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Introduction:  The COVID-19 pandemic imposed an unimaginable challenge to the healthcare systems worldwide. This online survey captured the impact of the COVID-19 pandemic on nuclear medicine services in Germany comparing 2020 to 2019., Materials and Methods:  A web-based questionnaire was developed to record the 2020 numbers of nuclear medicine procedures and, in particular, the change compared with 2019. The changes in nuclear medicine diagnostics and therapy were queried, as well as the extent to which "Coronavirus SARS-CoV-2" recommendations provided by the DGN were implemented., Results:  91 complete responses were recorded and evaluated. This corresponds to about 20 % of all German nuclear medicine facilities. Nuclear medicine diagnostic tests showed a decrease in scintigraphies for thyroid (15.9 %), bone (8.8 %), lung (7.6 %), sentinel lymph nodes (5.5 %), and myocardium (1.4 %) with small increases in PET/CT examinations (1.2 %) compared with 2019. Among nuclear medicine therapies, reductions were highest for benign indications (benign thyroid 13.3 %, RSO 7.7 %), while changes from 2019 were less pronounced for malignant indications (PRRT: + 2.2 %, PSMA: + 7.4 %, SIRT: -5.9 %, and RJT for thyroid carcinoma -2.4 %). The DGN recommendations for action were fully or partially applied in 90 %., Conclusions:  The initial significant reduction in nuclear medicine procedures in the first three weeks of the COVID-19 pandemic did not continue, but there was no compensation of the previously not performed services. The decrease in diagnostics and therapy procedures of benign diseases was particularly severe., Competing Interests: Lutz Freudenberg and Markus Essler: none.Ken Herrmann reports personal fees from Bayer, personal fees and otherfrom Sofie Biosciences, personal fees from SIRTEX, non-financial supportfrom ABX, personal fees from Adacap, personal fees from Curium, perso-nal fees from Endocyte, grants and personal fees from BTG, personal fees from IPSEN, personal fees from Siemens Healthineers, personal fees fromGE Healthcare, personal fees from Amgen, personal fees from Novartis,personal fees from ymabs, outside the submitted work., (Thieme. All rights reserved.)

COVID-19 pandemic is having a strong impact on healthcare providers around the world, by refocusing and reducing non-essential medical activities. Nuclear medicine departments among others, have been reorganizing and reprioritizing diagnostic and theragnostic procedures. This reorganizing had a negative impact on the supply of positron emission tomography (PET) services to oncologic patients, whose health was affected. We herein present the PET findings in three different cancer scenarios in which disease course was dramatically affected by the COVID-19 outbreak.

Background: The IAEA recommends a quality assurance program in radiotherapy to ensure safe and effective treatments. In this study, radiotherapy departments were surveyed on their current practice including the extent and depth of quality assurance activities. Methods: Radiotherapy departments were voluntarily surveyed in three stages, firstly, in basic facility information, secondly, in quality assurance activities and treatment techniques, and thirdly, in a snapshot of quality assurance, departmental and treatment activities. Results: The IAEA received completed surveys from 381 radiotherapy departments throughout the world with 100 radiotherapy departments completing all three surveys. Dominant patterns were found in linac-based radiotherapy with access to treatment planning systems for 3D-CRT and 3D imaging. Staffing levels for major staff groups were on average in the range recommended by the IAEA. The modal patient workload per EBRT unit was as expected in the range of 21-30 patients per day, however significant instances of high workload (more than 50 patients per day per treatment unit) were reported. Staffing levels were found to correlate with amount of treatment equipment and patient workload. In a self-assessment of quality assurance performance, most radiotherapy departments reported that they would perform at least 60% of the quality assurance activities itemized in the second survey, with particular strength in equipment quality control. In a snapshot survey of quality assurance performance, again equipment quality control practice was well developed, particularly for the treatment equipment. Conclusions: The IAEA surveys provide a snapshot of current radiotherapy practice including quality assurance activities.

Introduction: Appointment non-attendance contributes added cost to the healthcare sector through wasted resource allocations. Medical imaging departments commonly schedule appointments for most modalities; however, no study has quantified patient attendance rates in the Australian regional setting. This is despite evidence that regional, rural and remote Australians tend to demonstrate poorer health than metropolitan counterparts. This study aims to identify the factors that influence appointment non-attendance at a teaching hospital in regional Australia., Methods: Categories restricted to age, gender, indigenous status, distance from investigation site, referral source and imaging modality were collected for all appointments (N = 13,458) referred to the medical imaging department in 2015. The likelihood of each of these factors correlating with a patient not attending a scheduled appointment was calculated using the chi-squared analysis and binary logistic regression., Results: Gender, indigenous status as well as specific imaging modalities, referral sources and age categories were significantly associated with non-attendance. Overall, male patients were 1.57 (P < 0.001) times more likely to miss a scheduled appointment than female patients. Patients who identified as Aboriginal and Torres Strait Islander were 2.66 (P < 0.001) times more likely to miss a scheduled appointment than patients who did not identify as Aboriginal and Torres Strait Islander., Conclusions: Several key factors appear to affect medical imaging appointment non-attendance. Key factors include indigenous status, gender, image modality, referral source and age. Further improvement is required to better meet the needs of underrepresented patient demographics., (© 2018 The Authors. Journal of Medical Radiation Sciences published by John Wiley & Sons Australia, Ltd on behalf of Australian Society of Medical Imaging and Radiation Therapy and New Zealand Institute of Medical Radiation Technology.)

