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Purpose The currently used scheme for radioligand therapy (RLT) of patients with metastatic castration-resistant prostate cancer (mCRPC) consists of 4–6 cycles of 6.0–7.4 GBq [177Lu]Lu-PSMA-617 each. This standard treatment scheme has proved safe and effective resulting in objective response in most patients with no significant toxicity. Many patients, however, show high-volume residual tumor burden after the sixth cycle and may benefit from treatment continuation. Extended treatment with additional cycles has been withheld due to concerns on potential increased toxicity. Methods Twenty-six patients with high-volume residual tumor burden (according to CHAARTED) after standard RLT with [177Lu]Lu-PSMA-617 and no alternative treatment option received additional RLT cycles reaching a median of 10 (range 7–16) cycles with a mean activity of 7.4 ± 0.9 GBq per cycle. Response assessment with [68Ga]Ga-PSMA-11 PET/CT was done every 2–3 cycles or if disease progression was clinically suspected or based on change in PSA value (according to the PCWG3 criteria). Toxicity was measured using routine blood work up including blood counts, liver and renal function, and was graded according to CTCAE v5.0 criteria. Survival outcome was calculated based on the Kaplan-Meier method. Results Further PSA decline of 33 ± 28% during the extended treatment was observed in 21/26 (81%) patients, whereas 5/26 (19%) patients showed a PSA increase; correspondingly in 11/21 patients with an initial response (PR or SD) to extended cycles, treatment was discontinued due to progressive disease, whereas six (23%) patients achieved low-volume residual disease. Two (8%) patients died without showing progression, and two (8%) patients are still under therapy. The median progression-free survival was 19 (95% CI: 15–23) months, and the overall survival was 29 (95% CI: 18–40) months. Grade ≥ 3 hematological toxicities occurred in 4/26 (15%) patients during treatment extension, and nephrotoxicity (grade ≥ 3) was observed in 1/26 (4%) patient during the follow-up. Conclusion Extended radioligand therapy is a feasible treatment option in patients with high-volume residual tumor after the completion of standard treatment with six cycles of [177Lu]Lu-PSMA-617. Improved survival and the acceptable safety profile warrant further investigation of the concept of additional cycles in selected patients.

ZusammenfassungDie Radiofrequenzablation ist ein effektives Verfahren, um benigne Schilddrüsenknoten bis zu einem Volumen von etwa 100 ml zu behandeln. Sie ist gut verträglich und kommt zurzeit − zusammen mit der Echopulstherapie − in Deutschland am häufigsten zur lokalen Therapie benigner Schilddrüsenknoten zum Einsatz. Insgesamt ist eine Volumenreduktion von etwa 50 % bis 70 % zu erwarten, bei zystischen Knoten und mixed-pattern-Läsionen etwas mehr als bei soliden Knoten. Anfangsvolumen, Struktur und Echogenität sind wichtige Parameter, welche die Effektivität beeinflussen. Es kommen bipolare und monopolare Verfahren zum Einsatz − die Auswahl des jeweiligen Verfahrens hängt v. a. von der persönlichen Präferenz des Behandelnden ab. Bei größeren Knoten wird eher die bipolare Technik angewendet. Gekühlte Systeme sind – insbesondere bei größeren Sonden – in jedem Fall vorzuziehen. Gravierendere Nebenwirkungen sind selten (

