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BackgroundTo determine genomic alterations in head and neck squamous cell carcinoma (HNSCC) using formalin-fixed, paraffin-embedded (FFPE) tumors obtained through routine clinical practice, selected cancer-related genes were evaluated and compared with alterations seen in frozen tumors obtained through research studies.Patients and methodsDNA samples obtained from 252 FFPE HNSCC were analyzed using next-generation sequencing-based (NGS) clinical assay to determine sequence and copy number variations in 236 cancer-related genes plus 47 introns from 19 genes frequently rearranged in cancer. Human papillomavirus (HPV) status was determined by presence of the HPV DNA sequence in all samples and corroborated with high-risk HPV in situ hybridization (ISH) and p16 immunohistochemical (IHC) staining in a subset of tumors. Sequencing data from 399 frozen tumors in The Cancer Genome Atlas and University of Chicago public datasets were analyzed for comparison.ResultsAmong 252 FFPE HNSCC, 84 (33%) were HPV positive and 168 (67%) were HPV negative by sequencing. A subset of 40 tumors with HPV ISH and p16 IHC results showed complete concordance with NGS-derived HPV status. The most common genes with genomic alterations were PIK3CA and PTEN in HPV-positive tumors and TP53 and CDKN2A/B in HPV-negative tumors. In the pathway analysis, the PI3K pathway in HPV-positive tumors and DNA repair-p53 and cell cycle pathways in HPV-negative tumors were frequently altered. The HPV-positive oropharynx and HPV-positive nasal cavity/paranasal sinus carcinoma shared similar mutational profiles.ConclusionThe genomic profile of FFPE HNSCC tumors obtained through routine clinical practice is comparable with frozen tumors studied in research setting, demonstrating the feasibility of comprehensive genomic profiling in a clinical setting. However, the clinical significance of these genomic alterations requires further investigation through application of these genomic profiles as integral biomarkers in clinical trials.

Background: This study examined the trajectory of health-related quality of life (HRQoL) for patients with clinical stage N0 HNSCC enrolled in ACRIN 6685 who underwent elective neck dissection(s)., Methods: HRQoL of 230 patients in the ACRIN 6685 trial was measured prospectively up to 2 years following surgery using the University of Washington Quality of Life instrument., Results: General Health Within the Last 7 Days did not differ significantly from baseline at any follow-up. General Health Relative to Before Cancer fell significantly by 5.8 points following surgery (p = 0.048), and then returned to 3.0 points above baseline at 1 year (p = 0.65). For Overall Quality of Life, HRQoL fell significantly by 4.3 points following surgery (p = 0.031) and then returned to levels not significantly different from baseline., Conclusions: Patients with stage N0 HNSCC experience significant declines in HRQoL immediately following surgery, including neck dissection, which recovers to near or better than baseline within 1-2 years., (© 2024 The Authors. Head & Neck published by Wiley Periodicals LLC.)

Extranodal extension of tumour on histopathology is known to be a negative prognostic factor in head and neck cancer. Compelling evidence suggests that extranodal extension detected on radiological imaging is also a negative prognostic factor. Furthermore, if imaging detected extranodal extension could be identified reliably before the start of treatment, it could be used to guide treatment selection, as patients might be better managed with non-surgical approaches to avoid the toxicity and cost of trimodality therapy (surgery, chemotherapy, and radiotherapy together). There are many aspects of imaging detected extranodal extension that remain unresolved or are without consensus, such as the criteria to best diagnose them and the associated terminology. The Head and Neck Cancer International Group conducted a five-round modified Delphi process with a group of 18 international radiology experts, representing 14 national clinical research groups. We generated consensus recommendations on the terminology and diagnostic criteria for imaging detected extranodal extension to harmonise clinical practice and research. These recommendations have been endorsed by 19 national and international organisations, representing 34 countries. We propose a new classification system to aid diagnosis, which was supported by most of the participating experts over existing systems, and which will require validation in the future. Additionally, we have created an online educational resource for grading imaging detected extranodal extensions., Competing Interests: Declaration of interests HM is the director and a shareholder of Warwickshire Head and Neck Clinic; Chair of the Head and Neck Cancer International Group; past President of the British Association of Head and Neck Oncologists; has received honoraria from AstraZeneca; served on speakers bureau for Merck Sharpe & Dohme (MSD) and Sanofi Pasteur; has received research funding from GSK Biologicals, MSD, Sanofi Pasteur, GSK, and AstraZeneca; and has received travel and accommodation expenses from Sanofi, Pasteur, and MSD. CG received royalties from Elsevier for authoring and editing books and chapters for Elsevier. WML is the Chair of the American Joint Committee on Cancer (ninth version) Head and Neck Task Force. All other authors declare no competing interests., (Copyright © 2024 Elsevier Ltd. All rights reserved, including those for text and data mining, AI training, and similar technologies.)

Significant improvement in molecular imaging and theranostics in the management of neuroendocrine tumors (NETs) has been made in the last few decades. Somatostatin receptor-targeted PET imaging outperforms conventional, planar, and single-photon emission computed tomography imaging and is indicated in the evaluation of these patients when available, resulting in a significant impact on staging, treatment response assessment, and restaging of these patients. Radionuclide therapy can have an impact on patient outcome in metastatic disease when not many treatment options are available., Competing Interests: Disclosure C. Marcus: No relevant disclosures. S. Muzahir: No relevant disclosures., (Copyright © 2023 Elsevier Inc. All rights reserved.)