Objective: To determine the status of neuroimaging studies of Nuclear Medicine in Spain during 2013 and first quarter of 2014, in order to define the activities of the neuroimaging group of the Spanish Society of Nuclear Medicine and Molecular Imaging (SEMNIM)., Material and Methods: A questionnaire of 14 questions was designed, divided into 3 parts: characteristics of the departments (equipment and professionals involved); type of scans and clinical indications; and evaluation methods. The questionnaire was sent to 166 Nuclear Medicine departments., Results: A total of 54 departments distributed among all regions completed the questionnaire. Most departments performed between 300 and 800 neuroimaging examinations per year, representing more than 25 scans per month. The average pieces of equipment were three; half of the departments had a PET/CT scanner and SPECT/CT equipment. Scans performed more frequently were brain SPECT with 123 I-FP-CIT, followed by brain perfusion SPECT and PET with 18 F-FDG. The most frequent clinical indications were cognitive impairment followed by movement disorders. For evaluation of the images most sites used only visual assessment, and for the quantitative assessment the most used was quantification by region of interest., Conclusions: These results reflect the clinical activity of 2013 and first quarter of 2014. The main indications of the studies were cognitive impairment and movement disorders. Variability in the evaluation of the studies is among the challenges that will be faced in the coming years., (Copyright © 2017 Elsevier España, S.L.U. y SEMNIM. All rights reserved.)

Background: Errors by nuclear medicine technologists during the preparation of radiopharmaceuticals or at other times can cause patient harm and may reflect the impact of interruptions, busy work environments and deficient systems or processes. We aimed to: (a) characterise the rate and nature of interruptions technologists experience and (b) identify strategies that support safety., Methods: We performed 100 hours of observation of 11 technologists at a major public hospital and measured the proportions of time spent in eight categories of work tasks, location of task, interruption rate and type and multitasking (tasks conducted in parallel). We catalogued specific safety-oriented strategies used by technologists., Results: Technologists completed 5227 tasks and experienced 569 interruptions (mean, 4.5 times per hour; 95% CI 4.1 to 4.9). The highest interruption rate occurred when technologists were in transit between rooms (10.3 per hour (95% CI 8.3 to 12.5)). Interruptions during radiopharmaceutical preparation occurred a mean of 4.4 times per hour (95% CI 3.3 to 5.6). Most (n=426) tasks were interrupted once only and all tasks were resumed after interruption. Multitasking occurred 16.6% of the time. At least some interruptions were initiated by other technologists to convey important information and/or to render assistance. Technologists employed a variety of verbal and non-verbal strategies in all work areas (notably in the hot-lab) to minimise the impact of interruptions and optimise the safe conduct of procedures. Although most were due to individual choices, some strategies reflected overt or subliminal departmental policy., Conclusions: Some interruptions appear beneficial. Technologists' self-initiated strategies to support safe work practices appear to be an important element in supporting a resilient work environment in nuclear medicine., Competing Interests: Competing interests: None declared., (Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.)

Objectives: In 2009-2010 a Portuguese consortium was created to implement the methodologies proposed by the Dose Datamed II (DDM2) project, aiming to collect data from diagnostic X-ray and nuclear medicine (NM) procedures, in order to determine the most frequently prescribed exams and the associated ionizing radiation doses for the Portuguese population. The current study is the continuation of this work, although it focuses only on NM exams for the years 2011 and 2012., Material and Methods: The annual frequency of each of the 28 selected NM exams and the average administered activity per procedure was obtained by means of a nationwide survey sent to the 35 NM centres in Portugal., Results: The results show a reduction of the number of cardiac exams performed in the last two years compared with 2010, leading to a reduction of the annual average effective dose of Portuguese population due to NM exams from 0.08 mSv ± 0.017 mSv/caput to 0.059 ± 0.011 mSv/caput in 2011 and 0.054 ± 0.011 mSv/caput in 2012. Portuguese total annual average collective effective dose due to medical procedures was estimated to be 625.6 ± 110.9 manSv in 2011 and 565.1 ± 117.3 manSv in 2012, a reduction in comparison with 2010 (840.3 ± 183.8 manSv)., Conclusions: The most frequent exams and the ones that contributed the most for total population dose were the cardiac and bone exams, although a decrease observed in 2011 and in 2012 was verified. The authors intend to perform this study periodically to identify trends in the annual Portuguese average effective dose and to help to raise awareness about the potential dose optimization., (Copyright © 2014 Elsevier España, S.L.U. and SEMNIM. All rights reserved.)

A database software application for comprehensive management and traceability of hospital radiopharmacies has been developed and implemented. This software is a customizable shareware called Radiolab, which provides an immediate and complete traceability of all preparations, controls and radiopharmaceuticals, as well as a great help in the management of reports, orders, stock and radioactive waste. Available by now in five languages (English, Spanish, French, Portuguese and Italian) this software and its manual can be downloaded from the Internet at www.radiopharmacy.net., (Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.)

Nuclear medicine technicians work daily with radioactive isotopes, and therefore receive a certain amount of radiation dose. The aim of this study was to assess the radiation dose, during various tasks, to the technicians at four nuclear medicine departments and to investigate to what extent there are differences between the departments and possible reasons for such. Measurements were made at nuclear medicine departments at four Norwegian hospitals. Doses to the technicians were measured with an educational direct dosimeter-instrument worn outside the lead apron during work at hot-lab, administrating the injection and image acquisition. Calculated annual collective and individual doses were compared with data from personal dosimetry. A value of ∼1 nSv MBq(-1) seems to be representative for modern Norwegian nuclear medicine departments. In departments with upgraded hot-labs, the largest dose contribution is received during image acquisition.