Zusammenfassung Ziel Ziel ist es, einen praxisorientierten Beitrag zur Diskussion eines Algorithmus zur Entlassung unter Strahlenschutzgesichtspunkten von Patienten nach Therapien mit Lu-177 markiertem PSMA zu leisten. Dieser kann als Basis zur Weiterentwicklung von Vorgaben für die Entlassungspraxis für andere zukünftige Therapien mit offenen radioaktiven Stoffen dienen. Material und Methoden Anhand der Analyse der Behandlungsdaten von 478 Zyklen Lu-177-PSMA-617 (140 Patienten) wurde der Zusammenhang zwischen Restaktivität im Patienten und der damit verbundenen Dosisleistung erstellt. Aus den kinetischen Daten regelmäßiger intratherapeutischer Ganzkörpermessungen mit einer Sonde (biexponentieller Fit) wurden daraus Szenarien für die Entlassung entwickelt. Ergebnis 34 % der Patienten wurden 3- bis 5-mal in einem Kalenderjahr behandelt. 1 mSv pro Kalenderjahr in 2 m Entfernung kann bei der prospektiven Entlassung von 3 bzw. 4 Therapiezyklen pro Jahr nach 72 Stunden stationärem Aufenthalt in 10 % bzw. 15 % der Fälle nicht eingehalten werden. Die mittlere spezifische Dosisleistung im Patienten betrug 0,00462µSv/(h MBq) in 1 m Entfernung. Ein allgemeingültiger quantitativer Zusammenhang der Dosisleistung mit der Restaktivität im Patienten konnte nicht gefunden werden. Schlussfolgerung Wegen des Ansatzes einer Mehrfachbehandlung der mit Lu-177-PSMA therapierten Patienten müssen die Entlassungsbedingungen prospektiv angepasst werden. Die Zugrundelegung der physikalischen Halbwertszeit von Lu-177 und von 4 Behandlungen im Kalenderjahr führt zu einer konservativen, übersichtlichen Regelung.

Introduction Mycobacterium genavense is a fastidious slow growing mycobacterium (SGM) that causes disseminated infections in immunocompromised hosts. It has been described in HIV-positive individuals and increasingly in patients without HIV. The infections are difficult to treat and the optimal antimycobacterial regimen is still unknown. Methods An individual patient data meta-analysis was conducted aiming at including all hitherto published cases of infection with M. genavense. Clinical manifestations, microbiological data, dispositions and immunosuppression were recorded. Antimycobacterial therapies and mortality were analysed by logistic regression and time-to-event analysis. Results We included 223 patients with infection due to M. genavense published from 1992-2021. While the majority was HIV positive (n=223, 76.7 %), 52 patients were non-HIV-patients (23.3 %), 36 of whom received immunosuppressive therapy (69 %). We could confirm the bacterium's tropism for the gastrointestinal tract with abdominal pain, hepato-/splenomegaly and abdominal lymphadenopathy being major clinical manifestations. More than 90 % of patients received antimycobacterial therapy. The regimens consisted mainly of macrolides, rifamycins and ethambutol. Overall mortality was high, but in logistic regression and time-to-event analysis a macrolide containing regimen was associated with better outcomes. Conclusion In this first individual patient data meta-analysis of infections with M. genavense we confirm its tropism for the gastrointestinal tract. The high overall mortality underlines the clinical relevance of infection with this bacterium for the individual patient. In addition, our data give a hint that a macrolide containing regimen is associated with better survival.

Radiofrequency ablation is an effective tool to treat benign thyroid nodules up to about 100 ml. It is well tolerated and is - together with echopulse therapy - currently the most frequently used technique in Germany for the local therapy of benign thyroid nodules. Overall, a volume reduction of about 50 % to 70 % can be expected. Cystic nodules and mixed-pattern lesions respond slightly better than solid nodules. Initial volume, structure and echogenicity are important parameters influencing the therapeutic efficacy. Bipolar as well as monopolar methods are used - the choice of the method depends mainly on the personal experience. For bigger nodules, the bipolar technique is preferred. Cooled systems should be favored, especially when using larger probes. Serious side effects are rare ( 1 %) and transient in most cases.Die Radiofrequenzablation ist ein effektives Verfahren, um benigne Schilddrüsenknoten bis zu einem Volumen von etwa 100 ml zu behandeln. Sie ist gut verträglich und kommt zurzeit − zusammen mit der Echopulstherapie − in Deutschland am häufigsten zur lokalen Therapie benigner Schilddrüsenknoten zum Einsatz. Insgesamt ist eine Volumenreduktion von etwa 50–70 % zu erwarten, bei zystischen Knoten und Mixed-pattern-Läsionen etwas mehr als bei soliden Knoten. Anfangsvolumen, Struktur und Echogenität sind wichtige Parameter, welche die Effektivität beeinflussen. Es kommen bipolare und monopolare Verfahren zum Einsatz − die Auswahl des jeweiligen Verfahrens hängt v. a. von der persönlichen Präferenz des Behandelnden ab. Bei größeren Knoten wird eher die bipolare Technik angewendet. Gekühlte Systeme sind – insbesondere bei größeren Sonden – in jedem Fall vorzuziehen. Gravierendere Nebenwirkungen sind selten ( 1 %) und meist nur transient.

