Search

Evidence supporting the potential contribution of targeted radiotherapy to the management of neuroendocrine tumours is now strong. Acting systemically, this is an effective option for patients with inoperable or multi-site disease. Toxicity is generally low, being limited to reversible myelosuppression and theoretical nephrotoxicity. Prerequisites for treatment success include demonstration of high tumour uptake relative to non-target tissues on quantitative diagnostic radionuclide imaging and stable haematological and biochemical function. In addition to 131 I metaiodobenzylguanidine therapy, which is now well established, there is growing interest in radiolabelled peptide therapy using a range of somatostatin receptor analogues such as 90 Y DOTATOC and 90 Y lanreotide. The results of clinical experience are summarised and the direction for future research is discussed. Endocrine-Related Cancer (2003) 10 497–501

Guidelines for the provision of physics support to nuclear medicine were published in 1999 by a joint working group of the British Institute of Radiology, the British Nuclear Medicine Society, and the Institute of Physics and Engineering in Medicine. Following publication of the guidelines, a survey was conducted by the working group to gather data on the actual level of physicist support in UK hospitals of different types and on the activities undertaken by physicists. The data were collected in the 12 months following the publication of guidelines and cover different hospital models and seven UK regions. The results provide evidence that many of the smaller units - small teaching hospitals and, particularly, small district general hospitals - have insufficient physics support. Although, on average, there is good agreement between the guidelines and the survey data for medium and large district general hospitals, there is wide variation in the level of physics provision between hospitals delivering apparently similar services. This emphasizes the need for national guidelines, against which institutions may be bench-marked and which may be used as a recommendation for the staffing levels necessary to ensure services are delivered safely and standards are not compromised. The complexity and variety of workload is an important factor in determining the level of physics support. As services develop, it is vital that this aspect is recognized to ensure that appropriate resources are available for the required physics input, even if any new service represents only a modest clinical throughput in terms of patient numbers.

Metaiodobenzylguanidine (MIBG) targeted radiotherapy is a promising treatment for malignant phaeochromocytoma. It is an effective palliative therapy and may influence prognosis by reducing tumour metabolic function and preventing excessive catecholamine secretion. Repeated treatments are necessary to achieve tumour arrest and disease regression, and it is essential that patients are followed closely for life. Toxicity is limited to myelosuppression but is cumulative. Bone marrow harvesting is recommended for all patients who are likely to undergo repeated treatments. Heightened clinical awareness and easier diagnosis of malignancy using MIBG scintigraphy are likely to result in an increasing number of referrals for treatment. It is essential, therefore, that experience is pooled from individual centres and that patients are treated according to agreed protocols, so that results can be directly compared.

OBJECTIVE—To evaluate the extent of intrapulmonary right to left shunting in children after bidirectional cavopulmonary anastomosis (BCPA). DESIGN—Prospective study of patients who underwent BCPA in a single centre. PATIENTS—17 patients with complex cyanotic congenital cardiac malformations who underwent BCPA at 1-45 months of age (median 21 months) were evaluated 15-64 months postoperatively (median 32 months). Five children between 1 and 10 years (median 5 years) with normal or surgically corrected intracardiac anatomy and peripheral pulmonary circulation who required V/Q scanning for other reasons were used as controls. INTERVENTIONS—All patients underwent cardiac catheterisation to exclude angiographically demonstrable venovenous collaterals followed by pulmonary perfusion scanning using 99mtechnetium (99mTc) labelled albumen microspheres to quantify the intrapulmonary right to left shunt. MAIN OUTCOME MEASURE—Percentage of intrapulmonary right to left shunt. RESULTS—The mean (SD) level of physiological right to left shunting found in the control group was 5.4 (2.3)%. All patients with BCPA showed the presence of a significantly higher level of intrapulmonary shunting (26.8 (16.9)%, p