Aim: To explain the spectrum and number of in-vivo nuclear medicine examinations and therapies based on official statistics about out-patient and in-patient care. Trends in time of the frequency and spectrum of procedures as well as data on the health care structure for nuclear medicine in Germany should be collected., Methods: Data from the Gesundheitsberichterstattung des Bundes, from the frequency statistics of the statutory health insurance for out-patients and from the Bundesärztekammer were used. Customized queries were performed to analyse temporal changes., Results: Nuclear medicine physicians are more frequently consulted by out-patients over the last years (2008: 2024498; 2009: 2164664) and the number of colleagues in private practice increased. For in-patients, the frequency of conventional nuclear medicine procedures (mainly for brain, lymphatic system, lung and heart) increased since 2008 after a decline in previous years (2009: 323515; +4.6%) and the number of PET(/CT) examinations continued to rise (2009: 25123; +18%), even if changes in OPS keys may hamper comparisons. Nearly 600 gamma cameras and 76 PET(/CT) scanners were installed in hospitals in 2008. Nuclear medicine procedures are increasingly performed as cross sectional imaging like SPECT(/CT) and PET(/CT). With the supply shortfall with 99Mo, the frequency of thyroid scans with 123I iodine increased as well as the use of 18F PET as a substitute for conventional bone scans. The number of radionuclide therapies, in particular non-thyroid treatments, increased since the mid-nineties and stabilized at nearly 50000 cases per year with shorter lengths of stay., Conclusion: The details of the present analysis may help to understand the positive evolution of key numbers for nuclear medicine.

Objective: To evaluate the number of patients needed to treat (NNT) to assess the magnitude of benefit of coronary revascularisation (CR) in patients with ischaemic cardiomyopathy (IC) in relation to the presence or absence of myocardial viability in myocardial perfusion gated-SPECT (single photon emission computed tomography) images., Method: We studied 198 consecutive patients with IC using rest gated-SPECT with technetium-based agents. The cardiac mortality was analysed in four groups: viable with CR (n = 50), viable with medical treatment (MT) (n = 90), non-viable with CR (n = 18), and non-viable with medical treatment (n = 40)., Results: During 2.3 +/- 1.2 years of follow-up, the cardiac mortality rate in patients with scintigraphic viability criteria undergoing revascularisation was 5.9/100 patients/year and 12.9/100 patients/year in those who received medical treatment. In patients without viability who underwent revascularisation, the cardiac mortality rate was 6.2/100 patients/year and in those who received MT it was 1.9/100 patients/year. In patients with myocardial viability the NNT was 4, while in patients without myocardial viability, the NNT was 24., Conclusions: In patients with scintigraphic viability criteria, the NNT to obtain one survival with CR was 6 times lower with respect to patients without viability, with lower cost and mortality.

Objective: To determine the perception and satisfaction level of referring physicians requesting scans as final users of the Nuclear Medicine Department., Material and Methods: A self-administered questionnaire was designed; it was composed of 10 closed questions (5 categorised and 5 with numerical scale) and 3 open questions. The indicators evaluated were: physician's information about available tests, test indications and diagnostic information, accessibility, delay in the examination and reception of the diagnostic report, usefulness of diagnostic information and overall satisfaction with the department. Two hundred and fifteen questionnaires were sent., Results: Seventy eight questionnaires were returned, so the response index was 36.3 %. The 44.6 % of physicians surveyed considered that they had sufficient information about the tests and 59.5 % were satisfied with the indications and diagnostic information. The accessibility was 7 or more out of 10 for 78.5 %. The 64.9 % of physicians considered the delay in performing examinations to be correct but the satisfaction was lower in the delay between performance and reception of the diagnostic report. The diagnostic information was considered useful by 81.9 % and relevant in the management of patients by 70.5 % of the participants surveyed. The overall satisfaction was > or = 7 out of 10 in 86.8 %., Conclusions: Overall satisfaction was high, although the level of knowledge about available tests and the delay between test performance and report reception could be improved.

Objective: To survey nuclear medicine scans carried out in Beijing during 2005., Methods: Forty-two nuclear medicine departments were surveyed by using mailed questionnaires sent during September 2006., Results: By the end of January 2007, 30 out of 42 hospitals had replied to our survey. The estimated annual number of SPECT procedures was 6.72 per 1000 population during 2005. Among SPECT applications, whole-body bone scans (n=23,090) were performed with the highest frequency, followed by myocardial perfusion imaging (n=19,092), and renal function imaging (n=10,287). The estimated number of myocardial perfusion scintigraphy scans was 1530 procedures per million population. The annual number of PET procedures was 0.25 per 1000 population. Most of these PET and SPECT examinations used relative monotonous radiotracers and most patients were in the age group of 40-70 years. However, for each cancer and each type of application, age distributions slightly varied. In addition, the analysis of gender distribution revealed that the number of male patients was higher than for female patients., Conclusion: The number of nuclear medicine scans carried out in Beijing during 2005 was considerable, with unbalanced clinical applications. Excluded myocardial perfusion scintigraphy, the frequencies of some applications were still lower than in western countries. Furthermore, most procedures used relatively monotonous radiotracers. Most patients were in the age group of 40-70 years and were male.

Introduction: When diagnostic imaging is cancelled on short notice or an examination is delayed, the Imaging Department suffers a loss. Based on voluntary reporting of such events, we have estimated the total expenditure involved., Materials and Methods: For one year an orderly reported cases in which, when he arrived to fetch an inpatient, the latter was no longer in the ward or was not ready. From this study material we estimated the waste of time for the staff and the total price of cancelled or delayed examinations, spread over various categories. This sum is related to the estimated cost of one preventive measure: letting the orderly check in the hospital's electronic administrative system whether the patient is still in the ward indicated., Results: A total of 436 cancelled or delayed examinations were reported in 2004. In 249 cases the examination was cancelled, and since the recorded total number of cancellations was 1,435, we estimate the total number of cancelled or delayed exams to be approximately 2,500 (1,435 x 436/249). The estimated total waste of time is 66 weeks (1(1/2) years' work). The estimated price of the cancelled or delayed examinations is 2.4 million Danish kroner. When we relate the savings if the problem is solved to the cost of prevention, we find that it would be clearly profitable to address fluoroscopy and CT scanning. Conversely, addressing bone X-rays would generate a loss., Conclusion: We conclude that there is a very large waste of resources caused by cancelled or delayed imaging examinations.