Aim Radioiodine therapy (RIT) may trigger the development of Graves’ ophthalmopathy (GO) or exacerbate pre-existing subclinical GO. Therefore, glucocorticoid administration is recommended for patients with pre-existing GO. Aim of this study was to analyze the influence of glucocorticoid therapy with methylprednisolone on intratherapeutic effective half-life (EHL) of radioiodine-131 in patients with Graves’ disease (GD) as recent studies showed an effect for prednisolone. Methods In a retrospective study, 264 patients with GD who underwent RIT without any additional antithyroid medication were evaluated. Intrathyroidal EHL was determined pre- and intratherapeutically. Patients with co-existing GO (n = 43) received methylprednisolone according to a fixed scheme starting 1 day prior to RIT, patients without GO (n = 221) did not receive any protective glucocorticoid medication. The ratios of EHL during RIT and during radioiodine uptake test (RIUT) were compared. Results Patients receiving methylprednisolone showed a slight decrease of the mean EHL from 5.63 d (RIUT) to 5.39 d (RIT) (p > 0.05). A comparable result was obtained in patients without glucocorticoids (5.71 d (RIUT) to 5.47 d (RIT); p > 0.05). The ratios of the EHL between RIT and RIUT failed to show a significant difference between the two groups. EHL is therefore not significantly influenced by an additional protective treatment with methylprednisolone. Conclusions In the present study a decreased intrathyroidal EHL under glucocorticoid medication with methylprednisolone could not be detected. Therefore, co-medication with methylprednisolone in patients with GO may be preferred to avoid an intratherapeutic decrease of EHL by accompanying protective glucocorticoides.

Aim: Therapy success in patients with differentiated thyroid cancer (DTC) after thyroidectomy and radioiodine therapy (RIT) is proven by permanent decrease in human thyroglobulin (hTg) to

The aim is to add a pragmatic contribution to the discussion of an algorithm to discharge patients treated with Lu-177-PSMA under the aspect of radiation protection. This also may be applied to therapies with other radioactive tracers in the future.478 cycles of Lu-177-PSMA-617 (140 patients) were analyzed. The remaining activity in the patient and the dose rate were correlated. From frequent intratherapeutic measurements (biexponential fit) scenarios for discharging patients are deduced.Thirty-four per cent of all patients treated with Lu-177-PSMA received 3 to 5 cycles per calendar year. The dose limit of 1 mSv per calendar year (German Law) at a distance of 2 m from the patient would be exceeded in 10 % and 15 % of the treated patients if discharged 72 hours after treatment given 3 and 4 cycles per calendar year, respectively. Mean specific dose rate was 0.00462µSv/(h MBq) at a distance of 1 m. A universal correlation between dose rate and the remaining activity in the patient could not be found.The multi cycle concept of the therapies with Lu-177 PSMA has to be taken into account prospectively when discharging the patients. Given the physical half-life of Lu-177 an anticipation of 4 treatment cycles per calendar year leads to a clearly arranged, conservative rule.ZIEL: Ziel ist es, einen praxisorientierten Beitrag zur Diskussion eines Algorithmus zur Entlassung unter Strahlenschutzgesichtspunkten von Patienten nach Therapien mit Lu-177 markiertem PSMA zu leisten. Dieser kann als Basis zur Weiterentwicklung von Vorgaben für die Entlassungspraxis für andere zukünftige Therapien mit offenen radioaktiven Stoffen dienen.Anhand der Analyse der Behandlungsdaten von 478 Zyklen Lu-177-PSMA-617 (140 Patienten) wurde der Zusammenhang zwischen Restaktivität im Patienten und der damit verbundenen Dosisleistung erstellt. Aus den kinetischen Daten regelmäßiger intratherapeutischer Ganzkörpermessungen mit einer Sonde (biexponentieller Fit) wurden daraus Szenarien für die Entlassung entwickelt.34 % der Patienten wurden 3- bis 5-mal in einem Kalenderjahr behandelt. 1 mSv pro Kalenderjahr in 2 m Entfernung kann bei der prospektiven Entlassung von 3 bzw. 4 Therapiezyklen pro Jahr nach 72 Stunden stationärem Aufenthalt in 10 % bzw. 15 % der Fälle nicht eingehalten werden. Die mittlere spezifische Dosisleistung im Patienten betrug 0,00462µSv/(h MBq) in 1 m Entfernung. Ein allgemeingültiger quantitativer Zusammenhang der Dosisleistung mit der Restaktivität im Patienten konnte nicht gefunden werden.Wegen des Ansatzes einer Mehrfachbehandlung der mit Lu-177-PSMA therapierten Patienten müssen die Entlassungsbedingungen prospektiv angepasst werden. Die Zugrundelegung der physikalischen Halbwertszeit von Lu-177 und von 4 Behandlungen im Kalenderjahr führt zu einer konservativen, übersichtlichen Regelung.