This article focuses on the role of PET/computed tomography in evaluating and managing gastric cancer and colorectal cancer. The authors start with describing the common aspects of imaging with 2-deoxy-2- 18 F-d-glucose, followed by tumor-specific discussions of gastric and colorectal malignancies. Finally, the authors provide a brief overview of non-FDG tracers including their potential clinical applications, and describe future directions in imaging these malignancies., (Copyright © 2023 Elsevier Inc. All rights reserved.)

The clinical landscape of lymphomas has changed dramatically over the last 2 decades, including significant progress made in the understanding and utilization of imaging modalities and the available treatment options for both indolent and aggressive lymphomas. Since the introduction of hybrid PET/CT scanners in 2001, the indications of 18F-fluorodeoxyglucose (FDG) PET/CT in the management of lymphomas have grown rapidly. In today's clinical practice, FDG PET/CT is used in successful management of the vast majority patients with lymphomas., (Copyright © 2023 Elsevier Inc. All rights reserved.)

Objectives: This practice parameter was revised collaboratively by the American College of Radiology (ACR), the American College of Nuclear Medicine, the American Radium Society, the American Society for Radiation Oncology, and the Society of Nuclear Medicine and Molecular Imaging. The document is intended to serve as a resource for appropriately trained and licensed physicians who perform therapeutic procedures with unsealed sources, referred to in the document using the more inclusive terminology of radiopharmaceuticals, for which a written directive is required for authorized users under NRC 10 CFR 35.300., Methods: This practice parameter was developed according to the process described under the heading The Process for Developing ACR Practice Parameters and Technical Standards on the ACR website ( https://www.acr.org/Clinical-Resources/Practice-Parameters-and-Technical-Standards ) by the Committee on Practice Parameters-Radiation Oncology of the ACR Commission on Radiation Oncology in collaboration with the American Radium Society., Results: This practice parameter addresses the overall role of the applicable physician-authorized user, Qualified Medical Physicist, and other specialized personnel involved in the delivery of radiopharmaceutical therapy. Therapeutic radiopharmaceuticals include those administered as elemental radioactive isotopes (radionuclides) or the radioactive element incorporated into a targeting molecule (ligand) by one or more chemical bonds. This document provides guidance regarding general principles of radionuclide therapies and indications of various alpha, beta, gamma, and mixed emission agents with references to several recent practice parameters on new and commonly performed radiopharmaceutical therapies., Conclusion: This document addresses clinical circumstances, elements of available agents, and the qualifications and responsibilities of various members of the radiation care team, specifications of consultation and other clinical documentation, post-therapy follow-up, radiation safety precautions, elements of quality control and improvement programs, infection control, and patient education to ensure optimal patient care and safety when utilizing radiopharmaceuticals., (Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.)

During the last 2 decades, f-18 fluorodeoxyglucose positron emission tomography/computed tomography (18F FDG PET/CT) has transformed the clinical head and neck cancer imaging for patient management and predicting survival outcomes. It is now widely used for staging, radiotherapy planning, posttherapy assessment, and for detecting recurrence in head and neck cancers and is widely included in NCCN and other evidence based clinical practice guidelines. Future Directions would include evaluating the potential value of FAPI PET/CT for head and neck cancers, opportunity to use volumetric and tumor heterogeneity parameters and deploying AI in diagnostic and therapeutic assessments., Competing Interests: Disclosure No conflict of interest., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Prostate cancer is the second most prevalent cancer in men globally. De novo neuroendocrine prostate cancer (NEPC) is uncommon at initial diagnosis, however, (treatment-induced) t-NEPC emerges in up to 25% of prostate adenocarcinoma (PRAD) cases treated with androgen deprivation, carrying a drastically poor prognosis. The transition from PRAD to t-NEPC is underpinned by several key genetic mutations; TP53, RB1, and MYCN are the main genes implicated, bearing similarities to other neuroendocrine tumours. A broad range of epigenetic alterations, such as aberrations in DNA methylation, histone post-translational modifications, and non-coding RNAs, may drive lineage plasticity from PRAD to t-NEPC. The clinical diagnosis of NEPC is hampered by a lack of accessible biomarkers; recent advances in liquid biopsy techniques assessing circulating tumour cells and ctDNA in NEPC suggest that the advent of non-invasive means of monitoring progression to NEPC is on the horizon. Such techniques are vital for NEPC management; diagnosis of t-NEPC is crucial for implementing effective treatment, and precision medicine will be integral to providing the best outcomes for patients., (Copyright © 2024. Published by Elsevier Inc.)

Positron emission tomography (PET) imaging in prostate cancer has advanced significantly in the past decade with prostate cancer targeted radiopharmaceuticals now playing a growing role in diagnosis, staging, and treatment. This narrative review focuses on the most commonly used PET radiopharmaceuticals in the USA: prostate-specific membrane antigen (PSMA), fluciclovine, and choline. 18F-fluorodeoxyglucose (FDG) is used in many other malignancies, but rarely in prostate cancer. Previous literature is discussed regarding each radiopharmaceutical's utility in the settings of screening/diagnosis, initial staging, biochemical recurrence, advanced disease, and evaluation prior to targeted radiopharmaceutical therapy and radiation therapy. PET imaging has demonstrated utility over traditional imaging in various scenarios; however, there are few head-to-head studies comparing PET radiopharmaceuticals. PSMA radiopharmaceuticals are the newest tracers developed and have unique properties and uses, especially at low prostate-specific antigen (PSA) levels. However, each PET radiopharmaceutical has different properties which can affect image interpretation. Choline and fluciclovine have minimal urinary activity, whereas PSMA agents can have high urinary activity which may affect locoregional disease evaluation. Of the three radiopharmaceuticals, only PSMA is approved for both diagnostic and therapeutic indications with 177 Lu-PSMA. A variety of diagnostic PET radiotracers for prostate cancer allows for increased flexibility, especially in the setting of supply chain and medication shortages. For the time being, keeping a diverse group of PET radiopharmaceuticals for prostate cancer is justifiable., Competing Interests: The authors declare that there is no conflict of interest., (© The Author(s), 2023.)