Purpose: The main objective of the program <> is to establish a group with detailed information on brachytherapy throughout Europe., Methods: The data was compiled by the general coordinator, the ESTRO, and the <> through a website., Results: A total of 32 countries reported data from at least 50% of their centres (criteria of inclusion). Countries were grouped in three categories based on the time of incorporation to the European Union. The majority of treatments belonged to gynaecological tumours. A large spread was found regarding workload of specialists depending on centre and group., Conclusion: Collection of information by a website is a feasible methodology. An increase in brachytherapy treatment was observed in all 3 groups by a rate of more than 20% (year 2002 versus year 1997). These results advocate for the continuation of the PCBE study to demonstrate the development in the field, such as an increase or decrease of patient numbers per tumour category.

Objectives: This survey was designed to assess the trends in the frequencies of nuclear medicine procedures in the UK and to determine their contributions to the annual collective effective dose to the UK population. The average activities administered by nuclear medicine departments were compared with guidance on diagnostic reference levels issued by the Administration of Radioactive Substances Advisory Committee., Method: The survey was carried out by e-mailing a questionnaire to every known nuclear medicine centre in the UK., Results: The total number of procedures performed annually has increased by 36% over the last 10 years to a level of about 11 procedures per 1000 head of population in the financial year 2003-2004. Seventy-three per cent of all nuclear medicine administrations are for planar imaging, with single-photon emission computed tomography and positron emission tomography contributing 16% and 2%, respectively. Non-imaging diagnostic procedures represent 7% of all nuclear medicine administrations, and therapy 2%. Bone scans continue to be the most frequent procedure. The UK annual collective effective dose from diagnostic nuclear medicine is about 1600 man Sv, resulting in an annual per caput dose of nearly 0.03 mSv. Bone scans are the largest contributor to the collective dose, but myocardium scans are close behind. Planar imaging is responsible for 62% of the total collective effective dose from diagnostic nuclear medicine in the UK, with single-photon emission computed tomography, positron emission tomography and non-imaging contributing 33%, 5% and 0.3%, respectively., Conclusions: The practice of nuclear medicine is still expanding in the UK with single-photon emission computed tomography imaging of the myocardium rapidly approaching bone scans as the main contributor to population exposure. The activities administered for most procedures have remained substantially unchanged and adhere closely to those recommended by the Administration of Radioactive Substances Advisory Committee.

Objectives: To audit standards developed for children undergoing nuclear medicine procedures involving day case attendance on the renal unit., Methods: A prospective audit was undertaken of 210 children (113 males) undergoing day case nuclear medicine procedures in a teaching hospital department catering for adult and paediatric patients. An audit sheet was completed by both ward and nuclear medicine staff at the time of the procedure over an 18-month period., Results: The majority of families were given relevant information about the procedures and adequate notice before the scan date. Most patients were offered surface analgesia for the venepuncture and play preparation before the procedure. Fifty-eight per cent of patients were successfully cannulated at the first attempt and 88% after three attempts. Only 4% of children were sedated. The median delay between the scheduled and actual scan time was 15 min, with 71% of children being scanned within the standard of a 0-20-min delay. Most delays were due to logistic problems within the department (43%). Cannulation problems (35%) and patient-related factors (22%) accounted for further delays., Conclusions: The audit of these locally agreed standards has resulted in changes in practice, including nurse training for cannulation and better scheduling within the nuclear medicine department. We believe that play preparation is an essential component for all potentially painful procedures, with few patients requiring sedation. The standards could be used for comparative audits between units.

Background: The National Institute for Health and Clinical Excellence (NICE) has recently published a very positive technology appraisal of myocardial perfusion scintigraphy (MPS). This has important implications for service provision within the National Health Service, and an accurate knowledge of the current level of MPS activity is necessary., Methods: A postal questionnaire was sent to 207 nuclear medicine departments in the UK, requesting information about nuclear cardiology facilities, activity, and practice. Non-responding departments were sent a second questionnaire, followed where necessary by a telephone call., Results: A response rate of 61% was achieved; 52% of departments performed MPS, and these tended to have more gamma cameras than those which did not (median (25th-75th centile) 2.0, 1.5-2.5 v 1.0, 0.5-1.5; p = 0.02). The median number of studies performed was 256 (144-460). The estimated rate of MPS in the UK for the year 2000 was 1200 per million population. The median (25th-75th centile) waiting time for MPS was 16 (9-24) weeks. Pharmacological stress was used in 77% of studies, and a technetium-99m based radiopharmaceutical in 60% (two day protocol in 75%). Tomographic rather than planar imaging was performed in 88% of studies, of which 22% were ECG gated. A cardiologist was involved in reporting in 35% of studies., Conclusions: MPS activity in the UK remains low, and it tends to be provided as a low volume service with unacceptably long waiting times and a lack of involvement by cardiologists. The recent NICE appraisal may provide an impetus for further resourcing and development.

Objective: The use of PET in Australia has grown rapidly. We conducted a prospective study of the radiation exposure of technologists working in PET and evaluated the occupational radiation dose after implementation of strategies to lower exposure., Methods: Radiation doses measured by thermoluminescent dosimeters over a 2-y period were reviewed both for technologists working in PET and for technologists working in general nuclear medicine in a busy academic nuclear medicine department. The separate components of the procedures for dose administration and patient monitoring were assessed to identify the areas contributing the most to the dose received. The impact on dose of implementing portable 511-keV syringe shields (primary shields) and larger trolley-mounted shields (secondary shields) was also compared with initial results using no shield., Results: We found that the radiation exposure of PET technologists was higher than that of technologists performing general nuclear medicine studies, with doses averaging 771 +/- 147 and 524 +/- 123 microSv per quarter, respectively (P = 0.01). The estimated dose per PET procedure was 4.1 microSv (11 nSv/MBq). Injection of 18F-FDG contributed the most to radiation exposure. The 511-keV syringe shield reduced the average dose per injection from 2.5 to 1.4 microSv (P < 0.001). For the longer period of dose transportation and injection, the additional use of the secondary shield resulted in a significantly lower dose of radiation than did use of the primary shield alone or no shield (1.9 vs. 3.6 microSv [P = 0.01] and 3.4 microSv [P = 0.03], respectively)., Conclusion: The radiation doses currently received by technologists working in PET are within accepted occupational health guidelines, but improved shielding can further reduce the dose.