Bone-seeking 223Radium-dichloride (223Ra) is an established treatment prolonging survival and reducing morbidity in selected patients with metastatic castration-resistant prostate cancer (mCRPC) with skeletal involvement. Radioligand therapy with 177Lutetium-PSMA-617 (177Lu-PSMA-617) has been increasingly implemented in patients with mCRPC failing conventional treatment options. In this study, the safety and efficacy of 177Lu-PSMA-617 in patients with progressive bone involvement under treatment with 223Ra was assessed. Twenty-eight men (median age 73 years, range 63–89 years) with progressive mCRPC, who started 177Lu-PSMA-617 within 8 weeks after the last 223Ra administration, received a median of 4 (IQR 3–6) and a total of 120 cycles of 223Ra and a median of 4 (IQR 2–7) cycles 177Lu-PSMA-617 with a mean treatment activity of 6.5 ± 1.2 GBq per cycle, reaching a mean cumulative activity of 30.7 ± 23.4 GBq. A PSA response (≥50% PSA decline 12 weeks after the first 177Lu-PSMA-617 cycle) was observed in 18/28 (64.3%) patients and imaging-based partial remission (PR) was observed in 11/28 (39.3%) patients. Median imaging-based progression-free survival (PFS) was 10 (95% CI, 6–14) months and median overall survival (OS) was 18 (95% CI, 14–22) months. Patients with low bone tumor burden (2–20 lesions) had a significantly longer OS (28 vs. 14 months, p < 0.045) compared to patients with a high tumor burden (>20 lesions). Grade ≥ 3 hematological toxicity was observed in six patients after their last treatment cycle with anemia, leukopenia and thrombocytopenia in 5/28 (17.9%), 4/28 (14.3%) and 6/28 (21.4%) patients, respectively. In progressive bone-metastatic mCRPC patients, prompt initiation of 177Lu-PSMA-617 after failing 223Ra is effective with an acceptable toxicity profile.

Bone-seeking 223Radium-dichloride (223Ra) is an established treatment prolonging survival and reducing morbidity in selected patients with metastatic castration-resistant prostate cancer (mCRPC) with skeletal involvement. Radioligand therapy with 177Lutetium-PSMA-617 (177Lu-PSMA-617) has been increasingly implemented in patients with mCRPC failing conventional treatment options. In this study, the safety and efficacy of 177Lu-PSMA-617 in patients with progressive bone involvement under treatment with 223Ra was assessed. Twenty-eight men (median age 73 years, range 63–89 years) with progressive mCRPC, who started 177Lu-PSMA-617 within 8 weeks after the last 223Ra administration, received a median of 4 (IQR 3–6) and a total of 120 cycles of 223Ra and a median of 4 (IQR 2–7) cycles 177Lu-PSMA-617 with a mean treatment activity of 6.5 ± 1.2 GBq per cycle, reaching a mean cumulative activity of 30.7 ± 23.4 GBq. A PSA response (≥50% PSA decline 12 weeks after the first 177Lu-PSMA-617 cycle) was observed in 18/28 (64.3%) patients and imaging-based partial remission (PR) was observed in 11/28 (39.3%) patients. Median imaging-based progression-free survival (PFS) was 10 (95% CI, 6–14) months and median overall survival (OS) was 18 (95% CI, 14–22) months. Patients with low bone tumor burden (2–20 lesions) had a significantly longer OS (28 vs. 14 months, p < 0.045) compared to patients with a high tumor burden (>20 lesions). Grade ≥ 3 hematological toxicity was observed in six patients after their last treatment cycle with anemia, leukopenia and thrombocytopenia in 5/28 (17.9%), 4/28 (14.3%) and 6/28 (21.4%) patients, respectively. In progressive bone-metastatic mCRPC patients, prompt initiation of 177Lu-PSMA-617 after failing 223Ra is effective with an acceptable toxicity profile.

