Year 2023, Volume 13 - Issue 1

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Over the past few decades, the incidence of thyroid cancer, which was once a relatively uncommon aspect of oncology, has significantly increased worldwide. This tendency makes opening of new horizons, and finding new modalities for both its diagnosis and therapy all the more crucial. The concept of theranostics in thyroid cancer has shown potential in individualizing treatments, tailoring therapies to the specific molecular characteristics of the patient's cancer.

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Papillary thyroid cancer (PTC) is the most prevalent and indolent thyroid cancer, but still, around 20% of cases will develop regional recurrence or distant metastasis. Isolated or coexistent BRAF V600E and pTERT mutations in thyroid cancer are associated with poor clinical outcomes. The prior knowledge of BRAF V600E and pTERT mutation may help to identify the cases that may recur or become refractory to standard radioactive iodine treatment. Such cases could be treated initially with complete disease eradication through extensive surgery followed by maximum permissible high-dose radioactive I-131 ablation and vigilant follow-up. Conventional risk assessment coupled with genotype-based risk assessment can help in the precise management of aggressive thyroid cancers.

Prostate cancer (PCa) is the 2nd most common malignancy in males and the leading cause of cancer-related deaths among men. In recent years, novel therapies have emerged for metastatic castration-resistant prostate cancer (mCRPC) including immunotherapy, androgen-receptor signaling inhibitors, and radio-nuclide therapies. DNA Damage Repair (DDR) genes are frequently mutated in advance PCa and are useful biomarkers for targeted therapy such as poly-ADP ribose polymerase (PARP) inhibitors. DDR gene defects may affect tissue radio-sensitivity and could serve as biomarkers for therapy with alpha and beta-emitting radionuclides. Preliminary clinical reports suggest a potential trend toward longer survival in DDR+ subjects when treated with α-emitters, however, survival benefit was not significant in patients treated with β-emitting radionuclides. A comprehensive study regarding the impact of DDR genes in prostate cancer patients treated with alpha emitters is vital.

Background Technitium-99m (99mTc) is a widely used radioisotope for the diagnostic procedures in nuclear medicine. The radioisotope is eluted from 99Mo/99mTc generator. Ideally there should be no Molybdenum-99 (99Mo) or any other contamination; however, sometimes traces of 99Mo are co-eluted from the generator. This impurity interferes labeling of 99mTc with pharmaceuticals result in poor quality radiopharmaceutical and unnecessary exposure to patients. The purpose of this study is to assess the contamination level of 99Mo in the eluted activity of 99mTc used for the diagnostic procedures at Swat Institute of Nuclear Medicine, Oncology and Radiotherapy (SINOR), Swat Pakistan. Also the purpose is to check the integrity of the generators being transported by road, and it is a part of quality audit of PAKGEN 99Mo/99mTc generators. Methods The data was collected for 166-PAKGEN 99Mo/99mTc generators used over 6 years at SINOR. The generators were procured from Isotope Production Division (IPD), Pakistan Institute of Nuclear Science and Technology (PINSTECH), Islamabad, Pakistan. The 99Mo impurity concentration was measured for each elution with dose calibrator (Capintech Inc. CRC-25R) and canister. Results Results for most of the generators (99.4%) were within the permissible limit (0.15 μCi of 99Mo/mCi of 99mTc) as per Pakistan Nuclear Regulatory Authority (PNRA), Nuclear Regulatory Commission (NRC), and other regulatory authorities. Only one generator (0.6%) had the values out of range. Conclusion 99Mo breakthrough concentration for most of the generators was within permissible range which shows integrity of 99Mo/99mTc PAKGEN generators and approves the quality of locally prepared 99Mo/99mTc PAKGEN generators. The study replicates excellent manufacturing and quality control of PAKGEN generators which offers a confirmation of safe medical practices.

Background: Radiation workers have reported that some errors during measurement of radioiodine-131 activities have been observed, which may result poor quality images, greater radioactive waste and financial burden in the hospital. The purpose of this retrospective study was to estimate the net percent errors in radioiodine-131 activities during administration to thyroid patients and give some fruitful suggestions to reduce such errors.

Methods: We included180 random patients i.e. thirty for each advised activity of 3 mCi, 15 mCi, 20 mCi, 25 mCi, 30 mCi and 150 mCi in this study from January 2019 to June 2022. All the recommended activities were measured with CRC-25R dose calibrator. The percent difference in the measured & prescribed activities and percent difference in the measured & residual activities were estimated. Finally, the net percent errors in administered activities were measured for all patients.