Imaging of head and neck cancer at initial staging and as part of post-treatment surveillance is a key component of patient care as it guides treatment strategy and aids determination of prognosis. Head and neck cancer includes a heterogenous group of malignancies encompassing several anatomic sites and histologies, with squamous cell carcinoma the most common. Together this comprises the seventh most common cancer worldwide. At initial staging comprehensive imaging delineating the anatomic extent of the primary site, while also assessing the nodal involvement of the neck is necessary. The treatment of head and neck cancer often includes a combination of surgery, radiation, and chemotherapy. Post-treatment imaging is tailored for the evaluation of treatment response and early detection of local, locoregional, and distant recurrent tumor. Cross-sectional imaging with CT or MRI is recommended for the detailed anatomic delineation of the primary site. PET/CT provides complementary metabolic information and can map systemic involvement. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment., (Copyright © 2023 American College of Radiology. Published by Elsevier Inc. All rights reserved.)

Fibroblast-activation protein is a promising target for oncologic molecular imaging. Studies show that fibroblast activation protein inhibitor (FAPI) radiotracers are accurate diagnostics with favorable tumor-to-background ratios across various cancers. Therefore, we performed a systematic review and metaanalysis to assess the diagnostic performance of FAPI PET/CT in comparison with [ 18 F]FDG PET/CT, the most widely used radiotracer in oncology. Methods: We conducted a systematic search in MEDLINE, Embase, Scopus, PubMed, Cochrane Central Register of Controlled Trials, relevant trial registries, and bibliographies. The search consisted of combinations of terms for 3 topics: neoplasia, PET/CT, and FAPI. Two authors independently screened retrieved articles using predefined inclusion and exclusion criteria and extracted the data. Study quality was assessed using the criteria of QUADAS-2 (Quality Assessment of Diagnostic Accuracy Studies 2). For each study, the sensitivity, specificity, and 95% CIs were calculated to determine diagnostic accuracy for primary, nodal, and metastatic lesions. A random-effects metaanalysis was used for pooling the data, and heterogeneity was assessed (I 2 index). Results: Thirty-nine studies (1,259 patients) investigating the use of FAPI PET/CT were included. On a patient-based analysis, pooled sensitivity was 0.99 (95% CI, 0.97-1.0) for the detection of primary lesions. Pooled sensitivity for nodal and distant metastases was 0.91 (95% CI, 0.81-0.96) and 0.99 (95% CI, 0.96-1.0), respectively. On a paired analysis between FAPI and [ 18 F]FDG PET/CT, FAPI had a higher sensitivity in the detection of primary, nodal, and metastatic lesions (all P  < 0.001). The differences in sensitivities between FAPI and [ 18 F]FDG were statistically significant. In terms of heterogeneity, analyses on primary lesions were moderately affected, distant metastatic lesions were highly affected, and the nodal metastatic analyses had negligible heterogeneity. Conclusion: The diagnostic performance of FAPI PET/CT is superior to that of [ 18 F]FDG in the detection of primary, nodal, and distant metastases. However, further studies are needed to better evaluate its utility and indication in specific cancer types and clinical settings., (© 2023 by the Society of Nuclear Medicine and Molecular Imaging.)