Background and Aim: According to the report of the Intercollegiate Standing Committee on Nuclear Medicine, the UK requires 40-60 positron emission tomography (PET) machines in the next decade (Intercollegiate Standing Committee on Nuclear Medicine). Positron Emission Tomography: a Strategy for Provision in the UK. London: Royal College of Physicians of London; 2003, pp. 1-9). This figure is based mainly on patients receiving only one examination and restricting the clinical indication to three primary diagnoses. The aim of this study was to assess the appropriateness of this figure and the assumptions made in the Intercollegiate report on UK PET provision., Methods: We examined retrospectively our institution's entire PET and PET/computed tomography (CT) database, which spans 4 years and 9 months. We recorded the number of patients who received repeat examinations., Results: Reports were available for 3354 PET/CT or PET-only studies; 418 of 2268 patients (18.4%) received at least one repeat PET/CT examination. The three main indications for PET examination in the Intercollegiate report only accounted for approximately 60% of the examinations undertaken., Conclusion: Our records suggest that basing the UK's future PET provision on a single examination and on three clinical indications only is no longer realistic.

Background: The second survey of nuclear cardiology in the Czech Republic was conducted to ascertain whether the activity had increased since the first survey in 2001; we also intended to identify new trends in clinical practice., Materials and Methods: All 46 departments of nuclear medicine in the Czech Republic completed a questionnaire concerning nuclear cardiology activity in 2002-2003 and current clinical and technical practices., Results: There were 66 SPET cameras in 2003 in comparison with 54 SPET cameras in 2001. Of the 46 centres, 39 (85%) provided nuclear cardiology service. The total number of cardiac studies was 19,261 in 2003 (i.e. 1.9 studies/1,000 population; myocardial perfusion imaging (MPI) studies accounted for 91.3% of total nuclear cardiology. In 2001-2003, the utilization rate of MPI increased annually by 10%, 13% and 21% respectively. Twenty-six departments (67%) reported that the number of MPI had increased. The utilization of gated SPET method showed a very positive trend; as only 39% of all MPI studies were acquired using ECG-gating in 2001, but in 2003, there was an increase to 61%. We observed no increase in utilization of attenuation correction (3 centres in 2003 in comparison with 5 centres in 2001). Despite new PET capacity in the Czech Republic, the total number of FDG cardiology studies was somewhat lower in 2003 than in 2001 (155 compared with 163 studies)., Conclusions: Our data documented substantial growth in the number of MPI examinations in 2001-2003. However, Czech Republic nuclear cardiology activity still remained below the European average (2.2 studies/1,000 population in 1994); a further increase in MPI activity is necessary to adequately support the needs of cardiac patients.

Unlabelled: The Subcommittee on Survey of Nuclear Medicine Practice in Japan has performed a nationwide survey of nuclear medicine practice every five years since 1982 to provide detailed information on its current status., Methods: Questionnaires were sent to every institution known to the Japan Radioisotope Association to provide nuclear medicine examinations. The questionnaires address the number and kind of nuclear medicine examinations performed as well as the kind and dose of the radiopharmaceuticals used during the month of June 2002. The annual number of total or specific examinations was then estimated., Results: Of the institutions sent questionnaires, 1,204 were for in vivo study, 124 were for in vitro study, and 36 were for positron emission tomography (PET) study. Out of these, 95.8% answered them. A total of 1,697 gamma cameras were installed in 1,160 facilities, of which 50% were dual-head cameras. The estimated total annual number of examinations expressed by the number of administered radiopharmaceuticals was 1.60 million, similar to that of the previous survey (1997). The frequency of study with single photon emission computed tomography (SPECT) increased to 40%, from 30% in the previous survey. The scintigraphy most frequently performed was bone (35%), followed by myocardium (24%) and brain perfusion (12%). All showed a continuous increase over the past 20 years. Tumor imaging, however, fell from third to fourth place. The most commonly used radiopharmaceutical for each scintigraphy was 99mTc-HMDP for bone, 201Tl-chloride for myocardium, 67Ga-citrate for tumor, and 123I-IMP for brain. A total of 29,376 PET studies were performed yearly. Among them, 18F-FDG rapidly increased 3.7-fold. 131I therapy for thyroid cancer and hyperthyroidism was conducted yearly in 1,647 and 3,347 patients, respectively. A total of 31.35 million in vitro radioassays were carried out yearly, the number of which has been decreasing continuously since 1992., Conclusions: It was proved that the content of nuclear medicine practice in Japan has changed in the past five years. This report might be useful for understanding the current trends of nuclear medicine practice in Japan.

A representative Nuclear Medicine Service in Spain has two or three gammacameras. It performs neurologic studies one or two days at week wich account 2,1% of total workload. Brain Perfusion SPECT, specially in cognitive disorders, is the most frequent application. Neurooncology has a lower but established relevance. Neuroreceptors imaging are increasing in the last months. Emission tomography is obtained using a double-headed camera fitted with high-resolution parallel hole collimators and a half an hour total acquisition time. Datasets are reconstructed by filtered backprojection with Butterworth or Metz filtres. Images are visually interpreted with comparison to MRI and/or CT findings.