Results: The net percent error in recommended activities of 3 mCi, 15 mCi, 20 mCi, 25 mCi, 30 mCi & 150 mCi and administered activities were [6.73 (-32.7, 20.95) ± 11.15] %, [3.91 (-3.85, 8.77) ± 2.94] %, [3.63 (-2.39, 7.79) ± 2.51] %, [3.55 (-0.65, 10.67) ±2.6] %, [2.93 (-1.98, 6.78) ± 1.89] % & [0.88 (-1.04, 2.68) ±0.87] % respectively.

Conclusion: This study concludes that the patients receive approximately 6.73%, 3.91%, 3.63 %, 3.55 %, 2.93 % and 0.88 % less activities than the aforementioned activities respectively. The net percent error in radioiodine-131 activities is not alarming, but needs to be adjusted in order to ensure high quality images and optimum dose delivery.

ABSTRACT Background: Bone lesions in children are very common and can be benign or malignant. Benign bone lesions, fortunately, are more common as compared to rare malignant neoplasms of bone. Osteosarcoma and Ewing sarcoma are the most common malignant bone tumors in younger age group. Multimodality imaging plays a major role in bridging the gap between clinical diagnosis and final diagnosis Case Presentation: We present here a case of 8-year-old male patient complained of progressive soft tissue swelling and pain in left thigh from 25-30 days. His X-ray of left femur showed a mixed density, predominantly sclerotic lesion involving mid-diaphysis. His contrast enhanced MRI of left thigh showed large, ill-defined, abnormal signal intensity medullary lesion seen in left femur involving mid to lower diaphyseal shaft, extending to metaphyseal region. His 99mTc MDP bone scintigraphy was done showing abnormal radiotracer uptake in lower half of left femur and adjoining soft tissue. Conclusion: Single modality imaging may not be enough in predicting the true extent of bone pathologies. Multimodality imaging plays a major role in characterizing the lesions to differentiate benign from malignant and bridging the gap between clinical diagnosis and final diagnosis. Keywords: Osteosarcoma, Ewing sarcoma, 99mTc MDP bone scintigraphy, case report

Background: Osteopoikilosis is a benign, uncommon disorder that is inherited by the autosomal dominant gene. Multiple benign enostoses are present in this specific kind of sclerosing skeletal dysplasia, which can be mistaken for osteoblastic skeletal metastases. Case Presentation: We present here a case of 50-year-old male patient with pain in lower back for 3 months. His pelvic X-ray showed few sclerotic rounded lesions in ilium, acetabulum and proximal femur. His MRI pelvis showed T1WI and T2WI hypo intense focal lesions in ilium and acetabulum. His 99mTc MDP bone scan was done showing no focal abnormal uptake in lesion reported on pelvic X-ray and MRI. These features are suggestive of Osteopoikilosis, ruling out osteoblastic skeletal metastasis. Conclusion: Osteopoikilosis is usually an incidental finding on radiograph. Both x-ray and MRI findings can mimic skeletal metastasis, but a normal bone scan can rule out metastasis and is useful if metastatic disease is thought to be a possibility.

Background: Bone scintigraphy with 99mTc-labelled diphosphonates can identify prostate cancer (PCa) bone metastases with high sensitivity but relatively low specificity. Single photon emission computed tomography /computed tomography (SPECT/CT) can add value to the planar bone scintigraphy in the detection of bone metastases. Case presentation: We present a diagnosed case of Prostatic Adenocarcinoma of a 62 year old male patient who underwent 99mTc-Methyldiphosphonate (MDP) planar bone scintigraphy followed by SPECT/CT as a part of staging algorithm. Planar bone imaging showed homogeneous and symmetrical tracer uptake throughout the visualized skeleton. As the patient had complaints of urinary obstruction and severe backache: so, the sacrum could not be adequately assessed on planar bone imaging; therefore SPECT/CT of lumbar spine and pelvic region was performed. His regional SPECT-CT study of the lumbar and pelvic region, revealed widespread diffuse tracer avid osteoblastic lesions throughout the visualized lower lumbar spine, sacrum, pelvis and proximal femori, suggestive of skeletal metastases. Conclusion: We conclude that SPECT/CT scintigraphy has a diagnostic edge over planar bone imaging in detecting bone metastases in prostate cancer patients.

Obtaining clear localization images in nuclear medicine can be challenging when radiotracers are administered locally. This lack of anatomical information can make it difficult to relate the scintigraphic findings to specific body structures. Various localization techniques such as point source, cobalt wires, transmission scans using Cobalt-57 (57Co) and Gadolinium-153 (153Gd), and hybrid imaging (SPECT-CT) can be employed to overcome this issue. The primary goal of this communication is to summarize the available body contour outlining methods in nuclear medicine and provide a comprehensive guide for nuclear medicine trainees to obtain high-quality localization images that can facilitate better evaluation of nuclear medicine scans.

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