Background: Pretreatment identification of pathological extranodal extension (ENE) would guide therapy de-escalation strategies for in human papillomavirus (HPV)-associated oropharyngeal carcinoma but is diagnostically challenging. ECOG-ACRIN Cancer Research Group E3311 was a multicentre trial wherein patients with HPV-associated oropharyngeal carcinoma were treated surgically and assigned to a pathological risk-based adjuvant strategy of observation, radiation, or concurrent chemoradiation. Despite protocol exclusion of patients with overt radiographic ENE, more than 30% had pathological ENE and required postoperative chemoradiation. We aimed to evaluate a CT-based deep learning algorithm for prediction of ENE in E3311, a diagnostically challenging cohort wherein algorithm use would be impactful in guiding decision-making., Methods: For this retrospective evaluation of deep learning algorithm performance, we obtained pretreatment CTs and corresponding surgical pathology reports from the multicentre, randomised de-escalation trial E3311. All enrolled patients on E3311 required pretreatment and diagnostic head and neck imaging; patients with radiographically overt ENE were excluded per study protocol. The lymph node with largest short-axis diameter and up to two additional nodes were segmented on each scan and annotated for ENE per pathology reports. Deep learning algorithm performance for ENE prediction was compared with four board-certified head and neck radiologists. The primary endpoint was the area under the curve (AUC) of the receiver operating characteristic., Findings: From 178 collected scans, 313 nodes were annotated: 71 (23%) with ENE in general, 39 (13%) with ENE larger than 1 mm ENE. The deep learning algorithm AUC for ENE classification was 0·86 (95% CI 0·82-0·90), outperforming all readers (p<0·0001 for each). Among radiologists, there was high variability in specificity (43-86%) and sensitivity (45-96%) with poor inter-reader agreement (κ 0·32). Matching the algorithm specificity to that of the reader with highest AUC (R2, false positive rate 22%) yielded improved sensitivity to 75% (+ 13%). Setting the algorithm false positive rate to 30% yielded 90% sensitivity. The algorithm showed improved performance compared with radiologists for ENE larger than 1 mm (p<0·0001) and in nodes with short-axis diameter 1 cm or larger., Interpretation: The deep learning algorithm outperformed experts in predicting pathological ENE on a challenging cohort of patients with HPV-associated oropharyngeal carcinoma from a randomised clinical trial. Deep learning algorithms should be evaluated prospectively as a treatment selection tool., Funding: ECOG-ACRIN Cancer Research Group and the National Cancer Institute of the US National Institutes of Health., Competing Interests: Declaration of interests BHK reports research support from the US National Institutes of Health (NIH; grant number K08DE030216-01) and the Radiological Society of North America, honoraria from Dedham Group, and stock options in Monogram Orthopedics. JDS reports research support paid to their institution from Merck, Bristol Myers Squibb (BMS), Regeneron, Debiopharm, and Merck KGA; consulting, scientific advisory board, and travel fees from Castle Biosciences, Genentech, Immunitas, Debiopharm, BMS, Nanobiotix, Tilos, AstraZeneca, LEK Consulting, Catenion, ACI Clinical, Astellas, Stimit, and Merck KGA; expert witness fees; stock options in Immunitas; and equity in Doximity. RH reports payment for consulting from Celgene, Nanobiotix, ISA, Merck, Eisai, BMS, AstraZeneca, Pfizer, Loxo, Genentech, Immunomic Therapeutics, GlaxoSmithKline, Gilead Sciences, Vaccinex, Emmanuel Merck Darmstadt (EMD), Serono, BioNTech, Achilles Therapeutics, Bayer, Coherus Biosciences, Boehringer Ingelheim, and Mirati Therapeutics; and research funding from Boehringer Ingelheim, Merck, BMS, Celgene, AstraZeneca, Genentech, Pfizer, Kura Oncology, EMD, and Serono. SA reports research support from the Agency for Healthcare Research and Quality, National Cancer Institute, National Science Foundation, American Cancer Society, American Society of Clinical Oncology, Amazon, and Patterson Trust; fees from American Society of Clinical Oncology, HighCape Capital, Emmerson Collective; and stock options in Prophet Brand Strategy. HJWLA reports research support from NIH (grant numbers U24CA194354, U01CA190234, U01CA209414, and R35CA22052), and the European Union—European research Council (grant number 866504) and stock and other ownership interests in Onc.Ai, Love Health, Health-AI, and Bayerische Motoren Werke AG. BAB reports a consulting or advisory role with Merck, Debiopharm Group, CUE Biopharma, Maverick Therapeutics, Rakuten Medical, Nanobiotix, Macrogenics, ALX Oncology, IO Biotech, Ipsen, Genentech/Roche, Kura Oncology, Merck KGA, Pharmaceutical Product Development Global, and Exelixis; research funding to their institution from Merck, Aduro Biotech, Formation Biologics, BMS, and CUE Biopharma; and travel, accommodations, or expenses from Merck and Debiopharm Group. RLF reports stock and other ownership interests in Novasenta; a consulting or advisory role with Merck, Pfizer, EMD Serono, Numab, Macrogenics, Aduro Biotech, Novasenta, Sanofi, Zymeworks, and BMS; and research funding from Bristol Myers Squibb, AstraZeneca/MedImmune, Merck, Tesaro, and Novasenta. All other authors declare no competing interests., (Copyright © 2023 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY-NC-ND 4.0 license. Published by Elsevier Ltd.. All rights reserved.)

Objective: Intratumor heterogeneity has prognostic value in cervical cancer, which can be depicted on 18 F-fluorodeoxyglucose ( 18 F-FDG) PET/computed tomography (PET/CT) and then quantitatively characterized by texture features. This study aimed to evaluate the discriminative performance and predictive ability of the texture features in determining lymph node involvement in cervical cancer., Methods: A total of 101 patients with newly diagnosed cervical cancer, who underwent pre-treatment whole-body 18 F-FDG PET/CT imaging were retrospectively recruited. Patients were categorized based on their nodal status. Thirty-five radiomic features together with the maximum standardized uptake value (SUVmax), metabolic tumor volume (MTV) and total lesion glycolysis (TLG) of the primary cervical tumors were extracted. Conventional indices were used to build logistic regression model and texture features were used to build random forest model. The performances for differentiating nodal status were assessed by receiver operating characteristic analysis., Results: Conventional PET indices were significantly higher in patients with nodal involvement compared to those without: SUVmax = 14.22 vs. 10.05; MTV = 57.02 vs. 28.73; TLG = 492.8 vs. 188.8 ( P  < 0.05). Nineteen radiomic features describing regional heterogeneity were significantly different between nodal involvements. Area under the curves of the models with conventional indices and PET texture features for discriminating nodal status were 0.72 and 0.76, respectively., Conclusion: PET-derived radiomic features had moderate performance in discriminating nodal involvement in cervical cancer; and they did not outperform model based on conventional indices., (Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.)

Gastroenteropancreatic neuroendocrine tumors(NETs), which arise from the small intestine, rectum, colon, appendix, or pancreas, have variable malignant potential with clinical behavior determined by proliferative activity according to the Ki-67 index and tumor differentiation. Somatostatin receptor (SSTR) expression by NETs allows SSTR imaging using 68Ga-DOTATATE PET/computed tomography (CT) and treatment with octreotide or SSTR-targeted peptide receptor radionuclide therapy (PRRT). 68Ga-DOTATATE PET/CT is indicated for localization of the primary tumor in select cases, staging patients with known NET, and selecting patients for PRRT. NCCN guidelines consider imaging with 68Ga-DOTATATE PET/CT appropriate for staging and receptor status assessment., Competing Interests: Disclosure The authors have nothing to disclose., (Copyright © 2022 Elsevier Inc. All rights reserved.)