Objective: To better understand the consultative role of the radiology resident after hours., Methods: Data were collected prospectively from Mar. 15, 1999, to Jan. 5, 2001, during on-call coverage hours at our university hospital. Urgent radiologic examinations for which the on-call resident rendered a preliminary interpretation were included in our analysis, with the following entered into a database: patient demographics, consultative time and weekday, imaging modality, consulting clinical service and indication for each study., Results: A total of 1784 studies were performed on 1451 patients; most were requested by the emergency department (844 cases [47.3%]). The mean number of radiographic studies performed was 20.1 (standard error of the mean [SEM] 1.1) per weekday (n = 44) and 49.4 (SEM 1.8) per weekend day or holiday (n = 18). There were 1227 (68.8%) computed tomographic (CT), 338 (18.9%) ultrasonographic, 98 (5.5%) plain radiograph, 63 (3.5%) nuclear medicine, 21 (1.2%) interventional, 20 (1.1%) fluoroscopic and 17 (1.0%) magnetic resonance imaging examinations. The 3 most common studies were CT of the head in 692 cases, CT of the abdomen in 230 and venous Doppler ultrasonography in 158., Conclusions: Radiology residents are performing a diverse and increasing number of emergent diagnostic examinations after hours. It is therefore important that radiology departments are aware of these consultative needs to best ensure that appropriate resident skills are developed to meet these demands.

Radionuclide myocardial perfusion imaging (MPI) has been on the rise in Europe and the USA. Details on nuclear cardiology in the Czech Republic are not available as yet, as it is impossible to obtain comprehensive data from official registers owing to different methods of reporting and data evaluation. A questionnaire concerning nuclear cardiology activity and practice in 2001 was sent to all nuclear medicine departments in the Czech Republic. All 48 departments completed the questionnaire. In 2001, 50 planar and 54 tomographic (SPET) scintillation cameras were used. The average age of the SPET cameras was 5 years (13% of SPET cameras were >8 years old). Out of the 48 centres, 39 (81%) provided a nuclear cardiology service; the total number of cardiological studies was 15,740 in 2001 (1.5 studies/1,000 population/year). The most frequently employed method was MPI (81.7%), the frequency of which had increased by 10% compared with 2000; 26 of the 39 (67%) departments reported that MPI activity was increasing. Nevertheless, the Czech Republic nuclear cardiology activity remained below the European average (2.2/1,000 population in 1994) and, particularly, below activity in the USA (15/1,000 in 1997). The activity was rather unevenly spread. Whereas two centres with >1,000 studies/year accounted for 20% of the total MPI studies, 16 of 39 (41%) departments exhibited low activity (<200 studies/year) and accounted for only 15% of the total MPI studies. The use of SPET increased from 91% in 2000 to 94% in 2001 (only three institutes performed planar examinations). The most widely used tracer was (99m)Tc-MIBI (60% of total MPI), followed by (201)Tl (21%) and (99m)Tc-tetrofosmin (19%). ECG-gated SPET was employed by 20/39 (51%) centres, of which 11 (28%) performed it as a standard examination; 39% of the total MPI studies included this technique. Thirteen percent (5/39) of the departments used attenuation correction, and 69% (27/39) of the departments used a prone projection. Equilibrium radionuclide ventriculography, with 2,317 examinations (14.7%), ranked second among all nuclear cardiology methods, followed by first-pass angiocardiography (406 studies, 2.6%) and (18)F-FDG (163 studies, 1%).

A questionnaire was sent to all departments of nuclear medicine in Denmark (n=20) asking for details of myocardial perfusion imaging (MPI), including the number of patients examined each year from 1997 to 2001 and the current clinical and technical practice. All (100%) departments replied, and the survey thus covers all MPI performed in Denmark during the period in question. The number of MPI studies (examined patients) was 2,531 in 1997 (0.47 MPI/1,000/year) and 4,961 (0.93 MPI/1,000/year) in 2001, which is a doubling in activity in 5 years. Nineteen (95%) of the Danish departments performed MPI in 2001, and 14 (74%) of these reported that activity had increased over the past 5 years. MPI activity was unevenly distributed between hospitals and regions. In 2001, the university hospitals in the central Copenhagen region (capital) accounted for the highest MPI activity (2.00/1,000/year), while the non-university hospitals in general had the lowest activity rate (0.73/1,000/year). The most pronounced increment found in the period was observed in the university hospitals outside Copenhagen, where activity increased by 300% from 0.44/1,000/year in 1997 to 1.33/1,000/year in 2001. All departments providing MPI used tomographic acquisition technique and all departments used technetium tracers. The more sophisticated techniques of MPI - gated acquisition, attenuation correction and iterative reconstruction - were used in 74%, 32% and 42% of departments, respectively. The stress mode in perfusion studies was dipyridamole/adenosine in 76%, exercise in 18% and dobutamine in 6%. Despite these encouraging figures, MPI activity for 2001 remained well below what is recommended by other national and international societies. The anticipated further increase in nuclear cardiology is encouraging, but the nuclear medicine community needs to address the issues that prevent it from keeping up with demand. In general, the restricted camera time and the limited number of trained personnel explain the excessive waiting lists in Denmark.