Baseline uptake on prostate-specific membrane antigen (PSMA)-targeted imaging is a prerequisite for radioligand therapy (RLT) with [177Lu]Lu-PSMA-617. This study aims to quantify lesion-based response to RLT in relation to pretreatment standard molecular imaging metrics derived from [68Ga]Ga-PSMA-11 PET/CT. Sixty-one patients with mCRPC underwent [68Ga]Ga-PSMA-11 PET/CT imaging before and after a median of 4 (IQR 2–6) RLT cycles. Maximum and mean standardized uptake values (SUVmax, SUVmean), as well as tumor-to-liver ratio (TLR), were assessed. A median of 12 (IQR 7–17) lesions was analyzed per patient, resulting in a total of 718 lesions. Lesions with ≥30% SUVmax decline or falling below the blood pool uptake were considered responsive; ≥30% SUVmax increase marked lesion progression. Additionally, 4-point visual scoring was performed according to E-PSMA consensus. In total, 550/718 (76.6%) lesions responded to RLT, including 389/507 (76.7%) bone metastases and 143/181 (79.0%) lymph node metastases. Baseline SUVmax, SUVmean, and TLR values were associated with lesion response by a moderate but significant correlation (rs = 0.33, p < 0.001, rs = 0.32, p < 0.001, and rs = 0.31, p < 0.001, respectively). For the classification of lesion progression based on baseline PSMA uptake, receiver operating characteristics (ROC) found SUVmax, SUVmean, and TLR to have comparable discriminatory value (AUC 0.85, 0.87, and 0.83). Of 42 tumor sites with baseline uptake below the liver (V-score < 2), 19/42 (45.2%) were responsive, 9/42 (21.4%) were stable, and 14/42 (33.3%) showed progression, leaving liver uptake a threshold with low prognostic value for the identification of RLT-refractory lesions (PPV 33%). This was observed accordingly for various liver uptake-based thresholds, including TLR < 1.5

Bone-seeking

Background Myelosuppression is a potential dose-limiting factor in radioligand therapy (RLT). This study aims to investigate occurrence, severity and reversibility of hematotoxic adverse events in patients undergoing RLT with 177Lu-PSMA-617 for metastatic castration-resistant prostate cancer (mCRPC). The contribution of pretreatment risk factors and cumulative treatment activity is taken into account specifically. Methods RLT was performed in 140 patients receiving a total of 497 cycles. A mean activity of 6.9 \documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$\pm$$\end{document}± 1.3 GBq 177Lu-PSMA-617 per cycle was administered, and mean cumulative activity was 24.6 \documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$\pm$$\end{document}± 15.9 GBq. Hematological parameters were measured at baseline, prior to each treatment course, 2 to 4 weeks thereafter and throughout follow-up. Toxicity was graded based on Common Terminology Criteria for Adverse Events v5.0. Results Significant (grade ≥ 3) hematologic adverse events occurred in 13 (9.3%) patients, with anemia in 10 (7.1%), leukopenia in 5 (3.6%) and thrombocytopenia in 6 (4.3%). Hematotoxicity was reversible to grade ≤ 2 through a median follow-up of 8 (IQR 9) months in all but two patients who died from disease progression within less than 3 months after RLT. Myelosuppression was significantly more frequent in patients with pre-existing grade 2 cytopenia (OR: 3.50, 95%CI 1.08–11.32, p = 0.04) or high bone tumor burden (disseminated or diffuse based on PROMISE miTNM, OR: 5.08, 95%CI 1.08–23.86, p = 0.04). Previous taxane-based chemotherapy was associated with an increased incidence of significant hematotoxicity (OR: 4.62, 95%CI 1.23–17.28, p = 0.02), while treatment with 223Ra-dichloride, cumulative RLT treatment activity and activity per cycle were not significantly correlated (p = 0.93, 0.33, 0.29). Conclusion Hematologic adverse events after RLT have an acceptable overall incidence and are frequently reversible. High bone tumor burden, previous taxane-based chemotherapy and pretreatment grade 2 cytopenia may be considered as risk factors for developing clinically relevant myelosuppression, whereas cumulative RLT activity and previous 223Ra-dichloride treatment show no significant contribution to incidence rates. Supplementary Information The online version contains supplementary material available at 10.1186/s13550-021-00805-7.