Molecular imaging evaluation of pheochromocytomas and paragangliomas depends on multiple factors, such as localized versus metastatic disease, the genetic, and biochemical profile of tumors. Positron emission tomography/computed tomography (PET/CT) imaging of these tumors outperforms Meta-Iodo-Benzyl-Guanidine (MIBG) scintigraphy in most cases. A few PET radiotracers have been studied in evaluating these patients with somatostatin receptor PET imaging and have shown superior performance compared with other agents in most of these patients. 18F-fluorodeoxyglucose PET/CT imaging is useful in select patients, such as those with succinate dehydrogenase complex subunit B-associated disease. Treatment strategy depends on multiple factors and necessitates a multidisciplinary approach., (Copyright © 2022 Elsevier Inc. All rights reserved.)

Neuroendocrine tumors have variety of biological and clinical characteristics. The classification of neuroendocrine neoplasm has evolved, and the newest 2019 World Health Organization classification outlines a well-differentiated high-grade G3 subtype, recognizing its differences from the poorly differentiated neuroendocrine carcinoma.  68 Ga-DOTAT PET has largely replaced somatostatin scintigraphy as the diagnostic workup choice for NENs. NETest, a multi-analyte liquid biopsy, is a promising recent development in the biochemical diagnosis. Management includes wait and watch approach, surgical resection, somatostatin analogs,  177 Lu DOTATATE therapy, chemotherapy, radiotherapy or immunotherapy combinations. Further clinical trials are necessary for determining the appropriate sequencing., Competing Interests: Disclosure The authors have nothing to disclose., (Copyright © 2022 Elsevier Inc. All rights reserved.)

Introduction: Medical imaging is integrated across all years in the medical programs at the Medical School, in our country. Little is known about this pedagogical approach from the perspective of those who participate in it. This study investigated how students and educators experience an integrated medical imaging curriculum., Methods: One-on-one interviews were conducted with nine educators and three undergraduate medical students and analyzed using a reflexive thematic approach. Educators included radiologists, non-radiologists clinicians, and scientists and health professionals from the medical program., Results: The integrated medical imaging curriculum appears to be incoherently experienced by educators and students as learning opportunities that were 'everywhere and nowhere'. Teaching events were 'repetitive and patchy' and featured a transmission-oriented pedagogy emphasizing 'exposure and absorption'. Educators expressed paradoxical views of their responsibility for teaching medical imaging reflected in this sentiment: 'I don't teach medical imaging… (but I do)'., Discussion: When medical imaging is integrated into learning resources and course work across the undergraduate program, it may lose its visibility and importance as a distinct learning area despite its crucial role in medical practice. An integrated curriculum may inadvertently separate knowing about medical imaging from learning to apply medical imaging knowledge in clinical practice., Conclusions: Further work is required to construct an integrated medical imaging curriculum that explicitly emphasizes medical imaging learning outcomes, so they are experienced coherently and consistently by medical students and those who prepare them for practice as doctors., (Copyright © 2022 The Association of University Radiologists. Published by Elsevier Inc. All rights reserved.)

Recently, advancement of somatostatin receptor (SSTR) imaging and theragnostic approach using peptide receptor radionuclide therapy (PRRT) have changed the paradigm of diagnosis and management of neuroendocrine tumor. 68Ga-DOTATATE PET/CT can diagnose the lung carcinoids with high SSTR expression. With combination of 68Ga-DOTATATE PET/CT and 18F-FDG PET/CT, tumor heterogeneity of lung carcinoid can be identified, which may guide optimal patient selection for PRRT. PRRT may be an effective and safe treatment of advanced lung carcinoids during progression with first-line somatostatin analog therapy. This review provides updates on the diagnosis and management of lung carcinoids, focusing on SSTR imaging and PRRT., (Copyright © 2022 Elsevier Inc. All rights reserved.)

177Lu-DOTA-TATE therapy is a highly effective therapy in metastatic, well-differentiated, somatostatin receptor-positive GEP-neuroendocrine tumors (NETs) with mostly tolerable adverse effects. Guidelines generally refer to peptide receptor radionuclide therapy as a second-line therapy after SSA in gastroenteric and second- or third-line therapy in pancreatic NETs to improve survival rates and quality of life. Although we do not have sufficient data, 177Lu-DOTA-TATE therapy may also have a role in high-grade NET therapy, mostly in combination with other treatments such as chemotherapy., (Copyright © 2022 Elsevier Inc. All rights reserved.)

Neuroendocrine neoplasms (NENs) are a group of rare, heterogeneous tumors of neuroendocrine cell origin, affecting a range of different organs. The clinical management of NENs poses significant challenges, as tumors are often diagnosed at an advanced stage where overall survival remains poor with current treatment regimens. In addition, a host of complex and often unique molecular changes underpin the pathobiology of each NEN subtype. Exploitation of the unique genetic and epigenetic signatures driving each NEN subtype provides an opportunity to enhance the diagnosis, treatment, and monitoring of NEN in an emerging era of individualized medicine., (Copyright © 2022 Elsevier Inc. All rights reserved.)