A questionnaire was sent to 251 nuclear medicine centres asking for details of nuclear medicine activity, and nuclear cardiology activity and practice in 1997. One hundred and seventy-one (68%) centres replied. Nuclear medicine activity was estimated at 11.8 studies/1,000 population/year, and 9.5% of these studies were within cardiology (1.12 studies/1,000/year). Myocardial perfusion imaging (MPI) studies accounted for 77% and radionuclide ventriculography (RNV) for 22% of all nuclear cardiology. On a national basis this represents activity levels of 0.86 and 0.25 studies/1,000/year for MPI and RNV, respectively. Of the 171 responding centres, 102 (60%) performed MPI studies and 81 (79%) of these reported that activity was increasing. However, MPI activity was unevenly distributed between hospitals. Two centres accounted for 13% of total MPI; others had far lower activity rates, and 51/102 (50%) centres performed less than 200 MPI studies/year. Comparison with previous surveys showed that nuclear medicine activity had almost doubled since 1990 (it was 6.0 studies/1,000 population in 1990, 9.3 studies/1,000 in 1994 and 11.8 studies/1,000 in 1997). Over the same period, nuclear cardiology activity had also risen, the greatest increase being seen for the last 3 years (it was 0.7 studies/1,000 population in 1990, 0.82 studies/1,000 in 1994 and 1.12 studies/1,000 in 1997). Despite these encouraging figures, MPI activity for 1997 remained well below that recommended by the British Cardiac Society in 1994 (2.6 studies/1,000/year) as adequate to serve the needs of patients with cardiac disease in the UK; it was also below the European average activity for the same year (2.2 studies/1,000/year). The anticipated increased workload for nuclear cardiology is encouraging despite the wide and varied practice of nuclear cardiology around the UK. The nuclear medicine community now needs to address the issues that will prevent it keeping up with demand, such as restricted camera time, excessive waiting lists and outdated equipment, but also to standardise acquisition and reporting techniques so that all studies, wherever performed, will be of a uniformly high standard.

This survey investigated the nature of imaging staff and the distribution and structure of nuclear medicine departments in the UK. Total numbers of cameras and average per department were lower than in 1989/90 but higher than the 1992/93 survey. Total whole time equivalents, average per department and average per camera had increased. Excluding the Isle of Man, Wales had the lowest population per camera and Northern Ireland the highest. This survey identified 237 departments (90 independent, 116 integrated and 31 satellite), radiographers being the chief technologists in 64% and MTOs in 36%. Over half had one single-headed camera but one third had dual- or triple-headed cameras. Chief technologist grades ranged from Basic to Superintendent II and MTO3 to MTO5. The most common grades for other staff were Senior II or MTO3. Of the 786 technologists who provided details, 68% had initially trained as radiographers. Specific nuclear medicine qualifications were held by 67% of all technologists. In 52% of departments at least one member of staff rotated between nuclear medicine and another department or hospitals and 25% had no full-time staff. Survey returns revealed that, although 84% of imaging technologists often or occasionally attended conferences, 5% never attended.

Objective: To survey practice in nuclear cardiology in the UK in 1994., Design: A questionnaire was sent to 219 centres performing nuclear imaging asking for details of current practice in nuclear cardiology. Replies were received from 192 centres (88%)., Main Outcome Measures: Activity in performance of myocardial perfusion imaging (MPI) and radionuclide ventriculography (RNV), anticipated changes in activity, differences between regional and district hospitals, technical imaging parameters, and referral sources., Results: Of the responding centres, 125 (65%) performed nuclear cardiology procedures. More regional than district hospitals performed nuclear cardiology procedures (85% v 55%, p < 0.0003) and regional centres performed a higher proportion (62% v 24%, p < 0.001) of nuclear cardiology activity. Nuclear cardiology activity was 0.82 scans per 1000 population per year (MPI 0.56, RNV 0.26). There has been a significant increase (24%) in nuclear cardiology since 1988. There has been a pronounced rise in MPI (350%) while RNV has fallen by 47%. Myocardial perfusion activity in the UK remains very low (25% and 5% in regional and district hospitals, respectively) compared with the 1994 figures of 2.2/1000/year for Europe or 10.8/1000/year for the USA., Conclusions: MPI has increased on average by 23%/annum (compound rate) since 1988, but in 1994 was still only 32% of the British Cardiac Society target of 2.6/1000/year. Proper resources for capital expenditure on new equipment and new staff will be important to maintain momentum in closing the gap. Also important is improved clinical understanding, as already implemented by including nuclear cardiology in guidelines for specialist cardiology training.

Radiographic correlation is essential for many of the examinations performed in nuclear medicine. The purpose of this study was to evaluate the impact of a picture archiving and communications system (PACS) on the function and efficiency of a nuclear medicine department at a tertiary care institution. We evaluated 250 consecutive noncardiac nuclear medicine imaging examinations and asked the interpreting physician the following questions: (1) Was PACS used in the interpretation of the study? (2) Did the use of PACS expedite examination completion or aid in study interpretation? And (3) Did the use of PACS permit a definitive diagnosis to be made? PACS was accessed for correlative radiographic images in 155 of the 250 (62%) nuclear medicine examinations. Images available on PACS for review aided in study interpretation in 74% (115 of 155) of cases. The use of PACS was thought to expedite examination completion in 55% (86 of 155) of cases. The system was accessed but not operational in only 1% of cases (2 of 155). PACS provides reliable, rapid access to multimodality correlative radiographic images that aid in the interpretation of nuclear medicine examinations. Such systems also increase the efficiency of a nuclear medicine service by allowing timely and conclusive interpretations to be made.

The Nuclear Medicine Department at Kent and Canterbury Hospital operates a limited weekend on-call service staffed on a rota basis by a technician, a nurse and a doctor. Following a review of the service over a 2-year period, a prospective study was carried out to analyse the workload of the on-call service from August 1991 to July 1992. The aim was to assess the impact of the service on patient management and examine the cost implications. Sixty-two scans were performed during the year (38 Saturday, 22 Sunday, 2 Bank Holiday) of which 52 were ventilation/perfusion (V/Q) lung scans. The study examined the reports on the scans and the subsequent course of treatment and changes in patient management. For V/Q lung scans, anticoagulation therapy was changed in 13 cases as a result of the scan report. Of the lung scans showing low probability of pulmonary emboli, four patients were discharged on the day of the scan and a further eight within 48 h. The total cost of the on-call service (staff and consumables) was 6020 pounds, i.e. less than 100 pounds per patient and less than 2% of the departmental budget. The low cost and high number of changes in patient management indicate a reasonable cost-benefit ratio.

