa Maria della Misericordia Hospital, Rovigo, Italy Oncology Unit, Santa Maria della Misericordia Hospital, Rovigo, Italy Clinical Surgery, University of Verona, Verona, Italy

BACKGROUND: To evaluate the role of a multi-imaging PET with (18)F-DOPA and (18)F-FDG in comparison with conventional imaging (CI) in recurrent medullary thyroid carcinoma (MTC). METHODS: 18 MTC patients who had thyroidectomy were included; they presented with elevated and rapidly increasing calcitonin levels during follow up. CI had revealed metastatic deposits in 9 patients. Patients were referred to us for a PET/CT with (18)F-DOPA and (18)F-FDG. Histologic/cytologic confirmation of recurrent MTC was obtained in at least one PET-positive lesion in all patients. RESULTS: Foci of abnormal uptake were observed in 15 patients at (18)F-DOPA and in 11 at (18)F-FDG; 8 patients showed the same number of positive lesions with both tracers, 2 showed more lesions on (18)F-FDG, 1 was positive at (18)F-FDG alone and 5 at (18)F-DOPA alone. In 3 patients with a DOPA-positive loco-regional relapse a re-operation with curative intent was offered. SUV(max) values were higher for (18)F-FDG compared to (18)F-DOPA (mean 12.7+/-4.1 vs. 5.5+/-2.1, p

The role of (18)F-FDG PET in the management of gynaecologic malignancies remains unclear mainly due to the failure of clinicians to appreciate the significance of this imaging tool. However, this under utilisation is being actively re-addressed with a large number of reviews and studies, particularly in the last few years.PET has been shown to have high sensitivity and specificity in the evaluation of relapse and nodal disease in cervical cancer, while other uses such as staging and monitoring response to therapies being under further investigation. Similarly, promising results have been published in the use of PET in patients affected by endometrial cancer and uterine sarcomas for detecting lymph nodes metastasis and recurrent disease. In ovarian cancer, PET appears to have a great potential in staging and assessment of disease relapse. An important utility of PET in gynaecologic tumours, which is shared with a large number of other malignancies, is its value in positively changing the patients' management.The surge in studies using PET in gynaecological malignancies is in its early stages, and further studies are required to optimise the role of PET in these conditions.

Dear Sir, We read with interest the recent paper by Rubello et al. entitled “Role of Tc-sestamibi SPECT in accurate selection of primary hyperparathyroid patients for minimally invasive radio-guided surgery” [1]. Minimally invasive radio-guided surgery (MIRS) is widely employed for primary hyperparathyroidism caused by a solitary parathyroid adenoma. Since an intraoperative gamma probe is used, significant sestamibi uptake by the adenoma is important [2, 3]. Obviously, as the authors underline, radiation attenuation problems may cause underestimation of the sestamibi uptake by adenomas in an anterior planar image, resulting in doubt as to the appropriateness of MIRS in some cases. In this regard the authors report an interesting finding, namely that the parathyroid to background (P/B) ratio derived from SPECT correlates well with the intrasurgery P/B ratio; this means that using SPECT it is possible to predict the intraoperative measurement obtained with the gamma probe, thus allowing better patient selection for MIRS. However, we believe that this finding is not going to have a significant impact on the selection of patients for MIRS since only patients with a high probability of having a solitary adenoma are candidates for MIRS [4]. In our experience most of these patients demonstrate a P/B ratio significantly higher than the threshold, referred to by the authors, of 1.2 in the anterior planar image and thus do not require any quantitative confirmation. In the case of deeply located adenomas, despite the relatively reduced sestamibi intensity in the anterior planar image, they will still be well recognised as parathyroid lesions and any doubt about the appropriateness for MIRS in those cases can be dispelled just by knowing that the adenoma is located deeply. In this regard we visually estimate the depth and at the same time take into account the attenuation effect on sestamibi uptake from adenomas by using oblique planar imaging in all cases, rather than the time-consuming and rather complicated SPECT technique. Oblique planar imaging is easy to perform and very valuable even when the adenoma is behind the thyroid gland [5, 6]. In the presented study the ratio derived from SPECT was useful in only 1/22 patients although 7/22 adenomas were deeply located. The quantification might possibly be useful in estimating the appropriateness of the sestamibi uptake for MIRS in a few borderline cases. However, trying to include these patients will inevitably increase the probability of multiple gland disease since it is well known that frequently only the largest gland is visible in hyperplasia, especially in the early stages, when the size of the other glands remains below the sensitivity of the techniques used [7, 8]. The result will then be that more operations will be changed to bilateral exploration assuming that rapid PTH measurement is available. In this regard, SPECT, because of its slightly better sensitivity compared with planar imaging, would be most useful not in selecting more patients but rather in excluding some on the basis of the identification of more than one parathyroid lesion in cases of multi-gland disease. Nevertheless, ultrasound can contribute this important information even better than SPECT. In conclusion, we believe that in the selection of eligible patients for MIRS, quantification is not needed and that performance of SPECT exclusively for this purpose is not justified. Eur J Nucl Med Mol Imaging (2007) 34:607–608 DOI 10.1007/s00259-006-0332-y