Introduction Information on the responsiveness of the New Zealand (NZ) health system to Asians to enable navigation of healthcare services is currently lacking. Barriers experienced by Asian patients to enable optimal navigation of, and engagement with, healthcare services are also sparse. Aim This research aimed to: (1) document and analyse resources available on the websites of general practices that aid in optimal health care navigation for NZ Asians; and (2) explore the barriers perceived by Asian migrants to navigating the NZ Health System, particularly primary care. Methods This study involved qualitative document analysis of existing resources on general practice websites. Information on perceived barriers and experiences of navigating the health system was collected through semi-structured interviews (n  = 9). Results Overall, 293 general practice websites were analysed. The themes from content analysis were: availability of basic information, linguistic accessibility, and culturally appropriate support for patients. Relevant and reliable information facilitating effective navigation of the NZ health system by Asians was lacking. Interview data supported the findings about the general practices, with participants reporting significant difficulties navigating and understanding NZ primary care services. Discussion Current navigational resources presume knowledge that Asian migrants do not often possess. Participants felt this lack of accessible information acutely, and it influenced how they perceived and engaged with healthcare services. Increased accessibility through resources in Asian languages, including an overview of how Health NZ functions in providing health care and professional interpreter services, would be critical to increase appropriate engagement with healthcare services and thus contribute to better health outcomes for Asians.

The purpose of this study was to determine the negative predictive value (NPV) of a 12- to 14-wk posttreatment PET/CT for 2-y progression-free survival (PFS) and locoregional control (LRC) in patients with p16-positive locoregionally advanced oropharyngeal cancer (LA-OPC). Study was a secondary endpoint in NRG-HN002, a noncomparative phase II trial in p16-positive LA-OPC, stage T1-T2, N1-N2b or T3, N0-N2b, and ≤10 pack-year smoking. Patients were randomized in a 1:1 ratio to reduced-dose intensity-modulated radiotherapy (IMRT) with or without cisplatin. Methods: PET/CT scans were reviewed centrally. Tumor response evaluations for the primary site, right neck, and left neck were performed using a 5-point ordinal scale (Hopkins criteria). Overall scores were then assigned as negative, positive, or indeterminate. Patients with a negative score for all 3 evaluation sites were given an overall score of negative. The hypotheses were NPV for PFS and LRC at 2-y posttreatment ≤ 90% versus >90% (1-sided P value, 0.10). Results: A total of 316 patients were enrolled, of whom 306 were randomized and eligible. Of these, 131 (42.8%) patients consented to a posttherapy PET/CT, and 117 (89.3%) patients were eligible for PET/CT analysis. The median time from the end of treatment to PET/CT scan was 94 d (range, 52-139 d). Estimated 2-y PFS and LRC rates in the analysis subgroup were 91.3% (95% CI, 84.6, 95.8%) and 93.8% (95% CI, 87.6, 97.5%), respectively. Posttreatment scans were negative for residual tumor for 115 patients (98.3%) and positive for 2 patients (1.7%). NPV for 2-y PFS was 92.0% (90% lower confidence bound [LCB] 87.7%; P = 0.30) and for LRC was 94.5% (90% LCB 90.6%; P = 0.07). Conclusion: In the context of deintensification with reduced-dose radiation, the NPV of a 12- to 14-wk posttherapy PET/CT for 2-y LRC is estimated to be >90%, similar to that reported for patients receiving standard chemoradiation. However, there is insufficient evidence to conclude that the NPV is >90% for PFS., (© 2023 by the Society of Nuclear Medicine and Molecular Imaging.)

Purpose: To provide evidence-based recommendations for practicing physicians and other health care providers on immunotherapy and biomarker testing for head and neck cancers., Methods: ASCO convened an Expert Panel of medical oncology, surgical oncology, radiation oncology, radiology, pathology, and patient advocacy experts to conduct a literature search, including systematic reviews, meta-analyses, randomized controlled trials, and prospective and retrospective comparative observational studies published from 2000 through 2022. Outcomes of interest included survival, overall response, and locoregional control. Expert Panel members used available evidence and informal consensus to develop evidence-based guideline recommendations., Results: The literature search identified 28 relevant studies to inform the evidence base for this guideline., Recommendations: When possible, evidence-based recommendations were developed to address biomarker testing, first-line treatment regimens based on programmed death ligand-1 scores, immunotherapy in platinum-refractory recurrent or metastatic head and neck squamous cell carcinoma, immunotherapy in nasopharyngeal carcinoma, and radiation therapy in combination with immunotherapy for treatment of local recurrence.Additional information is available at www.asco.org/head-neck-cancer-guidelines.

Introduction: FDG PET/CT was prospectively studied in 287 cN0 head and neck cancer patients in ACRIN 6685, and additional analysis of neck FDG uptake upon recurrence-free survival (RFS) and overall survival (OS) was performed., Patients and Methods: Two hundred eight had analyzable data. Survival analysis was performed to compare RFS and OS based on neck FDG visual assessment (VA) and SUV max . For SUV max , the optimal thresholds were calculated using conditional inference trees on a randomly selected 70% training data set and validated using the remaining 30% of data. Kaplan-Meier curves with log-rank tests were generated for the patient groups based on VA and optimal SUV max thresholds, and the hazards ratios (HRs) and 95% confidence intervals (CIs) were also calculated. Hypothesis testing was set at a significance level of 0.05., Results: A total of 73.9% of bilateral cN0 and 50.0% of unilateral cN0 were alive at the end of the study with the remaining being dead or lost to follow-up. Overall survival median follow-up time was 24.0 months (interquartile range, 15.8-25.3; range, 0-37.0). A total of 63.3% of bilateral cN0 and 42.5% of unilateral cN0 patients remained disease free during the study. Recurrence-free survival median follow-up time was 23.9 months (interquartile range, 12.4-25.2; range, 0-35.6). Visual assessment of necks by our panel of radiologists was significantly associated with RFS (HR [95% CI], 2.30 [1.10-4.79]; P = 0.02), but not with OS (HR [95% CI], 1.64 [0.86-3.14]; P = 0.13). The optimal SUV max thresholds were 2.5 for RFS and 5.0 for OS. For SUV max assessment, applying the optimal thresholds to the 30% test data yielded HRs (95% CIs) of 2.09 (0.61-7.14; P = 0.23) for RFS and 3.42 (1.03-11.41; P = 0.03) for OS. The SUV max threshold of 5.0 was significantly associated with RFS (HR [95% CI], 5.92 [1.79-19.57]; P < 0.001)., Conclusions: Neck FDG uptake by VA is significant for RFS. An SUV max threshold of 5.0 is significantly associated with OS and RFS., Competing Interests: Conflicts of interest and sources of funding: The authors declare that they have no conflicts of interest. This study was supported by the National Cancer Institute through grants no.U01 CA079778, U01 CA080098, CA180820, and CA180794. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health, nor does mention of trade names, commercial products, or organizations imply endorsement by the US government., (Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.)