249 patients with well differentiated thyroid cancer attended the Nuclear Medicine Department of the Royal Liverpool Hospital (formerly housed at the Liverpool Clinic) from 1967 to 1990. Papillary carcinoma was histologically evident in 68% of patients and follicular carcinoma in 32%. Fifteen percent of all patients died of their cancer. The extent of initial surgery did not appear to influence the recurrence of disease, nor the patient survival. Univariate analysis showed that males had a worse survival rate than females during the 5 years after diagnosis but thereafter survival rates were similar. Multivariate analysis indicated that unfavourable survival factors were "age over 45 years at diagnosis" and "presence of distal metastases". Survival was not significantly different with or without 131I ablation where there were no distal metastases. Outcome of pregnancy after 131I ablation gave no cause for concern. No serious complications were observed following 131I therapy. Serum thyroglobulin tests were introduced only half way through the review period and were helpful in predicting the presence of tumour recurrence but these data are to be discussed in another communication.

Purpose: To determine changes in usage of radiologic services between 1980 and 1990., Materials and Methods: Complete data were obtained from 107 (42%) hospitals and incomplete data from eight (3%) (total survey response rate, 45%). Information was requested about the number of general radiologic examinations; specific modalities of computed tomography (CT), magnetic resonance (MR) imaging, nuclear medicine, and ultrasonography (US); and numbers of CT, MR imaging, and US machines., Results: The number of general radiologic examinations in hospitals increased from approximately 126 million to 179 million (> 42%); for CT, from 3.6 million to 13.3 million; nuclear medicine, from 6.4 million to 7.4 million; and US, from 4.3 million to 11.8 million. MR imaging examinations performed during 1990 were estimated at 1.8 million., Conclusion: The number of radiologic examinations performed in U.S. hospitals increased by 30%-60% between 1980 and 1990, mainly due to increased usage of CT, MR imaging, and US.

Part III is the final installment of the 1993 AHRA membership survey on staff utilization and includes results for radiation therapy, nuclear medicine, interventional/angiography and cardiac catheterization. The information includes the volume of procedures and numbers of FTEs in departmental areas and comparisons with results reported from a similar survey of AHRA members conducted in 1989.

A postal survey of UK nuclear medicine departments was carried out to obtain information on activity during the year 1989/90. A rise of 14% in the number of administrations of radiopharmaceuticals was found compared to 1982: a rise of 22% in imaging studies was offset by a 30% decrease in the number of nonimaging investigations. The estimated total number of administrations in the UK was 430,000.

With 47% of the population under 15 years of age and the control of infectious and other communicable diseases, cancer will likely constitute a major health problem in West Africa in future. Radiotherapy facilities and trained manpower to run them are very limited within the subregion. This paper quantifies the severity of the situation and discusses a practical approach aimed at coping with the situation through the organisation of a training programme for radiotherapists, medical physicists and radiation technologists as part of the strategies for cancer control in West Africa. A curriculum is proposed for the training of radiotherapists.

A survey of UK radiologists in 360 acute hospitals was undertaken to assess the current use of pulmonary angiography and radionuclide lung scanning in the investigation of suspected pulmonary thromboembolism (PTE). Replies were received from 340 (94%) hospitals, of which 48 (out of 50) were teaching hospitals or centres which perform cardiothoracic surgery. Lung scintigraphy was provided by 200 (59%) hospitals and angiography by 120 (35%), with 99 (29%) providing both. Twenty-two hospitals which could undertake angiography had not performed more than one angiogram for suspected PTE in the preceding 3 years. Average numbers of lung scans performed in each hospital were 21.8 per month, in contrast with an average of 4.1 angiograms (including digital subtraction angiography) per year performed for suspected PTE over the previous 3 years. The total number of V/Q lung scans performed for the diagnosis of PTE per year was approximately 47,000 compared with 490 pulmonary angiograms.

Despite publication of the Approved Code of Practice and the Notes for Guidance, implementation of the UK Ionising Radiation Regulations has required local interpretation by nuclear medicine departments. One problem has been the lack of data upon which decisions can be based. In the last five years we and others have made a number of measurements of radiation doses to staff relating to nuclear medicine practice. This paper collates, summarizes and comments on this information. Where possible, results have been expressed in relation to the workload of an average nuclear medicine department.

The current role of nuclear medicine in clinical diagnosis was surveyed in a retrospective review of medical records by two internists. About one radiologic imaging study in 20 was a radionuclide procedure, and a somewhat larger fraction was performed in outpatients. The internists found that diagnostic screening procedures in nuclear medicine influenced patient management in 63% of hospital inpatients, and quantitative/monitoring types of tests influenced management in 56%. Of the projected health care costs in the United States of $490 billion, all imaging procedures will account for only $12 billion, and nuclear medicine procedures will account for about $1 billion. Nuclear medicine research continues to blossom. The National Institutes of Health budget for diagnostic imaging research in fiscal year 1988 totaled $86.6 million; nuclear medicine projects represented 43% of this total, all other projects in radiology represented 30%, and projects outside radiology represented 30%. Research with positron emitters and positron emission tomography totaled $20.5 million, and research with radiolabeled monoclonal antibodies totaled $6.2 million. Two major problems may hinder the future practice of nuclear medicine in the United States compared with that in other developed countries: (a) the serious time lag in the approval process for new radiopharmaceuticals by the U.S. Food and Drug Administration and other agencies and (b) the lack of a facility dedicated to the continuous production of radionuclides for biomedical research. Now, there is sporadic production permitted only during high-energy physics experiments. The recent developments which will probably induce the greatest changes in clinical nuclear medicine in the near future are the improvements in design and utilization of single photon emission computed tomographic devices and prolific generation of new radiopharmaceuticals, especially technetium-99m agents for cerebral and myocardial imaging and tumor agents.