ZusammenfassungZiele: Neben der Feinnadelpunktion ist die Szintigraphie mit Tc99m-Sestamibi (99mTc-MI- BI) ein ergänzendes Diagnostikum bei der Beurteilung von hypofunktionellen Knoten. Um die Frage nach der Verlässlichkeit dieses Diag- nostikums zu beantworten, wurde in dieser Studie die Intra- und Interobserverüberein- stimmung bei der Beurteilung hypofunktioneller Knoten von99mTc-MIBI-Szintigrammen bestimmt.Methoden: In eine retrospektive Stu die wurden 284 Patienten (16-85 Jahre, 194 w, 90 m) mit mindestens einem hypofunktionellen Knoten, einer Szintigraphie mit Tech- netium-99m-Pertechnetat und mindestens einer Szintigraphie mit99mTc-MIBI eingeschlossen. Acht Nuklearmediziner beurteilten die Szintigramme an zwei Terminen und wurden per Fragebogen angewiesen, die Kombination der Bilder als „match”, „mismatch” oder „unentschieden” einzustufen. Zudem wurde jeweils abgefragt, ob die Früh- oder die Spätaufnahme der99mTc-MIBI-Szintigra- phie besser verwertbar war oder ob kein Unterschied bestand.Ergebnisse: Die Intraob- serverübereinstimmung reichte von κ = 0,56 (mittelmäßig) bis κ = 0,78 (überzeugend). Die Interobserverübereinstimmung lag bei κ=0,44 und κ=0,53 (mittelmäßig). Die In- terobserverübereinstimmung von Untersuchern mit mehr als 5 Jahren Berufserfahrung in der Nuklearmedizin lag bei κ = 0,61 und κ = 0,70 (überzeugend), mit 2-5 Jahren bei κ=0,53 (mittelmäßig) und κ=0,61 (überzeugend), und mit weniger als 2 Jahren bei κ=0,47 (mittelmäßig) und κ=0,61 (überzeugend). In 26 % der Fälle in Sitzung 1 bzw. 20 % in Sitzung 2 wurde die Frühaufnahme als besser verwertbar eingestuft, in 4 bzw. 3 % die Spätaufnahme und in 70 bzw. 77 % „kein Unterschied”.Schlussfolgerung: Die Werte der Interobserverübereinstimmung aller acht Untersucher zeigen, dass die Beurteilung der99mTc-MIBI-Szintigramme einer gewissen Varianz unterliegen kann. Somit sollten diese von einem Untersucher mit mindestens 5 Jahren Berufserfahrung abschließend beurteilt werden. Berufsanfänger benötigen mehr Zeit zur Beurteilung von99mTc-MIBI- Szintigrammen als Erfahrene und sollten Rücksprache halten.

A supplementary diagnostic tool in the assessment of cold thyroid nodules is scintigraphic imaging withA retrospective study with 284 patients (16-85 years of age, 194 women, 90 men) was performed. They had at least one cold nodule and from each of whom were available at least oneIntraobserver agreement ranged from κ = 0.56 (moderate) to κ = 0.78 (substantial). Interobserver agreement ranged from κ = 0.44 to κ = 0.53 (moderate). Interobserver agreement for observers with more than 5 years of work experience in nuclear medicine ranged from κ=0.61 to κ = 0.70 (substantial), for observers with 2-5 years from κ = 0.53 (moderate) to κ = 0.61 (substantial) and for observers with2 years from κ = 0.47 to κ = 0.61. "No difference" was chosen in 70 resp. 77 % of all cases in session 1 resp. 2. The early image was preferred in 26 resp. 20 %, and the delayed one in 3 resp. 4 % of all cases.The values of interobserver agreement of all eight observers show that the assessment of Tc-MIBI scintigrams is subject to a certain variance. Hence, they ought to be finally assessed by observers with at least 5 years of work experience.