To our knowledge, no prior multicenter clinical trial has reported interobserver agreement of 18 F-FDG PET/CT scans for staging of clinical N0 neck in head and neck cancer. Methods: A total of 287 participants were recruited. For visual analysis, positive nodal uptake of 18 F-FDG was defined as uptake visually greater than activity seen in the blood pool. Results: The negative predictive value of the 18 F-FDG PET/CT for N0 clinical neck was 86% or above for visual assessment (95% CI, 86%-88%) for the 2 central readers and above 90% (95% CI, 90%-95%) for SUV max for central reads and site reads dichotomized at the optimal cutoff value of 1.8 and the prespecified cutoff value of 3.5, respectively. The κ coefficients between the 2 expert readers and between central reads and site reads varied between 0.53 and 0.78. Conclusion: The NPV of the 18 F-FDG PET/CT for N0 clinical neck was 86% or above for visual assessment and above 90% for SUV max cut points of 1.8 and 3.5 with moderate to substantial agreements., (© 2022 by the Society of Nuclear Medicine and Molecular Imaging.)

Lung cancer is the leading cause of cancer-related mortality in the United States. Accurate staging at initial diagnosis determines appropriate treatment and is the most important predictor of survival. Since 2018, the 8th edition of the TNM staging system has been used to stage lung cancer based on local tumor extent (T), nodal involvement (N), and metastases (M). 18 F fluorodeoxyglucose (FDG) PET/CT, which combines functional and anatomic imaging, is the standard of care and an integral part of clinical staging of patients with lung cancer. Malignant pleural mesothelioma (MPM), the most common primary malignant pleural tumor affecting the pleura is staged with 8th edition of TNM staging for MPM. 18 F FDG PET/CT is indicated in select patients who are surgical candidates to identify locally advanced tumor, nodal metastases, or extrathoracic metastases, which may preclude surgery., (Copyright © 2022 Elsevier Inc. All rights reserved.)

Abstract: PET imaging plays an essential role in achieving earlier and more specific diagnoses of dementia syndromes, important for clinical prognostication and optimal medical management. This has become especially vital with the recent development of pathology-specific disease-modifying therapy for Alzheimer disease, which will continue to evolve and require methods to select appropriate treatment candidates. Techniques that began as research tools such as amyloid and tau PET have now entered clinical use, making nuclear medicine physicians and radiologists essential members of the care team. This review discusses recent changes in the understanding of dementia and examines the roles of nuclear medicine imaging in clinical practice. Within this framework, multiple cases will be shown to illustrate a systematic approach of FDG PET interpretation and integration of PET imaging of specific molecular pathology including dopamine transporters, amyloid, and tau. The approach presented here incorporates contemporary understanding of both common and uncommon dementia syndromes, intended as an updated practical guide to assist with the sophisticated interpretation of nuclear medicine examinations in the context of this rapidly and continually developing area of imaging., Competing Interests: Conflicts of interest and sources of funding: none declared., (Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.)

Objectives: This practice parameter (PP) for Lutetium-177 (Lu-177) DOTATATE peptide receptor radionuclide therapy (PRRT) aims to guide authorized users in selection of appropriate adult candidates with gastroeneropancreatic neuroendocrine tumors (GEP-NETs) from foregut, midgut, and hindgut. The essential selection criteria include somatostatin receptor-positive GEP-NETs, which are usually inoperable and progressed despite standard therapy. Lu-177 DOTATATE is a radiopharmaceutical with high avidity for somatostatin receptors that are overexpressed by these tumors. This document ensures safe handling of Lu-177 DOTATATE by the authorized users and safe management of affected patients., Methods: The document was developed according to the systematic process developed by the American College of Radiology (ACR) and described on the ACR Web site (https://www.acr.org/Clinical-Resources/Practice-Parameters-and-Technical-Standards). The PP development was led by 2 ACR Committees on Practice Parameters (Nuclear Medicine and Molecular Imaging and Radiation Oncology) collaboratively with the American College of Nuclear Medicine, American Society of Radiation Oncology, and Society of Nuclear Medicine and Molecular Imaging., Results: The Lu-177 DOTATATE PP reviewed pharmacology, indications, adverse effects, personnel qualifications, and required clinical evaluation before starting the treatment, as well as the recommended posttherapy monitoring, quality assurance, documentation, and appropriate radiation safety instructions provided in written form and explained to the patients., Conclusions: Lu-177 DOTATATE is available for therapy of inoperable and/or advanced GEP-NETs when conventional therapy had failed. It can reduce tumor size, improve symptoms, and increase the progression free survival. The PP document provides clinical guidance for authorized users to assure an appropriate, consistent, and safe practice of Lu-177 DOTATATE., Competing Interests: Conflicts of interest and sources of funding: N.B.D. reports a grant from Boston Scientific, consulting fees from Boston Scientific, and honoraria from MedLearning. L.B. reports a grant from AAA Novartis, and participation on an advisory board for AAA Novartis. R.K.J.B. reports participation on an advisory board for Covera Health. E.C.G. reports consulting fees from Advanced Accelerator Applications. R.F.H. reports funding from National Institutes of Health/National Cancer Institute, and a leadership role as Chairman of the Radiopharmaceutical Therapy Subcommittee of the American Association of Physicists in Medicine. T.A.H. reports grants or contracts from Philips and Clovis Oncology, consulting fees from Curium and ITM, and participation on advisory boards for Ipsen and Blue Earth Diagnostics. D.A.P. reports grants from Siemens, Nordic Nanovector, Progenics, and 511 Pharma, and consulting fees from Siemens, 511 Pharma, Progenics, Actinium, and Ipsen. B.S.-B. reports a grant from Blue Earth Diagnostics, honoraria from PETNET and Blue Earth Diagnostics, and a leadership role as Society of Nuclear Medicine and Molecular Imaging (SNMMI) co-chair of outreach committee secretary of American College of Nuclear Medicine, Central Chapter SNMMI, and Academic Council SNMMI. R.M.S. reports a grant from Endocyte Inc. For the remaining authors, none were declared., (Copyright © 2022 Clinical Nuclear Medicine and American Journal of Clinical Oncology.)

This article presents guidelines for initial imaging utilization in patients presenting with sinonasal disease, including acute rhinosinusitis without and with suspected orbital and intracranial complications, chronic rhinosinusitis, suspected invasive fungal sinusitis, suspected sinonasal mass, and suspected cerebrospinal fluid leak. CT and MRI are the primary imaging modalities used to evaluate patients with sinonasal disease. Given its detailed depiction of bony anatomy, CT can accurately demonstrate the presence of sinonasal disease, bony erosions, and anatomic variants, and is essential for surgical planning. Given its superior soft tissue contrast, MRI can accurately identify clinically suspected intracranial and intraorbital complications, delineate soft tissue extension of tumor and distinguish mass from obstructed secretions.The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment., (Copyright © 2022 American College of Radiology. Published by Elsevier Inc. All rights reserved.)

The COVID-19 global pandemic has highlighted the potential roles and responsibilities of medical students in healthcare systems. Senior clinical students may be able to contribute practically, but all medical students, regardless of their level of training have the opportunity to assist public health measures, eg supporting vaccination uptake. Medical students may tread a difficult line in such situations. On one hand, students are advised not to act beyond their level of expertise, yet they can feel an expectation to be authoritative by the community. Navigating these spaces can be challenging for medical students and an important part of their professional development., Competing Interests: Nil.

18 F-FDG-PET/CT (2-deoxy-2-[ 18 F] fluoro-d-glucose PET/computed tomography) is a reliable modality for accurate assessment of treatment response, early detection of recurrence, or second primary tumors in head and neck squamous cell carcinoma (HNSCC), if performed at the appropriate time after therapy. This review focuses on the utility of posttreatment 18 F-FDG-PET/CT in HNSCC, reviews the expected imaging findings and pitfalls after treatments, summarizes common 18 F-FDG-based quantitative and qualitative response assessment methods, and discusses the value of imaging surveillance in HNSCC. We also provide an overview of recently approved immune checkpoint inhibitors in HNSCC and current recommendations on immunotherapy-response monitoring., (Copyright © 2021 Elsevier Inc. All rights reserved.)

PET/computed tomography (CT) is a valuable tool in post-therapy follow-up of head and neck cancers. PET/CT is sensitive and specific, can detect recurrences that otherwise may be missed on routine clinical examination or conventional imaging, and also can have an impact on patient management. National Comprehensive Cancer Network guidelines recommend PET/CT be performed within 3 months to 6 months after therapy. After this baseline scan, however, further routine PET/CT surveillance in asymptomatic patients has unclear benefit. Additional post-therapy PET/CT imaging should be individualized to patients based on considerations such as tumor type, stage, prognostic factors, symptoms, and clinical assessment., Competing Interests: Disclosure The authors have nothing to disclose., (Copyright © 2021 Elsevier Inc. All rights reserved.)

Fluorine-18 fluorodeoxyglucose PET/computed tomography ( 18 F-FDG PET/CT) plays an important role in the staging, treatment planning, treatment response assessment, detecting recurrent disease, and predicting prognosis in patients with oral cavity and oropharyngeal squamous cell carcinoma. PET/CT has advantage especially in the detection of nodal, distant metastatic disease and second primary malignancy. PET/MR provides superior soft tissue contrast while decreasing radiation exposure, which is advantageous in evaluation of the primary tumor., Competing Interests: Disclosure The authors have nothing to disclose., (Copyright © 2021 Elsevier Inc. All rights reserved.)

Treatment of laryngeal and hypopharyngeal tumors with surgery, radiation therapy, and chemotherapy is aimed at improving survival and preserving function. PET with fluorodeoxyglucose F 18 ( 18 F FDG-PET)/computed tomography is the standard of care and an integral part of staging and treatment response assessment in patients with laryngeal and hypopharyngeal cancers. Knowledge of cross-sectional laryngeal and hypopharyngeal anatomy, expected patterns of tumor spread, and awareness of physiologic FDG uptake in head and neck structures is essential for accurate TNM staging. 18 F FDG-PET/computed tomography is superior to anatomic imaging in identifying posttreatment local, regional, and distant tumor recurrence., Competing Interests: Disclosure The authors have nothing to disclose., (Copyright © 2021 Elsevier Inc. All rights reserved.)